Maternal-Child Nursing McKinney 4th Edition Test Bank

This is completed downloadable of Maternal-Child Nursing McKinney 4th Edition Test Bank

Product Details:

• ISBN-10 ‏ : ‎ 1437727751
• ISBN-13 ‏ : ‎ 978-1437727753
• Author:   Emily Slone McKinney MSN RN C (Author), Susan Rowen James PhD RN (Author), Sharon Smith Murray MSN RN C (Author), Kristine Nelson RN MN (Author), Jean Ashwill MSN RN (Author)

Ideal for accelerated maternity and pediatrics courses, Maternal-Child Nursing, 4^th Edition is filled with user-friendly features to help you quickly master essential concepts and skills. It offers completely updated content that’s easy to read and understand. Plus, active learning tools give you the chance to practice applying your knowledge and make learning fun!

 

Table of Content:

1. Front Matter
2. Contributors
3. Reviewers
4. Preface
5. Concepts
6. Features
7. Objectives
8. Nursing Process
9. Critical Thinking Exercises
10. Evidence-Based Practice
11. Critical Alerts
12. Want to Know
13. Health Promotion
14. Clinical Reference Pages
15. Pathophysiology
16. Procedures
17. Drug Guides
18. Key Concepts
19. Ancillaries
20. For Students
21. For Instructors
22. Acknowledgments
23. Interactive Review – Maternal-Child Nursing Care
24. Introduction to Maternal-Child Health Nursing
25. Interactive Review – Introduction to Maternal-Child Nursing
26. Chapter 1 Foundations of Maternity, Women’s Health, and Child Health Nursing
27. Learning Objectives
28. Historical Perspectives
29. Maternity Nursing
30. “Granny” Midwives
31. Emergence of Medical Management
32. Government Involvement in Maternal-Infant Care
33. TABLE 1-1 FEDERAL PROJECTS FOR MATERNAL-CHILD CARE
34. Impact of Consumer Demands on Health Care
35. Development of Family-Centered Maternity Care
36. Current Settings for Childbirth
37. Traditional Hospital Setting
38. Labor, Delivery, and Recovery Rooms
39. FIG 1-1 A typical labor, delivery, and recovery room. Home-like furnishings (A) can be adapted quickly to reveal needed technical equipment (B).
40. Labor, Delivery, Recovery, and Postpartum Rooms
41. Birth Centers
42. Home Births
43. Nursing of Children
44. Historical Perspectives
45. Societal Changes
46. Hygiene and Hospitalization
47. Development of Family-Centered Child Care
48. Current Trends in Child Health Care
49. Cost Containment
50. Diagnosis-Related Groups
51. Managed care ExemplarManaged care organizations ExemplarManaged Care
52. Capitated Care
53. Effects of Cost Containment
54. Case management ExemplarNurse case management ExemplarCase Management
55. Evidence-Based Nursing Care
56. Outcomes Management
57. Nurse Sensitive Indicators
58. Variances
59. Clinical Pathways
60. Home care models ExemplarHome Care
61. Community Care
62. Access to Care
63. Public Health Insurance Programs
64. FIG 1-2 Uninsured Children by Poverty Status, Household Income, Age, Race and Hispanic Origin, and Nativity, 2009. Federal surveys now give respondents the option of reporting more than one race. This figure shows data using the race-alone concept. For example, Asian refers to people who reported Asian and no other race.
65. Preventative health activities ExemplarPreventive Health
66. Health Care Assistance Programs
67. Statistics on Maternal, Infant, and Child Health
68. Maternal and Infant Mortality
69. Maternal Mortality
70. FIG 1-3 Infant mortality rates, 1950-2007
71. Infant Mortality
72. Racial Disparity for Mortality
73. TABLE 1-2 INFANT MORTALITY DATA FOR SELECTED COUNTRIES (BASED ON 2007 DATA)
74. International Infant Mortality
75. TABLE 1-3 LEADING CAUSES OF DEATH AMONG CHILDREN AGES 1 TO 14 YEARS: DEATH RATES PER 100,000
76. Adolescent Births
77. Childhood Mortality
78. Morbidity
79. Ethics ExemplarEthical Perspectives on Maternity, Women’s Health, and Child Nursing
80. Ethics and Bioethics
81. Ethical Dilemmas
82. Ethical Principles
83. BOX 1-1 ETHICAL PRINCIPLES
84. Solving Ethical Dilemmas
85. Ethical Concerns in Reproduction
86. Elective Pregnancy Termination
87. Belief that Induced Abortion is a Private Choice
88. BOX 1-2 SUPREME COURT DECISIONS ON ABORTION SINCE ROE V. WADE
89. Belief that Elective Pregnancy Termination is Taking a Life
90. Implications for Nurses
91. Fetal Injury
92. Ethical Concerns in Child Health Nursing
93. Cessation of Treatment
94. Terminating Life Support
95. Social Issues
96. Poverty
97. Homelessness
98. FIG 1-4 The cycle of poverty.
99. Prenatal Care in the United States
100. Government Programs for Health Care: Medicaid
101. Distribution of health care ExemplarAllocation of Health Care Resources
102. Care versus Cure
103. Health Care Rationing
104. Violence
105. Legal Issues
106. Safeguards for Health Care
107. Scope of practice education requirements ExemplarNurse Practice Acts
108. Standards of Care
109. Agency Policies
110. Accountability
111. Malpractice
112. NURSING QUALITY ALERT: Elements of Negligence
113. Prevention of Malpractice Claims
114. Informed consent ExemplarInformed Consent
115. NURSING QUALITY ALERT: Requirements of Informed Consent
116. Competence
117. Full Disclosure
118. Understanding of Information
119. Voluntary Consent
120. Refusal of Care
121. Adoption
122. Documentation
123. Discharge teaching ExemplarDocumenting Discharge Teaching
124. Disclosure of medical errors ExemplarDocumenting Incidents
125. The Nurse as an Advocate
126. Maintaining Expertise
127. Current Trends and Their Legal and Ethical Implications
128. Use of Unlicensed Assistive Personnel
129. Concerns about Early Discharge
130. Dealing with Early Discharge
131. KEY CONCEPTS
132. References and Readings
133. Chapter 2 The Nurse’s Role in Maternity, Women’s Health, and Pediatric Nursing
134. Learning Objectives
135. The Role of the Professional Nurse
136. BOX 2-1 ANA CODE OF ETHICS FOR NURSES
137. Care Provider
138. FIG 2-1 In the prenatal clinic, the nurse teaches a woman one-on-one.
139. Teacher
140. Factors Influencing Learning
141. Principles of Teaching and Learning
142. Collaborator
143. Researcher
144. Advocate
145. Manager of Care
146. Advanced Preparation for Maternity and Pediatric Nurses
147. Certified Nurse-Midwives
148. Nurse Practitioners
149. Clinical Nurse Specialists
150. Clinical Nurse Leaders
151. Implications of Changing Roles for Nurses
152. Therapeutic Communication
153. Guidelines for Therapeutic Communication
154. Therapeutic Communication Techniques
155. Critical Thinking
156. The Purpose of Critical Thinking
157. Steps in Critical Thinking
158. A Recognizing Assumptions
159. B Examining Biases
160. C Analyzing the Need for Closure
161. D Data management Exemplar Managing Data
162. Collecting Data
163. Validating Data
164. Organizing and Analyzing Data
165. E Evaluating Other Factors
166. The Nursing Process in Maternity and Pediatric Care
167. BOX 2-2 COMMUNICATION TECHNIQUES
168. TABLE 2-1 BEHAVIORS THAT BLOCK COMMUNICATION
169. Assessment
170. Screening Assessment
171. Focused Assessment
172. Nursing Diagnosis
173. BOX 2-3 DEVELOPING INDIVIDUALIZED NURSING CARE THROUGH THE NURSING PROCESS
174. Assessment
175. Analysis
176. Planning
177. Implementing Nursing Interventions
178. Evaluation
179. Planning
180. Setting Priorities
181. Establishing Goals and Expected Outcomes
182. Implementation
183. Evaluation
184. Complementary and Alternative Medicine
185. Research studies ExemplarNursing Research and Evidence-Based Practice
186. KEY CONCEPTS
187. References and Readings
188. Chapter 3 The Childbearing and Child-Rearing Family
189. Learning Objectives
190. Family-Centered Care
191. Family Structure
192. FIG 3-1 Traditional, two-parent families typically have the resources to prepare for childbirth and the needs of infants.
193. Types of Families
194. Traditional Families
195. Nontraditional Families
196. Single-Parent Families
197. Blended Families
198. Adoptive Families
199. Multigenerational Families
200. FIG 3-2 A nurse caring for a child needs to know the child’s family structure and the identity of the child’s primary caregiver. This background becomes the context in which the nurse provides care. If family support is a concern, the nurse can provide information about local community resources. For example, in some communities, after-school programs and “warm lines” can help children with schoolwork and alleviate loneliness and fear.
201. Same-Sex Parent Families
202. Communal Families
203. Characteristics of Healthy Families
204. Factors that Interfere with Family Functioning
205. High-Risk Families
206. Marital Conflict and Divorce
207. Adolescent Parenting
208. Violence
209. Substance Abuse
210. Child with Special Needs
211. Healthy Versus Dysfunctional Families
212. Coping with Stress
213. Coping Strategies
214. BOX 3-1 COPING STRATEGIES OF FAMILIES
215. Internal Coping Strategies
216. Relationship Strategies
217. Cognitive Strategies
218. Communication Strategies
219. External Coping Strategies
220. Community Strategy: Maintaining Active Linkages with the Community
221. Social Support Strategies
222. Spiritual Strategies
223. Cultural Influences on Maternity and Pediatric Nursing
224. FIG 3-3 Visible and hidden layers of culture are like the visible and submerged parts of an iceberg. Many cultural differences are hidden below the surface.
225. Implications of Cultural Diversity for Nurses
226. Western Cultural Beliefs
227. TABLE 3-1 RELIGIOUS BELIEFS AFFECTING HEALTH CARE
228. Cultural Influences on the Care of People from Specific Groups
229. Asians and Pacific Islanders
230. Hispanics
231. African-Americans
232. American Indians and Alaska Natives
233. Middle Easterners
234. Cross-Cultural Health Beliefs
235. Traditional Methods of Preventing Illness
236. Traditional Practices to Maintain Health
237. Traditional Practices to Restore Health
238. Cultural Assessment
239. Parenting
240. Parenting Styles
241. Parent-Child Relationship Factors
242. Parental Characteristics
243. Characteristics of the Child
244. Temperament and Parental Expectations
245. BOX 3-2 CHARACTERISTICS OF TEMPERAMENT IN CHILDREN
246. Discipline
247. BOX 3-3 EFFECTIVE DISCIPLINE FOR POSITIVE SOCIALIZATION AND SELF-ESTEEM
248. Dealing with Misbehavior
249. Redirection
250. Reasoning
251. Time-Out
252. Consequences
253. Behavior Modification
254. SAFETY ALERT: Avoiding the Use of Corporal Punishment as Discipline
255. Corporal Punishment
256. Nursing Process and the Family
257. Family Assessment
258. Nursing Diagnosis and Planning
259. Intervention and Evaluation
260. CRITICAL THINKING EXERCISE 3-1
261. KEY CONCEPTS
262. References and Readings
263. Chapter 4 Communicating with Children and Families
264. Learning Objectives
265. Components of Effective Communication
266. Touch
267. FIG 4-1 Communication with children is enhanced by direct eye contact and by body language that conveys attentiveness and openness.
268. Physical Proximity and Environment
269. FIG 4-2 For effective communication, the nurse needs to be at the child’s eye level.
270. Listening
271. Attentiveness
272. Clarification through Reflection
273. Empathy
274. Impartiality
275. Visual Communication
276. NURSING QUALITY ALERT: Tips to Enhance Listening and Communication Skills
277. Tone of Voice
278. TABLE 4-1 OPEN AND CLOSED BODY POSTURES
279. Body Language
280. Timing
281. Family-Centered Communication
282. NURSING QUALITY ALERT: Communicating with Families
283. Establishing Rapport
284. Availability and Openness to Questions
285. FIG 4-3 The child’s continuing health care, both preventive and during illness, is enhanced by participation of the family.
286. Family Education and Empowerment
287. Effective Management of Conflict
288. BOX 4-1 STRATEGIES FOR MANAGING CONFLICT
289. TABLE 4-2 CHOOSING WORDS CAREFULLY
290. Feedback from Children and Families
291. Spirituality
292. Transcultural Communication: Bridging the Gap
293. BOX 4-2 WARNING SIGNS OF OVERINVOLVEMENT
294. BOX 4-3 WARNING SIGNS OF UNDERINVOLVEMENT
295. Therapeutic Relationships: Developing and Maintaining Trust
296. NURSING QUALITY ALERT: Maintaining a Therapeutic Relationship
297. Nursing Care
298. Communicating with Children and Families
299. Assessment
300. Nursing Diagnosis and Planning
301. Expected Outcomes
302. Expected Outcome
303. Expected Outcomes
304. Expected Outcomes
305. Expected Outcomes
306. CRITICAL THINKING EXERCISE 4-1
307. Interventions
308. TABLE 4-3 DEVELOPMENTAL MILESTONES AND THEIR RELATIONSHIP TO COMMUNICATION APPROACHES
309. Play
310. BOX 4-4 STORYTELLING STRATEGIES
311. Storytelling
312. Explaining Procedures and Treatments
313. Strategies for Enhancing Self-Esteem
314. TABLE 4-4 CONSIDERATIONS IN CHOOSING LANGUAGE
315. TABLE 4-5 SELF-ESTEEM IN CHILDREN: COMMUNICATION PRACTICES
316. Evaluation
317. Communicating with Children with Special Needs
318. The Child with a Visual Impairment
319. NURSING QUALITY ALERT: Communicating with Children with Special Needs
320. The Child with a Hearing Impairment
321. The Child Who Speaks Another Language
322. The Child with Other Communication Challenges
323. The Child with a Profound Neurologic Impairment
324. KEY CONCEPTS
325. References and Readings
326. Chapter 5 Health Promotion for the Developing Child
327. Learning Objectives
328. Overview of Growth and Development
329. Definition of Terms
330. TABLE 5-1 STAGES OF GROWTH AND DEVELOPMENT The Following Stages and Age-Groupings Refer to Stages of Childhood Growth and Development
331. Stages of Growth and Development
332. Parameters of Growth
333. Principles of Growth and Development
334. Patterns of Growth and Development
335. FIG 5-1 Changes in body proportions with growth.
336. BOX 5-1 PATTERNS OF GROWTH AND DEVELOPMENT
337. BOX 5-2 DIRECTIONAL PATTERNS OF GROWTH AND DEVELOPMENT
338. Cephalocaudal Pattern (Head to Toe)
339. Examples
340. Proximodistal Pattern (from the Center Outward)
341. Examples
342. Critical Periods
343. Factors Influencing Growth and Development
344. Genetics
345. Environment
346. Culture
347. FIG 5-2 Pediatric environmental history (0 to 18 years of age).
348. Nutrition
349. Health Status
350. Family
351. Parental Attitudes
352. Child-Rearing Philosophies
353. Theories of Growth and Development
354. Piaget’s Theory of Cognitive Development
355. Nursing Implications of Piaget’s Theory
356. Freud’s Theory of Psychosexual Development
357. TABLE 5-2 THEORIES OF GROWTH AND DEVELOPMENT
358. Nursing Implications of Freud’s Theory
359. Erikson’s Psychosocial Theory
360. Nursing Implications of Erikson’s Theory
361. Kohlberg’s Theory of Moral Development
362. Nursing Implications of Kohlberg’s Theory
363. Theories of Language Development
364. Assessment of Growth
365. Assessment of Development
366. Denver Developmental Screening Test II (DDST-II)
367. Nurse’s Role in Promoting Optimal Growth and Development
368. Developmental Assessment
369. Interviewing ExemplarInterview
370. Play
371. Classifications of Play
372. Social Aspects of Play
373. Solitary Play
374. Parallel Play
375. Associative Play
376. Cooperative Play
377. Onlooker Play
378. Types of Play
379. Dramatic Play
380. Familiarization Play
381. FIG 5-3 Types of play.
382. Functions of Play
383. Physical Development and Play
384. Cognitive Development
385. Emotional Development
386. Social Development
387. Moral Development
388. Health Promotion
389. Vaccination ExemplarImmunizations
390. Active and Passive Immunity
391. SAFETY ALERT: Preventing Vaccine Reactions
392. Obstacles to Immunizations
393. Informed Consent
394. BOX 5-3 BARRIERS TO IMMUNIZATION
395. Immunization Schedule
396. Children with an Uncertain History of Immunization
397. Administration of Vaccines
398. Precautions and Contraindications
399. BOX 5-4 NURSING RESPONSIBILITY IN ADMINISTERING VACCINES
400. SAFETY ALERT: Special Considerations Related to Immunizations
401. BOX 5-5 COMMON MISCONCEPTIONS ABOUT ADMINISTRATION AND SAFETY OF VACCINES
402. Immunocompromised Children
403. Education
404. Nutrition and Activity
405. Carbohydrates
406. Fats
407. Proteins
408. Water
409. Vitamins and Minerals
410. Dietary Guidelines
411. BOX 5-6 KEY DIETARY RECOMMENDATIONS SPECIFIC TO CHILDREN AND ADOLESCENTS
412. Energy, Calories, and Servings
413. Physical Activity
414. FIG 5-4 MyPlate.
415. Cultural and Religious Influences on Diet
416. Assessment of Nutritional Status
417. Anthropometric Data
418. Clinical Evaluation
419. Dietary History
420. Twenty-Four-Hour Recall
421. Food Frequency Questionnaire
422. Food Diary
423. Safety
424. Injury prevention ExemplarInjury Prevention
425. Anticipatory Guidance
426. BOX 5-7 WHAT NURSES CAN DO TO PREVENT CHILDHOOD INJURIES
427. SAFETY ALERT: Relationship Between Safety and Childhood Development
428. Teaching Strategies
429. KEY CONCEPTS
430. References and Readings
431. Chapter 6 Health Promotion for the Infant
432. Learning Objectives
433. Growth and Development of the Infant
434. TABLE 6-1 SUMMARY OF GROWTH AND DEVELOPMENT: THE INFANT
435. HEALTH PROMOTION: Healthy People 2020 Objectives for Infants
436. Physical Growth and Maturation of Body Systems
437. Neurologic System
438. Respiratory System
439. Cardiovascular System
440. Safety Alert: Risks Caused by the Infant’s Immature Body Systems
441. Immune System
442. Gastrointestinal System
443. Renal System
444. Motor Development
445. PATIENT-CENTERED TEACHING: How to “Baby-Proof” the Home
446. Cognitive Development
447. NURSING QUALITY ALERT: Possible Signs of Developmental Delays
448. Sensory Development
449. Vision
450. Hearing
451. BOX 6-1 LANGUAGE DEVELOPMENT AND DEVELOPMENTAL MILESTONES IN INFANCY
452. 1 to 3 Months
453. 3 to 4 Months
454. 4 to 6 Months
455. 6 to 8 Months
456. 8 to 9 Months
457. 9 to 12 Months
458. Language Development
459. FIG 6-1 This 6-month-old infant responds delightedly to her mother with a true social smile. Such interactive responses between parent and child promote communication and emotional development.
460. Psychosocial Development
461. Parent-Infant Attachment
462. Stranger Anxiety
463. Health Promotion for the Infant and Family
464. CRITICAL THINKING EXERCISE 6-1
465. Immunization
466. BOX 6-2 CONTINUING ASSESSMENT QUESTIONS
467. Feeding and Nutrition
468. NURSING QUALITY ALERT: Essential Information for Infant Nutrition
469. Factors Influencing Choice of Feeding Method
470. Breastfeeding
471. Formula Feeding
472. Types of Formula
473. Cow’s Milk
474. EVIDENCE-BASED PRACTICE
475. Formula Feeding Techniques
476. Weaning
477. Juices
478. Water
479. Solid Foods
480. BOX 6-3 READINESS FOR INTRODUCTION OF SOLIDS
481. Finger Foods
482. Health Promotion: 2-Week-Old to 1-Month-Old Infant
483. Focused Assessment
484. Developmental Milestones
485. Health Maintenance
486. Physical Measurements
487. Immunizations
488. Health Screening
489. Anticipatory Guidance
490. Nutrition
491. Elimination
492. Dental
493. Sleep
494. Hygiene
495. Safety
496. Snacks
497. Food Allergies
498. HEALTH PROMOTION: The 2-Month-Old Infant
499. Focused Assessment
500. Developmental Milestones
501. Critical Milestones∗
502. Health Maintenance
503. Physical Measurements
504. Immunizations
505. Health Screening
506. Anticipatory Guidance
507. Nutrition
508. Elimination
509. Dental
510. Sleep
511. Hygiene
512. Safety
513. Play
514. Dental Care
515. Teething
516. Assessment of Dental Risk
517. Cleaning Teeth
518. Fluoride Supplementation
519. Bottle-Mouth Caries
520. HEALTH PROMOTION: The 4-Month-Old Infant
521. Focused Assessment
522. Developmental Milestones
523. Critical Milestones∗
524. Health Maintenance
525. Physical Measurements
526. Immunizations
527. Health Screening
528. Anticipatory Guidance
529. Nutrition
530. Elimination
531. Dental
532. Sleep
533. Hygiene
534. Safety
535. Play
536. Sleep and Rest
537. Safety
538. Motor Vehicle Safety
539. FIG 6-2 The infant rides facing the rear of the vehicle, ideally in the middle of the back seat. The infant seat is secured to the vehicle with the seatbelt, and straps on the car seat adjust to accommodate the growing baby.
540. FIG 6-3 After the child reaches 2 years of age and has attained the manufacturer’s height and weight recommendations for a rear-facing car seat, the child uses a forward-facing upright car safety seat. The safety straps should be adjusted to provide a snug fit, and the seat should be placed in the back seat of the car, ideally in the middle.
541. Providing a Safe Home Environment
542. Burn Prevention
543. Safe Baby Furnishings
544. PATIENT-CENTERED TEACHING: Crib Safety
545. Fall prevention ExemplarPreventing Falls
546. FIG 6-4 Safety education for parents of infants should emphasize the need for constant supervision and the use of restraining devices to prevent falls.
547. HEALTH PROMOTION: The 6-Month-Old Infant
548. Focused Assessment
549. Developmental Milestones
550. Critical Milestones∗
551. Health Maintenance
552. Physical Measurements
553. Immunizations
554. Health Screening
555. Anticipatory Guidance
556. Nutrition
557. Elimination
558. Dental
559. Sleep
560. Hygiene
561. Safety
562. Play
563. Preventing Asphyxiation
564. BOX 6-4 LEAD EXPOSURE RISK ASSESSMENT
565. Preventing Lead Exposure
566. Concerns during Infancy
567. Patterns of Crying
568. HEALTH PROMOTION: The 9-Month-Old Infant
569. Focused Assessment
570. Developmental Milestones
571. Critical Milestones∗
572. Health Maintenance
573. Physical Measurements
574. Immunizations
575. Health Screening
576. Anticipatory Guidance
577. Nutrition
578. Elimination
579. Dental
580. Sleep
581. Hygiene
582. Safety
583. Play
584. The Infant with Colic
585. Etiology
586. Management
587. Nursing Considerations
588. HEALTH PROMOTION: The 12-Month-Old Infant
589. Focused Assessment
590. Developmental Milestones
591. Critical Milestones∗
592. Health Maintenance
593. Physical Measurements
594. Immunizations
595. Health Screening
596. Anticipatory Guidance
597. Nutrition
598. Elimination
599. Dental
600. Sleep
601. Hygiene
602. Safety
603. Play
604. KEY CONCEPTS
605. References and Readings
606. Chapter 7 Health Promotion During Early Childhood
607. Learning Objectives
608. Growth and Development During Early Childhood
609. FIG 7-1 Growth and development of the toddler.
610. Physical Growth and Development
611. The Toddler
612. The Preschooler
613. FIG 7-2 Growth and development of the preschooler.
614. HEALTH PROMOTION: Healthy People 2020 Objectives for Toddlers and Preschoolers
615. Motor Development
616. The Toddler
617. The Preschooler
618. Cognitive and Sensory Development
619. The Toddler
620. The Preschooler
621. HEALTH PROMOTION: The 15- to 18-Month-Old Child
622. Focused Assessment
623. Developmental Milestones
624. Critical Milestones∗
625. Health Maintenance
626. Physical Measurements
627. Immunizations
628. Health Screening
629. Anticipatory Guidance
630. Nutrition
631. Elimination
632. Dental
633. Sleep
634. Hygiene
635. Safety
636. Play
637. TABLE 7-1 Characteristics of Preoperational Thinking
638. HEALTH PROMOTION: The 2-Year-Old Child
639. Focused Assessment
640. Developmental Milestones
641. Critical Milestones∗
642. Health Maintenance
643. Physical Measurements
644. Immunizations
645. Health Screening
646. Anticipatory Guidance
647. Nutrition
648. Elimination
649. Dental
650. Sleep
651. Hygiene
652. Safety
653. Self-Esteem and Competence
654. Play
655. Language Development
656. The Toddler
657. The Preschooler
658. Psychosocial Development
659. The Toddler
660. Negativism
661. Ritualism and the Importance of Routine
662. Separation Anxiety
663. Play
664. Psychosexual Development
665. FIG 7-3 Types of play.
666. BOX 7-1 Age-Related Activities and Toys for Toddlers and Preschoolers
667. General Activities
668. Toddler
669. Preschooler
670. Toys and Specific Types of Play
671. Toddler
672. Preschooler
673. NURSING QUALITY ALERT: Important Tasks of the Toddler Period
674. The Preschooler
675. Play
676. Psychosexual Development
677. Spiritual and Moral Development
678. Health Promotion for the Toddler or Preschooler and Family
679. Nutrition
680. BOX 7-2 Nutritious Snacks
681. Nutritional Requirements
682. Solid Foods
683. FIG 7-4 By age 1 year, most children are eating the same foods as the rest of the family. Toddlers should be offered three meals and two healthy snacks each day. Most 2-year-olds can drink from a cup and use a spoon well if given the opportunity to practice.
684. Age-Related Nutritional Challenges
685. Food Jags
686. Physiologic Anorexia
687. BOX 7-3 Increasing Nutritional Intake
688. Obesity Risk
689. Dental Care
690. Sleep and Rest
691. FIG 7-5 Care of the deciduous teeth promotes healthy development of the permanent teeth. Some toddlers and preschoolers enjoy brushing their own teeth, but because toddlers and preschoolers lack the manual dexterity to remove plaque adequately, parents must assume this responsibility.
692. CRITICAL THINKING EXERCISE 7-1
693. Discipline
694. Toddler Safety
695. Car Safety
696. PARENTS WANT TO KNOW: Guidelines for Disciplining a Toddler
697. PATIENT-CENTERED TEACHING: Childhood Poison Prevention
698. SAFETY ALERT: Car Safety
699. Airplane Safety
700. Fire and Burn Safety
701. Preventing Falls
702. Water Safety
703. Preventing Poisoning
704. Preschooler Safety
705. Car Safety
706. FIG 7-6 A high-back booster seat designed to properly hold a car lap and shoulder belt is strongly recommended for children who have outgrown a child safety seat. Booster seats raise the young child high enough to allow the car seatbelts to be correctly positioned over the child’s chest and pelvis.
707. Fire and Burn Safety
708. Firearm Safety
709. Personal Safety
710. Sexual Abuse
711. Selected Issues Related to the Toddler
712. Toilet Training
713. HEALTH PROMOTION: The 3-Year-Old Child
714. Focused Assessment
715. Developmental Milestones
716. Critical Milestones∗
717. Health Maintenance
718. Physical Measurements
719. Immunizations
720. Health Screening
721. Anticipatory Guidance
722. Nutrition
723. Elimination
724. Dental
725. Sleep
726. Hygiene
727. Safety
728. Self-Esteem and Competence
729. Play
730. BOX 7-4 Signs of Readiness for Toilet Training
731. Physical Readiness
732. Psychological Readiness
733. FIG 7-7 No set rules exist for toilet training. The nurse can help parents understand that both physical readiness and psychological readiness are necessary for success.
734. Temper Tantrums
735. Sibling Rivalry
736. PARENTS WANT TO KNOW: Strategies to Decrease Sibling Rivalry
737. Selected Issues Related to the Preschooler
738. Stuttering
739. PARENTS WANT TO KNOW: How to Help the Child Who Stutters
740. Preschool and Daycare Programs
741. HEALTH PROMOTION: The 4- and 5-Year-Old Child
742. Focused Assessment
743. Developmental Milestones
744. Critical Milestones∗
745. Health Maintenance
746. Physical Measurements
747. Immunizations
748. Health Screening
749. Anticipatory Guidance
750. Nutrition
751. Elimination
752. Dental
753. Sleep
754. Safety
755. Self-Esteem and Competence
756. Play
757. Preparing the Child for School
758. BOX 7-5 Checklist for School Readiness
759. KEY CONCEPTS
760. References and Readings
761. Chapter 8 Health Promotion for the School-Age Child
762. Learning Objectives
763. Growth and Development of the School-Age Child
764. Physical Growth and Development
765. HEALTH PROMOTION: Healthy People 2020 Objectives for School-Age Children
766. Body Systems
767. Dentition
768. Sexual Development
769. FIG 8-1 Growth and development of the school-age child.
770. NURSING QUALITY ALERT: Components of Sex Education
771. BOX 8-1 AGE-RELATED ACTIVITIES AND TOYS FOR THE SCHOOL-AGE CHILD
772. General Activities
773. Toys and Specific Types of Play
774. Motor Development
775. Development of Gross Motor Skills
776. Importance of Active Play
777. PATIENT-CENTERED TEACHING: Assessing an Organized Recreational Sports Program
778. Preventing Fatigue and Dehydration
779. Development of Fine Motor Skills
780. Cognitive Development
781. Intuitive Thought Stage
782. Concrete Operations Stage
783. Reversibility
784. Conservation
785. Classification and Logic
786. Humor
787. Sensory Development
788. Vision
789. Hearing
790. Language Development
791. Psychosocial Development
792. Development of a Sense of Industry
793. Fostering Self-Esteem
794. PATIENT-CENTERED TEACHING: How to Promote Self-Esteem in School-Age Children
795. Spiritual and Moral Development
796. Piaget
797. Kohlberg
798. Family Influence
799. Spirituality and Religion
800. Health Promotion for the School-Age Child and Family
801. Nutrition During Middle Childhood
802. Nutritional Requirements
803. Age-Related Nutritional Challenges
804. Dental Care
805. Malocclusion
806. Preventing Dental Injuries
807. Dental Health Education
808. Sleep and Rest
809. HEALTH PROMOTION: The 6- to 8-Year-Old Child
810. Focused Assessment
811. Developmental Milestones
812. Health Maintenance
813. Physical Measurements
814. Immunizations
815. Health Screening
816. Anticipatory Guidance
817. Nutrition
818. Elimination
819. Dental
820. Sleep
821. Safety
822. Play
823. Self-Esteem and Competence
824. CRITICAL THINKING EXERCISE 8-1
825. Discipline
826. Safety
827. Car Safety
828. Fire and Burn Safety
829. SAFETY ALERT: Fire Safety Rules
830. Bicycle, In-line Skating, Scooter, and Skateboard Safety
831. PATIENT-CENTERED TEACHING: Bicycle, In-line Skating, Scooter, and Skateboard Safety
832. Rules of the Road
833. Pedestrian Safety
834. Water Safety
835. HEALTH PROMOTION: The 9- to 11-Year-Old Child
836. Focused Assessment
837. Developmental Milestones
838. Health Maintenance
839. Physical Measurements
840. Immunizations
841. Health Screening
842. Anticipatory Guidance
843. Nutrition
844. Elimination
845. Dental
846. Sleep
847. Hygiene
848. Safety
849. Play
850. Self-Esteem and Competence
851. Selected Issues Related to the School-Age Child
852. Adjustment to School
853. Peer Influence
854. Influence of Teachers
855. Parents’ Role
856. School Refusal
857. Helping a Child Overcome School Refusal
858. Self-Care Children
859. Obesity ExemplarObesity
860. Assessing the Scope of the Problem
861. Prevention
862. Diet ExemplarInterventions and Anticipatory Guidance
863. PARENTS WANT TO KNOW: How to Prevent and Manage Obesity
864. EVIDENCE-BASED PRACTICE
865. Stress
866. Sources of Stress in Children
867. BOX 8-2 MANIFESTATIONS OF STRESS IN CHILDREN
868. School Pressures
869. Physical Threats
870. Competitive Sports
871. Tight Schedules and Adaptation Overload
872. Family Pressures
873. Media Influence
874. Interventions and Anticipatory Guidance
875. FIG 8-2 Health promotion for the school-age child and family.
876. NURSING QUALITY ALERT: Sources of Stress for School-Age Children
877. Bullying ExemplarPeer Victimization
878. KEY CONCEPTS
879. References and Readings
880. Chapter 9 Health Promotion for the Adolescent
881. Learning Objectives
882. Adolescent Growth and Development
883. HEALTH PROMOTION: Selected Healthy People 2020 Objectives for Adolescents
884. Physical Growth and Development
885. Psychosexual Development, Hormonal Changes, and Sexual Maturation
886. NURSING QUALITY ALERT: Understanding Tanner Staging
887. Female Sexual Maturation
888. TABLE 9-1 SEXUAL MATURITY RATING (SMR): TANNER STAGES OF ADOLESCENT SEXUAL DEVELOPMENT
889. Male Sexual Maturation
890. Motor Development
891. SAFETY ALERT: The Adolescent Who Is Involved in Athletics
892. BOX 9-1 NURSING GOALS FOR PREPARTICIPATION SPORTS PHYSICAL EXAMINATION
893. Cognitive Development
894. Sensory Development
895. Language Development
896. PARENTS WANT TO KNOW: Communicating with Adolescents
897. Psychosocial Development
898. FIG 9-1 Adolescent growth and development.
899. BOX 9-2 AGE-RELATED ACTIVITIES AND GAMES FOR ADOLESCENTS
900. General Activities
901. Games and Special Types of Play
902. NURSING QUALITY ALERT: The Adolescent and Erikson
903. Early Adolescence
904. Middle Adolescence
905. BOX 9-3 SIGNS OF GANG INVOLVEMENT
906. NURSING QUALITY ALERT: Elements of Adolescent Care
907. Vocational Exploration
908. Late Adolescence (18 to 21 Years)
909. Moral and Spiritual Development
910. Health Promotion for the Adolescent and Family
911. CRITICAL THINKING EXERCISE 9-1
912. Nutrition during Adolescence
913. BOX 9-4 FACTORS INFLUENCING THE ADOLESCENT’S DIET
914. Age-Related Nutritional Challenges
915. Nutritional Guidance for the Adolescent
916. Hygiene
917. Dental Care
918. PATIENT-CENTERED TEACHING: Caring for a Child with an Avulsed Tooth
919. Sleep and Rest
920. HEALTH PROMOTION: The Adolescent
921. Focused Assessment
922. Developmental Milestones
923. Health Maintenance
924. Physical Measurements
925. Immunizations
926. Health Screening
927. Anticipatory Guidance
928. Nutrition
929. Elimination
930. Dental
931. Sleep and Activity
932. Safety
933. Emotional Health
934. Exercise and Activity
935. Safety
936. Car Safety
937. Water Safety
938. Suicide
939. Violence Toward Others
940. BOX 9-5 FACTORS CONTRIBUTING TO ADOLESCENT VIOLENCE
941. Selected Issues Related to the Adolescent
942. Body Piercing
943. Tattoos
944. ADOLESCENTS WANT TO KNOW: Tattooing
945. Tanning
946. Sexual Activity
947. Adolescent Sexuality
948. NURSING QUALITY ALERT: Factors to Consider in Selecting Adolescent Contraception
949. Contraception
950. KEY CONCEPTS
951. References and Readings
952. Chapter 10 Hereditary and Environmental Influences on Development
953. Learning Objectives
954. Hereditary Influences
955. Structure of Genes and Chromosomes
956. DNA
957. FIG 10-1 Diagrammatic representation of the deoxyribonucleic acid (DNA) helix, which is the building block of genes and chromosomes.
958. Genes
959. Chromosomes
960. FIG 10-2 When viewed before karyotyping, chromosomes appear jumbled. This photo is a spectral karyotype (SKY) from a normal female.
961. Transmission of Traits by Single Genes
962. Alleles
963. Dominance
964. FIG 10-3 Karyotypes of chromosomes that were stained, creating bands to distinguish each chromosome and identify missing or duplicated chromosome material. A, Normal male karyotype: 46,XY. B, Normal female karyotype 46,XX.
965. Chromosome Location
966. Patterns of Single-Gene Inheritance
967. CRITICAL TO REMEMBER: Single-Gene Abnormalities
968. Autosomal Dominant Traits
969. BOX 10-1 SINGLE-GENE TRAITS
970. Genogram (Pedigree) Symbols
971. Autosomal Recessive
972. Characteristics
973. Transmission of Trait from Parent to Child
974. Examples
975. Genogram
976. Autosomal Dominant
977. Characteristics
978. Transmission of Trait from Parent to Child
979. Examples
980. Genogram
981. X-Linked Recessive
982. Characteristics
983. Transmission of Trait from Parent to Child
984. Examples
985. Genogram
986. Autosomal Recessive Traits
987. X-Linked Traits
988. X-Linked Recessive Disorders
989. Chromosome Abnormalities
990. FIG 10-4 Karyotype of a male with trisomy 21 (Down syndrome: 47, XY, +21).
991. CRITICAL TO REMEMBER: Chromosome Abnormalities
992. Numerical
993. Structural
994. Numerical Abnormalities
995. Trisomy
996. FIG 10-5 Karyotype of a female with monosomy X (Turner syndrome 45,X).
997. Monosomy
998. Polyploidy
999. Structural Abnormalities
1000. FIG 10-6 Illustration of a translocation of chromosome material between chromosomes 4 and 20.
1001. Multifactorial Disorders
1002. CRITICAL TO REMEMBER: Multifactorial Birth Defects
1003. Characteristics of Multifactorial Disorders
1004. Risk for Occurrence
1005. Environmental Influences
1006. Teratogens
1007. BOX 10-2 SELECTED ENVIRONMENTAL SUBSTANCES KNOWN OR THOUGHT TO HARM THE FETUS∗
1008. Avoiding Fetal Exposure
1009. Infections
1010. Drugs and Other Substances
1011. Ionizing Radiation
1012. Maternal Hyperthermia
1013. Manipulating the Fetal Environment
1014. Mechanical Disruptions to Fetal Development
1015. Genetic testing ExemplarGenetic Counseling
1016. Availability
1017. Focus on the Family
1018. BOX 10-3 DIAGNOSTIC METHODS THAT MAY BE USED IN GENETIC COUNSELING
1019. Preconception Screening
1020. Prenatal Diagnosis for Fetal Abnormalities
1021. Postnatal Diagnosis for an Infant with a Birth Defect
1022. Process of Genetic Counseling
1023. Supplemental Services
1024. Nursing Care of Families Concerned About Birth Defects
1025. Nurses as Part of a Genetic Counseling Team
1026. PARENTS WANT TO KNOW: About Birth Defects
1027. Nurses in General Practice
1028. Women’s Health Nurses
1029. Antepartum Nurses
1030. Identifying Families for Referral
1031. Helping the Woman Decide About Genetic Counseling
1032. Teaching About Lifestyle
1033. BOX 10-4 REASONS FOR REFERRAL TO A GENETIC COUNSELOR OR OTHER HEALTH CARE SPECIALIST
1034. BOX 10-5 PROBLEMS ENCOUNTERED IN GENETIC COUNSELING AND PRENATAL DIAGNOSIS
1035. Providing Emotional Support
1036. Helping the Woman and Family Deal with Abnormal Results
1037. Intrapartum and Neonatal Nurses
1038. Pediatric Nurses
1039. KEY CONCEPTS
1040. References and Readings
1041. Maternity Nursing Care
1042. Interactive Review – Maternity Nursing Care
1043. Chapter 11 Reproductive Anatomy and Physiology
1044. Learning Objectives
1045. Sexual Development
1046. Prenatal Development
1047. Childhood
1048. Sexual Maturation
1049. Initiation of Sexual Maturation
1050. Female Puberty Changes
1051. Breast Changes
1052. Body Contours
1053. Body Hair
1054. Skeletal Growth
1055. Reproductive Organs
1056. Menarche
1057. Male Puberty Changes
1058. Growth of the Testes and Penis
1059. TABLE 11-1 Major Hormones in Reproduction
1060. TABLE 11-2 Comparison Of Secondary Sex Characteristics In Females And Males
1061. Nocturnal Emissions
1062. Body Hair
1063. Body Composition
1064. Skeletal Growth
1065. Voice Changes
1066. Decline in Fertility
1067. FIG 11-1 External female reproductive structures.
1068. Female Reproductive Anatomy
1069. External Female Reproductive Organs
1070. Mons Pubis
1071. Labia Majora and Labia Minora
1072. FIG 11-2 Internal female reproductive structures, anterior view.
1073. Clitoris
1074. Vestibule
1075. Perineum
1076. Internal Female Reproductive Organs
1077. Vagina
1078. Uterus
1079. Divisions of the Uterus
1080. Corpus
1081. FIG 11-3 Internal female reproductive structures, midsagittal view.
1082. Isthmus
1083. Cervix
1084. Layers of the Uterus
1085. Perimetrium
1086. Myometrium
1087. FIG 11-4 Layers of the myometrium, showing the three types of smooth muscle fiber.
1088. Endometrium
1089. FIG 11-5 Structures of the bony pelvis, shown in lateral, A, and anterior, B, views.
1090. Fallopian Tubes
1091. Ovaries
1092. Support Structures
1093. Pelvis
1094. Muscles
1095. FIG 11-6 Muscles of the female pelvic floor.
1096. Ligaments
1097. Lateral Support
1098. Anterior Support
1099. Posterior Support
1100. Blood Supply
1101. Nerve Supply
1102. Female Reproductive Cycle
1103. FIG 11-7 The female reproductive cycle, showing the changes in hormone secretion from the anterior pituitary and interrelated changes in the ovary and uterine endometrium.
1104. Ovarian Cycle
1105. Follicular Phase
1106. Ovulatory Phase
1107. Luteal Phase
1108. Endometrial Cycle
1109. Proliferative Phase
1110. Secretory Phase
1111. Menstrual Phase
1112. Changes in Cervical Mucus
1113. The Female Breast
1114. Structure
1115. FIG 11-8 Structures of the female breast.
1116. Function
1117. Male Reproductive Anatomy and Physiology
1118. External Male Reproductive Organs
1119. Penis
1120. Scrotum
1121. FIG 11-9 Structures of the male reproductive system, midsagittal view.
1122. Internal Male Reproductive Organs
1123. Testes
1124. FIG 11-10 Internal structures of the testis. Production of sperm begins within the tiny coiled seminiferous tubules. Immature sperm pass from the seminiferous tubules to the epididymis and then to the vas deferens. During their passage through these structures, the sperm mature and acquire the ability to propel themselves.
1125. Accessory Ducts and Glands
1126. KEY CONCEPTS
1127. References and Readings
1128. Pageburst Integrated Resource
1129. Animation
1130. Chapter 12 Conception and Prenatal Development
1131. Learning Objectives
1132. Gametogenesis
1133. Oogenesis
1134. FIG 12-1 Gametogenesis. A, Formation of the mature ovum. B, Formation of mature sperm.
1135. TABLE 12-1 COMPARISON OF FEMALE AND MALE GAMETOGENESIS
1136. Spermatogenesis
1137. Conception
1138. Preparation for Conception in the Female
1139. Release of the Ovum
1140. Ovum Transport
1141. Preparation for Conception in the Male
1142. FIG 12-2 Mature sperm.
1143. Ejaculation
1144. Transport of Sperm in the Female Reproductive Tract
1145. Preparation of Sperm for Fertilization
1146. Fertilization
1147. Entry of One Spermatozoon into the Ovum
1148. Fusion of the Nuclei of Sperm and Ovum
1149. FIG 12-3 Process of fertilization. A, A sperm enters the ovum. B, The 23 chromosomes from the sperm mingle with the 23 chromosomes from the ovum, restoring the diploid number to 46. C, The fertilized ovum, now called a zygote, is ready for the first mitotic cell division.
1150. Pre-Embryonic Period
1151. Initiation of Cell Division
1152. Entry of the Zygote into the Uterus
1153. Implantation in the Decidua
1154. Maintaining the Decidua
1155. Location of Implantation
1156. Mechanism of Implantation
1157. FIG 12-4 Prenatal development from fertilization through implantation of the blastocyst. Implantation gradually occurs from the 6th through the 10th days. Implantation is complete by the 10th day.
1158. Embryonic Period
1159. Differentiation of Cells
1160. Second Week
1161. Third Week
1162. Fourth Week
1163. FIG 12-5 Embryonic development from the 3rd week through the 8th week after fertilization. CRL, Crown-rump length.
1164. TABLE 12-2 TIMETABLE OF PRENATAL DEVELOPMENT BASED ON FERTILIZATION AGE∗
1165. TABLE 12-3 DERIVATIVES OF THE THREE GERM LAYERS: DEVELOPING STRUCTURES
1166. Fifth Week
1167. Sixth Week
1168. Seventh Week
1169. Eighth Week
1170. Fetal Period
1171. Weeks 9 Through 12
1172. Weeks 13 Through 16
1173. Weeks 17 Through 20
1174. Weeks 21 Through 24
1175. Weeks 25 Through 28
1176. Weeks 29 Through 32
1177. FIG 12-6 Fetal development from 9 weeks of fertilization age through 38 weeks of fertilization age. Gestational age, measured from the first day of the last menstrual period, is about 2 weeks longer than the fertilization age.
1178. Weeks 33 Through 38
1179. Auxiliary Structures
1180. Placenta
1181. Maternal Component
1182. Development
1183. Circulation in the Maternal Side
1184. Fetal Component
1185. Development
1186. Circulation in the Fetal Side
1187. Metabolic Functions
1188. Transfer Functions
1189. Gas Exchange
1190. FIG 12-7 A, Placental structure, showing relationship of placenta, fetal membranes, and uterus. Arrows indicate the direction of blood flow between the fetus and placenta through the umbilical arteries and vein. Blood from the woman bathes the fetal chorionic villi within the intervillous spaces to allow exchange of oxygen, nutrients, and waste products without gross mixing of maternal and fetal blood. B, Structure of a chorionic villus, showing its fetal capillary network.
1191. FIG 12-8 Placental variations. Normal placenta, with insertion of umbilical cord near center and branching of fetal umbilical vessels over the surface Placenta with cord inserted near margin of placenta Placenta with a small accessory lobe Velamentous insertion of umbilical cord. Cord vessels branch far out on membranes. When membranes rupture, fetal umbilical vessels may be torn, and the fetus can hemorrhage.
1192. TABLE 12-4 MECHANISMS OF PLACENTAL TRANSFER
1193. Nutrient Transfer
1194. Waste Removal
1195. Antibody Transfer
1196. Transfer of Maternal Hormones
1197. Endocrine Functions
1198. Fetal Membranes and Amniotic Fluid
1199. Fetal Circulation
1200. Umbilical Cord
1201. Fetal Circulatory Circuit
1202. FIG 12-9 A, Fetal circulation. Three shunts—the ductus venosus, the ductus arteriosus, and the foramen ovale—allow most blood from the placenta to bypass the fetal lungs and liver. B, Circulation after birth. Note that the fetal shunts have closed. The umbilical vessels, the ductus venosus, and the ductus arteriosus have been converted to ligaments.
1203. Changes in Blood Circulation After Birth
1204. FIG 12-10 A, Monozygotic twinning. The single inner cell mass divides into two inner cell masses during the blastocyst stage. These twins have a single placenta and chorion, but each twin develops in its own amnion. B, Dizygotic twinning. Two ova are released during ovulation, and each is fertilized by a separate spermatozoon. The ova may implant near each other in the uterus, or they may be far apart.
1205. Multifetal Pregnancy
1206. Monozygotic Twinning
1207. Dizygotic Twinning
1208. KEY CONCEPTS
1209. References and Readings
1210. Pageburst Integrated Resource
1211. Animation
1212. Chapter 13 Adaptations to Pregnancy
1213. Learning Objectives
1214. Physiologic Responses to Pregnancy
1215. Changes in Body Systems
1216. Reproductive System
1217. Uterus
1218. Growth
1219. FIG 13-1 Uterine growth pattern during pregnancy.
1220. Pattern of Uterine Growth
1221. Contractility
1222. Uterine Blood Flow
1223. FIG 13-2 Cervical changes that occur during pregnancy. Note the thick mucous plug filling the cervical canal.
1224. Cervix
1225. Vagina and Vulva
1226. FIG 13-3 Breast changes that occur during pregnancy. The breasts increase in size and become more vascular, the areolae become darker, and the nipples become more erect.
1227. Ovaries
1228. Breasts
1229. Cardiovascular System
1230. Heart
1231. Heart Size and Position
1232. Heart Sounds
1233. Blood Volume
1234. Total Volume
1235. Plasma Volume
1236. Red Blood Cell Mass
1237. Cardiac Output
1238. Systemic Vascular Resistance
1239. Blood Pressure
1240. Effect of Position on Blood Pressure
1241. Supine Hypotension
1242. FIG 13-4 Supine hypotensive syndrome. When the pregnant woman is supine, the weight of the uterus partially occludes the vena cava and the descending aorta. A side-lying position corrects supine hypotension.
1243. Blood Flow
1244. Blood Components
1245. Respiratory System
1246. Oxygen Consumption
1247. Hormonal Factors
1248. Progesterone
1249. Estrogen
1250. TABLE 13-1 LABORATORY VALUES IN NONPREGNANT AND PREGNANT WOMEN
1251. Physical Changes
1252. Gastrointestinal System
1253. Mouth
1254. Esophagus
1255. Stomach
1256. Large and Small Intestine
1257. Liver and Gallbladder
1258. Urinary System
1259. Bladder
1260. Kidneys and Ureters
1261. Changes in Size and Shape
1262. Functional Changes
1263. Integumentary System
1264. Skin
1265. Hyperpigmentation
1266. Cutaneous Vascular Changes
1267. Connective Tissue
1268. FIG 13-5 Linea nigra, a dark line of pigmentation from the fundus to the symphysis pubis, appears during pregnancy.
1269. Hair
1270. Musculoskeletal System
1271. Calcium Storage
1272. Postural Changes
1273. Abdominal Wall
1274. Endocrine System
1275. Pituitary Gland
1276. Thyroid Gland
1277. Parathyroid Glands
1278. Pancreas
1279. Adrenal Glands
1280. Changes Caused by Placental Hormones
1281. Human Chorionic Gonadotropin
1282. Estrogen
1283. Progesterone
1284. Human Chorionic Somatomammotropin (hCS)
1285. Relaxin
1286. Changes in Metabolism
1287. Weight Gain
1288. Water Metabolism
1289. Dependent Edema
1290. Carpal Tunnel Syndrome
1291. Carbohydrate Metabolism
1292. Sensory Organs
1293. Eye
1294. Ear
1295. Immune System
1296. Confirmation of Pregnancy
1297. Presumptive Indications of Pregnancy
1298. Amenorrhea
1299. Nausea and Vomiting
1300. Fatigue
1301. Urinary Frequency
1302. FIG 13-6 Maternal changes based on the date of the last menstrual period.
1303. TABLE 13-2 INDICATIONS OF PREGNANCY AND OTHER POSSIBLE CAUSES
1304. Breast and Skin Changes
1305. Vaginal and Cervical Color Changes
1306. FIG 13-7 Hegar’s sign—compressibility of the lower uterus—reflects softening of the isthmus of the cervix.
1307. Fetal Movement
1308. Probable Indications of Pregnancy
1309. Abdominal Enlargement
1310. Cervical Softening
1311. Changes in the Uterus
1312. Uterine Consistency
1313. FIG 13-8 When the cervix is tapped, the fetus floats upward in the amniotic fluid. A rebound is felt by the examiner when the fetus falls back.
1314. Ballottement
1315. Braxton Hicks Contractions
1316. Palpation of the Fetal Outline
1317. Uterine Souffle
1318. Pregnancy Tests
1319. Agglutination Inhibition Test
1320. Radioreceptor Assay
1321. Radioimmunoassay
1322. Inaccurate Pregnancy Test Results
1323. Positive Indications of Pregnancy
1324. Auscultation of Fetal Heart Sounds
1325. Fetal Movements Felt by Examiner
1326. Visualization of the Fetus
1327. Antepartum Assessment and Care
1328. Preconception and Interconception Care
1329. Initial Visit
1330. History
1331. Obstetric History
1332. BOX 13-1 CALCULATION OF GRAVIDA AND PARA
1333. Menstrual History and Estimated Date of Delivery
1334. CRITICAL THINKING EXERCISE 13-1
1335. Gynecologic and Contraceptive History
1336. Medical and Surgical History
1337. Family Health History
1338. Partner’s Health History
1339. Psychosocial History
1340. Physical Examination
1341. Vital Signs
1342. Blood Pressure
1343. Pulse
1344. Respiratory Effort
1345. Temperature
1346. Cardiovascular System
1347. Venous Congestion
1348. Edema
1349. Musculoskeletal System
1350. Posture and Gait
1351. Height and Weight
1352. Abdomen
1353. Neurologic System
1354. Integumentary System
1355. Endocrine System
1356. Gastrointestinal System
1357. Mouth
1358. Intestine
1359. Urinary System
1360. Protein
1361. Glucose
1362. Ketones
1363. Bacteria
1364. Reproductive System
1365. Breasts
1366. External Reproductive Organs
1367. TABLE 13-3 COMMON LABORATORY TESTS
1368. Internal Reproductive Organs
1369. Pelvic Measurements
1370. Laboratory Data
1371. Risk Assessment
1372. Subsequent Assessments
1373. TABLE 13-4 SUMMARY OF HIGH-RISK FACTORS IN PREGNANCY
1374. Vital Signs
1375. Weight
1376. Urinalysis
1377. Fundal Height
1378. FIG 13-9 Measuring the uterus involves measuring from the upper border of the symphysis pubis to the top of the fundus.
1379. Leopold’s Maneuvers
1380. Fetal Heart Rate
1381. Fetal Activity
1382. Signs of Labor
1383. Ultrasound Screen
1384. Glucose Screen
1385. Isoimmunization
1386. Pelvic Examinations
1387. Multifetal Pregnancy
1388. Diagnosis
1389. Maternal Adaptation to Multifetal Pregnancy
1390. Antepartum Care in Multifetal Pregnancy
1391. Common Discomforts of Pregnancy
1392. PATIENT-CENTERED TEACHING: How to Overcome the Common Discomforts of Pregnancy
1393. Nausea and Vomiting
1394. Heartburn
1395. Backache
1396. Round Ligament Pain
1397. Urinary Frequency
1398. Varicosities
1399. Constipation
1400. Hemorrhoids
1401. Leg Cramps
1402. Nausea and Vomiting
1403. Heartburn
1404. Backache
1405. Round Ligament Pain
1406. Urinary Frequency
1407. FIG 13-10 Posture during pregnancy may cause or alleviate backache. A, Incorrect posture. The neck is jutting forward, the shoulders are slumping, and the back is sharply curved, creating back pain and discomfort. B, Correct posture. The neck and shoulders are straight, the back is flattened, and the pelvis is tucked under and slightly upward.
1408. Varicosities
1409. Constipation
1410. Hemorrhoids
1411. FIG 13-11 Techniques for lifting. Squatting places less strain on the back. A, Incorrect technique. Stooping or bending places a great deal of strain on muscles of the lower back. B, Correct technique. Squatting and moving the object close permits the stronger muscles of the legs to do the lifting.
1412. Leg Cramps
1413. Nursing Care
1414. Family Responses to Physical Changes of Pregnancy
1415. Assessment
1416. Nursing Diagnosis and Planning
1417. FIG 13-12 Exercises to prevent backache.
1418. Expected Outcomes
1419. Interventions
1420. Teaching Health Behaviors
1421. Bathing
1422. NURSING CARE PLAN: Early Pregnancy Concerns
1423. Focused Assessment
1424. Nursing Diagnosis
1425. Planning
1426. Expected Outcomes
1427. Interventions and Rationales
1428. Evaluation
1429. Additional Nursing Diagnosis to Consider
1430. Hot Tubs and Saunas
1431. Douching
1432. Breast Care
1433. Clothing
1434. Exercise
1435. FIG 13-13 During the third trimester, pillows supporting the abdomen and back provide a comfortable position for rest.
1436. Sleep and Rest
1437. Nutrition
1438. Employment
1439. Maternal Safety
1440. Exposure to Teratogens
1441. Travel
1442. Immunizations
1443. Teaching Necessary Lifestyle Changes
1444. Prescription and Over-the-Counter Drugs
1445. Complementary and Alternative Therapies
1446. Tobacco
1447. Alcohol
1448. Illegal Drugs
1449. Signs of Possible Complications
1450. Evaluation
1451. SAFETY ALERT: Signs of Possible Complications During Pregnancy
1452. Psychological Responses to Pregnancy
1453. Maternal Responses
1454. First Trimester
1455. Uncertainty
1456. Ambivalence
1457. The Self as Primary Focus
1458. Second Trimester
1459. Physical Evidence of Pregnancy
1460. FIG 13-14 Fetal movement (quickening) confirms that a separate life is developing.
1461. The Fetus as Primary Focus
1462. Narcissism and Introversion
1463. Body Image
1464. NURSING CARE PLAN: Body Image During Pregnancy
1465. Focused Assessment
1466. Nursing Diagnosis
1467. Planning
1468. Expected Outcomes
1469. Interventions and Rationales
1470. Evaluation
1471. Additional Nursing Diagnoses to Consider
1472. Changes in Sexuality
1473. Third Trimester
1474. Vulnerability
1475. Increasing Dependence
1476. FIG 13-15 During the third trimester, the mother feels increasingly vulnerable. She cradles her fetus to signify her protectiveness.
1477. Preparation for Birth
1478. TABLE 13-5 PROGRESSIVE CHANGES IN MATERNAL RESPONSES TO PREGNANCY
1479. Maternal Role Transition
1480. Transitions Experienced throughout Pregnancy
1481. Steps in Maternal Role Taking
1482. Mimicry
1483. Role Play
1484. Fantasy
1485. The Search for a Role Fit
1486. Grief Work
1487. Maternal Tasks of Pregnancy
1488. Seeking Safe Passage
1489. Securing Acceptance
1490. Learning to Give of Herself
1491. Committing Herself to the Unknown Child
1492. Paternal Adaptation
1493. Variations in Paternal Adaptation
1494. Developmental Processes
1495. Grappling with the Reality of Pregnancy and the Child
1496. Struggling for Recognition as a Parent
1497. FIG 13-16 Reality boosters such as hearing the sounds of the fetal heart make the fetus more real for the father.
1498. Creating the Role of Involved Father
1499. Parenting Information
1500. Couvade
1501. Adaptation of Grandparents
1502. Age
1503. Number and Spacing of Other Grandchildren
1504. Perceptions of the Role of Grandparents
1505. Adaptation of Siblings
1506. Toddlers
1507. Older Children
1508. Adolescents
1509. Factors that Influence Psychosocial Adaptations
1510. Age
1511. Multiparity
1512. CRITICAL THINKING EXERCISE 13-2
1513. FIG 13-17 A pregnant woman spends time with her child to provide affection and a sense of security.
1514. Social Support
1515. Absence of a Partner
1516. TABLE 13-6 IMPACT OF SOCIOECONOMIC FACTORS ON FAMILY’S RESPONSE TO PREGNANCY
1517. Socioeconomic Status
1518. Abnormal Situations
1519. Barriers to Prenatal Care
1520. EVIDENCE-BASED PRACTICE
1521. Cultural Influences on Childbearing
1522. Differences within Cultures
1523. Cultural Differences that May Cause Conflict
1524. Health Care Practices Beliefs ExemplarHealth Beliefs
1525. Health Maintenance During Pregnancy
1526. Belief in Fate
1527. Preventing Illness
1528. Restoring Health
1529. Modesty
1530. Female Genital Cutting
1531. Therapeutic communication ExemplarPatient Provider Communication ExemplarCommunication Techniques
1532. Language
1533. Communication Style
1534. NURSING CARE PLAN: Language Barrier During Pregnancy
1535. Focused Assessment
1536. Nursing Diagnosis
1537. Planning
1538. Expected Outcomes
1539. Interventions and Rationales
1540. Evaluation
1541. Additional Nursing Diagnoses to Consider
1542. Developmental Family roles ExemplarDecision Making
1543. Eye Contact
1544. Touch
1545. Time Orientation
1546. Culturally Competent Nursing Care
1547. Cultural Assessment
1548. TABLE 13-7 PSYCHOSOCIAL ASSESSMENT
1549. Cultural Negotiation
1550. Nursing Care
1551. Psychosocial Concerns
1552. Assessment
1553. Nursing Diagnosis and Planning
1554. Expected Outcomes
1555. Interventions
1556. Providing Information
1557. Adapting Nursing Care to Pregnancy Progress
1558. Discussing Resources
1559. Helping the Family Prepare for the Birth
1560. Modeling Communication Techniques
1561. Identifying Cultural Factors that Could Cause Conflict
1562. Evaluation
1563. Childbirth education ExemplarPerinatal Education
1564. Providers of Education
1565. Class Participants
1566. Choices for Childbearing
1567. Setting and Health Care Provider
1568. FIG 13-18 An expectant mother may ask a sister or close female friend to be her labor partner and to attend classes with her.
1569. BOX 13-2 BIRTH PLAN CONSIDERATIONS
1570. Support Person
1571. Education
1572. Types of Classes Available
1573. Preconception Classes
1574. Early Pregnancy Classes
1575. Exercise Classes
1576. Childbirth Preparation Classes
1577. FIG 13-19 The nurse teaches the support person how to check for relaxation.
1578. Cesarean Birth Preparation Classes
1579. Breastfeeding Classes
1580. Parenting Classes
1581. Classes For Fathers
1582. Postpartum Classes
1583. KEY CONCEPTS
1584. References and Readings
1585. Chapter 14 Nutrition for Childbearing
1586. Learning Objectives
1587. Weight Gain During Pregnancy
1588. Recommendations for Total Weight Gain
1589. TABLE 14-1 RECOMMENDED WEIGHT GAIN DURING PREGNANCY
1590. Pattern of Weight Gain
1591. FIG 14-1 Distribution of weight gain in pregnancy for women of normal prepregnancy weight. The numbers represent a general distribution because variation among women is great. Weight increases with the greatest fluctuation are those attributed to extravascular fluids (edema) and maternal reserves of fat.
1592. Maternal and Fetal Distribution
1593. Factors that Influence Weight Gain
1594. Nutritional Requirements During Pregnancy
1595. Dietary Reference Intakes
1596. Energy
1597. Carbohydrates
1598. Fats
1599. TABLE 14-2 DIETARY REFERENCE INTAKES: RECOMMENDED ENERGY AND PROTEIN INTAKES
1600. Calories
1601. Protein
1602. Vitamins
1603. Folic Acid
1604. Minerals
1605. Iron
1606. TABLE 14-3 DIETARY REFERENCE INTAKES: RECOMMENDATIONS FOR VITAMINS AND MINERALS
1607. TABLE 14-4 FOODS HIGH IN IRON
1608. BOX 14-1 CALCIUM SOURCES APPROXIMATELY EQUIVALENT TO 1 CUP OF MILK
1609. Calcium
1610. BOX 14-2 FOODS HIGH IN SODIUM
1611. Sodium
1612. Nutritional Supplementation
1613. Purpose
1614. Disadvantages and Dangers of Nutritional Supplementation
1615. PATIENT-CENTERED TEACHING: Vitamins and Minerals
1616. Water
1617. Food Plan
1618. Whole Grains
1619. Vegetables and Fruits
1620. TABLE 14-5 FOOD PLAN FOR PREGNANCY AND LACTATION
1621. Dairy Group
1622. Protein Group
1623. Other Elements
1624. Food Precautions
1625. SAFETY ALERT: Food Safety During Pregnancy and Lactation
1626. Factors that Influence Nutrition
1627. Age
1628. Nutritional Knowledge
1629. Exercise
1630. Diet Nutrition ExemplarCulture
1631. Southeast Asian Dietary Practices
1632. Effect of Culture on Diet During Childbearing
1633. Increasing Nutrients with Traditional Foods
1634. Hispanic Dietary Practices
1635. Nutritional Risk Factors
1636. Socioeconomic Status
1637. Poverty
1638. Food Supplement Programs
1639. Adolescence
1640. Nutrient Needs
1641. Common Problems
1642. NURSING CARE PLAN: Nutrition for the Pregnant Adolescent
1643. Focused Assessment
1644. Nursing Diagnosis
1645. Planning
1646. Expected Outcomes
1647. Interventions and Rationales
1648. Evaluation
1649. Additional Nursing Diagnoses to Consider
1650. Teaching the Adolescent
1651. Vegetarianism
1652. Meeting the Nutritional Requirements of the Pregnant Vegetarian
1653. Energy
1654. Protein
1655. Calcium
1656. Iron
1657. Zinc
1658. Vitamin B12
1659. Vitamin A
1660. Lactose Intolerance
1661. Nausea and Vomiting of Pregnancy
1662. Anemia
1663. Abnormal Prepregnancy Weight
1664. Eating Disorders
1665. Food Cravings and Aversions
1666. Pica
1667. CRITICAL THINKING EXERCISE 14-1
1668. Multiparity and Multifetal Pregnancy
1669. Substance Use and Abuse
1670. Smoking
1671. Caffeine
1672. Alcohol
1673. Drugs
1674. Other Risk Factors
1675. Nutrition After Birth
1676. Nutrition for the Lactating Mother
1677. Energy
1678. Protein
1679. Fats
1680. Vitamins and Minerals
1681. Specific Nutritional Concerns
1682. Dieting
1683. Adolescence
1684. Vegan Diet
1685. Avoidance of Dairy Products
1686. Inadequate Diet
1687. Alcohol
1688. Caffeine
1689. Fluids
1690. Foods to Avoid
1691. Nutrition for the Nonlactating Mother
1692. Weight Loss
1693. Nursing Care
1694. Nutrition for Childbearing
1695. Assessment
1696. Interview
1697. Appetite
1698. Eating Habits
1699. Food Preferences
1700. Identify Potential Problems
1701. Diet History
1702. Twenty-Four-Hour Diet History
1703. Food Intake Records
1704. Food-Frequency Questionnaires
1705. Physical Assessment
1706. FIG 14-2 Weight gain for pregnancy. The range for weight gain in women of normal prepregnancy weight is 11.5 to 16 kg (25 to 35 lb).
1707. Weight at Initial Visit
1708. CRITICAL THINKING EXERCISE 14-2
1709. Weight at Subsequent Visits
1710. Signs of Nutrient Deficiency
1711. Laboratory Tests
1712. Reassessing Nutritional Status at Each Visit
1713. Nursing Diagnosis and Planning
1714. Expected Outcomes
1715. Interventions
1716. Explaining Nutrient Needs
1717. Providing Reinforcement
1718. FIG 14-3 Women often make changes in their diets for the good of their unborn children that they would not consider for themselves alone.
1719. Evaluating Weight Gain
1720. Encouraging Supplement Intake
1721. Making Referrals
1722. Evaluation
1723. KEY CONCEPTS
1724. References And Readings
1725. Chapter 15 Prenatal Diagnostic Tests
1726. Learning Objectives
1727. Indications for Prenatal Diagnostic Tests
1728. Ultrasound
1729. Emotional Responses
1730. FIG 15-1 Two-dimensional sonogram showing the fetal body profile and details of the fetal arm, hand, and fingers.
1731. BOX 15-1 INDICATIONS FOR FETAL DIAGNOSTIC PROCEDURES
1732. Medical Conditions
1733. Demographic Factors
1734. Obstetric Factors
1735. Concurrent Maternal Factors
1736. FIG 15-2 Three-dimensional ultrasound image of a fetus in the third trimester, showing the detail of facial features.
1737. First Trimester
1738. Procedure
1739. Purposes
1740. Second and Third Trimesters
1741. Procedure
1742. Purposes
1743. FIG 15-3 The sonographer provides information as she moves the transducer over the mother’s abdomen to obtain an image.
1744. Advantages
1745. Disadvantages
1746. Doppler Ultrasound Blood Flow Assessment
1747. Purpose
1748. Color Doppler
1749. FIG 15-4 Color Doppler imaging of the umbilical vein and two arteries. Blood flow toward the transducer is typically shown as red whereas the flow away from the transducer is shown as blue.
1750. Alpha-Fetoprotein Screening
1751. Purpose
1752. BOX 15-2 CONDITIONS ASSOCIATED WITH ABNORMAL MATERNAL SERUM ALPHA-FETOPROTEIN LEVELS
1753. Elevated Levels of Alpha-Fetoprotein (AFP)
1754. Low Levels of AFP
1755. Procedure
1756. Advantages
1757. Limitations
1758. Multiple-Marker Screening
1759. Chorionic Villus Sampling
1760. Purpose
1761. Indications
1762. Procedure
1763. FIG 15-5 Transcervical chorionic villus sampling. Tissue is aspirated to identify some genetic defects in the fetus. Transabdominal aspiration is an alternative method.
1764. Advantages
1765. Limitations
1766. Amniocentesis
1767. FIG 15-6 In amniocentesis, a needle is inserted through the mother’s abdomen to aspirate fluid from the amniotic sac. The fluid can then be tested to detect chromosomal abnormalities in fetal cells or other problems and to determine fetal lung maturity.
1768. Purposes
1769. Second-Trimester Amniocentesis
1770. Third-Trimester Amniocentesis
1771. BOX 15-3 COMMON INDICATIONS FOR SECOND-TRIMESTER AMNIOCENTESIS
1772. Tests to Determine Fetal Lung Maturity
1773. Test for Fetal Hemolytic Disease
1774. Procedure
1775. Advantages
1776. Disadvantages
1777. Risks
1778. FIG 15-7 In percutaneous umbilical blood sampling, a needle is inserted through the mother’s abdomen and into an umbilical vessel (vein or artery) to withdraw a sample of fetal blood.
1779. Percutaneous Umbilical Blood Sampling
1780. Procedure
1781. Risks
1782. Antepartum Fetal Surveillance
1783. Nonstress Test
1784. Purpose
1785. Procedure
1786. Interpretation
1787. FIG 15-8 A nonstress test is a noninvasive test that measures the ability of the fetal heart to accelerate, often in response to fetal movements. Here the nurse reassures the parents by pointing to fetal heart rate accelerations detected by the external fetal monitor.
1788. Advantages
1789. Disadvantages
1790. FIG 15-9 A, Several accelerations have a duration of at least 15 seconds, reaching a peak of 25 to 30 beats per minute in this example of a reactive nonstress test. Comparable accelerations without fetal movement are also reassuring. B, In this recording of a nonreactive nonstress test, accelerations are absent after fetal movement.
1791. Vibroacoustic (Acoustic) Stimulation
1792. Purpose and Procedure
1793. Fetal Responses
1794. Risks
1795. Contraction Stress Test
1796. Purpose
1797. Procedure
1798. Interpretation
1799. Advantages
1800. Disadvantages
1801. Biophysical Profile
1802. Purpose
1803. FIG 15-10 Interpretation of contraction stress test (CST). UPI, Uteroplacental insufficiency.
1804. FIG 15-11 Effects of gradual hypoxemia and worsening fetal acidosis.
1805. Procedure and Interpretation
1806. TABLE 15-1 SCORING THE BIOPHYSICAL PROFILE FOR A TERM FETUS
1807. Modified Biophysical Profile
1808. Advantages
1809. Disadvantages
1810. Maternal Assessment of Fetal Movement
1811. Advantages
1812. Disadvantages
1813. Nursing Care
1814. The Patient Who Has Diagnostic Testing
1815. Assessment
1816. Nursing Diagnosis and Planning
1817. Expected Outcomes
1818. Interventions
1819. Providing Information
1820. Providing Support
1821. Helping Patients Set Realistic Goals
1822. Supporting the Woman’s Decision
1823. Evaluation
1824. KEY CONCEPTS
1825. References and Readings
1826. Chapter 16 Giving Birth
1827. Learning Objectives
1828. Issues for New Nurses
1829. Pain Associated with Birth
1830. Inexperience or Negative Experiences
1831. Unpredictability
1832. Intimacy
1833. Physiologic Effects of the Birth Process
1834. Maternal Response
1835. Reproductive System
1836. Characteristics of Contractions
1837. Coordinated Contractions
1838. Involuntary Contractions
1839. Intermittent Contractions
1840. Contraction Cycle
1841. Uterine Body
1842. FIG 16-1 Contraction cycle.
1843. Cervical Changes
1844. FIG 16-2 Opposing characteristics of uterine contraction in the upper and lower segments of the uterus.
1845. Effacement
1846. Dilation
1847. Cardiovascular System
1848. Respiratory System
1849. Gastrointestinal System
1850. FIG 16-3 Cervical dilation and effacement. During labor, the multigravida’s cervix remains thicker than that of the primigravida.
1851. Urinary System
1852. Hematopoietic System
1853. Fetal Response
1854. Placental Circulation
1855. Cardiovascular System
1856. Pulmonary System
1857. Components of the Birth Process
1858. Powers
1859. Uterine Contractions
1860. Maternal Pushing Efforts
1861. Passage
1862. Passenger
1863. Fetal Head
1864. Bones, Sutures, and Fontanels
1865. Fetal Head Diameters
1866. Variations in the Passenger
1867. Fetal Lie
1868. Attitude
1869. Presentation
1870. FIG 16-4 Pelvic divisions and measurements. INLET The boundaries of the inlet are the symphysis pubis anteriorly, the sacral promontory posteriorly, and the linea terminalis on the sides. The inlet is slightly wider in its transverse diameter (13.5 cm) than in its anteroposterior (diagonal conjugate) diameter (11.5 cm or greater). The diagonal conjugate is slightly larger than both the obstetric and true conjugates. The obstetric conjugate is the narrowest of the three conjugate diameters but cannot be measured directly. The obstetric conjugate is estimated by first measuring the diagonal conjugate and then subtracting 1.5 to 2 cm. If the inlet is small, the fetal head may not be able to enter it. Because it is almost entirely surrounded by bone, except for cartilage at the sacroiliac joint and symphysis pubis, the inlet cannot enlarge much to accommodate the fetus. The bony measurements are essentially fixed.
1871. MIDPELVIS The midpelvis, or pelvic cavity, is the narrowest part of the pelvis through which the fetus must pass during birth. Midpelvic diameters are measured at the level of the ischial spines. The anteroposterior diameter averages 12 cm. The transverse diameter (bispinous or interspinous) averages 10.5 cm. Prominent ischial spines that project into the midpelvis can reduce the bispinous diameter.
1872. OUTLET Three important diameters of the pelvic outlet are (1) the anteroposterior, (2) the transverse (bi-ischial or intertuberous), and (3) the posterior sagittal. The angle of the pubic arch also is an important pelvic outlet measure. The anteroposterior diameter ranges from 9.5 to 11.5 cm, varying with the curve between the sacrococcygeal joint and the tip of the coccyx. The anteroposterior diameter can increase if the coccyx is easily movable. The transverse diameter is the bi-ischial, or intertuberous, diameter. This is the distance between the ischial tuberosities (“sit bones”). It averages 11 cm. The posterior sagittal diameter is normally at least 7.5 cm. It is a measure of the posterior pelvis. The posterior sagittal diameter measures the distance from the sacrococcygeal joint to the middle of the transverse (bi-ischial) diameter.
1873. The angle of the pubic arch is important because it must be wide enough for the fetus to pass under it. The angle of the pubic arch should be at least 90 degrees. A narrow pubic arch displaces the fetus posteriorly toward the coccyx as it tries to pass under the arch.
1874. FIG 16-5 A, Bones, sutures, fontanels of the fetal head. Note that the anterior fontanel has a diamond shape, whereas the posterior fontanel is triangular. B, Lateral view of the fetal head. Anteroposterior diameters vary with the amount of flexion or extension.
1875. FIG 16-6 Lie. A, In a longitudinal lie, the long axis of the fetus is parallel to the long axis of the woman. B, In a transverse lie, the long axis of the fetus is at right angles to the long axis of the mother. The woman’s abdomen has a wide, short appearance.
1876. Cephalic Presentation
1877. FIG 16-7 Attitude. A, The fetus is in the normal attitude of flexion, with the head, arms, and legs flexed tightly against the trunk. B, The fetus is in an abnormal attitude of extension. The head is extended, and the right arm is extended. A face presentation is illustrated.
1878. Vertex
1879. FIG 16-8 Four types of cephalic presentation. The vertex presentation is normal. Note positional changes of the anterior and posterior fontanels in relation to the maternal pelvis.
1880. Military
1881. Brow
1882. Face
1883. Breech Presentation
1884. Frank breech
1885. Full (or complete) breech
1886. Footling breech
1887. Shoulder
1888. Position
1889. Right (R) or Left (L)
1890. Occiput (O), Mentum (M), or Sacrum (S)
1891. Anterior (A), Posterior (P), or Transverse (T)
1892. FIG 16-9 Three variations of a breech presentation. Frank breech is the most common variation. Footling breeches may be single or double.
1893. FIG 16-10 Four quadrants of the maternal pelvis, used to describe fetal position.
1894. Psyche
1895. Interrelationships of the Components of Birth
1896. Individual and Cultural Values
1897. FIG 16-11 Fetal presentations and positions.
1898. Birth as an Experience
1899. Normal Labor
1900. Theories of Onset
1901. Premonitory Signs
1902. True Labor and False Labor
1903. Mechanisms of Labor
1904. PATIENT-CENTERED TEACHING: How to Know Whether Labor Is “Real”
1905. Stages and Phases of Labor
1906. First Stage of Labor
1907. Latent Phase
1908. Active Phase
1909. FIG 16-12 Mechanisms (cardinal movements) of labor.
1910. TABLE 16-1 CHARACTERISTICS OF NORMAL LABOR
1911. FIG 16-13 A labor curve, often called a Friedman curve, may be used to identify whether a woman’s cervical dilation is progressing at the expected rate. Typical labor curves for a multiparous and a nulliparous woman are illustrated for comparison of patterns.
1912. Second Stage of Labor
1913. Third Stage of Labor
1914. Fourth Stage of Labor
1915. EVIDENCE-BASED PRACTICE
1916. FIG 16-14 A, Fetal side of the placenta. B, Maternal side of the placenta. C, Separating membranes. D, Umbilical cord vessels—two arteries and one vein.
1917. Duration of Labor
1918. Nursing Care During Labor and Birth
1919. Admission to the Birth Center
1920. Nursing Responsibilities during Admission
1921. Establishing a Therapeutic Relationship
1922. Making the Family Feel Welcome
1923. PATIENT-CENTERED TEACHING: When to Go to the Hospital or Birth Center
1924. Contractions
1925. Ruptured Membranes
1926. Bleeding
1927. Decreased Fetal Movement
1928. Other Concerns
1929. CRITICAL THINKING EXERCISE 16-1
1930. Determining Family Expectations about Birth
1931. Conveying Confidence
1932. Assigning a Primary Nurse
1933. Using Touch for Comfort
1934. Respecting Cultural Values
1935. Assessments at the Time of Admission
1936. Focused Assessment
1937. Fetal Assessment
1938. Maternal Vital Signs
1939. Impending Birth
1940. Database Assessment
1941. Basic Information
1942. TABLE 16-2 INTRAPARTUM ASSESSMENT GUIDE Women who have had prenatal care have much of this information available on their prenatal record. The nurse need only verify it or update it as needed.
1943. PROCEDURE: Leopold’s Maneuvers
1944. Purposes
1945. First Maneuver
1946. Second Maneuver
1947. Third Maneuver
1948. Fourth Maneuver
1949. Fetal Assessments
1950. Labor Status
1951. Physical Examination
1952. Admission Procedures
1953. Notifying the Physician or Midwife
1954. Consent Forms
1955. CRITICAL THINKING EXERCISE 16-2
1956. Laboratory Tests
1957. Intravenous Access
1958. Assessments After Admission
1959. Fetal Assessments
1960. FHR
1961. Amniotic Fluid
1962. Maternal Assessments
1963. Vital Signs
1964. Contractions
1965. Progress of Labor
1966. Intake and Output
1967. Response to Labor
1968. PROCEDURE: Palpating Contractions
1969. Purpose
1970. The Support Person’s Response
1971. Nursing Care
1972. The Woman with False or Early Labor
1973. Assessment
1974. Nursing Diagnosis and Planning
1975. Expected Outcomes
1976. Interventions
1977. Providing Reassurance
1978. Teaching
1979. Evaluation
1980. Nursing Care
1981. The Woman in True Labor
1982. SAFETY ALERT: Conditions Associated with Fetal Compromise
1983. Fetal Oxygenation
1984. Assessment
1985. Nursing Diagnosis and Planning
1986. Expected Outcome
1987. Interventions
1988. Promoting Placental Function
1989. Observing for Conditions Associated with Fetal Compromise
1990. Evaluation
1991. Discomfort
1992. Assessment
1993. Nursing Diagnosis and Planning
1994. Expected Outcomes
1995. Interventions
1996. Providing Comfort Measures
1997. Lighting
1998. Temperature
1999. Cleanliness
2000. Mouth Care
2001. Bladder
2002. Positioning
2003. Water
2004. Teaching
2005. First Stage of Labor
2006. Second Stage of Labor
2007. Laboring Down
2008. Positions
2009. Method and Breathing Pattern
2010. Labor Support
2011. Providing Encouragement
2012. FIG 16-15 Maternal positions for labor.
2013. Giving of Self
2014. Offering Pharmacologic Measures
2015. Caring for the Birth Partner
2016. Evaluation
2017. Preventing Injury
2018. Assessment
2019. Nursing Diagnosis and Planning
2020. Expected Outcome
2021. Interventions
2022. Transfer to a Delivery Room
2023. Positioning for Birth
2024. Observing the Perineum
2025. BOX 16-1 ASSISTING WITH AN EMERGENCY BIRTH
2026. Nursing Priorities for an Emergency Birth in Any Setting
2027. Preparing for an Emergency Birth in the Birth Facility
2028. During the Birth
2029. After the Birth
2030. Evaluation
2031. Nursing Care During the Late Intrapartum Period
2032. Responsibilities During Birth
2033. Responsibilities After Birth
2034. Care of the Infant
2035. Maintaining Cardiopulmonary Function
2036. Supporting Thermoregulation
2037. FIG 16-16 Sequence of delivery.
2038. Identifying the Infant
2039. FIG 16-17 Vaginal birth.
2040. Care of the Mother
2041. Observing for Hemorrhage
2042. Vital Signs
2043. Fundus
2044. NURSING CARE PLAN: Normal Labor and Birth
2045. Focused Assessment
2046. Nursing Diagnosis
2047. Planning
2048. Expected Outcomes
2049. Interventions and Rationales
2050. Evaluation
2051. Focused Assessment
2052. Nursing Diagnosis
2053. Planning
2054. Expected Outcome
2055. Interventions and Rationales
2056. Evaluation
2057. Focused Assessment
2058. Nursing Diagnosis
2059. Planning
2060. Expected Outcome
2061. Interventions and Rationales
2062. Evaluation
2063. Focused Assessment
2064. Nursing Diagnosis
2065. Planning
2066. Expected Outcome
2067. Interventions and Rationales
2068. Evaluation
2069. TABLE 16-3 APGAR SCORE∗
2070. FIG 16-18 When the birthing room nurse turns over care of the newborn to the nursery nurse, both check the identification bands and record for the same information.
2071. Bladder
2072. Lochia
2073. Relieving Discomfort
2074. Ice Packs
2075. Analgesics
2076. TABLE 16-4 MATERNAL PROBLEMS DURING THE FOURTH STAGE OF LABOR
2077. Warmth
2078. Promoting Early Family Attachment
2079. KEY CONCEPTS
2080. References and Readings
2081. Pageburst Integrated Resource
2082. Animation
2083. Chapter 17 Intrapartum Fetal Surveillance
2084. Learning Objectives
2085. Fetal Oxygenation
2086. Uteroplacental Exchange
2087. Fetal Circulation
2088. Fetal Heart Rate Regulation
2089. Autonomic Nervous System
2090. Baroreceptors
2091. Chemoreceptors
2092. Adrenal Glands
2093. Central Nervous System
2094. Pathologic Influences on Fetal Oxygenation
2095. Maternal Cardiopulmonary Alterations
2096. BOX 17-1 POTENTIAL MATERNAL, FETAL, OR NEONATAL RISK FACTORS
2097. Antepartum Period
2098. Maternal History
2099. Problems Identified during Pregnancy
2100. Intrapartum Period
2101. Maternal Problems
2102. Fetal or Placental Problems
2103. Uterine Activity
2104. Placental Disruptions
2105. Interruptions in Umbilical Flow
2106. Fetal Alterations
2107. Risk Factors for Fetal Compromise
2108. Auscultation and Palpation
2109. Advantages
2110. Limitations
2111. Evaluating Auscultated Fetal Heart Rate Data
2112. FIG 17-1 Low intervention methods for evaluating fetal heart rate during labor. A, Fetoscope with head attachment to enhance conduction of faint fetal heart sounds. B, Doppler ultrasound transducer to sense the fetal heart rate electronically.
2113. Electronic Fetal Monitoring
2114. PROCEDURE: Auscultating the Fetal Heart Rate
2115. Purpose
2116. Advantages
2117. Limitations
2118. Electronic Fetal Monitoring Equipment
2119. Bedside Monitor Unit
2120. FIG 17-2 Paper strip for recording electronic fetal monitoring data. Each dark vertical line represents 1 minute, and each lighter vertical line represents 10 seconds. Computerized displays that depict the fetal heart rate and uterine activity patterns have a similar appearance.
2121. Paper Strip
2122. Remote Surveillance
2123. Devices for External Fetal Monitoring
2124. FIG 17-3 The nurse applies the uterine activity transducer to the woman’s upper abdomen, in the fundal area. The Doppler transducer for sensing the fetal heart rate is usually placed on her lower abdomen when the fetus is in the cephalic presentation.
2125. PROCEDURE: External Fetal Monitor
2126. Purposes
2127. FIG 17-4 Fetal scalp electrode and intrauterine pressure catheter (IUPC). A, Parts of the fetal scalp electrode before it is applied. B, Fetal scalp electrode and IUPC in place and connected to the bedside monitor unit.
2128. Fetal Heart Rate Monitoring with an Ultrasound Transducer
2129. Uterine Activity Monitoring with a Tocotransducer
2130. Devices for Internal Fetal Monitoring
2131. Fetal Heart Rate Monitoring with a Scalp Electrode
2132. FIG 17-5 Intrauterine pressure catheter (IUPC) with transducer in its tip. This model has a lumen for amnioinfusion and is shown with its introducer over the catheter. The amnioinfusion port is on the side of the catheter connection and has a blue cap covering it when not in use.
2133. Uterine Activity Monitoring with an Intrauterine Pressure Catheter
2134. Evaluating Electronic Fetal Monitoring Strips
2135. Baseline Fetal Heart Rate
2136. Baseline FHR Variability
2137. FIG 17-6 Electronic fetal monitor strip showing a reassuring pattern of fetal heart rate and uterine activity. The baseline fetal heart rate averages 135 beats per minute (bpm), with a moderate variability of 10 bpm. An acceleration to 150 bpm is present. The contraction frequency is approximately every 2 to 3 minutes, duration is about 50 to 60 seconds, intensity is 75 to 90 mm Hg, and uterine resting tone is approximately 10 mm Hg. Fetal scalp electrode and intrauterine pressure catheter (IUPC) are being used.
2138. Periodic Patterns in FHR
2139. Accelerations
2140. Decelerations
2141. Early Decelerations
2142. FIG 17-7 Contrasts in fetal heart rate variability. A fetal scalp electrode is being used. A, Minimal variability (less than 5 beats per minute [bpm]). Note the smooth, flat line in the upper graph for the fetal heart rate. B, Moderate variability (average 20 bpm variability). Note the zigzag appearance of the fetal heart rate line compared with the flat appearance in A.
2143. FIG 17-8 Accelerations in the fetal heart rate.
2144. FIG 17-9 Early decelerations. The slowing of the fetal heart rate is gradual, and the nadir of the deceleration occurs at the peak of the contraction. It returns to the baseline by the end of the contraction. Cause: fetal head compression.
2145. FIG 17-10 Late decelerations. Note that the decelerations look similar to early decelerations but are offset to the right. They begin at about the peak of the contraction, and the nadir occurs well after the peak of the contraction, often during the interval. Cause: uteroplacental insufficiency.
2146. Late Decelerations
2147. FIG 17-11 Variable decelerations. The decelerations are sharp in onset and offset. Note slight rate accelerations (shoulders) after each variable deceleration. These variable decelerations are periodic in that they occur during contractions. Cause: umbilical cord compression.
2148. SAFETY ALERT: Differences Between Early and Late Decelerations
2149. Both Early and Late Decelerations
2150. Early Decelerations
2151. Late Decelerations
2152. Variable Decelerations
2153. Uterine Activity
2154. Significance of FHR Patterns
2155. Reassuring Patterns
2156. Indeterminate Patterns
2157. Nonreassuring Patterns
2158. SAFETY ALERT: Nursing Responses to Nonreassuring Fetal Heart Rate Patterns
2159. FIG 17-12 Fetal scalp stimulation identifies fetal response to gentle massage. An acceleration in the fetal heart rate of 15 beats per minute for 15 seconds suggests that the fetus is in normal oxygen and acid-base balance. Accelerations often occur with vaginal examination unrelated to nonreassuring fetal heart rate patterns.
2160. TABLE 17-1 REASSURING (NORMAL) AND NONREASSURING (ABNORMAL) FETAL SURVEILLANCE ASSESSMENTS
2161. Clarification of Data
2162. Fetal Scalp Stimulation
2163. VAS
2164. Fetal Scalp Blood Sampling
2165. Fetal Oxygen Saturation Monitor
2166. Cord Blood Gases and pH
2167. Interventions for Nonreassuring Patterns
2168. FIG 17-13 Obtaining a blood sample to determine umbilical cord blood gas values and pH. Samples are drawn from the umbilical artery and vein. Arterial samples most closely reflect fetal oxygen and acid-base status. The samples in capped syringes may be kept for up to 60 minutes at room temperature.
2169. Identifying the Cause of a Nonreassuring Pattern
2170. Increasing Placental Perfusion
2171. Increasing Maternal Blood Oxygen Saturation
2172. Reducing Cord Compression
2173. FIG 17-14 The nurse teaches the woman and her partner about electronic fetal monitoring to reduce anxiety and promote the woman’s comfort during labor. Electronic fetal monitoring is only one method used to evaluate fetal well-being during labor.
2174. Nursing Care
2175. The Woman Having Intrapartum Fetal Monitoring
2176. Learning Needs
2177. Assessment
2178. NURSING CARE PLAN: Intrapartum Fetal Compromise
2179. Focused Assessment
2180. Nursing Diagnosis
2181. Planning
2182. Expected Outcome
2183. Interventions and Rationales
2184. Evaluation
2185. Focused Assessment
2186. Potential Complication
2187. Planning
2188. Expected Outcomes
2189. Interventions and Rationales
2190. Evaluation
2191. Focused Assessment
2192. Nursing Diagnosis
2193. Planning
2194. Expected Outcomes
2195. Interventions and Rationales
2196. Evaluation
2197. Nursing Diagnosis and Planning
2198. Expected Outcome
2199. Interventions
2200. Explaining FHR Auscultation with Uterine Palpation
2201. Explaining the Electronic Fetal Monitor
2202. Addressing Parents’ Safety Concerns
2203. Coping with Misleading Data
2204. PARENTS WANT TO KNOW: About Electronic Fetal Monitoring
2205. Can I move around with the monitor?
2206. What if I need to go to the bathroom?
2207. Will the monitor shock me? I don’t know if I want to be hooked to an electrical outlet, especially since my water has broken
2208. Why is the baby’s heart beating so fast?
2209. Why do those numbers for the baby’s heart rate change all the time?
2210. What do those numbers for contractions on the machine (external monitor) mean? They change all the time
2211. My contractions don’t look very strong, but they sure seem strong to me! (External uterine activity monitor is being used.)
2212. Will the internal monitor hurt my baby?
2213. Including the Labor Partner
2214. CRITICAL THINKING EXERCISE 17-1
2215. CRITICAL THINKING EXERCISE 17-2
2216. Enhancing Comfort
2217. Evaluation
2218. Fetal Oxygenation
2219. Assessment
2220. BOX 17-2 GUIDELINES FOR ASSESSMENT AND DOCUMENTATION OF FETAL HEART RATE AUSCULTATION FOR WOMEN AT LOW RISK
2221. Active First-Stage Labor
2222. Second-Stage Labor
2223. Other Times to Document Fetal Heart Rate
2224. Nursing Diagnosis and Planning
2225. Interventions
2226. Taking Corrective Actions
2227. Reassuring Parents
2228. Reporting Nonreassuring Patterns
2229. Documentation ExemplarDocumenting Assessments and Care
2230. Evaluation
2231. BOX 17-3 DOCUMENTING ELECTRONIC FETAL MONITORING
2232. Documentation When Monitoring Is Initiated
2233. Monitor Strip
2234. Labor Record (If Paper-Only Documentation)
2235. Continuing Documentation
2236. Monitor Strip
2237. Labor Record
2238. KEY CONCEPTS
2239. References and Readings
2240. Chapter 18 Pain Management for Childbirth
2241. Learning Objectives
2242. Unique Nature of Pain During Birth
2243. Adverse Effects of Excessive Pain
2244. Physiologic Effects
2245. Psychological Effects
2246. Variables in Childbirth Pain
2247. Physical Factors
2248. Sources of Pain
2249. Tissue Ischemia
2250. Cervical Dilation
2251. Pressure and Pulling on Pelvic Structures
2252. Distention of the Vagina and Perineum
2253. Factors Influencing the Perception or Tolerance of Pain
2254. FIG 18-1 Pathways of pain transmission during labor. Pain stimuli from cervical dilation enter the spinal cord at these segments. Pain stimuli from vaginal and perineal distention travel through the pudendal nerve and enter the spinal cord at these segments
2255. Intensity of Labor
2256. Cervical Readiness
2257. Fetal Position
2258. Characteristics of the Pelvis
2259. Fatigue
2260. Intervention of Caregivers
2261. Psychosocial Factors
2262. Culture
2263. Anxiety and Fear
2264. Previous Experiences with Pain
2265. Preparation for Childbirth
2266. Support System
2267. Standards for Pain Management
2268. Nonpharmacologic Pain Management
2269. Advantages
2270. Limitations
2271. Preparation for Pain Management
2272. FIG 18-2 General comfort measures such as the nurse’s reassuring presence or a cool, damp cloth applied to the face supplement other methods of nonpharmacologic and pharmacologic pain control.
2273. Application of Nonpharmacologic Techniques
2274. Relaxation techniques ExemplarRelaxation
2275. Environmental Comfort
2276. General Comfort
2277. Reducing Anxiety and Fear
2278. Implementing Specific Relaxation Techniques
2279. Cutaneous Stimulation
2280. Self-Massage
2281. Massage by Others
2282. FIG 18-3 The coach applies sacral pressure to counter the back pain that is common during labor.
2283. Thermal Stimulation
2284. Acupressure
2285. Hydrotherapy
2286. BOX 18-1 USE OF WATER THERAPY DURING LABOR
2287. Benefits
2288. Disadvantages
2289. Contraindications and Precautions
2290. Mental Stimulation
2291. Imagery ExemplarImagery
2292. FIG 18-4 A woman and her partner who are prepared for labor have learned a variety of skills to master pain as labor progresses. The coach uses hand signals to tell the woman how to change her pattern of paced breathing.
2293. Focal Point
2294. Breathing Techniques
2295. First-Stage Breathing
2296. Cleansing Breath
2297. FIG 18-5 Slow-paced breathing. Although a specific rate may or may not be taught, slow-paced breathing should be no slower than half the woman’s usual respiratory rate to ensure adequate oxygenation. This pace is generally about six to nine breaths per minute.
2298. FIG 18-6 Modified-paced breathing. The pattern for modified-paced breathing should be comfortable to the woman and no faster than twice her normal respiratory rate to prevent hyperventilation or interference with relaxation.
2299. Slow-Paced Breathing
2300. Modified-Paced Breathing
2301. Pattern-Paced Breathing
2302. FIG 18-7 Combining breathing techniques during a contraction. Slow- and modified-paced breathing can be combined by using the slower breathing at the beginning and end of the contraction and the more rapid breathing over the peak of the contraction.
2303. FIG 18-8 Pattern-paced breathing. Pattern-paced breathing adds a slight emphasis or “blow” on the exhalation in a pattern. The diagram shows the emphasis after every third inhalation.
2304. Controlling the Urge to Push
2305. Common Problems
2306. Second-Stage Breathing
2307. Pharmacologic Pain Management
2308. Special Considerations When Medicating a Pregnant Woman
2309. Effects on the Fetus
2310. Maternal Physiologic Alterations
2311. Cardiovascular Changes
2312. Respiratory Changes
2313. Gastrointestinal Changes
2314. Nervous System Changes
2315. Effects on the Course of Labor
2316. Effects of Complications
2317. Interactions with Other Substances
2318. Regional Pain Management Techniques
2319. Epidural Block
2320. FIG 18-9 A, Cross section of spinal cord, meninges, and protective vertebra. The dura and arachnoid lie close together. The pia mater is the innermost of the meninges and covers the brain and spinal cord. The subarachnoid space is between the arachnoid and pia mater. B, Sagittal section of spinal cord, meninges, and vertebrae. The epidural and subarachnoid spaces are illustrated. Note that the spinal cord ends at the L2 vertebra.
2321. Technique
2322. Dural Puncture
2323. Contraindications and Precautions
2324. FIG 18-10 Technique for epidural block.
2325. Adverse Effects of Epidural Block
2326. Maternal Hypotension
2327. Bladder Distention
2328. Prolonged Second Stage
2329. Migration of the Epidural Catheter
2330. Fever
2331. TABLE 18-1 DRUGS COMMONLY USED FOR INTRAPARTUM PAIN MANAGEMENT
2332. Adverse Effects of Epidural Opioids
2333. Nausea and Vomiting
2334. Pruritus
2335. Delayed Respiratory Depression
2336. Nursing Care
2337. Intrathecal (Subarachnoid) Opioid Analgesics
2338. Technique
2339. Adverse Effects of Intrathecal Opioids
2340. Nursing Care
2341. Subarachnoid (Spinal) Block
2342. Technique
2343. Contraindications and Precautions
2344. Adverse Effects of an SAB
2345. Systemic Drugs for Labor
2346. Opioid Analgesics
2347. FIG 18-11 Technique for subarachnoid block.
2348. FIG 18-12 Levels of anesthesia for epidural and subarachnoid blocks. A level of T10 through S5 is adequate for vaginal birth. A higher level, to T4-T6, is needed for cesarean birth.
2349. Opioid Antagonists
2350. Adjunctive Drugs
2351. FIG 18-13 Blood patch for relief of spinal headache. Ten to 15 mL of the woman’s blood is injected into the epidural space to seal a dural puncture.
2352. Sedatives
2353. Vaginal Birth Anesthesia
2354. Local Infiltration Anesthesia
2355. Pudendal Block
2356. FIG 18-14 Local infiltration anesthesia numbs the perineum just before birth for an episiotomy or after birth for suturing of a laceration. The birth attendant protects the fetal head by placing a finger inside the vagina while injecting the perineum in a fanlike pattern or as needed.
2357. General Anesthesia
2358. Technique
2359. FIG 18-15 Pudendal block provides anesthesia for an episiotomy and the use of low forceps. A needle guide (“trumpet”) protects the maternal and fetal tissues from the long needle needed to reach the pudendal nerve. Only about 1.25 cm (½ in) of the long needle protrudes from the guide.
2360. Adverse Effects of General Anesthesia
2361. Maternal Aspiration of Gastric Contents
2362. Respiratory Depression
2363. Uterine Relaxation
2364. Methods to Minimize Adverse Effects
2365. FIG 18-16 Sellick maneuver to prevent vomitus from entering the woman’s trachea while she is being intubated for general anesthesia. An assistant applies pressure to the cricoid cartilage to obstruct the esophagus. Once the woman is successfully intubated with a cuffed endotracheal tube, gastric secretions cannot enter the trachea.
2366. Nursing Care
2367. Pain Management
2368. Pain
2369. Assessment
2370. NURSING CARE PLAN: Intrapartum Pain Management
2371. Focused Assessment
2372. Nursing Diagnosis
2373. Planning
2374. Expected Outcomes
2375. Interventions and Rationales
2376. Evaluation
2377. Focused Assessment
2378. Nursing Diagnosis
2379. Planning
2380. Expected Outcomes
2381. Interventions and Rationales
2382. Evaluation
2383. Additional Nursing Diagnoses and Collaborative Problems to Consider:
2384. Labor Status
2385. CRITICAL THINKING EXERCISE 18-1
2386. Nursing Diagnosis and Planning
2387. Expected Outcomes
2388. Interventions
2389. Promoting Relaxation
2390. Reducing Outside Sources of Discomfort
2391. Reducing Anxiety and Fear
2392. Helping the Woman Use Nonpharmacologic Techniques
2393. Massage
2394. Mental Stimulation
2395. Breathing
2396. Incorporating Pharmacologic Methods
2397. PARENTS WANT TO KNOW: How Will This Medicine Affect Our Baby?
2398. Evaluation
2399. Respiratory Compromise
2400. Assessment
2401. Nursing Diagnosis and Planning
2402. Expected Outcome
2403. Interventions
2404. Identifying Risk Factors
2405. Reducing Risk for Aspiration or Lung Injury
2406. Perioperative Care
2407. TABLE 18-2 PHARMACOLOGIC METHODS OF INTRAPARTUM PAIN MANAGEMENT
2408. Postoperative Care
2409. Evaluation
2410. KEY CONCEPTS
2411. References and Readings
2412. Chapter 19 Nursing Care During Obstetric Procedures
2413. Learning Objectives
2414. Amniotomy
2415. Indications
2416. Risks
2417. Prolapse of the Umbilical Cord
2418. Infection
2419. Abruptio Placentae
2420. Technique
2421. FIG 19-1 A, Disposable plastic membrane perforator (Amnihook). B, Hook end of plastic membrane perforator. C, Correct method of opening the package. D, Technique for artificial rupture of membranes.
2422. Nursing Considerations
2423. Obtaining Baseline Information
2424. Assisting with Amniotomy
2425. Providing Care after Amniotomy
2426. Identifying Complications
2427. CRITICAL THINKING EXERCISE 19-1
2428. Promoting Comfort
2429. Induction and Augmentation of Labor
2430. Indications
2431. Determining Whether Induction Is Indicated
2432. Contraindications
2433. TABLE 19-1 BISHOP SCORING SYSTEM TO EVALUATE THE CERVIX
2434. Risks
2435. Technique
2436. Cervical Ripening
2437. Medical Methods
2438. TABLE 19-2 PROSTAGLANDIN PREPARATIONS FOR CERVICAL RIPENING AT TERM
2439. Mechanical Methods
2440. Oxytocin Administration
2441. FIG 19-2 Intravenous (IV) pump setup for infusion from two IV lines. Fluid in the primary line (nonadditive, or maintenance line) contains no medication but is regulated by the infusion pump to maintain the correct rate. Oxytocin solution is regulated in the secondary line in the same pump, giving the nurse options to change or discontinue the oxytocin infusion rate while maintaining the primary line infusion at the same rate. A single IV line at the lower part of the pump connects to the woman’s infusion site.
2442. Nursing Considerations
2443. DRUG GUIDE: Oxytocin (Pitocin)
2444. CRITICAL THINKING EXERCISE 19-2
2445. Observing the Fetal Response
2446. Observing the Mother’s Response
2447. SAFETY ALERT: Signs of Tachysystole
2448. Nursing Actions for Tachysystole
2449. Version
2450. Indications
2451. External Cephalic Version
2452. Internal Version
2453. Contraindications
2454. Risks
2455. Technique
2456. External Version
2457. FIG 19-3 External version. Intravenous (IV) access is established in case of emergency or for some tocolytic drugs. If terbutaline is the tocolytic drug, it is given by subcutaneous injection.
2458. Internal Version
2459. Nursing Considerations
2460. Providing Information
2461. Promoting Maternal and Fetal Health
2462. Reducing Anxiety
2463. Operative Vaginal Birth
2464. Indications
2465. Contraindications
2466. FIG 19-4 Obstetric forceps and their application.
2467. Risks
2468. Technique
2469. FIG 19-5 Birth assisted with a vacuum extractor. The chignon is scalp edema that often forms under the suction cup when the vacuum extractor is used.
2470. Nursing Considerations
2471. FIG 19-6 A, Vacuum extractor with a low-profile cup that can be used for occiput posterior fetal positions. Note the green band that denotes adequate suction and the red band that warns of excess suction. B, Application of the low-profile cup to the fetal head in an occiput posterior position.
2472. Episiotomy
2473. Technique
2474. Nursing Considerations
2475. FIG 19-7 Types of episiotomies.
2476. Cesarean Birth
2477. VBAC
2478. BOX 19-1 VAGINAL BIRTH AFTER CESAREAN BIRTH
2479. Indications
2480. Contraindications
2481. Risks
2482. Technique
2483. Preparation
2484. FIG 19-8 Skin (abdominal wall) incisions for cesarean birth.
2485. Surgical incision ExemplarIncisions
2486. FIG 19-9 Uterine incisions for cesarean birth. The abdominal and uterine incisions do not always match. VBAC, Vaginal birth after cesarean.
2487. Nursing Considerations
2488. Providing Emotional Support
2489. BOX 19-2 NURSING CARE FOR A WOMAN HAVING A CESAREAN BIRTH
2490. Before the Cesarean Birth
2491. During the Recovery Period
2492. NURSING CARE PLAN: Cesarean Birth
2493. Focused Assessment
2494. Nursing Diagnosis
2495. Planning
2496. Expected Outcomes
2497. Interventions and Rationales
2498. Evaluation
2499. Focused Assessment
2500. Nursing Diagnosis
2501. Planning
2502. Expected Outcomes
2503. Interventions and Rationales
2504. Evaluation
2505. Additional Nursing Diagnoses to Consider
2506. Teaching
2507. Promoting Safety
2508. Providing Postoperative Care
2509. KEY CONCEPTS
2510. References and Readings
2511. Chapter 20 Postpartum Adaptations
2512. Learning Objectives
2513. Reproductive System
2514. Involution of the Uterus
2515. Descent of the Uterine Fundus
2516. Afterpains
2517. Etiology
2518. Nursing Considerations
2519. FIG 20-1 Involution of the uterus. Height of the uterine fundus decreases by approximately 1 cm/day. The fundus is no longer palpable by 14 days.
2520. Lochia
2521. Changes in Color
2522. Amount
2523. FIG 20-2 Guidelines for assessing the volume of lochia based on the amount of stain on a perineal pad in 1 hour.
2524. TABLE 20-1 CHARACTERISTICS OF LOCHIA
2525. Cervix
2526. Vagina
2527. BOX 20-1 LACERATIONS OF THE BIRTH CANAL
2528. Perineum
2529. Periurethral Area
2530. Vaginal Wall
2531. Cervix
2532. Perineum
2533. Discomfort
2534. Nursing Considerations
2535. Cardiovascular System
2536. Cardiac Output
2537. Plasma Volume
2538. Blood Values
2539. Coagulation
2540. Gastrointestinal System
2541. Urinary System
2542. FIG 20-3 A full bladder displaces and prevents contraction of the uterus.
2543. Musculoskeletal System
2544. Muscles and Joints
2545. Abdominal Wall
2546. Integumentary System
2547. FIG 20-4 Diastasis recti occurs when the longitudinal muscles of the abdomen separate during pregnancy.
2548. FIG 20-5 Abdominal exercises for diastasis recti. A, The woman inhales and supports the abdominal wall firmly with her hands. B, Exhaling, the woman raises her head as she pulls the abdominal muscles together.
2549. Neurologic System
2550. Endocrine System
2551. Resumption of Ovulation and Menstruation
2552. Lactation
2553. Weight Loss
2554. Postpartum Assessments
2555. Clinical Pathways
2556. Initial Assessments
2557. Chart Review
2558. Need for Rho(D) Immune Globulin
2559. Need for Vaccines
2560. Rubella Vaccine
2561. Pertussis Vaccine
2562. DRUG GUIDE: Rubella Vaccine
2563. Risk Factors for Hemorrhage and Infection
2564. SAFETY ALERT: Postpartum Risk Factors
2565. Hemorrhage
2566. Infection
2567. Focused Assessments after Vaginal Birth
2568. Vital Signs
2569. Blood Pressure
2570. Orthostatic Hypotension
2571. TABLE 20-2 OBSERVATIONS OF THE UTERINE FUNDUS AND NURSING ACTIONS
2572. Pulse
2573. Respirations
2574. Temperature
2575. Pain
2576. Fundus
2577. Lochia
2578. PROCEDURE: Assessing the Uterine Fundus
2579. Purpose
2580. Perineum
2581. Bladder Elimination
2582. SAFETY ALERT: Signs of a Distended Bladder
2583. PROCEDURE: Assessing the Perineum
2584. Purpose
2585. Breasts
2586. Lower Extremities
2587. Homans Sign
2588. Edema and Deep Tendon Reflexes
2589. Care in the Immediate Postpartum Period
2590. Providing Comfort Measures
2591. Ice Packs
2592. Sitz Baths
2593. Perineal Care
2594. Topical Medications
2595. Sitting Measures
2596. Analgesics
2597. Promoting Bladder Elimination
2598. CRITICAL THINKING EXERCISE 20-1
2599. Providing Fluids and Food
2600. Preventing Thrombophlebitis
2601. Nursing Care After Cesarean Birth
2602. Assessment
2603. Pain Relief
2604. Respirations
2605. Abdomen
2606. Intake and Output
2607. Interventions
2608. The First 24 Hours
2609. Providing Pain Relief
2610. Overcoming the Effects of Immobility
2611. Providing Comfort
2612. After 24 Hours
2613. Resuming Normal Activities
2614. Assisting the Mother with Infant Care
2615. Preventing Abdominal Distention
2616. Nursing Care
2617. Teaching After Birth
2618. Assessment
2619. Nursing Diagnosis and Planning
2620. Expected Outcomes
2621. Interventions
2622. Preparing for Teaching
2623. Determining Teaching Topics
2624. NURSING CARE PLAN: Postpartum Hypotension, Fatigue, and Pain
2625. Focused Assessment
2626. Nursing Diagnosis
2627. Planning
2628. Expected Outcome
2629. Interventions and Rationales
2630. Evaluation
2631. Focused Assessment
2632. Nursing Diagnosis
2633. Planning
2634. Expected Outcomes
2635. Interventions and Rationales
2636. Evaluation
2637. Additional Nursing Diagnoses to Consider
2638. Teaching the Process of Involution
2639. Teaching Self-Care
2640. Handwashing
2641. Breast Care for Lactating Mothers
2642. Measures to Suppress Lactation
2643. Care of the Cesarean Incision
2644. Perineal Care
2645. Kegel Exercises
2646. Promoting Rest and Sleep
2647. Rest at the Birth Facility
2648. Rest at Home
2649. Providing Nutrition Counseling
2650. Food Supply
2651. Diet
2652. Promoting Regular Bowel Elimination
2653. Promoting Good Body Mechanics
2654. Exercise
2655. Preventing Back Strain
2656. Counseling about Sexual Activity
2657. FIG 20-6 Postpartum exercises.
2658. Instructing About Follow-up Appointments
2659. Teaching about Signs and Symptoms that Should Be Reported
2660. Ensuring that All Elements Have Been Taught
2661. Documenting Teaching
2662. Evaluation
2663. The Process of Becoming Acquainted
2664. FIG 20-7 The infant is quiet and alert during the initial sensitive period. The newborn gazes at the mother and responds to her voice and touch. The mother touches only with her fingertips at first.
2665. Bonding
2666. Attachment
2667. FIG 20-8 The mother begins to stroke her infant as she progresses in becoming acquainted.
2668. NURSING QUALITY ALERT: Reciprocal Attachment Behaviors
2669. Maternal Touch
2670. FIG 20-9 Mothers progress from exploratory touching to enfolding the infant. Their pleasure is enhanced by skin-to-skin contact.
2671. FIG 20-10 The binding-in, or claiming, process includes the mother’s identification of her baby’s specific features, relating them to other family members. This mother states, “His long toes are exactly like mine.”
2672. Verbal Behaviors
2673. The Process of Maternal Role Adaptation
2674. Puerperal Phases
2675. Taking-In Phase
2676. Taking-Hold Phase
2677. Letting-Go Phase
2678. CRITICAL THINKING EXERCISE 20-2
2679. Maternal Role Attainment
2680. Heading Toward a New Normal
2681. Appreciating the Body
2682. Settling In
2683. Becoming a New Family
2684. Redefining Roles
2685. Role Conflict
2686. NURSING CARE PLAN: Adaptation of the Working Mother
2687. Focused Assessment
2688. Nursing Diagnosis
2689. Planning
2690. Expected Outcomes
2691. Interventions and Rationales
2692. Evaluation
2693. Additional Nursing Diagnoses to Consider
2694. Major Maternal Concerns
2695. Body Image
2696. Smoking
2697. Postpartum Blues
2698. FIG 20-11 Fathers’ behaviors at initial contact with their infants often correspond to maternal behaviors. The intense fascination that fathers exhibit is called engrossment. Note the eye-to-eye contact between father and infant.
2699. Expanding family ExemplarThe Process of Family Adaptation
2700. Fathers
2701. FIG 20-12 A, Although they may hesitate to touch the infant, children often want to be close. B, This boy’s relief and joy are obvious as he reclaims a favorite spot.
2702. Siblings
2703. Grandparents
2704. FIG 20-13 Grandparents may develop strong bonds with grandchildren.
2705. Factors Affecting Family Adaptation
2706. Discomfort and Fatigue
2707. Knowledge of Infant Needs
2708. Previous Experience
2709. Expectations about the Newborn
2710. Maternal Age
2711. Maternal Temperament
2712. Temperament of the Infant
2713. Availability of a Strong Support System
2714. Other Factors
2715. Cesarean Birth
2716. Preterm or Ill Infant
2717. Birth of Multiple Infants
2718. NURSING QUALITY ALERT: Factors That Affect Adaptation
2719. Cultural Influences on Adaptation
2720. Communication
2721. Dietary Practices
2722. Health Beliefs
2723. Nursing Care
2724. Maternal Adaptation
2725. Assessment
2726. TABLE 20-3 ASSESSING MATERNAL ADAPTATION
2727. Nursing Diagnosis and Planning
2728. Expected Outcomes
2729. Interventions
2730. Assisting the Mother through Recovery Phases
2731. “Mother” the Mother
2732. Monitor and Protect
2733. Listen to the Birth Experience
2734. Foster Independence
2735. Promote Bonding and Attachment
2736. FIG 20-14 By teaching about the newborn and family, the nurse helps parents develop confidence in their ability to provide care for the infant.
2737. Involve Parents in Infant Care
2738. Evaluation
2739. Nursing Care
2740. Family Adaptation
2741. Assessment
2742. Fathers
2743. Siblings
2744. Support System
2745. Nonverbal Behavior
2746. Nursing Diagnosis and Planning
2747. Expected Outcomes
2748. TABLE 20-4 ASSESSING FAMILY ADAPTATION
2749. Interventions
2750. Teaching the Family about the Newborn
2751. Infant Needs
2752. Infant Signals
2753. Helping the Family Adapt
2754. Providing Anticipatory Guidance about Stress Reduction
2755. Helping the Father Co-parent
2756. Providing Ways to Reduce Sibling Rivalry
2757. Identifying Resources
2758. Evaluation
2759. Postpartum Home and Community Care
2760. Criteria for Discharge
2761. EVIDENCE-BASED PRACTICE
2762. Community-Based Care
2763. KEY CONCEPTS
2764. References and Readings
2765. Chapter 21 The Normal Newborn: Adaptation and Assessment
2766. Learning Objectives
2767. Initiation of Respirations
2768. Development of the Lungs
2769. FIG 21-1 Internal causes of the initiation of respirations are the chemical changes that take place at birth. External causes of respirations include thermal, sensory, and mechanical factors.
2770. Causes of Respirations
2771. Chemical Factors
2772. Mechanical Factors
2773. Thermal Factors
2774. Sensory Factors
2775. Continuation of Respirations
2776. Cardiovascular Adaptation: Transition from Fetal to Neonatal Circulation
2777. Ductus Venosus
2778. Foramen Ovale
2779. Pulmonary Blood Vessels
2780. Ductus Arteriosus
2781. Changes at Birth
2782. CRITICAL THINKING EXERCISE 21-1
2783. Neurologic Adaptation: Thermoregulation
2784. Newborn Characteristics Leading to Heat Loss
2785. Methods of Heat Loss
2786. FIG 21-2 Methods of heat loss.
2787. Nonshivering Thermogenesis
2788. FIG 21-3 Sites of brown fat in the neonate.
2789. Effects of Cold Stress
2790. Neutral Thermal Environment
2791. FIG 21-4 Effects of cold stress.
2792. BOX 21-1 HAZARDS OF COLD STRESS
2793. Hyperthermia
2794. Hematologic Adaptation
2795. Factors Affecting the Blood
2796. Blood Values
2797. Erythrocytes and Hemoglobin
2798. TABLE 21-1 LABORATORY VALUES IN THE NEWBORN
2799. Hematocrit
2800. Leukocytes
2801. Risk of Clotting Deficiency
2802. Gastrointestinal System
2803. Stomach
2804. Intestines
2805. Digestive Enzymes
2806. Stools
2807. Hepatic System
2808. Blood Glucose Maintenance
2809. Conjugation of Bilirubin
2810. Source and Effect of Bilirubin
2811. Normal Conjugation
2812. FIG 21-5 Sources of bilirubin and how it is removed from the body.
2813. Risk Factors for Elevated Bilirubin
2814. Hyperbilirubinemia
2815. Physiologic Jaundice
2816. Nonphysiologic (Pathologic) Jaundice
2817. Jaundice Associated with Breastfeeding
2818. Breastfeeding or Early Onset Jaundice
2819. True Breast Milk Jaundice
2820. Blood Coagulation
2821. Iron Storage
2822. Drug Metabolism
2823. Urinary System
2824. Kidney Development
2825. Kidney Function
2826. Fluid Balance
2827. Water Distribution
2828. BOX 21-2 INTAKE AND OUTPUT IN THE NEWBORN
2829. First 3 to 5 Days of Life
2830. After the First 3 to 5 Days
2831. Insensible Water Loss
2832. Urine Dilution and Concentration
2833. Acid-Base and Electrolyte Balance
2834. Immune System
2835. IgG
2836. IgM
2837. IgA
2838. Psychosocial Adaptation
2839. Periods of Reactivity
2840. First Period of Reactivity
2841. Period of Sleep or Decreased Activity
2842. Second Period of Reactivity
2843. Behavioral States
2844. Deep or Quiet Sleep State
2845. Light or Active Sleep State
2846. Drowsy State
2847. Quiet Alert State
2848. Active Alert State
2849. Crying State
2850. Early Assessments
2851. SAFETY ALERT: Protection from Bloodborne Infections
2852. TABLE 21-2 SUMMARY OF NEWBORN ASSESSMENT
2853. History
2854. Assessment of Cardiorespiratory Status
2855. Airway
2856. Respiratory Rate
2857. Breath Sounds
2858. Infant respiratory distress syndrome ExemplarSigns of Respiratory Distress
2859. Tachypnea
2860. PROCEDURE: Assessing Vital Signs in the Newborn
2861. Purpose
2862. Temperature
2863. Respirations
2864. Apical Pulse
2865. Retractions
2866. Flaring of the Nares
2867. Cyanosis
2868. FIG 21-6 Acrocyanosis.
2869. Grunting
2870. Seesaw or Paradoxical Respirations
2871. Asymmetry
2872. Choanal Atresia
2873. Color
2874. Pallor
2875. Ruddy Color
2876. Heart Sounds
2877. Position
2878. Rhythm and Murmurs
2879. Brachial and Femoral Pulses
2880. Blood Pressure
2881. Capillary Refill
2882. Assessment of Thermoregulation
2883. FIG 21-7 The infant is held securely to prevent injury and obtain an accurate reading when taking the temperature.
2884. BOX 21-3 NORMAL VITAL SIGNS IN THE NEWBORN
2885. Assessing for Anomalies
2886. Head
2887. Molding
2888. Fontanels
2889. FIG 21-8 Palpation of the anterior fontanel. Note elevation of the head.
2890. Caput Succedaneum
2891. FIG 21-9 Caput succedaneum is an edematous area on the head from pressure against the cervix. It may cross suture lines.
2892. Cephalhematoma
2893. Face
2894. Neck and Clavicles
2895. FIG 21-10 A cephalhematoma is characterized by bleeding between the bone and its covering, the periosteum. It may occur on one or both sides and does not cross suture lines.
2896. Cord
2897. Extremities
2898. Hands and Feet
2899. Hips
2900. Vertebral Column
2901. Measurements
2902. Weight
2903. FIG 21-11 Assessment of the hips. Place the fingers over the infant’s greater trochanter and thumbs over the femur. Flex the knees and hips. A, Barlow test: adduct the hips, and apply gentle pressure down and back with the thumbs. In hip dysplasia, the examiner can feel the femoral head move out of the acetabulum. B, Ortolani test: abduct the thighs, and apply gentle pressure forward over the greater trochanter. A “clunking” sensation indicates a dislocated femoral head moving into the acetabulum. A hip click is normal from ligament movement.
2904. FIG 21-12 Note the symmetry of gluteal and thigh creases.
2905. FIG 21-13 A tape is placed alongside the infant to measure the length. A mark can be made on the bed at the head and foot and the distance between the marks measured.
2906. Length
2907. Head and Chest Circumference
2908. CRITICAL THINKING EXERCISE 21-2
2909. Assessment of Body Systems
2910. Neurologic System
2911. Reflexes
2912. Sensory Assessment
2913. Ears
2914. Eyes
2915. Sense of Smell and Taste
2916. Other Neurologic Signs
2917. FIG 21-14 Reflexes.
2918. FIG 21-15 An imaginary line is drawn from the outer canthus of the eye to the ear. The line should intersect with the area where the upper ear joins the head.
2919. TABLE 21-3 SUMMARY OF NEONATAL REFLEXES
2920. BOX 21-4 RISK FACTORS FOR HYPOGLYCEMIA
2921. Assessment of Hepatic Function
2922. Blood Glucose
2923. SAFETY ALERT: Signs of Hypoglycemia
2924. PROCEDURE: Obtaining Blood Samples from the Newborn by Heel Puncture
2925. Purpose
2926. EVIDENCE-BASED PRACTICE
2927. Bilirubin
2928. BOX 21-5 RISK FACTORS FOR HYPERBILIRUBINEMIA
2929. Gastrointestinal System
2930. Mouth
2931. Suck
2932. Initial Feeding
2933. Abdomen
2934. Stools
2935. Genitourinary System
2936. Kidney Palpation
2937. Urine
2938. Genitalia
2939. Female
2940. Male
2941. Integumentary System
2942. Skin
2943. FIG 21-16 The testes are palpated from front to back with the thumb and forefinger. Placing a finger over the inguinal canal holds the testes in place for palpation.
2944. Color
2945. Harlequin Color Change
2946. Mottling
2947. Vernix Caseosa
2948. Lanugo
2949. Milia
2950. FIG 21-17 Lanugo is abundant on this slightly preterm infant.
2951. FIG 21-18 Milia.
2952. FIG 21-19 Erythema toxicum.
2953. Erythema Toxicum
2954. Birthmarks
2955. FIG 21-20 Mongolian spots.
2956. FIG 21-21 Nevus simplex (stork bite, salmon patch).
2957. FIG 21-22 Nevus flammeus (port-wine stain).
2958. Marks from Delivery
2959. Other Skin Assessments
2960. Documentation
2961. Breasts
2962. Hair and Nails
2963. Assessment of Gestational Age
2964. Assessment Tools
2965. Neuromuscular Characteristics
2966. Posture
2967. Square Window
2968. Arm Recoil
2969. Popliteal Angle
2970. FIG 21-23 New Ballard Score.
2971. Scarf Sign
2972. FIG 21-24 Posture in newborns. A, The healthy, full-term infant remains in a strongly flexed position. B, The preterm infant’s extremities are extended.
2973. FIG 21-25 The square window sign is performed on an arm without an identification bracelet. The nurse flexes the wrist and measures the angle. A, Infant near full term. B, Preterm infant.
2974. Heel to Ear
2975. Physical Characteristics
2976. Skin
2977. Lanugo
2978. FIG 21-26 Arm recoil. A, Arms flexed. B, Arms extended. C, Recoil for the full-term infant.
2979. FIG 21-27 The popliteal angle is measured by flexing the thigh against the abdomen and extending the lower leg to the point of resistance. A, Full-term infant. B, Preterm infant.
2980. FIG 21-28 Scarf sign. The nurse determines how far the arm will move across the chest and observes the position of the elbow when resistance is felt. A, Full-term infant. B, Preterm infant. (Note the many visible veins in the preterm infant and the absence of visible veins in the full-term infant.)
2981. FIG 21-29 Heel to ear. The nurse grasps the foot and brings it up toward the ear. The score is recorded when resistance is felt. A, Full-term infant. B, Preterm infant.
2982. FIG 21-30 Plantar creases begin to develop at the base of the toes and extend to the heel. A, The postterm infant has deep creases. B, The preterm infant has few creases on the entire foot.
2983. Plantar Surface
2984. Breasts
2985. Eyes and Ears
2986. FIG 21-31 The nurse places a finger on either side of the breast bud and measures the size. In the full-term infant, the areola is raised and the nipple is easily distinguished from surrounding skin. (Note the peeling skin.)
2987. Genitals
2988. FIG 21-32 Ear maturation. A, The nurse folds the ears and notes how quickly they return to position. B, Ears in the full-term infant are well formed and have instant recoil. C, In the preterm infant, ears show less incurving of the pinna and recoil slowly or not at all.
2989. FIG 21-33 Female genitals. As the female fetus matures, the labia majora cover the labia minora and clitoris completely; in the preterm infant, these structures are not covered. A, Near-term infant. B, Preterm infant.
2990. Scoring
2991. Gestational Age and Infant Size
2992. FIG 21-34 Male genitals. A, The full-term infant has a pendulous scrotum with deep rugae. B, In the preterm infant, the testes may not be descended and rugae are few.
2993. Assessment of Behavior
2994. Periods of Reactivity
2995. Behavioral Changes
2996. Orientation
2997. Habituation
2998. Self-Consoling Activities
2999. Parents’ Response
3000. KEY CONCEPTS
3001. References and Readings
3002. Chapter 22 The Normal Newborn: Nursing Care
3003. Learning Objectives
3004. Early Care
3005. Administering Vitamin K
3006. Providing Eye Treatment
3007. DRUG GUIDE: Vitamin K1 (phytonadione)
3008. FIG 22-1 Administration of ophthalmic ointment. The nurse gently cleans the eyes of blood or vernix wiping from inner to outer canthus. Then, placing a finger and thumb near the edge of each lid, the nurse gently presses against the periorbital ridges to open the eyes, avoiding pressure on the eye itself. A ribbon of ointment is squeezed into each conjunctival sac.
3009. DRUG GUIDE: Erythromycin Ophthalmic Ointment
3010. Nursing Care
3011. Cardiorespiratory Status
3012. Assessment
3013. Nursing Diagnosis and Planning
3014. Expected Outcome
3015. Interventions
3016. Positioning and Suctioning
3017. PROCEDURE: Using a Bulb Syringe
3018. Purpose
3019. Providing Continuing Care
3020. Evaluation
3021. Nursing Care
3022. Thermoregulation
3023. Assessment
3024. Nursing Diagnosis and Planning
3025. Expected Outcome
3026. Interventions
3027. Preventing Heat Loss
3028. Preparing the Environment Before Birth
3029. Providing Immediate Care
3030. FIG 22-2 Radiant warmers allow easy access to the infant without increasing heat loss caused by exposure. The nurse should be careful not to come between the infant and the overhead source of heat when giving care.
3031. Providing Ongoing Prevention
3032. Restoring Thermoregulation
3033. Performing Expanded Assessments
3034. Evaluation
3035. Nursing Care
3036. Hepatic Function
3037. NURSING CARE PLAN: The Normal Newborn
3038. Focused Assessment
3039. Nursing Diagnosis
3040. Planning
3041. Expected Outcomes
3042. Interventions and Rationales
3043. Evaluation
3044. Focused Assessment
3045. Nursing Diagnosis
3046. Planning
3047. Expected Outcomes
3048. Interventions and Rationales
3049. Evaluation
3050. Additional Nursing Diagnoses to Consider
3051. Blood Glucose
3052. Assessment
3053. Nursing Diagnosis and Planning
3054. Interventions
3055. Maintaining Safe Glucose Levels
3056. Repeating Glucose Tests
3057. Providing Other Care
3058. Evaluation
3059. CRITICAL THINKING EXERCISE 22-1
3060. Bilirubin
3061. Assessment
3062. Nursing Diagnosis and Planning
3063. Expected Outcomes
3064. Interventions
3065. Evaluation
3066. Ongoing Assessments and Care
3067. Providing Skin Care
3068. Bathing
3069. Cleansing the Diaper Area
3070. Providing Cord Care
3071. Assisting with Feedings
3072. FIG 22-3 The cord clamp is removed when the end of the cord is dry and crisp. The clamp is cut (A) and separated (B).
3073. Positioning the Infant
3074. Protecting the Infant
3075. Identifying the Infant
3076. Preventing Infant Abduction
3077. FIG 22-4 The nurse unwraps the infant to compare the infant’s identification band with the mother’s band. The mother may be asked to read the identification number on her band as the nurse checks the infant’s band or the nurse may look at both bands together.
3078. BOX 22-1 PRECAUTIONS TO PREVENT INFANT ABDUCTIONS
3079. FIG 22-5 The nurse uses a code to open the door to maternity units.
3080. Preventing Infection
3081. Circumcision
3082. Reasons for Choosing Circumcision
3083. Reasons for Rejecting Circumcision
3084. Pain Relief
3085. Methods
3086. Nursing Considerations
3087. Assisting in Decision Making
3088. FIG 22-6 Circumcision using the Gomco (Yellen) clamp. The physician pulls the prepuce over a cone-shaped device that rests against the glans. A clamp is placed around the cone and prepuce and is tightened to provide enough pressure to crush the blood vessels. This procedure prevents bleeding when the prepuce is removed after 3 to 5 minutes.
3089. FIG 22-7 Circumcision using the PlastiBell. The physician places the PlastiBell, a plastic ring, over the glans, draws the prepuce over it, and ties a suture around the prepuce and PlastiBell. This procedure prevents bleeding when the excess prepuce is removed. The handle is removed, leaving only the ring in place over the glans. The PlastiBell usually falls off in 7 to 14 days.
3090. PATIENT-CENTERED TEACHING: How to Care for an Uncircumcised Penis
3091. Providing Care during Circumcision
3092. Evaluating Pain
3093. Providing Postprocedure Care
3094. FIG 22-8 The infant is placed on the circumcision board just before the procedure is begun.
3095. FIG 22-9 An infant with a newly circumcised penis.
3096. PATIENT-CENTERED TEACHING: How to Care for a Circumcision Site
3097. PATIENT-CENTERED TEACHING: Techniques for Infant Care
3098. Handling the Infant
3099. Head Support
3100. Positioning
3101. Wrapping
3102. Normal Body Processes
3103. Breathing
3104. Using a Bulb Syringe
3105. Temperature
3106. Using a Thermometer
3107. Urine Output
3108. Stool Output
3109. Diarrhea
3110. Skin Care
3111. Cord
3112. Diaper Area
3113. Bathing
3114. Sponge Baths
3115. Tub Bath
3116. Behavior
3117. Sleep Phases
3118. Awake Phases
3119. Socialization
3120. Teaching Parents
3121. SAFETY ALERT: Signs of Complications after Circumcision
3122. Nursing Care
3123. Parents’ Knowledge of Newborn Care
3124. Assessment
3125. Nursing Diagnosis and Planning
3126. Expected Outcomes
3127. Interventions
3128. Determining Who Teaches
3129. Setting Priorities
3130. Using Various Teaching Methods
3131. Modeling Behavior
3132. Teaching Intermittently
3133. Including the Father
3134. Documenting Teaching
3135. Incorporating Cultural Considerations
3136. Providing for Follow-up Care
3137. Evaluation
3138. Immunization
3139. Newborn Screening
3140. Hearing Screening
3141. Other Screening Tests
3142. Discharge and Newborn Follow-Up Care
3143. Discharge
3144. Follow-up Care
3145. Home Visits
3146. Content of the Home Visit
3147. Identification of Jaundice
3148. Feeding Concerns
3149. General Considerations in Home Visits
3150. Outpatient Visits
3151. Telephone Counseling
3152. Follow-up Calls
3153. Warm Lines
3154. Telephone Techniques
3155. Guidelines and Documentation
3156. KEY CONCEPTS
3157. References and Readings
3158. Chapter 23 Newborn Feeding
3159. Learning Objectives
3160. Nutritional Needs of the Newborn
3161. Calories
3162. Nutrients
3163. Water
3164. BOX 23-1 DAILY CALORIE AND FLUID NEEDS OF THE NEWBORN
3165. Breast Milk and Formula Composition
3166. Breast Milk
3167. Changes in Composition
3168. Lactogenesis I
3169. Lactogenesis II
3170. Lactogenesis III
3171. Nutrients
3172. Protein
3173. Carbohydrate
3174. Fat
3175. Vitamins
3176. Minerals
3177. Enzymes
3178. Infection-Preventing Components
3179. Effect of Maternal Diet
3180. Formulas
3181. Cow’s Milk
3182. Formulas for Infants with Special Needs
3183. Considerations in Choosing a Feeding Method
3184. Breastfeeding
3185. BOX 23-2 BENEFITS OF BREASTFEEDING
3186. For the Infant
3187. For the Mother
3188. Formula Feeding
3189. Combination Feeding
3190. Factors Influencing Choice
3191. Support from Others
3192. Culture
3193. Employment
3194. Staff Knowledge
3195. Other Factors
3196. Normal Breastfeeding
3197. Breast Changes during Pregnancy
3198. Milk Production
3199. Hormonal Changes at Birth
3200. Prolactin
3201. Oxytocin
3202. Continued Milk Production
3203. Preparation of Breasts for Breastfeeding
3204. FIG 23-1 Effect of prolactin and oxytocin on milk production. When the infant begins to suckle at the breast, nerve impulses travel to the hypothalamus and cause the anterior pituitary to secrete prolactin to increase milk production. Suckling causes the posterior pituitary to secrete oxytocin, producing the let-down reflex, which releases milk from the breast. Oxytocin also causes the uterus to contract, which aids in involution.
3205. FIG 23-2 Normal everted nipple and other types of nipples that may cause the infant difficulty in latching on. Nipples shown after stimulation.
3206. Nursing Care
3207. Breastfeeding
3208. Assessment
3209. Maternal Assessment
3210. Breasts and Nipples
3211. BOX 23-3 HUNGER CUES IN INFANTS
3212. Knowledge
3213. Assessment of Infant Feeding Behaviors
3214. LATCH Scoring Tool
3215. Nursing Diagnosis and Planning
3216. Expected Outcomes
3217. FIG 23-3 For the cradle hold, the mother positions the infant’s head at or near the antecubital space and level with her nipple, with her arm supporting the infant’s body. Her other hand is free to hold the breast. Once the infant is positioned, pillows or blankets can be used to support the mother’s arm, which may tire from holding the baby.
3218. Interventions
3219. Assisting with the First Feeding
3220. Teaching Feeding Techniques
3221. Position of the Mother and Infant
3222. FIG 23-4 For the football or clutch hold, the mother supports the infant’s head in her hand, with the infant’s body resting on pillows alongside her hip. This method allows the mother to see the position of the infant’s mouth on the breast, helps her control the infant’s head, and is especially helpful for mothers with heavy breasts. This hold also avoids pressure against an abdominal incision.
3223. FIG 23-5 The cross-cradle or modified cradle hold is helpful for infants who are preterm or have a fractured clavicle. The mother holds the infant’s head in the hand opposite the side on which the infant will feed and supports the infant’s body across her lap with her arm. The other hand holds the breast. The mother can guide the infant’s head to the breast and see the mouth on the breast during the feeding.
3224. FIG 23-6 The side-lying position avoids pressure on episiotomy or abdominal incisions and allows the mother to rest while feeding. She lies on her side, with her lower arm supporting her head or placed around the infant. Pillows behind her back and between her legs provide comfort. Her upper hand and arm are used to position the infant on the side at nipple level and hold the breast. When the infant’s mouth opens to nurse, the mother draws the infant to her to insert the nipple into the mouth.
3225. Position of the Mother’s Hands
3226. Latch-On Techniques
3227. Eliciting Latch-On
3228. FIG 23-7 C position of hand on breast. The hand is positioned so the thumb is on top of the breast while the fingers support the breast from below. Note the flaring of the infant’s lips.
3229. FIG 23-8 Position of infant’s mouth while suckling. When the nipple and areola are properly positioned in the infant’s mouth, the gums compress the areola instead of the nipple. The tongue is between the lower gum and the breast. The infant’s lips are flared outward.
3230. Position of the Mouth
3231. Suckling Pattern
3232. Removal from the Breast
3233. Frequency of Feedings
3234. Length of Feedings
3235. Preventing Problems
3236. Teaching
3237. Minimizing Interruptions
3238. EVIDENCE-BASED PRACTICE
3239. Formula Gift Packs
3240. Formula Supplements
3241. Insufficient Milk Supply
3242. Increasing Confidence
3243. Providing Resources
3244. Evaluation
3245. MOTHERS WANT TO KNOW: Is My Baby Getting Enough Milk?
3246. Common Breastfeeding Concerns
3247. Infant Problems
3248. SAFETY ALERT: Infant Signs of Breastfeeding Problems
3249. Sleepy Infant
3250. Nipple Confusion
3251. Latch-on Problems
3252. Infant Complications
3253. Jaundice
3254. Prematurity
3255. NURSING CARE PLAN: Breastfeeding an Infant with a Complication
3256. Focused Assessment
3257. Nursing Diagnosis
3258. Planning
3259. Expected Outcomes
3260. Interventions and Rationales
3261. Evaluation
3262. Late Preterm Infants
3263. Illness and Congenital Defects
3264. Maternal Concerns
3265. SAFETY ALERT: Maternal Signs of Breastfeeding Problems
3266. Common Breast Problems
3267. Engorgement
3268. Nipple Pain
3269. Flat and Inverted Nipples
3270. Plugged Ducts
3271. Illness in the Mother
3272. FIG 23-9 Note the cracked area on this nipple.
3273. FIG 23-10 Rolling helps flat nipples become erect in preparation for latch-on.
3274. PATIENT-CENTERED TEACHING: Solutions to Common Breastfeeding Problems
3275. Problem: Sleepy Infant
3276. Prevention
3277. Solutions
3278. Problem: Nipple Confusion
3279. Prevention
3280. Solution
3281. Problem: Latch-on Difficulty
3282. Prevention
3283. Solution
3284. Problem: Engorgement
3285. Prevention
3286. Solutions
3287. Problem: Nipple Pain
3288. Prevention
3289. Solutions
3290. Problem: Flat or Inverted Nipples
3291. Prevention
3292. Solutions
3293. Drug Transfer to Breast Milk
3294. FIG 23-11 To massage the breasts the mother places her hands against the chest wall with her fingers encircling the breasts. She gently slides her hands forward until the fingers overlap. The position of the hands is rotated to cover all breast tissue. Massaging with the fingertips in a circular motion over all areas of the breast also is helpful.
3295. Conditions in which Breastfeeding Should Be Avoided
3296. Previous Breast Surgery
3297. Employment
3298. Milk Expression and Storage
3299. FIG 23-12 To express milk from the breast, the mother places her hand just behind the areola, with the thumb on top and the fingers supporting the breast. The tissue is pressed back against the chest wall; then the fingers and thumb are brought together and toward the nipple to cause the milk to flow. The action is repeated to simulate the infant’s suckling. Moving the hands around the areola allows compression of all areas and complete removal of milk from the breast. Compression should be gentle to avoid trauma.
3300. FIG 23-13 The nurse helps the mother use an electric breast pump.
3301. Hand Expression
3302. Use of a Breast Pump
3303. Milk Storage
3304. Breastfeeding after Multiple Births
3305. Weaning
3306. Home Care
3307. Other Concerns
3308. Formula Feeding
3309. Nursing Care
3310. Formula Feeding
3311. Assessment
3312. Nursing Diagnosis and Planning
3313. Expected Outcomes
3314. Interventions
3315. Teaching about Formula
3316. Types of Formula
3317. Ready-to-Use
3318. Concentrated Liquid
3319. Powdered Formula
3320. Equipment
3321. Preparation
3322. SAFETY ALERT: Formula Dilution
3323. Explaining Feeding Techniques
3324. Positioning
3325. Burping
3326. FIG 23-14 This mother holds her infant close during bottle feeding. The bottle is positioned so the nipple is filled with milk at all times. The father offers encouragement.
3327. Frequency and Amount
3328. Cautions
3329. Infant Variations
3330. Evaluation
3331. Key Concepts
3332. References and Readings
3333. Chapter 24 The Childbearing Family with Special Needs
3334. Learning Objectives
3335. Adolescent Pregnancy
3336. Incidence of Teenage Pregnancy
3337. Factors Associated with Teenage Pregnancy
3338. BOX 24-1 FACTORS THAT CONTRIBUTE TO TEENAGE PREGNANCY
3339. Sex Education
3340. FIG 24-1 Pregnant adolescent. Of teenage girls who become pregnant, approximately 1 in 5 have had a previous birth.
3341. Preconception Counseling
3342. Options When Pregnancy Occurs
3343. Socioeconomic Implications of Teenage Pregnancy
3344. Implications for Maternal Health
3345. Implications for Fetal-Neonatal Health
3346. The Teenage Expectant Father
3347. Impact of Teenage Pregnancy on Parenting
3348. Nursing Care
3349. The Pregnant Teenager
3350. Assessment
3351. Physical Assessment
3352. Cognitive Development
3353. Knowledge of Infant Needs
3354. Family Assessment
3355. Nursing Diagnosis and Planning
3356. Expected Outcomes
3357. Interventions
3358. Eliminating Barriers to Health Care
3359. NURSING CARE PLAN: An Adolescent’s Responses to Pregnancy and Birth
3360. Focused Assessment
3361. Nursing Diagnosis
3362. Planning
3363. Expected Outcomes
3364. Interventions and Rationales
3365. Evaluation
3366. Focused Assessment
3367. Nursing Diagnosis
3368. Planning
3369. Expected Outcomes
3370. Interventions and Rationales
3371. Evaluation
3372. Focused Assessment
3373. Nursing Diagnosis
3374. Planning
3375. Expected Outcomes
3376. Interventions and Rationales
3377. Evaluation
3378. Additional Nursing Diagnoses to Consider
3379. Applying Teaching or Learning Principles
3380. Nutrition counseling ExemplarCounseling
3381. Nutrition
3382. Self-Care
3383. Stress Reduction
3384. Attachment to the Fetus
3385. Breastfeeding
3386. Promoting Family Support
3387. Providing Support during Labor
3388. Providing Referrals
3389. Evaluation
3390. Delayed Pregnancy
3391. Maternal and Fetal Implications of Delayed Pregnancy
3392. Advantages of Delayed Childbirth
3393. Disadvantages of Delayed Childbirth
3394. FIG 24-2 Older primigravidas bring maturity and problem-solving skills to the maternal role, but they are at somewhat increased risk for physiologic problems related to pregnancy and birth.
3395. Nursing Considerations
3396. Preconception Care
3397. Reinforcing and Clarifying Information
3398. Facilitating Expression of Emotions
3399. Providing Parenting Information
3400. Substance Abuse
3401. Incidence
3402. Maternal and Fetal Effects
3403. Tobacco
3404. TABLE 24-1 MATERNAL AND FETAL OR NEONATAL EFFECTS OF COMMONLY ABUSED SUBSTANCES
3405. Alcohol
3406. Marijuana
3407. Cocaine
3408. Actions
3409. Maternal and Fetal Effects
3410. Neonatal Effects
3411. Amphetamines and Methamphetamines
3412. Maternal and Fetal Effects
3413. Neonatal Effects
3414. Antidepressants
3415. Maternal and Fetal Effects
3416. Neonatal Effects
3417. Opioids
3418. Fetal Effects
3419. Neonatal Effects
3420. Diagnosis and Management of Substance Abuse
3421. Nursing Care
3422. Maternal Substance Abuse
3423. Antepartum Period
3424. Assessment
3425. CRITICAL TO REMEMBER: Behaviors Associated with Substance Abuse
3426. Medical and Obstetric History
3427. History of Substance Abuse
3428. Nursing Diagnosis and Planning
3429. Expected Outcomes
3430. Interventions
3431. Examining Attitudes
3432. Preventing Substance Abuse
3433. Communicating with the Woman
3434. Helping the Woman Identify Strengths
3435. Providing Ongoing Care
3436. Evaluation
3437. Intrapartum Period
3438. Assessment
3439. Cocaine
3440. CRITICAL TO REMEMBER: Signs and Symptoms of Recent Cocaine Use
3441. Heroin
3442. Nursing Diagnosis and Planning
3443. Expected Outcome
3444. Interventions
3445. Preventing Injury
3446. Admitting Procedure
3447. Setting Limits
3448. Initiating Seizure Precautions
3449. Maintaining Effective Communication
3450. Providing Pain Control
3451. Preventing Heroin Withdrawal
3452. Evaluation
3453. Postpartum Period
3454. Birth of an Infant with Congenital Anomalies
3455. Factors Influencing Emotional Responses of Parents
3456. Timing and Manner of Being Told
3457. Prior Knowledge of the Defect
3458. FIG 24-3 Touching and cuddling between parents and the infant with a congenital anomaly foster attachment and help resolve the grieving process. This infant has anomalies of the hand and arm.
3459. Type of Defect
3460. Irreparable Defect
3461. Grief and Mourning
3462. Nursing Considerations
3463. Assisting with the Grieving Process
3464. Promoting Bonding and Attachment
3465. Providing Accurate Information
3466. Facilitating Communication
3467. Participating in Infant Care
3468. Planning for Discharge
3469. Providing Referrals
3470. Perinatal Loss
3471. Early Pregnancy Loss
3472. Concurrent Death and Survival in Multifetal Pregnancy
3473. Previous Pregnancy Loss
3474. Nursing Care
3475. Pregnancy Loss
3476. Assessment
3477. Nursing Diagnosis and Planning
3478. Expected Outcome
3479. Interventions
3480. Allowing Expression of Feelings
3481. Acknowledging the Infant
3482. Presenting the Infant to the Parents
3483. Preparing a Memory Box or Packet
3484. Respecting Cultural Practices
3485. Assisting with Other Needs
3486. Providing Referrals
3487. Evaluation
3488. Adoption
3489. Intimate Partner Violence
3490. FIG 24-4 The woman who is abused by her partner lives with an ever-present risk of violence. Because they may not seek help, all women should be asked about abuse whenever they receive health care.
3491. EVIDENCE-BASED PRACTICE
3492. Effects of Intimate Partner Violence during Pregnancy
3493. Factors that Promote Violence
3494. Characteristics of the Abuser
3495. TABLE 24-2 MYTHS AND REALITIES OF VIOLENCE AGAINST WOMEN
3496. Cycle of Violence
3497. Nurses’ Role in Prevention of Abuse
3498. Nursing Care
3499. The Battered Woman
3500. Assessment
3501. FIG 24-5 Types of behaviors evident in each step of the cycle of violence.
3502. CRITICAL THINKING EXERCISE 24-1
3503. CRITICAL TO REMEMBER: Cues Indicating Violence Against Women
3504. Nursing Diagnosis and Planning
3505. Expected Outcomes
3506. Interventions
3507. Listening
3508. Developing a Personal Safety Plan
3509. Affirming She Is Not to Blame
3510. Providing Education
3511. Providing Referrals
3512. Evaluation
3513. Key Concepts
3514. References and Readings
3515. Chapter 25 Pregnancy-Related Complications
3516. Learning Objectives
3517. Hemorrhagic Conditions of Early Pregnancy
3518. Abortion
3519. Spontaneous Abortion
3520. FIG 25-1 Three types of spontaneous abortion.
3521. Threatened Abortion
3522. Manifestations
3523. Therapeutic Management
3524. Inevitable Abortion
3525. Manifestations
3526. Therapeutic Management
3527. Incomplete Abortion
3528. Manifestations
3529. Therapeutic Management
3530. Complete Abortion
3531. Manifestations
3532. Therapeutic Management
3533. Missed Abortion
3534. Manifestations
3535. Therapeutic Management
3536. Disseminated Intravascular Coagulation (Consumptive Coagulopathy)
3537. Recurrent Spontaneous Abortion
3538. Manifestations
3539. Therapeutic Management
3540. Nursing Considerations
3541. CRITICAL THINKING EXERCISE 25-1
3542. Ectopic Pregnancy
3543. Incidence and Etiology
3544. FIG 25-2 Sites of tubal ectopic pregnancy. Numbers indicate the order of prevalence. (1) Ampular, (2) Fimbrial, (3) Isthmic, (4) Interstitial.
3545. BOX 25-1 RISK FACTORS FOR ECTOPIC PREGNANCY
3546. Manifestations
3547. Diagnostic Evaluation
3548. Therapeutic Management
3549. Nursing Considerations
3550. Gestational Trophoblastic Disease (Hydatidiform Mole)
3551. FIG 25-3 Hydatidiform mole.
3552. Incidence and Etiology
3553. Manifestations
3554. Diagnostic Evaluation
3555. Therapeutic Management
3556. Nursing Considerations
3557. Nursing Care
3558. The Woman with a Hemorrhagic Condition of Early Pregnancy
3559. Assessment
3560. Nursing Diagnosis and Planning
3561. Expected Outcomes
3562. Interventions
3563. Providing Information about Tests and Procedures
3564. Teaching Measures to Prevent Infection
3565. Providing Dietary Information
3566. Teaching Signs of Infection to Report
3567. Emphasizing the Importance of Follow-up Care
3568. Evaluation
3569. Hemorrhagic Conditions of Late Pregnancy
3570. Placenta Previa
3571. Incidence and Etiology
3572. FIG 25-4 The three classifications of placenta previa.
3573. Manifestations
3574. Therapeutic Management
3575. Nursing Considerations
3576. Home Care
3577. Inpatient Care
3578. Abruptio Placentae
3579. Incidence and Etiology
3580. Manifestations
3581. Therapeutic Management
3582. FIG 25-5 Types of abruptio placentae.
3583. SAFETY ALERT: Signs and Symptoms Suggesting Concealed Hemorrhage in Abruptio Placentae
3584. CRITICAL THINKING EXERCISE 25-2
3585. Nursing Considerations
3586. Nursing Care
3587. The Woman with a Hemorrhagic Condition of Late Pregnancy
3588. Assessment
3589. NURSING CARE PLAN: Antepartum Bleeding
3590. Focused Assessment
3591. Nursing Diagnosis
3592. Planning
3593. Expected Outcomes
3594. Interventions and Rationales
3595. Evaluation
3596. Focused Assessment
3597. Nursing Diagnosis
3598. Planning
3599. Expected Outcomes
3600. Interventions and Rationales
3601. Evaluation
3602. Additional Nursing Diagnoses to Consider
3603. Nursing Diagnosis and Planning
3604. Interventions
3605. Monitoring for Signs of Hypovolemic Shock
3606. SAFETY ALERT: Signs and Symptoms of Impending Hypovolemic Shock Caused by Blood Loss
3607. Monitoring the Fetus
3608. Promoting Tissue Oxygenation
3609. Collaborating with the Physician for Fluid Replacement
3610. Providing Emotional Support
3611. Care Related to Surgery
3612. Evaluation
3613. Hyperemesis Gravidarum
3614. Etiology
3615. Therapeutic Management
3616. Nursing Considerations
3617. Reducing Nausea and Vomiting
3618. Maintaining Nutrition and Fluid Balance
3619. Providing Emotional Support
3620. Preeclampsia ExemplarHypertension During Pregnancy
3621. TABLE 25-1 CLASSIFICATIONS OF HYPERTENSION IN PREGNANCY
3622. Preeclampsia
3623. Risk Factors
3624. BOX 25-2 RISK FACTORS FOR PREGNANCY-RELATED HYPERTENSION
3625. Pathophysiology
3626. Preventive Measures
3627. Manifestations
3628. Classic Signs
3629. Additional Signs
3630. FIG 25-6 Generalized edema is a possible sign identified with preeclampsia, although it may occur in both normal pregnancy or in a pregnancy complicated by another disorder. A, Facial edema may be subtle. B, Pitting edema of the lower leg.
3631. TABLE 25-2 ASSESSMENT OF EDEMA
3632. Symptoms
3633. Therapeutic Management
3634. Home Care for Mild Preeclampsia
3635. Activity Restrictions
3636. Fetal Activity
3637. Blood Pressure
3638. TABLE 25-3 MILD VS SEVERE PREECLAMPSIA
3639. Weight
3640. Urinalysis
3641. Diet
3642. Fetal Assessment
3643. Inpatient Management for Severe Preeclampsia
3644. Antepartum Management
3645. Bed rest
3646. Anticonvulsant Medications
3647. DRUG GUIDE: Magnesium Sulfate
3648. Antihypertensive Medications
3649. Intrapartum Management
3650. Postpartum Management
3651. PROCEDURE: Assessing Deep Tendon Reflexes
3652. Purpose
3653. Deep Tendon Reflex Rating Scale
3654. TABLE 25-4 NURSING ASSESSMENTS FOR PREECLAMPSIA AND MAGNESIUM TOXICITY
3655. Therapeutic Management of Eclampsia
3656. Nursing Care
3657. The Woman with Preeclampsia
3658. Assessment
3659. Assessments for Magnesium Toxicity
3660. Psychosocial Assessment
3661. NURSING CARE PLAN: Preeclampsia
3662. Focused Assessment
3663. Nursing Diagnosis
3664. Planning
3665. Expected Outcomes
3666. Interventions and Rationales
3667. Evaluation
3668. Focused Assessment
3669. Nursing Diagnosis
3670. Planning
3671. Expected Outcomes
3672. Interventions and Rationales
3673. Evaluation
3674. Potential Complications to Consider
3675. Nursing Diagnosis and Planning
3676. Interventions
3677. Interventions for Seizures
3678. Initiating Preventive Measures
3679. Monitoring for Signs of Impending Seizures
3680. Preventing Seizure-Related Injury
3681. Protecting the Woman and Fetus during a Seizure
3682. Providing Information and Support for the Family
3683. Interventions for Magnesium Toxicity
3684. Monitoring for Signs of Magnesium Toxicity
3685. Responding to Signs of Magnesium Toxicity
3686. Evaluation
3687. HELLP Syndrome
3688. Chronic Hypertension
3689. Incompatibility Between Maternal and Fetal Blood
3690. Rh Incompatibility
3691. Pathophysiology
3692. Fetal and Neonatal Implications
3693. FIG 25-7 The process of maternal sensitization to the Rh factor.
3694. PARENTS WANT TO KNOW: About Rh Incompatibility
3695. Prenatal Assessment and Management
3696. DRUG GUIDE: Rho(D) Immune Globulin (RhoGAM, HypRho-D, Gamulin Rh)
3697. Postpartum Management
3698. ABO Incompatibility
3699. Key Concepts
3700. References and Readings
3701. Chapter 26 Concurrent Disorders During Pregnancy
3702. Learning Objectives
3703. Diabetes Mellitus
3704. Pathophysiology
3705. Etiology
3706. Effect of Pregnancy on Fuel Metabolism
3707. Early Pregnancy
3708. Late Pregnancy
3709. Classification
3710. BOX 26-1 CLASSIFICATION OF DIABETES MELLITUS
3711. Incidence
3712. Pathology
3713. Preexisting Diabetes Mellitus
3714. Maternal Effects
3715. Fetal Effects
3716. Congenital Malformation
3717. Variations in Fetal Size
3718. NURSING CARE PLAN: Pregnancy and Diabetes Mellitus
3719. Focused Nursing Assessment
3720. Nursing Diagnosis
3721. Planning
3722. Expected Outcomes
3723. Interventions and Rationales
3724. Evaluation
3725. Focused Assessment
3726. Nursing Diagnosis
3727. Planning
3728. Expected Outcomes
3729. Interventions and Rationales
3730. Evaluation
3731. Additional Nursing Diagnoses to Consider
3732. Neonatal Effects
3733. Hypoglycemia
3734. Hypocalcemia
3735. Hyperbilirubinemia
3736. Respiratory Distress Syndrome
3737. Maternal Assessment
3738. History
3739. Physical Examination
3740. Laboratory Tests
3741. Fetal Surveillance
3742. Therapeutic Management
3743. Preconception Care
3744. Diet
3745. Self-Monitoring of Blood Glucose (SMBG)
3746. Insulin Therapy
3747. First Trimester
3748. Second and Third Trimesters
3749. During Labor
3750. Postpartum
3751. Timing of Delivery
3752. Diabetes, gestational ExemplarGestational Diabetes Mellitus
3753. Risk Factors
3754. Identifying Gestational Diabetes Mellitus
3755. Glucose Challenge Test
3756. Oral Glucose Tolerance Test
3757. Maternal, Fetal, and Neonatal Effects
3758. TABLE 26-1 MAJOR EFFECTS OF DIABETES MELLITUS ON PREGNANCY
3759. Therapeutic Management
3760. Diet
3761. Exercise
3762. Glucose Level Monitoring
3763. Fetal Surveillance
3764. Nursing Considerations
3765. Increasing Effective Communication
3766. Providing Opportunities for Control
3767. Providing Normal Pregnancy Care
3768. Nursing Care
3769. The Pregnant Woman with Diabetes Mellitus
3770. Assessment
3771. Nursing Diagnosis and Planning
3772. Expected Outcomes
3773. Interventions
3774. Teaching Self-Care Skills
3775. Self-Monitoring of Blood Glucose
3776. Insulin Administration
3777. Continuous Subcutaneous Insulin Infusion
3778. Teaching Dietary Management
3779. Recognizing and Correcting Hypoglycemia and Hyperglycemia
3780. Hypoglycemia ExemplarHypoglycemia
3781. SAFETY ALERT: Signs and Symptoms of Maternal Hypoglycemia
3782. Hyperglycemia
3783. SAFETY ALERT: Signs and Symptoms of Maternal Hyperglycemia
3784. Explaining Procedures, Tests, and Plan of Care
3785. Evaluation
3786. Heart failure ExemplarCardiac Disease
3787. SAFETY ALERT: Signs and Symptoms of Congestive Heart Failure
3788. Incidence and Classification
3789. EVIDENCE-BASED PRACTICE
3790. U.S. Preventive Services Task Force (USPSTF) CHD Screening Recommendations
3791. Implications for Nursing Practice
3792. Rheumatic Heart Disease
3793. Congenital Heart Disease
3794. Left-to-Right Shunt
3795. Atrial Septal Defect
3796. Ventricular septal defect ExemplarVentricular Septal Defect
3797. Patent Ductus Arteriosus
3798. Right-to-Left Shunt
3799. Tetralogy of Fallot
3800. Eisenmenger Syndrome
3801. Mitral Valve Prolapse
3802. Peripartum and Postpartum Cardiomyopathy
3803. Diagnostic Evaluation of Cardiac Disease
3804. Therapeutic Management
3805. Class I and Class II Heart Disease
3806. BOX 26-2 NEW YORK HEART ASSOCIATION FUNCTIONAL CLASSIFICATION OF HEART DISEASE
3807. Class III and Class IV Heart Disease
3808. Drug Therapy
3809. Anticoagulants
3810. Antidysrhythmics
3811. Antiinfectives
3812. Drugs for Heart Failure
3813. Intrapartum Management
3814. Postpartum Management
3815. Nursing Considerations
3816. Anemias
3817. Iron deficiency (anemia) ExemplarIron Deficiency Anemia
3818. Maternal Effects
3819. Fetal and Neonatal Effects
3820. Therapeutic Management
3821. Folic Acid Deficiency (Megaloblastic) Anemia
3822. Maternal Effects
3823. Fetal and Neonatal Effects
3824. Therapeutic Management
3825. Sickle Cell Disease
3826. Maternal Effects
3827. Fetal and Neonatal Effects
3828. Therapeutic Management
3829. Thalassemias
3830. Maternal Effects
3831. Fetal and Neonatal Effects
3832. Therapeutic Management
3833. Immune Complex Diseases
3834. Systemic Lupus Erythematosus
3835. Antiphospholipid Syndrome
3836. Hashimoto’s Thyroiditis
3837. Seizure Disorders: Epilepsy
3838. Infections During Pregnancy
3839. TABLE 26-2 INFECTIONS THAT IMPACT PREGNANCY: SEXUALLY TRANSMITTED DISEASES, VAGINAL AND URINARY TRACT INFECTIONS
3840. Viral Infections
3841. Cytomegalovirus
3842. Fetal and Neonatal Effects
3843. Therapeutic Management
3844. Rubella
3845. Fetal and Neonatal Effects
3846. Therapeutic Management
3847. Varicella-Zoster Virus
3848. Fetal and Neonatal Effects
3849. Therapeutic Management
3850. Herpesvirus Serotypes 1 and 2
3851. Fetal and Neonatal Effects
3852. Therapeutic Management
3853. Parvovirus B19
3854. Fetal and Neonatal Effects
3855. Therapeutic Management
3856. Hepatitis B
3857. Fetal and Neonatal Effects
3858. Therapeutic Management
3859. Human Immunodeficiency Virus (HIV)
3860. Pathophysiology
3861. Fetal and Neonatal Effects
3862. Prevention
3863. Therapeutic Management
3864. Nursing Considerations
3865. BOX 26-3 RECOMMENDATIONS FOR PREVENTION OF PERINATAL HUMAN IMMUNODEFICIENCY VIRUS INFECTION OF THE INFANT
3866. Nonviral Infections
3867. Toxoplasmosis
3868. Fetal and Neonatal Effects
3869. Therapeutic Management
3870. Group B Streptococcus Infection
3871. Fetal and Neonatal Effects
3872. Therapeutic Management
3873. Tuberculosis
3874. Fetal and Neonatal Effects
3875. Therapeutic Management
3876. TABLE 26-3 MEDICAL CONDITIONS AND THEIR EFFECT ON PREGNANCY
3877. KEY CONCEPTS
3878. References and Readings
3879. Chapter 27 The Woman with an Intrapartum Complication
3880. Learning Objectives
3881. Dysfunctional Labor
3882. Problems of the Powers
3883. Ineffective Contractions
3884. TABLE 27-1 PATTERNS OF LABOR DYSFUNCTION
3885. Hypotonic Labor Dysfunction
3886. Hypertonic Labor Dysfunction
3887. Ineffective Maternal Pushing
3888. Problems with the Passenger
3889. Fetal Size
3890. Macrosomia
3891. Shoulder Dystocia
3892. FIG 27-1 Methods used to relieve shoulder dystocia. A, McRoberts maneuver. The woman flexes her thighs sharply against her abdomen, which straightens the pelvic curve. A supported squat has a similar effect and adds gravity to her pushing efforts. B, Suprapubic pressure by an assistant pushes the fetal anterior shoulder downward to displace it from above the mother’s symphysis pubis. Fundal pressure should not be used because it will push the anterior shoulder more firmly against the mother’s symphysis.
3893. Abnormal Fetal Presentation or Position
3894. Rotation Abnormalities
3895. CRITICAL THINKING EXERCISE 27-1
3896. FIG 27-2 A hands-and-knees position helps the fetus rotate from a left occiput posterior (LOP) position to an occiput anterior position.
3897. FIG 27-3 The “lunge” to one side promotes rotation of the fetal occiput from a posterior position to an anterior one.
3898. Deflexion Abnormalities
3899. Breech Presentation
3900. Multifetal Pregnancy
3901. FIG 27-4 Twins can present in any combination of presentations and positions.
3902. Fetal Anomalies
3903. Problems of the Passage
3904. Pelvis
3905. Maternal Soft Tissue Obstructions
3906. Problems of the Psyche
3907. Abnormal Labor Duration
3908. Prolonged Labor
3909. FIG 27-5 Pelvic shapes.
3910. Precipitate Labor
3911. Nursing Care
3912. The Woman in Dysfunctional Labor
3913. Intrauterine Infection
3914. Assessment
3915. Nursing Diagnosis and Planning
3916. Expected Outcomes
3917. Interventions
3918. Reducing the Risk for Infection
3919. Identifying Infection
3920. Evaluation
3921. SAFETY ALERT: Signs Associated with Intrapartum Infection
3922. Maternal Exhaustion
3923. Assessment
3924. Nursing Diagnosis and Planning
3925. Expected Outcomes
3926. Interventions
3927. Conserving Maternal Energy
3928. Promoting Coping Skills
3929. Evaluation
3930. Premature Rupture of the Membranes
3931. Etiology
3932. Complications
3933. Therapeutic Management
3934. Determining True Membrane Rupture
3935. Gestation Near Term
3936. Preterm Gestation
3937. Maternal Antibiotics
3938. Nursing Considerations
3939. Preterm Labor
3940. SAFETY ALERT: Late Preterm is Not Term
3941. EVIDENCE-BASED PRACTICE
3942. Associated Factors
3943. Manifestations
3944. Preventing Preterm Birth
3945. Community Education
3946. TABLE 27-2 MATERNAL RISK FACTORS FOR PRETERM LABOR
3947. During Pregnancy
3948. Improving Access to Care
3949. Identifying Risk Factors
3950. Progesterone Supplementation
3951. Promoting Adequate Nutrition
3952. Educating Women and Their Partners about Preterm Labor
3953. Empowering Women and Their Partners
3954. Therapeutic Management
3955. Predicting Preterm Birth
3956. Cervical Length
3957. Fetal Fibronectin
3958. Infections
3959. Identifying Preterm Labor
3960. Stopping Preterm Labor
3961. Initial Measures
3962. Identifying and Treating Infections
3963. Identifying Other Causes for Preterm Contractions
3964. Limiting Activity
3965. Hydrating the Woman
3966. Tocolytics
3967. Magnesium Sulfate
3968. Calcium Antagonists
3969. Prostaglandin Synthesis Inhibitors
3970. TABLE 27-3 DRUGS USED IN PRETERM LABOR
3971. Beta-Adrenergic Drugs
3972. Accelerating Fetal Lung Maturity
3973. DRUG GUIDE: Betamethasone, Dexamethasone
3974. Nursing Care
3975. The Woman in Preterm Labor
3976. Psychosocial Concerns
3977. Assessment
3978. Nursing Diagnosis and Planning
3979. Expected Outcome
3980. Interventions
3981. Providing Information
3982. Promoting Expression of Concerns
3983. Teaching What May Occur during a Preterm Birth
3984. Evaluation
3985. Management of Home Care
3986. Assessment
3987. Nursing Diagnosis and Planning
3988. Expected Outcomes
3989. Interventions
3990. Caring for Children
3991. NURSING CARE PLAN: Preterm Labor
3992. Focused Assessment
3993. Nursing Diagnosis
3994. Planning
3995. Expected Outcome
3996. Interventions and Rationales
3997. Evaluation
3998. Focused Assessment
3999. Nursing Diagnosis
4000. Planning
4001. Expected Outcome
4002. Interventions and Rationales
4003. Evaluation
4004. Additional Nursing Diagnoses to Consider
4005. Maintaining the Household
4006. Evaluation
4007. Boredom
4008. Assessment
4009. Nursing Diagnosis and Planning
4010. Expected Outcome
4011. Interventions
4012. Identifying Appropriate Activities
4013. Changing the Physical Surroundings
4014. Evaluation
4015. Prolonged Pregnancy
4016. Complications
4017. Therapeutic Management
4018. Nursing Considerations
4019. Intrapartum Emergencies
4020. Placental Abnormalities
4021. Prolapsed Umbilical Cord
4022. Etiology
4023. FIG 27-6 Variations of prolapsed umbilical cord.
4024. Manifestations
4025. Therapeutic Management
4026. SAFETY ALERT: Factors that Increase a Woman’s Risk for a Prolapsed Umbilical Cord
4027. FIG 27-7 Measures to relieve pressure on a prolapsed umbilical cord until delivery can take place.
4028. Nursing Considerations
4029. Uterine Rupture
4030. FIG 27-8 Uterine rupture in the lower uterine segment.
4031. Etiology
4032. Manifestations
4033. Therapeutic Management
4034. Nursing Considerations
4035. Uterine Inversion
4036. Etiology
4037. Manifestations
4038. Therapeutic Management
4039. Nursing Considerations
4040. Anaphylactoid Syndrome
4041. Trauma
4042. Therapeutic Management
4043. Nursing Considerations
4044. KEY CONCEPTS
4045. References and Readings
4046. Pageburst Integrated Resource
4047. Animation
4048. Chapter 28 The Woman with a Postpartum Complication
4049. Learning Objectives
4050. Postpartum Hemorrhage
4051. Early Postpartum Hemorrhage
4052. FIG 28-1 A, When the uterus remains contracted, the placental site is smaller, so bleeding is minimal. B, If uterine muscles fail to contract around the endometrial arteries at the placental site, hemorrhage occurs.
4053. Uterine Atony
4054. Predisposing Factors
4055. Manifestations
4056. BOX 28-1 COMMON PREDISPOSING FACTORS FOR POSTPARTUM HEMORRHAGE
4057. FIG 28-2 Technique for fundal massage.
4058. Therapeutic Management
4059. DRUG GUIDE: Methylergonovine (Methergine)
4060. DRUG GUIDE: Carboprost Tromethamine (Hemabate, Prostin/15M)
4061. Trauma
4062. FIG 28-3 Bimanual compression. One hand is inserted in the vagina, and the other compresses the uterus through the abdominal wall.
4063. Predisposing Factors
4064. Lacerations
4065. Hematomas
4066. Therapeutic Management
4067. Late Postpartum Hemorrhage
4068. Predisposing Factors
4069. Therapeutic Management
4070. Hypovolemic Shock
4071. Pathophysiology
4072. Manifestations
4073. Therapeutic Management
4074. Nursing Considerations
4075. Immediate Care
4076. SAFETY ALERT: Signs of Postpartum Hemorrhage
4077. Nursing Care
4078. The Woman with Excessive Bleeding
4079. Assessment
4080. Uterine Atony
4081. Trauma
4082. TABLE 28-1 NURSING ASSESSMENTS FOR POSTPARTUM HEMORRHAGE
4083. Nursing Diagnosis and Planning
4084. Interventions
4085. Preventing Hemorrhage
4086. Collaborating with the Health Care Provider
4087. Providing Support for the Family
4088. Posthemorrhage Care
4089. Home Care
4090. CRITICAL THINKING EXERCISE 28-1
4091. Evaluation
4092. Subinvolution of the Uterus
4093. Therapeutic Management
4094. Nursing Considerations
4095. Venous thrombosis ExemplarThromboembolic Disorders
4096. Incidence and Etiology
4097. Venous Stasis
4098. BOX 28-2 FACTORS THAT INCREASE THE RISK OF THROMBOSIS
4099. Hypercoagulation
4100. Blood Vessel Injury
4101. Additional Predisposing Factors
4102. Superficial Venous Thrombosis
4103. Manifestations
4104. Therapeutic Management
4105. Deep Venous Thrombosis
4106. Diagnostic Evaluation
4107. Therapeutic Management
4108. Preventing Thrombus Formation
4109. Initial Treatment
4110. Subsequent Treatment
4111. Nursing Care
4112. The Mother with Deep Venous Thrombosis
4113. Assessment
4114. WOMEN WANT TO KNOW: How Do I Prevent Thrombosis (Blood Clots)?
4115. Nursing Diagnosis and Planning
4116. Expected Outcomes
4117. Interventions
4118. Monitoring for Signs of Bleeding
4119. Explaining Continued Therapy
4120. Helping the Family Adapt to Home Care
4121. Evaluation
4122. Pulmonary embolism ExemplarPulmonary Embolism
4123. Pathophysiology
4124. Manifestations
4125. Therapeutic Management
4126. Nursing Considerations
4127. Monitoring for Signs
4128. Facilitating Oxygenation
4129. Seeking Assistance
4130. Puerperal Infection
4131. Definition
4132. Pathophysiology
4133. Etiology
4134. TABLE 28-2 RISK FACTORS FOR PUERPERAL INFECTION
4135. Specific Infections
4136. Endometritis
4137. Etiology
4138. Manifestations
4139. Therapeutic Management
4140. Complications
4141. Nursing Considerations
4142. Wound Infection
4143. Manifestations
4144. Therapeutic Management
4145. Nursing Considerations
4146. Urinary Tract Infections
4147. Etiology
4148. Manifestations
4149. Therapeutic Management
4150. Nursing Considerations
4151. Mastitis
4152. Etiology
4153. Manifestations
4154. FIG 28-4 Mastitis typically occurs in the breast of a woman who breastfeeds after 2 to 3 weeks following birth.
4155. Therapeutic Management
4156. Nursing Considerations
4157. Septic Pelvic Thrombophlebitis
4158. Manifestations
4159. Therapeutic Management
4160. Nursing Care
4161. The Woman with an Infection
4162. Assessment
4163. SAFETY ALERT: Signs and Symptoms of Postpartum Infection
4164. Nursing Diagnosis and Planning
4165. Expected Outcome
4166. NURSING CARE PLAN: Risk for Postpartum Infection
4167. Assessment
4168. Nursing Diagnosis
4169. Planning
4170. Expected Outcomes
4171. Interventions and Rationales
4172. Evaluation
4173. Additional Nursing Diagnoses to Consider
4174. Postpartum psychosis ExemplarAffective Disorders
4175. Postpartum Mood Disorders
4176. Postpartum Depression
4177. Incidence
4178. Etiology
4179. Manifestations
4180. Impact on the Family
4181. Therapeutic Management
4182. Postpartum Psychosis
4183. Bipolar II Disorder
4184. Postpartum Anxiety Disorders
4185. Nursing Care
4186. Postpartum Affective Disorders
4187. Assessment
4188. SAFETY ALERT: Signs and Symptoms of Postpartum Depression
4189. Nursing Diagnosis and Planning
4190. Expected Outcomes
4191. Interventions
4192. Providing Anticipatory Guidance
4193. EVIDENCE-BASED PRACTICE
4194. Demonstrating Caring
4195. Helping the Mother Verbalize Feelings
4196. Enhancing Sensitivity to Infant Cues
4197. Helping Family Members
4198. Discussing Options and Resources
4199. Evaluation
4200. CRITICAL THINKING EXERCISE 28-2
4201. KEY CONCEPTS
4202. References And Readings
4203. Chapter 29 The High-Risk Newborn: Problems Related to Gestational Age and Development
4204. Learning Objectives
4205. Care of High-Risk Newborns
4206. Late Preterm Infants
4207. Incidence and Etiology
4208. Characteristics of Late Preterm Infants
4209. FIG 29-1 The infant in a neonatal intensive care unit (NICU) is cared for by nurses with highly specialized skills.
4210. Therapeutic Management
4211. Nursing Considerations
4212. Assessment and Care of Common Problems
4213. Thermoregulation
4214. Feedings
4215. Discharge
4216. Preterm Infants
4217. Incidence and Etiology
4218. Scope of the Problem
4219. Causes
4220. Prevention
4221. Characteristics of Preterm Infants
4222. Appearance
4223. Behavior
4224. Assessment and Care of Common Problems
4225. Problems with Respiration
4226. Assessment
4227. Nursing Interventions
4228. Working with Respiratory Equipment
4229. FIG 29-2 The oxygen hood is one way of delivering oxygen to an infant who can breathe unassisted.
4230. Positioning the Infant
4231. Suctioning Secretions
4232. Maintaining Hydration
4233. Problems with Thermoregulation
4234. Assessment
4235. FIG 29-3 This preterm infant has mildly mottled skin and slight abdominal distention and retractions.
4236. SAFETY ALERT: Signs of Inadequate Thermoregulation
4237. Nursing Interventions
4238. Maintaining a Neutral Thermal Environment
4239. Weaning to an Open Crib
4240. Problems with Fluid and Electrolyte Balance
4241. Assessment
4242. Urinary Output
4243. Weight
4244. Signs of Dehydration or Overhydration
4245. SAFETY ALERT: Signs of Fluid Imbalance in the Newborn
4246. Dehydration
4247. Overhydration
4248. Nursing Interventions
4249. Problems with the Skin
4250. Assessment
4251. Nursing Interventions
4252. Problems with Infection
4253. Assessment
4254. Nursing Interventions
4255. Problems with Pain
4256. Assessment
4257. NURSING QUALITY ALERT: Common Signs of Pain in Infants
4258. Nursing Interventions
4259. EVIDENCE-BASED PRACTICE
4260. Nursing Care
4261. The Preterm Infant
4262. Environmentally Caused Stress
4263. Assessment
4264. Nursing Diagnosis and Planning
4265. Expected Outcomes
4266. SAFETY ALERT: Signs of Overstimulation in Preterm Infants
4267. Oxygenation Changes
4268. Behavior Changes
4269. Interventions
4270. Scheduling Care
4271. Reducing Stimuli
4272. Promoting Rest
4273. Promoting Motor Development
4274. Individualizing Care
4275. Communicating Infants’ Needs
4276. Evaluation
4277. Nutrition
4278. Assessment
4279. Feeding Tolerance
4280. Readiness for Nipple Feeding
4281. NURSING QUALITY ALERT: Advancing to Nipple Feeding
4282. Signs of Readiness for Nipple Feedings
4283. Signs of Nonreadiness for Nipple Feedings
4284. Adverse Signs during Nipple Feedings
4285. Nursing Diagnosis and Planning
4286. Expected Outcomes
4287. Interventions
4288. Administering Parenteral Nutrition
4289. Administering Enteral Feedings
4290. Administering Gavage Feedings
4291. Administering Oral Feedings
4292. Preparing for Feedings
4293. FIG 29-4 The nurse feeds a preterm infant.
4294. Giving Bottle Feedings
4295. CRITICAL THINKING EXERCISE 29-1
4296. Facilitating Breastfeeding
4297. NURSING CARE PLAN: The Preterm Infant
4298. Focused Assessment
4299. Nursing Diagnosis
4300. Planning
4301. Expected Outcomes
4302. Interventions and Rationales
4303. Evaluation
4304. Focused Assessment
4305. Nursing Diagnosis
4306. Planning
4307. Expected Outcomes
4308. Interventions and Rationales
4309. Evaluation
4310. Nursing Diagnoses to Consider
4311. Making Ongoing Assessments
4312. Evaluation
4313. Parenting
4314. Assessment
4315. NURSING QUALITY ALERT: Signs that Bonding May Be Delayed
4316. Nursing Diagnosis and Planning
4317. Expected Outcomes
4318. FIG 29-5 An infant in the NICU is surrounded by highly technologic equipment. This can be very frightening to parents at first. Preparing parents before they visit is an important nursing responsibility.
4319. Interventions
4320. Making Advance Preparations
4321. Assisting Parents at Birth
4322. Supporting Parents during Early Visits
4323. BOX 29-1 INTRODUCING PARENTS TO THE NEONATAL INTENSIVE CARE UNIT SETTING
4324. Before Parents Visit the Neonatal Intensive Care Unit (NICU)
4325. When Parents Visit the NICU
4326. Providing Information
4327. Instituting Kangaroo Care (KC)
4328. FIG 29-6 This mother holds her 27-week-gestation infant under her clothes against her skin as she gives kangaroo care.
4329. Facilitating Interaction
4330. FIG 29-7 To promote family bonding with the infant, parents are involved as much as possible in the care of their infant. This father bottle feeds his infant in a radiant warmer.
4331. Increasing Parental Decision Making
4332. FIG 29-8 The parents look on while the grandmother holds the infant in the NICU.
4333. Alleviating Concerns
4334. Helping with Ongoing Problems
4335. Preparing for Discharge
4336. Evaluation
4337. Common Complications of Preterm Infants
4338. Respiratory Distress Syndrome (RDS)
4339. Pathophysiology
4340. Manifestations
4341. Therapeutic Management
4342. Nursing Considerations
4343. Bronchopulmonary Dysplasia (Chronic Lung Disease)
4344. Intraventricular Hemorrhage
4345. Pathophysiology
4346. Manifestations
4347. Therapeutic Management
4348. Nursing Considerations
4349. Retinopathy of Prematurity
4350. Pathophysiology
4351. Therapeutic Management
4352. Nursing Considerations
4353. Necrotizing Enterocolitis (NEC)
4354. Pathophysiology
4355. Manifestations
4356. Therapeutic Management
4357. Nursing Considerations
4358. Postterm Infants
4359. Scope of the Problem
4360. FIG 29-9 The postmature infant has dry, cracked, peeling skin and no vernix.
4361. Assessment
4362. Therapeutic Management
4363. Nursing Considerations
4364. Small-for-Gestational-Age Infants
4365. Etiology
4366. Scope of the Problem
4367. Characteristics of Small-for-Gestational-Age (SGA) Infants
4368. Therapeutic Management
4369. Nursing Considerations
4370. Large-for-Gestational-Age Infants
4371. Etiology
4372. Scope of the Problem
4373. Therapeutic Management
4374. Nursing Considerations
4375. KEY CONCEPTS
4376. References and Readings
4377. Chapter 30 The High-Risk Newborn: Acquired and Congenital Conditions
4378. Learning Objectives
4379. Respiratory Complications
4380. Asphyxia
4381. Manifestations
4382. Infants at Risk
4383. DRUG GUIDE: Naloxone Hydrochloride (Narcan)
4384. Neonatal Resuscitation
4385. Transient Tachypnea of the Newborn
4386. Etiology
4387. Manifestations
4388. Therapeutic Management
4389. PROCEDURE: Performing Resuscitation in Newborns
4390. Purpose
4391. Nursing Considerations
4392. Meconium Aspiration Syndrome
4393. Etiology
4394. Manifestations
4395. Therapeutic Management
4396. Nursing Considerations
4397. Persistent Pulmonary Hypertension of the Newborn
4398. Etiology
4399. Manifestations
4400. Therapeutic Management
4401. Nursing Considerations
4402. Hyperbilirubinemia
4403. Etiology
4404. Therapeutic Management
4405. Phototherapy
4406. Exchange Transfusions
4407. Procedure
4408. Complications
4409. Role of the Nurse
4410. Nursing Care
4411. The Infant with Hyperbilirubinemia
4412. Assessment
4413. Nursing Diagnosis and Planning
4414. Expected Outcomes
4415. Interventions
4416. Maintaining a Neutral Thermal Environment
4417. NURSING CARE PLAN: The Infant with Jaundice
4418. Focused Assessment
4419. Nursing Diagnosis
4420. Planning
4421. Expected Outcomes
4422. Interventions and Rationales
4423. Evaluation
4424. Additional Nursing Diagnoses to Consider
4425. Providing Optimal Nutrition
4426. Protecting the Eyes
4427. Enhancing Response to Therapy
4428. FIG 30-1 The infant receiving phototherapy is wearing eye patches to protect the eyes.
4429. Detecting Complications
4430. Teaching Parents
4431. Evaluation
4432. CRITICAL THINKING EXERCISE 30-1
4433. Infection
4434. Transmission of Infection
4435. Sepsis ExemplarSepsis Neonatorum
4436. Etiology
4437. TABLE 30-1 COMMON INFECTIONS IN THE NEWBORN
4438. Therapeutic Management
4439. Diagnostic Testing
4440. Treatment
4441. Nursing Considerations
4442. Assessment
4443. Risk Factors
4444. Signs of Infection
4445. Nursing Interventions
4446. Preventing Infection
4447. SAFETY ALERT: Signs of Sepsis in the Newborn
4448. General Signs
4449. Respiratory Signs
4450. Cardiovascular Signs
4451. Gastrointestinal Signs
4452. Central Nervous System Signs
4453. Signs that May Indicate Advanced Infection
4454. Providing Antibiotics
4455. Providing Other Supportive Care
4456. Supporting Parents
4457. Infant of a Diabetic Mother
4458. Scope of the Problem
4459. FIG 30-2 Macrosomia is common in infants of diabetic mothers.
4460. Characteristics of Infants of Diabetic Mothers (IDMs)
4461. Therapeutic Management
4462. Nursing Considerations
4463. Assessment
4464. Nursing Interventions
4465. Polycythemia
4466. Causes
4467. Manifestations
4468. Therapeutic Management
4469. Nursing Considerations
4470. Hypocalcemia
4471. Etiology
4472. Manifestations
4473. Therapeutic Management
4474. Nursing Considerations
4475. Prenatal Drug Exposure
4476. EVIDENCE-BASED PRACTICE
4477. Identification of Drug-Exposed Infants
4478. SAFETY ALERT: Signs of Intrauterine Drug Exposure
4479. Behavioral Signs
4480. Signs Relating to Feeding
4481. Respiratory Signs
4482. Other Signs
4483. Therapeutic Management
4484. Nursing Considerations
4485. Feeding
4486. Assessment
4487. Nursing Interventions
4488. Rest
4489. Assessment
4490. Nursing Interventions
4491. Bonding
4492. Assessment
4493. NURSING CARE PLAN: The Drug-Exposed Infant
4494. Focused Assessment
4495. Nursing Diagnosis
4496. Planning
4497. Expected Outcomes
4498. Interventions and Rationales
4499. Evaluation
4500. Focused Assessment
4501. Nursing Diagnosis
4502. Planning
4503. Expected Outcomes
4504. Interventions and Rationales
4505. Evaluation
4506. Additional Nursing Diagnoses to Consider
4507. Nursing Interventions
4508. Phenylketonuria
4509. Etiology
4510. Manifestations
4511. Therapeutic Management
4512. Nursing Considerations
4513. KEY CONCEPTS
4514. References and Readings
4515. Chapter 31 Management of Fertility and Infertility
4516. Learning Objectives
4517. Contraception
4518. Role of the Nurse
4519. Considerations when Choosing a Contraceptive Method
4520. FIG 31-1 Success of contraception is more likely when both the woman and her partner are involved in discussions. The nurse demonstrates filling a foam applicator.
4521. TABLE 31-1 ADVANTAGES AND DISADVANTAGES OF MOST COMMON CONTRACEPTIVE METHODS
4522. Safety
4523. Protection from Sexually Transmitted Diseases
4524. Effectiveness
4525. Acceptability
4526. TABLE 31-2 PREGNANCY RATES OF COMMON TYPES OF CONTRACEPTION: UNITED STATES
4527. Convenience
4528. Education Needed
4529. Benefits
4530. Side Effects
4531. Effect on Spontaneity
4532. Availability
4533. Expense
4534. Preference
4535. Religious and Personal Beliefs
4536. Culture
4537. Other Considerations
4538. Informed Consent
4539. Adolescents
4540. Adolescent Knowledge
4541. Misinformation
4542. Risk-Taking Behavior
4543. Counseling Adolescents
4544. FIG 31-2 Although many adolescents choose oral contraceptives, the nurse emphasizes the need to use condoms for protection against sexually transmitted diseases. Demonstrating with actual contraceptives increases understanding.
4545. CRITICAL THINKING EXERCISE 31-1
4546. Perimenopausal Women
4547. Contraception ExemplarMethods of Contraception
4548. Sterilization
4549. Tubal Sterilization
4550. Vasectomy
4551. Intrauterine Devices (IUDs)
4552. FIG 31-3 The Copper T 380A (ParaGard) intrauterine device (IUD) and the levonorgestrel intrauterine system (LNG-IUS or Mirena). Currently, IUDs are considered a very safe method for preventing pregnancy.
4553. Action
4554. Side Effects
4555. Teaching
4556. Hormonal Contraceptives
4557. Hormone Implant
4558. Hormone Injections
4559. Oral Contraceptives
4560. Progestin Only
4561. Combination
4562. Benefits, Risks, and Cautions
4563. SAFETY ALERT: Cautions in Using Oral Contraceptives
4564. BOX 31-1 POTENTIAL BENEFITS, DISADVANTAGES, AND RISKS OF ORAL CONTRACEPTIVES
4565. Side Effects
4566. Teaching
4567. Blood Hormone Levels
4568. Missed Doses
4569. Postpartum and Lactation
4570. Other Medications
4571. Follow-up
4572. Emergency Contraception
4573. TABLE 31-3 ACHES∗Warning Signs of Oral Contraceptive Complications
4574. Transdermal Contraceptive Patch
4575. FIG 31-4 The vaginal contraceptive ring (NuvaRing) is 5 cm (2 in) across and 4 mm thick.
4576. Contraceptive Vaginal Ring
4577. Barrier Methods
4578. Chemical Barriers
4579. Mechanical Barriers
4580. Male Condom
4581. Female Condom
4582. FIG 31-5 The female condom. A woman can protect herself from sexually transmitted diseases without relying on use of the male condom.
4583. COUPLES WANT TO KNOW: What Is the Proper Way to Use Condoms?
4584. Sponge
4585. Diaphragm
4586. WOMEN WANT TO KNOW: How to Use a Diaphragm
4587. Cervical Cap
4588. Lea’s Shield
4589. Natural Family Planning Methods
4590. Calendar or Rhythm Method
4591. Standard Days Method
4592. Cervical Mucus and Two-Day Method
4593. TABLE 31-4 NATURAL FAMILY PLANNING METHODS
4594. COUPLES WANT TO KNOW: How to Assess Cervical Mucus and Basal Body Temperature
4595. Cervical Mucus Assessment
4596. Basal Body Temperature (BBT)
4597. Symptothermal Method
4598. Abstinence
4599. Least Reliable Methods of Contraception
4600. Breastfeeding
4601. Coitus Interruptus
4602. Nursing Care
4603. Choosing a Contraceptive Method
4604. Assessment
4605. Introducing the Subject
4606. Determining the Woman’s Understanding
4607. Assessing the Woman’s Satisfaction
4608. Assessing Appropriate Choices
4609. Nursing Diagnosis and Planning
4610. Expected Outcomes
4611. Interventions
4612. Increasing Understanding of the Chosen Method
4613. Teaching about Other Methods
4614. Protecting Against Sexually Transmitted Diseases
4615. Including the Woman’s Partner
4616. Ongoing Teaching
4617. Evaluation
4618. Infertility ExemplarRole of the Nurse in Infertility Care
4619. Extent of Infertility
4620. Factors Contributing to Infertility
4621. Factors in the Man
4622. Abnormalities of the Sperm
4623. Erectile dysfunction ExemplarAbnormal Erections
4624. Abnormal Ejaculation
4625. Abnormalities of Seminal Fluid
4626. Factors in the Woman
4627. Disorders of Ovulation
4628. Abnormalities of the Fallopian Tubes
4629. Abnormalities of the Cervix
4630. Repeated Pregnancy Loss
4631. Abnormalities of the Fetal Chromosomes
4632. Abnormalities of the Cervix or Uterus
4633. FIG 31-6 Types of uterine malformations that may cause infertility or repeated pregnancy loss.
4634. Endocrine Abnormalities
4635. Immunologic Factors
4636. Environmental Agents
4637. Infections
4638. Evaluation of Infertility
4639. Preconception Counseling
4640. History and Physical Examination
4641. INFERTILE COUPLES WANT TO KNOW: What Is Infertility Treatment Like?
4642. General
4643. Men
4644. Women
4645. History
4646. Physical Examination
4647. Diagnostic Tests
4648. Therapies to Facilitate Pregnancy
4649. TABLE 31-5 SELECTED DIAGNOSTIC TESTS IN INFERTILITY
4650. TABLE 31-6 SELECTED MEDICATIONS FOR INFERTILITY THERAPY
4651. Medications
4652. Surgical Procedures
4653. Therapeutic Insemination
4654. Egg Donation
4655. Surrogate Parenting
4656. Assisted Reproductive Techniques
4657. In Vitro Fertilization (IVF)
4658. FIG 31-7 In vitro fertilization (IVF). Multiple oocytes are obtained by using a transvaginal or laparoscopic approach. The retrieved oocytes are mixed with prepared sperm, incubated approximately 18 hours, and then evaluated for cell division. Embryos are then transferred to the uterus immediately or after 48 to 96 more hours to allow 5 days of further cell division before implantation.
4659. Gamete Intrafallopian Transfer (GIFT)
4660. Zygote Intrafallopian Transfer (ZIFT)
4661. Comparison of In Vitro Fertilization, Gamete Intrafallopian Transfer, and Zygote Intrafallopian Transfer
4662. Intracytoplasmic Sperm Injection (ICSI)
4663. Responses to Infertility
4664. Assumption of Fertility
4665. Growing Awareness of a Problem
4666. Seeking Help for Infertility
4667. Identifying the Importance of Having a Baby
4668. Sharing Intimate Information
4669. Considering Financial Resources
4670. Ethical Issues
4671. Committing to Involvement in Care
4672. Reactions During Evaluation and Treatment
4673. Influences on Decision Making
4674. Social, Cultural, and Religious Values
4675. Difficulty of Treatment
4676. Probability of Success
4677. Financial Concerns
4678. Psychological Reactions
4679. Guilt
4680. Isolation
4681. Depression
4682. Stress on the Relationship
4683. Outcomes After Infertility Therapy
4684. Pregnancy Loss After Infertility Therapy
4685. Parenthood After Infertility Therapy
4686. Choosing to Adopt
4687. Menopause After Infertility
4688. Nursing Care
4689. The Infertile Couple
4690. Assessment
4691. Nursing Diagnosis and Planning
4692. Expected Outcomes
4693. Interventions
4694. Assisting Communication
4695. Increasing the Couple’s Sense of Control
4696. Reducing Isolation
4697. Promoting a Positive Self-Image
4698. Evaluation
4699. Key Concepts
4700. References and Readings
4701. Chapter 32 Women’s Health Care
4702. Learning Objectives
4703. Women’s Health Initiative
4704. Healthy People 2020
4705. Health Maintenance
4706. Health History
4707. Physical Assessment
4708. Health promotion ExemplarPreventive Counseling
4709. BOX 32-1 HEALTH HISTORY
4710. Personal History
4711. Menstrual History
4712. Obstetric History
4713. Sexual History
4714. Family History
4715. Psychosocial History
4716. Screening Procedures
4717. Breast Self-Examination
4718. Clinical Breast Examination
4719. WOMEN WANT TO KNOW: How to Perform Breast Self-Examination (BSE)
4720. Inspection
4721. Palpation
4722. TABLE 32-1 SCREENING PROCEDURES
4723. BOX 32-2 RISK FACTORS FOR BREAST CANCER
4724. Mammography
4725. Vulvar Self-Examination
4726. Pelvic Examination
4727. External Organs
4728. Speculum Examination
4729. Bimanual Examination
4730. FIG 32-1 Bimanual palpation provides information about the uterus, fallopian tubes, and ovaries.
4731. Pap Test
4732. Purpose
4733. Procedure
4734. Classification of Cervical Cytology
4735. Rectal Examination
4736. Breast Disorders
4737. Benign Disorders of the Breast
4738. Fibrocystic Breast Changes
4739. Fibroadenoma
4740. Ductal Ectasia
4741. Intraductal Papilloma
4742. Diagnostic Evaluation
4743. Nursing Considerations
4744. Breast cancer mortality ExemplarBreast cancer ExemplarMalignant Tumors of the Breast
4745. Incidence
4746. Predisposing Factors
4747. Pathophysiology
4748. Manifestations
4749. Staging
4750. Therapeutic Management
4751. Surgical Treatment
4752. Adjuvant Therapy
4753. Radiation Therapy
4754. Chemotherapy
4755. Hormonal Therapy
4756. Immunotherapy
4757. Breast Reconstruction
4758. Timing
4759. Methods
4760. Psychosocial Consequences of Breast Cancer
4761. Nursing Considerations
4762. Cardiovascular Disease
4763. EVIDENCE-BASED PRACTICE
4764. Recognition of Coronary Artery Disease (CAD)
4765. Risk Factors
4766. BOX 32-3 RISK FACTORS FOR CORONARY ARTERY DISEASE IN WOMEN
4767. Prevention
4768. Hypertension
4769. Smoking Cessation
4770. Diet and Glucose Control
4771. Increased Activity
4772. Aspirin
4773. Menstrual Cycle Disorders
4774. Amenorrhea
4775. Primary Amenorrhea
4776. Etiology
4777. Therapeutic Management
4778. Secondary Amenorrhea
4779. Nursing Considerations
4780. Abnormal Uterine Bleeding
4781. Etiology
4782. Management
4783. Nursing Considerations
4784. Pain Associated with the Menstrual Cycle
4785. Mittelschmerz
4786. Primary Dysmenorrhea
4787. Manifestations
4788. Etiology
4789. Therapeutic Management
4790. Endometriosis
4791. FIG 32-2 Common sites of endometriosis.
4792. Etiology
4793. Pathophysiology
4794. Manifestations
4795. Therapeutic Management
4796. Nursing Considerations
4797. BOX 32-4 SYMPTOMS OF PREMENSTRUAL SYNDROME (PMS)
4798. Physical Symptoms
4799. Behavioral Symptoms
4800. Premenstrual Syndrome (PMS)
4801. WOMEN WANT TO KNOW: How to Relieve Symptoms of Premenstrual Syndrome (PMS)
4802. Diet
4803. Exercise
4804. Stress Management
4805. Sleep and Rest
4806. Etiology
4807. Manifestations
4808. Therapeutic Management
4809. Nursing Considerations
4810. FIG 32-3 The woman uses a calendar to record occurrence and severity of premenstrual symptoms.
4811. Elective Termination of Pregnancy
4812. WOMEN WANT TO KNOW: Guidelines for Self-Care After Elective Termination of Pregnancy
4813. Methods of Induced Abortion
4814. Nursing Considerations Related to Elective Pregnancy Termination
4815. Menopause
4816. Age at Menopause
4817. Physiologic Changes
4818. Psychological Responses
4819. Therapy for Menopause
4820. Nursing Considerations Related to Menopause
4821. Osteoporosis
4822. Predisposing Factors
4823. Manifestations
4824. FIG 32-4 With progression of osteoporosis, the vertebral column collapses, causing loss of height and back pain. Dowager’s hump is the term used for this curvature of the upper back.
4825. Prevention and Therapeutic Management
4826. Drug Therapy
4827. Calcium and Vitamin D
4828. Exercise
4829. Nursing Considerations
4830. Nursing Diagnoses
4831. Pelvic Floor Dysfunction
4832. Vaginal Wall Prolapse
4833. Cystocele
4834. Enterocele
4835. FIG 32-5 Three types of vaginal wall prolapse. A, Note bulging of bladder into the vagina. B, Note loop of bowel between rectum and uterus. C, Note bulging of rectum into vagina. More than one type of vaginal wall prolapse may exist in the same woman.
4836. Rectocele
4837. FIG 32-6 Three degrees of uterine prolapse.
4838. Uterine Prolapse
4839. Manifestations
4840. Therapeutic Management
4841. Nursing Considerations
4842. Pelvic Exercises
4843. Stress incontinence ExemplarUrinary Incontinence
4844. Disorders of the Reproductive Tract
4845. Benign Disorders
4846. Cervical Polyps
4847. Uterine Leiomyomas
4848. Ovarian Cysts
4849. SAFETY ALERT: Signs and Symptoms that Should Always Be Investigated
4850. BOX 32-5 RISK FACTORS FOR CANCER OF THE REPRODUCTIVE ORGANS
4851. Uterus
4852. Cervix
4853. Ovaries
4854. Malignant Disorders
4855. Manifestations
4856. Diagnostic Evaluation
4857. Therapeutic Management
4858. Cervical Cancer
4859. Endometrial Cancer
4860. Ovarian Cancer
4861. Infectious Disorders of the Reproductive Tract
4862. Candidiasis
4863. Sexually Transmitted Diseases (STDs)
4864. Incidence
4865. Types of Sexually Transmitted Diseases (STDs)
4866. Trichomoniasis
4867. Bacterial Vaginosis
4868. Chlamydial Infection
4869. WOMEN WANT TO KNOW: About Sexually Transmitted Diseases
4870. Gonorrhea
4871. Syphilis
4872. Herpes Genitalis
4873. Human Papillomavirus (HPV)
4874. Acquired Immunodeficiency Syndrome
4875. Nursing Considerations
4876. Pelvic Inflammatory Disease (PID)
4877. Etiology and Pathophysiology
4878. Manifestations
4879. Therapeutic Management
4880. Nursing Considerations
4881. Toxic Shock Syndrome
4882. Nursing Considerations
4883. Key Concepts
4884. References and Readings
4885. Pageburst Integrated Resource
4886. Animation
4887. Pediatric Nursing Care
4888. Interactive Review – Pediatric Nursing Care
4889. Chapter 33 Physical Assessment of Children
4890. Learning Objectives
4891. General Approaches to Physical Assessment
4892. Infants from Birth to 6 Months
4893. Infants from 6 to 12 Months
4894. NURSING QUALITY ALERT: Adapting the Physical Examination to the Child
4895. Toddlers
4896. Preschoolers
4897. FIG 33-1 During the assessment, the nurse allows the child to remain on her mother’s lap, enlisting the child’s trust and increasing the likelihood of a successful physical examination.
4898. School-Age Children
4899. Adolescents
4900. Techniques for Physical Examination
4901. Inspection
4902. Palpation
4903. NURSING QUALITY ALERT: Using the Hands for Palpation
4904. Percussion
4905. Auscultation
4906. Smell
4907. Sequence of Physical Examination
4908. General Appearance
4909. BOX 33-1 SOUNDS IDENTIFIED DURING PERCUSSION
4910. History Taking
4911. BOX 33-2 POTENTIAL INDICATORS OF CHILD ABUSE
4912. CRITICAL THINKING EXERCISE 33-1
4913. Recording Data
4914. BOX 33-3 THE COMPLETE HISTORY
4915. Vital Signs
4916. BOX 33-4 PROBLEM-ORIENTED HISTORY
4917. Temperature
4918. TABLE 33-1 NORMAL VITAL SIGNS BY AGE
4919. Pulse
4920. Respirations
4921. Blood Pressure
4922. Pain Assessment
4923. Anthropometric Measurement
4924. Height
4925. NURSING QUALITY ALERT: Importance of Anthropometric Measurements
4926. Weight
4927. Head Circumference
4928. FIG 33-2 Measuring head circumference. The head circumference is measured from birth through age 36 months. The nurse uses a nonstretching tape and measures in a “hat band” position, just above the eyebrows and around the occipital prominence in the back. Chest circumference is also routinely measured in the newborn; it is usually smaller than the newborn’s head circumference.
4929. Chest Circumference
4930. Midarm Circumference
4931. Triceps Skinfold
4932. Use of Growth Charts
4933. Skin, Hair, and Nails
4934. Skin
4935. Inspection
4936. BOX 33-5 SKIN COLOR TERMINOLOGY
4937. NURSING QUALITY ALERT: Skin Inspection in Dark-Skinned Children
4938. Palpation
4939. Hair
4940. Nails
4941. Lymph Nodes
4942. FIG 33-3 Location of superficial lymph nodes.
4943. Head, Neck, and Face
4944. Head
4945. BOX 33-6 CHARACTERISTICS OF ENLARGED LYMPH NODES AND MASSES
4946. BOX 33-7 HEAD SHAPE TERMINOLOGY
4947. FIG 33-4 Fontanels are inspected and palpated for size, tenseness, and pulsation.
4948. Neck
4949. Face
4950. FIG 33-5 The child’s ears are inspected for alignment. Low-set ears could indicate an intellectual disability or renal anomalies.
4951. Nose, Mouth, and Throat
4952. Nose
4953. Mouth and Throat
4954. FIG 33-6 The frontal, ethmoid, and maxillary sinuses.
4955. FIG 33-7 Sequence of eruption of primary and secondary teeth.
4956. Eyes
4957. Visual Acuity
4958. BOX 33-8 TYPES OF EYE CHARTS
4959. Color Vision
4960. Peripheral Vision
4961. Binocular Vision and Strabismus
4962. Corneal Light Reflex Test
4963. Field-of-Vision Test
4964. FIG 33-8 Visual fields (cranial nerve II) are tested in each eye separately. One eye is covered as the child stares straight ahead. An object is slowly moved from the side of the head into the field of vision. The child says “now” upon first seeing the object.
4965. Tests for Eye Muscle Function
4966. External Eye
4967. FIG 33-9 External structures of the eye.
4968. FIG 33-10 The cover/uncover test detects small degrees of deviated eye alignment. With one eye covered, the child gazes straight ahead with the uncovered eye. The cover is then removed, and the eye should continue to stare straight ahead. Movement in either eye suggests muscle weakness. Extraocular muscle function is controlled by cranial nerves III, IV, and VI.
4969. Ophthalmoscopic Examination
4970. Ears
4971. Hearing Acuity
4972. Infant Assessment
4973. Preschool and School-Age Assessment by Audiometry
4974. FIG 33-11 Landmarks of the external ear.
4975. Preschool, School-Age, and Adolescent Assessment: The Whisper Test
4976. Conduction Tests (Tuning Fork Hearing Tests)
4977. External Ear
4978. Otoscopic Examination
4979. Thorax and Lungs
4980. Inspection
4981. Palpation
4982. FIG 33-12 Inspection of the tympanic membrane with the otoscope. The auditory canal is inspected before the otoscope is inserted to see the child’s tympanic membrane.
4983. To straighten the ear canal of a child older than 3 years, the nurse pulls the child’s pinna up and back.
4984. For children younger than 3 years, the pinna is pulled down and back.
4985. Auscultation
4986. FIG 33-13 Anatomic landmarks of the thorax in infants and children.
4987. Adventitious Breath Sounds
4988. FIG 33-14 Common alterations in chest configuration.
4989. Heart
4990. Inspection
4991. FIG 33-15 To identify areas of fremitus, tenderness, symmetry, and depth and equality of expansion, the nurse palpates the child’s posterior and anterior chest. When palpating any area, warm hands increase the child’s comfort.
4992. Palpation
4993. FIG 33-16 Auscultation is most easily done when the child is quiet, so this part of the examination is best performed first if the child is quiet or asleep. To allay fears, the child can play with the stethoscope first and can be distracted with a toy while the nurse is listening. Warming the stethoscope bell increases comfort. Infants and toddlers can be held sitting upright in the parent’s lap while the nurse listens to breath sounds.
4994. If the child is upset, the examiner may have to listen to breath sounds between cries. Keeping this child in the comfort of her mother’s arms lessens distress.
4995. Auscultation
4996. FIG 33-17 Sequence for listening to breath sounds.
4997. TABLE 33-2 ORIGIN AND CHARACTERISTICS OF ADVENTITIOUS BREATH SOUNDS
4998. Normal Rate and Rhythm
4999. Extra Heart Sounds, Including Murmurs
5000. Peripheral Vascular System
5001. NURSING QUALITY ALERT: Normal Findings in Children
5002. FIG 33-18 Location of the heart within the thorax in the infant and the older child, showing landmarks and areas of auscultation.
5003. Breast
5004. Abdomen
5005. FIG 33-19 Abdominal quadrants and structures.
5006. FIG 33-20 Abdominal contours. The contour of the abdomen provides an indication of the child’s overall nutritional state.
5007. Inspection
5008. Auscultation
5009. Percussion
5010. Palpation
5011. Male Genitalia
5012. FIG 33-21 When a boy’s scrotum is examined, the cremasteric reflex may cause the testes to withdraw into the inguinal canal. To prevent this reflex, the examiner can have the boy sit in a tailor position. The examiner uses one hand to block the inguinal canal and the other to palpate.
5013. Female Genitalia
5014. FIG 33-22 Postpubertal female genitalia.
5015. Musculoskeletal System
5016. Infants
5017. Toddlers, Preschoolers, and School-Age Children
5018. Adolescents
5019. Range of Motion
5020. Muscle Strength and Mass
5021. Joints
5022. Gait
5023. BOX 33-9 SCREENING PROCEDURE FOR SCOLIOSIS
5024. Adam’s position demonstrates the rib hump of structural scoliosis. Lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of involved vertebral bodies. Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending. It may be compensatory for other abnormalities such as leg-length discrepancy.
5025. Structural scoliosis is fixed; the curvature is evident both when the individual stands and when the individual bends forward. Note the rib hump with forward flexion. When the child is standing, unequal shoulder elevation, unequal scapulae, obvious curvature, unequal elbow level, and unequal hip level is seen.
5026. Neurologic System
5027. TABLE 33-3 GROSS MOTOR DEVELOPMENT IN THE INFANT: PROGRESSION TO WALKING
5028. Cerebral Function
5029. TABLE 33-4 ASSESSING CRANIAL NERVES∗
5030. BOX 33-10 SPECIFIC CEREBRAL FUNCTION TESTS
5031. Cranial Nerves
5032. Cerebellar Function
5033. Motor System
5034. Sensory System
5035. Reflex Status
5036. Neurologic “Soft” Signs
5037. BOX 33-11 CEREBELLAR FUNCTION: TESTS OF BALANCE AND COORDINATION
5038. Conclusion and Documentation
5039. TABLE 33-5 EVALUATING COMMON REFLEXES
5040. BOX 33-12 TESTS FOR EVALUATING SENSORY FUNCTION
5041. Primary Forms of Sensation
5042. Cortical and Discriminatory Forms of Sensation
5043. BOX 33-13 EXAMPLES OF NEUROLOGIC “SOFT” SIGNS
5044. Key Concepts
5045. References and Readings
5046. Pageburst Integrated Resource
5047. Animation
5048. Chapter 34 Emergency Care of the Child
5049. Learning Objectives
5050. CLINICAL REFERENCE
5051. General Guidelines for Emergency Nursing Care
5052. Encouraging parents to remain with their child in the emergency setting can bolster the family’s coping.
5053. PEDIATRIC EMERGENCY EQUIPMENT
5054. PEDIATRIC EMERGENCY MEDICATIONS
5055. BOX 34-1 WORKING WITH CHILDREN IN EMERGENCIES: DEVELOPMENTAL GUIDELINES
5056. Infants
5057. Toddlers
5058. Preschoolers
5059. School-Age Children
5060. Adolescents
5061. Growth and Development Issues in Emergency Care
5062. The Infant
5063. The Toddler
5064. The Preschooler
5065. The School-Age Child
5066. The Adolescent
5067. The Family of a Child in Emergency Care
5068. Emergency Assessment of Infants and Children
5069. Primary Assessment
5070. Airway Assessment
5071. NURSING QUALITY ALERT: Initial Observations for Triage
5072. TABLE 34-1 PRIMARY ASSESSMENT IN PEDIATRIC EMERGENCIES
5073. Breathing Assessment
5074. Cardiovascular Assessment
5075. Disability: Neurologic Assessment
5076. Hypothermia ExemplarExposure
5077. Secondary Assessment
5078. Vital Signs
5079. TABLE 34-2 SECONDARY ASSESSMENT IN PEDIATRIC EMERGENCIES
5080. History and Head-to-Toe Assessment
5081. Diagnostic Tests
5082. Weight
5083. Parent-Child Relationship
5084. EVIDENCE-BASED PRACTICE
5085. Cardiopulmonary Resuscitation of the Child
5086. Airway and Breathing
5087. Initial Assessment and Intervention
5088. Obstructed Airway Management
5089. SAFETY ALERT: Airway Obstruction in Children
5090. Circulation
5091. TABLE 34-3 HEALTH CARE PROFESSIONAL BASIC LIFE SUPPORT ELEMENTS FOR INFANTS AND CHILDREN
5092. Shock ExemplarThe Child in Shock
5093. Etiology
5094. Hypovolemic Shock
5095. Distributive Shock
5096. Cardiogenic Shock
5097. PATHOPHYSIOLOGY: Shock
5098. Hypovolemic Shock
5099. Distributive Shock
5100. Cardiogenic Shock
5101. BOX 34-2 MANIFESTATIONS OF SHOCK IN CHILDREN
5102. Hypovolemic Shock
5103. Distributive (Septic) Shock: Early
5104. Septic Shock: Late
5105. Cardiogenic Shock
5106. Manifestations
5107. SAFETY ALERT: Hypotension in Children with Shock
5108. TABLE 34-4 ASSESSING A CHILD’S GENERAL APPEARANCE: “LOOKS GOOD” VERSUS “LOOKS BAD”
5109. Diagnostic Evaluation
5110. Therapeutic Management
5111. Hypovolemic Shock
5112. Distributive Shock
5113. Cardiogenic Shock
5114. Nursing Care
5115. The Child in Shock
5116. Assessment
5117. Hypovolemic Shock
5118. Distributive Shock
5119. Cardiogenic Shock
5120. Nursing Diagnosis and Planning
5121. Expected Outcome
5122. Expected Outcome
5123. Expected Outcome
5124. Expected Outcomes
5125. Interventions
5126. Maintaining Tissue Perfusion
5127. Ensuring Oxygenation
5128. Preventing Infection
5129. Enhancing Coping
5130. Evaluation
5131. Pediatric Trauma
5132. Mechanism of Injury
5133. Blunt Trauma
5134. Motor Vehicle Trauma
5135. Pedestrian Injury
5136. Penetrating Trauma
5137. Multiple Trauma
5138. Primary Survey
5139. FIG 34-1 Waddell’s triad of injuries.
5140. Airway Assessment and Management
5141. Breathing Assessment and Management
5142. FIG 34-2 The child with multiple trauma injuries must remain on an immobilization board (long backboard) with a cervical immobilization device in place until the child has been evaluated for spinal injuries.
5143. Circulation Assessment and Management
5144. NURSING QUALITY ALERT: Artificial Airways
5145. Disability
5146. Secondary Survey
5147. Obtaining a History of the Injury
5148. Trauma Scoring
5149. Assessing for Child Abuse
5150. BOX 34-3 HISTORY OF INJURY QUESTIONS
5151. For a Victim of a Motor Vehicle Collision
5152. For a Victim of a Fall
5153. For a Victim of a Penetrating Injury
5154. BOX 34-4 Trauma Scoring Systems
5155. Trauma Score (TS)
5156. Revised Trauma Score (RTS)
5157. Pediatric Trauma Score (PTS)
5158. Nursing Considerations
5159. The Child and Family
5160. The Child during Recovery
5161. Ingestions and Poisonings
5162. CRITICAL THINKING EXERCISE 34-1
5163. Incidence
5164. Manifestations
5165. Diagnostic Evaluation
5166. Therapeutic Management
5167. TABLE 34-5 COMMON POISONOUS SUBSTANCES
5168. Removal of Dermal and Ocular Toxins
5169. Diluting the Ingested Toxin
5170. Activated Charcoal
5171. Antidotes
5172. Nursing Care
5173. The Child Who Has Ingested a Toxic Substance
5174. Assessment
5175. Nursing Diagnosis and Planning
5176. Expected Outcome
5177. Expected Outcome
5178. Expected Outcome
5179. Expected Outcomes
5180. Expected Outcome
5181. Interventions
5182. NURSING QUALITY ALERT: Assessment of Poison Ingestion
5183. Evaluation
5184. Environmental Emergencies
5185. Animal, Human, Snake, and Spider Bites
5186. Etiology
5187. Animal and Human Bites
5188. Snake and Spider Bites
5189. Incidence
5190. Manifestations
5191. Animal and Human Bites
5192. Snake Bites
5193. Spider Bites
5194. Therapeutic Management
5195. Animal Bites
5196. Snake Bites
5197. Spider Bites
5198. Nursing Considerations
5199. Submersion Injuries (Near Drowning)
5200. Etiology
5201. Incidence
5202. Manifestations
5203. PATHOPHYSIOLOGY: Submersion Injury
5204. Therapeutic Management
5205. Prehospital Emergency Management
5206. Hospital Management
5207. Nursing Care
5208. The Child with a Submersion Injury
5209. Assessment
5210. Nursing Diagnosis and Planning
5211. Expected Outcomes
5212. Expected Outcomes
5213. Expected Outcome
5214. Expected Outcomes
5215. Interventions
5216. Providing Respiratory Support
5217. Restoring Appropriate Circulatory Status
5218. Identifying and Preventing Neurologic Consequences
5219. Restoring Fluid Balance
5220. Controlling Infection
5221. Maintaining Nutritional Status
5222. Providing Emotional Care for the Family
5223. Evaluation
5224. NURSING QUALITY ALERT: Needs Expressed by Families of Critically Ill Children
5225. Heat-Related Illnesses
5226. Incidence
5227. Manifestations and Therapeutic Management
5228. Nursing Considerations
5229. TABLE 34-6 Heatstroke Exemplar HEAT-RELATED ILLNESS
5230. CRITICAL THINKING EXERCISE 34-2
5231. Dental Emergencies
5232. Incidence and Etiology
5233. Therapeutic Management
5234. Nursing Considerations
5235. KEY CONCEPTS
5236. References and Readings
5237. Pageburst Integrated Resource
5238. Animation
5239. Chapter 35 The Ill Child in the Hospital and Other Care Settings
5240. Learning Objectives
5241. Settings of Care
5242. The Hospital
5243. 24-Hour Observation
5244. Emergency Hospitalization
5245. Outpatient and Day Facilities
5246. Rehabilitative Care
5247. The Medical-Surgical Unit
5248. The Intensive Care Unit
5249. School based services exemplarSchool-Based Clinics
5250. FIG 35-1 Parents are encouraged to stay with their child whenever possible. This mother is holding her child in the postanesthesia recovery room, a setting that in the past was off limits to parents.
5251. Community Clinics
5252. FIG 35-2 Nurses today help take health care on the road to provide services to those who otherwise might not obtain them. This mobile van is stationed at a public school, where it offers health screenings and prevention services to children.
5253. Home Care
5254. Stressors Associated with Illness and Hospitalization
5255. NURSING QUALITY ALERT: Children’s Responses to Illness
5256. The Infant and Toddler
5257. Separation Anxiety
5258. BOX 35-1 STAGES OF SEPARATION
5259. Fear of Injury and Pain
5260. Loss of Control
5261. FIG 35-3 Separation is one of the stressors of hospitalization that affects both child and parent. A toddler exhibits separation anxiety by reacting with protest to leaving her parent’s arms.
5262. Rooming-in reduces the stress of hospitalization and provides opportunities for parent teaching.
5263. The Preschooler
5264. Separation Anxiety
5265. Fear of Injury and Pain
5266. NURSING QUALITY ALERT: Maintaining a Safe Place
5267. Loss of Control
5268. Guilt and Shame
5269. The School-Age Child
5270. Separation
5271. Fear of Injury and Pain
5272. FIG 35-4 Activities for the hospitalized child are important for growth and development, stress relief, socialization, and a sense of control. This model railroad “trainscape” in a pediatric hospital provides children and adults with a welcome respite from real-life stresses.
5273. Hospitalized teens need to interact with their peers, as they do when they are well. A lounge area that is separate from the playroom used by younger children fulfills this need.
5274. Loss of Control
5275. The Adolescent
5276. Separation
5277. Fear of Injury and Pain
5278. Loss of Control
5279. Fear of the Unknown
5280. Regression
5281. Factors Affecting a Child’s Response to Illness and Hospitalization
5282. Age and Cognitive Development
5283. Parental Response
5284. EVIDENCE-BASED PRACTICE
5285. BOX 35-2 DEVELOPMENTAL APPROACHES TO THE HOSPITALIZED CHILD
5286. Neonate
5287. Infant
5288. Toddler
5289. Preschooler
5290. School-Age Child
5291. Adolescent
5292. Preparing the Child and Family
5293. Coping Skills of the Child and Family
5294. Psychological Benefits of Hospitalization
5295. Play for the Ill Child
5296. FIG 35-5 To provide diversion and allow interaction with other children, the play therapist wheels the child, while still in bed with traction in place, to the playroom.
5297. Playrooms
5298. Therapeutic Play
5299. FIG 35-6 Therapeutic play can be used to teach children about medical procedures or help them work through their feelings about what has happened to them in the health care setting. Child life specialists are often members of the team in children’s hospitals to provide expert guidance for therapeutic play. Art materials allow children to express their thoughts and feelings about illness and hospitalization.
5300. Giving a doll an injection can help a child work through anxiety and anger about injections she may be receiving.
5301. Emotional Outlet Play
5302. Teaching through Play
5303. Enhancing Cooperation through Play
5304. Unstructured Play
5305. Evaluation of Play
5306. Admitting the Child to a Hospital Setting
5307. Taking the History
5308. FIG 35-7 To reduce the stress of unfamiliar surroundings and people, the nurse assesses the child who remains in the security of her mother’s arms.
5309. Physical Examination
5310. Initial Inspection
5311. Baseline Data
5312. NURSING CARE PLAN: The Child and Family in a Hospital Setting
5313. Focused Assessment
5314. Nursing Diagnosis
5315. Planning
5316. Expected Outcomes
5317. Interventions and Rationales
5318. Evaluation
5319. Nursing Diagnosis
5320. Planning
5321. Expected Outcomes
5322. Interventions and Rationales
5323. Evaluation
5324. Nursing Diagnosis
5325. Planning
5326. Expected Outcome
5327. Interventions and Rationales
5328. Evaluation
5329. Nursing Diagnosis
5330. Planning
5331. Expected Outcomes
5332. Interventions and Rationales
5333. Evaluation
5334. Nursing Diagnosis
5335. Planning
5336. Expected Outcomes
5337. Interventions and Rationales
5338. Evaluation
5339. The Ill Child’s Family
5340. Parents
5341. FIG 35-8 The family of a hospitalized child may not speak the prevailing language. Interpreters are available (on-site or on-call) at many hospitals to help parents and children communicate with health care team members. This arrangement provides a familiar link to the parents’ and child’s culture and language.
5342. PARENTS WANT TO KNOW: Information for Discharge
5343. CRITICAL THINKING EXERCISE 35-1
5344. Siblings
5345. BOX 35-3 CARING FOR THE SIBLINGS OF AN ILL OR HOSPITALIZED CHILD
5346. Factors that Add to the Stress of Siblings
5347. Nursing Care Guidelines for Meeting the Needs of Siblings
5348. Siblings of ill children may experience jealousy, insecurity, resentment, confusion, and anxiety. The nurse can help them cope by assessing and implementing care to meet their needs.
5349. KEY CONCEPTS
5350. References and Readings
5351. Chapter 36 The Child with a Chronic Condition or Terminal Illness
5352. Learning Objectives
5353. Chronic Illness Defined
5354. The Family of the Child with Special Health Care Needs
5355. Family Dynamics and Impact on the Family
5356. BOX 36-1 COMMON CHRONIC CONDITIONS OF CHILDHOOD
5357. Coping and the Grieving Process
5358. The Child with Special Health Care Needs
5359. Coping and Growth and Development Concerns
5360. BOX 36-2 THE ILLNESS EXPERIENCE: THE CHILD AND ADOLESCENT
5361. Infant
5362. Toddler
5363. Preschooler
5364. School-Age Child
5365. Adolescent
5366. Coping and Parental Responses to Developmental Issues
5367. NURSING QUALITY ALERT: Goals for Chronic Care
5368. Goals for the Child
5369. Goals for the Family
5370. The Child With a Chronic Illness
5371. FIG 36-1 The nurse or a child life specialist can use therapeutic play, medical play, and therapeutic art to enhance self-expression, education, and growth and development.
5372. Ongoing Care
5373. Education
5374. Communication
5375. Caring for Parents
5376. Grief Education and Support
5377. Cultural and Religious Beliefs
5378. Referrals
5379. Schooling
5380. The Nurse as Liaison
5381. Caring for Siblings
5382. FIG 36-2 Chronic illness is stressful for the siblings of an ill child. Siblings’ emotional needs may be overlooked. Siblings should be given the opportunity to express negative feelings, such as anger and jealousy, through therapeutic art and play, as well as through physical outlets, such as striking a punching bag, as this little girl is doing.
5383. NURSING QUALITY ALERT: Nursing Care for Children with Chronic Conditions and Their Families
5384. NURSING CARE PLAN: The Child with a Chronic Condition in the Community Setting
5385. Focused Assessment
5386. Nursing Diagnosis
5387. Planning
5388. Expected Outcomes
5389. Interventions and Rationales
5390. Because more children with chronic conditions are living longer, more attend public school. However, these children are likely to be frequently hospitalized, so hospitals often provide an area where teachers can help them with their studies.
5391. Evaluation
5392. Nursing Diagnosis
5393. Planning
5394. Expected Outcomes
5395. Interventions and Rationales
5396. Evaluation
5397. CRITICAL THINKING EXERCISE 36-1
5398. Death dying ExemplarThe Terminally Ill or Dying Child
5399. Coping and the Child’s Concept of Death
5400. Infants and Toddlers
5401. TABLE 36-1 THE CHILD’S CONCEPT OF DEATH
5402. Preschoolers
5403. School-Age Children
5404. Adolescents
5405. Coping and Responses to Death and Dying
5406. The Child’s Response
5407. The Parents’ Response
5408. The Siblings’ Response
5409. Caring for the Dying Child
5410. Nursing Professionalism and Boundaries
5411. FIG 36-3 The family of the child with a terminal condition needs compassion and support from the nurse. Nursing care includes physical care and support of the family’s care giving efforts, and assistance with the grieving process.
5412. Communication with patient or family ExemplarCommunication
5413. Family Dynamics, Beliefs, and Practices
5414. BOX 36-3 RESOURCES ON DEATH AND DYING FOR FAMILIES AND HEALTH PROFESSIONALS
5415. Internet Resources
5416. Book Selections for Children
5417. Book Selections for Adults—Parents and Nurses
5418. Book Selections for Nurses
5419. Pain Control
5420. Hospice Care
5421. The Dying Process and the Time of Death
5422. Privacy for the Child and Family
5423. Changes in Family Routines
5424. Family Concerns about Oral Intake
5425. Fluids and Oral Care
5426. Responsiveness and Communication
5427. Indicators of Imminent Death
5428. NURSING QUALITY ALERT: Nursing Care for the Dying Child and the Child’s Family
5429. NURSING CARE PLAN: The Terminally Ill or Dying Child
5430. Focused Assessment
5431. Nursing Diagnosis
5432. Planning
5433. Expected Outcomes
5434. Interventions and Rationales
5435. Evaluation
5436. Nursing Diagnosis
5437. Planning
5438. Expected Outcomes
5439. Interventions and Rationales
5440. Evaluation
5441. The Family after Death
5442. The Nurse’s Response to the Dying Child
5443. KEY CONCEPTS
5444. References and Readings
5445. Chapter 37 Principles and Procedures for Nursing Care of Children
5446. LEARNING OBJECTIVES
5447. Preparing Children for Procedures
5448. Explaining Procedures
5449. SAFETY ALERT: Standard Precautions
5450. BOX 37-1 TIPS FOR PREPARING AND SUPPORTING CHILDREN UNDERGOING PROCEDURES
5451. Before the Procedure
5452. During the Procedure
5453. After the Procedure
5454. FIG 37-1 Because a child should feel that the hospital room is a safe place, a treatment room is used for invasive or painful procedures. The parent is present, not to restrain the child, but to provide emotional support.
5455. Consent for Procedures
5456. NURSING QUALITY ALERT: Preparation for Procedures
5457. Holding and Transporting Infants and Children
5458. Safety Issues in the Hospital Setting
5459. FIG 37-2 Methods of transporting infants and children. The nurse carries the infant securely, anticipating sudden movement. A, Cradle carry. B, Football hold. C, Over-the-shoulder carry, which can be used until the infant is 6 to 7 months old. D, Transport can be fun for young children, especially when it is on wheels.
5460. SAFETY ALERT: Using Restraints
5461. Infection Control
5462. Hand Hygiene
5463. Standard Precautions
5464. Implementing Precautions
5465. Family Teaching
5466. Bathing Infants and Children
5467. Special Considerations
5468. FIG 37-3 Using hand to support infant’s neck and head. When giving an infant a tub bath, the nurse supports the infant’s body at all times.
5469. Documentation
5470. Parent Teaching
5471. Oral Hygiene
5472. Feeding
5473. Special Considerations
5474. Documentation
5475. Parent Teaching
5476. Vital Signs
5477. Measuring Temperature
5478. FIG 37-4 Four methods of temperature measurement.
5479. NURSING QUALITY ALERT: Measuring Temperature
5480. Measuring Pulse
5481. Evaluating Respirations
5482. Measuring Blood Pressure
5483. FIG 37-5 Locating the apical pulse. Apical pulse is lateral to the left midclavicular line (MCL) and fourth intercostal space (ICS) in children younger than 7 years and to the left MCL and fifth ICS in children older than 7 years.
5484. FIG 37-6 Blood pressures can be measured in the upper arm, lower arm, thigh, calf, or ankle. An appropriate-size cuff must be used to obtain accurate results.
5485. TABLE 37-1 RECOMMENDED DIMENSIONS FOR BLOOD PRESSURE CUFF BLADDERS
5486. Documenting Vital Sign Measurement
5487. Preparing the Child and Family
5488. Parent Teaching
5489. NURSING QUALITY ALERT: Measuring Vital Signs
5490. Special Considerations: Cardiorespiratory Monitors
5491. Fever-Reducing Measures
5492. Description of Fever
5493. Medications and Environmental Management
5494. DRUG GUIDE: Acetaminophen (Tylenol, Tempra, Panadol)
5495. Specimen Collection
5496. Urine Specimens
5497. Voided Specimens
5498. Urinary Catheterization
5499. PROCEDURE: Urine Specimen Collection from the Incontinent Child
5500. Purpose
5501. Home Adaptations
5502. PROCEDURE: Urinary Catheterization
5503. Purpose
5504. Home Adaptations
5505. BOX 37-2 GUIDELINES FOR URINARY CATHETER SELECTION BY AGE
5506. Stool Specimens
5507. PROCEDURE: Venipuncture
5508. Purpose
5509. Blood Specimens
5510. Jugular and Femoral Venipuncture
5511. FIG 37-7 Two additional sites for obtaining blood specimens from infants and young children are the large superficial external jugular veins and the femoral veins.
5512. Capillary Blood Sampling
5513. PROCEDURE: Capillary Blood Sampling
5514. Purpose
5515. Sputum Specimens
5516. Throat and Nasopharyngeal Specimens
5517. PROCEDURE: Nasal Washing
5518. Purpose
5519. PROCEDURE: Throat or Nasopharyngeal Culture
5520. Purpose
5521. SAFETY ALERT: Throat Cultures
5522. Cerebrospinal Fluid Specimens
5523. Bone Marrow Aspiration
5524. Gastrointestinal Tubes and Enteral Feedings
5525. Tube Route and Placement
5526. Tube Selection
5527. Safety Issues Related to Tube Placement
5528. PROCEDURE: Feeding Tube Insertions
5529. Purpose
5530. Home Adaptations
5531. Contraindications to Tube Placement
5532. Enteral Feedings
5533. NURSING QUALITY ALERT: Enteral Feedings
5534. PROCEDURE: Administering Enteral Feedings (via the Orogastric, Nasogastric, or Nasointestinal Route)
5535. Purpose
5536. Intermittent Feedings (Bolus)
5537. Continuous Feedings
5538. Home Adaptations
5539. Gastrostomy Tubes and Buttons
5540. CRITICAL THINKING EXERCISE 37-1
5541. Enemas
5542. Enema Administration
5543. Solutions and Volumes
5544. Ostomies
5545. TABLE 37-2 RECOMMENDED VOLUME AND DEPTH FOR ENEMA TIP INSERTION, BY AGE
5546. Oxygen Therapy
5547. Oxygen Administration
5548. FIG 37-8 When administering oxygen to children, special consideration is given to the size and type of equipment selected, and the needs of the child and family for education and support. A, Nasal cannula. B, Simple facemask.
5549. Documentation
5550. Parent Teaching
5551. FIG 37-9 A, The pulse oximeter is a reliable, noninvasive method that allows periodic or continuous measurement of blood oxygen saturation. The sensor is applied to a child’s finger (B) or an infant’s toe (C).
5552. Assessing Oxygenation
5553. PROCEDURE: Pulse Oximetry
5554. Purpose
5555. NURSING QUALITY ALERT: Assisting with Arterial Blood Gas Sampling
5556. Tracheostomy Care
5557. Suctioning
5558. Stoma Care
5559. PROCEDURE: Suctioning a Tracheostomy Tube
5560. Purpose
5561. Home Adaptations
5562. PROCEDURE: Care of a Tracheostomy
5563. Purpose
5564. Home Adaptations
5565. Surgical Procedures
5566. Preparation for Surgery
5567. Preoperative Medication and Anesthesia Induction
5568. BOX 37-3 GUIDELINES FOR PREOPERATIVE FASTING
5569. Postanesthesia Care
5570. Postoperative Care
5571. KEY CONCEPTS
5572. References and Readings
5573. Pageburst Integrated Resource
5574. Animation
5575. Chapter 38 Medication Administration and Safety for Infants and Children
5576. LEARNING OBJECTIVES
5577. Pharmacokinetics in Children
5578. Absorption
5579. Oral Route
5580. FIG 38-1 Physiologic differences between children and adults affect drug absorption, metabolism, distribution, and excretion. These differences are most significant for infants.
5581. Gastric Acidity
5582. Gastric Emptying
5583. Gastrointestinal Motility
5584. Enzyme Activity
5585. Other Routes
5586. Distribution
5587. Differences in Body Fluids
5588. Differences in Fat Percentages
5589. Differences in Proteins
5590. Blood-Brain Barrier
5591. Metabolism
5592. Excretion
5593. Concentration
5594. Psychological and Developmental Factors
5595. PARENTS WANT TO KNOW: Medication Administration and Parent Roles
5596. Infants
5597. Toddlers and Preschoolers
5598. School-Age Children
5599. Adolescents
5600. Calculating Dosages
5601. FIG 38-2 Nomogram for calculating body surface area (BSA), which is used for determining medication dosages for infants and children.
5602. Medication Administration Procedures
5603. Medication Reconciliation
5604. Administering Oral Medications
5605. CRITICAL THINKING EXERCISE 38-1
5606. Preparation
5607. FIG 38-3 Administering an oral medication to an infant using an oral syringe.
5608. CRITICAL THINKING EXERCISE 38-2
5609. Administration
5610. FIG 38-4 Two methods of holding a child for an intramuscular (IM) injection at the vastus lateralis site.
5611. Alternative Routes for Oral Medications
5612. Administering Injections
5613. Intramuscular Injections
5614. TABLE 38-1 PREFERRED INTRAMUSCULAR INJECTION SITES IN CHILDREN
5615. SAFETY ALERT: Guidelines for Maximum Safe Volumes for Intramuscular Injections∗
5616. CRITICAL THINKING EXERCISE 38-3
5617. Subcutaneous Injections
5618. Intradermal Injections
5619. Rectal Administration
5620. FIG 38-5 Two of the preferred subcutaneous injection sites for infants and toddlers.
5621. FIG 38-6 Intradermal injection site and technique.
5622. Vaginal Administration
5623. Ophthalmic Administration
5624. Otic Administration
5625. Nasal Administration
5626. Topical Administration
5627. PROCEDURE: Administering Otic Drops
5628. Purpose
5629. PROCEDURE: Administering an Ophthalmic Preparation
5630. Purpose
5631. Inhalation Therapy
5632. FIG 38-7 Administration of nebulized medication to an infant.
5633. Intravenous Therapy
5634. Intravenous Catheter Insertion
5635. FIG 38-8 Venous access sites in children.
5636. PROCEDURE: Using a Metered-Dose Inhaler (MDI)
5637. Purpose
5638. NURSING QUALITY ALERT: Using EMLA Anesthetic Cream
5639. FIG 38-9 Intravenous (IV) sites in children are secured and well-protected to allow for activities and prevent dislodging the IV catheter. A foot vein is an acceptable IV site for an infant who is not walking or crawling. A padded arm board gently limits movement of the hand, and a plastic shield allows visibility yet keeps the IV site intact.
5640. Intravenous Catheter Monitoring
5641. Intravenous Infusion Monitoring
5642. FIG 38-10 Alaris® System intravenous (IV) infusion pump.
5643. Infusion Rates and Methods
5644. Administering Intravenous Medications
5645. Intravenous Bolus Administration
5646. BOX 38-1 DAILY MAINTENANCE FLUID REQUIREMENTS AND RATES Formula for Calculating Daily Fluid Requirements∗
5647. Example 1:
5648. Example 2:
5649. Example 3:
5650. Intravenous Intermittent Infusion Administration
5651. CRITICAL THINKING EXERCISE 38-4
5652. Venous Access Devices
5653. Intermittent Infusion Ports
5654. Central Venous Access Devices
5655. Administration of Blood Products
5656. Child and Family Education
5657. PARENTS WANT TO KNOW: Medication Administration at Home
5658. KEY CONCEPTS
5659. References and Readings
5660. Pageburst Integrated Resource
5661. Animation
5662. Chapter 39 Pain Management for Children
5663. LEARNING OBJECTIVES
5664. Definitions and Theories of Pain
5665. Gate Control Theory
5666. Acute and Chronic Pain
5667. Research on Pain in Children
5668. TABLE 39-1 PAIN AND PAIN MANAGEMENT IN CHILDREN: MYTHS AND REALITIES
5669. Obstacles to Pain Management in Children
5670. BOX 39-1 PAIN MANAGEMENT RESOURCES ON THE INTERNET
5671. Assessment of Pain in Children
5672. BOX 39-2 INDICATORS OF PAIN ACCORDING TO DEVELOPMENTAL LEVELS
5673. Neonate and Infant
5674. Toddler
5675. Preschooler
5676. School-Age Child
5677. Adolescent
5678. Assessment According to Developmental Level
5679. Neonates and Infants
5680. Toddlers
5681. FIG 39-1 Infant total body response to pain with arms thrashing, tremors, and vigorous crying.
5682. CRITICAL THINKING EXERCISE 39-1
5683. Preschoolers
5684. School-Age Children
5685. FIG 39-2 Toddlers and preschoolers may express pain by guarding or touching the painful area. The toddler pulling on his ear is a characteristic expression of ear pain from otitis media.
5686. FIG 39-3 School-age children may become very quiet and withdrawn when ill or in pain. The child with asthma is not attentive or active; his mother knew that something was wrong because of his withdrawn behavior.
5687. Adolescents
5688. TABLE 39-2 PAIN ASSESSMENT TOOLS
5689. NURSING QUALITY ALERT: Assessing Pain in Children
5690. Assessment Tools
5691. Non-Pharmacologic and Pharmacologic Pain Interventions
5692. FIG 39-4 A, The Hispanic version of the Oucher pain scale. B, The African-American version.
5693. FIG 39-5 FACES Pain Rating Scale. Explain to the child that each face is for a person who feels happy because he or she has no pain (hurt) or sad because he or she has some or a lot of pain. Ask the child to choose the face that best describes his or her own pain.
5694. FIG 39-6 Adolescent and Pediatric Pain Tool (APPT). Use with 8- to 17-year-olds.
5695. BOX 39-3 PAIN EXPERIENCE HISTORY
5696. Child Form∗
5697. Parent Form
5698. Non-Pharmacologic Interventions
5699. PATIENT-CENTERED TEACHING: Pain Management for Children at Home
5700. FIG 39-7 The boy listens to music, which serves as a distraction to refocus attention and reduce pain.
5701. TABLE 39-3 NON-PHARMACOLOGIC PAIN RELIEF TECHNIQUES
5702. Pharmacologic Interventions
5703. Administration of Analgesics
5704. NURSING QUALITY ALERT: Disadvantages of Intramuscular (IM) Analgesics
5705. Patient-Controlled Analgesia
5706. FIG 39-8 Patient-controlled analgesia (PCA) allows the child greater control over her own pain management.
5707. BOX 39-4 ASPECTS OF PATIENT-CONTROLLED ANALGESIA (PCA) ORDERS
5708. Topical Anesthetic Agents
5709. Acetaminophen and Antiinflammatory Drugs
5710. DRUG GUIDE: Ibuprofen
5711. DRUG GUIDE: Acetaminophen
5712. DRUG GUIDE: Ketorolac
5713. Opioids
5714. DRUG GUIDE: Codeine
5715. DRUG GUIDE: Hydrocodone
5716. DRUG GUIDE: Oxycodone
5717. DRUG GUIDE: Morphine
5718. DRUG GUIDE: Hydromorphone
5719. DRUG GUIDE: Fentanyl
5720. Procedural Sedation
5721. NURSING QUALITY ALERT: Pain Management for Children
5722. DRUG GUIDE: Methadone
5723. Epidural Analgesia
5724. KEY CONCEPTS
5725. References and Readings
5726. Chapter 40 The Child with a Fluid and Electrolyte Alteration
5727. LEARNING OBJECTIVES
5728. Clinical Reference
5729. Review of Fluid and Electrolyte Imbalances in Children
5730. PEDIATRIC DIFFERENCES RELATED TO FLUID AND ELECTROLYTE BALANCE
5731. Infants
5732. Infants and Young Children
5733. Infants and Children
5734. Alterations in Acid-Base Balance in Children
5735. NURSING QUALITY ALERT: Treatment Goals in Acid-Base Imbalance
5736. OVERVIEW OF FLUID AND ELECTROLYTE DISORDERS
5737. ASSESSMENT OF FLUID DISTURBANCES
5738. COMMON LABORATORY AND DIAGNOSTIC TESTS FOR FLUID AND ELECTROLYTE IMBALANCE∗
5739. SELECTED LABORATORY VALUES FOR ACID-BASE DISTURBANCES
5740. • ACID-BASE DISTURBANCES: PRINCIPAL CAUSES, CLINICAL MANIFESTATIONS, AND TREATMENT
5741. Dehydration ExemplarDehydration
5742. Etiology and Incidence
5743. Manifestations
5744. TABLE 40-1 TYPES OF DEHYDRATION: ETIOLOGY, CLINICAL MANIFESTATIONS, AND LABORATORY VALUES
5745. SAFETY ALERT: Signs of Impending Shock in the Dehydrated Child
5746. TABLE 40-2 ASSESSMENT OF THE SEVERITY OF DEHYDRATION
5747. PATHOPHYSIOLOGY: Dehydration
5748. Diagnostic Evaluation
5749. Therapeutic Management
5750. Minimal Dehydration
5751. TABLE 40-3 ORAL REPLACEMENT AND REHYDRATION THERAPY IN CHILDREN WITH VOMITING OR DIARRHEA
5752. Mild to Moderate Dehydration
5753. Severe Dehydration
5754. BOX 40-1 MAINTENANCE FLUID REQUIREMENTS AND MINIMUM URINE OUTPUT
5755. Daily Fluid Requirements by Body Weight
5756. Minimum Urine Output by Age-Group
5757. SAFETY ALERT: Guidelines When Administering Potassium
5758. Adjunctive Management
5759. Nursing Care
5760. The Child with Dehydration
5761. Assessment
5762. FIG 40-1 Testing skin turgor. Turgor refers to the elasticity of the skin, which is affected by the extent of hydration. The nurse tests turgor by gently grasping the skin. When the skin is released, it should instantly spring back into place; if it does not, tissue turgor is considered poor.
5763. Nursing Diagnosis and Planning
5764. Expected Outcome
5765. Expected Outcomes
5766. Interventions
5767. PATIENT-CENTERED TEACHING: Dehydration
5768. Signs and Symptoms of Dehydration
5769. Evaluation
5770. Diarrhea ExemplarDiarrhea
5771. EVIDENCE-BASED PRACTICE
5772. CRITICAL THINKING EXERCISE 40-1
5773. Etiology and Incidence
5774. PATHOPHYSIOLOGY: Diarrhea
5775. Manifestations
5776. Diagnostic Evaluation
5777. Therapeutic Management
5778. TABLE 40-4 CAUSES AND MANIFESTATIONS OF DIARRHEA IN INFANTS AND CHILDREN
5779. Prognosis
5780. Nursing Care
5781. The Child with Diarrhea
5782. Assessment
5783. Nursing Diagnosis and Planning
5784. Expected Outcomes
5785. Expected Outcomes
5786. Expected Outcomes
5787. Expected Outcome
5788. Interventions
5789. PATIENT-CENTERED TEACHING: Caring for a Child with Diarrhea
5790. Diet
5791. Mild Diarrhea (Mushy Stools) in Children of Any Age
5792. Moderate Diarrhea (Watery or Frequent Stools) in Children Younger than 1 Year
5793. Moderate Diarrhea (Watery or Frequent Stools) in Children Older than 1 Year
5794. Preventing the Spread of Infection
5795. Skin Care
5796. When to Call the Physician
5797. Oral Rehydration Therapy
5798. Evaluation
5799. CRITICAL THINKING EXERCISE 40-2
5800. Vomiting ExemplarVomiting
5801. Etiology
5802. Manifestations
5803. Diagnostic Evaluation
5804. Therapeutic Management
5805. PATHOPHYSIOLOGY: Vomiting
5806. Nursing Care
5807. The Vomiting Child
5808. Assessment
5809. NURSING QUALITY ALERT: Caring for the Child Who Is Vomiting
5810. Nursing Diagnosis and Planning
5811. Expected Outcomes
5812. Expected Outcomes
5813. Interventions
5814. Evaluation
5815. KEY CONCEPTS
5816. References and Readings
5817. Chapter 41 The Child with an Infectious Disease
5818. Learning Objectives
5819. Clinical Reference
5820. Review of Disease Transmission
5821. Chain of Infection
5822. Transmission of Pathogens
5823. Epidemiologic Investigations
5824. Infection and Host Defenses
5825. Immunity
5826. Viral Exanthems
5827. Nursing Considerations for the Child with a Viral Exanthem Infection
5828. Rubeola (Measles)
5829. Manifestations
5830. FIG 41-1 Sample notification letter from school nurse informing parents and caregivers about an exposure to an infectious disease.
5831. NURSING CARE PLAN: The Child with an Infection in the Community Setting
5832. Focused Assessment
5833. Nursing Diagnosis
5834. Planning
5835. Expected Outcomes
5836. Interventions and Rationales
5837. Evaluation
5838. Nursing Diagnosis
5839. Planning
5840. Expected Outcomes
5841. Interventions and Rationales
5842. Evaluation
5843. Nursing Diagnosis
5844. Planning
5845. Expected Outcome
5846. Interventions and Rationales
5847. Evaluation
5848. Nursing Diagnosis
5849. Planning
5850. Expected Outcomes
5851. Interventions and Rationales
5852. Evaluation
5853. Nursing Diagnosis
5854. Planning
5855. Expected Outcomes
5856. Interventions and Rationales
5857. Evaluation
5858. PATIENT-CENTERED TEACHING: How to Care for the Child with a Viral Exanthem
5859. Complications
5860. FIG 41-2 Rubeola (measles) lesions and rash distribution.
5861. Therapeutic Management
5862. Rubella (German Measles, 3-Day Measles)
5863. Manifestations
5864. Complications
5865. FIG 41-3 Rubella (German measles) lesions and rash distribution.
5866. FIG 41-4 Erythema infectiosum lesions and rash distribution.
5867. Therapeutic Management
5868. SAFETY ALERT: Congenital Rubella
5869. Erythema Infectiosum (Fifth Disease, Parvovirus B19)
5870. Manifestations
5871. Complications
5872. FIG 41-5 Roseola infantum lesions and rash distribution.
5873. Therapeutic Management
5874. Roseola Infantum (Exanthem Subitum)
5875. Manifestations
5876. Complications
5877. Therapeutic Management
5878. Enterovirus (Nonpolio) Infections (Coxsackieviruses, Group A and Group B), Echoviruses, and Enteroviruses
5879. Manifestations
5880. Complications
5881. Therapeutic Management
5882. FIG 41-6 Coxsackievirus mouth lesions.
5883. Nursing Considerations
5884. Varicella-Zoster Infections (Chickenpox, Shingles)
5885. FIG 41-7 Chickenpox and shingles lesions and rash distribution.
5886. Manifestations
5887. Varicella
5888. Herpes Zoster (Shingles)
5889. Complications
5890. Therapeutic Management
5891. Nursing Considerations
5892. SAFETY ALERT: Varicella and the Immunocompromised Child
5893. Other Viral Infections
5894. Mumps
5895. Manifestations
5896. Complications
5897. Therapeutic Management
5898. Nursing Considerations
5899. Cytomegalovirus (CMV)
5900. Therapeutic Management
5901. Nursing Considerations
5902. Epstein-Barr Virus (Infectious Mononucleosis)
5903. Manifestations
5904. Complications
5905. Therapeutic Management
5906. Nursing Considerations
5907. PATIENT-CENTERED TEACHING: How to Care for the Child with Infectious Mononucleosis
5908. Rabies
5909. Manifestations
5910. Therapeutic Management
5911. Nursing Considerations
5912. Bacterial Infections
5913. Pertussis (Whooping Cough)
5914. Manifestations
5915. Complications
5916. Therapeutic Management
5917. BOX 41-1 STAGES OF MANIFESTATION OF PERTUSSIS
5918. Catarrhal
5919. Paroxysmal
5920. Convalescent
5921. Nursing Considerations
5922. Scarlet Fever
5923. Manifestations
5924. Complications
5925. Therapeutic Management
5926. Nursing Considerations
5927. Methicillin-Resistant Staphylococcus aureus (MRSA)
5928. FIG 41-8 Scarlet fever rash distribution and appearance. Note the characteristic skin peeling.
5929. PATIENT-CENTERED TEACHING: How to Care for the Child with Scarlet Fever
5930. Manifestations
5931. Therapeutic Management
5932. Nursing Considerations
5933. Clostridium difficile
5934. Manifestations
5935. Therapeutic Management
5936. Nursing Considerations
5937. Serious Bacterial Illness in Infants
5938. Rare Viral and Bacterial Infections
5939. Fungal Infections
5940. Rickettsial Infections
5941. Rocky Mountain Spotted Fever
5942. Manifestations
5943. Therapeutic Management
5944. TABLE 41-1 RARE VIRAL AND BACTERIAL INFECTIONS
5945. Nursing Considerations
5946. Borrelia Infections
5947. Relapsing Fever
5948. FIG 41-9 Lesions of variola are at the same stage of development on all body parts.
5949. BOX 41-2 PREVENTIVE MEASURES TO AVOID INSECT AND TICK BITES
5950. Manifestations
5951. FIG 41-10 Dog (wood) ticks and deer (black-legged) ticks compared with a pencil. Dog ticks: A, engorged female; B, female; C, male. Deer ticks: D, larvae; E, nymphs; F, males; G, females; H, engorged female.
5952. Therapeutic Management
5953. Nursing Considerations
5954. Lyme Disease
5955. FIG 41-11 Characteristic lesion of Lyme disease.
5956. Manifestations
5957. Therapeutic Management
5958. Nursing Considerations
5959. Helminths
5960. Therapeutic Management
5961. Nursing Considerations
5962. TABLE 41-2 COMMON HELMINTHS
5963. PATIENT-CENTERED TEACHING: How to Prevent Parasitic Infections
5964. Sexually transmitted infections ExemplarSexually Transmitted Diseases
5965. Chlamydial Infection
5966. PATIENT-CENTERED TEACHING: Sexually Transmitted Diseases
5967. Manifestations
5968. Therapeutic Management
5969. Gonorrhea
5970. Manifestations
5971. Therapeutic Management
5972. Herpes Simplex Virus
5973. Manifestations
5974. Therapeutic Management
5975. CRITICAL THINKING EXERCISE 41-1
5976. Human Papillomavirus
5977. Manifestations
5978. Therapeutic Management
5979. Bacterial Vaginosis
5980. Manifestations
5981. Syphilis
5982. Manifestations
5983. Therapeutic Management
5984. Trichomoniasis
5985. Manifestations
5986. Therapeutic Management
5987. Nursing Considerations
5988. EVIDENCE-BASED PRACTICE
5989. KEY CONCEPTS
5990. References and Readings
5991. Chapter 42 The Child with an Immunologic Alteration
5992. Learning Objectives
5993. CLINICAL REFERENCE
5994. Review of the Immune System
5995. Nonspecific Immune Functions
5996. Specific Immune Functions
5997. The Humoral Response
5998. CELLS INVOLVED IN THE IMMUNE RESPONSE
5999. PEDIATRIC DIFFERENCES IN THE IMMUNE SYSTEM
6000. The Organs of the Immune System Mature during Infancy and Childhood
6001. Immaturity of the Immunologic System Places the Infant and Young Child at Greater Risk for Infection
6002. Disorders of the Immune System Manifest Differently in Children than in Adults
6003. The Cell-Mediated Response
6004. Development of Immunity
6005. Active Acquired Immunity
6006. Passive Acquired Immunity
6007. IMMUNOGLOBULIN FUNCTION AND PEDIATRIC IMPLICATIONS
6008. Common Laboratory and Diagnostic Tests of Immune Function
6009. Immunodeficiencies
6010. Allergy
6011. COMMON LABORATORY AND DIAGNOSTIC TESTS OF IMMUNE FUNCTION
6012. LABORATORY AND CLINICAL SCREENING TESTS FOR ALLERGY
6013. Human Immunodeficiency Virus Infection
6014. Etiology
6015. CRITICAL THINKING EXERCISE 42-1
6016. Incidence
6017. PATHOPHYSIOLOGY: HIV Infection
6018. Manifestations
6019. BOX 42-1 CLINICAL FINDINGS ASSOCIATED WITH IMMUNODEFICIENCY
6020. Frequently Present, Highly Indicative Signs
6021. Frequently Present, Somewhat Suggestive Signs
6022. Diagnostic Evaluation
6023. Diagnosing HIV-Exposed Infants
6024. Ongoing Diagnostic Monitoring
6025. Therapeutic Management
6026. HIV-Exposed Infants
6027. HIV-Infected Infants and Children
6028. Treatment Considerations
6029. Treatment Initiation
6030. Additional Issues Related to the Child with HIV Infection
6031. Multigenerational Problems
6032. TABLE 42-1 CONSIDERATIONS FOR INITIATING ANTIRETROVIRAL MEDICATIONS IN INFANTS AND CHILDREN WITH HIV
6033. Disclosure
6034. NURSING CARE PLAN: The Child with HIV Infection in the Community
6035. Focused Assessment
6036. Nursing Diagnosis
6037. Planning
6038. Expected Outcome
6039. Interventions and Rationales
6040. Evaluation
6041. Nursing Diagnosis
6042. Planning
6043. Expected Outcomes
6044. Interventions and Rationales
6045. Evaluation
6046. Nursing Diagnosis
6047. Planning
6048. Expected Outcomes
6049. Interventions and Rationales
6050. Evaluation
6051. TABLE 42-2 RECOMMENDATIONS FOR ROUTINE IMMUNIZATION OF HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN IN THE UNITED STATES
6052. HIV and School Settings
6053. PATIENT-CENTERED TEACHING: How to Care for the Child with an HIV Infection
6054. Transmission
6055. Prevention
6056. Testing
6057. Illness (AIDS)
6058. Medications
6059. Home Care
6060. NURSING CARE PLAN: The Adolescent with HIV Infection
6061. Focused Assessment
6062. Nursing Diagnosis
6063. Planning
6064. Expected Outcomes
6065. Interventions and Rationales
6066. Evaluation
6067. Corticosteroid Therapy
6068. Incidence
6069. Pathophysiology
6070. DRUG GUIDE: Prednisolone (Pediapred, Prelone)
6071. Manifestations
6072. Diagnostic Evaluation
6073. Therapeutic Management
6074. Nursing Care
6075. The Child Receiving Corticosteroids
6076. Assessment
6077. Nursing Diagnosis and Planning
6078. Expected Outcome
6079. Expected Outcome
6080. Expected Outcome
6081. Expected Outcomes
6082. Expected Outcome
6083. Interventions
6084. SAFETY ALERT: The Child Taking Oral Corticosteroids
6085. Evaluation
6086. Immune Complex and Autoimmune Disorders
6087. Immune Complex Disorders
6088. Autoimmune Disorders
6089. Systemic Lupus Erythematosus
6090. Etiology
6091. Incidence
6092. Manifestations
6093. PATHOPHYSIOLOGY: Systemic Lupus Erythematosus
6094. Diagnostic Evaluation
6095. FIG 42-1 The butterfly rash of systemic lupus erythematosus.
6096. Therapeutic Management
6097. Nursing Care
6098. The Child with Systemic Lupus Erythematosus
6099. Assessment
6100. Nursing Diagnosis and Planning
6101. Expected Outcome
6102. Expected Outcome
6103. Expected Outcome
6104. Expected Outcome
6105. Expected Outcome
6106. Interventions
6107. TABLE 42-3 CLASSIFICATION OF ALLERGIC REACTIONS
6108. Evaluation
6109. Allergic Reactions
6110. TABLE 42-4 COMMON ALLERGIC CONDITIONS IN CHILDREN
6111. Anaphylaxis
6112. Etiology
6113. Incidence
6114. PATHOPHYSIOLOGY: Anaphylaxis
6115. Manifestations
6116. Diagnostic Evaluation
6117. Therapeutic Management
6118. Nursing Care
6119. The Child with Anaphylaxis
6120. Assessment
6121. Nursing Diagnosis and Planning
6122. Expected Outcome
6123. Expected Outcome
6124. Interventions
6125. PATIENT-CENTERED TEACHING: Communicating with the School about Peanut Allergies
6126. Evaluation
6127. PATIENT-CENTERED TEACHING: How to Prevent Insect Stings
6128. KEY CONCEPTS
6129. References and Readings
6130. Chapter 43 The Child with a Gastrointestinal Alteration
6131. Learning Objectives
6132. CLINICAL REFERENCE
6133. Review of the Gastrointestinal System
6134. Upper Gastrointestinal System
6135. Lower Gastrointestinal System
6136. Prenatal Development
6137. COMMON LABORATORY AND DIAGNOSTIC TESTS FOR GI DISORDERS
6138. MAJOR DIGESTIVE ENZYMES
6139. PEDIATRIC DIFFERENCES IN THE GASTROINTESTINAL SYSTEM
6140. Disorders of Prenatal Development
6141. Cleft Lip and Palate
6142. Incidence
6143. PATHOPHYSIOLOGY: Cleft Lip and Palate
6144. Child born with a cleft lip and palate, before (A) and after (B) repair. Repair of facial clefts usually requires multiple surgeries at different stages in the child’s growth. Early repair of a cleft lip facilitates parent-infant bonding and improves feeding. Children generally experience good outcomes with today’s surgical, orthodontic, and speech therapy techniques.
6145. Manifestations and Diagnostic Evaluation
6146. Therapeutic Management
6147. FIG 43-1 Before and after repair of a cleft lip or palate, special feeding techniques are essential for adequate nutrition. A feeder with compressible plastic sides allows gentle squeezing of the sides of the bottle to help eject the breast milk or formula. A slightly longer nipple allows the milk to be swallowed with less chance of milk entering the nasopharynx and without stimulating the gag reflex.
6148. Esophageal Atresia with Tracheoesophageal Fistula
6149. Etiology and Incidence
6150. Manifestations
6151. Diagnostic Evaluation
6152. NURSING CARE PLAN: The Child with a Cleft Lip or Palate
6153. Focused Assessment
6154. Nursing Diagnoses
6155. Planning
6156. Expected Outcomes
6157. Interventions and Rationales
6158. Evaluation
6159. Nursing Diagnosis
6160. Planning
6161. Expected Outcomes
6162. Interventions and Rationales
6163. Evaluation
6164. Nursing Diagnoses
6165. Planning
6166. Expected Outcomes
6167. Interventions and Rationales
6168. Evaluation
6169. Nursing Diagnosis
6170. Planning
6171. Expected Outcome
6172. Interventions and Rationales
6173. Evaluation
6174. Nursing Diagnosis
6175. Plannning
6176. Expected Outcomes
6177. Interventions and Rationales
6178. Evaluation
6179. Nursing Diagnosis
6180. Planning
6181. Expected Outcomes
6182. Interventions and Rationales
6183. Evaluation
6184. PATIENT-CENTERED TEACHING: Home Care of the Child with Cleft Lip or Palate
6185. FIG 43-2 Most common type of esophageal atresia (EA) and tracheoesophageal fistula (TEF).
6186. Therapeutic Management
6187. PATHOPHYSIOLOGY: Esophageal Atresia and Tracheoesophageal Fistula
6188. Nursing Care
6189. The Infant with Tracheoesophageal Fistula
6190. Assessment
6191. Nursing Diagnosis and Planning
6192. Expected Outcome
6193. Expected Outcomes
6194. Expected Outcome
6195. Expected Outcomes
6196. Expected Outcome
6197. Expected Outcome
6198. Expected Outcome
6199. SAFETY ALERT: Assessing and Managing the Child with Esophageal Atresia and Tracheoesophageal Fistula
6200. Interventions
6201. Minimizing Aspiration Risk
6202. Postoperative Care
6203. Gastrostomy Tube Use
6204. Home Care
6205. FIG 43-3 The skin-level gastrostomy button is good for children who require long-term gastrostomy feeding. It is relatively flat, reduces skin breakdown, increases comfort, and is fully immersible in water.
6206. Evaluation
6207. Upper Gastrointestinal Hernias
6208. Other Developmental Disorders
6209. Motility Disorders
6210. Gastroesophageal Reflux Disease
6211. Etiology
6212. Incidence
6213. TABLE 43-1 UPPER GI HERNIAS
6214. Manifestations and Diagnostic Evaluation
6215. Therapeutic Management
6216. TABLE 43-2 DEVELOPMENTAL GI DEFECTS
6217. BOX 43-1 TYPES OF GASTROESOPHAGEAL REFLUX
6218. Physiologic (Gastroesophageal Reflux [GER])
6219. Pathologic (Gastroesophageal Reflux Disease [GERD])
6220. PATIENT-CENTERED TEACHING: Home Care of the Child with a Gastrostomy Tube
6221. Diet
6222. Positioning
6223. Medications
6224. Treatment of Acute Bleeding
6225. PATHOPHYSIOLOGY: Gastroesophageal Reflux
6226. Surgery
6227. Nursing Care
6228. The Infant with Gastroesophageal Reflux Disease
6229. Assessment
6230. Nursing Diagnosis and Planning
6231. Expected Outcome
6232. Expected Outcomes
6233. Expected Outcomes
6234. Expected Outcomes
6235. Expected Outcomes
6236. Interventions
6237. Minimizing Reflux
6238. Family Education and Support
6239. Evaluation
6240. Constipation ExemplarConstipation and Encopresis
6241. PATHOPHYSIOLOGY: Constipation and Encopresis
6242. Etiology and Incidence
6243. Manifestations
6244. Constipation
6245. Encopresis
6246. Diagnostic Evaluation
6247. Therapeutic Management
6248. Nursing Care
6249. The Child with Constipation or Encopresis
6250. Assessment
6251. Nursing Diagnosis and Planning
6252. Expected Outcome
6253. Expected Outcomes
6254. Expected Outcomes
6255. Expected Outcome
6256. Interventions
6257. Overcoming Withholding
6258. Dietary Changes
6259. Changing the Retention Habit
6260. Emotional Support
6261. Home Care
6262. Evaluation
6263. Recurrent Abdominal Pain/Irritable Bowel Syndrome
6264. Etiology and Incidence
6265. Manifestations and Diagnostic Evaluation
6266. Therapeutic Management and Nursing Considerations
6267. PATHOPHYSIOLOGY: Irritable Bowel Syndrome
6268. Inflammatory and Infectious Disorders
6269. Ulcers
6270. PATHOPHYSIOLOGY: Ulcers
6271. Etiology
6272. Incidence
6273. Manifestations and Diagnostic Evaluation
6274. Therapeutic Management
6275. Nursing Considerations
6276. Providing Information
6277. Home Care
6278. Infectious Gastroenteritis
6279. Etiology
6280. PARENTS WANT TO KNOW: Care of the Child with an Ulcer
6281. Incidence
6282. TABLE 43-3 CHARACTERISTICS OF INFECTIOUS GASTROENTERITIS
6283. Manifestations
6284. PATHOPHYSIOLOGY: Infectious Gastroenteritis
6285. Diagnostic Evaluation
6286. Therapeutic Management
6287. Nursing Care
6288. The Child with Infectious Gastroenteritis
6289. Assessment
6290. Nursing Diagnosis and Planning
6291. Expected Outcomes
6292. Expected Outcome
6293. Expected Outcome
6294. Expected Outcomes
6295. Expected Outcomes
6296. Expected Outcome
6297. Interventions
6298. Maintaining Fluid Balance
6299. Decreasing Risk
6300. Home Care
6301. PATIENT-CENTERED TEACHING: Care of the Child with Infectious Gastroenteritis
6302. Evaluation
6303. Appendicitis
6304. Etiology and Incidence
6305. Manifestations and Diagnostic Evaluation
6306. PATHOPHYSIOLOGY: Appendicitis
6307. FIG 43-4 McBurney point is midway between the right anterior superior iliac crest and the umbilicus. It is usually the location of greatest pain in the child with appendicitis.
6308. Therapeutic Management
6309. Nursing Care
6310. The Child with Appendicitis
6311. Assessment
6312. Nursing Diagnosis and Planning
6313. Expected Outcome
6314. Expected Outcomes
6315. Expected Outcome
6316. Expected Outcomes
6317. NURSING QUALITY ALERT: Assessing Appendicitis in the Young Child
6318. Interventions
6319. Uncomplicated Appendicitis
6320. Ruptured Appendix
6321. Home Care
6322. Evaluation
6323. Ulcerative colitis ExemplarInflammatory Bowel Disease
6324. Etiology
6325. Incidence, Manifestations, and Diagnostic Evaluation
6326. Therapeutic Management
6327. TABLE 43-4 CROHN DISEASE AND ULCERATIVE COLITIS
6328. Nursing Care
6329. The Child with Inflammatory Bowel Disease
6330. Assessment
6331. Nursing Diagnosis and Planning
6332. Expected Outcomes
6333. Expected Outcome
6334. Expected Outcome
6335. Expected Outcome
6336. Expected Outcomes
6337. Expected Outcomes
6338. Expected Outcomes
6339. Interventions
6340. Medications
6341. Nutritional Management
6342. Family Education and Support
6343. PATHOPHYSIOLOGY: Inflammatory Bowel Disease
6344. Home Care
6345. Evaluation
6346. Obstructive Disorders
6347. Hypertrophic Pyloric Stenosis
6348. Etiology and Incidence
6349. Manifestations
6350. PATHOPHYSIOLOGY: Hypertrophic Pyloric Stenosis
6351. Diagnostic Evaluation
6352. Therapeutic Management
6353. NURSING QUALITY ALERT: Gathering Information from a Parent About Infant Vomiting
6354. Nursing Care
6355. The Child with Hypertrophic Pyloric Stenosis
6356. Assessment
6357. Nursing Diagnosis and Planning
6358. Expected Outcomes
6359. Expected Outcomes
6360. Expected Outcomes
6361. Expected Outcomes
6362. Expected Outcomes
6363. Expected Outcomes
6364. Interventions
6365. Preoperative Care
6366. Postoperative Care
6367. Home Care
6368. Evaluation
6369. CRITICAL THINKING EXERCISE 43-1
6370. Intussusception
6371. Etiology and Incidence
6372. Manifestations and Diagnostic Evaluation
6373. Therapeutic Management
6374. Nursing Care
6375. The Child with Intussusception
6376. Assessment
6377. PATHOPHYSIOLOGY: Intussusception
6378. Nursing Diagnosis and Planning
6379. Expected Outcome
6380. Expected Outcome
6381. Expected Outcomes
6382. Expected Outcomes
6383. Expected Outcomes
6384. Expected Outcome
6385. Interventions
6386. Initial Care
6387. Post Reduction Care
6388. Family Education and Support
6389. Evaluation
6390. Volvulus
6391. Hirschsprung Disease
6392. Etiology and Incidence
6393. Manifestations and Diagnostic Evaluation
6394. PATHOPHYSIOLOGY: Hirschsprung Disease
6395. Therapeutic Management
6396. Nursing Care
6397. The Child with Hirschsprung Disease
6398. Assessment
6399. Nursing Diagnoses and Planning
6400. Expected Outcome
6401. Expected Outcomes
6402. Expected Outcomes
6403. Expected Outcome
6404. Expected Outcomes
6405. Expected Outcomes
6406. Expected Outcomes
6407. Expected Outcomes
6408. Expected Outcomes
6409. Interventions
6410. Preparing the Child for Surgery
6411. Preventing Infection and Maintaining Skin Integrity
6412. Maintaining Nutritional and Hydration Status
6413. Reducing Pain
6414. Providing Education and Relieving Anxiety
6415. Evaluation
6416. Malabsorption syndromes ExemplarMalabsorption Disorders
6417. Lactose Intolerance
6418. Etiology and Incidence
6419. Manifestations and Diagnostic Evaluation
6420. Therapeutic Management
6421. PATHOPHYSIOLOGY: Lactose Intolerance
6422. Nursing Care
6423. The Child with Lactose Intolerance
6424. Assessment
6425. PARENTS WANT TO KNOW: Care of the Child with Lactose Intolerance
6426. Nursing Diagnosis and Planning
6427. Expected Outcomes
6428. Expected Outcome
6429. Expected Outcomes
6430. Interventions
6431. Evaluation
6432. Celiac Disease
6433. Etiology and Incidence
6434. Manifestations
6435. Diagnostic Evaluation
6436. PATHOPHYSIOLOGY: Celiac Disease
6437. Therapeutic Management
6438. Nursing Care
6439. The Child with Celiac Disease
6440. Assessment
6441. Nursing Diagnosis and Planning
6442. Expected Outcome
6443. Expected Outcome
6444. Expected Outcome
6445. Expected Outcomes
6446. Expected Outcome
6447. Interventions
6448. PATIENT-CENTERED TEACHING: Care of the Child with Celiac Disease
6449. Evaluation
6450. Short Bowel Syndrome
6451. Etiology and Incidence
6452. Pathophysiology
6453. Manifestations
6454. Therapeutic Management
6455. Nursing Considerations
6456. Hepatic Disorders
6457. Viral Hepatitis
6458. Etiology
6459. Incidence
6460. TABLE 43-5 DIFFERENTIATION OF VIRAL HEPATITIS
6461. Manifestations
6462. PATHOPHYSIOLOGY: Viral Hepatitis
6463. Diagnostic Evaluation
6464. Therapeutic Management
6465. Hepatitis A
6466. Hepatitis B
6467. Nursing Care
6468. The Child with Viral Hepatitis
6469. Assessment
6470. TABLE 43-6 HEPATITIS PROPHYLAXIS
6471. Nursing Diagnosis and Planning
6472. Expected Outcomes
6473. Expected Outcomes
6474. Expected Outcomes
6475. Expected Outcomes
6476. Interventions
6477. Child and Parent Teaching
6478. Home Care
6479. Evaluation
6480. Biliary Atresia
6481. Etiology and Incidence
6482. Manifestations
6483. Diagnostic Evaluation
6484. Therapeutic Management
6485. Nursing Considerations
6486. Nutritional Support
6487. Skin Care
6488. Developmental Stimulation
6489. Continued Assessment
6490. Family Education and Support
6491. PATHOPHYSIOLOGY: Biliary Atresia
6492. Home Care
6493. Cirrhosis
6494. PATHOPHYSIOLOGY: Cirrhosis
6495. Etiology
6496. Incidence
6497. Manifestations
6498. Diagnostic Evaluation
6499. Therapeutic Management
6500. Nursing Considerations
6501. Nutritional Support
6502. Skin Care
6503. Prevention of Complications
6504. Developmental and Parental Support
6505. Home Care
6506. KEY CONCEPTS
6507. References and Readings
6508. Pageburst Integrated Resource
6509. Animation
6510. Chapter 44 The Child with a Genitourinary Alteration
6511. Learning Objectives
6512. CLINICAL REFERENCE
6513. Review of the Genitourinary System
6514. Structure
6515. PEDIATRIC DIFFERENCES IN THE GENITOURINARY SYSTEM
6516. Function
6517. COMMON LABORATORY AND DIAGNOSTIC TESTS FOR GENITOURINARY DISORDERS
6518. Enuresis
6519. Etiology
6520. Incidence
6521. PATHOPHYSIOLOGY: Enuresis
6522. Manifestations
6523. Nocturnal Enuresis
6524. Diurnal Enuresis
6525. Diagnostic Evaluation
6526. Therapeutic Management
6527. Nursing Care
6528. The Child with Enuresis
6529. Assessment
6530. Nursing Diagnosis and Planning
6531. Expected Outcome
6532. Expected Outcome
6533. Expected Outcomes
6534. Expected Outcome
6535. Interventions
6536. Evaluation
6537. CRITICAL THINKING EXERCISE 44-1
6538. Urinary tract infection ExemplarUrinary Tract Infections
6539. Etiology
6540. Incidence
6541. PATHOPHYSIOLOGY: Urinary Tract Infections
6542. BOX 44-1 MANIFESTATIONS OF URINARY TRACT INFECTION IN INFANTS AND CHILDREN
6543. Infants
6544. Children
6545. Children with Pyelonephritis
6546. Manifestations
6547. PATHOPHYSIOLOGY: Hydronephrosis
6548. PATHOPHYSIOLOGY: Vesicoureteral Reflux
6549. Diagnostic Evaluation
6550. Therapeutic Management
6551. Nursing Care
6552. The Child with a Urinary Tract Infection
6553. Assessment
6554. Nursing Diagnosis and Planning
6555. Expected Outcome
6556. Expected Outcome
6557. Expected Outcomes
6558. Interventions
6559. NURSING QUALITY ALERT: Evaluation after a Documented Urinary Tract Infection
6560. PATIENT-CENTERED TEACHING: How to Manage and Prevent Urinary Tract Infections
6561. Evaluation
6562. Cryptorchidism
6563. Incidence
6564. PATHOPHYSIOLOGY: Cryptorchidism
6565. Manifestations
6566. Diagnostic Evaluation
6567. Therapeutic Management
6568. NURSING QUALITY ALERT: Assessing for Cryptorchidism
6569. Nursing Care
6570. The Child with Cryptorchidism
6571. Assessment
6572. Nursing Diagnosis and Planning
6573. Expected Outcomes
6574. Expected Outcomes
6575. Interventions
6576. Evaluation
6577. Hypospadias and Epispadias
6578. Etiology and Incidence
6579. FIG 44-1 Epispadias and hypospadias are congenital anomalies in which the urethral opening is above or below its normal location on the glans of the penis. Stenosis of the opening could occur, leading to possible urinary tract infections (UTIs) or hydronephrosis. Hypospadias might interfere with fertility if it is left uncorrected.
6580. PATHOPHYSIOLOGY: Hypospadias
6581. Manifestations and Diagnostic Evaluation
6582. Therapeutic Management
6583. Nursing Care
6584. The Child with Hypospadias
6585. Assessment
6586. Nursing Diagnosis and Planning
6587. Expected Outcomes
6588. Expected Outcome
6589. Expected Outcomes
6590. Expected Outcome
6591. Interventions
6592. Evaluation
6593. Miscellaneous Disorders and Anomalies of the Genitourinary Tract
6594. Acute Poststreptococcal Glomerulonephritis
6595. Etiology and Incidence
6596. Manifestations
6597. TABLE 44-1 MISCELLANEOUS DISORDERS AND ANOMALIES OF THE GENITOURINARY TRACT
6598. Diagnostic Evaluation
6599. Therapeutic Management
6600. PATHOPHYSIOLOGY: Acute Poststreptococcal Glomerulonephritis
6601. Nursing Care
6602. The Child with Acute Poststreptococcal Glomerulonephritis
6603. Assessment
6604. Nursing Diagnosis and Planning
6605. Expected Outcome
6606. Expected Outcome
6607. Expected Outcome
6608. Expected Outcome
6609. Expected Outcomes
6610. Interventions
6611. Preventing the Consequences of Fluid Excess
6612. Providing Adequate Rest
6613. Maintaining Skin Integrity
6614. Maintaining Nutritional Status
6615. Relieving Anxiety
6616. Evaluation
6617. Nephrotic Syndrome
6618. NURSING QUALITY ALERT: Differences between Children with Glomerulonephritis and Children with Nephrotic Syndrome
6619. Etiology
6620. Incidence
6621. Manifestations
6622. Diagnostic Evaluation
6623. Therapeutic Management
6624. PATHOPHYSIOLOGY: Nephrotic Syndrome
6625. Remission Induction
6626. NURSING CARE PLAN: The Child with Nephrotic Syndrome
6627. Focused Assessment
6628. Nursing Diagnosis
6629. Planning
6630. Expected Outcome
6631. Interventions and Rationales
6632. Evaluation
6633. Nursing Diagnosis
6634. Planning
6635. Expected Outcome
6636. Interventions and Rationales
6637. Evaluation
6638. Nursing Diagnosis
6639. Planning
6640. Expected Outcome
6641. Interventions and Rationales
6642. Evaluation
6643. Nursing Diagnosis
6644. Planning
6645. Expected Outcome
6646. Interventions and Rationales
6647. Evaluation
6648. Nursing Diagnoses
6649. Planning
6650. Expected Outcomes
6651. Interventions and Rationales
6652. Evaluation
6653. Additional Therapy
6654. FIG 44-2 This child has nephrotic syndrome. He previously received steroid therapy and is now receiving CellCept immunosuppressant therapy to control the process. During the acute phase of the nephrotic syndrome, the child may have massive edema because blood proteins are lost in the urine. Skin pallor is also common.
6655. Acute Renal Failure
6656. Etiology and Incidence
6657. PATHOPHYSIOLOGY: Acute Renal Failure
6658. Manifestations
6659. Diagnostic Evaluation
6660. History
6661. Fluid Volume Status
6662. Laboratory Data
6663. PATHOPHYSIOLOGY: Hemolytic Uremic Syndrome
6664. Physical Examination
6665. Imaging Studies
6666. Therapeutic Management
6667. Fluid Imbalances
6668. Electrolyte Imbalances
6669. Potassium
6670. Sodium
6671. Acid-Base Imbalances
6672. Nutrition
6673. NURSING QUALITY ALERT: Indications for Dialysis in Acute Renal Failure
6674. Dialysis
6675. Nursing Considerations
6676. BOX 44-2 DIALYSIS
6677. Hemodialysis
6678. Teenager receiving hemodialysis.
6679. Peritoneal Dialysis
6680. Peritoneal dialysis. Implanted line allows instillation of the dialyzing fluid into this child’s peritoneal cavity.
6681. Infection of the peritoneal cavity is the chief hazard of peritoneal dialysis. When the lines are open to begin or end the dialyzing cycle, both adult and child wear masks.
6682. Peritoneal dialysis catheter exit site.
6683. Chronic Renal Failure and End-Stage Renal Disease
6684. Etiology
6685. Incidence
6686. Pathophysiology
6687. Manifestations
6688. Diagnostic Evaluation
6689. Therapeutic Management
6690. Chronic Renal Failure
6691. End-Stage Renal Disease
6692. Kidney Transplantation
6693. Nursing Care
6694. The Child with Chronic Renal Failure and End-Stage Renal Disease
6695. Assessment
6696. Nursing Diagnosis and Planning
6697. Expected Outcome
6698. Expected Outcomes
6699. Expected Outcome
6700. Expected Outcome
6701. Expected Outcomes
6702. Expected Outcome
6703. Interventions
6704. Evaluation
6705. KEY CONCEPTS
6706. References and Readings
6707. Pageburst Integrated Resource
6708. Animation
6709. Chapter 45 The Child with a Respiratory Alteration
6710. Learning Objectives
6711. CLINICAL REFERENCE
6712. Review of the Respiratory System
6713. The Upper Airway
6714. The Lower Airway
6715. Prenatal Respiratory Development
6716. Postnatal Respiratory Changes
6717. Gas Exchange and Transport
6718. Diagnostic Tests
6719. Blood Gas Analysis
6720. COMMON LABORATORY AND DIAGNOSTIC TESTS FOR RESPIRATORY DISORDERS
6721. Pulmonary Function Tests
6722. Pulse Oximetry
6723. Transcutaneous Monitoring
6724. End-Tidal Carbon Dioxide Monitoring
6725. PEDIATRIC DIFFERENCES IN THE RESPIRATORY SYSTEM
6726. Respiratory Illness in Children
6727. Allergic Rhinitis
6728. Etiology and Incidence
6729. PATHOPHYSIOLOGY: Allergic Rhinitis
6730. Manifestations
6731. FIG 45-1 Children with allergic rhinitis often have dark circles under their eyes, called allergic shiners, and may be seen rubbing their noses upward with the palm—the “allergic salute.”
6732. Diagnostic Evaluation
6733. Therapeutic Management
6734. Nursing Considerations
6735. PATIENT-CENTERED TEACHING: How to Implement Environmental Modifications
6736. Pollen and Dust
6737. Mold
6738. Dander
6739. Sinusitis
6740. Etiology and Incidence
6741. Manifestations
6742. PATHOPHYSIOLOGY: Sinusitis
6743. Diagnostic Evaluation
6744. Therapeutic Management
6745. Nursing Considerations
6746. Otitis media ExemplarOtitis Media
6747. Etiology
6748. Incidence
6749. Manifestations
6750. PATHOPHYSIOLOGY: Otitis Media
6751. Diagnostic Evaluation
6752. Therapeutic Management
6753. FIG 45-2 Appearance of tympanic membrane in otitis media compared with normal tympanic membrane. A, Normal right tympanic membrane and middle ear. B, Acute otitis media: bulging right tympanic membrane. C, Otitis media with effusion: air-fluid level and bubbles visible through right retracted, translucent tympanic membrane. D, Otitis media with effusion: severely retracted, opaque right tympanic membrane.
6754. Nursing Care
6755. The Child with Otitis Media
6756. Assessment
6757. Nursing Diagnosis and Planning
6758. Expected Outcome
6759. Expected Outcome
6760. Expected Outcome
6761. Expected Outcome
6762. Interventions
6763. Evaluation
6764. EVIDENCE-BASED PRACTICE
6765. Pharyngitis and Tonsillitis
6766. Etiology
6767. Incidence
6768. Manifestations
6769. TABLE 45-1 COMPARISON OF VIRAL AND BACTERIAL PHARYNGITIS
6770. PATHOPHYSIOLOGY: Pharyngitis
6771. Diagnostic Evaluation
6772. Therapeutic Management
6773. Nursing Considerations
6774. Nursing Care
6775. The Child Undergoing a Tonsillectomy
6776. Assessment: Preoperative Period
6777. Nursing Diagnosis and Planning: Preoperative Period
6778. Expected Outcome
6779. Expected Outcome
6780. Interventions: Preoperative Period
6781. Evaluation: Preoperative Period
6782. Assessment: Postoperative Period
6783. SAFETY ALERT: Caring for the Child Who Has Had a Tonsillectomy
6784. Nursing Diagnosis and Planning: Postoperative Period
6785. Expected Outcome
6786. PATIENT-CENTERED TEACHING: Caring for a Child after a Tonsillectomy
6787. Expected Outcome
6788. Expected Outcome
6789. Expected Outcome
6790. Expected Outcome
6791. Interventions: Postoperative
6792. Evaluation: Postoperative
6793. CRITICAL THINKING EXERCISE 45-1
6794. Laryngomalacia (Congenital Laryngeal Stridor)
6795. Manifestations
6796. Therapeutic Management
6797. Nursing Considerations
6798. Croup
6799. Etiology and Incidence
6800. Manifestations
6801. TABLE 45-2 COMPARISON OF TYPES OF CROUP
6802. PATHOPHYSIOLOGY: Croup
6803. Diagnostic Evaluation
6804. Therapeutic Management
6805. Nursing Care
6806. The Child with Croup
6807. Assessment
6808. Nursing Diagnosis and Planning
6809. Expected Outcome
6810. Expected Outcome
6811. Expected Outcome
6812. Expected Outcome
6813. Interventions
6814. Facilitating Airway Clearance
6815. Maintaining Fluid Balance
6816. Decreasing Fear
6817. Providing Teaching
6818. Evaluation
6819. Epiglottitis (Supraglottitis)
6820. Etiology and Incidence
6821. Manifestations
6822. Diagnostic Evaluation
6823. SAFETY ALERT: Cardinal Signs and Symptoms of Epiglottitis
6824. PATHOPHYSIOLOGY: Epiglottitis
6825. Therapeutic Management
6826. Nursing Considerations
6827. Bronchitis
6828. Etiology and Incidence
6829. PATHOPHYSIOLOGY: Bronchitis
6830. Manifestations and Diagnostic Evaluation
6831. Therapeutic Management
6832. Nursing Considerations
6833. Bronchiolitis
6834. Etiology and Incidence
6835. PATHOPHYSIOLOGY: Bronchiolitis
6836. Manifestations
6837. Diagnostic Evaluation
6838. Therapeutic Management
6839. Nursing Care
6840. The Child with Bronchiolitis
6841. Assessment
6842. Nursing Diagnosis and Planning
6843. Expected Outcome
6844. Expected Outcome
6845. Expected Outcome
6846. Expected Outcome
6847. Expected Outcomes
6848. Interventions
6849. Facilitating Gas Exchange
6850. Preventing Transmission
6851. Maintaining Fluid Balance
6852. Reducing Fever
6853. Decreasing Anxiety
6854. Evaluation
6855. Pneumonia ExemplarPneumonia
6856. Nursing Care
6857. The Child with Pneumonia
6858. Assessment
6859. TABLE 45-3 COMPARISON OF TYPES OF PNEUMONIA
6860. Nursing Diagnosis and Planning
6861. Expected Outcome
6862. Expected Outcome
6863. Expected Outcome
6864. Expected Outcome
6865. Expected Outcome
6866. Expected Outcome
6867. Expected Outcome
6868. Interventions
6869. PATIENT-CENTERED TEACHING: Home Management of the Child with Pneumonia
6870. Evaluation
6871. BOX 45-1 COMMON ITEMS OF ASPIRATION
6872. Foreign Body Aspiration
6873. Etiology and Incidence
6874. Pathophysiology
6875. Manifestations
6876. Diagnostic Evaluation
6877. Therapeutic Management
6878. Nursing Considerations
6879. Pulmonary Noninfectious Irritation
6880. Acute Respiratory Distress Syndrome
6881. Pathophysiology
6882. Passive Smoking
6883. Pathophysiology
6884. Smoke Inhalation
6885. Pathophysiology
6886. TABLE 45-4 PULMONARY NONINFECTIOUS IRRITANTS
6887. Apnea
6888. Manifestations
6889. Diagnostic Evaluation
6890. TABLE 45-5 APNEA OF PREMATURITY COMPARED WITH INFANT APNEA
6891. Nursing Care
6892. The Infant with Apnea
6893. Assessment
6894. Nursing Diagnosis and Planning
6895. Expected Outcome
6896. Expected Outcome
6897. Expected Outcome
6898. Interventions
6899. FIG 45-3 Teaching the family about using an apnea monitor and how to respond to alarms is an important element in caring for the child with infant apnea. The nurse must assess the parents’ ability to tolerate the stressors of living with a child who is prone to apnea and support them as they deal with these stressors.
6900. Evaluation
6901. Sudden Infant Death Syndrome
6902. Etiology and Incidence
6903. BOX 45-2 HOME APNEA MONITORING
6904. PATHOPHYSIOLOGY: Sudden Infant Death Syndrome
6905. Manifestations
6906. Diagnostic Evaluation
6907. Nursing Care
6908. The Family of the Infant Who Has Died of SIDS
6909. Assessment
6910. Nursing Diagnosis and Planning
6911. Expected Outcome
6912. Expected Outcome
6913. Expected Outcome
6914. Interventions
6915. Evaluation
6916. Asthma ExemplarAsthma
6917. Etiology
6918. Incidence
6919. PATHOPHYSIOLOGY: Asthma
6920. Immediate Reaction (Early-Phase Response)
6921. Delayed Reaction (Late-Phase Response)
6922. Manifestations
6923. Diagnostic Evaluation
6924. Therapeutic Management
6925. Acute Asthma Episode
6926. Long-Term Management
6927. Environmental Control
6928. Irritants and Allergens
6929. Exercise
6930. Infection
6931. Emotions
6932. Monitoring Symptoms
6933. SAFETY ALERT: Emergency Asthma Management
6934. BOX 45-3 MONITORING BREATHING CAPACITY WITH A PEAK FLOW METER
6935. Procedure
6936. Medications
6937. Rescue Medications
6938. Routine Medications
6939. FIG 45-4 Asthma action plan.
6940. BOX 45-4 CLASSIFICATION OF ASTHMA SEVERITY
6941. Intermittent
6942. Mild Persistent
6943. Moderate Persistent
6944. Severe Persistent
6945. Medication Delivery
6946. Bronchopulmonary Dysplasia
6947. Etiology
6948. Incidence
6949. PARENTS WANT TO KNOW: Tips on Using a Nebulizer
6950. The powered nebulizer delivers a bronchodilator to the child who is having an acute asthma episode. This boy has a viral respiratory infection, which is a common trigger of acute asthma episodes in the pediatric population.
6951. NURSING CARE PLAN: The Child Hospitalized with Asthma
6952. Focused Assessment
6953. Nursing Diagnoses
6954. Planning
6955. Expected Outcomes
6956. Interventions and Rationales
6957. Evaluation
6958. Nursing Diagnosis
6959. Planning
6960. Expected Outcome
6961. Interventions and Rationales
6962. Evaluation
6963. Nursing Diagnosis
6964. Planning
6965. Expected Outcomes
6966. Interventions and Rationales
6967. Evaluation
6968. Nursing Diagnosis
6969. Planning
6970. Expected Outcomes
6971. Interventions and Rationales
6972. Evaluation
6973. Nursing Diagnosis
6974. Planning
6975. Expected Outcomes
6976. Interventions and Rationales
6977. Evaluation
6978. Nursing Diagnosis
6979. Planning
6980. Expected Outcomes
6981. Interventions and Rationales
6982. Evaluation
6983. PATHOPHYSIOLOGY: Bronchopulmonary Dysplasia
6984. Manifestations
6985. Diagnostic Evaluation
6986. Therapeutic Management
6987. Oxygen Therapy
6988. Medications
6989. Nutrition
6990. Prognosis
6991. Nursing Considerations
6992. Cystic Fibrosis
6993. FIG 45-5 Example of a letter that can be used to notify the local public service company that a technology-dependent child is living in the service area.
6994. PATIENT-CENTERED TEACHING: Safe Use of Oxygen at Home
6995. Etiology
6996. Incidence
6997. FIG 45-6 Digital clubbing may be an indication of hypoxia, which often occurs in cystic fibrosis and other respiratory disorders.
6998. Manifestations
6999. Respiratory System
7000. Digestive System
7001. PATHOPHYSIOLOGY: Cystic Fibrosis
7002. Respiratory System
7003. Digestive System
7004. Integumentary System
7005. Reproductive System
7006. Exocrine Glands
7007. Reproductive System
7008. Diagnostic Evaluation
7009. Therapeutic Management
7010. Respiratory Problems
7011. Digestive Problems
7012. Nursing Care
7013. The Child with Cystic Fibrosis
7014. Assessment
7015. Respiratory Assessment
7016. Digestive Assessment
7017. Reproductive Assessment
7018. Nursing Diagnosis and Planning
7019. Expected Outcome
7020. Expected Outcome
7021. Expected Outcome
7022. Expected Outcome
7023. Expected Outcome
7024. Expected Outcome
7025. Expected Outcome
7026. Expected Outcome
7027. Interventions
7028. Facilitating Airway Clearance and Gas Exchange
7029. Preventing Infection
7030. Providing Optimal Nutrition for Growth
7031. Promoting Increased Exercise Tolerance
7032. Meeting the Child’s and Family’s Emotional Needs
7033. Home Care
7034. Evaluation
7035. Tuberculosis
7036. Etiology
7037. Incidence
7038. PATHOPHYSIOLOGY: Tuberculosis
7039. BOX 45-5 RISK FACTORS FOR THE DEVELOPMENT OF TUBERCULOSIS
7040. Manifestations
7041. Diagnostic Evaluation
7042. Therapeutic Management and Nursing Considerations
7043. Tuberculosis Infection
7044. BOX 45-6 DEFINITION OF A POSITIVE MANTOUX SKIN TEST
7045. Area of Induration ≥5 mm Considered Positive in:
7046. Area of Induration ≥10 mm Considered Positive in:
7047. Induration ≥15 mm Considered Positive in:
7048. Tuberculosis Disease
7049. Prevention and Screening
7050. KEY CONCEPTS
7051. References and Readings
7052. Pageburst Integrated Resource
7053. Animation
7054. Chapter 46 The Child with a Cardiovascular Alteration
7055. Learning Objectives
7056. CLINICAL REFERENCE
7057. Review of the Heart and Circulation
7058. Normal Cardiac Anatomy and Physiology
7059. Fetal Circulation
7060. A, Normal heart cycle, represented as an electrocardiographic configuration. B, Cardiac electrical conduction system.
7061. Normal pressures (in millimeters of mercury) and saturations (percents).
7062. Transitional and Neonatal Circulation
7063. DIFFERENCES IN THE HEART AND CIRCULATION OF NEONATES AND INFANTS
7064. COMMON DIAGNOSTIC TESTS FOR CARDIAC DISORDERS
7065. Congenital Heart Disease
7066. Classification of CHD
7067. TABLE 46-1 CLASSIFICATION OF CONGENITAL HEART DISEASE
7068. Shunting: Saturation Considerations
7069. Blood Flow Considerations
7070. Physiologic Consequences of CHD in Children
7071. Heart Failure
7072. Etiology
7073. Manifestations
7074. PATHOPHYSIOLOGY: Heart Failure
7075. Diagnostic Evaluation
7076. Therapeutic Management
7077. NURSING CARE PLAN: The Child with Heart Failure
7078. Focused Assessment
7079. Nursing Diagnosis
7080. Planning
7081. Expected Outcome
7082. Interventions and Rationales
7083. Evaluation
7084. Nursing Diagnosis
7085. Planning
7086. Expected Outcome
7087. Interventions and Rationales
7088. Evaluation
7089. Nursing Diagnosis
7090. Planning
7091. Expected Outcomes
7092. Interventions and Rationales
7093. Evaluation
7094. Nursing Diagnosis
7095. Planning
7096. Expected Outcome
7097. Interventions and Rationales
7098. Evaluation
7099. Nursing Diagnosis
7100. Planning
7101. Expected Outcomes
7102. Interventions and Rationales
7103. Evaluation
7104. EVIDENCE-BASED PRACTICE
7105. PATIENT-CENTERED TEACHING: Giving Your Child Digoxin Elixir
7106. NURSING QUALITY ALERT: Feeding the Infant or Child with Heart Failure
7107. Pulmonary Hypertension
7108. CRITICAL THINKING EXERCISE 46-1
7109. Cyanosis
7110. Hypercyanotic Episode
7111. Nursing Care
7112. The Child with Cyanosis
7113. Assessment
7114. Nursing Diagnosis and Planning
7115. Expected Outcomes
7116. Expected Outcomes
7117. Expected Outcomes
7118. Expected Outcomes
7119. Expected Outcomes
7120. Expected Outcome
7121. Interventions
7122. Evaluation
7123. Assessment of the Child with a Cardiovascular Alteration
7124. TABLE 46-2 CARDIAC ASSESSMENT FOR THE CHILD WITH CHD∗
7125. NURSING QUALITY ALERT: Assessing Murmurs
7126. Cardiovascular Diagnosis
7127. Cardiac Catheterization
7128. Complications
7129. Nursing Care
7130. Congenital Cardiac Defects
7131. The Child Undergoing Cardiac Surgery
7132. Preoperative Preparation
7133. Postoperative Management
7134. TABLE 46-3 CONGENITAL CARDIAC DEFECTS
7135. FIG 46-1 A, A preoperative visit to the intensive care unit and other units should be directed at an age-appropriate level for the child and the family before the child undergoes cardiac surgery. The experience prepares the family for the sights and sounds of the unit. B, Going home.
7136. Monitoring Cardiac Output
7137. Supporting Respiratory Function
7138. Maintaining Fluid and Electrolyte Balance
7139. Promoting Comfort
7140. Promoting Healing and Recovery
7141. Acquired Heart Disease
7142. Infective Endocarditis
7143. Etiology
7144. PATIENT-CENTERED TEACHING: Care after Heart Surgery
7145. Activity
7146. Diet
7147. Incision
7148. School
7149. When to Call the Physician
7150. Checkup
7151. Incidence
7152. PATHOPHYSIOLOGY: Infective Endocarditis
7153. Manifestations
7154. Diagnostic Evaluation
7155. Therapeutic Management
7156. Nursing Care
7157. The Child with IE
7158. Assessment
7159. Nursing Diagnosis and Planning
7160. Expected Outcome
7161. Expected Outcome
7162. Expected Outcome
7163. Expected Outcomes
7164. Interventions
7165. Evaluation
7166. Cardiac Dysrhythmias ExemplarDysrhythmias
7167. Etiology
7168. Incidence
7169. PATHOPHYSIOLOGY: Dysrhythmias
7170. Tachydysrhythmias
7171. Supraventricular tachycardia.
7172. Bradydysrhythmias
7173. Heart block—two or three P waves for every QRS. Cardiac output is based on the rate of the QRS complexes—ventricular contraction.
7174. Manifestations
7175. Diagnostic Evaluation
7176. Therapeutic Management
7177. Fast Pulse Rate
7178. Supraventricular Tachycardia
7179. Ventricular Tachycardia
7180. Slow Pulse Rate
7181. Bradydysrhythmias
7182. Absent Rhythms
7183. Nursing Care
7184. The Child with a Dysrhythmia
7185. Assessment
7186. SAFETY ALERT: Dysrhythmias
7187. Nursing Diagnosis and Planning
7188. Expected Outcome
7189. Expected Outcome
7190. Expected Outcomes
7191. Interventions
7192. Evaluation
7193. Rheumatic Fever
7194. Etiology
7195. PATHOPHYSIOLOGY: Rheumatic Fever
7196. Incidence
7197. Manifestations
7198. FIG 46-2 Clinical manifestations of rheumatic fever.
7199. Diagnostic Evaluation
7200. BOX 46-1 DIAGNOSIS OF ACUTE RHEUMATIC FEVER BY THE JONES CRITERIA—1992 UPDATE
7201. Major Manifestations
7202. Minor Manifestations
7203. Therapeutic Management
7204. Nursing Care
7205. The Child with RF
7206. Assessment
7207. Nursing Diagnosis and Planning
7208. Expected Outcome
7209. Expected Outcomes
7210. Expected Outcomes
7211. Expected Outcomes
7212. Interventions
7213. NURSING QUALITY ALERT: Streptococcal Prophylaxis for the Child with Rheumatic Fever
7214. Evaluation
7215. Kawasaki Disease
7216. Etiology
7217. Incidence
7218. PATHOPHYSIOLOGY: Kawasaki Disease
7219. Manifestations
7220. Diagnostic Evaluation
7221. FIG 46-3 Erythematous rash of Kawasaki disease.
7222. Therapeutic Management
7223. Nursing Care
7224. The Child with Kawasaki Disease
7225. Assessment
7226. Nursing Diagnosis and Planning
7227. Expected Outcome
7228. Expected Outcomes
7229. Expected Outcome
7230. Interventions
7231. Evaluation
7232. Hypertension ExemplarHypertension
7233. Etiology
7234. Incidence
7235. PATHOPHYSIOLOGY: Hypertension
7236. Manifestations
7237. Diagnostic Evaluation
7238. Therapeutic Management
7239. Primary Hypertension
7240. Weight Reduction
7241. Physical Conditioning
7242. Dietary Modification
7243. Relaxation Techniques
7244. Pharmacologic Treatment
7245. Secondary Hypertension
7246. SAFETY ALERT: Infusing Intravenous Antihypertensive Medications
7247. Nursing Care
7248. The Child with Hypertension
7249. Assessment
7250. Blood Pressure Screening
7251. Physical Assessment
7252. Nursing Diagnosis and Planning
7253. Expected Outcome
7254. Expected Outcomes
7255. Interventions
7256. Evaluation
7257. Cardiomyopathies
7258. High Cholesterol Levels in Children and Adolescents
7259. Assessment of Children at Risk
7260. Therapeutic Management
7261. Nursing Considerations
7262. KEY CONCEPTS
7263. References and Readings
7264. Pageburst Integrated Resource
7265. Animation
7266. Chapter 47 The Child with a Hematologic Alteration
7267. Learning Objectives
7268. CLINICAL REFERENCE
7269. Review of the Hematologic System
7270. TYPES AND FUNCTIONS OF WHITE BLOOD CELLS
7271. PEDIATRIC HEMATOLOGIC SYSTEM
7272. Iron Deficiency Anemia
7273. Etiology and Incidence
7274. Manifestations
7275. Diagnostic Evaluation
7276. PATHOPHYSIOLOGY: Iron Deficiency Anemia
7277. PARENTS WANT TO KNOW: Home Care of the Child with Iron Deficiency Anemia
7278. Dietary Changes
7279. Administration of Iron
7280. Follow-up Care
7281. Therapeutic Management
7282. NURSING CARE PLAN: The Child with Iron Deficiency Anemia in the Community Setting
7283. Focused Assessment
7284. Nursing Diagnosis
7285. Planning
7286. Expected Outcome
7287. Interventions and Rationales
7288. Evaluation
7289. NURSING QUALITY ALERT: Obtaining a Dietary Intake History
7290. Sickle Cell Disease
7291. CRITICAL THINKING EXERCISE 47-1
7292. PATHOPHYSIOLOGY: Sickle Cell Disease
7293. Etiology
7294. Incidence
7295. Manifestations
7296. Diagnostic Evaluation
7297. Therapeutic Management
7298. TABLE 47-1 CLINICAL MANIFESTATIONS AND THERAPEUTIC MANAGEMENT OF SICKLE CELL DISEASE COMPLICATIONS
7299. PATIENT-CENTERED TEACHING: Home Care of the Child with Sickle Cell Disease
7300. NURSING CARE PLAN: The Child with Sickle Cell Disease
7301. Focused Assessment
7302. Nursing Diagnosis
7303. Planning
7304. Expected Outcomes
7305. Interventions and Rationales
7306. Evaluation
7307. Nursing Diagnosis
7308. Planning
7309. Expected Outcome
7310. Interventions and Rationales
7311. Evaluation
7312. Nursing Diagnosis
7313. Planning
7314. Expected Outcomes
7315. Interventions and Rationales
7316. Evaluation
7317. Nursing Diagnosis
7318. Planning
7319. Expected Outcomes
7320. Interventions and Rationales
7321. Evaluation
7322. EVIDENCE-BASED PRACTICE
7323. Thalassemia
7324. Etiology and Incidence
7325. Manifestations
7326. BOX 47-1 CHARACTERISTIC FEATURES OF A CHILD WITH BETA-THALASSEMIA
7327. PATHOPHYSIOLOGY: Beta-Thalassemia
7328. Diagnostic Evaluation
7329. Therapeutic Management
7330. PATIENT-CENTERED TEACHING: Home Chelation Therapy
7331. Subcutaneous Route by Infusion Pump
7332. Intravenous Route: Totally Implantable or Tunneled Access Device
7333. Nursing Care
7334. The Child with Beta-Thalassemia
7335. Assessment
7336. Nursing Diagnosis and Planning
7337. Expected Outcome
7338. Expected Outcomes
7339. Expected Outcomes
7340. Expected Outcomes
7341. Interventions
7342. Evaluation
7343. Hemophilia ExemplarHemophilia
7344. Etiology and Incidence
7345. Manifestations
7346. PATHOPHYSIOLOGY: Hemophilia
7347. FIG 47-1 Hemarthrosis and joint destruction are characteristic of hemophilia.
7348. NURSING CARE PLAN: The Child with Hemophilia
7349. Focused Assessment
7350. Nursing Diagnosis
7351. Planning
7352. Expected Outcome
7353. Interventions and Rationales
7354. Evaluation
7355. Nursing Diagnosis
7356. Planning
7357. Expected Outcomes
7358. Interventions and Rationales
7359. Evaluation
7360. Nursing Diagnosis
7361. Planning
7362. Expected Outcomes
7363. Interventions and Rationales
7364. Evaluation
7365. Diagnostic Evaluation
7366. Therapeutic Management
7367. SAFETY ALERT: Acetylsalicylic Acid: Contraindication
7368. NURSING QUALITY ALERT: Interviewing a Child with Hemophilia
7369. Von Willebrand Disease
7370. Etiology
7371. Pathophysiology
7372. PATIENT-CENTERED TEACHING: Home Care of the Child with Hemophilia
7373. Control of deficient blood clotting in hemophilia requires injection of the missing clotting factors. This young man is injecting his factor into an implanted central venous access port. Sterile technique is essential.
7374. Manifestations
7375. Diagnostic Evaluation
7376. Therapeutic Management
7377. Nursing Care
7378. The Child with Von Willebrand Disease
7379. Assessment
7380. Nursing Diagnosis and Planning
7381. Expected Outcome
7382. Expected Outcomes
7383. Interventions
7384. Evaluation
7385. Immune Thrombocytopenic Purpura
7386. Etiology and Incidence
7387. Pathophysiology
7388. Manifestations
7389. Diagnostic Evaluation
7390. FIG 47-2 Multiple petechiae are characteristic of immune thrombocytopenic purpura. This disorder results in the destruction of circulating platelets and decreased bone marrow production of new platelets.
7391. Therapeutic Management
7392. Nursing Care
7393. The Child with Immune Thrombocytopenic Purpura
7394. Assessment
7395. PATIENT-CENTERED TEACHING: Home Care of the Child with Immune Thrombocytopenic Purpura∗
7396. Nursing Diagnosis and Planning
7397. Expected Outcome
7398. Expected Outcomes
7399. Expected Outcomes
7400. Interventions
7401. SAFETY ALERT: Actions to Avoid in Children with Low Platelet Counts
7402. Evaluation
7403. Disseminated intravascular coagulation ExemplarDisseminated Intravascular Coagulation
7404. Etiology
7405. Manifestations
7406. Diagnostic Evaluation
7407. Therapeutic Management
7408. Nursing Considerations
7409. PATHOPHYSIOLOGY: Disseminated Intravascular Coagulation
7410. BOX 47-2 CONFIRMATORY LABORATORY FINDINGS IN DISSEMINATED INTRAVASCULAR COAGULATION
7411. Aplastic Anemia
7412. Etiology and Incidence
7413. Manifestations
7414. Diagnostic Evaluation
7415. PATHOPHYSIOLOGY: Aplastic Anemia
7416. Therapeutic Management
7417. Nursing Care
7418. The Child with Aplastic Anemia
7419. Assessment
7420. Nursing Diagnosis and Planning
7421. Expected Outcome
7422. Expected Outcomes
7423. Expected Outcome
7424. Expected Outcomes
7425. Interventions
7426. Evaluation
7427. KEY CONCEPTS
7428. References and Readings
7429. Pageburst Integrated Resource
7430. Animation
7431. Chapter 48 The Child with Cancer
7432. Learning Objectives
7433. Clinical Reference
7434. Review of Cancer
7435. CARDINAL SIGNS AND SYMPTOMS OF CANCER IN CHILDREN
7436. Overt Signs
7437. Signs and Symptoms That May Be Covert
7438. DIAGNOSTIC TESTS AND PROCEDURES FOR CANCER
7439. The Child With Cancer
7440. Incidence
7441. Childhood Cancer and Its Treatment
7442. FIG 48-1 Incidence of Cancers in Children. Rate per million children younger than age 20 years, 2003-2007.
7443. Therapeutic Management
7444. Chemotherapy
7445. BOX 48-1 COMMON SIDE EFFECTS OF CHEMOTHERAPY AND RADIATION THERAPY
7446. Chemotherapy Side Effects
7447. Suppression of the bone marrow because of chemotherapy or radiation therapy reduces the blood counts. Low platelet levels lead to spontaneous bruising, as shown. Nosebleeds and bleeding of the gums are other consequences. The nurse must make a special effort to observe for bruising in dark-skinned children because it will be more difficult to see.
7448. Radiation Side Effects
7449. Acute (During and Shortly after Irradiation)
7450. Mucositis (inflammation of the mucous membranes) and mouth ulcers are common side effects of chemotherapeutic drugs. Any mucous membrane can be affected.
7451. Subacute (1 to 6 Months after Irradiation)
7452. Late Effects (More Than 6 Months after Irradiation)
7453. Hair loss is a distressing side effect of cancer treatment. School-age children and adolescents are most likely to feel this distress. Activities such as crafts or playgroups help children feel more normal and provide interaction with others in an accepting environment.
7454. Surgery
7455. BOX 48-2 NURSING RESPONSIBILITIES AND PRECAUTIONS FOR CHEMOTHERAPY
7456. Radiation Therapy
7457. EVIDENCE-BASED PRACTICE
7458. Hematopoietic Stem Cell Transplantation
7459. Steroid Therapy
7460. Biologic Agents
7461. Complementary and Alternative Medical (CAM) Therapies
7462. CRITICAL THINKING EXERCISE 48-1
7463. Leukemia ExemplarLeukemia
7464. Etiology
7465. Incidence
7466. Manifestations
7467. Diagnostic Evaluation
7468. Therapeutic Management
7469. FIG 48-2 Varicella (chickenpox) can be deadly in the immunocompromised child. Thrombocytopenia (low platelet count) associated with chemotherapy can cause the varicella lesions to be hemorrhagic, like those shown here. Secondary infections of the lesions are also common because of low white blood cell (WBC) counts.
7470. PARENTS WANT TO KNOW: Caring for the Child with Cancer
7471. PATHOPHYSIOLOGY: Leukemia
7472. NURSING CARE PLAN: The Child with Leukemia
7473. Focused Assessment
7474. Nursing Diagnosis
7475. Planning
7476. Expected Outcomes
7477. Interventions and Rationales
7478. Evaluation
7479. Nursing Diagnosis
7480. Planning
7481. Expected Outcomes
7482. Interventions and Rationales
7483. Evaluation
7484. Nursing Diagnosis
7485. Planning
7486. Expected Outcomes
7487. Interventions and Rationales
7488. Evaluation
7489. Nursing Diagnosis
7490. Planning
7491. Expected Outcomes
7492. Interventions and Rationales
7493. Evaluation
7494. Nursing Diagnosis
7495. Planning
7496. Expected Outcome
7497. Interventions and Rationales
7498. Evaluation
7499. Nursing Diagnosis
7500. Planning
7501. Expected Outcomes
7502. Interventions and Rationales
7503. Evaluation
7504. Nursing Diagnosis
7505. Planning
7506. Expected Outcome
7507. Interventions and Rationales
7508. Evaluation
7509. Nursing Diagnosis
7510. Planning
7511. Expected Outcomes
7512. Interventions and Rationales
7513. Evaluation
7514. Nursing Diagnosis
7515. Planning
7516. Expected Outcome
7517. Interventions and Rationales
7518. Evaluation
7519. Malignant brain tumor ExemplarBrain Tumors
7520. Etiology
7521. Incidence
7522. Manifestations
7523. Diagnostic Evaluation
7524. Therapeutic Management
7525. FIG 48-3 Lobes of the brain.
7526. PATHOPHYSIOLOGY: Brain Tumors
7527. NURSING QUALITY ALERT: Signs of Brain Tumor in Children
7528. Nursing Care
7529. The Child with a Brain Tumor
7530. Assessment
7531. Nursing Diagnosis and Planning
7532. Expected Outcome
7533. Expected Outcomes
7534. Expected Outcomes
7535. Expected Outcomes
7536. Expected Outcome
7537. Interventions
7538. BOX 48-3 POTENTIAL FUNCTIONAL DEFICITS RELATED TO A BRAIN TUMOR
7539. Evaluation
7540. Malignant Lymphomas
7541. Non-Hodgkin Lymphoma
7542. Etiology
7543. Manifestations
7544. Diagnostic Evaluation
7545. Therapeutic Management
7546. NURSING QUALITY ALERT: Tumor Lysis Syndrome
7547. Nursing Care
7548. The Child with Non-Hodgkin Lymphoma
7549. Assessment
7550. Nursing Diagnosis and Planning
7551. Expected Outcome
7552. Expected Outcome
7553. Expected Outcome
7554. Expected Outcomes
7555. Interventions
7556. Evaluation
7557. Hodgkin lymphoma ExemplarHodgkin Disease
7558. Etiology
7559. SAFETY ALERT: Prevention of Urinary Tract Infection in the Immunocompromised Child
7560. Manifestations
7561. Diagnostic Evaluation
7562. PATHOPHYSIOLOGY: Hodgkin Disease
7563. Therapeutic Management
7564. Nursing Considerations
7565. Neuroblastoma
7566. Etiology
7567. Incidence
7568. Pathophysiology
7569. Manifestations
7570. Diagnostic Evaluation
7571. Therapeutic Management
7572. Nursing Care
7573. The Child with Neuroblastoma
7574. Assessment
7575. Nursing Diagnosis and Planning
7576. Expected Outcome
7577. Expected Outcome
7578. Expected Outcomes
7579. Interventions
7580. Evaluation
7581. Osteosarcoma
7582. Etiology
7583. Incidence
7584. Pathophysiology
7585. Manifestations
7586. Diagnostic Evaluation
7587. Therapeutic Management
7588. Nursing Care
7589. The Child with Osteosarcoma
7590. Assessment
7591. Nursing Diagnosis and Planning
7592. Expected Outcome
7593. Expected Outcomes
7594. Expected Outcome
7595. Expected Outcome
7596. Expected Outcome
7597. Expected Outcomes
7598. Interventions
7599. Evaluation
7600. Ewing Sarcoma
7601. Etiology
7602. Incidence
7603. Pathophysiology
7604. Manifestations
7605. Diagnostic Evaluation
7606. Therapeutic Management
7607. Nursing Considerations
7608. Rhabdomyosarcoma
7609. Etiology
7610. Incidence
7611. Pathophysiology
7612. Manifestations
7613. Diagnostic Evaluation
7614. Therapeutic Management
7615. Nursing Considerations
7616. Wilms Tumor
7617. Etiology
7618. Incidence
7619. Pathophysiology
7620. Manifestations
7621. Diagnostic Evaluation
7622. Therapeutic Management
7623. NURSING QUALITY ALERT: Assessing the Child with a Wilms Tumor
7624. Nursing Care
7625. The Child with Wilms Tumor
7626. Assessment
7627. Nursing Diagnosis and Planning
7628. Expected Outcomes
7629. Expected Outcome
7630. Expected Outcomes
7631. Expected Outcome
7632. Interventions
7633. Evaluation
7634. Retinoblastoma
7635. Etiology
7636. Incidence
7637. Pathophysiology
7638. Manifestations
7639. Diagnostic Evaluation
7640. Therapeutic Management
7641. Nursing Care
7642. The Child with Retinoblastoma
7643. Assessment
7644. Nursing Diagnosis and Planning
7645. Expected Outcomes
7646. Expected Outcome
7647. Expected Outcomes
7648. Interventions
7649. Evaluation
7650. Rare Tumors of Childhood
7651. KEY CONCEPTS
7652. References and Readings
7653. Chapter 49 The Child with an Alteration in Tissue Integrity
7654. Learning Objectives
7655. Clinical Reference
7656. Review of the Integumentary System
7657. PEDIATRIC DIFFERENCES IN THE SKIN
7658. Variations in the Skin of Newborn Infants
7659. Common Birthmarks
7660. Etiology
7661. Incidence
7662. Manifestations
7663. Diagnostic Evaluation
7664. Therapeutic Management
7665. Nursing Considerations
7666. PARENTS WANT TO KNOW: Care of Newborn and Infant Skin
7667. Skin Inflammation
7668. Seborrheic Dermatitis
7669. FIG 49-1 “Cradle cap,” the most frequent form of seborrheic dermatitis in infants. The condition often begins in the first 2 to 3 weeks of life and usually disappears by age 12 months.
7670. Contact Dermatitis
7671. Etiology
7672. FIG 49-2 Seborrheic diaper dermatitis.
7673. PATHOPHYSIOLOGY: Contact Dermatitis
7674. Incidence
7675. Manifestations
7676. FIG 49-3 Contact diaper dermatitis.
7677. Diagnostic Evaluation
7678. Therapeutic Management
7679. Nursing Care
7680. The Child with Contact Dermatitis
7681. Assessment
7682. Nursing Diagnosis and Planning
7683. Expected Outcomes
7684. Expected Outcome
7685. Expected Outcomes
7686. Interventions
7687. Evaluation
7688. Atopic Dermatitis
7689. Etiology
7690. Incidence
7691. Manifestations
7692. FIG 49-4 Atopic dermatitis, an allergic skin condition, usually begins in infancy and clears by age 2 to 3 years. However, it can continue into childhood. A, Lesions on cheeks often spread to the forehead, scalp, and extensor surfaces of arms and legs. B, Flexor surfaces of wrists, ankles, knees, and elbows may be affected in the childhood form of the disease.
7693. PATHOPHYSIOLOGY: Atopic Dermatitis
7694. Diagnostic Evaluation
7695. Therapeutic Management
7696. Nursing Care
7697. The Child with Atopic Dermatitis
7698. Assessment
7699. Nursing Diagnosis and Planning
7700. DRUG GUIDE: Topical Corticosteroids
7701. Expected Outcome
7702. Expected Outcomes
7703. Expected Outcome
7704. Expected Outcomes
7705. Expected Outcome
7706. Expected Outcomes
7707. Interventions
7708. Evaluation
7709. Skin Infections
7710. Impetigo
7711. Etiology
7712. PATHOPHYSIOLOGY: Impetigo
7713. Incidence
7714. Manifestations
7715. FIG 49-5 Impetigo lesions are usually located around the mouth and nose but may be located on the extremities.
7716. Diagnostic Evaluation
7717. Therapeutic Management
7718. Nursing Care
7719. The Child with Impetigo
7720. Assessment
7721. Nursing Diagnosis and Planning
7722. Expected Outcomes
7723. Expected Outcomes
7724. Interventions
7725. Evaluation
7726. SAFETY ALERT: Caring for a Child with Impetigo
7727. Cellulitis ExemplarCellulitis
7728. Etiology and Incidence
7729. Pathophysiology
7730. Manifestations
7731. Diagnostic Evaluation
7732. Therapeutic Management
7733. Nursing Care
7734. The Child with Cellulitis
7735. Assessment
7736. Nursing Diagnosis and Planning
7737. Expected Outcome
7738. Expected Outcome
7739. Expected Outcome
7740. Interventions
7741. Evaluation
7742. Candidiasis
7743. FIG 49-6 White, curdlike plaques of thrush (oral candidiasis, oral moniliasis), a common fungal infection in infants.
7744. Etiology
7745. Incidence
7746. Manifestations
7747. Diagnostic Evaluation
7748. Therapeutic Management
7749. FIG 49-7 Diaper candidiasis.
7750. Nursing Care
7751. The Child with Candidiasis
7752. Assessment
7753. Nursing Diagnosis and Planning
7754. Expected Outcome
7755. Expected Outcome
7756. Expected Outcomes
7757. Expected Outcomes
7758. Interventions
7759. FIG 49-8 Tinea (ringworm) is an infection caused by dermatophytes, a group of fungi. Tinea is classified according to the part of the body affected. Five common types of tinea are shown here. Tinea capitis (scalp); Tinea corporis (trunk, face, extremities); Tinea cruris (groin, buttocks, scrotum); Tinea pedis (feet); Tinea unguium (nails, nail beds).
7760. Evaluation
7761. Tinea Infection
7762. Etiology
7763. PATHOPHYSIOLOGY: Tinea Infection
7764. Incidence
7765. Manifestations
7766. Diagnostic Evaluation
7767. Therapeutic Management
7768. Tinea Capitis
7769. Tinea Corporis
7770. Tinea Cruris
7771. Tinea Pedis
7772. Nursing Care
7773. The Child with a Tinea Infection
7774. Assessment
7775. Nursing Diagnosis and Planning
7776. Expected Outcomes
7777. Expected Outcomes
7778. Expected Outcomes
7779. Expected Outcome
7780. Interventions
7781. Evaluation
7782. Herpes Simplex Virus Infection
7783. PATIENT-CENTERED TEACHING: Home Care for a Child or Adolescent with a Tinea Infection
7784. Etiology
7785. Incidence
7786. PATHOPHYSIOLOGY: Herpes Simplex Type 1 Infection
7787. Manifestations
7788. Herpes Labialis (“Cold Sore,” “Fever Blister”)
7789. FIG 49-9 Herpes simplex infection in an infant.
7790. Herpetic Gingivostomatitis
7791. Herpetic Ocular Infection
7792. Herpetic Whitlow
7793. Diagnostic Evaluation
7794. Therapeutic Management
7795. Nursing Care
7796. The Child with a Herpes Simplex Infection
7797. Assessment
7798. Nursing Diagnoses and Planning
7799. Expected Outcomes
7800. Expected Outcome
7801. Expected Outcome
7802. Expected Outcomes
7803. Interventions
7804. Evaluation
7805. Skin Infestations
7806. Lice Infestation
7807. Etiology
7808. Incidence
7809. PATHOPHYSIOLOGY: Pediculosis
7810. Manifestations
7811. Pediculosis Capitis (Head Lice)
7812. FIG 49-10 Head lice (pediculosis capitis). Note the nits attached to the hair shafts.
7813. Pediculosis Corporis (Body Lice)
7814. Pediculosis Pubis (Pubic Lice, Crab Lice)
7815. Diagnostic Evaluation
7816. Therapeutic Management
7817. Killing Active Lice and Nits
7818. Addressing the Environment
7819. Nursing Care
7820. The Child with Pediculosis
7821. Assessment
7822. Nursing Diagnosis and Planning
7823. Expected Outcomes
7824. Expected Outcome
7825. Expected Outcomes
7826. Expected Outcomes
7827. Interventions
7828. Evaluation
7829. CRITICAL THINKING EXERCISE 49-1
7830. EVIDENCE-BASED PRACTICE
7831. Mite Infestation (Scabies)
7832. Etiology
7833. Incidence
7834. Pathophysiology
7835. Manifestations
7836. Diagnostic Evaluation
7837. FIG 49-11 Scabies lesions on an infant.
7838. Therapeutic Management
7839. Nursing Considerations
7840. Acne Vulgaris
7841. Etiology
7842. Incidence
7843. PATHOPHYSIOLOGY: Acne Vulgaris
7844. Manifestations and Diagnostic Evaluation
7845. Therapeutic Management
7846. FIG 49-12 An adolescent with acne vulgaris.
7847. Nursing Care
7848. The Adolescent with Acne Vulgaris
7849. Assessment
7850. Nursing Diagnosis and Planning
7851. Expected Outcome
7852. Expected Outcome
7853. Expected Outcomes
7854. Expected Outcome
7855. Interventions
7856. Evaluation
7857. Miscellaneous Skin Disorders
7858. TABLE 49-1 SKIN DISORDERS
7859. Insect Bites or Stings
7860. Burns ExemplarBurn Injuries
7861. TABLE 49-2 SKIN LESIONS CAUSED BY INSECTS AND ARACHNIDS
7862. Etiology
7863. TABLE 49-3 AGE-RELATED RISKS FOR BURN INJURY
7864. BOX 49-1 PEDIATRIC DIFFERENCES IN THE EFFECTS OF BURN INJURY
7865. Incidence
7866. FIG 49-13 These burns were sustained when the child’s pajamas caught fire while he was playing with matches.
7867. FIG 49-14 These burns were sustained when the child sucked on an electrical socket.
7868. Pathophysiology
7869. PATIENT-CENTERED TEACHING: Measures to Prevent and Initially Manage a Burn
7870. Prevention
7871. Initial Emergency Burn Management
7872. BOX 49-2 BURN CENTER REFERRAL CRITERIA
7873. Depth of Burn Injury
7874. Extent of Burn Injury
7875. Severity of Burn Injury
7876. FIG 49-15 Calculating total body surface area (TBSA) burned in children. The standard “rule of nines” and standard body surface charts must be adapted because of the difference in body proportions between adults and children.
7877. TABLE 49-4 DEPTH OF BURN INJURY
7878. Manifestations
7879. Therapeutic Management
7880. Superficial Burn Injuries
7881. TABLE 49-5 CLASSIFICATION OF SEVERITY OF BURN INJURY IN CHILDREN
7882. Superficial Partial-Thickness Burn Injuries
7883. Wound Cleaning
7884. Débridement
7885. Application of Antimicrobial Agents and Dressings
7886. FIG 49-16 Burn dressings can be changed in the hydrotherapy room. The room is kept warm because children who have been burned have poor body temperature control. The child life therapist reads a book to the child to distract her from the discomfort associated with the procedure.
7887. TABLE 49-6 TOPICAL ANTIMICROBIAL AGENTS COMMONLY USED FOR BURNS
7888. PATIENT-CENTERED TEACHING: Home Care for a Child with Burns
7889. Parents will need to know the following to adequately care for the child:
7890. Teach the parents the following:
7891. NURSING CARE PLAN: The Child with a Minor Partial-Thickness Burn
7892. Focused Assessment
7893. Nursing Diagnosis
7894. Planning
7895. Expected Outcome
7896. Interventions and Rationales
7897. Evaluation
7898. Nursing Diagnosis
7899. Planning
7900. Expected Outcome
7901. Interventions and Rationales
7902. Evaluation
7903. Nursing Diagnosis
7904. Planning
7905. Expected Outcomes
7906. Interventions and Rationales
7907. Evaluation
7908. Nursing Diagnosis
7909. Planning
7910. Expected Outcome
7911. Interventions and Rationales
7912. Evaluation
7913. Nursing Diagnosis
7914. Planning
7915. Expected Outcomes
7916. Interventions and Rationales
7917. Evaluation
7918. Conditions Associated with Major Burn Injuries
7919. Conditions Associated with Electrical Injury
7920. Cardiac Arrest or Dysrhythmia
7921. Tissue Damage
7922. Myoglobinuria
7923. Metabolic Acidosis
7924. TABLE 49-7 BODY SYSTEM ALTERATIONS AFTER MODERATE TO SEVERE BURNS
7925. Other Complications
7926. Key Concepts
7927. References and Readings
7928. Pageburst Integrated Resource
7929. Animation
7930. Chapter 50 The Child with a Musculoskeletal Alteration
7931. Learning Objectives
7932. Clinical Reference
7933. Review of the Musculoskeletal System
7934. Skeletal System
7935. Child with hand differences.
7936. Articular System
7937. Muscular System
7938. Cartilage
7939. PEDIATRIC DIFFERENCES IN THE MUSCULOSKELETAL SYSTEM
7940. Growth and Development
7941. Diagnostic and Laboratory Tests
7942. COMMON DIAGNOSTIC PROCEDURES FOR MUSCULOSKELETAL DISORDERS IN CHILDREN
7943. Casts, Traction, and Other Immobilizing Devices
7944. Splints
7945. Casts
7946. Traction
7947. FIG 50-1 Child in a synthetic cast.
7948. BOX 50-1 TYPES OF SKIN TRACTION
7949. Buck
7950. Bryant
7951. Skin Traction
7952. BOX 50-2 TYPES OF SKELETAL TRACTION
7953. Halo
7954. 90/90 Femoral
7955. Skeletal Traction
7956. External Fixation Devices
7957. FIG 50-2 Skeletal traction is used to reduce and immobilize fractures and allows greater pull than would be possible with skin traction. Osteomyelitis may be a serious complication because skeletal traction is invasive.
7958. SAFETY ALERT: The Child in a Cast or Traction
7959. Nursing Considerations
7960. Neurovascular Status
7961. FIG 50-3 Ilizarov external fixator.
7962. Special Considerations for the Child in Halo Traction
7963. TABLE 50-1 NEUROLOGIC ASSESSMENT FOR PATIENTS REQUIRING HALO TRACTION
7964. Assessing and Managing Compartment Syndrome
7965. Immobility
7966. Special Considerations for the Child in Traction
7967. Home Care
7968. TABLE 50-2 CONSEQUENCES OF IMMOBILITY
7969. Fracture ExemplarFractures
7970. Etiology
7971. FIG 50-4 Upper extremity fractures in children often occur when the child attempts to break a fall with an outstretched arm.
7972. PARENTS WANT TO KNOW: Home Care for the Child in a Cast
7973. Check the Edges of the Cast as Follows:
7974. To Assist with Drying the Cast, Do the Following:
7975. Swelling Generally Peaks within 24 to 48 Hours. To Prevent Problems, Do the Following:
7976. Protect the Cast as Follows:
7977. Contact the Physician If Any of the Following Occurs:
7978. When Preparing to Remove the Cast, Do the Following:
7979. Incidence
7980. Manifestations
7981. Therapeutic Management
7982. Reduction Methods
7983. Retention
7984. PATHOPHYSIOLOGY: Fractures and Physeal Growth Plate Injuries
7985. Nursing Considerations
7986. Initial Trauma Assessment
7987. Assessing and Managing Complications
7988. TABLE 50-3 SPORT-SPECIFIC INJURY RISK
7989. Soft Tissue Injuries: Sprains, Strains, and Contusions
7990. Etiology
7991. Incidence
7992. Manifestations and Diagnostic Evaluation
7993. Therapeutic Management
7994. Nursing Considerations
7995. NURSING QUALITY ALERT: The Child with a Soft Tissue Injury
7996. Osteomyelitis
7997. Etiology
7998. Incidence
7999. PATHOPHYSIOLOGY: Osteomyelitis
8000. Manifestations
8001. Diagnostic Evaluation
8002. Therapeutic Management
8003. Nursing Care
8004. The Child with Osteomyelitis
8005. Assessment
8006. Nursing Diagnosis and Planning
8007. Expected Outcome
8008. Expected Outcomes
8009. Expected Outcomes
8010. Expected Outcomes
8011. Interventions
8012. Administering IV Antibiotics
8013. Providing Wound Care
8014. Maintaining Nutritional Status
8015. Teaching Home Management
8016. Promoting Optimal Development
8017. Evaluation
8018. Scoliosis
8019. TABLE 50-4 CLASSIFICATIONS OF SCOLIOSIS
8020. Adolescent Idiopathic Scoliosis
8021. Prevalence and Etiology
8022. Manifestations
8023. Diagnostic Evaluation
8024. School Screening
8025. FIG 50-5 Most spinal abnormalities in children are abnormal curvatures. In scoliosis, the spine curves laterally and the vertebrae rotate, pulling the ribs along. Kyphosis is a front-to-back rounding, usually of the thoracic spine; it is often accompanied by scoliosis. Lordosis is an exaggerated concave curvature of the spine, usually in the lumbar area.
8026. Physical Examination
8027. Radiographs
8028. FIG 50-6 Plain radiographs of scoliosis before (A, B) and after spinal fusion (C, D).
8029. Treatment
8030. Nonsurgical Interventions
8031. Surgical Intervention
8032. FIG 50-7 Adolescent with scoliosis brace.
8033. Surgical Complications
8034. Postoperative Management
8035. Follow-Up Care
8036. Kyphosis
8037. Scheuermann’s Kyphosis
8038. NURSING CARE PLAN: The Adolescent Undergoing a Spinal Fusion
8039. Focused Assessment
8040. Preoperative Assessment
8041. Postoperative Assessment
8042. Nursing Diagnosis
8043. Planning
8044. Expected Outcome
8045. Interventions and Rationales
8046. Evaluation
8047. Nursing Diagnosis
8048. Planning
8049. Expected Outcomes
8050. Interventions and Rationales
8051. Evaluation
8052. Nursing Diagnosis
8053. Planning
8054. Expected Outcome
8055. Interventions and Rationales
8056. Evaluation
8057. Other Causes of Hyperkyphosis
8058. Limb Differences
8059. Etiology and Incidence
8060. Diagnostic Evaluation
8061. Therapeutic Management
8062. Nursing Considerations
8063. Developmental Dysplasia of the Hip
8064. Etiology and Incidence
8065. TABLE 50-5 LIMB DIFFERENCES
8066. Manifestations
8067. FIG 50-8 Genu varum (bowlegs). In the child with genu varum, or bowlegs, a persistent space is present between the knees when the ankles are together. Genu varum is a normal finding for 1 year after the child begins walking.
8068. FIG 50-9 Genu valgum (knock knees). In the child with genu valgum, or knock knees, a space is present between the ankles when the knees are together. To remember the terminology, liken the r’s and g’s: genu var um—knees apar t; genu valg um—knees tog ether.
8069. Diagnostic Evaluation
8070. Therapeutic Management
8071. PATHOPHYSIOLOGY: Developmental Dysplasia of the Hip
8072. Nursing Care
8073. The Child with Developmental Dysplasia of the Hip
8074. Assessment
8075. FIG 50-10 An infant in a Pavlik harness to treat developmental dysplasia of the hip.
8076. Nursing Diagnosis and Planning
8077. Expected Outcomes
8078. Expected Outcome
8079. Expected Outcomes
8080. Expected Outcome
8081. Expected Outcomes
8082. Interventions
8083. Teaching about the Pavlik Harness
8084. Teaching about Spica Cast Care
8085. FIG 50-11 Regular assessment of circulation, sensation, and movement in the lower extremities is essential when a child has a hip spica cast.
8086. Alleviating Anxiety
8087. Preventing Injury
8088. FIG 50-12 Use a car seat that can accommodate the wide leg spread caused by the spica cast or a car vest restraint for older children.
8089. Evaluation
8090. Legg-Calvé-Perthes Disease
8091. Etiology and Incidence
8092. PATHOPHYSIOLOGY: Legg-Calvé-Perthes Disease
8093. Manifestations
8094. Diagnostic Evaluation
8095. Therapeutic Management
8096. Nursing Care
8097. The Child with Legg-Calvé-Perthes Disease
8098. Assessment
8099. Nursing Diagnosis and Planning
8100. Expected Outcomes
8101. Expected Outcomes
8102. Interventions
8103. Facilitating Appropriate Activity
8104. Teaching Home Management
8105. Evaluation
8106. Slipped Capital Femoral Epiphysis
8107. Etiology and Incidence
8108. Pathophysiology
8109. Manifestations and Diagnostic Evaluation
8110. Therapeutic Management and Nursing Considerations
8111. CRITICAL THINKING EXERCISE 50-1
8112. Clubfoot
8113. Etiology and Incidence
8114. FIG 50-13 An infant with left clubfoot. Note the positional difference between the two feet.
8115. Manifestations and Diagnostic Evaluation
8116. Therapeutic Management
8117. Ponseti Casting Method
8118. Clubfoot Recurrence
8119. Nursing Considerations
8120. Education and Anticipatory Guidance
8121. Reduction of Discomfort and Pain
8122. Patient Advocacy
8123. Muscular Dystrophies
8124. Etiology
8125. Incidence
8126. Pathophysiology
8127. Manifestations
8128. Diagnostic Evaluation
8129. Therapeutic Management
8130. TABLE 50-6 MUSCULAR DYSTROPHIES OF CHILDHOOD
8131. Nursing Considerations
8132. TABLE 50-7 MAJOR TYPES OF JUVENILE IDIOPATHIC ARTHRITIS
8133. Rheumatoid arthritis ExemplarJuvenile Idiopathic Arthritis
8134. Etiology
8135. Incidence
8136. PATHOPHYSIOLOGY: Juvenile Idiopathic Arthritis
8137. Manifestations
8138. Diagnostic Evaluation
8139. Therapeutic Management
8140. Drug Therapy
8141. DRUG GUIDE: Naproxen, Naproxen Sodium
8142. Physical and Occupational Therapy
8143. Surgical Treatment
8144. Nursing Care
8145. The Child with JIA
8146. Assessment
8147. Nursing Diagnosis and Planning
8148. Expected Outcome
8149. Expected Outcomes
8150. Expected Outcomes
8151. Expected Outcomes
8152. Expected Outcome
8153. Interventions
8154. Managing Pain
8155. Promoting Mobility
8156. Managing Potential Infections
8157. Facilitating Emotional and Social Development
8158. Family Education
8159. Evaluation
8160. Syndromes and Conditions with Associated Orthopedic Anomalies
8161. TABLE 50-8 SYNDROMES AND CONDITIONS WITH ASSOCIATED ORTHOPEDIC ANOMALIES
8162. Key Concepts
8163. References and Readings
8164. Pageburst Integrated Resource
8165. Animation
8166. Chapter 51 The Child with an Endocrine or Metabolic Alteration
8167. Learning Objectives
8168. Clinical Reference
8169. Review of the Endocrine System
8170. PEDIATRIC DIFFERENCES IN THE ENDOCRINE SYSTEM
8171. Diagnostic Tests and Procedures
8172. COMMON LABORATORY AND DIAGNOSTIC TESTS OF ENDOCRINE FUNCTION
8173. Phenylketonuria
8174. Etiology
8175. Incidence
8176. Manifestations
8177. Diagnostic Evaluation
8178. PATHOPHYSIOLOGY: Phenylketonuria
8179. Therapeutic Management
8180. Nursing Considerations
8181. Inborn Errors of Metabolism
8182. Congenital Adrenal Hyperplasia
8183. Etiology
8184. Manifestations
8185. TABLE 51-1 INBORN ERRORS OF METABOLISM
8186. Diagnostic Evaluation
8187. Therapeutic Management
8188. Nursing Considerations
8189. SAFETY ALERT: Congenital Adrenal Hyperplasia
8190. Congenital Hypothyroidism
8191. Etiology
8192. PATHOPHYSIOLOGY: Congenital Hypothyroidism
8193. Incidence
8194. Manifestations
8195. Diagnostic Evaluation
8196. FIG 51-1 A, This untreated 6-month-old infant with congenital hypothyroidism fed poorly and was constipated. She was lethargic and had no social smile or head control. Note her puffy face, large tongue, dull expression, and excessive hair growth (hirsutism) on the forehead. B, The same infant 4 months after treatment. Note the decreased facial puffiness, decreased forehead hirsutism, and an alert appearance.
8197. Therapeutic Management
8198. Nursing Care
8199. The Infant with Congenital Hypothyroidism
8200. Assessment
8201. Nursing Diagnosis and Planning
8202. Expected Outcomes
8203. Expected Outcomes
8204. Expected Outcome
8205. Interventions
8206. NURSING QUALITY ALERT: The Child with Congenital Hypothyroidism
8207. Evaluation
8208. Acquired Hypothyroidism
8209. Etiology
8210. Pathophysiology
8211. Manifestations
8212. Diagnostic Evaluation
8213. BOX 51-1 INDICATORS OF HYPOTHYROIDISM OR HYPERTHYROIDISM
8214. Therapeutic Management
8215. Nursing Care
8216. The Child with Acquired Hypothyroidism
8217. Assessment
8218. Nursing Diagnosis and Planning
8219. Expected Outcome
8220. Expected Outcome
8221. Expected Outcomes
8222. Expected Outcome
8223. Interventions
8224. Evaluation
8225. Hyperthyroidism (Graves Disease)
8226. Incidence
8227. Pathophysiology
8228. Manifestations
8229. NURSING QUALITY ALERT: Autoimmune Thyroid Disorders
8230. Diagnostic Evaluation
8231. Therapeutic Management
8232. Nursing Care
8233. The Child with Hyperthyroidism
8234. Assessment
8235. Nursing Diagnosis and Planning
8236. Expected Outcome
8237. Expected Outcomes
8238. Expected Outcome
8239. Expected Outcome
8240. Expected Outcome
8241. Interventions
8242. Evaluation
8243. Diabetes Insipidus
8244. Etiology
8245. Incidence
8246. Manifestations
8247. Diagnostic Evaluation
8248. BOX 51-2 INDICATORS OF DIABETES INSIPIDUS OR SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH)
8249. Therapeutic Management
8250. NURSING QUALITY ALERT: Diabetes Insipidus
8251. Nursing Considerations
8252. PATHOPHYSIOLOGY: Diabetes Insipidus
8253. Syndrome of Inappropriate Antidiuretic Hormone
8254. Etiology
8255. Manifestations
8256. PATHOPHYSIOLOGY: Syndrome of Inappropriate Antidiuretic Hormone
8257. Diagnostic Evaluation
8258. Therapeutic Management
8259. Nursing Considerations
8260. NURSING QUALITY ALERT: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
8261. BOX 51-3 SIGNS OF HYPONATREMIA
8262. Precocious Puberty
8263. Etiology
8264. Incidence
8265. Manifestations
8266. Diagnostic Evaluation
8267. Therapeutic Management
8268. Nursing Care
8269. The Child with Precocious Puberty
8270. Assessment
8271. PATHOPHYSIOLOGY: Precocious Puberty
8272. Nursing Diagnosis and Planning
8273. Expected Outcomes
8274. Expected Outcomes
8275. Expected Outcome
8276. NURSING QUALITY ALERT: Precocious Puberty
8277. Interventions
8278. Evaluation
8279. Growth Hormone Deficiency
8280. Etiology
8281. Incidence
8282. Manifestations
8283. PATHOPHYSIOLOGY: Growth Hormone Deficiency
8284. Diagnostic Evaluation
8285. Therapeutic Management
8286. Nursing Care
8287. The Child with Growth Hormone Deficiency
8288. Assessment
8289. Nursing Diagnosis and Planning
8290. Expected Outcomes
8291. Expected Outcome
8292. Expected Outcome
8293. Expected Outcomes
8294. NURSING QUALITY ALERT: Criteria for Suspecting Growth Hormone Deficiency
8295. Interventions
8296. Evaluation
8297. CRITICAL THINKING EXERCISE 51-1
8298. Diabetes, Type 1 ExemplarDiabetes Mellitus
8299. Type 1 Diabetes Mellitus
8300. Etiology
8301. Incidence
8302. Manifestations
8303. Diagnostic Evaluation
8304. TABLE 51-2 ACTIONS OF INSULIN
8305. TABLE 51-3 COMPARISON OF HYPOGLYCEMIA, HYPERGLYCEMIA, AND KETOACIDOSIS
8306. Therapeutic Management
8307. Insulin Therapy
8308. PATHOPHYSIOLOGY: Type 1 Diabetes Mellitus
8309. TABLE 51-4 INSULIN ACTION BY TYPE
8310. Schedule
8311. FIG 51-2 Peak action of insulin injections is timed to correspond with the child’s usual meal and snack times to minimize the chance of hypoglycemia. L/A, Lispro/Aspart (rapid-acting insulin).
8312. Administration
8313. FIG 51-3 Subcutaneous insulin injection sites most commonly used. Rate of absorption varies by site.
8314. Nutrition Therapy
8315. Physical Activity
8316. NURSING QUALITY ALERT: Managing the Child with Type 1 Diabetes Mellitus
8317. Insulin
8318. Nutrition
8319. Exercise
8320. Blood Glucose Monitoring
8321. Blood Glucose Monitoring
8322. Developmental Issues
8323. Infant and Toddler
8324. Preschooler
8325. School-Age Child
8326. Adolescent
8327. TABLE 51-5 EXAMPLES OF DIABETES MANAGEMENT TASKS DELEGATED TO CHILD (WITH SUPERVISION)
8328. NURSING CARE PLAN: The Child with Type 1 Diabetes Mellitus in the Community Setting
8329. Focused Assessment
8330. Nursing Diagnosis
8331. Planning
8332. Expected Outcome
8333. Interventions and Rationales
8334. Evaluation
8335. Nursing Diagnosis
8336. Planning
8337. Expected Outcomes
8338. Interventions and Rationales
8339. Evaluation
8340. Nursing Diagnosis
8341. Planning
8342. Expected Outcomes
8343. Interventions and Rationales
8344. Evaluation
8345. Nursing Diagnosis
8346. Planning
8347. Expected Outcomes
8348. Interventions and Rationales
8349. Evaluation
8350. Delegating Diabetes Management Responsibilities
8351. Diabetic ketoacidosis ExemplarDiabetic Ketoacidosis
8352. Etiology
8353. Manifestations
8354. PATIENT-CENTERED TEACHING: Home Management of Type 1 Diabetes Mellitus
8355. Outcomes
8356. General Information
8357. Medication Therapy
8358. The school-age child is usually able to perform daily self-monitoring of blood glucose with parental help. However, the child should not be expected to adjust the insulin dose based on the reading. By early adolescence, the child can be in charge of recording blood glucose values in the diary.
8359. Home Glucose Monitoring
8360. Hypoglycemia
8361. When other parts of the treatment regimen have become familiar, the injection technique can be taught. Initially, self-injecting insulin may be frightening for the school-age child, so the parent may insert the needle and have the child then push the plunger. The child can then progress to performing self-injection.
8362. Hyperglycemia
8363. Nutrition/Exercise
8364. Complications
8365. Psychological Adjustment and Family Involvement
8366. Community Resources
8367. BOX 51-4 SICK-DAY MANAGEMENT FOR THE CHILD WITH TYPE 1 DIABETES MELLITUS
8368. Diagnostic Evaluation
8369. Therapeutic Management
8370. Long-Term Health Care Needs for the Child with Type 1 Diabetes Mellitus
8371. NURSING CARE PLAN: The Child in Diabetic Ketoacidosis (DKA)
8372. Focused Assessment
8373. Nursing Diagnosis
8374. Planning
8375. Expected Outcome
8376. Interventions and Rationales
8377. Evaluation
8378. Nursing Diagnosis
8379. Planning
8380. Expected Outcome
8381. Interventions and Rationales
8382. Evaluation
8383. Nursing Diagnosis
8384. Planning
8385. Expected Outcome
8386. Interventions and Rationales
8387. Evaluation
8388. Nursing Diagnosis
8389. Planning
8390. Expected Outcome
8391. Interventions and Rationales
8392. Evaluation
8393. Diabetes, Type 2 ExemplarType 2 Diabetes Mellitus
8394. Etiology
8395. Incidence
8396. Manifestations
8397. Diagnostic Evaluation
8398. Therapeutic Management
8399. Medication Therapy
8400. Nutrition Therapy
8401. Physical Activity
8402. Blood Glucose Monitoring
8403. Prevention
8404. KEY CONCEPTS
8405. References and Readings
8406. Pageburst Integrated Resource
8407. Animation
8408. Chapter 52 The Child with a Neurologic Alteration
8409. Learning Objectives
8410. Clinical Reference
8411. Review of the Central Nervous System
8412. Embryologic Development
8413. The Myelin Sheath
8414. PEDIATRIC DIFFERENCES IN THE CENTRAL NERVOUS SYSTEM
8415. The Neural System
8416. The Axial Skeleton
8417. The Meninges
8418. The Brain
8419. The Cranial Nerves
8420. The Spinal Cord
8421. CSF ANALYSIS IN CHILDREN: NORMAL FINDINGS
8422. CEREBROSPINAL FLUID ANALYSIS: FINDINGS IN PATHOLOGIC CONDITIONS
8423. Cerebrospinal Fluid
8424. Cerebral Blood Flow and Intracranial Regulation
8425. COMMON DIAGNOSTIC TESTS AND PROCEDURES FOR NEUROLOGIC DISORDERS
8426. LUMBAR PUNCTURE: EDUCATING THE FAMILY
8427. For the lumbar puncture: Place one hand farther down, under the child’s neck. Your forearm moves behind the child’s head to support the neck. Place the other arm farther under the child’s upper thighs and curl the child’s body by bringing the knees up to the head. Note that this nurse’s weight is supported on the edge of the examination table, and the nurse leans slightly over the child, controlling the arms and legs. Because direct visibility of the child’s respiratory status is limited in this position, a cardiorespiratory monitor must be used for the child.
8428. NURSING CARE PLAN: The Child with a Neurologic System Disorder
8429. Focused Assessment
8430. Nursing Diagnosis
8431. Planning
8432. Expected Outcomes
8433. Interventions and Rationales
8434. Evaluation
8435. Nursing Diagnosis
8436. Planning
8437. Expected Outcome
8438. Interventions and Rationales
8439. Evaluation
8440. Nursing Diagnosis
8441. Planning
8442. Expected Outcome
8443. Interventions and Rationales
8444. Evaluation
8445. Nursing Diagnosis
8446. Planning
8447. Expected Outcome
8448. Interventions and Rationales
8449. Evaluation
8450. Nursing Diagnosis
8451. Planning
8452. Expected Outcome
8453. Interventions and Rationales
8454. Evaluation
8455. Increased Intracranial Pressure
8456. Etiology
8457. Manifestations
8458. BOX 52-1 DEVELOPMENTAL MANIFESTATIONS OF INCREASED INTRACRANIAL PRESSURE
8459. TABLE 52-1 GLASGOW COMA SCALE MODIFIED FOR CHILDREN
8460. Level of Consciousness
8461. Behavior
8462. NURSING QUALITY ALERT: Delirium ExemplarStandard Terms for Level of Consciousness
8463. Pupil Evaluation
8464. Motor Function
8465. Vital Signs
8466. FIG 52-1 Flexion and extension posturing.
8467. PATHOPHYSIOLOGY: Increased Intracranial Pressure
8468. Diagnostic Evaluation and Therapeutic Management
8469. EVIDENCE-BASED PRACTICE
8470. BOX 52-2 INSTRUMENTS FOR MONITORING INCREASED INTRACRANIAL PRESSURE
8471. Spina Bifida
8472. Etiology and Incidence
8473. Manifestations
8474. FIG 52-2 Three forms of spina bifida.
8475. PATHOPHYSIOLOGY: Spina Bifida
8476. FIG 52-3 This infant has a repaired myelomeningocele. Note the left clubfoot. This deformity often accompanies the defect because normal intrauterine movement does not occur in the fetus with spina bifida, interfering with the development of the extremities. The legs are flaccid, and normal neonatal flexion is absent. The infant also dribbles stool and urine constantly. Hydrocephalus commonly accompanies these neural tube defects.
8477. Diagnostic Evaluation
8478. Therapeutic Management
8479. Hydrocephalus
8480. Etiology
8481. Incidence
8482. Manifestations and Diagnostic Evaluation
8483. TABLE 52-2 EARLY AND LATE MANIFESTATIONS OF HYDROCEPHALUS
8484. PATHOPHYSIOLOGY: Hydrocephalus
8485. Therapeutic Management
8486. Cerebral palsy ExemplarCerebral Palsy
8487. Etiology and Incidence
8488. FIG 52-4 A ventriculoperitoneal shunt may be implanted in the child with hydrocephalus to prevent excess accumulation of cerebrospinal fluid (CSF) in the ventricles. The tubing diverts the CSF from the ventricles into the peritoneal cavity, where it is reabsorbed. Nursing care includes monitoring for infection, obstruction, and pain, administering antibiotics and pain medications as ordered, and teaching the family how to change dressings and how to recognize shunt blockages or other problems.
8489. BOX 52-3 FACTORS ASSOCIATED WITH CEREBRAL PALSY
8490. Prenatal
8491. Perinatal
8492. Postnatal
8493. Manifestations
8494. Diagnostic Evaluation and Therapeutic Management
8495. PATHOPHYSIOLOGY: Cerebral Palsy
8496. NURSING CARE PLAN: The Child with Cerebral Palsy in the Community Setting
8497. Focused Assessment
8498. Nursing Diagnosis
8499. Planning
8500. Expected Outcomes
8501. Interventions and Rationales
8502. Evaluation
8503. Nursing Diagnosis
8504. Planning
8505. Expected Outcome
8506. Interventions and Rationales
8507. Evaluation
8508. Nursing Diagnosis
8509. Planning
8510. Expected Outcomes
8511. Interventions and Rationales
8512. Evaluation
8513. Nursing Diagnosis
8514. Planning
8515. Expected Outcome
8516. Interventions and Rationales
8517. Evaluation
8518. Head Injury
8519. Types of Head Injuries
8520. FIG 52-5 Epidural and subdural hematomas are the two most common cranial hematomas, occurring in 6% to 7% of all children with head injuries. With epidural hematoma, a rapid decline in neurologic function may occur 4 to 8 hours after a brief period of lucidity. If untreated, the increased intracranial pressure (ICP) can cause death in a short time. A subdural hematoma is often caused when the head strikes an immovable object. A subdural hematoma (along with retinal hemorrhage) in an infant or child may occur as a result of child abuse involving aggressive shaking, blunt impact, or both (abusive head trauma).
8521. Skull Fractures
8522. Contusion
8523. Concussion
8524. Intracranial Hemorrhage
8525. Incidence
8526. BOX 52-4 CLASSIFICATION OF SEVERITY OF HEAD INJURIES BASED ON GLASGOW COMA SCALE (GCS)∗
8527. Manifestations
8528. Diagnostic Evaluation
8529. Therapeutic Management
8530. PATHOPHYSIOLOGY: Head Injury
8531. PARENTS WANT TO KNOW: Guidelines for the Child with a Head Injury∗
8532. Postconcussion Syndrome
8533. Second Impact Syndrome
8534. Nursing Considerations
8535. Spinal cord injury ExemplarSpinal Cord Injury
8536. Etiology
8537. PATHOPHYSIOLOGY: Spinal Cord Injury
8538. Incidence
8539. Manifestations
8540. Diagnostic Evaluation
8541. Therapeutic Management
8542. FIG 52-6 Children who have injuries or birth defects that involve the upper spine may be placed in halo traction to stabilize the spine and prevent added nerve damage. Spinal cord injury is a catastrophic event for the child and family; intense nursing support and education as well as referral to support groups, will be needed.
8543. Nursing Care
8544. The Child with a Spinal Cord Injury
8545. Assessment
8546. Nursing Diagnosis and Planning
8547. Expected Outcome
8548. Expected Outcome
8549. Expected Outcomes
8550. Expected Outcome
8551. Expected Outcome
8552. Interventions
8553. Evaluation
8554. Seizure ExemplarSeizure Disorders
8555. Etiology
8556. Incidence
8557. Pathophysiology
8558. Manifestations
8559. Diagnostic Evaluation
8560. Therapeutic Management
8561. BOX 52-5 INTERNATIONAL CLASSIFICATION OF SEIZURES
8562. Generalized Seizures
8563. Tonic, Clonic, and Tonic-Clonic Seizures
8564. Atonic Seizures
8565. Myoclonic Seizures
8566. Absence Seizures
8567. Focal Seizures
8568. Unknown
8569. TABLE 52-3 COMMON SEIZURE MEDICATIONS
8570. NURSING CARE PLAN: The Child with a Seizure Disorder in the Community Setting
8571. Focused Assessment
8572. Nursing Diagnosis
8573. Planning
8574. Expected Outcomes
8575. Interventions and Rationales
8576. Evaluation
8577. Nursing Diagnosis
8578. Planning
8579. Expected Outcomes
8580. Interventions and Rationales
8581. Evaluation
8582. PATIENT-CENTERED TEACHING: Guidelines for the Child or Adolescent Taking Seizure Medication
8583. Status Epilepticus
8584. Etiology
8585. Incidence
8586. Pathophysiology
8587. NURSING QUALITY ALERT: Observations and Nursing Care during a Seizure
8588. Manifestations
8589. Diagnostic Evaluation
8590. Therapeutic Management
8591. Nursing Care
8592. The Child with Status Epilepticus
8593. Assessment
8594. Nursing Diagnosis and Planning
8595. Expected Outcome
8596. Expected Outcome
8597. Expected Outcome
8598. Expected Outcome
8599. Interventions and Evaluation
8600. SAFETY ALERT: Drug Therapy for Generalized Tonic-Clonic Status Epilepticus
8601. Bacterial meningitis ExemplarViral meningitis ExemplarMeningitis
8602. Etiology
8603. FIG 52-7 As part of the assessment for meningitis, the nurse can attempt to elicit Kernig sign and Brudzinski sign. Both are early indicators of meningitis in children and adolescents. Kernig sign The child can easily extend the leg when in the supine position. However, when the thigh is flexed toward the abdomen, pain prevents complete extension of the leg. Brudzinski sign In the supine position, the child bends her head toward her chest (in the younger child, the nurse can bend the child’s head). This action usually produces involuntary hip and knee flexion in the child with meninigitis.
8604. Incidence
8605. Manifestations
8606. Diagnostic Evaluation
8607. Therapeutic Management
8608. PATHOPHYSIOLOGY: Meningitis
8609. Nursing Care
8610. The Child with Meningitis
8611. Assessment
8612. Nursing Diagnosis and Planning
8613. Expected Outcome
8614. Interventions
8615. NURSING QUALITY ALERT: Guidelines for the Child with Meningitis
8616. CRITICAL THINKING EXERCISE 52-1
8617. Evaluation
8618. Guillain-Barré Syndrome
8619. Incidence
8620. Pathophysiology
8621. Manifestations
8622. Diagnostic Evaluation
8623. Therapeutic Management
8624. Nursing Care
8625. The Child with Guillain-Barré Syndrome
8626. Assessment
8627. Nursing Diagnosis and Planning
8628. Expected Outcome
8629. Expected Outcome
8630. Expected Outcome
8631. Expected Outcome
8632. Expected Outcome
8633. Expected Outcome
8634. Expected Outcomes
8635. Expected Outcome
8636. Interventions
8637. Evaluation
8638. Neurologic Conditions Requiring Critical Care
8639. Headaches
8640. Etiology
8641. Incidence
8642. Manifestations
8643. Migraine
8644. Tension-Type Headaches
8645. Diagnostic Evaluation
8646. TABLE 52-4 NEUROLOGIC CONDITIONS REQUIRING CRITICAL CARE
8647. Nursing Care
8648. The Child with Headaches
8649. Assessment
8650. Nursing Diagnosis and Planning
8651. Expected Outcome
8652. Expected Outcomes
8653. Expected Outcome
8654. Interventions
8655. Evaluation
8656. KEY CONCEPTS
8657. References and Readings
8658. Pageburst Integrated Resource
8659. Animation
8660. Chapter 53 Psychosocial Problems in Children and Families
8661. Learning Objectives
8662. Clinical Reference
8663. Overview of Psychosocial Disorders of Childhood
8664. PSYCHOSOCIAL DISORDERS TYPICALLY MANIFESTED IN CHILDHOOD
8665. Precipitating Factors
8666. Diagnostic Evaluation
8667. MENTAL STATUS EXAMINATION OF CHILDREN
8668. EVIDENCE-BASED PRACTICE
8669. Emotional Disorders
8670. Anxiety Disorders
8671. Social Anxiety Disorder
8672. Separation Anxiety
8673. Panic attack ExemplarPanic Disorder
8674. Posttraumatic distress disorder ExemplarPosttraumatic Stress Disorder
8675. Obsessive compulsive disorder ExemplarObsessive-Compulsive Disorder
8676. Mood Disorders
8677. Depressive disorders ExemplarDepression ExemplarMajor Depressive Disorder and Dysthymic Disorder
8678. Adjustment Disorder
8679. Bipoar ExemplarBipolar disorder ExemplarBipolar Disorder
8680. Etiology and Physiology of Emotional Disorders
8681. Biologic Factors
8682. Environmental Factors
8683. Traumatic brain injury ExemplarTraumatic Brain Injury
8684. Manifestations
8685. Therapeutic Management of Children with Emotional Disorders
8686. Nursing Care
8687. The Child with an Emotional Disorder
8688. Assessment
8689. Nursing Diagnosis and Planning
8690. Expected Outcome
8691. Expected Outcome
8692. Expected Outcome
8693. Expected Outcome
8694. Expected Outcome
8695. Interventions
8696. Evaluation
8697. Self-harm ExemplarSuicide ExemplarSuicide
8698. NURSING QUALITY ALERT: Resources for People with Thoughts of Suicide
8699. Manifestations and Risk Factors
8700. Therapeutic Management
8701. Prevention
8702. When Prevention and Intervention Fail
8703. Nursing Care
8704. The Child or Adolescent at Risk for Suicide
8705. Assessment
8706. BOX 53-1 QUESTIONS TO ASSESS SUICIDE POTENTIAL
8707. Nursing Diagnosis and Planning
8708. Expected Outcome
8709. Expected Outcome
8710. Expected Outcome
8711. Expected Outcome
8712. Expected Outcome
8713. Interventions
8714. Evaluation
8715. Behavioral Disorders
8716. Etiology
8717. Manifestations
8718. Diagnostic Evaluation
8719. Therapeutic Management
8720. Nursing Care
8721. The Child with ADHD
8722. Assessment
8723. Nursing Diagnosis and Planning
8724. Expected Outcomes
8725. Expected Outcome
8726. Expected Outcome
8727. Expected Outcome
8728. Interventions
8729. Evaluation
8730. Anorexia nervosa ExemplarBulimia ExemplarEating Disorders: Anorexia Nervosa and Bulimia Nervosa
8731. Etiology
8732. Manifestations
8733. Anorexia Nervosa
8734. FIG 53-1 In anorexia nervosa, the adolescent refuses to maintain adequate body weight, partly because of a distorted body image: She perceives herself as overweight when in fact she is below minimum weight.
8735. Bulimia Nervosa
8736. Diagnostic Evaluation
8737. Therapeutic Management
8738. Nursing Care
8739. The Child or Adolescent with an Eating Disorder
8740. Assessment
8741. Nursing Diagnosis and Planning
8742. Expected Outcome
8743. Expected Outcome
8744. Expected Outcome
8745. Expected Outcome
8746. Interventions
8747. Evaluation
8748. Substance Abuse
8749. TABLE 53-1 Opioid ExemplarAlcohol intoxication ExemplarTobacco products Exemplar COMMONLY ABUSED DRUGS AND THEIR EFFECTS
8750. Etiology
8751. BOX 53-2 PHASES OF SUBSTANCE ABUSE
8752. Phase 1: Experimentation
8753. Phase 2: Early Drug Use
8754. Phase 3: True Drug Addiction
8755. Phase 4: Severe Drug Addiction
8756. Manifestations
8757. NURSING QUALITY ALERT: Relapse Among Substance Abusers
8758. Therapeutic Management
8759. Nursing Care
8760. The Child or Adolescent with a Substance Abuse Problem
8761. Assessment
8762. Nursing Diagnosis and Planning
8763. Expected Outcome
8764. Expected Outcome
8765. Expected Outcome
8766. Expected Outcome
8767. Expected Outcome
8768. Expected Outcome
8769. Interventions
8770. Evaluation
8771. Child abuse ExemplarChildhood Physical and Emotional Abuse and Child Neglect
8772. Etiology
8773. Incidence
8774. BOX 53-3 CHARACTERISTICS OF THE ABUSIVE FAMILY
8775. Manifestations
8776. Indicators of Physical Abuse
8777. Indicators of Neglect
8778. FIG 53-2 Physical signs of child abuse. The nurse should be alert for the typical behavioral indicators of abuse.
8779. Nonaccidental distribution of bruises: All four surfaces of the torso are involved, but there are no bruises on arms and legs.
8780. Pattern of injury: Linear scars of various ages indicate repeated abuse with a switch or a whip. The loop pattern on the boy’s anterior torso is consistent with a looped electrical cord used as a whip.
8781. Scald burn of shoulder and neck: The typical distribution of a scald burn in a toddler. This type of injury occurs when a toddler pulls a cup of coffee or pan of water off a stove.
8782. Nonaccidental immersion scald: Involvement of virtually the entire posterior surface of the legs indicates that the legs were held under scalding water; even an infant this young would flex the knees to avoid the hot water.
8783. Indicators of Emotional Abuse
8784. Indicators of Sexual Abuse
8785. Other Specific Abusive Situations
8786. Abusive Head Trauma
8787. Munchausen Syndrome by Proxy
8788. CRITICAL THINKING EXERCISE 53-1
8789. NURSING CARE PLAN: The Abused Child
8790. Focused Assessment
8791. Nursing Diagnosis
8792. Planning
8793. Expected Outcome
8794. Interventions and Rationales
8795. Evaluation
8796. Nursing Diagnosis
8797. Planning
8798. Expected Outcomes
8799. Interventions and Rationales
8800. Evaluation
8801. Nursing Diagnosis
8802. Planning
8803. Expected Outcomes
8804. Interventions and Rationales
8805. Evaluation
8806. Nursing Diagnosis
8807. Planning
8808. Expected Outcome
8809. Interventions and Rationales
8810. Evaluation
8811. FIG 53-3 Disclosure of abuse may be slow because the child often has difficulty trusting any adult. Physical examination and interview of children who may be victims of sexual abuse require particular sensitivity because physical inspection of the child’s genitalia to detect signs of injury or sexually transmitted disease may frighten the child, who associates handling of the genitalia with pain or shame. Anatomically correct dolls are often used in the assessment of abuse within a family. These dolls help children express what they cannot express in words; young children in particular have a limited vocabulary to use when describing the events that have occurred. Note the communication techniques designed to reassure the child and give the child some power. The little girl is not immediately positioned for a genital examination. The physician first sits to talk with the child at her eye level and makes eye contact with her. Drawings may help to identify the abused child and assist in therapy. Art can also help the child express what cannot be expressed in words.
8812. KEY CONCEPTS
8813. References and Readings
8814. Chapter 54 The Child with a Developmental Disability
8815. Learning Objectives
8816. CLINICAL REFERENCE
8817. Genetics and Genomics
8818. COMMON DIAGNOSTIC TESTS FOR INTELLECTUAL AND DEVELOPMENTAL DISORDERS
8819. Intellectual and Developmental Disorders
8820. Developmental Disability and the Americans with Disabilities Act: The Impact of Public Policy
8821. Terminology
8822. Mental Age, Functional Age, Adaptive Functioning
8823. Intellectual Impairment and Intellectual Disability
8824. Intellectual Impairment versus Mental Retardation
8825. Autism Spectrum Disorders versus Pervasive Developmental Disorders
8826. Etiology of Intellectual Disabilities and Pervasive Developmental Disorders
8827. BOX 54-1 CAUSES OF INTELLECTUAL DISABILITY
8828. Genetic
8829. Alterations Occurring during Pregnancy
8830. Neonatal Alterations
8831. Acquired Childhood Conditions or Diseases
8832. Environmental Problems
8833. EVIDENCE-BASED PRACTICE
8834. Incidence of Intellectual and Developmental Disorders
8835. BOX 54-2 PROBLEMS RELATED TO INTELLECTUAL DISABILITY
8836. Mild
8837. Severe
8838. Manifestations
8839. FIG 54-1 Children with intellectual impairments may have other dysfunctions as well. The family of a child with an intellectual impairment often feels continual grief because the child does not meet their expectations. This child has additional dysfunctions that require respiratory and nutritional support.
8840. Diagnostic Evaluation
8841. BOX 54-3 EXPECTED SKILLS ACCORDING TO INTELLIGENCE QUOTIENT (IQ) SCORES
8842. Normal Intelligence (IQ 85 to 115)
8843. Borderline Intellectual Disability (IQ 71 to 84)
8844. Mild Intellectual Disability (IQ 50-55 to ~70)
8845. Moderate Intellectual Disability (IQ 35-40 to 50-55)
8846. Severe Intellectual Disability (IQ 20-25 to 35-40)
8847. Profound Intellectual Disability (IQ <20 to 25)
8848. TABLE 54-1 SAFETY CONCERNS FOR DEVELOPMENTALLY DELAYED OR IMPAIRED CHILDREN
8849. Management
8850. General Strategies
8851. Safety Challenges
8852. SAFETY ALERT: The Child with a Developmental Disorder
8853. Disorders Resulting in Intellectual or Developmental Disability
8854. NURSING CARE PLAN: The Child with a Developmental Disorder or Disability in the Community Setting
8855. Focused Assessment: The Child
8856. Focused Assessment: The Family
8857. Nursing Diagnosis
8858. Planning
8859. Expected Outcome
8860. Interventions and Rationales
8861. Evaluation
8862. Nursing Diagnosis
8863. Planning
8864. Expected Outcomes
8865. Interventions and Rationales
8866. Evaluation
8867. Nursing Diagnosis
8868. Planning
8869. Expected Outcomes
8870. Interventions and Rationales
8871. Evaluation
8872. Nursing Diagnosis
8873. Planning
8874. Expected Outcomes
8875. Interventions and Rationales
8876. Evaluation
8877. FIG 54-2 Special Olympics International is the largest recreational program in the world for people with intellectual impairment. With more than 1 million athletes in 125 countries, Special Olympics offers opportunities for social interaction with peers and assists children who are intellectually disabled in reaching their maximum potential.
8878. Down syndrome ExemplarDown Syndrome
8879. FIG 54-3 Children with delayed motor or cognitive function, whether temporary or pervasive, benefit from early and vigorous therapy to help them reach their maximum development.
8880. BOX 54-4 MEDICAL CONDITIONS ASSOCIATED WITH DOWN SYNDROME
8881. Conditions Frequently Identified during the Neonatal Period
8882. Conditions Frequently Identified during Childhood
8883. Etiology
8884. Incidence
8885. PATHOPHYSIOLOGY: Down Syndrome
8886. Manifestations
8887. Diagnostic Evaluation
8888. Therapeutic Management
8889. Nursing Care
8890. The Child with DS
8891. Assessment
8892. Nursing Diagnosis and Planning
8893. Expected Outcome
8894. Expected Outcome
8895. Expected Outcomes
8896. Interventions
8897. Evaluation
8898. Fragile X Syndrome
8899. Etiology
8900. Incidence
8901. PATHOPHYSIOLOGY: Fragile X Syndrome
8902. Manifestations
8903. Intellectual Functioning
8904. Physical Characteristics
8905. Social and Emotional Relatedness
8906. Speech and Language Capability and Sensory Impairment
8907. Co-Morbid Disorders
8908. Diagnostic Evaluation
8909. Therapeutic Management
8910. Nursing Considerations
8911. Rett Syndrome
8912. Fetal Alcohol Spectrum Disorder
8913. Etiology and Incidence
8914. PATHOPHYSIOLOGY: Fetal Alcohol Syndrome
8915. Manifestations
8916. Diagnostic Evaluation
8917. FIG 54-4 Toddler with fetal alcohol syndrome. Subtle indicators are flat mid-face, indistinct philtrum, and low-set ears.
8918. Nursing Care
8919. The Infant with FAS
8920. Assessment
8921. Nursing Diagnosis and Planning
8922. Expected Outcome
8923. Expected Outcome
8924. Expected Outcome
8925. Expected Outcome
8926. Interventions
8927. Evaluation
8928. Nonorganic Failure to Thrive
8929. Etiology
8930. Incidence
8931. Manifestations and Risk Factors
8932. Diagnostic Evaluation
8933. Therapeutic Management
8934. Nursing Considerations
8935. Autism ExemplarAutism Spectrum Disorders
8936. Asperger Syndrome
8937. Autism
8938. TABLE 54-2 Schizophrenia Exemplar DIFFERENTIAL DIAGNOSIS OF AUTISM, INTELLECTUAL DISABILITY, AND SCHIZOPHRENIA
8939. Etiology
8940. Incidence
8941. Manifestations
8942. Social
8943. Language
8944. Restricted Behavioral Repertoire
8945. Diagnostic Evaluation
8946. Therapeutic Management
8947. CRITICAL THINKING EXERCISE 54-1
8948. Nursing Care
8949. The Child with Autism
8950. Assessment
8951. Nursing Diagnosis and Planning
8952. Expected Outcome
8953. Expected Outcomes
8954. Expected Outcomes
8955. Interventions
8956. NURSING QUALITY ALERT: Maintaining Routine for the Child with Autism
8957. Evaluation
8958. KEY CONCEPTS
8959. References and Readings
8960. Chapter 55 The Child with a Sensory Alteration
8961. Learning Objectives
8962. CLINICAL REFERENCE
8963. Review of the Eye
8964. Structure and Function
8965. Neonatal Development
8966. Review of the Ear
8967. Structure and Function
8968. Neonatal Development
8969. Speech Development
8970. PEDIATRIC DIFFERENCES IN SENSORY FUNCTION
8971. Vision
8972. Hearing
8973. Speech and Language
8974. Vision screening ExemplarDisorders of the Eye
8975. NURSING QUALITY ALERT: Vision Screening
8976. Nursing Considerations for the Child with Color Deficiency
8977. BOX 55-1 SIGNS AND SYMPTOMS OF POTENTIAL VISION PROBLEMS
8978. Nursing Considerations for the Child with a Blocked Lacrimal Duct
8979. Nursing Considerations for the Child with a Refractive Error
8980. TABLE 55-1 TYPES OF REFRACTIVE DISORDERS
8981. Nursing Considerations for the Child with Amblyopia
8982. Nursing Considerations for the Child with Strabismus
8983. PATIENT-CENTERED TEACHING: Information about Eye Patching
8984. BOX 55-2 TYPES OF STRABISMUS
8985. Child with early onset esotropia. The deviation may not be apparent until age 3 or 4 months.
8986. Child with left exotropia. Most exodeviations in childhood are intermittent.
8987. Glaucoma ExemplarNursing Considerations for the Child with Glaucoma
8988. Cataracts ExemplarNursing Considerations for the Child with a Cataract
8989. Eye Surgery
8990. NURSING CARE PLAN: The Child Having Eye Surgery
8991. Focused Assessment
8992. Nursing Diagnosis
8993. Planning
8994. Expected Outcomes
8995. Interventions and Rationales
8996. Evaluation
8997. Nursing Diagnosis
8998. Planning
8999. Expected Outcome
9000. Interventions and Rationales
9001. Evaluation
9002. Nursing Diagnosis
9003. Planning
9004. Expected Outcome
9005. Interventions and Rationales
9006. Evaluation
9007. Nursing Diagnosis
9008. Planning
9009. Expected Outcome
9010. Interventions and Rationales
9011. Evaluation
9012. Eye Infections
9013. Nursing Considerations for the Child with Conjunctivitis
9014. Nursing Considerations for the Child with Orbital Cellulitis
9015. Nursing Considerations for the Child with a Corneal Ulcer
9016. Eye Trauma
9017. Nursing Considerations for the Child with a Corneal Abrasion
9018. Nursing Considerations for the Child with Hemorrhage
9019. Nursing Considerations for the Child with Hyphema
9020. PARENTS WANT TO KNOW: How to Prevent Eye Injuries While Participating in Sports
9021. Nursing Considerations for the Child with a Chemical Splash Injury
9022. Conductive hearing loss ExemplarHearing Loss in Children
9023. Etiology
9024. SAFETY ALERT: Working with a Child Who Has a Visual Impairment
9025. Incidence
9026. BOX 55-3 TYPES AND ETIOLOGY OF HEARING LOSS
9027. BOX 55-4 RISK FACTORS INDICATING THE NEED FOR HEARING SCREENING
9028. Neonates (Birth to 28 Days)
9029. Infants (29 Days to 2 Years) Developing Certain Conditions Associated with Hearing Loss
9030. Diagnostic Evaluation
9031. PATHOPHYSIOLOGY: Hearing Loss
9032. BOX 55-5 HEARING TESTS USED FOR INFANTS
9033. Auditory Brainstem Response
9034. Evoked Otoacoustic Emissions
9035. Therapeutic Management
9036. Nursing Considerations for the Child with Hearing Loss
9037. PATIENT-CENTERED TEACHING: How to Encourage Language Development
9038. Talk
9039. Look
9040. Control Distance
9041. Loudness
9042. Be a Good Speech Model
9043. Play and Talk
9044. Read
9045. Do Not Wait
9046. CRITICAL THINKING EXERCISE 55-1
9047. Language Disorders
9048. FIGURE 55-1 Expressive speech disorders include disorders of voice, articulation, and fluency. A speech therapist works with the child to help the child speak more clearly and be better understood. Early intervention is important to correct speech disorders. The nurse should therefore assess speech patterns during each health screening. Referrals should be made for any problems noted.
9049. KEY CONCEPTS
9050. References and Readings
9051. Features
9052. Critical to Remember
9053. Drug Guide
9054. Nursing Care Plan
9055. Nursing Quality Alert
9056. Patient-Centered Teaching
9057. Procedure
9058. Safety Alert
9059. Want to Know
9060. Temperature Equivalents and Pediatric Weight Conversion
9061. Temperature Equivalents: Celsius and Fahrenheit
9062. Pediatric Weight Conversion: Pounds to Kilograms
9063. Glossary