Principles of Pediatric Nursing. Caring for Children

1186 Pages·2011·270.136 MB·English

by  Jane W. Ball, et al.

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Dedication
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Principia 01 peJiottlc "w ...... : g.ins For child ..n I I. ... W.1Id.
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About the Authors
Jane W. 8allgriMluated (rom PhysiroJ Emlll/nlllion, which Is currently In its seventh edilion.
the Johns Hopkins Hospital After relocating to the Washington, DC, area, she jolJlt'd Chilo
School of Nursing. and iubse dren'l National Medical Cn'Iter to manage a federal pro",ct Ie
quenlly recelvtd a BS from the teach Instructors of emergency medkal technicians from al:
Johns Hopkin! Unlvenity. She nates about thelpecial ClIrechildren need during an emergeIll.)'
worked In the SWBIcaI, emer Exposure 10 the shortcomings of the emergency medical sec·
gency, and outpatient units of the vias system In the late 19805 with regard to pedlatrk care was a
Johns Hopkins Olildren's Med career-changlng event. With federal funding, lhedevdoped ed
Ial and SuJiIcaI Cenler. first as a ucational currkula for emergency medical IKhnldans a.nd
sraff nurse and then as a pediatric e-rne~ncy nurws to hdp lhem provide improvN care for chilo
nul'$<' practitioner, beginning her dren. A IeXlbook entlt1ed Pedj~tric Emergmcia. A MllnUIlI/o,
Clreer as a pediatric nurse and advocate for children's health fuhmpitlll ProvldtrSwai deVl'loped (rom these educational ven·
needs. Jane obblned both a maSler of publlt he;dlh and a doc tures. For 1S ~n she rmnaged the federally funded Emergency
tor of public he;Jl!h degree from the Johns Hopkins University Medical Servlcet forOlildren's National ResourceCenter./Un;.
Bloomberg School of Publk Health with a (oall on maternal e-cutive director, Dr. Ball directed Ihe provision of consuilatior.
and chUd health. Aftergradu:ltion she hearne the chief of child and resource development for state he.tlth agencies, health pro
health services (or the Commonwealth of Pennsylvania Depart_ (rss.lonals. (amUIes., and adl'OCates about SUCCffiful methods to
ment of Health. In this ClpKity she oveI'$IW the 51ate-funded Improve the health care system so that chUdren get optimal
Wl'1I.chlld dinla and aplored wa)'110 IrnpnM' educalklo for emeJtfncy ClIre in all health care settings. Having left that posl·
the stale", community health nurses.. Afit!' relocating to Texu, tion,she devoles mo~ lime 10 WTilingand serves al a conJultanl
she Joined the fKUlty at the University of 1ms al Arlington 10 lhe American CoIlese of Surgeons, 5l1pporling lute Irnuma
School of Nursing to teach community pediatrics 10 registered system development. In 2010, Dr. Ball receiwd the D~in­
nurws rtlurnlng 10 school for a BSN. During Ihls lime she be· gulshed Alumna Award from the Johns Hopkins Unl~nlty.
came Involvtd In wrillng her finl tal book, MoWy" Gullie to
Ruth C. McGllIis Bfndler colleges and Is now the Washington Slalt' Univenity (WSU:
rrcel"'-'Ct IlIif BSN from ComeU College o(Nunlng. Ruth obtained a PhD in human nutrition al
Universlly-New York Hospilal WSU. She hu taught theory and dlnlcal courses In chUd health
Sdlool of Nursing. She worktd In nunlng. cultural diversity and health, gradUlte research, pharo
oncology nursing al ML-morbJ· macology, and asseument, as wdI as serving as lead faculty (01
Sloan Kelltrlng Cancer Center child hrulth nuning. She Ii presently proft'$SOr and associau
in New York. and then mO\'ed 10 dean for the college's graduale programs. Her Ilnt profes.slonal
Wisconsin and beame a publk book, PrdiD,rk Medialriom, was published In 1981, and the hI.!
health nurse In Dane County, continued 10 publish articles and books In the areas of pediatriC
Wisconsin. ThUJ began her com· medications and ped~llrk health. Research efforu are focused in
mitmmt to work with children the area of childhood obesity. type 2 diabetes, metabolic syn
as she visited children and their families at home, and served a5 drome. and cardlometabollc risk factors in children. EthniC dl·
a school nUHf for ~ral elementary, middle, and high schoob. IoYfSlty and Inttrprofes.slonal collaboration hav.!' been addlUon.tl
Oue 10 Ihillnterest in child health care ne«is,sheeMned her MS themes in IlIif 'WOrk. Dr. Blndler bdif'll'S Ihal her role;u a (acult)
in child de\'eIopment from the UniversltyofWisconsin. A move member has enabled IlIif to learn continually, f06ter the develop
to W~hlngton Slale was acwmpanied by a new Job as a faculty ment of studenu In nursing, lead and mentO!' junior faculty into
member at the Inlerroll~le Cn'IIer for Nursing Educalion in the teaching role, and par11c1patefully in the profi'S$1on of nurs
Spokane. Dr. Bindler has been fortuna Ie 10 he In-.utved forOVl!f Ing. In addition to !<,achlng, research, publication, and leadn·
35 years in the growth of this nursing education conKlrlium, ship. she tnlwlces her life by proCessional and community
which Is a combination of public and private univrrsilies and service, and by activities with her family.
Kay l. (owen l\.'CeIved her chapter "Hospital Care for Children" In Jackson 8c Saunders'
BSN from EasI urolina Univer· Child Heillth Nursi"g: A Comprmerrslvt Appl'Ollch ro 'he Glre of
sity In Greenville, North Car· Childre" IlM Thdr FoImllfts published In 1993.
olin •• ~nd bepn her career ;as In II'Ie dassroom, Mrs. Cowm realll.Ai"d thai studtnts leun
~ II4lIf nurw on the pediatric through a variety of teaming .sU1l1egles ~nd became especially
unit of North Carolina Baptist Imerested In the strategy of gaming. She ltd I re5e'.lrch Jtudy to
eo.'llIuate the elfect"'~IK'SS of gaming In the dauroom and sub$t·
H06prt~11n Winston·~m. She quentlycontinues to incorporate gaming In her teaching. In the
~oped ~ JP«i.tl inteR$! In cUnlc.tl 5tf11ng, Mrs. Cowen teaches htr students the skUls
the psy<:ho5ocbl neWs of bospl· needed to are (or patients; and the Importance of family.
taJiud children and pn-paring centered care, focusing on 001 only the physical n«ds of the
thfm for hOlpitaJlutlon. This child but also the psychC40ClaJ neNso( the child and family.
ltd to tlx> lOcus of her master's thesis ~t the University of North During her teaching carrer, Mrs. Cowen has rontinued to
Carolina ~t Grren5boro (UNCG) where she receMrl a master of work pan time as • staff nurse: first on the pediatric Wlit of
science in nursing education dtgret with a focus in m~tern3l Moses Cone Hospital in Gre-ensboro and then at Bmantr Chll·
child nuning. dren's Hospital in Winston·SaIem.ln 2006 she became the p3rt·
Mrs. Cowm began her to.~ch(ng ureer in 1984 at UNCG time pediatric nuIW ooucator In Brenntr's Family Resource
where six> rontinues today as dlnlc.tl professor In the Parent Center. Through this rol<-she is able to extend her love of teach·
Oiild Depmment. Her prlm3ry responsibilities include coordi· ing to children and f.Jmilies.
nning the pediatric nursing course, teaching dasnoom roment, Through her roLe as an author, Mrs. Cowen Is able to extend
and supervising a clinic.tl group of students. M rs. Cowen shared her dooication to pediatric nunlng and nuning education. She
her passion for the psychosocial are of children and the needs is married and the mother of two college-age sons.
of their families through her first experience as an author in the
Thank You!
We 0ilI1l! grateful. to ilIl the nurses, both dinidan$ Ind educators. Robin I.!. Kodl, Piedmont Virginia Community College
who rtvie_d the manuscript of this text. Their insights, sug Sar~h Kulimikl, Lenoir Rhyne University
gestions, ,nd eye for detail helped us prepare a mort reitYilnt,
Palrida A. Kuster, Samuel Merritt University
useful. ,rid current book, rtflecti~ of the present time ilnd
of the tssenti,,\ components of lumirog in the Odd of child Meredith laW, Pediatric Nurse Practitioner, Qeveland Oinie
llealth nursing_ Mlkki Me:.tdows-OUver, Y;lIe University School of Nursing
Aim Atana, Kent Stale Unr,ersity Cheryl Mele, Drexel Uni~'ersity
KIm Adams, Forsyth Technical Community College Earlene MerriU, Coppin State University
Mike Aldridge. University of Tens at Austin School San Mitchell, Georgia Baptist College of Nursing of Mercer
of NursIng Unillersity
Monique Alston-Davis, Montgomery College Mary Ellen Mitchell·Rosen, No~ Southeastern University
Trgd Arney. Asthma Athletics CEO, Banner Olildren's Maureen E. O'Brien, Marquette University College of Nursing
Hospital Brenda PlVill, University of North Carolina Wllmington
Johnett Bemon-Soros, Kent State University at Ashtabula Marisue Rayno, Luxeme County Community College
Sharen Brady, Weber Slale University Katherine Robert~ Lamar UniVl'TSity
Cari~ Carle. Medkal Uniwrsity of South Carolina Cheryl Shaffer, Suffolk County Community College
Dawn ChaptUe, Natiooallnstitutes of Health Sue Solecki, Drext'l Uni\\'TSity
Teresa Ollst, University of Kentucky CoU<'geofNursing Usa D. South, East Mississippi Community College
JenniferCompere, Brenner Children's Hospital, Joanna Sprlhis. Children', MedIcal Center Dallas
WlIUlon-Salem Daphnee Stewart, Georgia Bal't~ College of Nursing,
Marilyn Cox, Children's Medical Center Dallas Mercer University
Klrl Cnwford, Levine Children's Hospital. Charlotte Marie H, Thomas, Forsyth 1«hnical Community College
Joseph De Santis, University of Miami s<:hool of Nursing Maureen llppen, Univt'TSity of Michigan-Flim
and Health Studies Debbie Treolar, Ea~1 Mississippi CommlJnity College
Ann B:lrhart, Clinical Nur.;e Specialist, Mesa. Arizona Diane K. Van Os, \Vestminsler College
Pat B. Esland, City University of New York, Borough Terri L. Walker, Oklahoma Oty Community CoIlegt'
of Manhattan Community College
Rosie Wilbon, East Mississippi Community College
Tonsh~ Emeuon, East Mississippi CommunIty CoUege
Cynlhi~ Williams, Oklahoma City Community College
lori Sholders Farmer, Advanced Practice Nurse In GenetIcs,
Donna Wilsker, Lamar UniVl'rsity
Distance Education Imlmnor, University of North Carolina
at Pembroke Rond~ M. Wood, Long Beach City College
Betty Fnund, College of Nursing, Kent State UniVl'rsity
Contributor
Julie Garcia, University of Thus Health Science Center
al San Anlonlo Lind. D. Ward, MN, ARNP
Oinkal Assistant Profes.s.or
VIcki Grubbs, EaSlern Kentucky University
Washington State Uni,'ersity CoUege of Nursing
Amy ZIomek Hedden, Califomia State Unillersity, Bakersfield Spokane, WashIngton
Karen Joris, Lorain County Community College Chapter J: Genetic and Genomic Injluffl(CS
Preface
Health care and health caU' delivery systems are changing dra~ Pediatric nursing care is provided within the context of a rap
mallealt)'. PedIatric nW'5eS must respond to and Intewate these idly changing society. An examination of the major morbidities
changes into their practice. In addition. pediatric nursing pre and mortalities of childhood guided the revision of material and
sen\li unique challenges and isslles in the changing health care topics throughout the text. Spectfic chapters focus on the fam
Mt'1k'. Studo.-nt DurSo!! must larn I'>nat helps them to providt ily, health promotion across th~ lif. . span, pediatric n:.ltrition.
safe, effectIve, and excellent care today. while lntegrallng new and care for chronic conditions. A chapter addres.slng cultural
knowledge and slulis l\e('ded as nursing P"Klice conI inues 10 de influenCl'$ on health care provides guidance for 51udents caring
velop and respond to health care neros. Srudents must learn for children in our growing intercultural society. A chapter on
how 10 think and apply information as newknowledge becomes genetics has been added to help students recognize the impact of
available. "As the itudent uses knowledge In silwlion! of prac genet lcs and genomlcs knowledge on pediat ric nursing. Otrrent
tice, new understanding is gairled as well as knowing how, when, social challenges for children have guided the further develop
and why it is re\e"nnl in particular situations .... WI.' call this ment of a chapter on societal and environmental influences on
leaching for a sense of salience ... • child health.
Facultyare responsible for selecting patient care assignments Many graduating nurses practice In acute cue facilltles, and
thaI assist the student to apply koQ\\-1edge in the dink"a! setting. this textbookconlinues to emphasi1.l' lhe information necenary
as well as various pedagogies toassistthe litudentto focus on the to prepare students for working in hospitals. In addition, the in
patientexperienu. WI' have integrated these coiKepts and oth formation provided In this textbook will enable gradualeS to as
ers In this \eJ:t fl'Oll1 the Carnegie Reporl by offering a variety of sume positions In ambulatory care facmties, hornt health
(riliad Ihinking and diniOiI reasoning queslions. p;tlient care nursing, schools, and a variety of other Sl'{tings. Effective com
scenarios, researdt and evidem:e·blIsed practice features, and munkation methods, printiples of working with families, and
supporl for teaching with curJ't'nt information technology In knowledge of pathophysiologic, psychologic, developmental,
mind. and environmental factors found In this book can all beapplied
in a wide variety of settings.
Preparation for Nursing Excellence In keeping with the pres.sures and demands on student time
The goal of the fdlh edition of this textbook iii to provide core to learn and J't'ad, the textbook was redesigned to be nIQre com
pediatric nursing kn0\\01edge that prepares students for excel pact and focus on essential conlent. The companion website is
lence in nursing, and to offer the toob of scholarship and criti used to provide some supplemental con rent, ,ase $Iudies, and
(allhinking needoo toappty this learning in the fUture.Students carl' planning exerdses to enhance learning.
musllearn to qUl':!tion, evaluate the research evidence available, Another major change In our society Involves acce;s to In
apply pertinent information In c1inlal settings, and constantly formation and reliance on the Internet. Nurses must learn to
adapt togrowing knowledge and an evolving health care system. obtain information and then analyze and judge Ihe quality of
This textbook reflects a multitude of approaches 10 learning information they find. Increasingly, nurses need experienu
that can be helpful to all students. WI' acknowledge that malI)' with Infornlatlon technology and management. In Ihlsedltion,
students learn pediatric nursing In a very shon time period. margin tabs send the student onlllll' 10 obtain the latestlnfor
Therefore. the approaches in this textbook are designed to malion available on many topics. Nurses must also assist ,hil
assi§t students to assess Ihe child's needs. take into account dren and famity members 10 use the Internet wisety to help
popuiation-blised practice, and make care decisions based on them In making health care decisions. so the student Is assisted
the standards of pediatric nursing practice. to make practice decisions based on scholarship and e~ence­
based resear,h.
Realities of Pediatric Nursing
Organization and Integrated Themes
Pediatric nuning occurs in many acutl' carl' and community
health care settings, such as hospitals. homes. schools, and v.oe have organized Principles ofP rdlntrlc Nursing: Carlng"r Chil
health cl'ntl'rs. Milly procedures are performed in shorl-stry dren, fifth edition. to present imporunt information OIl growth
units,and long-term carl' is often proVided at home for children and devclopment, fiunily-centered care, culture, gelll'lics.. ph~iGlI
with complex health conditions. Families are often the providers assessment, health promotion, nutrition, health Issues III today's
of care and case managers for these children. Thchnologlcal ad world, and chUdren's responses to Ulness and Injury. This infor
vancesare resulting in earlier diagnoses and newtherapies; these mation is needed to carl' for children in the many health care 51'1-
technological approaches are integrated whenever pertinent tings where pediatric nursing care is plUllided. Following the
throughout the textbook. foundational chapters, this book Is organized by body systems to
vii
viii Pnf""~
fadlitate the student's ability 10 locate Information, focus study· thinking in their everyda)" lives, but need help to apply these
lng, and p~re for dlnlcal experiences with children and f.11111- ron,epts to the pfll(:tlc~ of nursing. This book and the a'·
lies. The orpr.lzatlonal ff1lmework also rUmInates redundancy, so rompanying learning l1I:aterlais hell' students understand
that the stude.lt uses tIme efficiently. how their normal curiosity and problem-solving ability can
In addition to thesig.nitlcant revisions ffiadeto all ,tupters to be applied to pediatric nllrsing.
updnl" clink,1 Information and resources. we added Oil(' ntw Communiclltion is one of the most important skills thaI stu·
dtapler-Ch1pler): Genetic and Geoomk Influences-to r. ... dents nec!d 10 learn. Effective ronllnunlcatlon wIth children
Ilect the emerging Information about the Im~ of gt'lIttics on is challenging because thty communicate differently, acrorti
thr health ccnditions occurring In clliidren. SIKh contrnt is ing to theirdeveiopmentaJ Ie\·eb. Family memben have rom·
cited in -Oiaieal Prevention and Population Health- in The mUtliation needs in addition to thole ofthelrclllldren. This
~11'iQh of BlICI'o/aurtar~ fJUl'fI,1011 for ~Ionlll Nursing book int<'Sf<ltes communication $lcllls by applied example5
PTllcric~(Am(flon AssoI:latlon ofCollegH of Nursing, 20(8). that help the student to ml1lmuniate d'f«tlvcly with 'hll
'ille Ulndltr-llaU (;hl1d I"ellthca~ Model Is used to lUus· drcn and their famlli1s.
trate the important core value that all 'hlklren n«d health pro Fllmily lind plltient edu(iltlon aboul health care is an lnle
motion and hL-aJth maintenance Interventions, no matter wik>re
graJ part ofthe pediatrk nurse', responslblllties. SInce hospi
they 5eek health ore or what health condItions they may be talizations are $hort and famliln Increasingly eire for
experiencing. cllildren It home, Infofltl.1tion about health care n('t'(h and
TIle nursing process Is used as the framework for nursing care.
procedures has become e>'en mort Important.
Nunlng Mamgement is the major heading, with subheadings of
Oewloping cultural competenells crltkal for all nurses In
NursIng Aueo;,o;ment Ind Olagno~ls, Planning lind [mplenlen the Increasingly dIverse community of tod~y'l world. Stu
tulon, and evaluation. When It Is appropriate to focus on care
dents have all met IleOIlle from dlffefl."'lll L1hnlc and ruituf1l1
In a speclfk .!el1lng, Hosplt~I-Based ClI'I', Discharge PL1nnlng, groups, but they need he41to understand, rt'5jl('ct, and Int ...
and Community Care nre 5ep;1rated Into ,sectIons. We feature
grate differing beliefs, practices, and health care needs when
nursing ClIrt'pLlns throughout the text to help 5tudentsapproach
providing care.
care from the nursing proceu perspectlw. Additional nursing
Growth and d. .... lopmlnl consld.ratlons lind physical .s
care plans are provided on the corn p;1nlon Wl!bslt'e. Nursing CIl rt
nssment are central to the t'ff«tlve practice of pediatric
Plans Inc1udt nursing Interwntion classifications (NIC) and
nursing. A separate chapter Is de\'owd to each area. Oapter 4
nursing outcome cllwiflcations (NOC), as well HS nursing diag
and Chapter S. teSPl'I=tively, In addition. both IOplo are Inte
noses, go,ils, Interventions. and f1Ition.1ie.
grated where appropriate In narrntive. growth and develop
Sevef1li major conceplJ are Inttgf1lted throughout the text
ment boxes. figures. captions. and on thecompanlon website,
book to encounge the studcl1t to think crtatlvely and critically
about nursill@care. 1lIese major themes are IntefWOvt'n through Hulth promotion Is an Important focus of nursing Oft' for
out the text ttrough the (e;JIUre5 and supplement$. ,hildren with acute and chronIc health rondilions. Four
ctuptl'rs focus on health promotion, One provides an over
Nursing " .. Is thecritlcllli and centf1ll COrt of this textbook. vitwof concq>15 rebtt'd to lli'alth promotion. Thra! (hapten
Nunlng a!.SeSSment and nt.an1gement art emphasized In all address health protl)()(lon prlndpks f..,rchlldrtn of dlfferent
5«IIons 01 the booI!:, with nUlW$lhown provkiing care In a agel. In addition. health fromotlon bo:le5 help Illustrate 01"
variety 01 settings. portunities for health promotion for children ,,"1th health
Colbbontive ca .. descrIptions of the diagnostic and thef1l. conditions.
peutlc care for various health cooditlons reflects the Intetpro Community are Isanlncrnslng part ofnunlng rHponslbll
fesslonal te:lm role of nurses with other health professionals Itles. To assist students In tf1lnJfenlng know1fdge to caring
(e.g., physicians. physical ther.lplsts, mmtal health coun forcllildren in rommunity settings. InformatIon Is provided
selors, pharmadsts, and others) as described In 1k ESSDlriais in tbe nursing management sections of cllapters.ln additIon,
of Baoru/aurtllte EduCIl/wn f()f Profrnlonnl Nursing Pm(fk~ an mtire chapler Is de\(ljed to nursing care In the commu·
(Ameron Association of Colleges of Nursing, 2008). nity and dlre<:tly addre5.1e5 the nurse'$ roles In several com·
(liniCiI Rnonlng lind probl.m_soLving principles are munity settings.
Integrnted in the organization, pedagogy, writing style,
evidence-based prnctlce features, reseaKh bo.xes, clinical Thesethemes andothersarflnterwovcn In the narrative of most
judgment boxes. exercises on the companion website, and chapters and are reflKted in the art. as well as In the supple..
art ,aptions. Students pn"tice clinical reasoning and critical ments that students can u~ to augment their learning.
InstructoT$ ,nd students 'Like v,lut the in-text lurning ,ids
that we iMWde in our textbooks to help mul the chaUenges
of pediatric nurs;ng_ The following guide will help you use the
ftatul'H "ld rHOUrtes froll'l Principles of Ptdi.tric Nursing: Car
ing for Children, fifth edition. to be succesfuL in the dns
room, in tIM cllnic.lsetting, on the NClEX-RN(r) eumil'lltion.
,nd in nursing pqctice.
Case Scenarios and photos at the lqinningofe adi chapleT
engage you with a child's rea.l-Iife experience with a 5p«ifk
he;Jlth challenge. Questions at the end of elCh S«narlo highlight
nursing considerations. Additional Information appears
throughout the chapter to help build knov.1edge.
Key Terms are introduced at the beginning of eac:h chapter.
with page numbers showing where each term flrst appears in the
chapter, designated in bold type.
learning Outcomes identify measurableoojectlve; basN on _ _ I-~'
topl" covtftd in each chaptel".
A FUl;u) 011 So!'Cllon appears althe beginning of tach systems
chapter as a reference to use while reading the chapter. Each Fo
cus On section Includes the following features:
wtomy anc! Ph)'$loIogy provides a quick review of the sys
,~.
--.-------_ Ptcllatri( I)II'f.r ...( 6 wUi help you fecognlu physkal and
mental differences In children at vuious...,..
--... -..-.- .--_---------..
__ The MHS5IMnt CulcleltllH bblfo in each ofthesysle.m chap
...... --...-.. -~....-.....-., ---­- atesrsse spsrmoveindte ws iatnh iOn l'tthfVt ibeowd oyf s ytMste kme.y aspects of an Integrated
-~.--
OlagnoJtk Tnb and Llborlltory PrOCHurtJ offer information
related to the speclflc sy'tem to assbt in clinical application.
As Children Grow boxes illustrate the families Want to Know boxes apply the con
anatomic and physIologic differences cepl$ of family-centered nursing rnre by offering
between children and adults. This visual teaching in formats directly applicable when
fellture wlll help you consIder develop working with fm,;;'Ii', ,.,_
mental differences when working with
children in different age groups.
- -.
::-...._.. ----,.--,...... -,..--
-~--.--~ -- -
__ _
:..:..:..: -.:=.....=.....=. -.-... -...
_.----
-.=..=....-.... .. __ .. _. ...... -
.= ::::::=::::z::::::w"'-'.
----
:c:.''::::.=:,=::=;.:-:i'"-=':".===---_--:-t".~-.:
~;~~!:~~r~~~;~"':~u~"~';;.~"~d: ~boxes
the teenx-t ..=.= -:::.-.;---_--_.... . -.--. .=....=. -
by offering a cause of various
-;::--::.......~ "'~
diseases and the effect on children. These il
lustrations show conditions at a cellular or :
::::..,,:,,~;-....:r=""
organ level, and may also portray step-by
~'::;-'-'-"""-'"
step disease processes.
-__._ _ ___ ._...... ----_
-_ _ -_.__--- - ..... -
tpNHerxEeotam Wlttooh t i hoenPlp rf ooyrm ocuoh tirlideocrneo ng nswpizieteeh d ; t; b:u~~m:p~s, ~~a;p~pfeOa:r" ~. i~nh :~t~"h"eh --..~~..=... :_-. -.-...-.-..._..- ..~...... ....~. _-._.. .......-.:... .. ._.. ~.....,_...... .6....0.;.. . -:.: ..-...:-. ..-.-........~-.-- ._ ;..:.-_..; -.:_. :. •.- --.---"~-".. .?..__...:-.. :-_. : O.... ...~...:...:.- ._.: ._._=6.- _. o. -. _...:".-.... ..-:..-.._.-- .-- .._ .-....-..-.--_._...............- ~- .-__.__ .-..._.. .....'..._ .. ..--._ .-... ...-4.. ..... ............. .. .......
_4 __ ........... _'---'-~ --...-........
---"~__..-,-, .-.,.-...-..... --_----- -
--- ..-.. -...~.-. -,---.......... ...
__
NEW -'~_-....-._........ ......!.... :....:.. -...:...'.. _.- _._. -..~_ ....... ._.. ..-...... ............. .-. -..-.. --.... -.=.-~....!..=...:..-..=.!..-.. .!-._: -:-.:.-.:' -:. .:.!........-.'..:....:.."... . .". .-.'~."..: .~-._:..... ....:. ... . .::.. :-.:.:...-...'e.-. ...: .::.
Clinical Judgment speed bumps appear in the text
to help hone critical thinking and clinirnl reasoning _
skills by presenting a brief scenario and asking for the ---_
-
appropriate responK' In that situation.
..
..
;-=--..:.: .... :::::-.;.:."::J
t::"..:.::..7!:t;..-E:-- ::z
_ . ___. ..... r-"
------ -
:-!-."-:t='_ __ ..-...........
..... _.,....,.. ... ..
-,. ... _.. ....
--. "
",====::::=::::::::===:-i~ Evl dence-Based PractIce boxes further enhance
our approach to research by describing a nursing
problem and inwstigating theevidence from stud
ies that explore solutions. Theemphasis is on nurs
ing research, exploring the implications of the
studies, and critical thinking and application of the
findings to your nursing care.
I.,C"''',,,
boxes heighten your awareness of diverse
perspt'\:tives, cultural variations, and health dispar
ities, alerting you to potential impacts on the health
ofthechild.
MedIcatIons Used to Treat boxes list actions, in
d.ications, and important nursing considerations for
medications.
r-------.".,:~' ::!.'< ~,~ Manlfestatlo
tables link etiology, manif
tations, and clinical ther<
,
for spt'\:ific conditions.
'"
Research boxes focus
relevant research that gi
you additional informatiol
and Development bo
highlight nursing care at specific stage!
development.
EthIcs boxes highlight the many issues that
nurses face related to pediatric nursing, preparing you
for the dinical setting.