NUR 505 Homework Assignment for Unit 1 Answer key Questions from Chapters 1 & 3 1.

List the Healthy People 2020 goals and leading health indicators goals. Goals: increase quality and length of healthy life; eliminate health disparities Leading Health Indicators: physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, access to health care. 2. List the 6 health promotion categories of behavior that should be focused on in order to help decrease the incidence of many leading causes of disease, disability, and death in children. 1. Tobacco use 2. Behavior that results in injury and violence 3. Alcohol and substance abuse 4. Dietary and hygienic practices that cause disease 5. Sedentary Lifestyle 6. Sexual behavior that causes unintended pregnancy and disease 3. List the major health concerns for the pediatric population. Obesity and related health conditions (type II diabetes, HTN, hyperlipidemia, heart disease) Childhood injuries (#1 mortality) Violence Substance Abuse Mental Health Problems 4. List the risk factors for childhood injuries. See box 1-2 on p. 64 5. List the major causes of mortality (top 3) for each of the age groups listed: Infants: 1. Congenital anomalies 2. LBW 3. SIDS (although SIDS is highest from the post-neonatal period (after 28 days) through the rest of infancy) Ages 1-4: 1. Accidents (MVA being #1) 2. Congenital anomalies 3. Homicide

Ages 5-9: 1. Accidents (MVA being #1) 2. Cancer 3. Congenital anomalies Ages 10-14: Accidents (MVA being #1) 2. Cancer 3. Homicide Ages 15-19: Accidents (MVA being #1) 2. Homicide 3. Suicide 6. Describe the key elements of family-centered care. Family-centered care is where nurses support families in their natural care-giving and decision-making roles by building on their unique strengths and acknowledge their expertise in caring for their child both within and outside the hospital setting. Key elements include partnership, collaboration, respect, enabling, and empowerment. 7. Explain the key concepts of providing atraumatic care. Performing nursing interventions in such a way as to always minimize psychological and physical harm to the greatest extent possible. 8. Define the following family structures: Traditional nuclear- Two parents and their biological children Nuclear family- Two parents and their children (not necessarily biological) Blended- Two parents and children, where at least one child is a stepchild, foster child, adoptive child, half-sibling, etc.) Extended family- At least one parent, one or more children, and one or more other family members (aunts/uncles, grandparents, nieces/nephews, etc.) Single-parent- Only one parent in household(can have two parents who are divorced where one has sole custody) Binuclear- Parents are divorced but have joint custody. 9. Explain the different parenting styles of control listed in the text. Authoritarian- classified as high control/low warmth. Authoritative-classified as moderate control/high warmth. Permissive-classified as low control/high warmth. Indifferent (not listed in text but added to ppt)-classified as low control/low warmth. 10. Explain the different types of discipline along with the pros/cons of each one. Reasoning-involves explaining why an act is wrong. Child has to have the cognitive abilities to be able to reason.

Scolding-use of shame or criticism to guide behaviors. Can have potential negative impact of causing low self-esteem. Behavior modification- based on the theory that behavior that is rewarded will be repeated; behavior that is not rewarded will discontinue. Uses some form of a positive rewards system (stars, tokens, etc.). Ignoring-undesired behavior is ignored, with the intention of decreasing the undesired behaviors at children typically like attention. Consequences-negative outcomes result from bad behavior (taking away a certain toy) Time-out-commonly used. Children are placed in an unstimulating and/or isolated place for a certain amount of time (should be 1 min per year of age). Corporal punishment- often spanking, is a form of behavior modification in the sense that it is thought that experiencing pain as a result of a behavior will in turn decrease the incidence of that specific behavior. Can have serious negative consequences in certain circumstances, there are multiple studies supporting potential negative outcomes of using spanking as a frequent form of discipline.

Questions from Chapter 27 and Pharmacology review: 1. Explain the difference between informed consent and assent. Both involve providing information about the expected care or treatment, including potential risk/benefits, along with alternative treatments, and potential outcomes if no treatment is provided. Informed consent requires the individual to be of age 18 or older, and is required for most treatment (with the exception of medical emergencies and medically emancipated conditions). Assent is the same process but for an individual less than 18 years of age. Assent happens in conjunction with informed consent, not in place of. The information presented for assent should be geared towards the childs specific developmental stage. The age that assent should be obtained differs for each facility (have seen as young as 7 years old). In very basic terms, informed consent is a legal obligation whereas assent is an ethical obligation. 2. Explain the concept of medical emancipation and detail all the situations it applies to. There are conditions in which adolescents under the age of 18 are able to consent for without parental consent. These conditions vary by state, but generally include treatment for STIs, mental health services, alcohol and drug dependency, pregnancy, and contraceptive advice. The idea is that these conditions are ones that teens would likely try to hide from a parental figure, so if they are

not allowed to consent without parental knowledge, many would not seek out treatment and many adverse health outcomes would arise. 3. Explain things the nurse should do to prepare a child for diagnostic or therapeutic procedures, making sure to be specific. In the simplest terms, children should be psychologically prepared by establishing trust, encouraging and supporting parental presence, providing explanations at age/developmentally-appropriate levels, and providing positive reinforcement post procedure. Children should be physically prepared by the nurse being confident, involving the child in the procedure when applicable/appropriate, providing distraction during the procedure, and allowing the child to express his/her feelings prior to, during, or after the procedure. More specifically: Establishing trust- If a nurse establishes trust and a good relationship with the child, his or her cooperation is more likely. This can be done by spending time with the child, or being introduced by a person who has an established relationship with the child and family. It is ideal if your first interaction with the child does not involve a painful procedure. Encouraging and supporting parental presence-One of the main stressors for children in hospital settings is forced separation from their parents. It is therefore pertinent that nurses strive to advocate for parental presence, regardless of the procedure. The one place that this is often not feasible is in the OR setting, as sterility could be compromised. One way around this is many Childrens Hospitals have special rooms separate from the OR where they put patients under general anesthesia, and parents can be present in this room. Then parents can be present in the PACU. That way, children are never aware of the separation. Parental presence should be possible in all other situations if desired by the child and family. Providing explanation- It is important to educate the parents, and especially the child about the procedure so that the child knows what to expect and understands (to the degree their developmental level allows) what will happen. This requires the nurse verify the current knowledge of both the parents and the child and base any teaching needed on the childs developmental age and current understanding. The parents may be included in the teaching and may need coaching on their role during the procedure. The use of concrete terms and visual aids is recommended and plenty of time should be allowed to answer any questions from either the parents or the child. The teaching should specify the body part affected, the fact that no other body part will be affected and any change in the body part that may result from the procedure. It is important to speak at the childs level of development with appropriate words and sentence length and to avoid words or phrases with dual meanings. The child should be prepared with information regarding what they will feel, see, hear, smell and touch during the procedure all the sensory aspects of the procedure, and what they will be allowed to do or not do (move, hold a doll, etc.). If the procedure requires the child to perform any specific actions, it is important to review them with the child and actually practice them. Information that might upset the child

should be the last information conveyed and the information should be conveyed honestly but calmly and objectively in a way that minimizes concern. The benefits of the procedure should be stressed as well as the positive events following the procedure and childs cooperation and involvement should be praised. Physical preparation- The child should also be prepared physically for the procedure as ordered by the doctor. This may include appropriate sedation and analgesia to make the child comfortable. These should be administered in the least traumatic route (oral or IV). The nurse should have all supplies ready in order to minimize delays and the least amount of people possible should be in the room. Traumatic procedures should never be performed in safe areas such as the playroom. Involve the child-give the child options whenever possible, but do not give the child an option if there is not one (i.e. do not ask can I take your BP now? if you need to take their BP). Instead you could say I need to take your BP now, which arm would you like me to use? Provide distraction-Reading books, singing songs, blowing bubbles, listening to music, playing games are just a few examples of distraction techniques which have shown to decrease childrens awareness of painful stimuli and helps them to cope. 4. A child who weighs 32 lbs needs a dose of Amoxicillin. The safe dose range for amoxicillin is 80-90 mg/kg/day divided every 12 hours. Amoxicillin comes in a concentration of 125mg/5ml. What is the safe dose range for this child? mg dose mg dose = 80mg kg/day = 90mg kg/day x 1 kg x 2.2 lbs 1 kg x 2.2 lbs 32lbs x 1 day = 2 doses 1 day = 2 doses 581.82mg/dose

32lbs x

654.552mg/dose

Safe dose range is 581.82-654.55mg/dose If the physician orders 600mg, how many ml should the nurse administer for a single dose?

ml

5ml x 125mg

600mg = 24ml

Amount to be administered for a 600 mg dose equals 24 ml 5. What is the metric formula for body surface area in children (m2)? The square root of (weight (kg) x height (cm)/3600)

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