NURS 341 Final Exam 1 Study Guide. Latest 2023.Ch. 1
Standards of Care
- A standard of care is a minimally accepted action expected of an individual of a certain
skill or knowledge level and reflects what a reasonable and prudent person would do in a
similar situation. Professional standard...
Ch. 1
Standards of Care
- A standard of care is a minimally accepted action expected of an individual of a certain
skill or knowledge level and reflects what a reasonable and prudent person would do in a
similar situation. Professional standards from regulatory agencies, state or federal laws,
nurse practice acts, and other specialty groups regulate nursing practice in general
Ethicolegal Issues
- Ethical nursing care includes the basic principles of autonomy (self, making own
decision), beneficence (making good), nonmaleficence (not harm), justice (fairly),
veracity (honest), and fidelity (loyalty).
- Parents and guardians generally make choices about their child’s health and services. As
the legal custodians of minor children, they decide what is best for their child.
Legal Issues related to patient and families – there are many parts related to this.
- The pediatric nurse must balance these ethical components when dealing with families
from a variety of cultural and religious backgrounds who are making health care
decisions for their children. The process is as follows:
Identify the problem -> Gather information about the problem -> Weigh the risks against
the benefits -> Choose a solution -> Implement the solution -> Evaluate the outcome of
the situation.
- Minor children (younger than age 18 years) must have their parents or legal guardians
provide consent for health care in most cases.
- Mature minor: The physician must determine that the adolescent (usually older than 14
years of age) is sufficiently mature and intelligent to make the decision for treatment.
- Emancipated minor: Membership in a branch of the armed services; Marriage; Court-
determined emancipation; Financial independence and living apart from parents;
Pregnancy; Mother younger than 18 years of age
- Special situation: If the parent is not available, then the person in charge (relative,
babysitter, or teacher) may give consent for emergency treatment if that person has a
signed form from the parent or legal guardian allowing him or her to do so.
- During an emergency situation, a verbal consent via telephone may be obtained. Two
witnesses must be listening simultaneously and will sign the consent form, indicating that
consent was received via telephone. Physicians can provide emergency treatment to a
child without consent if they have made reasonable attempts to contact the child’s parent
or legal guardian
- In urgent or emergent situations, appropriate medical care should never be delayed or
withheld due to an inability to obtain consent.
- Assent refers to the child’s participation in the decision-making process about health
care. The pediatric patient needs to be empowered by physicians to the extent of their
capabilities, and as children mature and develop over time they should become the
primary decision maker regarding their health care.
- Advance directives determine the child’s and family’s wishes should life-sustaining
care become necessary. Life-sustaining care may include antibiotics, chemotherapy,
, dialysis, ventilation, cardiopulmonary resuscitation, and artificial nutrition and
hydration. Some families may choose to withdraw these treatments if they are already
in place or not begin them should the need arise. “Do not attempt resuscitation
(DNAR)” orders are in place for some children, particularly the terminally ill.
Role of the Pediatric Nurse
- The primary role of the pediatric nurse is to provide direct nursing care to children and
their families, being an advocate, educator, and manager. The pediatric nurse also serves
as a collaborator, care coordinator, and consultant.
- People have taken increased responsibility for their own health. Parents now want
information about their child’s illness, they want to participate in making decisions about
treatment, and they want to accompany their children to all health care situations.
- As child advocates who value family-centered care, pediatric nurses can provide such
empowerment and can address specific issues for children and families.
- The three general concepts that form the philosophy of pediatric nursing care are
family-centered care, atraumatic care, and evidence-based care.
Table 1.2 Page 17 standards of practice and standards of professional performance
Ch. 2
Genetic Influences: gender, race, temperament, genetically linked diseasze.
- Can identify groups at high risk for genetic problems
- Children’s temperaments may be categorized into three major groups: easy (even-
tempered and have regular biological functions, predictable behavior, and a positive
attitude toward new experiences), difficult (irritable, overactive, and intense), and slow to
warm up (moody and less active and have more irregular reactions);
Health Status and Lifestyle
- In utero, the child can be affected by poor maternal nutrition or by exposure to the
mother’s use of alcohol, tobacco, or drugs or infections (ex: teratogens.) Exposure to air
pollution, tobacco, and water or food contaminants can impair a child’s health status. (ex:
Lead poisoning in children younger than 6 years of age are common. Lead exposure can
result in developmental and behavioral problems ranging from inattentiveness and
hyperactivity to permanent brain damage and death, depending on level of exposure.)Z
- The term resilience refers to the qualities that enable an individual to cope with
significant adverse events or stresses and still function competently and have positive
outcomes. Various internal and external protective factors promote resiliency.
- Parents with uninsured children often delay care for their children and are less likely to
have a usual place of care for their children; The percentage of children without health
insurance has dropped slightly over the past 2 years to 9.7% in 2011; This decrease is
attributed to the stabilization of private employer-based insurance plans and the states’
ability to improve enrollment in Medicaid and the State Children’s Health Insurance
Program (SCHIP)
- Teaching guideline 2.1 Page 40
, Family Roles
- The caregiver–child interaction is critical to the survival and healthy development of a
young child. The primary caregivers are the parents.
- Typical parental roles include nurturer/caregiver, financial provider, decision maker,
schedule manager, financial manager, problem solver, counselor, teacher, behavior
support manager, and health manager.
- PARENTING STYLES:
→ The authoritarian parent expects obedience from the child and discourages the child
from questioning the family’s rules
→The authoritative or democratic parent shows some respect for the child’s opinions.
Authoritative parents allow children to be different and believe that each child is an
individual.
→Permissive or laissez-faire parents have little control over the behavior of their
children.
→Uninvolved parents are indifferent. They do not provide rules or standards.
→Neglect or reject the child. They can be cold and uninterested in meeting the child’s
needs
- Effective discipline:
→Maintaining a positive, supportive, and nurturing caregiver–child relationship.
→Using positive reinforcement to increase desirable behaviors.
→Removing positive reinforcements or using punishment to reduce or eliminate
undesirable behaviors.
Culture.
- Table 2.3 Components of cultural competence P41
- Table 2.4 Beliefs and practices of selected cultural groups P43
Ch. 3
Know your milestones
- Weighs: The average newborn weighs 3.400 kg (7.5 lb) at birth, double their birth
weight by 4 months of age and triple their birth weight by the time they are 1 year old.
- Height: The average newborn is 50 cm (20 inches) long at birth. By 12 months of age,
the infant’s length has increased by 50%
- HC: The average head circumference of the full-term newborn is 35 cm (14 inches).
Velocity slows slightly in the 6- to 12-month period, exhibiting an average 10-cm (4-
inch) gain from birth to 1 year of age.
- Teeth: On average, the first primary teeth begin to erupt between the ages of 6 and 8
months. The average 12-month-old has four to eight teeth.
- Brain: By 6 months of age the infant’s brain weighs half that of the adult brain. At age
12 months, the brain has grown considerably, weighing 2½ times what it did at birth.
Anterior fontanelle usually closes at 12-18 months (sometime at 9 months) and the
posterior fontanelle at 2-4 months.
- Resp: The respiratory rate slows from an average of 30 to 60 breaths in the newborn to
about 20 to 30 in the 12-month-old. The nasal passages are narrower. →The trachea and
chest wall are more compliant. →The bronchi and bronchioles are shorter and narrower.
→The larynx is more funnel shaped. →The tongue is larger. →There are significantly
fewer alveoli. (which place the infant at higher risk for respiratory compromise)
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