WK 1 PEDS

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West Coast University, Orange County *

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307

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Health Science

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Feb 20, 2024

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docx

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1 WEEK 1 BALL: 1, 2, 4-11, 15, 17 ATI: 1-10  Chap 1: Nurse’s Role in Care of Child: Hospital, Community, and Home o Nurse provides care for healthy children, those with illness, injuries, and chronic conditions o Contribute to health and welfare o Monitor growth and development o Help them adapt to and manage their health conditions o Healthcare settings:  Hospital  Physician’s office, clinics, healthcare centers  Child’s home  Rehab centers  Schools, childcare centers, camps  The community o Role of nurses:  Uses family-centered care approach  Focus on promoting health of children from newborn through young adulthood  Protect from illness and injury  Recognize presentation of disease between children and adults  Assist and educate the family to care for child  Includes: direct care, client education, advocacy, and case management  Collaborate with other healthcare professionals  Additional competencies:  Interact with children of different ages and their families  Modifying physical assessment techniques for age and development of child  Identify strategies to reduce child’s pain and stress  Accurately calculating medication dosages and volume for administration  Consider child’s developmental status  Adapt nursing procedure to developmental age o Direct Nursing Care  Nurse assesses the child  Identifies the health concerns  Lists the nursing diagnoses  Implements/evaluates care  Designed to meet physical/emotional needs of child and family

2  Offered in a sensitive manner  Compatible with cultural beliefs of child and family  Nurses minimize the psychologic and physical distress  Provide support to families o Patient education  Goal is to help parents or guardians make informed choices about health and healthy behaviors  Help children adapt to hospital settings and prepare them for procedures  Teach parents to look for important signs or responses to therapies, increase child’s comfort, and even provide advanced care  Assessment of knowledge regarding health conditions/practices, past experiences, and attitudes/beliefs are the start point of education  Promote adherence – client/parent follows recommended care for health problem o Patient advocacy  Acting to safeguard/advance the interests of another  Nurse must be aware of needs of child and family, family resources, and healthcare services available in community  Nurse must protect child/family by taking action with incidents related to incompetent, unethical, or illegal practices o Case management  Process that involves the assessment, planning, facilitation, and delivery of healthcare services  Promotes continuity of care  May be used to care for patient when hospitalized and for long-term care of chronic conditions  Discharge planning – promotes smooth, rapid, and safe transition into community and improves results of treatment o Research  Helps develop, refine, and expand knowledge  Focus on evaluating innovations in care o Nursing process  Clinical reasoning – assessing client cues and information, synthesizing information, applying it to understand child/family problem/concern, then plan/evaluate child’s care  Critical thinking – individualized, creative thinking or reasoning process

3 o Evidence based research  Problem-solving approach that integrates research evidence with healthcare professional’s clinical expertise  Keeps nursing practice current o Settings of Pediatric Care  Acute care: emergency department, observation or short-stay unit, post anesthesia, ICU, general inpatient, outpatient o Family-centered care  Efforts made to meet emotional, social, and developmental needs of children and families seeking healthcare o Pediatric Health Statistics  Infant mortality – death in infants under 1 year of age  5 leading causes of mortality  Congenital malformations  Low birth weight  Maternal complications  SIDS  Unintentional injuries (leading cause older than 1 year to 19 year)  Morbidity – illness or injury that limits activity, requires medical attention or hospitalization, or results in chronic condition  5 leading causes of hospitalization  Mood disorders  Pneumonia  Asthma  Appendicitis  Epilepsy o Healthcare Issues  Healthcare financing  Cost and access are important policy issues  CHIP created in 1997 to serve uninsured children up to age 19  Healthcare technology  Research and technology have enabled many children with congenital anomalies and low birth weights to survive  Has led to technologic advances and development of portable medical equipment for home care o Legal Concepts and Responsibilities  Regulation of Nursing Practice  Each state regulates nursing practice with a nurse practice act

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4  Defines legal roles and responsibilities as nurses  Accountability and Risk Management  Accountability  The family entrust the child’s care to the healthcare team  Expect good medical and nursing care and to avoid mistakes that cause harm  Patient Safety  Freedom from intentional injury caused by medical care  Includes freedom from harm by death- related or adverse drug events, misidentification of the patient, and healthcare-associated infections  Medication errors within the hospital are “system errors” o Reasons why?  Medication dosage is based on weight and body surfaces, often making dosage calculations more complex  Misplaced decimal when calculating dosage  Off-label medication  Young children cannot communicate well regarding adverse effects  Risk Management  Process established by a healthcare institution to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors, thus reducing the institution’s liability  Quality improvement – continuous study of systems, services, and processes of care using information to improve healthcare process, service, and patient outcome  Documentation is an essential part of risk management and quality improvement o Legal and Ethical Issues in Pediatric Care  Informed consent – formal authorization by the child’s parent or guardian allowing an invasive procedure to be performed or for participation in research

5  Information provided: o Explanation of child’s diagnosis o Description of proposed treatments or research o Alternative treatments and potential outcome o Answers to questions o Informing a parent/guardian about the right to refuse treatment  Physician is legally responsible to obtaining informed consent  Nurse verifies informed consent obtained prior to any procedure or research participation  In an emergency, treatment to preserve life or limb does not require consent o Child Participation in Healthcare Decisions  Emancipated minors – economically self-supporting adolescents under the age of 18  Married, pregnant, enlisted, incarcerated  Not subject to parental control  Minor parents of a child patient  Mature minors – adolescents between 14 and 18 able to understand treatment risks  May give independent consent to receive or refuse treatment for limited conditions  Testing/treating STI  Contraceptive services  Substance abuse  Mental health care  Do not have the authority to consent for general medical treatment in most states  Assent – voluntary agreement to accept treatment or to participate in research project  To give, child needs a basic understanding of what will be done and what is required for participation  Must also know they can say no (dissent)  Parents make final decision regarding treatment  Consent considerations  By 7 to 8 years of age, child usually able to understand concrete explanations  By 11, child’s abstract reasoning and logic are advanced  By 14, adolescent can usually weigh options and make decisions regarding consent as capably as an adult

6 o Child’s Rights vs Parent’s Rights  Parents have authority to make choices except:  Parent’s choice of treatment does not permit lifesaving treatment for the child  There is potential conflict of interest between child and parent (suspected child abuse or neglect)  Child and parent do not agree on major treatment options  Confidentiality – agreement between client and provider that information discussed during healthcare encounter will not be shared w/o client’s permission  Health Insurance Portability and Accountability Act (HIPAA)  Goal to protect the privacy of citizens by establishing standards for the management of confidential electronic medical information o Patient Self-Determination Act  Directs healthcare institutions to inform hospitalized patients about their rights  Includes advance directives – writing a living will or authorizing a durable power of attorney for healthcare decisions on client’s behalf  DNR – have become more common for children with terminal illnesses o Ethical Issues  Healthcare professionals have a moral obligation to deliver care with compassion and respect for the worth and uniqueness of each individual; must understand/respect religious and cultural differences  Ethics – philosophic study of morality and analysis of moral problems and moral judgement  Ethical issues may arise from moral dilemma – a conflict involving individual beliefs, social values, and ethical principles  Emotion plays a significant role in the development of ethical dilemmas  Ethics committee resolve conflicts about treatment decisions between healthcare professionals and child/family or resolve dispute between healthcare professionals  Resolve or dispute by performing individual case consultation o Withholding or Withdrawing Medical Treatment  Child Abuse and Treatment Act 1984  Baby Doe Regulations

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7  Withholding of medically indicated treatment of a child with life-threatening condition as medical neglect  Protects the rights of newborns with severe defects  Futility – situation in which treatment do not provide a clear clinical benefit  physicians not obligated to offer interventions that cause extreme pain and suffering when there is no or limited potential benefit o Genetic Testing of Children  With advances, it is possible to test infants and children for the presence of genetic condition carrier status o Organ Transplant Issues  The Children’s Health Act passed in 2000  Directed the development of specific criteria, policies, and procedures to address the specific needs of children regarding priorities for organ allocation

WK 1 PEDS

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