Nursing 104

N104: Essentials of Nursing Care – Health Safety Study Guide o Persistence, or the continuation of behaviors o Distractibility, or the ease of being interrupted by external sources o Initial reaction to new situations, like whether the child approaches or withdraws from new situations o Adaptability, or the ability of the child to change behaviors in a new situation o Mood, or the positive or negative emotional expression in different situations o Intensity, or the amount of energy expressed in social situations o Sensitivity, or the degree to which the child reacts to external stimuli o Regularity, or the extent to which normal activities are consistent from day to day 5.4 The Nursing Process in Pediatric Care The nurse will use the nursing process in caring for the pediatric patient. Assessment The assessment of the pediatric patient involves taking a health history and performing a physical exam. The pediatric health history will include the same elements as identified for an adult. In the case of the very young child, much of this information will be elicited from the parent or caregiver; the older child should be encouraged to provide the information. Particularly important in the health history for a child are the history of childhood illnesses and immunizations, current medications, and sleep habits. The family medical history is critical in helping to identify any genetic issues to which the child might be predisposed. A sexual history is critical in the late childhood and adolescent stages. These discussions may be more productive if they are conducted without the parent in the room and done in a non-threatening manner. The astute nurse will carefully watch the interactions between the child and other family members to determine how the child fits into the family structure. Nutrition is critical for normal growth and development. The nurse will evaluate dietary intake, bowel and bladder habits, and the physical exam. Hair, skin, teeth, gums, lips, and eyes can provide the nurse with critical information about nutrition. Height and weight can also provide information about the child's nutritional status. The physical exam can produce stress in the child. Understanding the stages of development can guide the nurse in easing this stress. In general, the physical exam can be done in a playful manner that encourages the child to be an active participant in the exam. Short and direct explanations should be used before doing any part of the exam. If something painful must be done, it should be done last in the exam. Allowing the child to touch and "use" any instruments may decrease the fear associated with the unknown. Children may be more amenable to an exam if they know a reward will be given at the end of theexam.

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