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Essentials ofPediatric Nursing

Essentials ofPediatric NursingTerri Kyle, MSN, CPNPAssistant Professor, Nursing PediatricsUniversity of Central FloridaOrlando, Florida

Acquisitions Editor: Elizabeth Nieginski/Jean RodenbergerDevelopment Editor: Danielle DiPalma/Erin SweeneySenior Production Editor: Tom GibbonsDirector of Nursing Production: Helen EwanSenior Managing Editor / Production: Erika KorsDesign Coordinator: Holly Reid McLaughlinCover Designer: Bess KiethasArt Director, Illustration: Brett MacNaughtonSenior Manufacturing Manager: William AlbertiIndexer: Kathy PitcoffCompositor: Circle GraphicsISBN-13: 978-0-7817-5115-2ISBN-10: 0-7817-5115-2Copyright 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer business. All rights reserved. This book isprotected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, includingas photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval systemwithout written permission from the copyright owner, except for brief quotations embodied in critical articles andreviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. governmentemployees are not covered by the above-mentioned copyright. To request permission, please contact LippincottWilliams & Wilkins at 530 Walnut Street, Philadelphia PA 19106, via email at permissions@lww.com or via websiteat lww.com (products and services).9 8 7 6 5 4 3 2 1Printed in ChinaLibrary of Congress Cataloging-in-Publication DataKyle, Terri.Essentials of pediatric nursing / Terri Kyle.p. ; cm.Includes bibliographical references and index.ISBN-13: 978-0-7817-5115-5 (hardcover : alk. paper)ISBN-10: 0-7817-5115-2 (hardcover : alk. paper) 1. Pediatric nursing. I. Title.[DNLM: 1. Nursing Care—methods. 2. Child. 3. Infant. 4. Nursing Assessment—methods. 5. Pediatric Nursing. WY 159 K99e 2008]RJ245.K95 2008618.92'00231—dc222007025968Care has been taken to confirm the accuracy of the information presented and to describe generally acceptedpractices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respectto the currency, completeness, or accuracy of the contents of the publication. Application of this information in aparticular situation remains the professional responsibility of the practitioner; the clinical treatments described andrecommended may not be considered absolute and universal recommendations.The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forthin this text are in accordance with the current recommendations and practice at the time of publication. However, inview of ongoing research, changes in government regulations, and the constant flow of information relating to drugtherapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indicationsand dosage and for added warnings and precautions. This is particularly important when the recommended agent isa new or infrequently employed drug.Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA)clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertainthe FDA status of each drug or device planned for use in his or her clinical practice.LWW.COM

This book is dedicated to my incredible family, without whomI could never have accomplished this monumental task.My husband John has unfailingly stood by my side, providingcontinuous positive affirmation and infinite support forthis project. My son Christian and my daughter Caitlinhave blessed me with their patience and faith in me, as wellas the opportunity for me to experience all the stages of growthand development first-hand. The book is also dedicatedto the wonderful babies born during this project:Natalie, Ben, Grace, and Ella.

ACKNOWLEDGMENTSThe thrilling and challenging experience ofauthoring this textbook would not have been possible without the tremendous support of the Lippincott Williams& Wilkins family. In particular I want to thank MichelleMcIlvain (Regional Sales Manager) for initially queryingme about this idea that had long been a secret goal ofmine; Elizabeth Nieginski (Senior Acquisitions Editor)for believing so strongly in my ideas and never letting megive up; and Danielle DiPalma (Senior DevelopmentEditor) for her vision and organization, but especially forher patience with me. I would like to express immensegratitude to Sarah Kyle (Development Editor) for soclearly being able to see what I wanted and her tirelessattention to detail even up through the ninth month ofpregnancy and while moving her family across continents.Thank you to Maryann Foley (Development Editor) forstepping in and filling the gaps, Erin Sweeney for assistingwith transmission of the manuscript, Brett MacNaughton(Art Director) and the entire art team for the beautifulillustrations, as well as Tom Gibbons (Senior ProductionEditor) and the production team for their diligent efforts.My good friend and colleague, Susan Carman, deservesspecial thanks for her significant contribution not onlyto writing chapters and case studies as well as beinginvolved in the development of the online study guide,but also for always listening to, supporting, and encouraging me. Special thanks to Amy Gellerman (Producer),Gus Freedman (Photographer), Newton-Wellesley Hospital pediatric department, and Boston Shriner’s Hospital for the beautiful photography they contributed. I wouldalso like to thank all of the pediatric nurses who contributed their wealth of knowledge and expertise to developing chapters for this book. This would not have beenpossible without all of you.

ABOUT THE AUTHORTerri Kyle earned a Bachelor of Science in Nursing from the Universityof North Carolina at Chapel Hill and a Master of Science in Nursing fromEmory University in Atlanta, Georgia. She is a certified pediatric nursepractitioner and is currently enrolled in the Doctor of Nursing Practiceprogram at the University of Florida. Practicing pediatric nursing for over20 years, Terri has had the opportunity to serve children and their familiesin a variety of diverse settings.She has experience in inpatient pediatrics in pediatric and neonatalintensive care units, newborn nursery, specialized pediatric units, and community hospitals. She has worked as a pediatric nurse practitioner in pediatric specialty clinics and primary care. She has been involved in teachingnursing for over 15 years with experience in both undergraduate andgraduate nursing education. Terri is a fellow in the National Associationof Pediatric Nurse Practitioners and a member of Sigma Theta TauInternational Honor Society of Nursing, the National League for Nursing,the Society of Pediatric Nurses, and the Association of Camp Nurses.With the limited time allotted in schools to the topic of pediatric nursing, Terri recognized the need for a textbook that “got to the point.” Shestrongly believes in a concepts-based approach for learning nursing—thatis, to teach the basics to students in a broad contextual format so that theycan apply that knowledge in a variety of situations. The concepts-basedapproach to nursing education is time-efficient for nursing educators andfosters the development of critical thinking skills in student nurses.

CONTRIBUTORSKathie Aduddell, EdD, MSN, RNCarol Holtz, RN, PhDAssociate ProfessorKennesaw State University, School of NursingKennesaw, GeorgiaCHAPTER 1 Perspectives of Pediatric NursingCHAPTER 2 Factors Influencing Child HealthCHAPTER 11 Nursing Care of Children During Illness andHospitalization (co-authored with Kathy Ordelt)CHAPTER 14 Medication Administration, IntravenousTherapy, and Nutritional SupportCHAPTER 15 Pain ManagementCHAPTER 20 Nursing Care of the Child with aCardiovascular Disorder (co-authored with Carol Holtz)CHAPTER 28 Nursing Care of the Child with anEndocrine DisorderProfessor of NursingKennesaw State University, School of NursingKennesaw, GeorgiaCHAPTER 20 Nursing Care of the Child with aCardiovascular Disorder (co-authored with Kathie Aduddell)Barbara Browning, RN, MS, CPNPClinical Assistant ProfessorGeorgia State UniversityAtlanta, GeorgiaCHAPTER 8 Growth and Development of the AdolescentSusan Carman, BSN, MSN, MBAHubertus, WisconsinCHAPTER 12 Nursing Care of the Child in theCommunityCHAPTER 16 Nursing Care of the Child with an InfectiousDisorderCHAPTER 30 Nursing Care of the Child with a GeneticDisorderMyra Carmon, EdD, CPNP, RNDirector for the Health and Wellness NursingCollaborativeGeorgia State UniversityAtlanta, GeorgiaCHAPTER 7 Growth and Development of the School-AgeChildKim HamiltonAtlanta, GeorgiaCHAPTER 21 Nursing Care of the Child with aGastrointestinal DisorderMaeve Howett, RN, PhD(c), CPNP, IBCLCAssistant ProfessorEmory UniversityAtlanta, GeorgiaCHAPTER 10 Health Assessment of ChildrenRandall Johnson, RN, M.S.N, ARNPAssociate ProfessorFlorida Hospital College of Health SciencesOrlando, FloridaCHAPTER 24 Nursing Care of the Child with aMusculoskeletal DisorderKathy Ordelt, RN, CPN, CRRNPatient and Family Education CoordinatorChildren’s Healthcare of AtlantaAtlanta, GeorgiaCHAPTER 11 Nursing Care of Children During Illness andHospitalization (co-authored with Kathie Aduddell)Marie Oren-Sosebee, RN, BSN, CWOCNWound, Ostomy and Continence NurseChildren’s Healthcare of AtlantaAtlanta, GeorgiaCHAPTER 14 Medication Administration, IntravenousTherapy, and Nutritional SupportMaggie Payne-Orton, RN, PNPClinical InstructorEmory UniversityAtlanta, GeorgiaCHAPTER 32 Nursing Care During a Pediatric EmergencyGayle Wetzel, BSN, MSN, ARNP, CPNPProfessor, Advanced Placement Nursing ProgramCoordinatorEdison CollegeFort Meyers, FloridaCHAPTER 9 Health Supervision

REVIEWERSMarguerite Aube, BS, MS, CASDonna Curry, RN, PhDAssistant ProfessorUniversity of New EnglandPortland, MaineAssociate ProfessorWright State UniversityDayton, OhioMichele Avila-Emerson, RN, BA, MSNDianne DeLong, MSN, RNFresno City CollegeLucille Packard Children’s Hospital at StanfordUniversityFresno, CaliforniaProfessor, Dean of Professional Accreditation andCurriculumLeigh Carbon Community CollegeSchnecksville, PennsylvaniaMarty Bachman, RN, PhDBernadette Dragich, PhD, APRN, BCAssociate Professor of NursingFront Range Community College at LarimerFort Collins, ColoradoProfessorBluefield State CollegeBluefield, West VirginiaVicky Becherer, MSN, RNPat Durham-Taylor, RN, PhDPediatric Clinical InstructorUniversity of Missouri at St. LouisSt. Louis, MissouriProfessor of NursingTruckee Meadows Community CollegeReno, NevadaJody Bivona, RN, MSNAlison Fisher, RN, MSN, CPNNursing InstructorState University of New York at UlsterStone Ridge, New YorkInstructorDel Mar CollegeCorpus Christi, TexasSally Boyster, RN, MSLois Griffin, MSN, CFNPProfessor, Nursing Science ProgramRose State CollegeMidwest City, OklahomaNursing InstructorShelton State Community CollegeTuscaloosa, AlabamaSusan Brillhart, RN, MSN, CPNPAnna Gryczman, MSN, RN, PHN, HNCAssistant ProfessorBorough of Manhattan Community CollegeNew York, New YorkProfessorCentury CollegeWhite Bear Lake, MinnesotaMarJo Bunten, RN, MSNMelanie Hamilton, MN, BN, RNAssistant ProfessorBradley UniversityMorton, IllinoisNursing InstructorGrand Prairie Regional CollegeAlberta, CanadaGrace Buttriss, RN, FNPCarol Hargate, BS, MPH, CPNPNursing InstructorQueens University of CharlotteConcord, North CarolinaAssistant ProfessorMinnesota State University at MankatoMankato, MinnesotaKaren Carpenter, APRN, BC, FNP, JDPat Hendrix, MSN, RNProfessorQuinsigamond Community CollegeWorcester, MassachusettsDirector of NursingMotlow State Community CollegeTullahoma, Tennessee