eo.,,, .. LIb",.,. cf C. ..I oIJl.,·I".PubIIaoUon D.IO Dedication BaII.lone. Principia 01 peJiottlc "w ...... : g.ins For child ..n I I. ... W.1Id. R~I!> C. BindI<~ Ind KaJ l c--.....-5Ib ed. We dedicafe this book (0: !,:cm. Roo. ed. 01: p.,j",.1c n ....i aa: "'riD& Inr dWd .... / [oditcd byl • Our families who are ever lao< w. &I, RIll!> C. Biodor. (til ..d.C! 2001. Indudeo bibIlop'ophial ..~ 1K1!S and inda. supportive and understanding ISBN_I J: 911-&-1l·11117S·1 (olk. paf't') about our passion for children and ISBN. 10 : ~ U.! 1117s-6 (lL 1' .....1 I. l'o<Ii.1<"' ........... I. iii. ..... RoItb M<Gi1io.II.Cowm. Koy I. writing. Ill. IlaD, " .... !'Ni ...; ., nwoinJ.1V. Till<. • Our mentors, colleagues, and [DNLM: I. PNi."lc Nuroins-<n<thodo. 2. awd. 3. I"fam. (. NOlfJi"l ............." I-mt1hods. WY 1,9] students who inspire us to apply Rr:u.,.PUI(2012 our knowledge and challenge our 611.91'001.11-<1<12 thinking, • The childr('n, adolescents, and ...b li ...." Julio Leo;" AIc:a"",,", families with whom we work and .-.....1 10 ...h llo"'" RqinI &W"O who foster our philosophy of "-...... olcquhl,l_ EdlI .... 1CIm Monirnor &II. ...... ","101_0: Mva.ConlIob pediatric nursing. DhgJo,vI MltbtlnlF Daoid c-Il Mlrbtill_SO" Pt.otnil IUnqo Morbtlll Spcd.U", Mkhod Siri..m Dr. .. Iop .... , EcI,o,", KltnWyMI ,,'o: o.-...Iop .... ', Sopplo, .. Mol1y Ward NoII«: Co .. hoI boon Iwn 10 conf"m tN oocuracr of M. ....I n,EdI'or, ProduCllo", Patrick W.1sII infonnll!ion p ....m ed illhlobook. , ...... ul!>o ... edito ... ond ,he ProduCllo" Edhor: yrnn SI"; ...~ S.Codid. Publi,hlnl S. ...i ca pub/i.!>",. hawtOOl" ...." r.ot acapt any rnpon»Dility for 01.0 .. o. Produdlon LI&I>O", An ... COlri. ,,''';I0I0 .. 0. for con""l .. nm from .pplie.';on of the Media P rod ... Me"",." T.avi. Mo_W. ..p haI inform ...... I" tIW bool.nd mob ~o .......0 1)'. <%p .." .... 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For inforrn:ro:i<>n ~ permiuicln(".), wrM 10: Rich" and Pftmi>oio ... o.p.t. ... n~ 1 Lab SI-.lJpp<o-SaddI. ~,NI 07(S&' - PEARSON 10~'7U4311 ISBN_ll: 971-0--1)...211115-1 ISBN_IO: 11--1)",211175-6 About the Authors Jane W. 8allgriMluated (rom PhysiroJ Emlll/nlllion, which Is currently In its seventh edilion. the Johns Hopkins Hospital After relocating to the Washington, DC, area, she jolJlt'd Chilo School of Nursing. and iubse dren'l National Medical Cn'Iter to manage a federal pro",ct Ie quenlly recelvtd a BS from the teach Instructors of emergency medkal technicians from al: Johns Hopkin! Unlvenity. She nates about thelpecial ClIrechildren need during an emergeIll.)' worked In the SWBIcaI, emer Exposure 10 the shortcomings of the emergency medical sec· gency, and outpatient units of the vias system In the late 19805 with regard to pedlatrk care was a Johns Hopkins Olildren's Med career-changlng event. With federal funding, lhedevdoped ed Ial and SuJiIcaI Cenler. first as a ucational currkula for emergency medical IKhnldans a.nd sraff nurse and then as a pediatric e-rne~ncy nurws to hdp lhem provide improvN care for chilo nul'$<' practitioner, beginning her dren. A IeXlbook entlt1ed Pedj~tric Emergmcia. A MllnUIlI/o, Clreer as a pediatric nurse and advocate for children's health fuhmpitlll ProvldtrSwai deVl'loped (rom these educational ven· needs. Jane obblned both a maSler of publlt he;dlh and a doc tures. For 1S ~n she rmnaged the federally funded Emergency tor of public he;Jl!h degree from the Johns Hopkins University Medical Servlcet forOlildren's National ResourceCenter./Un;. Bloomberg School of Publk Health with a (oall on maternal e-cutive director, Dr. Ball directed Ihe provision of consuilatior. and chUd health. Aftergradu:ltion she hearne the chief of child and resource development for state he.tlth agencies, health pro health services (or the Commonwealth of Pennsylvania Depart_ (rss.lonals. (amUIes., and adl'OCates about SUCCffiful methods to ment of Health. In this ClpKity she oveI'$IW the 51ate-funded Improve the health care system so that chUdren get optimal Wl'1I.chlld dinla and aplored wa)'110 IrnpnM' educalklo for emeJtfncy ClIre in all health care settings. Having left that posl· the stale", community health nurses.. Afit!' relocating to Texu, tion,she devoles mo~ lime 10 WTilingand serves al a conJultanl she Joined the fKUlty at the University of 1ms al Arlington 10 lhe American CoIlese of Surgeons, 5l1pporling lute Irnuma School of Nursing to teach community pediatrics 10 registered system development. In 2010, Dr. Ball receiwd the D~in­ nurws rtlurnlng 10 school for a BSN. During Ihls lime she be· gulshed Alumna Award from the Johns Hopkins Unl~nlty. came Involvtd In wrillng her finl tal book, MoWy" Gullie to Ruth C. McGllIis Bfndler colleges and Is now the Washington Slalt' Univenity (WSU: rrcel"'-'Ct IlIif BSN from ComeU College o(Nunlng. Ruth obtained a PhD in human nutrition al Universlly-New York Hospilal WSU. She hu taught theory and dlnlcal courses In chUd health Sdlool of Nursing. She worktd In nunlng. cultural diversity and health, gradUlte research, pharo oncology nursing al ML-morbJ· macology, and asseument, as wdI as serving as lead faculty (01 Sloan Kelltrlng Cancer Center child hrulth nuning. She Ii presently proft'$SOr and associau in New York. and then mO\'ed 10 dean for the college's graduale programs. Her Ilnt profes.slonal Wisconsin and beame a publk book, PrdiD,rk Medialriom, was published In 1981, and the hI.! health nurse In Dane County, continued 10 publish articles and books In the areas of pediatriC Wisconsin. ThUJ began her com· medications and ped~llrk health. Research efforu are focused in mitmmt to work with children the area of childhood obesity. type 2 diabetes, metabolic syn as she visited children and their families at home, and served a5 drome. and cardlometabollc risk factors in children. EthniC dl· a school nUHf for ~ral elementary, middle, and high schoob. IoYfSlty and Inttrprofes.slonal collaboration hav.!' been addlUon.tl Oue 10 Ihillnterest in child health care ne«is,sheeMned her MS themes in IlIif 'WOrk. Dr. Blndler bdif'll'S Ihal her role;u a (acult) in child de\'eIopment from the UniversltyofWisconsin. A move member has enabled IlIif to learn continually, f06ter the develop to W~hlngton Slale was acwmpanied by a new Job as a faculty ment of studenu In nursing, lead and mentO!' junior faculty into member at the Inlerroll~le Cn'IIer for Nursing Educalion in the teaching role, and par11c1patefully in the profi'S$1on of nurs Spokane. Dr. Bindler has been fortuna Ie 10 he In-.utved forOVl!f Ing. In addition to !<,achlng, research, publication, and leadn· 35 years in the growth of this nursing education conKlrlium, ship. she tnlwlces her life by proCessional and community which Is a combination of public and private univrrsilies and service, and by activities with her family. Kay l. (owen l\.'CeIved her chapter "Hospital Care for Children" In Jackson 8c Saunders' BSN from EasI urolina Univer· Child Heillth Nursi"g: A Comprmerrslvt Appl'Ollch ro 'he Glre of sity In Greenville, North Car· Childre" IlM Thdr FoImllfts published In 1993. olin •• ~nd bepn her career ;as In II'Ie dassroom, Mrs. Cowm realll.Ai"d thai studtnts leun ~ II4lIf nurw on the pediatric through a variety of teaming .sU1l1egles ~nd became especially unit of North Carolina Baptist Imerested In the strategy of gaming. She ltd I re5e'.lrch Jtudy to eo.'llIuate the elfect"'~IK'SS of gaming In the dauroom and sub$t· H06prt~11n Winston·~m. She quentlycontinues to incorporate gaming In her teaching. In the ~oped ~ JP«i.tl inteR$! In cUnlc.tl 5tf11ng, Mrs. Cowen teaches htr students the skUls the psy<:ho5ocbl neWs of bospl· needed to are (or patients; and the Importance of family. taJiud children and pn-paring centered care, focusing on 001 only the physical n«ds of the thfm for hOlpitaJlutlon. This child but also the psychC40ClaJ neNso( the child and family. ltd to tlx> lOcus of her master's thesis ~t the University of North During her teaching carrer, Mrs. Cowen has rontinued to Carolina ~t Grren5boro (UNCG) where she receMrl a master of work pan time as • staff nurse: first on the pediatric Wlit of science in nursing education dtgret with a focus in m~tern3l Moses Cone Hospital in Gre-ensboro and then at Bmantr Chll· child nuning. dren's Hospital in Winston·SaIem.ln 2006 she became the p3rt· Mrs. Cowm began her to.~ch(ng ureer in 1984 at UNCG time pediatric nuIW ooucator In Brenntr's Family Resource where six> rontinues today as dlnlc.tl professor In the Parent Center. Through this rol<-she is able to extend her love of teach· Oiild Depmment. Her prlm3ry responsibilities include coordi· ing to children and f.Jmilies. nning the pediatric nursing course, teaching dasnoom roment, Through her roLe as an author, Mrs. Cowen Is able to extend and supervising a clinic.tl group of students. M rs. Cowen shared her dooication to pediatric nunlng and nuning education. She her passion for the psychosocial are of children and the needs is married and the mother of two college-age sons. of their families through her first experience as an author in the Thank You! We 0ilI1l! grateful. to ilIl the nurses, both dinidan$ Ind educators. Robin I.!. Kodl, Piedmont Virginia Community College who rtvie_d the manuscript of this text. Their insights, sug Sar~h Kulimikl, Lenoir Rhyne University gestions, ,nd eye for detail helped us prepare a mort reitYilnt, Palrida A. Kuster, Samuel Merritt University useful. ,rid current book, rtflecti~ of the present time ilnd of the tssenti,,\ components of lumirog in the Odd of child Meredith laW, Pediatric Nurse Practitioner, Qeveland Oinie llealth nursing_ Mlkki Me:.tdows-OUver, Y;lIe University School of Nursing Aim Atana, Kent Stale Unr,ersity Cheryl Mele, Drexel Uni~'ersity KIm Adams, Forsyth Technical Community College Earlene MerriU, Coppin State University Mike Aldridge. University of Tens at Austin School San Mitchell, Georgia Baptist College of Nursing of Mercer of NursIng Unillersity Monique Alston-Davis, Montgomery College Mary Ellen Mitchell·Rosen, No~ Southeastern University Trgd Arney. Asthma Athletics CEO, Banner Olildren's Maureen E. O'Brien, Marquette University College of Nursing Hospital Brenda PlVill, University of North Carolina Wllmington Johnett Bemon-Soros, Kent State University at Ashtabula Marisue Rayno, Luxeme County Community College Sharen Brady, Weber Slale University Katherine Robert~ Lamar UniVl'TSity Cari~ Carle. Medkal Uniwrsity of South Carolina Cheryl Shaffer, Suffolk County Community College Dawn ChaptUe, Natiooallnstitutes of Health Sue Solecki, Drext'l Uni\\'TSity Teresa Ollst, University of Kentucky CoU<'geofNursing Usa D. South, East Mississippi Community College JenniferCompere, Brenner Children's Hospital, Joanna Sprlhis. Children', MedIcal Center Dallas WlIUlon-Salem Daphnee Stewart, Georgia Bal't~ College of Nursing, Marilyn Cox, Children's Medical Center Dallas Mercer University Klrl Cnwford, Levine Children's Hospital. Charlotte Marie H, Thomas, Forsyth 1«hnical Community College Joseph De Santis, University of Miami s<:hool of Nursing Maureen llppen, Univt'TSity of Michigan-Flim and Health Studies Debbie Treolar, Ea~1 Mississippi CommlJnity College Ann B:lrhart, Clinical Nur.;e Specialist, Mesa. Arizona Diane K. Van Os, \Vestminsler College Pat B. Esland, City University of New York, Borough Terri L. Walker, Oklahoma Oty Community CoIlegt' of Manhattan Community College Rosie Wilbon, East Mississippi Community College Tonsh~ Emeuon, East Mississippi CommunIty CoUege Cynlhi~ Williams, Oklahoma City Community College lori Sholders Farmer, Advanced Practice Nurse In GenetIcs, Donna Wilsker, Lamar UniVl'rsity Distance Education Imlmnor, University of North Carolina at Pembroke Rond~ M. Wood, Long Beach City College Betty Fnund, College of Nursing, Kent State UniVl'rsity Contributor Julie Garcia, University of Thus Health Science Center al San Anlonlo Lind. D. Ward, MN, ARNP Oinkal Assistant Profes.s.or VIcki Grubbs, EaSlern Kentucky University Washington State Uni,'ersity CoUege of Nursing Amy ZIomek Hedden, Califomia State Unillersity, Bakersfield Spokane, WashIngton Karen Joris, Lorain County Community College Chapter J: Genetic and Genomic Injluffl(CS Preface Health care and health caU' delivery systems are changing dra~ Pediatric nursing care is provided within the context of a rap mallealt)'. PedIatric nW'5eS must respond to and Intewate these idly changing society. An examination of the major morbidities changes into their practice. In addition. pediatric nursing pre and mortalities of childhood guided the revision of material and sen\li unique challenges and isslles in the changing health care topics throughout the text. Spectfic chapters focus on the fam Mt'1k'. Studo.-nt DurSo!! must larn I'>nat helps them to providt ily, health promotion across th~ lif. . span, pediatric n:.ltrition. safe, effectIve, and excellent care today. while lntegrallng new and care for chronic conditions. A chapter addres.slng cultural knowledge and slulis l\e('ded as nursing P"Klice conI inues 10 de influenCl'$ on health care provides guidance for 51udents caring velop and respond to health care neros. Srudents must learn for children in our growing intercultural society. A chapter on how 10 think and apply information as newknowledge becomes genetics has been added to help students recognize the impact of available. "As the itudent uses knowledge In silwlion! of prac genet lcs and genomlcs knowledge on pediat ric nursing. Otrrent tice, new understanding is gairled as well as knowing how, when, social challenges for children have guided the further develop and why it is re\e"nnl in particular situations .... WI.' call this ment of a chapter on societal and environmental influences on leaching for a sense of salience ... • child health. Facultyare responsible for selecting patient care assignments Many graduating nurses practice In acute cue facilltles, and thaI assist the student to apply koQ\\-1edge in the dink"a! setting. this textbookconlinues to emphasi1.l' lhe information necenary as well as various pedagogies toassistthe litudentto focus on the to prepare students for working in hospitals. In addition, the in patientexperienu. WI' have integrated these coiKepts and oth formation provided In this textbook will enable gradualeS to as ers In this \eJ:t fl'Oll1 the Carnegie Reporl by offering a variety of sume positions In ambulatory care facmties, hornt health (riliad Ihinking and diniOiI reasoning queslions. p;tlient care nursing, schools, and a variety of other Sl'{tings. Effective com scenarios, researdt and evidem:e·blIsed practice features, and munkation methods, printiples of working with families, and supporl for teaching with curJ't'nt information technology In knowledge of pathophysiologic, psychologic, developmental, mind. and environmental factors found In this book can all beapplied in a wide variety of settings. Preparation for Nursing Excellence In keeping with the pres.sures and demands on student time The goal of the fdlh edition of this textbook iii to provide core to learn and J't'ad, the textbook was redesigned to be nIQre com pediatric nursing kn0\\01edge that prepares students for excel pact and focus on essential conlent. The companion website is lence in nursing, and to offer the toob of scholarship and criti used to provide some supplemental con rent, ,ase $Iudies, and (allhinking needoo toappty this learning in the fUture.Students carl' planning exerdses to enhance learning. musllearn to qUl':!tion, evaluate the research evidence available, Another major change In our society Involves acce;s to In apply pertinent information In c1inlal settings, and constantly formation and reliance on the Internet. Nurses must learn to adapt togrowing knowledge and an evolving health care system. obtain information and then analyze and judge Ihe quality of This textbook reflects a multitude of approaches 10 learning information they find. Increasingly, nurses need experienu that can be helpful to all students. WI' acknowledge that malI)' with Infornlatlon technology and management. In Ihlsedltion, students learn pediatric nursing In a very shon time period. margin tabs send the student onlllll' 10 obtain the latestlnfor Therefore. the approaches in this textbook are designed to malion available on many topics. Nurses must also assist ,hil assi§t students to assess Ihe child's needs. take into account dren and famity members 10 use the Internet wisety to help popuiation-blised practice, and make care decisions based on them In making health care decisions. so the student Is assisted the standards of pediatric nursing practice. to make practice decisions based on scholarship and e~ence­ based resear,h. Realities of Pediatric Nursing Organization and Integrated Themes Pediatric nuning occurs in many acutl' carl' and community health care settings, such as hospitals. homes. schools, and v.oe have organized Principles ofP rdlntrlc Nursing: Carlng"r Chil health cl'ntl'rs. Milly procedures are performed in shorl-stry dren, fifth edition. to present imporunt information OIl growth units,and long-term carl' is often proVided at home for children and devclopment, fiunily-centered care, culture, gelll'lics.. ph~iGlI with complex health conditions. Families are often the providers assessment, health promotion, nutrition, health Issues III today's of care and case managers for these children. Thchnologlcal ad world, and chUdren's responses to Ulness and Injury. This infor vancesare resulting in earlier diagnoses and newtherapies; these mation is needed to carl' for children in the many health care 51'1- technological approaches are integrated whenever pertinent tings where pediatric nursing care is plUllided. Following the throughout the textbook. foundational chapters, this book Is organized by body systems to vii viii Pnf""~ fadlitate the student's ability 10 locate Information, focus study· thinking in their everyda)" lives, but need help to apply these lng, and p~re for dlnlcal experiences with children and f.11111- ron,epts to the pfll(:tlc~ of nursing. This book and the a'· lies. The orpr.lzatlonal ff1lmework also rUmInates redundancy, so rompanying learning l1I:aterlais hell' students understand that the stude.lt uses tIme efficiently. how their normal curiosity and problem-solving ability can In addition to thesig.nitlcant revisions ffiadeto all ,tupters to be applied to pediatric nllrsing. updnl" clink,1 Information and resources. we added Oil(' ntw Communiclltion is one of the most important skills thaI stu· dtapler-Ch1pler): Genetic and Geoomk Influences-to r. ... dents nec!d 10 learn. Effective ronllnunlcatlon wIth children Ilect the emerging Information about the Im~ of gt'lIttics on is challenging because thty communicate differently, acrorti thr health ccnditions occurring In clliidren. SIKh contrnt is ing to theirdeveiopmentaJ Ie\·eb. Family memben have rom· cited in -Oiaieal Prevention and Population Health- in The mUtliation needs in addition to thole ofthelrclllldren. This ~11'iQh of BlICI'o/aurtar~ fJUl'fI,1011 for ~Ionlll Nursing book int<'Sf<ltes communication $lcllls by applied example5 PTllcric~(Am(flon AssoI:latlon ofCollegH of Nursing, 20(8). that help the student to ml1lmuniate d'f«tlvcly with 'hll 'ille Ulndltr-llaU (;hl1d I"ellthca~ Model Is used to lUus· drcn and their famlli1s. trate the important core value that all 'hlklren n«d health pro Fllmily lind plltient edu(iltlon aboul health care is an lnle motion and hL-aJth maintenance Interventions, no matter wik>re graJ part ofthe pediatrk nurse', responslblllties. SInce hospi they 5eek health ore or what health condItions they may be talizations are $hort and famliln Increasingly eire for experiencing. cllildren It home, Infofltl.1tion about health care n('t'(h and TIle nursing process Is used as the framework for nursing care. procedures has become e>'en mort Important. Nunlng Mamgement is the major heading, with subheadings of Oewloping cultural competenells crltkal for all nurses In NursIng Aueo;,o;ment Ind Olagno~ls, Planning lind [mplenlen the Increasingly dIverse community of tod~y'l world. Stu tulon, and evaluation. When It Is appropriate to focus on care dents have all met IleOIlle from dlffefl."'lll L1hnlc and ruituf1l1 In a speclfk .!el1lng, Hosplt~I-Based ClI'I', Discharge PL1nnlng, groups, but they need he41to understand, rt'5jl('ct, and Int ... and Community Care nre 5ep;1rated Into ,sectIons. We feature grate differing beliefs, practices, and health care needs when nursing ClIrt'pLlns throughout the text to help 5tudentsapproach providing care. care from the nursing proceu perspectlw. Additional nursing Growth and d. .... lopmlnl consld.ratlons lind physical .s care plans are provided on the corn p;1nlon Wl!bslt'e. Nursing CIl rt nssment are central to the t'ff«tlve practice of pediatric Plans Inc1udt nursing Interwntion classifications (NIC) and nursing. A separate chapter Is de\'owd to each area. Oapter 4 nursing outcome cllwiflcations (NOC), as well HS nursing diag and Chapter S. teSPl'I=tively, In addition. both IOplo are Inte noses, go,ils, Interventions. and f1Ition.1ie. grated where appropriate In narrntive. growth and develop Sevef1li major conceplJ are Inttgf1lted throughout the text ment boxes. figures. captions. and on thecompanlon website, book to encounge the studcl1t to think crtatlvely and critically about nursill@care. 1lIese major themes are IntefWOvt'n through Hulth promotion Is an Important focus of nursing Oft' for out the text ttrough the (e;JIUre5 and supplement$. ,hildren with acute and chronIc health rondilions. Four ctuptl'rs focus on health promotion, One provides an over Nursing " .. Is thecritlcllli and centf1ll COrt of this textbook. vitwof concq>15 rebtt'd to lli'alth promotion. Thra! (hapten Nunlng a!.SeSSment and nt.an1gement art emphasized In all address health protl)()(lon prlndpks f..,rchlldrtn of dlfferent 5«IIons 01 the booI!:, with nUlW$lhown provkiing care In a agel. In addition. health fromotlon bo:le5 help Illustrate 01" variety 01 settings. portunities for health promotion for children ,,"1th health Colbbontive ca .. descrIptions of the diagnostic and thef1l. conditions. peutlc care for various health cooditlons reflects the Intetpro Community are Isanlncrnslng part ofnunlng rHponslbll fesslonal te:lm role of nurses with other health professionals Itles. To assist students In tf1lnJfenlng know1fdge to caring (e.g., physicians. physical ther.lplsts, mmtal health coun forcllildren in rommunity settings. InformatIon Is provided selors, pharmadsts, and others) as described In 1k ESSDlriais in tbe nursing management sections of cllapters.ln additIon, of Baoru/aurtllte EduCIl/wn f()f Profrnlonnl Nursing Pm(fk~ an mtire chapler Is de\(ljed to nursing care In the commu· (Ameron Association of Colleges of Nursing, 2008). nity and dlre<:tly addre5.1e5 the nurse'$ roles In several com· (liniCiI Rnonlng lind probl.m_soLving principles are munity settings. Integrnted in the organization, pedagogy, writing style, evidence-based prnctlce features, reseaKh bo.xes, clinical Thesethemes andothersarflnterwovcn In the narrative of most judgment boxes. exercises on the companion website, and chapters and are reflKted in the art. as well as In the supple.. art ,aptions. Students pn"tice clinical reasoning and critical ments that students can u~ to augment their learning. InstructoT$ ,nd students 'Like v,lut the in-text lurning ,ids that we iMWde in our textbooks to help mul the chaUenges of pediatric nurs;ng_ The following guide will help you use the ftatul'H "ld rHOUrtes froll'l Principles of Ptdi.tric Nursing: Car ing for Children, fifth edition. to be succesfuL in the dns room, in tIM cllnic.lsetting, on the NClEX-RN(r) eumil'lltion. ,nd in nursing pqctice. Case Scenarios and photos at the lqinningofe adi chapleT engage you with a child's rea.l-Iife experience with a 5p«ifk he;Jlth challenge. Questions at the end of elCh S«narlo highlight nursing considerations. Additional Information appears throughout the chapter to help build knov.1edge. Key Terms are introduced at the beginning of eac:h chapter. with page numbers showing where each term flrst appears in the chapter, designated in bold type. learning Outcomes identify measurableoojectlve; basN on _ _ I-~' topl" covtftd in each chaptel". A FUl;u) 011 So!'Cllon appears althe beginning of tach systems chapter as a reference to use while reading the chapter. Each Fo cus On section Includes the following features: wtomy anc! Ph)'$loIogy provides a quick review of the sys ,~. --.-------_ Ptcllatri( I)II'f.r ...( 6 wUi help you fecognlu physkal and mental differences In children at vuious...,.. --... -..-.- .--_---------.. __ The MHS5IMnt CulcleltllH bblfo in each ofthesysle.m chap ...... --...-.. -~....-.....-., ---­- atesrsse spsrmoveindte ws iatnh iOn l'tthfVt ibeowd oyf s ytMste kme.y aspects of an Integrated -~.-- OlagnoJtk Tnb and Llborlltory PrOCHurtJ offer information related to the speclflc sy'tem to assbt in clinical application. As Children Grow boxes illustrate the families Want to Know boxes apply the con anatomic and physIologic differences cepl$ of family-centered nursing rnre by offering between children and adults. This visual teaching in formats directly applicable when fellture wlll help you consIder develop working with fm,;;'Ii', ,.,_ mental differences when working with children in different age groups. - -. ::-...._.. ----,.--,...... -,..-- -~--.--~ -- - __ _ :..:..:..: -.:=.....=.....=. -.-... -... _.---- -.=..=....-.... .. __ .. _. ...... - .= ::::::=::::z::::::w"'-'. ---- :c:.''::::.=:,=::=;.:-:i'"-=':".===---_--:-t".~-.: ~;~~!:~~r~~~;~"':~u~"~';;.~"~d: ~boxes the teenx-t ..=.= -:::.-.;---_--_.... . -.--. .=....=. - by offering a cause of various -;::--::.......~ "'~ diseases and the effect on children. These il lustrations show conditions at a cellular or : ::::..,,:,,~;-....:r="" organ level, and may also portray step-by ~'::;-'-'-"""-'" step disease processes. -__._ _ ___ ._...... ----_ -_ _ -_.__--- - ..... - tpNHerxEeotam Wlttooh t i hoenPlp rf ooyrm ocuoh tirlideocrneo ng nswpizieteeh d ; t; b:u~~m:p~s, ~~a;p~pfeOa:r" ~. i~nh :~t~"h"eh --..~~..=... :_-. -.-...-.-..._..- ..~...... ....~. _-._.. .......-.:... .. ._.. ~.....,_...... .6....0.;.. . -:.: ..-...:-. ..-.-........~-.-- ._ ;..:.-_..; -.:_. :. •.- --.---"~-".. .?..__...:-.. :-_. : O.... ...~...:...:.- ._.: ._._=6.- _. o. -. _...:".-.... ..-:..-.._.-- .-- .._ .-....-..-.--_._...............- ~- .-__.__ .-..._.. .....'..._ .. ..--._ .-... ...-4.. ..... ............. .. ....... _4 __ ........... _'---'-~ --...-........ ---"~__..-,-, .-.,.-...-..... --_----- - --- ..-.. -...~.-. -,---.......... ... __ NEW -'~_-....-._........ ......!.... :....:.. -...:...'.. _.- _._. -..~_ ....... ._.. ..-...... ............. .-. -..-.. --.... -.=.-~....!..=...:..-..=.!..-.. .!-._: -:-.:.-.:' -:. .:.!........-.'..:....:.."... . .". .-.'~."..: .~-._:..... ....:. ... . .::.. :-.:.:...-...'e.-. ...: .::. Clinical Judgment speed bumps appear in the text to help hone critical thinking and clinirnl reasoning _ skills by presenting a brief scenario and asking for the ---_ - appropriate responK' In that situation. .. .. ;-=--..:.: .... :::::-.;.:."::J t::"..:.::..7!:t;..-E:-- ::z _ . ___. ..... r-" ------ - :-!-."-:t='_ __ ..-........... ..... _.,....,.. ... .. -,. ... _.. .... --. " ",====::::=::::::::===:-i~ Evl dence-Based PractIce boxes further enhance our approach to research by describing a nursing problem and inwstigating theevidence from stud ies that explore solutions. Theemphasis is on nurs ing research, exploring the implications of the studies, and critical thinking and application of the findings to your nursing care. I.,C"''',,, boxes heighten your awareness of diverse perspt'\:tives, cultural variations, and health dispar ities, alerting you to potential impacts on the health ofthechild. MedIcatIons Used to Treat boxes list actions, in d.ications, and important nursing considerations for medications. r-------.".,:~' ::!.'< ~,~ Manlfestatlo tables link etiology, manif tations, and clinical ther< , for spt'\:ific conditions. '" Research boxes focus relevant research that gi you additional informatiol and Development bo highlight nursing care at specific stage! development. EthIcs boxes highlight the many issues that nurses face related to pediatric nursing, preparing you for the dinical setting.