Al Al-Bayt University

Al al-Bayt University Princess Salma Faculty of Nursing Maternal Child Health Nursing Department

Child Health Nursing-Theory 1001341

Teaching Faculty Kamlah Ahmed RN, M.Sc Jumana Hattab RN, M.Sc Wafa Saleh RN, M.Sc

Second semester 2009- 2010

1 Child Health Nursing /Theory

2009-2010

======Course Title : Child Health Nursing Credit Hours : Three credit hours Pre-requisites :Nur.1001222 (adult health nursing) Placement : 3rd year level Instructors Team: Ms: - Kamlah Ahmed

Course Description:

This course introduces the students to appropriate scientific knowledge which enables them to develop their clinical and educational approaches to care of children and their families. The course starts with concepts of health promotion and maintenance, and the prevention of illness and accidents. Selected physiological health problems including alteration in respiratory, metabolic, renal, neurological, endocrinology, cardiac and other health problems common to all children are introduced. The content also addresses the psychological health problems that face children including inorganic failure to thrive, child neglect and child abuse. Nursing management relevant to each problem is discussed using the nursing process, developmental theories, new trends and the recent approaches in the management and caring of children.

General Objectives: By the end of the course the student will be able to: 1. Utilize the nursing process and developmental theories to provide holistic care for children from infancy to adolescence and to their families. 2. Identify psychosocial problem in order to develop recommendation, management and follow-up to help clients to reach optimal level of wellness. 3. Define and describe a specific pediatric condition with emphasis on etiology, clinical manifestations, expected course, treatment, and issues or problems associated with such conditions. 4. Explain the condition, issues or problems of children based on the literature or clinical experiences. 5. Emphasize the physical, psycho-social or behavioral manifestations that are associated with a specific condition or problem. 6. Uses synthesis of knowledge, problem solving and critical thinking abilities in care of children. 7. Discuss knowledge and prevention strategies according to developmental characteristics of the child such as accidents, nutrition, immunization, and safety measures. 8. Identify appropriate nursing activities in support and teaching for parents of children with different health problems. 9. Utilize the research process in developing projects relevant to nursing care of children.

2 Evaluation Methods: Students will be evaluated according to the following:

First Exam 25% Second Exam 25% ------Final Written final exam 40% participation 10% * ______100% Methods of teaching: 1. Lecturing 2. Questioning 3. Case studies 4. Selected Readings

Unit I: Health Promotion, and Maintenance

Objectives: By the end of the unit, the students will be able to:- 1. Apply theoretical approaches of growth and development to children at different age groups 2. Evaluate normal growth and development through childhood years. 3. Identity deviations from normal growth and development. 4. Describe patterns of development, immunization, nutrition, elimination, sleep, psychosocial development, cognitive and language development, play and safety to children in all stages of development. 5. Identify teaching needs of parents related to promoting optimal health and development of children in all stages 6. State the importance and value the early and periodic screening of children to detect deviations in health 7. List specific screening tests and procedures appropriate for age group. 8. Discuss health maintenance and needs of infants, toddlers, preschoolers, school age and adolescents. 9. Discuss selected Health Concerns such as genetic counseling and child abuse Content Assessing, promoting, and maintaining optimal growth and development to all age groups:  P sychosocial aspects of hospitalization  R esponse to hospitalization  S eparation anxiety  P reparation for procedures  C hild abuse and neglect

3  Nursing role in assessment, management and prevention of child abuse  Legal aspects in accidents and neglect.

Nutrition  Feeding in first year of life  The importance and benefits of breast feeding for the infant and the mother.  Guideline of baby friendly hospital  Developmental considerate in feeding  Caloric, protein, and fluid requirement  Failure to thrive  Anorexia nervosa  Bulimia nervosa  Caloric, protein, and fluid requirement  Obesity among adolescence Elimination  Normal patterns,  Diaper rash  Toilet training for toddlers  Enuresis

Immunization  Optimal immunization schedule:-  New trends in immunization  Role of the nurses in immunizing children:  Methods of administration.  Vaccines safety and contraindications.  Health education of parents.  Global program of immunization  EPL and the target disease.  Role of UNICEF and WHO in promoting health of children through vaccination.  Immunization status and coverage rates in Jordan .  Immunization schedule, national and international.  Storage and handling of vaccines.

Unit 2: Homeostatic, mechanisms and responses:- Fluids and Electrolytes

Objectives: By the end of the unit the students will be able to:- 1. Describe the regulatory mechanism that maintain fluid and electrolyte balance in the body 2. Explain the differences in body fluid and electrolyte composition compared with those of the adults, making children especially vulnerable to imbalances 3. Discuss the primary physiologic processes that regulate acid-base balance 4. Identify clinical manifestations expected in a child with fluid deficit or

4 increase 5. Distinguish between respiratory and metabolic acidosis and alkalosis 6. Identify medical and nursing care of children with fluid and electrolyte disturbances

Content:-  Assessment of fluid and electrolyte regulation  Acid-base regulation  Altered fluid and electrolyte balance:  Hypovolemia, Hypervolemia, Dehydration and its severity, Hypokalemia, hyperkalemia, Hypocalcemia, hypercalcemia  Altered acid base balance: Respiratory acidosis, Respiratory alkalosis, Metabolic acidosis, Metabolic alkalosis  Nursing intervention for children with altered homeostatic mechanism Diarrhea and vomiting  Types and degrees and dehydration  Principles in the management and children with diarrhea - Nutrition - Complications - ORS - Follow up and referral -IV Therapy - Home management.

* Family awareness in the prevention, control and management of diarrhea diseases.

Unit 3:Nursing care of children with altered respiratory function

Objectives: By the end of the unit the students will be able to:- 1. Identify the differences in structure and function of the respiratory system in children 2. Describe the different assessment methodologies of the respiratory system 3. Define and describe the etiologies of selected cause and chronic respiratory ` disorders in children 4. Explain the pathophysiology of selected respiratory disorders in children 5. Analyze subjective and objective findings associated with selected respiratory disorders in children 6. Summarize appropriate nursing and medical interventions for the care of children with selected respiratory disorders 7. Evaluate nursing care of children with altered respiratory function with emphasis on parental education

Content:  History and physical examination related to respiratory system  Diagnostic assessment related to the respiratory system  Therapeutic management:- a. O2 therapy b. Chest physical therapy c. Breathing exercise  Otitis media  Tonsillitis

5  Croup (acute laryngotracheobronchitis)  Bronchiolitis  Epiglottises  Pneumonia  Tuberculosis (TB)  RSV  Asthma  Cystic fibrosis  Allergies  Congenital anomalies  Brunchopulmmary dysplasia (BPD)  Respiratory distress syndrome (RSD)  Tracheoesophageal atresia (TEA)  Esophageal atresia  Parental education on clinical manifestation of children with ARI specific to age groups.  The application of UNICEF guidelines for the management of ARI.

Unit 4:Nursing care of children with altered cardiovascular function

Objectives: By the end of the unit the students will be able to: 1. Describe the transitional differences in structure and function of the cardiovascular system in children 2. Identify assessment techniques available for children with cardiovascular system disorders 3. Describe the general principles of nursing care of children having alterations in cardiovascular system 4. Define and describe the etiology and pathophysiology of selected cardiovascular disorders in children 5. Analyze subjective and objective findings associated with selected altered cardiovascular disorders 6. Identify the nursing interventions to be applied to the care of children with altered cardiovascular function Content  Changes in circulation after birth  Cardiac function  Assessment of children with altered cardiovascular function  Congestive heart failure  Cyanosis: hypoxemia  Congenital heart defects:- a. Coarctation of the aorta b. Atrial septal defect c. Ventricular septal defect d. Patent ductus arteriosus e. Pulmonic stenosis f. Tetrology of fallot g. Aortic stenosis

6 h. Transposition of great vessels

Unit 5:Nursing care of children with altered hematological function

Objectives By the end of the unit the students will be able to:- 1. Demonstrate knowledge pertinent to the anatomy and physiology of blood and blood products in children 2. Discuss assessment of children with altered hematological function 3. Define and describe the etiology and pathophysiology of selected childhood blood disorders 4. Analyze subjective and objective findings associated with selected childhood blood disorders 5. Summarize and apply appropriate nursing and medical interventions for the care of children with selected hematological disorders 6. Evaluate nursing care of children with altered hematological function emphasizing parental education Content * Structure and function of the blood * History and physical assessment of children with blood disorders * Diagnostic assessment * Iron deficiency anemia * Sickle cell disease * Beta-thalessemia * Aplastic anemia * Hemophilia * Idiopathic thrombocytopnia purpura * Favism, G6PD deficiency

Unit 6:Nursing care of children with altered genitourinary function

Objectives By the end of the unit the students will be able to: 1. Identify the assessment and diagnostic procedures relevant to history taking and physical examination for evaluation of genitourinary function in children 2. Discuss the pathophysiology, assessment, management and nursing care of selected genitourinary alterations or disorders in children 3. Describe a selected genitourinary tract anomalies and discuss their therapeutic management 4. Compare the etiology, clinical manifestations, and nursing care of the child with nephrotic syndrome and the child with acute glomerulonephritis 5. Discuss medical and nursing management related to selected genitourinary disorders Content  Nursing assessment  History, physical assessment, and diagnostic tests

7  Congenital anomalies of genitourinary function (hypospadias, epispadias,  Urinary tract infection  Vesicoureteral reflux  Nephrotic syndrome  Acute glomerulonephritis  Renal failure

Unit 7:Nursing care of children with altered gastrointestinal function

Objectives By the end of the unit the students will be able to: 1. Identify the assessment and diagnostic procedures relevant to history taking and physical examination for evaluation of gastrointestinal function in children 2. Discuss the pathophysiological, assessment, management and nursing care of selected gastrointestinal alteration or disorders in children 3. discuss assessment, physiologic processes, diagnostic evaluation, management and nursing care needed for a child with a congenital gastrointestinal anomaly or obstruction that mentioned below

Content  Nursing assessment o History, physical assessment, nutritional assessment and diagnostic tests  Congenital anomalies and obstructions o Cleft-lip and cleft palate  Pyloric stenosis  Intussuception  Hirschsprung disease  Meconium ileus  Alteration associated with inflammatory process, functional and o malabsorption  Inflammatory bowel disease (ulcerative colitis and crohn disease)  Colic  Constipation  Malabsorptive alteration (celiac disease)

 Unit 8:Nursing care of children with altered neurological function

Objectives By the end of the unit the students will be able to: 1. Identify the assessment and diagnostic procedures relevant to history taking and physical examination for evaluation of neurological function in children 2. Discuss the pathophysiological assessment, management and nursing care of the neurological alteration mentioned below 3. Define and describe various categories of seizure 4. Describe care provided for children with seizure disorder 5. Describe a selected congenital anomalies affecting the central nervous system

8 6. Discuss increased intracranial pressure 7. Discuss nursing care and implication for selected neurological alterations

Content  Nursing assessment  History, physical examination and diagnostic test  Hydrocephalus  Spina Bifida  Epilepsy  Febile seizures  C.N.S. infections Bacterial meningitis Aseptic meningitis Encephalitis  Reye’s syndrome  RKU

Unit 9:Nursing care of children with altered endocrine function

Objectives By the end of the unit the students will be able to: 1. Identify and describe a selected alterations of endocrine function in children 2. Discuss nursing responsibilities in preparing children and families for diagnostic tests associated with endocrine disorders 3. Describe nursing care of children with selected pediatric endocrine condition

Content:  Nursing assessment  History, physical assessment and relevant diagnostic tests  The thyroid gland (hypothyroidism, hyperthyroidism)  The gonads (ambiguous genitalia in newborn) undescended testicles  Altered pancreatic endocrine function (hypoglycemia, and hyperglycemia)

Unit 10: Nursing care of children with life threatening disorders

Objectives By the end of the unit the students will be able to: 1. Describe the incidence, etiology and tumor characteristics of childhood cancer 2. Discuss the different types of childhood cancers with emphasis on common clinical presentations, diagnostic studies, available treatment and prognosis of childhood cancer 3. Describe nursing management and interventions for the care of children undergoing chemotherapy 4. List nursing diagnosis pertinent to childhood cancer 5. Discuss the nursing role of providing support for children with cancer and their families

9 6. Discuss the incidence, etiology and pathophysiology of AIDS in pediatrics 7. List signs and symptoms of children with AIDS 8. Describe available treatment of AIDS 9. Discuss nursing role in teaching for parents of children with AIDS

Content  Assessment of children with cancer (signs and symptoms)  Treatment for childhood cancer:- a. chemotherapy b. radiation therapy c. bone marrow transplantation  Incidence and etiology and of selected childhood cancer:- a. leukemia b. brain tumor c. Hodgkin and non Hodgkin  Incidence of AIDS  Etiology, pathophysiology, signs symptoms of AIDS  Mode of infection  Available treatment for children with AIDS  Nursing role of caring of children with cancer and AIDS

Unit 11: Nursing care of children with altered musculosketetal function

Objectives: By the end of the unit the students will be able to: 1. Describe the content of a complete physical assessment of the child’s musculoskeletal function 2. Define and describe the etiology and pathophysiology of selected common musculoskeletal conditions in children 3. Analyze subjective and objective findings associated with each of the selected musculoskeletal condition 4. Discuss various studies and diagnostic tests used in the diagnosis of the musculoskeletal disorder 5. Summarize appropriate nursing interventions for each of the selected disorder Content  Child history and physical examination  Diagnostic studies  Developmental dislocation of the hip (DDH)  Clubfoot  Scoliosis  Juvenile Rheumatoid Arthritis  Rheumatic heart disease  Cerebral palsy

Unit 12: Nursing care of children with special needs

Objectives:

10 By the end of the unit the students will be able to: 1. Identify the normal development and variations of the sensory and motor system 2. Recognize the early indicator of sensory and motor deficits 3. Discuss the nurse’s role in facilitating the normal growth and development for a child who has a developmental disability. 4. Explore available resources in order to arrange a multidisciplinary plan and care for the children and their families. 5. Discuss legal, ethical and public rights of children with special needs.

Content Nursing assessment  History, physical exam and relevant diagnostic tests  Sensory disorders a. Visual impairments b. Auditory impairments c. Communication disorders  Selected cognitive disorders a. Mental retardation b. Down syndrome c.Attention deficit hyperactivity disorders  Screening and detection of sensory neuro , physical, cognitive and Communication disorders. e.g CP, MR , learning disability visual and auditory impairments.  Nursing assessment: - guidelines for referral for audiologic and, speech-language evaluation.

11 Time Table (Monday /Wednesday) Date Contents Instructor 8/2  Course Introduction  Child Health indicators in Jordan 10/2  Roles of Pediatric Nurses in Health 15/2 Services  Health Promotion, an Maintenance 17/2 (hospitalization) 22/2  Nutrition  Immunization 24/2  Homeostatic, mechanisms and 1/3 responses:-Fluids and Electrolytes 3/3  Nursing care of children with 8/3 altered respiratory function 10/3 15/3  Nursing care of 17/3 children with altered cardiovascular function 17/3 First Exam 22/3  Nursing care of 24/3 children with altered hematological function 29/3  Nursing care of 31/3 children with altered genitourinary function 5/4  Nursing care of 7/4 children with altered 12/4 gastrointestinal function 14/4  Nursing care of 19/4 children with altered neurological function 18/4 Second Exam 21/4  Nursing care of 26/4 children with altered endocrine function 28/4  Nursing care of 3/5 children with altered 5/5 musculoskeletal function 10/5  Nursing care of 12/5 children with life threatening disorders 23/5 Final Exams

12 Time Table (Sunday /Tuesday) Date Contents Instructor 7/2  Course Introduction  Child Health indicators in Jordan 9/2  Roles of Pediatric Nurses in Health 13/2 Services  Health Promotion, an Maintenance 15/2 (hospitalization) 21/2  Nutrition  Immunization 23/2  Homeostatic, mechanisms and 28/2 responses:-Fluids and Electrolytes 2/3  Nursing care of children with 7/3 altered respiratory function 9/3 14/3  Nursing care of 16/3 children with altered cardiovascular function 17/3 First Exam 21/3  Nursing care of 23/3 children with altered hematological function 28/3  Nursing care of 30/3 children with altered genitourinary function 4/4  Nursing care of 6/4 children with altered 11/4 gastrointestinal function 13/4  Nursing care of 18/4 children with altered neurological function 18/4 Second Exam 20/4  Nursing care of 25/4 children with altered endocrine function 27/4  Nursing care of 2/5 children with altered 4/5 musculoskeletal function 9/5  Nursing care of 11/5 children with life threatening disorders 23/5 Final Exams

13 References:

Main book :-

Bal, J & Bindler (2008) Pediatric Nursing: Caring for Children, 4th edition, Pearson: Prentice Hall.

Other books:-

1. Wong, D. (2007) Wong’s Nursing Care of Infants and Children, 8th edition. Elsevier: Mosby, St. Louis.

2. Pillitteri, A. ( 2007) Maternal and Child Health Nursing Care of the Childbearing and Childrearing Family, 5th edition, Lippincott Williams & Wilkins: Philadelphia.

3. Klossner, N. & Hatfield, N. (2006): Introductory Maternity and Pediatric Nursing, Lippincott: Williams & Wilkins: Philadelphia.

4. Wong, D. (2005) Wong’s Essential of Pediatric Nursing, 7th edition. Elsevier: Mosby, St. Louis.

5. Hatfied, N.( 2003) Broadribb’s Introductory Pediatric Nursing, 6th edition, Lippincott Williams & Wilkins: Philadelphia.

6. Curley, M. (2001) Critical Care Nursing of Infants and Children, 2nd edition. W. B.Saunders: Philadelphia

THE END