Patricia A. Wieland Ladewig, PhD, RN Professor and Academic Dean Rueckert-Hartman School for Health Professions Regis University Denver, Colorado

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1 lon23944_fm.qxd 2/21/06 6:44 PM Page i SECOND EDITION Marcia L. London, RN, MSN, APRN, NNP Senior Clinical Instructor & Director of Neonatal Nurse Practitioner Option Beth-El College of Nursing and Health Sciences University of Colorado at Colorado Springs Colorado Springs, Colorado Patricia A. Wieland Ladewig, PhD, RN Professor and Academic Dean Rueckert-Hartman School for Health Professions Regis University Denver, Colorado Jane W. Ball, RN, CPNP, DrPH Executive Director Emergency Medical Services for Children National Resource Center, Children s National Medical Center Washington, District of Columbia Ruth C. Bindler, RNC, PhD Associate Professor Washington State University Intercollegiate College of Nursing Spokane, Washington Upper Saddle River, New Jersey 07458

2 lon23944_fm.qxd 2/21/06 6:44 PM Page ii Library of Congress Cataloging-in-Publication Data Data on file with the Library of Congress Publisher: Julie Levin Alexander Assistant to Publisher: Regina Bruno Editor-in-Chief: Maura Connor Executive Editor: Pamela Lappies Senior Managing Editor: Marilyn Meserve Development: Elena Mauceri, Dynamic WordWorks, Inc. Assistant Editor: Sladjana Repic Editorial Assistant: Joanna Satkowitz Director of Production and Manufacturing: Bruce Johnson Managing Production Editor: Patrick Walsh Production Liaison: Nicholas Radhuber Production Editor: Lynn Steines, Carlisle Publishing Services Manufacturing Manager: Ilene Sanford Design Director: Cheryl Asherman Design Coordinator: Maria Guglielmo Interior Designer: Wanda Espana Cover Designers: Maria Guglielmo Electronic Art Creation: Precision Graphics Manager of Media Production: Amy Peltier New Media Project Manager: Stephen Hartner New Media Production: Hector Grillone, Anne Lukens, Jody Small, Kate Stillings, Video Production Services; CD programming and design: Red Frog, Inc. Marketing Manager: Francisco Del Castillo Marketing Coordinator: Michael Sirinides Composition: Carlisle Publishing Services Cover Printer: Phoenix Color Corp. Printing and Binding: Quebecor World Notice: Care has been taken to confirm the accuracy of information presented in this book. The authors, editors, and the publisher, however, cannot accept any responsibility for errors or omissions or for consequences from application of the information in this book and make no warranty, express or implied, with respect to its contents. The authors and publishers have exerted every effort to ensure that drug selections and dosages set forth in this text are in accord with current recommendations and practice at time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package inserts of all drugs for any change in indications of dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright 2007 by Pearson Education, Inc., Upper Saddle River, New Jersey All rights reserved. Printed in the United States of America. This publication is protected by Copyright and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or likewise. For information regarding permission(s), write to: Rights and Permissions Department. Pearson Education, LTD. Pearson Education Singapore, Pte. Ltd. Pearson Education Canada, Ltd. Pearson Education Japan Pearson Education Australia PTY, Limited Pearson Education North Asia Ltd. Pearson Educación de Mexico, S.A. de C.V. Pearson Education Malaysia, Pte. Ltd. Pearson Education, Upper Saddle River, New Jersey Permission was granted by Elsevier Science to reprint in our Nursing Care Plans the nursing intervention and outcome classifications (NIC and NOC), from McCloskey & Bulechek, Nursing Interventions Classification and Johnson et al., Nursing Outcomes Classification ISBN

3 lon23944_fm.qxd 2/21/06 6:44 PM Page iii About the Authors Marcia L. London Marcia L. London has been able to combine her two greatest passions by being both a nurse caring for children and families, and a teacher for almost 35 years. She received her BSN and school nurse certificate from Plattsburgh State University in Plattsburgh, New York. After graduation, she began her nursing career as a pediatric nurse at St. Luke s Hospital in New York City. She then moved to Pittsburgh, where she began her teaching career. Mrs. London accepted a faculty position at Pittsburgh s Children s Hospital Affiliate Program and received her MSN in pediatrics as a clinical nurse specialist from the University of Pittsburgh. Mrs. London began teaching at Beth-El School of Nursing and Health Science in 1974 after opening the first intensive care nursery at Memorial Hospital of Colorado Springs. She has served in many administrative and faculty positions at Beth-El, including coordinator for nursing care of children for 32 years. Mrs. London maintains her clinical skills working in an urgent care and after-hours clinic and doing undergraduate pediatric clinical supervision. She obtained her postmaster s neonatal nurse practitioner certificate in 1983 and subsequently developed the neonatal nurse practitioner (NNP) program and the master s NNP program at Beth-El. She is active nationally in neonatal nursing and was involved in the development of the Neonatal Nurse Practitioner Educational Program Guidelines. She has contributed five chapters to various neonatal nursing texts. Mrs. London is active in nurse practitioner education in general. She was involved in the revision of the Core Competency for Nurse Practitioners and Curriculum Guidelines for Nurse Practitioner Education, as a member of the Education Committee of the National Organization of Nurse Practitioner Faculties and participated as part of the Core Competency Validation Expert Panel. Mrs. London has also pursued her interest in college student learning by taking doctoral classes in higher education administration and adult learning at the University of Denver in Colorado. She feels fortunate to be involved in the education of her future colleagues. Her teaching philosophy is that, with support, students can achieve more than they may initially believe they are capable of achieving. Mrs. London and her husband have two sons and one dog (Reilly, daughter by proxy). Her two sons, Craig and Matthew, are involved in computer informatics, and media arts and animation and are more than willing to give Mom helpful hints. Patricia A. Wieland Ladewig Patricia A. Wieland Ladewig received her BS from the College of Saint Teresa in Winona, Minnesota. After graduation, she worked as a pediatric nurse before joining the U.S. Air Force. After completing her tour of duty, she relocated to Florida, where she accepted a faculty position at Florida State University. There she embraced teaching as her calling. Over the years, she taught at several schools of nursing while earning her MSN in maternalnewborn nursing from Catholic University of America in Washington, D.C., and her PhD in higher education administration from the University of Denver in Colorado. In addition, she became a women s health nurse practitioner and maintained a part-time clinical practice. In 1988 Dr. Ladewig became the first director of the nursing program at Regis College in Denver and, in 1991, when the college became Regis University, she became dean of the Rueckert-Hartman School for Health Professions. Under her guidance, the Department of Nursing has added a graduate program and the school has added three departments: the Department of Physical Therapy, the Department of Health Services Administration and Management, and the Department of Health Care Ethics. Dr. Ladewig feels that teaching others to be excellent, caring nurses gives her the best of all worlds because it keeps her in touch with the profession she loves and enables her to help shape the future of the nursing profession. When not at work or writing textbooks, Pat and her husband, Tim, enjoy skiing, baseball games, and traveling. However, their greatest pleasure comes from their family: son Ryan, his wife, Amanda, and grandson Reed, and son Erik, his wife, Kedri, and granddaughter Emma. iii

4 lon23944_fm.qxd 2/21/06 6:44 PM Page iv iv ABOUT THE AUTHORS Jane W. Ball Jane W. Ball graduated from the Johns Hopkins Hospital School of Nursing, and subsequently received a BS from the Johns Hopkins University. She worked in the surgical, emergency, and outpatient units of the Johns Hopkins Children s Medical and Surgical Center, first as a staff nurse and then as a pediatric nurse practitioner. This began her career as a pediatric nurse and advocate for children s health needs. Jane obtained both a master of public health and doctor of public health degree from the Johns Hopkins University Bloomberg School of Public Health with a focus on maternal and child health. After graduation she became the chief of child health services for the Commonwealth of Pennsylvania Department of Health. In this capacity she oversaw the state-funded well-child clinics and explored ways to improve education for the state s community health nurses. After relocating to Texas, she joined the faculty at the University of Texas at Arlington School of Nursing to teach community pediatrics to registered nurses returning to school for a BSN. During this time she became involved in writing her first textbook, Mosby s Guide to Physical Examination, which is currently in its sixth edition. After relocating to the Washington, D.C., area, she joined Children s National Medical Center to manage a federal project to teach instructors of emergency medical technicians from all states about the special care children need during an emergency. Exposure to the shortcomings of the emergency medical services system in the late 1980s with regard to pediatric care was a career-changing event.with federal funding, she developed educational curricula for emergency medical technicians and emergency nurses to help them provide improved care for children. A textbook entitled Pediatric Emergencies, A Manual for Prehospital Providers was developed from these educational ventures. For the past 14 years, she has managed the federally funded Emergency Medical Services for Children National Resource Center. As executive director, Dr. Ball directs the provision of consultation and resource development for state health agencies, health professionals, families, and advocates about successful methods to improve the healthcare system so that children get optimal emergency care in all healthcare settings. Ruth C. McGillis Bindler Ruth Bindler received her BSN from Cornell University New York Hospital School of Nursing in New York. She worked in oncology nursing at Memorial Sloan Kettering Cancer Center in New York, and then moved to Wisconsin and became a public health nurse in Dane County. Thus began her commitment to work with children as she visited children and their families at home, and served as a school nurse for several elementary, middle, and high schools. Due to this interest in child healthcare needs, she earned her MS in child development from the University of Wisconsin. A move to Washington State was accompanied by a new job as a faculty member at the Intercollegiate Center for Nursing Education in Spokane, Washington. Dr. Bindler has been fortunate to be involved for over 30 years in the growth of this nursing education consortium, which is a combination of public and private universities and colleges and is now the Washington State University/Intercollegiate College of Nursing. She has taught theory and clinical courses in child health nursing, cultural diversity and health, graduate research, pharmacology, and assessment, as well as serving as lead faculty for child health nursing. Her first professional book, Pediatric Medications, was published in 1981, and she has continued to publish articles and books in the areas of pediatric medications and pediatric health. Research efforts are focused in the area of childhood obesity, type 2 diabetes, and cardiovascular risk factors in children. Ethnic diversity has been another theme in her work. She facilitates international and other diversity experiences for students and performs research with culturally diverse children. Dr. Bindler believes that her role as a faculty member has enabled her to learn continually, to foster the development of students in nursing, and to participate fully in the profession of nursing. In addition to teaching, research, publication, and leadership, she enhances her life by service in several professional and community activities, and by activities with her family.

5 lon23944_fm.qxd 2/21/06 6:44 PM Page v Thank You! We are grateful to all the nurses, both clinicians and educators, who reviewed the manuscript of this text. Their insights, suggestions, and eye for detail helped us prepare a more relevant and useful book, one that focuses on the essential components of learning in the fields of maternal, newborn, and child health nursing. Joan P. Anderson, MA, RN, Suffolk County Community College Jane L. Andrews, RNC, MSN, Shasta Community College Margaret Batson, RNC, MSN, San Joaquin Delta College Ann L. Bianchi, RN, MSN, Calhoun Community College Mary Beth Bohli, MSN, RN, Onondaga Community College Diana Breed-Williamson, RN, MSN, Mesa Community College Brenda S. Broussard, RN, MSN, CNM, WHNP, University of Louisiana at Lafayette College of Nursing Nancy Danou, RN, CPN, MSN, Viterbo University Katherine Tate Dewar, RN, MN, PNP, Ohlone College Pamela DiNapoli, RN, PhD, University of New Hampshire Mary Dooley, RN, MSN, ANP, Onondaga Community College Eileen Drabik, RN, MS, Orange County Community College Anna M. Drazenovic, MSN, RN, FNP, Mesa Community College Cynthia A. Dyson, MSN, RN, BC, Charleston Southern University Patricia Eads, BSN, MS, Ivy Tech Community College Patricia H. Economidis, MS, ARNP-BC, Lake-Sumter Community College Sandra B. Englert, BS, MSN, Niagara County Community College Bonnie Ewing, PhD, RN, Adelphi University Lisa Fernandez, RNC, MS, OGNP, ANP, Suffolk County Community College Heather H. Finley, MSN, RN, Grambling, LA Alison Fisher, MSN, RN, Del Mar College Denise Flynn, BSN, RN, Keiser College Lisa Fraine, RN, CNM, MS, Cedarcrest College Betty Drake Freund, MSN, RN, BC, Kent State University Jean H. Gardeski, MA, BSN, RN, Bergen Community College Carolyn M. Garzone, RN, MSN, ANP, Bergen Community College Shari Gholson, MSN, RN, West Kentucky Community and Technical College Sharon K. Hammond, RN, MSN, McLennan Community College Cynthia Hatcher, MSN, RN, San Antonio College Ramona Hunter, BSN, Rush University Karen A. Joho, RN, MS, BC, Union County College Helen W. Jones, PhD, RN, APN, BC, Raritan Valley Community College Mary F. King, RN, MS, Phillips Community College of the University of Arkansas Amy Knepp, NP-C, MSN, RN, University of St. Francis Darcus M. Kottwitz, RN, MSN, Fort Scott Community College Christine King Kuoni, MSN, RN, San Antonio College Maxine Lesser, ARNP-C, MSN, SANE-A, Daytona Beach Community College Cherie A. Mavissakalian, RN, MS, Niagara Community College Deborah M. Miller, RN, MSN, Calhoun Community College Susan M. Miovech, PhD, RNC, Holy Family University Kathy Mix, RN, MS, Linn Benton Community College Mary Neville, MSN, RN, San Joaquin Delta College Jan Jones Nolan, MS, RN, Tulsa Community College Jennifer Ortiz, RNC, MSN, Suffolk Community College Brenda L. Overton, MSN, RN, Baltimore City Community College Gena Porter-Lankist, ARNP, MSN, Chipola College Jill A. Price, RN, MSN, Waukesha County Technical College Christine M. Rosner, RN, PhD, Holy Family University Karen S. Randall, RN, MS, Ivy Tech Community College Lori Riden, MSN, RN, Gateway Community College Zepure Samawi, RN, MSN, Saint Xavier University Sheryl Sandahl, MPH, CNP, RN, College of St. Scholastica June M. Sanders, RN, MSN, Bristol Community College Joanne Burgess Schnell, PhD, State University of New York Susan Parnell Scholtz, RN, DNSc, Moravian College Terri Klasko Snow, RN, MSN, CPNP, Shasta College Claudia Stoffel, RN, MSN, West Kentucky Community and Technical College v

6 lon23944_fm.qxd 2/21/06 6:44 PM Page vi vi THANK YOU! Shari Stoops, MSN, RNC, FNP-C, Del Mar College Mary Tanner, PhD, RN, College of St. Scholastica Sharon K. Tighe, EdD, MN, RN-C, ARNP, Daytona Beach Community College Michelle Tippitt, RN, BSN, MSN, Phillips Community College of the University of Arkansas, University of Phoenix Loretta Wack, RN, BSN, MSN, Blue Ridge Community College Cheryl M. Ward-Simons, BSN, MA, Orange County Community College Marcie Weissner, MSN, BNC, University of St. Francis Kathryn L. Whitley, MSN, Patrick Henry Community College Susan J. Wroten, RN, BSN, MSN, Pima Community College Mindy Yoder, APRN, BC, University of St. Francis

7 lon23944_fm.qxd 2/21/06 6:44 PM Page vii Dedication Throughout the ages, nurses have made a difference treating, healing, soothing, and caring. And so we dedicate this book to nurses For their wisdom, expertise, and compassion For their willingness to challenge the system when necessary For their ability to remain strong during times of difficulty and stress And for their unfailing commitment to the families they assist. And to nursing students everywhere For seeking to serve others when so many have become self-serving For committing their minds and talents to a proud profession For accepting the challenges posed by the changes in healthcare And for daring to envision a brighter tomorrow. Then, too, as always, we honor our beloved families David London, Craig and Matthew Timothy Ladewig, Ryan, Amanda, and Reed, Erik, Kedri, and Emma Ronald Ball Julian Bindler, Dana and her fiancé, Brady, and Ross vii

8 lon23944_fm.qxd 2/21/06 6:44 PM Page viii Preface Faculty and students in today s maternity and pediatric nursing courses face a wide variety of issues and challenges. Courses are growing increasingly shorter, and clinical experiences are more limited. Time truly is precious for both students and faculty. The primary goal in this edition is to present key content in an accurate, readable format that helps students and faculty focus on what s important and helps students develop the skills and abilities they need now and in the future in an ever-changing healthcare environment. This is done through the new Critical Concept Review feature at the end of each chapter, through the illustrations and photographs that clarify concepts more efficiently than words can do, and through the accompanying Student CD-ROM, which depicts clinical situations and requires students to engage in critical thinking. In its structure, format, and delivery, this text provides a concise look at maternal-newborn, women s health, and pediatric nursing. ORGANIZATION The organization of the text also reflects a time-saving approach. As educators and nurses, we know how difficult it is to teach everything that students need to learn in so little time. Consequently, we sought to reduce duplication in the text by carefully integrating maternity and pediatric nursing topics. For example, Chapter 1 begins with introductory concepts important for maternal, newborn, and child nursing, such as family-centered care, cultural considerations, health promotion, community and home care, and legal and ethical considerations, as well as emerging areas such as cord blood banking, the Human Genome Project, and stem cell research. Later chapters focus on reproductive issues and women s health, pregnancy, birth processes, postpartum care, and newborn management, and then transition into the pediatric care chapters. The pediatric chapters also cover general issues first, beginning with introductory concepts followed by two chapters, Chapters 37 and 38, on health promotion for children ranging from infancy to adolescence. Chapters 39 through 57 cover the nursing care of children with various disorders, organized by body system. Throughout the text we have eliminated potentially conflicting information. Students may notice a voice change within chapters. For example, within theory-based sections, we use the nurse. Within the nursing management sections, however, we speak to the students directly in second person, e.g., Assess... or Manage.... This way, students have a very clear understanding of their responsibilities and can put themselves in the role of the nurse more easily. IMPORTANT THEMES IN THIS EDITION Central to this edition are several key themes that are increasingly evident in nursing care of childbearing and childrearing families. Family-Centered Nursing Care Nursing care for pregnant women and children is a familycentered process. The underlying philosophy of Maternal & Child Nursing Care is simple: We believe that family members are co-participants in care, whether this is related to pregnancy and childbirth or to care of the infant or child at any stage of development. Families experience the excitement and exhilaration of welcoming a healthy infant into their home, but they also experience sorrow and concern when a health problem occurs. Nurses play a pivotal role in helping families celebrate the normal life processes associated with birth, in promoting the health of the family and child, and in fostering the child s growth and development from infancy through adolescence. We are committed to providing a text that integrates the needs of families across the continuum from conception through adolescence. Health Promotion In this textbook, we subscribe to the paradigm that all childbearing and childrearing families and children need health promotion and health maintenance interventions, no matter where they seek healthcare or what health conditions they may be experiencing. Families may visit offices or other community settings, specifically to obtain health supervision care. Nurses may also integrate health promotion and health maintenance into the care for childbearing and childrearing families and children with acute and chronic illness in a variety of inpatient and outpatient settings. This textbook integrates health promotion and health maintenance content throughout, most visibly in three new chapters: Chapter 4, Health Promotion for Women, Chapter 37, Health Promotion and Health Maintenance for the Infant and Young Child, and Chapter 38, viii

9 lon23944_fm.qxd 2/21/06 6:44 PM Page ix PREFACE ix Health Promotion and Health Maintenance for the Older Child and Adolescent. In addition, a new feature entitled Health Promotion summarizes the needs of children with specific chronic conditions, such as asthma or diabetes. These overviews teach the student to look at the child with a chronic illness like any other child, with health maintenance needs for prevention, education, and basic care. Nursing Care in the Community Most maternity and pediatric nursing care occurs in the community setting, especially since most children and pregnant women are healthy and have only episodic acute health conditions. Even women with high-risk pregnancies and children with serious chronic health conditions are receiving more care in their homes and in the community. This textbook integrates community and home care throughout, including information on long-term management of complex health conditions, which are especially challenging to manage in community settings. Four chapters provide a theoretical perspective and important tools in caring for childbearing and childrearing families in the community setting: Chapter 10, Antepartal Nursing Assessment, Chapter 11, The Expectant Family: Needs and Care, Chapter 32, Home Care of the Postpartum Family, and Chapter 39, Nursing Considerations for the Child and Family in the Community. In addition, Nursing Care in the Community is a special heading used throughout this text. Because we consider home care to be one form of community-based care, it often has a separate heading under Nursing Care in the Community sections of Nursing Management. Client Education Client education remains a critical element of effective nursing care, one that we emphasize in this text. Nurses teach their clients during all stages of pregnancy and the childbearing process, and during the child s health visits and care for specific conditions. Throughout the book, we include Teaching Highlights that present a special healthcare issue or problem and the related key teaching points for care by the family. Critical Thinking Today s nurses must be able to think critically and problem solve effectively. Nurses are often faced with managing care for multiple families with diverse healthcare needs, and working collaboratively with other health professionals to enhance care. To promote the development of critical thinking skills that will support nurses in challenging situations, Thinking Critically boxes provide brief scenarios that ask students to determine the appropriate response. Students can test their own decision-making skills by submitting answers to these questions via the Companion Website, where the feature also appears. The instructor can then grade their answers using the suggested answers provided in the Instructor s Manual, which is replicated on the Instructor s Resource CD-ROM. Students can access a variety of critical thinking exercises and case studies on the textbook s Companion Website at Another feature that emphasizes these skills is the Critical Thinking in Action feature. This case study introduces a client situation at the end of each chapter and continues on the Student CD-ROM, where it comes to life with videos and images. Students benefit from experiencing the case on the CD-ROM as they decide what nursing actions are appropriate. The Instructor s Resource Manual has more suggestions for critical thinking exercises for both the classroom and clinicals. Research and Evidence-Based Nursing Practice Healthcare professionals are increasingly aware of the importance of using evidence-based approaches as the foundation for planning and providing effective care. The approach of evidence-based practice draws on information from a variety of sources, including nursing research. To help nurses become more comfortable integrating new knowledge into their nursing practice, a brief discussion of evidence-based practice is included in Chapter 1. A new feature entitled Evidence-Based Nursing further enhances the approach of using research to determine nursing actions. It describes a particular problem or clinical question and investigates the evidence that suggests solutions to the problem. In these features, we provide an interpretation explaining the implications of the studies and then invite the student to apply critical thinking skills to further identify nursing care approaches. Cultural Competence The influence of a family s culture on health beliefs and healthcare practices cannot be underestimated. Chapter 1 briefly introduces cultural issues relevant to maternity and child nursing care. Additionally, we devote a new chapter entirely to culture, Chapter 2, Culture and the Family. We also emphasize cultural competence throughout the text. We highlight specific cultural issues and their application to nursing care in the Developing Cultural Competence features.

10 lon23944_fm.qxd 2/21/06 6:48 PM Page x x PREFACE Other New or Expanded Concepts in This Edition Many other important concepts are emphasized throughout this text: Assessment is an essential and core role in the nursing process. Several chapters are dedicated to helping the student perform an assessment at each stage along the pregnancy continuum, initially of the fetus and newborn, and later through the stages of childhood. Communication is one of the most important skills that students need to learn. Effective communication is the very fiber of nursing practice. This book integrates communication skills in an applied manner where students can most benefit. It is an essential part of the Nursing Process and Teaching Highlights boxes. Ensuring appropriate nutrition during pregnancy, infancy, and childhood is important to promote growth, development, and health. A growing national focus on healthy nutrition patterns underscores the importance of this information. Chapters 12, 29, and 34 address nutrition for pregnant women, newborns, and children. Pain is now considered the fifth vital sign, and pain management is a priority in healthcare settings. All of the chapters in Unit IV, Birth and the Family, address pain assessment and management, as do five of the chapters (23, 24, 25, 28, and 32) in Unit V, The Postpartal Childbearing Family and Newborn. In Unit VI, Chapters 35, 40, and 41 address pain assessment and management, and it is the primary subject in Chapter 42, Pain Assessment and Management in Children. We discuss applicable pain management when appropriate in other chapters, including each of the chapters in Unit VII, Caring for Children with Alterations in Health Status. End-of-life care has gained greater national prominence. Expanded focus on the care of the family and the child who is dying has been added to Chapter 41, The Child with a Life-Threatening Illness and End-of-Life Care. Grief and loss associated with miscarriage is addressed in Chapter 15, Pregnancy at Risk: Gestational Onset and in Chapter 21, Childbirth at Risk. TOOLS THAT FOCUS STUDENT REVIEW TO MAXIMIZE TIME Instructors and students both value learning aids that unify the objectives and concepts of a chapter as well as reinforce the overall themes in a text. In keeping with our theme of family-centered care, each chapter begins with a Family Quote that helps set the stage for content that follows from the family s perspective. This is followed by a list of Learning Objectives (new to this edition) and Key Terms with page numbers to identify the place where the term first appears in the chapter. An Audio Glossary of these terms commonly used in the field of maternal-newborn and child nursing can be found on the Student CD-ROM and the Companion Website, with audio pronunciations of the terms as well as printed definitions. Critical Concept Review In this new edition, we responded to instructors and students requests by providing more opportunities for review. Each chapter ends with a Critical Concept Review, a new feature designed to help stu- Critical Concept Review LEARNING OBJECTIVES CONCEPTS Compare the differences between meiotic Mitosis produces cells that cause growth in the body. Results in daughter cells that are an exact dents retain the cellular division and mitotic cellular division. copy of the parent cell. They contain a full diploid set (46) of chromosomes. Compare the processes by which ova and sperm are produced. Describe the components of the process of fertilization. Meiosis produces cells called gametes that are necessary for reproduction of the species. Results in cells that contain only one half (haploid or 23) of the chromosomes of the parent cell. Ova are present in the female ovary at birth but are dominant until puberty. Meiosis initially produces via oogenesis two haploid cells (secondary oocyte and a minute polar body) that are released at ovulation. At the end of meiosis in the female, there are four haploid cells: the three polar bodies and one ovum. Sperm are produced in the seminiferous tubules of the testes beginning at puberty. Meiosis in the male creates four haploid sperm able to fertilize the ovum. Two sperm carry the Y chromosome and two sperm contain the X chromosome. Preparation is the first component of fertilization. Ovum released into fallopian tube viable for 24 hr. Sperm deposited into vagina viable for 48 to 72 hr (highly fertile for 24 hr). Sperm must undergo capacitation and acrosomal reaction. Sperm penetration causes a chemical reaction that blocks more sperm penetration. Moment of fertilization is the second component of fertilization. It occurs in the empulla (outer third) of the fallopian tube. Sperm enters ovum. The nuclei of the ovum and sperm swell, unite and become a diploid zygote. most important concepts from a chapter in a short period of time. This visual tool isolates the essential content in a chapter by means of a flowchart that links Learning Objectives to their corresponding Concepts. Students save time by having the important concepts identified for them, allowing them to use more of their study time for reviewing the concepts themselves. Critical Thinking in Action Following the Critical Concept Re- CRITICAL THINKING IN ACTION View the Critical Thinking in Action video in Chapter 1 of the CD-ROM. Then, answer the questions that follow. You are working as a prenatal mother, including fundal height, fetal heart rate and fetal position if nurse in a local clinic. Before appropriate, maternal blood pressure, weight gain, and urine analysis. entering a client s room, you With each client, you discuss the community resources available such view is a feature review the chart for pertinent as prenatal classes, lactation consultants, and prenatal exercise/yoga information such as cultural classes. Based upon the information you obtain, you might refer the background, significant mother to social services or the WIC program as appropriate. At the family members, weeks of end of the clinic session, you review the clients with the collaborating that challenges students to apply all gestation, test results, birth physician. plan, and education for health 1. How would you define the terms family and family-centered care? promotion. You greet each 2. Describe how the nursing process provides the framework for the client and family members by delivery of direct nursing care. name and ask how they are coping with the pregnancy. Depending on 3. How would you describe the concept of community-based care? the trimester of the pregnancy, you review the discomforts or concerns 4. How would you describe culturally competent care? of the mother/family and what they may expect. You examine the concepts learned in that chapter. Critical Thinking in Action provides a real-life scenario with a series of critical thinking questions so that students can practice what they learned. To further enhance the true-tolife nature of the case study, the Student CD-ROM continues the exercise with a video enactment of the situation, followed by the critical thinking questions from the text as well as five short-answer questions. Not only can students review chapter content in an easy, quick-view format, but they can also apply the concepts used in preparation for clinical work. EXPLORE MEDIAL INK EXPLORE MediaLink The review section ends with a list of references and a section entitled EXPLORE MediaLink. This last section encourages students to use the additional chapter-specific NCLEX-RN Review questions and other interactive exercises that appear on the accompanying Student CD-ROM and the Companion Website at The MediaLink

11 lon23944_fm.qxd 2/21/06 6:45 PM Page xi PREFACE xi feature will further enhance the student s learning experience, build upon knowledge gained from this textbook, prepare students for the NCLEX-RN, and foster critical thinking. APPLICATION OF THE NURSING PROCESS NURSING MANAGEMENT The nursing process is emphasized throughout the nursing care chapters. The heading Nursing Management highlights nursing actions. In chapters with frequently seen or high-risk health issues or conditions, the expanded section on nursing management helps students understand and apply the nursing process more completely. The expanded section includes Nursing Assessment and Diagnosis, Planning and Implementation, and Evaluation. In keeping with changing approaches to nursing care management, we feature Nursing Care Plans and Clinical Pathways throughout the text. The Nursing Care Plans address nursing care for clients who have complications, such as a woman with preeclampsia or a child with otitis media. We designed this feature to help students approach care from the nursing process perspective. They integrate Nursing Diagnosis, Nursing Intervention Classifications (NIC), and Nursing Outcome Classifications (NOC). In this edition, we added 10 new Nursing Care Plans to help students better understand the conceptual approach that nurses employ in providing care for clients. The Clinical Pathways describe nursing actions as they are integrated into care of other health professionals. They help students plan and manage care within normally anticipated time frames as the patient s health status improves. The plans and pathways help students become familiar with these two approaches to managing care so that they are better equipped for variations in clinical settings. VISUALS THAT TEACH The conviction that art can teach is evident throughout the book. There are hundreds of contemporary photographs of childbearing and childrearing families and children in healthcare and related settings throughout the textbook, as well as illustrations, all of which serve to display conditions, compare developmental stages, and depict concepts. Pathophysiology Illustrated figures allow the student to see into the body and to visualize the causes and effects of conditions on childbearing women, newborns, and children. These unique drawings illustrate conditions on a cellular or organ level, and may also portray the step-by-step process of a disease. Drawings or photos with artistic overlays relate disease to its anatomic location and action. As Children Grow illustrations help the student visualize the important anatomic and physiologic differences between a child and an adult. These features illustrate the important ways that a child s development influences healthcare needs and how the child progresses through developmental stages. MORE FEATURES THAT HELP YOU USE THIS BOOK SUCCESSFULLY On the foldout inside the front cover of this book, we show you how some of the features of the textbook and media can help you to be successful in this course. In addition, we offer the following features to further enhance the learning process and help you use this book successfully: Nursing Practice features offer hands-on suggestions and clinical tips. These are placed at locations in the text that will help students apply them. They include topics such as legal and ethical considerations, nursing alerts, and home and community care considerations. Complementary Care boxes present information about commonly used alternative and complementary measures to treat or provide comfort for various conditions. Drug Guides for selected medications commonly used in maternal-newborn and child nursing guide students in correctly administering the medications and evaluating their actions. There are also tables of Medications Used to Treat certain health conditions, to provide an overview of the types of medications that can be used for a specific condition. We highlight important laboratory values within the text as a tool for students to assess their patients conditions a critical precursor to determining appropriate nursing interventions. In addition, an appendix presents normal ranges for pregnant women, newborns, and children by age group. Cross-reference icons help the student to easily locate related information in other chapters. MEDIALINK Entry into practice application MediaLink tabs with CD-ROM and Skills icons remind the student to use the Student CD-ROM or

12 lon23944_fm.qxd 2/21/06 6:45 PM Page xii xii PREFACE Companion Website to find additional information or activities related to the concepts introduced on that page in the textbook. These resources enhance learning and provide an application beyond the textbook experience. Assessment Guides,found in the maternalnewborn chapters, assist students with diagnoses by incorporating physical assessment and normal findings, alterations and possible causes, as well as guidelines for nursing interventions. Clinical Manifestations tables help students understand the association between the pathophysiology and the signs and symptoms of a particular condition. In some cases, these tables present several similar conditions so that students can see the differentiation between conditions. In others, the tables include treatment for the clinical manifestations and conditions. Growth and Development boxes, found exclusively in the pediatric chapters, provide information about the different responses of children at various ages to health conditions. MORE RESOURCES TO HELP YOU MANAGE YOUR TIME To enhance the teaching and learning process, we developed the following resources to correlate with this textbook. The full complement of supplemental teaching materials is available to all qualified instructors from your Prentice Hall sales representative. Student CD-ROM. Packaged with every copy of the textbook is a CD-ROM that includes many valuable learning supplements. Provided for each chapter are the following: Objectives Learning goals are offered at the beginning of each chapter. Audio Glossary The glossary reviews key terms from the textbook and presents correct pronunciation. Nursing Skills This feature provides step-by-step procedures and the rationales for specific actions for the care of pregnant women, newborns, and children. NCLEX-RN Review Written at the analysis and application levels, these questions emphasize the application of nursing care. Students can test their knowledge and gain immediate feedback through rationales for right and wrong answers. Animations and Videos To help students understand and visualize difficult concepts, animations and videos appear where applicable. Nursing in Action These brief video clips of real nurses and clients depict scenarios linked to chapter topics and are followed by questions to stimulate critical thinking. Critical Thinking in Action Linked to the end-ofchapter Critical Thinking in Action feature in the text, these case studies are presented in video or graphic format, followed by questions that require the use of critical thinking skills. Tools Resources to facilitate learning and aid in applying principles from the text are available for printing. Companion Website and Syllabus Manager. Faculty and students using this textbook may access the free Companion Website at This Website serves as a text-specific, interactive online workbook for Maternal & Child Nursing Care. It includes modules for objectives, chapter outlines, an audio glossary with definitions, discussion questions with essay responses, research activities, NCLEX-RN Review questions with automatic grading, links to other sites for student research and essay responses, additional nursing care plans and clinical pathways activities, and more. Instructors adopting this textbook for their courses have access to an online Syllabus Manager with a whole host of features that facilitate the students use of this Companion Website as assigned homework and allow faculty to post their syllabi online for their students. For more information or a demonstration of Syllabus Manager, please contact your Prentice Hall sales representative. Clinical Skills Manual. Also available is the Clinical Skills Manual, which describes a more comprehensive set of commonly performed maternal, newborn, women s health, and pediatric nursing skills. This colorful and highly visual manual clearly depicts the steps required to perform each skill and is formatted for easy use in the clinical setting. It includes both hospital-based and community-based skills. Marginal boxes emphasize material such as clinical tips and safety considerations. The protocols for performing skills contain rationales when needed to clarify recommended actions. Instructor s Resource Manual. This effective teaching aid guides instructors on how to use Maternal & Child Nursing Care for their courses. It includes lecture suggestions, objectives, test questions, answers to the textbook s Thinking Critically exercises, a guide to the PowerPoint images and animations on the Instructor s Resource CD-ROM, and a guide to using the Companion Website and Syllabus Manager. Finally, it includes a test bank of items that follow the NCLEX-RN format and are classified by cognitive level, nursing process step, and client needs.

13 lon23944_fm.qxd 2/21/06 6:45 PM Page xiii PREFACE xiii Instructor s Resource CD-ROM. This CD-ROM has everything instructors need for classroom preparation. For each learning objective, it offers correlating lecture notes, numbered PowerPoint slides, and suggestions for classroom and clinical activities. With more than 100 animations and videos, the Instructor s Resource CD-ROM enables instructors to view and select resources to show in the classroom. Each chapter gives an overview of the homework to assign on the Student CD-ROM and the Companion Website. The Instructor s Resource CD-ROM also provides chapterspecific, integrated PowerPoint presentations with more than 2100 text slides and 1000 image slides all ready to go and integrated in the classroom. Online Course Management Systems. Also added to this package are online course companions available for schools using Blackboard, WebCT, or Course Compass course management systems. For more information about adopting an online course management system to accompany Maternal & Child Nursing Care, please contact your Prentice Hall Health sales representative or go online to Nursing is facing many new challenges: an ongoing nursing shortage, dramatic advances in healthcare knowledge, and natural and man-made disasters that create a critical need for skilled nurses. We believe that nursing is becoming reenergized, and is facing these issues and challenges with enthusiasm and commitment. Many people feel a strong desire to choose professions that make a difference professions such as nursing. We, like you, know that expert nurses can have a tremendous impact on the lives of childbearing and childrearing families. Our goal in writing this text is to help prepare nurses with the skills and knowledge to make a difference one family at a time. Marcia L. London Patricia W. Ladewig Jane W. Ball Ruth C. Bindler

14 We would personally like to thank several people. At Prentice Hall, Maura Connor, editor-in-chief, first envisioned and supported the need for this textbook. Her creative, visionary enthusiasm is outstanding. This edition has been guided by Pamela Lappies, the new nursing editor, who merits our deepest thanks. She has been open, enthusiastic, and dedicated; she is always receptive to our ideas and encourages our development as authors. Our thanks also go to Julie Levin Alexander, our publisher. Julie is committed to excellence and creativity. She is the driving force behind the exciting changes occurring at Prentice Hall Health and is truly a creative futurist in publishing. We also wish to thank Maria Guglielmo, art director, for the striking design of the text; Nick Radhuber, production editor, for his calm coordination of the production of the manuscript; Danielle Doller, associate editor, for her carefully orcheslon23944_fm.qxd 2/21/06 6:45 PM Page xiv Acknowledgments Nursing is a dynamic, exciting healthcare profession. As curricula develop, many nursing programs have begun to offer nursing of childbearing families and nursing of children together in a single course. This combined format requires that faculty approach these two fields with a similar framework and philosophy, and with similar teaching methods, so that students can maximize learning. With this second edition, we have created a tool that will enable students to master these two critical areas of nursing the care of childbearing families and the care of children. Creating a dynamic and integrated text would not be possible without the skill and dedication of a host of people. We wish to acknowledge the contributions to the Complementary Care features in the textbook and on the Companion Website. These individuals brought their specialized knowledge to the project: Faye Bailey, RN, BSN, C, CIMI Carol Baldwin, PhD, RN, HNC Karen Fontaine, RN, MSN, AASECT Lynette Leeseberg Stamler, RN, PhD Marilyn Joy Leeseberg, BA, MMT Karen C. Haack, BMtrs Sylvia M. Kubsch, RN, PhD Geralyn Jadin, RN, BSN, C Nicette Julevics, MC, ICCE Kathryn Landon-Malone, PNP John D. Mark, MD Sunny Pendleton Mayor, BS Suzi Cekarmis Schoon, DNS, RN Ilene Spector, DO Maria Luisa Urdaneta, RN, PhD Sherry Warden, PhD, RN Beverly Yates, ND Claudia Stoffel, MSN, RN, contributed one of the pivotal features in the text, the Learning Outcomes and Concepts in the Critical Concept Review. Wendy Bowles, MSN, CPNP, and Joyce Stehle, RN, MSN, contributed the cutting-edge Critical Thinking in Action features that are also at the end of every chapter. Thank you, Claudia, Wendy, and Joyce, for creating such valuable tools for student success! For their reviews and suggestions to the Critical Thinking in Action vignettes on the Student CD-ROM, we wish to acknowledge the work done by Michael D. Aldridge, MSN, RN, CCRN, CNS, from the University of Texas at Austin, and Ann Bianchi, RN, MSN, ICCE, ICD, from Calhoun Community College. We wish to express gratitude to the following individuals who contributed to the CD-ROM and Companion Website: Marcia Gasper, RNC, MSN, EdD East Stroudsburg University, East Stroudsburg, Pennsylvania Rebecca Gesler, MSN, RN Spalding University, Louisville, Kentucky Susan M. Miovech, PhD, RNC Holy Family University, Philadelphia, Pennsylvania LaDonna Northington, DNS, RN, BC, CCRN University of Mississippi, Jackson, Mississippi Robin Wilkerson, PhD, RN University of Mississippi, Jackson, Mississippi We also wish to acknowledge the authors of the Instructor s Resource Manual: Michael D. Aldridge, MSN, RN, CCRN, CNS University of Texas at Austin Mary Dowell, PhD University of Mary Hardin Baylor Bernadette Dragich, PhD, APRN, BC Bluefield State College Yvette Rolle, MSN Houston Community College xiv

15 lon23944_fm.qxd 2/21/06 6:45 PM Page xv ACKNOWLEDGMENTS xv trated work on the supplements; and Joanna Satkowitz, editorial assistant, for helping with the myriad details involved in preparing a manuscript of this size. Operationally, this book exists in large part because of the tremendous dedication, patience, and skill of our developmental editor, Elena Mauceri. During the long months of hard work, Elena remained calm, focused, organized, and creative. She noted discrepancies, worked for continuity, pitched in everywhere, and earned the respect of all of us. She is truly amazing and we hope to work with her on future projects. Special thanks to the people of Carlisle Communications, especially Lynn Steines, for coordinating production, and Joan Lyon, for her work as copyeditor. They are perceptive, organized, and skillful in all of the tasks of publishing. Finally we all wish to thank our other co-authors. As four individuals, but two teams, we came together with our own ideas, writing styles, and vision for this book. We collaborated, argued, cajoled, and compromised. It was a challenging but rewarding process. Together we created a new and different text for maternal, newborn, and child health nursing, a book and associated learning aids that we hope will be a useful tool for legions of nursing students to come. Marcia L. London Patricia W. Ladewig Jane W. Ball Ruth C. Bindler

16 lon23944_fm.qxd 2/21/06 6:45 PM Page xvi Special Features ASSESSMENT GUIDES Initial Prenatal Assessment p. 220 Intrapartal First Stage of Labor p. 425 Newborn Physical Assessment p. 690 Postpartal First 24 Hours after Birth p. 579 Postpartal First Home Visit and Anticipated Progress at 6 Weeks p. 874 Subsequent Prenatal Assessment p. 232 AS CHILDREN GROW Airway Development p Not Just Small Adults p. 963 Physical Effects of Cancer Treatment p Eustachian Tube p Fluid and Electrolyte Differences p Sinuses p. 985 Infant Sleep Patterns p Integumentary System Changes p Sutures p. 976 Trachea Position p CLINICAL MANIFESTATIONS Abused Drugs p Acute Renal Failure p Apparent Life-Threatening Events p Asthma p Autistic Spectrum Disorders p Thalassemia p Blood Transfusion Reactions p Brain Tumors p Cerebral Palsy p Chemotherapy p Child Abuse p Cirrhosis p Compartment Syndrome p Congestive Heart Failure p Cushing Syndrome p Diabetes by Type p Diabetes Insipidus p Diarrhea p Drug Reactions p Dying Child p Eczema p Extracellular Fluid Volume Deficit p Headache p Heart Defects p Human Immunodeficiency Virus p Hydrocephalus p Hypersensitivity Reactions p xvi Hypoglycemia and Hyperglycemia p Hypovolemic Shock p Insect Bites and Stings p Intestinal Parasitic Disorders p Intracranial Hematomas p Kyphosis and Lordosis p Lead Poisoning p Learning Disabilities p Legg-Calvé-Perthes Disease p Muscular Dystrophies p Myelodysplasia p Newborn Withdrawal p. 800 Obstructive Lesions of the Urinary System p Otitis Media p Renal Failure p Respiratory Failure and Imminent Respiratory Arrest p Seizures p Sexual Abuse p Skeletal Tuberculosis and Septic Arthritis p Strains, Sprains, and Dislocations p Systemic Lupus Erythematosus p Tinea Infections p Toxic Agents p Traumatic Brain Injury by Severity p Tumor Lysis Syndrome p Ulcerative Colitis and Crohn s Disease p Urinary Tract Infection p Viral Pharyngitis and Strep Throat p Visual Disorders p CLINICAL PATHWAYS Induction of Labor p. 548 Intrapartal Stages p. 450 Newborn Care p. 719 Postpartum Period p. 592 Pyloric Stenosis p Stages of Inpatient Care for Children with Severe Asthma p Tonsillectomy and Adenoidectomy p COMPLEMENTARY CARE Acupressure p. 484 ADHD p Aromatherapy p. 431 Asthma p Ayurveda p. 183 Atopic Dermatitis p Backache and Other Pregnancy Related Muscular Pain p. 251 Chemotherapy p Chronic Renal Failure p Cobedding of Twins p. 857 Dietary Supplements and Children p. 954 Doulas p. 481 Essential Fatty Acids p. 275 Evening Primrose Oil p. 546 Garlic and HIV Medication p. 324 Ginger and Acupressure p. 248 Heartburn p. 249 Herbs During Pregnancy p. 200 Herbs and Miscarriage p. 339 Herbs, Homeopathy, and Essential Oils for Breastfeeding p. 761 Horse Chestnut for Varicose Veins p. 249 Hot and Cold p Hypnotherapy p Infant Massage p. 904 Infertility p. 132 Intuitive Touch p. 462 Laxatives p Lysine p. 584 Moxibustion p. 509 Music p. 404 NICU p. 793 Nutritional Content of Herbs p. 278 Otitis Media p Pain Management p Pain Relief in the NICU p. 833 Phytoestrogens p. 90 Preeclampsia p. 354 Probiotics p. 627 Reiki p Sickle Cell Anemia p Skin Lesions p SLE and Stress p Transcendental Meditation and Blood Pressure Control p Headaches p Visualization p. 408 Water Therapy p. 461 Yoga p. 231 Youth and CAM p CRITICAL THINKING IN ACTION Annual Medical Checkup of the Adolescent p. 1123

17 lon23944_fm.qxd 2/21/06 6:45 PM Page xvii SPECIAL FEATURES xvii Aspects of the Home Postpartum Visit p. 885 Assessing the Newborn after Delivery p. 668 Asthma Care Plan p Basal Body Temperature (BBT) Method of Fertility Awareness p. 152 Benefits of Ambulation during Labor p. 446 Biophysical Profile (BPP) for Fetal Well-being p. 391 Birth of an Ill or At-Risk Infant p. 811 Blood Transfusion in the Child with Sickle Cell Anemia p Breastfeeding Techniques p. 766 Bulimia in the Teenager p Burn Care in the Hospital and Home p Cervical Ripening Using Prostaglandin Gel p. 419 Community-Based Prenatal Care p. 19 Concerns after Giving Birth p. 612 Coping with Pregnancy Discomforts in the Third Trimester p. 267 Coping with Symptoms of PMS p. 120 Cultural Assessment in Inner City Clinic p. 40 Discussing Birth Plans with Expectant Parents p. 194 Educating Parents about Vaccinations and Infection Prevention p Encouraging Bonding between Mother and Infant p. 714 ER Assessment of the Infant after an Auto Accident p Establishing Routines and Discipline for the Toddler p External Cephalic Version Procedure p. 562 Family-Centered Care at Children s Clinic p Health Promotion and Cognitive Development in the Child with Spina Bifida p Help for the Autistic Child and Parents p Helping Parents and Child Cope with Cancer Treatment p Helping the Family Cope with the Death of a Premature Infant p Infant with Patent Ductus Arteriosis (PDA) p Infants and Solid Food p. 958 Instructing the Mother in Care of Her Newborn p. 742 Labor Induction or Augmentation Using Oxytocin p. 537 Lead Poisoning Risk Factors and Treatment p Nutritional Needs of Mother and Fetus during Pregnancy p. 288 Otitis Media Treatment p Pain Management for Children p Phototherapy by Fiberoptic Blanket p. 861 Postpartal Care Procedures for the New Mother p. 588 Prenatal Education: Nausea, Urinary Frequency, and Exercise Safety p. 211 Preventing HIV Transmission to the Fetus during Labor p. 333 Preventing Infection in the Hospitalized HIV-Positive Child p Psychologic and Cultural Factors in Teenage Pregnancy p. 303 Reducing Anxiety during a First Pelvic Exam p. 98 Reducing Stress and Anxiety during Labor p. 478 Regional Analgesia during Labor and Birth p. 495 Respiratory Distress in Children p Role of the Nurse in a Muscular Dystrophy Clinic p Signs of a Health Pregnancy p. 239 Suggestions for Parents of a Child with Developmental Delay p. 925 Supportive Care of the HIV-Positive Mother and Infant p. 643 Supportive Techniques Used by the Child Life Specialist p Talking with Teenage Girls about Menstruation and Birth Control p. 69 Teaching Diabetes Management p Treating Hemolytic Uremic Syndrome (HUS) due to E-Coli Infection p Using the Left-Side Lying Position when Bed Rest Is Ordered p. 373 Vulnerability of the Unborn Child to Maternal Illness p. 180 DEVELOPING CULTURAL COMPETENCE Acne Lesions in Individuals with Dark Skin p AIDS Incidence p. 320 Alcohol Consumption p Asthma Management p Baby Care p. 732 Birth Choices p. 183 Blood Pressure and Ethnicity p Blood Samples and Chinese Americans p Breastfeeding in the Asian Culture p. 751 Calcium Intake and Osteoporosis p Childbirth Attendance p. 189 Child Rearing Practices p. 909 Chinese Blood Detoxification Methods p Complications of Pregnancy p. 341 Corrective Surgery for Cleft Lip and Palate p Cultural Conflicts p. 9 Dealing with Death p Death p Developmental Tests p Culture Shock p. 31 Cupping and Cao Gio p Dental Care p Developmental Dysplasia of the Hip p Eating Practices that Influence Dietary Intake p. 942 Education p. 292 English as a Second Language and Developmental Testing p Expression of Pain p Eye Contact p. 964 Father Attachment p. 576 Fetal Alcohol Syndrome p Fetal Loss p. 339 Genetic Screening Recommendations p. 149 Growth Patterns among Immigrant Children p. 936 Growth Standards p. 948 Health Professional s Attitudes about Children s Pain p Herbalism p. 37 HIV/AIDS and Hispanics p Home Visit p. 866 Hot and Cold Disease Theory p Infectious Disease p Infertility Treatments p. 136 Integrating Cultural Practices p Interpreting Illness through Cultural Beliefs p. 660 Jaundice p. 836 Kosher Diets p. 261 Lactose Intolerance p. 963 Latina Women Who Are Victims of Abuse p. 93 Lead p Legg-Calvé-Perthes Disease p Litargirio Use p Lowering the Reading Level of Client Education Materials p. 4 Low-Sodium Foods p Mental Health p Muslim Cultural Preferences p. 455 Muslim Cultural Responses to Male Hospital Personnel p. 455 Native American Cultures p. 244 Native American Techniques for Healing and Protecting p Native American Women and Childbirth p. 424 Nutrition p Operative Reports p. 556 Otitis Media p Overweight p. 943

18 lon23944_fm.qxd 2/21/06 6:45 PM Page xviii xviii SPECIAL FEATURES Parteras p. 186 Patient Education Materials p. 4 Perspective of Health and Disease p Phenylketonuria p Phrasing Your Questions p. 963 Postpartal Cultural Tips for Southeast Asian Women p. 605 Poverty Rates p Prenatal Care p. 209 Presence of the Father p. 409 Puberty p Renal Transplant Waiting List p Red Blood Cell Abnormalities in Southeast Asians p Reducing Sodium in the Child s Diet p Respecting the Wishes of Families of Hospitalized Children p Responses to Pain p. 482 Russian Culture Pain Relief Methods p. 485 Seizures p Skin Tone Differences p. 971 Smoking Rates p Spina Bifida p Spiritual Beliefs and Mental Health p Suicide and Ethnicity p Terms that Describe Pain Intensity p Therapeutic Relationship p. 71 Tinea Capitis p Touching the Child s Head p. 976 Type 2 Diabetes p Unintentional Childhood Injuries p Vitamin A Deficiency p. 945 DRUG GUIDE Acetaminophen p Albuterol p Amoxicillin p Betamethasone p. 346 Calcium Gluconate p Carboprost Tromethamine (Hemabate) p. 473 Ceftriaxon Sodium (Rocephin) p Clomiphene Citrate p. 134 Digoxin p Dinoprostone Prepidil Vaginal Gel p. 543 Erythromycin Ophthalmic Ointment (Ilotycin Ophthalmic) p. 725 Hepatitis B Vaccine (Engerix-B, Recombivax HB) p. 737 Immune Globulin p Insulin p Iron p. 946 Isotretinoin (Accutane) p Magnesium Sulfate p. 350 Methylergonovine Maleate (Methergine) p. 596 Methylphenidate Hydrochloride (Ritalin) p Metronidazole (Flagyl) p. 105 Nalbuphine Hydrochloride (Nubain) p. 483 Naloxone Hydrochloride (Narcan) p. 817 Oxytocin (Pitocin) p. 546 Phenytoin p Postpartum Epidural Morphine p. 607 Prednisone p Ranitidine (Zantac) p Vitamin K1 Phytonadione (AquaMEPHYTON) p. 724 EVIDENCE-BASED NURSING Antiretroviral Drugs p. 323 Asthma p Backpacks p Bicycle Helmet Effectiveness and Use p Breastfeeding p. 753 Cancer and Stress p Congenital Heart Defect p CPAP for Respiratory Distress Syndrome p. 821 Culture and Healthcare Barriers p. 34 Diabetes p End-Stage Renal Disease p Epilepsy p Fetal Heart Rate Assessments p. 431 HIV Infection and Medication Regimen Adherence p Home Health Care p Homelessness p Hydrotherapy p. 485 Immunizations p Infant Sleep p Injuries in Child Care Centers p Intravenous Starts p Mental Healthcare p Neonatal Skin Care p. 723 Osteoporosis p. 91 Otitis Media p Pain Medication p Perinatal Group B Streptococcal Disease p. 231 Pelvic Muscle Function p. 601 Pediatric End-of-Life Care in the PICU p Positioning During the Second Stage of Labor p. 410 Postoperative Feeding Methods Following Pyloromyotomy p Postpartum Depression p. 638 Preterm Birth Prevention p. 348 Self-Efficacy p. 896 Sickle Cell Anemia and Pain Management p Skin-to-Skin Contact for Mothers and Infants p. 573 STI Screening During Pregnancy p. 293 Subfertility p. 133 Sunburn Prevention p Ultrasound for Fetal Assessment p. 388 Vaginal Birth after Cesarean-Birth p. 559 GROWTH AND DEVELOPMENT Adopted Children p. 890 Alveoli Development p Apical Pulse Location p. 996 Blood Volume p Bone Fractures and Carbonated Beverages p Bradycardia p Bradycardia Criteria p Breath Sounds p. 993 Breathing with Occluded Nose p. 984 Chest Diameter p. 990 Cleft Repair Surgery p Communicating with the Adolescent p. 922 Communicating with the Infant p. 908 Communicating with the Preschooler p. 916 Communicating with the School-Age Child p. 919 Communicating with the Toddler p. 912 Coping Behavior p Death and Helping Children Understand the Finality p Deep Breathing p Depression p Distal Pulses p. 998 Drowning Locations p Female Athletes p Fluid in the Ear and Speech and Language Development p Fluid Intake p Gait and Motor Development p Genital Area p Glasgow Coma Scale Assessment p Hearing Loss p. 981 Hematopoietic Stem Cell Transplantation p Hyperkalemic Children p Hypocalcemia in Infants p Inflammatory Bowel Disease p Informed Consent p. 12 Hemophilia p Learning Needs and the School-Age Child p Legg-Calvé-Perthes Disease ands School-age Boys p Memory Testing p Obesity p. 943 Older Children p. 1699

19 lon23944_fm.qxd 2/21/06 6:45 PM Page xix SPECIAL FEATURES xix Ossification of Vertebrae p Osteomyelitis in Newborns p Ostomy Care p Pain Scales p Palpating the Clavicles of the Newborn p Postural Lordosis p Pressure Sites p Pubic Hair Development p. 973 Respiratory Rate p. 992 School-Age Children and Adolescents p Separation Anxiety p Separation of the Foreskin p Specific Gravity p Startle Reflex p Stomach Capacity p Stress Fractures in Adolescents p Tibial Torsion p Toddlers Eating Habits p. 934 Toilet Training and Wetting Episodes p Urinary Output p Vegetarianism and the Pregnant Teen p. 955 Visual Acuity Development p. 979 Visual Impairment in Children p Visual Impairment and Infants p Vitamin D Deficiency p. 946 Bronchopulmonary Dysplasia p Cancer Treatment p Chronic Renal Failure p Cleft Lip or Cleft Palate p Congenital Heart Disease p Diabetes Mellitus p Hearing Impairment p Hematopoietic Stem Cell Transplantation p Muscular Dystrophy p Myelodysplasia p NURSING CARE PLANS Prenatal: Diabetes Mellitus p. 316 Hemorrhage in the Third Trimester p. 520 HIV Infection p. 325 Language Barriers at First Prenatal Visit p. 245 Preeclampsia-Eclampsia p. 356 Puerperal Infection p. 621 Thromboembolic Disease p. 633 Newborn: Cleft Lip and/or Palate p Hyperbilirubinemia p. 839 Respiratory Distress Syndrome p. 826 Small for Gestational Age p. 774 Substance-Abusing Mother p. 803 Childhood: Acquired Immunodeficiency Syndrome p Asthma in the Community Setting p Bacterial Meningitis p Bronchiolitis p Cerebral Palsy p Congestive Heart Failure p Congestive Heart Failure Being Cared for at Home p Coping with a Life-Threatening Illness or Injury p Gastroenteritis p Home Care of the Child with Cancer p Home Peritoneal Dialysis p Hospital Care of the Child with Cancer p Hospitalized with Depression p Immunizations p Major Burn Injury p Mild or Moderate Dehydration p Newly Diagnosed Type 1 Diabetes Mellitus p Otitis Media p Overweight Child p. 939 Postoperative Pain p Severe Dehydration p Sickle Cell Anemia p Surgery p Surgery for Scoliosis p Type 1 Diabetes Being Cared for At Home p Violent Behavior p Visual Impairment Secondary to Retinopathy of Prematurity p Adolescence: Adolescent with Acne p Acute Renal Failure p Airway Diameter p Aldosterone Effects p Appendicitis p Asthma p Barrel Chest p Bicarbonate Buffer System p Brain Injury p Brain Tumors p Buffer Responses to Acid and Base p Burn Classifications p Calcium Imbalances p Cardiac Defects of the Early Newborn Period p. 806 Cardiogenic Shock p Central Nervous System Infection p Chemotherapy Drug Action p Clubfoot p Croup Airway Changes p Diabetes Mellitus p Edema and Capillary Dynamics p Ectopic Pregnancy p. 340 Esophageal Atresia and Tracheoesophageal Fistula p Fever p Fracture Classifications p Hodgkins Disease p Human Immunodeficiency Virus p Hydrocephalus p Hypovolemic Shock p Infection Chain p Metabolic Acids p Nutritional Needs p. 956 Obstructive Shock due to Mediastinal Shift p Obstruction Sites in the Urinary System p Pain Perception p Pneumothorax p Potassium Ions p Preeclampsia p. 353 Primary Immune Response p Proto-oncogene Alteration p Pyloric Stenosis p Respiratory Distress Syndrome (RDS) p. 820 Retraction Sites p Septic Shock p Sickle Cell Anemia p Skin Lesions and Associated Conditions p. 974 Slipped Epiphysis p Tonsil Size with Infection p. 988 Ulcer Formation p Viral Hepatitis p Visual Abnormalities p Wound Healing p TEACHING HIGHLIGHTS Acne Care p Allergens in the Home p Amniotic Membranes p. 347 Animal Bite Prevention p Bottle-Feeding and the Newborn p Brace Wear Guidelines p Breast Self-Examination p. 87 Breastfeeding p. 755 Bronchiolitis Discharge Teaching p Burn Care p Caloric Additions during Pregnancy p. 274 Cancer Incidence in Children p Cancer Therapy p Car Safety for the School-Age Child p. 1110

20 lon23944_fm.qxd 2/21/06 6:45 PM Page xx xx SPECIAL FEATURES Cardiac Surgery Care p Cast Care p Chemotherapy Reportable Events p Child Care Evaluation p Child with Mental Illness p Colic p Contacting the Healthcare Provider p Contraception Methods p. 85 Cystitis Prevention p. 115 Discipline p DKA Prevention p Enhancing Attachment p. 731 Episiotomy Care p. 598 Epistaxis Prevention and Management p Eye Medications p Fetal Activity Assessment p. 253 Fetal Blood Sampling p. 944 Fever Treatment Guidelines p Fire Escape Plan p Food Community Resources p. 943 Food Safety p Foodborne Safety Guidelines p. 944 Formula Preparation p. 764 Grandparents and Cultural Health Practices in the Teaching Plan p. 26 HIV and Infection Risk p Home Care after Cardiac Catheterization p Home Care Considerations for the Child with Sickle Cell Anemia p Home Care Instructions for Apnea Monitoring p Home Care Instructions for Asthma p Home Care Instructions for Gastrostomy Tube Feedings and Care p Hydrocortisone Administration p Hypoglycemia Treatment p Hypospadias and Epispadias Repair p Infant Formula Preparation p Infection Transmission p Inflammatory Bowel Disease Diet p Labor p. 453 Leukemia Chemotherapy p Media Rating Systems p Neuroblastoma p Newborn Care p. 734 Nutrition and the Child with Cancer p Oral Care p Orthopedic Devices p Ovulation Determination Methods p. 129 Pain Management p Patient-Controlled Analgesia (PCA) p Pavlik Harness Application p Perineal Inspection p. 597 Physical Activity Guidelines for Youth p Poison Ivy or Poison Oak Exposure p Poisoning p Preterm Labor p. 351 Respiratory Distress p. 819 Seizure Disorder p Self-Esteem p Sexual Activity after Childbirth p. 882 Sexual Activity during Pregnancy p. 259 Sibling of a Hospitalized Child p Sick Day Guidelines p Soft Tissue Tumor Care p Spina Bifida p STI Prevention p. 111 Substance Abuse and Youth p Sunburn Prevention p Supplements for Breastfed Babies p. 930 Tattoo and Body Piercing Care p Teaching and Optimal Timing p. 784 Tonsillectomy and Adenoidectomy Complications p Tonsillectomy Care p Tooth Avulsion Care p Touch Relaxation p. 191 Traumatic Events p Tympanotomy Tube Care p Urinary Tract Infections p Vaginal Exam Fears p. 460 Visually Impaired Child Development p THINKING CRITICALLY Abusive Relationship p. 422 Adolescent Health Plan p Adoption Considerations p. 299 AIDS and the Toddler p Anal Atresia and Esophageal Atresia p Analgesia Counseling for the Woman in Labor p. 484 Asthma Attacks at School p Autosomal Dominant Disorders p Bladder Infection p. 371 Body Piercings and the Adolescent p BPD and the Infant p Braces and Adolescent Self-Image p Brain-injured Child Care p Breastfeeding Assessment p. 881 Bronchiolitis Assessment p Cast Care p Contraception Advice p. 86 Cute Little Noises p. 722 Dehydrated Child p Demographics and Nursing Care p Diabetes and the Adolescent p Diet and the Pregnant Woman p. 279 Fetal Heart Rate Tracing p. 501 Fever during Pregnancy p. 178 Fundal Height p. 203 Gender-specific Care Preferences p. 456 Glucose Intolerance p. 319 Hemodialysis p Hospitalization or Short-Stay Surgery Preparation p Illness Signs p. 735 Immunizations p Infusion Rate Determination p. 550 International Adoption Counseling p. 891 Lochia Assessment p. 583 Newborn Behavior p. 711 Oxygen Delivery Devices p Pain and Children p Partial-Thickness Burn p PICU Stressors p Postpartal Leg Pain Assessment p. 631 Post-traumatic Stress Disorder p Prenatal Exam Questions p. 217 Ready to Go Home? p. 602 Respiratory Difficulty in the Newborn p. 727 Retinopathy of Prematurity p Sickle Cell Anemia p Special Nutritional Needs p. 956 Strenuous Physical Activity Counseling p. 256 Transient Tachypnea of the Newborn p. 829 VSD and the Infant p. 1455