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Increased heart rate
Thrashing of arms and legs
Facial expression of discomfort
Not useful as the sole indicator for pain.
The best indicator of pain in children of all ages.
Of most value when children also report having pain.
Essential to determine whether a child is telling the truth about pain.
Poker Chip Tool
Visual Analog Scale
FACES Pain Rating Scale
Word-Graphic Rating Scale
The child will be pain free.
Only the child is allowed to push the button for a bolus.
The pump allows for a continuous basal rate and delivers a constant amount of medication to control pain.
There is a high risk of overdose so monitoring is done every 15 minutes.
Same as the intravenous dose
Greater than the intravenous dose
One half of the intravenous dose
One fourth of the intravenous dose
Give only an opioid analgesic at this time.
Increase the dosage of analgesic until the child is adequately sedated.
Plan a preventive schedule of pain medication around the clock.
Give the child a clock and explain when she or he can have pain medications.
Often lie about experiencing pain.
Tolerate pain better than adults.
Become accustomed to painful procedures.
Commonly experience treatment-related moderate to severe pain when they have cancer.
Having a loss or abnormality of structure or function
Having a condition or barrier imposed by society, the environment, or one’s self
Having a condition that interferes with daily function for more than 3 months a year, causes hospitalization of more than 1 month a year, or is likely to do either of these
Being at increased risk for a chronic physical, behavioral, developmental, or emotional condition and also requiring health and related services of a type or amount beyond those required by children in general
Help parents learn special care needs of their child.
Help parents provide safe opportunities to explore the environment at home and in the hospital.
Expose child to pleasurable experiences as much as possible.
Avoid separation from family during hospitalization.
The father is experiencing denial.
The father is expressing his own views.
Child is using an adaptive coping style.
Child is using a maladaptive coping style.
Verbal cue to stop crying
Part of assessing parent’s coping skills
Inappropriate, because parent is so upset
Diverting the present crisis to similar situations with which parent has dealt
Recommend the parents attend school at first to prevent teasing.
Request to visit the school.
Refer the child to a school where the children have similar chronic disabilities.
Discuss with the child and parents how unlikely it is that the classmates will accept the child as they did before.
Explain to the siblings that embarrassment is unhealthy.
Encourage the parents not to expect siblings to help them care for the child with special needs.
Provide information to the siblings about the child’s condition only as requested.
Suggest to the parents ways of showing gratitude to the siblings when they help care for the child with special needs.
“What is really wrong?”
“Being angry is only natural.”
“Yelling at me will not change things.”
“I will come back when you settle down.”
Death is temporary.
Death is permanent.
Death is inevitable at some age.
Death is personified in various forms.
The child is denying the seriousness of the illness.
This is a common reaction and a way to express anger.
More discipline is needed to deal with the uncooperativeness.
Permissiveness is needed as child copes with a life-threatening illness.
Be available to family.
Attempt to “lighten the mood.”
Suggest activities to cheer up the family.
Discourage crying until actual time of death.
Change in respiratory pattern
Sensation of cold although body feels hot
Loss of hearing followed by loss of other senses
Grant their request.
Assess why they think this is necessary.
Discourage this because it will only prolong their grief.
Kindly explain that they need to say good-bye to their child now and leave.
Contact a clergyperson to discuss this problem with them.
Explain that their daughter is disfigured and it would be best not to see her.
Encourage them to wait for viewing until the funeral home has prepared her body.
Inform them of what to expect and then let them see their daughter.
Encourage child to attend funeral but not see the body.
Refer the child to someone who can assess her readiness for these experiences.
Suggest that instead of these experiences the child visit the grave site after the services are over.
Explain that her parents or another significant person should provide support during these experiences.
These are normal grief responses.
The pain of the loss is usually less by this time.
These grief responses are more typical of the early stages of grief.
This grieving is essential until the pain is gone and the child is gradually forgotten.
Removal of affected piece of bowel
The drug should be given 30 minutes before bedtime.
Three times a day dosing has maximum effect.
The drug can be stopped once symptoms have resolved.
Several days may pass before full effect is reached.
Irritable bowel syndrome
Dilation of pylorus
Hypertrophy of pyloric muscle
Hypotonicity of pyloric muscle
Reduction of tone in the pyloric muscle
Measure abdominal girth.
Auscultate for bowel sounds.
Take vital signs, including blood pressure.
Refer to a nutritionist for detailed dietary instructions and education.
Help child and family understand that diet restrictions are usually only temporary.
Teach proper hand washing and Standard Precautions to prevent disease transmission.
Suggest ways to cope more effectively with stress to minimize symptoms.
Prepare family for impending death.
Teach family how to calculate caloric needs.
Ensure that family can identify signs of central venous catheter infections.
Secure TPN and gastrostomy tubing under diaper to lessen risk of dislodgment.
Allow ambulation as tolerated.
Monitor vital signs every 2 hours.
Assess the affected extremity for temperature and color.
Check pulses above the catheterization site for equality and symmetry.
Inability to sweat
Increased urinary output
Force fluids appropriate to age.
Monitor respirations during active periods.
Organize activities to allow for uninterrupted sleep.
Give larger feedings less often to conserve energy.
Coarctation of the aorta
Atrial septal defect
Patent ductus arteriosus
Tetralogy of Fallot
Take vital signs and blood pressure and compare them with baseline.
Dilute infusing blood with equal amounts of normal saline.
Stop transfusion and maintain a patent intravenous line with normal saline and new tubing.
Refer parents and child for genetic counseling.
Teach parents and child how to recognize signs and symptoms of crises.
Help the child and family adjust to a short-term disease.
Observe for complications of multiple blood transfusions.
They are often ordered but not usually needed.
When they are medically indicated, children rarely become addicted.
They are given as a last resort because of the threat of addiction.
They are used only if other measures, such as ice packs, are ineffective.
Apply warm, moist compresses.
Apply tourniquet for at least 5 minutes.
Elevate arm above the level of the heart.
Begin passive range of motion unless pain is severe.
Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells.
Infiltration will not occur unless superficial veins are used for the intravenous infusion.
Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates.
Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary.
Acute tumor lysis syndrome
Superior vena cava syndrome
Petechiae, fever, fatigue
Headache, papilledema, irritability
Muscle wasting, weight loss, fatigue
Decreased intracranial pressure, psychosis, confusion
Skeletal proportions are normal for age.
Weight is usually more retarded than height.
Growth is normal during the first 3 years of life.
Most of these children have subnormal intelligence.
The child is not yet fertile.
Heterosexual interest is usually advanced.
Dress and activities should be appropriate to chronologic age.
Appearance of secondary sexual characteristics does not proceed in the usual order.
Prepare family for impending death.
Prepare the family for each procedure.
Prepare family for long-term consequences of paralysis.
Reassure family that flaccid paralysis is not problematic.
It is caused by excessive production of cortisol.
Treatment involves replacement of cortisol.
The major clinical features are exophthalmia and pigmentary changes.
Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.
It is an easier method of testing.
Parents are better able to manage the diabetes.
Children have a greater sense of control over the diabetes.
Fewer visits to the primary care provider will be necessary.
Exercise is contraindicated.
The level of activity depends on the type of insulin required.
Exercise is not restricted unless indicated by other health conditions.
Soccer and baseball are too strenuous, but swimming is acceptable.
Best treated at home
Best treated at practitioner’s office or clinic