Fluent Essays

Nursing evolution Pediatrics  Clinical was online simulation scenarios using swift-river Nursing Evolution Due No Due Date Points 10 Submitting a text entry box or a file upload NURS_307 - Nursing Evolution Rubric Start Assignment Each student is required to complete and turn in the evolution of the course prior to sitting for the final exam. This is a portfolio requirement that must be completed at the end of each course. You will not be allowed to sit for the final without having completed the evolution for this course. Total Points: 10 Criteria Ratings Pts 3.3 pts 3.4 pts 3.3 pts Reflects on current theory and clinical class with concepts and theories using the Program Learning Outcomes and BSN Essentials listed in the syllabus 3.3 pts Meets Expectations 1. Reflects on current theory class and clinical and how courses support each other (transfer of knowledge to apply to clinical)- Focused to Current Term. 2. Synthesizes theories and concepts from liberal education to build an understanding of the human experience. 3. Uses skills of inquiry and analysis to address practice issues 4. Applies knowledge of social and cultural factors in the care of populations encountered in this course. 2.51 pts Approaches Expectations 1. Limited reflection on current theory class and clinical and how courses support each other (transfer of knowledge to apply to clinical)- Focused to Current Term. 2. Limited synthesis of theories and concepts from liberal education to build an understanding of the human experience 3. Use limited skills of inquiry and analysis to address practice issues 4. Applies limited knowledge of social and cultural factors in the care of populations encountered in this course. 1.65 pts Does Not Meet Expectations 1.No reflection on current theory class and clinical and how courses support each other 2. Does not synthesize theories and concepts from liberal education to build an understanding of the human experience 3. Does not use skills of inquiry and analysis to address practice issues 4. Does not apply knowledge of social and cultural factors in the care of populations encountered in this course. Develops an effective communication style for interacting with current patients, families, and the interdisciplinary health team when providing holistic, patient centered nursing care to populations encountered in this course. 3.4 pts Meets Expectations 1. Reflects on providing holistic patient care to populations encountered in this course. 2. Describes inter-collaborative involvement (i.e. Interprofessional rounds; consultations and interaction with PT/OT; Respiratory Therapy, Pharmacist consultation---describe their role/ contribution.) 2.58 pts Approaches Expectations 1. A limited reflection on providing holistic patient care to populations encountered in this course. 2. Describes limited inter-collaborative involvement 1.7 pts Does Not Meet Expectations 1. No reflection on providing holistic patient care to populations encountered in this course. 2. Does not describes inter-collaborative involvement Models leadership when providing safe, quality nursing care; coordinating the healthcare team; and when tasked with oversight and accountability for care delivery. 3.3 pts Meets Expectations 1. Describe an event that demonstrates: • application of leadership concepts, skills and decision making in the provision of high quality nursing care, • healthcare team coordination • the oversight and accountability for care delivery 2. Describe an event that demonstrates leadership, appropriate teambuilding and collaborative strategies to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team 2.51 pts Approaches Expectations 1. Describes limited leadership concepts, skills and decision making in the provision of high quality nursing care, healthcare team coordination and the oversight and accountability for care delivery 2. Limited description of an event that demonstrates leadership, appropriate teambuilding and collaborative strategies to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team 1.65 pts Does Not Meet Expectations 1. Gives no examples of leadership concepts, skills and decision making in the provision of high quality nursing care, healthcare team coordination and the oversight and accountability for care delivery in a variety of settings 2. Does not describe an event that demonstrates leadership, appropriate teambuilding and collaborative strategies to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team xxvii $��B\%$//����B��B6(B)0�LQGG����� ���������������30 $��B*25����B��B6(B)0�LQGG���� ����������������SP This page intentionally left blank Brief Contents 1 Nurse’s Role in Care of the Child: Hospital, Community, and Home 1 2 Family-Centered Care and Cultural Considerations 17 3 Genetic and Genomic Influences 45 4 Growth and Development 66 5 Pediatric Assessment 98 6 Introduction to Health Promotion and Maintenance 144 7 Health Promotion and Maintenance for the Newborn and Infant 154 8 Health Promotion and Maintenance for the Toddler and Preschooler 166 9 Health Promotion and Maintenance for the School-Age Child and Adolescent 182 10 Nursing Considerations for the Child in the Community 207 11 Nursing Considerations for the Hospitalized Child 222 12 The Child With a Chronic Condition 246 13 The Child With a Life-Threatening Condition and End-of-Life Care 260 14 Infant, Child, and Adolescent Nutrition 281 15 Pain Assessment and Management in Children 310 16 Immunizations and Communicable Diseases 333 17 Social and Environmental Influences on the Child 367 18 Alterations in Fluid, Electrolyte, and Acid–Base Balance 404 19 Alterations in Eye, Ear, Nose, and Throat Function 440 20 Alterations in Respiratory Function 474 21 Alterations in Cardiovascular Function 518 22 Alterations in Immune Function 563 23 Alterations in Hematologic Function 589 24 The Child With Cancer 610 25 Alterations in Gastrointestinal Function 655 26 Alterations in Genitourinary Function 701 27 Alterations in Neurologic Function 739 28 Alterations in Mental Health and Cognitive Function 790 29 Alterations in Musculoskeletal Function 821 30 Alterations in Endocrine Function 861 31 Alterations in Skin Integrity 900 Appendix A Physical Growth Charts 942 Appendix B Blood Pressure Tables 952 Appendix C Dietary Reference Intakes 954 Appendix D Selected Pediatric Laboratory Values 956 Appendix E Diagnostic Tests and Procedures 959 Appendix F Body Surface Area Nomogram 964 Appendix G Conversions and Equivalents 965 Glossary 966 Index 978 $��B\%$//����B��B6(B)(3�LQGG���� ���������������30 $��B\%$//����B��B6(B)(3�LQGG���� ���������������30 $��B*25����B��B6(B)0�LQGG���� ����������������SP This page intentionally left blank Principles of Pediatric Nursing Caring for Children Seventh Edition Jane W. Ball, RN, CPNP, DrPH Consultant, Trauma System Development, Gaithersburg, Maryland Ruth C. Bindler, RNC, PhD Professor Emeritus, Washington State University College of Nursing, Spokane, Washington Kay J. Cowen, RN-BC, MSN, CNE Clinical Professor, University of North Carolina at Greensboro School of Nursing, Greensboro, North Carolina Michele R. Shaw, RN, PhD Associate Professor, Washington State University College of Nursing, Spokane, Washington 330 Hudson Street, NY NY 10013 $��B\%$//����B��B6(B)0�LQGG���� �������������������DP ISBN-13: 978-0-13-425701-3 ISBN-10: 0-13-425701-4 Publisher: Julie Levin Alexander Editorial Coordinator: Sarah Henrich Portfolio Manager: Katrin Beacom Content Producer: Erin Rafferty Editorial Assistant: Erin Sullivan Vice President of Sales & Marketing: David Gesell Vice President, Director of Marketing: Margaret Waples Senior Product Marketing Manager: Christopher Barry Field Marketing Manager: Brittany Hammond Director, Publishing Operations: Paul DeLuca Team Lead, Project Management: Cynthia Zonneveld Team Lead, Program Management: Melissa Bashe Development Editor: Mary Cook Full-Service Vendor: SPi Global Full-Service Senior Production Editor: Patty Donovan, SPi Global Manufacturing Manager: Maura Zaldivar-Garcia Senior Producer: Amy Peltier Media Producer and Project Manager: Lisa Rinaldi Art Director: Mary Siener Cover Credit: A Day In May, painting used with permission from Katie m. Berggren, www.KmBerggren.com Printer/Binder: Courier Kendalville Cover Printer: Courier Kendalville Notice: Care has been taken to confirm the accuracy of information presented in this book. The authors, edi- tors, 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 publisher 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 ongo- ing research, changes in government regulations, and the constant flow of information relating to drug therapy and reactions, the reader is urged to check the package inserts, pharmacy information, or current online infor- mation of all drugs for any change in indications or dosage and for added warning and precautions. This is particularly important when the recommended agent is a new and/or infrequently administered drug. Copyright © 2017, 2015, 2012, 2008, 2004 by Pearson Education, Inc. All rights reserved. Manufactured 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. To obtain permission(s) to use material from this work, please submit a written request to Pearson Education, Inc., Permissions Department, 221 River Street, Hoboken, New Jersey 07030. Many of the designations by manufacturers and seller to distinguish their products are claimed as trademarks. Where those designations appear in this book, and the publisher was aware of a trademark claim, the designa- tions have been printed in initial caps or all caps. A note about nursing diagnoses: Nursing diagnoses in this text are taken from Nursing Diagnoses—Definitions and Classification 2015–2017. Copyright © 2014, 1994–2012 by NANDA International. Used by arrangement with John Wiley & Sons Limited. In order to make safe and effective judgments using NANDA-I nursing diagnoses it is essential that nurses refer to the definitions and defining characteristics of the diagnoses listed in this work. Library of Congress Cataloging-in-Publication Data Names: Ball, Jane (Jane W.), author. | Bindler, Ruth McGillis, author. | Cowen, Kay J., author. | Shaw, Michele R., author. Title: Principles of pediatric nursing: caring for children / Jane W. Ball, Ruth C. Bindler, Kay J. Cowen, Michele R. Shaw. Description: Seventh edition. | Hoboken, NJ : Pearson Education, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016035091| ISBN 9780134257013 | ISBN 0134257014 Subjects: | MESH: Pediatric Nursing | Nursing Assessment--methods | Child | Infant Classification: LCC RJ245 | NLM WY 159 | DDC 618.92/00231—dc23 LC record available at https://lccn.loc.gov/2016035091 2014017177 10 9 8 7 6 5 4 3 2 1 $��B\%$//����B��B6(B)0�LQGG���� �������������������DP iii We dedicate this book to: š� Our families who are ever supportive and understanding about our passion for children and writing, š� Our mentors, colleagues, and students who inspire us to apply our knowledge and challenge our thinking, š� The children, adolescents, and families with whom we work and who foster our philosophy of pediatric nursing. Dedication $��B\%$//����B��B6(B)0�LQGG���� �������������������DP $��B*25����B��B6(B)0�LQGG���� ����������������SP This page intentionally left blank About the Authors JANE W. BALL graduated from the Johns Hopkins Hospital School of Nursing and subsequently received a BS from the Johns Hopkins University. She began her nursing career work- ing in the pediatric surgical inpatient, emergency department, and outpa- tient clinic of the Johns Hopkins Medi- cal Center, first as a staff nurse and then as a pediatric nurse practitioner. After recognizing a need to focus on the health of children, she returned to school and obtained both a master ’s degree of pub- lic health and a doctorate of public health degree from the Johns Hopkins University Bloomberg School of Public Health with a focus on maternal and child health. After graduation, Dr. Ball 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 Univer- sity of Texas at Arlington School of Nursing to teach community pediatrics to registered nurses returning to school for a BSN. During this time Dr. Ball became involved in writing her first textbook, Mosby’s Guide to Physical Examination, which is cur- rently in its eighth edition. After relocating to the Washington, DC, area, she worked at Children’s National Medical Center on a number of federally funded projects. The first project in 1986, teaching instructors of emergency medical technicians from all states about the special care children need during an emergency, revealed the shortcomings of the emergency medical services system for children. This exposure was a career-changing event. A textbook titled Pediatric Emergencies: A Manual for Prehospital Providers was subsequently developed. A second project led to the development of a pediatric emergency education program for nurses in emergency departments to promote improved care for children. Both of these programs served as a foundation for other pediatric emergency education developed and sponsored by national organizations. For 15 years Dr. Ball managed the federally funded Emergency Medical Services for Children’s National Resource Center. As executive director, she provided and directed the provision of consultation and resource devel- opment for state health agencies, health professionals, families, and advocates about successful methods to improve the health- care system so that children get optimal emergency care in all healthcare settings. After leaving that position, she continues to be engaged in many projects with a focus on the emergency care system. She is a consultant to the American College of Sur- geons Committee on Trauma, supporting state trauma system development. She recently completed a federally funded project to study whether the implementation of a statewide pediatric emergency department recognition program improved pediat- ric emergency care. In 2010, Dr. Ball received the Distinguished Alumna Award from the Johns Hopkins University. RUTH C. MCGILLIS BINDLER re- ceived her BSN from Cornell Uni- versity—New York Hospital School of Nursing. She worked in oncology nursing at Memorial-Sloan Ketter- ing Cancer Center in New York, and then as a public health nurse in Dane County, Wisconsin. Thus began her commitment to work with children as she visited children and their families at home and served as a school nurse. 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 Inter- collegiate Center for Nursing Education in Spokane. Dr. Bindler was fortunate to be involved for over 38 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 (WSU) College of Nursing. She obtained a PhD in human nutrition at WSU, where she taught theory and clinical courses in child health nursing, cultural di- versity and health, graduate research, pharmacology, and as- sessment, and served as lead faculty for child health nursing. Dr. Bindler was the first director of the PhD in Nursing program at WSU and most recently served as Associate Dean for Graduate Programs, which include Master of Nursing, Post-Masters cer- tificates, PhD, and Doctor of Nursing Practice (DNP) programs. She recently retired and serves the college and profession as a professor emeritus, continuing work with graduate students and research. 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 foci have been childhood obesity, type 2 dia- betes, metabolic syndrome, and cardiometabolic risk factors in children. Ethnic diversity and interprofessional collaboration have been additional themes in her work. Dr. Bindler believes that her role as a faculty member and administrator enabled her to learn continually, foster the development of students in nursing, lead and mentor junior faculty into the teaching role, and participate fully in the profession of nursing. In addition to teaching, research, publication, and leadership, she enhances her life by professional and community service and by activities with her family. v $��B\%$//����B��B6(B)0�LQGG���� �������������������DP vi About the Authors KAY J. COWEN received her BSN from East Carolina University in Greenville, North Carolina, and began her career as a staff nurse on the pediatric unit of North Carolina Baptist Hospital in Winston-Salem. She developed a spe- cial interest in the psychosocial needs of hospitalized children and preparing them for hospitalization. This led to the focus of her master ’s thesis at the University of North Carolina at Greensboro (UNCG), where she received a master of science in nursing education degree with a focus in maternal child nursing. Mrs. Cowen began her teaching career in 1984 at UNCG, where she continues today as clinical professor in the Parent Child Department. Her primary responsibilities include coor- dinating the pediatric nursing course, teaching classroom con- tent, and supervising a clinical group of students. Mrs. Cowen shared her passion for the psychosocial care of children and the needs of their families through her first experience as an au- thor in the chapter “Hospital Care for Children” in Jackson and Saunders’ Child Health Nursing: A Comprehensive Approach to the Care of Children and Their Families published in 1993. In the classroom, Mrs. Cowen realized that students learn through a variety of teaching strategies and became especially interested in the strategy of gaming. She led a research study to evaluate the effectiveness of gaming in the classroom and sub- sequently continues to incorporate gaming in her teaching. In the clinical setting, Mrs. Cowen teaches her students the skills needed to care for patients and the importance of family-cen- tered care, focusing not only on the physical needs of the child but also on the psychosocial needs of the child and family. Dur- ing her teaching career, Mrs. Cowen has continued to work part time as a staff nurse, first on the pediatric unit of Moses Cone Hospital in Greensboro and then at Brenner Children’s Hospital in Winston-Salem. In 2006, she became the part-time pediatric nurse educator in Brenner ’s Family Resource Center. Through Mrs. Cowen’s expertise, she is able to extend her love of teach- ing to children and families, and through her role as an author, she is able to extend her dedication to pediatric nursing and nursing education. MICHELE R. SHAW received her BSN from Pacific Lutheran University in Tacoma, Washington. She began her career as a nurse at a long-term care facility and then as a home healthcare nurse in Spokane, Washington. While making home visits, she became in- terested in the nursing care needs of children and families. She realized the importance of educating the fam- ily about their child’s condition and to include family members while planning and carrying out the nursing care plan. This in- terest in family nursing led her into the area of maternal-child nursing, where she served as a postpartum nurse for nearly 18 years. Her experience with providing nursing care to families in various settings has highlighted her belief in the need of a fam- ily-centered approach in order to provide optimal nursing care. Dr. Shaw began her teaching career as a teaching assistant in 2001 at the Washington State University (WSU) College of Nurs- ing, where she continues today as an associate professor. It was during those early years as a teaching assistant that she began to realize her passion for educating nursing students. This in- terest led to her completing a master ’s degree in nursing with an emphasis on education at WSU. Knowing that she wanted to continue working in nursing academia, Dr. Shaw went on to receive her PhD in nursing from the University of Arizona in Tucson. She has taught theory, seminar, and clinical courses in maternal-child nursing, family health, evidence-based practice, ethical decision making, physical assessment, and professional practice. Dr. Shaw recently assisted in the development of the Bachelor of Science-to-PhD in Nursing program at WSU. This fast-track program will enable students with an earned bach- elor’s degree to complete a PhD in nursing in four years. Dr. Shaw enjoys working with undergraduate and gradu- ate students and encourages active participation in research. Her research interests include children with asthma and their families, childbearing women and their families, and substance use among youth and childbearing women. She is particularly interested in children’s and families’ unique perspectives, and thus much of her research uses qualitative approaches. She con- tinues to publish articles in the areas of pediatric asthma and substance use among childbearing women. Dr. Shaw believes her active role in nursing academia and research allows her to stay current in various pedagogical approaches to enhance nursing students’ learning experiences, as well as continuous learning about evidence-based interventions to provide nursing care to children and families. $��B\%$//����B��B6(B)0�LQGG���� �������������������DP vii Thank You! We are forever grateful to nurse geneticist Linda D. Ward, PhD, APRN, the author of this book’s genetics chapter, Chapter 3, “Genetic and Genomic Influences.” We appreciate her expertise in genetic and genomic science, her superb writing skills, and her willingness to contribute such an essential chapter to our text. We are also thankful to Brenda Senger, RN, PhD, for contributing the content on mitochondrial diseases in Chapter 30. 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, useful, and current book, reflective of the present time and of the essential components of learning in the field of child health nursing. Mary Armstrong, MSN, RN, CCRN, CPN Carson Newman University Jefferson City, Tennessee Elizabeth Bettini, APRN, MSN, PCNS-BC, CHPPN Division of Anesthesiology & Pain Medicine Children’s National Medical Center Washington, D.C. Melissa Black, PhDc, MSN, FNP, RN NCLEX Review Nurse Kaplan Greenville, South Carolina Ann M. Bowling, PhD, RN, CPNP-PC, CNE Assistant Professor Wright State University Dayton, Ohio Michele I. Bracken, PhD, WHNP-BC Associate Professor Clinical Coordinator Ma- ternal/Newborn/Women’s Health Salisbury University Salisbury, Maryland Robin Caldwell, RNC-OB Instructor Catawba Valley Community College Hickory, North Carolina Karan Dublin, MEd, RN Professor Tyler Junior College Tyler, Texas Barbara S. Edwards, RN, CPN Staff Nurse Brenner Children’s Hospital Winston-Salem, North Carolina Linda B. Esposito, MSN, RN, CCRN Nurse Practice Specialist Brenner Children’s Hospital Wake Forest Baptist Medical Center Winston-Salem, North Carolina Julie Fitzgerald, PhD, RN, CNE Assistant Professor Ramapo College of New Jersey Mahwah, New Jersey Niki Fogg, MS, RN, CPN Assistant Clinical Professor Texas Woman’s University Dallas, Texas Vivienne Friday, EdD, RN Nurse Educator Bridgeport Hospital School of Nursing Bridgeport, Connecticut Deborah Henry, MSN, RN Nursing Faculty Blue Ridge Community College Flat Rock, North Carolina Indra Hershorin, PhD, RN, CNE Assistant Professor Barry University Miami Shores, Florida Karen L. Hessler, PhD, FNP-C Assistant Professor University of Northern Colorado Greeley, Colorado Catherine Hrycyk, MScN, RN Faculty, Pediatric Nursing and Pharmacology De Anza College Cupertino, California Gina Idol, RN, BSN, CPN Wake Forest Baptist Health Brenner Children’s Hospital Winston-Salem, North Carolina Laura Kubin, PhD, RN, CPN, CHES Assistant Professor Texas Woman’s University Dallas, Texas Meredith Lahl, MSN, PCNS- BC, PPCNP-BC, CPON Senior Director of Advanced Practice Nursing Cleveland Clinic Cleveland, Ohio Robyn Leo, MS, RN Associate Professor and Chairperson for Nursing Worcester State University Worcester, Massachusetts Angela P. Lukomski, RN, DNP, CPNP Associate Professor Eastern Michigan University Ypsilanti, Michigan Patricia Novak, RN, BSN, MSN Faculty Gateway Community College Phoenix, Arizona Gloanna J. Peek, PhD, RN, CPNP Clinical Associate Professor PNP Specialty Option Coordinator The University of Arizona Tucson, Arizona Susan Perkins, MSN, RN Senior Instructor Washington State University Spokane, Washington Linda Sue Pippin, MSN, RN-BC Adjunct Faculty Newberry College Newberry, South Carolina Theresa Puckett, RN, CNE Instructor Stark State College North Canton, Ohio Colleen Quinn, RN, MSN, EdD Professor Broward College Davie, Florida JoAnne Silbert-Flagg, DNP, PNP, IBCLC Assistant Professor Johns Hopkins University Baltimore, Maryland Jennifer S. Simmons, MSN, RN, CPNP-AC/PC, CPON Pediatric Oncology Nurse Practitioner Brenner Children’s Hospital Wake Forest Baptist Medical Center Winston-Salem, North Carolina $��B\%$//����B��B6(B)0�LQGG���� �������������������DP viii Thank You! Anita Smith, CPNP Nurse Practitioner Department of Pediatric Hematology Wake Forest Health Sciences Winston-Salem, North Carolina Charla Smith, MSN, RN, CPN, CNE Associate Professor Jackson State Community College Jackson, Tennessee Nancy M. Smith, DNP, CRNP, FNP-BC Assistant Professor Salisbury University Salisbury, Maryland Maureen P. Tippen, RN, C, MS Clinical Assistant Professor University of Michigan Flint, Michigan Teresa Tyson, RN, PhD Assistant Professor Winston-Salem State University Winston-Salem, North Carolina Diane K. Van Os, MS, RN Professor Westminster College Salt Lake City, Utah Amber Welborn, RN, MSN Lecturer University of North Carolina Greensboro, North Carolina Cecilia Wilson, PhD, RN, CPN Associate Clinical Professor Texas Woman’s University Dallas, Texas $��B\%$//����B��B6(B)0�LQGG���� �������������������DP ix Preface Health care and healthcare delivery systems are chang-ing dramatically. The Affordable Care Act, a focus on interprofessional collaboration, an emphasis on patient safety, and evidence-based practice will contribute to ongoing challenges and evolution in health care in the com- ing years. Pediatric nurses must respond to and integrate these changes into their practice. In addition, pediatric nursing presents its own unique challenges for practitioners of health care. Student nurses must learn what helps them to provide safe, effective, and excellent care today, while integrating new knowledge and skills needed as nursing practice continues to develop and respond to healthcare needs. Students must learn how to think and apply information as new knowledge be- comes available. “As the student uses knowledge in situations of practice, new understanding is gained as well as knowing how, when, and why it is relevant in particular situations. . . . We call this teaching for a sense of salience.”* Faculty are responsible for selecting patient care assign- ments that assist the student in applying knowledge in the clinical setting, as well as utilizing various pedagogies to assist the student in focusing on the patient experience. We have in- tegrated concepts from the Carnegie Report that foster clinical expertise by offering a variety of critical thinking and clinical reasoning questions, patient care scenarios, and re- search and evidence-based practice features. Information tech- nology plays a major role in both health care and teaching, and therefore features in this text encourage the student to use and analyze content available through information technology. Preparation for Nursing Excellence The goal of this seventh edition of Principles of Pediatric Nurs- ing is to provide core pediatric nursing knowledge that pre- pares students for excellence in nursing and to offer the tools of scholarship and critical thinking needed to apply this learning in the future. Students must learn to question, evaluate the re- search evidence available, apply pertinent information in clini- cal settings, and constantly adapt to growing knowledge and an evolving healthcare system. This text reflects a multitude of approaches to learning that can be helpful to all students. We acknowledge that many stu- dents learn pediatric nursing in a very short time period. There- fore, the approaches in this text are designed to assist students to assess the child’s needs, take into account population-based practice, and make care decisions based on the standards of pe- diatric nursing practice. Realities of Pediatric Nursing Pediatric nursing occurs in many acute care and community healthcare settings, such as hospitals, homes, schools, and health centers. Procedures may be performed in short-stay units, and long-term care is often provided at home for children with complex health conditions. Families are often the provid- ers of care as well as the case managers for these children. Tech- nologic advances are resulting in earlier diagnoses and new therapies; these technologic approaches are integrated when- ever pertinent throughout the text. Pediatric nursing care is provided within the context of a rapidly changing society. An examination of the major morbidi- ties and mortalities of childhood guided the revision of material and topics throughout the text. Specific chapters focus on the family, health promotion across the life span, pediatric nutri- tion, and care for children with chronic conditions. Chapter 2 addresses cultural influences on health care and provides guid- ance for students caring for children in our growing intercul- tural society. Chapter 3, on genetics and genomics, is intended to help students recognize the impact of such knowledge …