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This comprehensive study guide combines the requirements from your NURS 321 Exam #1 Content Guide with the core concepts from the ATI "Pediatric Clients in the Hospital" module and the ATI Review Modules (Chapters 1-10).
I. Developmental Theories & Milestones (Erikson & Piaget)
Nurses use these theories to tailor care. Hospitalization often causes regression (moving back to a previous developmental stage). Stage Age Erikson (Psychos ocial) Piaget (Cognitive) Nursing Interventions Infant Birth– 1yr Trust vs. Mistrust Sensorimotor : Learns through senses. Object permanence (9mo). Maintain routine; respond to cries quickly; use soothing voice. Toddle r
3yrs Autono my vs. Shame/D oubt Preoperation al : Symbolic thought begins. Egocentric. Offer choices (e.g., "cup or spoon?"); use simple words; allow "safe" pushback. Presch ool
6yrs Initiativ e vs. Guilt Preoperation al : Magical thinking; animism (dolls are real). Use medical play (stethoscopes on dolls); assure them they didn't "cause" illness. School -Age
12yrs Industry vs. Inferiori ty Concrete Operational : Logic, conservation (volume/mass) . Encourage schoolwork/hobbies; give tasks; explain "how" things work. Adoles cent
20yrs Identity vs. Role Confusio Formal Operational : Abstract Provide privacy; talk to them directly; encourage peer connection.
n thinking; future planning.
II. Hospitalization, Play, and Communication
Responses to Stress & Separation Anxiety
- Protest: Screaming, clinging to parents, kicking.
- Despair: Withdrawal, depression, lack of communication.
- Detachment: Apparent interest in surroundings, but ignores parents (sign of long-term trauma). Infants (Birth to 1 Year): Stress is primarily caused by separation and disruption of trust. Young infants communicate through crying or cooing, while older infants experience significant separation anxiety. Toddlers (1 to 3 Years): Separation from parents is the greatest stressor. They may exhibit regression (e.g., thumb sucking, bed- wetting) and temper tantrums because they cannot express their frustration in words. Preschoolers (3 to 6 Years): Due to their active imaginations, they often view pain and hospitalization as punishment for bad behavior. They also fear that procedures will cause permanent damage to their bodies. School-Age (6 to 12 Years): These children fear a loss of control over their routine and a loss of opportunities to practice developing skills, such as schoolwork and sports. They may respond to stress with withdrawal, aggression, or regression. Adolescents (12 to 20 Years): Stress is often related to changes in body image and a loss of identity. They value privacy and may shield their emotions or act out through dangerous activities.
Communication Techniques (AIDET: Acknowledge, Introduce, Duration,
Explanation, Thank you. & Prep)
Infant: Non-verbal; hold and rock. Toddler: Use sensory terms (what they will feel/smell). Give 1– minutes of warning before a procedure.
IV. Clinical Skills: Lead, Pain, and Medication
Lead Poisoning
Who is at risk? Children living in homes built before 1978 or near industrial sites. Normal Level: < 5 mcg/dL. Symptoms: Behavior issues, learning delays, irritability, abdominal pain, anemia. Teaching: Increase Iron and Calcium (blocks lead absorption). Frequent handwashing. Use cold water for cooking (hot water leaches lead from pipes).
Pain Assessment
FLACC (2 months to 7 years): Based on F ace, L egs, A ctivity, C ry, C onsolability. FACES (3 years and up): Uses drawings of faces to show pain levels. Numeric (5–12 years): Only if the child understands the relationship of numbers (can count/rank).
Medication Administration
Dosage: Always calculated by Weight (mg/kg). Safety: Use the "Teach-back" method with parents. Never call medicine "candy." Procedures: Perform painful procedures in a treatment room , never the child's hospital bed (safe space). This is a comprehensive, non-interactive "Master Review" that combines your Exam #1 Content Guide , the ATI Review Modules (Chapters 1-10) , and the ATI "Pediatric Clients in the Hospital" module. This covers EVERY bullet point listed on your study guide.
2. Play: Types, Toys, and Therapeutic Use
Play is the "work" of the child and is essential for assessment and coping.
Solitary Play (Infants): Plays alone.
o Toys: Mobiles, rattles, mirrors, cloth books, blocks.
Parallel Play (Toddlers): Plays next to, but not with, others. No rules.
o Toys: Push-pull toys, large puzzles, thick crayons, finger paint.
Associative Play (Preschoolers): Group play without a formal plan or goal.
o Toys: Dress-up/costumes, puppets, tricycles, simple crafts.
Cooperative Play (School-Age): Organized group play with rules.
o Toys: Board games, team sports, video games, hobbies.
Therapeutic/Medical Play: Used to decrease fear. Let a child "give a shot" to a teddy bear or listen to their own heart with a stethoscope before a procedure.
3. Therapeutic Play and Communication
Play Interventions: o Infants: Lullabies, mobiles, mirrors, and rattles. o Toddlers: Stacking blocks, coloring, hammering toys, and simple books. o Preschoolers: Pretend play (dress-up), arts and crafts with scissors/glue, and social play. o School-Age: Board games, video games, journaling, and interacting with peers. o Adolescents: Peer engagement (cell phones/internet), movies, and scrapbooking.
3. Hospitalization Preparation
Procedure Prep by Age: Infant/Toddler: Prep immediately before. Focus on sensory (cold, loud). Preschool: Prep 1–2 hours before. Use simple terms. School-Age: Prep 1 day before. Use diagrams/books.
Non-pharmacologic: Swaddling/sucrose (infant); Blowing bubbles (toddler/preschooler); Guided imagery (school-age/adolescent). Pharmacologic: Use EMLA cream (topical anesthetic) 60 mins before needle sticks.
8. Family-Centered Care & Med Administration
AIDET: Acknowledge, Introduce, Duration, Explanation, Thank you. Siblings: Often feel resentment/guilt. Encourage parents to spend "special time" with them. Medication: Always calculated by mg/kg. o Safe Haven: Never perform procedures in the child's room; always use the treatment room. o Teach-Back: Ask the parent to explain the plan back to you to ensure understanding.
2. Family-Centered Care and Support Systems
Family Systems Theory: The family is an emotional unit where the stress of one member (e.g., the hospitalized child or parent) impacts everyone else. Siblings: Often experience resentment, jealousy, and guilt because of the extra attention given to the hospitalized child. Nurses should promote family communication and provide age-appropriate explanations to siblings. Parental Presence: Parents should be encouraged to stay at the bedside, but if they must leave, they should tell the child when they will return and perhaps leave recorded messages.
4. Safe Nursing Interventions
Procedure Rooms: Scary or painful procedures (like IV starts) should be done in a separate treatment room so that the child's hospital room remains a "safe space". Interpreters: Always use professional medical interpreters for clients who speak another language; do not use family members or the child to interpret except in extreme emergencies.
Discharge: Education should begin on admission and continue throughout the stay using the teach-back method to verify understanding.
Practice Questions (Non-Interactive)
1. A nurse is caring for a 4-year-old child who is about to undergo a dressing change. Which of the following is an appropriate nursing action? A. Explain the procedure using medical terminology. B. Perform the procedure in the child’s hospital bed. C. Allow the child to play with the tape and bandages before the procedure. D. Give the child 2 hours of notice before starting the procedure.
Answer: C. Medical play helps preschoolers cope with fear.
2. A mother of a 10-month-old infant is concerned that the child cries when the nurse enters the room. How should the nurse interpret this? A. The child is exhibiting signs of attachment disorder. B. The child is experiencing normal separation and stranger anxiety. C. The mother is over-protecting the infant. D. The infant is experiencing regression.
Answer: B. This is developmentally appropriate for an infant of this
age.
3. Which toy is most appropriate for a toddler in parallel play? A. A set of building blocks. B. A board game with specific rules. C. A mobile with music. D. A science kit.
