SEMINAR IN NURSING 2

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session 3

LESSON TITLE: PEDIATRIC NURSING PART 1

LEARNING OUTCOMES:
Upon completion of this lesson, the student nurse can:

1. Utilize the nursing process to administer care for pediatric Materials:

patients with clearly defined, commonly occurring health
care needs and problems
2. Explain the different theories of growth and development
3. Breakdown the different pediatric disorders per system
4. Appraise the corresponding nursing management of the
different disorders
5. Interconvert nursing management based on the needs of
the pediatric client
Book, pen and notebook, paper
References:
Pillitteri, A. (2003). Maternal & Child Health
Nursing: Care of the Childbearing & Childrearing
Family (4th Edition). Lippincott Williams & Wilkins

KNOWLEDGE CHECK (5 min)

• A nurse is caring for an infant with a diagnosis of tetralogy of Fallot. The infant suddenly becomes cyanotic and
the nurse recognizes that the infant is experiencing a hyper cyanotic spell.
1. What is the priority nursing action in the case mentioned above?
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2. The nurse should immediately place the infant in what position? Why?
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MAIN LESSON (90 minutes)

Guide Questions:
1. Based on the developmental milestones, is it safe to allow a preschooler to use the car seatbelt?
2. Differentiate Gilligan’s Theory and Kohlberg’s theory of moral development
3. What is the highest level of Kohlberg’s moral development?
4. How does Vygotsky’s sociocultural theory affect the growth and development of a child?
5. Why would you question a doctor’s order of a throat culture for a pediatric client with epiglottitis?
6. What would be the best position to place an infant with TOF experiencing a hyper cyanotic spell?
7. Why would a physician prescribe an Intravenous immune globulin to a child with Kawasaki disease?
8. Why would you question a doctor’s order of fleet enema for a child who is scheduled for an appendectomy?
9. What does ESSR mean in terms of feeding a child with cleft palate?
10. What is the most accurate way of measuring fluid loss and gain of a pediatric client?

Theories of Growth and Development

Piaget’s Theory of intellectual
development
Kohlberg’s Stages of Moral
Development
Gilligan's Theory of Moral
Development
Fowler’s Theory of Spiritual
Development
Vygotsky’s sociocultural
theory
deals with the nature of knowledge itself and how humans gradually come to
acquire, construct, and use it; A comprehensive theory about the nature and
development of human intelligence.
holds that moral reasoning, which is the basis for ethical behaviours, has six
identifiable developmental stages
focused on both care- based morality and justice-based morality
proposes a staged development of faith (or spiritual development) across the life
span
believed that parents, caregivers, peers, and the culture at large were responsible
for developing higher-order functions

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Gardner's theory of multiple
intelligences
Erik Erikson’s theory of
psychosexual development
Sigmund Freud’s
psychosexual theory
introduced eight different types of intelligences consisting of: Logical/Mathematical,
Linguistic, Musical, Spatial, Bodily-Kinesthetic, Naturalist, Interpersonal,
Intrapersonal.
identifies a series of eight stages that a healthy developing individual should pass
through from infancy to late adulthood.
proposed that psychological development in childhood takes place during five
psychosexual stages: oral, anal, phallic, latency, and genital. These are called
psychosexual stages because each stage represents the fixation of libido (roughly
translated as sexual drives or instincts) on a different area of the body.

Respiratory Disorders

Pediatric pneumonia an inflammation of the air sacs, also known as the alveoli, in the
lungs, usually caused by infection that causes them to fill with fluid
or pus
Tuberculosis (TB) caused by bacteria (Mycobacterium tuberculosis) that most often
affect the lungs.

Cystic Fibrosis is a hereditary disease that affects the lungs and digestive system.
The body produces thick and sticky mucus that can clog the lungs
and obstruct the pancreas.

Sudden infant death syndrome (SIDS) the unexplained death, usually during sleep, of a seemingly
healthy baby less than a year old.

Cardiovascular Disorders

Atrial septal defect is a hole in the wall (septum) between the two upper chambers of
your heart (atria). The condition is present at birth (congenital).

Patent Ductus Arteriosus is a persistent opening between the two major blood vessels
leading from the heart. The opening, called the ductus arteriosus,
is a normal part of a baby's circulatory system before birth that
usually closes shortly after birth.

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Coarctation of the Aorta is a narrowing, or constriction, in a portion of the aorta. The
condition forces the heart to pump harder to get blood through the
aorta and on to the rest of the body.

Aortic Stenosis is a narrowing of the aortic valve opening. Aortic stenosis restricts
the blood flow from the left ventricle to the aorta and may also
affect the pressure in the left atrium.

Tetralogy of Fallot a congenital heart condition involving four abnormalities occurring

together, including a defective septum between the ventricles and
narrowing of the pulmonary artery, and accompanied by cyanosis.

Transposition of the great arteries is a birth defect of the heart in which the two main arteries carrying
blood out of the heart – the main pulmonary artery and the aorta –
are switched in position, or “transposed.”

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Truncus Arteriosus occurs when the blood vessel coming out of the heart in the
developing baby fails to separate completely during development,
leaving a connection between the aorta and pulmonary artery.

Gastrointestinal Disorders

Cleft lip and palate are birth defects that occur when a baby's lip or mouth do not form
properly during pregnancy.

Gastroesophageal Reflux is a digestive disorder that occurs when acidic stomach juices, or
food and fluids back up from the stomach into the esophagus.
Celiac Disease is an immune reaction to eating gluten, a protein found in wheat,
barley and rye.

Hypertrophic Pyloric Stenosis is blockage of the passage out of the stomach due to thickening
(hypertrophy) of the muscle at the junction between the stomach
and the intestines

Hirschsprung’s Disease a condition that affects the large intestine (colon) and causes
problems with passing stool. The condition is present at birth
(congenital) as a result of missing nerve cells in the muscles of the
baby's colon

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 Intussusception the invagination (telescoping) of a part of the intestine into itself

Hydrocele is a type of swelling in the scrotum that occurs when fluid collects
in the thin sheath surrounding a testicle

Imperforate anus a defect in which the opening to the anus is missing or blocked

CHECK FOR UNDERSTANDING (20 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You
are given 20 minutes for this activity:

1. The parents of a 2-year-old arrive at a hospital to visit their child. The child is in the playroom when the parents arrive.
When the parents enter the playroom, the child does not readily approach the parents. The nurse interprets this behavior
as indicating that:
a. The child is withdrawn
b. The child is self-centered
c. The child has just adjusted to the hospitalized setting
d. This is a normal pattern

ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. A mother arrives at a clinic with her toddler and tells the nurse that she has a difficult time getting the child go to bed at
night. Which of the following is most appropriate for the nurse to suggest to the mother?
a. Inform the child of bedtime a few minutes before it is time for bed
b. Allow the child to have temper tantrums
c. Allow the child to set bedtime limits
d. Avoid a nap during the day

ANSWER: ________
RATIO:___________________________________________________________________________________________
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3. A mother of a 3-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse tells the mother
that the most appropriate toy for a 3-year-old is which of the following?
a. a farm set
b. a golf set
c. a jack set with marbles
d. a wagon

ANSWER: ________
RATIO:___________________________________________________________________________________________
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4. A clinic nurse provides information to the mother of a toddler regarding toilet training. Which statement if made by the
mother indicates a need for further information regarding the toilet training?
a. “The child will not be ready to toilet train until the age of about 18 to 24 months.”
b. “Bladder control is usually achieved before bowel control”.
c. “The child shouldn’t be forced to sit on the potty for long periods.”
d. The ability of the child to remove clothing is a sign of physical readiness

ANSWER: ________
RATIO:___________________________________________________________________________________________
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5. The mother of a 3-year-old is concerned because the child is still insisting on a bottle at nap time and bedtime. Which of
the following is the most appropriate suggestion to the mother?
a. Do not allow the child to have the bottle
b. Allow bottle during naps but not at bedtime
c. Allow the bottle if it contains juice
d. Allow the bottle if it contains water.

ANSWER: ________
RATIO:___________________________________________________________________________________________
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6. A student nurse is caring for a 2-year-old child diagnosed with croup. A nursing instructor asks the student about the
clinical manifestations associated with croup. Which statement by the student indicates a need for further research?
a. “Symptoms usually worsen at night and are better during the day.”
b. “Symptoms usually worsen during the day and are relieved during sleep.”
c. “The cough is harsh and brassy.”
d. “Inspiratory stridor and a low-grade fever may be present.”

ANSWER: ________
RATIO:___________________________________________________________________________________________
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7. A 10-year old child with asthma is treated for acute exacerbation in the emergency room. A nurse reports which of the
following, knowing that it is not an indication that the condition is improving?
a. Increased wheezing
b. Decreased wheezing
c. Warm, dry skin
d. A pulse rate of 90 beats per min

ANSWER: ________
RATIO:___________________________________________________________________________________________
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8. A nurse caring for an infant with bronchiolitis is assessing for signs of dehydration. The nurse assesses which of the
following, knowing that it is the most reliable method of determining fluid loss?
a. Intake and output
b. Fontanels
c. Mucous membranes
d. weight

ANSWER: ________
RATIO:___________________________________________________________________________________________
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9. An emergency room nurse is caring for a child diagnosed with epiglottitis. Assessing the child, the nurse monitors for
which indication that the child may be experiencing airway obstruction?
a. The child is leaning backward, supporting himself with the hands and arms
b. A low-grade fever and complaints of a sore-throat
c. The child is leaning forward with the chin thrust out
d. Nasal flaring and bradycardia
ANSWER: ________
RATIO:___________________________________________________________________________________________
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10. The mother of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The
mother tells the nurse that the child complains of discomfort on the right side and that acetaminophen (Tylenol) is not very
effective. The nurse most appropriately tells the mother to:
a. Increase the dose of the acetaminophen
b. Increase the frequency of the acetaminophen
c. Encourage the child to lie on the right side
d. Encourage the child to lie on the left side

ANSWER: ________
RATIO:___________________________________________________________________________________________
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11. A 3-year old child is hospitalized because of persistent vomiting. A nurse monitors the child closely for:
a. Diarrhea
b. Metabolic acidosis
c. Metabolic alkalosis
d. Hyperactive bowel sounds

ANSWER: ________
RATIO:___________________________________________________________________________________________
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12. A nurse is monitoring for signs of dehydration in 1-year-old child who has been hospitalized for diarrhea. The nurse
prepares to take the child’s temperature and avoids which method of measurement?
a. Tympanic
b. Axillary
c. Rectal
d. Electronic

ANSWER: ________
RATIO:___________________________________________________________________________________________
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13. A home care nurse provides instructions to the mother of an infant with cleft palate regarding feeding. Which
statement if made by the mother indicates a need for further instructions?
a. “I will use a nipple with a small hole to prevent choking.”
b. “I will stimulate sucking by rubbing the nipple on the lower lip.”
c. “I will allow the infant time to swallow.”
d. “I will allow the infant to rest frequently to provide time for swallowing what has been placed on the mouth

ANSWER: ________
RATIO:___________________________________________________________________________________________
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14. A clinic nurse review the record of an infant seen in the clinic. The nurse notes that a diagnosis of esophageal atresia
with tracheoesophageal fistula (TEF) is suspected. The nurse expects to note which most likely sign of this condition
documented the record?
a. Severe projectile vomiting
b. Coughing at night time
c. Choking with feedings
d. Incessant crying

ANSWER: ________
RATIO:___________________________________________________________________________________________
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15. A nurse prepares a teaching plan for the parents of an infant with gastroesophageal reflux (GERD) regarding proper
positioning to manage the reflux. The nurse documents that the infant should be maintained in which position following
feedings at night?
a. 30-degree angle when supine
b. 60-degree angle when supine
c. Head-elevated prone position
d. 20-degree angle when supine

ANSWER: ________
RATIO:___________________________________________________________________________________________
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16. A nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On admission assessment, which data
would the nurse expect to obtain when asking the mother about the child’s symptoms?
a. Vomiting large amounts of bile
b. Watery diarrhea
c. Increased urine output
d. Projectile vomiting
ANSWER: ________
RATIO:___________________________________________________________________________________________
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17. A nurse provides home care instructions to the parents of a child with celiac disease. The nurse teaches the parents
to include which of the following food items in the child’s diet?
a. Rice
b. Rye toast
c. Oatmeal
d. Wheat bread

ANSWER: ________
RATIO:___________________________________________________________________________________________
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18. A nurse caring for an infant with congenital heart disease is monitoring the infant closely for signs of congestive heart
failure (CHF). The nurse assesses the infant closely for which early sign of CHF?
a. Cough
b. Tachycardia
c. Slow and shallow breathing
d. pallor

ANSWER: ________
RATIO:___________________________________________________________________________________________
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19.Prostaglandin E1 is prescribed for a child with transposition of the great arteries, the mother of the child is registered
nurse and asks the nurse why the child needs the medication. The most appropriate response would be to tell the mother
that the medication:
a. Maintains an adequate hormonal level
b. Maintains the position of the great arteries
c. Provides adequate oxygen saturation and maintains cardiac output
d. Prevents tet spells

ANSWER: ________
RATIO:___________________________________________________________________________________________
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20. A clinic nurse reviews the record of a child just seen by a physician. The physician has documented a diagnosis of
suspected aortic stenosis. The nurse expects to note documentation of which of the following clinical manifestations
specifically found in the disorder?
a. Hyperactivity
b. Exercise intolerance
c. Pallor
d. Gastrointestinal disturbances

ANSWER: ________
RATIO:___________________________________________________________________________________________
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
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3. ANSWER: ________
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4. ANSWER: ________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________

RATIO:_______________________________________________________________________________________
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11. ANSWER: ________
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12. ANSWER: ________
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13. ANSWER: ________
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14. ANSWER: ________
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15. ANSWER: ________
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16. ANSWER: ________
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RATIO:_______________________________________________________________________________________
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18. ANSWER: ________
RATIO:_______________________________________________________________________________________
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19. ANSWER: ________
RATIO:_______________________________________________________________________________________
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20. ANSWER: ________
RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.

Towards the end of the class, students are asked to use half-sheets of paper to provide written feedback to the following
questions within five minutes:

Three things you learned:

1. __________________________________________________
2. __________________________________________________
3. __________________________________________________

Two things that you’d like to learn more about:

1. __________________________________________________
2. __________________________________________________
One question you still have:
1. __________________________________________________

Students may submit it during the face to face session or submit via online messaging.

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