Separation or stranger anxiety occurs when the primary caregivers leave the child in the care of others who are not familiar to the child. This behavior starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. Separation anxiety produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, this reaction is normal and resolves as the child approaches age 3 years.
Educational objective:Separation anxiety starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. It produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, separation anxiety is normal and resolves by age 3 years. During adolescence, being with a peer group is part of the process of achieving individual identity, the most important developmental task at this age. An adolescent's friends have more influence than parents, teachers, or any other adults. Social relationships and activities help to provide a sense of belonging, acceptance, and approval. Having face-to-face visits and spending time with friends will help counteract feelings of isolation and loneliness during the client's recuperative period.
In addition, the client is at risk for body image disturbance related to the scoliosis and surgery. The client may be particularly sensitive about body image and needs understanding and acceptance from peers.
(Option 1) The client can attend school functions or social activities with friends when off all pain medication and when the spine has healed sufficiently.
(Option 2) It is important for the client to keep up with schoolwork, but it is not a priority for recovery.
(Option 3) Reading teen magazines can be a diversionary activity and may help distract the client from any pain, but it is not a priority.
Educational objective:Friends play a significant role in the adolescent's quest for identity and provide a source of support, belonging, and understanding. Interacting with friends during recuperation after surgery is important to help counteract feelings of loneliness and isolation. Some of the first stressors faced by children from infancy through the preschool years are related to illness and hospitalization. Separation anxiety, also known as anaclitic depression, particularly affects children age 6-30 months. There are 3 stages of separation anxiety: protest, when the child refuses attention from others, screams for the parent to return, and cries inconsolably; despair, when the child is withdrawn, quiet, uninterested in activities or meals, and displays younger behavior (eg, use of pacifier, wetting the bed); and detachment, when the child suddenly appears happy and interested in building relationships.
Nursing care of hospitalized clients experiencing separation anxiety focuses on maintaining a calm environment and a supportive demeanor to build trust between the nurse and the child, and encouraging connection with family and familiar environments, even when they are absent. Key interventions include:
Encouraging the parents to leave favorite toys, books, and pictures from home
Establishing a daily schedule that is similar to the child's home routine
Maintaining a close, calming presence when the child is visibly upset
Facilitating phone or video calls when parents are available
Providing opportunities for the child to play and participate in activities
(Option 3) When the child is visibly upset, it is important to provide a calming presence and implement strategies to reduce the child's anxiety. Leaving the child alone at such times can further increase stress.
(Option 5) Providing pictures of the child's family is actually beneficial, as it reminds the child of something familiar and safe.
Educational objective:Toddlers and preschool-age children experience separation anxiety in response to the stress of illness and hospitalization. Key nursing interventions to alleviate separation anxiety include encouraging the presence of favorite items, establishing a daily routine, providing opportunities for play, facilitating phone calls with the parents, and providing support when the child is upset. FTT, or growth failure, is a state of undernutrition and inadequate growth in infants and young children. Most cases of FTT are related to an inadequate intake of calories, which can be tied to many different etiologies. Physiologic risk factors for FTT include preterm birth, breastfeeding difficulties, gastroesophageal reflux, and cleft palate. Socioeconomic risk factors include:
Poverty - most common
Social or emotional isolation - parents may lack the support system needed to assist them with the problems of child rearing
Cognitive disability or mental health disorder
Lack of nutritional education - parents may not have knowledge of proper feeding techniques or appropriate calorie intake based on age and size of the child
(Option 1) There is no known relationship between caregivers working outside the home and FTT. Caregivers who are fully employed may be more able to provide adequate food resources.
(Option 5) There is no indication that unmarried parents pose a higher risk for an infant to develop FTT. More important protective factors include having a stable environment and living with 2 parents.
Educational objective:FTT is a state of undernutrition and inadequate growth found in infants and young children. Physiologic risk factors for FTT include preterm birth, breastfeeding difficulties, gastroesophageal reflux, and cleft palate. Socioeconomic risk factors include poverty, social or emotional isolation, caregivers with cognitive disabilities or mental health disorders, and lack of nutritional education. The sequence of examination steps for infants requires a different approach than the typical head-to-toe order used for older clients. The steps are altered to accommodate the developmental needs of the infant, minimize the infant's stress, and increase assessment accuracy.
The correct order of assessment in infants is:
Before handling the infant, the nurse first observes the infant for activity level, skin color, and respiratory rate and pattern to obtain findings during a calm state (Option 4).
Auscultation is performed next while the infant is still quiet, allowing the nurse to hear sounds clearly (Option 2).
Palpation and percussion are then performed while the infant remains relatively still. This allows the nurse to accurately assess the abdomen while the abdominal muscles are relaxed. The fontanelles are also palpated while the infant is calm, as crying can cause temporary bulging (Option 5).
Traumatic procedures (eg, examine eyes, ears, mouth) are performed near the end of the assessment after completing any procedures that require accurate observation or counting (Option 1).
Elicitation of the Moro reflex (ie, reflexive startle and cry to a sudden dropping or jarring motion) is performed last because the infant is usually awake and moving around by this point (Option 3).
Educational objective:When assessing an infant, the nurse should observe, auscultate, palpate, and then perform traumatic procedures (eg, examine eyes, ears, mouth). Elicitation of the Moro reflex should be performed last. Play is an integral part of a child's mastery of emotional, social, and physical development. When a child is hospitalized, play can also serve as a diversion and a way to express stress and anxiety. Preschoolers enjoy play that enables them to imitate others and be dramatic. They have rich imaginations and enjoy make-believe. Their play often centers on imitating adult behaviors by playing dress up and using housekeeping toys, telephones, medical kits, dolls, and puppets. Quiet play appropriate for the preschooler includes finger paints, crayons, illustrated books, puzzles with large pieces, and clay. Through playing with objects such as dolls or puppets, preschoolers can often process fears and anxieties that are difficult for them to express.
(Option 1) Board games are appropriate for children of school age, when play becomes more complex and competitive.
(Option 3) Soap bubbles are appropriate for toddlers, who learn from tactile play and environmental exploration.
(Option 4) Stacking and nesting toys are appropriate for toddlers who are developing fine motor skills.
Educational objective:Play serves as an important part of children's emotional, social, and physical development. It is important that they be provided with toys that can help them achieve developmental tasks. Appropriate toys for preschoolers are those that encourage imitation of adults, such as dolls, puppets, imaginative toys, dress-up clothing, medical kits, cars, and planes. chemistryUse the following data to estimate, $S^{\circ}\left[\mathrm{C}_6 \mathrm{H}_6(\mathrm{~g}, 1 \mathrm{~atm})\right]$ at $298.15 \mathrm{~K}$. For $\mathrm{C}_6 \mathrm{H}_6(\mathrm{~s}, 1 \mathrm{~atm})$ at its melting point of $5.53^{\circ} \mathrm{C}, 5^{\circ}$ is $128.82 \mathrm{~J} \mathrm{~mol}^{-1} \mathrm{~K}^{-1}$. The enthalpy of fusion is $9.866 \mathrm{~kJ} \mathrm{~mol}^{-1}$. From the melting point to $298.15 \mathrm{~K}$, the average heat capacity of liquid benzene is $134.0 \mathrm{~J} \mathrm{~mol}^{-1} \mathrm{~K}^{-1}$. The enthalpy of vaporization of $\mathrm{C}_6 \mathrm{H}_6(\mathrm{l})$ at $298.15 \mathrm{~K}$ is $33.85 \mathrm{~kJ} \mathrm{~mol}^{-1}$, and in the vaporization, $\mathrm{C}_6 \mathrm{H}_6(\mathrm{~g})$ is produced at a pressure of 95.13 Torr. Imagine that this vapor could be compressed to $1 \mathrm{~atm}$ pressure without condensing and while behaving as an ideal gas. [Hint: Refer to the preceding exercise, and note the following: For infinitesimal quantities, $d S=\delta q / d T$; for the isothermal compression of an ideal gas, $\delta q=-d w$; and for pressure-volume work, $\delta w=-P d V$. 15th EditionJohn David Jackson, Patricia Meglich, Robert Mathis, Sean Valentine249 solutions
7th EditionJulie S Snyder, Mariann M Harding2,512 solutions
13th EditionDavid N. Shier, Jackie L. Butler, Ricki Lewis1,402 solutions
15th EditionJohn David Jackson, Patricia Meglich, Robert Mathis, Sean Valentine249 solutions
