The foundations of pediatric nursing

 

Apply the foundations of pediatric nursing when caring for clients with health alterations.

Scenario
You are working in a large urban pediatric clinic after-hours.
A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.
• The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
• Born at 36 weeks gestation.
• Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
• T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
• A swab for respiratory syncytial virus (RSV) is positive.

Doctor orders – Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.
After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.
Client is discharged with these orders:
• methylprednisolone 0.4 mg/kg oral BID for 3
• Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
• Call if needed prior to the Q4 dose.
• Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
• Return for re-evaluation in 3 days

Sample Solution

The Pediatric nurses carry a heavy responsibility for caring not only for this vulnerable, highly diversified population with complicated and intermingled medical needs but also understanding the importance of their emotional needs. Their emotional needs must become the top priority. Although regression is expected with hospitalized children of all ages, it is the nurse`s responsibility to foster growth and acclimation within the healthcare setting. The way a nurse approaches his/her patients can do a great deal in encouraging a frightened or wary child. The children who have access to protective factors are better able to overcome adversity and traumatic events.

There are other contingency theories that provide a more continuum based approach such as Redding’s theory of leadership and management, however Fielder’s description of how situational factors affect the leadership style required for the situation is extremely useful in understanding the fundamentals of leadership (Pettinger, 2007). Chelladurai in his Multi Dimensional Model of Leadership, expands on much of Fiedler’s theory but in a continuum based approach, in which the leader can adapt their leadership style to fit the situation (Chelladurai and Madella, 2006). Chelladurai’s theory is taken from sports psychology but can be applied to an organisational scenario. It provides a much more empirical categorisation of task structure, clearly differentiating a plethora of situations that require certain leadership styles for success. Chealldurai found three characteristics that affect the leadership style required for a situation, called antecedents, they mainly expand upon Fiedler’s situational factors and leader – member relations and ultimately affect how a leader should behave towards a situation. The first are situational characteristics, the environment in which the leader must perform, the second are leader characteristics, the experience, personal qualities and skills of the leader, and the third are member characteristics, the motivation, skill and experience levels of group members (Chelladurai and Madella, 2006). The situational characteristics and member characteristics have a required behaviour to ensure maximum group performance, they also have a preferred behaviour to ensure the satisfaction of group members, if the leaders actual behaviour matches both the required behaviour and preferred behaviour of the situation the consequence is maximum group performance and satisfaction. However, if the group are not performing and achieving goals or are not satisfied or both, then the leader is able to amend their actual behaviour to improve this. Leaders able to monitor performance and satisfaction, and understand what is required to amend the situation will achieve optimum group performance in Chelladurai’s model.
The one limitation of Chealldurai’s model is that it assumes the leader is in a position of complete positional power over the group, and can implement any leadership style of their choosing without constraints. Positional power is the authority and influence a leader has over a group, if the leader has positional power, they will be able to implement the leadership style they best see fit for the situation. Positional

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