The endocrine or ductless glands work with the nervous system to regulate the body’s metabolic processes. Hormones interact with specific target organs to create an effect on the body. This chapter reviews the pathophysiology behind the metabolic system in pediatric clients. It describes nursing care required for pediatric clients with various metabolic conditions. The chapter explores instruction necessary for families of clients with metabolic conditions. Most of the glands and structures of the endocrine system develop during the first trimester of fetal development. Hormonal control is immature until approximately 18 months of age, leaving the infant prone to dysfunction of the endocrine system. Hundreds of hereditary biochemical disorders affect the metabolism. As the infant adjusts to life, symptoms can rapidly emerge that are life-threatening. The most common endocrine dis.
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This chapter provides practical strategies for nursing care related to sleep promotion and prevention and treatment of sleep disorders in pediatric primary care settings, acute care settings, and schools. In children with sleep disorders, inadequate sleep does not often result in excessive daytime sleepiness, but in behavioral difficulties such as inattention, hyperactivity, cognitive dysfunction, and/or scholastic problems. Nurses who see children in the primary care setting can take an active role in the evaluation and assessment of all children’s sleep health and provide follow-up care and ongoing treatment monitoring for children who have sleep disorders. In the acute care setting, nurses can incorporate regular treatment plans for a child’s sleep disorder during hospitalization and should be aware of potential for obstructive sleep apnea (OSA)-related perioperative complications for children undergoing adenotonsillectomy. School nurses have the opportunity to promote healthy sleep and improve behavior and school performance in children at risk.
This chapter explores how three successful nursing leaders, using different leadership approaches, demonstrate traditional leadership attributes such as strategic vision; risk-taking and creativity; interpersonal and communication effectiveness; and inspiring and leading change. It discusses the opportunities and implications for nursing leaders and those external to the profession to develop collaborative and transformative partnerships to advance quality health care. Pragmatic leaders demonstrate leadership excellence by effectively translating their nursing care assessment skills into the ability to approach organizational problem solving and decision making in a systematic, logical manner. In contrast to the present-needs focus of pragmatic leaders, charismatic leaders are vision-based leaders who predicate their leadership agenda on attaining future goals. Each of the three nursing leaders profiled understands the importance of being politically astute and effectively leveraging power and influence to make value-added contributions. To varying degrees, the various constituents of the nursing leaders profiled view them as socialized leaders.
The provision of end-of-life care to inmates with terminal illnesses is one of the distinguishing features of correctional nursing. Both the American Correctional Association (ACA) and the National Commission on Correctional Health Care (NCCHC) have established accreditation standards for end-of-life care. Aspects of pain management that are emphasized or unique in palliative care are that the pain will get worse, it is managed aggressively, and side effects must be anticipated. An oral health assessment should be included in the admission and periodic nursing assessment of inmates who are receiving end-of-life care in an inpatient setting. The results of the oral health assessment are used to develop a plan to maintain oral hygiene. The American Association of Colleges of Nursing has established competencies for nursing care of patients at the end of life that include assisting patients with emotional and spiritual issues, including distress.
This chapter describes nursing care for sleep disorders in the primary care setting. The most prevalent sleep disorders in adults and older adults, and those most commonly seen in primary care settings are insomnia, sleep-disordered breathing, and restless legs syndrome. There is a compelling need for widespread access to sleep assessment and treatment among the large population of primary care clients who have sleep disorders-many of which are currently undetected. Primary care providers, especially nurses, are in an ideal position to assess, implement, and evaluate sleep promotion and sleep disorders treatment in primary care clients. The reach, adoption, implementation, and long-term maintenance of sleep promotion and sleep disorders treatment is most likely to be successful if implemented at the practice/organizational level. Nurses, especially advanced practice nurses play a pivotal role in implementing and evaluating policies and procedures to assure the translation and uptake of these important services.
Research is a foundation of correctional nursing practice. Correctional nurses can apply general nursing research to the correctional patient population and environment to improve care outcomes. In addition, research specific to correctional nursing practice can provide a basis for nursing care delivery in the specialty setting. Evidence-based practice (EBP) expands upon research utilization to include clinical expertise and patient preference. EBP and best practice guidelines apply external sources of information to local clinical practice. By using research principles in practice, correctional nurses can have greater confidence when changing clinical practice to improve patient outcomes. Involvement in a clinical trial should be of benefit to the inmate and a possible treatment for a known condition. Common therapeutic clinical trial involvement includes treatments for cancer, human immunodeficiency virus (HIV), and Hepatitis C. Clinical issues specific to the specialty practice can be investigated to expand the knowledge base and improve patient outcomes.
This chapter describes the characteristics, epidemiology, pathophysiology, and treatment of movement disorders: periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) and suggests implications for nursing practice. Parasomnias and movement disorders are associated with many behaviors that occur in proximity to the sleep period during sleep stage transitions, or during REM or NREM sleep. Movement disorders, in particular, are associated with significant impairment in quality of life and possibly negative cardiovascular consequences. Both groups of conditions occur in adults and children. Although some conditions are occasional, benign, and self-limiting, others are persistent and associated with significant sleep loss and/or the risk of injury to self and others. Nursing care for movement disorders and parasomnias is focused on patient education, providing appropriate reassurance regarding benign and self-limiting behaviors, a safe environment, and symptom control where necessary. Sleep hygiene, avoiding caffeine, and regularly scheduled sleep-wake cycle often reduces negative consequences.
Faith community nurses (FCNs) are called upon to provide spiritual care as well as traditional nursing care, both in institutional settings and in the home, to congregants who suffer from chronic illness, have had surgery, or have had an accident. After conducting a holistic assessment of a patient who is chronically ill, a FCN can help the patient and his or her family copes with the disease and can provide comfort by listening, just being present, reading scripture, and/or praying. Sudden, unanticipated acute illness may pose serious emotional and spiritual problems related to fear of possible death or disability. Psychological depression may result from severe pain or fatigue. The leading chronic diseases in developed countries include arthritis, cardiovascular disease such as heart attacks and stroke, cancer such as breast and colon cancer, diabetes, epilepsy and seizures, obesity, and oral health problems.
Barry H. Smith’s opening is significant: that nursing care is at the core of humanity. He recounts his own experiences with nurses, when as a surgical resident he learned the value of team work, and developed a respect for the nurses who were so tuned in to the needs of the patients and families. Smith asserts that nurses must be the central point of any health care system, and yet many factors have converged to keep nurses in a subservient role within health care. Today, there are Nurses Aides, Licensed Practical Nurses, Registered Nurses, Nurse Practitioners, and those with doctorates in nursing, with an increasing premium being placed on advanced nursing clinical practice, as well as research. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
This chapter describes nurses’ care of acute and critically ill patients’ families, highlighting the clinical judgment and skill required for this important relational work. A crucial aspect of family care is ensuring that a family can be with their ill loved one, as family access promotes family cohesion, connection, and closure, fosters patient well-being and provides the family with information. Commonly cited rationales to limit family access include: concerns regarding patient stability, infection, rest, privacy, the effect of visitation on the family, space limitations and healthcare providers’ performance abilities. Encouraging family involvement in care giving activities is another essential aspect of family care, and can range from minor involvement to major involvement. An excerpt highlights some of the difficulties associated with shifting care giving responsibilities from healthcare providers to family members who may be unable to see other options.