Foreword

xv

Reviewers

xvii

Contributors

xix

PART I

INTERPROFESSIONAL PATIENT CARE

1

1

The Interprofessional Team

3

Team Members

4

Roles and Functions of Team Members

4

Best Practice for Successful Teams

5

References

7

2

Research, Evidence-Based Practice, and Clinical Decision Making

9

Research as a Basis for Clinical Practice

10

Evidence-Based Practice

10

Using EBP and Research for Clinical Decision Making

13

References

15

3

Certification, Licensure, and Credential Ine/Privileeine for the Health Care Professional

16

Certification

17

Licensure

17

Credentialing and Privileging

17

Health Care Professionals in Pediatric Acute Care

18

Regulatory Issues Far Health Care Professionals in Pediatric Acute Care

21

References

22

4

Documentation and Coding

24

Reimbursement for Professional Services

25

Documentation Guidelines and Rules

26

Basic Evaluation and Management Documentation

26

Basic Diagnosis Coding

30

References

30

5

Structures of Communication within Organizations

31

Communication

32

Committees and Task Forces

32

Shared Governance

33

References

33

6

Patient Safety

35

Theoretical Foundation for Patient Safety

36

High-Reliability Organizations

38

Patient Safety: Application to Pediatric Acute Care

41

References

45

PART II

APPROACH TO THE PEDIATRIC PATIENT AND FEMILYV

47

7

Child Life: Developmental Considerations

49

Child Life Specialists

50

Stressors in the Health Care Setting

50

Stress and Coping in Pediatric Patients

50

Hospitalization and Psychosocial Development

51

Supporting Children during Health Care Experiences

53

Siblings and Families

54

Play in the Hospital Setting

54

Death and Grief in the Health Care Setting

55

Developmental Considerations in the Acute Care Setting

57

References

57

8

Patient- and Family-Centered Care

58

Core Principles of Patient- and Family-Centered Care

59

Definition of Family

60

Assessing Families

61

Examples of Patient- and Family-Centered Care

61

Empowering the Family in Care Goals

62

References

62

9

Communicating Bad News

64

Steps to Communicating Bad News

65

References

66

10

Ethical Considerations

67

Ethical Approach to Consent

68

Advance Directives

68

Refusal of Care

69

Inappropriate Care/Futile Care

69

Issues in Death and Dying

69

Confidentiality

70

Research

70

References

70

11

Care of the Minor and Legal Implications

71

Who is a Minor?

72

State Statutes

72

Parental Rights

76

Emancipated Minor and Mature Minor

76

Immature Minor

77

Recent Rulings

77

Consent, Permission, and Assent

78

Confidentiality

79

Research and Clinical Practice Definitions

79

Emergency Procedures

79

Organ Donation

80

Reproductive Decision Making

80

Sperm Banking, Ovarian Tissue Preservation, and Other Protective Reproductive Strategies

80

Genetic Testing

80

The Health Care Professional and Care of the Minor

81

References

81

12

Transition to Adulthood

82

Definition of Health Care Transition

83

National Policies and Statements

83

Role of the Health Care Team

83

Timing of Transition

83

Goals for Transition

84

Planning for Transition

84

References

84

13

Care of the Medically Fragile

85

Terms and Classifications

86

Epidemiology

87

High Dependency Care Needs

87

Models of Care

88

Impact on Families

89

The Medically Fragile Patient and the Health Care Team

90

References

90

14

Management in the Emergency Setting

92

Levels of Care

93

History

93

Physical Examination

94

Differential Diagnosis

94

Plan of Care

95

Patient and Family Teaching

95

Disposition and Discharge Planning

95

References

96

15

Management in the Inpatient Setting

97

Levels of Care

98

Pediatric Intensive Care Admission Criteria

98

Level I and II Units

99

Pediatric Risk of Mortality (PRISM)

99

History

93

Physical Examination

101

Problem Lists

102

Differential Diagnosis

102

Plan of Care

103

Communication among HCPs

103

Presenting during Hospital Rounds

103

Transfer or Discharge of the Hospitalized Pediatric Patient

104

References

104

16

Management of the Premature Infant in the Pediatric Acute Care Setting

106

The Premature Infant

107

History and Physical Examination Findings Specific to the Newborn

107

Environment of Care

111

Selected Problems in the Newborn or Premature Infant

114

Planning for Home

122

References

123

17

Transport

125

Goal of Transport

126

Indications for Pediatric Transport

126

Transport Team Crew Composition

126

Communication

126

Air Transport

127

Ground Transport

127

Safety

127

Physiologic Stressors of Transport

128

Equipment

129

Preparation for Transport

130

Families

132

Outreach Education and Follow-Up

133

References

133

18

Integrative Medicine

134

Prevalence of Use

135

Evidence-Basedimin Pediatric Care

136

Examples of Evidence-Based IM in Pediatric Care

136

Communication and Collaboration

138

References

139

19

Rehabilitation

140

Prolonged Immobility

141

Orontotor Dysfunction

141

Stimulation Therapy, L4l Circadian Rhythm Aids

141

Seizures

142

Spasticity

142

References

143

20

Palliative Care

144

The Need for Pediatric Palliative Care

145

Principles of Palliative Care

145

Challenges Associated with Pediatric Palliative Care

145

Essential Elements in the Approach to Pediatric Palliative Care

145

Care of the Imminently Dying Patient

146

Practical Aspects of Care

146

Introducing Palliative Care to the Pediatric Patient and Family

146

References

147

PART III

SELECTED DISORDERS AND THEIR MANAGEMENT

149

21

Analgesia, Paralytics, Sedation, and Withdrawal

151

Classification of Pain

152

Anxiety and Agitation

152

Physiology of Pain

152

Physiologic Effects of Untreated Pain

154

Developmental Considerations

155

Pain and Sedation Assessment

155

Sedation Agents

156

Analgesic Agents

157

Other Agents

170

Local Anesthetics

170

Neuromuscular Blocking Agents

170

Monitoring

171

Reversal Agents

172

Procedural Sedation Strategies

173

Patient, Caregiver-, and Nurse-Controlled Analgesia

178

Sedation Strategies for Mechanically Ventilated Children

179

Weaning Narcotics and Sedatives

180

References

184

22

Cardiac Disorders

188

Physiology and Diagnostics

189

Advanced Life Support Education

197

Arrhythmias and Pacemakers

202

Cardiac Transplantation

217

Cardiomyopathy

234

Cardiogenic Shock

236

Cardiovascular Agents

241

Carditis

252

Chylothorax

260

Congenital Heart Lesions

262

Congestive Heart Failure

296

Extracorporeal Life Support

304

Postpericardiotomy Syndrome

308

Pulmonary Hypertension

310

Rheumatic Fever

316

Syncope

321

References

324

23

Dermatologic Disorders

336

Physiology and Diagnostics

337

Bites

340

Erythema Multiforme

347

Stings

351

Wounds and Wound Care

354

References

360

24

Endocrine Disorders

363

Physiology and Diagnostics

364

Adrenal Disorders

369

Diabetes Insipidus, Syndrome of Inappropriate Antidiuretic Hormone, and Cerebral Salt Wasting

376

Diabetic Ketoacidosis

385

Thyroid and Parathyroid Disorders

394

References

400

25

Fluid, Electrolytes, and Nutrition

403

Physiology and Diagnostics

404

Assessment of Nutrition

408

Dehydration and Fluid Management

412

Eating Disorders

420

Electrolyte Imbalances

423

Enteral Nutrition

436

Failure-To-Thrive

447

Parenteral Nutrition

453

References

462

26

Gastrointestinal Disorders

466

Physiology and Diagnostics

467

Appendicitis

478

Abdominal Mass

481

Abdominal Pain

484

Cholecystitis

489

Cholestasis

491

Constipation

494

Esopbageal Atresia/Fistula and Duodenal Atresia

497

Foreign Body Ingestion

501

Hepatitis

503

Gastroenteritis

507

Gastroesophageal Reflux Disease

512

Gastrointestinal Bleeding

515

Gastrointestinal Transplantation

517

Indirect Hyperbilirubineifiia in the Neonate

528

Inflammatory Bowel Disease

535

Intestinal Failure (Short Gut Syndrome)

540

Intestinal Obstructions

544

Liver Failure

557

Pancreatitis

560

Superior Mesenteric Artery Syndrome

568

Typhlitis

569

References

571

27

Genetic and Metabolic Disorders

578

Physiology and Diagnostics

579

Inborn Errors of Metabolism

586

Overview of Selected Genetic Syndromes

588

References

595

28

Hematolo&Ic and Oncolocic Disorders

597

Physiology and Diagnostics

598

Anemia

601

Coagulation Disorders

607

Oneologic Disorders

621

References

658

29

Immunologic and Rheumatologic Disorders

663

Physiology and Diagnostics

664

Anaphylaxis

667

Immunodeficiencies

679

Juvenile Idiopatkic Arthritis

691

Systemic Lupus Erythematosus

700

Vasculitis

705

References

710

30

Infectious Disorders

714

Fever

715

Health Care-Associated Infections

724

Fungal Infections

728

Opportunistic Infections

734

Resistant Organisms

740

Sexually Transmitted Infections

744

Systemic Inflammatory Response Syndrome and Septic Shock

751

Travel Organisms and Parasites

760

Vector-Borne Infections

766

Viral Infections

771

Selected Infections

789

References

806

31

Kidney and Genitourinary Disorders

815

Physiology and Diagnostics

816

Acute Disorders of the Mate Genitalia

821

Dialysis and Renal Replacement Therapy

826

Hematuria

830

Hypertension

831

Kidney Insufficiency

836

Kidney Transplantation

841

Nephrolithiasis

845

Nephrotic Syndrome

849

Pelvic Pain

852

Pyelonephritis and Nephritis

856

Renal Tubular Acidosis

861

Urinary Tract Infection

864

References

867

32

Musculoskeletal Disorders

872

Physiology and Diagnostics

873

Compartment Syndrome

877

Gait Disturbances

878

Osteomyelitis

883

Septic Arthritis

886

Spinal Fusion

888

References

891

33

Neurologic Disorders

893

Physiology and Diagnostics

894

Altered Mental Status

914

Arteriovenous Malformation

916

Brain Death and Organ Donation

920

Cerebral Palsy

924

Cerebral Vascular Accidents

927

Encephalopathy

930

Hospital Psychosis and Depression

934

Hydrocephalus and Intracranial Shunt Disorders

938

Hypotonia in the Infant

941

Meningitis and Encephalitis

943

Muscular Dystrophies

945

Neurocutaneous Disorders

948

Neuropathy

951

Seizures

954

Submersion Injuries

960

References

963

34

Orofacial Disorders

968

Anatomy

969

Dental Abscess and Trauma

981

Mastoiditis

983

Orbital and Preseptal (Periorbital) Cellulitis

984

Orofacial Devices and Surgical Repairs

987

References

993

35

Pulmonarv Disorders

995

Physiology and Diagnostics

996

Acute Respiratory Distress Syndrome

1005

Air leak Syndromes

1009

Apparent Life-Threatening Events

1012

Asthma

1016

Botulism and Guillain-Barre Syndrome

1026

Bronchiolitis

1030

Chronic Lung Disease

1034

Congenital Central Hypoventilation Syndrome

1044

Foreign Body Aspiration

1046

Lung Transplantation

1047

Obstructive Sleep Apnea Syndrome

1050

Pertussis

1052

Pneumonia and Parapneumonic Effusions

1055

Pulmonary Edema

1062

Smoke Inhalation

1065

Ventilation Support

1066

Ventilator-Induced Lung Injury

1081

References

1082

36

Child Maltreatment

1090

Epidemiology

1091

Approach to the Maltreated Pediatric Patient

1091

Emotional or Psychological Maltreatment

1092

Munchausen Syndrome-By-Proxy

1093

Neglect

1094

Physical Abuse

1095

Sexual Abuse

1106

References

1116

37

Toxicologic Exposures

1119

Poison Control Centers

1120

General Principles

1120

Gastrointestinal Decontamination

1122

Selected Pediatric Poisoning Management

1124

References

1133

38

Traumatic Injuries

1135

Epidemiology

1136

Approach to the Pediatric Trauma Patient

1142

Abdominal Trauma

1149

Cardiothoracic Trauma

1161

Extremity Fractures

1167

Facial Trauma

1171

Ophthalmic Trauma

1173

Spinal Cord Injury

1179

Thermal Injuries

1183

Traumatic Brain Injury

1197

Post traumatic Stress Disorder

1204

References

1206

PART IV

EMERGENCY PREPAREDNESS

1213

39

Principles of Disaster Management and Clinical Practice

1215

Disaster Management

1216

Biological Disasters

1224

Blast Injuries

1234

Chemical Disasters

1238

Radiation Injuries

1244

References

1250

PART V

PROCEDURES

1253

40

Arterial Catheter Insertion

1255

41

Central Venous Catheter Insertion and Removal

1259

42

Chest Tube Insertion and Removal

1268

43

Intracardiac Line Removal

1272

44

Intraventricular Catheter Insertion and Shunt Access

1275

45

Lumbar Puncture

1278

46

Postovloric Feedine Tubes Insertion

1285

47

Peripherally Inserted Central Catheter Insertion and Removal

1289

48

Peritoneal Catheter Insertion

1297

49

Raoid-Sequence Intubation

1301

50

Slit Lamp

1307

51

Wound Closure

1310

PART VI

LABORATORY VALUES

1315

Index

1321