NUR 505

Homework Assignment for Unit 3 Readings-Answer key

Questions from Chapters 22 and 26
1. Define the following terms:- (p. 845 box 22-1)
Chronic illness-condition that interferes with daily functioning for more than 3 months in
a year, causes hospitalization of more than 1 month in a year, or (at the time of diagnosis) is
likely to do either of these.
Congenital disability-a disability that has existed since birth but is not necessarily
hereditary.
Developmental delay-a maturational lag; an abnormal, slower rate of development in
which a child demonstrates a functioning at a level below that which is observed in normal
children of the same age.
Developmental disability-any mental and/or physical disability that is manifested before
age 22 years and is likely to continue indefinitely.
Disability-a long-term reduction in the childs ability to engage in day-to-day activities
because of a chronic condition.
Handicap-a condition or barrier imposed by society, the environment, or ones own self;
not a synonym for disability
Impairment-a loss or abnormality of structure or function.
Technology-dependent child-a child b/w the ages of birth-21 years with a chronic
disability that requires the routine use of a medical device to compensate for the loss of a life-
sustaining bodily function; required daily ongoing care and /or monitoring by trained
professionals.
2. Explain the potential impact of chronic illness and disability on children and their families.
Many facets of a childs and his/her familys life will be impacted by chronic illness and
disability. Potential impacts on the child include more school days are missed, have more
doctors visits which can be emotionally and/or physically draining, daily activities and
functioning may be limited, children with chronic illness have a higher incidence of being
abused physically, emotionally, or sexually, having behavioral problems, not completing high
school or going to college, or being incarcerated.
In regards to families, many additional time and monetary expenditures often result from a
chronic illness. Additionally, it is often physically, emotionally, and mentally draining to provide
care for children with chronic illnesses. There is a higher incidence of missing days from work,
social isolation, depression, and divorce in families with children who have chronic illnesses.
Siblings can be impacted as well, either positively or negatively. Many report an increased bond
with their sibling and a strong protective role. Others report negative emotions, saying that they
did not get a lot of attention as a child because their parents were so focused on their sibling.
3. Define the following and explain nurses role in both:
Normalization-the change in thought process where a family accepts whatever their
routine is as normal living, instead of being a traumatic set of life experiences that need to be
dealt with. (p. 847) Nurses can help in promoting this process in many ways, including providing
education to the families regarding the disease process, coping mechanisms, available resources,
or just education on the process of normalization itself. Nurses can also advocate for assistive
devices to help the child become more independent, participate in multidisciplinary teams with
school officials or other healthcare professionals to establish IEPs or IFSPs, help the family to
establish a routine if they are struggling, provide referrals to social work/psychologists as
needed.
Mainstreaming-the process of integrating children with special needs into traditional
classroom setting with children similar to their age. (p.847) It is the nurses role to teach the
parent what the child is legally entitled to, including services in the particular state the child
lives, which consequently requires that nurses stay informed on the laws protecting children with
disabilities and know where the parent can obtain more information.
Early intervention-includes any systematic and sustained effort to assist young, disabled,
and developmentally vulnerable children from birth to 3 years of age. Federal law mandates that
states develop and enact statewide coordinated, comprehensive, multidisciplinary interagency
program of early intervention services for infants and toddlers with disabilities, in addition to
support services for their families.
4. What does the Individuals with Disabilities Education Act (IDEA) mandate, and what is the
nurses role in it? The original law passed called the Education for All Handicapped Children
Act of 1975 ensures that all children with disabilities are entitled to a free appropriate public
education in the least restrictive environment possible. In 1990, the law was amended, where the
name was changed to the Individuals with Disabilities Education Act (IDEA). Under this act, the
state must identify, diagnose, teach, and provide appropriate services to disabled children
between ages 3 and 21 years.
The law was reauthorized in 2004, and provides state and local aid for special education and
related services for children with disabilities, specifically in development and maintaining early
intervention programs for infants and toddlers with disabilities. Nursings role is to coordinate
with school officials to help ensure the health care needs of the children in schools are being met,
and collaborate with school officials in the development of individualized health plans that will
be implemented by the schools. Nursings role is also to educate parents about these laws, in the
event that children are being denied education based on having special needs.
5. Please explain the difference between and individualized education program (IEP) and an
individualized family service plan (IFSP).
An IEP focuses mainly on the educational goals of the child, and is written by a multidisciplinary
team consisting of healthcare professionals and school officials. IEPs are required for each child
with disabilities per the IDEA.
While also a product of multidisciplinary collaboration, an IFSP incorporates the entire family
instead of just the child, and is focused on the childs entire development instead of just
education (the plan will be specific to whatever developmental delay is present). IFSPs are
mostly a product of the Education of the Handicapped Act Amendments of 1986, which directs
states to develop and enact statewide coordinated, comprehensive, multidisciplinary interagency
programs of early intervention services for infants and toddlers with disabilities.
6. Please explain how nurses can promote proper development in hospitalized children. See
supportive interventions listed in table 22-1 on pp. 850-851. Also see the nursing considerations
on the G&D chart handout.
7. Summarize how nurses can minimize loss of control and autonomy for hospitalized children.
Promoting freedom of movement as much as possible (can often be accomplished by preserving
parent-child contact), maintaining the childs home routine as much as possible, encouraging
independence by promoting self-care when appropriate and giving options whenever possible,
and provide explanations of what to expect and causes of illness in developmentally appropriate
language.