Hospitalized Child

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Hospitalized Child

• Presented by
• Marlene Meador RN, MSN, CNE

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(No Transcript)
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Childs Reactions to Illness or Hospitalization

• Influencing factors Internal
• Age (cognitive development)
• Preparation coping skills
• Culture
• Previous experience with healthcare system

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Childs Reactions to Illness or Hospitalization

• Influencing factors External
• Parents reaction to illness
• Siblings reaction to current illness/hospitalizat
  ion

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What age is most effected by separation anxiety?

• 0-8 months
• 9-36 months
• Preschool
• School aged
• Adolescent

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Stages of Separation
Protest Despair Detachment
Screaming Crying Inconsolable Clinging to parents Agitated Resists caregivers Child becomes hopeless and becomes quiet, withdrawn, apathetic Sadness, depression Crying when parents appear Lack of protest when parents leave Appearance of happy and content with caregivers and other children Close relationships not established May ignore parents when they return
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Effects of Illness/hospitalization on
theInfant/Toddler

• Separation anxiety
• Fear of injury
• Loss of control

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Effects of Illness/hospitalization on
thePreschooler

• Separation anxiety
• Fear of injury
• Loss of control
• Guilt and shame

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Effects of Illness/hospitalization on the
School-age Child

• Separation anxiety
• Fear of injury/pain
• Loss of control

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Effects of Illness/hospitalization on
theAdolescent

• Separation anxiety
• Fear of injury
• Loss of control
• Fear of the unknown

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Regression

• Preschool-typically regress in comfort measures
  and toilet training, temper tantrums and
  toddler-like behaviors
• School age- may become more fearful of strangers
  and require more emotional support (crying or
  baby talk)

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Clinical Judgment

• How would a nurse best respond to a parent who is
  overly concerned about the childs regression?
• How does toileting pattern and pacifier/bottle
  response differ from other regression?

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What determines the familys response to a
childs hospitalization?
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Familys Response to Hospitalization

• Perception
• Support system
• Coping mechanism

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Families Response to Illness/Hospitalization

• Parents may become anxious
• Financial stressors
• Additional obligations
• Guilt

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Clinical Judgment

• What are some psychological benefits of
  hospitalization for a child and family?

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Developmental Approaches to the Hospitalized Child

• Page 883 BOX 35-2

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Nursing InterventionsHow does the nurse meet
the needs of the hospitalized child in each age
group?

• Infant
• Toddler-Preschool
• School- aged
• Adolescent
• P891 BOX 35-2

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What is the best method for
communicating with the family of a
hospitalized child?

• What factors influence the familys ability to
  interact with the hospital staff?
• What nursing interventions should receive highest
  priority when communicating with these families?

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Nursing interventions for the family of a
hospitalized child

• Augment coping mechanisms- (what specific factors
  influence client teaching?)
• Reinforce information and encourage questions
  (who would have difficulty with asking
  questions?)
• Anticipate discharge needs (when should this
  begin?)

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PPEN

• Why is this an effective tool for assisting the
  child and the family?
• How would the nurse assist the child and family
  to arrive at the PPEN?
• Is this a static assessment?

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Preparation for Hospitalization

• What nursing interventions prepare a child for
  hospitalization?
• Are the interventions the same for all children?
• Who should the nurse include in these
  preparations?

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Preparation

• Tour of the Hospital or surgical area
• Photographs or a videotape of medical setting and
  procedures
• Health Fairs
• Contact with peers who had similar experience

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Promoting Coping and Normal Development

• Child life specialists assist with preparing
  child for procedures, and to adjust to illness
  and hospitalization.
• Therapeutic play emotional outlet, teaching
  strategy, assessment tool
• Anticipate child/familys needs

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Difficult Families

• What is the nurses best response to a family
  identified as difficult?
• What additional information does the nurse
  require?
• What is COPE, and how is it helpful with families
  in crisis?

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COPE Convey genuine caring, concern and interest
in the childs wellbeing.

• C- collaboration
• O- objective
• P- proactive
• E- evaluate
• Avoid placating or condescending phrases.

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Nursing Care of the Child with Special Needs

• Special equipment- visually or hearing impaired,
  wheelchairs,
• Specialized care- feeding tubes, trachs/vents
• Assess family coping ability- who is primary
  caregiver
• Assess support systems
• Involve additional members of the healthcare team
  

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Play in the Hospital Setting
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Safe place to just be a child
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Advantages to play

• Therapeutic play
• Motional outlet
• Instructional
• Improve physiological abilities
• Enhancing cooperation through play
• Rewards the childs payment for a job well done!

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Play as an assessment tool

• When might a nurse use play as an assessment
  tool?
• Why is this and effective technique?

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Child Life Specialist

• A person who plans activities to provide
  age-appropriate playtime for children either in
  the childs room or in a playroom.
• Goal Assist children to work through feelings
  about their illness

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Pain Assessment

• What happens when you ask a patient of any age
  what is your pain level?
• How would you best assess a childs pain?

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Pain Assessment

• Infant- grimacing, poor feeding, restlessness,
  crying
• Toddler- clinging to parent, crying, pulling or
  rubbing area of pain, anorexia, vomiting,
  restlessness.

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Pain assessment in the Neonate
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Pain Assessment cont

• Preschool- verbalize pain, guard injured
  extremity, anorexia, vomiting, sleeplessness.
• Adolescent- verbalize pain, may not understand
  type of pain. Possibly reluctant to call for
  help.

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Oucher Scale

• After determining that the child has an
  understanding of number concepts, teach the child
  to use the scale.
• Point to each photo, explain that the bottom
  picture is a no hurt, the second picture is a
  little hurt, the third picture is a little
  more hurt, the fourth picture is even more
  hurt the fifth picture is a lot of hurt and
  the sixth picture is the biggest or most hurt
  you could ever have.
• The numbers beside the photos can be used to
  score the amount of pain the child reports.

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Pain Assessment Tools

• FLACC- face, legs, activity, cry and
  consolability (p. 1215-1216)
• NIPS- neonatal pain during/after procedures-
  facial expression, cry quality, breathing
  patterns, arm leg position, state of arousal

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FACES- smile to worst hurt (tears)

• Remember to ask where they hurt.
• To children, emotional feelings are a hurt

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Physiological response to pain

• What happens to VS?
• How does the nurse assess anxiety in a
  hospitalized child?
• How does sleeplessness impact healing?

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Consequences of unrelieved pain

• Respiratory increase/changes
• Neurologic changes
• Metabolic changes
• Immune system changes
• GI changes.

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Nursing interventions pharmacologic

• PCA- what age can use this most effectively?
• Ketoralac- why is this effective? What specific
  nursing interventions apply to this medication?
• Why are NSAIDS used with children?
• What lab values and contraindications are
  important for analgesic medications used with
  children?

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Nursing interventions nonpharmacologic

• What actions should the nurse include with each
  of the following?
• Positioning for comfort (turning or elevation)
• Thermal therapy (heat or cold)
• Diversion therapy
• What actions would work best with an infant?

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Pain Management

• The presence of the parent is an important part
  of pain management.
• Children often feel more secure telling their
  parents about their pain and anxiety

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Pet therapy- play
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• If you have any questions or concerns regarding
  this information please contact Marlene Meador
  via email mmeador_at_austincc.edu