hospitalized child presented by marlene meador rn, msn, cne
TRANSCRIPT
Hospitalized Child
Presented by
Marlene Meador RN, MSN, CNE
Child’s Reactions to Illness or Hospitalization
Influencing factors Internal–Age (cognitive development)–Preparation & coping skills–Culture–Previous experience with healthcare system
Child’s Reactions to Illness or Hospitalization
Influencing factors External – Parent’s reaction to illness– Sibling’s reaction to current
illness/hospitalization
What age is most effected by separation anxiety?
0-8 months9-36 monthsPreschoolSchool agedAdolescent
Stages of Separation
ProtestDespairDetachment
Effects of Illness/hospitalization on the:
Infant/Toddler
Separation anxietyFear of injuryLoss of control
Effects of Illness/hospitalization on the:
Preschooler Separation anxietyFear of injuryLoss of controlGuilt and shame
Effects of Illness/hospitalization on the:
School-age Child
Separation anxietyFear of injury/painLoss of control
Effects of Illness/hospitalization on the:
AdolescentSeparation anxietyFear of injuryLoss of controlFear of the unknown
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”)
Clinical Judgment
What are some psychological benefits of hospitalization for a child and family?
Clinical Judgment:
How would a nurse best respond to a parent who is overly concerned about the child’s regression?
How does toileting pattern and pacifier/bottle response differ from other regression?
What determines the family’s response to a child’s hospitalization?
Family’s Response to Hospitalization
PerceptionSupport systemCoping mechanism
Families’ Response to Illness/Hospitalization
Parents may become anxious
Financial stressorsAdditional obligations Guilt
Developmental Approaches to the Hospitalized Child
Page 891 BOX 35-2
Nursing Interventions:
How does the nurse meet the needs of the hospitalized child in each age group?
InfantToddler-PreschoolSchool- agedAdolescentP891 BOX 35-2
What is the best method for communicating with the family of a hospitalized child?
What factors influence the family’s ability to interact with the hospital staff?
What nursing interventions should receive highest priority when communicating with these families?
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?)
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?
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?
Preparation
Tour of the Hospital or surgical area
Photographs or a videotape of medical setting and procedures
Health FairsContact with peers who had
similar experience
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/family’s needs
Difficult Families
What is the nurse’s 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?
COPE: Convey genuine caring, concern and interest in the child’s wellbeing.
C- collaborationO- objectiveP- proactiveE- evaluateAvoid placating or condescending
phrases.
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
Play in the Hospital Setting
Safe place to just “be a child”
Advantages to play:
Therapeutic play– Motional outlet– Instructional– Improve physiological abilities
Enhancing cooperation through play
Rewards the child’s payment for a job well done!
Play as an assessment tool:
When might a nurse use play as an assessment tool?
Why is this and effective technique?
Child Life Specialist
A person who plans activities to provide age-appropriate playtime for children either in the child’s room or in a playroom.
Goal: Assist children to work through feelings about their illness
Pain Assessment
What happens when you ask a patient of any age “what is your pain level?”
How would you best assess a child’s pain?
Pain Assessment
Infant- grimacing, poor feeding, restlessness, crying
Toddler- clinging to parent, crying, pulling or rubbing area of pain, anorexia, vomiting, restlessness.
Pain assessment in the Neonate
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.
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.
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
FACES- smile to worst hurt (tears)
Remember to ask “where” they hurt.
To children, emotional feelings are a “hurt”.
Physiological response to pain:
What happens to VS?
How does the nurse assess anxiety in a hospitalized child?
How does sleeplessness impact healing?
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?
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?
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
Pet therapy- play…
If you have any questions or concerns regarding this information please contact Marlene Meador via email [email protected]
Or cell phone 512-422-8749