Nursing Care of the Hospitalized Child by 7MeY67O


									 Nursing Care of the
  Hospitalized Child

Christina Hernandez RN, MSN
    A Child’s Understanding of their
   Based on:
       Their cognitive ability at different
        developmental stages
       Previous experiences with healthcare
       Preparation & Coping Skills
       Culture
       Parents reaction to illness
       Siblings reaction to illness
          Importance of Effective
        Communication with Children
   More than words
       Touch
       Physical proximity and environment
       Listening with impartiality
       Visual communication
       Tone of voice
       Body language
       Timing
       Establishing rapport with the family
       Being open to questions/resolving conflict
      Developmental milestones and
       approach to communication
Infants    Toddlers               Preschoolers School-age             Adolescents
                                  (3-5 yrs)    (6-11)                 (12 and older)
 (0-12 mo) (1-2 yr)
Use of calm      Learn the        Seek             Photos,            Engage in
voice;           toddler’s        opportunities    books, videos;     conversations
respond to       words for        to offer         est. limits, use   about their
cries, mimic     common           choices, use     play,              interests, use
baby sounds,     items, picture   play for         introduce          of videos to
talk and read    books,           explanations,    preparatory        explain, foster
regularly, use   respond to       simple           materials 1-5      independence,
a slow           their            sentences,       days in            preparatory
approach and     receptiveness,   picture books,   advance of         materials up
allow time to    preparation      puppets, be      the event          to 1 wk in
get to know      should occur     concise; limit                      advance,
you              immediately      length of                           respect
                 before event     explanations                        privacy needs
          ! Critical to remember !
   Child’s response to Illness
       Fear of the unknown
       Separation anxiety
       Fear of pain or mutilation
       Loss of control
       Anger
       Guilt
       Regression
Stages of Separation
             Protest

             Despair

             Detachment
Stressors by developmental age
Infants / Toddlers
 **separation anxiety

 Nurses experience
  protest and despair in
  this group
 Fear of injury and
 Loss of control

 Need contact with
Stressors by developmental age
   Preschooler
   Separation anxiety
    generally less than the
   Less direct with protests;
    cries quietly
   May be uncooperative
   Fear of injury
   Loss of control
   Guilt and shame
     Stressors by developmental age

   School age
   Separation: may
    have already
    experienced when
    starting to school
   Fear of injury and
   Loss of control
Stressors by developmental age

                  Separation from
                   friends rather than
                   family more imp
                  Fear of injury and
                  Loss of Control
                  Fear of unknown
         Factors Affecting a Child’s
          Response to Illness and
   Age/cognition
   Parental response
   Coping skills of
   Preparation of
   Hospitalization can be
    a positive factor

   Pre-school: typically regress in comfort
    measures and toilet training, ‘temper
    tantrums’ and toddler-like behaviors
   School age: may be more fearful of
    strangers and require more emotional
    support (crying or ‘baby talk’)
Developmental Approaches to
   the Hospitalized Child

      *Page 891 BOX 35-2
    Factors Affecting a Parents
response to illness & hospitalization
   Perception
   Support system
   Coping Mechanism
    Factors Affecting a Parents
response to illness & hospitalization
   Parents may become anxious
   Financial stressors
   Additional obligations
   Guilt
    Nursing Interventions for the
    family of a hospitalized child
   Augment coping mechanisms (what
    specific factors influencing client
   Reinforce information and encourage
    questions (who would have difficulty with
    asking questions?)
   Anticipate discharge needs (when should
    this begin)
    Preparation for Hospitalization

   Tour the hospital or surgical area
   Photographs or a videotape of medical
    setting and procedures
   Health fairs
   Contact with peers who had similar
                 Types of facilities
   Hospital
       Medical/surgical units
       ICU
       Rehab
       Outpatient/day facilities
       24 hr observation units
   School-based clinics
   Community clinics
   Home Care
    Environmental consideration in
         a healthcare setting
   Safe place
       Playroom
       Patient’s room
   Treatment Room/end of crib
   Senses: lighting, sound, temperature, smells
   Dynamics: designate one person to
   Medical play
Safe place to just “be a child”
        Specialists that assist the
       hospitalized pediatric client
   Child Life Specialist
   Occupational therapist
   Physical therapist
Play in the Hospital Setting
          Advantages of play to the
             hospitalized child
   Therapeutic
       Emotional outlet
       Instructional
       Improve physiological abilities
   Enhances cooperation
   Rewards the child. Payment for a job well
Pet therapy- play…
    Dealing with Difficult Families

   Remember that the child, and the family
    bring “baggage”
   Child: fear, expectations and ??
   Parent: preexisting dynamics and
    communication styles, finances, coping
How to deal with the “baggage”

   Claiming potential baggage
   Bring the “good baggage”: competency,
    calmness, caring, tolerance, openness
   Flexibility by all members of the team
   Avoiding the negative baggage
   COPE
Creating Partnerships with Families of
Children with Special Healthcare Needs
   CSHCN: Children with Special Health Care
   Defined as those with elevated risk for
    chronic physical, developmental,
    behavioral or emotional conditions
               CSHCN, cont.

   About 13% of the children
   Account for 65-80% of all pediatric
    healthcare expenditures
   Goals: accessing the resources available!
                  CSHCN, cont

   Care differs from other children:
       May require special equipment – visually or
        hearing impaired, wheelchairs
       Specialized care – feeding tubes, trachs/vents
       Assess who is the primary caregiver?
       Involve additional members of the healthcare
      CSHCN, cont. “ending on a
           happy note”
   Share the joys of focusing on the child’s
    growth and development
   Support and encourage the parents
   Empower families to regain control of their
   Engage in authentic communication
   Support strengths of families
            Managing pain in the
             hospitalized child
   According to age which technique is best
   Types of techniques:
       Behavioral distraction
       Assorted visuals
       Breathing techniques
       Comfort measure
       Diversional talk
             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

   Preschool: verbalize pain, guard injured
    extremity, anorexia, vomiting,
   Adolescent: verbalize pain, may not
    understand ‘type’ of pain. Possible
    reluctant to call for help.
    Consequences of unrelieved pain

   Respiratory changes
   Neurologic changes
   Metabolic changes
   Immune system changes
   GI changes
                 Pain scales

   FLACC: face, legs, activity, cry, and
    consolability (p. 1215-1216)
   FACES: smile to worst hurt (tears)
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
   The numbers beside the photos can be
    used to score the amount of pain the
    child reports.
    Pharmologic vs. Non-pharmologic
          treatment for pain
   Pharmacologic                   Non-pharmacologic
       Opiods                        Distraction
       Nonsteroidals                 Cutaneous stimulation

       Nonnarcotic analgesics        Sucrose solution

                                      Electroanalgesia (TENS

                                     Application of heat/cold
                                     Relaxation, hypnosis,
                                       guided imagery
Pain Management

        The presence of the
         parent is an important
         part of pain
        Children often feel more
         secure telling their
         parents about their pain
         and anxiety
The End!

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