Nursing Care of the Hospitalized Child

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					Nursing Care of the
 Hospitalized Child
A child’s understanding of their
   Based on:
       Their cognitive ability at different
        developmental stage
       Previous experiences with healthcare
          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
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

                  Adolescence
                  Separation from
                   friends rather than
                   family more imp
                  Fear of injury and
                  Loss of Control
         Factors Affecting a Child’s
          Response to Illness and
   Age/cognition
   Parental response
   Coping skills of
   Preparation of
   Hospitalization can be
    a positive factor
        Advantages of play to the
           hospitalized child
   Therapeutic
   Emotional outlet
   Teaches
   Enhances
Hospital Admission
            Taking the history
            Physical Exam
                Initial inspection
                Baseline data

            Family dynamics
    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
                 Types of facilities
   Hospital
       Medical/surgical units
       ICU
       Rehab
       Outpatient/day facilities
       24 hr observation units
   School-based clinics
   Community clinics
   Home Care
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:
       Requires more info about the family
       Family does most of the care
       Involves many systems and people
       Balance condition r/t needs with general well-
        being of the child
      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
    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
      Specialists that assist the
     hospitalized pediatric client
   Child Life specialist
   Occupational therapist
   Physical therapist
            Managing pain in the
   According to age which technique is best
   Types of techniques:
       Behavioral distraction
       Assorted visuals
       Breathing techniques
       Comfort measure
       Diversional talk
     Consequences of unrelieved
   Respiratory changes
   Neurologic changes
   Metabolic changes
   Immune system changes
   GI changes
            Pain scales

Pharmologic vs. Nonpharmologic treatment
                 for pain

   Pharmologic                     Nonpharmalogic methods
    treatments                          Distraction
                                        Cutaneous stimulation
                                        Sucrose solution
       Opiods                          Electroanalgesia (TENS
       Nonsteroidals                    units)
                                        Application of heat/cold
       Nonnarcotic analgesics
                                        Relaxation, hypnosis,
                                         guided imagery
               Pain control, cont.

   As nurses, we must remember:

       Pain is what the child says it is! All pain is
        significant to document and treat

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