Transcript PowerPoint Hospitalized Child

Presented by
Marlene Meador RN, MSN, CNE
 Influencing factors
Internal
◦Age (cognitive development)
◦Preparation & coping skills
◦Culture
◦Previous experience with
healthcare system
 Influencing factors External
 Parent’s reaction to illness
 Sibling’s reaction to current
illness/hospitalization
 0-8 months
 9-36 months
 Preschool
 School aged
 Adolescent
Protest
Screaming
Crying
Inconsolable
Clinging to parents
Agitated
Resists caregivers
Despair
Detachment
Lack of protest when
parents leave
Child becomes
hopeless and becomes
quiet, withdrawn,
Appearance of happy
apathetic
and content with
caregivers and other
Sadness, depression
children
Crying when parents
appear
Close relationships not
established
May ignore parents
when they return
 Separation anxiety
 Fear of injury
 Loss of control
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Separation anxiety
Fear of injury
Loss of control
Guilt and shame
 Separation anxiety
 Fear of injury/pain
 Loss of control
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Separation anxiety
Fear of injury
Loss of control
Fear of the unknown
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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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?
 Perception
 Support
system
 Coping mechanism
 Parents may become anxious
 Financial stressors
 Additional obligations
 Guilt
 What are some psychological
benefits of hospitalization for
a child and family?
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Infant
Toddler-Preschool
School- aged
Adolescent
P891 BOX 35-2
 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?
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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 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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What nursing interventions prepare a child for
hospitalization?
Are the interventions the same for all children?
Who should the nurse include in these preparations?
 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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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
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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?
 C- collaboration
 O- objective
 P- proactive
 E- evaluate
Avoid placating or condescending phrases.
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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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Therapeutic play
◦ Motional outlet
◦ Instructional
◦ Improve physiological abilities
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Enhancing cooperation through play
Rewards the child’s payment for a job well done!
 When might a nurse use play as
an assessment tool?
 Why is this and effective
technique?
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A person who plans activities to provide ageappropriate playtime for children either in the child’s
room or in a playroom.
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Goal: Assist children to work through feelings about
their illness
 What happens when you ask a
patient of any age “what is your pain
level?”
 How would you best assess a child’s
pain?
 Infant- grimacing, poor feeding,
restlessness, crying
 Toddler- clinging to parent,
crying, pulling or rubbing area of
pain, anorexia, vomiting,
restlessness.
 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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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.
 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
Remember to ask “where” they hurt.
To children, emotional feelings are a
“hurt”
 What happens to VS?
 How does the nurse assess anxiety in a
hospitalized child?
 How does sleeplessness impact healing?
 Respiratory
increase/changes
 Neurologic changes
 Metabolic changes
 Immune system changes
 GI changes.
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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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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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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If you have any questions or concerns
regarding this information please contact
Marlene Meador via email
[email protected]