Transcript The Hospitalized Child

The Hospitalized Child
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Four primary problems of the Pediatric
Nurse when dealing with the
hospitalized child:
– Separation Anxiety
– Loss of Control
– Pain management
– Diversional Activities reflective of
developmental stage of client
The Hospitalized Child
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Separation Anxiety!
– Early Childhood
• Protest
• Despair
• Detachment
– Later Childhood
• Loneliness
• Boredom
• Isolation
– Attitude is everything!
The Hospitalized Child
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Loss of Control!
– Early Childhood
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Trust
Limitation of movement
Regression
Fantasy (can not synthesize beyond senses)
– Later Childhood
• Loss of independent activities
• Depersonalization
– Attitude is everything!
The Hospitalized Child
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Pain!
– Fallacies
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Infants do not feel pain
Children tolerate pain better than adults
Children can not tell you where they hurt
Children always tell you the truth about pain
Children become used to pain and painful
procedures
• Pain intensity is reflected by a child’s behavior
• Opioids are too dangerous for children
Pain Assessment:
Subjective
Pain Assessment:
Objective
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Body rigidity, thrashing about, loud
crying, restlessness
Flushing of skin
Blood Pressure, pulse, resp increase
Pupils Dilate
O2 Sat decreases
• These are less reliable than subjective- better
to believe what the child tells you than to rely
on objective signs
Pain Management
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Non-pharmacological
– Involve Parents
– Prepare the child without planting the idea
of pain
– Distraction
– Cutaneous Stimulation
– Rewards
Pain Management
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Pharmacological
– Right Drug
• opioids vs non-opioids?
– Right Dose
• body weight
• Parenteral vs Oral doses
Pain Management
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Pharmacological
– Right Route
• Oral
• IM
– EMLA
– buffered lidocaine
• IV
– Side effects
– Attitude is everything!
Diversional Activities
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Play is the work of children and is
critical in their development
– JCAHO requirements
– puts children in charge- all children even
the sick ones!
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Play Room
– should be a sanctuary
The Hospitalized Child
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Care Plan:
– Fear related to separation anxiety
• withdrawal
• regression
The Hospitalized Child
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Care Plan
– Alteration in comfort related to pain
• Non-pharmacological
• Pharmacological
• Side Effects
The Hospitalized Child
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Care Plan
– Powerlessness related to hospitalization
The Hospitalized Child
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Care Plan:
– Diversional Activity Deficit related to
immobility and hospitalization
• Activity Levels
• Adequate rest
Pediatric Variations from Adults:
Assessment and Techniques
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Safety!
Language!
Medication Administration!
– PO
– IM
– IV
– PR
Positioning
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Lumbar Puncture
– lie on side with knees flexed to the
abdomen and chin flexed to chest
• infant- two hands
• child- lean over body using forearms against
the thighs
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Papoose Board/ Mummy Restraint
– IV’s, phlebotomy, suturing,
Normal Pediatric Heart RatesAlways Apical!!
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Newborn120-170
1 year100-130
3 years
80-120
5 years70-110
10 years
60-100
affected by fever, dehydration,
respiratory illnesses and drugs
Respiratory Rates- Abdominal
rather than chest movements!!
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Newborn:
30-60
1 year:
24-40
3 years:
24-30
6 years:
18-22
10 years:
12-20
Affected by anxiety, fever, drugs, illness
Blood Pressures- neonatal, infant,
child, small adult cuffs
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Newborn:
70/50
1 year:
90/50
3 years:
90/60
6 years:
100/60
12 years:
110/60
18 years:
120/70
affected by pain, dehydration, anxiety
Temperature: an elevated
temperature is called a fever!!
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Any temp. >100.5 in a child<3 mos- is
serious- seek medical attention!!
Mercury Glass Thermometer
– oral- no seizure, 4 or older, 3 minutes,
under tongue
– rectal- lubrication, 2 minutes, usually
younger than 2, insert 1/2 inch (no
immunosuppressed!!!)
– both require protective sheath!
Temperature- continued
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Axillary- last resort- usually in public
places, seizure prone and
immunosuppressed!
Press arm close to side- hold in place 6
minutes!
Rectal=oral plus 1 degree or axillary
plus 2 degrees
Oral = axillary plus one degree
Temperature- continued
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Tympanic- not recommended for
children less than 2 years- but is done
all the time!
Use probe cover
pull pinna back and down, insert probe
covering entire canal, parallel to face,
then rotate towards mouth- like
speaking into telephone- press scan
button. Discard probe.
Oxygen saturation- normal- 95%
or greater!
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Indicated in any patient with abnormal vital
signs, cough, excessive secretions, sedation,
or whenever the nurse feels it is necessary.
Spot check vs continuous
Usually children require taping probe over
thumbnail nail or large toenail, can also use
pinna of ear
Measurement of oxygenation as well as
perfusion!
Intake and Output
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Measured in cc’s or mL’s- useless
without daily weights!
– 1 gram = 1cc (1,000 grams = 1Kg=1liter!)
– Used on the following- renal disease, IV
fluids, surgery, DM, hypovolemic,
dehydrated (vomiting), CHI, burns, CHF,
certain medications, meningitis (ICP)
– Weigh all diapers!
Specimen Collection (less than 5
years old)
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Venipuncture- usually do not use a vacutainer
on children- a 20-25 gauge needle with a
syringe- usually 3 cc’s enough. Do not put in
regular blood tubes, but rather pedi bullets.
Can do a heel stick if unable to get blood on
kids less than 1- need lancet and micro-sized
collection tubes. Must wipe away the first
drop of blood.
Specimen Collection- Urine
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Cath
Clean Catch
Pedibag- clean meatus before applying the bag with
a soap solution, sterile water, and sterile gauze - wipe
from the tip of the penis towards the scrotum or from
the clitoris towards the anus on three separate wipes.
Attach the bag with adhesive tabs around the labia or
around the scrotum
Should be done before any other specimen
collection!
Specimen Collection- Throat
Culture
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Open the culturette- do not let it come into
contact with anything- hold in dominant hand.
(contains two swabs in one) Have patient
open mouth and say AHHH. (May need
tongue depressor to get tongue out of way)
Do not let swab come into contact with the
tongue- swab each tonsil with a different
swab. Expect patient to gag! Place swab
back into culturette tube- Label!!