Transcript Hospitalized Child - Austin Community College

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 months
9-36 months
Preschool
School aged
Adolescent
Stages of Separation
Protest
Despair
Detachment
Effects of Illness/hospitalization
on the:
Infant/Toddler
Separation anxiety
Fear of injury
Loss of control
Effects of Illness/hospitalization
on the:
Preschooler
Separation anxiety
Fear of injury
Loss of control
Guilt and shame
Effects of Illness/hospitalization
on the:
School-age Child
Separation anxiety
Fear of injury/pain
Loss of control
Effects of Illness/hospitalization
on the:
Adolescent
Separation anxiety
Fear of injury
Loss of control
Fear 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
Perception
Support system
Coping mechanism
Families’ Response to
Illness/Hospitalization
Parents may become anxious
Financial stressors
Additional 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?
Infant
Toddler-Preschool
School- aged
Adolescent
P891 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 Fairs
Contact 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- collaboration
O- objective
P- proactive
E- evaluate
Avoid 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