Pediatrics Unit II Part 1
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The child with a chronic illness needs to be assessed repeatedly to determine health maintenance needs.
An effective partnership among the child's ______, ______, and _______ is vital for a child with a chronic illness.
Medical home, family, and community
_________ and _______ optimize the family's adaptation to the stressors of chronic illness.
Support groups and community-based resources
Comprehensive health supervision includes frequent ________ assessments.
- Issues to be covered include:
- Health insurance coverage
- Transportation to facilities
- Financial stressors
- Family coping effectiveness
- School personnel response to the chronic illness
The nurse can educate school personnel about the child's illnesses and assist them in maximizing the child's potential for academic success.
____ and _____ account for the majority of hospitalizations in children younger than 5 years old, while asthma, injuries, and mental health problems lead to more hospitalizations in older children.
Infections and birth related problems
Adolescents between 15 and 17 years of age are often hospitalized because of problems related to ______ and ______
Pregnancy and child-bearing
Distress related to removal from family and familiar surroundings.
Hospitalization can cause a general loss of control over a child's life and sometimes their emotions and behavior. The result may be anger, guilt, regression, acting out, and other types of defense mechanisms.
Normal fears of childhood include the fear of separation, loss of control, and bodily injury, mutilation, or harm.
Occurs most commonly in children from middle infancy throughout preschool years, with the peak incidence between the ages of 6 and 30 months.
- Separation anxiety
- Major stressor for children of certain ages
First phase of separation anxiety:
Protest-Occurs when the child is separated from parents. may last from a few hours to several days. Child reacts aggressively to separation and exhibits great distress by crying, agitation, and rejecting others.
Second phase of separation anxiety:
Despair-child displays hopelessness by withdrawing from others, becoming quiet without crying, exhibiting apathy, depression, disinterest in play and food, and overall feelings of sadness.
Third and final phase of separation anxiety:
Detachment (Denial)-child forms coping mechanisms to protect himself from further emotional pain. Occurs more often during long term sep. Child shows interest in env., starts to play again, and forms superficial relationships with the nurses and other children. If parents return child ignores them. Exhibits resignation not contentment. More difficult to reverse this stage and developmental delays occur.
Confinement to bed or crib worsens _____.
Loss of control
Children often feel powerless when in the hosp not having their feelings and wishes respected and having minimal control over events.
Need a secure pattern of restful sleep, satisfaction of oral and nutritional needs, relaxation of body systems, and spontaneous response to communication and gentle stimuli.
By ______ of age, infants have developed an awareness of self as separate from the mother.
- 5 to 6 months of age
- Are acutely aware of the absence of their primary caregiver and become fearful of unfamiliar persons.
Are more self aware and can communicate their desires. Need to master accomplishments to minimize the development of shame and doubt. Control becomes an issue. Need opportunities to explore, and need consistent routines. Need familiarity and closeness to primary caregiver.
- Often fearful of strangers and can recall traumatic events
- Disruption in usual routines also contributes to loss of control, and the toddler feels insecure resulting in regression in toilet training and refusal to eat is common
Understand that they are in the hosp because they are sick but may not understand cause of illness. Fear mutilation and are afraid of intrusive procedures since they do not understand body integrity. Interpret words literally and have an active imagination.
- Thinking is egocentric; believe that some personal deed or thought caused their illness which can lead to guilt or shame.
- Concrete, egocentric, and magical thinking limits ability to understand so comm must be on their level
- Naturally curious about surroundings and learns best by observing and working with objects
Generally are hops because of long term illnesses or trauma
General task of their developmental stage is to develop confidence through a sense of industry, which can be disrupted due to hosp. Are concerned about disability and death and fear injury and pain.
- School age child
- Want to know the reasons why procedures and tests are being performed.
- Can understnad cause and effect and how it relates to illness.
- Uncomfortable with any type of sexual examination
- Like being involved
- Accustomed to making choices about meals and activities
- Give them opportunities to maintain independence, enhance self-esteem, and work towards achieving sense of industry.
Fear injury and pain. Concerned how illness/injury wil affect their body image. Anything that changes perception of themselves has a major impact on their response. Do not like to be different, like being "cool."
- Feelings of invincibility may cause them to take risks and be noncompliant with treatment.
- Strive for independence, self assertion, and liberation while developing identity
______ and _____ frequently interpret illness as punishment for wrongdoing.
- Toddlers and preschoolers
- Children below 5 are more vulnerable to emtional distress from hosp
Four phases of nursing care for hosp child:
- Building trusting relationship
- Making decisions
- Providing comfort and reassurance
Use fav toys and tv shows to est rapport. Allow child to participate in the conversation without the pressure of having to comply with requests.A trusting relationship can be build by using appropriate language, games, and play such as singing a song during procedure, preparing the child adequately for procedures, and providing explanations and encouragement. Get down to the childs level and play on his or her terms.It is imperative to decide how much control the child will have during treatment, how much info to share, and whether parents should participate. Comfort and reassurance phase uses tecniqes such as praising the child and providing opps to cuddle with fav toy
Educate children about what to expect so they can cope with their imagination and distinguish reality from fantasy. Describe the intervention and the sequence of steps that will occur and include sensory info such as how they will feel during
How to est a trusting relationship with child and fam:
- Smile, introduce self and give title.
- Let the child and fam know what will happen and what is expected from them
- Ask fam and child names they refer to be called
- Maintain eye contact at appropriate level
- With younger child, start with fam first so child can see fam trusts you
- Orient to the hospital unit
- Place the child in a room close to nurses station and order food appropriate for age and dev level
The number one reason for illness and hosp in children is _______
- Injuries from accidents
- Allow fam to stay with child, provide support, and allow the family and when appropriate the child to participate in decisions.
- Provide comfort such as holding, touching, talking softly
Senory overload (increased stimulation) or sensory deprivation (lack of stimulation) can affect both child and fam.
Frequently touch the child and encourage fam to comfort him or her
Child and family ______ is essential in preoperative care.
- In preparation for surgery, use items such as stuffed animals or dolls to help children understand what is going to happen to them.
- Allow child to role play various experiences with dolls
Studies have shown that parents being present at anesthesia induction can be beneficial
Parents must receive thorough prep; inadequate increases anxiety
In post operative care, _______ is key.
- Assessment of the child's airway, breathing, and circulation.The surgical site is insepcted and fluids and hydration are admin.
- If possible, allow parents to be present in the post anesth care unit ASAP to provide child with support
______ management is crucial in post-op care.
- Pain management
- Use appropriate pain assessment tool to rate child's pain.
- Distraction techniques are very effective
Ensure the child has an ________ in place at all times.
Needed for restraints:
- Use of at least one alternative method prior to using
- Use of least restrictive type
- Need for a written order by a licensed indep. practitioner within 1 hour of app.
- Need for eval by LIP within 1 hour of appl
Use of a holding position that promotes close phys. contact between the child and a parent or caregiver where child must remain still.
Check restraints ___ minutes following initial placement and then ____ for proper placement
Use _____ knot to secure restraints with ties
Assess temp of affected extremities, pulses, and cap refill initially after ____ minutes and then _____ after placement.
After 15 min and then every hour after placement
Remove the restraint every _____ to allow for range of motion and repositioning with documentation of this process and any fnidings.
Every 2 hours
When carrying an infant, good support of back and head is vital. Rails should be up on all beds and wagons. Use safety belts with strollers and wheelchairs
Never leave a child unattended during transport. Keep visible at all times
Before bathing and performing other hygiene measures, assess fam prefs and home practicies.
Carrying infants up to 3 mos. of age
Carrying infants up to 7 months of age
Over the shoulder method
Carrying infatns up to 2 months of age
Never attempt to force a child to eat. This can exacerbate nausea and vomiting and can lead to an aversion to food that extends past hosp stay
- Never punish child for not eating or drinking
- Encuorage older child to keep track of what he or she eats and drinks
Include ice chips as fluid intake. Ice is approx equiv to half the same amount as water
Facial expression is most consistent indicator of pain or bodily injury
- Newborns and infants
- Be alert to signs of discomfort other than crying such as furrowed brow or tense body psoture
Key concerns when caring for _____ care sep anxiety, adequate growth and dev., and autonomy.
- Est trusting relationship
- Be alert to subtle nonverbal indicatorys of grief or discontent
- Maintain home routine related to meals and sleep or nap provides structure
- Closely monitor intake and output
Keep bed or cirb and playroom as saffe places. Perform invasive procedures such as venipunctures in the treatment room if possible. Never perform any interventions in the play room, no matter how nonthreatening they may appear to the nurse
Use magical thinking and fantasy. Be honest and specific, providing infor just prior to intervention to allay fears.
- Allowing preschooler to make simple decisions such as which color bandage to use or whether to take medicine from a cup or syringe helps the child to feel some sense of control
Provide honest infor using concrete, meaningful words to minimize fear of the unknown.
- School age children
- Encourage parental involvement
- Involve child in making simple decisions and planning schedule as approp to give sense of control.
May or may not express fears. Educate honestly. Respect need for privacy
- Younger require more concrete expla while older can process abstract
- Collaborate with adolescent to increase sense of control.
Using awards is good to help in nursing care such as a sticker, baseball card, or small item.
Determine whether activity enhanced desired effect
Parents of children with multiple medical needs may benefit from a ______
- Trial period of home care
- Occurs while child is still hosp but parents provide all of the care that child requires
- Praise accomps
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