The hospitalized child

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Jenn33ok
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243061
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The hospitalized child
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2013-10-29 15:21:11
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Hospitalized Child
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Children who are hospitalized
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  1. Misconceptions about Pain in infants and children--Is this a Myth or Reality? 
    Newborn and infants are incapable of feeling pain.Children do not feel pain with the same intensity as adults because a child's nervous system is immature.
    Myth
  2. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    The anatomic and functional requirements for pain processing are present in early fetal life. Preterm and full term newborn may be more sensitive to pain stimuli because of the immature spinal cord descending pain control mechanisms
    Reality
  3. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Infants are incapable of expressing pain.
    Myth
  4. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Infants express pain with both behavioral and physiologic cues that can be assessed.
    Reality
  5. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Infants and children have no memory of pain
    Myth
  6. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Preterm infants have been noticed to associate the smell of alcohol with heel sticks and to try to pull the foot away to avoid pain. Infants cry in anticipation of immunizations.
    Reality
  7. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Parent exaggerate or aggravate their childs pain
    Myth
  8. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Parents know their child and are able to identify when the child is in pain
    Reality
  9. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children are not in pain if they can be distracted or if they are sleeping
    Myth
  10. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children use distraction to cope with pain, but they soon become exhausted when coping with pain and fall asleep
    Reality
  11. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Repeated experience with pain teaches the child to be more tolerant of pain and cope with it better
    Myth
  12. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Child who have more experience with pain respond more vigorously to pain. Experience with pain teaches how severe the pain can become
    Reality
  13. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children tolerate discomfort well. They become accustomed to pain after having it for a while
    Myth
  14. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children do not tolerate pain any better than adults.  Infants may develop pain sensitivity with repeated exposure and have a higher pain reaction
    Reality
  15. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children recover more quickly than adults from painful experiences such as surgery
    Myth
  16. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children heal quickly from surgery, but they have the same amount of pain from surgery as an adult
    Reality
  17. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children tell you if they are in pain. They do not need medication unless they appear to be in pain
    Myth
  18. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children may be too young to express pain or afraid to tell anyone other than a parent about the pain. The child fears the treatment for pain may be worse than the pain itself.
    Reality
  19. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children without obvious physical reasons for pain are not likely to have pain
    Myth
  20. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    The cause of pain cannot always be determined. The feeling of pain is subjective and should be accepted by nurses.
    Reality
  21. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Children run the risk of becoming addicted to pain medication when used for pain management.
    Myth
  22. Misconceptions about Pain in infants and children--Is this a Myth or Reality?

    Addiction is extremely rare when the child is treated for an acute condition
    Reality
  23. The Child's Understanding of Pain, Behavioral Responses, and Verbal Descriptions by developmental stage

    6 month 
    Understanding of pain: No understanding of pain; is responsive to parental anxiety 

    Behavioral response: Generalized body movements, chin quivering, facial grimacing, poor feeding

    Verbal Description: Cries
  24. The Child's Understanding of Pain, Behavioral Responses, and Verbal Descriptions by developmental stage 

    6-12 months 
    Understanding of Pain: Has a pain memory; is responsive to parental anxiety 

    Behavioral Response: Reflex withdrawal to stimulus, facial grimacing, disturbed sleep, irritability, restlessness

    Verbal description: Cries
  25. The Child's Understanding of Pain, Behavioral Responses, and Verbal Descriptions by developmental stage 

    1-3 years: Toddlers  
    • Understanding of pain: Does not understand what causes pain and why they might be experiencing it
    • Behavioral Response: Localized withdrawal, resistance of entire body, aggressive behavior, disturbed sleep

    Verbal description: Cries and screams, cannot describe intensity or type of pain. Use common words for pain such as owie or boo-boo 
  26. The Child's Understanding of Pain, Behavioral Responses, and Verbal Descriptions by developmental stage 

    3-6 years (preoperational) Preschoolers
    • Understanding pain- Pain is hurt. Does not relate pain to illness; may relate pain to an injury, often believes pain is punishment. Unable to understand why a painful procedure will help them feel better or why an injection takes the pain away 
    • Behavioral response-Active physical resistance, directed aggressive behavior, strikes out physically and verbally when hurt, low frustration level
    • Verbal Description-Has the language skills to express pain on a sensory level 
    • Can identify location and intensity of pain, denies pain, may believe his or her pain is obvious to others
  27. The Child's Understanding of Pain, Behavioral Responses, and Verbal Descriptions by developmental stage 

    7-9 years (concrete operations) School Age Children 
    • Understanding of pain- Does not understand the cause of pain, but understands simple relationships between pain and disease 
    • Understands the need for painful procedures to monitor or treat disease
    • May associate pain with feeling bad or angry
    • May recognize psychologic pain related to grief and hurt feelings 
    • Behavioral Response-Passive resistance, clenches fists, holds body rigidly still, suffers emotional withdrawal, engages in plea bargaining
    • Verbal Description-Can specify location and intensity of pain and describes pain physical characteristics in relation to body parts
  28. The Child's Understanding of Pain, Behavioral Responses, and Verbal Descriptions by developmental stage 

    10-12 years (Transitional) 
    • Understanding of pain-Better understanding of the relationship between an event and pain. Has more complex awareness of physical and psychologic pain such as more dilemmas and mental pain
    • Behavioral Responses: May pretend comfort to project bravery, may regress with stress and anxiety 
    • Verbal description: Able to describe intensity and location with more characteristics in relation to body parts
  29. The Child's Understanding of Pain, Behavioral Responses, and Verbal Descriptions by developmental stage 

    13-18 (Formal Operations) Adolescents
    • Understanding of pain: Has the capacity for sophisticated and complex understanding of the cause of physical and mental pain
    • Recognizes that pain has both qualitative and quantitative characteristics, can relate to the pain experienced by others
    • Behavioral Response: Want to behave in a socially acceptable manner (like adults), show controlled behavioral response, may not even complain about pain if given cues that nurses and other health care providers believe it should be tolerated 
    • Verbal description-More sophisticated descriptions as experience is gain; may think nurses are in tune with their thoughts, so they dont need to tell the nurse about their own pain
  30. Physiologic consequences of unrelieved pain in Children: Respiratory Changes
    Responses to pain: Rapid shallow, inadequate lung expansion, inadequate cough

    Potential Physiologic Consequences: Alkalosis, Decreased oxygen saturation, atelactasis, retention of secretions
  31. Physiologic consequences of unrelieved pain in Children: Neurologic Changes
    Response to Pain: Increased sympathetic nervous system activity and release of catecholoamines

    • Potential Physiologic consequences: 
    • Tachycardia, elevated blood pressure, change in sleep patterns, irritability
  32. Physiologic consequences of unrelieved pain in Children: Metabolic Changes
    • Responses to pain: Increased metabolic rate with increased perspiration
    • Increased cortisol production 
    • Potential Physiologic Consequences: 
    • Increased fluid and electrolyte losses
    • Increased cortisol and blood glucose levels
  33. Physiologic consequences of unrelieved pain in Children: Immune System Changes
    Responses to pain: Depressed immune and inflammatory responses

    • Potential Physiologic consequences:
    • Increased risk of infection, delayed wound healing
  34. Physiologic consequences of unrelieved pain in Children: gastrointestinal Changes
    • Responses to pain: Increased intestinal secretions and smooth muscle sphincter tone, nausea, anorexia 
    • Potential Physiologic Consequences: 
    • Impaired gastrointestinal functioning, poor nutritional intake, ileus
  35. Physiologic consequences of unrelieved pain in Children: Altered pain response
    Responses to Pain: Increased pain sensitivity 

    Potential Physiologic consequences: Hyperalgesia, decreased pain threshold, exaggerated memory of painful experiences
  36. Stressors of Hospitalization for Children at Various Development Stages: Infant
    • Stressors Responses: Separation anxiety, stranger anxiety, painful, invasive procedures
    • immobilization, sleep deprivation, sensory overload,sleep-awake cycle disrupted,feeding routines disrupted, displays excessive irritability 

    Nursing Implications: Encourage parental presence, Adhere to infants home routine as much as possible, Utilize topical anesthetics or procedural sedation as prescribed, promote a quiet environment and reduce excess stimuli
  37. Stressors of Hospitalization for Children at Various Development Stages: Toddler
    • Stressors Response: 
    • Separation Anxiety
    • Loss of self control
    • Immobilization
    • Painful, invasive procedures
    • Bodily injury or mutilation
    • Fear of the dark,
    • Cries if parents leave the bedside
    • Is frightened if forced to lie supine
    • Wonders why parents don't come to the rescue
    • Associates pain with punishment 

    • Nursing Implications: 
    • Encourage parental presence 
    • Allow parents to hold child in their lap for examinations and procedures when possible 
    • Allow choices when possible
    • Utilize topical anesthetics or preprocedural sedation as prescribed
    • Explain all procedures using simple developmentally appropriate language
    • **Provide night light**
  38. Stressors of Hospitalization for Children at Various Development Stages: Preschooler
    • Stressors Responses: 
    • Separation anxiety and fear of abandonment 
    • Loss of self control 
    • Bodily injury or mutilation
    • Painful, invasive procedures
    • Fear of the dark and monsters 
    • Displays difficulty separating reality from fantasy
    • Fears ghosts and monsters
    • Fears body parts will leak out when skin is not intact
    • Fears that tubes are permanent
    • Demonstrates withdrawal, projection, aggression, and regression

    • Nursing implications:
    • Encourage parental presence
    • Allow choices when possible 
    • Utilize topical anesthetics or preprocedural sedation as prescribed 
    • Explain all procedures
    • **Provide night light or flashlight***
  39. Stressors of Hospitalization for Children at Various Development Stages: School Age
    • Stressors Responses: 
    • Loss of control
    • Loss of privacy and control over bodily functions
    • Bodily injury
    • Separation from family and friends
    • Painful, invasive procedures
    • Fear of death
    • Displays increased sensitivity to the environment
    • Demonstrates detailed recall of events to self and other patients 
    • Nursing implications:
    • Encourage  parental participation
    • Allow the child choices when possible
    • Explain all procedures and offer reassurance
    • Utilize topical anesthetics or preprocedural sedation as prescribed
    • Encourage peer interaction via Internet, phone calls and other methods of communication
  40. Stressors of Hospitalization for Children at Various Development Stages: Adolescent
    • Stressors response:
    • Loss of control
    • Fear of altered body image
    • disfigurement, disability and death
    • separation from peer group
    • Loss of privacy and identity  
    • Displays denial, regression, withdrawal, intellectualization, projection and displacement

    • Nursing implications: 
    • Include the adolescent in the plan of care
    • Encourage discussion of fears and anxieties
    • Explain all procedures
    • Ask the adolescent his or her desire for parental involvement
    • Encourage peer interaction
  41. Stages of Separation Anxiety: Protest p1078
    • Screaming, crying
    • Clinging to parents 
    • May resist attempts by other adults to comfort them
  42. Stages of Separation Anxiety:Despair p.1078
    • Sadness
    • Quiet, appear to have "settled in"
    • Withdrawal or compliant behavior
    • Crying when parents return
  43. Stages of Separation Anxiety: Denial(detachment) p.1078
    • Lack of protest when parents leave
    • Appearance of being happy and content with everyone 
    • Show interest in surroundings
    • Close relationships not established
  44. Family Assessment: Family Roles 
    • What changes will the child's illness create in the family?
    • Will the household task need to be reallocated?
    • What specific burdens will be placed on family members?
    • Will one parent stay with the child or spend a great deal of time in the hospital? 
    • Will one parent or guardian be primarily responsible for communicating with other family members?
  45. Family Assessment: Knowledge 
    • What knowledge does the family have about the child's condition and treatment? 
    • Does the family need further information?
    • How quickly can discharge planning and teaching begin?
  46. Family Assessment: Support Systems
    • Does the child or family have health insurance?
    • What percentage of cost will it cover? 
    • Will other financial support be needed? 
    • Will costs continue for ongoing care after hospitalization? If so, will existing health insurance cover those costs?
    • Are close friends and family available to provide care for other children, assist with family tasks, or help in other ways?
    • Are there community services such as support groups, camps for children with disabilities, education sessions, or equipment and financial resources to which the nurses can refer the family?
  47. Family Assessment: Siblings
    • Have siblings been informed of the ill child's condition and the expected outcome?
    • Have they been reassured that they did not cause the illness?
    • Do they understand the change in roles and family routines? 
    • Are they able to visit the ill child?
    • Have their teachers been informed of the family stress? 
    • If the hospitalized child's life is threatened, are the siblings involved in plan to promote coping?
  48. Variations in Medication Administration to Children: Oral
    • Developmental consideration: Children under 5 years of age cannot generally swallow pills and capsules
    • Children may not want to take medicine
    • Techniques: Medications are usually given in liquid form (elixir, syrup, or suspension)
    • Avoid putting medications in a bottle in formula since it will be impossible to determine how much medication the child has taken, if some of the formula is left in the bottle. 
    • Sometimes tablets are crushed or capsules are opened and mixed with a liquid flavoring  or small amount of food. 
    • Check with pharmacy to be sure this does not inactivate the drug. 
    • **Never crush enteric coated or timed released medication
    • When choosing a vehicle for crushed tablets, use only one spoonful of applesauce. 
    • Use a 1ml oral syringe for amounts less than 1ml to increase accuracy.
    • Position young children upright to avoid chocking or aspiration
    • Give liquid medicines slowly  by oral syringe (for infants) aimed at the inside of the cheek. 
    • A preschooler may prefer to drink medicine  from a medicine cup, but the medication must first be measured using a syringe to ensure accuracy. 
    • Have the expectation that the medicine will be taken. Let children choose the type of fluid to drink after, but do not ask if they will take their medicine now
  49. Variations in Medication Administration to Children: Rectal
    Developmental consideration: Colon is small

    • Techniques: For children younger than 3 years, the nurses gloved fifth finger is used for insertion. After this age, the index finger can usually be used. 
    • Lubricate the tip of the suppository. The nurse may need to hold the buttocks together for a few minutes to keep the medication from being expelled
  50. Variations in Medication Administration to Children: Ophthalmic and otic
    Developmental considerations: Young children may be fearful of medicines placed in the eyes or ears. 

    • Techniques: Adequate immobilization is needed to avoid injury.
    • The nurses hand can be stabilized by resting  the wrist on the child's head
    • Explanations and therapeutic play can be used with children old enough to explain the process of administration
    • Have medication at room temperature
  51. Variations in Medication Administration to Children: Topical 
    • Developmental Considerations: skin of infants is thin and fragile 
    • Techniques: Only prescribed doses and medicines appropriate for young children should be used on skin. 
    • Covering the area or keeping the child's hands occupied may be necessary to ensure adequate contact of medication with the skin.
  52. Variations in Medication Administration to Children: Intramuscular (IM)
    • Developmental considerations:  Anatomy and physiology of children differ from those of adults
    • Techniques: Gluteus maximus muscle (dorsal gluteal site) must not be used until the child has been walking for at least 1 year and has well developed muscle mass. 
    • Vastus lateralis (anterior thigh) site is preferred for young children because it is  the larges muscle mass in children younger than 3 years. 
    • Amounts to be administered should be limited to no more than 1-2 ml for ventrogluteal site depending on muscle size. Refer to clinical skills manual for illustrations
    • The deltoid muscle is rarely used in young children expect for small amounts injected in some vaccines
  53. Variations in Medication Administration to Children: Intravenous
    Developmental consideration: Veins are small and fragile. Fluid balance is critical. 

    • Techniques: Careful maintenance of sites is needed 
    • Common infusion sites include hands and feet, although scalp veins are sometimes used  in infants. 
    • Infusion pumps require frequent monitoring
    • Syringe pumps are often used  when minimal fluid is to be given over an extended  period of time
    • Central lines are commonly used for long term intravenous medication therapy
  54. Assisting Children through Procedures: Infant
    • Before Procedure: None for infant. Explain to the parents the procedure, the reason for it and their role. 
    • Allow parents the option of being present for procedures. 
    • During Procedure: Nursing staff should immobilize the infant securely and gently. 
    • Parents should not be asked to hold the child down. Perform procedure quickly. 
    • Use touch, voice, pacifier, and bottle as distractions. Ask parent to hold, rock, and sing to infant after procedure.
  55. Assisting Children through Procedures: Toddler
    Before Procedure: Give explanation just before the procedure, since toddlers concept of time is limited. Explain that child did nothing wrong; the procedure is simply necessary. 

    During Procedure: Perform in treatment room. Nursing staff should immobilize the child securely. Give short explanations and directions in positive manner. Avoid giving choices when none are available.  For example, " We are going to do this now" is better than " Is it ok to do this now?"  Allow child to cry or scream. Give child a choice of favorite drink if allowed or special sticker.
  56. Assisting Children through Procedures: Preschool child 
    • Before Procedure: Give simple explanations of procedure. Basic drawings may be useful. While providing supervision, allow the child to touch and play with equipment to be used if possible.  Since any entry into the body is viewed as a threat, state that the child's body will remain the same, and use adhesive bandages to reassure the child that the body is intact and part will not "fall out" 
    • During Procedure: Perform in treatment room. Nursing staff should immobilize the child securely. Give short explanations and directions in a positive manner. Encourage control by having child count to 10 or spell name. Allow child to cry. Give positive feedback for cooperation and getting through procedure. Encourage the child to draw afterward to explore the experience.
  57. Assisting Children through Procedures: School Age Child 
    • Before Procedure: Clear, thorough explanations are helpful. Use drawings, pictures, books and contact with equipment. Teach stress reduction techniques such as deep breathing and visualization. Offer a choice of reward after procedure is completed
    • During Procedure: Be ready to immobilize the child if needed. Allow child to remain in position by self if child is able to be still. Explain throughout procedure what is happening.  Facilitate use of stress control techniques. Praise for cooperative efforts.
  58. Assisting Children through Procedures: Adolescents 
    Before Procedure: Give clear explanations orally and in writing. Teach stress reduction techniques. Explore fear of certain procedures such as staple removal, and venipuncture

    During Procedure: Assist adolescent in self control. Assist use of stress reduction techniques. Explain expected outcome and tell when results of test will be completed.
  59. Therapeutic Play Techniques: Stories
    Assessment: Have the child make up a story about a picture. Analyze content and emotional clues in the story. Have child tell a story about an important experience  in a group of other children.

    Interventions: Read or make up stories to explain illness, hospitalization, or other specific aspects of health care. Emotions such as fear can be included.
  60. Therapeutic Play Techniques: Drawings
    Assessment: Ask the child to draw a picture about being in the hospital. Consider the subject matter, size and placement of items in drawings, colors used, presence or absence of physical barriers, and general emotional feeling. 

    Interventions: Use the childs drawings or outlines of the body to explain care, procedures or conditions. Provide an opportunity for the child to draw pictures of his or her choice or directed topics such as a picture  of the child's family or healthcare encounter. Ask the child, " Tell me about your picture."  Be alert to the child's emotions: " This child must be frightened by the big xray machine"
  61. Therapeutic Play Techniques: Music
    Assessment: Observe types of music chosen and effects of played music on behavior

    Interventions: Encourage parents and children to bring favorite tapes to the hospital for stress relief. Have tapes playing during tests and procedures. Parents can tape their voices to play for infants and young children during separations. During longer hospitalizations child can tape messages for siblings or classmates, who are then encouraged to retape their responses. Playtime can include the opportunity to play instruments and sing.
  62. Therapeutic Play Techniques: Puppets 
    Assessment: The puppets can ask questions to young children, who are often more than likely to answer the puppet than a person. 

    Interventions: Perform short skits to teach children necessary healthcare information include emotional content when appropriate
  63. Therapeutic Play Techniques: Dramatic Play
    Assessment: Provide dolls and medical equipment and analyze the roles assigned to dolls by the child, the behavior demonstrated by the dolls in the child's play, and the apparent emotions. Dolls with health problems like those of the child are especially helpful.

    Interventions: Provide dolls and equipment for play sessions. To ensure safety, supervise close when actual equipment is used. Respond to emotions and behavior shown. Use dolls and equipment such as cast, nebulizer and intravenous apparatus and stethoscope to explain care. Use dolls with problems or handicaps similar to those of the child when available. Provide toys that foster expression of emotion such as pounding on board and indoor darts.
  64. Therapeutic Play Techniques: Pets
    • Assessment: Provide animal assisted therapy. Watch the interaction between child and animal. 
    • Interventions: Respond to emotions the child shows. Facilitate touch and stroking of animals
  65. Neonatal Infant Pain Scale (NIPS) Facial Expression
    • Characteristic:
    • Facial expression-              Scoring Criteria
    • 0= Relaxed muscles   Restful face with                                        neutral expression

    1= grimace               Tight facial muscles, furrowed brow, chin and jaw (Note: At low gestational age, infants may have no facial expression)
  66. Neonatal Infant Pain Scale (NIPS) Cry
    • Characteristic:          Scoring criteria 
    • 0= No cry                Quiet not crying

    1=Whimper   Mild moaning, intermittent cry

    2=vigorous cry    Loud screaming, rising, shrill, and continous (Note: Silent cry maybe scored if infant is intubated, as indicated by obvious facial movements)
  67. Neonatal Infant Pain Scale (NIPS) Breathing patterns
    • Characteristics:            Scoring Criteria
    • 0=Relaxed        Relaxed,usual breathing                                pattern maintained

    1=change in breathing  Change in drawing breath; irregular, faster than usual, gagging or holding breath
  68. Neonatal Infant Pain Scale (NIPS)- Arm Movements
    • Characteristics                      Scoring                                                              Criteria
    • 0=relaxed/restrained   relaxed, no muscle                                       rigidity, random                                           movements of arms
    • 1=flexed/extended           tense, straight arms,                                 rigid, or rapid                                             extension and                                                 flexion
  69. Neonatal Infant Pain Scale (NIPS) Leg Movements
    Characteristics                   Scoring Criteria 

    0=Relaxed/restrained    Relaxed, no muscle rigidity, occasional random movements 

    1=Flexed/Extended       Tense, straight legs, rigid, or rapid extension and flexion
  70. Neonatal Infant Pain Scale (NIPS) State of Arousal 
    Characteristic                  Scoring Criteria

    0=Sleeping/Awake     Quiet, peaceful,sleeping; or alert and settled 

    1=Fussy                 Alert and restless or thrashing;fussy
  71. FLACC Behavioral Pain Assessment scale- Category 0 
    Category 0 

    Face- no particular expression or smile

    Legs- Normal position or relaxed

    Activity- Lying quietly, normal position, moves easily

    Cry- no cry (awake or asleep) 

    Consolability- Content, relaxed
  72. FLACC Behavioral Pain Assessment scale: Category 1
    Category 1

    Face: Occasional grimace or frown; withdrawn, disinterested

    Legs: Uneasy, restless, tense

    Activity: Squirming, shifting back and forth, tense 

    Cry: Moans or whimpers, occasional complaint 

    Consolability: Reassured by occasional touching, hugging or being talked to; distractible
  73. FLACC Behavioral Pain Assessment scale: Category 2
    Category 2

    Face: Frequent to constant frown, clenched jaw, quivering chin

    Legs: Kicking legs, drawn up

    Activity: Arched, rigid, or jerking

    Cry: Crying steadily, screams or sobs; frequent complaints

    Consolability: Difficult to console or comfort
  74. Erik's Theory of Psychosocial development: Trust VS Mistrust (Birth to 1 year) 
    The task of the first year of life is to establish trust in the people providing care. Trust is fostered by provision of food, clean clothing, touch and comfort. If basic needs are not met, the infant eventually learn to mistrust others.
  75. Erik's Theory of Psychosocial development:Autonomy VS Shame and Doubt (1-3 years) 
    The toddlers sense of autonomy or independence is shown by controlling body excretions, saying no when asked to do something, and directing motor activity and play. Children who are consistently criticized for expressions of autonomy or for lack of control- for example,  during toilet training--will develop a sense of shame about themselves and doubt in their abilities.
  76. Erik's Theory of Psychosocial development: Initiative VS Guilt (3-6)
    The young child initiates new activities and considers new ideas. This interest in exploring the world creates a child who is involved and busy. Constant criticism, on the other hand, leads to feelings of guilt and a lack of purpose.
  77. Erik's Theory of Psychosocial development: Industry VS inferiority (6-12) 
    The middle years of childhood are characterized by development of new interest and by involvement in activities. The child takes pride in accomplishments in sports, school, home and community. In the child, cannot accomplish what is expected, however, the result will be a sense of inferiority.
  78. Erik's Theory of Psychosocial development: Identity VS Role Confusion
    In Adolescence, as the body matures and thought processes become more complex, a new sense of identity or self is established. The self, family, peer group and community are all examined and redefined. The adolescent who is unable to establish a meaningful definition of self will experience confusion in one or more roles of life.
  79. Piaget's Theory of cognitive development: Sensorimotor Stage (Birth to 1 year)
    Characteristics of Stage: The baby learns from movement and sensory input

    Nursing Applications: Use crib mobiles, manipulative toys, wall mural and bright colors to provide interesting stimuli and comfort. Use toys to distract the baby during procedures and assessments
  80. Piaget's Theory of cognitive development: Preoperational (2-7 years) 
    Characteristics of Stage-The child shows increasing curiosity and explorative behavior. Language skills improve. The young child thinks by using words as symbols, but logic is not well developed. 

    The child is increasingly verbal but has some limitations in thought processes. Causality is often confused, so the child may feel responsible for causing illness. 

    Nursing Applications-Ensure safe surroundings to allow opportunities to manipulate objects. Name objects and give simple explanations. 

    Offer explanations about procedures and treatments. Clearly explain that the child is not responsible for causing an illness in self or family member.
  81. Piaget's Theory of cognitive development: Concrete operational (7-11 years) p 864, 865
    • Characteristics of Stage-Transductive reasoning has given way to a more accurate understanding of cause and effect. The child can reason quite well if concrete objects are used in teaching or experimentation. The concept of conservation (that matter does not change when its form is altered) is learned at this age. 
    • The child is capable of mature thought when allowed to manipulate and see objects. 
    • Nursing Applications- Give clear instructions about details of treatment. Show the child the equipment that will be used for treatment. 
  82. Piaget's Theory of cognitive development: Formal Operations (12-18 years) 
    • Characteristics of Stage- The adolescent is capable  of mature, abstract thought.  
    • Fully mature intellectual thought has now been attained. The adolescent can think abstractly about objects or concepts and consider different alternatives or outcomes. 

    Nursing Applications- Give clear and complete information about healthcare and treatments. Offer both written and verbal instructions. Continue to provide education about the disease to the adolescent with a chronic illness, as mature thought now leads to great understanding.

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