Nursing of Children during Illness, hospitalization and in the school setting

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  1. Hospitalization in Childhood: Stressors
    • Stressors of Hospitalization
    • Fear and Anxiety- hosp setting, equip, needles, noises, parents too, diff enviroment from home
    • Separation Anxiety- away from parent, are they coming back 8 months 6-30 months (assure them their parents coming back, comfort, play games, bring family pics, music,  distraction, therapeutic play)
    • Loss of Control- cant use the bathroom alone, even parents may feel this, not usual routine, cant get out of bed (play is the work of children)- can act irrational, regression- (a form of coping with unpleasant experience)

    • Children's response/behavior changes:
    • 1. infants- fearful w/strangers, separation anxiety 6-30 months soldifies 8 months
    • 2. Toddlers- aware of themselves and talk about desire erikson autonomy v shame and doubt - allow this child to make some choices, praise, they need to play
    • 3. Preschool- Similar- therapeutic play, magical thinker, concrete thinker- they take words  literally. encourage parents participation, develop trust, bring pictures of the, or have special toys (items) 
    • 4. School age- acute/chronic erikson- industry v inferiority- at this age children want to accomplish and finish task (they are industrus)- ie puzzles, board games, chest. fearful of their bodies being injured, fear of death, give approriate info, be honest
    • 5. Adolescents- likes to be cool- they maybe stoic- they may not show it helps. they might want control over their situations, erikson- identity v role confusion. the most important people to adolescents- friends. express feelings and pain. let them invite friends to visit. meeting other kids who have the same problems. room teens together. involved them in their care. be supportive, respectful, consistent, truthful.
  2. The Nurses roles in Caring for the hospitalized child PLAY
    Providing play activities and recreation for the hospitalized child

    • Unstructured play- just playing...toddlers playing side by side
    • play as part of nursing care- this helps children to cope
    • Therapeutic play- can pretend they are playing doctor
    • Child life specialist- explain procedures, distract the kids, developmental specialist, tours,
  3. The hospitalized Child Family: feelings and reactions
    reactions of parents

    • Guilt- for not taking them in sooner
    • denial- may feel that children aren't sick
    • anger- why did this happen to me (communication may be impacted)
    • depression- that their child is sick
    • confusion- explanation 
    • helplessness- ans question, encourage parents to participant in child's care
    • uncertainty- is my child going to survive
  4. Stragtegies for fear
    • night light
    • transport- parents should be there or someone else familar with
    • always let them know when u are leaving. introduce new nurse to child
    • make sure child knows what is going on
  5. Pain
    everyone should be medicated for pain

    • Causes
    • - disease process
    • - treatment protocols
    • - surgical interventions
    • - injury

    assessment of pain- pain scales (subjective)
  6. FLACC scale
    2-7 age
    • Face- grimace, frown, crying
    • Leg activity, legs up
    • cry- crying moaning whimpering
    • consolability- hugging

    The higher the score the higher than pain
  7. CRIES
    1-28 days
    • Crying 
    • oxygen required for saturation above 95%- how much
    • increase in vital signs
    • espression
    • sleepness
  8. wong baker scale
    • 1-5 scale
    • or even number 2-10

    explain each face to the children
  9. Visual analog scale
    numeric pain
    5 + age
    • 0 no pain
    • 10 worst pain u ever felt in ur life
  10. Management of Pain
    • Non Pharmacological management 
    •  - behavioral- cognitive strategies 
    •    - relaxation- head shoulder, arms, to their toes
    •    - distraction
    •    - imagery
    •    - positive self talk- i will have some pain and then go home.

    • Hot and cold- heat- vasodilation, reduce pain. ice vasoconstricts- reduce swelling, not to much blood flowing 
    • nonnutritive sucking- sucking pacifers 
    • massage and pressure- not calfs
  11. Management of Pain
    • non opioid analagesics- acetminophen, NSAID's motrin, taradol
    •  - mild to moderate pain
    • - no aspirin to children less than 12 yrs of age bc of risk of Reyes syndrome

    • Opioid analgesics: morphine and others 
    •  - moderate - severe
    • - injection, IV, PCA (bolus) (pt controlled analgesia) 
    • - adverse affects- lowers respiratory rate

    • Local anesthetic application
    • - topical: EMLA (takes like an hour)- used this to help put IV in so it wont hurt
    • - other lidocaine- for local procedure
  12. Management of pain cont
    • Oral is the preferred method
    • rectal- for pt who have difficulty swallowing or N/V
    • IV choice for emergency or severe pain
    •  PCA
  13. Adverse effects with Opioid's
    Constipation- fluids, ambulation, increase fiber- wheat, fruits and vegatables, stool softeners. laxative last resorts cause they can cramp

    Pruritus- itchy- cool compresses. benedryl

    N/V- small frequent meals, anti emetic
  14. Safety
    children are vunerable to harm

    • identifiers- are u working with the right patient
    • monitor closely
    • restraints- cause of IV for ex. MD written order, checking for their circulation, assess hrly, 
    • therapeutic hugging- another restraint.
  15. Methods for carrying children in the hospital
    • Cradle- 3 months
    • football- 2 months 
    • over the shoulder- 7 months
    • Wagon-
  16. How school Nursing has changed?
    • changes dramatically 
    • now we have these kids from all types of disablities in the classroom. 
    • chronic conditions - dm, surgeries, 
    • IHP- individualized health plans for each student
    • focus on immunization, screenings, sexual activity, drug abuse
    • school nurses do it all.
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Nursing of Children during Illness, hospitalization and in the school setting
2014-09-13 15:20:49

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