Pediatrics Care of the Hospitalized Child
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What are some variable that affect a child's response to hospitalization?
- Child's age
- Type and amount of preparation
- Length of hospitalization and frequency
- Previous experience
- Child's temperament
- Coping abilities of both the child and the parents
- Parent/child relationship
- Reason for hospitalization
- Hospital environment
What are some stressors of hospitalization?
- Separation from parents, peers, and trusted adults
- Harm and injury
- Loss of control, mobility, and decision making role
- Unknown and unfamiliar events and environment
- Unclear limits and expectations
What are the three phases of separation anxiety?
- 1. Protest Phase: Cry and scream, cling to parent
- 2. Despair Phase: Crying stops, evidence of depression
- 3. Detachment Phase: denial-resignation but not contentment. This may seriously affect the attachment to parent after separation
What are the infant's needs when they lose control during the hospital stay?
- Consistent loving caregivers
- Daily Routines
When they lose control, what are the toddler's needs?
- Daily routines and rituals
- Loss of control may contribute to regression of behaviors, negativity, and temper tantrums
What are the preschooler's needs when they lose control during a hospital stay?
- Egocentric and magical thinking typical of this age
- May view illness or hospitalization as punishment for deeds
- (Preoperative thought)
When adolescents lose control, what are their needs?
- Struggle for independence and liberation
- Separation from peer group
- May respond with anger, frustration
- Need for information about their condition
What are the effects of hospitalization on the child?
- Effects may be seen before admission, during hospitalization or after discharge
- Child's concept of illness is more important than the intellectual maturity in predicting anxiety
- Fears and negative experiences by children may persist into adulthood and result in avoidance of needed care
What are the beneficial effects of the hospitalization on the child?
- Recovery from illness
- Increase in Coping skills
- Master stress and feel competent in coping
- New socialization experiences
How do parents respond to the stressors of hospitalization?
- Disbelief, anger, guilt (Esp if sudden illness)
- Fear and anxiety related to child's pain and seriousness of illness
- Frustration (especially related to the need for information)
How do siblings respond to the stressors of hospitalization?
- Loneliness, fear, and worry
- Anger, resentment and jealousy
- Guilt (especially if they had wished their sibling ill-magical thinking)
During hospitalization, how are family roles altered?
- There may be jealousy between siblings
- Ill child obligated to play sick role
- Parents continue in pattern of overprotection and indulgent attention to the sick child
What are some strategies for reducing the stress of hospitalization?
- Preparation for hospitalization when possible (tour of hospital prior to scheduled procedures)
- Increase the child's contact with parents
- Pain management and procedural preparation
- Child life programs and child life specialists
- Reduce the amount of time the child is in the hospital
How can the nurse prevent or minimize separation?
- THIS IS THE PRIMARY NURSING GOAL!!
- Family centered care
- Parents are not visitors (respect privacy, respect family discussions, traditions, routines, etc)
- Bring in familiar items from home
How can the nurse "normalize" the hospital environment?
- If possible, maintain the child's daily routine
- Give the child a daily time schedule
- If age appropriate, let the child participate in self care (brushing teeth, combing care, etc)
- Establish a means to complete school work (tutor or cyber school)
- Allow friends and visitors
What nursing care needs to be considered during isolation?
- Its an added stressor of hospitalization
- Child may have a limited understanding of isolation or restraint
- Deal with the child's fears
- Keep in mind the potential for sensory deprivation
What are some considerations for the PICU?
- There is increased stress for the child and the parents
- Stress can be decreased by limiting stimuli such as light and sound (install yacker tracker)
- Parent's need information and should be included in the care plan
- Perception of security for constant monitoring ad individualized care
What are some considerations for Emergency admission to the hospital?
- Admission counseling is essential!
- There should be counseling after the event -"postvention"
- The parents and child should participate as appropriate
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