Hospitalized Child

Presented by

Marlene Meador RN, MSN, CNE

What age is most effected by separation anxiety?

0-8 months9-36 monthsPreschoolSchool agedAdolescent

Stages of Separation

Protest

Despair

Detachment

Nursing Interventions:

How does the nurse meet the needs of the hospitalized child in each age group?

InfantToddler-PreschoolSchool- agedAdolescent

Family’s Response to Hospitalization

Perception

Support system

Coping mechanism

What determines the family’s response to a child’s hospitalization?

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?

Developmental Milestones

Infant- Trust vs. MistrustToddler- Initiative vs. GuiltPreschool- IndustryAdolescence- Identity vs. Identity

diffusion

Nursing Care of the Child with Special Needs:

Special equipment- visually or hearing impaired, wheelchairs,

Specialized care- feeding tubes, trachs/ventsAssess family coping ability- who is primary

caregiverAssess support systems Involve additional members of the healthcare

team

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- collaborationO- objectiveP- proactiveE- evaluateAvoid placating or condescending phrases.

Pain Assessment

Infant- grimacing, poor feeding, restlessness, crying

Toddler- clinging to parent, crying, pulling or rubbing area of pain, anorexia, vomiting, restlessness.

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.

Pain Assessment Tools:

FACES- smile to worst hurt (tears)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

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?

If you have any questions or concerns regarding this information please contact Marlene Meador via email mmeador@austincc.edu

Or cell phone 512-422-8749