Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds > 3.2 Pediatric Hospitalization > Flashcards

3.2 Pediatric Hospitalization Flashcards

1
Q

MEDICATION ADMINISTRATION

A

We would always like to use the least invasive method that we can.

  • Oral medication would be the first one we choose as long as it is effective
  • We also want to make sure we use to the lowest effective dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Oral Medications

A

Most are liquid medications (especially for school-aged or younger)

Methods

Oral Medication Syringe (Orange)
- Syringes come in 1, 3, 5, 10 mL
- Take the syringe, and place it into their cheek to reduce risk of aspiration or spitting out medications

Med Cup
- Medications greater than 5mL children have the choice between syringe or med-cup

  • Some medications do not taste very good. We can mix medications with SMALL amounts of food like apple sauce to make it taste better.
  • DO NOT MIX MEDICATIONS WITH A BOTTLE (milk, juice, formula) BECAUSE IF THE CHILD DOES NOT FINISH THEIR BOTTLE, WE DON’T KNOW HOW MUCH MEDICATION THEY RECEIVED.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

IM Medications

A

Considerations

  • Size
    22 or 25 gauge needle
    1/2 or 1 inch needle
  • Site
    Infants - Vastus Lateralis (middle outer high. best way)
    Age 12-24 months - Deltoid or Vastus Lateralis
  • Max Volumes
    Vastus Lateralis - Maximum of 0.5mL for infants, 1-2mL for toddlers, 3mL for adolescents
    Deltoid - Maximum of 0.5 mL for children and 1mL for adolescents.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

IV Medications

A
  • Veins in children are much smaller and fragile than adults
  • Protection of IV sites are incredibly important (check every 1 hour and document)
  • Risk of infiltration is much higher in children (cold, hard, swollen, puffy)
  • Risk of phlebitis (warm, red streaks running down up and down extremities. Veins are hard)
  • Risk of Infection (redness, drainage, tenderness)
  • Comparing extremities between each other is a good way of assessing IV’s

Size - 22 gauge or 24 gauge for small infants
Site - IV’s tend to be in the foot (because it is easier to find veins)

METHODS
- Transilluminators or ultrasounds can be used to find veins in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Eye and Ear Drops

A

Ear Drops
- 3+ years old pinna up and back
- >3 years old ear down and back

Eye Drops
- Never touch the opening of the bottle directly to the eye
- Always go from inner campus to outer campus with ointments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CHILDS REACTION TO HOSPITILIZATION

A
  • Children’s understanding of their hospitalization is based on their developmental stages
  • All children understand play, so use play to help educate and reduce stress.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Significant Stressors

A
  • Caregiver separation (minimize separation)
  • Loss of control, autonomy, privacy
  • Fear of bodily injury
  • Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Infant Hospitilization

A
  • Communicate through non-verbal communication
  • SEPARATION ANXIETY (4-8 months)
  • Stranger Anxiety (6-8 months until 18 months)
  • Sleep Deprivation
  • Infants sense fear and anxiety (they will pick up on you/parents being anxious)
  • Encourage parent’s to be present as much as possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Separation Anxiety Phases

A

1st Phase - Protest Phase
- When parent’s leave, the infant will look and reach for the parent. They do not want to the parents to leave and will act out to try and get their parent’s to stay

2nd Phase - Despair Phase
- They are sad and withdrawn when they realize their parents aren’t there.
- Typically issue resolves in despair phase

3rd Phase - Detachment Phase (RARE)
- If issues do not resolve in despair phase then they move forward to detachment phase
- Happens with prolonged separation from parents
- Child starts bonding with other caregivers and acts like they don’t know their parents at all when they return.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Toddler Hospitilization

A
  • MOST AT RISK FOR STRESSFUL EXPERIENCE
  • Fear of pain, invasive procedures, change, mutilation
  • Separation anxiety
  • Loss of control (REALLY DO NOT LIKE DISRUPTION OF ROUTINE AND LOSS OF CONTROL)
  • They think hospitalization is their fault

STRATEGIES
- Get on their level when talking to them
- Initially talk to parent’s to gain toddler’s trust
- Encourage parent’s to be present
- Allow toddler choices whenever you can

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Preschool Hospitalization

A
  • Fear of being alone, abandoned
  • Loss of control
  • FEAR OF BODILY INJURY
  • VERY CONCRETE THINKERS
  • Difficulty separating reality from magical thinking and animism

STRATEGIES
- Use very concrete words and be non-threatening
- Re-assure that being hospitalized is not their fault
- Nightlights
- They do not understand the concept of time (tell them time in relation to events instead of “6:00pm”
- Try to keep home schedules or let them know schedules because they like routine
- Encourage independence of choice (because they are in the initiative phase)
- Encourage parent’s to call from work
- ASSURE THAT HOSPITILAZATION IS NOT THEIR FAULT
- Show them materials that you will be using for the procedures to provide comfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

School-aged Child Hospitalization

A
  • Loss of control and bodily functions
  • Privacy
  • Fear of injury, body integrity, pain, and death
  • PEER GROUPS ARE IMPORTANT (INCLUDE THEIR PEER GROUPS)

Strategies
- Concrete literal terms. Keep it simple
- Include peer groups as much as possible
- Explain to parent’s that regression is normal

Developmental Stage - Industry vs Inferiority
- Allow them to help and doing things on their own
- Encourage them to continue to work on school work (or arts and crafts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Adolescents Hospitilization

A
  • CHANGES IN BODY IMAGE
  • PRIVACY/CONTROL (INDEPENDENCE)
  • LOSS OF PEER GROUP CONTACT

Strategies
- Capable of abstract thought (BE HONEST WITH THEM)
- Treat them like an adult (but may become angry because they depend on their parents)
- Motivational interviewing technique (tell me about another time that was challenging for you and how did you respond, what did you learn?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PARENTS AND SIBLINGS DURING A CHILD’S HOSPITALIZATION

A
  • Parents experience anger or guilt when children are hospitalized
  • It is important to address these feelings and help to resolve them (active listening, offer support)

PARENTAL ROLES MAY CHANGE
- If one parent is staying at the hospital with the child, the other parent may need to take on both roles at home. (This can be stressful)

PARENTS ARE NO LONGER PRIMARY DECISION MAKER
- Nurses and physicians become the primary decision maker and loss of control can be challenging. Important to include parents in decision making process.

PARENT NEEDS
- Be informed (Inform parents of treatments and determine best forms of communication with them.
- Seen as competent parents
- Have some control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Siblings

A
  • Anger and jealousy between sibling and ill child
  • Siblings might feel lonely, resentment, guilt
  • Ill child may feel obligated to play sick role
  • Parents may try to overprotect a child if they are always sick
  • Siblings don’t like other siblings are getting more attention

EXPERIENCE
- Jealousy
- Hostility
- Guilt
- Insecurity
- REGRESSION
- Fear

STRATEGIES
- Important to tell parents not to neglect the other sibling.
- Encourage the other sibling to come visit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Informed Consent vs Assent

A

Informed Consent (VARIES STATE BY STATE)
- Legal protection for a minor under 18, we need informed consent from parents

EXCEPTIONS
- Emergency treatment that is life threatening and cannot get a hold of parents.
- Harm to self or others
- STI, birth control, pregnancy
- Substance abuse
- Mature Minor Doctrine - You can decide for yourself under 18 if you are married, emancipated, military

Assent
- Looking for agreement of child for different treatments
- Provide information (school-age and above) and ask if child agrees with what they’re doing.
- Answer child’s questions
- Usually worried about in research because we need both informed consent from parents and assent from the child in regards to the research study and experimental treatments they are involved with.
- Operations should not be done on a child’s bed because this is the child’s safe space. Operations should be done in the treatment room

17
Q

PEDIATRIC PAIN

A
18
Q

Child Life Specialists

A
  • Mix between knowledge of psychology and medical procedures
  • They help children psychologically adjust to the hospital
  • They explaining procedures to children in a way they will understand,
  • They help keep children occupied in the hospital
19
Q

Preparing Children for Procedures

A
  • Explain procedures based on developmental level
  • Demonstrate things on a teddy bear or parent or show videos
  • Ask parents if they would like to be present (parents provide child with security/safety) but some parents do not like to be present. If they do chose to be present, make sure to educate on the procedure and how they can be helpful.
  • PROVIDE A-TRAUMATIC CARE AND INCREASE CHILDS SENSE OF CONTROL
  • Approach child with confidence (they can sense anxiety)

TREATMENT ROOM
- Used to preform procedures

20
Q

Fever Management

A
  • 100.4+ (38C+)

Most Common Medications
- Acetaminophen (Tylenol) - Given at any age
(Oral, Tablets - for older kids, Rectal, IV. Dosage - 10-15 mg/kg/dose every 4-6 hours)
- Ibuprofen (Motrin) - Only 6+ months or older
(Oral, Tablet. Dosage - 5-10 mg/kg/dose every 6-8 hours)
- NO ASPIRIN DUE TO RISK OF REYES SYNDROME

OTHER STRATEGIES
- Cool cloth over head
- Lower temperature of room
- Take off excessive clothes/blankets
- Uncover head/feet

21
Q

Restraints

A
  • Intent to remove medical devices (IV, NG, Chest Tube, Dressing, Sutures)
  • Intent to immobilize, prevent falls, violence (if they are aggressive)

IMPORTANT
- Use least restrictive way possible
- Physicians order
- Check skin integrity and pulse frequently
- “No-no” is used to cover IV’s. It is NOT considered a restraint
- If a child has the ability to move an extremity and is not pinned down to a surface, it is not a restraint.
- Having bed-rails up is also NOT considered a restraint like adults.

22
Q

Feeding a Sick Child

A
  • Most have a loss of appetite
  • It is okay if they don’t eat for a little while but hydration is VERY important. We need them to have adequate urinary output otherwise they will need to placed on IV fluids.

Urinary Output - 1 mL/kg/hour

23
Q

Pain Behaviors

A

Infants
- Facial grimace, chin quiver, poor feeding, crying

Toddlers
- Body withdrawal and resistance, aggressive, crying and screaming
- They will verbally tell you I am hurting

Pre-schooler
- Verbal resistance and frustration
- They will tell you where the pain is and become frustrated because you don’t understand they are in pain

School-Aged Child
- Passive, fist clench, emotional withdrawal, avoid movement
- Tries to be brave (does not want you to know they are in pain)

Adolescents
- They try to behave socially acceptable (does not lash out or cry)
- They usually do not report pain because they feel it is obvious

24
Q

Pain in Children

A
  • Children not feeling pain is a MYTH
  • Adrenergic nervous system is stimulated during pain response
    (tachycardia, tachypnea, dilated pupils, perspiration, increase in catecholamines, epinephrine, hyper/hypotension)
  • Body typically adapts to pain within 5 minutes, but still take vitals into consideration especially if there is a spike
  • Parents know their child better than we know them. LISTEN TO PARENTS WHEN THEY SAY THEY ARE IN PAIN OR NOT NORMAL
25
Q

Pain Assessment Tools

A

FLACC Scale - Age 0-3
- Go through parameters, assign child a score, and base pain off of score
- FLACC (Face, Legs, Activity, Cry, Consolability)

Wong Baker Scale (Faces Scale) - Ages 3-8
- Children can point to a face of how they are feeling

Numeric Pain Rating Scale - Age 8+
- 0 is no pain and 10 is the worst pain
- In addition include where the pain is, what does it feel like, how long has it been present

26
Q

Pain Medication

A
  • Always go from least heavy to most heavy

Pain Medication Levels

NSAIDs - Mild-Moderate Pain

Morphine - Gold Standard for Moderate-Severe Pain
- IV first then oral
Hydromorphone - Longer duration and less n/v
Oxycodone

Fentanyl - (100x more potent than morphine) VERY SPECIFIC MEDICATION

27
Q

CHRONIC ILLNESS, DEATH, AND DYING

A

Chronic Illness - Condition that is expected to last 3+ months and receive most of their healthcare in the community

28
Q

Impact on Parents

A
  • Parents will feel shock and denial first, then transition to guilt/anger
  • Once parent’s acknowledge the diagnosis, they are more able to cope (normalize)
  • When coping doesn’t happen, parents isolate themselves.
  • Parents are usually overprotective but do not provide discipline to children with chronic illness.
  • We need to consider caregiver burnout when taking care of a patient with chronic illness
29
Q

Impact on Siblings

A
  • Siblings may feel anger but they want to stay informed about their siblings condition
  • Siblings want to feel appreciated for extra responsibilities of caring for siblings (acknowledge these siblings)
30
Q

How to Support Patient with Chronic Illness

A
  • Goal is to promote optimal growth and development, self image, and quality of life. We want them to live as normal of a life as possible and alleviate as many situations of them feeling different.
  • Take the time to talk about how to incorporate the disease process into their life with the patients and parents.
31
Q

Physical Signs of Approaching Death

A
  • Loss of sensation, movement, weakness
  • Hearing is the last sensation to go
  • Anorexia, difficulty swallowing, unable to cough effectively.
  • Cool, clammy diaphoretic skin
  • Confusion, slurred speech, loss of consciousness, visions
  • Cheyne-Stokes (respiratory), apnea, audible breath sounds
  • Slow weak pulse, low BP
  • Incontinence (Bowel and Bladder)
32
Q

Family Support During Dying Process

A
  • Work very closely with the family
  • Prepare family for changes in behavior or appearance the child may experience
  • Ask family what is most important in the final moments (who do they want to be there, rituals they want preformed, do they want a priest to be present)
  • Allow family to be close with the child
  • Saying as a group goodbye and cry together
  • Would the family prefer to be alone or have you there?
33
Q

Awareness of Dying by Developmental Level

A

Infants - Not aware of death situations (only react to grief of those around them)

Toddler - They know they are feeling bad but don’t know why (react to the behaviors around them)

Preschooler - View death as temporary and reversible. Don’t necessarily understand what’s happening

School-Aged - Starting at age 9-10 they know that death is final and irreversible. They have anxiety around death. Concerned about loved ones and those they are leaving behind.

Adolescents - Very mature understanding of death, but difficulty coping. Teenagers feel angry about their body image changing and that they don’t get to experience all that life has to offer. Extremely distressing.

34
Q

Evaluations of Outcomes in Death

A

GOALS

  • Child is pain free and comfortable. Physiological needs are met.
  • Family and Child receive as much support as possible.
  • Provide continued support after death

Peds (72 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions