Chapter 21: Care of the Child in the Hospital, Community, and Across Care Setting Flashcards
Hospital Settings
- Hospital
- Children’s Hospital
- Day Hospital
Hospital
- may be an entirely new experience; exposed to unfamiliar medical environment
- provide many health-care services; emergency care, specialized inpatient care, surgery, critical care, diagnostic tests and treatments, therapies, patient education, and other specialized services
- can be a specialty children’s hospital located in a separate building or may be a part of a general care hospital
Children’s Hospital
specialty pediatric hospital that is specially designed and managed for children that provide carious health-care services
>emergency care, specialized inpatient care, surgery, critical care, diagnostic tests and treatments, patient education, and other specialized services where physicians, nurses, child life specialists, other health-care providers, and employees are specially trained to work with children
Day Hospital
specialized hospital that serves children who require medical treatments such as blood transfusions, chemotherapy, steroid pulse therapy, IV hydration, IV antibiotic therapy, immunoglobulin therapy, or Remicade (infliximab) infusions
Twenty-Four Hour Observation Unit
short-stay hospitalization experience
-occurs when a child becomes suddenly ill and will most likely recover quickly
-may need for observation for treatments such as rehydration, aerosol treatment for acute asthma, or medication for allergic reaction
>at conclusion of the 24-hour period, the child is reassessed and it is then determined whether continued hospitalization is needed or whether the child can be discharged home
>pediatric nurse= provides acute nursing care and then begins to prepare for discharge; part of discharge process the nurse explains specific medical orders as well as when to notify the primary health-care provider with any questions, concerns, or change in condition
Ambulatory Surgery Center
where children receive minimal surgical treatment, recover from the procedure, and are discharged soon after surgery
Fast Track Care
where less urgent children are quickly assessed, treated by a physician, and then discharged home
- in hospitals
- sometimes, after child receives initial assessment and treatment, she is admitted to the hospital depending on the diagnosis and subsequent treatment
Emergency Department
-emergency care provided in the hospital or health-care facility that provides quick treatment for children who have become suddenly ill or experienced a severe injury
-open 24 hours, 7 days a week
-first receive a rapid screening or triage assessment to establish the nature and severity of their presenting illness
>if the illness is severe, the child is treated in an urgent manner, and all necessary procedures, treatments, and tests are performed immediately
-ED may have several areas of treatment; general and minor care area, resuscitation room, or specialty areas for specific populations such as women, or persons requiring mental health care
Critical Care Unit
when critical care of the child is required
>common problems: shock, acute respiratory failure, chronic respiratory failure, infection, sepsis, renal failure, neurological conditions, bleeding and clotting disorders, or multiorgan dysfunction
>nurses usually care for just one or two patients
Caring for a Child at Home after Minor Surgery
- taking the child’s axillary temperature
- assess level of consciousness
- when to give liquids
- when to offer liquids based on type of surgery, prescribed diet, and age
- when to offer solid food based on type of surgery, prescribed diet, and age
- what type of activity is expected or encouraged
- actions and side affects of medications
- signs and symptoms of infection
- signs of poor airway exchange
- how to use assistive devices and medical equipment and perform home treatments
- how to contact nurse, pharmacist, health-care professional, or community agency
- when to call doctor
Reasons for Accessing Medical Care
-illnesses that include fever, cough, vomiting, and diarrhea = leading causes of visits to the ED
-upper respiratory infections, abdominal pain, and asthma = causes of visits to the ED
>epistaxis (nosebleed)
>poisoning from ingesting medications
>lead poisoning
Epistaxis
nosebleed
- common in children
- mostly benign; but serious warrants accessing a care facility
- r/t the increased vascularity of nasal mucosa
Controlling Epistaxis (Nosebleeds)
-don gloves
-put child in sitting position, leaning forward
-apply direct pressure to the anterior nasal septum for 10 to 15 minutes
-remind child to breathe through mouth, so he doesn’t become anxious
-applying ice to nose area is beneficial
>if a large amount of blood occurs, must monitor vital signs
>in cases of severe bleeding lasting longer than 10 to 15 minutes, nasal packaging, as well as topical epinephrine
>when infection present, antibiotics ordered
-nurse keep child and family quiet and calm by providing support and reassurance
-families able to demonstrate first aid measures necessary to control an occurrence of epistaxis
Poisoning by Ingestion of Medication
-common ingestions: acetaminophen (Tylenol) and iron
-caustic ingestions: hydrocarbons and corrosives
>treatment of acetaminophen overdose= most successful when started within 8 hours of the ingestion with N-acetylcysteine (NAC) solution; the NAC binds to the metabolite of acetaminophen, preventing its absorption and metabolism by the liver; this antidote is given orally and may be mixed with fruit juice to increase palatability, if cant tolerate orally a NG tube can be inserted; NAC given q4 hours for 20 to 72 hours depending on level of toxicity and response to therapy
Treatment for Acetaminophen (Tylenol) Toxicity/ Overdose
- started within 8 hours of ingestion
- N-acetylcysteine (NAC) solution; binds to the metabolite of acetaminophen, preventing its absorption, and metabolism by the liver
- antidote given orally, or by NG tube if can tolerate oral
- may be mixed with fruit juice to increase palatability
- given q4 hours for 20 to 72 hours depending on level of toxicity and response to treatment
