Chapter 23: nursing care of hospitalized child Flashcards
family centered care provides…
patient & family consistency, collaboration, and empowerment
- helps decrease the negativity surround hospitalization
hospital settings for children vs adults
- requires child friendly and child focused care to achieve best clinical outcomes
- medical play
- play room is “safe space” - no physical exams, medication administration, or any medical assessment or discussions take place
admission procedures
- demographics
- chief complaint, associated symptoms, and PMH
- known allergies
- medication reconciliation
- developmental milestones
- toilet training and patterns
- immunization history and any need for updates
- pain response, previous pain experiences, how the child expresses pain, and what soothes the child
- eating patterns and typical diet
- spiritual needs, religious practices, and cultural influences to the child’s care
- special comfort item such as a blanket or stuffed animal
3 stages of emotional response to hospitalization
- protest
- despair
- detachment/denial
results of emotional response to hospitalization
- when a hospitalized child’s relationship w/ parents and family is disrupted
- hospital experience promotes a feeling of distrust
- children feel lack of control and perceive hospital experience as a threat
- separation anxiety occurs in ages 6-36 months
nursing goals in hospital settings for children vs adults
- build trust
- offer support
reactions: stranger anxiety, regression, sleep deprivation
- stranger anxiety: anxiety w/ presence of stranger
- regression: behavior associated w/ younger developmental stage
other issues in hospital settings for children vs adults
- bed selection: age, safety, no coeds once preteen, let them pick out their bed, contagious diseases safety, their plan for care if they have other children, etc
- visiting hours
- parents at the bedside
- child’s age
- nature of the disease process
- parental employment
- availability of extended family members
- trust in the hospital safety system
- presence of a child life specialist
- cultural and ethnic norms and practices
- siblings reactions to hospitalization
- meals
- safety w/ alarm systems
- sensory impairment
functions of play
- creativity
- sensorimotor development
- intellectual development
- socialization and moral development
- self awareness
- distractibility from stress, anxiety, and tension
types of play
infants: solitary
toddlers: parallel
preschoolers: associative
school aged children: cooperative
adolescents: cooperative; abstract problem solving
functions of medical play
- accomplish therapeutic goals
- express emotions and fears
- master the unknown
- express fear and anger
- learning opportunity
providing a safe environment: teach parents
- how to use call bell
- symptoms or linical signs to report
- how and when to call for help
- how to use side rails on cribs
- have all electrical equipment checked for safety
- supervised ambulation policies
- never walk barefoot
- do not sleep with infants or young toddlers in big beds
- lock up supplies
- prevent infusion and monitoring equipment from being touched
pain management
- report all changes in clinical status
- short and long term consequences of untreated pain
short term consequences of untreated pain
- vital signs changes: decrease in 02 sats, increased BP and HR
- changes in glucose metabolism
- mistrust in environment and healthcare team
- impaired sleep and physical function
long term consequences of untreated pain affects
- poor motor performance
- poor adaptive behavior, learning disorders, cognitive issues
- temperament changes and psychosocial problems
pain assessment considers 3 areas
physiologic indicators
behavioral aspects of pain
results of pain tool assessments
assessment of pediatric responses to pain
response to pain and assessments of pain differ based on age
pain tools
objective: infants
subjective: preschoolers, school age children, and adolescents
pharmaceutical interventions
- consult current drug guide
- have the child’s most current weight in kg
- follow safety procedures for narcotics
- double check infant an young children’s pain medication doses with a 2nd nurse
- involve the parents in the assessment and management of pain
- document non pharmaceutical and pharmaceutical interventions
- use topical anesthetics as appropriate
- be aware of how cultural considerations influence pain
- special concerns when conscious sedation is used
hospital procedures w/ children in mind
- prepare children and families for procedures
- assess child’s and family’s understanding
- allow time to process and ask questions
- explain in simpler language, use visual aids
- parent/legal guardian signs the consent form after explanation of the procedure, possible risks, expected benefits, and alternatives
- use interpreter if primary language is not english
- special consent needed for photographs
preparing for surgery
- explain the surgery
- comfort the child
- talk in a quiet, soft voice w/ direct eye contact
- keep the child w/ the parents UNTIL sedation
physical aspects of hospital procedures w/ children in mind
- remove jewelry
- tie hair back
- wash skin
- remove nail polish
- report loose teeth
- ensure readable identification band in place
postop care assessment
- airway, breathing, and circulation (ABCs)
- neurologic status
- vital signs, oxygen saturation, need for oxygen
- pain
- IV lines/pumps/catheters patency
- wound or surgical incision areas
- safety
- position for comfort
- need for elimination
- emotional support parents/caregivers
activities for recovery after medical procedures
- early ambulation
- increasing fluid intake
- deep breathing/incentive spirometer
- dressing changes
- removal of monitoring devices
positioning for procedures
- varies depending upon the procedure
restraints: purpose
- prevent movement
- protect procedural site
guidelines for child restraints
- use least restrictive restraint
- follow institutional policy about the use of restraints
- consder therapeutical hugging instead
types of restraints
- pediatric immobilizers or extremity restraints (protect IV lines) —> assess every 30 min
- mummy (swaddle) restraint
- leg and arm restraints
safety steps for IV
- prevent accidental bolus of fluids or drugs
- prevent medication infiltrations
- prevent strangulation in young child
- prevent tissue injury by assessing and reporting child who is crying inconsolably or is fussy
feeding considerations for sick and hospitalized child
- have family bring food from home to assist w/ child’s intake
- allow child to select foods from hospital food service, encouraging mild and colorful choices
- before and after procedure, children are NPO. progress to clear fluids, then full liquid, then soft diet, then regular
- adhere to prescribed diet
- calorie counts may be prescribed
- determine the child’s minimal fluid maintenance
- provide GI feeds as prescribed
- prevent aspiration and skin breakdown
- assess patency for administration
- monitor intake and output
- positive fluid balance: intake>output - risk fluid overload
- negative fluid balance: output>input
administrating medications to hospitalized children
- follow “10 rights” of medication administration (page 421, box 23.4 davis*)
- focus on safety: safe storage, safe dosing, verify accuracy
- never leave medications at the bedside
the 10 rights of medication administration
right pt
right drug
right dose
right route
right time
right method
right pre admin assessment
right family education
right post admin assessment
right documentation
oral medications
- flavored liquid or a chewable tablet
- if not palpable, mix w/ small amount flavored syrup
- draw up in oral syringe
- ask for parental help when giving medication to older infants and toddlers
- do not force a crying infant or young child to take medication
sublingual medications
- medication placed under the tongue or against cheek
subcutaneous and intradermal medications
- use the smallest gauge needle
- inject the smallest volume
- use 45 degree w/ little subcutaneous tissue
- use 90 degree angle w/ adequate tissue
- insert needle bevel up
- use upper outer arm, central thigh, or abdomen
- rotate sites
intramuscular (IM) medications
- commonly used for antibiotics or pain medication
- consider 3 aspects of the medication: amount determines syringe size, viscosity determines needle gauge, depth of tissue determines needle length
maximum amounts of medications administered
- 1ml for infants, young children up to 5 years of age
- .5ml for 6-10 years of age
- 2ml for 11-18 years of age
common injection sites
vasus lateralis
ventrogluteal
deltoid
pediatric injection sites
- Emla cream provides topical analgesia
ear medications
side lying position
place a cotton ball in the ear after aministration
use medication at room temperature
eye medications
supine position
topical medications
use a thin layer of
rectal medications
- lubricate the suppository
- gently insert w/ a gloved finger
specimen collection: general
wear gloves
place in appropriate container
label w/ collector’s initials, date, MR#, time of collection
types of specimens
urine
stool
sputum
viral respiratory
MRSA
influence A and B
medication storage for parents
- keep out of reach of children
- keep medications in original containers
- close child safe containers
calculating doses for parents education
- teach how to read the label
- teach how to calculate amount to be administered
- use marked spoons, large font syringes, and clearly marked medication cups for accuracy
