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PNC 102 lecture > Chapter 23: nursing care of hospitalized child > Flashcards

Chapter 23: nursing care of hospitalized child Flashcards

1
Q

family centered care provides…

A

patient & family consistency, collaboration, and empowerment
- helps decrease the negativity surround hospitalization

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2
Q

hospital settings for children vs adults

A
  • 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
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3
Q

admission procedures

A
  • 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
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4
Q

3 stages of emotional response to hospitalization

A
  • protest
  • despair
  • detachment/denial
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5
Q

results of emotional response to hospitalization

A
  • 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
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6
Q

nursing goals in hospital settings for children vs adults

A
  • build trust
  • offer support
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7
Q

reactions: stranger anxiety, regression, sleep deprivation

A
  • stranger anxiety: anxiety w/ presence of stranger
  • regression: behavior associated w/ younger developmental stage
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7
Q

other issues in hospital settings for children vs adults

A
  • 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
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8
Q

functions of play

A
  • creativity
  • sensorimotor development
  • intellectual development
  • socialization and moral development
  • self awareness
  • distractibility from stress, anxiety, and tension
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9
Q

types of play

A

infants: solitary
toddlers: parallel
preschoolers: associative
school aged children: cooperative
adolescents: cooperative; abstract problem solving

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10
Q

functions of medical play

A
  • accomplish therapeutic goals
  • express emotions and fears
  • master the unknown
  • express fear and anger
  • learning opportunity
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11
Q

providing a safe environment: teach parents

A
  • 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
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11
Q

pain management

A
  • report all changes in clinical status
  • short and long term consequences of untreated pain
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12
Q

short term consequences of untreated pain

A
  • 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
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13
Q

long term consequences of untreated pain affects

A
  • poor motor performance
  • poor adaptive behavior, learning disorders, cognitive issues
  • temperament changes and psychosocial problems
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14
Q

pain assessment considers 3 areas

A

physiologic indicators
behavioral aspects of pain
results of pain tool assessments

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15
Q

assessment of pediatric responses to pain

A

response to pain and assessments of pain differ based on age

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16
Q

pain tools

A

objective: infants
subjective: preschoolers, school age children, and adolescents

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17
Q

pharmaceutical interventions

A
  • 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
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18
Q

hospital procedures w/ children in mind

A
  • 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
19
Q

preparing for surgery

A
  • explain the surgery
  • comfort the child
  • talk in a quiet, soft voice w/ direct eye contact
  • keep the child w/ the parents UNTIL sedation
20
Q
A
21
Q

physical aspects of hospital procedures w/ children in mind

A
  • remove jewelry
  • tie hair back
  • wash skin
  • remove nail polish
  • report loose teeth
  • ensure readable identification band in place
22
Q

postop care assessment

A
  • 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
23
Q

activities for recovery after medical procedures

A
  • early ambulation
  • increasing fluid intake
  • deep breathing/incentive spirometer
  • dressing changes
  • removal of monitoring devices
24
Q

positioning for procedures

A
  • varies depending upon the procedure
25
Q

restraints: purpose

A
  • prevent movement
  • protect procedural site
26
Q

guidelines for child restraints

A
  • use least restrictive restraint
  • follow institutional policy about the use of restraints
  • consder therapeutical hugging instead
27
Q

types of restraints

A
  • pediatric immobilizers or extremity restraints (protect IV lines) —> assess every 30 min
  • mummy (swaddle) restraint
  • leg and arm restraints
28
Q

safety steps for IV

A
  • 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
29
Q

feeding considerations for sick and hospitalized child

A
  • 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
30
Q

administrating medications to hospitalized children

A
  • 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
31
Q

the 10 rights of medication administration

A

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

32
Q

oral medications

A
  • 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
33
Q

sublingual medications

A
  • medication placed under the tongue or against cheek
34
Q

subcutaneous and intradermal medications

A
  • 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
35
Q

intramuscular (IM) medications

A
  • 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
36
Q

maximum amounts of medications administered

A
  • 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
37
Q

common injection sites

A

vasus lateralis
ventrogluteal
deltoid
pediatric injection sites
- Emla cream provides topical analgesia

38
Q

ear medications

A

side lying position
place a cotton ball in the ear after aministration
use medication at room temperature

39
Q

eye medications

A

supine position

40
Q

topical medications

A

use a thin layer of

41
Q

rectal medications

A
  • lubricate the suppository
  • gently insert w/ a gloved finger
42
Q

specimen collection: general

A

wear gloves
place in appropriate container
label w/ collector’s initials, date, MR#, time of collection

43
Q

types of specimens

A

urine
stool
sputum
viral respiratory
MRSA
influence A and B

44
Q

medication storage for parents

A
  • keep out of reach of children
  • keep medications in original containers
  • close child safe containers
45
Q

calculating doses for parents education

A
  • 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
46
Q
A

PNC 102 lecture (42 decks)

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