Family-Centred Care of the Child During Illness and Hospitalization Flashcards
Stressors of Hospitalization for Children: Infant
Separation anxiety
Stressors of Hospitalization for Children: Toddler
Separation Anxiety
Stressors of Hospitalization for Children: Pre-schooler
separation anxiety and fear of abandonment
Stressors of Hospitalization for Children: School-age child
- loss of control
- loss of privacy & control over bodily functions
- bodily injury
- painful, invasive procedures
- fear of death
Stressors of Hospitalization for Children: Adolescent
Loss of control
Fear of altered body image, disfigurement, disability, & death
Separation from pear group
Responses to Pain: Newborn & young Infant
crying, facial appearance, generalized body response
no relationship b/n cause & response
Responses to Pain: Older infant
Crying; localized body response; expression of pain or anger; physical struggle
Responses to Pain: Young child
Crying & screaming; verbal expressions; thrashing; lack of cooperation; begging; anticipates pain
Children are especially vulnerable to crises of illness & hospitalization because:
stress represents a change from the usual state of health & routine
Children have a limited number of coping mechanisms to resolve stressors
Children’s understanding of health and illness: Infant
separation anxiety (12-30 months esp)
- protest
- despair
- detachment/denial
Behavioural Pain Measures
Typically 0-4 years
more accurate when used alongside self-report tools
Neonatal Infant Pain Scale (NIPS) (6)
Facial Expression
Cry
Breathing patterns
Arm movements
Leg movements
State of Arousal
Separation Anxiety
In the protest phase of separation anxiety, children cry loudly and are inconsolable in their grief for the parent
Healthy for child to be attached to parents
During the despair phase of separation anxiety, children are sad, lonely, and disinterested in play or food
Inactive, noncommumicative, withdrawal, regress to earlier behaviours
Kids rely on structure, routine, and predictability
During the detachment phase of separation anxiety, young children may appear withdrawn and sad, even in the presence of a parent
Stressors for All Children
Separation -> loss of control, autonomy & privacy -> being subjected to painful & invasive procedures -> fear of bodily injury and disfigurement
FLACC Behavioural Pain Assessment Scale
Face
Legs
Activity
Cry
Consolability
Responses to Pain: School-age child
similar to young child; time-wasting behaviours; muscular rigidity
Responses to Pain: Adolescent
Less vocal; less physical resistance; more verbal; increased muscle tension & body control
FACES Pain Rating Scale
- 3+ years
- Ask child to choose face that best describes own pain
Numeric Scale
5+ years (must be able to count & have some concept of numbers & their value in relation to other numbers)
Pharmacological Management
Use two-step strategy
- nonopioids for mild pain
- strong opioids for moderate to severe pain
Regular interval dosing
Use appropriate route of administration
Adapt treatment to individual child
Coping Mechanisms (all ages)
Regression
Denial
Repression (involuntary forgetting)
Postponement
Bargaining
Strategies to Promote Coping and Normal Development
Child Life programs
Rooming in
Therapeutic Play
- toddler
- pre-schooler
- school
Therapeutic Recreation
Why are children vulnerable?
Illness
Limitation of understanding
Little control over what is happening
Trusting relationships may have hidden agenda for nurses
Tension between promoting autonomy & right of self-determination and tenet of protection from harm
Consent versus Assent
Infants Act
A person under the age of 19 years may consent to health care if the following conditions are met:
Person providing health care has:
- explained to the minor and has been satisfied that the minor understands the nature & consequences and the reasonably forseeable benefits & risks of the health care and
- made reasonable efforts to determine & has concluded that the health care is in the minor’s best interest
Nursing Management for Child with a life-threatening illness
Promote sense of security
Provide education about illness or injury & prepare child for procedures
Facilitate use of play
Promote a sense of control
Reactions to Life-threatening Illness or Injury
Shock and disbelief -> anger and guilt -> deprivation and loss -> anticipatory waiting -> readjustment or mourning