Hospitalization, Illness, and Play

Question 1

Hospitalization and Illness

Answer 1

Families and children can experience major stress related to hospitalization. The nurse should monitor for evidence of stress and intervene as appropriate.
Families should be considered clients when children are ill.
Separation anxiety manifests in three behavioral responses: protest, despair, detachment.
Each child’s understanding of illness and hospitalization is dependent on the child’s stage of development and cognitive ability.

Question 2

Protest

Answer 2

screaming, clinging to parents, verbal and physical aggression toward strangers.

Question 3

Despair

Answer 3

withdrawal from others, depression, decreased communication, developmental regression.

Question 4

Detachment

Answer 4

interacting with strangers, forming new relationships, happy appearance.

Question 5

Infant Level of Understanding

Answer 5

Inability to describe illness and follow directions.

Lack of understanding of the need of therapeutic procedures.

Question 6

Infant Impact of Hospitalization

Answer 6

Experiences stranger anxiety between 6-18 months of age.
Displays physical behaviors as expressions of discomfort due to inability to verbalize.
Can experience sleep deprivation due to strange noises, monitoring devices, and procedures.
Can experience anxiety due to unfamiliar environment and the fear of the unknown.

Question 7

Toddler Level of Understanding

Answer 7

Limited ability to describe illness.
Poorly developed sense of body image and boundaries.
Limited understanding of the need for therapeutic procedures.
Limited ability to follow directions.

Question 8

Toddler Impact of Hospitalization

Answer 8

Experiences separation anxiety.
Can exhibit an intense reaction to any type of procedure due to the intrusion of boundaries.
Behavior can regress.

Question 9

Preschooler Level of Understanding

Answer 9

Limited understanding of the cause of illness but knows what illness feels like.
Limited ability to describe manifestations.
Fears related to magical thinking.
Ability to understand cause and effect inhibited by concrete thinking.

Question 10

Preschooler Impact of Hospitalization

Answer 10

Can experience separation anxiety.
Can harbor fears of bodily harm.
Might believe illness and hospitalization are a punishment.

Question 11

School-age child Level of Understanding

Answer 11

Beginning awareness of body functioning.
Ability to describe pain.
Increasing ability to understand cause and effect.

Question 12

School-age Child Impact of Hospitalization

Answer 12

Fears loss of control.
Seeks information as a way to maintain a sense of control.
Can sense when not being told the truth.
Can experience stress related to separation from peers and regular routine.

Question 13

Adolescent Level of Understanding

Answer 13

Increasing ability to understand cause and effect.

Perceptions of illness severity are based on the degree of body image changes.

Question 14

Adolescent Impact of Hospitalization

Answer 14

Develops body image disturbance.
Attempts to maintain composure but is embarrassed about losing control.
Experiences feelings of isolation from peers.
Worries about outcome and impact on school/activities.
Might mot adhere to treatments/ medications regimen due to peer influence.

Question 15

Family Responses

Answer 15

Fear and guilt regarding no bringing the child in for care earlier.
Frustration due to the perceived inability to care for the child.
Altered family roles.
Worry regarding finances if work is missed.
Worry regarding care of other children within the household.
Fear related to lack of knowledge regarding illness or treatments.
Siblings experiencing loneliness, jealousy, guilt, fear, or anger.
Caregiver role strain, related to the impact of hospitalization on family process.

Question 16

Assessment

Answer 16

Child’s and family’s understanding of the illness or the reason for hospitalization.
Stressors unique to the child and family (needs of other children in the family, socioeconomic situation, health of other extended family members)
Past experiences with hospitalization and illness.
Developmental level and needs of child/family.
Parenting role and the family’s perception of role changes.
Support available to the child/family.
Coping strategies for periods of crisis.

Question 17

Nursing Intervention (General)

Answer 17

Teach the child and family what to expect during hospitalization.
Encourage family members to stay with the child during the hospital experience to reduce the stress.
Maintain routine as much as possible.
Encourage independence and choices.
Explain treatments, procedures, and cares to the child.
Provide developmentally appropriate activities.

Question 18

Nursing Interventions for Infant

Answer 18

Place infants whose parents are not in attendance close to the nurses station so that their needs can be met quickly.
Provide consistency.

Question 19

Nursing Interventions for Toddlers

Answer 19

Encourage parents to provide routine care for the child, such as changing diapers and feeding.
Encourage the child’s autonomy by offering appropriate choices.
Provide consistency in assigning caregivers.

Question 20

Nursing Interventions for Preschoolers

Answer 20

Explain procedures using simple, clear language. Avoid medical jargon and terms that can be misinterpreted.
Encourage independence by letting child provide self care.
Encourage the child to express feelings.
Validate the child’s fears and concerns.
Provide toys that allow for emotional expression, such as pounding board to release feelings of protest.
Provide consistency in assigning caregivers.
Give choices when possible, such as, “Do you want your medicine in a cup or a spoon?”.
Allow younger children to handle equipment if it is safe.

Question 21

Nursing Interventions of Adolescents

Answer 21

Provide factual information.
Include the adolescent in the planning of care to relieve feelings of powerlessness and lack of control.
Encourage contact with peer group.

Question 22

Play

Answer 22

Allows children to express feelings and fears.
Facilitates mastery of development stages and assists in the development of problem solving abilities.
Activities should be specific to each child’s stage of development.
Can be used to teach children.
A means of protection from everyday stressors.

Question 23

Social Affective

Answer 23

taking pleasure in relationships

Question 24

Sense-Pleasure

Answer 24

objects in the environment catching the child’s attention.

Question 25

Skill

Answer 25

demonstrating new abilities

Question 26

Unoccupied behavior

Answer 26

focusing attention on something of interest.

Question 27

Dramatic

Answer 27

pretending and fantasizing.

Question 28

Games

Answer 28

initiative, formal, or competitive.

Question 29

Onlooker

Answer 29

the child observing others.

Question 30

Solitary

Answer 30

the child playing alone

Question 31

Parallel

Answer 31

children playing interdependently but among other children, which is characteristic of toddlers.

Question 32

Associative

Answer 32

Children playing together without organization, which is characteristic of preschoolers.

Question 33

Cooperative Play

Answer 33

organized playing in groups, which is characteristic of school-aged children.

Question 34

Functions of Play

Answer 34

Play helps in the development of carious types of skills. 
Intellectual
Sensorimotor
Social
Self-Awareness
Creativity
Therapeutic and moral values.

Question 35

Infant Play Activities

Answer 35

Birth to 3 months: colorful moving mobiles, music/sound boxes.
3-6 months: Noise-making objects, soft toys.
6-9 months: teething toys, social interaction.
9-12 months: large blocks, toys that pop apart, push-and-pull toys.

Question 36

Toddler Play Activities

Answer 36

Cloth books, puzzles with large pieces.
Large crayons and paper. 
Push-and-pull toys, balls. 
Tricycles. 
Educational television. 
Videos for children.

Question 37

Preschooler Play Activities

Answer 37

Imitative and imaginative play.
Drawing, painting, riding a tricycle, swimming, jumping, running.
Educational television and videos.

Question 38

School-age Play Activities

Answer 38

Games that can be played alone or with another person. 
Team sports. 
Musical Instruments. 
Arts and crafts. 
Collections.

Question 39

Adolescent Play Activities

Answer 39

Team sports.
School activities.
Reading, listening to music.
Peer interactions.

Question 40

Therapeutic Play

Answer 40

Makes use of doll and/or stuffed animals.
Encourages the acting out of feelings of fear, anger, hostility, and sadness.
Enables the children to learn coping strategies in a safe environment.
Assists in gaining cooperation for medical treatment.

Question 41

Assessment of Play

Answer 41

Developmental level of the child.
Motor skills.
Level of activity Tolerance.
Child’s preferences.

Question 42

Nursing Interventions of Play

Answer 42

Select toys that are safe for the child.
Consider isolation precautions and the child’s illness in relation to toy selection.
Select activities that enhance development.
Observe the child’s play for clues to the child’s fears or anxieties.
Encourage parents to bring one favorite toy from home.
Use dolls or stuffed animals to demonstrate a procedure before it is preformed.
Provide play opportunities that met the child’s level of activity tolerance.
Allow the child to go to the play room if available.
Encourage the adolescent’s peers to visit.
Involve the child life specialist in planning activities.