Hospitalized Child Flashcards
How do you promote trust vs. mistrust in hospitalized child?
simulate home routine create routines assign same nurse keep frightening objects out of view hold infant for feedings even with NG tube control light and sound stimulation
how to prepare an infant for a procedure
keep parents calm cuddles and hugs safe restraint (swaddling) sensory soothing (non-nutrive sucking) security objects from home
when assessing a 4 month old, which of the following would the nurse expect to find as being most developed?
a) cooing
b) babbling
c) imitated sounds
d) combined syllables
a) cooing
Which of the following toys should the nurse recommend for a 5 month old?
a) red balloon
b) teddy bear with button eyes
c) a push-pull wooden truck
d) a colorful busy box
D) colorful busy box
which of the following is the primary nursing intervention used to help a 1 month old infant tolerate hospitalization?
a) using consistent care givers
b) providing sensorimotor stimulation
c) following the home schedule as closely as possible
d) keeping the infant warm and dry
A) using consistent care givers (most correct answer, really all answers are correct)
PRAISE- toddlers
p- parallel play r- rituals, routines, regression a- autonomy vs. shame and doubt, accidents i- involve parents s- separation anxiety e- explore
what is the biggest fear of a hospitalized toddler?
loss of bodily control
hospitalized toddlers will exibit
regression
separation anxiety
have a perception the of illness that is unrelated to the event
autonomy vs. shame and doubt
how do you promote toddler developement?
develop care rituals and write in care plan
allow security objects from home
praise everything
allow outlet for aggression
access to finger foods
allow exploration of environment
repeat syllables and talk through patient care
toys that promote toddler development
board and mallet push-pull toys toy telephone stuffed animals story books with pictures *allow them to go to play room*
how do you prepare a toddler for a procedure
KISS ( keep it short and sweet)
do this the day of!!!
let them know what they will see, hear, smell, and feel
praise everything they do!
tell them “ mommy and daddy will be waiting”
which of the following is an appropriate toy for an 18m old?
a) multiple piece puzzle
b) miniature cars
c) finger paints
d) comic books
C) finger paints
wellness promotion for toddlers should include which of the following?
a) discussing negativity and temper tantrums
b) discussing nightmares and night terrors
c) encouraging gross motor skills
d) reinforcing supine sleeping positions
e) talking about bedtime rituals
f) helping a child differentiate junk from healthy foods
a) discussing negativity and temper tantrums
c) encouraging gross motor skills
e) talking about bedtime rituals
when teaching parents about typical toddler eating patterns, which of the following should be included?
a) food jags
b) preference to eat alone
c) consistent table manners
d) increase in appetitie
a) food jags ( means they are not consistent in what they eat, they could only want grapes and mac and cheese for a week)
MAGIC- preschoolers
m- mutilation a- associative play, abandonment g- guilt vs. initiative i- imaginary playmate, imagination c- curious
what is the biggest fear of the hospitalized preschooler?
mutilation
abandonment
cognitive development of the hospitalized preschooler
transductive reasoning
animism
magical thinking
egocentrism
guilt vs. initiative for the hospitalized toddler
they think they are being punished, let them know that they are not being punished that they are sick.
what is vital for the hospitalized preschooler?
socailization
what to expect of the hospitalized preschooler
overly aggressive or extreme withdraw imaginary playmates often refuse meds or to cooperate with care have little understanding of time regress (potty training) need transitional objects enjoy play time with other children enjoy silly humor
how do we promote preschoolers development when hospitalized
use very specific language and look directly at child
make silly mistakes and let them catch you
speak using socially excepted words
comfort them by holding and rocking
make sure they have a transitional object
how do you get a hospitalized preschooler to cooperate?
use phrases such as “lets do this” or “how about”
keep them as close to home routine as possible
make everything a game (let them throw and catch objects)
toys to promote preschooler development in the hospital
coloring books, puzzles, cutting and pasting, dolls, building blocks
how to prepare the preschooler for procedures
use simple explanations and diagrams or dolls (very basic pictures)
let the child play with surgical caps, gowns, and stethoscope
describe ONLY what they will feel, hear, see and smell
SAY OUT LOUD- this is not a punishment
allow medical play
when providing therapeutic play, which of the following toys would be best to promote imaginative play in a 4 year old?
a) large blocks
b) dress up clothes
c) wooden puzzles
d) big wheels
B) dress up clothes
after administering an IM injections to a preschoolers, which of the following is the primary reason for the nurse to apply a band-aid to the site?
a) children will use them to get attention from their parents
b) children are afraid that they will leak from the “hole”
c) bandages help to alleviate fear of strangers
d) children will collect bandages to show their peers
b) children are afraid that they will leak from the “hole”
DIMPLE- schoolagers
d- doers i- industry vs. inferiority m- modesty p- peers l- loss of control e- explanation of procedures
what is the biggest fear of hospitalized schoolagers
loss of control
what type of thinkers are schoolagers?
concrete thinkers
what is important to remember about hospitalized schoolagers?
need to be involved in structuring care
privacy and modesty
they miss their peers
get bored easily but can cope with hospitalization
what to expect with hospitalized schoolagers
like to take risks (resetting IV pumps)
likes adults to be involved in decision making
enjoy contact with other children of same age/sex
want to be by themselves
RULES!!!!
how do we promote schoolager’s development
encourage continuation of schoolwork
give realistic and truthful explanations
allow quiet and private time
allow them to teach new staff
allow them to be involved in care (making ice packs)
allow them to collect things ( syringes, BP cuffs)
make a game out of normal routines
how do you prepare schoolager’s for procedures?
use correct simple terminology
explain why
explain equipment in concrete terms
allow child to manipulate equipment (start BP machine)
allow responsibility, and time for questioning
suggest ways of maintaing control
When assessing a school age child, which of the following best describes typical annual growth?
a) the child grows an average of 2 inches per year
b) the child gains an average of 3 pounds per year
c) few differences are noted between age mates
d) increased fat pads give school age children a chubby appearance
a) the child grows an average of 2 inches per year
unrealistic expectations or a sense of failing to meet standards would cause a school-age child to develop a sense of which of the following?
a) shame
b) guilt
c) inferiority
d) role confusion
c) inferiority
PAIRS- adolescents
p- peer group a- altered body image i- identity r- role confusion s- separation from peers
what is the biggest fear of the hospitalized adolescents
altered body image, loss of control and separation from peers
what to expect of a hospitalized adolescent
they want to be related to their own level
be able to answer and ask reasonable questions about their care
follow instructions r/t mobility, diet, and medication compliance
let them be a part of the team
can act like an adult one min and a child the next
how do we promote adolescent development during hospitalization
teach at a realistic level discuss concerns about the future and bring issues up if necessary want parents to be involved help maintain their identity ask open ended questions
preparing adolescents for procedures
they are capable of abstract thought and reasoning
answer their why questions
conscious of appearance (let them know what to expect)
strive for independence
peer relationships and group identity are very important
suggest ways they can maintain control
when teaching about accident prevention to a group of high school juniors, the school nurse’s primary focus would be on which of the following areas?
a) falls
b) MVA
c) firearms
d) diving accidents
b) MVA
Which of the following characteristics would the nurse expect to see in an adolescent who had developed the capacity of formal thought?
a) ability to analyze relationships for the effects
b) use of random cognitive behavior to approach problems
c) ability to say that something is wrong but not why
d) focusing on immediate physical reality of hear and now
a) ability to analyze relationships for the effects
parental reactions to their child’s hospitalization
disbelief anger guilt fear frustration depression * don't take it personally*
how do you work effectively with parents of the hospitalized child?
encourage visitation and rooming in allow parents to be present during procedures and comfort them afterwards participate in care provide respite to the parents model appropriate interactions
children who are particularly vulnerable when hospitalized
have a difficult temperament lack of fit between parent and child male children ages 6m-4yr rural children passive children
separation anxiety manifestations
phase of protest
phase of despair
phase of detachment
strategies’ to decrease separation anxiety
have a primary nurse (assign same patients)
take a thorough history
maintain parental contact
teach parents to be honest ( tell kids they are leaving and when they will be back)
make surroundings more familiar
soften medical equipment ( ex: NS is really super hero juice)
after returning home from the hospital children may reject what?
caregivers
things to consider after hospitalization (children)
schoolagers and adolescents adjust more easily to home
infants, toddlers, and preschoolers make adjust more slowly to home
they my regress
consider pain
things to consider after hospitalization (parents)
re-establish routines
fill days with activities
let children tell their stories
do not take trips to soon after hospitalization
