Lecture 09.09.2015 Flashcards
When a newborn or toddler has to stay in the hospital and gets attached to a caregiver, what can occur if the caregiver isn’t present?
separation anxiety
What are the responses to stressors due to hospitalization for 1) Infants 2) Toddlers 3) Preschoolers 4) School-Age 5) Adolescents (lots of info but gives overview of every age group)
Infants: inability to verbalize and understand, so they experience
- sleep deprivation, shyness, and expressions of discomfort (crying, grimacing)
Toddler: limited ability to verbalize and understand so they experience
- separation anxiety, intense reactions, regression (bed wetting)
Preschoolers: limited ability to describe feelings, magical thinking, so they experience
- fears of bodily harm, punishment, seperation anxiety
School- age: beginning awareness of body functions and can describe feelings, pains, cause/effect so they experience
- fears of loss of control, information seeking (lots of Qs), separation stress from peers/routine
Adolescents: knows cause/effect, understand very well so they experience
- BODY IMAGE problems, embarassment, isolation from peers, worries aobut school (note: peer influences may lead to non-compliance
Why do kids regress as a response to a stressor?
They want to go back to a time when they felt comfort
Why do we have to be careful what we say to preschoolers/be very clear and concrete with what we say to preschoolers?
They have magical thinking and could misunderstand something we say as a future prediction of bodily harm
ex: they are being punished for a past misconduct they committed
ex: don’t use words like shot or dye, might think of a gunshot or die denoting bodily harm
What are the phases of separation anixety
Phase 1: protest
- crying, agitation, rejects others
Phase 2: Despair
- withdrawn, sad if parents don’t returns
Phase 3: Detachment
- develops protective mechanism (forms bond with nurses, ignores parents)
Other than the pediatric patient, who else can have reactions to the stressors of hospitalization?
1) parents: MAJOR stress, guilt, frustration, role changes (parent left at home has to work AND run house), financial worries (identify resources), lack of knowledge
2) siblings: loneliness, jealousy, guilt, fear, anger
What are the three biggest things for the nurse’s role in peds?
1) prepare children and families for hospitalization/surgery
2) addressing the developmental effects of hospitalization
3) teaching for discharge
Developmental Issues for all the pediatric age groups when providing nursing care
1) Infants: avoid separation and encourage parents to stay
2) Toddlers: avoid separation anxiety by trying to maintain home routine
3) Preschoolers: address fears fantasies: be honest/specific, allow simple decisions
4) School-age children: provide concrete, honest info and provide diversional activity
5) Adolescents: respect need for privacy, encourage friends to visit, collaborate with teen with their care
How do you prevent or minimize separation anxiety?
- encourage parents to stay, body contact for infants or visits from peers
What’s a great way to minimize loss of control in the pediatric patient?
provide options to decide from when appropriate, maintain child’s routine
Safety for different age groups
1) Infants: close supervision, crib rails up, keep small objects out of crib
2) Toddlers: crib rails up, never leave unattended, keep cords and equipment out of reach,
3) (look up rest on slides)
Dealing with death through the pediatric developmental stages
1) Infants/Toddlers: little to no concept of death, mirror parental emotions, regression
2) Preschoold: magical thinking (again think death is a punishment for something they did), death is temporary
3) School-age: begins to have adult concept of death (can experience fear and curiosity)
4) Adolescents: adult-like concept of death (difficulty accepting), peers important
What’s a great non-pharmacologic pain reliever specific to children? What must we do to most efficiently perform this?
1) distraction
2) must know child’s likes/interests
What tools do we use to assess pain in the younger pediatric patient?
- ***The FLACC scale (Face Legs Activity Cry Consolobility)
- the faces scale
How do we assess pain the older pediatric patients?
Scale 0-10
