objective 9 (1) Flashcards
what are the factors that influence a childs reactions to hospitalization?
- Promoting a positive experience
– Attitude of personnel child comes in
contact with is of the utmost importance
– For many children, the only exposure to
health care is through brief clinic
appointments
- Designed to meet the
needs of the child and
their families - Special treatment room
for child to be
examined or receive
some form of treatment - Playrooms for the
children are also
available - Daily routine
emphasizes parent
rooming-in - Provision of consistent
caregivers - Flexible schedules to
meet the needs of the
growing child
children’s hospital unit
what does the childs reaction to hospitalization depend on?
– Age
– Amount of preparation given
– Security of home life
– Previous hospitalizations
– Support of family and medical personnel
– Child’s emotional health
what is the child’s reaction to hospitalization influenced by>
- Child’s developmental age
- Maturity of Parents
- Culture and economics
- Religious background
- Past experiences
- State of health on admission
- Other factors
what are the 3 major causes of all stress for children of all ages?
separation
pain
fear of body intrusion
- Occurs in infants age 6
to 30 months - More pronounced in
toddlers (18 months)
separation anxiety
what are the 3 stages of separation anxiety?
protest
despair
denial/detachment
what does pain in patients do?
- secrete higher levels of cortisol,
- have compromised immune systems
- experience more infections
- show delayed wound healing
what is PICIC?
pain indicator for communicatively impaired children
what does PICIC consist of?
- Crying with or without tears
- Screaming or groaning
- Distressed facial expression
- Tense body
- Irritability to touch
- Difficulty in being comforted or
consoled
what is FLACC?
- Face: grimace
- Legs: restless → kicking
- Activity: quiet → arched
- Cry: moan → scream
- Consolability: touch →
inconsolable
what are the nonpharmacological management techniques?
Drawing
Distraction
Imagery
Relaxation
Cognitive (thinking) strategies
Back rub or hand massage
Skin to skin contact, breastfeeding or oral sucrose
(infants)
what is the pharmacological management?
- DRUG PHYSIOLOGY
– Elimination of the drug may be prolonged because of an
immature liver enzyme system
– Dosages are influenced by weight and differences in
absorption, metabolism, and clearance are expected
what are the key concepts that WHO emphasizes is important of pain management in children?
– Using a two-step strategy
– Dosing at regular intervals
– Using the appropriate route of administration
– Adapting treatment to the individual child
what are the drugs used for pain relief
acetaminophen
NSAIDs
opioids
mild to moderate pain
can lead to liver failure if not dosed correctly
acetaminophen
mild to moderate pain
NSAIDs
moderate to severe pain
if used for long periods of time tolerance and respiratory depression can occur
opioids
what are the types of opioids uses?
morphine
fentanyl
naloxone
local anesthetics
patient-controlled analgesia
considered best opioid for children
morphine
potent analgesic given for short surgical procedures
fentanyl
used in case of opioid overdose
naloxone
used for skin sutures, IV catheter placement, lumbar punctures
local anesthetics
child as young as 5 or 6 can be taught to use
patient-controlled analgesia
The administration of IV drugs to a patient to impair
consciousness but retain protective reflexes, the ability to
maintain a patent airway, and the ability to respond to
physical and verbal stimuli
conscious sedation
- Intrusive procedures are fear provoking
- Disrupts child’s trust level
- Threatens self-esteem and self-control
- May require restriction of activity
fear
- The loss of an achieved level of functioning to a past level
of behavior that was successful during earlier stages of
development - Can be minimized by an accurate nursing assessment of
the child’s abilities and the planning of care to support and
maintain growth and development - When the child is free of the stress that causes the
regression, praise will motivate the achievement of
appropriate behavior
regression
what are the approaches to various cultures that involve knowing what is and is not acceptable as it relates to?
personal space
smiling
eye contact
touch
focus
what is the parents reaction to the childs hospitalization?
- May believe they are to blame for their child’s illness
- Feelings of guilt, helplessness, and anxiety
- Parents are seldom the direct cause for hospital admission
- Imp to listen &acknowledge parental concerns and feelings
- Encourage, support and stress importance of parents and
other family members in the care and recovery of the child
what is the nurses role in hospital admission?
Must be prepared to meet the emotional needs of those
involved
*Parents should try to be as matter-of-fact as possible
about this new experience for their child
*It is not necessary to go into great detail with the child
about what is going to happen because it may increase
the child’s anxiety
*Poor communication can result in unnecessary fear
