The hospitalized child Flashcards
Why do children get stressed in the hospital?
- Stress represents a change from the usual state of health & routine
- Children have a limited number of coping mechanisms to resolve stressors
Infants understanding of health and illness
Separation anxiety
- protest (cry)
- despair (sad, lonely)
- detachment/denial (sad or withdrawn even with parent present)
Toddler and preschooler in hospital
all about routine
Adolescent in hospital
care about privacy
Stressor for all children
Separation
Loss of control, autonomy and privacy
Being subjected to painful and invasive procedures
Fear of bodily injury and disfigurement
Infant stressors
o separation anxiety**
o stranger anxiety
o painful, invasive procedures
o immobilization
o sleep deprivation
Toddler stressors
o separation anxiety**
o loss of self-control
o immobilization
o painful, invasive procedures
o bodily injury or mutilation
o fear of the dark
Pre-schooler stressors
o separation anxiety** and fear of abandonment
o loss of self-control
o bodily injury or mutilation
o painful, invasive procedures
o fear of the dark, ghosts & monsters
School aged child stressors
o loss of control
o loss of privacy & control over bodily functions
o bodily injury
o painful, invasive procedures
o fear of death
Adolescent stressors
o loss of control**
o fear of altered body image, disfigurement, disability, & death
o separation from peer group
Newborn and infant response to pain
Crying, facial appearance, generalized body response
No relationship b/n cause & response
Older infant response to pain
Crying; localized body response; expression of pain or anger; physical struggle
Young child response to pain
Crying & screaming; verbal expressions; thrashing; lack of cooperation; begging; anticipates pain
School aged child response to pain
Similar to young child; time-wasting behaviours; muscular rigidity
Adolescent response to pain
Less vocal; less physical resistance; more verbal; increased muscle tension & body control
Non-pharmacological strategies for pain
- General strategies
- Distraction
- Relaxation
- Guided Imagery
- Positive self-talk
- Thought-stopping
- Behavioural contracting
FLACC
Face
Legs
Activity
Cry
Consolability
Two step strategy of pharm management of pain
Nonopioids (e.g. acetaminophen &NSAIDS) for mild pain
Strong opioid (morphine) for moderate to severe pain
Coping mechanisms for pain
- Regression
- Denial
- Repression (forgetting)
- Postponement
- Bargaining
Strategies to promote coping
Child Life programs
Rooming in
Therapeutic Play (Toddler, pre-schooler, school-age)
Therapeutic Recreation
Family assessment
- Family roles
- Knowledge
- Support system
- Siblings
Reactions to life threatening illness or injury
- Shock and disbelief
- Anger and guilt
- May feel responsible for cause
- May feel guilty for not noticing onset of illness - Deprivation and loss
- Anticipatory waiting
- Readjustment or mourning
Nursing management
- Provide information and build trust
- Promote parental involvement
- Provide for physical and emotional needs
- Facilitate positive staff-parent relationships and communication
- Maintain or strengthen family support systems
Factors increasing siblings reactions
- Younger and experiencing many changes
- Cared for outside the home by non-relatives
- Little information about ill sibling
- Perceived parents to be treating them differently than before siblings hospitalization
