Unit 6 Hospitalized Child Flashcards
What types of admissions are there?
General inpatient unit
Emergency and urgent care
Pediatric intensive care unit
Outpatient or special procedures unit
Rehabilitation unit or hospital
What are steps to the admission process?
- Establishing a trusting, caring relationship (LISTEN)
- Introduce self and smile
- Let the child and family know what will happen and what is expected of them
- Communicate at age-appropriate levels
- Orient child and family to the hospital unit
- Perform nursing interview (assess what they know)
What are the majority reasons for hospitalization of children?
Children younger than 5
-Respiratory diseases, congenital heart disease
Other children
-Respiratory diseases, mental health problems, injuries, and gastrointestinal disorders
Adolescents
-Problems related to pregnancy, childbearing, mental health, and injury
What is the focus for family-centered care?
- Respect for child and family
- Recognition of the effects of culture, racial, ethnic, and socioeconomic diversity on the family’s health care experience
- Identification of and expansion of family’s strength
- Support of family’s choices related to child’s health care
- Honest approach in a positive way
- Collaboration with family
Name some positive outcomes for family centered care for children.
- Anxiety is decreased
- Children are calmer and pain management is enhanced
- Recovery times shortened
- Decrease is health care costs
- Communication between family and health care team are improved
- Families’ confidence and problem-solving skills are improved
What is true regarding asking permission with children?
Don’t ask for permission for what you must do!
Giving options are a better choice
What is assent?
Child giving expression of agreement
How will hospitalizing effect and what to do? Trust vs Mistrust? Autonomy vs shame & doubt? Initiative vs guilt? Industry vs inferiority? Identity vs role confusion?
Infant- provide trusting environment by trying to keep primary caregiver there
Toddler- allow them to do what they can do, will provide autonomy; talk to them about what you will do so they don’t develop shame
Preschooler- make sure they realize it’s not their fault, they feel guilty
School-age child- keep their body integrity
Adolescent- Concern with what the injury will do regarding their peers, and looks.
What are the psychological effects of hospitalizing on Children?
-Anxiety and fear
-Separation anxiety
(protest, despair, detachment)
How to minimize separation anxiety?
- Encourage parent’s to stay (or grandparents, whoever is close to them)
- Respect parent’s input
- Encourage parents to participate in care
- Late school age and adolescents: let them decide if parents should stay
What are principles of atraumatic care?
- Prevent/minimize physical stressors
- Avoid/reduce intrusive or painful procedures
- Control pain
- Prevent/minimize separation
- Promote sense of CONTROL (choices when possible)
What are techniques for providing atraumatic care?
Therapeutic communication
-goal directed, focused and purposeful)
Therapeutic play
- provides emotional outlet or coping devices
ex: for kids play with toy syringe, maybe doll play
Child and parent education
-helps child and parent understand the reason for the hospitalization/procedures
-Structure activities to suit the family NOT the unit your on. (Ask, how are things done at home?)
What are methods to promote coping in children?
- Breathing techniques
- Distraction techniques
- Imagery
- Music
- Humor
- Child teaching before events
- Homelike routines
- Familiar/favorite objects
What are some distraction methods?
- Have child blow bubbles (good for deep breathing)
- Point out pictures on the ceiling
- Encourage child to count aloud
- Ask the child to squeeze
- Play music appealing to child
- Have the child point toes inward and wiggle them
What are other resources to consider for the hospitalized child?
- Pet therapy
- Clown therapy
- Music therapy
- Art therapy
- Child Life Specialist
What are ways to minimize physical stress during procedures for the child?
- Use positions comfortable for the child
- Therapeutic hugging (parent can hold child while the nurse performs and intervention such as putting in an IV)
What techniques reduce stress in children during procedures?
- Perform nursing care on stuffed animals or dolls, allow child to touch equipment when appropriate
- Older children can draw to relieve stress
- Avoid use of medical terms
- Show the child the room where he/she will be staying
- Introduce the child to the health care personnel
Where should procedures occur for children?
In the treatment room, NOT patient’s room that is their sanctuary
Describe the guidelines for preparing a child of each age group for a procedure.
The older the child the more leeway/time.
Infant- prepare the parent, explain to them
Toddler- therapeutic hugging, DISTRACTIONS, prepare right before procedure
Preschooler- simple explanation, 5-10 min, props, treatment room
School age- give more info, give them something to do
Adolescent- partners in their own care, videos with peers, address what it will do to their body
What should be tried before restraints?
Therapeutic hugging, comfortable positions
What do adults and children fear equally?
The unknown
What are some factors affecting child’s response to illness and hospitalization?
- Age
- Amount of separation from parent/caregivier
- Cognitive level
- Developmental level
- Previous experience with illness and hospitalization
- Temperament
- Cultural background
- Coping skills
- Seriousness of illness
- Support system available
What is the restraint policy for a child?
- Reason for restraint
- Use at least one alternative method for restriction before restriction
- Use of the least restrictive type of restraint for the purpose
- Need for a written order by a licensed independent practitioner within 1 hour of application of the restraint
- Need for face-to-face evaluation by LIP within 1 hour of application of the restraint
Describe home health care for children.
The Goal
-promoting, restoring, and maintaining the health and safety of the child in the home setting
Roles of the nurse in the home care setting are:
-Direct providers of care, child and family educators, child and family advocate, case manager
What are roles of the nurse in outpatient and ambulatory care settings?
Admission and assessment Preoperative teaching and preparation Child assessment and support Postoperative monitoring Case management Discharge planning Teaching
Before teaching what cultural assessment questions could you ask?
- Who is the person caring for the child at home?
- Who is the authority figure in the family?
- Any special dietary needs or concerns?
- Are any traditional health practices used?
- What religious beliefs are important?
What are key points to working with an interpreter?
- Help the interpreter prepare and understand what needs to be done ahead of time
- Speak slowly and clearly; avoid jargon
- Pause every few seconds so the interpreter can translate your information
- Talk directly to the family, not the interpreter
- Do not use children as interpreters
What is important to NOT do regarding patient and family education?
DO NOT just hand pamphlet for them to read the info.
What are some learning barriers?
Language, health, pain, anxiety, etc
What are ways to improve learning and the best way to evaluate learning?
- Slow down and repeat information
- Assess what child/parent already knows
- Speak in plain language
- Teach in small amounts
- Prioritize info
- Use visuals
***Teach-back is best way to determine if what was taught was learned
Regarding IVs, what does a child need to be on?
an IV pump
