Variations & The Hospitalized Child

Question 1

Stressors

Answer 1

• Loss of control = no sense of control
• Incrs perception of threat
• Impacts coping skills
• Overwhelming stimuli
  > lights, noise, smell
  > no sense of personal space
• Separation

Question 2

Separation Anxiety

Answer 2

• Protest Phase
  > crying & screaming, clinging to parent
• Despair Phase
  > cessation of crying; evidence of depression
• Detachment Phase
  > denial; resignation but not contentment
  > possible serious effects on attachment to parent after separation

Question 3

Risk Factors tht Increase Vulnerability to Stressors

Answer 3

• “Difficult” temperament
• Age
• Gender
• Below-average intellingence
• Multiple & continuing stresses
  > ex: frequent hospitalizations

Question 4

Stressors & Reaction of the Family of the Child who is Hospitalized

Answer 4

• Parental Reactions
  > overall sense of helplessness
  > questioning skills of staff
  > accepting reality of hospitalization
  > dealing w/ fear
  > coping w/ uncertainty
  > seeking reassurance

Question 5

Nurse’s Role - Preparation for Hospitalization

Answer 5

• Preparing child for admission
• Preventing or minimizing separation
• Preventing or minimizing parental absence
• Minimizing loss of control
  > promoting freedome of movement
  > maintaining child’s routine
  > encouraging independence & industry

Question 6

Nurse’s Role - Nursing Interventions

Answer 6

• Providing developmentally apprpriate activities
• Providing opportunities for play & expressive activities
  > diversional activities
  > toys
  > expressive activities
  > creative expression
  > dramatic play

Question 7

Child Life Specialists

Answer 7

• CLS are pediatric hlth care professionals who work w/ children & families in hospitals & other settings to help them cope w/ the challenges of hospitalization, illness, & disability
• On staff at children’s hospitals
• Important member of interdisciplinary team
• Services provided:
  > therapeutic play
  > activities to support normal G&D
  > sibling support
  > advocacy
  > grief/bereavement support
  > tours & info programs
  > outpatient consultations

Question 8

Restraining Methods

Answer 8

• Alternative Methods: consider first
  > diversional activities
  > parental participation
  > therapeutic holding
• Use least restrictive
• Orders
• Physical vs. Chemical restraints
• Reordered every hr & child must be assessed every 15 minutes

Question 9

Legal & Ethical Aspects

Answer 9

• Informed consent
• Emancipation
• Reproductive rights
• Drug/substance abuse/addiction
• Ethical committees

Question 10

Age Related Interventions - Infant

Answer 10

• Parental involvement
• Development of sense of trust
  > want parents involved bc kids trust their parents
• Eyes/mouth
  > put everything in mouth
• Stranger anxiety around 6-8 months
• Med Admin
  > topical
  > IV
  > IM: in the leg
  > oral: first choice
  > rectal: try to avoid 1st month

Question 11

Age Related Interventions - Toddler

Answer 11

• Parental involvement
• Development of autonomy
• Be clear and concise; what do you need THEM to do (but give choices)
• It is all about them (aka egocentric)
• Hide scary equipment
• Distraction!
• Med Admin
  > topical; can rub in self
  > IM: in thigh
  > IV: not ideal unless very needed
  > oral: first choice
  > rectal

Question 12

Age Related Interventions - Preschooler

Answer 12

• Parental involvment
• **Development of **
• Be clear & concise; what do you need THEM to do
• **Concerned w/ body **
• Distraction: allow for more time for understanding
• Slight control over time, play w/ equipment
• Med Admin
  > topical
  > IM
  > IV
  > oral
  > rectal

Question 13

Age Related Interventions - School Age

Answer 13

• Parental involvment
• **Development of **
• Be clear & concise; explain what is happening
• Want to , they will often watch & ask questions
• Allow time for understanding, can prepare ahead of time
• Control over time
• Med Admin
  > topical
  > IM
  > IV
  > oral
  > rectal

Question 14

Age Related Interventions - Adolescent