Week 2 Care of children with special needs, Acute , chronic, and Term. Illnessess Flashcards
What are the three major stressors of hospitalization for pediatric clients?
- Separation
- Loss of control
- Bodily injury and pain
Separation anxiety begins around ____ and peaks at ___ but can be present up to age ___ especially when the child is hospitalized
6 months
1-3 years
5 years
When a child is hospitalized, some parents are able to get paid family leave. This helps prevent ____ in the pediatric patient.
Developmental delays
With school-aged children and older, it is important to allow _____ to visit not just ____
Friends and other family members
not just parents.
Hospitalized adolescents require ____support in addition to family support
Peer
What are the three stages of separation anxiety?
- Protest
- Despair
- Detachment
What occurs during the Protest stage of sep. anxiety
The child will cry and cling to the parent
The child will resist any attempts to comfort them
What occurs during the Despair stage of sep. anxiety
The child will ignore their parents when they return
What occurs during the detachment stage of sep. anxiety
There will be a notable lack of protest when parents leave. The child will be happy, content, and indifferent.
What is a special consideration that a child’s caregivers need to take during the detachment stage of separation anxiety?
The child will often attach themselves to their caregivers and can form a stronger bond with them than their parents
Loss of control is based on the _____ of the individual
Preception
What control does an infant need?
Que’s of when they are hungry or need to be changed or in pain. This communication is their sense of control and is important for them to build trust
What control does a toddler need?
They need to be able to make choices and be an individual.
What control does a preschooler need?
Similar to a toddler. They need to know they have choices, they can make their own play plans. let them interact with equipment.
What control does a school-aged child need?
What friends they play, what activities they do. Individualize things to fit their personality
What control do adolescents need?
Control over their appearance, control over peer group visits, control over some health care choices
What is reverse PRN?
Children are not going to be able to keep their PRN schedule in their head or anticipate their pain. Sometimes you anticipate the pain for them and give them their PRN meds before the pain starts and assess afterward instead of waiting for a request
When is the NIPS assessment used?
in neonatal patients
What is the FLACC tool used for?
Pain assessment in non-verbal patients
What does FLACC stand for
- Face
- Legs
- Activity
- Cry
- Consolability
What is the oucher scale?
An infographic showing pain expressions in children of different ethnicities
Why should you always consider culture in pediatric pain assessments?
Because some cultures teach their children(especially male children) not to express pain.
Always try to assess a pediatrics pain without ____ present. Because ___
Parents
Because the child may be embarrassed or shamed to admit pain in front of parents
What are some non-pharmacological pain relief techniques for children?
- Distraction
- Playing
- Sucrose water as an analgesic toot sweet
- Buzzys
- Cold packs
How does fear influence pain?
It magnifies it
What are five things that can help prepare a child for procedures?
- Play
- Read books
- Ask questions
- Be honest
- Allow visits before
All pediatric medication orders are based on ____
mg/kg/day or dose
Weight-based medication doses are usually only used up to _____kg
50
When applying topical medications to younger children, it is import to consider that
they have a large BSA in proportion to adults
When a child has an IV we check it every _____
Why?
30 minutes
Because they are more likely to infiltrate and are hurt much quicker than adults if this happens
When administering IV medications to a pediatric patient, ALWAYS USE A_____
pump
If no IV pump is available for a pediatric patient you can use a____
Volutrol chamber IV system
What are some considerations when supporting a patient’s sibling?
Consider their developmental level
- Be honest with them
- Encourage questions and discussions
- Encourage visitations
- Prepare them if their sibling can’t speak or will be asleep/sedated.
- Encourage the expression of their feelings
What is the developmental focus for children with special needs?
Emphasize abilities and strengths
Be person focused
What does it mean to be person focused?
“the child with diabetes”
Not
“The Diabetic child”
What are the aspects of family-centered care that are important for children with special needs?
- Collaboration (parents may be experts in condition)
- The therapeutic relationship
- Communication
What is normalization?
The integration of a child with special needs into society?
What is an example of normalization?
Inclusion therapy, allowing the child with special needs to play and participate with activities that all other children are participating in
Children with special needs need managed care. What does this mean
It means that they are fully depended on adults for care
Discuss the impact of caring for a child with special needs on a family.
- The time of diagnosis means everything
- It can cause major role strain and even cause families to grow distant if the stress and strain are not managed
What type of coping is the best for families with children with special needs
Use a direct approach, not avoidance.
Use the child’s strengths instead of using white lies and wishful thinking.
Example: Let the child keep score in the game when they can’t physically participate don’t tell them “someday you will be out there on the field”
It doesn’t mean they will never be able to participate but it does teach them to focus strengths and abilities instead of feeling isolated
What are the 6 stages of adjustment?
GBORDG
- Guilt and Self-accusation
- Bitterness and anger
- Overprotection
- Rejection
- Denial
- Gradual Acceptance
What do parents often do during the bitterness and anger phase of adjustment?
they stop caring for themselves.
During the overprotective phase of adjustment, what is there commonly a lack of?
Discipline. The parent doesn’t want the child to feel any other pain or hardships so they eliminate rules
What is the ultimate goal of family coping?
Acknowledgment and Reintegration
What occurs during Acknowledgement and reintegration?
- It is a culmination of the adjustment phase
- Social reintegration begins
- Needs of the family change over time
- Chronic sorrow is present
- Complete resolution is not possible yet but it’s not seen as impossible
What is chronic sorrow and why is it good
It is the realization that nothing you can do will change the current condition of the child. It’s good because it shows that the parent is finally accepting the child’s condition.
Sometimes parents Need permission to feel this because they feel wrong thinking this way
What are the four aspects of parental support?
- Family
- Friends
- Parent- to - parent
- Parent-professional
What is transition care and when does it begin?
It is when we begin to help the child understand that they will soon be responsible for managing their own care. We teach them how and this process begins around 12-13 years old depending on the developmental level
What are the three most common fears stated by families and children when diagnosed with a terminal illness
- Fear of pain and suffering
- Fear of dying alone or not being there at the time of death
- Fear of the actual death
Describe the concept of death for a 0-2 year-old
There is none but the tension is felt
Describe the concept of death for a 2-3 year old
The see it as a separation “they will come back
Describe the concept of death for a 4-6 year old
They see it as temporary. Thoughts cause death, MAgic thinking is present. “ they will wake up I just know it!”
“this is my fault because I was bad”
Describe the concept of death for a School aged child.
Its exaggerated and universal
Describe the concept of death for a 8-10 year old
They realize that it is permanent
Describe the concept of death for an adolescent
It happens to everyone but me
“selective immortality/universality”
What are the five traits of the best nurses that grieving families have identified
- non-abandonment
- Respect for the client
- Care for the family
- Facilitation of the family process
- Followup after the clients death
What are some important considerations the nurse needs to know regarding the grieving sibling
- The parents may not be emotionally available
- They need honesty
- They need to express their feelings
- They will ask loaded questions and have behavior changes
- They may need peer support
- Notify their school (parents do this)
