Nursing considerations for the hospitalized child

1
Nursing considerations for the hospitalized child

P164

• It is stressful for children of all ages and
  their families.?1??2?
• Hospitalized children are in an unknown
  environment, surrounded by strange people,
  equipment, and frightening sights and sounds.
  They are subjected to unfamiliar procedures, some
  of which are invasive, and may even have surgery.
  ?4?
• Nurses need to provide support (before, during,
  and after hospitalization) ?2??1?

2
??

• ???????????????
• Effects of illness and hospitalization on
  children and families
• Childrens understanding of health and illness
• Family responses to hospitalization P180
• Preparation for hospitalization (p180)
• Adaptation to hospitalization

3
???????????????

• Childs perceptions of the event
• Availability of social support
• Childs coping skills
• Individual risk factors

4
Effects of illness and hospitalization on
children and families P164

• Childrens understanding of health and illness
• Their understanding is based primarily on their
  cognitive ability at various developmental stages
  and on previous experiences with health care
  professionals.
• Infancy? Toddlerhood and Preschool age? School
  age? Adolescent
• Family responses to hospitalization P165

5
Infancy(lt 1 years)

• ????
• learning through sensorimotor exploration
• developing attachment with primary care giver
• acguiring a sense of trust
• The concepts of illness
• Separation anxietyprotest?despair?denial(detachme
  nt)
• Stressors to the child
• Nursing intervention

6

• Nursing intervention P164
• --Protest is viewed as a healthy response
  ?3????4?
• --Parents should be encouraged to remain with and
  provide care to the hospitalized
  infants.(rooming-in)
• --primary nurse
• --self-comforting measure-pacifier
• --human touch, talking, stroking, singing, eye
  contact

7
Toddlerhood and Preschool age(2-6 years)

• ????
• -- Preoperational
• --Autonomy v.s. shame and doubt (1-3y/o)
• --Initiative versus guilt (3-6y/o)
• The concepts of illness
• (1)  Understand illness but not its cause
  P164???1?
• (2)  Two unrelated events may appear to have a
• cause-and-effect relationship
• (3)  May blame other people, event, or themselves
  for
• an illness ?????2?
• (4)  Limited to names and locations of some body
  parts
• ?2??1?
• Stressors to the child
• Nursing intervention

8

• Nursing intervention
• --rooming-in
• --reminders can be left with the child
  p165?2??2?
• --encourage the parents to be present as much as
• possible for important rituals such as
  toileting,
• carrying out bedtime routines and singing
• favorite nursery rhymes. ???3?
• --explain the procedure ???3?
• --??????????????????

9
School age(7-10 years)

• ????
• --Concrete operation
• --Industry v.s. inferiority
• The concepts of illness
• (1)  More realistic understanding of the reasons
  for illness and are able to Comprehend
  explanations. ???1?
• (2)  The concept of body parts and function is
  maturing ?2?
• (3) Concepts of time are well formed ?3?
• Stressors to the child
• Nursing intervention

10

• Nursing intervention
• --Encourage parents to tell the child when they
  will return. ???3?
• --Telephone calls ?4?
• --Stressful procedures can lead to regression
  or other behavioral changes. The child relies on
  parents and others for support and understanding
  during these event. ?5?
• --???????????
• --???????????
• --???????
• --????????

11
Adolescent(11-15 years)

• ????
• Formal operation
• Identity v.s. role confusion
• The concepts of illness
• Aware of the physiologic, psychologic, and
  behavioral causes of illness and injury.
  ?1??1?
• Concerned with appearance. ?2?
• Privacy and modesty are major concerns ?1????2?
• Stressors to the child
• Nursing intervention

12

• Nursing intervention
• --Allowing choices ?1??3?
• --respect childs feelings
• --Adolescents can control over aspects of their
  care is important ?2??1?
• --peer group is major influences ?2?
• --having recreation and teen lounge ?3?

13
Family responses to hospitalization P165

• Altered family roles
• Other parent or siblings take on additional tasks
  at home. ?2?
• May be anxious and fearful, especially when the
  outcome is unknown or potentially serious. ?3?
• Parental reactions
• Sibling reactions

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• Parental reactions P166?2?
• (1) Disbelief
• (2) Anger, guilt
• (3) Fear, anxiety, frustration
• (4) Depression
• Nursing care P166
• ?Maintain positive communication ?2??2?
• ?Ask for their participation and partnership in
  care ???4?
• ?Explain all aspects of treatment ???3?
• ?parent need support to lessen their anxiety

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• Sibling reactions p166
• (1)Receive little attention ?3??1?
• (2)Fantasize about the illness or the appearance
  of the child ?3?
• (3)May fear that the child will be disabled or
  even die.
• ?4???
• (4) May feel guilty ???3???
• (5)May feel insecure and anxious?4??1?
• (6)Behavioral problems or school performance may
  deteriorate
• (7)May jealous ?2?
• Nursing care(chapter 8)

16
Preparation for hospitalization (P166)

• Provide information
• Tours fig 5-1 5-2
• Photographs or a videotape
• Books or films
• Parents as be instrumental

17
Adolescent

• Different approaches are useful for adolescent
• Written materials, models, and videotapes.
• Talking with peers who have had similar
  experiences
• Provide an opportunity for asking questions
  without parents present should be provided.

18
Adaptation to hospitalization P168

• Special care units
• Family assessment P170
• Child and family teaching
• Strategies to promote coping and normal
  development
• Strategies to meet educational needs P179
• Preparation for procedures

19
Special care units

• Emergency care
• Intensive care
• Preoperative and postoperative areas
• Short stay units
• Isolation
• Rehabilitation

20
Child and family teaching P170

• Teaching may be informal or structured.?1??2?
• Account their developmental level and cognitive
  abilities. P171?2??1?
• More than one sense. ?2??2?
• Time scheduling specific times. ?3??1?
• Cognitive, psychomotor or affective domains
• 
  ?4??1?
• Teaching plans P173-Families want to know

21
Strategies to promote coping and normal
development P172

• Not only on meeting physiologic, but also on
  meeting psychosocial and developmental needs.
  ???1?
• 1.Child life programspsychosocial needs p173
• 2.Room inParent may want to perform all of the
  childs basic care or help with some of the
  medical care. P175?2?
• 3.Therapeutic play and therapeutic recreation
• 4.Minimizing loss of control
• 5.Preventing or minimizing bodily injury
• 6.Pain management

22
Strategies to meet educational needs

P179

• Assess the effects of hospitalization on the
  childs education ?1????1?
• Provided with schoolwork to do in the hospital or
  at home ?2??2?
• Provide pencils, paper, comfortable work areas,
  computers, and quiet work time. ?2????3?
• Telephone calls or Internet connections with
  teachers ?2????2?
• Peers can be encouraged to visit a hospital.
  ?3??1???

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Preparation for procedures P179

• Administration of medication can also be
  frustration. P181 Table 5-8
• Assess the childs feelings about the procedure.
  P180
• Assisting children through procedures P182(Table
  5-9)

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Assess the childs feelings about the procedure
P180, 181

• Purpose?
• Experience?
• What happen?
• Painful?
• Control techniques
• Provide support?

25
Preparation for surgery P183

• Preoperative care
• Psychosocial preparation P183
• Physical preparation(Table 5-10)
• Postoperative care
• Consciousness
• Vital signs
• Drainage
• Dressing
• Intake and output
• Pain relief
• Parents allow to visiting as soon.