Hospitalized Child

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Hospitalized Child

• Presented by
• Marlene Meador RN, MSN, CNE

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What age is most effected by separation anxiety?

• 0-8 months
• 9-36 months
• Preschool
• School aged
• Adolescent

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Stages of Separation

• Protest
• Despair
• Detachment

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Nursing InterventionsHow does the nurse meet
the needs of the hospitalized child in each age
group?

• Infant
• Toddler-Preschool
• School- aged
• Adolescent

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Familys Response to Hospitalization

• Perception
• Support system
• Coping mechanism

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What determines the familys response to a
childs hospitalization?
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What is the best method for communicating with
the family of a hospitalized child?

• What factors influence the familys ability to
  interact with the hospital staff?
• What nursing interventions should receive highest
  priority when communicating with these families?

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Nursing Interventions for the family of a
hospitalized child

• Augment coping mechanisms- (what specific factors
  influence client teaching?)
• Reinforce information and encourage questions
  (who would have difficulty with asking
  questions?)
• Anticipate discharge needs (when should this
  begin?)

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PPEN

• Why is this an effective tool for assisting the
  child and the family?
• How would the nurse assist the child and family
  to arrive at the PPEN?
• Is this a static assessment?

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Preparation for Hospitalization

• What nursing interventions prepare a child for
  hospitalization?
• Are the interventions the same for all children?
• Who should the nurse include in these
  preparations?

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Developmental Milestones

• Infant- Trust vs. Mistrust
• Toddler- Initiative vs. Guilt
• Preschool- Industry
• Adolescence- Identity vs. Identity diffusion

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Nursing Care of the Child with Special Needs

• Special equipment- visually or hearing impaired,
  wheelchairs,
• Specialized care- feeding tubes, trachs/vents
• Assess family coping ability- who is primary
  caregiver
• Assess support systems
• Involve additional members of the healthcare team
  

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Promoting Coping and Normal Development

• Child life specialists assist with preparing
  child for procedures, and to adjust to illness
  and hospitalization.
• Therapeutic play emotional outlet, teaching
  strategy, assessment tool
• Anticipate child/familys needs

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Difficult Families

• What is the nurses best response to a family
  identified as difficult?
• What additional information does the nurse
  require?
• What is COPE, and how is it helpful with families
  in crisis?

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COPE Convey genuine caring, concern and interest
in the childs wellbeing.

• C- collaboration
• O- objective
• P- proactive
• E- evaluate
• Avoid placating or condescending phrases.

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Pain Assessment

• Infant- grimacing, poor feeding, restlessness,
  crying
• Toddler- clinging to parent, crying, pulling or
  rubbing area of pain, anorexia, vomiting,
  restlessness.

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Pain Assessment cont

• Preschool- verbalize pain, guard injured
  extremity, anorexia, vomiting, sleeplessness.
• Adolescent- verbalize pain, may not understand
  type of pain. Possibly reluctant to call for
  help.

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Pain Assessment Tools

• FACES- smile to worst hurt (tears)
• FLACC- face, legs, activity, cry and
  consolability (p. 1215-1216)
• NIPS- neonatal pain during/after procedures-
  facial expression, cry quality, breathing
  patterns, arm leg position, state of arousal

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Physiological response to pain

• What happens to VS?
• How does the nurse assess anxiety in a
  hospitalized child?
• How does sleeplessness impact healing?

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Nursing interventions pharmacologic

• PCA- what age can use this most effectively?
• Ketoralac- why is this effective? What specific
  nursing interventions apply to this medication?
• Why are NSAIDS used with children?
• What lab values and contraindications are
  important for analgesic medications used with
  children?

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Nursing interventions nonpharmacologic

• What actions should the nurse include with each
  of the following?
• Positioning for comfort (turning or elevation)
• Thermal therapy (heat or cold)
• Diversion therapy
• What actions would work best with an infant?

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• If you have any questions or concerns regarding
  this information please contact Marlene Meador
  via email mmeador_at_austincc.edu
• Or cell phone [phone]