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Slide 1 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Textbook For Nursing.

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Presentation on theme: "Slide 1 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Textbook For Nursing."— Presentation transcript:

1 Slide 1 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Textbook For Nursing Assistants Chapter 41 - CARING FOR PEDIATRIC PATIENTS

2 Slide 2 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Introduction to Caring for Pediatric Patients

3 Slide 3 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Children receive health care in many different types of health care settings For example: Children who have acute illnesses or injuries are often cared for in a hospital setting Children who need regular therapy or medical treatment for congenital or chronic health conditions may receive this care in a hospital, clinic, or home health care setting Other children are residents of long-term care facilities because of developmental disabilities, injuries, or illnesses Where Do Children Receive Health Care?

4 Slide 4 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants A childs ability to understand and cooperate with the health care team depends on his particular stage of development A 3-year-old will need to be cuddled and sung to for comfort during a treatment or procedure, while… An 8-year-old will need answers to specific questions before he will feel comfortable What exactly is going to happen? What are you going to use to do that? Can I see it/ touch it/ hold it? How will it feel? An understanding of the basic stages of growth and development will better prepare you to provide the type of care that each child requires Children Are Not Just Little Adults

5 Slide 5 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants A health care facility must be a frightening place to a child A child, especially a very young child, does not understand illness and pain She has been taken from the comfort of her home and is now surrounded by people she does not know Her room may be filled with strange, frightening machines, and getting better might mean having to have painful treatments or therapies first What Is It Like To Be A Child In A Health Care Facility?

6 Slide 6 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Family members will worry that the child is suffering or uncomfortable If the childs injury or illness is severe or acute, they may wonder whether the child will survive the event… And if he does, what effects the illness or injury will have on his future growth and development How Does A Childs Illness Affect The Family?

7 Slide 7 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Sometimes, a childs illness requires one family member to travel to a distant health care facility to be with the child The rest of the family stays at home The family member who is away may worry about the rest of the family at home, and how they are managing on their own Families may worry about how they will pay for the health care that the child is receiving How Does A Childs Illness Affect The Family?

8 Slide 8 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants The other children in the family may feel: Left out while most of the familys attention is being focused on the child who is sick or injured Guilty that they are healthy while their brother or sister is sick When caring for a sick child include the childs family members in his or her care whenever possible Helps the family cope with a childs illness Helps the family feel like they are actively doing something to help the child, and the child will be happier being cared for by familiar people How Does A Childs Illness Affect The Family?

9 Slide 9 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants When working with children and families, remember that families come in all different shapes and sizes Many families are traditional, in the sense that they consist of two parents and one or more children Many families consist of only one parent and the children The children may be raised by grandparents, guardians, foster parents, or other caregivers Regardless of the family structure, the effects of a childs illness on the people who care about the child are the same How Does A Childs Illness Affect The Family?

10 Slide 10 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants CARING FOR INFANTS

11 Slide 11 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Infancy is the period of time from a childs birth to his first birthday Infants grow and develop very rapidly during the first year of life They progress from being totally helpless unable to roll over, sit up, or move about without helpto being able to crawl, walk, and feed themselves small pieces of food by the time they reach the age of 1 year Infancy

12 Slide 12 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants An infant is totally dependent on her caregiver to help her meet her most basic physical needs, such as: Feeding Diapering Bathing Positioning Meeting the Infants Physical Needs

13 Slide 13 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants An infant who is ill or unable to drink or eat properly can quickly become dehydrated An infant who is receiving adequate food and fluid will urinate regularly and have regular bowel movements Since it is not possible to know exactly how much breast milk a nursing infant is taking at each feeding, keeping track of the number of wet diapers or actually weighing the wet diapers may be necessary to ensure that the baby is not dehydrated Observing and recording the number, consistency, and amount of bowel movements may also be one of your responsibilities Monitoring Food and Fluid Intake and Output

14 Slide 14 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants An infant, especially one who is ill or very young, must be kept warm A very small infant can be wrapped securely in a blanket An older, more mobile infant can be clothed in snuggly one-piece pajamas if the weather is cold A change in body temperature (either above or below the normal range) is cause for concern and should be reported immediately Because an infants medical condition can change very quickly, you must report any unusual signs or symptoms to the nurse immediately Monitoring Body Temperature

15 Slide 15 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants An infants greatest need is to feel secure and loved Human contact is essential for an infant to develop physically and emotionally Many studies have shown that infants, even those who are well cared for physically, fail to grow and develop both physically and emotionally if they are not held and talked to (failure to thrive) Meeting the Infants Emotional Needs

16 Slide 16 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants To help meet an infants emotional needs, a nursing assistant must take the time to touch, cuddle, stroke, and talk soothingly to him Encourage family members to hold the baby, if the babys condition allows The nurse can show family members how to hold the baby without disturbing medical devices, such as monitors and tubes Provide music and infant-appropriate toys If possible, position the infants bed so that he can watch activity out a window or through a doorway Meeting the Infants Emotional Needs

17 Slide 17 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Safety and the prevention of accidents is essential for children of all ages, but especially for the youngest As helpless as they may seem, infants can wriggle, roll, and twist themselves into dangerous situations very quickly Meeting the Infants Need for Safety

18 Slide 18 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Never leave an infant on a surface unattended, even for a moment Even very young infants can easily roll off of a bed, changing table, or examination table An infant who falls to the floor could receive severe or fatal head injuries If you are changing diapers, taking vital signs, or bathing an infant, keep one hand on the child at all times to prevent a fall Meeting the Infants Need for Safety

19 Slide 19 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants As the infant grows and is placed in an infant carrier, swing, or high chair, make sure that safety straps are securely fastened both across the infants waist and between his legs to prevent him from falling out of, or sliding down in, the carrier, swing, or chair. Always secure the infant in a car seat when traveling in a car or other vehicle. An infant car seat is placed in the back seat. The baby faces the back of the car, not the front. Meeting the Infants Need for Safety

20 Slide 20 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants An infant explores her world by placing everything she can get her hands on in her mouth Make sure that toys are appropriate for the age of the infant and that they have no small, removable parts that she could choke on Keep the toys clean by washing them frequently in warm, soapy water As the infant learns to crawl and move about, make sure that the floor or play area is free of small objects or plants that the infant could place in her mouth Meeting the Infants Need for Safety

21 Slide 21 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Keep plastic bags away from infants A young infant could roll over and become tangled in the plastic An older infant could put the bag over his head The infant is unable to breathe through the plastic, and suffocates Balloons also pose a suffocation risk The infant may put the balloon (or a piece of a broken balloon) in his mouth When the infant inhales, the rubber balloon gets sucked into the airway, blocking air flow and leading to suffocation Meeting the Infants Need for Safety

22 Slide 22 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Do not leave an infant unattended, even for a moment, in water of any depth. Babies who can stand up have drowned in a mop bucket! Make sure that electrical cords and window blind cords are out of the reach of the infant The infant could become tangled in the cord and strangle himself. Or, he could put the electrical cord in his mouth, which could result in electrocution. Meeting the Infants Need for Safety

23 Slide 23 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants CARING FOR TODDLERS

24 Slide 24 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants A toddler is a child between the ages of 1 and 3 years Toddlers are mobile, curious, independent spirits who are into everything Toddlers can feed themselves, and are busy learning how to communicate, how to use the potty, and how to dress themselves Because of their newfound independence, toddlers may be very uncooperative with treatment and therapy related to health care Understanding the Toddlers Needs

25 Slide 25 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Toddlers who need health care services are also likely to be very, very frightened It is not uncommon for a child of this age to regress, or return to an earlier stage of development For instance, a child who has been potty trained for some time may suddenly start wetting her pants, or she may ask for a bottle or pacifier after being previously weaned from these items Understanding the Toddlers Needs

26 Slide 26 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants While frustrating, especially for the childs caregivers, regression is just a normal way for a young child to cope with stress A toddler is still too young to verbalize her fears or even understand what exactly she is afraid of, so she just returns to an earlier, more comfortable stage of development temporarily until the stress passes Understanding the Toddlers Needs

27 Slide 27 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants When caring for a toddler, it is important to recognize regression for what it is and ignore it For example, rather than scolding a potty- trained child who has had an accident and telling her to stop acting like a baby, clean her up and comfort her, without drawing a lot of attention to the accident Understanding the Toddlers Needs

28 Slide 28 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants A toddler will rely on you for assistance with meeting many of his physical needs, according to his abilities Ask the toddlers regular caregiver how much help the child usually needs with eating, toileting, and dressing Find out what words the child uses for urination and bowel movements Meeting the Toddlers Physical Needs

29 Slide 29 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants It is important for you to allow the toddler to remain as independent as possible Offer choices that are realistic. For example: Do not ask the child what he wants to wear Ask the child Do you want to wear your red pajamas, or your blue ones? Meeting the Toddlers Physical Needs

30 Slide 30 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants A toddlers physical growth slows during this stage His appetite may also be small Being scared can also affect the toddlers appetite Ask the childs caregiver what he likes to eat and drink Many children in this age group have very clear, and very limited, food preferences Most toddlers enjoy finger foods such as crackers; fruit (for example, an apple or banana) cut into small pieces; and dry cereal Meeting the Toddlers Physical Needs

31 Slide 31 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants They can drink from a cup and may enjoy a variety of juices and milk Toddlers are usually on an eat and run type of dietary schedule and need to have small amounts of food provided throughout the day You may be responsible for monitoring and recording the toddlers food and fluid intake If the toddlers fluid intake is low, try offering foods such as popsicles, ice cream, or gelatin These foods count toward the fluid intake and may be more enticing than a cup of water Meeting the Toddlers Physical Needs

32 Slide 32 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Older toddlers who sleep in a regular bed at home may be offered a small adjustable bed in the health care facility if their condition allows However, a toddler who is at risk for falling out of bed may need a crib with side rails and a top cover The use of restraints is common among children in this age group, because toddlers are simply to young to understand that intravenous lines, drains, catheters, and other medical devices are a necessary part of their treatment and should not be pulled out If restraints are being used, be sure to check on the toddler very frequently (at least every 10 minutes) The best alternative to using a restraint is to keep the toddler occupied by offering distracting activities and toys, and by having someone stay with the toddler at all times Meeting the Toddlers Physical Needs

33 Slide 33 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Most toddlers are afraid of strangers and therefore, will prefer to be with their usual caregiver Remember that you are a stranger to the toddler Speak softly and get down on the toddlers level when you are talking with him That way you will not appear quite so tall and scary Meeting the Toddlers Emotional Needs

34 Slide 34 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Many toddlers are more cooperative during procedures and therapy if they are allowed to sit in their usual caregivers lap They also like to touch and explore any equipment that is being used in the procedure Allow the child to handle your stethoscope and blood pressure cuff before attempting to measure vital signs Meeting the Toddlers Emotional Needs

35 Slide 35 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Toddlers love to play with brightly colored toys such as blocks, simple puzzles, and stuffed toys They love to clap, move, and sing along with childrens songs Their attention spans are very short- toddlers become bored and fretful very quickly Make sure that the toddler has access to activities that can help keep him entertained Toddlers also may need to nap in the middle of the day, especially if they are sick or injured Provide quiet time, soothing music, and a comforting touch to help the child fall asleep Meeting the Toddlers Emotional Needs

36 Slide 36 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Toddlers are sometimes referred to as tornadoes in training pants because of their boundless energy, mobility, and natural curiosity They learn to open locked doors quickly and can wander away from the facility or home They run, climb, and reach for things without any thought to safety They love to explore cabinets and will not hesitate to taste the contents of any containers they find there As a result, accidental poisonings are very common among this age group Meeting the Toddlers Need for Safety

37 Slide 37 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Toddlers must be observed at all times to help prevent accidents, and safety locks on doors, cabinets, and drawers are essential When a child reaches 1 year of age and 20 pounds in weight, she moves from an infant car seat to a toddler car seat Toddler car seats, like infant car seats, are placed in the back seat of the car However, the toddler sits facing forward As with infants, it is illegal in all states to transport a toddler in a car without first properly securing him in a car seat Meeting the Toddlers Need for Safety

38 Slide 38 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants CARING FOR PRESCHOOLERS

39 Slide 39 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Preschoolers are children between the ages of 3 and 5 years Preschoolers are very physically active and love to Run, jump, swing Ride on toys The preschoolers attention span is now a bit longer so she may enjoy activities that require her to sit still for a period of time, such as Arts and crafts projects using paper, scissors, crayons, beads, and glue Understanding the Preschoolers

40 Slide 40 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants The preschooler enjoys being physically active- being confined to bed or indoors because of an injury or illness can become quite a challenge Books, art supplies, games, movies, and television can be good entertainment for a child of this age Preschoolers also love to have stories read to them and many are learning to read simple books on their own Understanding the Preschoolers

41 Slide 41 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants At this age, a child has developed most of his or her self-care skills A healthy preschooler can dress himself, go to the bathroom unassisted, and brush his own teeth However, a sick or injured preschooler may need help with these daily tasks Meeting the Preschoolers Physical Needs

42 Slide 42 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Most preschoolers are picky eaters and eat only a small variety of foods, in small amounts You may find it frustrating when your attempts to get a preschooler to eat foods that are high in nutritional value are met with failure A preschooler who is not feeling well is even less likely to have an appetite for foods that are good for her Offering a variety of nutritious foods in small amounts throughout the day is often more effective than insisting that the preschooler eat regular meals Meeting the Preschoolers Physical Needs

43 Slide 43 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants You may be required to help hold or restrain a preschooler during a procedure Make sure you plan ahead and have been shown how to hold a child gently but securely, so that the procedure can be performed as efficiently as possible Remember that a frightened child can be very strong if he feels cornered and may strike out to protect himself in any way possible He may kick, pinch, hit, or bite to get away You will have to protect both the child and yourself from injury in this situation Meeting the Preschoolers Physical Needs

44 Slide 44 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Preschoolers have vivid imaginations and enjoy pretend play As a result, preschoolers may have a lot of anxiety about being in a health care facility A young preschooler may fear that a procedure will involve cutting off body parts or other drastic measures An older preschooler has begun to understand the concept of death and may think that the hospital is where people go to die Meeting the Preschoolers Emotional Needs

45 Slide 45 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants The children of this age have learned to understand that discipline or punishment is the consequence of bad behavior They may think that the reason they have to have a painful treatment or stay in bed is because they were bad Meeting the Preschoolers Emotional Needs

46 Slide 46 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Magical thinking is a thought process that is common among preschoolers Preschoolers believe that if they wish for something hard enough, it will happen As a result, a preschooler may think that because she wished for something bad to happen to a parent or a sibling, her current medical condition is punishment for having those bad thoughts She may think that her bad thoughts actually made something bad happen (for example, if several members of a family are now hospitalized because of an accident or fire) Meeting the Preschoolers Emotional Needs

47 Slide 47 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Preschoolers need their questions answered simply and honestly They are very interested in whether a procedure will hurt If the procedure will hurt, please do not tell a child that it will not Be truthful and describe what the procedure will feel like in words that the child can understand For example, you might tell the child that the procedure will pinch, squeeze, or pull Meeting the Preschoolers Emotional Needs

48 Slide 48 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Use a stuffed animal or doll to demonstrate procedures (e.g., range-of-motion exercises) Helps the child to understand what is expected of her Helps to relieve the childs fears Similarly, the preschooler will enjoy being able to listen to his own heart through the stethoscope, or seeing a demonstration of how the blood pressure cuff squeezes her arm to check her muscles Meeting the Preschoolers Emotional Needs

49 Slide 49 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants A preschooler is beginning to learn the difference between right and wrong behavior He is more able to follow the rules of safety, if these rules are explained to him in a way that he understands Some preschoolers are still prone to placing items in their mouths and are therefore at risk for choking Meeting the Preschoolers Need for Safety

50 Slide 50 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants As in younger children, balloons and inflated gloves pose a choking risk and should be used with caution Scissors used for crafts projects should be blunt- tipped Markers, crayons, glue, and other art supplies should be non-toxic and approved for use for children between the ages of 3 and 5 Meeting the Preschoolers Need for Safety

51 Slide 51 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants The toddler car seat is used until the child weighs 40 pounds At that point, the child will have outgrown the toddler car seat and will need a booster seat The booster seat raises the child up so that the lap and shoulder belts in the car fit properly The booster seat is placed in the back seat of the car, facing forward As with younger children, it is illegal to drive with a child in the car who is not properly restrained Meeting the Preschoolers Need for Safety

52 Slide 52 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants CARING FOR SCHOOL-AGE CHILDREN

53 Slide 53 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants School-age children are children between the ages of 5 and 12 years This is a period of relative tranquility, compared with the rapid growth and development of earlier years, and the yet-to-come rapid growth and development of adolescence School-age children are developing many interests outside of their own families They are learning to socialize and spend a lot of time playing with their friends Understanding the School-age Child

54 Slide 54 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants They enjoy physical activities, such as: Riding bicycles Swimming Skating Skiing Climbing Unfortunately, these activities often result in injury and a stay in a health care facility Fitting in socially is very important to the school-age child, and children who are physically or mentally disabled may be excluded from play or teased by their peers Understanding the School-age Child

55 Slide 55 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Caring for a child of this age in a health care setting involves answering lots of questions School-age children are typically very cooperative if their questions are answered in a manner that they can understand These children like to be included as active participants in their own care and are very good at following directions Understanding the School-age Child

56 Slide 56 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants School-age children are very independent and are quite proud that they no longer have to rely on anyone else for self-care, although they do need to be reminded that the purpose of a bath or shower is to clean their bodies If a child is not able to bathe, dress, or go to the bathroom by himself as a result of injury or illness, he will need the assistance of others, and this is likely to make him very unhappy Meeting the School-age Childs Physical Needs

57 Slide 57 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Allow the child to do as much as he is able to by himself Take the approach that the child is helping you because you simply cannot do the task without his assistance Check on the child frequently Even if the child is badly injured or in pain, she may not pay attention to your directions to call for help if she needs to get out of bed Rewards and praise work very well for children of this age Meeting the School-age Childs Physical Needs

58 Slide 58 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants School-age children expect to receive direct, although simple, answers to their questions If a school-age child asks you a question that you cannot answer, be sure to relay the question to the nurse, so that she can answer it for the child Never make promises or assurances about a school-age childs condition or treatment that are not certain Children of this age are usually very aware of when they are being told the truth, and when they are not A school-age child usually has developed a very strong moral conscience and feels very strongly about what is right and what is wrong Meeting the School-age Childs Emotional Needs

59 Slide 59 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants A school-age child will enjoy reading, doing arts and crafts projects, playing video games, and talking with caregivers If possible, allow the child to accompany you throughout the health care facility in a wheelchair for company, or take her to a common area where there may be other children her age to socialize or play games with Meeting the School-age Childs Emotional Needs

60 Slide 60 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants For a child of this age who is confined due to accident or illness, staying in touch with friends is a huge emotional boost Phone calls, visits (if possible), and cards from friends and classmates are thoroughly enjoyed Make sure you help the child to place cards and notes safely on a table or bulletin board so they can be looked at often Meeting the School-age Childs Emotional Needs

61 Slide 61 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants The school-age child is less vulnerable to certain dangers than younger children are For example, school-age children know not to drink poisonous liquids or stick objects into an electrical socket However, their curiosity and habit of pushing their physical abilities to the limit brings new dangers School-age children are often interested in fire Meeting the School-age Childs Need for Safety

62 Slide 62 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants They may dart into the path of oncoming traffic on bicycles and skateboards or when chasing a ball They climb trees and buildings, and then fall The reason many children in this age group require hospitalization and rehabilitation include: Burns Broken bones Head injuries Meeting the School-age Childs Need for Safety

63 Slide 63 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants When transporting a school-age child in a car, a booster seat is used until the cars lap and shoulder restraints fit the child properly This usually occurs when the child reaches a height of 4 feet, 9 inches and a weight of about 80 pounds Children should continue to ride in the backseat until the age of 12 years Meeting the School-age Childs Need for Safety

64 Slide 64 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants CARING FOR ADOLESCENTS

65 Slide 65 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Adolescents are children between the ages of 12 and 20 years Adolescence is a time of tremendous growth and development We enter adolescence as children and exit as young adults During adolescence, logical thinking skills develop Adolescents have the ability to understand possibilities and make judgments As a result, it is essential that children of this age be included in plans and decisions regarding their medical care Understanding the Needs of Adolescents

66 Slide 66 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Allow the child to be as independent as possible with his daily care An adolescent may hesitate to ask for help or for pain medication if he is trying to seem tough, mature, or grown up He may act angry or aloof when in reality he is really just frightened Meeting the Adolescents Physical Needs

67 Slide 67 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Adolescents are often very embarrassed by care or treatments that expose their bodies to others The physical changes that occur during adolescence can make adolescents self-conscious about their bodies Make a special effort to provide privacy Be aware that an adolescent girl may need your assistance with obtaining or changing sanitary napkins or tampons, if she is too ill to manage this task on her own Meeting the Adolescents Physical Needs

68 Slide 68 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants To help adolescents meet their nutritional needs, offer the types of foods that they like to eat A teenager may totally refuse the types of meals served in a health care facility, but will eat pizza, milkshakes, or other nutritional alternatives Because of the increased need for extra calories during periods of growth spurts, an adolescent may need nutritious snacks in between meals Peanut butter and crackers, cheese, fruit, yogurt, and ice cream are good nutritious alternatives for chips and soda and should be readily available for the teenager if her dietary orders allow Meeting the Adolescents Physical Needs

69 Slide 69 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Psychologically, the period of adolescence is stormy Adolescents are egocentric, meaning that they place themselves at the center of the world and often overestimate their importance to others They begin to question the moral teachings of authority figures and parents As a result, experimentation with alcohol, drugs, and sex may occur during this stage Meeting the Adolescents Emotional Needs

70 Slide 70 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Adolescents are torn between wanting to be treated as grown-ups and being afraid to make their own decisions They need adults to respect their individuality When caring for an adolescent, listen to what she is saying Try not to lecture her on morals or proper behavior Include the adolescent in discussions and decisions regarding her care and treatment Adolescents need to feel that their opinions count Meeting the Adolescents Emotional Needs

71 Slide 71 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Many adolescents require care in a health care facility because of complications related to mental illnesses, such as Depression Attempted suicide Eating disorders Accidents related to drug or alcohol abuse An adolescent girl may need health care as a result of a pregnancy, which may not be planned or wanted Meeting the Adolescents Emotional Needs

72 Slide 72 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Sexually transmitted diseases (STDs) are common among this age group All of these situations require tact and sensitivity on the part of caregivers Be very observant for any changes in the adolescents emotional behavior or mood and report anything unusual to the nurse immediately Meeting the Adolescents Emotional Needs

73 Slide 73 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants In the health care setting, most adolescents are fairly safe However, an adolescent who has a history of abusing drugs or other substances may try to obtain pain medication that is not needed Depressed adolescents will need to be observed closely for suicide attempts or other types of self-injury Make sure that the adolescent knows you are available if he needs assistance, and answer the call light promptly Meeting the Adolescents Need for Safety

74 Slide 74 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants CHILD ABUSE

75 Slide 75 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Child abuse can be Physical Psychological (emotional) Sexual Neglect is a common form of physical abuse in children.The childs caregiver simply fails to provide for the childs basic physical human needs For example: The child may be malnourished from lack of nutritious food Dirty from lack of proper hygiene Ill from a lack of medical care Forms of Abuse

76 Slide 76 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Physical abuse can also take the form of: Striking Biting Slapping Shaking Handling a child roughly Violently shaking an infant or toddler can cause the childs brain to hit the inside of his skull repeatedly, leading to severe brain damage or death This is called shaken baby syndrome Physical Abuse

77 Slide 77 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Shaken baby syndrome is most often seen in children younger than 1 year About 25% of children with shaken baby syndrome die, and the rest suffer from permanent disabilities Many cases of shaken baby syndrome occur accidentally, when a frustrated caregiver shakes a child to get him to stop crying Because of the risk of head injury, it is never acceptable to shake an infant or toddler Physical Abuse

78 Slide 78 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Munchausen syndrome by proxy is a form of physical abuse seen in children The childs caregiver (usually the mother) deliberately does things to make the child appear ill. For example: The caregiver may feed the child soap or other substances to make her vomit She might smother the child for a period of time to deprive her of oxygen, leading to neurological symptoms Physical Abuse

79 Slide 79 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Often, the child is forced to have painful diagnostic procedures or surgery as health care providers try to discover the cause of the childs strange signs and symptoms Munchausen syndrome by proxy is often very difficult to detect and to prove, because nearly constant observation is needed to determine the cause of the childs health problems In some cases, it becomes necessary to hide a camera in the childs hospital room to observe what happens when the caregiver is alone with the child Physical Abuse

80 Slide 80 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants A caregiver can inflict psychological (emotional) abuse on a child in many ways A caregiver might make a child fearful by threatening him with physical harm or abandonment He might say cruel things to the child, such as Youre no good, Youre stupid, I wish you had never been born Psychological (Emotional) Abuse

81 Slide 81 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Involuntary seclusion (isolating a child by preventing him from seeing friends or other family members) is another form of psychological abuse Keeping a child in a room alone with the door closed Locking a child in a closet or attic for years Children who are the victims of psychological abuse can struggle for the rest of their lives with: Emotional pain Depression Thoughts of suicide Lack of self-esteem Psychological (Emotional) Abuse

82 Slide 82 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Sexual abuse occurs when a parent or caregiver: Touches or fondles a childs sexual organs Shows his or her sexual organs to a child, or asks the child to touch or otherwise stimulate them Forces a child to have sexual intercourse with him or her (rape) Forces a child to engage in a sexual act and then films or photographs it (pornography) Forces a child to engage in a sexual act for money, often with many different people (prostitution) When a stranger sexually abuses a child, it is called sexual assault Sexual Abuse

83 Slide 83 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants Child abuse can occur in all levels of society and in all ethnic groups Situations that seem to increase the risk that abuse will occur include the following: Caregivers who are very stressed by situations such as unemployment, depression, marital or relationship problems, substance abuse, or health problems of their own Caregivers who are very young, lack parenting skills, or lack knowledge about the normal behaviors and developmental stages of children Caregivers who have no family or social support and feel trapped by their parenting responsibilities Children who are difficult to care for, such as those who cry frequently, do not sleep well, are hyperactive or aggressive, wet the bed, or suffer from physical or mental disabilities Risk Factor For Child Abuse

84 Slide 84 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants As a nursing assistant, you may find yourself in a situation where you suspect that one of your pediatric patients is being abused You may see physical signs that suggest abuse, or the childs behavior or play-acting may raise your suspicions In some cases, the child might tell you something that makes you suspicious Make sure to listen carefully to what the child is telling you Report the childs words exactly as you heard them Be very careful not to influence the childs ideas or put words in her mouth Role of the Nursing Assistant in Reporting Abuse

85 Slide 85 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants If you are suspicious about something a child has told you, do not question the child further yourself In the event of an abuse investigation, a young child may repeat what she has been told, rather than describe what actually happened Report your suspicions to the nurse and allow a person who has experience and training in detecting child abuse to continue the questioning Role of the Nursing Assistant in Reporting Abuse

86 Slide 86 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants It may be very difficult to work with parents or caregivers if you suspect that their child has been abused You may feel angry toward the parents or caregivers, or disgusted by their behavior Remember that it is not your place to pass judgment on a parent or caregiver Your responsibility is to simply report your suspicions, and to let the state agencies that handle abuse reports determine if abuse has occurred and if so, who did it Role of the Nursing Assistant in Reporting Abuse

87 Slide 87 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants The agencies will also determine how the child will be protected going forward Your top priority is to meet the childs physical and emotional needs as best you can while the child is in your care If you feel that your emotions about a particular situation may affect your ability to provide care, talk with your supervisor and ask for help or to be assigned to another area Role of the Nursing Assistant in Reporting Abuse

88 Slide 88 Copyright © 2005 Lippincott Williams & Wilkins Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants End of Presentation


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