1. Hospitalized Child Presented by Marlene Meador RN, MSN, CNE

2. What age is most effected by separation anxiety?  0-8 months  9-36 months  Preschool  School aged  Adolescent

3. Stages of Separation  Protest  Despair  Detachment

4. Nursing Interventions: How does the nurse meet the needs of the hospitalized child in each age group?  Infant  Toddler-Preschool  School- aged  Adolescent

5. Family’s Response to Hospitalization  Perception  Support system  Coping mechanism

6. What determines the family’s response to a child’s hospitalization?

7. What is the best method for communicating with the family of a hospitalized child?  What factors influence the family’s ability to interact with the hospital staff?  What nursing interventions should receive highest priority when communicating with these families?

8. 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?)

9. 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?

10. 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?

11. Developmental Milestones  Infant- Trust vs. Mistrust  Toddler- Initiative vs. Guilt  Preschool- Industry  Adolescence- Identity vs. Identity diffusion

12. 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

13. 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/family’s needs

14. Difficult Families  What is the nurse’s 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?

15. COPE: Convey genuine caring, concern and interest in the child’s wellbeing.  C- collaboration  O- objective  P- proactive  E- evaluate Avoid placating or condescending phrases.

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

17. 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.

18. 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

19. Physiological response to pain:  What happens to VS?  How does the nurse assess anxiety in a hospitalized child?  How does sleeplessness impact healing?

20. 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?

21. 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?

22. If you have any questions or concerns regarding this information please contact Marlene Meador via email mmeador@austincc.edu mmeador@austincc.edu Or cell phone 512-422-8749