Care of the Hospitalized Child Chapter 4

Causes of Stress for the Family of the Hospitalized Child The cause and treatment of the illness Guilt about the illness Past experiences of illness and hospitalization Disruption in family life Threat to the child’s long-term health Cultural or religious influences Coping methods within the family Financial impact of the hospitalization

Components of the Pediatric Unit Safe, attractive, and size-appropriate furniture Warm and friendly surroundings Colorful staff uniforms Children wearing their own clothing or colorful pajamas A separate room for procedures A playroom and rooming-in facilities Meals planned to include the child’s favorite foods

Nursing Interventions Performed During a Child’s Admission to PICU Assessing the child’s developmental level to provide appropriate explanations of procedures Providing positive reinforcements for the child, such as stickers and small badges Interpreting technical information for family members Promoting the relationship between the family caregiver and the child as much as possible Encouraging the caregiver to touch and talk to the child

Infection Control in the Pediatric Setting Standard precautions Blend of universal precautions and body substance isolations Apply to blood, all body fluids, secretions, and excretions (except sweat), nonintact skin, and mucous membranes Reduce the risk of transmission of microorganisms from sources of infection in hospitals Used in the care of all patients

Infection Control in the Pediatric Setting (cont.) Transmission-based precautions Pertain to patients documented or suspected to have highly transmissible pathogens Require additional precautions beyond those covered under standard precautions Include three types: airborne precautions, droplet precautions, and contact precautions

Characteristic Stages of the Child's Response to Separation First stage (protest) The child cries, refuses to be comforted, and constantly seeks the primary caregiver Second stage (despair) The child becomes apathetic and listless and gives up Third stage (denial) The child begins taking interest in the surroundings and appears to accept the situation

Nursing Measures to Facilitate “Rooming-In” Explaining to caregivers the facility and its rules before admission Explaining provision for meals to the caregiver Avoiding situation in which primary caregivers appear to be expected to perform as health care technicians Describing the primary caregiver’s role as a provider of security and stability for the child Allowing siblings to visit the ill child Being aware of the caregiver’s needs

Focus of Preadmission Education Preparing the child for hospitalization Making the experience less threatening Answering questions and exploring anxieties Discussing common questions and feelings Telling the child that some things will hurt but that everything will be done to make the hurt go away Being sensitive to cultural and language differences

Emergency Admissions Physical needs assume priority over emotional needs Nurses must be sensitive to the needs of the child and the family Nurses must recognize the child’s cognitive level and how it affects the child’s reactions The staff must explain procedures and conduct themselves in a caring, calm manner

Components of the Admission Process Identification bracelets Admission interview Client history Physical examination

Focus of the Admission Interview Previous experience with hospitals and health care providers Understanding of the child’s condition Expectations of the hospitalization Available support systems when the child returns home Any disturbing or threatening concerns on the part of the caregiver or the child

Discharge Planning Begins early in the hospital experience Assesses the family’s level of understanding of the child’s condition and necessary home care Discusses giving medications, using special equipment, and enforcing necessary restrictions with the caregiver Provides specific, written instructions for reference at home Ensures that the caregiver can understand the written materials

Focus of Preoperative Care for the Child Undergoing Surgery Patient teaching Skin preparation Preparation of the gastrointestinal and urinary systems Preoperative medication

Focus of Patient Teaching for Surgery Determining how much the child knows and is capable of learning Correcting any misunderstandings Explaining the preparation for surgery, what the surgery will “fix,” and how the child will feel after surgery Basing preparation on the child’s age, developmental level, previous experiences, and caregiver support Making sure explanations are clear and honest and simply expressed Encouraging questions to ensure understanding

Indications of Pain in Children Rigidity Thrashing Facial expressions Loud crying or screaming Flexion of knees (indicating abdominal pain) Restlessness Irritability Physiologic changes

Focus of Postoperative Nursing Care Carefully observing for any signs or symptoms of complications Monitoring and recording vital signs according to postoperative orders Keeping the child warm with blankets as needed Observing dressings, IV apparatus, urinary catheters, and any other appliances

Focus of Discharge Planning Home care Use of any special equipment or appliances Medications Diet Restrictions on activities Therapeutic exercise

Play Therapy versus Therapeutic Play A technique used to uncover a disturbed child’s underlying thoughts, feelings, and motivations to help understand the child better Therapeutic play A play technique used to help the child have a better understanding of what will be happening to him or her in a specific situation