1. Care of the Hospitalized Child
Chapter 4

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. 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

13. 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

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

15. 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

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

17. 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

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

19. 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