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Peds Exam 2
Care of Hospitalized Child and Med Admin pt 1
| Question | Answer |
|---|---|
| developmental level of infant | no concept of illness and death, they love their home routine Anxiety-separation & stranger, sleep deprivation, NPO |
| how do infants express their discomforts | through physical behaviors since they don't talk |
| developmental level of toddlers | no concept, limited ability to describe an illness and have a short attention span Separation anxiety, intense reactions, behavior regression |
| toddlers tend to associate people in the hospital with | causing pain and harm to them |
| developmental level of preschoolers | magical thinking- think death is temporary, limited understanding of cause of illness but know what it feels like but have limited ability to describe the symptoms separation anxiety, fears bodily harm, regression |
| how do preschoolers view death/illness | as punishment |
| preschoolers regress in | separation anxiety |
| school age (6 years and older) understand | death is permanent sense when lied to, may act out |
| why may preschoolers act out when sense they're being lied to | in a way of processing illness and lack of feeling in control |
| school age children fear | Fears loss of control, stress with separation –peers and routine |
| why do school age children need boundaries in the hospital | parents are often more lenient in the hospital which scares the children into thinking there is something seriously wrong |
| developmental level of adolescents | Adult concept of death Body image important Embarrassed of loss of control, isolation from peers Compliance issues |
| Adult concept of death in adolescents | aware of cause and effect of death and illness |
| what should you encourage for adolescents | peer visitation and contact |
| compliance issues in adolescents | will stop taking meds because of how they make them feel or look which is a big concern |
| adolescents are concerned with | impact of illness on their ability to go to school/activities |
| Separation Anxiety Stages | Protest Despair Detachment (Denial) |
| protest | very upset, angry lasts hours or days |
| despair | if protest stage continues, crying stops, child seems depressed and is not eating or playing, may reject parent if returns initially |
| detachment (denial) | if despair stage continues, this stage requires prolonger separation and the child appears adjusted superficially but is not content just resigned to the fact that they're without parents |
| hospital stressors | separation anxiety loss of control bodily injury pain |
| loss of control due to | separation from parents/pears, physically restriction, enforced dependency |
| Factors affecting reaction to Illness, Hospitalization | Previous Experience Recent Stresses Parents’ Response Sibling response |
| a previous experience is going to affect | child's reaction to illness |
| recent stresses | how much is changing their life/activities |
| parents response | if parent isn't truthful, there will be weakened trust so keep consistent routine |
| sibling response | may think sibling is going to die or that they're gonna get sick too |
| nursing interventions for child | Atraumatic care Prevent or minimize separation Minimize: loss of control Dev. appropriate language/activities Painful procedures in treatment room, not room or playroom Peer interaction for school-age children and adolescents |
| atraumatic care | least harmful/painful way as possible |
| minimize their sense of loss of control by | encouraging patient preference and promoting freedom |
| what should you do before any experience | prepare the child! this will decrease fear and increase cooperation |
| Dev. appropriate language/activities | Choices when possible Therapeutic play (child life), typical play, schoolwork Allow to touch medical equipment |
| Holding and Restraints | anything used outside of the hospital to ensure a child's safety would NOT be considered a restraint- side rails or seat belt, anything of mechanical support |
| Holding and Restraint examples | Mummy restraint/ swaddle Arm and leg restraints Elbow restraints |
| things not considered as restraints | Mechanical supports Dev appropriate safety interventions Comfort positioning |
| Nasogastric, Orogastric Tube Measurement | Tip of nose- earlobe - midpoint between xiphoid process and umbilicus |
| why is ng tube placed deeper in children than adults | child's body is so small so there is a much more narrow margin and we want to make sure it is in correctly |
| when putting the tube in, | Lubricate tube and insert to marked area |
| when to remove tube during placement | Choking, coughing, change in voice, cyanosis - this indicates it is in the trachea |
| after placing the tube, important to | tape it to cheek! and document |
| enteral gastric feeds in infants | hold infant and give pacifier so can associate suck with pleasure and if getting a bolus, give how they eat at home |
| kids will get .... aversion if | oral aversion if things in their mouths are always bad! |
| Keeping Kids Safe | Identification bands – document location Hospital must be child-proofed just like home |
| When the environment can’t be made safe for the children, | supervision - sitter if needed restriction/containment Cribs & beds: safe haven, side rails up always! |
| falls prevention | Falls risk assessment/ bracelet Bed lowest position, locked, siderails up Crib siderails up, crib top if climbing Call bell and items within reach Offer toileting on regular basis Wheelchairs locked Appropriately sized gown, nonskid footwear |
| Falls risk assessment/ bracelet | Medication effects Altered mental status Altered or limited mobility Postoperative |
Created by:
leh195