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1307 Test 2 BP

admission questions use focused questions and allow time for answering; conducted asap after admission; ID bracelet placed on child
leading statements use open-ended questions
subjected vs. objective data subjective - said by the child or family; objective - information you observe directly; baseline measurements of child's height, weight, temp, pulse, respiration, and BP
chief complaint reason for the child's visit to the health care setting; caregivers primary concern is his or her rason for seeking health care for the child
therapeutic play vs. play therapy play therapy - psychoanalysis that clincians use to uncover a disturbed child's underlying thoughts, feelings, and motivations to help understand them better; therapeutic play - to help child understand what will happen to them in specific situations
safety during exams always use standard precautions
abnormal assessment findings bruises in soft tissue, bruises with a clear outline of an object, or unexplained injuries might indicate child abuse
Glasgow coma scale neurologic assessment tool used to monitor a child's neurologic status after the initial neurologic exam; compares results from one time to another and from one examiner to another; monitors various aspects of the child's neurological functioning
answering children's questions be honest and simple
security about hospitalization
siderails and safety always raise when you leave pt unattended
physical and emotional safety
discharge conference discharge preparations begin when admitted
SIDS prevention position infants on their backs or supported on their sides for sleeping
procedure teaching for different age groups should be done according to the child's developmental level (CHECK)
pre-op teaching - anything need to note or special documentation patient teaching about procedure, skin preparation, preparation of gastrointestinal and urinary systems, preop medication
pre-op medication - when to give medications sedative about 1.5 to 2 hours before surgery; analgesic-atropine mixture mya be given immediately before pt leaves for OR - dim lights and minimize noise; administer meds carefully and quickly due to child's anxiety
anuria - when is it dangerous if it persists for more than 6 hours
care of chronically ill child
how to deal with the separation of children and parents rooming-in; have parent give something of theirs to the child so the child knows they are coming back; be friendly; surroundings should be warm and inviting
help children overcome fear friendly, warm surroundings; safe, attractive age-appropriate furniture; colorful staff uniforms; let children wear their own clothes; separate room for procedures; playroom and rooming-in; meals to include child's favorite foods
feelings of guilt about hospitalization child may feel guilt;family may feel guilt about illness, past experiences of illness & hospitalization, disruption in family life, threat to child's long-term health, cultural or religious influences, coping methods, financial impact, how family responds
teach about hospitalization consider child's developmental level; child-life program can make hospitalization less threatening for children and parents; works with nurses, physicians, and other health team members to help meet developmental, emotional, and intellectual needs
helping family with anxiety allow family to help; encourage them to take breaks for meals and rest; give a personal possession to the child to help reassure them the caregiver will return
normal responses to hospital anxiety and stress
siblings adjusting to hospital allow siblings to visit; may be at home imagining a much more serious illness than is actually the case; must not have a cold or other contagious illness and must have up-to-date immunizations
apical pulse in infants preferred method to determine pulse in infant or young child; try to take while child is asleep; count pulse before child is disturbed for other procedures; place stethoscope between left nipple and sternum
head circumference place paper or plastic measuring tape arount the most prominent part of the back of the head; record and plot on a growth chart to monitor the growth of the child's head; chest will exceed head circumfrence
rectal temperatures may be taken in children but usually only if another method cannot be used; in newborns - danger of irritation to the rectal mucosa or in children who have had rectal surgery or who have diarrhea; lubricate end of thermometer with lubricant;
monitoring changes in vital signs closely monitor temp by checking frequently; document baseline temp and additional temps
care of a child with temperature, febrile seizures Febrile seizures are usually a generalized seizure early in the course of fever; often one of the initial symptoms of an acute infection somewhere in the body
use of different testing equipment - cardiac monitors
use of different testing equipment - O2 saturation
physical signs of pain, how family responds to pain changes in behavior like rigidity, thrashing, facial expressions, loud crying or screaming, flexion of knees, restlessness, irritability; increased pulse rate and BP, sweating palms, dilated pupils, flushed or moist skin, loss of appetite
patient-controlled analgesia can be used with children 7 and up
moist heat, why heat? moist heat produces faster results, usually applied in the form of a warm compress or soak; heat increases circulation by vasodilation, promotes muscle relaxation, relieving pain and congestion; speeds the formation of drainage of superficial abscesses
ileostomy care requires emmaculate care, especially when diapering
urine specimen - potty trained and not urine collection bag used if not potty trained - must be placedon clean, dry skin; offer fluids 15-20 minutes before specimen is needed; genetalia are exposed; clean and dry; place collection bag; replace diaper. Trained - clean catch, catheterization
LP position restrain child in position that will enlarge the intervertebral spaces; strict asepsis used; position to curve spine
tube placements and tube feedings
oxygen tents
nasal drainage sample
diluting elixir meds can dilute with water or juice if not contraindicated
IM sites infants - preferred site is vastus lateralis
PRN meds and safety
PO meds to infants
teens adjusting to hospital and chronic illness
family adjusting with chronic illness siblings may feel left out from being cared for; financial stress, marital problems, etc.
respite program care of ill child so caregivers can have a period of rest and refreshment
dying child unrealistic comprehension of death; help sibling talk about death
how each age group feels when another child dies or has chronic illness preschool - egocentric; 6-7 - magical thinking; 8-9 - death is universal and irreversible; school-age - sad, vocal, aggression; adolescents - mad, creates crisis, needs opportunities to talk
hearing and death hearing is the last sense to go
pattern of death
child abuse s/s bruises in soft tissue, bruises with a clear outline of an object, or unexplained injuries might indicate child abuse; signs could also be seen in the genitalia and rectal area
spiral fractures not a commonly seen fracture in long bones; suspect child abuse if story doesn't add up
sexual abuse the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct
Munchausen Munchausen by proxy - one person either fabricates or induces illness in another to get attention; caregiver frequently reports symbptoms of illness when child is well; mother is most often the person with syndrome
possible abuse cases must be reported
feeding tube verify placement
sexual abuse(continued) rape, interfamilial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children or inces with children
Created by: akgalyean