Download presentation
Presentation is loading. Please wait.
1
Chapter 29 Care of the Hospitalized Child
2
Care of the Hospitalized Child
Stressors when a child is in the hospital Cause, 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, religious influences Coping methods within the family Financial impact of the hospitalization
3
Care of the Hospitalized Child (cont.)
Child’s developmental level Child-life program
4
The Pediatric Hospital Setting
Early childhood education about hospitals Hospitals are part of the child’s community Some have orientation programs Families Encouraged to help young children develop a positive attitude about hospitals Avoid negative attitudes about hospitals Honest answers to questions about death
5
The Pediatric Hospital Setting (cont.)
Pediatric unit atmosphere Friendly, warm surroundings for children Safe, attractive, and size-appropriate furniture 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
6
The Pediatric Hospital Setting (cont.)
Pediatric intensive care units Admission can be overwhelming, especially if unexpected Nurses should prepare family for how child will look Give visiting schedule Provide developmentally appropriate explanations of procedures Provide positive reinforcements for the child, such as stickers and small badges
7
The Pediatric Hospital Setting (cont.)
Pediatric intensive care units (cont.) Interpret technical information for family members Promote the family relationship as much as possible Encourage the caregiver to touch, talk to the child Safety Essential aspect of pediatric nursing care Pediatric environment should meet all the safety standards Child’s developmental level may add other safety concerns
8
The Pediatric Hospital Setting (cont.)
Infection control 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
9
The Pediatric Hospital Setting (cont.)
Infection control (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
10
The Pediatric Hospital Setting (cont.)
Infection control (cont.) Transmission-based precautions (cont.) Child subject to social isolation Encourage family caregivers to spend time with the child If masks or gloves are part of the necessary precautions, the child may experience even greater feelings of isolation Be alert to child’s loneliness and sadness
11
The Pediatric Hospital Setting (cont.)
Importance of caregiver participation Separation can have damaging effects Stages of response to the separation First stage (protest) Cries, refuses to be comforted, constantly seeks primary caregiver Second stage (despair) Becomes apathetic and listless, gives up Third stage (denial) Begins taking interest in surroundings, appears to accept the situation
12
The Pediatric Hospital Setting (cont.)
Rooming-in Explain facility and rules to caregiver before admission Explain provision for meals to the caregiver Avoid seeming to expect caregivers to perform as health care technicians Define caregiver’s role as a provider of security and stability for the child Allow siblings to visit the ill child Be aware of the caregiver’s needs
13
Question Some hospital pediatric units have a program to make the hospitalization less frightening for both children and their parents. This program is overseen by whom? a. Head nurse b. Charge nurse c. Child psychologist d. Child-life specialist
14
d. Child-life specialist
Answer d. Child-life specialist Rationale: Many hospitals have a child-life program to make hospitalization less threatening for children and their parents. These programs are usually under the direction of a child-life specialist, whose background is in psychology and early childhood development.
15
Admission and Discharge Planning
Planned admissions Preadmission preparation may make the experience less threatening Answer questions, explore anxieties Discuss common questions and feelings Tell children that some things will hurt, but everything will be done to make the hurt go away Be sensitive to cultural and language differences
16
Admission and Discharge Planning (cont.)
Emergency admissions Leave little time for explanation Physical needs assume priority over emotional needs Nurses must be sensitive to the needs of child and family Nurses must recognize child’s cognitive level and its impact on the child’s reactions The staff must explain procedures and conduct themselves in a caring, calm manner
17
Admission and Discharge Planning (cont.)
The admission interview Content Identification, allergy bracelets Client history Physical examination
18
Admission and Discharge Planning (cont.)
The admission interview (cont.) 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 Disturbing or threatening concerns on the part of the caregiver or the child
19
Admission and Discharge Planning (cont.)
The admission physical examination Occurs after orientation to unit Caregiver may undress child for physical examination Caregiver may stay with the child during physical examination
20
Admission and Discharge Planning (cont.)
Begins early in the hospital experience Assesses the family’s level of understanding of the child’s condition and necessary home care Teaches caregiver regarding giving medications, using special equipment, and enforcing necessary restrictions Provides specific, written instructions for reference at home Assures caregiver understanding of written materials
21
Question There are several components to the admission interview. Which of the following is one of them? a. Maintaining the confidentiality of other children on unit by orienting new patient to their room only b. Assessment of caregiver’s understanding of caregiver’s disciplinary responsibilities c. Determining what the child and caregiver understand about reason for hospitalization d. Explaining that the child can have toys in their room but cannot take them out of the room
22
Answer c. Determining what the child and caregiver understand about reason for hospitalization Rationale: Through careful questioning, the interviewer tries to determine what the family’s previous experience has been with hospitals and health care providers. It is also important to ascertain how much the caregiver and the child understand about the child’s condition and their expectations of this hospitalization, what support systems are available when the child returns home, and any disturbing or threatening concerns on the part of the caregiver or the child.
23
The Child Undergoing Surgery
Surgery can frighten both child and caregivers Outpatient surgery facilities eliminate separation of child from caregiver Child who has surgery needs compassionate, thorough preoperative and postoperative care
24
The Child Undergoing Surgery (cont.)
Preoperative care General aspects Patient teaching Skin preparation Preparation of the gastrointestinal, urinary systems Preoperative medication
25
The Child Undergoing Surgery (cont.)
Preoperative care (cont.) Patient teaching Determining child knowledge, learning ability Correcting any misunderstandings Explaining the preparation for surgery, what the surgery will “fix,” and how the child will feel after surgery Preparation based on the child’s age, developmental level, previous experiences, and caregiver support
26
The Child Undergoing Surgery (cont.)
Preoperative care (cont.) Patient teaching (cont.) Making sure explanations are clear, honest, and simply expressed Encouraging questions to ensure understanding Prepare for tests and procedures Prepare for postanesthesia unit Prepare for postoperative pain
27
The Child Undergoing Surgery (cont.)
Preoperative care (cont.) Skin preparation May include a tub bath or shower Special cleaning and inspection of the operative site Gastrointestinal, urinary system preparation May need cleansing enema Nothing by mouth (NPO) four to 12 hours before surgery Urinary catheterization may needed
28
The Child Undergoing Surgery (cont.)
Preoperative care (cont.) Preoperative medication: Usually given in two stages Sedative is administered about half to two hours before surgery Analgesic–atropine mixture may be administered immediately before the patient leaves for the operating room Take medications to clients room Another staff member may accompany you to hold child
29
The Child Undergoing Surgery (cont.)
Postoperative care Nursing care focuses: Careful observation for any signs or symptoms of complications: Shock, hemorrhage, or respiratory distress Monitor, record vital signs according to postoperative orders Keep child warm First voiding Anuria Intake and output Coughing, deep breathing, and position changes
30
The Child Undergoing Surgery (cont.)
Postoperative care (cont.) Pain management Children often undermedicated Signs/symptoms of pain in children Rigidity Thrashing Facial expressions
31
The Child Undergoing Surgery (cont.)
Postoperative care (cont.) Pain management (cont.) Signs/symptoms of pain in children (cont.) Loud crying or screaming Flexion of knees (indicating abdominal pain) Restlessness; irritability Physiologic changes Assess with pain tool geared to child’s developmental age
32
The Child Undergoing Surgery (cont.)
Postoperative care (cont.) Pain management (cont.) Pain medication may be administered Orally Routine intramuscular or IV routes Patient-controlled analgesia (PCA) Programmed IV infusion of narcotic analgesia that the child may control within set limits
33
The Child Undergoing Surgery (cont.)
Postoperative care (cont.) Pain management (cont.) Comfort measures should be used in conjunction with analgesic administration No child should suffer pain needlessly Surgical dressings Close observation of any dressings for drainage, hemorrhage Reinforcing or changing dressings as ordered Explain to the child what will be done and why
34
The Child Undergoing Surgery (cont.)
Postoperative care (cont.) Postoperative patient teaching As important as preoperative teaching Encourage the caregivers and child to share their feelings about the surgery, any changes in body image, and their expectations for recovery and rehabilitation Focuses on home care at discharge
35
Question Jimmy is 6 years old. He has been admitted to your unit for gastric surgery the following day. The surgeon has ordered a preoperative enema to be given. When would you expect to give this enema? a. Before the evening meal the day before surgery b. The evening before surgery c. Right before bedtime the night before surgery d. About one hour before surgery
36
Answer b. The evening before surgery
Rationale: You would not give an enema just prior to a meal if you want the gastrointestinal tract cleaned out for surgery; you would never give an enema just prior to putting a child to bed for the night; and you would not give an enema one hour before the planned surgery because the child would receive a sedative one and a half to two hours before going to the operating room.
37
The Hospital Play Program
Play is the business of children Play helps children come to terms with the hurts, anxieties, and separation that accompany hospitalization Must not be allowed to harm themselves or others
38
The Hospital Play Program (cont.)
The hospital play environment An organized and well-planned play area is important If possible, adolescents should have a separate recreation room Play therapy: Technique of psychoanalysis Therapeutic play: Play technique used to help child better understand what will be happening to him or her in a specific situation A play technique that play therapists, nurses, child- life specialists, or trained volunteers may use to help the child express feelings, fears, and concerns
39
The Hospital Play Program (cont.)
Play material Chosen with safety in mind Constant supervision necessary for safety Hospital equipment useful for play therapy Dolls or puppets Other useful play materials include clay, paints, markers, crayons, stamps, stickers, sand art, cut-out books, construction paper, puzzles, building sets, and board games
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.