1. Care of the Hospitalized Child
Chapter 29:
Care of the Hospitalized Child

2. Care of the Hospitalized Child
The cause of the illness,
its treatment,
guilt about the illness,
past experiences of illness and hospitalization,
disruption in family life,
the threat to the child's long-term health,
cultural or religious influences,
coping methods within the family,
and financial impact of the hospitalization
These may all affect how the family responds to the child's illness.

3. The Pediatric Hospital Setting
The family caregiver's role in educating the child about hospitals includes helping the child develop a positive attitude about hospitals, hospitalization, and illness, and giving children simple, honest answers to their questions.
Pediatric units are developed to create comfortable and safe atmospheres for children and are decorated with a variety of colors.
Treatments are done in treatment rooms rather than the child's room.
Playrooms encourage activities for promoting normal age-related development.

4. The Pediatric Hospital Setting (cont.)
Safety is an essential aspect of pediatric care. The stress that infants, children, and their family caregivers experience when a child is hospitalized may increase the frequency of accidents.
Understanding the growth and development levels of each age group helps you be alert to possible dangers for each child.

5. The Pediatric Hospital Setting (cont.)
Microorganisms are spread by :
contact (direct, indirect, or droplet);
vehicle (food, water, blood, or contaminated products);
airborne (dust particles in the air);
or vector (mosquitoes, vermin) means.
Standard precautions reduce the risk of transmission of microorganisms from recognized or unrecognized sources of infection.

6. The Pediatric Hospital Setting (cont.)
Transmission-based precautions are used for clients documented or suspected of having highly transmissible pathogens that require additional precautions.
Hand washing is the cornerstone of all infection control.
Wash hands conscientiously between seeing each client, even when gloves are worn for a procedure.
For a child placed on transmission-based precautions, spending extra time in the room when performing treatments and procedures, reading a story, playing a game, or talking with the child can help ease feelings of isolation.

7. The Pediatric Hospital Setting (cont.)
The three stages of response to separation seen in the child include:
protest (the child cries, refuses to be comforted, and constantly seeks the primary caregiver);
despair (the child becomes apathetic and listless when the caregiver does not appear);
and denial (the child appears to accept the situation, but ignores the primary caregiver when he or she returns).

8. The Pediatric Hospital Setting (cont.)
Family caregiver participation is important to relieve the child's separation anxiety.
Rooming-in is encouraged to make the child feel more secure and to provide opportunities to reinforce teaching with family caregivers about how to care for the child after discharge.
Encourage caregivers to take breaks from the child when needed.

9. Admission and Discharge Planning
In a planned admission, preadmission education helps prepare the child for hospitalization.
In an emergency admission there is little time to prepare the child for hospitalization.
There is time to explain procedures to the child and let the child play with equipment to become familiar with it. In an emergency admission, there may be little time for explanations because physical needs are the priority.

10. Admission and Discharge Planning (cont.)
The family caregiver is a vital participant in the care of an ill child.
The caregiver participates in the admission interview and should be included in the planning of nursing care.

11. Admission and Discharge Planning (cont.)
Discharge planning includes:
reinforcing teaching with the child and the family about the care needed after discharge from the hospital.
Written instructions should be provided.
Also include information about how the child may respond after discharge.
When readjusting to the home environment, the family should encourage positive behavior, avoid making the child the center of attention, and provide loving but firm discipline.

12. The Child Undergoing Surgery
In reinforcing preoperative teaching, health professionals determine:
how much the child knows and is capable of learning,
help correct any misunderstandings,
explain the preparation for surgery,
and explain how the child will feel after surgery.
Information given must be based on:
the child's age,
developmental level,
previous experiences,
and caregiver support.

13. The Child Undergoing Surgery (cont.)
Preoperative preparation for the child may include:
skin preparation, such as a tub bath or shower,
shaving the surgical site,
administering enemas,
keeping the child NPO,
urinary catheterization,
and administering preoperative medications.

14. The Child Undergoing Surgery (cont.)
Postoperative care of the child following surgery includes:
careful observation and looking for signs of complications,
close monitoring of vital signs,
dressings,
intake and output,
following postoperative orders,
and reinforcing client and family teaching.

15. 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 1 hour before surgery

16. 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 1 hour before the planned surgery because the child would receive a sedative 1.5 to 2 hours before going to the operating room.

17. Pain Management
Gathering data and treatment of pain is important in caring for children.
Use of pain assessment tools helps children express the amount of pain they are having.

18. Pain Management Behaviors such as : rigidity, thrashing,
facial expressions,
loud crying or screaming,
flexion of knees (indicating abdominal pain), restlessness,
and irritability may indicate the child is in pain.

19. Pain Management Physiologic changes, such as:
increased pulse rate and blood pressure,
sweating palms,
dilated pupils,
flushed or moist skin,
and loss of appetite, may also indicate pain.

20. The Hospital Play Program
Play is the principal way in which children learn, grow, develop, and act out feelings and problems.
In hospital play programs, children may express frustrations, hostilities, and aggressions through play without the fear of being scolded.
A well-planned hospital play area with safe play materials and activities for children of all ages is important.
Play therapy is a technique used to uncover a disturbed child's underlying thoughts, feelings, and motivations to help understand them better.
Therapeutic play is 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.