1. CARE OF THE HOSPITALIZED CHILD UNIT 1
NURSING OF CHILDREN
CARE OF THE
HOSPITALIZED CHILD
UNIT 1

2. Separation Anxiety Protest Despair Denial / Detachment
Feel abandoned by Mom
Despair
Appear sad & depressed
Denial / Detachment
Appear to deny need for parent & become uninterested in visits

3. Interventions Preserve & heal parent-infant bonding Privacy
Parent participation
Speak of parent to child
Communication
Do not interfere in parent/child relationship
Let parent know times of procedures
Resources for care of siblings
Encourage sibling visits

4. Sibling Problems Feelings Interventions Guilt Left out Resentful
Jealous
Helpless
Interventions
Visits
Letter writing
Pictures
Phone calls/texts
Assist in care

5. Lessening Parent Stress
Objective & empathetic
Communication

6. Sensorimotor Activities
Cuddling, rocking, talking & singing
Swing
Bath with squeeze toys
Mobile

7. Surgical Preparation & Adaptations
Child’s level of understanding
Listen & reassure
Infants - NPO no longer than 4-6 hrs
Avoid a prolonged wait
Pacifiers

8. Preschool Child Psychosocial Development
Concrete thinking
- Realistic terms
Initiative vs. Guilt
Clear, understandable, truthful explanations
Praise

9. Preschool & School Aged Children
Need to feel grown up
Industry vs independence
Participate in care
Offer simple choices
Positive direction & consistency
Education continues
Express feelings

10. Adolescents Feel loss of control
Independence, self-assertion, & identity are threatened = withdrawal, noncompliant, anger

11. Adolescents Early adolescents (10-13yrs) Middle adolescents (14-16)
Body image threat; appearance, functioning & mobility; Privacy
Middle adolescents (14-16)
Peer group assumes > importance to determining acceptability & behavior
Struggle for emancipation from family
Incorporate choices, privacy, appropriate appearance, peer visitors

12. Adolescents Late adolescents (17-21)
Education, career, marriage, children, community, & life style
Contact with school
- Think abstractly
Understand implications & participation
Roommate selection

13. Safety Measures Crib side rails up when unattended ID bracelet
Avoid outlets & equipment
Inspect sharp edges & removable parts on toys

14. Restraints
Mummy
Hug
Elbow

15. Lumbar Puncture
Position
See page 499; Figure 22-7; 2 positions

16. Dosage Calculations
Garamycin 3mg/kg/day, divided into 3 doses, is recommended for a child. How much would a child weighing 20kg receive per dose? _____mg per day? ____mg

17. Dosage Calculations
The drug is available labeled Garamycin 40mg/mL. Based on the dose computed on previous slide, how much would you give per dose? ____mL

18. Dosage Calculations Weight: 8.8lbs. Dose ordered: 30mg po bid
Dose recommended: 15mg/kg/day
Is this dose safe?
How many mg will they get in 24 hrs?

19. Dosage Calculations
A child is receiving an IVPB of 58mL of fluid per hour with a drop factor of 60. What is the gtts per min?
125mL per hr with a gtt factor of 10 gtts per min?

20. Administration of Medicines
Legally & ethically responsible
Observe for toxic symptoms
Positive & negative responses charted
Pediatric dosage calculations

21. Oral Administration Difficulty swallowing pills Bad taste
Can give juice, popsicle to get rid of taste
“Candy”
Administer slowly with head & shoulders elevated (esp. if crying)
Prepare to hold child ‘s hands
Use oral syringe or dropper placed in side of infants & small children mouth
No meds in bottle

22. Ear Drop Administration
Allow to warm before instilling
Under 3, pinna pulled down & back
Older child, pinna is pulled up & back

23. Intramuscular Injections
Infants - vastus lateralis muscle
Free of major nerves & blood vessels
0.5 mL
Children walking > 1yr – ventrogluteal
Toddler - 1 mL
School age / adolescent – deltoid 1 mL or vastus lateralis 2 mL

24. Parenteral Fluids Restrain arm If infant NPO – pacifier offered
Microdrop tubing used
Every hr. observation
Rate, volume in bag
Site appearance
I & O

25. Oxygen Therapy Avoid friction toys, nylon & wool Infection control
High O2 concentrations toxicity
Humidification
Terminate gradually
↑ restlessness, ↑ P & R indicates not tolerating withdrawal
Administer age appropriate
See page 518, Box 22-3

26. Vital Signs
See page 491, Table 22-1 & Table 22-2 for pulses & respirations
See page 495, Table 22-3 for temps

27. Urine & Stool Specimens
Urine – see page 498, skill 22-5
Stool
Explanations
BSC, bedpan,, or speci hat in commode
Infants – scrape diaper

28. Infant Weights Naked Use scale paper or diaper, then balance scale
Lay gently on scale preventing fall
Have hand over baby & weigh when still

29. Pain Management See page 473 for pain scales
Restlessness, ↑ P & R as well as BP, inability to be consoled, crying, uncooperative
Distraction, relaxation, music, hand holding, explanations, stroking
Meds
Primary nursing responsibilities
Prevention
Assessment
Relief