1. Presented by Marlene Meador RN, MSN, CNE

3.  Influencing factors Internal ◦ Age (cognitive development) ◦ Preparation & coping skills ◦ Culture ◦ Previous experience with healthcare system

4.  Influencing factors External  Parent’s reaction to illness  Sibling’s reaction to current illness/hospitalization

5.  0-8 months  9-36 months  Preschool  School aged  Adolescent

6. ProtestDespairDetachment Screaming Crying Inconsolable Clinging to parents Agitated Resists caregivers Child becomes hopeless and becomes quiet, withdrawn, apathetic Sadness, depression Crying when parents appear Lack of protest when parents leave Appearance of happy and content with caregivers and other children Close relationships not established May ignore parents when they return

7.  Separation anxiety  Fear of injury  Loss of control

8.  Separation anxiety  Fear of injury  Loss of control  Guilt and shame

9.  Separation anxiety  Fear of injury/pain  Loss of control

10.  Separation anxiety  Fear of injury  Loss of control  Fear of the unknown

11.  Preschool-typically regress in comfort measures and toilet training, “temper tantrums” and toddler-like behaviors  School age- may become more fearful of strangers and require more emotional support (crying or “baby talk”)

12. How would a nurse best respond to a parent who is overly concerned about the child’s regression? How does toileting pattern and pacifier/bottle response differ from other regression?

14.  Perception  Support system  Coping mechanism

15.  Parents may become anxious  Financial stressors  Additional obligations  Guilt

16.  What are some psychological benefits of hospitalization for a child and family?

17.  Page 883 BOX 35-2

18.  Infant  Toddler-Preschool  School- aged  Adolescent  P891 BOX 35-2

19.  What factors influence the family’s ability to interact with the hospital staff?  What nursing interventions should receive highest priority when communicating with these families?

20.  Augment coping mechanisms- (what specific factors influence client teaching?)  Reinforce information and encourage questions (who would have difficulty with asking questions?)  Anticipate discharge needs (when should this begin?)

21.  Why is this an effective tool for assisting the child and the family?  How would the nurse assist the child and family to arrive at the PPEN?  Is this a static assessment?

22.  What nursing interventions prepare a child for hospitalization?  Are the interventions the same for all children?  Who should the nurse include in these preparations?

23.  Tour of the Hospital or surgical area  Photographs or a videotape of medical setting and procedures  Health Fairs  Contact with peers who had similar experience

24.  Child life specialists: assist with preparing child for procedures, and to adjust to illness and hospitalization.  Therapeutic play: emotional outlet, teaching strategy, assessment tool  Anticipate child/family’s needs

25.  What is the nurse’s best response to a family identified as “difficult”?  What additional information does the nurse require?  What is COPE, and how is it helpful with families in crisis?

26.  C- collaboration  O- objective  P- proactive  E- evaluate Avoid placating or condescending phrases.

27.  Special equipment- visually or hearing impaired, wheelchairs,  Specialized care- feeding tubes, trachs/vents  Assess family coping ability- who is primary caregiver  Assess support systems  Involve additional members of the healthcare team

30.  Therapeutic play ◦ Motional outlet ◦ Instructional ◦ Improve physiological abilities  Enhancing cooperation through play  Rewards the child’s payment for a job well done!

31.  When might a nurse use play as an assessment tool?  Why is this and effective technique?

32.  A person who plans activities to provide age- appropriate playtime for children either in the child’s room or in a playroom.  Goal: Assist children to work through feelings about their illness

33.  What happens when you ask a patient of any age “what is your pain level?”  How would you best assess a child’s pain?

34.  Infant- grimacing, poor feeding, restlessness, crying  Toddler- clinging to parent, crying, pulling or rubbing area of pain, anorexia, vomiting, restlessness.

36.  Preschool- verbalize pain, guard injured extremity, anorexia, vomiting, sleeplessness.  Adolescent- verbalize pain, may not understand “type” of pain. Possibly reluctant to call for help.

37.  After determining that the child has an understanding of number concepts, teach the child to use the scale.  Point to each photo, explain that the bottom picture is a “no hurt,” the second picture is a “little hurt,” the third picture is “a little more hurt,” the fourth picture is “even more hurt” the fifth picture is “a lot of hurt” and the sixth picture is the “biggest or most hurt you could ever have.”  The numbers beside the photos can be used to score the amount of pain the child reports.

38.  FLACC- face, legs, activity, cry and consolability (p. 1215-1216)  NIPS- neonatal pain during/after procedures- facial expression, cry quality, breathing patterns, arm & leg position, state of arousal

39. Remember to ask “where” they hurt. To children, emotional feelings are a “hurt”

40.  What happens to VS?  How does the nurse assess anxiety in a hospitalized child?  How does sleeplessness impact healing?

41.  Respiratory increase/changes  Neurologic changes  Metabolic changes  Immune system changes  GI changes.

42.  PCA- what age can use this most effectively?  Ketoralac- why is this effective? What specific nursing interventions apply to this medication?  Why are NSAIDS used with children?  What lab values and contraindications are important for analgesic medications used with children?

43.  What actions should the nurse include with each of the following? ◦ Positioning for comfort (turning or elevation) ◦ Thermal therapy (heat or cold) ◦ Diversion therapy  What actions would work best with an infant?

44.  The presence of the parent is an important part of pain management.  Children often feel more secure telling their parents about their pain and anxiety

46. If you have any questions or concerns regarding this information please contact Marlene Meador via email mmeador@austincc.edu