1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 36 Nursing Care of a Family With an Ill Child

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: An Ill Child Assessment Nursing diagnosis Outcome identification, planning Implementation Outcome evaluation

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Meaning of Illness Factors affecting –Cognitive ability –Past experiences –Level of knowledge

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Meaning of Illness (cont’d) Differences in responses of children, adults to illness –Inability to communicate –Inability to monitor own care, manage fear –Nutritional needs –Fluid, electrolyte balance –Age-specific diseases

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Ill Child Preparing for hospitalization –Family –Infant –Toddler or preschooler –School age or adolescent –Different cultural background –Physically ill or chronically ill

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Ill Child (cont’d)

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Ill Child (cont’d) Admitting an ill child –Admission assessment Promoting positive hospital stay –Minimizing length of stay –Providing continuity of care –Decreasing separation anxiety

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Ill Child (cont’d) Promoting positive hospital stay –Promoting visitation –Encouraging parents to participate –Supporting sibling, grandparent visitation –Minimizing negative effects of procedures –Reducing or eliminating pain

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Ill Child (cont’d) Promoting positive hospital stay –Maintaining child’s bed as safe area –Helping children maintain control –Adequate play facilities –Setting limits on behavior Discharge planning

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Ill Child at Home Advantages –Reduced cost –Comfort, support Disadvantages

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Ill Child at Home (cont’d) Home assessment –Identifying primary-care provider –Knowledge of family –Available resources –Current level of family functioning

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Ill Child at Home (cont’d) Planning, implementing care –Therapeutic environment –Promoting healthy family functioning

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of the Ill Child at Home (cont’d)

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Responsibilities Promoting growth, development –Infant –Toddler or preschooler –School-aged child –Adolescent

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Nutritional Health Encouraging fluid intake Encouraging food intake

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Safety Fire safety Standard precautions

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Adequate Sleep Sleep pattern –Nonrapid eye movement (NREM) –Rapid eye movement (REM) Sleep deprivation Managing chronic sleep problems

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Adequate Stimulation Sensory deprivation Children on bedrest Children on transmission-based precautions Sensory overload

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Play Assessing health through play Play in ambulatory settings Play in hospital Play for children on bedrest Safety with play Child life programs

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Play (cont’d)

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Play (cont’d) Therapeutic play –Energy release –Dramatic play –Creative play Guidelines for conducting therapeutic play

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Play (cont’d)

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Play (cont’d)

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What would be a game you might play to urge a school-aged child to ingest a high fluid intake? A.Hangman B.“Simon says” C.Battleship D.Hide and go seek

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. “Simon says” Rationale: “Simon says” is a game that appeals to a school-aged child’s developmental needs because it is concerned with rules.

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A hospitalized 4-year-old cries and tries to bite during each physical assessment. What would be the best response by the parent that would help the nurse? A.“Can you just come back later?” B.“He is just scared and can’t help it.” C.“I can’t get him to stop biting a home, so I know I won’t be able to here.” D.“You are going to the ‘timeout’ chair if you try to bite again.”

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. “You are going to the ‘timeout’ chair if you try to bite again.” Rationale: Limit setting is still necessary with unacceptable behavior even though the child is hospitalized. Provision of behavioral guidelines helps the child to know what to expect.

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question In developing your plan for preoperative and postoperative teaching for an adolescent, it would be important to recognize that A.adolescents may act as if they know more than they actually do. B.an adolescent will not be interested in reassurance that things will go well. C.postoperative teaching should wait until after the surgery. D.the adolescent will need few explanations of the procedure because he or she has seen medical shows on television.

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Adolescents may act as if they know more than they actually do. Rationale: Adolescents may manifest an air of knowing more than they actually do as part of working through a sense of identity.