UNIT 6 The Nursing Role in Supporting the Health of Ill Children and Their Families

Chapter 36 Nursing Care of a Family with an Ill Child

Nursing Process for an Ill Child

 An assessment for a child diagnosed with an illness that requires hospitalization begins with an
interview of the child and parents to identify ways they think the illness will change their lives
 Nursing diagnoses vary greatly depending on the extent of a child’s illness, the care needed, and
the age of the child.
 Planning for the care of an ill child requires consideration of all aspects of the child’s and the
family’s life: financial, social, and personal.
 Five hazards that may occur with children with all illnesses are (1) experiencing harm or injury, such
as physical discomfort, pain, mutilation, and death; (2) being separated from routines, parents,
peers, and respected adults; (3) facing the unknown (new and strange sights and sounds and
happenings); (4) facing uncertain limits (unclear definition of acceptable and expected behavior);
and (5) experiencing a loss of control (loss of competence or loss of the ability to make decisions).
 An evaluation of expected outcomes for ill children should include specific measures such as
whether discomfort was kept to a minimum during the experience.
KEY POINTS FOR REVIEW

 Illnesses may be more traumatic for children than for adults because of children’s inability to
communicate and monitor their own care and because they have different nutrition, fluid, and
electrolyte needs. The stress of hospitalization can be so acute that it can result in PTSD.
 Separation from parents because of hospitalization can have permanent psychological effects on
children. Methods to reduce this include keeping hospital stays as brief as possible, promoting open
parent and sibling visiting, and providing primary or case management nursing. Case management
nursing is a collaborative approach of applying the nursing process to meet the needs of patient
and their family.
 Currently, many medical procedures can be done on an ambulatory basis. Advocating for care to be
done in such settings is a nursing responsibility.
 The presence of parents during health care can help reduce trauma to children. Making parents as
welcome as possible in healthcare facilities makes it possible for them to room-in. Include parents
in both the planning and the implementation of care. Parents reinfect children with fear if their
own fear is not reduced.
 Preschoolers may have the most difficult time during hospitalization because they have so many
fears. Preparation and promotion of therapeutic play may be essential to reduce trauma to a
tolerable level.
 Because hospitalizations currently are so brief, parents need good discharge instructions to
continue to care for children safely at home. Providing clear instructions, including suggestions for
play or how to avoid sleep deprivation, is important to help plan nursing care that not only meets
QSEN competencies but also best meets a family’s total needs.
KEY TERMS
calorie counting - as the name implies, involves counting the number of calories that children ingest each
day
non–rapid eye movement (NREM) sleep - A feeling of drifting or falling. Often described as twilight sleep.
Temperature and heart rate decrease slightly; electroencephalogram (EEG) waves show.
play therapy - addresses basic and persistent psychological issues associated with how a child may interact
with his or her world
primary nursing - Primary nursing promotes ongoing communication between the patient, family, nurses,
and physicians by building rapport and facilitating discharge planning beginning on admission.
rapid eye movement (REM) sleep - Eyes move in rapid, involuntary motions. Respirations are irregular;
body turnings, movements, and penile erections may occur. Lasts 10 to 30 min and then a new sleep cycle
with NREM sleep begins.
sensory deprivation – is the condition of being deprived of, or lacking, adequate sensory, social, physical,
or cognitive stimulation.
sensory overload - in contrast to deprivation, occurs when children receive more stimulation than they can
tolerate or process
sleep deprivation - After approximately 4 days of poor sleep, this can cause them to experience difficulty in
concentrating and episodes of disorientation and misperception.
therapeutic play - is play designed to help children express their feelings about painful or frightening
procedures

Chapter 37 Nursing Care of a Family When a Child Needs Diagnostic or Therapeutic Modalities
Nursing Process for a Child Who Needs Diagnostic or Therapeutic Procedures

 Before performing procedures such as assisting with a diagnostic test or collecting laboratory
specimens, first carefully evaluate a child’s age and developmental stage as well as any special
needs a child may have.
 Common nursing diagnoses related to diagnostic and therapeutic procedures are as varied as the
procedures themselves.
 Procedures can produce stress in addition to the anxiety caused by a primary illness. An important
nursing goal, therefore, is to perform procedures and complete interventions with the least amount
of anxiety possible.
 As a final follow through step, plan for introducing therapeutic play techniques that would be
helpful in relieving stress caused by the procedure.
 Evaluating expected outcomes related to diagnostic and therapeutic procedures is not only helpful
in determining the effect of the procedure on a child but also aids in future planning should other
procedures be required
KEY POINTS FOR REVIEW

 Preparing children for procedures reduces anxiety. Prepare a child and parents by trying to relate a
procedure to something a child is already familiar with, such as comparing an X-ray machine to a
camera.
 Include parents in both the planning and implementation of care because parents can reinfect
children with fear if their own fear is uncontrolled. Try to give explanations on two levels: “I’m
going to change the dressing on her suture line” for a parent; “I’m going to put a clean bandage on
your tummy” for the child.
 Minimize the number of painful procedures; for instance, combine blood sampling procedures, if
possible.
  Perform any procedures that will cause pain in a treatment room or away from the child’s bedside
so the bed remains a “safe” place.
 Perform treatments without chilling or exposure. Respect modesty even in very young children.
 Allow a child to voice anger or fear of a procedure. Provide therapeutic play after a procedure to
help reduce these reactions.
 Children feel more secure with adults who are confident in their actions. Practice as necessary the
steps of a procedure before you begin so you can demonstrate confidence and skill.
 Once you have announced that a procedure needs to be done, proceed to do it; waiting for
something to happen is often as stressful as actually having it done.
 Involve children in procedures to implement care that not only meets QSEN competencies but also
best meets a family’s total needs. Allow a child to examine electrodes or apply gel for electrode
contact before a procedure, for example. Give children a portion of an ECG strip as a badge of
courage after the procedure, or let children apply their own adhesive bandage.
 Praise children for cooperation even if none was visibly obvious. For painful procedures, any
behavior short of hysterical screaming counts as cooperation.
 Following the use of moderate sedation, observe children carefully until they are fully awake. Check
for the return of the child’s gag reflex before offering any fluids to minimize the risk of aspiration.
 Help make feeding by a route such as a gastrostomy tube as close to normal as possible by talking
to the child to simulate mealtime conversation and socialization.
KEY TERMS
aspiration studies - which are the removal of body fluids by such techniques as lumbar
puncture or bone marrow aspiration, are always anxiety-causing procedures.
Bronchoscopy - is the direct visualization of the larynx, trachea, and bronchi through a lit, flexible,
fiberoptic tube (i.e., a bronchofiberscope) that is passed through the naris or trachea
clean-catch urine specimen - is ordered when urine is needed for urinalysis and culture. The objective is to
obtain urine that is uncontaminated by external organisms, such as skin flora, which would increase the
organism count of the urine.
Colonoscopy - is an endoscopic examination of the large intestine with a flexible fiberscope that is inserted
through the anus and advanced as far as the ileocecal valve.
computed tomography (CT) - more commonly known as a CT or CAT scan, is an Xray procedure in which
many views of an organ or body part are obtained to represent what the organ would look like if it were
cut into thin slices.
electrical impulse studies - are those that include electrical conduction
endoscopy - involves the use of an endoscope, which is passed through the mouth, to examine the
gastrointestinal tract and has become a common method of diagnosis for gastrointestinal disorders in
children.
magnetic resonance imaging (MRI) - combines a magnetic field, radio frequency, and computer
technology to produce diagnostic images that aid in the diagnosis of disorders such as the cause of renal or
brain pathology.
positron emission tomography (PET) - involves imaging after injection of positron-emitting
radiopharmaceuticals into a vein.
radiopharmaceuticals - are radioactive-combined substances that when given orally or by injection, flow to
designated body organs.
single-photon emission computed tomography (SPECT) - a similar procedure used mainly for blood flow
evaluation.
total parenteral nutrition (TPN) - or nutrition administered intravenously, has become one of the most
important therapies for children who have gastrointestinal illnesses that prevent proper absorption of
basic caloric or fluid requirements or respiratory illnesses that make infants too exhausted to suck.
ultrasound - is a painless procedure in which images of internal tissue and organs, such as the appendix,
are produced by the use of sound waves
Chapter 38 Nursing Care of a Family When a Child Needs Medication Administration or Intravenous
Therapy
Nursing Process for a Child Needing Medication/Intravenous Therapy

 Because children vary so greatly in size and individual need, administering medication to children
begins by assessing the child’s weight in kilograms so that weight-based dosing can occur.
 Common nursing diagnoses related to medicine administration vary widely.
 Explain to children the effects that can be expected from any medicine. Be certain to give this
explanation at an age-appropriate level and be sure it is consistent with any prior explanation that a
parent or other healthcare provider has supplied.
 Interventions related to medication and IV therapy with children include both administering
medicine to ill children as well as teaching parents and children how to continue to take the
medicine when at home or at school.
 Expected outcomes associated with medication administration should ensure that a child receives
the medicine as prescribed and that the medicine has the desired effect.
KEY POINTS FOR REVIEW

 The effectiveness of medicines varies depending on the pharmacokinetics (absorption, distribution,

metabolism, and excretion) of the drug.
 The principles of safe medicine administration for adults also apply to children: right medicine, right
child, right dose, right route, right time, and right patient instructions.
 The correct drug dose in children is usually calculated according to the child’s body weight. Body
surface area, determined by using a nomogram or BSA formula, may also be used. The body surface
area formula is based on height and weight for calculating medication dosages.
 Use adequate restraints as needed when giving medicine to be certain children will not
inadvertently be harmed in the process.
 In children, the majority of medications are given orally or intravenously to avoid the discomfort of
other routes. Subcutaneous pumps infuse medicine such as insulin.
 IV therapy may be administered peripherally or via a central venous access site. A scalp vein is a
common IV site used for infants.
 An intraosseous infusion is used in an emergency when it is difficult to establish usual IV access or
in a child with such extensive burns that the usual sites for IV infusion are not available.
 Teach parents safe actions for giving medicine at home so children can continue to receive accurate
doses after hospital discharge and ensure they understand the importance of storing medications in
a locked area; such thoroughness helps in planning care that not only meets QSEN competencies
but also best meets a family’s total needs.
KEY TERMS
Absorption - the transfer of the drug from its point of entry in the body into the bloodstream
Distribution - refers to the movement of the drug through the bloodstream to a specific
site of action.
Excretion - the elimination of raw drug or drug metabolites, a process that largely prevents properly
administered drugs from becoming toxic
intermittent infusion devices - sometimes called saline locks, are devices that maintain open venous
access for medicine administration while allowing children to be free to move about without being
restricted by IV tubing and pumps
intracath - a slim, pliable catheter threaded into a vein
metabolism - involves conversion of the drug into an active form (biotransformation) or into an inactive
form (inactivation).
pharmacokinetics - or the way drugs are absorbed, distributed throughout the body, metabolized,
inactivated, and excreted.
vascular access ports (VAPs) - also known as Infusaports or PORT-A-CATHs, are small plastic infusion
devices that are implanted under the skin, usually on the anterior chest just under the clavicle, for long-
term fluid or medication administration via bolus or continuous administration