NURSING CARE OF THE HOSPITALIZED CHILD

Developmental Stages and Ages

 Infant (0-1 years)

 Toddler (1-3 years)

 Preschooler (3-5 years)

 School-Age (5-12 years)

 Adolescent (13-18 years)

FAMILY CENTERED CARE OF
THE CHILD DURING ILLNESS
AND HOSPITALIZATION
Stressors of Hospitalization
 Separation anxiety
 Protest phase
 Crying and screaming, clinging to parent
 Despair phase
 Cessation of crying; evidence of depression
 Detachment phase
 Denial; resignation but not contentment
 Possible serious effects on attachment to parent
after separation
Effects of Hospitalization on the Child

 Effects may be seen before admission, during

hospitalization, or after discharge
 Child’s concept of illness is more important than
intellectual maturity in predicting anxiety
 Child may or may not be affected by previous
hospitalizations
 Individual Risk Factors
Effects of Hospitalization on the Child

Beneficial Outcomes

Recovery from illness
Competence in abilities to cope
Mastery of stress
New socialization experiences

Adverse Outcomes

Regression
Separation anxiety
Apathy
Fears
Sleeping disturbances
Stressors and Reaction of the Family

 Parental Reactions
 Overall sense of helplessness
 Questioning the skills of staff
 Accepting the reality of hospitalization
 Dealing with fear
 Coping with uncertainty
 Seeking reassurance
 Sibling Reactions
 Experiencing many changes and being too young to understand them
 Being cared for by nonrelatives or outside of the home
 Receiving little information about the ill brother or sister
 Perceiving that parents will treat the sick child differently
Preparation for Hospitalization
 Admission Assessment
 ADLs
 Medications
 Physical Assessment
 Preparing the child for
admission
 Prehospital counseling
 Room assignment
Nursing Interventions
 Preventing or minimizing separation
 Preventing or minimizing parental absence
 Minimizing loss of control
 Preventing or minimizing fear of bodily injury
 Providing developmentally appropriate activities
 Provide opportunities for play and expression
 Diversional activities
 Expressive activities (ex. creative expression and dramatic play)
 Toys
 Utilize a child life specialist
Nursing Care of the Family
 Supporting family members
 Providing information
 Encouraging parent participation
 Preparing for discharge and home care
Maximizing Potential Benefits of Hospitalization

 Fostering parent-child relationships

 Providing educational opportunities
 Promoting self-mastery
 Providing socialization
Special Hospital Situations
 Ambulatory or outpatient setting
 Isolation
 Emergency Admission
 Intensive Care Unit
PEDIATRIC VARIATIONS OF
NURSING INTERVENTIONS
General Concepts
 Informed Consent
 Preparation for
Procedures
 Surgical
Procedures
 Postoperative
Care
Safety
 Environmental Factors
 Infection Control
 Transporting Infants and Children
 Restraining Methods and Therapeutic Holding
Collection of Specimens
 Fundamental procedure steps
 Urine specimens
 Clean catch
 24-hour
 Catheterization
 Stool specimens
 Blood specimens
 Respiratory secretions
Medication Administration
 Safety is very important
 Liver and kidneys aren’t fully developed
 Medications are weight based
 Use accurate measuring devices
 Identify the child
 Use nursing judgment and developmental
considerations for administration using particular
routes
Parenteral Fluid Therapy
 Site and Equipment
 Infusion Pumps
 Securing Lines
 Removing Lines
 Complications
PAIN ASSESSMENT AND
MANAGEMENT IN
CHILDREN
Pain Assessment
 Three types of
measures to assess
child’s pain
 Behavioral (FLACC,
NIPS)
 Physiologic
 Measures of self-
report
 Chronic Pain
Pain Assessment in Specific Populations

 Children with communication and cognitive

impairment
 Noncommunicating Children’s Pain Checklist
 Pain indicators for communicatively impaired children
 Cultural differences
 Children with chronic illness and complex pain
Nonpharmacologic Pain Management

 Distraction
 Relaxation
 Guided imagery
 Cutaneous
stimulation
 Containment and
swaddling
 Nonnutritive sucking
 Kangaroo care
 CAM
Pharmacologic Pain Management
 Acetaminophen
 Nonsteroidal anti-inflammatory drugs
 Opioids
 Coanalgesia or adjuvant analgesia
 Patient-controlled analgesia
 Transdermal Analgesia
 Side Effects
Consequences of Untreated Pain
 Infant pain often inadequately managed
 Mismanagement of infant pain partially because of
misconceptions regarding effects of pain
 Chemical and hormonal responses
 Greater morbidity for neonates in NICU
IMPACT OF COGNITIVE
OR SENSORY
IMPAIRMENT ON THE
CHILD AND FAMILY
Cognitive Impairment
 “Cognitive impairment” (CI) is a general term that
encompasses any type of mental difficulty or deficiency
 Used synonymously with “intellectual disability”
 Diagnosis
 Made after a period of suspicion by family or health
professionals
 In some instances, made at birth
 Classified as mild, moderate, severe, or profound
determined by IQ
Causes of Cognitive Impairment
 Intrauterine infection and intoxication
 Trauma (prenatal, perinatal, postnatal)
 Metabolic or endocrine disorders
 Inadequate nutrition
 Postnatal brain disease
 Unknown prenatal influences
 Chromosomal anomalies
 Prematurity, low birth weight, postmaturity
 Psychiatric disorders with onset in childhood
 Environmental influences
Nursing Care of Children with Impaired Cognitive
Function

 Educate child and

family
 Early intervention
 Teach child self-care
skills
 Promote child’s
optimal
development
 Encourage play and
exercise
Nursing Care of Children with Impaired Cognitive
Function (Cont.)

 Provide means of communication

 Establish discipline
 Encourage socialization
 Provide information on sexuality
 Help families adjust to future care
 Care for the child during hospitalization
Hospitalized Care for Child with Hearing
Impairment

 Promote Communication
 Reassess understanding of instructions given
 Supplement with visual and tactile media
 Provide communication devices
 Picture board with common words
 Assistance of child life specialist
 Additional aids
Hospitalized Care for Child with Visual Impairment

 Provide a safe environment

 Provide reassurance during all treatments
 Orient child to surroundings
 Encourage independence
 Treatment team members should be consistent
CHRONIC ILLNESS,
DISABILITY, AND END-
OF-LIFE CARE
Scope of the Problem
 Increasing viability of preterm infants
 Portability of life-sustaining technology
 Life-extending treatments
 Rise in the numbers of children with complex and
chronic diseases
Effects of the Child’s Chronic Illness or Disability

 Parents
 Parental roles
 Mother-father
differences
 Single-parent
families
 Siblings
Helping Families Cope
 Families often have stress of child’s care in
addition to regular family stressors
 Approach Behaviors vs. Avoidance Behaviors
 Parental Empowerment
 Recognizing, promoting, and enhancing competence
 Help family members manage their feelings
 Shock and denial, adjustment, reintegration and
acknowledgement
Nursing Care of the Family and Child

 Assessment
 Providing support at time
of diagnosis
 Supporting family’s coping
methods
 Educate about the disorder
and general health care
 Promote normal
development
 Establish realistic future
goals
Perspectives on Care of Children at End of Life

 Principles of palliative care

 Pain and symptom management
 Decision making at end of life
 Ethical considerations
 Physicians, health care team
 Parents
 The dying child
 Treatment options for terminally ill children
 Hospital
 Home care
 Hospice
Nursing Care of Child and Family at End of Life

 Child and family usually experience fears

 Fear of pain and suffering
 Fear of dying alone (child) or not being present at
death (parent)
 Fear of actual death
Organ or Tissue Donation and Autopsy

 Meaningfulness of acting to benefit another human

being
 Sensitive approach
 Organ donation: legislated in many states
 Common questions asked by families
 Unexplained, violent death, or suspected suicide
 Autopsy may be required by law
Grief and Mourning
 Grief: a process, not an event
 Highly individualized
 Anticipatory guidance
 Mourning process
 Recognition of when grief becomes “complicated” or
“abnormal”
 Parental grief
 Sibling grief
 Nurse’s reactions to caring for dying children