NU 352 - Exam 1 - PP_ - TBL (int. for care of a hospitalized child)

illness and hospitialization

Represents changes in…

-unusual state of health

-routine

-environment

limited coping skills

-influenced by developmental age

Effects on family

illness and/ or hospitalization

-affects the entire family

parents

-feelings of helplessness

-need info in simple terms

-coping with hears/ uncertainty

-seeking reassurance

-questioning staffs skills

Age appropriate vital signs

-0-3 months = 110-160 BPM / resp = 35-55

-5-6 months = 110-160 BPM/ resp = 30-45

-6-12 months = 90-160 BPM / resp = 22-38

-1-3 y = 70-120 BPM / resp = 22-30

-3-6 y = 70-120 BPM / resp = 20-24

-6-12 y = 60-110 BPM / resp = 16-22

>12 y = 60-100 BPM / resp = 12-20

Major stressors

#1 = separation

#2 = loss of control

#3 = bodily injury/ pain

#1 stressor = separation (separation anxiety)

(middle infancy throughout preschool years = highest 6-30 months, establish trust)

-stages:

1: protest = crying/ screaming, clinging to parents, verbal/ physical aggression, indirect anger

2: despair = withdrawal, depression, decrease communication, developmental regression

3: detachment = interacts with stranger, superficial relationships, appears happy

-school age = may have increased need for parental security and guidance

-adolescence = reacts to separation from unusual activities and peers more than parents

#1 stressor = separation (separation anxiety) interventions

prevent separation

-procedures, intervention, conferences

-leave favorites from home

-maintain usual contacts

STRESSOR #2: LOSS OF CONTROL

-lack of control (increased perception of threat)

-environment overwhelming

-physical restriction (gain cooperation)

-changed routines (establish a daily schedule

-enforced dependency (self-care independence, provide choices, opportunities for decision making)

-anticipatory guidance (what to expect, preschoolers: magical thinking)

STRESSOR #3: BODILY INJURY/ PAIN

-normal/ expected fear

-modify procedural techniques (implement least invasive, perform as quickly as possible)

-poorly defined body boundaries (“bandage” needed, size matters)

-clarify misconceptions

play and expressive activities

-relieves stress

-provides a sense of control'

-play/ activity room

communication: word choices

AVOID THESE WORDS

-”shot, bee sting, stick”

-”edema”

-”stool”

-”pain”

-”take (BP/ pulse/ temp)

informed consent

required for:

-major/ minor surgery

-diagnostics tests with an element of risk

-medical treatments with an element of risk

requirements:

-capable of giving consent (age of minority)

-receive information to make intelligent decision

mature/ emancipated minor:w

-legally underage pf majority but recognized as having legal capacity by state law

treatment without parental consent:

-urgent medical/ surgical treatment

-parental refusal

-medically emancipated conditions

Procedural & Perioperative Preparation/ Care

psychological preparation

-decrease anxiety

-increase cooperation

-supports coping skills

Psychological Preparation

-involve child/ parent

-tour physical area/ see/ touch equipment

-explain what to expect pre-, intra-, post-

-keep frightening objects out of view (animism)

-use distraction

-provide choices

-use noninvasive/ least invasive procedure

-restrain adequately; expect resistance

psychological preparation continued

infant:

-provide sensory measures

toddler:

-explain procedure using senses (sensory aspects)

-give one direction at a time

-use simple terms

-use or play to demonstrate

-5-10 mins teaching sessions

-prepare child shortly/ immediately before procedure

preschooler:

-use sensory aspects

-use simple/ neutral words

-allow to play with equipment

-”play out” experience

-10-15 minutes teaching sessions

-explain not a form punishment

school age:

-start using correct terminology

-explain using simple diagrams, photos

-explain function/ operation of equipment

-20 minute teaching sessions

-prepare up to 1 day in advance

adolescent:

-discuss why necessary/ beneficial

-explain long term consequences

-encourage questions

physical preparation for surgical procedures

-fluid/ food restriction

-allow to wear underwear

-notify anesthesiologist of loose teeth

-ID bands secured

-preoperative medications

Surgical Complications & Interventions

-hypothermia

-post extubation coup, laryngo/ bronchospasms

-apnea/ bradypnea

-atelectasis (cough/ deep breathe, change positions)

-hypotension/ fluid balance

-Maintenance fluid requirements

4 x 10kg (or any part of 1st 10kg) =

2 x 10kg (or any part of 2nd 10kg) =

1 x remaining kg =

mL/hr

-Minimum acceptable urine output (1 mL/kg/hr)