Overview of Chapter 21: Nursing Interventions for Pediatric Patients
This chapter consolidates the learning necessary to become effective nurses when working with infants, toddlers, preschoolers, and adolescents.
Key Points and Nursing Interventions
Nursing Interventions: Important to understand what possible interventions might be relevant for each age group. Common themes arise across different age ranges, particularly around emotional responses and communication.
1. Separation Anxiety
Definition: A developmental phenomenon where children experience distress when separated from their primary caregivers.
Example in a Hospital Setting:
When a toddler is hospitalized and a parent leaves, the toddler typically exhibits distress (crying, tantrums).
After a brief period, the child may calm down and engage in play.
Upon the parent’s return, they may again show distress.
Nursing Advice: It is crucial to encourage parents to return, as this is a normal behavior. Educate parents that their presence is important for the child’s emotional well-being.
2. Concept of Time for Children
Children often struggle with understanding time as adults do.
Instead of specific times (e.g., "4 PM" or "6 PM"), use relatable terms:
"Mom will be back after dinner."
"Mom will return after your playtime."
This helps children understand the timeline by relating events to routines (meals, bedtime).
3. Regression in Behavior
Definition: Regression refers to a child reverting to earlier behaviors when under stress.
Example:
A toilet-trained child may start wetting themselves again when a new sibling arrives or during hospital stays.
Nursing Approach: Notify caregivers that this is common and should not result in punishment. Assure them it is a temporary reaction to stress.
4. Transitional Objects for Comfort
Transitional objects are familiar items (like worn blankets or stuffed toys) that provide comfort in stressful situations.
Importance: Such objects can help children cope with discomfort or anxiety in a hospital setting.
Example: Encourage caregivers to bring the child’s favorite toy or blanket to the hospital.
5. Therapeutic Play
Definition: A method of explaining healthcare procedures or coping strategies using play.
Purpose: Helps children understand what to expect and reduces anxiety. Play can be illustrated using dolls or toys to demonstrate procedures like IV insertion.
Role of Child Life Specialists: Incorporate therapeutic play into the nursing process to prepare children for care interventions via relatable play scenarios.
6. Pain Assessment Scales
Understanding different pain scales for various age groups:
Neonatal Infant Pain Scale (NIPS): For infants under one year, assesses pain through facial expressions, cry, and behavior.
Indicators include grimacing, crying, breathing patterns.
FLACC Scale (Face, Legs, Activity, Cry, Consolability): Used for children aged 1-3 years; evaluates pain based on observable behaviors.
Faces Pain Rating Scales: For older children, where they can identify their pain using scales ranging from 0-10.
Critical for effective pain management.
Age Groups and Their Developmental Stages
1. Infants (0-1 years)
Erikson’s Stage: Trust vs. Mistrust
Motor Skills: Rolling, sitting, crawling, and eventually standing/walking.
Feeding: Primarily breast milk/formula, beginning solid foods around 6 months, transitioning to cow’s milk at 1 year.
Play: Exploration through mouthing, banging toys together.
Pain Scale: Use NIPS.
Behavior in Hospital: Crying; looking for caregiver. Nursing actions include calming them and encouraging the caregiver's presence.
2. Toddlers (1-3 years)
Erikson’s Stage: Autonomy vs. Shame and Doubt
Motor Skills: Walking, running, climbing, and beginning to ride tricycles.
Feeding: Picky eaters, often prefer finger foods.
Play: Engages in parallel play (playing near peers but not interacting).
Pain Scale: Use FLACC.
Behavior in Hospital: Possible regression (e.g., potty accidents), separation anxiety, general frustration.
Nursing Actions: Use transitional objects, honest acknowledgment of pain, and encourage choices to promote independence.
3. Preschoolers (3-6 years)
Erikson’s Stage: Initiative vs. Guilt
Cognitive Development: Concrete operational thinking (understanding cause and effect).
Motor Skills: Improved balance, running, skipping.
Feeding: Preference for finger foods, capable of using utensils.
Play: Cooperative play; able to engage with peers in shared activities.
Pain Scale: Use Faces Scale.
Behavior in Hospital: Can exhibit fear of pain and separation from caregivers. Use transitional objects and honest communication to help alleviate fears.
4. School-Age (6-12 years)
Erikson’s Stage: Industry vs. Inferiority
Cognitive Development: Concrete operational thoughts become more sophisticated.
Motor Skills: Can perform many physical activities and follow rules.
Feeding: Variety of foods, becoming independent with meals.
Play: Competitive play; focus on learning skills and teamwork.
Pain Scale: Use a 0-10 scale for pain assessment.
Behavior in Hospital: Concern over separation and fear of procedures. Use clear explanations and supportive communication.
5. Adolescents (12-18 years)
Erikson’s Stage: Identity vs. Role Confusion
Cognitive Development: Abstract thinking; consideration of hypothetical scenarios.
Motor Skills: Adult-level physical abilities; interested in complex sports and activities.
Feeding: Concerned with body image; may struggle with disordered eating habits.
Play: Engages in fantasy play (role-playing, imagination).
Pain Scale: Use a 0-10 scale; they can express pain numerically.
Behavior in Hospital: Seek privacy, anxious about body image and peer relationships during hospital stays. Important to provide support and reassurance.