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Hospitalized Child Q6
Terms in this set (52)
4 most common stressors for children during hospitalization
- Separation Anxiety
- Loss of control
- Fear of bodily injury and px
- Delayed growth and development
3 stages of separation anxiety
1. Protest - crying and screaming.
2. Despair - Depression/withdrawal sx
3. Detachment - the kid becomes more focused on forming shallow relationships with others and material objects. This is often considered as contentment/adjustment, but it's actually resignation. Rarely happens with hospitalized pts b/c its due to prologued absence.
How do these stages present when parents visit?
Protest - child cries and acts out when parents visit, making them feel like they're making things worse. Need to work though that shit.
Despair - child rejects parents in an attempt to protect self from emotion harm (after having gone through the protest stage)
What should the nurse teach the family about separation anxiety?
-Be involved if you can
-Be honest with child. Don't sneak out.
-Put pics/object in room to personalize for child.
How does age affect separation anxiety?
The younger the child, the more sensitive they are.
Toddlers and separation anxiety
Toddlers are more likely to throw tantrums, regress, bedwetting, pleading, and looking for parents.
Preschoolers and sep. anx
Preschoolers are more likely to refuse food, develop shallow substitute relationships, anger and hitting, asking for parents, cry quietly
School age and sep anx
School age are better at coping. They're likely to feel scared, lonely, and act out, but in more subtle ways. Less likely to ask or help because they are trying to attain independence.
Teens and sep. anx
Teens are likely to feel separation anxiety from their peers more than family. Loneliness, boredom, isolation and depression.
How should the nurse respond when a child regresses?
Accept the behavior as normal and teach family to do the same. The child will revert back once stressor is resolved.
What is a common stimuli that causes regression?
Loss of control in toddlers
They're striving for autonomy and tend to fight any attempt to control by throwing temper tantrums.
Maintaining routines are important. Alteration in routine leads to regression in that area (for example, altered toileting ritual leads to bed wetting). Important rituals include eating, sleeping, toileting, bathing and play.
Prolonged loss of autonomy leads to withdrawal and regression in all areas of development
preschoolers: Cause and effect and how it applies to loss of control
They are magical thinkers and egocentric. They often feel that hospitalization is a punishment or their fault. They'll also link nurses with pain and then think anyone with scrubs on will hurt them.
As they lose control, the imagination runs rampant and these magical thinking/omnipotent/egocentric thoughts are accentuated.
what do preschoolers do to try to gain control?
How should the RN provide the greatest amount of control to school aged children?
-Give them choices in procedures.
-Give them something to do - one of the most common issues is boredom.
How should the nurse work with adolescents regarding loss of control?
-Speak with them in their own language.
-Treat them with respect
- a plant (Ivy)
- changing your clothes
- little chairs
- you're in; your turn
- a shot from a gun
- a place for a boat
- to stretch your body
How should the nurse deal with fear of bodily harm?
- Show equipment
- Give child a job
- Practice position
- Choose distraction item
Where should procedures be performed?
Never in the patient's room. Go to a procedure room because they'll associate this room with px/fear.
Make sure the bed is a safe haven.
How can the RN create a safe and healthy procedure environment? (4)
-Set clear expectations, start and end times.
-Remain calm and confident
-Use positive reinforcement
-Affirm that crying is OK.
What Seattle Children's schooling services exist?
-School on site: 6 certified teachers, 4 aides
-No cost to families
-Kindergarten through high school
-Interpreter services as needed
-Consultation with child's school
Pain mgmt guidelines
Use age appropriate pain scale
Many children regress when in pain
Consider other causes. Wet, hungry, need parents, need burping?
Infants DO have pain
Stillness doesn't rule out pain
Nausea often concurrent. Treat both.
Incorporate family knowledge
Seek pain consultants as indicated
Face, Legs, Activity, Cry, Consolability, each category has scores 0, 1, or 2 for level of agitation.
3 year old pain assessment
use faces (oucher scale)
4 year old pain assessment
Can use faces and words like "a little, alot"
5 and 6 year old pain assessment
Can use numbers and descriptions.
Wong Bakers Faces
Has faces with descriptions. Many versions for different nationalities.
Faces with numbers
Which two specific px meds should be avoided in children?
Tramadol and Codeine
Hepatic metabolism for ages:
0-1: Slower metabolism, meaning meds are less potent
1-2: markedly faster metabolism. Risk for toxicity and shorter duration of efficacy.
>2: metabolism gradually decreases to adult level by puberty
GFR in children
Gradually increases to adult level by 12 months. Decreased GFR = increased toxicity
BBB in children
Blood brain barrier is more permeable in children less than 12 months
How is the GI system affected in infants
Gastric emptying time is increased, therefore increased absorption of meds
What causes discoloration of teeth 2' meds?
Antibiotics - tetracyclines in particular in children
Liver and brain inflammation from a virus, commonly the flu or chickenpox.
S/sx: same as encephalopathy. CAR, DLOC, sz, lethargy, weakness
Not recommended to give ASA to children with virus, puts them at higher risk.
Why should you be more careful with topical meds and children
Greater surface area, thinner skin
QUESTT Px assessment
Question the child
• Use a pain rating scale
• Evaluate the behaviour and physiological
• Secure parents involvement
• Take cause of pain into account
• Take action and evaluate results
What is the most common SE of px meds in peds?
Constipation from opioids
how long must px be present for it to be considered chronic?
What is an easy and common indicator for role interference when assessing px?
How often does the child miss school due to pain?
how do pre-term infants show pain?
Poorly! They can't robustly show their displeasure, so you have to assume that if you think it might hurt, it does.
Recommended px mgmt for 0-6/10 px?
Acetaminophen or NSAID
Recommended px mgmt for 6-10/10 px
Do children need higher or lower relative (mg/kg) doses of opioids than adults?
Higher doses most of the times.
3 mo - 6 mo
When the child's weight is >110 lbs, use the adult dose.
If an epidural is used on a child, when is respiratory depression most likely?
it's unlikely, but if it occurs, it would be 6-8 hrs after administration
Can children become addicted?
No. They don't have the cognitive ability to make the cause-effect associate, but they can become physically dependence. there is a difference.
Do children who use opioids become addicts later in life?
The evidenced doesn't suggest so.
Greater px in neonates =
greater morbidity and poorer outcomes
Nitrous oxide for which ages?
not for <3,
ok for >5
how should parents respond to chronic HA px in children?
Avoid giving excessive attn, and repond matter of factly. Focus on adaptive coping like relaxation and maintenance of normal activity patterns.
What is the only disease process in which opioids are considered the major therapy and started in early childhood, through the lifetime?
Sickle cell disease
re-occurrent abd px
Defined as px that occurs at least once per month fo 3 consecutive months and is severe enough to alter activities
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