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Care of Children in the Hospital Hannah O’Handley RN MSN CPNP Roles of the Nurse • • • • Direct Nursing Care Patient Education Patient Advocacy Case Management Understanding Growth and Development is key to appropriate care of child Developmental stressors for hospitalized children INFANT Object permanence Stranger Anxiety Separation anxiety Protest Despair Denial Stressors for infants hospitalized • Painful procedures • Immobilization of extremities • Sleep deprivation Nursing care of infants • • • • • • Trust vs. Mistrust Encourage parents to stay or visit often Encourage to hold infant Sucking soothing Eliminate excessive noise Play Hospitalized toddler at risk for stress • Lacks cognitive ability to understand • Separation major stressor • Change in routine Nursing Care of toddlers • • • • • • • Autonomy vs. shame and doubt Encourage parental presence Transitional objects Approach toddlers slowly Play Child Life Specialist Topical anesthetics Fears of Hospitalized Preschoolers • • • • Fear being alone, dark, abandonment Fear bodily injury Feel guilty about being sick Imagination is magical Care of preschoolers • • • • Encourage parental presence Allow choices when possible Topical anesthetics Play Preparing family for discharge from admission • “My patient is discharged” • Discharge planners on each unit • Often no advance warning about discharge • Home health Care • Rehabilitation School Age Child • • • • • • Loss of control r/t bodily functions Privacy Fear of bodily injury Pain Concerns about death Separation anxiety about family and friends Care of School age Child • • • • • • Promote sense of industry Encourage parental participation Allow choices Explain all procedures, offer reassurance Topical Anesthetics Encourage peers and friends Adolescent in hospital • • • • • Loss of control Fear of altered body image Separation from peer group Loss of privacy Loss of sense of identity Nursing Care of Adolescent • • • • • Identity vs. role confusion Include adolescent in plan of care Encourage discussions of fears Explain all procedures Ask adolescent his/her desire for parental involvement • Encourage peers interaction • Body image important Pediatric Medications • • • • • Under 5years can’t swallow pills TB syringe for under 1ml or cc Liquids slowly side of cheek Older may drink from med cup What if child refuses med? Pediatric Medications • • • • • Rectal Ophthalmic or otic Topical IM vastus lateralis site of choice Intravenous Eye drops Eye drops Little ones wear glasses too Eye gtts to children Eye gtts to children Ear drops to children dbc<3 Otic drops to children Ear irrigation in child Normal tympanic membrane Vastus lateralis muscle Vastus laterals muscle IM Family Centered Care • Sleeping Accommodations for parents • Sibling visitation Pediatric Intensive Care • Stressful for parents, children, and staff Discharge planning begins at admission Interim Home Health Care • Acute cases discharged early due to DRG • Administer blood, IV antibiotics, dressing changes • Many assessments and interventions Long Term Care or rehabilitation • • • • Villa Angela Heinzerling Rehab Unit Home OT, PT Questions??? • Children are discharged early do to the importance of being with family and for cost containment. • Nursing in Community is where majority of pediatric nursing care exists Children need primary care • Why more children in community than hospital? Roles of nurses in community settings • • • • • • • Primary Care Urgent Care Public Health Clinic Hospital Outpatient Center Child Care Centers Camp Settings Home Readiness for emergency • 25 to 50 emergencies in office settings per year Nurse in a school setting • • • • • • • Infection Control Health Education Health Care provision Special needs Emergency care Child advocate for safer school Community Resource School regulations • Education for handicapped Act 1975 • Individuals with Disabilities Education Act 1991, 1997 • IHP • IEP
