The Hospitalized Child - Cabrillo College

Evidence-based Practice Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care www.qsen.org 1 Who is Betty Neumans Client?

An individual, a family, a group or a community. Continuous exchanges between the client system and the environment The model is Wholisticlooks at all aspects of the clients five key variables and how each impacts and is impacted by the other. 2 The Client System According to

Neuman Physiological Developmental Stressor Spiritual Socio-cultural Resource

Psychological 3 How can we apply NSM to family? Family as core What are family strengths? (FLD) Individual systems as Stressors Resources

4 What makes a family healthy? 5 What are risk factors to a familys health? 6 Potential ND for families

Decisional conflict Compromised family coping Disabled family coping Ineffective family Therapeutic regimen management Interrupted Family processes Readiness for enhanced Family Coping

7 Stressors of Hospitalization Fear Separation family & peers

Feelings of loss of control Regression common 8 Infant & Toddlers Separation anxiety (6-30 months) 3 phases Protest: Despair: Detachment: F

9 Toddlers React to any intrusive procedure the same Developing autonomy Rituals and routines 10

Preschool Less obvious separation anxiety Fears mutilation Literal interpretation of words Like familiar routines & rituals Magical thinking

11 School-Age Some separation anxiety Fears: Body disability & death Dependence /loss of control Ask relevant questions Understand cause and effect 12

Adolescent Separation Body & body image Control important 13 Playroom A safe area NO Intrusive procedures

Not for administering medications. Therapeutic Play 14 Risk for Falls Whos at risk? Humpty Dumpty assessment tool Individualized plan of care

4 siderails up not a restraint, its safety. Communicate Educate 15 Risk for Impaired Skin Integrity Whos at risk? (i.e. risk factors) Braden Q Scale

Mobility Activity Sensory Perception Moisture Friction-Shear Nutrition Tissue perfusion and oxygenation 16 Pain Subjective and personal an unpleasant sensory and emotional

experience Associated with actual or potential tissue damage QSEN competencies on patientcentered care: Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain & comfort. (www.qsen.org) 17 Myths about Pain Neonates do not experience pain.* Children have no memory of pain.* Correct amount of pain for a specific

injury or procedure* Parents exaggerate. Children tell you about pain. Children become addicted to narcotics easier.* Narcotics cause respiratory depression easier in children.* 18

Influences on Pain Assessment Previous experience with pain Developmental level Ex: language ability Young infants: generalized response not able to localize. Type of pain acute or chronic Parental response to child's pain 19

Behavioral Indicators Restless, agitated Difficult to distract Irritability Facial grimacing

Posturing Drawing up knees Anorexia Lethargy Sleep disturbances 20 Spirituality

Spiritus Meaning Value Transcendence Connecting Becoming

21 Spiritual Assessment Religion: system of practices Culture strong influence on spirituality Professional responsibility Collaborative 22

Spiritual Assessment of Children Infant: sense of trust Toddler: rituals & routines Pre-school: concept of God concrete familys beliefs & customs important School-age: good vs evil; help receiving love, hope, forgiveness Adolescents: need for meaning & purpose in life. Listen

23 Nursing Dx Spiritual Distress Risk for Spiritual Distress Readiness for enhanced Spiritual well-being 24 Chronic Illness

McKinney : a chronic illness or condition is one that is: long term Does not resolve spontaneously Usually without complete cure frequently has residual characteristics that limit ADL &/or require adaptation or special assistance. 25

Needs of Family /Caregiver Illness a family experience Reduce physical & emotional burdens Provide knowledge & skill Resources for support Promote healthy coping Help prepare for impending death 26

Caregiver role strain Stages of caregiving http://www.alsa.org Caregiver and care recipient at risk when caregiver overloaded. 27 Perception of Death: Infants & Toddlers

Lack understanding of concept Greatest fear is separation No sense of time Reaction to loss of caregiver 28 Perception of Death: preschoolers

Death temporary & reversible Magical thinking Behaviors: Questions 29 Perception of Death:

School-age Death irreversible By age 10, universality Behaviors: 30 Perception of Death: Adolescent Death irreversible, universal,

inevitable Personal, but distant Better understanding illness & death Behaviors: 31 Nursing Care Be available Personal beliefs & expectations Time & attention to the dying

child. Recognize need to talk Pain control, oral care, privacy Information Allow family members time 32 Children with Special Needs Visual Neurologic

Impairment Hearing Impairment Language Aphonic impairment Chronic illness Congenital disability Developmental delay or disability

33 Etiology Hereditary- 5% Early embryonic alterations Early Intrauterine /neonatal conditions Acquired childhood Environmental problems Unknown

34 35 Congenital Hypothyroidism A deficiency of thyroid hormone present at birth. Screening: 2-6 days after birth Untreated: severe mental retardation. Primary prevention (of negative

outcome): lifelong thyroid supplements F 36 Down Syndrome

Small square head Upward slant to eyes Flat nasal bridge Protruding tongue Hyperflexibility, muscle weakness Wide space between big & 2nd toes 37 Down Syndrome-higher incidence of:

Congenital heart malformations Frequent respiratory tract infections Thyroid disorders incidence of leukemia Atlantoaxial instability 38

Nursing Care Early detection Developmental level Strengths vs. disabilities Support parents

Encourage socialization Appropriate therapy 39 Nursing Care Promote optimal growth & development Behavior modification program Anticipatory guidance

40 Safety Concerns Poor short-term memory Learn at a slower rate Physical problems w/mobility 41

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