Nursing of Children during Illness, hospitalization and in the school setting

• Stressors of Hospitalization
• Fear and Anxiety- hosp setting, equip, needles, noises, parents too, diff enviroment from home
• Separation Anxiety- away from parent, are they coming back 8 months 6-30 months (assure them their parents coming back, comfort, play games, bring family pics, music,  distraction, therapeutic play)
• Loss of Control- cant use the bathroom alone, even parents may feel this, not usual routine, cant get out of bed (play is the work of children)- can act irrational, regression- (a form of coping with unpleasant experience)

• Children's response/behavior changes:
• 1. infants- fearful w/strangers, separation anxiety 6-30 months soldifies 8 months
• 2. Toddlers- aware of themselves and talk about desire erikson autonomy v shame and doubt - allow this child to make some choices, praise, they need to play
• 3. Preschool- Similar- therapeutic play, magical thinker, concrete thinker- they take words  literally. encourage parents participation, develop trust, bring pictures of the, or have special toys (items) 
• 4. School age- acute/chronic erikson- industry v inferiority- at this age children want to accomplish and finish task (they are industrus)- ie puzzles, board games, chest. fearful of their bodies being injured, fear of death, give approriate info, be honest
• 5. Adolescents- likes to be cool- they maybe stoic- they may not show it helps. they might want control over their situations, erikson- identity v role confusion. the most important people to adolescents- friends. express feelings and pain. let them invite friends to visit. meeting other kids who have the same problems. room teens together. involved them in their care. be supportive, respectful, consistent, truthful.

Providing play activities and recreation for the hospitalized child

• Unstructured play- just playing...toddlers playing side by side
• play as part of nursing care- this helps children to cope
• Therapeutic play- can pretend they are playing doctor
• Child life specialist- explain procedures, distract the kids, developmental specialist, tours,

reactions of parents

• Guilt- for not taking them in sooner
• denial- may feel that children aren't sick
• anger- why did this happen to me (communication may be impacted)
• depression- that their child is sick
• confusion- explanation 
• helplessness- ans question, encourage parents to participant in child's care
• uncertainty- is my child going to survive

• night light
• transport- parents should be there or someone else familar with
• always let them know when u are leaving. introduce new nurse to child
• make sure child knows what is going on

everyone should be medicated for pain

• Causes
• - disease process
• - treatment protocols
• - surgical interventions
• - injury

assessment of pain- pain scales (subjective)

• Face- grimace, frown, crying
• Leg activity, legs up
• cry- crying moaning whimpering
• consolability- hugging

The higher the score the higher than pain

• Crying 
• oxygen required for saturation above 95%- how much
• increase in vital signs
• espression
• sleepness

• 1-5 scale
• or even number 2-10

explain each face to the children

• 0 no pain
• 10 worst pain u ever felt in ur life

• Non Pharmacological management 
•  - behavioral- cognitive strategies 
•    - relaxation- head shoulder, arms, to their toes
•    - distraction
•    - imagery
•    - positive self talk- i will have some pain and then go home.

• Hot and cold- heat- vasodilation, reduce pain. ice vasoconstricts- reduce swelling, not to much blood flowing 
• nonnutritive sucking- sucking pacifers 
• massage and pressure- not calfs

• non opioid analagesics- acetminophen, NSAID's motrin, taradol
•  - mild to moderate pain
• - no aspirin to children less than 12 yrs of age bc of risk of Reyes syndrome

• Opioid analgesics: morphine and others 
•  - moderate - severe
• - injection, IV, PCA (bolus) (pt controlled analgesia) 
• - adverse affects- lowers respiratory rate

• Local anesthetic application
• - topical: EMLA (takes like an hour)- used this to help put IV in so it wont hurt
• - other lidocaine- for local procedure

• Oral is the preferred method
• rectal- for pt who have difficulty swallowing or N/V
• IV choice for emergency or severe pain
•  PCA

Constipation- fluids, ambulation, increase fiber- wheat, fruits and vegatables, stool softeners. laxative last resorts cause they can cramp

Pruritus- itchy- cool compresses. benedryl

N/V- small frequent meals, anti emetic

children are vunerable to harm

• identifiers- are u working with the right patient
• monitor closely
• restraints- cause of IV for ex. MD written order, checking for their circulation, assess hrly, 
• therapeutic hugging- another restraint.

• Cradle- 3 months
• football- 2 months 
• over the shoulder- 7 months
• Wagon-

• changes dramatically 
• now we have these kids from all types of disablities in the classroom. 
• chronic conditions - dm, surgeries, 
• IHP- individualized health plans for each student
• focus on immunization, screenings, sexual activity, drug abuse
• school nurses do it all.