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18 Cards in this Set

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The Healthy Family
The capacity for clear boundaries i
The ability to operate mainly in the present i A respect for individual choice and autonomy
Skills in negotiating i The ability to share positive feelings
Family Reactions to Hospitalization
Parent Reactions
■Disbelief
■Anger &/or Guilt
■Fear, anxiety, frustration
■Depression
■ Sibling Reactions
■Loneliness, fears, and worry
■Anger,resentment, jealousy, guilt
Factors that Influence
Developmental cognitive level Previous experience i Culture i Spirituality
Concept of Illness
Preoperational (2-7 Years)
■Perceives external, unrelated, concrete
phenomenon as cause of illness
■Perceives cause of illness as proximity between
two events occurs by "magic"
Concrete Operational (7 - 10+ Years)
■Sees cause as a person, object, or action external
as "bad"
■Illness has external cause that located inside
Concept of Illness p2
Formal Operational (13+ Years)
■Sees cause as malfunctioning or
nonfunctioning organ or process
■Can explain illness in sequence of events
■Realizes that psychologic actions and
attitudes affect health and illness
The Hospitalized Child
Separation Anxiety
■Major stress from middle infancy thru
preschool
■Stages
m Protest
■Despair
■Detachment
Protest Later Infancy
Later Infancy:
■Cries
■Screams
■Searches for parent with eyes
■Clings to parent
■Avoids and rejects contact with strangers
Protest Toddler
Toddler
■Verbally attacks strangers
■Physically attacks strangers
■Attempts to escape to find parent
■Attempts to physically force parent to stay
Behaviors last hours to days
May be continuous ceasing with exhaustion
Despair
Inactive
Withdraws from others
Depressed, sad
Uninterested in environment
Uncommunicative
Regresses to earlier behavior
Physical condition may deteriorate
Detachment
■Shows increased interest in
surroundings
■Interacts with strangers
■Forms new, superficial relationships
■Appears happy
■Occurs after prolonged separation
Loss of Control
Lack of control increases the perception
of threat
Can affect child's coping skills i Additional stimuli (sight, sounds, smell)
may be overwhelming i Major areas: physical restriction,
altered routines or rituals, dependency
Interventions Infant
Infant
■Minimize use of restraints
■Hep lock IV
■Use crib with canopy
■Alter environment with infant seat, stroller,
etc
■Provide toys
Interventions Toddler
Toddler
■Promote home rituals
■Promote dietary practices
■Give choices when possible (toys, games)
■Take to playroom
■Provide opportunity for medical play
■Educate parents about regression
Interventions Preschooler
■ Preschooler
■Encourage autonomy
■Take to playroom
■Urge to participate in therapeutic play
■Be truthful
Interventions School-age
School-age
■Provide opportunities to discuss medical
dx.
■Encourage child to discuss feelings and
understanding of condition
■Allow child to "help" with tasks
■Promote choices in care
Interventions Adolescent
Adolescent
■Develop plan of care w/adolescent input]
■Respect need for independence
■Offer choices in routines
■Allow for privacy
■Be open about medical condition
■Allow time to discuss medical condition
Nursing Diagnoses
Anxiety/fear R/T separation from routine
Anxiety/fear R/T distressing procedures
Pain
Risk for poisoning or injury from medications
R/T sensitivity, dose,etc
Diversional activity deficit
Powerlessness
Risk for injury or trauma R/T environment,
equipment, therapies
Standards of Care
Issues R/T care of minors Consent for procedures
■Parent or legal guardian
■Mature minor doctrine
■Emancipated minor
■Custodial parent
■Judicial system
■No parental consent needed