Bluegrass Community and Technical College Assessment of the Child Hatfield: Chapter 3 Read: Peds Chapter 3 (pp.

169-181, 601), Chapter 4 (pp. 63-68), Chapter 5 (pp.92-95) & pp.45-50, 87-89, 186-188, 196-198, 200, 313, 338-342, 370-373, 408-409, 466-467, 518519, 591-594, 620-622, 627-628

1. Collecting Information: see figure 3.2, pgs. 44-45 2. Data collection ~ Continuously gathered throughout a childs care, most data is collected during : a) The initial interview b) The physical examination c) Results of diagnostic tests and studies.

3. Data is collected through a variety of means: 4. Collecting Information ~ Subjective- Information spoken by the child or family is called subjective data. Interview the family caregiver and the child allows the nurse to collect info that can be used to develop a plan of care for the child. Communicating with the child and caregiver requires knowledge of growth and development and an understanding of communication techniques. 5. Conducting the Interview: The interview helps establish relationships between the nurse, child, and the family. Things nurses should do: a) Listening and using appropriate communication techniques b) Using focused questions and allowing time for answering. c) Nurse should be introduced to the child and caregiver with purpose of the interview stated. d) A calm, reassuring manner is important to establish trust and comfort. (Past experiences with health care may influence interview) e) f) g) Caregiver and nurse should be comfortably seated with the child on lap if appropriate. Setting should be quiet and private Age-appropriate toys and activities may be provided to occupy the child to allow the caregiver

to focus on questions

h)

If there is a language barrier, be alert to this need and provide a translator if necessary i) Remember other cultural variations as appropriate 6. Interviewing the Caregiver: The family caregiver provides most of the information needed in caring for the child, (especially infant or toddler). Some things you may want to consider: a) Instead of asking the caregiver to fill out the form, the nurse may ask the questions and write down the responses. This process gives nurse opportunity to observe the reactions of the child and caregiver as they interact with each other and answer the questions. b) This will also ease the problem of an illiterate caregiver. c) Nurse must be nonjudgmental, being careful not to indicate disapproval by verbal or nonverbal responses. d) While gathering this info, the nurse must allow caregiver to express concerns and anxieties. If a certain topic seems to be uncomfortable for the caregiver to discuss in front of child, make a note to discuss later when little ears arent listening. 7. Interviewing the Child: It is important for the preschool child and older child to be included in the interview. Things to consider: a) Use age-appropriate questions when talking with the child. b) Showing interest in the child and what he/she says helps the child and caregiver to feel comfortable. c) By being honest when answering the childs questions, you establish trust with the child. d) Using stories or books written at a childs level helps with understanding what the child is thinking and feeling.

e)

The childs comments should be listened to attentively, and the child should be made to feel

important in the interview. 8. Interviewing the Adolescent: Adolescents can provide information about themselves. Interview

them in private as it will encourage them to be more forthcoming regarding possible drug use, smoking, or their sexual practices. 9. Obtaining the Client History: It is very important to gather info regarding childs current

condition as well as a health/medical history. This info is used to develop a careplan. In obtaining info

from the child and caregiver, the nurse is developing a relationship as well as noting what the child and family know and understand about the childs health. Observations of the child/caregiver relationship can also provide important info.

10. Biographical Data: To begin obtaining a client history, the nurse: a) Collects and records identifying info about the child 1. 2. 3. Childs name address phone number

b) A questionnaire used to gather info, such as: 1. 2. 3. 4. 5. 6. 7. 11. Childs nickname, or what he/she likes to be called. feeding habits food likes/dislikes allergies sleeping schedule toilet-training status Special words the child uses to indicate needs/desires such as words for elimination. Other Info: 12. Chief Complaint: The reason for the childs visit to the health care setting is called the chief complaint. In a well-child setting, this reason may be a routine check or immunizations. Whereas an illness or other condition might be the reason in another setting. To best care for the child, it is important to get the most complete explanation of what brought the child to the health care setting. Repeating the caregivers statement regarding the childs chief complaint will help clarify that the nurse has heard correctly what caregiver has said. 13. Present Illness: To help the nurse discover the childs needs, the nurse must elicit info about the current situation, including: a) Symptoms: when they began, how long have they been present. b) Description of the symptoms and their intensity and frequency, and treatments to this time.

c) The nurse needs to ask the questions in a way that encourages caregiver to be specific. d) This is also the time the nurse asks about any other concerns regarding the child. 14. Health History: Info regarding the mothers pregnancy and prenatal history are included in obtaining a health history for the child. Any occurrences during the delivery can contribute to the childs health concerns. The childs mother is usually who you need to ask. Other areas the nurse asks questions about: a) Common childhood illnesses b) Chronic or serious childhood illnesses c) immunizations d) health maintenance e) feedings and nutrition f) hospitalizations and injuries g) Family health history would also need to be noted to be abreast of prevention or detection. h) Certain risk factors in families contribute to development of health care concerns. i) Risk factors addressed early in a childs life can often be monitored or changed to decrease the childs risk of getting these diseases or conditions. 15. Review of Systems: see table 3.1, pg. 46

Review of Systems for Pediatric Patients General Skin Head and Neck Eyes Ears

Areas to be reviewed Weight gain or loss, fatigue, colds, illnesses, behavior changes, edema Itching, dryness, rash, color change Headache, dizziness, injury, stiff neck, swollen neck glands Drainage, trouble focusing or seeing, rubbing, redness Pulling, pain, drainage, difficulty hearing

Nose, mouth, throat

Nosebleeds, drainage, trouble breathing, toothache, sore throat, trouble swallowing Coughing, wheezing, shortness of breath, sputum, breast development, pain Nausea, vomiting, pain Pain or burning when voiding, blood in urine or stool, constipation, diarrhea Extremities-pain, difficult movement, swollen joints, broken bones, muscle sprains Seizures, loss of consciousness

Chest and lungs-respiratory

Abdomen-gastrointestinal Genitalia and rectum

Back and extremitiesmusculoskeletal Neurologic

16. Allergies, Medications, Substance Abuse: Allergic reactions to : a) Any foods b) medications c) or any KNOWN allergies should be discussed to prevent the child from being given any meds or substances that might cause an allergic reaction. Medications the child is taking or has taken, prescribed or over the counter NEED TO BE RECORDED. This info will help avoid the possibility of overmedicating or drug interactions. It is especially important with adolescents to assess the use of tobacco, alcohol, or illegal drugs. 17. Lifestyle: a) School history: includes: info regarding childs grade level and academic performance as well as behavior seen at school. Childs interactions with teachers and peers give insight into areas of concern that might effect childs health. b) Social history: offers info about the environment that the child lives in, including the home setting, parents occupations, siblings, family pets, religious affiliations, and economic factors. c) Personal history: refers to data collected about such things as

1. childs hygiene 2. and sleeping, 3. Elimination patterns. 4. Activities 5. exercise 6. special interests 7. childs favorite toys or objects 8. Questions about relationships and how the child emotionally handles certain situations. 9. Any behaviors such as thumb sucking, nail biting, temper tantrums d) Nutrition history: of the child offers info regarding eating habits and preferences as well as nutritions concerns that might indicate illness. 10. Developmental Level: Ask question related to the childs level of growth and developmental milestones. Knowing appropriate developmental milestones allows the nurse to determine if there is a concern and/or indication for further assessment. 11. Collecting Information ~ Objective The collection of objective data includes the nurse doing a baseline measurement of the childs : a) height b) weight c) blood pressure d) temperature e) pulse f) respirations More data collection involves an: g) Examination of body systems: not done in a head-to-toe manner as in adults but rather in a way that takes the childs age, developmental needs into consideration. h) If comfortable with helping, utilize help from caregiver, i.e. caregiver could help take young childs temperature and obtain a urine specimen. i) Arrangements should be made so that the caregiver is present for tests and examines that need to be performed. j) All observations are recorded, with the nurse documenting any finding that is not within normal limits. (WNL)

k) Nurse bears in mind during the physical exam any symptoms the caregiver has identified.

12. Examination of Body Systems: Not generally done in a head to toe approach like adult but rather in an order appropriate to the childs age and developmental stages. Aspects of the exam that seem traumatic or uncomfortable are saved for last.

13. General Status: The nurse uses knowledge of normal growth and development to note if the child appears to fit the characteristics of the stated age. Interactions the child has with caregivers and siblings provide the nurse info about these relationships. The childs overall: a) General appearance b) facial expressions c) speech d) behavior Are noted as the nurse begins collecting info about the child. 14. Nurses primary role in the complete physical assessment may be to support the child. The nurse documents all findings especially those NOT WNL! 15. Observe the childs: a) General Appearance: Observing physical appearance and condition can give clues to the childs overall health. I. II. III. IV. V. VI. VII. VIII. The infant or childs face should be symmetrical (i.e. well-balanced) Observe for nutritional status Observe hygiene mental alertness body posture movements. Observe hair texture, thickness and distribution Examine skin for color, lesions, bruises, scars and birthmarks.

b) Psychological and Behavior Status: Observation of behavior should include factors that:

I. II.

Influenced the behavior and how often the behavior is repeated. Physical behavior as well as emotional behavior should be noted, considering: 1. the childs age 2. Developmental level 3. abnormal environment of the healthcare facility

1. if the child has been hospitalized previously or is separated from caregivers or family. 2. Important to note if the behavior is consistent or unpredictable and any apparent reasons for the changed behavior. 3. Be sure to consider the childs developmental stage and abnormal environmental factors of the health care facility or separation from a caregiver Comparison of Observations Observation Activity of an Infants Physical and Healthy Activity Constantly active; some infants are more intense and curious than others Muscular state is tense; grasp is tight; head is raised when prone; kicks are vigorous. When supine, there is a space between the mattress and the infants back. Shows constancy in reaction; does not regress in development; peppy and vigorous; interested in food; responds to caregivers voice. Emotional Behavior Behavior Indicating Illness Lies quietly; little or no interest in surroundings; may stay in the same position. Lies relaxed with arms and legs straight and lax; makes no attempt to turn or raise head if placed in prone position; does not move about in crib.

State of muscular tension

Constancy of reaction

Not as peppy as usual; responds to discomfort and pain in apathetic manner; turns away from food that had once interested; turns head and cries instead of usual response.

Behavior indicating pain

Appreciates being picked up. Cries or protests when handled; seems to Activity is not restlessness. want to be left alone. May cry when picked Shows activity in every part of body. up, but settles down after being held for a time, indicating something hurts when moved. Turns head fretfully from side to side; pulls ear or rubs head; turns and rolls constantly, seemingly to get away from the pain. Strong, vigorous cry Weak, feeble cry or whimper High-pitched cry; shrill cry may indicate increased intracranial pressure Light-skinned babies may show unusual

Cry

Skin color

Healthy tint to skin; nail beds, oral

mucosa, conjunctivae, and tongue, are reddish-pink

pallor or blueness around the eyes and nose. all babies may have dark or cyanotic nail beds; pale oral mucosa, conjunctivae and tongue

Appetite or feeding pattern

May show indifference toward formula; sucks half-heartedly; vomits feeding; habitually regurgitates. May exhibit discomfort after feeding. Bizarre behavior Any behavior that differs from expected for level of development; unusually good or passive when in strange surroundings; responds with rejection to every overture, friendly or otherwise; extremely clinging, never satisfied with amount of attention received. 4. Measuring Height and Weight: see Nursing Procedure 3.1, pg. 49 Equipment: scale appropriate for childs age and ability to sit or stand Disposable paper for covering scale Paper and (black) pen to record weight Cleaning solution and equipment, according to facility policy Bedscales can be used for children who cannot get out of bed Infants and small children who cannot stand alone are measured lying down flat on a table and is recorded in centimeters and inches. Children who can steadily stand alone are measured standing against a wall without shoes. Weighing the Infant or Child 3.1 1. Explain the procedure to child and family caregiver 2. Wash hands. 3. Place paper on scale. 4. Balance scale to a reading of 0 (zero) 5. Weigh the hospitalized child at the same time, using the same scale, same amount of clothing each time the child is weighed. 6. Weigh infant with no clothing or diaper. Older child in underwear or lightweight gown; child should not wear shoes 7. Always hold one hand within 1 inch of the child for safety. 8. Pick up the child or have older child step off the scale 9. Remove and discard paper scale cover. 10. Read the weight on the scale. 11. Record the weight on paper to be transferred to permanent document. 12. Clean the scale according the facilitys policy. 13. Report the weight as appropriate. 5. Head Circumference: see figure 3.4, pg. 50

Exhibits an eagerness and impatience to satisfy hunger

The head circumference is measured routinely in children to the age of 2 or 3 years or in any child with a neurologic concern. A paper or plastic tape measure is placed around the largest part of the head just above the eyebrows and around the most prominent part of the back of the head. This measurement is recorded and plotted on a growth chart kept to monitor the growth of the childs head. During childhood, the chest exceeds the head circumference by 2-3 inches. 6. Vital Signs:These are taken at each visit. This includes: a) Temperature b) pulse c) respirations d) blood pressure And compared with the normal values for children of the same age as well as to that childs previous recordings. In a hospital setting, the vital signs are closely monitored and recorded; and any changes are reported. Keeping in mind the childs developmental needs will increase the nurses ability to take accurate vital sign measurements. It will be less traumatic for the infant if : a) the nursecounts the respirations before the child is disturbed, b) then the pulse c) and the temp.

7. Example

8. Temperature: Health care facility decides how a childs temp is measured. Can be oral, rectal, axillary, or tympanic. Temps are recorded in Celsius or Fahrenheit. Normal oral temp: 36.4 C - 37.4 C 97.6 F - 99.3F Taken on children older than 4-6 years of age; are conscious and cooperative. Should be placed in the side of childs mouth. Child should not be left unattended. rectal temp 0.5 1.0 than Taken in children only if another method cannot be oral used. measurement Not desirable in newborns because of danger of irritation to rectal mucosa; Not for children with diarrhea or who have had rectal surgery;

End of thermometer is lubricated, child place in prone, buttocks gently separated, and thermometer is placed to inch into rectum. If nurse feels any resistance, should remove immediately, take temp another method, notify Dr. immediately. Nurse must keep hand on childs buttocks and on one thermometer during the time taken. Axillary temp 0.5 1.0 than oral Taken on newborns, infants, and children with diarrhea or when rectal temp is contraindicated. Place tip well into armpit and bring childs arm down close to the body. Nurse must check if there is skin-to-skin contact with no clothing in the way. Left in place until electronic thermometer signals. Now used in many health care settings. Records temp rapidly, is noninvasive and causes little disturbance to the child. Can be obtained without awakening a sleeping child. A disposable speculum is used for each child.

Tympanic

Same as oral

9. Pulse: see table 3.3, pg. 52 Counting an apical rate is the preferred method to determine the pulse in and infant or young child. Nurse should try to accomplish this while the child is quiet. Apical pulse should be counted before child is disturbed for other procedures a child can be held on caregivers lab for security for the full minute that the pulse is counted. The stethoscope is placed between the childs left nipple and sternum. Radial pulse may be taken for an older child and counted for 30 seconds, multiplied by 2. Just like adults, any abnormalities, take it for a full minute. Report any rate that deviates from the norm. Normal Pulse Rates in Children Age Normal Range Average 0-24 hrs 70-170 bpm 120 bpm 1-7 days 100-180 bpm 140 bpm 1 month 110-188 bpm 160 bpm 1 month to 1 year 80-180 120-130 bpm 2 years 80-140 bpm 110 bpm 4 years 80-120 bpm 100 bpm 6 years 70-115 bpm 100 bpm 10 years 70-110 bpm 90 bpm 12-14 years 60-110 bpm 85-90 bpm 14-18 years 50-95 bpm 70-75 bpm 1. Counting the apical rate is the preferred method to determine the pulse in an infant or young child. 2. Accomplish while the child is quiet.

3. Approach the child in a soothing, calm, quiet manner. 4. The child can be held in the caregivers lap for comfort and security

10. Respirations: see figure 3.7, pg. 52 Procedure: 1. Count during a quiet time 2. Can observe with the child sitting or lying 3. Infants are abdominal breathers; therefore, the movements of the abdomen are observed to count respirations 4. Count respirations in the infant for a full minute since respirations are irregular 5. In the older child, observe the chest as an adult 6. Observe for retractions

Pulse Oximetry: see figure 3.8, pg. 53 Measures oxygen saturation of the arterial hemoglobin a) Tape the oxygen probe to the toe or finger b) May be clipped to the earlobe c) Take and record with other vital signs d) May be left in place for continuous monitoring in some situations. Apnea Monitor: see figure 3.9, pg. 53 Detects respiratory movements a) An alarms sounds if it detects no respiratory movement for a predetermined number of seconds(usually 15 seconds) b) Apnea monitors can be used in the healthcare setting and at home 1. Blood Pressure: see figure 3.10, pg. 54 and table 3.4, pg. 54; also, see Nursing Procedure 3.2, pg. 55 a) Part of the routine screening for 3 year olds and up b) Children of any age should have a baseline blood pressure if come to the healthcare facility c) Explain the procedure to the child; often explained as giving your arm a hug d) Taking a blood pressure on a stuffed animal or doll with further show the child the procedure e) Make sure to use an appropriate sized cuff f) Cuff should be wide enough to cover 2/3rds of the upper arm 2. Physical Examination:

Head: see figure 3.11, pg. 55 a) Observe for shape and movement b) Look for symmetry of facial features c) Observe the childs ability to control head ROM of Head and neck: a) ask the older child to move head in all directions b) In the infant, gently move the head to observe for any stiffness c) Observe the fontanels of the newborn/infant for opening/closure 3. Eyes: a) Look for symmetry b) Look for location in relation to the nose c) Observe for redness-evidence of rubbing, drainage d) Ask the older child to follow a light with his/her eyes e) Observe pupils for equality roundness, reaction to light.

4. Ears: a) Observe for alignment. b) Draw an imaginary line from the outside corner of the eye to the prominent part of the childs skull; The top of the ear should cross this line. c) Note ability to hear with normal conversation. d) Note any draining or swelling to ear.

5. Nose, Mouth, Throat: a) Note symmetry b) Observe for swelling, drainage, bleeding, flaring of the nose/nostrils c) Have the child hold his/her mouth wide open and move tongue side to side to inspect the mouth and throat; Use a tongue blade to hold tongue down.

d) Observe mucous membranes for color moisture, and any patchy areas that may indicate infection. e) Observe number and condition of teeth f) Lips should be moist and pink g) Note for cyanotic conditions by looking at the oral mucosa. h) Note any difficulty swallowing. 6. Chest and Lungs: a) Chest measurements are done on infants and children to determine normal growth. b) Take measurements at nipple line. c) Observe chest for size, shape, and movement of the chest with breathing; note any retractions. d) Note breast development in older school-aged or adolescent girls. e) Report any noisy or grunting respiratory sounds f) Listen to breath sounds in each lobe in the posterior and anterior chest while the child inhales and exhales. g) If the child is coughing or bringing up sputum, record frequency , color, and consistency.

7.

Heart: a. Note the Point of Maximum Impulse (PMI); youll hear the heartbeat best at this location. b. Listen for the rhythm and rate. c. count for a full minute. d. Note for abnormal or unusual heart sounds or irregular rhythms.

8. Assess pulses in various areas of the body: see figure 3.12, pg. 56 a. Carotid b. Brachial c. Radial Tibial d. Dorsalis Pedis e. Femoral f. Popliteal g. Posterior

9. Abdomen: a. May protrude slightly in infants and small children b. Describe the abdomen by dividing the abdomen into four sections. c. RLQ, RUQ, LLQ, LUQ d. Listen to bowel sounds in each section of the abdomen and record what is heard. e. Assess skin turgor on the ABDOMEN of the child. f. Observe the umbilicus for cleanliness and any abnormalities g. Infants and young children may have protrusions in the umbilicus or inguinal canal. May indicate a hernia. h. Report a tense or firm abdomen or any unusual tenderness.

10. Genitalia and Rectum: a) Respect the childs privacy while inspecting the genitalia and rectum b) Take into account the childs age and stage of growth and development.

c) Keep the child covered as much as possible. d) Inspect the genitalia and rectum for: Lesionssoresswellingdischarge. e) In male children, the testes descend at varying times during childhood; if testes cannot be palpated, inform physician. f) If unusual findings, the nurse must be alert to possible child abuse and further investigation should follow. 11. Back and Extremities: a. Observe back for symmetry b. Observe for any curvature of the spine c. The spine is rounded and flexible in the infant. d. As the child grows and develops motor skills , the spine further develops e. Note gait and posture when the child enters or is walking in the room. f. Extremities should be warm, have pink color, be symmetrical g. Note range of motion, movement of joints and muscle strength. h. Examine the hips in the infant ; report dislocation or asymmetry of gluteal folds indicating congenital hip dislocation.

12. Neurological: see figure 3.13, pg. 57 a. Most complex of the physical exam. b. Includes detailed examination of the reflex responses and functioning of each of the cranial nerves. c. Practitioner will perform a neurologic exam on children following a head injury, seizure, or on children who have metabolic conditions such as diabetes, drug ingestion, severe hemorrhage or dehydration. d. The neuro assessment is done to determine the level of the childs status following the initial neuro exam such as the Glasgow Coma Scale. e. Neuro status is monitored closely and the assessment tool is used every 1-2 hours to observe for significant changes. 13. Common Diagnostic Tests: Chapter 5 ~ pgs. 92-95 a. Used to further evaluate the subjective and objective data collected b. Help the practitioner to determine a cause of the childs health concern. c. The diagnostic needs of the child or infant will vary from child to child and from procedure to procedure. A. Enema- Pediatric nurse may administer an enema for a child or infant for various reasons 1. As a treatment for some disorders 2. Before a diagnostic or surgical procedure B. C. D. E. F. Procedure is uncomfortable and threatening so it is important for the nurse to Type and amount of fluid, as well as the distance the tube is inserted , varies Child cannot retain the fluid, so the nurse must hold his buttocks together for a Use a diaper or bedpan and head and back are supported by pillows. An older child (with an explanation) can usually hold the solution. Be sure to have

discuss the procedure with the child before the enema. according to age. short time to prevent the fluid from coming out.

a bedpan available before you start.

B. Ostomies~ Infants and children may have a ostomy created for various disorders or conditions. a) Colostomy- made by bringing part of the colon through the abdominal wall to create an outlet for fecal material elimination. 1. Can be temporary or permanent 2. A new colostomy may be left to open air or a bad, pouch or appliance used to collect the stool. b) Ileostomy-similar opening in the small intestine. Drainage from the ileostomy contains digestive enzymes so stoma must be fitted with a collection device to prevent skin irritation and breakdown. c) Teach caregivers or child how to care for the stoma and skin with ostomy. PREVENTING SKIN BREAKDOWN IS A PRIORITY. d) Urostomy- created to help in elimination. a) Ostomy bags must be checked for leakage b) Emptied frequently c) changed when needed. Follow facilities policy procedures, and record output accurately. C. Urine Specimens: Urine is collected for a variety of reasons, including : I. II. III. IV. Urinalysis urine cultures specific gravity dipsticking urine for glucose, protein, and pH

You can put cotton balls in the diaper of an infant, and squeeze those out for a urine test. Because kids and infants cant void on command, give them fluids 15 to 20 minutes before specimen is needed. Be sure to offer privacy with older kids and adolescents. 1. Collection Bag ~ a) Make sure skin is dry, clean, and free of oils, lotions, and powder.

b) Device has self-adhesive material to apply to childs skin. c) Device goes over penis/vulva, replace diaper d) Remove as soon as child voids. 2. Clean Catch ~Urine can be collected from older child with instructions. Parent can help with procedure. 3. 24-Hour Urine Specimen~ same procedure as adult, void before time starts, keep specimen on ice in special bag and measured, one final void before ending 24 hour. D. Stool Specimen ~Spool specimens are tested for: 1. Blood 2. Ova 3. Parasites 4. bacteria 5. glucose 6. excess fat d. Lumbar Puncture1. For analysis of cerebrospinal fluid. 2. Nurse must restrain the child until the procedure is completed. The nurse grasps the childs hands with the hand that has passed under the child s lower extremities and holds the child snugly against his/her chest. This position enlarges the intervertebral spaces for easier access with the aspiration needle 3. The nurse should tell the child that it is important to hold still and he/she will have to help with this. 4. Lumbar puncture is performed with strict asepsis. A sterile dressing is applied when procedure is complete. 5. Child must remain quiet for 1 hour after the procedure. 6. Vital signs, level of consciousness and motor activity should be monitored frequently for several hours after the procedure.

e. Blood Collection: 1. Nurse must explain procedure to child even if she isnt the one obtaining the specimen. 2. Obtained by pricking the heel, great toe, earlobe, or finger by venipuncture. 3. In infants, the jugular or scalp veins are most commonly used. Sometimes the femoral vein. 4. In older children, the veins in the arm are used. Hospitalization of the Child: Hatfield: Chapter 4 ~ pgs. 63-68 ER nurses must be sensitive to the childs needs and the familys needs. The ER nurses must recognize the childs cognitive level and how it affects the childs reactions. Staff must explain all procedures and maintain a calm, caring manner to reassure the child and the family Care of the Hospitalized Child: i.

Types of Admissions ~ 1. Planned: There may be an open house program or one that is specifically related to their upcoming experience. It is important for the family caregivers and siblings to attend the preadmission tour with the future patient to reduce anxiety in all family members. Children may be given surgical masks, caps, or shoe covers and have opportunity to operate on a doll or stuffed animal designed for that purpose. Many hospitals have coloring books to help prepare children for tonsillectomy or other specific surgical procedures. Questions may be answered and anxieties explored during the visit. Children and their families may be hesitant to ask questions or express feelings; the staff must be sensitive to this and discuss common questions and feelings. Children are told that some things will hurt, but the nurses and doctors will do everything they can to make the hurt go away. Honesty is key. Preadmission staff must be sensitive to cultural and language differences and make adjustments when appropriate.

Emergency: a. Emergencies leave little time for explanations. The emergency itself is frightening to the child and family and the need for treatment is urgent. Even though the caregivers may appear calm, the child can sense anxiety. If the hospital is still a great unknown, it will certainly add to the childs fear and panic. If the child has even a basic

understanding what happens there, the emergency may seem a little less frightening. b. In an emergency, physical needs assume priority over emotional needs. If a caregiver can conceal his own fear, it will be comforting to the child. c. The child may be angry that the caregiver does not prevent invasive procedures from being performed. d. Sometimes, it is impossible for the caregiver to stay with the child. When a caregiver is present, a staff member may use this time to collect info about the child. This will help the family member feel involved in the childs care. e. Emergency department nurses must be sensitive to the needs of the child and the family. Recognizing the childs cognitive level and how it effects the childs reactions is important. f. The staff must explain procedures and conduct themselves in a caring, calm manner to reassure both child and family.
The Pediatric Unit:

Orienting the child to the unit

Guidelines to Orient Child to Pediatric Unit 1. Introduce the primary nurse 2. Orient to the childs room: a. Demonstrate bed, bed controls, side rails b. Demonstrate call light c. Demonstrate television; include cost, if any d. Show bathroom facilities 3. Introduce to roommate(s); include families. 4. Give directions to or show special rooms; a. Playroom-rules that apply, hours available, toys or equipment that may be taken to the childs room b. Treatment room-explain purpose. c. Unit kitchen-rules that apply. d. Other special rooms. 5. Explain pediatric rules ; give written rules if available: a. Visiting hours and who may visit b. Mealtimes, rules about bringing in food. c. Bedtimes, naptimes, or quiet time d. Rooming in arrangement 6. Explain daily routines a. Vital signs routine.

b. c.

Bath routine Other routines.

7. Provide guidelines for involvement of family caregiver.