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ENT1

Care Plans to consider the psychological needs of


hospitalized children
Infant - Trust vs. Mistrust
Nursing
Diagnosis
Anxiety Related to
Separation

Goals
Contact with
mother

Continuity of
care
Alteration in
Family Processes
Related to
Hospitalized Infant

Will evidence
positive reactions
to hospital as
evidenced by:

Interventions
Encourage mother to visit often
Encourage mother to feed infant
ordered
Teach parents procedures they are
capable of doing
Discuss her arrangements for care of
family at home
Try to simulate home routine
Try to assign same nurse
Explain behavior to mom
Initiate interventions cited earlier

cries loudly
fussy
rejects
everyone but
mother

Absence of
negative
behaviors:

Alteration in
Parenting Related
to Childs
Behavior on
Returning Home

Anxiety Related
to Procedures

extremely
cooperative
withdraws
from everyone
cries
continually
completely
passive

Teach parents some children


may exhibit the following behaviors:
aggression
regression
nightmares
over-dependence

Allow parents to be present during


procedures
Encourage parent to comfort child
during and after painful procedure
Keep frightening objects from
view
If possible, use treatment room
for procedures

ENT2
Alteration in
Sensory Stimuli
Related to
Environment

Basic needs met as


evidenced by:

active interest
in environment

regress

4 hours of
sleep

Assess infants environment


Teach Mom (colorful objects, music
box, mobiles, pacifier, mom playing)
Encourage home routines
Encourage mom rooming in

Alteration in
Comfort Related
to Pain

Alleviate pain
evidenced by
absence of:

lack of
appetite

excessive
irritability

lethargy

increase
appetite

Assess source of pain and provide


appropriate interventions
Give pain relief med as ordered
Provide comfort measure
Teach mom
Project how long pain will last

Infant/Toddler - Autonomy vs. Shame & Doubt


Nursing
Diagnosis

Goals

Anxiety Related
to Stranger
Fear, Separation
Anxiety

Contact with
Mom
Minimize protest,
despair, denial
stages

Interventions

Encourage mom to room in


Provide warmth and support
Explain to parent stage child is
in
Have mom leave something of
hers
Leave the childs favorite toy
Ask mom to leave when child is
awake
Ask mom to inform nurse
Provide support when separating

Alteration in
Parenting
Related to
Knowledge
Deficit (temper
tantrums,
regression,
etc.)

Consistency in
approach to child
when these
behaviors are
exhibited:
negativism
temper
tantrums
dawdling
regression

Communicate in report/Kardex
Consistent limit setting
Give choices, simple decisions
Set time limits
Teach mom its okay

Self-care Deficit
Related to
Developmental
Level (toilet
training)

Encourage level
of toilet training
child is at

Teach mom child may regress


Promote potty chair if child has
been trained for a while
Offer potty chair frequently
(4x/shift)

ENT3
Sleep Pattern
Disturbance
Related to Fear
of Separation;
Negativism

Toddler will have


adequate rest
13 hours of sleep

Promote ritualistic
behavior for bedtime

Potential for
Injury Related
to Environment
Hazards

Toddler will
interact in
hazard-free
environment as
evidenced by lack
of accidents

Assess
Teach mom about hazards
(crib, chair, toys, equipment)
Supervise when out of crib
Crib net if climber
Strapped into highchair
Check on child Q 15 minutes
when mom gone

ENT4

Toddler/Preschooler - Initiative vs. Guilt


Nursing Diagnosis

Interventions

Alteration in Nutrition Related to


Moms Knowledge
Deficit; Physiologic Anorexia

Presence of Parent if Possible


Assess childs status by growth charts
Small portions
Foods child likes; hamburgers, P.J.
Comfortable atmosphere; acceptance of
mess
Encourage intake of fluids with games

Alteration in Family Processes


Related to Hospitalization of
Toddler/Preschooler

Encourage parent participation in care


Provide consistent environment
Reinforce coping behavior
Provide with as much mobility as
possible
Offer choices
Honest explanations, for prep for
procedures
Teach parent interventions, with
rationale

(Loss of Control, Ritualistic)

Fear of Mutilation Related to


Developmental Level and Minimal
Knowledge of the Way the Body
Works

Parents participation in care


Explain procedure simply (1 day/1 year
amount of time for prep for surgery)
Children may feel they are being
punished
Expose child to as much as possible to
prepare them for surgery
Provide play and diversional activities
Provide comfort and support
Acknowledge childs fears
Avoid intrusive procedures as much as
possible

Knowledge Deficit Related to


Possible Misinterpretation of Events
Secondary to Cognitive Level

Assess what parent has told child


Assess childs perception by asking to
draw a picture and tell about it
Encourage parents present during
explanation to reinforce and repeat
explanation
Encourage child to act out feelings and
fears
Honest, brief explanations
Consistency

ENT5

School Age/Industry
Nursing Diagnosis

Interventions

Fear of Bodily Injury


Related to Developmental
Level

Ascertain what child knows. Clarify using


scientific terminology and how body
functions.
Assess knowledge of illness related to body
Ascertain blame and explain accordingly
Direct questions more to the child when
teaching them (help master over feelings of
inferiority)
Use audiovisuals, pictures, body outlines.
Suggest ways of maintaining control
(i.e.: deep breathing relaxation).
Gain cooperation.
Include in decision-making (time to do it,
preferred site).
Encourage active participation (removing
dressings, doing PIN care).

Fear of Losing Emotional


Control Related to
Developmental Level

Plan childs day if possible with childs input


Explain what to expect and how
Plan activities to allow expression of aggression
Encourage activities based on interests
Have child help problem solve and make
choices
*Maintain clear and consistent limits
Give positive feedback
Allow for privacy

Anxiety Related to
Separation from Friends,
School and Family

Siblings usually perceive their stress as equal to


the hospitalized child
Encourage use of telephone to maintain
contact.
Provide opportunities to socialize with peers.
Encourage ventilation of concerns.
Encourage keeping up with school homework.

ADOLESCENT: IDENTITY vs IDENTITY DIFFUSION


Fear of Procedure

Assess knowledge.
Encourage questioning regarding fears, or risks.
Involve in decision-making.
Ask if patient wants parent there.
Make as few of restrictions as possible.
Suggest ways of maintaining control.
Accept regression to more childish ways of
coping.

ENT6
Give positive reinforcement.