The Hospitalized Child

Four primary problems of the Pediatric

Nurse when dealing with the
hospitalized child:
Separation Anxiety
Loss of Control
Pain management
Diversional Activities reflective of
developmental stage of client
The Hospitalized Child
Separation Anxiety!
Early Childhood
Protest
Despair
Detachment
Later Childhood
Loneliness
Boredom
Isolation
Attitude is everything!
The Hospitalized Child
Loss of Control!
Early Childhood
Trust
Limitation of movement
Regression
Fantasy (can not synthesize beyond senses)
Later Childhood
Loss of independent activities
Depersonalization
Attitude is everything!

The Hospitalized Child
Pain!
Fallacies
Infants do not feel pain
Children tolerate pain better than adults
Children can not tell you where they hurt
Children always tell you the truth about pain
Children become used to pain and painful
procedures
Pain intensity is reflected by a childs behavior
Opioids are too dangerous for children
Pain Assessment:
Subjective
Pain Assessment:
Objective
Body rigidity, thrashing about, loud
crying, restlessness
Flushing of skin
Blood Pressure, pulse, resp increase
Pupils Dilate
O2 Sat decreases
These are less reliable than subjective- better
to believe what the child tells you than to rely
on objective signs
Pain Management
Non-pharmacological
Involve Parents
Prepare the child without planting the idea
of pain
Distraction
Cutaneous Stimulation
Rewards
Pain Management
Pharmacological
Right Drug
opioids vs non-opioids?
Right Dose
body weight
Parenteral vs Oral doses
Pain Management
Pharmacological
Right Route
Oral
IM
EMLA
buffered lidocaine
IV
Side effects
Attitude is everything!
Diversional Activities
Play is the work of children and is
critical in their development
JCAHO requirements
puts children in charge- all children even
the sick ones!
Play Room
should be a sanctuary
The Hospitalized Child
Care Plan:
Fear related to separation anxiety


withdrawal


regression
The Hospitalized Child
Care Plan
Alteration in comfort related to pain

Non-pharmacological

Pharmacological

Side Effects
The Hospitalized Child
Care Plan
Powerlessness related to hospitalization


The Hospitalized Child
Care Plan:
Diversional Activity Deficit related to
immobility and hospitalization

Activity Levels


Adequate rest
Pediatric Variations from Adults:
Assessment and Techniques
Safety!
Language!
Medication Administration!
PO
IM
IV
PR
Positioning
Lumbar Puncture
lie on side with knees flexed to the
abdomen and chin flexed to chest
infant- two hands
child- lean over body using forearms against
the thighs
Papoose Board/ Mummy Restraint
IVs, phlebotomy, suturing,
Normal Pediatric Heart Rates-
Always Apical!!
Newborn- 120-170
1 year- 100-130
3 years 80-120
5 years- 70-110
10 years 60-100
affected by fever, dehydration,
respiratory illnesses and drugs
Respiratory Rates- Abdominal
rather than chest movements!!
Newborn: 30-60
1 year: 24-40
3 years: 24-30
6 years: 18-22
10 years: 12-20
Affected by anxiety, fever, drugs, illness
Blood Pressures- neonatal, infant,
child, small adult cuffs
Newborn: 70/50
1 year: 90/50
3 years: 90/60
6 years: 100/60
12 years: 110/60
18 years: 120/70
affected by pain, dehydration, anxiety
Temperature: an elevated
temperature is called a fever!!
Any temp. >100.5 in a child<3 mos- is
serious- seek medical attention!!
Mercury Glass Thermometer
oral- no seizure, 4 or older, 3 minutes,
under tongue
rectal- lubrication, 2 minutes, usually
younger than 2, insert 1/2 inch (no
immunosuppressed!!!)
both require protective sheath!

Temperature- continued
Axillary- last resort- usually in public
places, seizure prone and
immunosuppressed!
Press arm close to side- hold in place 6
minutes!
Rectal=oral plus 1 degree or axillary
plus 2 degrees
Oral = axillary plus one degree
Temperature- continued
Tympanic- not recommended for
children less than 2 years- but is done
all the time!
Use probe cover
pull pinna back and down, insert probe
covering entire canal, parallel to face,
then rotate towards mouth- like
speaking into telephone- press scan
button. Discard probe.
Oxygen saturation- normal- 95%
or greater!
Indicated in any patient with abnormal vital
signs, cough, excessive secretions, sedation,
or whenever the nurse feels it is necessary.
Spot check vs continuous
Usually children require taping probe over
thumbnail nail or large toenail, can also use
pinna of ear
Measurement of oxygenation as well as
perfusion!

Intake and Output
Measured in ccs or mLs- useless
without daily weights!
1 gram = 1cc (1,000 grams = 1Kg=1liter!)
Used on the following- renal disease, IV
fluids, surgery, DM, hypovolemic,
dehydrated (vomiting), CHI, burns, CHF,
certain medications, meningitis (ICP)
Weigh all diapers!
Specimen Collection (less than 5
years old)
Venipuncture- usually do not use a vacutainer
on children- a 20-25 gauge needle with a
syringe- usually 3 ccs enough. Do not put in
regular blood tubes, but rather pedi bullets.
Can do a heel stick if unable to get blood on
kids less than 1- need lancet and micro-sized
collection tubes. Must wipe away the first
drop of blood.
Specimen Collection- Urine
Cath
Clean Catch
Pedibag- clean meatus before applying the bag with
a soap solution, sterile water, and sterile gauze -
wipe from the tip of the penis towards the scrotum or
from the clitoris towards the anus on three separate
wipes.
Attach the bag with adhesive tabs around the labia or
around the scrotum
Should be done before any other specimen
collection!
Specimen Collection- Throat
Culture
Open the culturette- do not let it come into
contact with anything- hold in dominant hand.
(contains two swabs in one) Have patient
open mouth and say AHHH. (May need
tongue depressor to get tongue out of way)
Do not let swab come into contact with the
tongue- swab each tonsil with a different
swab. Expect patient to gag! Place swab
back into culturette tube- Label!!