Chapter 30: Atraumatic Care of Children and Families

A parent wants to wait outside the room while a procedure is completed on his young child, saying, "I don't think I can stand to see you do this!" The nurse's best response is: a) "This will only take a few minutes. You should be with your child." b) "Stay. It will be less scary for your child." c) "Good. That is what the team doing the procedure would prefer." d) "Certainly. I will stay with your child during the procedure." e) "Come, stand by his head. You won't see much up there"

"Certainly. I will stay with your child during the procedure." Explanation: Excusing the parent from the procedure is the best response. The parent's needs and abilities need to be respected and supported. Children usually receive the most support from parents. However, others can provide effective support including nurses and child life personnel. Consider, also, that an anxious parent usually means an anxious child. Assist the parent to comfort the child after the procedure.

The nurse is preparing to teach a 15-year-old boy about his recently diagnosed diabetes. What questions asked by the nurse will be of assistance in determining his needs for learning? Select all that apply.

"How has your diabetes impacted your family?" "Prior to seeing the physician for your condition, what did you do to manage it?" "What do you know about the diets recommended for a diabetic?" "Who do you think should receive teaching about your diabetes?"

The nurse is preparing a hospitalized child for a lumbar puncture. The health care provider states the procedure will be performed in the child's hospital room. To advocate for the child, what should the nurse inform the health care provider?

"I will have the procedure prepared in the treatment room, so that the child may view the hospital room as safe and secure." Explanation: In the hospital, all invasive procedures should be performed in the treatment room or a room other than the child's room. The child's room should remain a safe and secure area. The lumbar puncture requires special positioning and holding. This should be done by the nurse and not the parents. The decision to have the parents watch the procedure is up to the health care provider and/or hospital policy. If the parents observe the procedure, they need education prior to the procedure about what to expect.

A nurse is preparing to administer medication to a preschooler. What can the nurse do to ensure communication with the child is effective?

Allow the child to choose between juice, water, or soda to take the medication.

The nurse is caring for a child who appears fearful and is reluctant to talk. The nurse uses therapeutic communication skills to interact with the child. What initial goal does the nurse accomplish when using these skills to communicate with the child?

Assess the perception of the problem.

A 6 year old reports pain in the stomach upon eating. The nurse replies, "Let me see if I have this right. Every time you eat anything, you get a pain in your tummy?" The nurse is using which technique of therapeutic communication? a) perception checking b) open-ended questions c) clarifying d) reflecting

Clarifying Clarifying consists of repeating statements others have made so both people can be certain that the message is understood. This is an example of clarifying. Reflecting is restating the last word or phrase. Open-ended questions invite a variety of responses and allow the client to give all the pertinent information needed to answer the question. Perception checking documents a feeling or emotion that is reported. It is a way of understanding others accurately instead of jumping to conclusions.

The nurse is providing care for a 2-year-old girl with a chronic respiratory disease present since birth. Which would be of least help in working effectively with the parents?

Expect parents to perform procedures precisely as taught.

The nurse is teaching a 15-year-old boy with diabetes mellitus and his parents how to monitor glucose levels. Which communication technique is least effective?

Ignoring the adolescent's tirade about his therapy Explanation: The least effective technique is ignoring the adolescent's tirade about his therapy. He is expressing frustration over his lack of control, and his emotions should be acknowledged. Paraphrasing the parents' comments recognizes their feelings. Using the teen's words during the conversation indicates active listening and interest. Reflection clarifies the parents' understanding and point of view.

The nurse is caring for a 14-year-old boy, and his parents, who has just been diagnosed with a malignant tumor on his liver. Which intervention is most important to this child and family?

Involving the child and family in decision making Explanation: Since the child has just been diagnosed, concerns about postoperative home care would be least important. Arranging an additional meeting with the specialist and discussing treatment options may be necessary at some point, but involving the child and family in decision making is always a goal and is a part of family-centered care.

A nurse is assigned to care for a 6-month-old infant hospitalized with diarrhea and dehydration. Because the infant does not have developed speech, what can the nurse do to communicate with the infant?

Sing to the infant. Explanation: Infants primarily communicate through touch, sight, and hearing. Communication can occur through cuddling, holding, rocking, and singing to the infant. The child cannot read, so writing on the whiteboard would be beneficial only for the parents. A 6-month-old infant uses toys as developmental tools, not communication tools. The infant may want to snuggle with the stuffed animal while the nurse tells the story or sings.

A 9-year-old child with rheumatoid arthritis has difficulty moving the hands as well as other joints due to pain. The child refuses to participate in the prescribed physical therapy. What would be the best way for the nurse to make sure the child continues to exercise the joints?

Play a game like "Simon Says" to introduce exercises. School-aged children love to play games. By playing "Simon Says" and introducing different exercises to help with movement, the nurse may help stimulate the client to want to be active. Reading about exercises and seeing them demonstrated by a person or in a video will not increase the child's desire, especially since the child is in pain. Exercise for this child should be a pleaseant experience and playing a game will help in that aspect.

Prior to discharge, the nurse teaches a school-age child how to change the wafer on the new colostomy. The nurse observes the child making the hole too big to fit over the stoma. What action should the nurse implement following this child's return demonstration? Select all that apply.

Repeat the demonstration to show the child the proper technique. Offer positive reinforcement regarding the child's ability to follow through with obtaining the necessary supplies. Discharge the child with written instructions and illustrations to reinforce the correct procedure. Remind the child of the reason not to make the hole too large.

A couple is arguing and bickering all the time. This couple has not told the children yet that they are planning to get a divorce. When the couple discusses this with the school nurse, the nurse shares that at this early phase, children likely experience what type of feelings?

take blame for their parents quarreling and try to behave better

The nurse is assessing the teaching needs of the parents of an 8-year-old boy with leukemia. Which assessment should the nurse explore as a potential issue with the parent's health literacy?

The parents missed the last scheduled appointment. Explanation: Missing appointments is one of the red flags to health literacy problems as the parents may not have understood the importance of the appointment or may not have been able to read or understand appointment reminders. Being bilingual does not indicate health literacy issues. Taking notes or one parent being the primary spokesperson for the child's health care are not unusual practices.

An 5-year-old adoptive child has been injured on the playground and will require orthopedic surgery. The nurses encourage the parents to stay with the child as much as possible while the child is in the hospital based on which potential reason?

They may be afraid they are going to be given back to the foster-care system.

The father of a child hospitalized after a fire questions the use of therapeutic play. He reports he does not understand the purpose. What information can be provided to him?

This type of play gives the child an outlet to deal with stress. Explanation: Therapeutic play (type of play that provides an emotional outlet or improves the child's ability to cope with the stress of illness and hospitalization), and education to help the child and family understand the reason for the hospitalization and the necessary tests and procedures.

A couple with infertility has decided to adopt an infant and receive a call several months later that an infant is available. The social worker gives them the history of the biological mom, a teenager who tried to conceal her pregnancy by dieting and taking laxatives. However, at 6 months' gestation, the teenager shared her pregnancy with the family and received prenatal care. Given this history, the couple should be counseled to observe the infant for which possible abnormality?

abnormal neurologic development

Following a principle of learning, the nurse can anticipate that school-age children will best learn a skill such as bandaging if they:

are allowed to practice it. Explanation: School-age children are in a concrete cognitive stage. They learn best if they can actually practice procedures and demonstrate them on their own. Nurses should explain procedures and the reasons for them in a simple logical way. This age group is not yet where they can think abstractly. They learn best with role playing, games, and show and tell. They need activities that create enthusiam. Watching someone else do the procedure or seeing it in a book does not allow the child to learn the material and master the procedure. Children should not be criticized for not learning well. The technique of teaching should changed to meet the child's learning needs.

A nurse is preparing to teach an 8-year-old child recently diagnosed with diabetes how to give an insulin injection. Which is the best technique for the nurse to use?

demonstration Explanation: The purpose of demonstration is to show how the procedure actually is done. Having to imagine steps is little different than reading about them. School-aged children, because of their stage of cognitive development (concrete operations), learn best by demonstration. Watching a video is a good teaching strategy to show the process but it does not have the "real" syringe and vial the child can see and touch. Once the demonstration is complete the child should be allowed to return the demonstration and/or have time to practice with the nurse's assistance.

The nurse is having trouble communicating with a hospitalized child. Which communication technique would be the most beneficial for the nurse to offer the child?

drawing pictures