NURS 355 Chapter 22

What choice of words or phrases would be inappropriate to use with a child?

"catheter" for "intravenous" Children can grasp information only if it is presented on or close to their level of cognitive development. This necessitates an awareness of the words used to describe events or processes, and exploring family traditions or approaches to information sharing and creating patient specific language or context. Therefore, to prevent or alleviate fears, nurses must be aware of the medical terminology and vocabulary that they use every day and be sensitive to the use of slang or confusing terminology. "Catheter" is a medical term and would be confusing.

The nurse is assessing a child's functional self-care level for feeding, bathing and hygiene, dressing, and grooming and toileting. The child requires assistance or supervision from another person and equipment or device. What code does the nurse assign for this child?

III A code of III indicates the child requires assistance from another person and equipment or device. A code of I indicates use of equipment or device. A code of II indicates assistance or supervision from another person. A code of IV indicates the child is totally dependent.

What are core principles of patient- and family-centered care? (Select all that apply.)

empowering families providing formal and informal support Core principles of patent- and family-centered care include collaboration, empowerment, and providing formal and informal support. There should be flexibility in policy and procedures, and communication should be complete, honest, and unbiased, not withheld.

The nurse is caring for a 3-year-old child during a long hospitalization. The parent is concerned about how to support the child's siblings during the hospitalization. What statement is appropriate for the nurse to make?

"You could encourage a nightly phone call between the siblings as part of the bedtime routine." A supportive measure for siblings of a hospitalized child is to have a routine of a phone call at some point during the day or evening so the parent at the hospital can stay in touch and the children at home are involved and can hear that their sibling is doing well. Parents should alternate who stays at the hospital overnight to prevent burnout and to allow each parent time at home with the siblings. Encourage siblings to visit if appropriate to keep the family unit intact. Leaving the hospitalized child alone at night will not support the siblings at home and may cause problems with the hospitalized child.

The nurse is admitting a 7-year-old child to the pediatric unit for abdominal pain. To determine what the child understands about the reason for hospitalization, what should the nurse do?

Ask the child why he came to the hospital today. School-age children are able to answer questions. The only way for the nurse to know about the child's understanding of the reason for hospitalization is to ask the child directly. Finding out what the parents told the child and why they brought the child to the hospital or reading the admitting practitioner's description of the reason for admission will not provide information about what the child has heard and retained.

A spinal tap must be done on a 9-year-old boy. While he is waiting in the treatment room, the nurse observes that he seems composed. When the nurse asks him if he wants his mother to stay with him, he says, "I am fine." How should the nurse interpret this situation?

Children in this age group often do not request support even though they need and want it. The school-age child's visible composure, calmness, and acceptance often mask an inner longing for support. Children of this age have a more passive approach to pain and an indirect request for support. It is especially important to be aware of nonverbal cues such as facial expression, silence, and lack of activity. Usually when someone identifies the unspoken messages, the child will readily accept support.

The parents of a 3-year-old admitted for recurrent diarrhea are upset that the practitioner has not told them what is going on with their child. What is the priority intervention for this family?

Help the family develop a written list of specific questions to ask the practitioner. Often families ask general questions of health care providers and do not receive the information they need. The nurse should determine what information the family does want and then help develop a list of questions. When the questions are written, the family can remember which questions to ask or can hand the sheet to the practitioner for answers. The nurse may have the information the parents want, but they are asking for specific information from the practitioner. Unless it is an emergency, the nurse should not place a stat page for the practitioner. Being present is not necessarily the issue but rather the ability to get answers to specific questions.

A 13-year-old child with cystic fibrosis (CF) is a frequent patient on the pediatric unit. This admission, she is sleeping during the daytime and unable to sleep at night. What should be a beneficial strategy for this child?

Negotiate a daily schedule that incorporates hospital routine, therapy, and free time. Children's response to the disruption of routine during hospitalization is demonstrated in eating, sleeping, and other activities of daily living. The lack of structure is allowing the child to sleep during the day, rather than at night. Most likely the lack of schedule is the problem. The nurse and child can plan a schedule that incorporates all necessary activities, including medications, mealtimes, homework, and patient care procedures. The schedule can then be posted so the child has a ready reference. Sedatives are not usually used with children. The child has a chronic illness and most likely knows the importance of rest. The parents and child can be questioned about changes at home since the last hospitalization.

The nurse should expect a toddler to cope with the stress of a short period of separation from parents by displaying what?

Regression Children in the toddler stage demonstrate goal-directed behaviors when separated from parents for short periods. They may demonstrate displeasure on the parents' return or departure by having temper tantrums; refusing to comply with the usual routines of mealtime, bedtime, or toileting; or regressing to more primitive levels of development. Detachment would be seen with a prolonged absence of parents, not a short one. Toddlers would not be indifferent or happy when experiencing short separations from parents.

Two hospitalized adolescents are playing pool in the activity room. Neither of them seems enthusiastic about the game. How should the nurse interpret this situation?

The adolescents may be enjoying themselves but have lower energy levels than healthy children. Children who are ill and hospitalized typically have lower energy levels than healthy children. Therefore, children may not appear enthusiastic about an activity even when they are enjoying it. Pool is an appropriate activity for adolescents. They have the cognitive and psychomotor skills that are necessary. If the adolescents were significantly depressed, they would be unable to engage in the game.

The psychosexual conflicts of preschool children make them extremely vulnerable to which threat?

bodily injury and pain The psychosexual conflicts of children in this age group make them vulnerable to threats of bodily injury. Intrusive procedures, whether painful or painless, are threatening to preschoolers, whose concept of body integrity is still poorly developed. Loss of control, loss of identity, and separation anxiety are not related to psychosexual conflicts.

The nurse is caring for a 10-year-old child during a long hospitalization. What intervention should the nurse include in the care plan to minimize loss of control and autonomy during the hospitalization?

create a calendar with special events such as a visit from a friend to maintain a routine School-age children may feel an overwhelming loss of control and autonomy during a longer hospitalization. One intervention to minimize this loss of control is to create a calendar with planned special events such as a visit from a friend. Maintaining the child's daily routine is another intervention to minimize the sense of loss of control; allowing the child to skip morning self-care activities, sleep later, or stay up later would work against this goal. Environments should be as nonrestrictive as possible to allow the child freedom to move about, thus allowing a sense of autonomy.

What parents should have the most difficult time coping with their child's hospitalization?

parents of the child hospitalized for sepsis resulting from an untreated injury Factors that affect parents' reactions to their child's illness include the seriousness of the threat to the child. The parents of a child hospitalized for sepsis resulting from an untreated injury would have more difficulty coping because of the seriousness of the illness and because the wound was not treated immediately.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." How should the nurse interpret this behavior?

this is expected behavior for a school-age child This school-age child is attempting to maintain some control over the hospital experience. The nurse should provide the girl with structured choices about when the IV line will be inserted. Preschoolers can view procedures as punishment; this is not typical behavior of a preschool-age child.

What are signs and symptoms of the stage of despair in relation to separation anxiety in young children? (Select all that apply.)

withdrawn from others uncommunicative regresses to early behaviors Manifestations of the stage of despair seen in children during a hospitalization may include withdrawing from others, being uncommunicative, and regressing to earlier behaviors. Clinging to parents and physically attacking a stranger should be seen during the stage of protest, and forming new but superficial relationships is seen during the stage of detachment.

The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breastfeeding and provides all the care except for the medication administration. What should the nurse include in the plan of care?

ensuring that the mother has time away from the infant The mother needs sufficient rest and nutrition so she can be effective as a caregiver. While the infant is hospitalized, the care is the responsibility of the nursing staff. The mother should be made comfortable with the care the staff provides in her absence. The mother has a right to provide care for the infant. The nursing staff and the mother should agree on the care division.

An 8-year-old girl is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What intervention will help her most in her adjustment to the hospital?

explain hospital schedules to her, such as mealtimes School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for what to expect. The nurse should refer to the child by the preferred name. Explaining when parents can visit and why siblings cannot come focuses on the limitations rather than helping her adjust to the hospital. At the age of 8 years, the child should be oriented to the environment along with the parents.

What behavior should most likely be manifested in an infant experiencing the protest phase of separation anxiety?

inconsolable and crying For older infants, being inconsolable and crying is seen during the protest phase of separation anxiety. Inactivity is observed during the stage of despair. The child is much less active and withdraws from others. Depression, sadness, and regression to earlier behaviors are observed during the phase of despair.

A 6-year-old child is admitted to the pediatric unit and requires bed rest. Having art supplies available meets which purpose?

Lets the child express thoughts and feelings through pictures rather than words The art supplies allow the child to draw images that come into the mind. This can help the child develop symbols and then verbalize reactions to illness and hospitalization. The child can make gifts and drawings for parents, but the goal is to allow expression of feelings. Although art is developmentally and situationally appropriate, the child benefits by being able to express feelings nonverbally. The art supplies are not therapeutic play but a mechanism for expressive play. The child will not work on past problems.

What factors can negatively affect parents' reactions to their child's illness? (Select all that apply.)

additional stresses lack of support systems seriousness of the threat to the child The factors that can negatively affect parents' reactions to their child's illness are additional stresses, lack of support systems, and the seriousness of the threat to the child. Previous coping abilities and previous experience with hospitalization would have a positive effect on coping.

Cognitive development influences response to pain. What age group is most concerned with the fear of losing control during a painful experience?

adolescents Adolescents view illness as physiologic (an organ malfunction) and psychophysiologic (psychologic factors that affect health). Adolescents usually approach pain with self-control. They are concerned with remaining composed and feel embarrassed and ashamed of losing control. Toddlers and preschoolers react to pain primarily as a physical, concrete experience. Preschoolers may try to escape a procedure with verbal statements such as "go away." Young school-age children may view pain as punishment for wrongdoing. This age group fears bodily harm.

What influences a child's reaction to the stressors of hospitalization? (Select all that apply.)

separation support systems developmental age previous experience with illness Major stressors of hospitalization include separation, loss of control, bodily injury, and pain. Children's reactions to these crises are influenced by their developmental age; previous experience with illness, separation, or hospitalization; innate and acquired coping skills; seriousness of the diagnosis; and support systems available. Gender does not have an effect on a child's reaction to stressors of hospitalization.

The nurse is notified that a 9-year-old boy with nephrotic syndrome is being admitted. Only semiprivate rooms are available. What roommate should be best to select?

an 8-year old boy with a fractured femur An 8-year-old boy with a fractured femur would be the best choice for a roommate. The boys are similar in age. The child with nephrotic syndrome most likely will be on immunosuppressive agents and susceptible to infection. The child with a fractured femur is not infectious. A girl should not be a good roommate for a school-age boy. In addition, the 10-year-old girl with pneumonia and the 10-year-old boy with a ruptured appendix have infections and could pose a risk for the child with nephrotic syndrome.

The nurse is doing a prehospitalization orientation for a girl, age 7 years, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that after the surgery, the child will be in the intensive care unit. How might the explanation by the nurse be viewed?

an appropriate part of the child's preparation The explanation is a necessary part of preoperative preparation and will help reduce the anxiety associated with surgery. If the child wakes in the intensive care unit and is not prepared for the environment, she will be even more anxious. This is a joint responsibility of nursing, medical staff, and child life personnel.

What are signs and symptoms of the stage of detachment in relation to separation anxiety in young children? (Select all that apply.)

appears happy forms new but superficial relationships interacts with strangers or familiar caregivers Manifestations of the stage of detachment seen in children during a hospitalization may include appearing happy, forming new but superficial relationships, and interacting with strangers or familiar caregivers. Lacking interest in the environment and regressing to an earlier behavior are manifestations seen in the stage of despair.

A child, age 4 years, tells the nurse that she "needs a Band-Aid" where she had an injection. What nursing action should the nurse implement?

apply a band-aid Children in this age group still fear that their insides may leak out at the injection site. The nurse should be prepared to apply a small Band-Aid after the injection. No explanation should be required.

Parents tell the nurse that siblings of their hospitalized child are feeling "left out." What suggestions should the nurse make to the parents to assist the siblings to adjust to the hospitalization of their brother or sister? (Select all that apply.)

arrange for visits to the hospital encourage phone calls to the hospitalized child make or buy inexpensive toys or trinkets for the siblings identify an extended family member to be their support system Strategies to support siblings during hospitalization include arranging for visits, encouraging phone calls, giving inexpensive gifts, and identifying a support person. Information should be shared with the siblings not limited.

The parents of a 4-month-old infant cannot visit except on weekends. What action by the nurse indicates an understanding of the emotional needs of a young infant?

assign her to the same nurse as much as possible The infant is developing a sense of trust. This is accomplished by the consistent, loving care of a nurturing person. If the parents are unable to visit, then the same staff nurses should be used as much as possible. Placing her in a room away from other children would isolate the child. The parents should be encouraged to visit. The nurse should describe how the staff will care for the infant in their absence.

The nurse needs to assess a 15-month-old child who is sitting quietly on his father's lap. What initial action by the nurse would be most appropriate?

begin the assessment while the child is in his father's lap For young children, particularly infants and toddlers, preserving parent-child contact is a good way of decreasing stress or the need for physical restraint during an assessment. For example, much of a patient's physical examination can be done with the patient in a parent's lap with the parent providing reassuring and comforting contact. The initial action would be to begin the assessment while the child is in his father's lap.

A 9-year-old boy has an unplanned admission to the intensive care unit (ICU) after abdominal surgery. The nursing staff has completed the admission process, and his condition is beginning to stabilize. When speaking with the parents, the nurse should expect what additional stressor to be evident?

insufficient remembering of his condition and routine ICUs, especially when the family is unprepared for the admission, are strange and unfamiliar. There are many pieces of unfamiliar equipment, and the sights and sounds are much different from those of a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated on what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. In most ICUs, the staff works with a sense of urgency. It is difficult for parents to ask questions about their child when staff is with other patients. Usually little privacy is available for families in ICUs.

A parent needs to leave a hospitalized toddler for a short period of time. What action should the nurse suggest to the parent to ease the separation for the toddler?

leave a favorite article from home with the child If the parents cannot stay with the child, they should leave favorite articles from home with the child, such as a blanket, toy, bottle, feeding utensil, or article of clothing. Because young children associate such inanimate objects with significant people, they gain comfort and reassurance from these possessions. They make the association that if the parents left this, the parents will surely return. Bringing a new toy would not help with the separation. The parent should not leave when the child is distracted, and toddlers would not understand when the parent should return because time is not a concept they understand.

The nurse is assessing a family's use of complementary medicine practices. What practices are classified as nutrition, diet, and lifestyle or behavioral health changes? (Select all that apply.)

macrobiotics megavitamins health risk education Macrobiotics, megavitamins, and health risk reduction are classified as nutrition, diet, and lifestyle or behavioral health changes. Reflexology and chiropractic medicine are classified as structural manipulation and energetic therapies.

What nursing interventions should the nurse plan for a hospitalized toddler to minimize fear of bodily injury? (Select all that apply.)

maintain parent-child contact use progressively smaller dressings on surgical incisions Whenever procedures are performed on young children, the most supportive intervention to minimize the fear of bodily injury is to do the procedure as quickly as possible while maintaining parent-child contact. Because of toddlers' and preschool children's poorly defined body boundaries, the use of bandages may be particularly helpful. For example, telling children that the bleeding will stop after the needle is removed does little to relieve their fears, but applying a small Band-Aid usually reassures them. The size of bandages is also significant to children in this age group; the larger the bandage, the more importance is attached to the wound. Watching their surgical dressings become successively smaller is one way young children can measure healing and improvement. Prematurely removing a dressing may cause these children considerable concern for their well-being.

Parents of a hospitalized child often question the skill of staff. The nurse interprets this behavior by the parents as what?

normal Recent research has identified common themes among parents whose children were hospitalized, including feeling an overall sense of helplessness, questioning the skills of staff, accepting the reality of hospitalization, needing to have information explained in simple language, dealing with fear, coping with uncertainty, and seeking reassurance from the health care team. The behavior does not indicate the parents are paranoid, indifferent, or wanting attention.

The parents tell a nurse "our child is having some short-term negative outcomes since the hospitalization." The nurse recognizes that what can negatively affect short-term negative outcomes? (Select all that apply.)

parents' anxiety length of hospitalization multiple invasive procedures The stressors of hospitalization may cause young children to experience short- and long-term negative outcomes. Adverse outcomes may be related to the length and number of admissions, multiple invasive procedures, and the parents' anxiety. Consistent nurses would have a positive effect on short-term negative outcomes. The number of visitors does not have an effect on negative outcomes.

The nurse is providing support to parents adapting to the hospitalization of their child to the pediatric intensive care unit. The nurse notices that the parents keep asking the same questions. What should the nurse do?

patiently continue to answer questions, trying different approaches In addition to a general pediatric unit, children may be admitted to special facilities such as an ambulatory or outpatient setting, an isolation room, or intensive care. Wherever the location, the core principles of patient and family-centered care provide a foundation for all communication and interventions with the patient, family, and health care team. The nurse should do the therapeutic action and patiently continue to answer questions, trying different approaches.

A 6-year-old is being discharged home, which is 90 miles from the hospital, after an outpatient hernia repair. In addition to explicit discharge instructions, what should the nurse provide?

prescribed pain medications before discharge The nurse should anticipate that the child will begin experiencing pain on the trip home. By providing a dose of oral analgesia, the nurse can ensure the child remains comfortable during the trip. Transport by ambulance is not indicated for a hernia repair. Discharge instructions should be written. The parents will be focusing on their child and returning home, which limits their ability to retain information. The parents should know the most expedient route home.

When a preschool-age child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as what?

punishment The rationale for preparing children for the hospital experience and related procedures is based on the principle that a fear of the unknown (fantasy) exceeds fear of the known. Preschool-age children see hospitalization as a punishment. Loss of parental love would be a toddler's reaction. Threat to the child's self-image would be a school-age child's reaction. Loss of companionship with friends would be an adolescent's reaction.

What factors influence the effects of a child's hospitalization on siblings? (Select all that apply.)

receiving little information about their ill brother or sister being cared for outside the home by care providers who are not relatives perceiving that their parents treat them differently compared with before their sibling's hospitalization Various factors have been identified that influence the effects of a child's hospitalization on siblings. Factors that are related specifically to the hospital experience and increase the effects on the sibling are being cared for outside the home by care providers who are not relatives, receiving little information about their ill brother or sister, and perceiving that their parents treat them differently compared with before their sibling's hospitalization. Being younger, not older, and experiencing many changes, not minimal changes, are factors that influence the effects of a child's hospitalization on siblings.

The nurse relates to parents that there are some beneficial effects of hospitalization for their child. What are beneficial effects of hospitalization? (Select all that apply.)

recovery from illness improve coping abilities opportunity to master stress provide new socialization experiences The most obvious benefit is the recovery from illness, but hospitalization also can present an opportunity for children to master stress and feel competent in their coping abilities. The hospital environment can provide children with new socialization experiences that can broaden their interpersonal relationships. Having a break from school is not a benefit of hospitalization.

The nurse is assessing a family's use of complementary medicine practices. What practices are classified as mind-body control therapies? (Select all that apply.)

relaxation prayer therapy guided imagery Relaxation, prayer therapy, and guided imagery are classified as mind-body control therapies. Acupuncture and herbal medicine are classified as traditional and ethnomedicine therapies.

Because of their striving for independence and productivity, which age group of children is particularly vulnerable to events that may lessen their feeling of control and power?

school-age children When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that decrease their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as school-age children.

The nurse is instructing student nurses about the stress of hospitalization for children from middle infancy throughout the preschool years. What major stress should the nurse relate to the students?

separation anxiety The major stress from middle infancy throughout the preschool years, especially for children ages 6 to 30 months, is separation anxiety.