Ch 8 Pedi- Atraumatic Care
The encoder is a person who desires to share a thought or feeling with someone else so originates a message;
in this case, it is the nurse
Good listening, like speaking,
is not passive but active.
An adolescent with ulcerative colitis has a temporary colostomy. What intervention can the nurse provide to allow the child to have a sense of control over the situation?
Allow the child to participate in care.
A nurse is attempting to help a 10 year old focus their anger when learning how to use an insulin pump for newly diagnosed diabetes mellitus. What statement by the nurse can help the child focus this anger?
"Can you tell me what makes you angry about using the insulin pump?"
It is best to emotionally prepare a child for a major surgery all at once rather than in stages.
False
A nurse is visiting a local first grade class to provide basic teaching on nutrition. She begins by briefly explaining how our bodies need food to be able to perform all of the activities that we do. In the cafeteria at lunch time, she shows the class how to select healthy and diverse foods from the buffet line. She then has the children perform this same task to make sure they understand the principles. Which teaching strategies has this nurse used in this scenario? (Select all that apply.)
• Lecture • Demonstration • Redemonstration
A nurse is talking with a 9 year old about a procedure that will be done in the morning. The child is expressing fear. What listening skills does the nurse exhibit that makes it clear the nurse is actively listening? (Select all that apply.)
• Maintaining eye contact while the child is talking • Sitting at the level of the child • Nodding in response to comments the child makes
A 9 year old arrives in the clinic for a venipuncture. The child says to the nurse, "You better know what you are doing, because you only get one chance at this!" What is the best response by the nurse?
"I can understand that you are concerned about having your blood drawn. I will try and make this as comfortable as possible."
How much ahead of time should nurses recommend that a school-aged child be prepared for elective surgery?
A few days
A nurse is teaching an 11 year old about the use of incentive spirometry prior to abdominal surgery. The child yells, "I am not going to use this stupid thing, and I wish you would just leave me alone!" What is the priority therapeutic response by the nurse?
"I understand that you are angry and nervous about your surgery, but please don't yell."
A nurse is preparing a hospitalized child for a lumbar puncture. The physician states that he will perform the procedure in the child's hospital room. What should the nurse inform the physician to advocate for the child?
"I will have the procedure prepared in the treatment room, so that the child may view the hospital room as safe and secure."
Nursing students are learning about the importance of therapeutic communication in their pediatric course. The nursing instructor identifies a need for further teaching when a student makes which of the following statements?
"It is best to stand when listening to a patient to demonstrate knowledge."
A nurse is educating a 6 year old about the removal of a cyst on the back. What is the best explanation the nurse can give to the child?
"The doctor is going to make a special opening on your back to take out the bump."
A nurse is preparing a 7 year old for abdominal computed tomography -CT scanning with intravenous contrast. What statement would be most appropriate to explain the injection of the contrast dye to the child?
"The doctor is going to put a special medicine in your tube so that she will be able to see your stomach better."
Which statement is most appropriate when initiating a nursing action with a preschooler?
"These sticky snaps are for your chest."
A nurse is obtaining a blood pressure on an obese 13 year old. The blood pressure is 130/86 mm Hg. What statement by the nurse could incorporate an opportunity to educate about obesity?
"Your blood pressure reading should be 120/80. Let's talk about some of the things, such as diet and exercise, that can be done to lower the reading and your risk factors for high blood pressure."
Not every conversation you engage in has the same depth level, nor should it. Throughout a day, a person may use as many as five levels, from clichés to peak communication:
1) cliché conversation, 2) fact reporting, 3) shared personal ideas and judgments, 4) shared feelings, and 5) peak communication.
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.
When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about:
Appearing out of control of the situation and/or themselves
A parent brings a toddler to the clinic for treatment of a possible ear infection. What is the best way for the nurse to communicate effectively with this child?
Approach the toddler carefully. they are often not only fearful but also quite resistant. Nurses should use the toddlers' preferred words for objects or actions so these children can better understand. Toddlers enjoy stories, dolls, and books.
A nurse is providing some basic hygiene teaching to a preschooler who is continually developing upper respiratory infections from his time spent in daycare. Which of the following is an example of assessing the child's learning needs?
Asking him what germs are. By asking this boy what germs are, the nurse will elicit his current knowledge level on the subject, along with his intellectual and language levels.
A nurse is attempting to reduce pain that a child is experiencing after an emergency appendectomy. What intervention can the nurse provide to meet this goal?
Assess the child frequently and use pharmacologic and nonpharmacologic methods of pain relief as needed.
What should be the first step in developing a teaching plan for a 9 year old who needs education about a gluten-free diet for the treatment of celiac disease?
Assessing the child's current level of understanding
A nurse is preparing to start an intravenous (IV) line on a child and knows that it will cause pain. The nurse obtains EMLA cream to decrease the sensation of the injection. What type of care is the nurse providing?
Atraumatic care
A nurse is caring for a small child with leukemia who will be hospitalized frequently for chemotherapy. What type of referral can the nurse make that will help the child and family through this time?
Child life specialist
A nurse is talking with a 10 year old who is saying that his "stomach has been hurting for several days and is worse when he drinks milk." The nurse asks the child, "Let me be sure I understand. The pain gets worse when you drink milk?" What type of therapeutic communication technique is the nurse using?
Clarifying
The five levels of communication are listed below. Put them in the correct order, from first level to fifth:
Cliché conversation Fact reporting Shared personal ideas and judgments Shared feelings Peak communication
A 15-year-old patient with type 1 diabetes has been noncompliant with his dietary regimen. When educating the teen, what is the most important thing the nurse do to allow the teen to be in control and involved in the decision-making process?
Speak directly to the teen and consider his input in the decisions about care and education.
A nurse is assisting a physician with suturing a laceration on a preschooler's leg. What distraction methods can the nurse perform to promote atraumatic care? (Select all that apply.)
Distraction methods for preschoolers are as follows: Ask the child to squeeze your hand, encourage the child to count aloud, sing a song and have the child sing along, point out any pictures on the ceiling, have the child blow bubbles, and play music appealing to the child.
A 6-year-old child who does not speak English is in the hospital for an appendectomy. It is late at night when the nurse needs to catheterize the child for a distended bladder. Which action by the nurse would be most helpful in relaying this information?
Draw a picture of the procedure using an anatomically correct figure.
A 5-year-old girl tenses up when the nurse approaches to examine her. "Are you afraid?" the nurse asks her. The girl shakes her head in denial. As the nurse lifts the stethoscope to auscultate the girl's chest, however, the nurse notices that the girl tenses up again and grips the edge of the examination table tightly. "Oh—you are afraid of the stethoscope, aren't you?" the nurse replies. "It's okay—it doesn't hurt; see—reach out and touch it." Which of the following communication techniques is the nurse most demonstrating here?
Empathy
When the nurse is teaching the child how to self-administer insulin, what should the final step of the process include?
Evaluating the teaching that has occurred
A 7 year old with sickle-cell disease who comes to the hospital frequently appears withdrawn and depressed. He refuses to talk to anyone or even admit that he is sad. What would be the best thing for the nurse to do that might help the patient deal with his feelings?
Get him to draw a picture.
A nurse is working with a 13-year-old girl who continually demands cups of water or juice, specific foods, and constant changes to her bed position. How should the nurse respond to this patient?
Graciously meeting all of her requests, within reason
A nurse is caring for a hospitalized child with cystic fibrosis. What interventions can be provided to encourage family-centered care?
Have a team meeting with the child, family, and healthcare providers involved with the care of the child.
A 2 year old hospitalized with pneumonia is taking shallow breaths. The nurse wants to teach the child how to take deep breaths to better expand the lungs. Which of the following would be best for the nurse to use to accomplish this goal?
Have the child imitate the nurse taking deep breaths.
A 10 year old with sickle-cell disease is frequently a patient in the pediatric center of a hospital. What intervention can the nurse provide that will allow the child a sense of control that promotes atraumatic care?
Maintain the child's home routine related to activities of daily living.
Recomended time to prepare for elective surgery
Most school-agers will do well being prepared a few days ahead of the event. One week is suggested for adolescents. One hour ahead for preschoolers and immediately prior for toddlers is appropriate.
The space between 18 inches to 4 feet is sensed by most people as personal space. This is the distance people usually stand apart from each other for casual conversation or hand shaking.
People generally consider the space directly surrounding them (up to 18 inches) as intimate space, to be crossed only by people who know them well or with whom they are comfortable having close body contact.
A school-aged child learns how to do range-of-motion exercises but has been unable to perform them the same from day to day. Which approach would be best for you to take to encourage compliance?
Praise her for doing them when you see her doing them.
A nurse is caring for a child with cystic fibrosis who is concerned about being separated from parents. What interventions can the nurse provide that will prevent or minimize child and family separation?
Promote family-centered care.
A child is diagnosed with type 1 diabetes. The parents are devastated. They state, "No one in our family has ever had any problems like this." What interventions can the nurse provide to promote a sense of control and reduce fear of the unknown for the child and family?
Provide a comprehensive education program regarding the care of the child with diabetes.
The nurse is performing a preoperative assessment on a 6-year-old. The child is clinging to the parent and is not answering questions. The parent states, "My child has always been shy." What is the nurse's best action?
Provide support to the child in a nonthreatening manner
A 5-year-old is obviously relieved yet angry following a procedure he resisted and needed to be restrained to complete. Which nursing action may be most helpful to this child?
Providing play dough for him to manipulate
After teaching a school-aged child the technique of range-of-motion exercises, which of the following observations would be the best evaluation as to whether learning was successful?
She consistently performs the exercises each time.
A nurse is assigned to care for a 6 month old hospitalized with diarrhea and dehydration. Because a child this age does not have developed speech, what can the nurse do to communicate with the child?
Sing to the infant.
A nurse is talking with a school-age child with asthma who expresses concerns that peers will not want to be friends because of the disease. What therapeutic communication technique would be beneficial for the nurse to use?
Sit at the child's level and allow the child time for self-expression.
How can the nurse increase communication between the family of a child with sickle-cell disease and the health care team?
Using a dry erase board for updating the daily plan of care.
The nurse is teaching a 6-year-old girl and her mother about home care for an eye infection. Which of the communication techniques would be least effective with this child?
Standing beside the child when doing the teaching
An 8 year old is scheduled to have a tonsillectomy and adenoidectomy in 2 weeks. What intervention can the nurse provide to help the child and family adjust to the hospitalization?
Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively.
A nurse is teaching a child and parents about an outpatient surgical procedure the child will have the next day. The child is "shy" and does not maintain eye contact with the nurse. What is the best way for the nurse to approach the child?
Talk to the parents first to give the child a chance to "warm up."
What type of teaching would be best for a preschooler having an invasive procedure?
Teaching with dolls or toys
A nurse is examining a 6-year-old boy. The nurse says, "Point to where it hurts the most." The boy points to his stomach. In this scenario, which of the following is the decoder?
The 6-year-old boy
An 8-year-old child newly diagnosed with diabetes mellitus has been educated on the technique of insulin self-administration. What outcome evaluation would be an indicator that the education was successful?
The child demonstrates good technique in self-injection of insulin.
A nurse is caring for a 12 year old who is very demanding. Within 4 hours, the child has pressed a call light 12 times for multiple reasons. What does the nurse understand may be the reason for this child's demanding behavior?
The child may be insecure or afraid.
A nurse is talking with a 10 year old and her parent about the current treatment plan for the child's asthma. The child stands behind the parent and does not ask questions or look at the nurse. What should the nurse consider the child's behavior could indicate?
The child may be shy and have some reluctance about communicating.
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.
You plan to teach children in the fourth grade some elementary first-aid skills before they take a field trip. Which statement below would make you believe the children will learn this information most readily?
The topic will have direct application. Children who are concrete thinkers learn material best when it has direct application.
A 16-year-old girl confides in the nurse that her parents are difficult to deal with and that it stresses her out. The nurse responds by saying, "You think that's stressful, you should see some of the patients I have to deal with in here!" Which barrier to communication is this nurse demonstrating?
Topping up
A nurse is preparing to start an intravenous (IV) line in a child with severe pneumonia. The nervous child asks the nurse to wait until later to do the procedure. What is the best option for the nurse?
Use a firm, positive, confident approach when starting the IV.
A nurse is caring for an infant admitted with diarrhea. The parent tells the nurse that she has to leave to care for another child at home and will be back shortly. What is the most effective way for the nurse to communicate with the infant and meet the child's needs?
Use a soothing and calming tone when speaking to the infant.
Based on school-aged cognitive development, which teaching technique could you anticipate as being received the best?
Using containers of water to demonstrate how hemorrhage leads to decreased body fluid
Genuineness is a quality of projecting sincerity or being yourself.
Warmth is an innate quality some people manifest more spontaneously than others. Basic ways in which warmth is demonstrated are direct eye contact, use of a gentle tone of voice, listening attentively, approaching a child within a comfortable space of 1 to 4 feet, and using touch appropriately.
A nurse is teaching a 17-year-old boy with type 2 diabetes how to use a glucometer to check his blood glucose level and how to self-inject insulin. She also teaches him what foods he should avoid in his diet. Finally, she explains to him the value of these measures in avoiding the dangerous complications of diabetes and in enjoying a healthy life. Which of her teaching points requires primarily cognitive learning on the part of the client?
What foods to avoid in his diet
A 5-month-old infant has had a head-to-toe assessment by the nurse, been examined by a teaching team of physicians, and now experienced a blood draw. What behaviors might this infant manifest?
Yawning, turning away, and making little eye contact.This infant is likely overstimulated, and yawning, turning away, avoiding eye contact, and irritability are signs of this.The infant is attempting to disengage.
Psychomotor learning requires
a change in a person's ability to perform a skill, such as using a glucometer and administering a self-injection.
Cognitive learning involves
a change in the individual's level of understanding or knowledge, as would occur when the client in this scenario learns which foods to avoid in his diet.
Ways to increase collaboration between the family and the health care team may include
a family advisory board, newsletter, client conferences, or parent resource notebooks.
Following a principle of learning, you can anticipate that the children will best learn a skill such as bandaging if they
are allowed to practice it.
Designing a plan begins with
assessment of the individual child's needs and how the new knowledge will meld with the child's and family's lifestyle, the child's intellectual and language level, current knowledge level, physical/cognitive capabilities, sociocultural values, and attention span.
Affective learning involves a
change in a person's attitude and is the most difficult area in which to bring about change.Learning the value of measures that help the client avoid complications and enjoy a healthy life is an example of this type of learning
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?
clarifying
A nurse is preparing to teach an 8 year old recently diagnosed with diabetes how to give an insulin injection. Which is the best technique for the nurse to use?
demonstration
A nurse caring for a preschooler scheduled for abdominal surgery the next day needs to teach about the dressing and drainage tube that the child will have after surgery. Which would be the best technique for the nurse to use?
dolls and puppets
Cliché advice , advice given from a formula, not individualized to the situation is
meaningless because it is too general to be helpful.
Topping up" is
minimizing a child's views by telling a better story. A child tells you, for example, she has a problem; you say, "You want to know what problems really are? Come and work here.
A 9-year-old girl is newly diagnosed with asthma. The nurse plans to teach her about triggers related to her diagnosis. The best approach for this child would be to
play a diabetic allergy trivia game with her.
he principles of atraumatic care state to
promote sense of control; provide opportunities for control, such as participating in care; attempt to normalize daily schedule; and provide direct suggestions.
A child life specialist (CLS) is a
specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful. The CLS is a member of the multidisciplinary team and works in conjunction with health care providers and parents to foster an atmosphere that promotes the child's well being.
Children depend on adults to be knowledgeable. If a 6-year-old asks you a question for which you do not know the answer, your best response would generally be to
state that you do not know the answer but you will find out.
The nurse is meeting an 8-year-old girl with cancer and her family for the first time. Which of the following will best help to establish a relationship with the child and family? Select all that apply.
• Sitting at eye level with the child and parents • Keeping both a relaxed posture and word flow • Redirecting the conversation to maintain focus
Perception checking documents a
feeling or emotion reported to you. This makes it a step deeper than paraphrasing. In paraphrasing, you document a statement or fact; in perception checking, you document a feeling or emotion
Infants learn best by affective learning.
false, Infants learn by exploring the environment with their senses, psychomotor learning.
A 12-year-old girl nervously asks the nurse several questions about menstruation and then expresses a concern in a stammering, roundabout way. When she is finished talking, the nurse replies by saying, "so, you are telling me that you are afraid of getting your period while at school and it showing through your clothing, is that correct?" Which communication technique is the nurse using here?
Perception checking
A 9-year-old patient with rheumatoid arthritis has difficulty moving her painful hands as well as her other joints. She refuses to participate in ordered physical therapy. What would be the best way for the nurse to make sure that the patient continues to exercise her joints?
Play a game like "Simon Says" to introduce exercises.
When planning to teach a toddler about coughing and deep breathing, which would be most effective?
Playing a game with coughing and breathing
A nurse greets a 14-year-old boy in the waiting room of the hospital. He approaches her and stops about 5 feet away from her. He nods his head in response but does not say anything. Which of the following best describes the distance the client has positioned himself from the nurse?
Social space. The distance between 4 feet and 12 feet is social space, the usual distance used to conduct business or teach a class.
The nurse is talking with a 7 year old about fears related to a tonsillectomy the next day. What type of communication would help to alleviate the fears the child has?
Therapeutic communication
A child is preparing to undergo a lumbar puncture in the treatment room. What intervention can the nurse provide to minimize stress during the procedure?
Use alternative positioning such as "therapeutic hugging."
A nurse manager on a pediatric unit is making assignments for the day. What is the best method of care delivery to meet the goal of atraumatic care for the pediatric patient and to minimize parent-child separation?
Use core primary nursing.
To teach an adolescent about his or her disease, the best technique would be to
help him or her understand how new information about the disease will improve health status now.
The receiver -decoder- is the person who not only receives the message :hears it, reads it, views it, but interprets or decodes its meaning ,cognitive processing.
in this case, it is the boy.
The code is the message that is conveyed, as well as the medium or system used to convey it;
in this case, it is the instruction to point to where it hurts.
o communicate effectively with an infant
the nurse should respond to crying in a timely fashion, allow the infant time to warm up, use a soothing and calming tone when speaking to the infant, and talk to the baby directly.
The nurse enters a room and sees an 8 year old who has just learned that he needs to have surgery staring into space with a sad expression. The nurse sits by the patient and says, "You look so sad. Would you like to tell me about it?" The nurse is using which type of communication?
therapeutic
The nurse suggests to the parent of a preschooler who had unexpected surgery that the child be given a doctor/nurse kit to play with at home because: Select all that apply.
• Role-play is an age-appropriate, common form of play for preschoolers through which experimentation and learning occur. • The preschooler can pretend to be a physician or nurse practitioner who has the power to control events that the child lacked as a recipient of care. • The child can use the kit with dolls or stuffed animals to work through feelings about the health care experience. • The parent can observe the child's play to identify any misperceptions about the unprepared-for experience and correct them.
