Chapter 29: Care of the Hospitalized Child

The nurse is admitting a 14-year-old child for a tonsillectomy and is preparing the child for the procedure. Which communication is best?

"Are you wondering about anything related to your tonsillectomy?" Explanation: For a 14-year-old child, the best approach would be to ask questions so that concerns, lack of understanding, or a need for information can be determined. Asking if the child feels "scared" may get a "yes" or "no" response, which may or may not be honest, depending on what the child expects of oneself or believes others expect of the child. A child of this age is often reluctant to admit fear. Mentioning scary hospital sounds provides no information and is inappropriate developmentally. Introducing discharge instructions needs to come later after other needs are met. Some discharge information is covered during admission, because tonsillectomy is usually day surgery.

Which approach by the nurse best demonstrates the correct way to prepare a Hispanic child for a planned hospital admission?

Allow the child to put on surgical attire and "operate" on a doll to teach what will be happening. Explanation: Allowing the child to put on surgical attire lets him or her see that hospital equipment is "not scary" and prepares the child for what will be seen on the day of surgery. Both the child and parents should be encouraged to ask questions. Honesty is the most important part of the program, so the nurse would never tell the child that the procedure will be painless because even the best care by the nurse may not eliminate all pain. Assuming that the family only speaks Spanish is inappropriate and could be considered profiling and rude. The nurse needs to determine the family's preference of language.

When working on a pediatric unit, the nurse will perform which action(s) to minimize client fear and anxiety? Select all that apply.

Explain procedures to the child beforehand in age-appropriate terms. Include the child's family when providing education. Remain calm and empathetic with caring for the child. Encourage the child to inform the nurse of fears. Allow the child to bring a security blanket from home.

The nurse is caring for a 10-year-old child who is in a contact isolation room. Which intervention would be appropriate for this child?

Provide age-appropriate toys and games. Explanation: Children in this setting may experience sensory deprivation due to the limited contact with others and the use of personal protective equipment such as gloves and gowns. The nurse should stimulate the child by playing with the child using age-appropriate toys and games. Reducing noise would be appropriate if the child was experiencing sensory overload. The nurse should encourage the family to visit often and introduce oneself before entering the room. A mask is not needed for contact isolation.

A 5-year-old scheduled for surgery in the morning wakes at 2 am and asks the nurse for something to eat and drink. What should the nurse tell this client?

that not having food or drink before surgery will prevent an upset stomach Explanation: Children may better understand why they are NPO if they are told that food and drink are being withheld to prevent an upset stomach. During general anesthesia, food and drink are withheld to prevent vomiting and aspiration, but a young child will not comprehend this information

The nurse is caring for a 10-year-old child admitted for a surgical procedure to be done the next day. The nurse takes the child to a special area in the playroom and lets the child "start" an IV on a stuffed bear. This is an example of:

therapeutic play. Explanation: Therapeutic play is a play technique used to help the child have a better understanding of what will be happening to him or her in a specific situation. It is nondirected and focuses on helping the child cope with feelings and fears. Positive reinforcement is offering praise for doing well so that the good behavior will happen again. Play therapy or emotional outlet play is used for the child to act out or dramatize life stressors. An age-related activity would be one where the play was directed to the ability of the child's age, such as a toddler stacking blocks. The 10-year-old child would have the capability to start the IV on the bear, but a toddler or preschooler would not.

A 10-year-old is scheduled for an appendectomy in 6 hours. The child is placed on NPO status and wants to know why he cannot have anything to eat or drink. What is the best explanation by the nurse?

"We cannot give you anything to eat or drink before your procedure because we do not want you to get an upset stomach."

A hospitalized child is placed in droplet isolation. What intervention(s) will the nurse teach the parents and family to follow? Select all that apply.

how to put on and dispose of a gown good handwashing technique how to properly wear a mask

The nurse suspects that an infant is experiencing pain postoperatively. What behaviors would validate this suspicion? Select all that apply.

knees flexed facial grimacing rigid body posture

The nurse is working with a group of caregivers of children in a community setting. The topic of hospitalization and the effects of hospitalization on the child are being discussed. Which statement made by the caregivers supports the most effective way for children to be educated about hospitals?

"We are going to take our child to an open house at the hospital so she can see the pediatric unit." Explanation: One factor in how children deal with hospitalization is the amount of preparation and the type of preparation they have been given prior to being hospitalized. A child's lack of understanding and experience with illness, hospitals, and hospital procedures increases his or her anxiety. Anything parents can do to prepare the child will decrease this anxiety. Families are encouraged to help children develop a positive attitude about hospitals from an early age. The family should avoid negative attitudes about hospitals and should help the child understand that not all experiences will be good. Some hospitals have regular open house programs for healthy children. Children may attend with parents or caregivers or in an organized community or school group. Anytime the child can visually see the hospital and physically touch furniture, equipment, etc. a positive experience can occur. Showing pictures in a book, seeing posters, and talking about the experience are also effective if a tour of the hospital is not available, but these do not replace the actual experience.

Which approach by the nurse best demonstrates the correct way to prepare a Hispanic child for a planned hospital admission

Allow the child to put on surgical attire and "operate" on a doll to teach what will be happening. Explanation: Allowing the child to put on surgical attire lets him or her see that hospital equipment is "not scary" and prepares the child for what will be seen on the day of surgery. Both the child and parents should be encouraged to ask questions. Honesty is the most important part of the program, so the nurse would never tell the child that the procedure will be painless because even the best care by the nurse may not eliminate all pain. Assuming that the family only speaks Spanish is inappropriate and could be considered profiling and rude. The nurse needs to determine the family's preference of language

The nurse is caring for a 6-year-old client who is prescribed to cough and deep breathe following surgery. Which nursing action is best for this client?

Blow a pinwheel and bubbles with the child. Explanation: The nurse will have the child blow bubbles and a pinwheel to accomplish the prescription as these actions are most like play. These actions will encourage and engage the child and are likely to be accepted and even enjoyed. All of the measures have potential to get the child to cough and deep breathe to some extent, but blowing bubbles and a pinwheel is best for the client's age.

A mother of a recently discharged preschooler calls the pediatric floor that provided care to her child a week ago. She reports that the child is having elimination accidents, temper tantrums and is waking up at night with nightmares. How should the nurse respond to the mother's concerns?

Children this age often show regressive behaviors and have nightmares following hospitalization due to fear of another separation. Explanation: Preschoolers who have been hospitalized often show regression, have temper tantrums, or have nightmares following their discharge. The family is advised to be understanding but not dote on the child. Discipline should remain consistently firm and loving and parents should reward positive behavior.

The nurse is caring for a preoperative pediatric client. What would it be best for the nurse to do with this client?

Determine how much the child knows and is capable of understanding. Explanation: The nurse must determine how much the child knows and is capable of learning in order to best prepare the child for surgery. Keeping terminology at the child's and caregivers' level of understanding is important when doing teaching. Teaching the therapeutic plan is important, but it has to be done on the level of the child's and caregivers' knowledge and build on what they already know. The child going to surgery will be NPO, but the nurse needs to know on what level to teach the child the reason for this.

A preschooler is admitted to the pediatric floor for dehydration and is frightened. Which nursing intervention would be least effective in alleviating the child's anxiety?

Explain all procedures using medical terminology. Explanation: Using medical terminology will ensure that the child will not understand what is happening and only increase his or her anxiety. Allowing touching of equipment, assigning the child to the same nurse, and encouraging caregivers to stay with the child all help alleviate anxiety and reduce the child's fears.

A nurse is admitting a 7-year-old child to the pediatric unit of the hospital. While the nurse is showing the child and parents the room and explaining where things are, the child becomes upset and frightened. What is the best action by the nurse?

Go slowly with the acquaintance process. Explanation: The child who reacts with fear to well-meaning advances and who clings to the caregiver is telling the nurse to go slowly with the acquaintance process. The child who knows that the caregiver may stay is more quickly put at ease. To provide security for the child and to provide family-centered care, it is the responsibility of the nurse to form good partnerships with families. Asking the family to leave the room in this situation would only frighten the child more. The nurse should never provide false reassurance. Telling the child there is nothing to be afraid of or nothing will hurt him or her are promises the nurse cannot make to the child

A 6-year-old child will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child?

Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital.

A 6-year-old child will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child?

Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. Explanation: The best way to ease the stress of hospitalization is to ensure that the child has been well prepared for the hospital experience. Not only is the child's fear reduced but also the child has a better ability to cope. Preparation allows the child a better understanding of what's happening to him or her. Good preparation allows the child to see a hospital room, handle medical equipment and gain an understanding of procedures and hospital sounds. Another child would only give explanations from his or her point of view and that child may describe a negative experience. The child's favorite toy or blanket should come with the child to the hospital as a comfort to the child, but that does not prepare the child for hospitalization.

The nurse is preparing a nursing care plan for a child hospitalized for cardiac surgery. Which are examples of interventions that nurses perform in the "building a trusting relationship" stage? Select all that apply.

Preparing the child for a procedure by playing games. Explaining in simple terms what will happen during surgery.

A preschool teacher calls the hospital and wants to introduce the concept of a hospital to her preschool class in case they ever get sick and need to be admitted. What resources could the child life specialist provide for this group to aid in their learning? Select all that apply.

Provide a room for the class with hospital gowns, masks and equipment used on children. Tour the hospital, including the playrooms on the pediatric floors. Let the children lie in the beds, use the call lights and practice being a patient.

A 6-year-old with leukemia is placed on reverse isolation. What nursing actions could prevent depression and loneliness in this client? Select all that apply.

Spend extra time to talk while in the room. Read a story while in the room. Play a game while in the room. A child on isolation is subject to loneliness, which can be prevented by arranging to spend extra time in the room during treatments. Also, while in the room the nurse might read a story, play a game, or just talk to the child. Quickly exiting the room and providing cluster care will increase social isolation and may make the child feel punished.

The nurse is caring for a preschooler who requires postsurgical breathing exercises. Which approach will best elicit the child's cooperation?

"Let's see who can blow these cotton balls off the table first." Explanation: Any intervention should be developmentally appropriate, and play can often serve as a vehicle for care. Turning breathing exercises into a game is likely to engage the preschooler. Telling the child he needs to do breathing exercises or he will develop another illness or not feel better is not likely to impress the young child. Connecting the two events in a meaningful way is beyond his cognitive ability. Asking if the child "wants" to play a breathing game is an open invitation for a "No" answer.

A 10-year-old is scheduled for an appendectomy in 6 hours. The child is placed on NPO status and wants to know why he cannot have anything to eat or drink. What is the best explanation by the nurse?

"We cannot give you anything to eat or drink before your procedure because we do not want you to get an upset stomach." Explanation: Children may better understand why they are NPO if they are told that food and drink are being withheld to prevent an upset stomach

Caregivers of a hospitalized toddler are being given safety instructions upon admission to the pediatric floor. Which action by the caregiver would be most important to the toddler's safety?

Keep the crib side rails up at all times. Explanation: Many toddlers are climbers and are always curious. So side rails must be kept fully up at all times, except when direct care is being provided. If side rails are down, the nurse or caregiver must keep a hand firmly on the child. Providing a call button to a toddler is not a good idea since the child will be pushing it all the time. Beds and cribs are kept at the lowest setting to minimize the possibility of injury if the child does fall out.

The pediatric nurse is caring for a group of children. Which clinical situation will the nurse identify as being a safety concern?

Sleepy mother holding her sleeping child at the child's bedside. Explanation: Safety is the priority for the pediatric nurse. The nurse should not allow a sleepy family member to hold a sleeping child because the family member may accidentally drop the child. Friction toys should not be allowed when supplemental oxygen is used; and a rubber ball would not be considered a friction toy. The infant who can stand should be placed in a crib with the top on it to prevent the infant from climbing out. An infant in a crib should have all railings in the up position

A nurse caring for a 5-year-old who had abdominal surgery yesterday is trying to teach the child how to take deep breaths. The best way that the nurse can accomplish this is by:

using a pinwheel. Explanation: Postoperative care for children includes coughing, turning, and deep breathing every 2 hours. A useful and fun way to teach deep breathing to a child is by using a pinwheel. Pursed-lip breathing does not help in deep breathing. It is used for a client with chronic obstructive pulmonary disease who take shallow breaths. A flow meter regulates the flow of oxygen. Using an incentive spirometer will achieve the goal, but a child will be more inclined to do deep breathing if it involves some type of fun activity.