Family-Centred Care of the Child During Illness and Hospitalization

Question 1

Stressors of Hospitalization for Children: Infant

Answer 1

Separation anxiety

Question 2

Stressors of Hospitalization for Children: Toddler

Answer 2

Separation Anxiety

Question 3

Stressors of Hospitalization for Children: Pre-schooler

Answer 3

separation anxiety and fear of abandonment

Question 4

Stressors of Hospitalization for Children: School-age child

Answer 4

• loss of control
• loss of privacy & control over bodily functions
• bodily injury
• painful, invasive procedures
• fear of death

Question 5

Stressors of Hospitalization for Children: Adolescent

Answer 5

Loss of control
Fear of altered body image, disfigurement, disability, & death
Separation from pear group

Question 6

Responses to Pain: Newborn & young Infant

Answer 6

crying, facial appearance, generalized body response
no relationship b/n cause & response

Question 7

Responses to Pain: Older infant

Answer 7

Crying; localized body response; expression of pain or anger; physical struggle

Question 8

Responses to Pain: Young child

Answer 8

Crying & screaming; verbal expressions; thrashing; lack of cooperation; begging; anticipates pain

Question 9

Children are especially vulnerable to crises of illness & hospitalization because:

Answer 9

stress represents a change from the usual state of health & routine
Children have a limited number of coping mechanisms to resolve stressors

Question 10

Children’s understanding of health and illness: Infant

Answer 10

separation anxiety (12-30 months esp)
- protest
- despair
- detachment/denial

Question 11

Behavioural Pain Measures

Answer 11

Typically 0-4 years
more accurate when used alongside self-report tools

Question 12

Neonatal Infant Pain Scale (NIPS) (6)

Answer 12

Facial Expression
Cry
Breathing patterns
Arm movements
Leg movements
State of Arousal

Question 13

Separation Anxiety

Answer 13

In the protest phase of separation anxiety, children cry loudly and are inconsolable in their grief for the parent
Healthy for child to be attached to parents
During the despair phase of separation anxiety, children are sad, lonely, and disinterested in play or food
Inactive, noncommumicative, withdrawal, regress to earlier behaviours
Kids rely on structure, routine, and predictability
During the detachment phase of separation anxiety, young children may appear withdrawn and sad, even in the presence of a parent

Question 14

Stressors for All Children

Answer 14

Separation -> loss of control, autonomy & privacy -> being subjected to painful & invasive procedures -> fear of bodily injury and disfigurement

Question 15

FLACC Behavioural Pain Assessment Scale

Answer 15

Face
Legs
Activity
Cry
Consolability

Question 16

Responses to Pain: School-age child

Answer 16

similar to young child; time-wasting behaviours; muscular rigidity

Question 17

Responses to Pain: Adolescent

Answer 17

Less vocal; less physical resistance; more verbal; increased muscle tension & body control

Question 18

FACES Pain Rating Scale

Answer 18

• 3+ years
• Ask child to choose face that best describes own pain

Question 19

Numeric Scale

Answer 19

5+ years (must be able to count & have some concept of numbers & their value in relation to other numbers)

Question 20

Pharmacological Management

Answer 20

Use two-step strategy
- nonopioids for mild pain
- strong opioids for moderate to severe pain
Regular interval dosing
Use appropriate route of administration
Adapt treatment to individual child

Question 21

Coping Mechanisms (all ages)

Answer 21

Regression
Denial
Repression (involuntary forgetting)
Postponement
Bargaining

Question 22

Strategies to Promote Coping and Normal Development

Answer 22

Child Life programs
Rooming in
Therapeutic Play
- toddler
- pre-schooler
- school
Therapeutic Recreation

Question 23

Why are children vulnerable?

Answer 23

Illness
Limitation of understanding
Little control over what is happening
Trusting relationships may have hidden agenda for nurses
Tension between promoting autonomy & right of self-determination and tenet of protection from harm
Consent versus Assent

Question 24

Infants Act

Answer 24

A person under the age of 19 years may consent to health care if the following conditions are met:
Person providing health care has:
- explained to the minor and has been satisfied that the minor understands the nature & consequences and the reasonably forseeable benefits & risks of the health care and
- made reasonable efforts to determine & has concluded that the health care is in the minor’s best interest

Question 25

Nursing Management for Child with a life-threatening illness

Answer 25

Promote sense of security
Provide education about illness or injury & prepare child for procedures
Facilitate use of play
Promote a sense of control

Question 26

Reactions to Life-threatening Illness or Injury

Answer 26

Shock and disbelief -> anger and guilt -> deprivation and loss -> anticipatory waiting -> readjustment or mourning