Care Plans to consider the psychological needs of

                                hospitalized children

 

               Infant - Trust vs. Mistrust

 

 

 

 

Nursing Diagnosis

Goals

Interventions

 

Anxiety Related to Separation

↑ Contact with mother

· Encourage mother to visit often

· Encourage mother to feed infant ordered

· Teach parents procedures they are capable of doing

· Discuss her arrangements for care of family at home

· Try to simulate home routine

 

↑ Continuity of care

· Try to assign same nurse

 

Alteration in Family Processes Related to Hospitalized Infant

Will evidence positive reactions to hospital as evidenced by:

§         cries loudly

§         fussy

§         rejects everyone but mother

§  Explain behavior to mom

§  Initiate interventions cited earlier

 

Absence of negative behaviors:

§         extremely cooperative

§         withdraws from everyone

§         cries continually

§         completely passive

 

 

Alteration in Parenting Related to Child’s Behavior on Returning Home

 

 Teach parents some children may exhibit the following behaviors:

§     aggression

§     regression

§     nightmares

§     over-dependence

 

Anxiety Related to Procedures

 

§         Allow parents to be present during procedures

§         Encourage parent to comfort child during and after painful procedure

§         Keep frightening objects from view

§         If possible, use treatment room for procedures

 

Alteration in Sensory Stimuli Related to Environment

Basic needs met as evidenced by:

§         active interest in environment

§         regress

§         4 hours of sleep

·  Assess infants environment

·  Teach Mom (colorful objects, music box, mobiles, pacifier, mom playing)

·  Encourage home routines

·  Encourage mom rooming in

 

Alteration in Comfort Related to Pain

Alleviate pain evidenced by absence of:

§         lack of appetite

§         excessive irritability

§         lethargy

§         increase appetite

·  Assess source of pain and provide appropriate interventions

·  Give pain relief med as ordered

·  Provide comfort measure

·  Teach mom

·  Project how long pain will last

 

 

         

                 Infant/Toddler - Autonomy vs. Shame & Doubt

 

Nursing Diagnosis

Goals

Interventions

 

Anxiety Related to Stranger Fear, Separation Anxiety

↑ Contact with Mom

Minimize protest, despair, denial stages

·      Encourage mom to room in

·      Provide warmth and support

·      Explain to parent stage child is in

·      Have mom leave something of hers

·      Leave the child’s favorite toy

·      Ask mom to leave when child is awake

·      Ask mom to inform nurse

·      Provide support when separating

 

Alteration in Parenting Related to Knowledge Deficit (temper tantrums, regression, etc.)

Consistency in approach to child when these behaviors are exhibited:

·      negativism

·      temper tantrums

·      dawdling

·      regression

·      Communicate in report/Kardex

·      Consistent limit setting

·      Give choices, simple decisions

·      Set time limits

·      Teach mom it’s okay

 

Self-care Deficit Related to Developmental Level (toilet training)

Encourage level of toilet training child is at

·      Teach mom child may regress

·      Promote potty chair if child has been trained for a while

·      Offer potty chair frequently (4x/shift)

 

Sleep Pattern Disturbance Related to Fear of Separation; Negativism

Toddler will have adequate rest

13 hours of sleep

·       Promote ritualistic behavior for bedtime

 

Potential for Injury Related to Environment Hazards

Toddler will interact in hazard-free environment as evidenced by lack of accidents

·       Assess

·      Teach mom about hazards (crib, chair, toys, equipment)

·      Supervise when out of crib

·      Crib net if climber

·      Strapped into highchair

·      Check on child Q 15 minutes when mom gone


Toddler/Preschooler - Initiative vs. Guilt

 

 

Nursing Diagnosis

Interventions

 

 

Alteration in Nutrition Related to Mom’s Knowledge

Deficit; Physiologic Anorexia

Presence of Parent if Possible

Assess child’s status by growth charts

Small portions

Foods child likes; hamburgers, P.J.

Comfortable atmosphere; acceptance of mess

Encourage intake of fluids with games

 

Alteration in Family Processes Related to Hospitalization of Toddler/Preschooler

 

(Loss of Control, Ritualistic)

Encourage parent participation in care

Provide consistent environment

Reinforce coping behavior

Provide with as much mobility as possible

Offer choices

Honest explanations, for prep for procedures

Teach parent interventions, with rationale

 

Fear of Mutilation Related to Developmental Level and Minimal Knowledge of the Way the Body Works

Parents participation in care

Explain procedure simply (1 day/1 year amount of time for prep for surgery)

Children may feel they are being punished

Expose child to as much as possible to prepare them for surgery

Provide play and diversional activities

Provide comfort and support

Acknowledge child’s fears

Avoid intrusive procedures as much as possible

 

Knowledge Deficit Related to Possible Misinterpretation of Events Secondary to Cognitive Level

Assess what parent has told child

Assess child’s perception by asking to draw a picture and tell about it

Encourage parents present during explanation to reinforce and repeat explanation

Encourage child to act out feelings and fears

Honest, brief explanations

Consistency

 

 

                                School Age/Industry

 

 

Nursing Diagnosis

Interventions

 

 

Fear of Bodily Injury Related to Developmental Level

Ascertain what child knows.  Clarify using scientific terminology and how body functions.

Assess knowledge of illness related to body

Ascertain blame and explain accordingly

Direct questions more to the child when teaching them (help master over feelings of inferiority)

Use audiovisuals, pictures, body outlines.

Suggest ways of maintaining control (i.e.:  deep breathing relaxation).

Gain cooperation.

Include in decision-making (time to do it, preferred site).

Encourage active participation (removing dressings, doing PIN care).

 

Fear of Losing Emotional Control Related to Developmental Level

Plan child’s day if possible with child’s input

Explain what to expect and how

Plan activities to allow expression of aggression

Encourage activities based on interests

Have child help problem solve and make choices

*Maintain clear and consistent limits

Give positive feedback

Allow for privacy

 

Anxiety Related to Separation from Friends, School and Family

Siblings usually perceive their stress as equal to the hospitalized child

Encourage use of telephone to maintain contact.

Provide opportunities to socialize with peers.

Encourage ventilation of concerns.

Encourage keeping up with school homework.

 

 

       ADOLESCENT:  IDENTITY vs IDENTITY DIFFUSION

 

Fear of Procedure

Assess knowledge.

Encourage questioning regarding fears, or risks.

Involve in decision-making.

Ask if patient wants parent there.

Make as few of restrictions as possible.

Suggest ways of maintaining control.

Accept regression to more childish ways of coping.

Give positive reinforcement.

 

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