ENT1

Care Plans to consider the psychological needs ofhospitalized childrenInfant - Trust vs. MistrustNursing DiagnosisGoalsInterventions

Anxiety Related to Separation Contact with motherEncourage mother to visit oftenEncourage mother to feed infant orderedTeach parents procedures they are capable of doingDiscuss her arrangements for care of family at homeTry to simulate home routine

Continuity of careTry to assign same nurse

Alteration in Family Processes Related to Hospitalized InfantWill evidence positive reactions to hospital as evidenced by:cries loudlyfussyrejects everyone but motherExplain behavior to momInitiate interventions cited earlier

Absence of negative behaviors:extremely cooperativewithdraws from everyonecries continuallycompletely passive

Alteration in Parenting Related to Childs Behavior on Returning HomeTeach parents some children mayexhibit the following behaviors:aggressionregressionnightmaresover-dependence

Anxiety Related to ProceduresAllow parents to be present during proceduresEncourage parent to comfort child during and after painful procedureKeep frightening objects from viewIf possible, use treatment room for procedures

Alteration in Sensory Stimuli Related to EnvironmentBasic needs met as evidenced by:active interest in environmentregress4 hours of sleepAssess infants environmentTeach Mom (colorful objects, music box, mobiles, pacifier, mom playing)Encourage home routinesEncourage mom rooming in

Alteration in Comfort Related to PainAlleviate pain evidenced by absence of:lack of appetiteexcessive irritabilitylethargyincrease appetiteAssess source of pain and provide appropriate interventionsGive pain relief med as orderedProvide comfort measureTeach momProject how long pain will last

Infant/Toddler - Autonomy vs. Shame & DoubtNursing DiagnosisGoalsInterventions

Anxiety Related to Stranger Fear, Separation Anxiety Contact with MomMinimize protest, despair, denial stagesEncourage mom to room inProvide warmth and supportExplain to parent stage child is inHave mom leave something of hersLeave the childs favorite toyAsk mom to leave when child is awakeAsk mom to inform nurseProvide support when separating

Alteration in Parenting Related to Knowledge Deficit (temper tantrums, regression, etc.)Consistency in approach to child when these behaviors are exhibited:negativismtemper tantrumsdawdlingregressionCommunicate in report/KardexConsistent limit settingGive choices, simple decisionsSet time limitsTeach mom its okay

Self-care Deficit Related to Developmental Level (toilet training)Encourage level of toilet training child is atTeach mom child may regressPromote potty chair if child has been trained for a whileOffer potty chair frequently (4x/shift)

Sleep Pattern Disturbance Related to Fear of Separation; NegativismToddler will have adequate rest13 hours of sleepPromoteritualistic behaviorfor bedtime

Potential for Injury Related to Environment HazardsToddler will interact in hazard-free environment as evidenced by lack of accidentsAssessTeach mom about hazards (crib, chair, toys, equipment)Supervise when out of cribCrib net if climberStrapped into highchairCheck on child Q 15 minutes when mom gone

Toddler/Preschooler - Initiative vs. GuiltNursing DiagnosisInterventions

Alteration in Nutrition Related to Moms KnowledgeDeficit; Physiologic AnorexiaPresence of Parent if PossibleAssess childs status by growth chartsSmall portionsFoods child likes; hamburgers, P.J.Comfortable atmosphere; acceptance of messEncourage intake of fluids with games

Alteration in Family Processes Related to Hospitalization of Toddler/Preschooler(Loss of Control, Ritualistic)Encourage parent participation in careProvide consistent environmentReinforce coping behaviorProvide with as much mobility as possibleOffer choicesHonest explanations, for prep for proceduresTeach parent interventions, with rationale

Fear of Mutilation Related to Developmental Level and Minimal Knowledge of the Way the Body WorksParents participation in careExplain procedure simply (1 day/1 year amount of time for prep for surgery)Children may feel they are being punishedExpose child to as much as possible to prepare them for surgeryProvide play and diversional activitiesProvide comfort and supportAcknowledge childs fearsAvoid intrusive procedures as much as possible

Knowledge Deficit Related to Possible Misinterpretation of Events Secondary to Cognitive LevelAssess what parent has told childAssess childs perception by asking to draw a picture and tell about itEncourage parents present during explanation to reinforce and repeat explanationEncourage child to act out feelings and fearsHonest, brief explanationsConsistency

School Age/IndustryNursing DiagnosisInterventions

Fear of Bodily Injury Related to Developmental LevelAscertain what child knows.Clarify using scientific terminology and how body functions.Assess knowledge of illness related to bodyAscertain blame and explain accordinglyDirect 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 LevelPlan childs day if possible with childs inputExplain what to expect and howPlan activities to allow expression of aggressionEncourage activities based on interestsHave child help problem solve and make choices*Maintain clear and consistent limitsGive positive feedbackAllow for privacy

Anxiety Related to Separation from Friends, School and FamilySiblings usually perceive their stress as equal to the hospitalized childEncourage 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 DIFFUSIONFear of ProcedureAssess 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.