TLO 2.11 Psychological Well Being

Question 1

Children’s response to illness?

Answer 1

Fear of unknown
Separation anxiety
Fear of pain/mutilation
Loss of control
Anger
Guilt
Regression

Question 2

Infant and toddler response to illness?

Answer 2

Separation anxiety
Fear of injury and pain
Loss of control

Question 3

Preschooler response to illness?

Answer 3

Separation anxiety
Fear or injury and pain
Loss of control
Guilt and shame

Question 4

School age children response to illness?

Answer 4

Separation
Fear of injury and pain
Loss of control

Question 5

Adolescents response to illness?

Answer 5

Separation
Fear of injury and pain
Loss of control

Question 6

Developmental approaches to the hospitalized child

NEONATE?

Answer 6

Anticipate needs and full fill in timely manner
Sucking/oral stimulation
Swaddling
Provide stimulation to each sense
Watch for overstimulation
Comfort before/after painful procedures
Model appropriate behaviors with family
Provide consistent caregivers
Collaborate with parents
Involve parents in care
Encourage parents to room in

Question 7

Developmental approaches to the hospitalized child

YOUNGER INFANT AND OLDER INFANT?

Answer 7

Younger infant: same care as neonate
Older infant:
painful procedure= swaddle and provide nonnutritive sucking
expect regression and educate parents
consistent caregivers (limit number of caregivers)
infants security item
encourage parents to be present during procedures

Question 8

Developmental approaches to the hospitalized child

TODDLER?

Answer 8

Expect regression
Follow home routines
Involve parents in care
Provide for rooming
Allow for mobility when safe
Use all methods of pain control for painful procedure
Anticipate temper tantrums when child is frustrated
-maintain a safe environment during tantrum
Encourage independence
Provide support when needed
Positive firm attitude

Question 9

Developmental approaches to the hospitalized child

PRESCHOOLER?

Answer 9

Provide safe way to let out aggression
Communication
Expect egocentric behavior
Safe, secure environment
Consistency
Collaborate with parents: coping, home routines
Provide play and interaction with other children
Accept regression and educate parents
Encourage independence

Question 10

Developmental approaches to the hospitalized child

SCHOOL AGE CHILD?

Answer 10

Explain limits and enforce
Involve in care
Explanations
Accept regression, encourage independence
Privacy
Assist with social adjustment
Educational needs, bring in HW, study time

Question 11

Developmental approaches to the hospitalized child

ADOLESCENT?

Answer 11

Privacy
Maintain normalcy
Communication/explanations
Activities with other adolescents
Social adjustment
Educational needs, bring in HW, study time

Question 12

Children’s understanding and reactions to death

What should the nurse do?

Answer 12

Be honest, accurate information in clear simple language
Will be over a gradual process of time
Take into consideration of development level

Question 13

Kubler-Ross stages of grief and dying?

Answer 13

Denial
Anger
Bargaining
Depression
Acceptance

Question 14

Child’s concept of death

INFANTS AND TODDLERS

Answer 14

View death as a separation from caregiver/parent
Loss of comfort measures
Sense parent’s grief
Allow a much time as possible with primary caregiver

Question 15

Child’s concept of death

PRESCHOOL AGED

Answer 15

Temporary situation
Guilt and shame
Are they “bad?”
Nurse’s role

Question 16

Child’s concept of death

SCHOOL AGED

Answer 16

Irreversible event?
Fears
May wonder what the did to cause them to die so young
Make sure someone is with the child at all times
Parents should not avoid talking about death
School age are able to recognize death for what it is

Question 17

Child’s concept of death

ADOLESCENTS

Answer 17

Understands death is irreversible and inevitable
See themselves as invincible
Isolation
Peers reaction

Question 18

Child response to their own death- general

Answer 18

Children are not afraid of death, but of abandonment
Children are very sensitive to other’s reaction to dying
Children depend on their parents
They need their parents to give them “permission” to die
Important that they know “loved ones” will remember them

Question 19

Parent response to their child’s death- general

Answer 19

At first parents may want to do everything to cure the disease

Eventually face the fact

Child’s pain/suffering often push parents towards decision of care vs cure

Will need to talk about the experience of illness leading to death to help process it

When child finally dies, may initially feel relief because their child is not longer suffering

Later, parents will feel intense sadness and grief

Question 20

Sibling response to death of their sibling

Answer 20

Sibling grief must be acknowledge

May feel responsible for patient getting sick/dying

Important to acknowledge that siblings grief is just as important as parents grief

Sibling will usually need to help to work through grief