Special hospital admission

        • Special hospital admission
          • Emergency admission
            • Lengthy preparatory admission procedures are often impossible and inappropriate for emergency situations.
            • Focus assessment on airway, breathing, and circulation; weigh child whenever possible for calculation of drug dosages.
            • Unless an emergency is life-threatening, children need to participate in their care to maintain a sense of control.
            • Focus on essential components of admission counseling, including the following:
              • Appropriate introduction to the family
              • Use of child’s name, not terms such as “honey” or “dear”
              • Determination of child’s age and some judgment about developmental age (If the child is of school age, asking about the grade level will offer some evidence of intellectual ability.)
              • Information about child’s general state of health, any problems that may interfere with medical treatment (e.g., allergies), and previous experience with hospital facilities
              • Information about the chief complaint from both the parents and the child
          • Admission to Intensive Care Unit
            • Prepare child and parents for elective intensive care unit (ICU) admission, such as for postoperative care after cardiac surgery.
            • Prepare child and parents for unanticipated ICU admission by focusing primarily on the sensory aspects of the experience and on usual family concerns (e.g., people in charge of child’s care, schedule for visiting, area where family can stay).
            • Prepare parents regarding child’s appearance and behavior when they first visit child in ICU.
            • Accompany family to bedside to provide emotional support and answer questions.
            • Prepare siblings for their visit; plan length of time for sibling visitation; monitor siblings’ reactions during visit to prevent them from becoming overwhelmed.
            • Encourage parents to stay with their child:
              • If visiting hours are limited, allow flexibility in schedule to accommodate parental needs.
              • Give family members a written schedule of visiting times.
              • If visiting hours are liberal, be aware of family members’ needs and suggest periodic respites.
              • Assure family they can call the unit at any time.
            • Prepare parents for expected role changes, and identify ways for parents to participate in child’s care without overwhelming them with responsibilities:
              • Help with bath or feeding.
              • Touch and talk to child.
              • Help with procedures.
            • Provide information about child’s condition in understandable language:
              • Repeat information often.
              • Seek clarification of understanding.
              • During bedside conferences, interpret information for family members and child or, if appropriate, conduct report outside room.
            • Prepare child for procedures even if it involves explanation while procedure is performed.
            • Assess and manage pain; recognize that a child who cannot talk, such as an infant or child in a coma or on mechanical ventilation, can be in pain.
            • Establish a routine that maintains some similarity to daily events in child’s life whenever possible:
              • Organize care during normal waking hours.
              • Keep regular bedtime schedules, including quiet times when television or radio is lowered or turned off.
              • Provide uninterrupted sleep cycles (60 minutes for infants; 90 minutes for older children).
              • Close and open drapes and dim lights to allow for day and night.
              • Place curtain around bed for privacy.
              • Orient child to day and time; have clocks or calendars in easy view for older children.
            • Schedule a time when child is left undisturbed (e.g., during naps, visit with family, playtime, or favorite program).
            • Provide opportunities for play.
            • Reduce stimulation in the environment:
              • Refrain from loud talking or laughing.
              • Keep equipment noise to a minimum.
              • Turn alarms as low as safely possible.
              • Perform treatments requiring equipment at one time.
              • Turn off bedside equipment that is not in use, such as suction and oxygen.
              • Avoid loud, abrupt noises.


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