Structural manipulation and energetic therapies

Structural manipulation and energetic therapies 150 150 Tony Guo
  • Structural manipulation and energetic therapies:
    • Acupressure, chiropractic medicine, massage, reflexology, rolfing, therapeutic touch, Qi Gong
  • Pharmacologic and biologic therapies: 
    • Antioxidants, cell treatment, chelation therapy, metabolic therapy, oxidizing agents
  • Bioelectromagnetic therapies: 
    • Diagnostic and therapeutic application of electromagnetic fields (e.g., transcranial electrostimulation, neuromagnetic stimulation, electroacupuncture)
  • Hospital admission
    • Preadmission
      • Assign a room based on developmental age, seriousness of diagnosis, communicability of illness, and projected length of stay.
      • Prepare roommate(s) for the arrival of a new patient; when children are too young to benefit from this consideration, prepare parents.
      • Prepare room for child and family, with admission forms and equipment nearby to eliminate need to leave child.
    • Admission
      • Introduce primary nurse to child and family.
      • Orient child and family to inpatient facilities, especially to assigned room and unit; emphasize positive areas of pediatric unit.
      • Room: Explain call light, bed controls, television, bathroom, telephone, and so on.
      • Unit: Direct to playroom, desk, dining area, or other areas.
      • Introduce family to roommate and his or her parents.
      • Apply identification band to child’s wrist, ankle, or both (if not already done).
      • Explain hospital regulations and schedules (e.g., visiting hours, mealtimes, bedtime, limitations [give written information if available]).
      • Perform nursing admission history.
      • Take vital signs, blood pressure, height, and weight.
      • Obtain specimens as needed, and order needed laboratory work.
      • Support child and assist practitioner with physical examination (for purposes of nursing assessment).
  • 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.
  • Preventing or minimizing separation
    • Nurses must have an appreciation of the child’s separation behaviors.
      • The child is allowed to cry. 
    • Even if the child rejects strangers, the nurse provides support through physical presence.
    • The use of cellular phones can increase the contact between the hospitalized child and parents or other significant family members and friends.
  • Preventing or minimizing parental absence
  • Minimizing loss of control
    • Promoting freedom of movement
    • Maintaining child’s routine
    • Encouraging independence and industry
  • Providing developmentally appropriate activities
  • Providing opportunities for play and expressive activities
    • Functions of Play in the Hospital
      • Provides diversion and brings about relaxation
      • Helps the child feel more secure in a strange environment
      • Lessens the stress of separation and the feeling of homesickness
      • Provides a means for release of tension and expression of feelings
      • Encourages interaction and development of positive attitudes toward others
      • Provides an expressive outlet for creative ideas and interests
      • Provides a means for accomplishing therapeutic goals
      • Places the child in active role and provides opportunity to make choices and be in control
        • Diversional activities
        • Toys 
        • Expressive activities
        • Creative expression
        • Dramatic play
  • Maximizing the potential benefits of hospitalization
    • Fostering parent-child relationships
    • Providing educational opportunities
    • Promoting self-mastery
    • Providing socialization
  • Nursing care of the family
    • Supporting family members
      • Supporting Siblings During Hospitalization
      • Trade off staying at the hospital with spouse or have a surrogate who knows the siblings well stay in the home.
      • Offer information about the child’s condition to young siblings as well as older siblings; respect the sibling who avoids information as a means of coping with the situation.
      • Arrange for children to visit their brother or sister in the hospital if possible.
      • Encourage phone visits and mail between brothers and sisters; provide children with phone numbers, writing supplies, and stamps.
      • Help each sibling identify an extended family member or friend to be their support person and provide extra attention during parental absence.
      • Make or buy inexpensive toys or trinkets for siblings, one gift for each day the child will be hospitalized.
        • Wrap each gift separately, and place them in a basket, box, or other container at the child’s bedside.
        • Instruct siblings to open one gift at bedtime and to remember that he or she is in their parent’s thoughts.
      • If the child’s condition is stable and distance is not prohibitive, plan a special time at home with the siblings or have spouse or another relative or friend bring the children to meet parent(s) at a restaurant or other location near the hospital.
        • Have extended family members or friends schedule a visit to the child in the hospital during parental absence.
        • Arrange a pass for the child to leave the hospital to join the family if the child’s condition permits.
    • Providing information
      • The disease, its treatment, prognosis, and home care
      • The child’s emotional and physical reactions to illness and hospitalization
      • The probable emotional reactions of family members to the crisis.
    • Encouraging parent participation
    • Preparing for discharge and home care
      • In planning appropriate teaching, nurses need to assess 
        • The actual and perceived complexity of the skill
        • The parents’ or child’s ability to learn the skill
        • The parents’ or child’s previous or present experience with such procedures.

 

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