08.08 Developmental Considerations for the Hospitalized Individual

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Overview

  1. Developmental considerations for the hospitalized individual
    1. Development and care
    2. Neonates & infants
    3. Pediatrics
    4. Adolescents
    5. Adults
    6. Geriatrics

Nursing Points

General

  1. Development and care
    1. Developmental theories
      1. Offer framework for the RN
      2. Predicts patterns
      3. Help to understand responses
    2. Consider cognitive development vs physiologic age
    3. Classifications
      1. Neonates & infants
      2. Pediatrics
      3. Adult
      4. Geriatrics
  2. Neonates & infants
    1. Education is for the parents
    2. Considerations
      1. Age
      2. Ailments
      3. Development
      4. Involvement of parents
    3. Provide appropriate resources for parents
  3. Pediatrics
    1. Toddlers
      1. Pain is exaggerated
      2. Moods can change quickly
      3. Have short attention span
      4. Poor concept of time
      5. Separation from parents creates anxiety
        1. Promote parental bonding and involvement
      6. Use play to promote compliance
    2. School age children
      1. Need routine
      2. Can begin to reason
        1. Provide simple explanation
      3. Praise patients
      4. Allow privacy
      5. Promote safety
      6. Provide resources like child-care workers
  4. Adolescents
    1. Can be either adult or pediatrics
      1. Dependent on physiologic and cognitive age
    2. Encourage peer support
    3. Encourage questioning
    4. Begin to promote autonomy
  5. Adults
    1. Concern for stressors
      1. Missing work
      2. Caring for children or parents
      3. Financial concerns
    2. Strive for autonomy
      1. Reluctant to allow assistance
  6. Geriatrics
    1. Fall & injury are priority
      1. Increase in skin injury and breakdown risk
    2. Patient usually on many medications
    3. Increase in elimination issues
      1. Promote dignity
      2. Provide assistance
    4. Cognitive decline
    5. Discharge planning is complicated
      1. Complex
      2. May require more resources
      3. May not discharge home
      4. Work with case managers

Nursing Concepts

  1. Human Development
  2. Cognition
  3. Health Promotion

Patient Education

  1. For pediatric patients, involve parents in education for compliance
    1. Utilize parents to reinforce education and compliance in pediatric patients
  2. Consider age and cognition when educating patients

Reference Links

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Video Transcript

In this lesson we’re going to look at developmental considerations for our hospitalized patients.

When we’re looking at development and care, what we’re looking at is providing care for all of our patients despite any lifespan or age group they’re in.

The things you need to keep in the back of your mind when you’re caring for your patients are that these developmental theories offer framework for what you can expect for your patients. They can help to predict patterns, and it helps you to understand the responses that your patients are going to give based on their life stage that they’re in.

One thing that you should consider is the physiological age of your patient versus their cognitive development. So if you have a patient that has some sort of cognitive disease that doesn’t correspond to their age, you’re going to need to think about how that takes into account things like education and compliance and comprehension.

Most hospitals are going to classify your patients based on their age. So you’re going to be looking at things like neonates and infants, pediatrics, adolescents, adults and geriatrics. We’ve got a lot of ground to cover so let’s get going.

As you first start to take into account your neonatal or your infant patients, refer back to those developmental theories. These patients are not going to understand direction, they’re not going to understand logic, they’re not going to understand reasoning, so you’re going to really need to involve the parents or the guardian in promoting compliance and education.

The important thing that you need to do is to promote trust and build rapport with the patient because you’re going to be their direct lifeline to care. If you can focus on building trust and really building that relationship, you’ll be able to work with the patient. The other thing you’re going to need to do is provide resources, so sometimes parenting classes can help, especially for new parents. Other things that you need to consider are age, ailments, development, and the involvement of parents. The more you get the parents involved, the better your patient’s going to be.

As we move into pediatrics, the two most common groups that you’re going to run into are toddlers and school-age children.

With toddlers, pain is going to be exaggerated and they lack the ability to reason. Their moods can change quickly, and separation from parents really create anxiety. This is another reason to get the parents involved, and make sure that they’re there to provide support for both themselves and the patient. One thing that you can do with your pediatric patients is to use play to promote positivity and relationship-building. So if they have a stuffed animal, if you listen with your stethoscope to the stuffed animal first, that will show that you’re not going to hurt them, and you can reach over and take a listen to their heart and lungs.

With your school-age children, these guys are going to need routine and they also begin to use logic. Make sure that you’re providing praise to them, and also if you need somebody like a child care worker or someone who specializes to work with children to come help you out to provide resources to the family, that’s a good time to get them involved.

When you’re dealing with your adolescent patients, they’re going to run this fine line of being a pediatric patient or being an adult patient. It really depends on their body size. But don’t forget that even if they look like an adult, they still haven’t been able to develop all of those adult brain functions.

Adolescents really thrive on peer support, so if you can encourage their friends to visit, or promote things of interest for teenagers, this will really help your patient. Encourage them to ask questions, and be sure to promote autonomy. This is a time in their life where they’re going to start to become adults and start to make their own decisions, so encourage them to build upon that confidence and the ability to be responsible for their own health.

Adults can be really be impacted by stress in the hospital. They worry about missing work, and the cost of being in the hospital. If they’re unable to work, they could be unable to provide for their family so be sure to get them resources for financial support. It also can be really stressful for them if they are care providers, so if they have young children that need to go to daycare, or if they have parents that they take care of, this could also make for another stressful situation.

Adult patients also tend to strive for autonomy and they are reluctant to allow people to help them. They feel like they should be totally self-sufficient, and that they don’t need any help. What you can do as a nurse is to provide positive reinforcement and praise for when they actually do something correctly and then gentle correction when they need education. Most adults are going to be compliant as long as they’re not facing any barriers, so continue to work with them and educate them.

Geriatric patients are really prone to falling and injury, so you really need to focus on fall and injury prevention. This also means really staying on top of all their skin care issues. Your geriatric patients are going to be prone to skin breakdown so always make sure that you’re checking over those bony prominences and making sure you’re turning them regularly. Additionally geriatric patients also have an increase in elimination issues, so be sure that you’re providing them adequate toileting and assistance.

It’s also not uncommon to see your geriatric patients have some sort of cognitive decline. So when it comes to education make sure that you are educating them on a level that they understand, and make sure that you’re using the necessary resources like caseworkers, and family members so that they can really help to reinforce compliance. For example, after my grandmother had a stroke, she was really apprehensive about taking any medication because she didn’t trust anybody. So my mom had to get involved her really help get my grandmother to understand that she needed to take her medications.

The other thing that comes along with you geriatric patients is the complexity of discharge planning. You should be thinking about your discharge planning from the moment that you lay eyes on your patient, but it gets more complex with these geriatric patients because they may just not be going home. Sometimes you have to send them to places like skilled nursing facilities, or nursing homes, and you have to get other people involved like case workers and case managers. Not only that you have to be able to discuss with those other facilities in your care, and it can be complicated sometimes. These are just things you need to keep in mind whenever you’re dealing with your geriatric patients.

For this lesson we really focus on human development as we reflected back on to those theories when it comes to the lifespan. We also think about cognition and our patient’s ability to understand our education, and we also focus on health promotion for our nursing concepts for today.

Now let’s recap.

When you’re dealing with your patient consider all the theories involved, and refer back to them so that you can create a framework for taking care of your patients.

When you’re dealing with your infants, remember to promote compliance through the parents, and also work to develop trust with this patients.

when dealing with your pediatric patients, be sure to use playing from a positivity, and also work to build trust and rapport with them.

For your adult patients, continue to promote autonomy, consider stressors, and provide those resources necessary for them so that they feel like they’re in control.

And lastly when you’re dealing with your geriatric patients, provide safe care, consider the complexity of the geriatric population, and work on your discharge planning early, so that you can provide all the necessary resources for them.

And that’s it for a lesson. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

Read more

  • Question 1 of 9

A 78-year-old patient complains to the nurse that as he gets older, he’s noticed physical and mental changes. Which of the following changes are not a normal part of the aging process? Select all that apply.

  • Question 2 of 9

The nurse is assessing an adolescent in the clinic. For which of the following areas are the adolescent years most critical?

  • Question 3 of 9

A nurse is working with a family whose child is hospitalized for surgery. The nurse has given the parents a nursing diagnosis of Readiness for Enhanced Parenting related to the challenges of the child’s illness because the parents are open and receptive to learning more about how they can handle their child’s health situation. Which of the following would be appropriate nursing interventions for this diagnosis? Select all that apply.

  • Question 4 of 9

The nurse is assessing a 15-year-old client who is in the clinic for a well visit. Which of the following areas are common health concerns for a client of this age? Select all that apply.

  • Question 5 of 9

An older adult client tells the nurse that she does not want to take any more medications because she does not like the side effects that they cause. Which suggestions can the nurse make that would lessen the likelihood of this client developing medication side effects? Select all that apply.

  • Question 6 of 9

The parents of a newborn with jaundice are being instructed in home use of a phototherapy blanket to treat the condition. Which information would the nurse most likely give this family for instructions on home phototherapy?

  • Question 7 of 9

A nurse is talking to the parents of a child who has just been diagnosed with cystic fibrosis. Which intervention would be most appropriate in helping this family to cope with their child’s diagnosis and treatment management?

  • Question 8 of 9

A nurse is assisting an older adult with bathing. The client tells the nurse that he doesn’t like getting a bath from a nurse because it makes him feel like a child and he is embarrassed. Which intervention could the nurse employ that might help the client feel more comfortable?

  • Question 9 of 9

An adolescent girl is admitted to the hospital for appendicitis. The nurse notes that the client is uncomfortable changing into a gown and does not want to remove her clothing. The nurse recognizes that an increase in reproductive hormones causes which of the following characteristics in adolescent girls?

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