Pediatric Nursing
What is important to establish when caring for a pediatric patient?
Often the nurse is involved in supporting children through a difficult procedure or serious illness. Such an endeavor not only includes preparation for the event but also requires a level of trust that permits children to express their fear, apprehension, and anxiety. To establish a trusting relationship, convey respect to children, talk with them at a level they can understand, and, most importantly, be honest.
How can you tell if an infant is in pain?
Infants are not able to verbalize that they are in pain or the pain’s location. Rely on physiologic variables and behavioral variables, such as vocalization, facial expressions, and body movements.
Bathing the child provides the nurse with the opportunity to do which assessment?
A Complete Skin assessment
How is oxygen delivered to small infants?
plastic hood that fits over the baby’s head-It is an efficient method of providing oxygen at well-controlled levels. More important, the body is accessible for starting an IV line or performing a procedure.
A less-efficient method of delivering oxygen to an infant is use of a closed incubator. Incubators have imperfectly fitted lids, uncovered vents, and portholes that must be opened to perform an activity on the infant, all of which contribute to fluctuations in oxygen levels.
What are signs that an infant needs suctioning?
Signs that a child possibly needs suctioning include pallor; restlessness or anxiety; increased pulse, respiration, and temperature; dyspnea; bubbling (copious amounts of thin secretions); rattling (thick, tenacious secretions); drooling; mouth breathing; nasal flaring; grunting; gasping; retractions; cyanosis; and erythema (flushed face).
Use suctioning when secretions are audible in the airway or when signs of airway obstruction or oxygen deficit are present.
is a philosophy of care that recognizes the family as the constant in the child’s life and holds that systems and personnel are called on to support, respect, encourage, and enhance the strengths and competence of the family
Family-centered care
Why is pain sometimes undertreated in children?
Fear of respiratory depression or addiction sometimes means that a child does not receive an adequate amount of analgesic, does not receive it often enough, or is not considered a candidate for certain opioids. Although respiratory depression is a possible side effect with opioids in children older than 3 months of age (and possibly younger), opioids cause no greater respiratory depression than in adults.
As for addiction, nothing indicates that children are at any increased risk of physiologic or psychological dependence from the use of opioids for pain management.
A working relationship with the parents is important. Gain the trust of the parents by:
(1) reviewing and interpreting information from the physician as needed; (2) asking the parents whether they have any questions; (3) conveying concern for the parents’ well-being; (4) listening and being available; and (5) respecting them as experts on their child and soliciting their input.
What is the purpose of a mist tent?
to improve a child’s respiratory status by liquefying pulmonary secretions. The child is observed easily through the plastic canopy. All of the device’s working parts are outside of the tent, which is a distinct advantage when a toddler needs this form of therapy. Compressed air or oxygen runs through sterile water to form the therapeutic mist. A disadvantage is that the canopy must be opened for the treatments and procedures, which lowers the concentration of the mist.
What are the depth, timing, and frequency are important considerations when suctioning a tracheostomy or endotracheal tube?
Depth: Approximately 1/4 to 1/2 inch beyond the tip of the artificial airway; determine placement by placing an appropriately sized suction catheter into an artificial airway of the same size, insert the catheter to the appropriate depth, mark with tape, and keep at the bedside as a reference.• Timing: Limit suctioning to not more than 5 seconds. • Frequency: Allow 30 seconds between suctioning attempts (two or three attempts at most).
Two basic concepts in family-centered care are:
enabling and empowering
Professionals enable families by creating opportunities for all family members to make use of their abilities and competencies and to acquire new ones that are necessary to meet the needs of the child and the family.
Professionals empower families to establish or confirm a sense of control over their lives. Empowerment frees families to foster their own strengths, abilities, and actions and thus enables them to make positive changes in their lives.
How do you prepare a child for surgery?
Preparing a child for surgery entails providing information to parents and child about what will happen and what the child will experience.
When is the best time to bathe an infant?
When giving a bath, protect the infant from drafts and chilling. Usually the best time to bathe the infant is before a feeding to avoid stimulating regurgitation or vomiting. Check the water temperature. If the umbilical cord is still attached, give a sponge bath.
How do you maintain humidity with a mist tent?
Organize all activities and thus limit the number of times the tent is opened, to make maintenance of desired concentrations possible and to give the child longer rest periods. Tuck the tent under the mattress of a crib to maintain humidity levels. If the tent is functioning efficiently, dampness within it is significant, and frequent (every 3 to 4 hours) linen and clothing changes often are necessary.
“six rights” of medication administration
Give the right medication and the right amount of the right medication to the right child at the right time and by the right route with the right documentation. Also remember to assess and document the child’s response to the drug
have a second nurse check all computed dosages
refers to infants and children with congenital abnormalities; chronic physical conditions, such as malignant disease, gastrointestinal (GI) disease, or central nervous system (CNS) anomalies; and chronic developmental, behavioral, and emotional conditions. Many of these children need specialized care throughout childhood and into other developmental stages as they age.
children with special needs
Six stress points are common for children undergoing surgery:
(1) admission; (2) blood tests; (3) the afternoon of the day before surgery; (4) injection of preoperative medication; (5) the moments before and during transport to the operating room; and (6) return from the post anesthesia care unit (PACU). Think through each stress point from the child’s perspective and develop an individualized preparation plan.
How do you measure the tube before placing it for gavage feeding?
(1) measure from the nose to the distal area of the earlobe and then to the end of the xiphoid process or (2) measure from the nose to the earlobe and then to a point midway between the xiphoid process and the umbilicus.
Some restraint of infant activity is likely to be necessary when passing the tube. Pulling up the bottom of the shirt over both arms is often all that is needed to restrain the newborn. Some infants may need to be wrapped in a mummy type of safety reminder device before proceeding.
Ask children who are able to understand to swallow while the tube is being inserted.
Delivery of oxygen to newborns and all ages of children is possible by means of?
a nasal cannula.
This mode of delivery is used commonly with infants with broncho-pulmonary dysplasia (abnormal development of the bronchi and the lungs).
How do you encourage a child to accept an oral medication?
Give the child an ice pop or small ice cube to suck to numb the tongue before giving the drug.• Mix the drug with a small amount (about 1 tsp) of a sweet-tasting substance, such as honey (except in infants because of the risk of botulism), flavored syrups, jam, fruit purées, or ice cream; avoid using essential food items because the child may later refuse to eat them.• Give a “chaser” of water, juice, a soft drink, or an ice pop or frozen juice bar after the drug.• If nausea is a problem, give a carbonated beverage poured over finely crushed ice before or immediately after the medication. When medication has an unpleasant taste, have the child pinch the nose and drink the medicine through a straw. Much of what we taste is associated with smell.
take care to prevent aspiration
A mother is concerned because her 6 year old son has started sucking his thumb again since he has been hospitalized. What is the best response by the nurse?
Children often regress in the hospital
Hospitalization not only interrupts children’s normal routines but also threatens their normal developmental process. Children often regress when hospitalized. For instance, some young school-age children resume the practice of thumb sucking. Often regression persists for several months after a child is discharged.
Be sure to explain to the parents any diagnostic tests, medications, or procedures that the physician plans again after a test or procedure. Why might they forget?
Keep in mind that anxiety and the sheer volume of information they have to absorb sometimes results in parents becoming confused or forgetting what they have heard. Any change in plans has the potential to generate anxiety and result in a parent being unable to process the information.
Before gavage feedings, check tube placement by:
1) aspirating for stomach contents and (2) injecting a small amount of air (0.5 to 1 mL in premature or very small infants to 5 mL in larger children) through the syringe into the tube while simultaneously listening with a stethoscope over the stomach area for sounds of gurgling or growling. If any doubt exists about tube placement, do not proceed with feeding, and consult the practitioner. Sometimes radiographic data are necessary to confirm proper tube placement.
How do you keep a nasal cannula in place on an infant and child?
Maintenance of the cannula’s placement is often problematic in the infant, whose random head and hand movements disturb its position. Clear plastic tape placed around the oxygen tubing and over the nose and cheek helps prevent this. Adjusting the device at the back of an infant’s head allows the tubing to be fitted to the child, and hooking it over the pinnae helps stabilize it. In older children, keep the nasal cannula in place by using the adjustable elastic straps on the child’s head.
The primary site for IM injections are..
the vastus lateralis muscle and the ventrogluteal muscle. he deltoid muscle is possible to use in children who are 18 months or older as a site for intramuscular injections and in infants who are receiving their hepatitis B vaccine