Pediatric Nursing Interventions PDF

Pediatric Nursing Interventions Objectives Discuss Standards of Practice and Ethical Considerations in pediatric clients Describe the eight rights of pediatric medication administration Integrate the concepts of atraumatic care in medication administration Discuss important concepts relate...

Pediatric Nursing Interventions Objectives Discuss Standards of Practice and Ethical Considerations in pediatric clients Describe the eight rights of pediatric medication administration Integrate the concepts of atraumatic care in medication administration Discuss important concepts related to health assessment in children Distinguish normal variations in the physical examination from differences that indicate a serious issue Role of Therapeutic Relationships Goal Directed Mutual Respect and Trust Empathy Advocacy Avoidance of the extremes of the relationship continuum Developmentally Appropriate Care Children are not mini-adults They are in the process of developing in many realms. Use appropriate tools for assessment (FLACC, FACES, NIPS…ect) SAFETY!!! Medication errors Hospital Acquired infections Wrong surgery/site incidents Falls Skin breakdown Abduction General Care Safety: Two patient identifiers Nurse Maintains Hand Contact Medication precautions Hygiene Maintain Healthy Skin Turn every 2 hours Bathing Hair Care At least 1-2 times a week Diaper changing At least every three hours. With feeds/temps Oral Hygiene Feeding issues Feeding is work for an infant Refusal to eat is common in children control issue Allow choices Make eating interesting  Feeding an Do not warm in microwave-use warm infant water instead 1-3 months baby usually takes 3-5 oz formula 3-6 months baby usually takes 5-6 oz formula 6-12 months baby usually takes 6-7 oz formula Normal feeding schedule 3-4 hrs Remember to burp DO NOT ALLOW feeding to extend 20- 30 minutes (burning more calories than ingesting) DO NOT PROP BOTTLE (helps to prevent choking and aspiration) Alternative Feeding Techniques- Enteral Gavage feedings NG OG Gastrostomy feedings Jejunostomy feedings May be continuous drip or intermittent (bolus) feedings Skin-Level Gastrostomy Device Improving Absorption of Feeds Use pacifier during alternative feeds Nonnutritive sucking improves digestion Quiet, calm environment Consistent feeding techniques by caregivers/family members Alternative Feeding Techniques- Parenteral TPN- Total Parenteral Nutrition Interventions: Administer through a central line Use an in line filter Check blood glucose Use aseptic technique Monitor VS Monitor for infection Monitor for electrolyte imbalances Keep system closed at all times (avoid air embolism) Avoid administering medications through TPN line Medication Administration Eight rights of medication administration 1. Right medication 2. Right patient 3. Right time 4. Right route 5. Right dose---most commonly reported medication error 6. Right documentation 7. Right education 8. Right to refuse Differences in pediatrics (esp. infants) Medications affected by: Higher % of body water, decreased body fat, liver immaturity, decreased plasma proteins available for binding, limited renal excretion Oral medications: Slower gastric emptying, increased intestinal motility, higher PH, decreased lipase/amylase Intramuscular Amount of muscle mass and tone- faster absorption in infants Topical Greater body surface area- increased absorption/permeability Differences in pediatrics Pediatric dosages based on weight, body surface area (BSA), and maturation of body organs Oral Medication Greater risk of aspiration in children less than 6 Use liquids or crush and mix with SMALL amount of liquid Use calibrated equipment Oral syringe Direct liquid to posterior side of mouth, small amount at a time Oral medications Use syringe/ nipple DO NOT mix with formula (can turn away from it if used) DO NOT refer to as candy May mix with small amount of syrup, applesauce, ice cream Use popsicles to numb tongue Use a “chaser” if appropriate Devices for Delivering Medication to Children Rectal & Otic Administration Rectal: Otic Less than 3 years 3 years and of age use fifth younger- pinna finger (pinky) down and back Older child- index Older children- finger pinna upward and back Intramuscular Medications Preferred site: vastus lateralis (upper thigh) Deltoid may be used in children > years Dorsogluteal not recommended under age of 5 Needle size Approximate: 22-25 gauge/ 5/8 - 1 inch in younger children Volume: 0.5 ml- 1ml…school age 1.5- 2ml EMLA** (helps numb the skin) Intravenous Medications Use atraumatic care when inserting/removing PIV EMLA, parent participation, therapeutic hugging, adhesive remover Care must be taken to prevent fluid overload (< 10 kilo= 100 ml/kg/day) Always use pump Syringe pump ‘Buretrol” volume control device Maintenance fluids much less in pediatrics Prevent complications Inspect site every 1-2 hours Change dressing and tubing per institution protocol Types of venous access Heplock 1-3 cc saline I-Port 5cc saline----- 5cc 10 unit heparin Broviac 3cc saline------3cc 10 unit heparin PICC Use at least 5 cc syringe!!!! Read kardex for protocol Pediatric Health Assessment Health Assessment Expert nurses are constantly evaluating their patients Allow a “warm-up” period Observe behaviors that signal children’s willingness to cooperate Alter exams to accommodate children’s developmental level LEAST invasive first – observation, auscultation, etc… Involve children and family in examination Communicate with child and family members Observe parent-child interaction Praise child for cooperation Health Assessment Perform in a warm, well lit, nonthreatening environment Examine the child in a secure comfortable position Get child involved---ex: while listening to lungs “blow out candles” Use age-appropriate language to describe what you are doing Encourage questions from child/family  Approximate normal values: Temperature: Normal: < 37.7 C (99.9 F) ; report immediately young infant with temp > 38.0; older infant/children a fever is >38.5 Pulse: higher in infants- slows as you grow Normal: “100ish”- children under 12 Vital Signs years should always have pulse greater than 60/minute---recall BLS Respirations: higher in infants- slows as you grow Normal: “20-30ish” in infants/toddlers; “20ish” preschool & school age BP: lower in infants- gets higher with age Normal: “60-80/40-50” in infants; “100ish/50-70” in children Health Assessment Evaluate growth using a standardized growth chart Height Weight Head circumference 3 years and younger Example: http://www.cdc.gov/growthcharts/data/set1clinical/cj41l 017.pdf  General: Muscle tone Body odor Eye contact (can be a sign of abuse or Health autism) Assessment Follows commands Speech, language Motor skills Interaction with family Health Assessment Skin Hair Nails Lymph nodes Small, palpable, nontender, mobile not uncommon in children Head Shape of head Fontanels- (indications of hydration) Posterior closes 2-3 months Anterior closes 12-18 months Health Assessment Face Neck Assess ROM Eyes Visual acuity formally assessed after 3 years of age Corneal light reflex- symmetrical by 4-6 months of age PEERLA Red reflex Permanent color manifests by 1 year of age Health Assessment Ears Hearing Alignment Non tender external exam Internal 3 and younger- pinna down and back Older than 3- pinna up and back Red does not = infection; assess for decrease mobility, pus Nose Mouth and throat Visible tonsils common finding in children First 2 years: age child in months – 6= number of teeth Health Assessment Thorax and lungs Infants chest shape almost circular Less than 7 years of age abdominal movement is seen during respirations Infants respiratory movement is often irregular Often harder to determine upper versus lower respiratory sounds Assess for: Retractions, increased resp rate, increase resp effort If noted, act quickly Health Assessment Heart/pulses Sinus arrhythmia associated with respirations are common Innocent murmurs common in children Listen upright and reclined PMI Infant to 4 years of age- 4 ICS medial left clavicular line 4-6 years- 4 ICS left midclavicular line 7 years and older- 5 ICS left midclavicular line Clubbing Listen to all four valvular areas Pulses Infant- brachial, femoral Health Assessment Abdomen Infants and toddlers have rounded abdomen Genitalia Males Locate testes Examine scrotum Examine meatus Assess for adhesions Females Assess for discharge, adhesions Anus Health Assessment Musculoskeletal Examine spine Note muscle tone Examine joints- note swelling, redness, pain Note gait Toddler normally bowlegged Preschooler may appear knock knee Feet should face forward and shoes with even wear Health Assessment Neurologic system Innate reflexes (review from ob) DTR Language Cognition Fine and gross motor development