Pediatric Nursing Care Guidelines PDF

12/5/24, 11:56 PM OneNote (D) Topic 6 Pediatric Nursing Wednesday, November 13, 2024 1:44 PM Guiding Principles for Pediatric Nursing Care 1. Atraumatic Care: Therapeutic care that...

12/5/24, 11:56 PM OneNote (D) Topic 6 Pediatric Nursing Wednesday, November 13, 2024 1:44 PM Guiding Principles for Pediatric Nursing Care 1. Atraumatic Care: Therapeutic care that minimizes or eliminates psychological and physical distress that children and their families experience. Kinds of Trauma: a. Abuse b. Neglect c. Witnessing a death, violence or natural disaster EXAMPLES OF AUTRAUMATIC CARE Preventing physical stress.. Like injections, catheters, sleep deprivation Controlling pain through frequent assessments Prevent or minimize parent child separation Minimizing stress during procedures: 1. Use comforting positions during procedures 2. Therapeutic hugging, while doing things like injections. Make sure to hold them safe with a focus on stabilizing the body part as needed 3. Distraction methods 4. Preparation to reduce anxiety 5. Encourage cooperation 6. Trauma & Violence Informed Care "The four R's" a. Realization. The understanding that trauma can impact anyone at any time b. Recognize. Recognizing signs and symptoms of potential trauma c. Resist: retraumatizing them d. ______ WHAT: Treating children as if they have experienced trauma especially since medical events can be traumatic for some. HOW a. Treat every child as if they have experienced some kind of trauma b. Recognize some barriers that might prevent the child from fully participating in the care... (financial challenges, past traumas, fear of separation from family. You can combat this by finding out wat matters to them most and their worries abut their current care c. Involve the family in the care. The family knows the child best. Build a partnership with the family d. Provide control for the child. ALlow them to have a sense of control like let them take apart of their own care, try to keep daily routines as normal as possible... 7. Family Centered Care ○ Involve the family in the care and treatment which allows them to feel included and valued so they are more likely to engage positively in the child care. ○ It's important to educate the family about the childs condition, treatment and care. This allows them to better support their child and feel empowered to make informed decisions with the HCP Effective Communication with Children & Families Safe, calm, welcoming space Clear communication Consider both verbal and non-verbal Awareness of the age and developmental stage of the child IMPORTANT WHY: Effective communication builds trust. Clear and honest communication TECHNIQUES: Engage in age appropriate ways ○ Using dolls or toys to explain procedures to younger children ○ Using simple metaphors like the WBC as the bad guy fighters ○ Older children might benefit from writing or drawing Build a therapeutic relationship ○ Can start by talking to the parents to create a trusting environment ○ Speak at eye level and use calm confident language ○ Chek in on how they feel about the info given to see if they understand Communicating with the parents/family ○ Be honest ○ Help them understand the long term as well as the short term effects of the treatment ○ Teach the parent how the child will feel like and how they will look during the procedure https://stfxca-my.sharepoint.com/personal/x2023gbb_stfx_ca/_layouts/15/Doc.aspx?sourcedoc={b0236bc9-4a5e-44d3-b37b-e287cd4d7433}&action=edit&wd=target… 1/8 12/5/24, 11:56 PM OneNote Tips for Effective Communication Children Let them lead the interaction Appropriate tone and volume of your voice Get down on their level Speak to them! Not just their parents Awareness of your language Incorporate play Parents and Caregivers Be honest Listen and validate Include them in the care of their child—they know their child best! Education and anticipatory guidance Physical Assessment Considerations Health History Open ended questions are used in non-emergencies to provide deeper insights on their physical, emotional and social development. As well as establishing trust The structure of the interview varies by visit type, focusing on: 1. Demographics: Basic information (name, birthdate, language, etc.) and family composition. 2. Chief Complaint: The main reason for the visit in the child's or caregiver’s own words, along with history related to the illness (onset, symptoms, treatments). 3. Past Health History: Prenatal and birth history, prior illnesses, allergies, immunization status, medications, and (for older children) menstrual history. 4. Family Health History: A three-generation overview to assess genetic health risks. 5. Review of Systems: A systematic check of each body system (e.g., respiratory, cardiovascular, endocrine). 6. Developmental History: Milestones in motor skills, language, social skills, and self-care. 7. Functional Inquiry: Daily routines, safety, nutrition, physical activity, screen time, sleep, and relationships. 8. Social History: Family dynamics, economic resources, home environment, and potential environmental hazards (e.g., lead exposure). Physical Assessment Considerations Organize and coordinate care (head to toe; least invasive to most invasive) Do assessments from head-to-toe starting with the least invasive areas first then going to the more sensitive areas last Awareness of age and developmental stage Adapt your approaches based on the childs age and development Ex.) infants need more gentle handling where school aged children might want simple explanations Incorporate play Let them hold medical tools or use toys to demonstrate procedures Practice using Guiding Principles Follow best practices in ped care like engaging them and communicating in a way they understand Atraumatic Care Minimize pain and anxiety by being gentle, reassuring and using techniques that cause as little discomfort as possible Family Centered Care This involves the child's family in the assessment. Parents can help keep the child calm and provide comfort during the process TVIC Be sensitive to the child's needs and potential past trauma Pediatric Vital Signs NOTES: Consider the child’s age, size, and health condition when analyzing vital signs, as these factors can affect normal ranges. Assess vital signs while the child is quiet to ensure accurate readings. Comforting infants or distracting young children may be necessary to help them stay calm. Document if the child is crying or active during the assessment. Assess pain level alongside vital signs, as pain can impact these measurements. Temperature Oral: age dependent Axilla: all ages and stages of development https://stfxca-my.sharepoint.com/personal/x2023gbb_stfx_ca/_layouts/15/Doc.aspx?sourcedoc={b0236bc9-4a5e-44d3-b37b-e287cd4d7433}&action=edit&wd=target… 2/8 12/5/24, 11:56 PM OneNote ARMPIT: good for children who are uncooperative or have certain medical conditions. Needs to be accurately in place Tympanic (ear) and Temporal: acceptable > 3 months of age Measures from the pulmonary artery and is accurate for children 3 months and Olders Temporal: Uses Infared scanning to measure the temperature over the temporal artery. Not suitable for infants younger than 3months and with a fever Rectal: increased risk of perforating anus Accurate but invasive. Not always recommended due to discomfort and infection risks. USE only when necessary and avoid in children who are immunosuppressed Pulse Monitor when calm or sleeping To get the most accurate heart rate, it's best to measure the pulse when the child is calm or sleeping. Activity like crying, movement, or anxiety can elevate the heart rate, leading to inaccurate readings. Blood vessels are close to surface and easy to obliterate In young children, especially infants, the blood vessels are closer to the skin's surface and can be easily blocked or "obliterated" when palpating (feeling for the pulse) due to their small size and delicate skin. This makes it difficult to measure the radial pulse (the pulse at the wrist) accurately in younger children. For this reason, the apical pulse (heart rate listened to through a stethoscope) is often used instead. Methods: For children younger than 2 years, auscultate (listen to) the apical pulse for a full minute. For children older than 2 years, palpate (feel) the radial pulse for a full minute. Gold standard: auscultate apical heart rate x 1 minute The gold standard for measuring pulse in infants and children (especially under 2 years old) is to auscultate (listen to) the apical pulse Normal ranges vary based on age of child. Infants (0-12 months): 100-160 beats per minute Toddlers (1-3 years): 90-150 beats per minute Preschoolers (3-5 years): 80-120 beats per minute School-age children (6-11 years): 75-110 beats per minute Adolescents (12+ years): 60-100 beats per minute NOTE: Its important to document the method used (radial or apical) and if the child was crying or active during the assessment. This is the most reliable method. Respirations Assess when calm or sleeping Crying, feeding or anxiety can cause an increase in the RR RR increases with crying, feeding, fever, activity, anxiety, etc. Infants breathe with their diaphragm Infants: Infants primarily breathe using their diaphragm, which makes their abdominal movements more noticeable. Children over 1 year: After 1 year, children begin to breathe more from their chest (thoracic movements) rather than their abdomen. Normal ranges vary based on age of child. (See Table 32.3) INFANT T432qODD PRESCHOOLE SCHOOL AGE ADOLESCEN LER R T HR 80-150 70-120 65-110 60-100 55-95 RR 25-55 20-30 20-25 14-22 12-18 Oxygen Saturation How to measure? Monitors are placed on areas like the finger, toe, hand, wrist, foot, ear, or head. It’s crucial that the monitor is secure but not so tight that it restricts blood flow. Normal is > 95% but lower may be acceptable based on condition Ensure monitor is on secure but there is no restriction of blood flow Blood Pressure https://stfxca-my.sharepoint.com/personal/x2023gbb_stfx_ca/_layouts/15/Doc.aspx?sourcedoc={b0236bc9-4a5e-44d3-b37b-e287cd4d7433}&action=edit&wd=target… 3/8 12/5/24, 11:56 PM OneNote Use the correct cuff size Not routinely measured unless at risk for thins like hypertension or heart problems May assess multiple locations (i.e., radial, brachial, popliteal) Anticipatory guidance Weight and Height/Length Crucial for calculating med dose safely Growth charts: Help compare a child's development to standardized norms for their age How to measure? Use an appropriate scale based on the child’s size and whether they can stand still. For infants, a lying scale is often used Pediatric Medication Administration Children are at a higher risk for med errors cause their dosages depend heavily on their weight and age. SAFETY is key Pharmacodynamics and Pharmacokinetics Understanding how meds work (pharmacodynamics) and how the child's body processes them (pharmacokinetics) ensures safe and effective treatment How to Ensure safety: Review pediatric considerations and dosage differences prior to preparing and administering Accurate weight (kg or grams) Acceptable dosage range Double check calculations and confirm the dosage is within the acceptable range Prevent med errors Do independent double check of meds and math Pediatric Medication Calculations Child’s weight: 36 lb Order: Ceftriaxone 525 mg IM every 12 hours Safe dosage range: 50-75mg/kg/day Concentration: 350mg/mL Is the order in the safe medication range for the weight of the child? How many mL will be administered with each dose? STEP 1: convert the weight into kilograms 1Kg = 2.2lb Eg.) weight 36lb Weight in kg = 36lb/2.2 = 16.36 kg STEP 2: Calculate the safe dosage range The safe range is 50-75 mg/kg/day Multiply the child weight in kg by both ends of the range Minimum daily dose= 50×16.36= 818mg/day 𝑀𝑎𝑥𝑖𝑚𝑢𝑚 𝑑𝑎𝑖𝑙𝑦 𝑑𝑜𝑠𝑒 = 75 × 16. 36 = 1, 227 𝑚𝑔 / 𝑑𝑎𝑦 [Equation] The safe range is 818–1,227 mg/day. STEP 3: Compare the prescribed dose to the safe range The order is 525 mg every 12 hrs which means they will receive 525mg x 2 = 1050 mg/day Is it safe? ▪ Yes 1050mg/day is within the safe range of 818 --- 1227 mg/day STEP 4: calculate volume to administer per dose The concentration of the med is 350mg/ml To find the volume for a single dose (525mg) Volume = Dose/concentration Volume = 525/350mg/ml = 1.5ml ANSWER: The order is within the safe range for the child’s weight. 1.5 mL will be administered per dose. https://stfxca-my.sharepoint.com/personal/x2023gbb_stfx_ca/_layouts/15/Doc.aspx?sourcedoc={b0236bc9-4a5e-44d3-b37b-e287cd4d7433}&action=edit&wd=target… 4/8 12/5/24, 11:56 PM OneNote Pediatric Pain Children depending on their developmental stage may struggle to express or describe their pain clearly. So well use tools like the FACES scale or the OUCHER scale to help gauge their pain level based on their age and understanding Determining location and intensity of pain requires different techniques compared to adults (i.e., FACES scale, Oucher, etc.) FACES: shows faces expressing pain levels OUCHER SCALE: shows pictures with pain intesnity Each developmental stage exhibits pain differently Pain directly impacts vital signs Increased heart rate, RR or BP can signal that there is distress or discomfort. Managing it promptly improves recover and reduces stress on the child. Management of Pediatric Pain Non-pharmacologic ▪ Don’t remove pain immediately but help the child cope Relaxation (deep breathing, soothing touch) Distraction (games storytelling videos) They work adjuncts to pain meds Pharmacologic: 2 categories ▪ Non-opiods (NSAIDS, Acetaminophen) for mild to moderate pain ▪ Opioids (morphine, fentanyl) for moderate to severe pain What nursing assessments and evaluation are required? Ped meds need to be carefully dosed based on weight and age to prevent underdosing or overdosing Assess pain levels regularly using the scales Monitor for side effects (sedation or resp depression with opioids) Evaluate if the pain management is effective and adjust as needed IV Therapy Iv therapy provides fluids, meds or nutrients directly into the child bloodstream KEY CONSIDERATIONS Peripheral sites: hands, feet, forearm, scalp (newborns) Peripheral sites vary by age. Hands and feet and forearm are common places. But the scalp veins can be used in newborns Use of PICC lines or Port-a-Cath Used for longer term therapy. PICC lines are inserted into larger veins Port-a-caths are implanted inter the skin Use of butterfly needles Increased risk of fluid volume overload Children have a higher risk for fluid volume overload because they have a smaller body size and less developed organ systems This can cause swelling difficulty breathing or high blood pressure. Monitor IV site Frequent checks of the IV site in is done to ensure it remains... a. Intact b. Free of swelling, redness or infiltration (leakage into the surrounding tissues) IV Fluid Administration Calculations Based on Body Weight **Formula** 100mL/kg for the first 10kg PLUS 50mL/kg for the next 10kg PLUS 20mL/kg for the remaining kg Child’s weight: 16.3 kg What is the total amount of fluid they can receive in 24 hours? https://stfxca-my.sharepoint.com/personal/x2023gbb_stfx_ca/_layouts/15/Doc.aspx?sourcedoc={b0236bc9-4a5e-44d3-b37b-e287cd4d7433}&action=edit&wd=target… 5/8 12/5/24, 11:56 PM OneNote What maximum rate should the IV pump be set at? Infections in Childhood What puts children at risk for infection? Immature immune systems Children's immune systems are still developing making it harder for their bodies to fight off infections effectively Improper hand washing techniques Children may not wash their hands, or even if they do they wont wash it effectively, which increases their exposure to germs and an infection SDoH (i.e., poverty, level of health literacy, etc.) Factors like poverty or low health literacy can limit ppls access to healthcare or understanding of hygiene practices Immunization status Unvaccinated children are more vulnerable to preventable illnesses like measles or whooping cough Fever Guidelines Fever is the body's way of fighting off infections by making git harder for germs to survive No single numerical value—varies based on site Rare to see temperature >41 How to manage fevers Treat to lower temperature and increase comfort Antipyretics: Acetaminophen and Ibuprofen These reduce the fever and improve comfort Dressing lightly Using cool cloths Ensuring proper hydration Education for home management of fever Infection Control in the Hospital Setting Prevention of the spread of infection Have many vulnerable patients so there is strict infection control to minimizes outbreaks Awareness of symptoms and potential diagnosis Review policies and collaborate with infection control team Common reasons for admission: Respiratory infections GI infections Fever NYD Two tiers of precautions Tier 1: routine practices These are basic like hand washing, and PPE Tier 2: Airborne, Droplet, Contact These are isolation precautions: Depending on the type of isolation there is diff precautions for the. Airborne vs contact Education for child, parents, visitors Nursing Assessment of a Child with Possible Infection Health History Allergies Immunization status: up to date or not Ensures vaccination coverage Current symptoms To help us in determining diagnosis and treatment Medications Some meds can contribute to the child's current condition or interact with potential treatments Past health history Previous infections impact the child current immune response and the treatment needs Nutrition Poper nutrition supports the immune system. Bad nutrition makes it harder to get better Elimination Changes can related to infection or dehydration Sleep Fever, pain, or discomfort can alter the child sleep patterns Assess for rashes that can be measles, chickenpox, scarlet fever...) Physical Assessment Weight, height or length The growth measurements provide a baseline for overall health.. Weight loss can mean dehydration or severity of the infection Vital signs Temp (fever) HR Tesp https://stfxca-my.sharepoint.com/personal/x2023gbb_stfx_ca/_layouts/15/Doc.aspx?sourcedoc={b0236bc9-4a5e-44d3-b37b-e287cd4d7433}&action=edit&wd=target… 6/8 12/5/24, 11:56 PM OneNote BP Skin color and temperature Changes can me an infection, poor circulation or dehydration Respiratory effort Watch for labored breathing, tachy, use of accessory muscles (flaring nostrils, chest retractions) Energy level Fatigue or lethargy... could mean severe infection Hydration status Infections lead to dehydration, especially if the kid is vomiting or has diarrhea Look for signs: dry mouth, sunken eyes, decreased peeing, poor skin turgor Assess for rash Rashes can mean a specific infection Measles Chickenpox, scarlet fever Palpate lymph nodes Enlarged lymph nodes= infecting or inflammation Priority Nursing Interventions for a Child with Infection 1. Hydration Treatment: Oral rehydration help replenish lost fluids Small amounts, frequently What do they prefer to drink? Clear fluids (water, pedialyte, clear broth) if vomiting/diarrhea Incorporate play: engages he kid and encourages then to drink fluids in a fun way (fluids through posicles Use IV fluids if the oral intake isnt possible Monitor intake and output to ensure proper hydration Not enough water can weaken the immunity and decrease healing 2. IV hydration WHEN: Important if the child can't keep the fluids down (vomiting) or is severely dehydrated Ensure the correct fluid volume is given Intake and Output monitoring: Helps us assess the hydration status 3. Management of Fever Focus on comfort not cure. Fever does not alter infection progression but can make the child feel worse Antipyretics Acetaminophen/ ibuprofen--- can help reduce fever and improve comfort Comfort measures Dress lightly, remove blankets, tepid bath, cool cloth Awareness of febrile seizures: lay the child on their side, protect them from injury and seek emergency care 4. Medications Antibiotics if there is a bacterial infection that’s confirmed. ONLY after a culture is done Monitor for signs of allergic reaction Antivirals For viral infections (influenza, chickenpox, RSV) Educate on starting the med and completing the full course Antipyretics Used to treat symptoms not the infecting itself Follow appropriate dose schedule for the kids age and weight to manage fever discomfort Antihistamines If the kid has an allergic reaction... these relieve the symptom 6. Lab Values & Diagnostic Tests CBC: Evaluates WBC for signs of infection.. Before starting antibiotic or antiviral to ensure we use accurate meds ESR, CRP: These mean there is inflammation or infection Cultures (blood, urine, stool, wound, throat, nasal, etc.) Identify specific germs Blood work considerations Education prior to discharge Teach about inection prevention Home treatments https://stfxca-my.sharepoint.com/personal/x2023gbb_stfx_ca/_layouts/15/Doc.aspx?sourcedoc={b0236bc9-4a5e-44d3-b37b-e287cd4d7433}&action=edit&wd=target… 7/8 12/5/24, 11:56 PM OneNote When to seek care Signs of worsening infections (persistent fever, difficulty breathing, severe lethargy, dehydration...) Purpose of meds.. Complete full course of treatment Purpose of hydration Infection control https://stfxca-my.sharepoint.com/personal/x2023gbb_stfx_ca/_layouts/15/Doc.aspx?sourcedoc={b0236bc9-4a5e-44d3-b37b-e287cd4d7433}&action=edit&wd=target… 8/8