Chapter 39 Pediatric Variations of Nursing Interventions All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Requirements for obtaining informed consent  The person must be capable of giving consent: age at majority (usually age 18)  The person must receive the information needed to make an intelligent decision  The person must act voluntarily when exercising freedom of choice General Concepts 2 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Eligibility for giving informed consent  Parent or legal guardian status  Evidence of consent  Mature or emancipated minors  Treatment without parental consent  Adolescent’s consent and confidentiality  Medically emancipated conditions General Concepts (Cont.) 3 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Psychologic preparation  Age-specific guidelines for preparation  Developmental and cognitive ability  Establishment of trust  Parental presence and support  Explanation of procedures  Physical preparation Preparation for Procedures 4 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Expect success  Involve the child  Provide distraction  Use play during procedures  Allow expression of feelings  Provide postprocedural support  Allow expression of feelings Performance of the Procedure 5 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Performance of the Procedure (Cont.) 6 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Preoperative care  Parental presence  Preoperative sedation  Anxiety reduction  Amnesia  Sedation  Antiemetic effect  Reduction of secretions Surgical Procedures 7 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Surgical Procedures (Cont.) 8 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Continuous monitoring  Vital signs assessment  Managing pain  Respiratory tract infection  Patient education  Discharge instructions Postoperative Care 9 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Maintaining healthy skin  Bathing  Oral hygiene  Hair care  Feeding the sick child  Controlling elevated temperatures or hyperthermia Skin Care and General Hygiene 10 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Safety  Environmental factors Electrical equipment Furniture Strangulation  Toys Choking hazards  Preventing falls Falls; risk assessment Family Teaching and Home Care 11 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Family Teaching and Home Care (Cont.) 12 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Nosocomial infections: 2 million/year  Role of Centers for Disease Control and Prevention  Standard precautions  Transmission-based precautions  Airborne, droplet, and contact precautions Infection Control 13 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Infection Control (Cont.) 14 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Infants and small children can be carried short distances  Use a suitable conveyance for more extended trips  Bassinettes or cribs  Strollers or wagons  Wheelchair or stretcher Transporting Infants and Children 15 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Transporting Infants and Children (Cont.) 16 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Alternative methods: consider first  Diversional activities  Parental participation  Therapeutic holding  Medical-surgical restraints  A necessary part of the procedure  Behavioral restraints  Used if risk that patient will harm self or others is high Restraining Methods 17 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Restraining Methods (Cont.) 18 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Restraining Methods (Cont.) 19 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Restraining Methods (Cont.) 20 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Femoral venipuncture  Extremity venipuncture or injection  Lumbar puncture  Bone marrow aspiration or biopsy Positioning for Procedures 21 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Positioning for Procedures (Cont.) 22 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Fundamental procedure steps  Urine  Clean catch  24-Hour specimen  Bladder catheterization  Stool  Blood  Respiratory secretions Collection of Specimens 23 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Collection of Specimens (Cont.) 24 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Collection of Specimens (Cont.) 25 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Determination of drug dosage  Body surface area  Checking dosage  Identification  Two identifiers  Preparing the parents  Preparing the child Administration of Medication 26 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Oral  Intramuscular  Selecting the syringe and needle  Determining the site  Administering medication  Subcutaneous and intradermal  Intravenous Administration of Medication (Cont.) 27 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Administration of Medication (Cont.) 28 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Administration of Medication (Cont.) 29 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Peripheral intermittent infusion device or lock  Central venous access devices  Short term/nontunneled catheter  Long-term tunneled catheter  Implanted infusion ports  Peripherally inserted central catheters (PICCs) Intravenous Devices 30 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Intravenous Devices (Cont.) 31 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Advantages  Ability to administer medications around the clock without disturbing the child  Disadvantages  Occlusion, clogging  Adequate flushing Nasogastric, Orogastric, or Gastrostomy Administration 32 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Advantages  Alternative route when oral route is difficult or contraindicated  Disadvantages  Less reliable  Technique Rectal Administration of Medications 33 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Eyedrops and ointments  Techniques  May be difficult to obtain cooperation from the child  Infection control concerns Optic, Otic, and Nasal Administration 34 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Optic, Otic, and Nasal Administration (Cont.) 35 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Optic, Otic, and Nasal Administration (Cont.) 36 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Deposits medication directly into the airway  Useful in avoiding systemic side effects  Nebulized with oxygen  Metered-dose inhalers Aerosol Therapy 37 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Measurement of intake and output  Fluids to be measured  Practitioners usually order intake and output measurements  Nursing responsibility: to identify when fluids should be measured  Diaper weighing technique  Care of the child who is on NPO status Maintaining Fluid Balance 38 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Site selection and equipment  Intraosseous infusion  Safety catheters and needleless systems  Selection of scalp vein  Surgical cutdown  Infusion pumps  Securement of a peripheral intravenous catheter  Removal of catheter and complications Parenteral Fluid Therapy 39 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Parenteral Fluid Therapy (Cont.) 40 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Parenteral Fluid Therapy (Cont.) 41 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Parenteral Fluid Therapy (Cont.) 42 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Parenteral Fluid Therapy (Cont.) 43 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Parenteral Fluid Therapy (Cont.) 44 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Inhalation therapy  Oxygen therapy delivery devices Plastic hood/oxyhood Nasal cannula prongs or O 2 masks  Oxygen toxicity  Monitoring O 2 therapy  End-tidal CO 2 monitoring  Bronchial (postural) drainage  Chest physical therapy Procedures for Maintaining Respiratory Function 45 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Procedures for Maintaining Respiratory Function (Cont.) 46 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Procedures for Maintaining Respiratory Function (Cont.) 47 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Intubation  Mechanical ventilation  Tracheostomy  Suctioning  Routine care  Chest tubes Procedures for Maintaining Respiratory Function (Cont.) 48 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Procedures for Maintaining Respiratory Function (Cont.) 49 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Procedures for Maintaining Respiratory Function (Cont.) 50 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Procedures for Maintaining Respiratory Function (Cont.) 51 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Procedures for Maintaining Respiratory Function (Cont.) 52 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Gavage feedings  Nasogastric tubes  Orogastric tubes  Gastrostomy feedings  Jejunostomy feedings  May be continuous drip or intermittent (bolus) feedings Alternative Feeding Techniques 53 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Alternative Feeding Techniques (Cont.) 54 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Nasoduodenal and nasojejunal tubes  Skin-level devices  Total parenteral nutrition (TPN)  Provides for total nutritional needs  Intravenous infusion of highly concentrated nutrient solutions  Family teaching and home care Alternative Feeding Techniques (Cont.) 55 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Alternative Feeding Techniques (Cont.) 56 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Alternative Feeding Techniques (Cont.) 57 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Enemas  Purpose  Techniques (age/weight appropriate)  Ostomies  Purpose  Techniques  Skin/stoma care Procedures Related to Elimination 58 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 The preferred site for intramuscular injections in infants is: A. Deltoid. B. Dorsogluteal. C. Rectus femoris. D. Vastus lateralis. Question 59 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.