Transcript Lecture 6

Clinical Application for Child
Health Nursing
NUR 327
Child Abuse
Lecture 4-A
Types of Child Abuse
M Neglect:
Intentional or unintentional omission of basic
needs and support
M Physical Abuse:
Is non-accidental injury to a child by an adult
M Sexual Abuse:
Forced involvement of children in sexual
activities by an adult
M Emotional Abuse:
Withholding of affection, use of cruel and
degrading language towards a child by an adult
Child Abuse
M Reports of
violence against children has almost
tripled since 1976.
M Many of
the abused children are infants.
NURSES ARE MANDATED REPORTERS
Child Abuse
Neglect


Physical or emotional maltreatment
Failure to thrive
Physical Abuse



Minor or major physical injury (bruising, burns,
fractures)
May cause death
Shaken baby syndrome (SBS)
Sexual
Emotional


May be suspected, but difficult to substantiate
Impairs child’s self-esteem and competence
Child Abuse
Warning Signs

Incompatibility between history of event and injuries

Conflicting stories from various people involved

History inconsistent with developmental level of child

Repeated visits to emergency rooms

Inappropriate response from child and/or caregiver
Child Abuse
Nursing action

Assess: Physical assessment and history of event,
observe and listen to caregiver’s and child’s verbal and
non-verbal communication

Documentation: Contact Child Protective Services,
hospital documentation

Support family and child: Social services, resources,
teaching
THE CHILD’S SAFETY COMES FIRST
AND IS THE PRIORITY!
Medication Administration
for child
Lecture 4-B
Oral Medication
Hold infant with head elevated to prevent
aspiration
Slowly instill liquid meds by dropper along
side of the tongue
Crush pills and mix with sweet-tasting liquid
if permitted, but don’t add too much liquid!
Allow choices for the child such as which
med to take first
Flush following gastreostomy or NG tube
Factors to consider when selecting IM sites
 Age
 Weight
 Muscle development
 Amount of subcutaneous fat
 Type of drug
 Drug’s absorption rate
IM and SQ Meds
Select needle length according to muscle size
• Use Z-track for iron and tissue-toxic meds
•May mix medication with lidocaine
• Some medications may be need to be
separated into 2 injections depending on
amount
Peds IM Injection Sites
 Vastus lateralis for infants
Ventrogluteal and dorsogluteal
Don’t inject into dorsogluteal until age 3 years - muscle not
well developed until child walks and sciatic occupies a larger
portion of the area.
 Deltoid after 3 years
Vastus lateralis Site
Deltoid Site
Ventrogluteal Site
Dorsogluteal Site
IV Meds
 Site may be peripheral or central
 Administer IV fluids cautiously
 Always use infusion pumps with infants and small
children
 Inspect sites frequently (Q 1-2 hours) for signs of
infiltration
 Cool blanched skin, puffiness( infiltration)
 Warm and reddened skin (inflammation)
Nose Drops
 Suction nare with bulb syringe prior to
administration if nasal congestion present
Ear Meds
Pull the ear down and back to instill eardrops
in infants (↓3 years pull ↓)
•Pull the ear up and out to instill in older
children (↑ 3 years pull ↑)
• Have medication at room temperature
The End