Transcript PEDIATRIC VARIATIONS OF NURSING INTERVENTIONS

Pediatric Variations
of Nursing
Interventions
Chapter 22
Mosby items and derived items © 2005, 2001 by Mosby Inc.
General Concepts
• Informed consent
– Age of majority/competence
– Requirements for obtaining informed
consent
– Eligibility for giving informed consent
– Treatment without parental consent
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Preparation for Procedures
• Psychologic preparation
– Age-specific guidelines for preparation
– Based on developmental
characteristics
• Establish trust
• Parental support—to stay or not to stay?
• Explanation to the child
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Performing Procedures
• Benefits of using special treatment room
for procedures
• Expect success
• Distract the child
• Allow expression of feelings
• Praise the child
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Surgical Procedures
• Preoperative care
• Use of conscious sedation with children
• Concept of “deep sedation”
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Postoperative Care
• Prepare equipment
• Baseline information
• Assessment of patient’s status
• Pain management
• Observe for complications
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Nursing Care Plans
• Selection of appropriate nursing
diagnoses
• Develop expected outcomes
• Nursing interventions/rationales
• Evaluation
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Compliance
• Patient’s behavior follows prescribed
regimen
• Assessment of compliance
• Strategies to enhance compliance
Mosby items and derived items © 2005, 2001 by Mosby Inc.
General Hygiene and Care
• Skin care
– Bathing
• Oral hygiene
• Hair care
• Feeding
• Fever/hyperthermia management
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Safety
• Name bands
• Patient identity
• Environment
• Activity supervision
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Infection Control
• Nosocomial infections
• Role of Centers for Disease Control and
Prevention (CDC)
• Standard precautions
• Transmission-based precautions
• Airborne, droplet, and contact precautions
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Environmental Safety Factors
• Furniture and home
• Electrical
• Fire prevention
• Sleep safety
• Toys
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Restraining Methods
• Therapeutic hugging
• Jacket restraints
• Mummy or swaddle restraint
• Limb restraints
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Positioning for Procedure
• Appropriate restraints
• Analgesia, sedation
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Specimen Collection
• Urine
• Stool
• Blood
• Sputum
• Gastric washings
• Nasal washings
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Medication Administration
• Determination of drug dosage
• Most frequently dosage is based on
specific dosage per kilogram of body wt
• Checking dosage
• Identification
• Family aspects
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Administration
• Oral
• Intramuscular
• Subcutaneous and intradermal
• Intravenous
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Devices
• Peripheral lock/heparin lock/saline lock
• Central venous access devices
– Short term/non-tunneled catheter
– Long-term tunneled catheter
– Implanted infusion ports
• Peripherally inserted central catheters
(PICCs)
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Nasogastric, Orogastric, or
Gastrostomy Administration of
Medicines
• Advantages
• Disadvantages
• Logistics
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Rectal Administration of
Medications
• Advantages
• Disadvantages
• Technique
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Optic, Otic, and Nasal
Administration
• Eye drops and ointments
• Techniques
• Infection control concerns
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Measurement of
Intake and Output
• Fluids to be measured
• Diaper weighing technique
• Tip: 1 g of wet diaper weight = 1 mL of
urine
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Parenteral Fluid Therapy
• Site selection
• Scalp vein IVs
• Intraosseous infusion
• Surgical cutdown
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Equipment for Fluid Therapy
• Catheters
• Needleless systems
• Decreasing needle-stick injuries
• Infusion pumps
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Management of Peripheral
Intravenous Lines (PIVs)
• Securing PIVs
• Removal of PIVs
• Complications
– Infiltration
– Extravasation
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Inhalation Therapy
• Oxygen therapy delivery devices
– Plastic hood/“oxyhood”
– Nasal cannula “prongs”
– “Oxygen tents”
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Monitoring Oxygen Therapy
• Concerns about oxygen toxicity
• Pulse oximetry
• Concerns about oxygen
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Aerosol Therapy
• Handheld nebulizers
• MDIs
• Others
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Bronchial (Postural) Drainage
• Definition
• Technique
Mosby items and derived items © 2005, 2001 by Mosby Inc.
CPT
• Definition
• Technique
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Artificial Airways
• Usually used with artificial ventilation
• Endotracheal intubation
– Nasotracheal, oral, tracheostomy
– Endotracheal tubes—uncuffed for
children <8 years old (except in
special circumstances)
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Tracheostomy
• Surgical opening in the trachea
• May be emergency or elective procedure
• Tracheostomy care
• Tracheostomy suctioning
• Emergency management
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Alternative Feeding Techniques
• Gavage feedings
– NG
– OG
• Gastrostomy feedings
• Jejunostomy feedings
• May be continuous drip or intermittent
(bolus) feedings
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Equipment for Alternative
Feeding Methods
• NG/OG? ND tubes
• Pumps
• Gastrostomy tubes/buttons
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Improving Absorption of Feeds
• Use pacifier during alternative feeds
– Non-nutritive sucking improved
digestion
• Quiet, calm environment
• Consistent feeding techniques by
caregivers/family members
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Parenteral Feedings
• Provide nutrition through IV route
• Total parenteral nutrition (TPN)
• Hyperalimentation
• Lipid infusion
Mosby items and derived items © 2005, 2001 by Mosby Inc.
Procedures Related
to Elimination
• Enemas
– Purpose
– Techniques (age/wt appropriate)
• Ostomy management
– Purpose
– Techniques
– Skin/stoma care
Mosby items and derived items © 2005, 2001 by Mosby Inc.