Presentation is loading. Please wait.

Presentation is loading. Please wait.

Chapter 22 Health Care Adaptations for the Child and Family.

Similar presentations


Presentation on theme: "Chapter 22 Health Care Adaptations for the Child and Family."— Presentation transcript:

1 Chapter 22 Health Care Adaptations for the Child and Family

2 Objectives List five safety measures applicable to the care of the hospitalized child. Illustrate techniques of transporting infants and children. Plan the basic daily data collection for hospitalized infants and children. Identify normal vital signs of infants and children at various ages. 2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

3 Objectives (cont.) Devise a nursing care plan for a child with a fever. Discuss the techniques of obtaining urine and stool specimens from infants. Position an infant for a lumbar puncture. Calculate the dosage of a medicine that is in liquid form. Demonstrate techniques of administering oral, eye, and ear medications to infants and children. 3Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

4 Objectives (cont.) Compare the preferred sites for intramuscular injection for infants and adults. Discuss two nursing responsibilities necessary when a child is receiving parenteral fluids and the rationale for each. Demonstrate the appropriate technique for gastrostomy tube feeding. 4Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

5 Objectives (cont.) Summarize the care of a child receiving supplemental oxygen. Recall the principles of tracheostomy care. List the adaptations necessary when preparing a pediatric patient for surgery. 5Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

6 Admission to the Pediatric Unit— Nursing Responsibilities Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.6

7 Informed Consent Ensure the parent/guardian signing consent for any procedure understands the purpose and risks involved Nurse acts as a patient advocate by ensuring the consent has been signed before the procedure When possible, provide the patient with age- appropriate information 7Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

8 Identification ID bracelet must be applied upon admission to the nursing unit Parent/guardian is also given one to wear and the identification numbers must match what is on the child’s bracelet ID bracelet must be verified before any medication, treatment, or procedure is provided 8Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

9 Essential Safety Measures in the Hospital Setting—the Do’s Keep crib sides up at all times when the child is unattended in bed Identify a child by ID bracelet and NOT by room or bed number Use a bubble-top or plastic- top crib for infants and children capable of climbing over the crib rails 9Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

10 Essential Safety Measures in the Hospital Setting—the Do’s (cont.) Place cribs so that children cannot reach sockets or appliances Inspect toys for sharp edges and removable parts Keep medications and solutions out of reach of the child Prevent cross-infection; do not borrow items such as toys from one child and give to another without cleaning the toy per hospital policy first Take proper precautions whenever oxygen is being administered 10Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

11 Essential Safety Measures in the Hospital Setting—the Don’ts Do not allow ambulatory patients to use wheelchairs or stretchers as toys Do not leave an active child in a baby swing, feeding table, or high chair unattended Do not leave a small child unattended when out of the crib Do not leave medications at the bedside Do not prop nursing bottles or force-feed small children—risk of choking 11Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

12 Preparation Steps for Performing Procedures Nursing actions prior to a procedure include –Verifying written order of health care provider –Gathering equipment –Identifying the patient –Explaining the procedure to the parent/child –Providing privacy –Performing hand hygiene –Utilizing standard/transmission-based precautions 12Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

13 Transporting, Positioning, and Restraining the Infant Method depends on age, level of consciousness, and how far the child must travel Older children are transported as adults are Young children—cribs, wagons, pediatric-sized wheelchair, or gurney Side rails are up ID bracelet has been checked to ensure the correct child is being transported The nurse documents time, method of transport, where child is transported, and who is accompanying child 13Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

14 Transporting, Positioning, and Restraining the Infant (cont.) 14Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

15 Verifying the Child Assessment Children are different from adults. Data collection is done to determine the level of wellness, the response to medication or treatment, or the need for referral. 15Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

16 Organizing the Infant Assessment Select a warm, non-stimulating room Expose only areas of body to be examined Observe without touching first, with minimal touching next, and with invasive touch last to assess reflexes and blood pressure Talk softly Utilize pacifier to comfort infant Swaddle/hold after assessment complete Utilize parent teaching opportunities Document findings Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.16

17 Basic Data Collection Observation –How does the child look? Growth and development –Are child’s size and actions age-appropriate? Level of interaction between child and environment –Is child’s behavior withdrawn, normal for age and development, or inappropriate? Is the child tipping his head or rubbing his ears? Is child maintaining a rigid body posture in order to breathe? Are there any obvious bruises (especially in various stages of healing) or cuts? How clean is the child? 17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

18 The History Survey Allows the nurse to teach parents about child’s needs as well as injury and illness prevention Should include questions about complementary and alternative medicine, over-the-counter medications, and immunization history Should also include –Child’s health and eating habits –Sleeping –Toileting –Activity patterns –Use of special words or gestures in order to communicate with others 18Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

19 The Physical Survey Head-to-toe review upon admission and then at least once per shift or clinic visit Vital signs –Temperature –Weight –Blood pressure –Pulse –Respiration rate Hydration status Heart sounds Lung sounds Bowel sounds Skin—rashes/lesions Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.19

20 Pulse Rate Apical pulse advised for children younger than 5 years of age Radial pulse used for children older than 5 years of age Pulse rate increases as temperature increases 20Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

21 Blood Pressure (BP) The width of the cuff should be ⅔ of the upper arm Electronic BP machines do not require auscultation with stethoscope Normal BP is lower in children than in adults Can secure BP cuff over brachial, popliteal, or femoral artery A BP reading taken when an infant is crying may not be accurate 21Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

22 Pathogenesis of Fever and the Use of Antipyretics Infection stimulates immune substances to work along with prostaglandins to stimulate the hypothalamus to raise body temperature –Triggers vasoconstriction, shivering, and decreased peripheral perfusion –Decreases body heat loss while maintaining homeostasis Antipyretic medications inhibit prostaglandin production Fever increases metabolic demand on the heart and lungs Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.22

23 Hyperthermia An increase in core body temperature occurs with central nervous system impairment Prostaglandins are not involved –Homeostasis mechanism is bypassed Treatment involves vigorous cooling measures 23Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

24 Techniques to Measure Body Temperature 24Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

25 Techniques to Measure Body Temperature (cont.) Usually done in one of five places –Oral –Axillary –Temporal artery –Tympanic –Core (not widely recommended due to increase risk of rectal mucosal tearing) 25Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

26 Pain The fifth vital sign Must be addressed in the plan of care 26Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

27 Weight Provides a means of determining progress Necessary to determine safe medication dosages 27Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

28 Height Infants –Birth to 2 years Measured lying on a flat surface Children –2 to 18 years Measured in a standing position 28Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

29 Head Circumference Measured on all infants and toddlers Place tape measure slightly above eyebrows, above ear, and around occipital prominence 29Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

30 Collecting Specimens Verify physician order Obtain lab requisitions, correct containers, and supplies Collect specimen Label clearly and attach proper forms Send to laboratory according to hospital policy Record in nurses’ notes and on intake and output record what specimens were obtained and, where appropriate, the amount of output Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.30

31 Examples of Specimens Urine Stool Blood Cerebral spinal fluid Wounds Body fluids, such as peritoneal fluid or fluid from surgical drain It is important to follow hospital protocols in the collection and handling of any laboratory specimen Urine should not be collected from a disposable diaper as chemicals in the diaper will alter the results 31Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

32 Physiological Responses to Medications in Infants and Children Understanding the differences in drug absorption, distribution, metabolism, and excretion between children and adults is essential to provide safe pediatric medication administration Age is the most important variable in predicting response to any drug therapy 32Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

33 Absorption of Medications in Infants and Children Gastric influences Intestinal influences Topical medications (ointments) Parenteral medications 33Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

34 Metabolism of Medications in Infants and Children Most are metabolized in the liver Drugs generally metabolize more slowly, especially because the liver and enzymes do not function at a mature level until 2 to 4 years of age 34Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

35 Excretion of Medications in Infants and Children Many medications depend on the kidney for excretion If younger than 1 year of age, the immature kidney function prevents effective excretion of drugs from the body Combination of –Slow stomach emptying –Rapid intestinal transmit time –Unpredictable liver function –Inability to effectively excrete medications via the kidney Can result in altered responses and places the child at risk for toxicity 35Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

36 Administering Medications to Infants and Children Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.36

37 Nursing Responsibilities Observe for toxic symptoms whenever medications are administered Document positive and negative responses Every medication administered should have the safety of the dose prescribed calculated before administration 37Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

38 Parent Teaching Is essential to ensure compliance when the child is sent home with medications Teaching should include –The importance of administering and completing the medications as prescribed –Techniques of measuring and administering each dose –Techniques for encouraging child compliance –Importance of writing and following a schedule for medication administration 38Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

39 Methods of Drug Administration Oral –Preferred route Parenteral –Nosedrops, eardrops, eyedrops –Rectal –Subcutaneous and intramuscular injections –Intravenous –Long-term venous access devices Saline lock Peripheral PICC –Central Hickman, Groshong, and Broviac catheters Implanted ports 39Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

40 Calculating Drug Doses Body surface area Milligrams per kilogram (mg/kg) Dimensional analysis 40Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

41 Formula for Dimensional Analysis Unit × Dosage wanted Dosage on hand Unit to give 41Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

42 Safety Alert Maximum volume for IM administration –Infants—0.5 mL –Toddlers—1 mL –School-age/adolescent Deltoid—1 mL Vastus lateralis—2 mL 42Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

43 Total Parenteral Nutrition Also known as hyperalimentation Provides nutritional needs to those who cannot use the gastrointestinal tract for nourishment for a prolonged period of time Allows highly concentrated solutions of protein, glucose, and other nutrients to infuse into a large vessel It is important for the nurse to monitor and report the following –Hypoglycemia –Hyperglycemia –Electrolyte imbalances 43Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

44 Nursing Care of a Child Receiving Parenteral Fluids Observe the child hourly for –Low volume in the bag or the need to refill the burette –The rate of flow of the solution –Pain, redness, or swelling at the needle insertion site –Moisture at or around the needle insertion site Accurate I&O is kept for all children receiving IV fluids 44Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

45 Nursing Care of a Child Receiving Parenteral Fluids (cont.) Key components to remember when providing intravenous therapies –The developmental level of the child –IV placement –Preparation of the child prior to insertion –Related nursing actions –Protection of the IV site –Mobility considerations –Safety needs 45Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

46 Preventing Medication Errors 6 Rights of Medication Administration –Patient –Drug –Dose –Time –Route –Documentation Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.46

47 Factors to Consider for Pediatric IVs Developmental characteristics Site where IV is to be inserted Preparation of child Family Involvement Related nursing actions Protection of IV site Mobility Considerations Safety needs Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.47

48 Avoiding Drug Interactions Selected drug-environment interactions –Phototoxicity Selected drug-drug interactions –Phenytoin (Dilantin) and antacid Selected drug-food interactions –Iron supplement and egg yolks 48Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

49 Nutrition, Digestion, and Elimination Gavage feeding –Given when infant cannot take food or fluids by mouth but the gastrointestinal tract is functioning –Places nutrients directly into the stomach so that natural digestion can occur 49Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

50 Nutrition, Digestion, and Elimination (cont.) Gastrostomy –Tube surgically placed through the abdominal wall into the stomach –Used in infants or children who cannot have food by mouth because of anomalies or strictures of the esophagus, severe debilitation, or coma Brown or green drainage may indicate that the tube has slipped from the stomach into the duodenum. This can cause an obstruction and is reported immediately. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.50

51 Nutrition, Digestion, and Elimination (cont.) Enema –Administration is essentially the same as with adults –Modifications include Type Amount Distance of insertion –Isotonic solutions –Tap water is contraindicated Plain water is hypotonic to the blood and could cause a rapid fluid shift and overload if absorbed through the intestinal wall Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.51

52 Respiration Tracheostomy –An artificial airway (a plastic tube) placed in the trachea through the neck –Nursing care is essential to the survival of the child –The tube can become plugged by mucus or other secretions and cause the child to suffocate –Tube prohibits vocalization 52Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

53 Respiration (cont.) Indications for suctioning –Noisy breathing –Bubbling of mucus –Moist cough or respirations Complications –Tracheoesophageal fistula –Stenosis –Tracheal ischemia –Infection –Atelectasis –Cannula occlusion –Accidental extubation Signs and symptoms to observe –Restlessness –Rising pulse rate –Fatigue –Apathy –Dyspnea –Sternal retractions –Pallor –Cyanosis –Inflammation or drainage around insertion site 53Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

54 General Considerations for the Child Receiving Oxygen Therapy Signs of respiratory distress include increased pulse rate and respirations –Restlessness –Flaring nares –Intercostal an substernal retractions –Cyanosis –Children with dyspnea often vomit, which increases the danger of aspiration Maintain clear airway by suctioning if needed Organize nursing care to minimize interruptions Observe children carefully because vision may be obstructed by mist and young children are unable to verbalize their needs Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.54

55 General Considerations for the Child Receiving Oxygen Therapy (cont.) Safety considerations Infection prevention and control Prolonged exposure to high concentrations Therapy is terminated gradually 55Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

56 Management of an Airway Obstruction Abdominal Thrusts –Works on the principle that forcing the diaphragm up causes residual air in the lungs to be forcefully expelled, resulting in popping the obstruction out of the airway 56Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

57 Procedure for Clearing an Airway Obstruction 57Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

58 Preoperative and Postoperative Care Preoperative –Children require both physical and psychological preparation at their level of understanding –Clarify any misunderstandings the child may have –Infants should not be maintained on NPO status for longer than 4 to 6 hours; provide a pacifier to assist in meeting developmental need for sucking Postoperative –Nursing interventions are aimed at assisting the child to master a threatening situation and minimize physical and psychological complications Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.58

59 Body Art, Body Jewelry, Tattoos Most body jewelry designed to stay in place –Can cover with occlusive dressing –May need to remove if in area of surgery –Flexible plastic retainer may help keep holes open Nipple rings removed for mammogram MRI—most body jewelry is not ferromagnetic –Tattoos or permanent cosmetics at risk for developing edema or burning during MRI –Document presence of any tattoos 59Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

60 Question for Review What is the nursing responsibility in the monitoring of IV therapy for the pediatric patient? 60Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

61 Review Objectives Key Terms Key Points Online Resources Review Questions 61Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.


Download ppt "Chapter 22 Health Care Adaptations for the Child and Family."

Similar presentations


Ads by Google