1. Procedures and Treatments
Chapter 30:
Procedures and Treatments

2. Nurse’s Role in Preparation and Follow-Up
When preparing for a procedure, nursing responsibilities include supporting and reinforcing teaching with the child and family to decrease their anxiety.
Follow guidelines and policies of the health care setting, such as checking the child's identification band and ensuring signed informed consent is obtained.
It takes maturity and experience to know exactly which questions are stalling techniques and which call for firmness and action. Children need someone to take charge in a kind, firm manner that tells them the decision is not in their hands. They are too young to take this responsibility for themselves.

3. Nurse’s Role in Preparation and Follow-Up (cont.)
After any procedure or treatment, nursing responsibilities include:
ensuring the child is in a safe position,
comforting and reassuring the child,
answering questions,
and following documentation and procedure policies of the health care setting.

4. Question Tell whether the following statement is true or false.
Before performing a procedure the nurse must validate the child’s identity. You can do this by simply asking the child their name.

5. Answer
False
Rationale: Always identify the child before any treatment or procedure; check the child’s ID band and verify that information by having the child or caregiver state the child’s name.

6. Performing Procedures Related to Position
Types of restraints used for children include mummy restraints, papoose boards, clove hitch restraints, elbow restraints, and jacket restraints.
A. Mummy restraint.
B. Papoose board.
C. Clove hitch restraint.
D. Elbow restraint.
E. Commercial elbow restraint.
F. Jacket restraint.
G. Crib top restraint.

7. Performing Procedures Related to Position
Children in restraints require regular, careful observation to prevent injury. Family caregivers need explanations about the need for restraints.
Remember to check the restraints every 1-2 hours

8. Performing Procedures Related to Position (cont.)
The three most common methods of holding a child are the horizontal position, upright position, or the football hold.
Always support the infant's head and back. When transporting a child, the child should be held or placed in a crib, bassinet, bed, wagon, wheelchair, or stroller; use seat belts or safety straps.
Position infants on their backs or supported on their sides for sleeping.
Positions to hold an infant or child:
horizontal position,
(B) upright position, (C) football hold.

9. Performing Procedures Related to Elevated Body Temperature
Methods of reducing an elevated body temperature include:
not overdressing or heavily covering the child,
encouraging the child to drink fluids,
keeping the room environment cool,
and using acetaminophen or other antipyretics according to the health care provider's instructions.
A cooling device may also be used.
With any method, closely monitor the child's temperature.

10. Question
When lowering a child’s temperature and shivering occurs you must stop what you are doing to lower the temperature. This is because shivering
a. is very uncomfortable for a child with a fever.
b. is the body’s mechanism for raising the temperature.
c. means you have lowered the temperature to fast.
d. lowers the temperature faster.

11. b. is the body’s mechanism for raising the temperature.
Answer
b. is the body’s mechanism for raising the temperature.
Rationale: If a child begins to shiver, whatever method is being used to lower the temperature should be stopped. Shivering indicates the child is chilling, which will cause the body temperature to increase.

12. Performing Procedures Related to Feeding and Nutrition
Accurately measuring and recording intake and output are especially important in working with the ill or hospitalized child to monitor and maintain the child's fluid balance recorded every hour.
A nasogastric (through the nose) or orogastric (through the mouth) tube is used to administer gavage feedings directly into the stomach for a child who is unable to get adequate food and fluid by mouth.
If tube feedings are needed for a long period of time, a gastrostomy tube may be surgically inserted into the stomach through the abdominal wall. After the incision is made, a catheter is inserted and used as the feeding tube.

13. Performing Procedures Related to Respiration
The infant often receives oxygen while in an isolette or incubator.
Other methods of oxygen administration include nasal cannula or prongs, mask, oxygen hood, or oxygen tent.
High concentrations of oxygen can be dangerous to children, so close monitoring is needed.
Oxygen safety measures are taught to family caregivers and followed by health care personnel.

14. Performing Procedures Related to Respiration

15. Performing Procedures Related to Respiration (cont.)
Oral and nasal secretions can obstruct the airway and are removed by coughing or suctioning with a bulb s yringe. May use saline to loosen secretions.
In emergency situations, a tracheostomy is surgically performed to create an opening in the trachea to allow breathing.
The tracheostomy must be monitored closely, suctioned, and kept clean to decrease possibilities of infection.
The tracheostomy prevents the child from being able to cry or speak.

16. Performing Procedures Related to Circulation
Local application of heat increases circulation by vasodilatation and promotes muscle relaxation, thereby relieving pain and congestion.
It also speeds the formation and drainage of superficial abscesses.
Heat treatments no longer than 20 min.
Moist heat works faster than dry heat
The local application of cold may help prevent swelling, control hemorrhage, and provide an anesthetic effect.
Cold treatments no longer than 20 min.

17. Question
Before beginning a gavage or gastrostomy feeding it is necessary to check the placement of the tube. What method of tube placement is considered unreliable?
a. Inserting air into tube and listening for sound
b. X-ray to check placement
c. Aspiration for stomach contents
d. Ask the client to talk

18. Answer a. Inserting air into tube and listening for sound
Rationale: Verifying positioning of the feeding tube by inserting air (using an Asepto syringe) and listening with a stethoscope for sounds in the stomach is considered an unreliable method of checking for tube placement and is no longer recommended. An x-ray is most reliable; aspirating stomach contents is acceptable; chest x-rays do not verify placement of tube in stomach.

19. Performing Procedures Related to Elimination
A colostomy is created as an outlet for fecal material elimination.
An ileostomy is a similar opening in the small intestine, and the drainage contains digestive enzymes.
A urostomy may be created to help in the elimination of urine.
Check ostomy bags for leakage, empty them frequently, and change the bags as needed.

20. Performing Procedures for Specimen Collection
To collect a urine specimen from an infant, place cotton balls in the diaper and squeeze urine from the cotton ball.
Other urine collection methods include using a pediatric urine collection bag, or collecting a midstream specimen (clean-catch), catheterization, and 24-hour collection.
Wear gloves and use a tongue blade to collect a stool specimen from the diaper or bedpan.

21. Performing Procedures for Specimen Collection (cont.)
For blood collection or lumbar puncture, explain the procedure to the child and family and help hold the child still.
For diagnostic tests and studies, assist by supporting and reinforcing teaching with the child and family caregiver, preparing the child for the procedure, completing required paperwork, verifying informed consents are signed, maintaining NPO status, clarifying allergies, and documenting what has been done.