Hosp Child

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Caring for the Hospitalized Child - Pediatric Nursing

Transcript of Hosp Child

  • The Hospitalized ChildFour primary problems of the Pediatric Nurse when dealing with the hospitalized child:Separation AnxietyLoss of ControlPain managementDiversional Activities reflective of developmental stage of client

  • The Hospitalized ChildSeparation Anxiety!Early ChildhoodProtestDespairDetachmentLater ChildhoodLonelinessBoredomIsolationAttitude is everything!

  • The Hospitalized ChildLoss of Control!Early ChildhoodTrustLimitation of movementRegressionFantasy (can not synthesize beyond senses)Later ChildhoodLoss of independent activitiesDepersonalizationAttitude is everything!

  • The Hospitalized ChildPain!FallaciesInfants do not feel painChildren tolerate pain better than adultsChildren can not tell you where they hurtChildren always tell you the truth about painChildren become used to pain and painful proceduresPain intensity is reflected by a childs behaviorOpioids are too dangerous for children

  • Pain Assessment:Subjective

  • Pain Assessment:ObjectiveBody rigidity, thrashing about, loud crying, restlessnessFlushing of skinBlood Pressure, pulse, resp increasePupils DilateO2 Sat decreasesThese are less reliable than subjective- better to believe what the child tells you than to rely on objective signs

  • Pain ManagementNon-pharmacologicalInvolve ParentsPrepare the child without planting the idea of painDistractionCutaneous StimulationRewards

  • Pain ManagementPharmacologicalRight Drugopioids vs non-opioids?Right Dosebody weightParenteral vs Oral doses

  • Pain ManagementPharmacologicalRight RouteOralIMEMLAbuffered lidocaineIVSide effectsAttitude is everything!

  • Diversional ActivitiesPlay is the work of children and is critical in their developmentJCAHO requirementsputs children in charge- all children even the sick ones!Play Room should be a sanctuary

  • The Hospitalized ChildCare Plan:Fear related to separation anxiety

    withdrawal

    regression

  • The Hospitalized ChildCare PlanAlteration in comfort related to pain

    Non-pharmacological

    Pharmacological

    Side Effects

  • The Hospitalized ChildCare PlanPowerlessness related to hospitalization

  • The Hospitalized ChildCare Plan:Diversional Activity Deficit related to immobility and hospitalization

    Activity Levels

    Adequate rest

  • Pediatric Variations from Adults:Assessment and TechniquesSafety!Language!Medication Administration!POIMIVPR

  • PositioningLumbar Puncturelie on side with knees flexed to the abdomen and chin flexed to chestinfant- two handschild- lean over body using forearms against the thighsPapoose Board/ Mummy RestraintIVs, phlebotomy, suturing,

  • Normal Pediatric Heart Rates- Always Apical!!Newborn-120-1701 year- 100-1303 years 80-1205 years- 70-11010 years60-100affected by fever, dehydration, respiratory illnesses and drugs

  • Respiratory Rates- Abdominal rather than chest movements!!Newborn:30-60 1 year:24-403 years:24-306 years:18-2210 years:12-20Affected by anxiety, fever, drugs, illness

  • Blood Pressures- neonatal, infant, child, small adult cuffsNewborn:70/501 year:90/503 years:90/606 years:100/6012 years:110/6018 years:120/70affected by pain, dehydration, anxiety

  • Temperature: an elevated temperature is called a fever!!Any temp. >100.5 in a child
  • Temperature- continuedAxillary- last resort- usually in public places, seizure prone and immunosuppressed! Press arm close to side- hold in place 6 minutes! Rectal=oral plus 1 degree or axillary plus 2 degreesOral = axillary plus one degree

  • Temperature- continuedTympanic- not recommended for children less than 2 years- but is done all the time!Use probe coverpull pinna back and down, insert probe covering entire canal, parallel to face, then rotate towards mouth- like speaking into telephone- press scan button. Discard probe.

  • Oxygen saturation- normal- 95% or greater!Indicated in any patient with abnormal vital signs, cough, excessive secretions, sedation, or whenever the nurse feels it is necessary. Spot check vs continuousUsually children require taping probe over thumbnail nail or large toenail, can also use pinna of earMeasurement of oxygenation as well as perfusion!

  • Intake and OutputMeasured in ccs or mLs- useless without daily weights!1 gram = 1cc (1,000 grams = 1Kg=1liter!)Used on the following- renal disease, IV fluids, surgery, DM, hypovolemic, dehydrated (vomiting), CHI, burns, CHF, certain medications, meningitis (ICP)Weigh all diapers!

  • Specimen Collection (less than 5 years old)Venipuncture- usually do not use a vacutainer on children- a 20-25 gauge needle with a syringe- usually 3 ccs enough. Do not put in regular blood tubes, but rather pedi bullets. Can do a heel stick if unable to get blood on kids less than 1- need lancet and micro-sized collection tubes. Must wipe away the first drop of blood.

  • Specimen Collection- UrineCathClean CatchPedibag- clean meatus before applying the bag with a soap solution, sterile water, and sterile gauze - wipe from the tip of the penis towards the scrotum or from the clitoris towards the anus on three separate wipes.Attach the bag with adhesive tabs around the labia or around the scrotumShould be done before any other specimen collection!

  • Specimen Collection- Throat CultureOpen the culturette- do not let it come into contact with anything- hold in dominant hand. (contains two swabs in one) Have patient open mouth and say AHHH. (May need tongue depressor to get tongue out of way) Do not let swab come into contact with the tongue- swab each tonsil with a different swab. Expect patient to gag! Place swab back into culturette tube- Label!!