Nursing Care of a Child Undergoing Diagnostics Techniques and Pain

8/4/2019 Nursing Care of a Child Undergoing Diagnostics Techniques and Pain

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Nursing care of a child

undergoing diagnosticstechniques; Pain

Management in Children

Dione Blas Rey R. Abogadie MAN, RN


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General Concepts Related to pediatric Procedures

Informed Consent


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Before undergoing any invasive procedure, including asurgical procedure,

the patient or the patients legal surrogate mustreceive sufficient information on which to make aninformed health care decision.

Informed consent refers to the process by whichpatients or their surrogates receive the information.

Information should include the expected care ortreatment, potential risk, benefits, and alternatives,and what might happen if the patient chooses not toconsent.


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To obtain valid informed consent, health careproviders must meet the following three

conditions:The person must be capable of giving consent; that is,

he or she must be over the age of majority (usually age18 years) and must be considered competent (i.e

processing the mental capacity to make choices andunderstand their consequences).

The person must receive the information needed tomake an intelligent decision.

The person must act voluntarily when exercisingfreedom of choice without force, fraud, deceit, duress, orother forms of constraint or coercion.


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Note!!!

The patient has the right to accept or refuse any

health care.

If a patient is treated without consent, the

hospital or health care provider may be charged

with assault and held liable for damages.


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Requirements for Obtaining Informed

Consent


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When informed consent of the parent or legal guardian is usuallyrequired for medical or surgical treatment, including many diagnostic

procedures. One universal consent must be obtained for each surgical or

diagnostic procedure, including:

Major surgery

Minor surgery (e.g cutdown, biopsy, dental extraction, suturing alaceration [especially one that may have a cosmetic effect], removalof a cyst, closed reduction of a fracture)

Diagnostic tests with element of risk (e.g, bronchoscopy, needlebiopsy, angiography, electrocardiography, lumbar puncture, cardiaccatheterization, ventriculography, bone marrow aspiration)

Medical treatments with an element of risk (e.g, blood transfusion,throcentesis or paracentesis, radiotherapy, shock therapy)


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Other situations that require patient or

parental consent include:

Taking photographs for medical, educational,

or other public use.

Removal of the child from the health careinstitution against physicians advice.

Postmortem examinations, except in

unexplained deaths, such as sudden infantdeath, violent death, or suspected suicide.

Release of medical information


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Preparation for Diagnostic and

Therapeutic Procedures

Technologic advances and changes in health care

have result in more pediatric procedures being

performed in a variety of settings.

Many procedures are both stressful and painful

experiences for children and their parents.

For most procedures the focus of care is

psychologic preparation of the child and family. However, some procedures require the

administration of sedatives and analgesics.


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Psychologic Preparation

Preparing the children for procedures decreases their anxiety,

promotes their cooperation, supports their coping skills and

may teach them new ones, and facilitates a feeling of mastery in

experiencing a potentially stressful event.

Many institutions have developed preadmission teaching

programs designed to educate the pediatric patient and family

by offering hands-on experience with hospital equipment, the

procedure performed, and departments they will visit.

Preparatory methods may be formal, such as group preparationfor hospitalization.

Most preparation strategies used by nurses are informal, focus

on providing information about the experience, and are directed

at stressful or painful procedures.


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Flexible strategies are needed for children and familymembers of diverse cultural background.

General guidelines for preparing children forprocedures are described, along with age-specificguidelines that consider childrens developmentalneeds and cognitive abilities, nurses should considerthe childs temperament, existing coping strategies, andprevious experiences in individualizing the preparatoryprocess.

Children who are distractable and highly active, orthose who are slow to warm up, may needindividualized sessions that are shorter for the activechild but more slowly paced for the shy child.


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Establish trust and provide Support.

The nurse who has spent time with and established apositive relationship with a child usually finds it easierto gain cooperation.

If the relationship is based on trust, the child willassociate the nurse with caregiving activities the givecomfort and pleasure most of the time, rather thandiscomfort and stress.

If the nurse does not know the child, it is best for the

nurse to be ntroduced by another staff person whomthe child trusts.

The first visit with the child should not include anypainful procedure and ideally should focus on the childfirst and then on an explanation of the procedure.


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Parental Presence and Support.

Children need support during procedures, and

for young children the greatest source of

support is the parent.


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They represent security, safety, and comfort.

Controversy exists regarding the role parents

should assume during the procedure,

especially if discomfort is involved.

Parental presence is preferable, however,

since it can reduce patient and parent anxiety

and decrease the need for sedation.


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Provide an Explanation.


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Age-appropriate explanations are one of the most

widely used interventions for reducing anxiety inchildren undergoing procedures.

Before performing a procedure, the nurse explains tochildren what is to be done and what is expected ofthem.

The explanation should be short, simple, andappropriate to the childs level of comprehension.

Long explanations are not necessary and may onlyincrease anxiety in a small child.

When explaining the procedure to parents with thechild present, the nurse uses language appropriate tothe child, since unfamiliar words can bemisunderstood.


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Allowing children to handle actual items that will beused in their care, such as a stethoscope,sphygmomanometer, or oxygen mask, helps themdevelop familiarity with these items and reduces thefear often associated with their use.

Miniature versions of hospital items such asgurneys(stretcher) and x-ray and intravenous (IV)equipment can be used to explain what the childrencan expect and permit them tosafely experiencesituations that are unfamiliar and potentiallyfrightening.

Written and illustrated meatrials are also valuable aids

to preparation.


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Physical Preparation

For many diagnostic and therapeutic procedures, no special

physical preparation is needed.

However, some do require physical preparation.

One are of special concern is the administration of appropriate

sedation and analgesia before stressful procedures.

The safety of sedated children can be ensured by performing a

detailed presedation assessment, carefully selecting patients for

sedation, and using drugs with a wide margin of safety.

Once sedatives are administered, astringent monitoring will

permit early recognition of untoward drug effects.

The use of sedating drugs for procedures has serious associated

risks, such as hypoventilation, apnea, airway obstruction, and

cardiopulmonary impairment.


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Performance of the Procedure

Supportive care continues during the procedure and can be a majorfactor in a childs ability to cooperate.

Ideally, the same nurse who explains the procedure should performor assist with the procedure.

Before beginning, all equipment is assembled and the room is

readied to prevent unnecessary delays and interruptions thatincrease the childs anxiety.

If possible, procedures should be performed in a special treatmentroom rather than the childs hospital room.

Traumatic procedures should never be performed in safe areas,such as the play room.

If the procedure is lengthy, the nurse should avoid conversation thatcould be misinterpreted by the child.

As the procedure is nearing completion, the nurse should informthe child that it is almost over in language the child understands.


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Expect Success

Nurses who approach children with confidence andwho convey the impression that they expect to besuccessful are less likely to encounter difficulty.

It is best to approach a child as though cooperation isexpected.

Children sense anxiety and uncertainty in an adult andwill respond by striking out or actively resisting.

Although it is not possible to eliminate such behavior inevery child, a firm approach with a positive attitudefrom the nurse tends to convey a feeling of security tomost children.


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Involve the Child.

As in any other aspect of care, involving children helps togain their cooperation.

Permitting them to make choices gives them some measureof control.

However, a choice is given only in situations in which one isavailable.

Asking children, Do you want to take your medicine now?or Im going to give you an injection now, ok? leads tobelieve they have an option and provides them the

opportunity to legitimately refuse or delay the medication. This places the nurse in a awkward, if not impossible,

position.

It is much better to state firmly, Its time to drink yourmedicine now.


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Children usually like to make choices, but the choice

must be one that they do indeed have (e.g, Its time for

your medicine. Do you want to drink it plain or with a

little water?). When giving instructions, describe the expected

behavior, such as Keep your leg still, rather than giving

orders, such as Dont move your leg.


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Many children respond to tactics thatappeal to their maturity or courage.

This also gives them a sense of participationand achievement.

For example, preschool children will beproud that they can hold the dressing

during the procedure or remove the tape. The same is true for the school-age child,

who often cooperates with minimumresistance.


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Provide Distraction

Distraction is a powerful coping strategy during

painful procedures.

It is accomplished by focusing the childs

attention on something other than the

procedure.

Singing favorite songs, listening to music with aheadset, counting aloud, or blowing bubbles to

blow the hurt away are effective techniques.


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Allow Expression of Feelings

The child should be allowed to express feelings of anger,anxiety, fear, frustration, or any other emotion.

It is natural for children to strike out in frustration or to tryto avoid stress-provoking situations.

The child needs to know that it is all right to cry.

Whatever the response, the nurse must accept thebehavior.

Telling a child with limited verbal skills, such as toddler, to

stop kicking, biting, or otherwise expressing frustrationconveys to the child that he or she is not being understood.

Behavior is childrens primary means of communication andcoping and should be permitted unless it inflicts harm onthem or those caring for them.


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Pain Management

Children may experience pain in surgery

(appendectomy, tonsillectomy)

Illness (sickle cell dse.,cancer, RA)

Procedures (dressing changes, immunizations,

venipuncture)


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Nonpharmacologic Mgt.

Distraction

Relaxation

Guided imagery Cutaneous stimulation

Education

Parental support

Cognitive behavioral intervention


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Distraction

Play

Radio

Tape recorder CD player

Computer game

Use of hrythmic breathing

Blow bubbles blow the hurt away


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Relaxation

Hold it well comfortable position

Rock in a wide, arc in a rocking chair

Help child assume comfortable position


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Guided Imagery

Have child describe details of the event,

including as many senses as possible (e.g.,

feel the cool breezes, see the beautiful

colors,

Hear pleasant music


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Complimentary Alternative Medicine

Biologically based (food, special diets, herbaland plants, vitamins, etc,)

Manipulative treatments (chiropractic(bodysystem manipulation), massage, osteopathy(use of surgery)

Energy based (reiki (hands on teaching),bioelectric or magnetic treatment, pulsedfield, current)


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Mind body techniques (mental healing,expressive treatments, spiritual healing,

hypnosis

Alternative medical treatments (homeopathy,

naturopathy, ayurvedic, traditional Chinese

medicine that includes accupuncture andmoxibustion)


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Pharmacologic

Tylenol, Paracetsmol

Lidocaine

Morphine

PCA


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Nursing Care of a Child Undergoing Diagnostics Techniques and Pain

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