CH. 14 Developmental Nursing Care

blood pressure

- LOWER than adult in children <10 - use appropriate size cuff --> can use upper/ lower arm, thigh or calf but be consistent and measure same place every time - instruct the child the "balloon" will gently squeeze their arm of give it a "hug" - may demonstrate on doll or parent

urine specimens

- U bag - clean catch - cath

giving IV antibiotics

- administer in smaller volume - piggyback (10-20 ml syringe) - child may not have been diagnosed with drug allergies yet so observe closely - push slowly - assess and document IV every hour buretol= for infants

decreasing the stress of hospitalization

- allow family to stay with child - patient room = safe zone - treat meant = used for procedures - therapeutic play - comforting items form home - maintain routine - involve the child in their care and allow them to retain as much independence as possible - keep NPO for short time

topical med administration

- applied to skin or mucous membrane - effective if can't tolerate oral or rectal med - creams, foams, gels, lotions and ointments

feeding

- assess for dehydration - pediatric diet - strict/ accurate I/O's

growth charts

- below 5th or above 95th percentile indicate out of normal range - changes of more than 2 growth channels indicates a need fro in depth assessment - height/ weight should be proportional - special charts for very low birth weight babies (VLBWB) - are they gaining weight when they shouldn't be

otic

- child recline, turn head to side and ear up - <3 years= pull pinna down and back - > 3years = pull pinna up and back

regression

- common when in hospital - have family and security items with child for comfort EX: toileting, eating, sleeping, self care --> resort back to younger)

disability

- congenital, genetic or develop fro illness, injury or disease progression emotional concerns: - disruption of routine, concerns about the future, financial concerns developmental concerns: - child may be delayed due to medical and surgical interventions physical concerns: - ongoing surgeries may be needed, self image may suffer, families need education on caring for child - caregiver fatigue - realize that parents know their child best - maintain respectful attitude towards the child and parent - assess the child's communication strategies and incorporate them into care

non pharmacologic pain management

- containment, swaddling, kangaroo care (skin to skin) - nonnutritive sucking --> sucrose dipped pacifier, give at least 2 minutes before to tart working - CAM therapies

temporary restraint

- elbow - circumcision board - papoose --> only if necessary (big straightjacket basically) - hugs

comprehensive health history

- family medical/ social history - genogram - past medical history - birth history--> pregnancy, L&D, and health of baby - history of acute/ chronic illnesses, injuries, operations, hospitalizations/ER visits - allergies - medications (OTC, herbal and folk remedies) - immunizations - developmental milestones - patterns of daily activities - SODA--> sleep, output, diet, activity - nutrition - play and school activities

injectable med administration

- faster and more reliable - more stressful for children - common for immunizations, antibiotics and allergy shots - hold child securely, EXPLAIN , distract

preparing child for procedures

- give tour of surgical area, show equipment - explain what will happen - use distractions - when appropriate give the child some control - praise child for completing procedure - know how to teach/prepare for different age groups

safety

- identify with name band (don't rely on child to identify themselves) - prevent falls --> side rails - choking hazards - abduction alarms

play

- is the work of the child (it's how they learn) - can help prepare child for procedures, distract them or help them express themselves

oral medication administration

- liquids (suspensions, concentrates) - granules - chewable - meltable - scored tablets - crushed tablets - capsules **based on child's ability NOT age

emotional/ spiritual support

- listen to concerns, clarify misconceptions and help develop coping strategies to decrease stress and optimize functioning - arrange meeting with leader from their faith community

length/height

- measured at each visit - measured lying under age two, standing over age 2

weight

- measured at each visit - weigh babies w/ diaper only on infant scale to nearest ounce - toddler can be weighed with and w/out parent on platform until they can stand - weigh older children in least clothes possible - document how you weighed (lying or standing) and what child was wearing - once height and weight are obtained BMI can be calculated to asses total body fat and nutritional status - BMI measured yearly

head circumference

- newborn: chest/ head circumference almost equal; chest larger by 1 year - measure in children up to 36 months --> watching for meglacephaly, microcephaly, hydrocephaly - anthropometric measure must be taken at every health care visit

common procedures

- peripheral IV lines - central venous access - PICC lines - vascular access ports - giving IV antibiotics - blood specimens - urine specimens - sputum specimens - oxygen therapy - enteral tube feeding

community settings

- schools - medical homes - primary health care providers office or clinic - mobile health care unit - rehabilitation service - state health program - Department of Health and Human Services - specialty camps - churches, synagogues, mosques - facilities--> where complex need children live - doctors office--> get VS, vaccines, testing - rehab --> Ot, PT, St, audiology

family centered care

- supports the presence and participation of parents in the care of their child, recognizes they are child's support system - goal is to increase coping and prevent anxiety and trauma

health assessment

- tailor the physical exam to the child's age and developmental level - infant and toddler--> assess in parent lap - allow older child privacy - usually done head to toe but on small children go least invasive to most invasive - eave painful or frightening procedures to the end (looking in ears or mouth, checking BP) - anthropometric measurements (height, weight, head circumference, body mass index (BMI), body circumferences to assess for adiposity (waist, hip, and limbs), and skinfold thickness

how to administer oral meds

- use med cups, syringes or droppers for most accurate dosage (DON'T use silverware) - can add flavors to med or mix with applesauce - DON'T add to formula --> give at beginning of feedings to make sure they dont get too full - hold child on lap to administer - take caution to avoid choking/ aspiration

nursing interventions for pain

- use most effective and least traumatic route (oral or IV) - opioids can produce sedation/ respiratory depression - infants and children receiving IV and epidural opioids should be monitored on pulse ox - Naloxone (Narcan) should be used for reversal - around the clock pain meds prevent periods without coverage - PRN meds can be given at regular intervals

pediatric fluid maintenance

- used when a patient is NPO - contains water, glucose, sodium and potassium - ALWAYS convert weight form pounds to kilograms

observation after injection

- vaso-vagal response/ fainting - can use EMLA cream one hour before procedure to help numb

IM

- vastus lateralis is preferred site for infants - deltoid for older child and adolescents

blood specimens

- venipuncture with butterfly - capillary sampling --> heal sticks for infant (areas outside 'V'), finger stick for older children

daily caloric requirements

0-1 month: 100-110 kcal/day 2-4 months: 90-100 kcal/day 5-60 months: 70-90 kcal/day >5 years: 1,500 kcal for first 20 kg +25 kcal for each additional kg

nutrtion breakdown

10-25% = protein 45-65%= carbs 20-35%= high quality fats

100/50/20 rule

100 ml/kg for first 10 kg of body weight 50ml/kg for the next 10 kg of body weight 20ml/kg for every kg over 20 kg

chronic or recurrent pain

> 3 months - assess physical, emotional, social and school functioning - sleep disruption, anxiety, and depression common

common fatal injury for school age/ adolescents

MVA

OLDCAT

Onset Location Duration Character Aggravating/ Alleviating factors Timing

measuring intake and output

always use kg for weight based meds and interventions diaper weights: - 1 gram of weight= 1 ml of output - subtract weight of dry diaper to get output

vital signs

assess pulses, respiration and abdomen first

hygiene

bathing, oral care

pain assessment/ management

behavioral assessment - mainly used in children under 4 or nonverbal patients - most reliable when used to measure short, sharp pain FLACC--> Face, Legs, Activity, Cry, Consolability self reports (gold standard) - used mainly in children 4 years and older - Wong Bakers FACES scale --> age 4-7 - Numeric scale --> age 7 and older - use the same scale each time - teach the child to use the scale before they experience pan when possible

fever treatment

call provider if: - infant <3 months has 100.4 F or greater - older child has temp >102 F - temp >3 days treatment: - NO ASPIRIN - cooling measures - minimal clothing - tepid sponge baths --> get head, arms and legs wet - don't induce shivering--> produces heat - give antipyretic meds (Acetaminophen, Ibuprofen) **Acetaminophen= 10-15 mg/kg q 4-6 hrs over age 3 months--> NO MORE than 5 doses in 24 hrs **Ibuprofen= 10 mg/kg q 6 hours over age 6 months can do every 3 hours if needed

hospitalizations benefits

children learn about and may become interested in a career in healthcare

respirations

count while quiet and for full minute - MORE than adult in children <10 - count while pretending to check pulse

common fatal injury for toddlers/ preschoolers

drowning

gather the child's health history

establish a relationships with the patient/family - introduce yourself and clarify your role - identify parent/ caregiver - young children need to feel secure - school aged children may want to be interviewed alone - adolescents may want to be interviewed privately asking questions: - organized, unhurried, calm - open ended - observe family dynamics - chief complaint/ present illness (OLDCAT) - provide age appropriate and culturally sensitive care - ensure continuity of care **MUST have a through understanding of normal growth and development to assess for disturbances or regression in progress

temperature

fever is good bc the child is naturally fighting off infection - route depends on age and developmental levels - chart the route w/ the results - DO NOT insert rectal thermometer more than 1/2 in

plagiocephaly

flattening of the occiput (position changes) - tummy time helps treat/prevent

medicating children

give based on weight (kgs) - dosage stated as individual, total or as dose ranges teach parents: - name of medication (trade ad generic) - reason child is receiving medication - possible side/ adverse effects - how much/ often to give - tips for administration - how long to continue administration - dietary restrictions - when to call provider **teach back is extremely important

understanding pain

infant to 2 years: may anticipate pain from experience or parental anxiety toddlers: can express pain (boo boo, owie) preschoolers: may view pain as punishment, may not know to report school age: more descriptive, can differentiate physical vs. emotional pain adolescents: understand causes, may not admit pain to seem "grown up", need for independence and control

optic/ophthalmic drops or ointment

inner to outer - clean eyes with different cloths - child reclined - pull down lower lid - don't contaminate dropper - can apply to nasal corner if eyes shut

communication

introduce yourself and clarify your role to parents and child VERBAL: - spoken/ written - clear, concise, slow speech - use developmentally appropriate words and not words with confusing meaning - be honest NONVERBAL: - they can feel your fear so watch your nonverbal cues - facial expressions - gestures - tone of voice - get on child's level ACTIVE LISTENING: - eye contact - relaxed posture - encouraging cues - touch (when appropriate) - clarify statements - acknowledge emotions - open ended questions--> DON'T use YES/NO - offer choices if appropriate, but only when they exist

peripheral IV lines

know good holds for starting IV's based on age/ development - always use an infusion pump - micro-drip tubing (60 qtt/ml) - children are especially vulnerable to overload, over dosage and adverse reaction - be careful with IV push --> can't take med back - assess site frequently fro signs of infiltration or problems

pulse

listen or feel for full minute - faster than adult in children <10 - FASTER is children <2 years - apical= children under 2 - radial= children over 2

volume

maximum volume for Im injections is based on age/ size of child 0.5 ml max fro small infants 1 ml volume for older infant/ small child up to 2-2.5 ml for adolescents **use smallest needle (25 g for infants)

reactions of siblings to child hospitalization

may experience jealously, insecurity, resentment, confusion, guilt and anxiety

pharmacology pain management

mild to moderate: - acetaminophen - NSAIDs - Acetaminophen w/ codeine - NO ASPIRIN severe: - morphine - have Narcan available - watch for constipation, N/V, urinary retention, cough suppression, pruritus

sputum cultures

nasal washing (lavage)

fever

natural and beneficial response to an invasive of offending organisms; it helps to kill the virus/ bacteria - usually NOT dangerous --> seriousness of illness is not determined by high how the fever - child may feel cold - increase O2 and fluids temp greater than 100.4 F (38 C)

intraosseous needle

provides quick IV access in emergency - <24 hours

maintaining skin care

risk for pressure ulcers

nasal

suction first - child reclined - hyperextend neck - stay supine for several minutes

common fatal injury for infants

suffocation

SQ

thigh or upper arm

torticollis

tightening of the muscles on one side of the neck (stretching and position changes, massage, and heat) - tummy time helps treat/prevent

restraints

treat them lie you would with adults - SAFETY IS ALWAYS FIRST

rectal med administration

used when child is vomiting or can't keep anything down - use water soluble lubricant - used gloved finger to insert past rectal sphincter - is suppository, cut half lengthwise - hold buttocks together fro 1 minutes because they will have urger to push back out

reactions of family members to child hospitalization

varied stages of grief. don't take it personal, causes marital strain

enteral tube feeding

via a NG of GO tube fro children that cant take feedings orally

oxygen therapy

want to keep O2 greater than 92-95% depending on health status