CH 13: Key Pediatric Nursing Interventions

Expected urine output for children and adolescents

1-2 mL/kg/hr

The primary health care provider prescribed ketoconazole for a child with ringworm. Which statement by the parents indicates the nurse needs to provider additional teaching on the prescription? A) "I will wrap the skin tightly after applying the medication." B) "I will wash my hands before and after I apply this medication." C) "If this medication gets in my child's eyes, I will rinse with water immediately." D) "My child needs to take the full prescribed dosage."

A) "I will wrap the skin tightly after applying the medication." Ketoconazole is an antifungal used to treat tinea infections. The nurse would teach to avoid covering treated skin areas with tightly. The area needs to be able to allow air to circulate to the skin to limit side effects. All other statements indicate correct understanding.

The nurse enters the room to give a subcutaneous injection of insulin to a 6-year-old female who is diabetic. What is the best method of medication administration? A) Ask her where she would like to have the nurse give the injection. B) Announce to the child that it is time for her insulin and give the injection matter-of-factly. C) Ask the child if it is okay to give her the injection now. D) Tell the child that she is to remain very still and not cry.

A) Ask her where she would like to have the nurse give the injection. Asking the client to choose where to receive the injection gives a degree of control. Announcing that it is time for the medication does not give any sense of control to the child. Asking permission to give a medication to a child is not appropriate: A child should not be given the opportunity to decline a medication. It is not appropriate to tell a child not to cry during a painful procedure: The child should be given permission to yell out or cry if they feel the need to.

The nurse is administering an oral liquid medication to a 5-year-old child. What would be the mostappropriate for the nurse to do when administering this medication? A) Let the child hold the medication cup. B) Administer the medication using a dropper. C) Ask the parent to hold the child's arms during administration. D) Have the child lying down with the head elevated on a pillow.

A) Let the child hold the medication cup. Droppers and oral syringes can be used to administer medications to infants and young children. Medication cups and spoons can be used to administer liquid medications to the older child. The child can hold the medication cup and drink the liquid medication. Depending upon the age of the child the child may still prefer to take liquid medications via the syringe. It makes taking the medication fun when the child can squirt it into the mouth by him- or herself. The child who is lying down when being given medications should have the head of the bed elevated to at least 45 degrees .A 5-year-old child does not need to be restrained for medication administration.

The nurse is administering a tube feeding to a child. The nurse aspirates the stomach contents as part of the process for checking placement of the tube. Which action is correct for the nurse to do with the aspirated stomach contents? A) The nurse should measure and replace the residual stomach contents. B) The nurse should check the pH of the stomach contents and discard the residual collected. C) The nurse should place the residual stomach contents in a sterile specimen cup and send to the lab for analysis. D) The nurse should save the residual stomach contents and refrigerate it until the next feeding.

A) The nurse should measure and replace the residual stomach contents. Measuring for residual is a way to determine gastric emptying time. Prior to each bolus feed or regularly during continuous feeds the nurse should aspirate some stomach contents, measure the amount, and then replace the contents if the volume does not exceed the parameter established by the health care provider. Not replacing can cause a decrease in the number of daily calories needed and can lead to electrolyte imbalances. The content does not need to be sent to the lab for analysis. If the nurse wishes to check tube placement that can be done at the bedside with a pH strip. If the stomach content is not going to replaced it should be discarded.

A child needs a peripheral IV start as well as a venous blood sample for a laboratory test. The nurse will take what action? A) coordinate placing the peripheral IV and the lab blood draw. B) Delay both the IV start and blood draw until the child is well hydrated orally. C) Make sure the laboratory specimen is drawn prior to placing the IV access device. D) Place the IV and start intravenous fluids promptly; then request the laboratory obtain the blood specimen.

A) coordinate placing the peripheral IV and the lab blood draw. Coordinate the IV placement and lab blood draw to minimize the number of venipunctures for the child. Gaining venous access for each purpose separately does not do this and is not necessary. Having a well-hydrated child makes venous access easier, but oral hydration will take some time, thus delaying needed treatment.

Immediately following administering a medication by enteral tube, the nurse will: A) flush the tube with water. B) position the child on his left side. C) elevate the head of the bed. D) check for signs of nausea or vomiting.

A) flush the tube with water. It is important to flush the tube to ensure all of the medication reaches the child's digestive tract and to prevent occlusion of the tube. Right (not left) side-lying position will aid in stomach emptying, although it was not specified that the enteral tube was located in the stomach. Elevating the head of the bed is done prior to placing material in the gastrointestinal tract. Checking for signs of nausea and vomiting is always important but not the immediately following nursing action in this situation.

The site most often used when administering a medication using the intradermal route is the: A) forearm. B) thigh. C) abdomen. D) deltoid.

A) forearm. Intradermal injections deposit medications just under the epidermis. They are most often used for tuberculosis screening and allergy testing. The forearm is the site most often used. The anterior thigh, lateral upper arms, and abdomen are the preferred sites for subcutaneous administration. The deltoid, vastus lateralis and the ventrogluteal are the preferred sited for intramuscular injections.

The pediatric nurse recognizes that what statement is true regarding medications administered via the intravenous route? A) The medication is injected into the fatty tissue between the skin and the muscle. B) Giving medications through the intravenous route is less traumatic than other routes. C) The medications are absorbed more slowly by being given intravenously. D) Administering medications intravenously is safer than by other routes.

B) Giving medications through the intravenous route is less traumatic than other routes. Delivering medications intravenously is actually less traumatic than administering multiple intramuscular injections.

A 4-year-old child is admitted to the hospital for surgery. Before the nurse administers medicine, the best way to identify the child would be to: A) call the child's name and see if he or she answers. B) read the child's armband. C) ask the child to state his or her name. D) tell the child to state his or her nickname.

B) read the child's armband. A child may answer to the wrong name or deny his or her identity to avoid an unpleasant situation or if scared of the unknown. If the child is avoiding the situation he or she may fail to answer. Using the child's nickname is okay in conversation but it is not a legal identification of the child. To verify the correct identity the nurse should verify the child's armband and the correct name with the child's caregiver. Bar code scanning the child's armband would also be a correct method of identification.

The nurse is teaching a new nurse how to assess vital signs of an infant. The mentor knows that teaching was effective when the nurse takes which measurement first? A) apical pulse B) respirations C) temperature D) blood pressure

B) respirations Respirations should be measured before an infant is disturbed because the respiratory rate increases with crying. Apical pulse, temperature, and blood pressure measurement typically wakes the infant and leads to distress and crying. Therefore, observing respirations is best done first, before the infant is crying.

Central IV Therapy

Large veins- subclavian, femoral, jugular

peripheral sites for pediatric IV

hands, feet, and forearm

The five "rights" of pediatric medicine administration

Right med- right pt.- right time- right route- right dose

The _________ site, often used in adults, is not recommended in children younger than 5 years of age

dorsogluteal

The preferred injection site for infants less than 7 months is the

vastus lateralis muscle

In infants and children greater than 7 months the ___________ site should be considered

ventrogluteal