Chapter 30: Procedures and Treatments Maternal Prep - U, Chapter 30: Procedures and Treatments, Chapter 30Procedures and Treatments- peds, Chapter 37 Nursing Care of a Family When a Child Needs Diagnostic or Therapeutic Modalities, PN108 PrepU Chapt…

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A school-aged child appears to be very brave about having blood drawn, but at time of venipuncture he begins to cry and pulls away. Which response would best demonstrate an understanding of his needs?

"It's okay to cry; I know having your blood tested hurts." Acknowledging that a procedure is painful helps a child to feel a sense of control.

A parent calls the nurse in the emergency department and reports giving a tepid bath to decrease temperature in a feverish child. The parent states the child is shivering and wants to know if this means the bath was effective. What is the best response by the nurse?

"Shivering means the child is chilling, which will cause the body temperature to increase." 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.

A 7-year-old boy has been admitted to the hospital with a diagnosis of fever of unknown origin. He has numerous tests ordered for diagnosis. When preparing him for the blood tests ordered, the best explanation would be,

"The doctor needs to look at your blood to see why you are sick; it will hurt for a second."

The nurse needs to obtain a blood sample from a 7-year-old child. How should the nurse explain this procedure to the client?

"The doctor needs to look at your blood to see why you are sick; it will hurt for a second." The nurse should offer the child a simple explanation of the procedure such as, "The doctor needs to look at your blood to see why you are sick; it will only hurt for a second." The nurse needs to let the child know you understand how difficult it is to agree to the procedure. Saying that the procedure does not hurt is not being truthful. Asking the patient to hold still does not provide enough of an explanation about the venipuncture. Saying that the technician is going to draw the blood and that it will only hurt for a minute does not explain why the blood is needed.

A 4-year-old child is being prepared to undergo a bronchoscopy to remove an aspirated pea. The nurse knows that the parents need reteaching based on which statement?

"We will be able to take our child home immediately after the procedure is completed." The child will not leave immediately. Procedural complications are not common but may include compromise to the airway such as hemorrhage, pneumothorax, and airway edema. After the procedure, the nurse will need to continue to assess the child's respiratory function and airway patency. Postprocedure complications may include bronchospasm, stridor, desaturation, or respiratory distress. The nurse will observe children carefully the first time they drink after the procedure to assess that their gag reflex is intact and they do not choke. All of the other options are correct.

A nurse is teaching the parents of a preschool-aged child how to collect a stool specimen at home for ova and parasites? The nurse determines that the teaching was successful based on which statement?

"We will take the specimen to the laboratory immediately."

Jacket restraints

- are used to secure the child from climbing out of bed or a chair, or to keep the child in a horizontal position. Make sure it is the right size. Ties secured to the bed frame.

heat therapy

- increases circulation by vasodilation and promotes muscle relaxation and pain relief. -also speeds the formation and drainage of superficial abscesses.

cold therapy

- reduces body temp, prevents swelling, controls hemorrhage, and provides an anesthetic effect. -Intervals of 20 minutes for both dry and moist -Provider must order the use of cold applications -Inspect child's skin before and after application -Document the application type, start time, therapy duration, and the skin's condition before and after the application -Procedure manual

Urine specimens

- sterile cotton balls can be placed in the diaper of the infant, then squeezed to collect urine for many urine tests. -when requesting a specimen, use the word the child knows to identify urination, such as "Pee-pee" or "potty" so the child will understand/ -offer fluids to 15-20 mins before collection to toddlers and young children. -offer privacy to the older child and adolescents.

Moist heat

-- produces faster results than dry heat. Warm compress or soak (do use micowave).

Gastrostomy feeding

--Surgically inserted through the abdominal wall into the stomach --Used in children who must receive tube feedings over a long period of time --Meticulous care of the wound site is necessary to prevent infection and irritation --Gastrostomy button may be inserted (figure 30-5) --Aspirate, measure, and replace the residual stomach contents at the beginning of the procedure. Elevate head and shoulder's during the feeding. --Following the feeding, flush the tube with water to clear the tubing and prevent the feeding solution from occluding the tube --After each feeding, place the child on the right side or in Fowler's position --Continuous feedings may be given during the night to allow for less restricted daytime activities

Data Documented During Gavage Feedings

--The type and amount of contents aspirated by the nurse --Measure stomach contents and replace --The amount of feeding given and type of formula given --Feeding should take 15 - 20 minutes, burped, then positioned on the right side for a least 1 hr. to prevent aspiration --The child's tolerance for the procedure

Intake and output measurements

-Accurately measuring and recording intake and output are especially important Oral fluids, feeding tube intake, IV fluids, and foods that become liquid at room temperature (e.g., frozen foods such as popsicles) are all measured and recorded as intake Urine, vomitus, diarrhea, gastric suctioning, and any other liquid drainage are measured and considered output Document color and characteristics Weigh diapers Monitoring and documenting the intake of fluids and nutrients Providing nourishment by means of gavage feedings or enteral tube feeding Gastrostomy feeding

performing procedures related to eliminations

-Administering an enema to a child as a treatment or as a preoperative procedure -when a child has a colostomy, ileostomy, you may care for the ostomy site and document the output from the ostomy.

Holding

-Child needs to feel safe and secure. -3 most common methods of holding a child -Horizontal position -Upright position -Football hold -Always support the infant's head and back

Types of ostomies

-Colostomy -Ileostomy -Urostomy

Ensuring legal and safety factors are enforced

-Ensuring an order is written for the procedure -Identifying the child before any treatment or procedure.check the child's ID band. -follow institutions policies and if consent is needed, see if the form is completed, signed, and witnessed -Performing handwashing -Following standard precautions

Providing psychological or emotional support

-Explaining the procedure and encouraging questions -Providing comfort to the child and caregivers -Explain the procedure to the child in a manner appropriate for the child's age and level of development -Encourage the child to ask questions and give complete answers -Toddlers understanding will be limited -Use diversion -Allow to cry

transporting

-In OB/NN infant must be transported in crib. - Toddler may be transported in a crib with high rails. -Strollers or wc when able to sit up. - Older children transported on stretchers or in their beds. - the sitting position for burping an infant.

The Nurse's Role Following Procedures

-Leave child in a safe position (siderails up, bed lowered), for older child-leave call light within reach. -Comfort and reassure the child -Answer caregiver questions -Remove and dispose of equipment and supplies properly -Label, prepare, and document specimens according to agency policy -Document the procedure and the child's response

Using methods to reduce fever (safety: prevent febrile seizures)

-Maintaining hydration by encouraging fluids -Administering acetaminophen -closely monitor the child's temp by checking frequently, document child's baseline temp and additional temp measurements, as well as information regarding the child's response to the treatment.

Types of Restraints Used for Proceduresexamples on page 665

-Mummy restraints -Papoose boards -Clove hitch restraints -Elbow restraints -Jacket restraints

performing procedures for specimen collection

-Nose and throat specimens -urine specimen -stool specimen

enema administration

-Nurse needs to hold buttocks of infant or young child in order to retain and be effective. -with explanation, the older child can usually hold the solution. -used for treatment for some disorders, or before a diagnostic test or surgical procedure. -important to discuss the procedure with the child before giving the enama.

Using restraints

-Often needed for protection -Should never be used as a form of punishment -Joint Commission's guidelines and standards for the use of restraints must be followed -many facilities require a written order and have a set procedure of releasing the restraint at least every 2 hours and document this and any findings. -Restraining by hand best method

control the environmental factors

-Removing excess blankets and clothing -Lowering the room temperature -apply cool compresses to the forehead -Tepid sponge baths no longer advised. -If shivering, stop procedure. Could increase child's temp.

Performing Procedures Related to Position

-Safety is the most important nursing responsibility when performing procedures related to positioning a child -the child's safety and comfort must be a priority when using restrainsts or transporting children -safety is also an important when holding, transporting, or positioning children for sleep

cooling devices

-Using cooling devices such as hypothermia blanket or pad. -Blanket is always covered before being placed next to the child's skin so moisture can be absorbed from the skin.

types of diagnostic testss and studies

-X-rays -Arteriograms -Computed tomography (CT) scans -Intravenous pyelograms -Bone or brain scans -Electrocardiograms (EKGs) -Electroencephalograms (EEGs) -Magnetic resonance imaging (MRI) scans -Cardiac catheterizations

preparation for procedures

-an inportant role in preparation is supporting the child and family. -it is also important to follow the facility's policies to ensure that legal requirements and safety precautions are met.

Crib top restraints

-are clear plastic coverings attached to the top of the crib. This type of restraint is used for older infants and toddlers who are able to stand and climb to prevent them from climbing over the side of the bed and falling (picture of crib top restraint on page 665)

Stool specimens

-are tested for various reasons, including the presence of occult blood, ova and parasites, bacteria, glucose, or excess fat. -must not be contaminated with urine -must be labeled and delivered to the lab promptly. -document the time of specimen collected, stool color, amt, consistency, and odor, the test to be performed, and skin condition - Easy to perform on infants and very young children in diapers. -May be embarrassing for older and adolescent child.

Oxygen tent/croupette

-equipment does not come in contact with the face. -allows for movement inside -difficult to see child in tent, difficult for the child to see outside the tent, child feels isolated, change clothing and linens often. and keep side rails up.

Nasal/oral suctioning

-excess secretions can pbstruct infant's or child's airway, decrease resp function. -Use a bulb syringe to remove secretions from the mouth, then nose -sterile NS drops may be used to loosen dried nasal secretions. -Nasotracheal suctioning with a sterile suction catheter may be needed if secretions cannot be removed by other methods

performing procedures related to circulations

-heat therapy- artificial therapy, moist heat, and dry heat. -cold therapy-dry cold, moist cold -after a provider has written an order for heat or cold therapy, you are responsible for applying treatment, closely monitoring the effects of the treament, and documenting those observations.

Nose and throat specimens

-help diagnose infection -Procedure --Swab back of nose or throat --Swab placed in culture tube --Transported to lab -If epiglottitis is suspected, a throat culture should not be done because of possible trauma and airway occlusion.

Gavage feeding-also called enteral tube feeding

-infants who have had surgery or a chronic or serious condition are unable to take adwquate food or fluid by mouth. -Can be intermittant (bolus feeding) or continuous -If gavage or enteral feedings are not well tolerated, report it and await alternate orders from the provider --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. What is the proper verification process?

performing procedures related to fedding and nutrition

-intake and output measurements -Gavage feeding -Gastrostomy

clean catch

-is needed for a culture. -older child may be able to cooperate -instruct the child as to the procedure so he/she understands -the genital area is cleaned , the child urinates in small amt, stops the flow, then continues to void into the specimen container

Tracheostomy care

-is performed in emergency situations or in conditions in which an infant or child has a blocked airway. -Tracheostomy tube is suctioned to remove mucus and secretions and to keep the airway patent -trach tubes must be cleaned to decrease infection -care of skin to prevent skin breakdown. -Tracheostomy prevents the child from being able to cry or speak, so monitor closely, and find alternative methods of communicating with the child.

Dry heat

-k pad circulates warm water through plastic tubing. -Should be covered with pillowcase. -Hot water bottles not recommended -document application type,start time, therapy duration, and skin's condition before and after the applicant.

oxygen safety

-keep equipment clean, dirty equipment can be a source of bacteria. -use signs noting that O2 is in use. -Give good mouth care, use swabs and mouth wash.. -offer fluid frequently. - keep nose clean -don't use electric or battery powered toys -don't allow smoking, matches, or lighters nearby -don't keep flammable solutions in the room -don't use wool or synthetic blankets.

methods of oxygen administration

-nasal prongs/cannula -Mask -Hood -Oxygen tent/croupette -tracheostomy

performed procedures related to respirations

-oxygen administration -Nasal/Oral suctioning -Tracheostomy

blood collection

-pricking the Heel, great toe, earlobe or finger for a blood specimen. -Venipuncture infants: scalp veins, jugular vein or femoral vein used. - In older children the veins in the arm are used. -Usually done by lab personnel or physician, but nurse asked to assist. -Explain procedure in age appropriate manner Holding or restraining a child during a blood test

Artificial heat

-should never be applied to the child's skin without a specific order -tissue damage can occur in those with sensory loss, or impaired circulations. -20 minutes at a time -Monitor closely --Document the application type, start time, therapy duration, and the skin's condition before and after the application

lumbar puncture

-when analysis of cerebrospinal fluid is necessary. -tell the child,that it is important to hold still. -Restraining a child in the proper position for a lumbar puncture, until the procedure is complete. -Child must remain quiet for 1 hour after the procedure -Document -monitor Vital signs -Level of consciousness -Motor activity frequently for several hours after the procedure

At what time interval should a cold compress be applied?

20 Minutes

A nurse has just received an order to apply an ice bag to a patient's groin. Which of the following intervals for placement of the ice bag does the nurse plan to use?

20 minutes

Ileostomy

A similar opening in the small intestine (contains digestive enzymes) -the stoma must be fitted with the collective device to prevent skin irritation and breakdown. -preventing skin breakdown is a priority

Which location should the nurse observe when measuring the respiratory rate of an infant?

Abdominal region

What can be used to reduce a fever?

Acetaminophen (Tylenol) or ibuprofen for a fever >101F. DO NOT give aspirin for a fever. Lightweight clothing & remove blankets (Removing excess coverings allows for evaporation, which aids in cooling the child). Cool cloth. Ice water. Tepid sponge baths are no longer recommended (Shivering means the child is chilling, which will cause the body temperature to increase.).

Which situations would the nurse allow the adolescent to sign the consent?

The nurse is caring for a minor who wishes to sign the informed consent instead of the parents. In which situations would the nurse allow the adolescent to sign the consent? Select all that apply.

Adolescent is married. Adolescent is serving in the armed forces. There is an emergent or life-threatening situation. Legal emancipation has been documented. Minor is sexually active and seeking prenatal care Foster parents would be considered legal guardians, so they would be required to sign the consent form. In the other listed situations, the minor is considered emancipated and able to provide informed consent for health care needs.

A child is prescribed several diagnostic procedures. How can the nurse advocate for this client?

Advocate for procedures to be separated to allow time for food and rest. Whenever possible, try to arrange time for meals, rest, and play between procedures to prevent fatigue. If food or fluid is restricted, then it is best to decrease time between procedures. It is best for the parent to accompany the child to the procedures, but if the parent is not able to, then it is optimal to have the nurse present. Painful procedures might be done under moderate sedation, but not all procedures will require general anesthesia.

An infant is scheduled to have a painful procedure performed. Which nursing action provides the best support for the parents and infant?

Allow the parents to hold the infant during the procedure. It is important for the nurse to advocate for parents to remain in the procedure room to provide support to the infant. The parent may choose to hold the infant during a painful procedure, but it is best that the parent not restrain the procedure. Their role should be supportive and comforting, not one that causes pain. Having the parents remain outside the room leaves the infant without needed support. Infants experience pain but express it differently than adults.

position for sleep for infants --ABC

Alone Back Crib

A nursing student is learning how to insert and administer enteral feedings through a nasogastric (NG) tube. The student identifies the best way to check placement before each feeding as which of the following?

Aspirating stomach contents and checking pH

A preschool child has been admitted to the hospital. Which prescription should the nurse question? A. NPO B. tap water enema 500 ml C. nasogastric tube to suction D. IV normal saline 25 ml/hour

B. tap water enema 500 ml (Tap water is not used in enemas with children because, as it is not isotonic, it causes a rapid shift of fluid in body compartments, possibly leading to water intoxication. The nurse would want to question the health care provider about the prescription for a large tap water enema. The other prescriptions could be completed safely for a preschool-age child.)

At what age is blood pressure assessed?

Beginning at 3 years of age, children should have their blood pressure measured

After inserting a nasogastric tube (NG) into a young child, how will the nurse tape the tube in place?

Below nose and to cheek

Colostomy

Bringing a part of the colon through the abdominal wall to create an outlet for fecal material elimination -can be temporary or permanent

After a gavage feeding has been completed for a young infant, the nurse will encourage the parent to take what action?

Burp the infant

ostomy care

Caring for an ostomy site and documenting the output from an ostomy Preventing skin breakdown is a priority -Check ostomy bags frequently for leakage, empty when needed, and change bags when needed -review and follow institution procedures -Document output

A child has been admitted to the pediatric unit with an oral temperature of 102° F (38.9° C). acetaminophen (Tylenol) has failed to control the fever. The nurse knows that she may utilize which of the following therapeutic modalities? (Select all that apply.)

Cooling blanket Hydration Lightweight clothes Cool room

How will the nurse collect a urine specimen from the infant who has significant skin irritation in the perineal area?

Cotton balls placed in the diaper will readily absorb urine, which can be squeezed with gloved hands into the specimen container

Urostomy

Created to help in the elimination of urine

The nurse will apply which type of restraint for the infant recovering from cleft lip repair?

Elbow

The nurse will apply which type of restraint for the infant recovering from cleft lip repair?

Elbow The reason for the restraint is to keep the infant from touching the lip and interfering with healing. The elbow restraint will do this while allowing all other movement. This device is the least restrictive while promoting safety. The other restraints would not be effective.

A nurse is starting an intravenous (IV) line in the antecubital fossa of a small child. What restraint would be best for the nurse to use to maintain patency of the IV?

Elbow restraint Elbow restraints are wrapped around the child's arm and tied securely to prevent the child from bending the elbow. They are often made of muslin or other materials in two layers. Pockets wide enough to hold tongue depressors are placed vertically in the width of the fabric. The top flap folds over to close the pockets. Care must be taken to ensure that the elbow restraints fit the child properly.

Following the repair of a cleft palate, the nurse places an 18-month-old child in restraints. The caregivers are with the child and will stay in the room at all times. Which of the following types of restraints would the nurse most likely use for this child?

Elbow restraints

How will the nurse properly collect and care for the child's 24-hour urine specimen?

Empty each void into a designated container that keeps the urine cool The 24-hour urine collection is cumulative over this time period and is sent to the laboratory when complete. The urine is kept cool to keep the bacterial count to a minimum. Sterile collection procedures are not needed. Hydration of the child should reflect the youngster's norm. Pushing clear fluids is not necessary.

The nurse is reinforcing teaching with a group of caregivers regarding steps that can be taken to lower a child's elevated temperature. Which action would the nurse include in the discussion? Select all that apply

Encourage fluids. Administer acetaminophen. Lower the room temperature. Methods used to reduce fever include maintaining hydration by encouraging fluids and administering acetaminophen. Keep room environment cool. Dress the child in lightweight clothing. Because of their ineffectiveness in reducing fever and the discomfort they cause, tepid or lukewarm sponge baths are no longer recommended for reducing fever.

A 13-month-old is having a dressing changed on a packed leg wound. Which action from the parents should be encouraged by the nurse during the treatment?

Encourage the father to talk quietly to the child. The role of a parent during treatments and procedures should be one of support and comfort.

The nurse is about to place a gastostomy tube in an infant. After gathering supplies, what is the first step in the procedure?

Explain the procedure to the parents.

The nurse is about to place a gastrostomy tube in an infant. After gathering the supplies, which is the first step in the procedure?

Explain the procedure to the parents. The procedure should be explained to the parents first. The nurse then proceeds with hand washing and commences the procedure.

The Nurse's Role in Performing or Assisting With Procedures

Following guidelines set by the health care institution including: -The preparation before the procedure -The follow-up needed when the procedure is completed -Ensuring patient safety before, during, and after all procedures and treatments

When the nurse is holding an infant, what positions are the most common methods are used? (Select all that apply.)

Football hold Horizontal position Upright position

A 6 year old has just returned to his room after a spinal tap. What could the nurse do to make this unpleasant procedure less memorable for the child?

Give him a little toy that he has been wanting.

When an infant is scheduled for a painful procedure, what is the most important action by the nurse?

Help to soothe and comfort the baby before and after the procedure Infants undergoing procedures can experience pain. Thus, the important action is to help soothe and comfort the child before and after the procedure. The nurse should explain everything to the care provider, but the patient's comfort in this case is the highest priority.

TPN

Highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. Provides all nutrients to meet a child's needs. Via central venous access to allow rapid dilution of hypertonic solution. Feed the child continuously throughout the night using a feeding pump. Regularly monitoring the child's blood glucose.

A nurse is caring for a 14-year-old with a gastrostomy tube. The girl has skin breakdown and irritation at the insertion site. Which would be the most appropriate method to clean and secure the gastrostomy tube?

If any drainage is present, use a presplit 2 × 2 and place it loosely around the site.

A nurse is preparing to apply heat therapy to a client who has a back abscess. Heat has which of the following benefits? Select all that apply.

Increases circulation Promotes muscle relaxation Causes vasodilation Local application of heat increases circulation by vasodilation and promotes muscle relaxation, thereby relieving pain and congestion. It also speeds the formation and drainage of superficial abscesses.

A nurse will explain to a child's caregiver any procedure that is to be done. What is the primary reason for this explanation?

It helps to reduce anxiety. Although it is a patient's right to know everything about his or her care, in this case the caregiver is not the patient. Communication helps to develop rapport and trust, but the main purpose of explaining procedures to the caregiver of a child is to reduce anxiety. Doing this also will help decrease the child's anxiety.

How should a stool sample be collected?

Keep urine from contaminating stools

Lower the room temperature. Administer acetaminophen. Encourage fluids. Methods used to reduce fever include maintaining hydration by encouraging fluids and administering acetaminophen. Keep room environment cool. Dress the child in lightweight clothing. Because of their ineffectiveness in reducing fever and the discomfort they cause, tepid or lukewarm sponge baths are no longer recommended for reducing fever.

How will the nurse determine the length of orogastric tubing needed to gavage the 14-month-old infant?

Measure from nose tip to earlobe to end of sternum

How will the nurse determine the length of orogastric tubing needed to gavage the 14-month-old infant?

Measure from nose tip to earlobe to end of sternum Measuring from the tip of the infant's nose to the earlobe and then to the end of the sternum determines how far the orogastric and nasogastric tubes should be inserted for an infant over age 12 months. Measuring bridge of nose to xiphoid or mouth to umbilicus is not an accurate way to determine length of tube insertion. The tip of the nose to the earlobe to halfway between the end of the sternum and the umbilicus is used for infants younger than 12 months of age.

A nurse is preparing to insert a nasogastric (NG) tube in an infant. How will the nurse determine the appropriate length of tubing to use for the infant?

Measure from the tip of the child's nose to the earlobe down to the tip of the sternum. The nurse determines the length of tubing to use by measuring from the tip of the child's nose to the earlobe, and from the earlobe down to the tip of the sternum.

Using restraints

Mechanical restraints must be used to secure a child during IV infusions; to protect a surgical site from injury, such as cleft lip and cleft palate; or when restraint by hand is impractical

Mummy restraints

Mummy restraints are snug wraps used to restrain an infant or small child during a procedure (scalp IV, NG tube insertion)

The floor nurse is making rounds on her clients and discovers that an 8-month-old admitted with pneumonia has an oxygen saturation of 91% on room air. The physician has standing orders to keep saturations at 96% or above. Which oxygen delivery system would the nurse choose for this client?

Nasal cannula For infants and older children, the nasal cannula is the most appropriate oxygen delivery system for this oxygenation level. It is the less invasive and most comfortable for the infant. A face mask or a non-rebreather mask are used if the nasal cannula is not successful in keeping the infant's oxygen saturations within the set parameters. Oxygen tents are rarely used due to the difficulty in maintaining a constant O2 level in the tent.

The nurse is caring for an 11-year-old admitted with a respiratory condition. Which of the following methods of oxygen administration would likely be used for this child?

Nasal prongs

The nurse is caring for an 11-year-old admitted with a respiratory condition. The child requires occasional administration of low-flow oxygen. Which of the following methods of oxygen administration would likely be used for this child?

Nasal prongs Depending on the child's age and oxygen needs, many different methods are used to deliver oxygen. Nasal prongs or a nasal cannula are used appropriately for an 11-year-old child, especially if the child has modest needs for supplementation.

The nurse is caring for an 11-year-old admitted with a respiratory condition. The child requires occassional administration of low-flow oxygen. Which of the following methods of oxygen administration would likely be used for this child?

why is a neonate's gavage tube was placed through the mouth?

Neonates are nose breathers, so tube in one naris will partially occlude it.

Parents asks the nurse why their premature infant is receiving a feeding through the mouth rather than the nose. What is the best explanation by the nurse?

Newborns are obligate nose breathers so nasogastric may obstruct their breathing. Whether enteral catheters should be passed through the nares or the mouth is controversial. Because newborns are obligate nasal breathers, passing a catheter through the nose may obstruct their breathing space, and repeated insertion of a nasal gastric tube can cause inflammation and obstruction of the nose; thus most tubes are inserted orally in small infants. Orogastric insertion can also decrease the possibility of striking the vagal nerve in the back of the throat and causing bradycardia, whereas nasogastric tubes increase the possibility of striking the vagal nerve.

Administering oxygen

Note methods of O2 administration on page 670 Note oxygen safety p. 671 Types of oxygen deliver for infants and children depends on their age. Infants: isolette or incubator. Older children: nasal cannula, mask, oxygen tent. Tent can be frightening. Performing nasal and oral suctioning (HINT: MN) Caring for a tracheostomy

A nurse receives a physician's order to collect a specimen for the diagnosis of respiratory syncytial virus. How should the nurse collect this specimen?

Obtain a nasal washing. To diagnose respiratory syncytial virus, a nasal washing may be done. A small amount of saline is instilled into the nose; then the fluid is aspirated and placed into a sterile specimen container.

A nurse inserts a nasogastric (NG) tube into a child for enteral feeding. How will the nurse ensure appropriate placement of the tube after insertion?

Obtain radiologic confirmation.

A nursing instructor is discussing oxygen therapy with a group of pediatric nursing students. Which of the following statements made by one of the students indicates a need for further teaching?

Oxygen should be removed immediately upon receiving the physician's order to stop therapy.

A nursing instructor is discussing oxygen therapy with a group of pediatric nursing students. Which of the following statements made by one of the students indicates a need for further teaching?

Oxygen should be removed immediately upon receiving the physician's order to stop therapy. Oxygen should be weaned or removed slowly.

The nurse is caring for a client needing oxygen. Many forms of oxygen delivery can be used. Which of the following is the most difficult to manage the oxygen concentration?

Oxygen tent

The nurse is caring for a client needing oxygen. Many forms of oxygen delivery can be used. Which of the following is the most difficult to manage the oxygen concentration?

Oxygen tent It is most difficult to manage the oxygen concentration in a tent because it is opened frequently.

A nurse is preparing to assist a physician to suture a scalp laceration for a toddler. Which restraint would be most appropriate to use for this procedure?

Papoose board

papoose boards

Papoose boards are similar restraints used for toddlers or preschoolers (sutures)

A child is receiving continuous tube feedings via a gastrostomy tube. The nurse needs to administer medication via the tube. After preparing the medication, what action should the nurse take next?

Pause or stop the feeding. Administering medications via a gastrostomy tube when continuous feedings are running requires the feeding pump to be paused or stopped. If not, the medications will be pushed into the formula tubing and not into the stomach. This means the medication will only be delivered at the rate the feeding is running. The medication could take several hours to completely enter the stomach. Checking for placement with pH paper and checking the amount of residual is important but not the first action. The tubing should be flushed with water prior to the medication administration, but this not the first action.

Which intervention should the nurse use when collecting a urine specimen from an 8-month-old client?

Place a urine collector on the baby just prior to feeding An infant who has not been toilet trained cannot be expected to urinate on command so a collecting device must be attached to the genitalia to collect their next voiding. Most infants void shortly after a feeding, so if the collector is applied just before a regular feeding, voiding will probably result soon afterward. Remove the collector as soon as the infant voids and transfer the specimen to a specimen cup by cutting a bottom corner of the bag. Waiting an hour after a feeding might not produce the needed urine for the specimen. It would be difficult to obtain a clean-catch specimen from a baby. It is inappropriate to send a saturated diaper to the laboratory for a urine specimen.

A novice nurse is instructed to collect a urine specimen from a 3-week-old. Which method of collection would an experienced nurse suggest first?

Placing cotton balls in the diaper and squeezing out urine To collect a urine specimen from an infant, the nurse places cotton balls in the diaper and squeezes urine from the cotton ball. Catheterization is not recommended. A pediatric urine bag is used with older infants and toddlers. A midstream specimen would not be possible to collect in an infant.

A child has been admitted to the pediatric unit with vomiting and diarrhea. The physician orders strict monitoring of intake and output. The mother asks the nurse what fluids she will need to measure. The nurse responds that fluid intake can include which of the following? (Select all that apply.)

Popsicles Gatorade Jello IV fluids

Restraints: Elbow restraints

Prevent. the child from touching the head or face. Long sleeves to prevent irritation. Secure velcro strips. Assess fingers for circulation.

Restraints: Wheelchairs & carts

Promote safety while transporting the child to & from a healthcare facility. Vest restraint. Never leave unattended.

A pediatic client is having difficulty breathing. Which nursing intervention is appropriate for this client?

Provide oxygen as needed to maintain oxygen saturation above 93% The nurse would provide oxygen to increase oxygen saturation as needed for this child. A decrease in oxygen saturation will cause the child to have an increase in the work of breathing. The positioning does not promote an open airway. Having family members leave the room could increase the child's anxiety, which would worsen the respiratory status. Continuing to monitor the child provides no assistance or relief.

Restraints: Jacket restraints

Restrain children <6 months in a supine position. Fasten ties at back of jacket & connect to under mattress. Check to make sure not blocking airway.

Colin, age 1, has been admitted for an injury on his head that requires sutures to be placed. He is crying and trying to sit up when he is placed on the examining table. To keep him safe during the procedure, the nurse would choose which method to restrain him?

Restrain him with a mummy restraint and release it as soon as the procedure is completed Restraints often are needed to protect a child from injury during a procedure or an examination, or to ensure the infant's or child's safety and comfort. A mummy restraint can be used for an infant or small child during a procedure. This device is a snug wrap that is effective when performing a scalp venipuncture, inserting a nasogastric tube, or performing other procedures that involve only the head or neck.

One-year-old Colin has been admitted for an injury on his head that requires sutures to be placed. He is crying and trying to sit up when he is placed on the examining table. To keep him safe during the procedure, the nurse would choose which of the following methods to restrain him?

Restrain him with a mummy restraint and release it as soon as the procedure is completed.

Restrain him with a mummy restraint and release it as soon as the procedure is completed. Restraints often are needed to protect a child from injury during a procedure or an examination, or to ensure the infant's or child's safety and comfort. A mummy restraint can be used for an infant or small child during a procedure. This device is a snug wrap that is effective when performing a scalp venipuncture, inserting a nasogastric tube, or performing other procedures that involve only the head or neck.

The nurse aspirates stomach contents before administering a nasogastric (NG) tube feeding. How will the nurse manage the aspirate? Select all that apply.

Return the aspirate to the stomach Determine the pH of the aspirate Record the amount of the aspirate Discarding the aspirate would deprive the child of both electrolytes and nutrients. The aspirate should not be discarded. The other measures are the ones to be used.

The nurse aspirates stomach contents before administering a nasogastric (NG) tube feeding. How will the nurse manage the aspirate? Select all that apply.

Return the aspirate to the stomach Determine the pH of the aspirate Record the amount of the aspirate

How will the nurse manage the aspirates of stomach contents before administering a nasogastric (NG) tube feeding?

Return the aspirate to the stomach. Determine the pH of the aspirate. Record the amount of the aspirate.

The nurse wishes to promote gastric emptying after administering the preschooler's gastrostomy feeding. Which position will facilitate this?

Right side-lying

Restraints: Clove-hitch restraints

Secure one arm or leg for a procedure. Disposable restraints like gauze, or muslin tape (will "give" a little). Fold several layers of gauze for cushion.

A nurse is unsure whether the nasogastric (NG) tube just placed is properly positioned in the child's stomach. How can the nurse most accurately verify the location of the tube?

Seek radiologic confirmation

How will the nurse properly collect and care for the child's 24-hour urine specimen?

Sent to the laboratory when complete. The urine is kept cool to keep the bacterial count to a minimum. Sterile collection procedures are not needed. Hydration of the child should reflect the youngster's norm. Pushing clear fluids is not necessary.

An older school-aged child is taught to apply warm, nonsterile compresses to an inflamed area on one leg. Which suggestion by the nurse will increase the effectiveness and safety of the child's self-care?

Set a timer for not longer than 20 minutes as a removal reminder Applying the compress for 20 minutes is the safe and therapeutic method. More lengthy application reverses the desired vasodilation. A microwave should not be used to heat the compress owing to the risk for uneven heating and burns. A hot water bottle increases the risk for burns.

An older school-age child is taught to apply warm nonsterile compresses to an inflamed area on one leg. Which suggestion by the nurse will increase the effectiveness and safety of the child's self-care?

Set a timer for not longer than 20 minutes as a removal reminder.

The nurse should consider which stool sample collected from a child as contaminated and not acceptable for analysis?

Stool removed from surrounding urine

A nurse is administering a bolus nasogastric (NG) feeding to a child who begins gasping, coughing, and developing cyanosis. What is the first action that the nurse should take after this observation?

Stop the feeding and withdraw the tube.

A nurse working with a patient who has an elevated temperature notices that the child is beginning to shiver. Which of the following should the nurse do immediately?

Stop whatever intervention is being done to lower the temperature Removing clothing and excess covering from a child with a fever permits additional cooling through evaporation. If a child starts 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.

Restraints: Mummy or blanket restraints

Temporarily immobilize young children for a procedure involving the head, neck, or throat. Only temporary (total restraint). Safety pins can be used for strength.

An adolescent is scheduled to have the present gastrostomy tube replaced with a gastrostomy button. What advantage of the button over the tube will the nurse emphasize?

The button will be smaller and less visible when not in use. The button is a skin level device that is not visible under clothing when not in use. It is accessed easily with a special tube. Residual is aspirated and flushing regularly done. Replacement is needed on a regular basis. The button is more expensive than a simple gastrostomy tube.

A child has returned to the unit after having a lumbar puncture. Which instructions are important for the nurse to provide the parents and child?

The child will need to remain flat to prevent a headache. After a lumbar puncture, remind children to remain quiet and with their head flat to help prevent a post dural puncture headache. Typically, children will not be fearful of staff nor will the child be up ambulating until later. The procedure should not need to be repeated in 24 hours.

The nurse is preparing a 7-year-old child for surgery. Which of the following nursing interventions is the highest priority?

The nurse should follow the facility's policies.

The nurse is preparing a 7-year-old child for surgery. Which nursing action is the highest priority?

The nurse should follow the facility's policies. It is important to follow the facility's policies to ensure that legal requirements and safety precautions are met. Explaining the prognosis or risks and benefits of surgery is not normally the role of the nurse. The child does not likely need teaching about the detailed approach to pain management postoperatively.

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?

The nurse should measure and replace the residual stomach contents.

A child has been admitted to the pediatric unit with diarrhea. The nurse must collect a stool specimen for ova and parasites. The nurse knows that the proper procedure must be followed for detection of the ova and parasites. The proper procedure includes:

Transport the stool specimen to the laboratory promptly. The stool specimen must go to the laboratory immediately so that it does not have to be redone. Refrigeration destroys ova and parasites. Urine should not be in contact with the stool, and the stool needs to be in a clean container. Stools are collected from diapers as well as bedpans.

The nurse finds an elevated temperature in a blanket-wrapped infant a mother is holding and rocking. What first temperature reduction measure will the nurse take?

Unwrap the infant and place the child in the crib

You are caring for a four month old infant who is running fever. The mother questions what can be done to get the child's temperature down. Which of the following are acceptable methods to manage fever in an infant. Select all that apply.

Use a hypothermic blanket Encourage the infant to drink fluids Use acetaminophen or other antipyretics Prevent overdressing the infant

You are caring for a 4-month-old infant who is running fever. The mother questions what can be done to get the child's temperature down. Which of the following are acceptable methods to manage fever in an infant? (Select all that apply.)

Use a hypothermic blanket. Encourage the infant to drink fluids. Use acetaminophen or other antipyretics. Prevent overdressing the infant.

The nurse notes that parents accompanying their child for a procedure appear tense and nervous. What intervention by the nurse will best assist the young child to relax?

Use measures to reduce the parents' anxiety

The nurse notes that parents accompanying their child for a procedure appear tense and nervous. What intervention by the nurse will best assist the young child to relax?

Use measures to reduce the parents' anxiety. Reducing the parents' anxiety will also reduce the child's anxiety. Anxious parents transmit their anxiety to the child and are less effective in providing support. The other nursing interventions are helpful, but relaxed parents are the key.

`The nurse is administering a prescribed bolus gavage feeding. Which action would be incorrect in performing this procedure?

Verify placement by auscultating for sounds in the stomach when air is inserted. Auscultating for sounds when air is injected into the stomach is no longer considered recommended for verifying tube placement because it has been found unreliable as a confirmation of position.

A young preschooler who has been playing in the hospital playroom needs transportation to the imaging department. What conveyance will the nurse choose?

Wagon

A young preschooler who has been playing in the hospital playroom needs transportation to the imaging department. What conveyance will the nurse choose?

Wagon The best choice is the wagon. It is familiar to the child, is nonthreatening, and continues the playroom fun. The other, more adult-like methods may be used to transport children as condition and treatment regimens require

The nurse is caring for a breastfed infant hospitalized for gastroenteritis. Which method can be used to most accurately measure intake?

Weigh the infant before and after feeding and subtract weight. Intake in breast-fed infants is generally recorded as "breast-fed for X minutes." If it is necessary to estimate the amount more closely than this, an infant can be weighed before and after a feeding. The difference in weight (measured in grams) is calculated to establish the number of milliliters of breast milk ingested (1 g = 1 ml). Weighing the infant before and after feeding is the most accurate method for strict intake. Comparing to a bottle-fed infant is inaccurate and therefore not correct.

The nurse is caring for a breastfed infant hospitalized for gastroenteritis. What method can be used to most accurately measure intake?

Weigh the infant before and after feeding and subtract weight. Intake in breastfed infants is merely recorded as breastfed for however many minutes. If it is necessary to estimate the amount more closely than this, an infant can be weighed before and after a feeding. The difference in weight (measured in grams) is calculated to establish the number of milliliters of breast milk ingested (1 g = 1 ml). Weighing the infant before and after feeding is the most accurate method for strict intake. Therefore, it is possible to get an accurate intake measurement. Comparing to a bottlefed infant is inaccurate and therefore not correct.

A nurse is caring for a hospitalized infant being treated for dehydration. What does the nurse need to do to measure the output when the child is wearing a diaper?

Weigh the wet diaper and subtract the weight of a dry diaper; the difference is the amount to record

How will the nurse measure urine output in the hospitalized toddler who is partially potty trained?

Weigh the wet pull-up or diaper and subtract the weight of a dry diaper

Clove Hitch restraints

are used to secure an arm or leg, most often when a child is receiving an IV infusion. The restraint is made of soft cloth formed in a figure eight. Padding under the restraint is desirable if the child puts any pull on it. Loosen the restraint and check the site at least every 1 to 2 hours. Secure to the crib or bed, not the side rail

assisting with procedures related to diagnostic tests and studies

as the nurse, -Teaching and preparing the child and the caregiver -Requesting and scheduling the tests or studies -Completing required paperwork; ensuring consents are signed -Ensuring that NPO status is maintained -Clarifying and documenting any allergies -Supporting, comforting, and restraining the child -Performing and documenting care after the procedure

You have just inserted a nasogastric tube for an enteral feeding in a 6-month-old infant. The best way to assess whether the tube has reached her stomach is to:

aspirate the tube for stomach contents.

A pediatric nurse is teaching a class about SIDS to new mothers. Which of the following positions for sleep would the nurse emphasize for parents to use?

back or side

A pediatric nurse is preparing to use a jacket restraint with a client. After making sure it is the correct size and applying the jacket, the nurse will secure the ties to which of the following?

bed frame Jacket restraints are used to secure the child from climbing out of bed or a chair. Ties must be secured to the bed frame, not the side rails, so that the jacket is not pulled when the side rails are moved up and down.

moist cold

compress or soak,

An infant is admitted to the hospital for cleft palate surgery. The type of restraint you would use with the infant postoperatively would be

elbow restraints

hood

fits over head and neck of the child. -clear so child can be seen -might be frightening for the child

A pediatric nurse teaching a new mother how to hold the infant emphasizes the need to support which of the following? Select all that apply.

head back When a child is held he or she needs to be safe and feel secure. When holding an infant, always support the infant's head and back.

Dry cold

ice bag or commercial instant-cold pads -lightly cover, to protect the child's skin from direct contact. -because cold decreases circulation, prolonged chilling may result in frostbite ans gangrene.

A nurse is preparing to apply heat therapy to a patient who has a back abscess. Heat has which of the following benefits? (Select all that apply.)

increases circulation causes vasodilation promotes muscle relaxation

nasal prongs/cannula

many sizes available nasal prongs fit into child's nose -toddlers may pull out of nose- use other methods, - not humidified, keep nasal prongs clean and clear of secretions -monitor nostrils for irritations,

assisting with the procedures related to collection of blood and spinal fluids

one of your role is to assist with the procedure performed on children -might assist with the collection of blood samples or in holding and supporting a child during lumbar puncture.

A nursing student is instructed to collect a urine specimen from a 3 week old. Which of the following would be the nurse's best option?

placing cotton balls in the diaper and squeezing out urine

The nurse is caring for a child who has a gastrostomy tube in place. The nurse is about to give a feeding when it becomes evident that the tube is filled with dark brown fluid. The nurse's best action would be to:

report to the primary care provider that a complication may be occurring. A potential complication of gastrostomy tubes is that they may migrate through the pyloric valve into the duodenum and cause obstruction. Brown fluid suggests this has happened, because the tube is filled with feces. An alkaline pH suggests the complication has occurred, because bowel secretions are alkaline, while stomach secretions are acidic.

You obtain a stool specimen for ova and parasites. It would be important for you to

see that it arrives at the laboratory promptly.

A pediatric nurse is instructing a new mother on the best position to burp her infant after feeding. Which of the following positions does the nurse recommend?

sitting position

A preschool child has been admitted to the hospital. Which prescription should the nurse question?

tap water enema 500 mL Tap water is not used in enemas with children because, as it is not isotonic, it causes a rapid shift of fluid in body compartments, possibly leading to water intoxication. The nurse would want to question the health care provider about the prescription for a large tap water enema. The other prescriptions could be completed safely for a preschool child.

A preschool child has been admitted to the hospital. Which prescription should the nurse question?

tap water enema 500 ml Tap water is not used in enemas with children because, as it is not isotonic, it causes a rapid shift of fluid in body compartments, possibly leading to water intoxication. The nurse would want to question the health care provider about the prescription for a large tap water enema. The other prescriptions could be completed safely for a preschool-age child.

24-hour urine collection

the caregiver can often assist and should be instructed in the procedure. -the urine is kept on ice in a special bag or container during the collection time period. -at the end of the timed collection, the entire specimen is sent to the lab.

when the caregiver's anxiety and concerns decrease

the cild in turn will often have less anxiety,

if towels are used to provide moist heat

they should not be warmed in the microwave because the microwave may unevenly heat the towels, which in turn may burn the child.

collection bag

to collect a urine specimen from infant and toddlers who are not toilet trained. -for collection bag to stay in place, the skin must be clean, dry, free of lotions, oil and powder. -replace the child's diaper -remove the collection device as soon as the child voids.

catherization

to obtain a specimen, particularily if a sterile specime is required. -if an indwelling or foley catheter is left in place, the ballon is inflated, and a collection bag is attached.

Which of the following are situations that might warrant a restraint of a pediatric patient? (Select all that apply.)

to protect the child from injury during a procedure or examination to ensure the child's safety

tracheostomy

used in emergencies or when long-term o2 is needed. -must keep clean with airway patent , suction is needed.

mask

various sizes available -over mouth and nose, humidified, decreases dryness. not used in comatose children

A child is to receive an IV. The nurse knows that the first step in initiating the procedure is to:

verify the physician's order. The first step before beginning the procedure is to verify the physician's order. The other steps are necessary but are not the first step

A child is to receive an IV. The nurse knows that the first step in initiating the procedure is to:

verify the physician's order. The first step before beginning the procedure is to verify the physician's order. The other steps are necessary but are not the first step.

Elbow restraints

wrapped around the child's arm and tied securely to prevent the child from bending the elbow. Make sure not too high under the axillae. Used for cleft lip surgery or to prevent scratching the skin.

encourage fluids administer acetaminophen lower the room temperature

The nurse will apply which type of restraint for the infant recovering from cleft lip repair?

elbow

The nurse instructs the mother of a preschool-aged child on the use of ibuprofen prescribed for a temperature. Which statement indicates that the teaching has been effective?

"I should give this medication with food." Because ibuprofen can cause gastrointestinal irritation, it should be given with food or fluids. The medication dosage should be measured by using the device supplied with the medication and not using a kitchen spoon. Fluids should be encouraged when taking this medication because renal failure can occur if the child becomes dehydrated. If the child complains of a stomachache while taking this medication, notify the health care provider. This could be an indication of an adverse effect.

A nurse is teaching a parent ways to reduce fever in a child. What statement made by the parent would require further education?

"I will give my child a tepid sponge bath to reduce the fever."

A nurse is teaching a parent ways to reduce fever in a child. What statement made by the parent would require further education?

"I will give my child a tepid sponge bath to reduce the fever." Because of their ineffectiveness in reducing fever and associated discomfort, tepid sponge baths are no longer recommended for reducing fever.

"Shivering means the child is chilling, which will cause the body temperature to increase." Explanation:

"The doctor needs to look at your blood to see why you are sick; it will hurt for a second."

The nurse needs to obtain a blood sample from a 7-year-old child. How should the nurse explain this procedure to the client?

"The doctor needs to look at your blood to see why you are sick; it will hurt for a second."

The nurse is preparing to assist with a procedure on a child. The nurse states the child can pick a toy from the prize box after the procedure. The parent asks the nurse, "Are you trying to bribe my child?" Which response by the nurse is appropriate?

"We give rewards to help children remember the experience as not all bad."

A 4-year-old child is being prepared to undergo a bronchoscopy to remove an aspirated pea. The nurse knows that the parents need additional teaching based on which statement?

"We will be able to take our child home immediately after the procedure is completed." The child will not leave immediately. Procedural complications are not common but may include compromise to the airway such as hemorrhage, pneumothorax, and airway edema. After the procedure, the nurse will need to continue to assess the child's respiratory function and airway patency. Postprocedure complications may include bronchospasm, stridor, desaturation, or respiratory distress. The nurse will observe children carefully the first time they drink after the procedure to assess that the gag reflex is intact and they do not choke. All of the other options are correct.

A nurse has just received an order to apply an ice bag to a client's groin. Which of the following intervals for placement of the ice bag does the nurse plan to use?

20 minutes

A nurse has just received an order to apply an ice bag to a client's groin. Which of the following intervals for placement of the ice bag does the nurse plan to use?

20 minutes As with heat, a provider must order the use of cold applications. Intervals of 20 minutes are recommended for both dry and moist cold.

A nasogastric tube for enteral feedings has just been inserted in a 6-month-old infant. Which method would the nurse anticipate being used to confirm placement?

Have an abdominal X-ray completed

An infant is scheduled to have a painful procedure performed. Which nursing action provides the best support for the parents and infant?

Allow the parents to hold the infant during the procedure.

An infant is scheduled to have a painful procedure performed. Which nursing action provides the best support for the parents and infant?

Allow the parents to hold the infant during the procedure. It is important for the nurse to advocate for parents to remain in the procedure room to provide support to the infant. The parent may choose to hold the infant during a painful procedure, but it is best that the parent not restrain the infant during the procedure. Their role should be supportive and comforting, not one that causes pain. Having the parents remain outside the room leaves the infant without needed support. Infants experience pain but express it differently than adults.

Aspirating stomach contents and checking pH Confirmation of placement by radiologic examination is the most accurate method of verifying placement and position of a feeding tube. Because of the risks of repeated radiation exposure, however, this procedure cannot be used before each feeding. The nurse should verify placement of the tube by aspirating stomach contents and checking the pH. Verifying position by inserting air into the feeding tube and listening for sounds in the stomach is now considered an unreliable method of checking for tube placement.

After inserting a nasogastric tube (NG) into a young child, how will the nurse tape the tube in place?

Below nose and to cheek The nurse will tape the tube below the nose and to the side of the cheek to avoid pressure on the naris, as also happens when taping to the forehead is done. Taping to the cheek and behind the ear will not stabilize the tube adequately. It will not be taped to the side of the mouth. A nasogastric tube enters the nose.

After a gavage feeding has been completed for a young infant, the nurse will encourage the parent to take what action?

Burp the infant.

The nurse needs to provide instructions to a school-age girl about how to obtain a clean catch midstream urine specimen. Which instructions are best?

Clean the labia from front to back, then void a small amount into the toilet before collecting in the cup.

The nurse needs to provide instructions to a school-aged girl about how to obtain a clean catch midstream urine specimen. Which instructions are best?

Clean the labia from front to back, then void a small amount into the toilet before collecting in the cup. For girls, clean the labia from front to back using a cleansing pad or cotton balls saturated with the agency's designated cleaning solution. During the child's voiding, ask the parent to collect a "midstream" sample into a sterile container provided. It is unnecessary to catheterize a school age child to get a clean catch urine specimen. Urinating into the cup is part of the process, but it follows cleaning the labia and voiding a small amount in the toilet. A urine collection bag is used for infants, not school age children.

Following the repair of a cleft palate, the nurse places an 18-month-old child in restraints. The caregivers are with the child and will stay in the room at all times. Which type of restraints would the nurse most likely use for this child?

Elbow restraint An elbow restraint prevents the child from being able to bend the elbows and thus prevents the child from reaching or touching the face or head areas.

How will the nurse properly collect and care for the child's 24-hour urine specimen?

Empty each void into a designated container that keeps the urine cool.

A toddler has a peripheral IV and has pulled it out twice on one shift. The nurse decides to apply an elbow restraint on the right arm to prevent the client from pulling the IV out again. What interventions would the nurse implement in caring for a client in elbow restraints? Select all that apply.

Ensure that the restraint does not go too high under the axillae. Check the skin under the restraint every 1 to 2 hours. Pin the restraint to the child's shirt for stability. Tongue depressors can be used to construct the restraint.

When performing a procedure on a child in the health care setting, what should the priority intervention by the nurse be?

Ensuring the child's safety

The nurse is attempting to insert an intravenous (IV) line in a child. The child will not remain still, moving constantly. The caregiver asks, "Can you use a restraint? The IV has to be in for my child to get the medicine needed to get better." Which action will the nurse take?

Explain that restraints are used only as a last resort.

The nurse is about to place a gastrostomy tube in an infant. After gathering the supplies, which is the first step in the procedure?

Explain the procedure to the parents.

A 6-year-old has just returned to his room after a spinal tap. What could the nurse do to make this unpleasant procedure less memorable for the child?

Give him a little toy that he has been wanting.

What action should the nurse take after collecting a stool specimen for ova and parasites from a preschool-aged child?

Have the specimen taken to the laboratory immediately. If a stool specimen is for ova and parasites, do not refrigerate it because refrigeration destroys the organisms to be analyzed. The specimen needs to arrive in the laboratory in less than 1 hour after collection so the parasites can be readily detected. Alcohol should not be added to the specimen container. The color of the stool sample is of no consequence.

When an infant is scheduled for a painful procedure, what is the most important action by the nurse?

Help to soothe and comfort the baby before and after the procedure.

When an infant is scheduled for a painful procedure, what is the most important action by the nurse?

Help to soothe and comfort the baby before and after the procedure. Infants undergoing procedures can experience pain. Thus, the important action is to help soothe and comfort the child before and after the procedure. The nurse should explain everything to the care provider, but the patient's comfort in this case is the highest priority.

A child is reporting pain where an IV infiltrated his hand earlier in the shift. The doctor orders warm compresses to the right hand every 4 hours. What precautions would the nurse implement for this client?

Limit treatments to 20 minutes at a time.

How will the nurse determine the length of orogastric tubing needed to gavage the 14-month-old infant?

Measure from nose tip to earlobe to end of sternum.

A nurse is preparing to insert a nasogastric (NG) tube in an infant. How will the nurse determine the appropriate length of tubing to use for the infant?

Measure from the tip of the child's nose to the earlobe down to the tip of the sternum.

Parents asks the nurse why their premature infant is receiving a feeding through the mouth rather than the nose. What is the best explanation by the nurse?

Newborns are obligate nose breathers so nasogastric may obstruct their breathing.

A nurse receives a physician's order to collect a specimen for the diagnosis of respiratory syncytial virus. How should the nurse collect this specimen?

Obtain a nasal washing.

The health care provider orders a urinalysis on a 15-month-old toddler. The mother states that the child is not potty-trained. What is the best way for the nurse to collect the specimen?

Place a urine collection bag on the child after cleaning off the perineum.

If a urine specimen for analysis is ordered for an 8-month-old girl, which intervention would you use?

Place a urine collector on her just prior to feeding.

A pediatric client is having difficulty breathing. Which nursing intervention is appropriate for this client?

Provide oxygen as needed to maintain oxygen saturation above 93%.

The nurse is caring for a comatose school-age child receiving gastrostomy tube feedings. The nurse aspirates 15 ml of stomach contents prior to administering a feeding. What is the appropriate action by the nurse?

Replace the stomach contents and continue with the feedings as prescribed.

The nurse has just inserted a nasogastric tube for an enteral feeding in a 6-month-old infant. The best way to assess whether the tube has reached her stomach is to:

aspirate the tube for stomach contents.

Restrain him with a mummy restraint and release it as soon as the procedure is completed.

The nurse aspirates stomach contents before administering a nasogastric (NG) tube feeding. How will the nurse manage the aspirate? Select all that apply.

Return the aspirate to the stomach. Determine the pH of the aspirate. Record the amount of the aspirate.

Set a timer for not longer than 20 minutes as a removal reminder.

A 6-month-old infant requires a routine urine specimen for analysis. Which action by the nurse would be appropriate?

Squeezing the diaper to obtain the urine sample. urine Place a urine collector on the baby just prior to feeding.

The nurse is caring for a child receiving oxygen. The nurse observes the caregiver remove petroleum-based cream from a bag and prepare to apply the cream to the child. The caregiver states the child has dry skin and this cream is applied daily at home. Which action will the nurse take?

Stop the caregiver from applying the cream.

A nurse working with a client who has an elevated temperature notices that the child is beginning to shiver. Which of the following should the nurse do immediately?

Stop whatever intervention is being done to lower the temperature.

A child has returned to the unit after having a lumbar puncture. Which instructions are important for the nurse to provide the parents and child?

The child will need to remain flat to prevent a headache.

A child has returned to the unit after having a lumbar puncture. Which instructions are important for the nurse to provide the parents and child?

The child will need to remain flat to prevent a headache. After a lumbar puncture, remind children to remain quiet and with their head flat to help prevent a postdural puncture (spinal) headache. Typically, children will not be fearful of staff nor will the child be up ambulating until later. The procedure should not need to be repeated in 24 hours.

The nurse is preparing a 7-year-old child for surgery. Which nursing action is the highest priority?

The nurse should follow the facility's policies.

A nurse is preparing to insert a feeding tube into a child and lubricates the tube with water or a water-soluble jelly first. Why does the nurse avoid the use of an oil-based lubricant?

There is a danger of oil aspiration into the lungs.

Transport the stool specimen to the laboratory promptly.

The nurse finds an elevated temperature in a blanket-wrapped infant a mother is holding and rocking. What first temperature reduction measure will the nurse take?

Unwrap the infant and place the child in the crib.

The nurse is administering a prescribed bolus gavage feeding. Which action would be incorrect in performing this procedure?

Verify placement by auscultating for sounds in the stomach when air is inserted.

The nurse is administering a prescribed bolus gavage feeding. Which action would be incorrect in performing this procedure?

The nurse needs to transport her preschool client to radiology for a chest X-Ray. Which transportation device would be most appropriate?

Wagon When transporting a child off the floor, the nurse needs to select the correct means of transportation based upon the child's age and developmental level. For a preschooler, a wagon would be the best choice for both safety and for enjoyment. A stretcher or wheelchair are both too large for such a young child and a crib is too small for them.

elbow restraint

For which client would the nurse question the doctor's orders for a throat culture swab?

a toddler suspected to have epiglottitis

While teaching parents how to effectively reduce the child's fever, the nurse should emphasize avoiding which intervention?

acetylsalicylic acid

A child has been admitted to the pediatric unit with an oral temperature of 102°F (38.9°C). Acetaminophen has failed to control the fever. The nurse knows that she may utilize which therapeutic modalities? Select all that apply.

cooling blanket hydration lightweight clothes cool room

The nurse is caring for an infant recovering from surgery for a cleft palate. Which type of restraint would the nurse anticipate using for this infant post-operatively?

elbow

A new graduate nurse is asking the nurse preceptor about enemas in pediatrics. The preceptor explains that the use of enemas in children is warranted under which circumstances? Select all that apply.

fecal impaction Hirschsprung disease preparation for surgery preparation for a colonoscopy Enemas are rarely used with children unless they are used as therapy for fecal impaction, Hirschsprung disease, a part of preparation for surgery, or a diagnostic test. Enemas would not be used for bloating or constipation.

A nurse is preparing to apply heat therapy to a client who has a back abscess. Heat has which of the following benefits? Select all that apply.

increases circulation causes vasodilation promotes muscle relaxation

nasal prongs

A preschool child has been admitted to the hospital. Which prescription should the nurse question?

tap water enema 500 ml

Which of the following are situations that might warrant a restraint of a pediatric client? Select all that apply.

to protect the child from injury during a procedure or examination to ensure the child's safety

A young preschooler who has been playing in the hospital playroom needs transportation to the imaging department. What conveyance will the nurse choose?

wagon

The nurse obtains a stool specimen for ova and parasites. It would be important for the nurse to:

see that it arrives at the laboratory promptly.

An adolescent is scheduled to have the present gastrostomy tube replaced with a gastrostomy button. What advantage of the button over the tube will the nurse emphasize?

The button will be smaller and less visible when not in use.

A nurse is caring for a hospitalized infant being treated for dehydration. What does the nurse need to do to measure the output when the child is wearing a diaper?

Weigh the wet diaper and subtract the weight of a dry diaper; the difference is the amount to record.

A nurse is caring for a 14-year-old with a gastrostomy tube. The girl has skin breakdown and irritation at the insertion site. What would be the most appropriate method to clean and secure the gastrostomy tube?

If any drainage is present, use a presplit 2 × 2 and place it loosely around the site.

The nurse is preparing a school-age child for a diagnostic procedure. What is an important nursing role in relation to obtaining informed consent for this procedure for this client?

Ensure the child understands and assents to the test.

If any drainage is present, use a presplit 2 × 2 and place it loosely around the site. Skin around the gastrostomy or jejunostomy insertion site may become irritated from movement of the tube, moisture, leakage of stomach or intestinal contents, or the adhesive device holding the tube in place. Keeping the skin clean and dry is important and will help prevent most of these problems. If any drainage is present, a presplit 2 × 2 can be placed loosely around the site and changed when soiled. If no drainage is present, the nurse should not place a dressing as it can cause undue pressure and trap moisture, leading to skin irritation. Preventing movement of the tube helps reduce skin irritation; however, the tube should be able to move slightly in and out of the child's stomach.

A nurse will explain to a child's caregiver any procedure that is to be done. What is the primary reason for this explanation?

It helps to reduce anxiety.

A 6-year-old has just returned to his room after a spinal tap. What could the nurse do to make this unpleasant procedure less memorable for the child?

Give him a little toy that he has been wanting. Children given a treat or small toy after an uncomfortable procedure tend to remember the experience as not totally bad. The nurse should never say that any patient will not have to go through an uncomfortable experience again. Saying the child was brave when maybe he was not could foster mistrust in the nurse.

A preschool-aged child has not been able to eat for several days until all diagnostic tests are complete to determine the cause of chronic diarrhea. Which nursing diagnosis should the nurse identify as being appropriate for the patient at this time?

Imbalanced nutrition, less than body requirements, related to food restriction for procedures Because the child has not been able to eat for several days, the risk for imbalanced nutrition is high. This is the appropriate diagnosis for the nurse to select at this time. There is no enough information to determine if the child is at risk for injury, fearful of procedure rooms, or experiencing a deficiency in diversionary activities.

Limit treatments to 20 minutes at a time. Warm compresses are used to increase circulation to an area of the body and to promote pain relief. For a child having warm compresses, the length of each session is a maximum of 20 minutes to prevent skin damage. Towels used in warm compresses are never heated in a microwave because of uneven heating. Parents are not to apply compresses because the nurse needs to assess the skin before and after the treatment. Gauze is not a good material for compresses; it does not hold heat well.

The nurse should consider which stool sample collected from a child as contaminated and not acceptable for analysis?

stool removed from surrounding urine

"The doctor needs to look at your blood to see why you are sick; it will hurt for a second." Using the term "drawing blood" implies you are suggesting a game, not a momentary painful procedure. Being honest about pain allows the child to trust you.

A nurse is preparing to apply heat therapy to a client who has a back abscess. Heat has which of the following benefits? Select all that apply.

Increases circulation Causes vasodilation Promotes muscle relaxation Local application of heat increases circulation by vasodilation and promotes muscle relaxation, thereby relieving pain and congestion. It also speeds the formation and drainage of superficial abscesses.

Replace the stomach contents and continue with the feedings as prescribed. The nurse should always aspirate nasogastric or gastrostomy tubes for stomach contents to check for tube placement and assess gastric residual amounts prior to administering feedings. The nurse will return any amount of stomach residue aspirated so the child does not lose large amounts of stomach acid. 15 ml is a very small amount of gastric contents and should not interfere with feedings.

A nurse working with a patient who has an elevated temperature notices that the child is beginning to shiver. Which of the following should the nurse do immediately?

Stop whatever intervention is being done to lower the temperature. Removing clothing and excess covering from a child with a fever permits additional cooling through evaporation. If a child starts 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.

A pediatric nurse wants to determine an accurate amount of urine output for a diapered baby. Which is the most effective method?

Weigh a diaper before use and mark with weight, then weigh after and subtract the weight of the diaper. Diapers can be readily used as a method of measuring urine output. Weigh a diaper before it is placed on an infant and record this weight conspicuously (e.g., mark it on the front of the plastic covering with a ballpoint pen). Reweigh the diaper after it is wet and subtract the difference to determine the amount of urine present. This difference will be in grams, but because 1 g = 1 ml, the amount can be recorded in milliliters. This is the most accurate measure of output for an infant. This knowledge makes the answer that measuring output is impossible an incorrect answer. For just everyday intake and output, counting the number of wet diapers is adequate. Using a urine collection device is not always accurate because many times urine leaks around the bag.

How will the nurse measure urine output in the hospitalized toddler who is partially potty trained?

Weigh the wet pull-up or diaper and subtract the weight of a dry diaper A toddler who is partially potty trained is likely to regress during the stress of hospitalization and need diapering. Subtracting dry weight in grams from wet weight reveals the number of milliliters of urine excreted. The other output measurement methods will not be accurate.

While teaching parents how to effectively reduce the child's fever, the nurse should emphasize avoiding which intervention?

acetylsalicylic acid Caution parents to never give acetylsalicylic acid (aspirin) to children with fever because aspirin is associated with Reye syndrome, a severe neurologic disorder. Acetaminophen is safe for children, and cool cloths and dressing lightly will help reduce fever.

Parents asks the nurse why their premature infant is receiving a feeding through the mouth rather than the nose. What is the best explanation by the nurse?

Newborns are obligate nose breathers so nasogastric may obstruct their breathing. Whether enteral catheters should be passed through the nares or the mouth is controversial. Because newborns are obligate nasal breathers, passing a catheter through the nose may obstruct their breathing space, and repeated insertion of a nasogastric tube can cause inflammation and obstruction of the nose; thus most tubes are inserted orally in small infants. Orogastric insertion can also decrease the possibility of striking the vagal nerve in the back of the throat and causing bradycardia, whereas nasogastric tubes increase the possibility of striking the vagal nerve.

The doctor orders a urinalysis on a 15-month-old toddler. The mother states that the child is not potty trained. What is the best way for the nurse to collect the specimen?

Place a urine collection bag on the child after cleaning off the perineum. In patients that are not potty trained, the best method for collecting a urine specimen is to place a urine collection bag on the child and wait for them to void. The doctor did not order a urine culture, so a catheterized urinalysis is not needed and would be traumatic for the child. Trying to catch urine from a voiding toddler is nearly impossible and aspirating urine out of the diaper is not the best approach or one that ensures the best results.

If a urine specimen for analysis is ordered for an 8-month-old girl, which intervention would you use?

Place a urine collector on her just prior to feeding. Most infants void following a feeding, so placing a urine collector just before a feeding will usually allow a urine specimen to be obtained.

The nurse is caring for a 2-year-old child in the pediatric unit. The child was being fed by unlicensed assistive personnel and had a temper tantrum and spit out the food. The child now needs to be taken for a diagnostic procedure. Which nursing action would be the best method of transporting this child?

Place the child in a crib with high side rails or in a crib with a bubble top.

aspirating stomach contents and checking pH

report to the health care provider that a complication may be occurring.

The nurse needs to transport her preschool client to radiology for a chest X-Ray. Which transportation device would be most appropriate?

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