1102 Test 1 1.4 Hospitalized Child

Front 1

Assisting with Procedures:

Back 1

Helping to obtain consent as needed
Explaining the procedure
Scheduling the procedure
Preparing the child physically
Accompanying the child for procedure
Providing support
Assessing the child’s responses

Providing care and obtaining specimens

Overseeing unlicensed personnel

Front 2

B
U
B
B
L
E
H
E

Back 2

B-breast-soft, tender,
U-fundal height-should be at umbilicas
B-bladder-voiding, distended
B-bowel sounds (hypoactive)
L-rubra, serosa(pinkish),
E-episiotomy or sits ice, tears TUCKS
H-HOmans's we dont do
E-emotions (status) happy, baby blues,
H-

Front 3

Hepatitis B Vaccine:

Back 3

A series of three IM doses
First, at birth or by age 2
Second, one month after the first dose
Third, at 5 months
Schedule changes by exposed or born to a positive mom – HBIG and then Hep B vaccine within 12 hours of birth
Reactions: redness and soreness at injection site and mild fever

Front 4

Diphtheria-Tetanus-Pertussis (DTP or DTaP):

Back 4

A series of four IM doses: 2, 4, 6, 12 to 18 months (then before entering school, 4-6 years)
Common Reactions: redness and tenderness at injection site, fever, drowsiness, fretfulness, loss of appetite
Children with progressive neurologic disorders should not receive pertussis vac.
Administer Tylenol before or shortly after the DTP or DTaP

Front 5

Inactivated Polio Vaccine (IPV):

Back 5

Used to be given in oral form
A killed virus given SQ
Given at 2 and 4 months, 6-18 months and a booster at 4-6 years
Most common side effect: soreness at the injection site

Front 6

Hemophilus Influenzae (Hib)

Back 6

Major cause of meningitis, epiglottis, septic arthritis, and vacteremia
Hib is an IM injection given at 2, 4, 6 months and 12 to 15 months
Side Effects: soreness and redness at injection site, fever over 101

Front 7

Measles, Mumps, and Rubella (MMR)

Back 7

Live attenuated vaccine
Given SQ at 12 to 15 months and 4 to 6 years
Contraindications: those who have had an anaphylactic reaction to neomycin or egg sensitivity
Common Side Effects: fever, mild rash, swelling of glands

Front 8

Varicella Zoster Vaccine (VZV)

Back 8

A live attenuated vaccine to prevent chickenpox
Given SQ, at 12 to 18 months or at 11 to 12 years
Children who have never had the chickenpox should receive two doses, 4 weeks apart
Side Effects: soreness or swelling at injection site, fever, mild rash

Front 9

Pneumococcal Conjugate

Back 9

Given in 4 doses: 2, 4, 6, 12-15 months
Mild reactions: redness, tenderness or swelling at injection site and mild fever
Good for 3 years

Front 10

Hepatitis A Vaccine

Back 10

Given to prevent HAV
Give in two doses, 6 months apart for lasting protection
Mild reactions: soreness at injection site, HA, loss of appetite, tiredness

Front 11

Documentation of Immunization:

Back 11

Date of immunization
Vaccine
Manufacturer
Batch or Lot Number
Site and Route of Administration
Name and Title of Person Administering
Report Adverse Reactions to CDC

Postpone if the child is febrile
If the child’s immunization status is unknown, consider susceptibility

Front 12

Nursing Considerations Immunization:

Back 12

Refer to manufacturers insert
Obtain informed consent
Minimize local reaction to IM injections
Use 5/8 inch long, 25-gauge needle for SQ
Adequately restrain the child
Multiple vaccines may be given in a single visit
Accurately document

Front 13

Stressors of Hospitalization

Infant:

Back 13

Separation and Stranger Anxiety; Painful, invasive procedures; Immobilization

Front 14

Stressors of Hospitalization

Toddler:

Back 14

Separation Anxiety; Loss of self-control, Painful, invasive procedures; Bodily injury; Fear of the dark

Front 15

Stressors of Hospitalization

Preschooler:

Back 15

Separation anxiety; Fear of abandonment; Loss of self-control; Bodily injury; Painful, invasive procedures; Fear of the dark, ghosts, and monsters

Front 16

Anaclitic depression:

Back 16

also called depression anxiety.

Front 17

Stessors of Hospitalization

School Age:

School age-5-6 11-12

Back 17

Loss of control; Bodily injury; painful, invasive procedures; Fear of death

Front 18

Stressors of Hospitalization:

Adolescent:

Adolescent-12-18

Back 18

Loss of control; Altered body image; Disfigurement; Separation from peer group

Front 19

Separation Anxiety

Phase I: Protest

Back 19

The child cries loudly and demandingly; rejects any attempts to be comforted by nurse or substitute primary caregiver-may last hours to days.

Front 20

Separation Anxiety

Phase II: Despair –

Back 20

The child becomes less active and cries monotonously or wails in a state of mourning; may turn away from parent’s approach; often lies on abdomen; facial expression flat; may lose weight and develop insomnia; loses developmental skills; prone to minor ailments; lower IQ

Front 21

Separation Anxiety

Phase III: Detachment –

Back 21

The child is silent, face expressionless; represses feelings for absent caregiver to protect self; deterioration in developmental milestones is apparent; may respond quickly but superficially to all caregivers; may have difficulty forming close relationships later in life. Rarely seen in hospitalized children.

Front 22

Assessment:

Back 22

Child’s Growth and Development
Psychosocial needs
Educational needs
Evaluate effects of illness

Front 23

Minimizing Effects of Hospitalization

Infants:

Back 23

Trust is estasblished thru consistent loving care by nurturing person. continuity of caretakers; maintain home routines; allow expression of behavior; encourage parents to bring in familiar objects from home; explain to parents that the child’s reactions is normal; accept regressive behavior

Front 24

Minimizing Effects of Hospitalization

Toddlers and Preschoolers –

Back 24

Allow expression of behavior; maintain routines; accept regressive behaviors; provide child as much mobility as possible; encourage parental participation in care; allow the child to participate in select decision making; provide play; acknowledge fears and anxieties; prepare the child. Strive for autonomy. Obstacles create temper tantrums. Main areas for rituals. When mealtime is diferrent from home may demand not eat, get a bottle or be fed by someone else.
Select decision making-do you want a purple popscicle or blue

Front 25

Minimizing the Effects of Hospitalization

Adolescents:

Back 25

Explore feelings regarding illness and hospitalization; prepare for treatments; encourage decision making concerning care and routines; encourage as much mobility as possible; encourage peer visitation; continue with education; provide privacy; provide age appropriate activities

Front 26

Maximizing the Benefits of Hospitalization:

Back 26

Fostering Parent-Child Relationship
Providing Support
Supplying Information

Front 27

Home Care

Benefits:

Back 27

decreased medical costs, comfort, and promoting healthy family behaviors

Front 28

Home Care

Disadvantages:

Back 28

strict health care regimens, financial strain, and social isolation of the parent

Be sure the child and family will be safe!!!


Child abuse story – Premie with high pitched cry, coded at home & in hospital

Front 29

Assisting with Procedures:

Back 29

Helping to obtain consent as needed
Explaining the procedure
Scheduling the procedure
Preparing the child physically
Accompanying the child for procedure
Providing support
Assessing the child’s responses
Providing care and obtaining specimens
Overseeing unlicensed personnel

See page 692

Front 30

Informed Consent –

Back 30

understand the risks of having or not having a procedure performed
Obtaining is the physician’s responsibility
As the patient advocate, the nurses’ responsibility is to explain
Other situations for consent: photographs, AMA, postmortem exams, look at medical records

Medical records….BIG deal in Peds

AMA-against medical advise

Front 31

Consents

Emancipated minor –

Back 31

children who are legally minors but who are considered to possess the maturity to give consent for their own medical care (court documentation)

When explaining procedures, parents must understand procedure, use age-appropriate language, try to keep parents relaxed for child to be relaxed

What type of language support does your facility have access to?
Language line/special phone, ect.

Front 32

Performing a Procedure

Back 32

Project a positive atmosphere
Expect success
Give necessary information
Provide distractions
Allow the child to express feelings
Praise the child at the end

Distraction, medication
-bubbles, toy, parent help

Front 33

Restraints/Immobilization

Back 33

Used with caution since children have difficulty distinguishing between restraints and punishment
Jacket, Elbow and Mummy restraints
Carefully explain restraints to parents
Check the extremity distal to restraints for temperature, pulses, and capillary refill q15 mins for 1 hour following initial placement, then q1hr, remove restraints q2hours to allow for ROM
Documentation!!! Must have an order to use RESTRAINTS, but not immobilization

Front 34

Hygiene:

Bathing –

Back 34

Never leave a child unattended in the bathtub or in water. Always have a hand on the child
Newborn infants can be immersed in water after the umbilical stump falls off and the circumcision healed – PREVENT CHILLING
Mouth care – age and disorder appropriate
Hair care – at least once a day combed or brushed. Newborns scalp washed daily, children washed one or twice weekly, adolescents frequently

Front 35

Feedings:

Back 35

Acute illnesses – nutritional state is seldom compromised
Encourage food and fluid intake
Never PROP a bottle !!
Have small frequent favorite fluids
I&0’s are required on all hospitalized children

Front 36

Fever:

Temperature > 100.4 orally

Back 36

increased O2 requirements, increased insensible fluid loss, and increased stress on CV system External cooling
Antipyretic medications: Tylenol and Ibuprofen. Route of administration determined by developmental level
Environmental management: Tepid baths, avoid shivering, retake temp in 30 min.
Observe for dehydration

Temperature – children get cold very easily and have a large BSA/volume ratio. Can lead to hypoglycemia, increased stress can lead to hypoxia, lactic acidosis and tachycardia.

Child with fever requires more calories than adults. Temp will increase calorie requirements by 12% by degree C over 37.0 (98.6 F)

Front 37

Specimen Collection:

Urine –

Back 37

clean catch, cath aspiration, U-bag

Front 38

Specimen Collection:

Stool:

Back 38

in a collecting device or diaper

Front 39

Specimen Collection:

Capillary Blood Sampling:

Back 39

finger or heel puncture, Do NOT use heel sticks after walking

Front 40

Specimen Collection:

Sputum –

Back 40

older children can, younger will need to be suctioned

Front 41

Specimen Collection

Throat –

Back 41

be sure to swab the red, irritated area

Front 42

Specimen Collection

Nasopharyngeal –

Back 42

like for Respiratory Syncytial Virus (RSV)

Front 43

CSF –

Back 43

Dr. will perform, nurse must hold and send specimens to lab without contamination

Front 44

Enemas:

Back 44

Same as giving to an adult
Recommended volume and depth of insertion by age
Care of ostomies is the same as adult

Front 45

Oxygen Therapy:

Hypoxemia –

Back 45

occurs more rapidly in children than in adults
Nasal cannula, face mask, oxygen hood, oxygen tent (30-50%)

Front 46

Oxygen Therapy:

Nasal cannula –

Back 46

low-flow delivery system. Flow rates should not exceed 6L/min (up to 40%)

Front 47

Oxygen Therapy:

Simple face mask –

Back 47

low-flow system, flow rates 6-10L/min or 35-60%

Front 48

Oxygen Therapy

Partial nonrebreathing masks –

Back 48

– flow rate of 10-12L/min or 50-60% , Full nonrebreather masks – flow rates 10-15L/min or almost 100%

Front 49

Oxygen Therapy:

Precautions:

Back 49

Be sure to select the correct size to ensure fit – mask extends from the bridge of the child’s nose to the cleft of the chin.
Use humidified O2
Oxygen hood or tent – deliver approximately 40%. Check for leakage, and change sheets frequently (sheets get wet, baby gets cold)
OXYGEN IN USE/NO SMOKING
Appropriate use of toys for play

Front 50

Oxygenation

Chest Physiotherapy (CPT) –

Back 50

postural drainage, chest percussion (5 to 10 min) and vibration, C & DB
To mobilize and eliminate secretions, re-expand the lungs, and promote efficient use of the respiratory muscles
Postural drainage is the same as in adults
Pulmonary toileting

Pulse Oximetry – assess oxygenation status
CPT and Pulse Ox are ordered usually

Front 51

Timing –

Back 51

refers to the time that the mother’s immunity decreases or disappears and the child develops the ability to make antibodies in response to a vaccine

Front 52

Influences for decreased immunizations:

Back 52

complexity of the healthcare system, expense, parental misconceptions, inaccurate record keeping, reluctance of health care workers to give more than two vaccines at a time, and lack of public awareness.

Front 53

The American Academy of Pediatrics Committee on Infectious Diseases recommends that immunizations for children begin at

Back 53

2 months of age, with the exception of the Hepatitis B vaccine, which can be given initially at birth or by age 2 months