Pediatric Variations in the Hospitalized Patient Copyright 2011

Pediatric Variations in the Hospitalized Patient Copyright © 2011, 2003, 1999 Mosby, Inc. All Rights Reserved. 1

Variations in Nursing Techniques with Children Pediatric medication administration is well covered on the videos on reserve in the library. These are mandatory to be viewed Go to Reggienet for websites where you can practice med calculations and improve your competence in this area – medication forms for clinical are also at this site Use past textbooks and information – med calculation book has chapter on Pediatrics; Health Assessment (Jarvis) has great info and pictures on Pediatric assessment & variations Use open hours at Lab to review clinical skills using the information from your textbook to apply these to the Pediatric patient. Copyright © 2003, 1999 Mosby, Inc. All Rights Reserved. 2

Preparation for Procedures Psychological preparation Age-specific guidelines for preparation • Drawings, puppets, dolls, etc Ø Based on developmental characteristics Ø Establish trust Parental support Explanation to the child Always think “atraumatic care” Copyright © 2011, 2003, 1999 Mosby, Inc. All Rights Reserved. 3

Performing Procedures Special treatment room for procedures Expect success Distract the child; use play if appropriate Conscious sedation may be used Allow expression of feelings – during and after procedure Praise the child afterward and provide positive reinforcement Copyright © 2003, 1999 Mosby, Inc. All Rights Reserved. 4

Therapeutic Hugging for Extremity Vein Puncture

Positioning for Procedures Analgesia, sedation Topical anesthetics (EMLA, numby) Use appropriate restraints; excellent pictures & descriptions on the Pediatric Unit and in book Therapeutic hugging Ø Jacket restraints Ø Mummy or swaddle restraint Ø Limb restraints Ø Copyright © 2011, 2003, 1999 Mosby, Inc. All Rights Reserved. 6

Mummy Restraint

Elbow Restraints

Nurse Maintains Hand Contact

Position for Lumbar Puncture

SPECIMEN COLLECTION Urine—sterile catheterization may be indicated or use of a U-bag Stool—if very loose diarrhea-like stools, may put U-bag over anal opening to collect stool Copyright © 2011, 2003, 1999 Mosby, Inc. All Rights Reserved. 11

Application of a Urine Collection Bag

Specimen Collection Blood—use EMLA prn, may be capillary or venous… Not for circumcision and may interact with acetaminophen Sputum—often needed for children with Cystic Fibrosis Gastric washings—in cases of poisonings Nasal washings—especially for RSV/bronchiolitis Copyright © 2003, 1999 Mosby, Inc. All Rights Reserved. 13

Alternative Feeding Techniques Gavage feedings NG Ø OG Ø Gastrostomy feedings Jejunostomy feedings May be continuous drip or intermittent (bolus) feedings G-button care Copyright © 2011, 2003, 1999 Mosby, Inc. All Rights Reserved. 14

Gavage Feeding (Always wear gloves)

Healthy Granulation Tissue Around Stoma

Skin-Level Gastrostomy Device

Improving Absorption of Feeds Use pacifier during alternative feeds Ø Non-nutritive sucking improves digestion Quiet, calm environment Consistent feeding techniques by caregivers/family members Hold and nurture during feedings Positioning is essential to foster gastric emptying especially for children with GERD HOB 30 degrees ( infant seat helps with this, but flat crib raised 30 degrees is better) Ø Right side promotes gastric emptying Ø Copyright © 2003, 1999 Mosby, Inc. All Rights Reserved. 18

Eating/Feeding is Social Copyright © 2003, 1999 Mosby, Inc. All Rights Reserved. 19

Devices for Delivering Medication to Children

Administering Oral Medication

Holding Child for IM Injection (Always wear gloves)

Instilling Nose Drops (Always wear gloves)

There you have it! You have a bird’s eye view of some of the unique approaches in working with children—what we do, why we do it, and how to do it atraumatically!! atraumatically Copyright © 2011, 2003, 1999 Mosby, Inc. All Rights Reserved. 24