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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Date:
Area:
Group:
Vital Signs
Body Temperature1 2 3 4 5 Comments
Indication:
To determine the childs temperature on admission as a base for
comparing future measurements.
To monitor fluctuation in temperature.
Equipment :
Cotton with alcohol & dry cotton
Container for waste Water soluble lubricant.
Thermometer
Oral TemperatureMethod range
Advantages
Disadvantages
Length of time
Age
1. Wash hands.
2. Explain the procedure to the child or to his parents.
3.Check that the child has not just had a cold or hot drink.
4. Clean thermometer with alcohol swab
5. Check thermometer to see the reading is down below 35c.
6. Instruct the child to raise his/her tongue and put thermometerunder it, , and ask him to close his lips without biting.
7. Instruct the child to close his/her mouth, hold thermometer for 5minutes
8. Remove the thermometer and wipe it with dry cotton swabs
9. Read and record temperature.
10. Wash thermometer with soap and water and dry it.
11.Wash hands.
Rectal TemperatureMethod range
Advantages
Disadvantages
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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Group:
Length of timeAge
1. Wash hands.
2. Explain the procedure to the child and his family.
3. Clean thermometer with alcohol swab
4. Check thermometer to see the reading is down to 35c.
5. Apply lubricant to thermometer.
6. Grasp the infants ankle and placing index finger between the
ankle bones.
7. Insert the thermometer bulb into the rectum 2.5cm.
8. Hold for 3 minutes.
9. Remove the thermometer and wipe it with dry cotton swabs.
10. Read and record temperature.
11. Clothe the child.
12. Clean the thermometer with soap and tape water.
13. Dry it and keep in its container.
14. Wash hands.
N. B:
1. Rectal temperature should not be used in children who having
rectal surgery or receiving chemotherapy.2. Procedure should be done by rectal thermometer.
3. Measuring rectal temperature is generally unnecessary because
of the risk of rectal perforation.
Axially TemperatureMethod range
Advantages
Disadvantages
Length of time
Age
1. Wash hands.
2. Assemble equipment.
3. Explain procedure to the child and infants family.
4. Clean thermometer with alcohol swab
5. Check thermometer to see that reading is down to 35c.
6. Dry the axially area and then Place thermometer under axilla andbring arm across chest.
7. Hold thermometer in place for 10 minutes.
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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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8. Remove the thermometer and wipe it with dry cotton swabs.9. Read and record temperature.
10. Clean the thermometer with soap and tape water.
11. Dry it and keep in its container.
12. Wash hands.
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Summer Semester 2012-2013
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Methods of Measuring Body Temperature In
Infants And Children
Method
Range
Advantages Disadvantages Length of time Age
Rectal
37.0 37.8c.
1. Safe for children who are
unable to co-operate and
may bite the thermometer.
2. Not directly influenced bythe ingestion of hot or
cold fluids.
3. Method of choice if child
has seizure or breathing
difficulties receiving
oxygen therapy, or has
oral surgery.
1. Values may be altered
by presence of stool.
2. Optional response may
be negative.3. Damage to rectal
mucosa may occur.
4. Replication of
thermometer
placement is difficult.
5. Contra indicated when
child has diarrhea and
following rectal
surgery.
3 minutes *New born
* Infant.
Oral
36.4 37.4c
1. Easily accessible.
2. Replication of
thermometer placement iseasy.
3. Responds more quickly
and regular to changes in
arterial temperature than
does rectal method.4. More aesthetically
pleasing.
1. Value is ready
influenced by
ingestion of hot orcold fluids, and
oxygen therapy.
2. Requires childs
cooperation to keep
mouth closed and notto bite the
thermometer.
3. Contra indicated if
child has oral injuries
surgery or under the
age of five years.
5 minutes * More than 6
year's
children.
Axillary35.8 36.6c
1. Safe and easily accessible.2. Avoids the danger of
rectal or colon
perforation.
3. Avoids initiating the
defecation stimulus.
4. Often recommended for
infants.
1. Value is more readilyinfluenced by
environmental
temperature and air
flow.
2. Requires a relatively
long period of time to
obtain accurate
reading.
10 minutes. Less than 6years children.
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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Group:
Pulse
1 2 3 4 5
Indication:
To gather information on the heart rate, pattern of beats (rhythm,
rate and strength of pulse).
Equipment:Watch with second hand.
Stethoscope.Cotton with alcohol.
Normal Heart Rate for different ages
Action
Peripheral Pulse1. Wash hands.
2. Explain the procedure to the child and his family.
3. Place child in comfortable position.
4. Place the third finger along the appropriate artery and pressgently.
5. Count for full minute.
6. Record rate, regularity & fullness.
7. Report for any abnormalities.
Apical Pulse1. Expose the chest over the apex of the heart.
2. Wipe the ears pieces & diaphragm with alcohol swabs andwarm diaphragm.
3. Place the stethoscope between the infants left nipple and
sternum between the 4th
& 5th
ribs.4. Listen and count for full minute.
5. Remove stethoscope and cover the child chest.
6. Wipe earpieces and diaphragm with alcohol swabs.
7. Record: rate, fullness and regularity.
8. Report any abnormal observation.
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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Group:
Respiration
Action 1 2 3 4 5 Comments
Indication:
To determine respiratory rate and assess respiratory
characteristics (rate, rhythm, strength).To evaluate the child response to medication or treatments.
Normal respiratory rate
Equipment:
Watch with second hand.
Procedure
1. Remove over cover to observe chest movement.
2. Observe respiratory movement, rate, and depth, patternand sound.
3. Count the rate for one minute.
4. Record rate, depth, pattern and sound.5. Report for any abnormality.
AgeNormal heart rate
(beats per minute)
Normal respiratory rate
(breaths per minute)
Newborn 100-160 30-50
15 months 90-150 25-40
612 months 80-140 20-30
13 years 80-130 20-30
35 years 80-120 20-30
610 years 70-110 15-30
1114 years 60-105 12-20
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Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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14+ years 60-100 12-20
Blood Pressure
1 2 3 4 5 Comments
Equipment:- Measuring cuff and Stethoscope.
-Alcohol swabFormulas of approximate average systolic pressure in relation to
childs age.
Formula of approximate average diastolic pressure in relation to
childs age.
Sites for measuring blood pressure
Action
1. Assemble the equipment.
2. Wash hands.
3. Review child's previous blood pressure reading
4. Explain the procedure to the child or to his mother.
5. Expose the site of measurement fully by removing clothes.
6. Position the limb at the level of the heart.
7. Place stethoscope ear pieces in ears and be sure sounds are
clear, not muffled.
8. With cuff fully dilated, warp cuff evenly around upper arm.
9. Be sure that manometer positioned vertically at the eye levelobserver (should be no further than 1 ml.)
10. Palpate brachial or radial artery with fingertips of one hand
while inflating cuff rapidly to pressure 20mm Hg. Above pointat which pulse disappears.
11. Slowly deflate the cuff, nothing when the pulse is first heard(systolic pressure) and when the sound becomes muffled or
disappears (diastolic pressure).
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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Group:
12. Remove equipment.
13. Hand wash.
14. Record your observation.
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Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Group:
Sites for measuring blood pressure:A. Upper armB. Lower arm
C. Thigh
D. Calf or ankle.
Formulas of approximate average systolic pressure in relation to childs age.
Childs Age Formula
1 to 7 years Age in years + 90
8 to 18 years (2 X Age in years) + 83
Formula of approximate average diastolic pressure in relation to childs age.
Childs Age Formula
1 to 5 years 56 mmHg
6 to 18 years Age in years + 52
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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Group:
Cold Compresses For Fever1 2 3 4 5 Comments
Purpose:
Decrease body temperature.
Relief discomfort.
Prevent complications.
Equipments:
Basin with tap water.
Small wash clothes.
Rubber sheet.
Towel
Draw sheet or linen to cover the child's chest
Degrees of fever (Oral or rectal)
Mild fever : 37.8 38.4 c
Moderate fever : 38.5 39.5c
High fever : 39.6 41.0
Hyperthermia above 41.0c
Procedure
1. Wash hands.
2. Prepare all the needed equipment
3. Prepare child & pulsating areas. Which the
compresses will be applied on.
4. Place rubber sheet under areas to which compresses
will be applied
5. Immerse wash cloth or material for the compresses in
the tap water, place wash cloth over pulsating areas.
6. Remove the compresses frequently & replace it with
another one
7. Measure patients temperature after 15-30 min8. Remove compresses after decrease body temperature
to the normal level.
9. Clean equipment after use
10. Leave patient clean and dry
11. Wash hands.
12. Record nursing care in the patients card & his last
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Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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temperature.N.B: If the temperature is not changed repeat the steps
from 5-7 for 8 min.
Chest Circumference
Action 1 2 3 4 5 CommentsEquipment:
1. A tape measures
2. Cotton with alcohol
1. Remove the childs clothing of upper half.2. Place on the flat table in
A supine position for infantOr stand alone for children
3. Place the tape across the nipple line.
4. Measure midway between inspiration and expiration.
5. Record in the patient chart.
Head CircumferenceHead circumference should be measured:
1. Under 36 months of age.
2. With neurological defects.Equipment:- Measuring tape
- Cotton with alcohol
-Measure the head at its great circumference; this is above
eyebrow and pinna of the, and at the occipital prominence at theback of the skull.
Action 1 2 3 4 5 Comments1. Note child's last recorded head Circumference, if available.
2. Perform hand washing.
3. Place light drape or paper on flat surface for the child to stand
on.4. Place infant/ toddler in sup
5. Child usually weighted while wearing their under wear or light
gown.
6. Record.
Comparison between head circumference and chestCircumference.
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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Group:
Birth. H. C. > CC12 14 months H. C. = CC
24 months H. C. < CC
Height
1 2 3 4 5 Comments
Height is referred to measurements taken when children are
standing upright. used over 24 months of age
Equipment:Measuring board for old child or, a measuring tape.
1. Remove the childs shoes and socks.
2. Stand as tall and straight as possible with head in midline and
the line of vision parallel to the floor.
3. The childs back should be to the vertical flat surface with
heels, buttocks and back of the shoulder touching the surface.
4. Any flexion of the knees, lumping of the shoulders or raising
of heels of the feet is checked and corrected.
5. Move the board on the top of the head.
6. Read & record.Height If Such Device Is Not Present
1 2 3 4 5 Comments
N.B: Height can be calculated by these formulae (age more
than 2 years x 5 +80)
Action
1. Attach a measuring tape to the wall.
2. Place the child adjacent to the tape.
3. Place a three-dimensional object, such as thick book or box
on the tape of the head.4. The side of the book must rest firmly against the wall to form
a right angle.
5. Length or stature is measure to the nearest 1 cm.
6. Record.
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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Length1 2 3 4 5 Comments
Length refers to measurement taken when children are in
supine position, also refers to recumbent length. Untilchildren are 24 months old, recumbent length is measured.
Equipment:
Measuring board for infant, dress tape, or metal tape.
Action
1. Place the towel on the board.
2. Remove the infant clothing.
3. Place the infant on the center of the board in the supineposition.
4. One assistant hold the head against the headboard
firmly.
5. Grasp the knees together gently.
6. Push down on knees until the legs are fully extended &
hold the legs firmly.
7. Bring the headboard against the soles of the heels
firmly.
8. Read and record.
Length If Measuring Device Is Not AvailableAction 1 2 3 4 5 Comments
1. Place the infant on a proper covered hard surface.
2. Push down the knees and head against a firm surface.
3. Make points of the top of the head and heel of the feet by a
point.
4. Remove infant from his place.
5. Measure between these two points.
6. Record.
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Summer Semester 2012-2013
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Weight
1 2 3 4 5 Comments
- Weight must be recorded accurately on admission.
- Weight of a patient provides a mean of determiningprogress.
- It is necessary to determine the dosage of certain
medications.
- The way in which the nurse weights the child depends onthe age.
Infant WeightEquipment's:
1. Appropriate sized beam balance scale.2. Cotton with Alcohol
3. Scale PaperAction
1. Place the scale horizontally on a firm surface.
2. Check to see that scale is balance by sitting it at zero,
and noting if the balance registers exactly in the middle of
the mark.
3. Close windows and doors to make the patients room
warm
4.Wipe the scale with cotton with alcohol5. Remove the infant clothing.
6. Put a scale paper on the scale.
7. Gently life the infant from his bed and place him in thescale basket.
8. For the safety, hold hand over the body of the infant.
9. Adjust the weight to balance scale by the right hand.
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10. Read the scale when the infant is lying still.11. Return the infant to his bed.
12. Record it in the patients chart.
13. Remove and dispose the scale paper.
The older infant may be weigh in a setting position
Weight of Older ChildrenEquipment:
Standing scale.Paper
Action
1. Balance the scale.
2. Place a paper towel on the scale for the child to stand on.
3. Keep child privacy.
4. Child usually weighed while wearing their underpants or
light gown.
5. Ask the child to keep erect
6. Remove shoes of the child.
7. Read and record.Once standing height is taken over 24 months, weight canalso be done on a standing type scale.
NB: - If the child cannot stand for any physical problem,the mother should carry the child and subtract the
difference between the mother weight and the mother who
carry the child
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Summer Semester 2012-2013
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Group:
Sponge Bath
1 2 3 4 5 CommentsPurposes:
1. To clean the skin and comfort the child.
2. To increase circulation and metabolism.
3. To Observe childs body.
4. To give chance for play and talk with child.5. To provide an opportunity to note childs growth and
development.
Equipment:
Bowl for warm water
Wash cloth or cotton (sponges) at least four wash cloth
Soft hair Brush
Bath towel
Baby clothes
Plastic bag
Mackintosh
Clear water
Baby lotion
Nail scissors Cotton with alcohol
Actions
1. Explain procedure to the mother
2. Wash hands.
3. Close the doors and windows
4. Assemble the equipment at the child bedside.
5. Provide safe environment (Free from drafts).
6. Fill the bowl two-thirds full of water 36.5-40c according to the
age and season, check water temperature by thermometer or by
elbow joint. (Change the water as needed).7. Precede bathing from top to bottom.
8. Wipe each eye with moist sponge from the inner to the outeraspect then dry gently each one.
9. Clean the baby face, wipe around mouth and nose then go overher cheeks and forehead, dry with sponge.
10. Clean each ear over and behind only (not inside)
11. Wipe the scalp & dry it.
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University of Hail- College of Nursing
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12. Wipe the neck thoroughly pays attention to creases.13. Take -off childs clothes
14. Clean hands from fingers then hands and dry well total.
15. Wipe under axially from front to back and dry well.
16. Clean the chest, abdomen, & back, then dry well in onedirection.
17. Dress the child clean clothes
18. Clean the lower extremities from bottom to top then dry well.
19. Clean diaper area.
Cord Care
1. hand wash2. position infant supine
3. Inspect the cord closely during the first 24 hours and then daily
for any abnormalities.
4. Clean area at base in circular motion with alcohol wipe or cotton
ball.
5. Wipe the top of the cord with cotton with alcohol wipe or
cotton ball.6. Squeeze cotton with alcohol over the tip of the cord.
7. Dress the child clean clothes.
8. Collect equipments and clean the surrounding environment.9. Wash hands.
10. Record.
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University of Hail- College of Nursing
Pediatric Nursing Practice NURS 432
Summer Semester 2012-2013
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Group:
Diaper Care
1 2 3 4 5 Commen
Purpose:
1. Maintain the baby more comfortable by keeping him dry.
2. Maintain healthy skin at diaper area.3. Observe any abnormal changes in the skin of the diaper
area.4. Inspect the infants body during the procedure.5. Protection against urinary tract infection.(ascending
infection)
Equipment:
Kidney basin.
Warm water.
Cotton/sponges or clean wash cloth.
Plastic bag.
Oil or ointment.
Disposable diaper or cloth diaper.
Action
1. Wash hands with soap and water.
2. Prepare all the needed equipment.
3 Explain to the parents the procedure in the purpose of
teaching them.
4. Put the baby on a mat or changing table.
5. Wipe off the feces with the corner of the unclean diaper and
fold the diaper down under the babys legs.
6. With clean wash cloth, clean thoroughly in the creases at the
tops of baby's legs and at the base of genitals wiping away
from the body.For a female :
a. Wipe away feces with wash cloth then using a moist baby
clean wash cloth, clean all over her stomach up to her
umbilical stump.
b. Lift her legs up with a finger between her ankles and wipe
the vulva from front to back.
For a male:
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Group:
a. Pause for a couple of seconds with the diaper held over hispenis.
b. Clean his penis, wiping away from the body.For uncircumcised boy pull the fore-skin back gently clean it
then replace the retracted skin to prevent paraphimosis
(edema of the glands),then clean scrotum change cloth asneeded.
7. Lift the babys legs to clean anus and buttocks, keeping afinger between ankles wipe over the backs of thighs too then
remove the diaper , repeat if baby still unclean
8. Dry baby's bottom with a clean wash cloth
9. Apply a barrier of cream or zinc oxide ointment.10. Place the new clean diaper under the infants buttocks and
sides in between his legs.
11. Bring diaper up over abdomen, place front part of diaper
next to babys skin bring back of diaper over front tuck it. ,
being careful to place your finger between the baby and the
diaper.
12. Fold diaper so that it does not cover the cord stump.
13. Discard the old diaper, collect your equipments; leave the
area clean and tidy.
14. Wash hands.
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Methods of Holding the Child
Lumbar Puncture1 2 3 4 5 Comments
Purpose: Minimizing their movement and
discomfortAction
1. Explain the procedure to the child and to hisparents.
1. Put the child in lateral side-lying position.
2. Restrain the child by holding the child withforearm behind the neck and the other behind
the thigh.
3. Maintain this flexed position of the back.
Jugular Vein Puncture
1. Explain the procedure to the child and to hismother.
2. Put the child in a mummy restraining.
3. Put the child supine in a table.
4. Extend the head and shoulder of the child overthe edge of the table.
5. Turn the head to one side, a maximum of (60degrees) from the midline.
6. Encourage crying during the procedure.
7. Check the patient after procedure for oozing,
bleeding or evidence of hematoma.
Femoral Vein Puncture1 2 3 4 5 Comments
Action1. Explain the procedure to the child and to his parents.
2. Put the child supine on examining table.
3. Put the legs of the child in frog position. (Flexion andabduction of the childs knees).
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4. Control the childs arms and legs by forearms.5. Uncovered the site used for the vein puncture.
6. Cover the genital area.
7. Apply pressure on tie site for (10-15) min afterwithdrawal of blood.
Clove Hitch Restraint
Indication: Immobilize arms or legs by attaching a
clove hitch tie at the wrist or ankle.Prevent dislodging of (Cannula) from sites in thelimb.
1 2 3 4 5 Comments
Equipment:
Cotton or dressing and gauze
Action
1. Pad the wrist or ankle with cotton or gauze dressing.
2. Tape the dressing.
3. Make double loop.
4. Pick up the loop.
5. Ship the wrist or ankle through the two loops.6. Tie the ends to the bed springs or frame.
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Mummy Restraining
1 2 3 4 5 Comments
Indications :
It immobilizes an infant or small child for a short
time while a procedure is performed or child isexamined.
It immobilizes the body, leaving only the head and
neck mobile for examination or treatment (e.g. veinpuncture, throat examination, gavages feeding).
Equipments:
Draw sheet or blanket.
Safety pins.Action
1. Wash your hands.
2. Explain the procedure to the child and his parents.
3. Place the blanket or sheet flat on the bed.
4. Place the child on the blanket with his shoulder at the
fold.
5. Pull the right side of the blanket over the childs right
shoulder.
6. Tuck the reminder of the right side of the blanket
under the left side of the childs body.7. Repeat the procedure with the left side of the blanket.
8. Separate the corner of the bottom portion of the sheet
and fold it up toward the childs neck.
9. Tuck both sides of the sheet under the infants body.
Modified Mummy RestrainingPurpose: To modify the mummy restraint for chest
examination, the folded edge of the blanket is brought
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over each arm under the back, the loose edge is foldedover and secured at a point below the chest to allow
visualization to the chest.
Special Precautions: Be sure that the childs
extremity is in a comfortable position during this
procedure.
1. Wash your hands.
2. Explain the procedure to the child and his parents.
3. Open a blanket on crib.
4. Fold the blanket in a rectangle form.
5. Place the child on the blanket with his shoulder at thefold.
6. His arm is positioned comfortably at his side.
7. Fold the blanket over the arm, and tuck it snugly
under childs back.
8. Repeat for the other arm.
9. Bring the excess up over the abdomen &leaving chest
exposed.
10 Secure sides of blanket behind childs back.
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Group:
Board Restrains
Palm Up Method
1 2 3 4 5 Comments
Purpose: Immobilize the extremities by attaching
board restrains.
Equipment:
- Board
- Adhesive stripsProcedure
1 Place arm palm up on an arm board
2. Place two adhesive strips across the hand in an Xfashion, Use 5-cm adhesive tape for the child, 2cm
for the infant,)
3. Make a double adhesive strip by using one long and
one short
Piece of tape, attach them to one another, adhesive
sides together. With the short strip touching the
childs arm, tape the arm to the arm board at the edgeof the antecubital fossa. Tape does not need to be
secured directly to the arm.
4. Final double adhesive strip may be placed midway
between the hand and the antecubital fossa or abovethe antecubital fossa.
P alm D own Method
Procedure
1. Place the arm palm down on to arm board
2. Place the first adhesive strip over the wrist. (Use 5-
cm width adhesive for the child, 2cm width for the
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infant).3. Secure the second adhesive strip across the proximal
end of the phalanges, leaving the thumb mobile.
4. Using a double adhesive strip (see step 3 under palm
up Method). Secure the arm just under the elbow.
5. The final piece of tape is placed obliquely over the
thumb and, for security, or over the second strip.
6. Adhesive placement for the infant.
Lower Extremities with Board Restrain
Comments54321
Procedure
Put the child in a supine position.1.
Leg is full external or internal rotation on the board2.
Extend the board from the end of the foot to the mid portion
of the buttock.
3.
Place the second adhesive strip over the heel and across the
foot in an X formation
4.
Using a double strip of adhesive (see step 3 of palm up
method
5.
Tap the third strip above the knee6.
On the infant, place one addition strip between mid-way the
knee and ankle
7.
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Elbow Restraint
1 2 3 4 5 Comments
Indications:
Preventing the child hand from reaching
the head or face, e.g. after lip/headsurgery, or when vein infusion is in place.
Preventing the child hand from scratching
in skin disorders.
Equipment:
A piece of cotton cloth or strips ofadhesive tape.
Tongue depressors
Action
1. Wash hands.
2. Explain the procedure to the child or to his
parents.
3. Expose the arm including the elbow area.
4. Make a pocket on the cloth or on the cotton
piece.
5. Insert the tongue blades in the pocket of thecloth.
6. Wrap the strain around the arm and secure it
with tapes or pins.
Special precaution:
The tongue depressors should be cut toabout 10 cm (4inches) in length if the elbow
cuff is to be used for an infant for greatest
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comfort.
Table Tub Bath
1 2 3 4 5 Comments
Purpose:
1. To satisfy the need for cleanliness.
2. To help the new mother at home bath her newborninfant.
3. To inspect infant body.
4. For therapeutic purpose as in burned child.
5. To relax the childs muscles before physicaltherapy.
6. To help remove dressings or crusts or to apply acertain soothing medication to the skin.
Equipments:
- Baby tub - Bath towel - Wash cloth 2-3- Mild soap - Childs cloth.
- Soft hair brush or comb
- Mackintosh. Toy - Pitcher- Cotton Container - Gauze swabs - Baby Oil
Actions
1. Explain the procedure to the childs mother.
2. Check room temperature and free from drafts (close
windows and doors).
3. Assemble equipment.
4. Fill the baby tub half to two third full of warm water
(37.8)-(40.6c) if there is no water thermometer checkit with your wrist.
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5. Spread the bath towel on the bed or table.6. Wash hands
7. Place the infant still dressed on the bath towel
8. Wash the infant eye, starting from the far eye, wipe theeye with moist cotton with water only from inner to
outer aspect, and then dry it with clean dry cotton in
one direction. Water only.
9. Wipe the infants face, forehead, cheeks and mouth
(clean inside the mouth if needed and nose with a
moist cotton).
10. Soap the scalp; support the infant using the football
hold (the baby is supported under the nurses arm andno her hip) first lather your hand with soap then apply
it to the scalp
11. The infants head should be held over the wash basin,
rinse thoroughly and if possible the ears should be
covered with the nurses fingers.
12. Place the infant on the table and dry the head with a
part of the folded bath towel.
13. Inspect the ears if any discharge present cleans it with
the corner of washcloth.
14. Remove the infants clothes.15. Lift the baby carefully and gradually into the tub, feet
first, using appropriate hold.
16. Quickly soap the infants entire body except the head
using another wash cloth paying special attention to
body creases, between toes, area under the chin andgenitalia (revise the diaper care)
17. Rinse the soap off the infant quickly.
18. Again lift the infant from the tub back to the towel and
dry well.
19. Dress the infant; comb his/her hair gently.
20. Clean all used equipment and return to its place.21. Wash hands.
22. Record time and observations.
NB:
Allow time for kicking, playing, and talking with
the infant to enjoy bathing.
Apply lotion or oil to body creases avoids using of
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talcum powder. Talcum powder with oil makes a past, which retain
body secretions and irritate the skin. It may be
inhaled leading to respiratory distress
Bottle Feeding1 2 3 4 5 Comments
Indication: Extra indications to breast-feedingexist.
Principles of Bottle Feeding:
1. Persons who prepare the formula must wash
hands well.2. The formula is prepared and bottled
immediately before each feeding.
3. Warming the formula is optional. (if it stored
in the refrigerator).
Equipment:
For a fully bottle-fed baby you will need at
least eight full-size (250 ml) bottle with
suitable nipples.
Measuring cup for mixing powder formula.
Plastic funnel useful for pouring formula.
Plastic spoon stirring formula.
Plastic knife for leveling off scope of powder
formula.
Bottlebrush needed to clean thoroughly inside
the bottle.
Action
1. Prepare the needed equipment.
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2. Hand washing by soap and running water.3. Prepare formula as prescribed.
4. Check amount of formula on straight surface.
5. Let a few drops of formula fall in the inner aspectof your wrist to Test formula for temperature
6. Hold the baby unless contraindicated in a semi upright position, if a baby cannot be removed from
the crib, sit the baby, and elevate his /her head,
shoulders.
7. Put cotton under the babys chin.
8. Do not contaminate the nipple a much as possible.
9. Stroke the nearest cheek of the baby, or let somedrops of formula touches the babys lips.
10. Hold the bottle so that the nipple and neck of the
bottle are full of formula.
11. During feeding, hold the bottle firmly so that the
baby can pull against it as he/she sucks.
12. Burp the baby halfway through the feeding and at the end by one of the following methods:
a. Place a small towel over your shoulder to protectyour gown, place the baby firmly against your
shoulder and pat the back.
b. Place the baby in sitting position put a towel
beneath the chin support the chest and head withone hand gently rub the back with the other hand.
13. The feeding should take 15 to 20 minutes, dont
hurry the baby or force the infant to feed too
much.
14. If the baby doesnt want to let go of the empty
bottle, slide the little finger between the babygums and nipple to release the sucking.
15. Provide mouth care after feeding.
16. Place the baby on the abdomen or on right side
position at least one hour.
17. Record the amount type of formula and baby
reactions.
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Gavages Feeding1 2 3 4 5 Comment
Purposes:
1. Introduce fluids, medications that cannot be given by mouth.2. Carry out diagnostic procedures.
3. Conserve energy of infant, In case of prematurity or illness orcongenital deformity or at risk of aspiration.
Equipments:
1. A sterile suitable tube selected according to the size of the childand the viscosity of the solution (e.g. usual size for premature 5
French and 8 French for other children).
2. A stethoscope.3. The solution of feeding.
4. Non allergic tape.
5. Sterile water for lubrication.
6. Container for the fluids.
7. 5ml 10ml syringes.8. A pacifier.
9. Restraining equipment.10. Gloves.
Measurements:
1. Measuring from the tip of the nose to the tip of the earlobe and
then to the end of xiphoid process, alternatively you may also
measure from the bottom
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2. Measuring from the nose to the ear lobe and then to point midwaybetween the xiphoid process and the umbilicus
3. The same measure from the mouth to insert oral tube.
Action
1. Prepare the needed equipment.
2. Hand wash by soap under running water.
3. Explain the procedure to the parent and the child if he can understand.
Use on age suitable restraining
Place the child supine with head slightly hyperflexed
4. Measure the tube for approximate length of insertion.
5. Mark the point with a small piece of tape.6. Lubricate the tube by sterile water.
Check that the nostrils are patent.
7. A pacifier is used or place the infants finger in his mouth
8. Insert the rounded end of the tube into clearest nostril.
9. Slide the tube backward and inwards gently along the floor of the noseuntil predetermined mark.
10. Check the position of the tube by using at least two methods (Clampindwelling tube before using any method):
a. Attach the syringe to the feeding tube and apply negative pressure
aspiration of stomach content indicate proper placement (Notifyphysician if a gastric residue is greater than 25% of the pervious
feeding)
b. by the syringe inject a small amount of air 0.5-1m in premature to 5m
older children into the tube while listening with a stethoscope over the
stomach area and then withdraw air.
c. Emerge the end of the tube into a container containing clean water, the
water during breathing if bubbling occur withdraw and reinsert.
11. If the tube is fixed, stabilize the tube by holding or taping it to the
cheek by adhesive tape.
12. Check the formula temperature to be as the room temperature.
13. Connect the syringe barrel into the tube.
14 Pour formula into the barrel of the syringe attached to the tube.
15. Raise the syringe barrel 20-25cm from the bed.
16. To start flow, give gentle push with the plunger and allow the fluid to
flow into the stomach by gravity.
17. The rate of flow 5-10ml/min in premature, and 10ml/min in older
infants and children.
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18. Just before the syringe is empty, pinch the tube by fingers.19. Flush the tube with sterile water or G5% 1-2cm.
20. Clamp indwelling tube & remove the syringe.
21. If the tube is to be removed pinch it firmly and withdraw the tubequickly.
22. Position the baby on right side or abdomen at least one hour.
23. Provide mouth care with gauze and normal saline.
24. Record the amount, type of formula and amount of gastric residue.
25. Remove equipment, leave area clean and tidy.
Gastrostomy Feeding
1 2 3 4 5 Comments
Providing nourishment and fluids via a tube that is
surgically induced through an incision made throughthe abdominal wall into the stomach for those requiring
tube feedings for an extended period of time.
Equipment
- Feeding formula
- Pacifier.
- Reservoir syringe or funnel- Syringe for aspirating.
- Dressing or piece of cotton
- Gauze for mouth care- Tape
Action
1. Explain to the child or to the family the feeding
procedure
2. Wash your hands.
3. Prepare the needed equipment
4. Check residual stomach contents before feeding.
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5. Attach syringe and aspirate stomach contents.6. Measure residual stomach contents
7. Residual fluid may be returned to stomach or
discarded, depending on amount.
8. Place the child on comfortable position, either flat or
with head slightly elevated
9. A pacified can be given.
10. Attach reservoir syringe to tube and fill syringe
with feeding fluid to unclamping tube.
11. Elevate tube and syringe to 1012 cm above
abdominal wall Do not apply any pressure to start flow
12. Feed slowly taking 20-45 min fill reservoir withfluid before it is empty to avoid instillation of air.
13. When feeding is completed:
a. Instill clear water 1-30o of clear water.
b. Apply clamp before water level reaches end of
reservoir
14. Place the child in comfortable position.
15. Mouth Care
16. Wash your hands
17. Record the feeding time formula content, route of
feeding and any changes or abnormality and report tothe doctor.
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Intramuscular Injections
1 2 3 4 5 Comments
A drug is administered by intramuscular route when:
1. A more rapid action is required than oral.
2. Giving medication into muscle.
Equipments:
1. Tray.2. Appropriate syringe and needle size.
3. Spirit lotion in container and swabs.
4. Prescription sheet.
5. Drug to be administered (vial or ampoule).6. Sterile saline bottle or ampoule of sterile distilled water.
Recommended Injection Sites for children:
1. Ventrogluteal area (any age).
2. Vastus lateralis (for infant and young child).
3. Rectus femoris (for infant and young child).4. Gluteal region (children who have been walking for at
least one year).
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5. Deltoid muscle for older child to administer a smallamount of drugs as insulin.
6. It is better to be avoided in childhood and infancy
Action
1. Check the medications order (Medications card) accuracyand frequency. It should contains the following, the five
rights:
The childs name.Name of drug.
Time for administration.
Route of administration.
Dose to be administered.2. Clarify any discrepancies in the order with the senior nurse
or the physician.
3. Arrange the medications cards in logical order for
distribution.
4. Wash hands and wear disposable gloves
5. Prepare the drug in suitable syringe, needle, and cottonswabs in a tray far from the child.
6. Attach the needle to the syringe without removing it from its
protective covering.
7. Prepare antiseptic swab.
8. Prepare the drug dose.
9. Remove old gloves and wear new one
10. Explain procedure to child and parents.
11. Talk to the child while preparing him/her.
12. Expose patient to a minimum stress, and select proper site
according to childs age:
Ventrogluteal area (any age), because its
sufficiently thick and does not contain major nerves
or vessels.
Vastus lateralis (for infant and young child).
Rectus femoris (for infant and young child).
Gluteal region (children who have been walking for
at least one year), the musculature itself is poorly
developed until the child has been walking for a yearor more.
Deltoid muscle for older child to administer a small
amount of drugs as insulin, it is better to be avoided
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in childhood and infancy, its poorly developed13. Clean the site with an antiseptic swab using a circular
motion from inner to outer.
14. Remove the needle cover.
15. Expel air bubbles unless one is to be left.
16. The muscle mass of the thigh to be injected in firmlygrasped in one hand to stabilize the limb and compress the
muscle mass for injection with other hand.
17. Insert the needle with proper angle according to the selected
muscle by quick, firm movement with minimum injury.
18. Stretch the skin taut between thumb and forefinger.
19. Fix the syringe with left hand and aspirate before injecting if
blood is revealed, the needle must be withdrawn andreinserted.
20. Inject the content of the syringe slowly.
21. Press the cotton against the injection site and pull the needlequickly.
22. Move the limb or massage the site with alcohol sponge, if
bleeding occurs apply pressure (with dry sponge untilbleeding stops) to the site until it stops.
23. Dispose of supplies according to agency procedures.
24. Wash hands.25. Hold the child and try to please or give him/her any toy
according to his age.
26. Record in patients chart name of drug, dose, route, time and
signature.
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Intravenous Fluid Therapy1 2 3 4 5 Comments
Purpose:
1. To restore and maintain the childs fluid and electrolyte
balance and body homeostasis when his oral intake is
inadequate to serve this purpose.2. To replace severe fluid loss in emergency situations such as
in severe burns, severe hemorrhage and dehydration.
3. To administer medication when other routes are notappropriate.
Equipment:
1. I.V. solution The kind of solution is specified by thedoctor
2. Tray
3. V. administration set.4. V. pole.
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5. Label.6. Doctors order sheet.
Procedure
Preparatory Phase
1. Check the infusion fluid which is prescribed by the doctor.
2. Check the following details:
a. Childs name, room and bed number.
b. Date of prescription.
c. Type of prescribed fluid.
d. Amount of prescribed fluid.
e. Container labeled for I.V. therapy.f. Expiry date of the I. V. fluid.
g. Time prescribed for starting the I.V. therapy.
h. Time to be taken for completion of I.V. infusion.
i. Signature of the medical practitioner.
3. Check the fluid for cloudiness, sedimentation or discoloration.
4. Check the system: the solution, set, cannula and patient
Performance Phase
1. Set up intravenous infusion in an area not visible to the child.
2. Inspect the solution and turn the I.V. bottle.
3. Write down data, rooms No; childs names, components, start
from, dripping/minute on the label and then put it on the bottle
4. Remove protective cap from spike of infusion set and insert
through outlet hole in bottle stopper.
5. Hang I.V. bottle on I.V. pole.
6. Squeeze a drip chamber and fill the drip chamber with one third
to half of solution, this volume prevents air bubbles from
entering the tube.
7. Remove protective covering from needle adapter and open
clamp, and then run solution through, tubing allowing some
fluid to flow needle adapter and close clamp dont touch theneedle adapter at any place.
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Intravenous Fluid TherapyCannula Insertion
Equipment:
1. Appropriate size of cannula 20-24 are appropriate size for
pediatric age The size of the cannula depends on the ageand size of the child and the type of fluid to be
administered.2. Tourniquet.3. Normal saline.
4. Cotton sponges with alcohol and dry cotton sponges.
5. Surgical adhesive tape.6. Kidney basin.
7. Label.
8. Padded arm board.
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9. Restraining devices if necessary.10. Syringe (5 or 10 ml).
1 Select an appropriate vein puncture site.
2 Restrain the child if needed.
3 Tighten tourniquet above the vein where needle will be inserted
4 Cleanse an area of needle insertion with cotton with alcohol.
5 Insert the needle and check for blood return
6 Remove the tourniquet.
7 Connect needle to infusion set and fit the tube.
8 Start to drop and set the I.V. flow rate according to doctors
order & calculate the dose.9 Dispose the equipment properly
Follow up phase: follow the system
1. Check the child at least hourly for: -
a. Note the color of the skin at the needlepoint.
b. Note the location of the I.V. needle.
c. Check for swelling of the skin at the needlepoint:If in a hand or foot, compare with the opposite extremity.
If in the head, look at the face to determine asymmetry.
d. Feel the area around the I.V. site for leakage.
2. Weigh the child at regular intervals, using the same scales eachtime.
3. Maintain an accurate record of intake and output every 8 hours.
4. Record essential information:Total amount of fluid infused compare with the total amount offluid intended to be infused.
Rate of flow.
Apparent condition of the child.
5. Irrigate the I.V. as necessary as follows: -
a. Gather equipment syringe with 1-3ml normal saline andseveral alcohol wipes.
b. Clamp off the solution aspirate first.
c. Disconnect the I.V. tubing at the needle insertion site. Keep itsterile.
d. Connect the syringe to the tubing at the needle insertion site.
e. Slowly inject the normal saline.
f. Disconnect the syringe and reconnect the I.V. tubing to theneedle insertion site
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g. Unclamp the I.V. and regulate the flow of the solution.h. Check frequently to make certain that the I.V. is functioning
properly.
Cannula CareEquipments:
1. Dry cotton balls.
2. Syringe with 2 ml saline3. Cotton with alcohol.
4. Cotton balls soaked with saline5. Gauze pads.
6. Adhesive tape
Action 1 2 3 4 5 Comments
1. Wash hands.
2. Prepare all equipment.
3. Explain procedure to the child or his/her mother.
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4. Remove old dressing with cotton soaked with saline.5. Inspect site for presence of any abnormalities.
6. Clean site of insertion to outward by cotton with
alcohol.
7. Clean I. V. site by cotton with alcohol.
8. Apply adhesive tape.
9. Remove & clean equipment.
10 Hand wash.
11 Record.
Colostomy Care
1 2 3 4 5 Comments
Objectives:
To promote healing of the stoma
To provide comfort
To teach patient or parents self care
Equipment; A tray with:
1. 1 bowl with soap solution (not irritant) or any
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solution according to hospitals policy.2. 1 bowl with clear water.
3. Large pieces of gauze.
4. Colostomy bag if available.5. Zinc oxide ointment or soothing cream.
6. Disposable gloves.
7. Rubber sheet.8. Towel.
9. Clean cloth.
Remember to:
1. Wash hands.
2. Wear gloves.3. Keep privacy , Close windows and doors to prevent
air graft
4. Explain procedure to the child or to his mother.
5. Check Colostomy site.6. Keep patient in a comfortable position.
Action
1. Explain procedure to the child and his mother.
2. Prepare all necessary equipment.
3. Close windows and screen patient.
4. Place disposable container in an easily accessible spot.
5. Protect bed with rubber sheet.
6. Wear disposable gloves
7. Remove any adhesive and cut bandage on each side of
colostomy
8. Remove soiled dressing, If no colostomy bag is used
9. If colostomy bag is used, remove it, pulling towardsthe stoma with clean forceps and dry Pieces of gauze
10. Assess the stoma output for volume, consistency andodor in relation to the type and location of the stoma.
11. Gently and thoroughly wash the skin using warm
water and mild soap (not irritant)12. Assess the stoma and surrounding skin by using gauze.
13. Clean well over and around stoma remove any stools
14. When the stoma became clean, repeat with gauze
soaked in clear water.
15. Wipe the Peri-stoma skin with mild soap and water
and dry it put zinc oxide, or any soothing cream
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16. If bag is used:a. Measure the circumference of stoma and choose
appropriate bag.
b. Fix bag on skin applying even, firm pressure tight tostick bag.
17. If bag is not used:Apply a folded cloth over the stoma and secure it with
a tape (Tape must be not irritant if available).
18. Remove and clean all equipment.
19. Wash hands.
20. Keep child dry and comfortable.
21. Reassure child, and mother, praise him for co-operation.
22. Record condition of dressing and stoma color of stoolsand character, time and signature.
EnemaIndications:
For cleansing these enemas may be used to empty
the lower intestine. Isotonic saline or commerciallyprepared solutions may be used for this type of
enema.
Therapeutic cool saline is used to reduce the body
1 2 3 4 5 Comments
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temperature of infant with a high fever; bariumenema may also used for the reduction of an
intussusceptions.
Diagnostic the most frequent use of diagnostic
enemas is the examination of lower intestinal tract
with liquid barium sulfate.
Equipments:
1. Container for enema solution.
2. Solution.
3. Rectal catheter, appropriate size.4. Lubricant.
5. Disposable gloves.6. Bath thermometer.7. Bed pan, diaper.
8. Rubber sheet or water proof pad.
Remember to
1 The amount of fluid instilled varies with the age andsize of the child, also the same as regard length of
catheter advancement.
2 Never Force the catheter into anal canal, if a well-lubricated catheter does not advance easily stop the
enema.
3 Tap water or hypotonic solution should be used withcaution. Absorption of large amounts of fluid instilled
into the bowel may produce hypo tonicity of the extracellular fluid and hyponatremia.
Action
1. Explain procedure to the child or his/her parent.
2. Wash hands.
3. Prepare all needed equipment.
4. Fill the container with enema with solution warmed tobody temperature, unless the purpose is to reduce body
temperature. In that case a cool solution is used.5. Provide for the child privacy, close curtains, around the
bed, drape the child with the anus exposed.
6. Put waterproof sheet under the child.
7. Place a bedpan under the childs buttocks; place the child in one of the following positions:
a. The child lies on the left side in the lateral recumbent
position with knees draw up to the chest
b. The infant is placed on the back and legs are lifted to
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expose the anal orifice(area for insertion)c. The Sins position is used for the older child, who lies on
the left side, with the right thigh flexed bout 45c to thebody axis
d. The knee chest position may be used for the older child.The child balances on the knees and chest, resting the
head on the forearms
*drape the child with the anus exposed.
8. Put on gloves
9. Lubricate the rectal catheter by lubricating jelly with
Lidocaine 2%.
10. Introduce the catheter past the anal sphincter to the analand lower rectum.
11. When the tip of the catheter is in place, elevate the bag
and instill the fluid slowly.
12. If the child shows symptoms of distress, does the flow
of fluid stooped.
13. Remove tip of catheter and the buttocks is hold together
for a few minutes; the child is urged to defecate.
14. Place the child on bed pan or apply clean diaper.
15. Dispose equipment.
16. Wash hands.17. Praise the patient For his cooperation
18. Record results of enema.
Age *Wt. *Amount of fluid Length of Advancement
Infant 5-10 kg. 100-200 ml 2.5cm
Small child 11-30 kg. 200-300 ml 5cm
Large child 31-50 kg. 300-500 ml 7.5cm
Adolescent Over 50 kg. 500-700 ml 10cm
Naso/ Oro pharyngeal suctioning
1 2 3 4 5 Comments
Purposes:
1. To maintain patent airway.2. To facilitate exchange of gasses.
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Equipment:- Suction tubing.
- Suction device.
- Irrigating solution (sterile water).
- Water soluble lubricant or sterile water.- Disposable gloves or sterile gloves.
- Oxygen source.
- Bag valve device.
Suction catheter sizes:
Neonate to 18 month 5 -8 French
18 months to 7 yrs 8 10 French
7 to 10 yrs 10 -14 French11yrs to adult 12- 16 French
Negative Suction Pressures:
Premature 40-60mmHgNeonates 60 - 80 mmHg
Infants 80 - 100 mmHg
Children 100-120 mmHg
Preparations
1- Assess the childs need for suction by respiratory rate, breath
sound and heart rate.
2- Prepare all needed equipment.
3- Done chest physiotherapy (active or passive).4- Check all equipment functioning.
5-Ventilate the child with 100% oxygen before during and aftersuctioning.
6- Reassure and calm the child and his relative.
Action
1. Wash hands.
2. Turn on suction apparatus and set vacuum regulator to
appropriate negative pressure.
3. Select appropriately sized suction catheter.
a. Straight catheter is generally recommended for oropharyngealand nasopharyngeal suctioning.
b. Select appropriate catheter diameter.
4. Secure one end of connecting tube to suction machine andplace the other end in a convenient location within reach.
5. Open sterile catheter package on a clean surface using the
inside of the wrapping as a sterile field.
6. Set up the sterile solution container or sterile basin on the
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sterile field. Be careful not to touch the inside of the container.Fill with approximately 100 ml of normal saline or sterile
water.
7. Open lubricant and squeeze on to sterile catheter package
without touching package.
8. Provide 3 hyperinflation, hyper-oxygenation breaths with a
bag valve mask connected to a manual resuscitation bag
attached to 100% oxygen
9. Don sterile glove goggles and mask.
10. Pick up suction catheter, being careful to avoid touching the
non-sterile surfaces. With the non-dominant hand, pick up
connecting tubing and secure the suction catheter to theconnecting tubing.
11. Check equipment for proper functioning by suctioning a
small amount of sterile saline from the container.
12. Coat the appropriate length of suction catheter with water-
soluble lubricant or sterile water by make an approximate
measure by measuring the distance from the tragus of thechild's ear to tip of the nose.
13. Leave catheter air vent open.
14. For suctioning Nasopharyngeal approach:
a. Identify patent nasal passageway.
b. Gently insert the catheter through the patent nostril, guiding
it medially and downward along the passageway (use same
technique when going through nasopharyngeal).
15. For suctioning Oropharynx approach:
Gently insert catheter into mouth and advance catheter tip 3 to 4
in. into secretions of the pharynx.
16. Slowly withdraw the suction catheter while rotating it backand forth between dominant thumb and forefinger. Apply
intermittent suction of the air vent during withdrawal.
17. Rinse catheter and connecting tubing with sterile water or
saline.18. Suction both sides of mouth and pharynx.
19. Repeat steps 15 through 18 to clear nasopharynx and
oropharynx.
20. Monitor patients ECG tracing and heart rate between
suction passes.
21. Dispose of catheter and gloves.
22. Reposition patient.
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23. Reassess patients respiratory status.24. Discard remainder of supplies in appropriate receptacle.
25. Wash hands.
26. Dispose of suction canisters and connecting tubing every 24
hours and set up new system.
Endotracheal Suctioning
1 2 3 4 5 Comments
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Summer Semester 2012-2013
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Indication: It is performed to remove blood or secretionfrom the endotracheal tube.
Equipment :
1- Suction catheter.
2- Suction tubing.
3- Suction device.4- Sterile irrigating solution.
5- Sterile gloves mask.
6- Water-soluble lubricant or sterile water.
7- Oxygen source.8- Bag-valve device.
Procedure1. Explain to the child and the family the need for
endotracheal suctioning, as time permits.
2. Note the childs cardiac monitor and pulse Oximetry
readings.
3. Wash your hands thoroughly with Betadine, don gloves
and mask.
4. Connect suction catheter to the tubing of the suction
device and set the suction pressures to the desired negative
pressure according to child age5. Ventilate the child with 100 % oxygen for 3
hyperinflation, hyper oxygenation with a bag valve device6. Lubricate the appropriate size of catheter with sterile
water.
7. Without applying suction, quickly and gently insert
catheter into the endotracheal tube and apply suction whilerotating the catheter between the thumb and forefinger. and
use a septic technique.
8. Apply suction by occluding the on / off port, and gentlywithdrawing the catheter with a twisting motion.
* Limit suction not more than 5 seconds.
9. After withdrawal of catheter, rinse it with sterile water.
10. Ventilate child in-between and after attempts with 100 %oxygen.
11. Monitor childs heart rate, color throughout theprocedure.
12. Repeat steps 7-11 as needed.
13. Return child to previous oxygen setting, auscultate
anterior lungs bilaterally.
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14. Comfort child during and after procedure.15. Discard reminder of equipment according to institution
policies.
16. Document the childs response to suctioning, the type
and amount of suctioned secretions, any changes in heart andrespiratory rates
Oxygen Therapy Through Simple Face Mask
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1 2 3 4 5 CommentsPurposes :
1- To prevent or relieve hypoxia.2- To keep healthy level of tissue
oxygenation.
Equipment :
1- Oxygen source
2- Flow meter.3- Humidifier with distilled water
4- Connecting tube (except in using nasal
cannula)
5- Selected device for oxygen administration(face mask, nasal cannula, incubator or
oxygen hood)
Action
1. Wash hands.
2. Attach humidifier to flow meter.
3. Connect flow meter to oxygen source, andcheck operation of flow meter and humidifier.
Set prescribed oxygen flow.
4. Attach oxygen mask to connecting tubing and
then to humidifier and flow meter.
5. Turn on oxygen.6. Place mask on patients mouth and nose, adjust
elastic or tubing for a snug fit.
7. Check oxygen flow.
8. Stress fire hazards involved with oxygen
administration.
9. Wash hands.
Oxygen Therapy Through Nasal Cannula
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1 2 3 4 5 Comments
Purposes :
3- To prevent or relieve hypoxia.
4- To keep healthy level of tissueoxygenation.
Equipment :
6- Oxygen source
7- Flow meter.
8- Humidifier with distilled water
9- Connecting tube (except in using nasal
cannula)10- Selected device for oxygen administration
(face mask, nasal cannula, incubator oroxygen hood)
Action
1. Wash hands.
2. Attach humidifier to flow meter.
3. Connect flow meter to oxygen source, and
check operation of flow meter and humidifier.
4. Open cannula package and attach to humidifier
with care to avoid contamination of cannula
nasal tips.5. Turn oxygen flow meter on to prescribed literflow/ oxygen concentration prior to applying
cannula. Observe that water in humidification
container is bubbling.
6. Insert the nasal tips into the nares. Direct
prongs posteriorly.
7. Loop the two plastic tubes of the cannula over
the ears and under the chin, or place elastic band
around the head.
8. Gently adjust the plastic slide until cannula is
secure.9. Wash hands.
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Closed incubators / Isolettes
1 2 3 4 5 Comments
1. The incubator is used to provide a controlled environment
for the neonate.
2. Adjust the oxygen flow to achieve the desired oxygen
concentration.
a. An oxygen limiter prevents the oxygen concentration
inside the incubator from exceeding 40 %.
b. Higher concentrations (up to 85%) may be obtained by
placing the red reminder flag in the vertical position.
3. Secure a nebulizer to the inside wall of the incubator ifmist therapy is desired.
4. Keep sleeves of incubator closed to prevent loss of
oxygen.
5. Periodically analyze the incubator atmosphere.
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Oxygen Hood
1 2 3 4 5 Comments
1. Warmed, humidified oxygen is supplied through a plasticcontainer that fits over the childs head.
2. Continuously monitor the oxygen concentration,temperature, and humidity inside the hood.
3. Open the hood or remove the baby from it as infrequentlyas possible.
4. Several different designs are available for use. The
manufacturers directions should be carefully followed.