Pediatric Variations of Nursing Interventions
Informed Consent in Pediatrics
Assent in the older child/adolescent = informed about what will happen & is willing to let the health care provider perform it.
Eligibility for Giving Informed Consent
Parents or Legal GuardiansMature & Emancipated Minors Mature Minors’ Doctrine – STDs, contraceptive services,
pregnancy, or drug or alcohol abuse Emancipated Minor – legal definition, pregnancy, marriage,
high school graduation, living independently, or military service
Treatment Without Parental Consent 2 physicians – emergencies that present a danger to life or the
possibility of permanent injury Consent by proxy Parental neglect or abuse
Preparation for Procedures
Psychologic Preparation (boxes 22-1 & 22-2)Establish Trust & Provide SupportParental Presence & Support (parents in the room during a procedure?)Provide an Explanation (use objects)Physical Preparation Sedation – conscious sedation assessment sheet
Performance of Procedure – expect success, involve the child, provide distraction, express feelings
Feeding the Sick Child
Loss of appetite is a common symptom of illnessUrging foods may precipitate N&V Control – refuse to eatShort term illness Nutrition usually not a problem (chart amount
consumed) Adequate fluids important
Causes of Elevated Temps
During infection pyrogenic substances cause an increase in set point, a process mediated by prostaglandins = hypothalamus increases heat production
Fever probably plays a role in enhancing the development of immunity and aiding in recovery
Reducing Elevated Temperature
Fever – principal reason to treat is relief of discomfortAntipyretics lower set point (acetaminophen & ibuprofen)Retake temp 30 min – 1 hour after givenEnvironment measures (prevent shivering)Cooling measures with hyperthermiaMetabolic rate increases 10% for every 1 degree C increase in temperature
Infection Control
Follow the infection precaution sign(s) outside the patient’s door
Hand wash going into and out of the room
Oral Medication Administration
Most accurate – plastic disposable syringe
Prevent aspiration with infant = sit up and place syringe along the side of the tongue and administer slowly (do not add to infant’s formula)
Mild physical coercion if needed in young child
Intramuscular Administration
Gauge of needle – as small as possible
Site Vastus lateralis – infants Ventrogluteal – CHCC after child has been
ambulating 1 year
Have someone help hold the child
Intravenous Administration
Peripheral venous access devices – CHCC saline lock
Central venous access devices (Hep flushes) PICCs (threaded into superior vena cava) Long-term central VADs
Broviac Mediport
Tape all connections to central lines
IV
Children’s Hospital Central California Assess and document IV site every hour Assess and document fluid infusion every hour
(also continuous NG/GT feedings) When assuming care, verify that the correct IV
solution/TPN/Lipids and rates are infusing
NG, OG, GT
Ease of administration
Check placement
Need adequate flushing to prevent risk of “clogging”