nurse as an educator for health promotion of the child and family

communication and interviewing

goal directed communication requires an organized approach

introduce yourself and role

provide privacy and explain limits of confidentiality

protect computer and telephone triage privacy

helpful approaches with communicating with families

encourage parents to talk

direct the focus when needed

listen with cultural awareness

use silence and empathy

interview without judgment

common barriers with communicating with families

unsolicited advice

premature reassurance

cliches or stereotyped comments

interrupting or talking more than the family

changing the focus deliberately

using an interpreter

use a qualified interpreter when language affects communication

do not use children as interpreters

consider cultural, legal, and ethical responsibilities

protect confidentiality and mutual respect

communication with infants and young children

use touch, repetitive actions, and colorful objects

use simple language and concrete choices

use play to build rapport and gather information

communication with school age children and adolescents

explain procedures and invite participation

speak directly to the child’ or adolescent

provide privacy when appropriate

child’s health history

identify the informant and chief complaint

review the present illness and symptoms

include birth, diet, allergies, medications, and immunizations

review illnesses, injuries, hospitalizations, and surgeries

family and environment health history

first degree relatives and geographic location

family structure and dynamics

psychosocial factors

environmental exposures and food practices

nutritional assessment

dietary intake and history

dietary reference intakes

cultural food practices

usual mealtimes and patterns

24 hour recall or food diary

childhood injury

a major cause of childhood death and disability

unintentional injury risk relates to growth, age, gender, and environment

development, cognition, and anatomy influence risk

morbidity may include acute illness, chronic disease, or disability

nurses role in injury prevention

should follow the child’s developmental stage and exposure risks

educate caregivers

promote a safe environment

avoid judging families after an injury

match teaching to the child’s developmental abilities and risk

infant safety: SAFEPAD

suffocation/sleep

asphyxia/animal safety

falls

electrical/burns

poisoning

automobile safety

drowning

car seat safety: infant-only seats

rear facing only; used until height/weight limits reached

car seat safety: convertible seats

rear-facing for infants and toddlers (recommended until >= 2)

forward facing with harness after outgrowing rear facing limits

typically use a 5 point harness

car seat safety: booster seats

use vehicle lap shoulder belt

for children <145 cm (4ft 9in) and not yet fitting adult belts

high back, backless, or combination models

car seat safety: safety belts

used when child fits properly; shoulder belt across chest, not neck. lap belt low on hips, not abdomen

usually 8-12 years depending on size

special needs restraints

for children with medical or physical conditions

ex: car beds, spica cast seats, adaptive vests

toddler/preschooler safety

vehicle safety

drowning

falls

burns

suffocation/aspiration

poisoning

general safety

school age safety

car safety

drowning

pedestrian and bike safety

sports and recreation

burns/injury

poisoning

bodily damage

adolescent safety

motor vehicle safety

substance abuse and risk behavior

violence and firearms safety

intentional injury and suicide

firearm safety

use safes, cabinets, cables, or trigger locks

store ammunition separately

teach children not to touch firearms

do not rely on hiding a firearm

vaping safety

e cigarette aerosol contains nicotine and other chemicals

use has increased among adolescents

discuss substance use and possible lung effects

poisoning prevention

poison-proof the home

keep poison control center number available

call 911 for an emergency

poison proof home

read product instructions and warning labels carefully

keep poisonous substances locked up and out of reach of children

install safety latches on all cabinets containing poisonous products

only buy meds with safety caps on the bottles

take all meds out of purses, pockets, and drawers. keep in locked cabinet

never refer to meds or vitamins as “candy”

safety dispose of all unused meds

emergency poisoning treatment: assess

cardiorespiratory support if needed

mental status

vital signs

evaluate for the possibility of concomitant trauma or illness

emergency poisoning treatment: terminate exposure

empty mouth of contaminant

flush any body system exposed with large amounts of warm water or saline

remove contaminated clothes

bring inhalation victims into fresh air

emergency poison treatment: identify the poison

question victim and witnesses

observe circumstances

environmental cues

s/s of potential poisoning in the absence of other evidence

call PCC for immediate advice

emergency poisoning treatment: prevent poison absorption

place child in a side lying, sitting or kneeling position with the head below the chest to prevent aspiration

decontamination

ipecac stimulates vomiting but is not recommended for in home use

gastric lavage uses a large bore tube and carries aspiration or perforation risk

activated charcoal absorbs some poisons

antidotes

acetaminophen: N-acetylcsteine

carbon monoxide: oxygen

opioids: naloxone

benzodiazepines: flumazenil

poisonous bites: antivenin

lead exposure common sources

older paint and house dust

contaminated soil

older housing or recent renovation

some toys, remedies, or products

screening for lead exposure

venous blood sample

screen at ages 1 and 2 years

screen ages 3-6 if not previously screened

assess children with risk factors

treatment for lead

environmental investigation and hazard reduction

follow up blood lead monitoring

nutrition counseling related to calcium and iron

chelation may be used for higher levels

prognosis of lead

CNS is most affected

possible cognitive and behavioral changes

seizures or paralysis may occur

prevent further exposure

corrosives acids and bases manifestations

severe burning pain in the mouth, throat, and stomach

white, swollen mucous membranes; edema of the lips, tongue, and pharynx (resp obstruction)

coughing, hemoptysis

drooling and inability to clear secretions

signs of shock

anxiety and agitation

corrosives acids and bases treatment

contact PCC immediately

don’t induce vomiting; will reburn

oral fluids

don’t try to neutralize

analgesics

monitor for s/s of shock

hydrocarbons manifestations

gagging, choking, and coughing

burning throat and stomach

n/v

alterations in sensorium, such as lethargy

weakness

resp symptoms of pulm involvement: tachypnea, cyanosis, retractions, grunting

hydrocarbons treatment

inducing emesis is contraindicated

gastric decontamination and emptying are questionable when dealing with a heavy metal or pesticide

if gastric decontamination needed: ET tube

symptomatic treatment of chemical pneumonia