Child Undergoing Diagnostic and Therapeutic Techniques

Helping obtained informed consent

Explaining the procedure to the child and parents

Scheduling the procedure

Preparing the child physically and psychologically

Obtaining equipment for the procedure

Accompanying a child to a treatment room

Providing support during the procedure

Ensuring adherence to standard precautions Assessing a child's response to the procedure

Nursing Responsibilities for A Child Undergoing Diagnostic and Therapeutic Techniques

Conscious Sedation

Administered to reduce pain and anxiety while maintaining responsiveness. a depressed level of consciousness induced by intravenous administration of a sedative

sedative such as midazolam in combination with a narcotic such as morphine sulfate and perhaps a hypnotic such as propofol

Medications used for Conscious Sedation

oral chloral hydrate

Given to children 60 mins before the procedure to relieve apprehension and make them feel sleepy

Infant

number of painful or uncomfortable procedures done should be kept to a minimum to avoid interfering with developing sense of trust

Toddler and preschooler

give children at this age short explanations of what to expect, close to the time of the procedure so that little time can be spent worrying over it.

School age and adolescent

they are interested in the theory and reason for procedures. Do not be misled into thinking a child age would not appreciate an explanation or a comforting hand on shoulder during a procedure

Safety

important component of all patient care. Children's immaturity, which makes them unable to form mature judgements, leaves them vulnerable to harm

15 mins

Interval to check restraints to see if they are not occluding circulation

restraint

keep the child safe during procedure, must always be used with care, because if improperly applied or used, they can cause more harm than help

assess how well a child reacted to the procedure by both observation and history. Allow children to explain what happened helps them retrace the procedure in their mind so they can conquer their fear of it. If conscious sedation was used, be sure children are wake before they are discharge home or return to an inpatient hospital unit.

Providing care after procedure

should be used only when necessary and after all other considerations are exhausted, never as a substitute for careful observation of the child.

Cannot be used on a continuous basis without an order. Continuous use requires justification and full documentation

Reason for use should be explained lo the child and parents to prevent misinterpretation and to ensure their cooperation with the procedure

Do not cover an IV site with a restraint when possible.

should be checked frequently to make sure it is effective and is not causing any ill side effects.

Any protective device that requires attachment to the child's bed should be secured to the bed springs or frame, never the mattress or side rails

General Considerations when using restraints

Electrical impulse studies

those that include electrical conduction. Electrodes are attached to the body by paste, which is easily removable. If possible give the child a portion of the test strip afterward as a souvenir

X ray studies

used to inspect internal body tissue. These range from the simple x ray to the more complicated computed tomography scan or dye contrast study

Flat Plate X-Rays

Dye Contrast Studies

Types of X-ray Studies

Flat plate x rays

an imaging test that uses X-rays to visualize the organs and structures within the abdomen, including the stomach, intestines, and urinary system.

lead apron and lead glove protection.

Protection for Flat plate x-rays

Dye contrast studies

Radiopaque dyes are used to visualize body cavities (e.g., barium for GI tract studies).

Computed Tomography (CT)

Provides cross-sectional images of organs. views of an organ or body part are obtained to represent what the organ would look like if it were cut into thin slices.

iodine-based contrast medium injection.

Medium used for CT scan

Magnetic Resonance Imaging (MRI)

Combines magnetic fields and radiofrequency waves to produce images. The child lies on a moving pallet that is pushed into the core of the machine-the magnet. When magnetic field surrounding the child is turned on, it causes tissue atoms to line up in a parallel fashion

Ultrasound

a painless procedure in which pictures of internal tissue and organs are produced by sound waves, it is noninvasive.

Nuclear medicine studies

Involves radiopharmaceuticals administered orally or by injection to visualize specific organs. Reassure parents that the radiation dose is minimal, comparable to standard X-rays.

Endoscopy

Bronchoscopy

Colonoscopy

Direct Visualization Procedures

Endoscopy

used as an emergency measure to remove objects such as quarters or safety pins swallowed by children. The child is NPO for 4 hours before the procedure. They may need sedative so they can lie quietly. After the procedure monitor for signs of edema to not interfere with vital functioning such as respiration. Check for gag reflex before offering any fluid

Bronchoscopy

direct visualization of the larynx, trachea, and bronchi. It is used to children who have aspirated a foreign object or to take culture and biopsy. Observe respiratory function and airway for at east 4 hours after the procedure Assess gag reflex before offering fluid An ice bag applied to the neck to help relieve edema

atropine

A child is given by injection to reduce bronchial secretions and to encourage bronchial relaxation

Colonoscopy

endoscopic exam of the large intestine with a flexible fiberscope inserted through the anus and advanced as far as the ileocecal valve. Air is then infused to expand the bowel walls. The technique allows the colon walls to be visualized, photographs can be taken for analysis. Before the procedure children are given a clear liquid diet for 24 hours. Children may pass a great deal of flatus in the first 12 hours because of air introduced during the procedure

isotonic saline laxative

given for colonoscopy that causes diarrhea so the bowel is clean

Aspiration studies

removal of body fluid such as lumbar puncture and bone marrow aspiration. A child may need sedative so he or she can lie quietly.

Blood specimen

should always be obtained away from a child's bed. Applying band-aid afterward to cover the needle site provides physical as well as psychological support

Dorsal hand veins, antecubital fossa, or, in rare cases, the jugular or femoral vein.

Common sites for venipuncture

Capillary Puncture

often obtained for glucose and hematocrit determinations. Apply an anesthetic cream before the procedure to reduce discomfort if needed

Routine analysis

often obtained for glucose and hematocrit determinations. Apply an anesthetic cream before the procedure to reduce discomfort if needed

Clean catch urine

ordered when urine is needed for urinalysis and culture. The technique for obtaining a clean-catch urine specimen from older child is the same as for the adult

24 hour urine specimen

to determine how much of a substance is excreted during a full day

Suprapubic aspiration

withdrawal of urine from the bladder of a child who is not old enough or in some other way cannot cooperate enough so that a clean-catch or catheterized specimen can be obtained. It is done by inserting sterile needle into the bladder through anterior wall of the abdomen