Chapter 20 - Pediatric Interventions & Skills

T/F: Postmortem examination does not require informed consent

FALSE

Assent

• Patient has been informed and is willing to permit a HCP to perform it

Requirements for verbal consent otp?

In the prescence of two witnesses

Emancipated Minor

• Legally under the age

  • Preggo

  • Married

  • High school grad

  • Independent living

  • Military service

Mature Minor

• >14yrs

  • has maturity and ability to understand informed consent

If consent cannot be obtained, what should the nurse do?

Document any effort made to obtain consent

Adolescents Consent to Treatment (w/out parents)

• STIs

• Mental health services

• subtance abuse/addiction

• pregnancy

• contraceptives

Prepping Child b4 Procedure

• Emphasize no other part will be involved

• Allow child to practice post op procedures (ex. IS)

• Introduce anxiety inducing info LAST

• Perform painful procedures outside the patient room

The younger the child…

The closer the explanation be to the actual procedure to prevent fantasizing/worries

POSTOP; fried foods…

Prolong gastric emptying time

IV Dantrolene Sodium

• Treatment for malignant hyperthermia

Why is high bp serious in premature infants?

It increases risk of intraventricular hemorrhage

Why are adhesive removers AVOIDED in preterm neonates?

Absorption rates vary and toxicity may occur

How should adhesive be removed in preterms?

• Use water

• Wet tape with water and alcohol gel

CHG contraindications?

Infants < 2mos

Set Point

Temp which body temp is regulated by the hypothalamus

Ibuprofen can be given for fever for children as young as

6 mos

T/F: Cooling procedures are ineffective in treating febrile cildren

TRUE

Seizures <10mins

Do not cause brain damage

What does gently rubbing the skin surface with a towel do?

Stimulate circulation

What does sponging help treat?

Elevated temps

T/F: Baby walkers are recommended

FALSE (theyre not)

Toilet Roll Guide

If toy fits, its a choking hazard

Armboards and hand mitts are

NOT considered restraints

Clean Catch/Midstream Specimen

Meatus is cleaned → first ml is voided → obtain!

What could a nurse ask the pt to do when foley meets sphincter?

Ask pt to inhale deeply and then advance foley

Max Volume of Blood Collected (over 24hrs)

Should NOT exceed 3ml/kg

What tubes are used for arterial blood samples?

Heparinized tubes

How are sputum cultures done in children?

Ask for an early morning gastric washing (lavage)

T/F: Children may require larger doses (per weight)/more frequent admin

TRUE

Dead Space

Fluid remaining in syringe after plunger is pushed completely forward

When giving IM injection, needle should be removed before

Releasing the skin

No TPN or vesicant is admin thru a

Midline

G Tube

• inserted thru the abdominal wall into the stomach

• zinc oxide helps with leakage

Moist beefy red tissue (granulation) around G Tube

• NORMAL

• NOT a sign of infection

G Tube Hypergranulation Tx

Triamcinolone Cream (0.5%)

Skin Level Gastrostomy

• For long term feeding

• Protrudes slightly, more comfy, immersible in water, $$

What should be done after g tube feedings

Position child on right side of fowlers

Why would a larger diaper be worn for pt with stoma?

To extend upward over stoma and absorb drainage

DOPE

• Possible etiologies is mech vent deterioration

  • Displacement

  • Obstruction

  • Pneumothorax

  • Equipment failure

How long is pt on NPO status b4 extubation?

4hrs

Chest Tubes

• Remove fluid/air

• Suction control chamber SHOULD have gentle continous bubbling

Water Seal Chamber (in Chest Tubes)

• protecting patients from air returning to body

When may chest tube be clamped?

• Exchanging collection chamber

• Determining site of air leak