Nursing care for children - Power point 1

how is weight affected in children during the first year?

• first year has rapid growth

• birth weight doubles by 6 months and triples by 12 months

how are growth charts used for children to ensure they are growing properly?

• want to ensure it follows an arc on the growth chart and is consistent

• all is plotted on a growth chart including height, weight, and length at ALL VISITS

• use centimeters and kilograms

how long is head circumference measured on a growth chart?

• up to 36 months

when is BMI calculated on a birth chart?

• after 2 years

what is important when doing a physical assessment of children?

• allow the child to guide you and participate in their own care

• ask and speak with the family for assistance to make the visit less traumatic for the child

• follow the parents lead during the assessment - they know best

• progress from least to most invasive- RR, HR, temp, BP, height, weight

in what order should a nurse perform a physical assessment on a child?

least to most invasive

• respiratory rate - count for a full minute, auscultation

• Apical pulse - count for 1 minute

• radial pulse - not accurate measure until after age of 2

• temperature - rectal, oral, axillary, temporal

• BP: upper arm, lower arm, upper leg

• weight/height

what is important regarding fevers in children?

• any infant less than 3 months of age needs to be evaluated immediately if febrile

• less than 28 days will usually receive a complete septic workup, up to 90 days of age the key is if they appear sick

• any child with a fever greater than 105 needs to be evaluated immediately

• a child that appear or acts sick needs to be evaluated immediately

what is a rule of thumb regarding the duration of fevers?

• patient must be evaluated in 24 hours if:

  • they have a fever of 104-105

  • are younger than 2 years of age

  • have a fever longer than 3 days or longer than 24 hours without reason

  • fever gone for 24 hours and then returns

  • if there are any parental concerns

what constitutes something as a fever?

• defined as a temperature greater than 38 degrees C or 100.4 F

• most fevers are brief with limited consequences and are viral in origin

• helpful in increasing WBC and interferon effectiveness

what is recommended for treating fevers in children?

• aimed at relieving discomfort, medications to lower set point

• acetaminophen 10-15 mg/kg per dose, no more than 5 doses in 24 hours

• ibuprofen 5-10 mg/kg per dose after 6 months of age

• NO ASPIRIN

what parental education should be given regarding treatment of fevers?

• parental support and education should be when to follow up and correct medications to use

what are the different medication administration options for children?

• oral

• otic

• optic

• nasal

• aerosol

• rectal

• injections - IM, subQ, intradermal

what are the 6 rights of medication administration?

• right route

• right dose

• right time

• right med

• right patient

• right documentation

how should PO meds be administered in children?

• liquid suspension in syringe, cup or spoon, slide syringe into the sheet pocket and administer meds

• parents should be included

• positioning is important

• if administered into food, use the smallest amount possible

when does pill swallowing begin?

• ages 6-11

how should optic meds be administered in children?

• child should sit in supine or sitting position, and head down look up with caregiver in sight

• pull the lower eyelid down and apply medication in the lacrimal pocket

• best time to do so is before nap or bedtime

examples of optic medications for children

• eye gtts for allergies or ointment for conjunctivitis

how should otic medications be administered in children?

• position should be prone with affected ear towards you

• typically drops but allow refrigerated meds to come to room temperature to avoid vertigo

• ages younger than 3 pull ear back and down

• ages older than 3 pull ear back and up

otic medication examples

• antibiotics for otitis media

• numbing drops for ear pain

how should nasal medications be administered in children?

• head should be extended or hyper extended, and a pillow or rolled towel should be used to extend the neck

• hold infants in a football hold

• insert the tip of the injector just inside the nares or at the tip of the inside of the nose

examples of nasal medications for children

• saline nasal spray for blocked nasal passages, allergy spray fluticasone (Flonase)

how should aerosolized medications be administered in children?

• position the child to be sitting up right

• remove cap from inhaler and spacer, shake the inhaler for 5 seconds and place it in the open end of the spacer

• tilt the head back and breath out as much as possible

• put the mouth piece of the spacer in the mouth and press the inhaler while breathing in slowly for 3-5 seconds

• hold breath for 10 seconds or as long as possible

• take the spacer away from the mouth and blow out slowly

examples of aerosolized medications for children

• metered dose inhalers, nebulizer (asthma medications)

how should rectal medications be administered in children?

• have the child lay on the side with one leg positioned forward to allow visual inspection of the rectum

• have the medication lengthwise is possible

• hold the buttock cheeks closed as long as the baby will allow - 5- 10 minutes

who are rectal medication contraindicated in?

• immunocompromised patients because of the increased risk of infection and bleeding

what is the difference between recommended and required vaccines?

• required vaccines are determined by the state for school attendance

• the American academy of pediatrics recommends entire list of vaccines

when is it ok to give a vaccine?

• mild to moderate local reaction to a past vaccine, just ask what the reaction was

• mild acute illness or without low grad fever

• current antibiotic therapy

• prematurity

• family history of seizures, SIDS or adverse reaction to a vaccine

• breastfeeding or household contact with a pregnant woman

what are contraindications for giving a vaccine?

• severe febrile illness ( fever is over 38 C or 100.4)

• past SERIOUS adverse reactions to a vaccine or vaccine component

• long term (over 2 weeks) use of a systemic steroid

• pregnancy

• recent blood, plasma, or IgG for live vaccines wait a minimum of 3 months

• seizure within days of receiving a prior dose of vaccine

when should vaccines be given in immunosuppression patients?

• transplantation patients should receive no live vaccines if undergoing immunosuppression therapy

• HIV patients can receive live virus vaccines if asymptomatic

• chemotherapy patients must wait at least 6 months usually to restart vaccination schedule

what are the 4 most important things when administering injections?

1. site and equipment, must know what is needed

2. safety - good restraint, ok to give multiple injection just must use different sites, do not combine vaccines, correct storage of vaccines

3. developmental approach - give injection quickly, with help and with warning but not extended periods of time for child to get upset or nervous, children younger than school age have a hard time with time measurement - rewards based on age, band aids is a must developmentally

4. documentation - in patient permanent record, MAR and paperwork with caregiver, site, VIS, consent, lot number

how should intramuscular injections be given?

• vastus laterals until age 1

• deltoid after 12 months

• ventrogluteal only in children who are walking

• ½ - 1in depth

• immunizations and meds, typically antibiotics

how should subcutaneous injections be given?

• fatty tissue over thigh muscle until 12 months of age

• arm for immunizations after 12 months

• injected live virus, hormone replacement, allergy shots, some vaccines

how should intradermal shots be given?

• place the needle almost flat against the patients skin, bevel side up and insert the needle into the skin ¼ inch with the entire bevel under the skin

• ½ and 5/8 needles are the most common needle length

• do not massage area after the injection and withdrawing at the same angle as insertion minimizes discomfort to the patient and damage to the tissue. Proper needle disposal prevents needle stick injuries

• PPD or allergy testing is common for intradermal injections

what degree do IM, SUBQ, and ID injections get inserted?

• IM - 90 degrees

• SubQ - 45 degrees

• ID - 15 degrees

what are developmental considerations for vaccine administration in infants and babies?

• perform the procedure quickly and ask parents for support information on the best way to approach the infant

• allow infants to swallow - pacifier, bottle, or breast

• provide comfort measures such as cuddling or holding

what are developmental considerations when administering vaccines in toddlers and preschoolers?

• brief concrete explanation immediately before performing

• expect aggressive behavior within limits, plan accordingly, provide outlet for response

• provide comfort measures such as touch, cuddling, holding, favorite stuffed animal or blanket

• provide a toy reward, sticker, and band aid

what are developmental considerations when administering vaccines in school aged children?

• explain the procedure, these kids are all about control

• set appropriate behavior limits, and resist using phrases such as good boy/girl

what are developmental considerations when administering vaccines in adolescents?

• explain procedure, allowing for control over their body and situation ( mom and dad in or out of the room)

• encourage participation in the procedure, encourage self expression, individuality, and self care needs

what is the FLACC scale?

• a pain scale used for children who are nonverbal from ages 2 months - 7 years old

• 1-3 mild pain, 4-6 moderate pain, 7-10 severe pain

what is FACES scale?

• a pain scale in which children 3 years and older point to each face using the words under them and expressions to describe the intensity of their pain

• ask the child to choose the face that best describes own pain and record the appropriate number

what are the numbers scale?

• pain scale from 0-10, 0 being no pain and 10 pain worst pain - must understand numbers and there relationship to each other

• most popular used tool in the world

• typically children 8 and older use this because they must understand simple math such as that 8 is larger than 5

what are some facts and difficulties about pain in children?

• infants do experience pain

• children are not more prone to complications of pain management

• children are good reporters of their pain when development is taken into consideration ( use a pain scale)

• if a child is sleeping or playing they can still be in pain

what are influential factors for pain in children?

• age

• developmental level

• chronic or acute disease

• prior experience with pain

• personality

• stressors

• culture

• socioeconomic status

what are assessment tools based on?

• development and age

what are some non pharmacological treatments of pain in children?

• distraction such as blowing bubbles

• relaxation

• guided imagery

• containment

• sucking

• kangaroo care

• complementary and alternative medicine