Quiz 1: Pediatric Variations Flashcards
(49 cards)
1
Q
Informed Consent
A
- Only ONE PARENT is required to give informed consent for non-urgent care. **
- If one parent agrees and the other disagrees then an issue arises.
- If under foster care, you must find out who is legally responsible for the child.
- NO parent is required if it is life threatening (if the parent is there get the consent but continue on if they aren’t there)**
2
Q
Procedures: Physician/surgeon responsibility
A
Responsible to explain to the patient about the procedure
3
Q
Procedure: Nurse responsibility
A
To witness and reinforce physician
4
Q
Questions the nurse should ask in relation to informed consent
A
- “Did the surgeon/physician tell you/inform you of what is going to happen?”
- “Has the physical spoke to you?”
- ALWAYS ASK PRIOR TO HAVING THE PATIENT SIGN CONSENT FORMS
- If answer is no -> you stop and you MUST get the surgeon to speak with the patient/family because they should be informed prior to signing the consent.
- If yes -> have them sign and ask if they have any more questions.
5
Q
Adolescents don’t need parental consent (in all 50 states) for the following
A
- STD treatment
- Mental health treatment
- Alcohol/drug treatment
- Pregnancy and contraceptive device
- Contraceptives: Unable to give pill that you can ingest (depending on state) but can give barriers such as condoms and advice.
6
Q
Pediatric Variations: Procedure Preparation
A
- Psychologically prepare the child and family.
- Use age appropriate explanations: tell them what we are doing and then do it ASAP; don’t hesitate because it increases anxiety.
- Let the child handle the equipment -> IF APPROPRIATE.
- Allow family presence but support the decision for them to stay OR leave: Reunite parents and child immediately after (reestablish connection)
7
Q
Pediatric Variations: During Procedures
A
- Avoid delay during procedure
- Best practice -> perform invasive procedures outside “safe” areas: safe areas are considered their assigned room/bedside. Need to perform in treatment room because if they get scared of procedures that are done at the bedside, they’ll be scared to be in their room/sleep.
- Permit choices if available (i.e if both arms have good veins, ask which arm would they like?)
- Provide distractions: TEAM EFFORT**, get help, utilize child specialists.
- Allow child to express feelings
8
Q
Pediatric Variations: After procedures
A
Praise child after procedure is complete -> positive reinforcement**
9
Q
Methods for Maintaining Healthy Skin in Children
A
- Rotate medical devices every shift if able to avoid pressure ulcers/burns (Take socks off and check feet. → Check all skin to make sure it’s intact; When taking V.S. change placements)
- Diaper changes every 2-4 hours (remember to change even if child is NPO)
- Use minimal amount of tape and adhesives
- Alternate electrode placement
- Routinely assess child nutritional/hydration status
10
Q
Pediatric Variation: Environmental Management
A
- Practice proper care and disposal of small objects such as caps, needle covers, temperature probes, etc.
- No pillows -> unless age appropriate.
- Age appropriate toys
- Maintain a safe environment
11
Q
When is it appropriate to allow pillows around children?
A
Once the child can roll**
12
Q
How can you maintain a safe environment for children?
A
- Crib side rails up and locked
- If you forgot something or have to turn your back, put your hand on child and get what need or put the side rails up
- Slide resistant socks
- Hand on infant at all times
13
Q
Pediatric Variations: Collecting urine specimen
A
- Urine collection bags used on young children (taped to body: not sterile)
- Cotton balls in diapers can be used for urine dips → squeeze urine from cotton onto dipstick
- Sterile: catheter
14
Q
Collection of stool specimen
A
- Use a tongue depressor (or gloved finger) to collect stool from diaper
- If child potty trained → two hats in toilet
15
Q
Collection of Blood Specimen
A
- Small bore catheters → 22-24 gauge
- Smaller amount of blood withdrawn → usually 0.5-1 mL**
- Heal sticks on infants → stick the heel and the blood will drip into the tube
16
Q
Blood withdrawn in children
A
- When drawing from CVL → less waste drawn back (smaller lumen)
- Think about volume and size of child to determine how much blood to get from children
17
Q
Collection of respiratory specimens
A
- Infants and small children unable to follow directions → suck it out, swab out → depends on what test is
- Sputum specimens
- Nasal washings
18
Q
Medication Administration: How to and Order of Meds (Chapter 14**)
A
…
19
Q
Medication Administration: What route is preferred?
A
Oral route because you can go home on PO meds -> children heal better at home.
20
Q
Most accurate measurement of medication is with what instrument?
A
With a plastic disposable syringe.
21
Q
Medication Administration in an infant
A
- Place syringe along side of mouth/tongue
- Administer small amounts, slowly
- Do NOT mix formula in bottle
22
Q
Why shouldn’t you mix medications with formula?
A
Formula is the main source of nutrition for up to first year and if you mix the medication and they don’t like it, they won’t want to eat and will have a problem with nutrition.
23
Q
Intramuscular Medication Administration: What is the maximum volume to a single site for infants and small children?
A
- 1 mL is maximum volume**
- Some may not tolerate >0.5 mL
24
Q
Medication Administration: What must be done if the child is getting 2 mL of medication through IM?
A
- You will give two separate doses at two separate locations.
- Usually two nurses will give the shots at the same time, on different sites to help prevent anxiety and fear of having to give it two separate times.
25
What can help with IM medication administration in children?
Lidocaine can help by numbing it.
26
What are sites of IM injection for children?
- Vastus lateralis: infants and small children (side of leg)
- Ventrogluteal
- Deltoid
27
What should you tell the child when giving them an injection?
-Always tell the child they are getting an injection -> never lie to them about the injections
I.e “You’re going to feel a little poke” for smaller children OR “We’re going to put in an IV” for adolescent.
28
IV Medication Administration
- Check site for patency minimum Q2hours**
- Medications calculated based on weight
- Syringe pumps: smaller volumes of medication administered
29
Medication Administration: Otic (ear drops)
Child < 3 years → Pull pinna down and straight back
| Child > 3 years → Pull pinna upward and back
30
Medication Administration: Optic
- Have child look up
- Pull lower lid downward
- Rest hand holding the dropper on child’s head → prevents trauma to eye
- Place medication in the pocket that is formed
31
Feeding Sick Children: Refusal to eat
- Could be the child’s way to control situation
- The one thing they can control, let them control. Feed them differently.
- Don’t give them the full tray**
- Worry about the good food once they get home and feel better.
- Key -> small amounts and a couple of items at a time.
32
Feeding Sick Children: What should the nurse do?
- Do not wake the child to take fluids
- Make meal times pleasant
- Monitor amount consumed -> descriptions need to be accurate (i.e 4 Oz of juice, 1/2 pancake)
- Praise child for amount consumed
- Do not punish
- Start with nutritious foods first
33
How often should I&O be assessed?
- Every single hour
| - Includes pee, poop, food and water.
34
When does a sick child’s appetite tend to improve?
Improves as child feels better.
35
What are the types of gavage feedings?
- NG
- Silastic
- Mickey Button
36
NG Tube: Placement
- Always check placement, esp when stuff is going into them → risk for filling up the lungs or having a hole in their sinus that will make infused material go into brain
- NICU never use XR for placement
- Older children → XR first time only
37
Other methods of confirming NG Tube Placement
1. Auscultation → but can be hard bc the child’s lung and stomach can sound the same
2. Aspirate contents → down fall: could be stomach, lung, CSF contents
3. Make sure the mark on the tube is at the same place
4. Free from respiratory distress → If it is in the lungs, it will pass the vocal cords which will prevent them from talk and will have respiratory distress
38
Silastic
-G tube is coming up and there is dangling piece externally
39
Mickey button
- G tube that has a “flappy” part that hangs.
| - Only hooked up and attached when needing to feed.
40
Nursing Implications for Medication Administration through Feeding Tubes
- Flush with 1-2 mL**; Flush before to check for patency and after administration.
- Give crushed meds first and then liquid**
- Do NOT flush between medications -> if you need to help it pass through you can, but with children you need to be really careful with liquids.
- Dissolve all medications -> crush and dissolve thoroughly
41
Communication
Based on growth and development -> assessment skills, S&S and interventions.
42
Assent
- Informing child/adolescent about proposed treatment.
| - NOT a legal requirement, but ethical
43
Assent involves
- Achieving developmentally appropriate awareness → word things according to age
- Telling/showing what pt can expect
- Assessing understanding
44
Fever Management: Pharmacological
- Acetaminophen: Ibuprofen in children > 6 months
| - NO aspirin which is associated with Reye’s syndrome in children.
45
How often should a child’s temperature be taken after administration of fever medication?
Take temperature every 30 minutes after administration of medication.
46
Febrile Seizures
- 6 months-6 years
| - Not due to the temperature amount but how quickly the increase.
47
Simple febrile seizures lasting <10 minutes
Do NOT cause brain damage or debilitating effects
48
Infection Control
- Wash hands frequently
- Wear globes when changing diapers
- Wear gowns
49
When should you wear gowns?
- During diaper changes with loose or explosive tools
| - During feedings if spit up/vomit is likely
