Pediatric Variations of Nursing Interventions

Informed Consent in Pediatrics

Assent in the older child/adolescent = informed about what will happen & is willing to let the health care provider perform it.

Eligibility for Giving Informed Consent

Parents or Legal GuardiansMature & Emancipated Minors Mature Minors’ Doctrine – STDs, contraceptive services,

pregnancy, or drug or alcohol abuse Emancipated Minor – legal definition, pregnancy, marriage,

high school graduation, living independently, or military service

Treatment Without Parental Consent 2 physicians – emergencies that present a danger to life or the

possibility of permanent injury Consent by proxy Parental neglect or abuse

Preparation for Procedures

Psychologic Preparation (boxes 22-1 & 22-2)Establish Trust & Provide SupportParental Presence & Support (parents in the room during a procedure?)Provide an Explanation (use objects)Physical Preparation Sedation – conscious sedation assessment sheet

Performance of Procedure – expect success, involve the child, provide distraction, express feelings

Feeding the Sick Child

Loss of appetite is a common symptom of illnessUrging foods may precipitate N&V Control – refuse to eatShort term illness Nutrition usually not a problem (chart amount

consumed) Adequate fluids important

Causes of Elevated Temps

During infection pyrogenic substances cause an increase in set point, a process mediated by prostaglandins = hypothalamus increases heat production

Fever probably plays a role in enhancing the development of immunity and aiding in recovery

Reducing Elevated Temperature

Fever – principal reason to treat is relief of discomfortAntipyretics lower set point (acetaminophen & ibuprofen)Retake temp 30 min – 1 hour after givenEnvironment measures (prevent shivering)Cooling measures with hyperthermiaMetabolic rate increases 10% for every 1 degree C increase in temperature

Infection Control

Follow the infection precaution sign(s) outside the patient’s door

Hand wash going into and out of the room

Oral Medication Administration

Most accurate – plastic disposable syringe

Prevent aspiration with infant = sit up and place syringe along the side of the tongue and administer slowly (do not add to infant’s formula)

Mild physical coercion if needed in young child

Intramuscular Administration

Gauge of needle – as small as possible

Site Vastus lateralis – infants Ventrogluteal – CHCC after child has been

ambulating 1 year

Have someone help hold the child

Intravenous Administration

Peripheral venous access devices – CHCC saline lock

Central venous access devices (Hep flushes) PICCs (threaded into superior vena cava) Long-term central VADs

Broviac Mediport

Tape all connections to central lines

IV

Children’s Hospital Central California Assess and document IV site every hour Assess and document fluid infusion every hour

(also continuous NG/GT feedings) When assuming care, verify that the correct IV

solution/TPN/Lipids and rates are infusing

NG, OG, GT

Ease of administration

Check placement

Need adequate flushing to prevent risk of “clogging”