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 Guardians
Mature & 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 Support
Parental 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
illness
Urging foods may precipitate N&V
Control refuse to eat
Short 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
discomfort
Antipyretics lower set point (acetaminophen &
ibuprofen)
Retake temp 30 min 1 hour after given
Environment measures (prevent shivering)
Cooling measures with hyperthermia
Metabolic rate increases 10% for every 1 degree C
increase in temperature

Infection Control
Follow the infection precaution sign(s)
outside the patients 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
infants 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
Childrens 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