Evidence-Based Pediatric Nursing Interventions

Evidence-Based Pediatric Nursing Interventions



Patient and Family Education—Spanish Translations

• Giving Aerosolized Medications (Nebulizer Treatments) (Administración de Medicamentos por Aerosol [Tratamiento con Nebulizador])

• Giving Nasogastric Tube Feedings (Administrando Alimentación a Través del Tubo Nasogástrico)

• Giving Nose Drops (Administración de Gotas Nasales)

• Giving Intramuscular (IM) Injections (Administración de Inyecciones Intramusculares [IM])

• Giving Inhaled Medications (Administración de Medicamentos Inhalados)

• Insulin Administration (Administración de Insulina)

• Giving Ear Medications (Administración de Medicinas en el Oído)

• Giving Oral Medications (Administración de Medicamentos por Vía Oral)

• Oral Rehydration Guidelines (Parámetros de Rehidratación Oral)

• Giving Subcutaneous (Sub Q) Injections (Administración de Inyecciones Subcutáneas [Sub Q])

Preparing Children for Procedures Based on Developmental Characteristics

Infancy: Developing a Sense of Trust and Sensorimotor Thought

Toddler: Developing a Sense of Autonomy and Sensorimotor to Preoperational Thought

Preschooler: Developing a Sense of Initiative and Preoperational Thought


Explain procedure in simple terms and in relation to how it affects child (as with toddler, stress sensory aspects).

Demonstrate use of equipment.

Allow child to play with miniature or actual equipment.

Encourage playing out experience on a doll both before and after procedure to clarify misconceptions.

Use neutral words to describe the procedure (Table 4-1).

School-Age Child: Developing a Sense of Industry and Concrete Thought

Adolescent: Developing a Sense of Identity and Abstract Thought

Preparing the Family

General principles of family education are as follows:

If equipment will be needed at home (e.g., suction machines, syringes), begin making the necessary arrangements in advance so that discharge can proceed smoothly. Whenever possible, make arrangements for the family to use the same equipment in the home that they are using in the hospital. This allows them to become familiar with the items. In addition, the staff can help troubleshoot the equipment in a controlled environment. Plan the teaching sessions well in advance of the time the family will be responsible for performing the care. The more complex the procedure, the more time is needed for training.

Review the instructions with family members. Encourage note taking if they desire. Allow ample practice time under supervision. At least one family member, but preferably two members, should demonstrate the procedure before they are expected to care for the child at home. Provide the family with the telephone numbers of resource individuals who are available to assist them in the event of a problem.

Skin Care and General Hygiene

Skin Care

General Guidelines

Keep skin free of excess moisture (e.g., urine or fecal incontinence, wound drainage, excessive perspiration).

Cleanse skin with gentle soap (e.g., Dove) or cleanser (e.g., Cetaphil). Rinse well with plain, warm water.

Provide daily cleansing of eyes, oral area, diaper or perineal area, and any areas of skin breakdown.

Apply non–alcohol-based moisturizing agents after cleansing to retain moisture and rehydrate skin.

Use minimum tape and adhesives. On very sensitive skin, use a protective, pectin-based or hydrocolloid skin barrier between skin and tape and adhesives.

Place pectin-based or hydrocolloid skin barriers directly over excoriated skin. Leave barrier undisturbed until it begins to peel off. With wet, oozing excoriations, place a small amount of stoma powder (as used in ostomy care) on site, remove excess powder, and apply skin barrier. Hold barrier in place for several minutes to allow barrier to soften and mold to skin surface. See Table 4-2 for common wound care products.


Wound Dressing Category Definitions and Examples of Products

Category Description Examples
Gauze or sponge for external use Nonresorbable Pads
  Sterile or nonsterile Island dressings
  Strip, piece, or pad  
  Woven or nonwoven mesh cotton cellulose  
  Simple chemical derivatives of cellulose  
  Intended for medical purposes  
Hydrophilic wound dressing Sterile or nonsterile Alginate dressings
  Nonresorbable Foam dressings
  Material with hydrophilic properties Hydropolymer dressings
  No added drugs or biologics Sheet gel dressings
  Intended to cover wound and absorb exudate Hydrocolloid dressings
    Composite dressings
    Hydrogel dressings
Occlusive wound dressing Sterile or nonsterile Transparent adhesive dressings
  Nonresorbable Thin film dressings
  Synthetic polymeric material with or without adhesive backing Foam dressings
    Hydrocolloid dressings
  Intended to cover wound, provide or support moist wound environment, and allow exchange of gases Composite dressings
    Hydropolymer dressings
Hydrogel wound dressing Sterile or nonsterile Alginate dressings
  Nonresorbable Hydropolymer dressings
  Matrix of hydrophilic polymers or other material combined with at least 50% water Hydrogel dressings
    Gauze dressings impregnated with hydrogel (without active ingredients)
  Intended to cover wound, absorb wound exudates, control bleeding or fluid loss, and protect against abrasion, friction, desiccation, contamination  
Porcine wound dressing Made from pigskin  
  Temporary burn dressing  

From van Rijswijk L: Recommendations to change the FDA classification of various wound dressings, Ostomy Wound Manag 45(3):31, 1999. Used with permission.

Alternate electrode and probe placement sites and thoroughly assess underlying skin, typically every 8 to 24 hours.

Eliminate pressure secondary to medical devices such as tracheostomy tubes, wheelchairs, braces, and gastrostomy tubes.

Be certain fingers or toes are visible whenever extremity is used for IV or arterial line.

Reduce friction by keeping skin dry (may apply absorbent powder such as cornstarch) and using soft, smooth bed linens and clothes.

Use a draw sheet to move a child in bed or onto a stretcher to reduce friction and shearing injuries; do not drag the child from under the arms.

Position in neutral alignment; pillows, cushions, or wedges may be needed to prevent hip abduction and pressure to bony prominences, such as heels, elbows, and sacral and occipital areas. When the child is positioned laterally, pillows/cushions between the knees, under the head, and under the upper arm will help promote neutral body alignment. Avoid donut cushions because they can cause tissue ischemia. Elevate the head of bed 30 degrees or less to reduce pressure, unless contraindicated

Do not massage reddened, bony prominences because this can cause deep tissue damage; provide pressure relief to these areas instead.

Routinely assess the child’s nutritional status. A child who is on nothing by mouth (NPO) status for several days and who is receiving only IV fluids is nutritionally at risk. This can also affect the skin’s ability to maintain its integrity. Hyperalimentation (TPN,TNA) should be considered for these children at risk.

Identify children who are at risk for skin breakdown before it occurs. Employ measures such as pressure-reducing devices (reduce pressure more than would usually occur on a regular hospital bed or chair) or pressure-relieving devices (maintain pressure below that which would cause capillary closing) to prevent breakdown (Table 4-3).


Pressure Reduction and Relief Devices

Description Advantages Disadvantages Examples*
Foam: Varying density; 3- to 4-inch convoluted and nonconvoluted Primarily pressure reduction, although in children may have pressure relief advantages; can be cut to fit cribs Can be soiled by incontinent patient; inability to reduce skin moisture because of lack of airflow Bio Clinic Brand BioGard (Sunrise Medical), Geo-Matt (Span America), Ultra Form Pediatric (American Health Systems, Inc.)
Gel or water filled: Pressure reduction; water or gel conforms to patient’s contours One-time charge; low cost for water; gels are expensive
Relieves pressure and shear; nonpowered, easy cleaning
Mattress is a dense collection of viscous fluid cells; there have been reports that the mattress is cold to the touch; patients may have to spare vital calories to warm the mattress
Comfort Zone Gel Overlay (Tele-Made Disposables, Inc.), RIK Fluid Overlay (KCI)
Alternating-pressure mattress: An overlay with rows of air cells and pump; pump cycles air to provide inflation and deflation over pressure points Intent is to relieve pressure points to create pressure gradients that enhance blood flow Studies show inconsistent results; some have reported very low deflation interface pressures, but only the deflation pressures were used for analysis; tissue interface pressures during inflation are consistently higher and must be incorporated into the statistical analysis; clinical trials indicate higher pressure ulcer incidence rates when compared with other products Aero Pulse (Medline), AlphaBed (Huntleigh Healthcare), Beta (Volkner Turning Systems), PressureGuard CFT (Span America)
Static air: Designed with interlocking air cells that provide dry flotation; inflated with a blower Mattress overlays that are designed with multiple chambers, allowing air exchange between the compartments Pressure reduction depends on adequate air volume and periodic reinflation ROHO (The ROHO Group) Sof-Care (Gaymar)
Low–air-loss specialty overlay: Multiple airflow cushions that cover the entire bed; pressures can be set and controlled by a blower Surface materials are constructed to reduce friction and shear and to eliminate moisture; pressure relief; can be used for prevention and/or treatment of ulcers Surface mattress and pump are a rental item; not available for cribs Acucair (Hill-Rom), BioTherapy (BioClinic), First Step Select (KCI), Plexus Aire Select (Gaymar), PressureGuard APM2 (Span America)
Specialty Beds
Low–air-loss beds: Bed surface consists of inflated air cushions; each section is adjusted for optimum pressure relief for patient’s body size; some models have built-in scales Provides pressure relief in any position; treatment for stages III and IV pressure ulcers; available in pediatric crib sizes Bed is more bulky than a hospital bed, and some homes may not be able to accommodate its size; reimbursement is questionable Clinitron (Hill-Rom), KinAir IV (KCI), TheraPulse ATP (KCI), TotalCare SpO2RT (Hill-Rom)
Low–air-loss mattress replacements Provides pressure relief in any position; fits on hospital frame Requires mattress storage First Step Select (KCI), Flexicair Eclipse (Hill-Rom)
Air-fluidized beds: Air is blown through beads to “float” patient Provides pressure relief for oncology patients and for treatment of full-thickness pressure ulcers, postoperative flaps, burns; lighter-weight home care units available Can be difficult to transfer patient Clinitron (Hill-Rom), FluidAir Elite (KCI), Skytron (KEISEI Medical)
Kinetic therapy: Therapy surfaces that provide continuous gentle side-to-side rotation of 40 degrees or more on each side; table-based or cushion-based Has been demonstrated to improve mucous transport, redistribute pulmonary blood flow, and mobilize pulmonary interstitial fluid; has been used for trauma victims and unstable spinal cord injuries (should use table-based; once stabilized, may use cushion-based) Used only in acute care settings RotoProne (KCI), RotoRest Delta Kinetic (KCI), Synergy Air Elite (Hill-Rom), Triadyne (KCI)
Continuous lateral rotation beds (CLRT): Less than 40 degrees side-to-side rotation Helps reposition unstable spinal cord injury patient; promotes comfort and shifts pressure points   BariAir (KCI), TotalCare SpO2RT (Hill-Rom), V-Cue Dynamic Air Therapy System (Hill-Rom)

Jan 16, 2017 | Posted by in NURSING | Comments Off on Evidence-Based Pediatric Nursing Interventions

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