1. Define the vocabulary terms listed 2. Discuss preparation techniques for the different developmental stages 3. Explain the necessary safety precautions when bathing an infant 4. Describe the collection of urine and stool specimens with infants and children 5. Discuss how to collect blood, throat, and nasopharyngeal specimens with infants and children 6. Describe the pediatric implications of assisting with a lumbar puncture 7. Contrast the administration of medicines to children and adults 8. Describe the preferred sites for intramuscular injections in infants and small children 9. Discuss precautions necessary when a child is receiving parenteral fluids and the rationale for each precaution 10. Compare and contrast gastrostomy button and gavage feedings with infants and children 11. Discuss care of the child with a tracheostomy 12. Describe oxygen therapy related to children 13. Explain how to measure an infant’s or child’s height, weight, and head circumference Bathing not only promotes cleanliness and stimulates circulation to the skin, but also provides exercise and may help the child relax and feel more comfortable (Skill 3-1). Explain the procedure in appropriate terms. Always remain with the child when bathing occurs. Be sure to check any allergies the child may have. Always assess conditions that influence the type of bath given, such as a recent surgical incision, EEG monitor, a cast, an intravenous (IV) line or Foley catheter in place, and so on. Examine the infant or child for skin abnormalities such as rashes, birthmarks, bruises, breaks in the skin, and so on. Never use baby powder after the bath because the powder can be inhaled and cause breathing problems. Skill 3-1 can be taught to parents for home use. Hyperthermia is defined as the body temperature exceeding the set point, such as from heat stroke or seizures. Tepid sponge bathing in warm water may be ordered to reduce hyperthermia (Hockenberry and Wilson, 2009). Tepid sponge bathing, however, is not effective in treating fever. When performed, the sponge bath may be given in a tub or in the child’s bed (Skill 3-3). The child should not be permitted to shiver because shivering causes vasoconstriction and increased metabolism and can lead to a rise in temperature. The bath is given for approximately 20 minutes. Alcohol should never be added to the water because it reduces the heat too rapidly and can be absorbed (leading to brain damage or even death in infants). A table of Celsius (centigrade) and Fahrenheit temperature equivalents is provided in Appendix E. • Thoroughly cleaning the perineum or tip of penis with mild soap and water or povidone-iodine (be sure there are no allergies to iodine). • Using the appropriate size lubricated catheter, inserting until urine is obtained. • Urine can flow freely into a clean container, urinal, bedpan, or toilet (if the child is old enough) Blood specimens are generally collected by the laboratory technician or a specially trained nurse. Children generally fear this procedure. EMLA (eutectic mixture of lidocaine and prilocaine) cream can be used to lessen the pain. Remember, however, that the cream needs to be in place approximately 60 minutes before the blood sample is taken (if LMX or lidocaine cream is used, allow 30 minutes). If time permits, have the blood specimen obtained in the treatment room, keeping the child’s bed a safe place. The antecubital fossa is a common site for venipuncture in children older than 2 years of age. The dorsum of the hand or foot can also be used (Figure 3-1). The heel is often used in infants (Figure 3-2). If blood is to be collected from the heel, it needs to be warmed with a warmed washcloth or commercial warmer to increase the blood flow. The external jugular vein can be used in infants when other sites have not worked. The femoral vein may be used when other sites have been exhausted. Jugular and femoral venipuncture are only performed by the physician. Both the jugular and the femoral veins are large; therefore, after venipuncture, the child is checked frequently to ensure that there is no bleeding. The child is soothed accordingly if either of these sites is used, because crying and thrashing may precipitate oozing or hemorrhage. If a child has a central venous catheter or port, specially trained nurses can obtain the blood specimen by following hospital procedure. Always use standard precautions when obtaining or assisting with blood specimens. Regardless of the location used to obtain the blood specimen, the nurse charts the site used, the name of the blood test, and any untoward developments.
Pediatric Procedures
Basic Hygiene and Care
Bathing
Fever, Hyperthermia, and Sponge Bathing
Collection of Specimens
Collection of Urine Specimens
Home Care Guidelines for Intermittent Catheterization Using a “Clean” Technique
Collection of Blood Specimens
Pediatric Procedures
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