Ch. 6 & 22 Flashcards
atraumatic care
making care as least scary as possible for children
goals of atraumatic care
- prevent and minimize separation from the family (rooming in)
- promote a sense of control (to the child)
- prevent or minimize bodily injury and pain
what is this an example of: foster the parent child relationship
atraumatic care
what is this an example of: prepare child before any treatment or procedure
atraumatic care
what is this an example of: control pain
atraumatic care
what is this an example of: provide play activities for expression of fear and aggression
atraumatic care
natural immunity
innate immunity or resistance to infection or toxicity
- ie. after getting the disease
acquired immunity
immunity from exposure to the invading agent, either bacteria, virus, or toxin
- ie. a vaccine against a disease
passive immunity
temporary immunity obtaining by transfusing immunoglobulins or antitoxins either artificially from another human or an animal that has ben actively immunized against an antigen or naturally from the mother to the fetus via the placenta
active immunity
a state in which immune bodies are actively formed against specific antigens, either naturally by having had the disease clinically or sub-clinically, or artificially by introducing the antigen into the individual
vaccine
a suspension of live (usually attenuated) or inactive microorganisms (ie bacteria, viruses, rickettsiae) or fractions of the microorganism administered to induce immunity and prevent infectious disease or its sequelae
immunization
inclusive term denoting the process of inducing or providing active or passive immunity artificially by administering an immunobiologic
immunoglobulin (Ig)
a sterile solution containing antibodies from large pools of human blood plasma; primarily indicated for routine maintenance of immunity of certain immunodeficient persons and for passive immunization against measles and Hep A
- can be given as subcutaneous (SCIG) injection or intravenously (IVIG)
intravenous immunoglobulin (IVIG)
a sterile solution containing antibodies from large pools of human blood plasma; primarily indicated for routine maintenance of immunity of certain immunodeficient persons and for passive immunization against measles and Hep A
- given as IV
combination vaccines
combination of multiple vaccines into one parenteral form
monovalent vaccines
vaccine designed to vaccinate against a single antigen or organism
polyvalent vaccines
vaccine designed to vaccinate against two or more antigens or organisms
- ie. inactive poliovirus vaccine (IPV)
cocooning
strategy of protecting infants ( ie. from pertussis) by vaccinating all persons who come in close contact with the infant, including the mother, grandparents, and health care workers
assent
when a child/adolescent (>7 years) has been informed about the proposed treatment, procedure, or research and is willing to permit a health care provider to perform it
enabling
professionals create opportunities and means for all family members to display their current abilities and competencies and acquire new ones to meet the needs of the child and family
empowerment
describes the interaction of professionals with families in such a way that families maintain or acquire a sense of control over their family lives and acknowledge postitive changes that result from helping behaviors that foster their own strengths, abilities, and actions
family-centered care
care is focused on patient and the family (parents, siblings, caretakers, teachers)
- empowering patient/parents with information
- provide resources
anticipatory guidance
how is natural immunity different from acquired immunity?
- natural immunity is something that you already have/are born with
- acquired immunity is something you get after exposure
how is a monovalent vaccine different from a polyvalent vaccine?
- mono: designed to fight one antigen
- poly: designed to fight two or more antigens
what is a VIS sheet?
a vaccine information statement sheet
- explains the benefits/risks, why we give it, what can happen ((ab)normal side effects), place to contact with new symptoms/reportings
- should encourage parents to take “just in case”
what routes can we use for administering vaccines?
- IM - all other vaccines
- SQ: MMR, Varicella (live vaccines)
- PO: Rota virus (not after 8 months)
- Nasal: Flu (> age 2)
what and who is cocooning used for?
cocooning is keeping an infant (or someone that is at risk) safe from a disease by vaccinating the people around that infant
- creating a safety bubble
RN immunization responsibilities include
- being familiar with the schedule (updated annually)
- being prepared for adverse reactions
- being aware of contraindications and precautions
- ensuring parental consent before administration
- providing safe administration
- providing vaccine teaching (VIS sheet) and anticipatory guidance to parents and caregivers
- ensure documentation is complete
what pediatric age group is at the highest risk of contracting Hepatitis B Virus (HBV)?
- newborns who contracted it through mom at birth (perinatal transmission)
- adolescents having unprotected sex, dirty needles, drugs, or who have a weaning immunity
when do we begin administering Hep B vaccines?
- if mom is HBsAG positive or unknown: within 12 hours of birth at 2 injection sites
- if mom is HBsAG negative: before hospital discharge
- newborns of <2000g: 1 month old
how many doses of the Hep B vaccine should a child get?
full series is 3 doses
- birth, 1 month, 6 months (normal newborn)
what route is the Hep B vaccine administered?
IM injection
if the mother is positive for Hep B or the status is unknown, what do we do?
we give a Hep B injection within 12 hours of life at 2 injection sites
what inactive components of a vaccine could cause a reaction?
- preservatives
- stabilizers
- adjuvants
- antibiotics (ie neomycin)
- purified culture medium proteins (ie egg)
mild reaction
- little red, localized in spot of injection
- little fever
- little warm to the touch
- little fussy, irritable
moderate reaction
- redness expands, takes over the limb
- high fever
- crying, inconsolable
- super irritable
- induce seizure
severe reaction
- anaphylaxis: cannot breathe, respiratory compromised, airway is swollen, angio-edema
how to manage a mild reaction
- Tylenol
- ice
how to manage a moderate reaction
how to manage a severe reaction
- epinephrine injection (EpiPen)
- call 911
what is the emergency management epinephrine dose for anaphylaxis?
- 0.3mg for >30kg
- 0.15mg for 15-30kg
what is severe febrile illness?
- the general contraindication for all immunizations
- onset of fever in the absence of an obvious focus of infection; may be associated with non-specific symptoms such as headache, body rash, muscle and joint pains
- fever of 100.5*F
if the patient had a previous reaction, and the child was scheduled to receive the next dose of the series, what would you do?
- a history of an anaphylactic reaction is a contraindication to the vaccine
- the nurse she contact an allergist to consult with to determine the best course of action
does the order of multiple injections matter?
- administering subcutaneous injections after intramuscular injections
- SQ burns because it is a live vaccine
what locations do you use for six-month vaccines?
vastus lateralis (outer thigh)
(PO for rota virus vaccine (only PO if <8months)
how can a nurse provide atraumatic care when administering vaccines to an infant?
teaching parent how to hold infant properly to give the infant the most comfort (which comes from parents/caretakers)
how can a nurse provide atraumatic care when administering vaccines to a child?
give toys to play with
how can a nurse provide atraumatic care when administering vaccines to an adolescent?
should be able to sit on an exam table for the vaccine
informed consent includes…
- the nature of the illness or condition, proposed care, or treatment
- potential risks, benefits, and alternatives
- what might happen if the patient chooses not to consent
- patient has to be 18 years of age to give informed consent, otherwise guardian gives informed consent
emancipated minor
- legally under the age of majority (<18) but is recognized as having the legal capacity of an adult under circumstances prescribed by state law, such as pregnancy, marriage, high school graduation, independent living, or military service
mature minor
children 14 years and older who possess the maturity and cognitive abilities to understand all elements of informed consent and make a choice based on the information
- legal action may be required for designation as a mature minor
- needs to be done through the court
not a legal requirement but an ethical one to protect the child’s rights is ___
assent
at what developmental age can children assent?
- when the child/adolescent is older than 7 years with appropriate age, maturity, and psychological state
medically emancipated
certain protections under HIPAA where the health care team does not have to share certain conditions with the parents of a minor
non-threatening words/phrases when preparing a child for a procedure
shot: medicine under the skin (a little booboo)
edema: puffy
pain: ouch
catheter: big straw
electrodes: stickers
play activities for specific procedures
- instead of/in prep for incentive spirometer: blow bubbles, do it with them, get child life involved, pinwheel
- need to increase fluids: give a cool water bottle with a crazy straw, ice pops using juice, tea party, use food coloring
- toddler that needs to start walking around/out of bed: get a little push toy, doll in a stroller to push around the unit, decorate the IV pole (if attached to one)
anticipatory guidance during illness and hospitalization: minimizing separation
- want to keep the family together
- offer for parents to stay with child whenever possible (walking to the OR doors, staying in the room overnight, etc.)
- encourage facetimes with siblings if the child has a prolonged hospital stay
anticipatory guidance during illness and hospitalization: post-hospital behaviors
- may take the child a little bit to get readjusted to living at home or if they have any modifications or restrictions since their hospital stay
anticipatory guidance during illness and hospitalization: parental reactions
- stressed, freaked out- which causes child to stress
- explain, empower with knowledge
- reinforce knowledge because parents are not processing information initially
anticipatory guidance during illness and hospitalization: sibling reactions
- sibling could be acting out at home because parent/sibling is in hospital
- could be asking where mom/sibling is
- visit at the hospital, facetime/call
- adolescent home alone: no supervision, testing limits/boundaries, feeling withdrawn
anticipatory guidance during illness and hospitalization: nursing interventions
- instruct parents that it is typical for children to regress while in the hospital (ie younger behavior, wetting the bed)
- explain to parents, answer questions that they may have
- repeat information for them
anticipatory guidance during illness and hospitalization: nursing care of the family
respiratory hygiene/ coughing etiquette is used for what kind of precaution?
droplet and airborne
droplet and airborne precaution measures
- covering the mouth and nose during coughing and sneezing
- offering a surgical mask to people who are coughing
- using tissues to contain respiratory secretions
- turning head away from others and keeping space of 3ft or more when coughing
what are examples of airborne infections
- measles
- varicella
- tuberculosis
airborne precautions include
- standard precautions
- airborne precautions
- airborne infection isolation rooms (AIIR)
droplet precautions include
- standard precautions
- droplet precautions
(mask)
what are examples of droplet illnesses
- invasive haemophilius influenzae type B (meningitis, pneumonia, epiglottis, and sepsis)
- invasive neisseria meningitidis (meningitis, pneumonia, sepsis)
- diptheria, mycoplasmal pneumonia, pertusis, pneumonic plague, streptococcal pharyngitis, pneumonia, or scarlet fever in infants and young children
- adenovirus, influenza, mumps, human parvovirus B19, rubella
what is the most critical infection control practice?
hand washing
which two organizations govern the recommended immunization policies and procedures
- the Advisory Committee on Immunizations Practices of the CDC
and - the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP)
the recommended age for beginning primary immunizations of infants is
at birth or within 2 weeks of birth
children who fail to receive all doses but started the primary immunizations at the recommended age do or do not have to restart the series?
they do not have to restart the series, but they do have to receive the missed doses
can immunizations be given simultaneosly?
yes at different injection sites, HBV vaccine, DTaP, IPV, MMR, varicella, and HiB vaccines can be given at the same time
side effects of inactivated antigens (ie DTaP)
- tenderness
- erythema
- swelling at the injection site
- low grade fever
- behavioral changes (drowsy, eating less, prolonged/unusual cry)
if epinephrine is administered, what adverse reactions should be observed for?
- tachycardia
- hypertension
- irritability
- headaches
- nausea
- tremors
contraindication
a condition in an individual that increases the risk for a serious adverse reaction
precaution
a condition in a recipient that might increase the risk for a serious adverse reaction or that might compromise the ability of the vaccine to produce immunity
when would a precaution not prevent a vaccine administration?
if the conditions are such that the benefit of the vaccine would outweigh the risk of having an adverse reaction or incomplete response
in general, live viruses should not be administered to ___
- severely immunodeficient people or people who’s immune function is not known
- person with recently acquired passive immunity through blood transfusions, immunoglobulins, maternal antibodies
- a known allergic reaction to the vaccine/substance in the vaccine
administration of MMR and varicella should be postponed for ____ after passive immunity with immunoglobulins and blood transfusions (except washed RBCs)
3 months
is breastfeeding a contraindication to vaccines?
no- none
pregnancy is a contraindication to what vaccine?
MMR
- but the risk for fetal damage is primarily theoretic
parent communication about vaccines
- provide accurate and user-friendly information
- realize and acknowledge parent’s concerns for their child’s health
- tailor discussion to needs of the parent
- avoid judgement and threatening statements
- be flexible and provide parents with options
- provide the VIS sheet
- help parent make an informed decision
- be knowledgable about the benefits, common adverse reactions, how to minimize those affects
- involve the parent in minimizing the potential adverse effects of the vaccine
- respect the parent’s ultimate wishes
the principal precautions in administering immunizations include
- proper storage to protect the potency
- institution of recommended procedures for injection
if a vaccine has to be refrigerated, where should it be stored?
the center shelf
- NOT the door (temp increases frequently with opening/closing of doors)
for protection against light
the vial can be wrapped in aluminum foil
DTaP vaccines contain an adjuvant that has what affect?
the adjuvant retains the antigen at the injection site and prolongs the stimulatory effect
subcutaneous and intracutaneous injections of an adjuvant can cause
- local irritation
- inflammation
- or abscess formation
when two or more injections are given at separate sites the order is __
arbitrary (random)
- some suggest to do the less painful one first
- best to do them simultaneously (requires two operators)
when administering a series vaccine, the injection site should be
rotated every time
one of the most important features of injecting an IM vaccine is
ensuring that the injection goes into the muscle and not just the SC tissue
- needle length*
IM injection needle length for infants <28 days old
5/8”
IM injection needle length for infants 1-2 months old
1”
IM injection needle length for children 3-18 years old
5/8” if the skin is stretched tightly and not bunched
or
1”
valid informed consent is achieved when what 3 conditions are met?
- the person must be capable of giving consent (ie 18+ and competent mind)
- the person must receive the information needed to make an intelligent decision
- the person must act voluntarily when exercising freedom of choice without force, fraud, deceit, duress, or other forms of constraint or coercion
valid assent should include…
- helping the patient achieve a developmentally appropriate awareness of their condition
- telling the patient what they can expect
- making a clinical assessment of the patient’s understanding
- soliciting an expression of the patient’s willingness to accept the proposed procedure
is assent a legal requirement?
- no it is not legal but it is an ethical requirement to protect the children’s rights
- but it does show the child patient respect from the healthcare team by treating them as an equal to their parents when it comes to making a decision about the patient’s health
if the parents are not present when emergency care of a pediatric patient is needed, what happens?
- care is not withheld
- parents reserve the right to withdraw consent later
if the legal caregivers disagree on treatment options, what happens?
it is within the health care providers’ scope to request consultation of a hospital ethics board to determine what care is in the best interest of the patient
when is verbal consent allowed?
- if parents are not available to sign the consent forms
- verbal consent over the phone can be obtained in the presence of two witnesses
- both witnesses have to record that informed consent was given and who it was given by
- the witnesses signatures indicate that they witnesses informed consent
examples of medically emancipated conditions
- STIs
- pregnancy
- contraceptive advice
- substance abuse and addiction
what do child life therapists/specialists address?
the psychosocial concerns that accompany stressful life experiences by promoting optimal child development and minimizing adverse effects
the most effective preparation for procedures is
- providing sensory-procedural information
- helping the child develop coping skills, such as imagery, distraction or relaxation
age specific prep for procedures based on developmental characteristics: infant
developing trust and sensorimotor thought
- attachement to parent
- stranger anxiety
- increased muscle control (expect older infants to resist)
- memory of past experiences
- imitation of gestures (model behavior)
age specific prep for procedures based on developmental characteristics: toddler
developing autonomy and sensorimotor to pre-operational thought
- egocentric thought
- negative behavior
- animism
- limited language skills
- limited concept of time
- striving for independence
age specific prep for procedures based on developmental characteristics: preschooler
developing initiative and pre-operational thought
- egocentric
- increased language skills
- limited concept of time and frustration tolerance
- illness and hospitalization viewed as punishment
- animism
- fears of bodily harm, intrusion, and castration
- striving for initiative
age specific prep for procedures based on developmental characteristics: school-age child
developing industry and concrete thought
- increased language skills, interest in acquiring knowledge
- improved concept of time
- increased self-control
- striving for industry
- developing relationships with peers
age specific prep for procedures based on developmental characteristics: adolescent
developing identity and abstract thought
- increasing abstract thought and reasoning
- consciousness of appearance
- concern more with present than with future
- striving for independence
- developing peer relationships and group identity
timing of preparation for a procedure
- exact timing varies with child’s age, developmental level, type of procedure
- in general, the younger the child, the closer the explanation should be to the actual procedure (day of, hour before) to prevent fantasizing and worrying
- older children may need more time (days) prior to a procedure
special concern for physical (procedure) preparation is
administering appropriate sedation and analgesia before stressful procedures
should traumatic procedures be performed in a child’s “safe” place?
no, never
- ie playroom- should never be used for a traumatic procedure- will make the safe place a traumatic place
when should a nurse permit the child with a choice? (ie when taking medicine)
- never ask the child “would you like to take your medicine now?” because it leaves them the option to delay or refuse their meds
- instead, ask the child “would you like to drink your medicine plain or with a little water?”
play activities for specific procedures: fluid intake
Make ice pops using child’s favorite juice.
Cut gelatin into fun shapes.
Make a game out of taking a sip when turning page of a book or in games such as Simon Says.
Use small medicine cups; decorate the cups.
Color water with food coloring or powdered drink mix.
Have a tea party; pour at a small table.
Cut straws in half and place in a small container (much easier for child to suck liquid).
Use a “crazy” straw.
Make a “progress poster”; give rewards for drinking a predetermined quantity.
play activities for specific procedures: deep breathing
Blow bubbles with a bubble blower.
Blow bubbles with a straw (no soap).
Blow on a pinwheel, feather, whistle, harmonica, balloon, or party blower.
Practice band instruments.
Have a blowing contest using balloons, boats, cotton balls, feathers, marbles, Ping-Pong balls, pieces of paper; blow such objects on a table top over a goal line, over water, through an obstacle course, up in the air, against an opponent, or up and down a string.
Suck paper or cloth from one container to another using a straw.
Dramatize stories such as “I’ll huff and I’ll puff, and I’ll blow your house down” from the “Three Little Pigs.”
Do straw-blowing painting.
Take a deep breath and “blow out the candles” on a birthday cake.
Use a little paintbrush to “paint” nails with water and blow nails dry.
play activities for specific procedures: range of motion and use of extremeties
Throw beanbags at a fixed or movable target or throw wadded-up paper into a wastebasket.
Touch or kick Mylar balloons held or hung in different positions (if child is in traction, hang balloon from a trapeze).
Play “tickle toes”; have the child wiggle them on request.
Play Twister game or Simon Says.
Play pretend and guessing games (e.g., imitate a bird, butterfly, or horse).
Have tricycle or wheelchair races in safe area.
Play kickball or throw ball with a soft foam ball in a safe area.
Position bed so that child must turn to view television or doorway.
Climb wall with fingers like a “spider.”
Pretend to teach aerobic dancing or exercises; encourage parents to participate.
Encourage swimming if feasible.
Play video games or pinball (fine motor movement).
Play hide and seek: hide toy somewhere in bed (or room if ambulatory) and have child find it using specified hand or foot.
Provide clay to mold with fingers.
Paint or draw on large sheets of paper placed on floor or wall.
Encourage combing own hair; play “beauty shop” with “customer” in different positions.
play activities for specific procedures: soaks
Play with small toys or objects (e.g., cups, soap dishes) in water.
Wash dolls or toys.
Pick up marbles or penniesa from bottom of bath container.
Make designs with coins on bottom of container.
Pretend a boat is a submarine by keeping it immersed.
Read to child during soaks; sing with child; or play game, such as cards, checkers, or other board game (if both hands are immersed, move board pieces for child).
Sitz bath: give child something to listen to (e.g., music, stories) or look at (e.g., View-Master, book).
Punch holes in bottom of plastic cup, fill with water, and let it “rain” on child.
play activities for specific procedures: injections
Let child handle syringe, vial, and alcohol swab and give an injection to doll or stuffed animal.
Draw a “magic circle” on area before injection; draw smiling face in circle after injection but avoid drawing on puncture site.
If multiple injections or venipunctures are planned, make a “progress poster”; give rewards for predetermined number of injections.
Have child count to 10 or 15 during injection.
play activities for specific procedures: ambulation
Give child something to push:
*Toddler: push-pull toy
*School-age child: wagon or a doll in a stroller or wheelchair
*Adolescent: decorated intravenous stand
Have a parade; make hats, drums, and so on.
play activities for specific procedures: extending environment (ie for patients in traction)
Make bed into a pirate ship or airplane with decorations.
Put up mirrors so patient can see around room.
Move bed frequently to playroom, hallway, or outside.
preparing the family for a procedure includes
- name of the procedure
- purpose of procedure
- length of time anticipated to complete the procedure
- anticipated effects
- signs of adverse effects
- assess the family’s level of understanding
- demonstrate and have family return demonstration (if appropriate)
should a nurse force fluids or food to a child not eating/drinking?
- in most cases, no
- forcing causes more issues
examples of well-tolerated foods
- crackers
- dry toast
- gelatin
- diluted clear soups
- carbonated drinks
- flavored ice pops
how should charting of intake be?
- exactly what the patient ate: 1 pancake, 4 oz of orange juice
- don’t say “ate well” or “ate poorly”
- chart duration, amount, and frequency for infants (breast/bottle)
set point
the temperature which body temperature is regulated by a thermostat- like mechanism in the hypothalamus
fever (hyperpyrexia)
an elevation in set point such that body temperature is regulated at a higher level; may be arbitrarily defined as rectal temp above 38C (100.4F)
hyperthermia
body temperature exceeding the set point, which usually results from the body or external conditions creating more heat than the body can eliminate, such as in heat exhaustion, heatstroke, aspirin toxicity, seizures, or hyperthyroidism
what is the preferred antipyretic drug for a fever?
acetaminophen (Tylenol)
what antipyretic drug should not be giving to children and why?
- aspirin
- associated with flu, chickenpox, and reye syndrome
how long should one wait to take a child’s temperature after they have ate/drank something hot/cold?
at least 15 minutes
safety measures for identification in the hospital
- ID bands
- use of two patient identifiers (name and DOB)
- allergy alert bands
standard precautions
- universal precautions (for blood and body fluid) designed to reduce the risk of transmissions of blood-borne pathogens
- body substance isolation designed to reduce the risk of transmission of pathogens from moist body surfaces
standard precautions include
hand hygiene and the use of barrier protection (gloves, mask, gown, goggles)
standard precautions prevent contamination from
- blood
- all bodily fluids, secretions, and excretions (except sweat)
- non-intact skin
- mucous membranes
transmission-based precautions
for patients with infections that are highly transmissible or epidemiologically important pathogens that require further precautions than standard precautions
- airborne
- droplet
- contact
airborne precautions
reduce the risk of airborne transmission of infectious agents
- special air handling and ventilation
droplet precautions
reduce the risk of droplet transmission of infectious agents
- droplet transmission includes coughing, sneezing, talking, and procedures of suctioning and bronchoscopy
contact precautions
reduce the risk of transmission of microorganisms by direct or indirect contact
- gown and gloves
direct-contact transmission
involves skin to skin contact and physical transfer of microorganisms
- ie when turning or bathing patients, hand contact
indirect contact transmission
involves contact of. a susceptible host with a contaminated intermediate object
- ie remote, door handle
how should infants and children be transported in the hospital (within and outside of the peds unit)?
- can be carried for short distances
- extended trips, should be transported in a suitable conveyance
- critically patients should always be transported on a stretcher or bed
- depends on their age, condition, and destination***
examples of restraints
- limb restraints
- elbow restraints
- vest restraints
- tight tucking of sheets to prevent movement in bed
are mechanical supports considered restraints?
no
- examples of these are immobilizers for fractures, leg brace, protective helmet, surgical dressings, orthopedic devices to maintain proper body alignment
behavioral restraints must be reordered every __
- 15 min for personal restraint
- 1hr for children under 9 years
- 2hr for children 9-17
- 4hr for 18 and older
restraints: a licensed independent practitioner must conduct an in-person evaluation ____
- within 1 hr
- every 24 hours to continue use
why may children require larger doses (per weight) and/or more frequent doses than adults?
beyond the newborn period, children tend to metabolize drugs faster than adults
how can taste of oral meds be camoflauged?
- put med in apple sauce
- mix med with small amount of juice
- pharmacy in hospital has flavored syrup: Syrpalta
the most accurate means for measuring less than 10mL of liquid med?
the plastic disposable calibrated oral syringe
the best way to administer an oral liquid to an infant
- hold infant in a semi-reclining position, place the medication in the mouth using an oral syringe
- place syringe along the side of the infant’s tongue and administer slowly in small amounts, waiting for infant to swallow between increments
IM injection site for small or debilitated children
- vastus lateralis muscle
- ventrogluteal muscle
IM injection site for school-age children or adolescents
- deltoid muscle
- ventrogluteal muscle
techniques to minimize pain with subcutaneous injection
- change needle if it pierced through a rubber stopper on a vial
- use a 26- to 30-gauge needle
- inject in small doses (</= 0.5mL)
angle of SQ injection
- 90* angle
- 45* angle for children with little SC tissue (baby)
common injection sites for SQ injections
- center third of the lateral aspect of the upper arm
- abdomen
- center third of the anterior thigh
IV administration is used to give drugs to children who:
- Have poor gastrointestinal absorption as a result of diarrhea, vomiting, or dehydration
- Need a high serum concentration of a drug
- Have resistant infections that require parenteral medication over an extended time
-Need continuous pain relief
-Require emergency treatment
what sources are included in the measurement of I&Os/fluid balance
all sources
- GI
- stools
- urine
- parenteral
- vomitus
- fistulas
- NG suction
- sweat
- drainage from wounds
I&O records must be kept with children that are:
- Current IV therapy
- Recent major surgery
-Medications that include diuretic or corticosteroid therapy
-Severe thermal burns or injuries
-Renal disease or damage
-Congestive heart failure - Dehydration
-Diabetes mellitus
-Oliguria
-Respiratory distress - Chronic lung disease
1g of wet diaper = __ mL loss
1mL of urine
for children who cannot brush their teeth or rinse their mouth without swallowing fluid, and are on a fluid restricting/NPO status, they can clean their mouth and teeth with
a saline-moistened gauze
how many dr visits does a newborn receive in their first year of life?
9 visits 1st year of life
RSV routine for infants born in October- March
- mom did not receive RSV/status unknown: 1 dose within 1 week of birth
- mom received RSV <14 days prior to delivery: 1 dose within 1 week of birth
- mom received RSV >/= 14 days prior to delivery: vaccine not needed/can be considered in rare circumstances
RSV routine for infants born April-September
- mom did not receive RSV/status unknown: 1 dose shortly before start of RSV
- mom received RSV <14 days prior to delivery: 1 dose shortly before start of RSV
- mom received RSV >/= 14 days prior to delivery: vaccine not needed/can be considered in rare circumstances
Hep B vaccine routine: full term, mom Hep B Negative
Hep B vaccine
- 3 dose series: Birth, 1 month of age, 6 months of age
- birth dose is monovalent, combination vaccine containing Hep B may be used for subsequent doses - example: combination vaccine: Pediarix (Dtap-HepB-IPV)
Hep B vaccine routine: premature infants, mom Hep B Negative
If premature infant is < 2000g, and gets Hep B at birth, will need 3 additional doses
- Birth, 1 month, 2 months, 6 months
If premature infant < 2000g, option to wait and give 1st dose when infant is 1 month of age
- 1 month, 2 month, 6 months
If premature infant > 2000g, will get 3 dose series starting at birth
- Birth, 1 month, 6 months
Hep B vaccine routine: mom Hep B Positive, all babies of all birth weights
All babies (regardless of weight) will receive Immunoglobulin (HBIG/IVIg) and Hep B within 12 hoursafter birth
- If baby < 2000g, will need total of 4 doses of Hep B Birth, 1 month, 2 months, 6 months
- If Baby > 2000g, will need total of 3 doses of Hep B Birth, 1 month, 6 months
Hep B vaccine routine: mom Hep B status unknown
- <2000g, will need Hep B and HBIG/IVIg within 12 hours
- > 2000g, will need Hep B (birth, 1 month, 6 months), AND wait for mom’s blood test on Hep status (if mom is HepB+ give HBIG/IVIg within 7 days of birth)
how should a nurse present control to a child?
- choices
- open-ended questions
flu vaccine: 6 months- 8 years of age
- 1st season: 6 months (1st dose) and 4 weeks later (2nd dose)
- every subsequent year, gets 1 dose
who cannot get live vaccines?
- pregnant
- immunocompromised
- anyone who has had an anaphylactic reaction
- asthmatics
angle of IM injection
90* always
what medication can we not give until 6 months of age?
Motrin (ibuprofen)
can you give multiple vaccines at once?
- yes
- different sites
- or same area, but injection sites are 1inch apart
is it common for children to regress developmentally in the hospital?
- yes it is
- temporary
- very stressful
- will go back to normal once at home again
