Chapter 10 Flashcards
Pediatric
Baby or child
Geriatric
Older
Pediatric Phlebotomy
Performing venipuncture or skin puncture on young patients.
Give two reasons why performing venipuncture on young patients is challenging.
Children have smaller bodies and are less prepared to cope with pain and anxiety.
True or False: The timing of the preparation depends on the child’s age.
True. Generally, the younger the child, the closer the explanation should be to the time of the procedure.
Correctly identify the patient by using at least ___ patient identifiers.
Two.
How are unnamed newborns identified? Give an example.
By their last names (eg. Baby Girl Smith).
Inform the child that the procedure can be stopped if it hurts too much, but that the more _______ the procedure is performed, the less _______ it will be.
Quickly; painful.
True or False: Parents should not get involved in a child’s blood collection. Instead, another nurse or phlebotomist should be called in to help.
False. Parent involvement should be encouraged, and it is your responsibility to explain how the parent can assist by holding, distracting, and soothing their child during the procedure. However, if the parent does not wish to be in the room during the procedure, you may ask another health care worked to assist.
What if a parent does not wish to help during their child’s venipuncture procedure, but is willing to be in the room?
Ask the parent to maintain eye contact with their child to reduce stress. Respect their wishes if they do not wish to be in the room at all.
Children _ to _ years may react extremely to painless procedures, such as taking a temperature.
1 to 2.
Children _ to _ years old perceive pain as a punishment for bad behavior, and may react aggressively.
3 to 5.
Children _ to __ years old are more likely to relate pain to past experiences (many children perceive a “shot” as something that hurts worse than anything else that has happened to them).
6 to 12.
Children __ to __ years old are more independent and may be embarrassed to show fear, and often require privacy and may act hostilely to mask fear.
13 to 17.
What age range responds well to distraction techniques? Give an example of a distraction technique.
Children older than 3 years respond well to distraction techniques. An example of a distraction is talking about a pleasant subject, counting, reading, pinwheels, listening to music, and more.
True or False: The room location of a child’s venipuncture procedure holds no importance, as venipuncture equipment can be moved anywhere.
False. For psychological reasons, the best room location for a painful procedure is a treatment room away from the child’s bed or play room. If the child cannot be moved to a treatment room, privacy should be maintained by drawing a curtain between the beds and speaking in a calm, quiet manner.
True or False: Wearing bright colors as opposed to white creates a more child-friendly environment.
True. White can be viewed as intimidating, and bright colors or printed clothing can be viewed as being more friendly.
Neonate
A newborn child; a child less than 4 weeks old.
What are two positions used to restrain a child during a venipuncture procedure?
The vertical position and the horizontal (supine) position).
Describe the vertical restraining technique for children.
The child is held on the parent’s lap. As the parent hugs and holds the child’s body and the arm not being used, the health care worker can firmly hold the other arm to perform the procedure.
Describe the horizontal, or supine, restraining technique for children.
A baby can be easily held in this position. However, more restraint may be required to hold an older child. The child can lay supine with the health care worker on one side of the bed and the parent on the opposite side. The parent can lean over the child to restrain the child’s unused arm while holding the opposite, extended arm securely for the healthcare worker.
True or False: Neonates and infants under 3 months usually require the restraint of multiple nurses, as the infants do not know that it is better to stay still.
False. They usually do not need restraint and can be managed by the health care worker alone. Swaddling helps to control and comfort an upset newborn.
What should you do if a child is being combative?
If there is a risk of injury to the patient of health care worker, discontinue the blood collection attempt and notify the nurse or the physician.
What does EMLA stand for?
Eutectic Mixture of Local Anesthetics
Anesthetic
Pain reliever
EMLA (Eutectic Mixture of Local Anesthetics)
A topical anesthetic can be rubbed on the skin when a needlestick is going to be used for venipuncture to a child. Ideal for use before venipuncture or started intravenous (IV) therapy because it does not require a needle.
How is EMLA applied?
It is applied to the skin as a patch or cream that is then covered with a transparent adhesive dressing. A thick layer of EMLA cream should be applied.
What are the downsides to EMLA?
The cost, the need to apply it 60 to 120 minutes before the procedure, and having to know in advance the location of the vein to be used.
What is sucrose? What is its significance in venipuncture?
A sugar. It is effective in reducing pain and crying time during a procedure for an infant up to 6 months old.
Sucrose Nipple or Pacifier
A pacifier that administers sucrose to an infant to reduce pain and crying during a procedure. It is given 2 minutes before heelsticks, and its action lasts about 5 minutes.
Premature Infants
Babies born before 37 weeks of pregnancy is completed.
