Chapter 21: Restraining the Child

Question 1

Why may restraining a child may be a necessary prevention?

Answer 1

to ensure a child’s safety during a procedure or to prevent injury to a operative site
-parents as well as the child need to be informed as to why a restraint is necessary

Question 2

When the Restraint is Applied

Answer 2

• the child must be checked and documentation made as to the condition of the skin and circulation of the affected extremity
• extremity checked q 15 minutes for 1 hour after initial application and then q 1 to 2 hours to ensure the child’s safety; follow hospital protocol

Question 3

Use of Restraints: Nurse Must Assess

Answer 3

• signs of injury associated with the application of restraint or seclusion
• nutrition/hydration
• circulation and range of motion in the extremities
• vital signs
• hygiene and elimination
• physical and psychological status and comfort
• readiness for discontinuation of restraint or seclusion

Question 4

Care of The Child In Restraints

Answer 4

1. remove restraints q 2 hours to assess skin and provide range of motion to the affected extremity
2. if appropriate, provide supervised time with restraints off to allow the child to engage in activities of daily living (e.g. toileting, feeding, reading a book, watching TV, etc.)
3. Encourage games and activities that promote growth development
4. Reapply restraints
5. document condition of skin, nursing care given with restraints off, and removal and reapplication of restraints
6. teach parents how to remove and reapply restraints

Question 5

Types of Physical Restraints

Answer 5

• elbow restraint

- papoose restraint

Question 6

Elbow Restraint

Answer 6

prevents the child from flexing the elbow, therefore preventing the child’s hands from reaching the head
-prevent pulling out an IV line in a scalp vein or other peripheral line
-prevents child from touching the incision area if recovering from cleft lip repair
-most tolerate without problems r/t skin integrity or circulatory compromise
>should be removed one at a time, every hour to allow for exercise of the arm; must be supervised when restraints removed

Question 7

Papoose Restraint

Answer 7

much like swaddling an infant
-total body restraint
-temporarily immobilizes an infant or small child for an examination or procedure that involves the head, neck, or throat
>this is ideal to keep the child safe during venipuncture, throat examination, insertion of nasogastric tube, or administration of ophthalmic, otic, or oral medications

Question 8

Pharmacological Restraints

Answer 8

administered to children during diagnostic and therapeutic procedures
-sedation of children is administered to allow the safe completion of a procedure
>Chloral hydrate (Aquachloral) is a nonbarbiturate sedative-hypnotic drug commonly used in children to produce sedation; drug decreases anxiety and induces sleep without respiratory depression or suppression of the cough reflex

Question 9

Chloral Hydrate (Aquachloral)

Answer 9

commonly used in children to produce sedation

• decreases anxiety and induces sleep without respiratory depression or suppression of the cough reflex
• assess level of consciousness at time of peak affect (1 hour); notify health-care provider if desired sedative effect not reached
• duration of action is 4 to 8 hours
• dilute chloral hydrate syrup in juice or water to decrease gastric irritation
• monitor for dizziness, confusion, excessive sedation, and paradoxical excitation