Pediatric Application Of Skills Flashcards
When preparing a child for a procedure should the information that may produce anxiety be told first or last?
Last
Should you lie to a child about a procedure to make them feel better?
No you should be honest
You should emphasize ______ aspects of procedure
Sensory- see, feel, hear, smell
How do you identify a child that doesn’t know their name
Reading Name tag
How long do you wash hands for a routine wash
15 seconds
How long do you wash your hands if they are contaminated
1 full minute
Should you wave your hands to dry them?
No you should rub in until dry
You should use soap and water after how many gels?
4
What kind of terms should you use when preparing a child for a procedure
Concrete–example: saying the place on the arm that is red, puffy, and hurts instead of saying infected (abstract term)
Should you only stress parts of the body that are involved when preparing a child for a procedure
No, you should stress parts of the body that are involved and parts that are not involved
Should you avoid medical terms with children
No use both concrete and medical terms….remember the doctors may use medical terms so you don’t want to avoid them
Is crying and being mad okay?
Yes! Allow expression of feelings. Biting and kicking are not ok
The child was awful during a procedure–how should you respond after
Praise the child after no matter how he/she behaved..this may be hard to do but it works because you are setting up positive for the next procedure
A child is on bed rest what kind of bath should the child get
Bed bath
Maximum water temperature for child and elderly for shower/bath/bed bath
100-105
Maximum water temperature for adults needing shower/bath/bed bath
110
Children and elderly 100-105
Should you assume the parent will give the child the bath?
No!! But it is ok if they want to do it just give them equipment and support as you help them
Naps are common in children less than ___ years of age
5
What should you remember when taking a child’s weight
Same time, same clothes, same scale
Are children allowed to run in hospital
No
Should infant sleep on back or belly
BACK!
Back to sleep
When should children be in a crib?
Under 3
When should children be in a bed
Over 3
If a kid gets out of bed do you put the side rails down
No. Side rails are up if a kid is in or out of bed
What is the most difficult vital sign to get
Respirations
How do you get respirations in a baby
Watch abdomen or stethoscope on back. You want to leave them in parents arms if that’s where they are
What may you see with toileting in kids
You may see Regression in kids
Should you go in room and say “I’m going to take your vital signs”
No! Use different words than take
What is the order you should get vital signs
Respirations Pulse Blood pressure Temperature **least invasive to most invasive
When do you use apical pulse
Up to 2 years
When do you do blood pressure on a child
Often not until 3 years or older
Cuff should cover ____ of upper arm in a child
2/3
What should you do if you are unable to ascultate look pressure
Dinamap (electronic) or Doppler
What kind of numbers does the Doppler give you
Only gives you top number. Example: 90/D
Focus on disease that are transmitted by large droplets expelled in the air and travel 3-6 feet from the patient
Droplet precautions
Focus on diseases that are transmitted by smaller droplets, which remain in the air for longer periods of time
Airborne precautions
Used for direct and indirect contact with patients and their environment
Contact precautions
Who are standard precautions used for?
All patients!
What type of precautions would be used with influenza
Droplet precautions
What is required with airborne precautions
Private room, negative-pressure airflow, N95 respirator
When do you take axillary temperatures
Babies less than 1 month
How do you straighten ear canal in children under 2
Down and back
Why is tympanic temperature inaccurate at times
When a child has a ear infection
When is a oral temperature taken
5 years and older; must be able to cooperate
When is a rectal temperature used
Young children and very ill
How is a rectal temperature taken
Be gentle, insert 1/2-1 inch, hold onto it at all times
How do you get a specimen in a diapered child
Urine collection bag”U-bag”, sitting up position, do not push fluids, check every 20 minutes
If you have to use restraints in a emergency how long do you have to get a doctors order
Written order within 1 hour
How often should you check restraints
Check after 15 minutes and then every hour
Is there a time when you should restrain all 4 limbs?
Never!
When opening a child tray what should you do
Open away from the child
What is the best position for a child after feeding
Right side with support
If you weigh a diaper 1gram = how much fluid
1 ml
Is a NG or PEG more permanent
PEG
What does a continuous tube feeding mean
Slow drip of liquid feed
What is a “Bolus” or Intermittent feeding
A volume of feeding all in one feeding
What is the difference between Bolus and intermittent feedings
They are the same thing
What type of tubes can be used for Bolus or intermittent feedings
Tubes in stomach: NG or PEG
What types of tubes can be used for Continuous tube feedings
Usually placed in intestinal: Dobhoff, NI
Why use continuous tube feeding
Tubes placed in intestines so less risk of aspiration
Why use Bolus or Intermittent tube feedings
More like how we normally eat
When are orogastric tubes used
For babies
How can oro/nasogastric tubes be placed
Continually or intermittently
Landmarks for NG in child over 1
Nose to ear to xiphoid process
Landmarks for NG tube in child under 1
Nose to ear to between belly button and xiphoid process
What is the #1 indicator when placing NG to tell if patient is ok/not ok
Respiratory symptoms
Okay- gagging
Not okay- coughing
Is gagging when placing NG okay?
Yes
Is coughing when placing a NG okay?
No! Take out immediately, in lungs
What do gastric contents look like? Lung content?
Gastric- green, tan, brown
Lungs- clear, mucus
What is the only absolute verification of NG placement
X-Ray
How should you do ongoing placement checks of NG
Assess respiratory status, examine external mark, withdraw contents and inspect( only when in stomach, not in intestines!!)
How do you do ongoing placement checks of a NI tube
Assess respiratory status
Examine external mark
What do you not do to verify ongoing placement of NI tube
Withdraw gastric contents. You do not do because there is no residual so you will harm them
How and when do you check residual in Bolus Feed
Check before each feeding: if volume of residual is more than 1/2 of previous feed you should feed it back and hold feed and call the doctor
What do you do with Bolus feeding if residual is less than 1/2 of previous feed
You can feed
Why do you put back feedings when you check residual even if it is more than 1/2 of previous feeding
Because it is full in nutrients and full of fluids and electrolytes
How do you check stomach residual in Continuous Feedings
Check every 4-6 hours, if volume of residual is more than 2 hours stop feeding and call the doctor
What do you do if the residual is more than 2 hours in a continuous feed into stomach
Stop feeding and call the doctor
What are general feeding rules
Go slow, golf the child, give a pacifier, during/after elevate head and place on right side
How many people are needed to change Velcro ties
2 people
How long should you wait to change Velcro ties
Only change after 96 hours
What kind of trach tubes do children usually have
1 piece trach tubes
What kind of trach tubes do older children have
2 piece trach tubes, disposable or non-disposable inner cannulas
What type of gauze is used for trach bib
Hydrocell gauze
How long do you do suctioning in children
5-10 seconds
