Pediatric Nursing Interventions and Skills

Question 1

Informed consent

Answer 1

-Must be capable of giving consent
-Must be over 18 y/o
-Must be considered competent
-Must receive info needed
-Must act voluntarily when exercising freedom of choice
-Decision making involving care of children older than 7 should include their assent (if feasible) as well as the parent’s consent
-Parents have full responsibility if child is a minor
-Married parents (only 1 parent required)
Divorced parents (consent rests w/ parent of legal custody)

Question 1

Evidence of consent

Answer 1

-Physician’s legal responsibility to explain procedure, risks, benefits, alternatives
-Nurse witnesses signature on consent form and may reinforce what pt has been told
-If parents unable to sign form, verbal consent may be obtained via telephone in presence of 2 witnesses

Question 2

Informed consent of an emancipated minor

Answer 2

Legally under age of majority but is recognized as having legal capacity of an adult under circumstances prescribed by state law (pregnancy, marriage, high school graduation, independent living, military service)

Question 2

Informed consent of a mature minor exempt from consent laws

Answer 2

-Recognized in few states for children over 14 who possess the maturity and cognitive ability to understand all elements of informed consent and make a choice based on the info
-Legal action may be required for designation as a mature minor

Question 3

Tx w/o parental consent

Answer 3

-Urgent medical or surgical tx and parent unavailable or refusing to give consent (where there is danger to life or permanent injury from failure to act immediately)
-Parental refusal for lifesaving tx requires notification to CPS
-Assessment for abuse or neglect

Question 4

Family education sessions include:

Answer 4

-Name of 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

Question 5

General procedure guidelines

Answer 5

-Psychological preparation
-Establish rapport
-Parental presence and support
-Explanation to the child
-22.1
-Involve child life specialist
-Special tx room for procedures
-Involve child
-Provide distraction
-Post procedural support thru play and expression of feelings

Question 6

Age-specific preparation: infant

Answer 6

-Developing trust and sensorimotor thought
-Attachment to parent
-Stranger anxiety
-Sensorimotor phase of learning
-Increased muscle control
-Memory for past experiences
-Imitation of gestures

Question 7

Age-specific preparation: toddler

Answer 7

-Developing autonomy and sensorimotor to preoperational thought
-Same approaches as infant
-Egocentric thought
-Negative behavior
-Animism
-Limited language skills
-Limited concept of time
-Striving for independence

Question 8

Age-specific preparation: preschooler

Answer 8

-Developing initiative and preoperational thought
-Egocentric
-Increased language skills
-Limited concept of time and frustration tolerance
-Illness and hospitalization viewed as punishment
-Animism
-Fear of bodily harm, intrusion, castration
-Striving for initiative

Question 9

Age-specific preparation: school-age child

Answer 9

-Developing industry and concrete thought
-Increase language skills and interest in acquiring knowledge
-Improved concept of time
-Increased self-control
-Striving for industry
-Developing relationships w/ peers

Question 10

Age-specific preparation: adolescent

Answer 10

-Developing identify 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

Question 11

Preoperative care: fasting recommendations to reduce risk of pulmonary aspiration

Answer 11

-Clear liquids: 2 hours
-Breast milk: 4 hours
-Infant formula: 6 hours
-Nonhuman milk: 6 hours
-Light meal: 6 hours

Question 12

Intraoperative care: nurse’s role

Answer 12

-Advocate for care
-Assess, recognize, intervene when pt is at high risk for pressure injury
-Clear communication
-Family-centered care

Question 13

Postoperative care

Answer 13

-Ensure preparations made to receive child
-Obtain baseline info
-Assess level of sedation and activity
-Notify physician of any irregularities in child’s condition
-Assess for evidence of pain
-Review surgeon’s orders
-Check bowel/urine output
-Observe for s/s of shock, abdominal distention, bleeding or dehydraiton
-Detect infection
-Collect specimens

Question 14

General hygiene care

Answer 14

-Prevent pressure injuries
-Bathin
-Oral hygiene
-Hair care
-Feeding sick child
-Detail descriptions of intake
-Controlling elevated temps (fever is 100.5 and above)

Question 15

Infection control

Answer 15

-Nosocomial infections
-CDC
-Standard precautions
-Transmission-based precautions
-Airborne, droplet, contact precautions

Question 16

Compliance

Answer 16

-Also termed adherence
-Assessment of compliance
-Self-reporting
-Direct observation
-Monitoring appts
-Monitoring therapeutic response
-Pill counts
-Chemical assay

Question 17

Strategies to enhance compliance

Answer 17

-Organizational: involve care setting and therapeutic plan
-Tx: r/t child’s refusal or inability to take prescribed med
-Behavioral: designed to modify behavior directly, use positive reinforcement

Question 18

Safety

Answer 18

-ID bands
-Environment: electrical, disposal of small objects, furniture
-Activity supervision: toys, preventing falls, sleep safety
-Infection control: standard precautions

Question 19

Transporting infants and children

Answer 19

-Within unit, infant transport may be carried for short distances
-In suitable conveyance for transports outside unit

Question 20

Restraining methods

Answer 20

-1st assess on need for restraint
-Behavioral restraints
-May need analgesia or sedation
-Physical restraints: therapeutic hugging, jacket restraint, mummy or swaddle restraint, limb restraint

Question 21

Specimen collection

Answer 21

-Urine (urine collection bags)
-Clean-catch: urine sample obtained for culture after urethral meatus is cleaned and 1st few mL of urine are voided (midstream specimen)
-Sterile: requires catheterization (straight cath)
-24 hour collection

Question 22

Straight cath sizes for children

Answer 22

-Neonate: 5-6
-Infant - 3 y: 5-8
-4-8 y: 8
-8 y - prepubertal: 8-12
-Pubertal: 12-14

Question 23

Respiratory secretion specimens

Answer 23

-URTIs are common in children
-COVID-19, flu, RSV can be diagnosed from epithelial cells of nasopharyngeal passage

Question 24

Inhalation therapy

Answer 24

-Plastic hood (oxyhood)
-Nasal cannula (prongs)
-O2 masks

Question 25

Rectal administration of meds

Answer 25

-Suppositories such as acetaminophen, sedatives, antiemetics
-Lubricate w/ lubricant before insertion
-Place beyond rectal sphincters
-Hold buttocks together for 5-10 min

Question 26

IV devices

Answer 26

-Peripheral lock/heparin lock/saline lock
-Central venous access devices (short-term cath, long-term cath, implanted infusion ports
-PICCs

Question 27

Mgmt of PIVs

Answer 27

-Securing and protecting
-Complication of infiltration, extravasation, phlebitis

Question 28

Alternative feeding techniques

Answer 28

-Gavage feedings (NG or OG)
-May be continuous drip or intermittent (bolus)
-Equipment: NG/OG/ND tubes, pumps, gastrostomy tube/buttons, TPN

Question 29

Feeding equipment administration

Answer 29

-Always check for correct placement before med admin
-Always flush between meds if giving multiple meds
-Always flush after med administration

Question 30

Improving absorption of feeds

Answer 30

-Child should be held or placed in a position of comfort
-Head is elevated, child is sitting or lying on R side
-Use a pacifier during alternative feeds
-Nonnutritive sucking improves digestion
-Quiet, calm environment
-Consistent feeding techniques used by caregivers

Question 31

Parenteral feedings

Answer 31

-Provide nutrition thru filtered central IV route
-TPN
-Lipid infusion

Question 32

TPN

Answer 32

-Use when GI feeding is not possible
-Rationale for instilling via central line vs peripheral line
-Role of intralipid infusion

Question 33

Procedures r/t elimination: enemas

Answer 33

-Often given for constipation
-Techniques (age/weight appropriate)
-Bc infants and young children are unable to retain solution after it is administered, the buttocks must be held together for a short time

Question 34

Procedures r/t elimination: ostomies

Answer 34

-Skin/stoma care
-Infants have very fragile skin and stool is irritating
-Young children like to remove pouches