Pediatric Nursing Interventions and Skills Flashcards
Informed consent
-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)
Evidence of consent
-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
Informed consent of an emancipated minor
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)
Informed consent of a mature minor exempt from consent laws
-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
Tx w/o parental consent
-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
Family education sessions include:
-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
General procedure guidelines
-Psychological preparation
-Establish rapport
-Parental presence and support
-Explanation to the child
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-Involve child life specialist
-Special tx room for procedures
-Involve child
-Provide distraction
-Post procedural support thru play and expression of feelings
Age-specific preparation: infant
-Developing trust and sensorimotor thought
-Attachment to parent
-Stranger anxiety
-Sensorimotor phase of learning
-Increased muscle control
-Memory for past experiences
-Imitation of gestures
Age-specific preparation: toddler
-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
Age-specific preparation: preschooler
-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
Age-specific preparation: school-age child
-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
Age-specific preparation: adolescent
-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
Preoperative care: fasting recommendations to reduce risk of pulmonary aspiration
-Clear liquids: 2 hours
-Breast milk: 4 hours
-Infant formula: 6 hours
-Nonhuman milk: 6 hours
-Light meal: 6 hours
Intraoperative care: nurse’s role
-Advocate for care
-Assess, recognize, intervene when pt is at high risk for pressure injury
-Clear communication
-Family-centered care
Postoperative care
-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
