At the end of unit 2, the students will be able to:
Appreciate the differences between children and adult
Describe the hospital environment for a sick child
Explain the impact of hospitalization on child
Discuss the grief and bereavement
Outline the role of a child health nurse
Explain the principles of pre- and post-operative care for children
Perform pain assessment in children
Mother & Child is a vulnerable group. But many areas concerned with the health of these groups are preventable. This presentation helps you identify preventive aspects in pediatrics.
TRENDS IN PEDIATRICS AND PEDIATRIC NURSING
Pediatric regarded as the medical science which enables an anticipated newborn to grow into a healthy adult, useful to the society
Effect of Hospitalization on Child and Family Jyotika Abraham
Understand the effects of Hospitalization on the child who is admitted along with the siblings, parents and caregivers and the family. Also, understand the Nurses' responsibility towards the admitted child and the family. This Ppt. deals with the Nurses responsibility in detail not only towards the child but also towards the family as they are also tremendously affected by the hospitalization of their child. Understand the stress caused by child hospitalization, the defence mechanisms used by the child, the stressors of hospitalization in children of different age groups, Post hospitalization behaviour, beneficial effects of hospitalization, parental reaction, sibling reaction, informed consent for care, situations in which consent is required. Nursing management and therapeutic care, the safety of the hospitalized child, special hospital situations and discharge.
Mother & Child is a vulnerable group. But many areas concerned with the health of these groups are preventable. This presentation helps you identify preventive aspects in pediatrics.
TRENDS IN PEDIATRICS AND PEDIATRIC NURSING
Pediatric regarded as the medical science which enables an anticipated newborn to grow into a healthy adult, useful to the society
Effect of Hospitalization on Child and Family Jyotika Abraham
Understand the effects of Hospitalization on the child who is admitted along with the siblings, parents and caregivers and the family. Also, understand the Nurses' responsibility towards the admitted child and the family. This Ppt. deals with the Nurses responsibility in detail not only towards the child but also towards the family as they are also tremendously affected by the hospitalization of their child. Understand the stress caused by child hospitalization, the defence mechanisms used by the child, the stressors of hospitalization in children of different age groups, Post hospitalization behaviour, beneficial effects of hospitalization, parental reaction, sibling reaction, informed consent for care, situations in which consent is required. Nursing management and therapeutic care, the safety of the hospitalized child, special hospital situations and discharge.
Childhood is a period where the needs vary according to age.
For a pediatric nurse when dealing with children they should be aware of the needs of a healthy child.
it is uploaded to nurse educator to teach students about unit -2 healthy child in pediatric nursing. it also help the para medics & general public about normal growth & development of child. it also help to identify deviation from normal growth.
HOSPITALIZATION: Effect on children and their parentsShivani Thakur
The experience of hospitalization in children can be considered as a process of effort for returning to health and, on the whole, the regaining of the individual's status in the world.
Nurse can ease this process by showing the importance of experience and feelings of individuals at the time of hospitalization and help people to adapt themselves to their new surroundings.
Preventive Pediatrics (MCH, RCH, ICDS, Underfive Clinic, BFHI and School Heal...Alam Nuzhathalam
Preventive Pediatrics (MCH, RCH, ICDS, BFHI Maternal and Child Health, Reproductive and Child Health, Integrated Child Development Services, Underfive Clinic, Baby Friendly Hospital Initiative and School Health Service)..
Describes the major stressors in child's life, and their reactions to them,reaction to bodily injury and pain, reaction of child to illness, pain, separation and treatment, reaction of parents, siblings and role of nurse to sase them.
Childhood is a period where the needs vary according to age.
For a pediatric nurse when dealing with children they should be aware of the needs of a healthy child.
it is uploaded to nurse educator to teach students about unit -2 healthy child in pediatric nursing. it also help the para medics & general public about normal growth & development of child. it also help to identify deviation from normal growth.
HOSPITALIZATION: Effect on children and their parentsShivani Thakur
The experience of hospitalization in children can be considered as a process of effort for returning to health and, on the whole, the regaining of the individual's status in the world.
Nurse can ease this process by showing the importance of experience and feelings of individuals at the time of hospitalization and help people to adapt themselves to their new surroundings.
Preventive Pediatrics (MCH, RCH, ICDS, Underfive Clinic, BFHI and School Heal...Alam Nuzhathalam
Preventive Pediatrics (MCH, RCH, ICDS, BFHI Maternal and Child Health, Reproductive and Child Health, Integrated Child Development Services, Underfive Clinic, Baby Friendly Hospital Initiative and School Health Service)..
Describes the major stressors in child's life, and their reactions to them,reaction to bodily injury and pain, reaction of child to illness, pain, separation and treatment, reaction of parents, siblings and role of nurse to sase them.
Enhancing pediatric care: A comprehensive presentation on hospitalized child ...Rachel Masih
This PowerPoint presentation provides a thorough overview of strategies and protocols for managing hospitalized child, aiming to improve pediatric care and enhance the overall well-being of young patients.
child management, child behavior, behavior management, age development, psychological development, child psychology, child psychological development, children in dentistry clinical management of children
HISTORY TAKING AND FAMILY ASSESSMENT IN PEDIATRIC NURSINGRitu Gahlawat
History taking is an art as well as science that requires a thorough knowledge of medicine along with patience and good command on the language of the patient.
The history is the written record of all the facts about the patient's present and past illnesses.
The format used for history taking may be
(1)direct, in which the nurse asks for information via direct interview with the informant, or
(2)indirect, in which the informant supplies the information by completing some type of questionnaire.
Much of the identifying information may already be available from other recorded sources. However, if the parent and child seem anxious use this opportunity to ask about such information to help them feel more comfortable.
Informant. The person(s) who furnishes the information. Record (1) who the person is (child, parent, or other). (2) an impression of reliability and willingness to communicate, and (3) any special circumstances such as the use of an interpreter or conflicting answers by more than one person.
The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It may be the theme, with the present illness viewed as the description of the problem. Elicit the chief complaint by asking open ended, neutral questions And Avoid labelling type questions.
Occasionally, it is difficult to isolate one symptom or problem as the chief complaint because the parent may identify many. In this situation, be as specific as possible when asking questions.
The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present.
Its four major components are
the details of onset,
a complete interval history,
the present status, and
the reason for seeking help now.
Analyzing a Symptom. Because pain is often the most characteristic symptom denoting the onset of a physical problem, it is used as an example for analysis of a symptom.
Assessment includes type, location, severity, duration, and influencing factors.
The history contains information relating to all previous aspects of the child's health status and concentrates on several areas that are ordinarily passed over in the history of an adult, such as birth history, detailed feeding history, immunizations, and growth and development.
Birth History
The birth history includes all data concerning
the mother's health during pregnancy,
the labor and delivery, and
the infant's condition immediately after birth.Dietary History
Parental concerns are common and nursing interventions are important in ensuring optimum nutrition.
Previous illnesses, Injuries, and Surgeries
When inquiring about past illnesses, begin with a general question. In addition to illnesses, ask about injuries that required medical intervention, surgeries, procedures, and hospitalizations, including the dates of each incident. Focus on injuries because these may be potential areas for parental guidance.
During our chapter reading group facilitation, my partner and I prepared an hour long presentation on the topic End of Life and Palliative Care. The basis of the presentation was from the weekly assigned chapters in our class textbook. We were required to present an engaging lecture, presentation, and/or hands-on activity for the class.
Objective: At the end of this unit, the students will be able to:
Describe internationally accepted rights of child
Discuss national policies, legislation and agencies related to child welfare
Explain National Health Programs related to child health
Enumerate changing trends in child health
Outline child morbidity and mortality
Describe the ethics in Pediatric Nursing
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
Child Welfare Clinic and Well baby clinicin Sri Lanka.ppsx
2 Hospitalized child
1. Unit 2
Care of Hospitalized Child
Prof. (Dr.) Smriti Arora
Amity College of Nursing, Amity University Haryana
smritiamit@msn.com
2. Objectives
• At the end of unit 2, the students will be able to:
1. Appreciate the differences between children and adult
2. Describe the hospital environment for a sick child
3. Explain the impact of hospitalization on child
4. Discuss the grief and bereavement
5. Outline the role of a child health nurse
6. Explain the principles of pre- and post-operative care for children
7. Perform pain assessment in children
3. 1. Differences between children and adult
Airway: An infant is an obligatory nose breather for the first 6 months, a blocked nose can lead to respiratory
failure. Infants have very short and softer tracheas than adults. Tonsils and adenoids grow disproportionately
fast in children, making any inflammatory response more likely to compromise the movement of air.
• Infants have proportionately large heads, short necks and large tongues, which makes airway obstruction
more likely.
Breathing: A child has much small upper and lower airways which results in a great chance of respiratory
difficulties and failure.
• Infants are abdominal breathers who rely primarily on the muscles of the diaphragm. Abdominal distension
can lead to respiratory problems.
• Immature respiratory centre - neonates and young infants have irregular respirations and are at a greater
risk of apnoea.
• Children have higher RR than adults. Higher RR leads to proportionately higher minute volumes. As a result,
children may be more susceptible to agents absorbed through the pulmonary route than adults with the
same exposure.
4. Differences between children and adult
• Larger Body Surface Area- Children have a proportionately larger body surface area
(BSA) than adults. As a result, children are at greater risk of excessive loss of heat and
fluids.
• Skin- Children have thinner skin than adults. Epidermis is thin and under-keratinized, as a
result, children are at risk for increased absorption of agents that can be absorbed through
the skin.
• Immature blood brain barrier- Children have immature BBB and enhanced CNS
receptivity. Thus, children may exhibit a prevalence of neurological symptoms. Nerve
agents may produce more symptoms in pediatric patients, requiring levels of treatment for
children that are not indicated for adults with the same level of exposure.
5. Differences between children and adult
Immature immune systems- susceptible to communicable diseases.
Heart Rate – children have higher HR as compared to adults. The HR of
newborn is 110-160 beats/min
Basic Metabolic Rate- Children have increased BMR, thus more susceptible to
contaminants in food or water; greater risk for increased loss of water when ill or
stressed. Medication doses must be carefully calculated based on the child's
weight and body size.
Undeveloped hypothalamus- their ability to regulate temperature is impaired.
6. Differences between children and adult
Rapidly dividing cells- Children's cells divide more rapidly than
adults to assist in their rapid rate of growth. Thus, children are more
susceptible to the effects of radiation than adults.
Kidneys- Until 12-18 months of age kidneys do not concentrate urine
effectively and do not exert optimal control over electrolyte secretion
and absorption.
7. Differences between children and adult
Psychosocial Differences
• Unlike adults, children and adolescents are still in a period of social development
which involves learning the values, knowledge and skills that enable them to relate
to others.
Emotional
• Children and adolescents are still developing their ability to recognize and manage
their emotions or feelings, and this can be influenced by many social and
environmental factors. For infants and young children, their emotional bond of
attachment to their caregivers is crucial to their emotional development.
Inability to communicate
• Small children do not have the vocabulary to describe symptoms. The school age
children an describe symptoms with accuracy.
8. 2. Hospital environment for a sick child
A child friendly environment should have:
specially trained and experienced professionals to provide high quality care
facilities, equipment and medications tailored to fit the needs of children.
bright colors, themed décor and plenty of areas and opportunities to play
9. Measures to make hospital environment friendly for children
Provide good illumination
Keep floors clear of fluid or objects that might contribute to falls
Use nonskid surfaces in washrooms
Familiar with the area-specific fire plan
Secure all windows, blind and curtain cords should be out of reach of children.
Keep plants away from immunocompromised children as they may harbor microbes.
Electrical equipment should be in good working order and kept away from children.
10. Measures to make hospital environment friendly for children
Furniture should be checked for safety. Do not leave infants and young children,
unattended on treatment tables, weighing scales or in treatment areas.
Prevent fall from the beds, and cribs by raising the side rails. Electronically
controlled beds cause danger of entrapment.
Asses the safety of toys. Toys should be appropriate to the child’s age, condition, and
treatment.
Setting limits is essential, and children should know where they are permitted to go
and what they are supposed to do.
Ensure safe transportation for children within or outside the unit.
Ongoing assessment, evaluation, and documentation of restraints should be done
11. 3. Impact of hospitalization on child
• The reaction of child to hospitalization depends on :
Child’s developmental level
Presence of the mother/caregiver, preparation of the
mother
Socioeconomic status of family
Hospital environment
13. Separation Anxiety
Phase of Protest Phase of Despair Phase of Detachment
• Aggressive
• cry and scream for their
parents, inconsolable.
• cling to parent when
they reach, and avoid or
reject contact with
anyone else.
• Toddlers verbally and
physically attack
strangers, attempt to
escape from the area to
find parents.
• Crying stops and depression is
evident.
• Child is less active and shows no
interest in food or play.
• looks sad, lonely, isolated and
apathetic.
• regress to earlier behavior- thumb
sucking, bed wetting, or use of a
pacifier.
• Child’s physical condition may
further deteriorate from refusal to
eat, drink or move.
• Others usually misinterpret this
phase for child’s cooperation, and
adjustment to his hospitalization.
• The child appears to
have finally adjusted
to the loss.
• Child starts showing
more interest in the
surroundings, plays
with others and
seems to form new
relationships.
14. Nursing management for a hospitalized child
Nursing Interventions
• Assess physical tolerance and abilities to perform ADL, and play activities and
restrictions imposed by the illness and medical protocol.
• Provide personal care for the infant and small child; assist child and adjust times
and methods to fit home routine.
• Anticipate child’s needs for toileting, feeding, brushing teeth, bathing and other
care if unable to manage on own; allow the child to do as much as possible.
1. Nursing diagnosis- Self-Care Deficit
Goal- Child will attain maximum self-care capability
15. Nursing interventions
• Praise the child for participation in own care according to
age, developmental level, and energy to promote self-esteem
and independence.
• Balance activities with rest as needed; place needed articles
and call light within reach if appropriate to prevent fatigue by
conserving energy
• Provide assistive aids or devices to perform ADL, allow choices
when possible.
16. 2. Nursing diagnosis- Anxiety R/T change in environment AEB crying,
restlessness
Goal- Child and family will experience reduced anxiety.
Nursing Interventions
• Assess child’s and parents’ level of anxiety, child’s developmental level,
understanding of illness, and reason for hospitalization, and responses to
this and prior hospitalizations during admission.
• Assess social and emotional history of child and family for strengths and
effective coping ability.
• Allow verbalization of feelings and concerns about condition
and procedures and listen individually to child and parents.
• Allow the child to play out feelings. Accept feelings and responses
expressed by the child.
17. Nursing Interventions
• Provide consistent same personnel in the care of child
• Provide orientation to hospital environment and room, routines,
meal and play time, introduction to staff members, forms to sign
and hospital policies.
• Interact with child in a positive manner; use child’s proper
name; avoid communicating, either verbally or nonverbally, any
rejection, judgments, or negativism.
18. Nursing Interventions
• Provide a calm, accepting environment and avoid hurrying through
interactions
and care.
• Maintain a quiet environment, control visitors, and interactions.
• Encourage involvement of child and parents in planning and interventions
of care; allow parents to remain with child; allow to hold and cuddle the
child.
• Allow child and parents to incorporate home routines as much as possible;
bring toys, tapes, photographs and favorite foods from home as
appropriate.
19. Nursing Interventions
• Assess and recognize regressive behavior as a part of the illness and
assist the child in handling dependency associated with the hospitalization.
• Provide support to child during any procedures associated with care,
including intrusive procedures, exposure of body parts, need for personal
privacy.
• Use therapeutic play to explain and prepare the child for procedures;
repeat any teaching as needed.
• Acquaint parents and child that behavior caused by anxiety and fear is
normal and expected.
20. 3. Nursing Diagnosis- Knowledge deficit
Goal- To provide adequate knowledge R/T disease condition and treatment
Nursing Interventions
• Inform and explain all procedures and plans in simple, understandable
language to child and parents based on their intellectual level and age; pace
information according to child/parental needs.
• If surgery is planned, provide information on the surgical procedure to
be done, purpose of surgery, and duration of hospitalization and preoperative
and postoperative care.
21. Care of hospitalized child includes:
Prepare for hospitalization – explain, encourage questioning
Prevent or minimize separation – Rooming in
Minimize loss of control
Prevent minimize bodily injury
Allow for regression
Provide pain management (Atraumatic care)
Provide for developmentally appropriate play activities
Focus on developmental age rather than chronological age.
22. 4. Grief and bereavement
Factors affecting grief and bereavement in children:
• age
• gender
• developmental stage
• personality
• ways they usually react to stress and emotion
• relationship with the person who has died
• earlier experiences of loss or death
• family circumstances
• how others around them are grieving
• amount of support around them
23. Infants and toddlers
Reactions Management
• looking for the person who has
died
• being irritable, crying more
• wanting to be held more; being
clingy
• being less active – quiet, less
responsive
• possible weight loss
• being jumpy, anxious, being
fretful, distressed
• keep routines and normal
activities going as much as
possible
• hold and cuddle them more
• speak calmly and gently to
them
• provide comfort items, such as
a cuddly toy, special blanket etc
24. Preschoolers
Reactions Management
• hard to understand that death is permanent.
• magical thinking- for example, thinking
someone will come alive again or thinking
somehow they made someone die.
• looking for the person who has died
• dreams, or sensing the presence of the person
who has died
• fearfulness, anxiety
• Clinginess, being fretful, distressed
• being irritable; having more tantrums
• withdrawing, being quiet, showing a lack of
response
• changes in eating, difficulty in sleeping
• toileting problems, bed wetting, regression
• explain that death is a part
of life, so they come to
understand it bit by bit.
• Give examples of plants
grow, bloom and die or
seasons change
25. Schoolage
Reaction Management
• Children understand that all body
functions stop with death. They begin
to internalize the universality and
permanence of death.
• The greatest death anxiety is in this
age group. They may be very curious
about the details of death, but begin
to hide feelings or engage in magical
thinking where they believe they are
powerful enough to cause someone’s
death by their thoughts.
• There may also be fear that death is a
punishment for bad thoughts or
actions.
• Offer constructive ways for them to
release the great energy of grief, such
as running, other sports activities, or
hitting a tennis racket on a mattress.
• Encourage a support group or writing.
• Provide reassurance and honesty.
26. Adolescents
Reaction Management
• being easily distracted, forgetful, having difficulty
concentrating at school
• overwhelmed by intense reactions, such as anger, guilt,
fear, having difficulty expressing intensity of emotions, or
conflict of emotions, blaming themselves for the death
• anxiety – increased fears about others' safety, and their
own
• having questions or concerns about death, dying,
mortality; dreams about, or sensing the presence of, the
person who has died
• wanting to be near family or friends more
• physical complaints- headaches
• being irritable, defiant, antisocial or display aggressive,
risk-taking behaviour- drinking, drugs, sex, reckless driving
• changes in eating, sleeping habits, bedwetting
• masking feelings, a sense of loneliness – isolation, a
change in self-image, lower self-esteem, possibly suicidal
thoughts, possibly moving from sadness into depression
• be honest and let them know what's
happening
• be willing to listen, and available to
talk about whatever they need to talk
about
• acknowledge the emotions they may
be feeling—fear, sadness, anger
• it can be helpful for parents, or other
adults, to share their own feelings
regarding the loss
• let them help in planning the funeral
or something to remember the loss
27. 5. Role of a child health nurse
Maintaining therapeutic and trusting relationship with the client and their family
Family advocacy and caring
Disease prevention and health promotion
Health teaching
Counseling and supporting
Restoration of health by caregiving activities
Coordination and collaboration with other professionals
Ethical decision making
Participating in Research and innovations
28. 6. Principles of pre- and post-operative care
for children
Preoperative management
• Elicit history, review previous medical records, interview the parent and child. Perform
focused preoperative assessment, do physical examination.
• Psychological preparation: pre-admission educational programmes reduce the stress of
admission for parents and children. Educate the caregiver about the surgery, encourage
questioning. Give age appropriate explanation to the child about surgery Toys and a
relaxed atmosphere are essential. Avoid separating the child from the parent.
• Recognize the need for blood transfusion.
29. Preoperative management
• Fasting guidelines: clear written instructions about the period of preoperative
fasting should be issued and the importance of compliance stressed (prevents
aspiration).
• Ensure that all the investigations are done and reports attached in the file.
• Ensure anaesthetic check up is done
• Premedication: administer anxiolytics like midazolam for the particularly anxious
child, anticholinergics and antibiotics. Topical local anaesthetic creams such as
Emla or Ametop are routinely used to enable virtually painless cannulation.
30. Postoperative management
• Ensure airway is patent. Perform oral, ET or tracheostomy suctioning as required.
• Change position 2 hourly.
• Administer oxygen. Monitor spO2 , ABG values.
• Maintain fluid and electrolyte balance, administer IV fluids at correct drop rate, maintain
intake output chart. Monitor serum electrolyte values. Notify physician if abnormal.
• Take care of drains (chest, abdominal), follow asepsis, monitor for signs of infection
• Follow standard precautions while performing any procedure to avoid infections
• Monitor and record vitals.
31. Postoperative management
• Keep the child NPO until advised which depends on the type of surgery done.
• Minimize pain by administering analgesics.
• Incorporate play while dealing with child.
• Monitor for complications- nausea, vomiting, bleeding, delayed micturition,
unsteady gait etc.
• Give postoperative health education to the caregivers related to the surgery eg
breathing exercises, advise about ambulation, colostomy care etc.
• Advise for follow up at regular intervals.
32. 7. Pain assessment in children
Self report measures Behavioural Indicators Physiologic Indicators
• valid,
• require a certain
level of
cognitive and
language
development for
the child to
understand and
give reliable
responses
• eg- NRS,
faces pain scale
• more frequently used with
neonates, infants, and younger
children where communication is
difficult
• Short attention span, irritability
• Facial expressions - grimacing, biting
or pursing lips
• Posturing (guarding a painful joint by
avoiding movement), remaining
immobile, or protecting the painful
area; Drawing up knees, massaging
affected area
• Lethargy, remaining quiet or
withdrawal , Sleep disturbances
• tachycardia
• tachypnea
• hypertension
• pupil dilation
• pallor
• increased perspiration
• increased secretion of
catecholamines and
adrenocorticoid
hormones.
34. The
Neonatal/Infant
Pain Scale (NIPS)
• Recommended for
children less than 1 year
old.
• Total pain scores range
from 0-7.
• A score greater than 3
indicates pain.
VARIABLE FINDINGS POINTS
1 Facial Expression
Relaxed muscles Restful face, neutral expression 0
Grimace Tight facial muscles; furrowed brow, chin, jaw,
(negative facial expression-nose, mouth and brow)
1
2 Cry
No cry Quiet, not crying 0
Whimper Mild moaning, intermittent 1
Vigorous Cry Loud scream; rising, shrill, continuous (Note: Silent
cry may be scored if baby is intubated as evidenced by
obvious mouth and facial movement)
2
3 Breathing Pattern
Relaxed Usual pattern for this infant 0
Change in
Breathing
In-drawing, irregular, faster than usual; gagging; breath
holding
1
4 Arms
Relaxed/Restraine
d
No muscular rigidity; occasional random movements
of arms
0
Flexed/Extended Tense, straight arms, rigid and/or rapid extension,
flexion
1
5 Legs
Relaxed/Restraine
d
No muscular rigidity; occasional random leg
movement
0
Flexed/Extended Tense, straight legs; rigid and/or rapid extension,
flexion
1
6 State of Arousal
Sleeping/Awake Quiet, peaceful sleeping or alert random leg movement 0
Fussy Alert, restless, and thrashing 1
35. Interpretation of NIPS
SCORES PAIN LEVEL INTERVENTION
0-2 Mild to no pain None
3-4 Mild to
moderate pain
Non-pharmacological intervention
with a reassessment in 30 minutes
>4 Severe pain Non-pharmacological intervention
and possibly a pharmacological
intervention with reassessment in 30
minutes
37. Interpretation of FLACC-R
SCORES PAIN LEVEL
0 Relaxed and comfortable
1-3 Mild discomfort
4-6 Moderate pain
7-10 Severe pain or discomfort or both
38. Pain management in children
• Non Pharmacological and Pharmacological methods
• Non Pharmacological methods
distraction to shift attention away from pain- visual aids like pictures, cartoons,
mobile phones, mirrors, playing with electronic devices, watching videos; auditory
aids like music, singing, talking, or reading a book; providing toys with lots of
colour or toys that light up
reducing noise and lighting, use of soothing smells and clustering procedures to
avoid over handling
non-nutritive sucking, skin to skin contact
rocking and holding the infant, swaddling the infant
breathing exercises like blowing bubbles
age appropriate explanation to school age and adolescents
39. Pharmacological methods to manage pain
Non-opioid analgesic Opioid analgesics
1. Nonsteroidal anti-inflammatory drugs- anti-
inflammatory, analgesic, antipyretic, and
antiplatelet properties. First line
pharmacologic therapy for pain management.
acetic acids (ketorolac),
proprionic acids (ibuprofen, naproxen)
cyclooxygenase-2 selective (celecoxib)
Ketorolac- IV or intranasal
2. Acetaminophen (paracetamol) – PO,
rectally, IV; for mild to moderate pain and
antipyretic
for acute moderate to severe pain
refractory to other therapies.
Examples:
• Codeine
• Tramadol
• Hydrocodone
• Morphine
• Hydromorphone
• Fentanyl
• Methadone
40. Summary
• Children have specific needs according to their age
• It is important to understand their development pattern to give
adequate care and for early identification of problems.
• Parents need to be involved in child care
• Different age groups of children express loss, death, grief and pain
differently. Their reactions to hospitalization are different.
• For a hospitalized child with surgical condition, some common
principles need to be followed.
• Pain in children can be measured.
Separation anxiety- It is most evident from middle infancy throughout the preschool years, especially for children ages 16 to 30 months.
2. Loss of control- Children perceive loss of control, in terms of physical restriction, altered routine and dependency