Peds

1. CHAPTER 31
BASIC PEDIATRIC NURSING CARE

2. HISTORY OF CHILD CARE—THEN
AND NOW
• Colonial America
• The value of children was related to the work they could
perform
• Many uncontrollable diseases, high mortality rates
• Industrialization in America
• Population shifted from rural to urban settings
• People lived in overcrowded and unsanitary conditions
• Children were looked at as little adults and worked in
factories 12-14 hours a day
• They had no legal rights and there were no labor laws
2

3. HISTORY OF CHILD CARE—THEN
AND NOW CONT’D
• 1860: Dr. Abraham Jacobi, a New York physician
referred to as the “father of pediatrics,” first
lectured to medical students on the special
diseases and health problems of children
• At “milk stations,” infants were weighed and
mothers were taught how to prepare milk before
giving it to their babies, *50% of children died
before 21
• Lillian Wald: founder of public health or
community nursing, created the Henry Street
Settlement (nursing services, social work,
cultural and educational activities)
• Early 1900s children with contagious diseases
were isolated from parents
3

4. HISTORY OF CHILD CARE—THEN
AND NOW CONT’D
• 1909: White House Conference on Children focused on
issues of child labor, dependent children, and infant care
• 1929: Great Depression 
• 1987: National Commission on Children formed; served
as a forum on behalf of the children of the nation, found
that US was failing by income insecurity, inadequate
immunizations, lack of support/protection for children
and families
• Children are the focus of many reform initiatives in the
twenty-first century! (Pg. 934)
4

5. PEDIATRIC NURSING
• Must enjoy working with children of
all ages
• Family-centered nursing in its truest
sense
• Must have keen observation skills
• Support children through difficult
procedures or illnesses
• Requires establishing a level of trust
• Must convey respect, talk at their
level, and be honest
• Must be a good role model! 
5

6. PADDLE QUESTION #1
The nursing student is reviewing what he/she
knows about the development of pediatrics as a
discipline. The nursing student recognizes which
of the following individuals as being the “father of
pediatrics”?
1. Hippocrates
2. Abraham Jacobi
3. James Mott
4. R.E. Behrman
6

7. PADDLE QUESTION #2
Lillian Wald, founder of the Henry Street
Settlement in New York City, focused on
which of the following? (select all that
apply)
1. Nursing Services
2. Social Work
3. Recreational Sports
4. Educational Activities
7

8. PADDLE QUESTION #3
The first White House Conference on Children
focused on issues of child labor, dependent
children, and infant care. As a result, what was
established in 1987 on behalf of children?
1. US Children’s Bureau
2. Office of Child Development
3. National Commission on Children
4. Women, Infants, and Children program
8

9. FAMILY-CENTERED CARE
• A philosophy of care that
recognizes the family as the
constant in the child’s life and
holds that systems and
personnel must support,
respect, encourage, and
enhance the strengths and
competence of the family
• Parents know their child better
than anyone else
9
child
family
disease

10. PEDIATRIC NURSING CONT’D
• Children with special needs refers to
infants and children may have congenital
abnormalities, malignancies,
gastrointestinal disease, or central nervous
system anomalies
• With appropriate services and support,
even children with very severe disabilities
are living at home with their families and
attending school with their peers
10

11. PEDIATRIC NURSING CONT’D
• Partnerships with parents
• Concept of partnerships with parents
• Parental involvement in their children’s care
has evolved from that of relinquishing their
role to institutions to today’s role of planners,
in addition to recipients, of services
• Treated as equals in deciding what is
important for themselves and their family
• Parents of special needs children often
become experts on their child’s condition
11

12. PEDIATRIC NURSING CONT’D
• Future challenges for the pediatric nurse
• Shift from treatment of disease to promotion of health is
likely to further expand nurses’ roles in ambulatory care, with
prevention and health teaching receiving a major emphasis
• Technologic advances will influence the pediatric nurse to
increase technical skills related to patient care
• Need to keep abreast of developments in adolescent medicine
and continually adapt their care to the cultural environment in
which they practice
12

13. NURSING IMPLICATIONS OF
GROWTH AND DEVELOPMENT
• Identifying an infant or child who is demonstrating cognitive
impairment
• Use a developmental rather than a chronologic approach to
pediatric nursing care
• Focus on what a child can do versus what a child cannot do
• Select age-appropriate toys for the infant or young toddler and
devise activities that appeal to the school-age child or adolescent
• Knowledge of growth and development is the basis for
anticipatory guidance with parents (pg 938)
13

14. PADDLE QUESTION #4
A 4-year old child is to be hospitalized for the first
time, and the parents voice anxiety about his
condition and hospitalization. Which action by the
nurse best addresses the concerns of the child’s
parents?
1. Provide only necessary information.
2. Provide an orientation to the child before
hospitalization.
3. Provide a tour of the entire hospital.
4. Provide anticipatory guidance and explain all
procedures.
14

15. REVIEW
1. Re-read pages 933-939
2. Review your notes
3. Finish homework
4. Read supplemental readings
5. Skim ahead
15

16. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT
• Growth measurements are a key element in evaluation
of the health status of children
• Plotted by percentiles on growth carts and
compared with those of the general pediatric
population to determine deviation from the norm
• How does the utilization of a growth chart assist the
nurse in his or her assessment of growth and
development?
16

17. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Growth measurements
• Length
• Measurements are taken when children are supine;
recumbent length (crown to heel) is usually measured until
2 years of age
• Height
• Measurement is of a child standing upright
• Head Circumference
• Measured in children up to 36 months, head circumference
is measured above the eyebrows and pinna of ears and
around the occipital prominence at the back of the skull.
17

18. 1
8
Measurement of head, chest, and abdominal circumference
and
crown-to-heel measurement.

19. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Growth measurements
• Weight
• Fluid loss and inadequate calories are reflected in a
child’s weight
• The child should be weighed at the same time every
day on the same scale
• Skin thickness
• Skinfold thickness should be determined at one site
with at least two measurements
• Arm circumference measures muscle mass
19

20. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Vital signs
• Temperature
• Reflects metabolism
• Fairly stable from infancy through adulthood
• Measure body temperature to detect abnormally high or
low values
• Routes: oral and axillary are used commonly in clinical
settings. Other sites used are tympanic membrane and
temporal artery. NOTE: rectal temperature is rarely used
today due to safety concerns and more reliable methods
• Normal findings approximately 97° F to 99° F
20

21. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Vital signs
• Heart rate/pulse
• Great variations exist
• Infection and physical activity increase heart rate; note
irregularities in volume, rate, and rhythm
• Apical (5th intercostal space, L midclavicular line) pulse
is taken on infants and young children; a radial pulse on
children 5 years of age and older
• Pulse rate should be counted for 1 full minute
• Apical beat of a newborn may be 152 bpm and
gradually slows to 72-75 bpm by adolescence
21

22. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Respirations
• Infants’ respirations are mainly diaphragmatic;
observe abdominal movement for1 full minute
• In older children, respirations are chiefly thoracic
• Respiratory rate slows as a child progresses from
infancy to adolescence
• Newborns are obligate nasal breathers
• Rate, depth, and quality should be assessed
• Rate may be as rapid as 40-50 breaths per minute,
gradually slowing to 25-32 per minute
https://www.youtube.com/watch?v=uxghTmNb0pU
22

23. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Blood pressure
• Blood pressure should be measured in children
3 years of age and older
• Blood pressure is low in a newborn and
gradually rises; at the end of adolescence, it is
about 120/78 mm Hg
• It is important to use the correct-sized cuff to
ensure accuracy -- 2/3 upper arm or leg
• Measure blood pressure before any anxiety-
producing procedures, “arm hug”, “I want to
feel your muscles”
23

24. PADDLE QUESTION #1
An accurate apical heart rate
measurement is assessed at the _______
intercostal space.
24

25. ANSWER
5th!
The apical heart rate is assessed at the 5th
intercostal space on L side of chest
(midclavicular line)
25

26. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Skin
• Genetic and physiologic factors affect assessment of
color
• Pallor may be a sign of anemia, chronic disease, edema,
or shock
• Erythema may be the result of increased temperature,
local inflammation, or infection
• Skin texture should be smooth, soft, and slightly dry to
the touch
26

27. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Accessory structures
• Hair
• Should be lustrous, silky, elastic
• Nails
• Should be pink, convex, smooth, and hard but flexible
• Handprints and footprints
• Palm normally shows three flexion creases
27

28. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Eyes
• At birth, visual acuity is 20/400; when holding a
baby, assume an en face position (8 inches
face to face)
• By the second week of life, tear glands begin to
function
• Newborns can follow bright, colorful objects by
the second or third week of life
• Vision improves to 20/30 by age 2-3 years
• Accommodation and refraction are present by
school age
https://kitsapkidsdentistry.com/blog/breastfeeding-a-baby-with-tongue-
tie-or-lip-tie/
28

29. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Ears
• Inspect for general hygiene
• Pull ear down and back to examine
• Advise parents and children to clean the ears with
a washcloth; wipe only the outer portion of the
canal with a swab
• Mineral oil may be used to soften cerumen
• Never use a q-tip (lego or tortilla chip)
29

30. PADDLE QUESTION #2
What is the appropriate method to
examine a 6-month old’s ear with an
otoscope?
1. Pull the ear up and back.
2. Pull the ear down and forward.
3. Pull the ear up and forward.
4. Pull the ear down and back.
30

31. PADDLE QUESTION #3
A 7 year old is about to have a finger-stick blood
draw. Which statement by the nurse is most effective?
1. "It will hurt a lot, but you're a big girl so you can grin
and bear it."
2. "it will hurt a lot, and you can cry if you want to."
3. Some children say they feel a little pinch."
4. "Close your eyes, and don't look; it will be over in a
minute."
31

32. PADDLE QUESTION #4
A nurse is meeting a new 4 year old patient for the first
time. Which intervention is most effective when entering the
patient's room for the first time?
1. Speak only to the parents because the child will be very
scared.
2. Explain all procedures in detail because the child will want
to know what's going on.
3. Be careful not to use words that may be misinterpreted by
the child, such as "take your temperature"
4. Tell the parents they must leave the room until the
physical assessment is complete.
32
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33. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Nose, mouth, and throat
• Nose should lie from the center point between the
eyes to the notch of the upper lip
• Normally there is no discharge from the nose
• Inspect the lining of the mouth and the number of
teeth
• Primary (deciduous) teeth the set of 20 normally
appear during infancy, begins at 6-9 months.
33

34. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Lungs
• Make sure the child is not crying
• Have them “blow out” an otoscope light
• Listen systematically
• Chest
• Chest is almost circular
• As the child grows, the chest normally increases in a
transverse direction
• Asymmetry may indicate serious underlying
problems
34
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35. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Back (pg 946)
• Newborn is C-shaped
• Older child typically has S-shaped curve
• Marked curvature in posture is abnormal
• Abdomen
• Inspection: cylindrical and flat
• Auscultation: listen for peristalsis (all 4 quadrants)
try for at least 3 min
35

36. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Extremities
• Examine for symmetry, range of motion, and signs of
malformation
• Fingers and toes should be counted
• Toddlers are usually bowlegged
• Observe for arch development and correct gait
• School-aged walking posture is more graceful and balanced
• During puberty, adolescents may experience awkward posture
from rapid growth of extremities
36

37. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Renal function
• There is a functional deficiency in the kidney’s
ability to concentrate urine and to cope with
conditions of fluid and electrolyte fluctuation,
such as dehydration or fluid overload
• Urine output varies and depends on the size of
the infant or child
• Urine is colorless and odorless
37

38. PHYSICAL ASSESSMENT OF THE
PEDIATRIC PATIENT CONT’D
• Head-to-toe assessment
• Anus
• Check the anal sphincter
• History of bowel movements should be noted
• Assess for perianal itching; may be pinworms
• Genitalia
• Excellent time to elicit questions concerning body
functions or sexual activity
38

39. FACTORS INFLUENCING GROWTH
AND DEVELOPMENT
• Nutrition
• Nutrition is probably the single most important influence on
growth.
• A child’s appetite fluctuates in response to growth spurts.
• Infants begin life outside the womb nursing at the breast or
ingesting formula or breast milk via bottle or tube.
• Most infants are given solid foods at 4 to 6 months of age, when
they begin to need more iron in the diet and their teeth begin to
erupt.
3
9

40. FACTORS INFLUENCING
GROWTH
AND DEVELOPMENT
• Metabolism
• Metabolic needs vary among individuals.
• Rate of metabolism is highest in the newborn infant because the
ratio of total body surface to body weight is much greater than it
is in the adult.
• The body uses energy provided by foods.
• Because metabolism is so high in infants and children, their ability
to recover from surgery or a fractured bone is swift compared
with that of an adult.
4
0

41. FACTORS INFLUENCING GROWTH
AND DEVELOPMENT
• Nutrition (continued)
• It is important for each new food to be introduced at weekly
intervals so that food allergies can be identified.
• By 9 months, several teeth have erupted, and junior foods, which
are a coarser texture, can be offered.
• By 12 to 15 months, toddlers should be eating table food
prepared for the family.
• As the child moves through toddler and preschool stages, fads
with strong preferences develop; encourage a balanced diet.
4
1

42. FACTORS INFLUENCING GROWTH
AND DEVELOPMENT
• Sleep and Rest
• Children spend less total time sleeping as they mature.
• Most babies are sleeping through the night by the latter part of
their first year and take one or two naps a day; the 3-year-old has
usually given up daytime naps.
• The best way to prevent sleep problems with the infant/child is to
establish bedtime rituals that do not foster problematic patterns.
• Ex: no milk or juice in bed vs. dinner, bath time, book, bedtime
(children love routine)
4
2

43. FACTORS INFLUENCING
GROWTH
AND DEVELOPMENT
• Speech and Communication
• Crying at birth is the earliest evidence of speech, followed by
other sounds like cooing, laughing, or babbling.
• By 9 months, infants practice and painstakingly repeat the noises
they can make.
• A 1-year-old has a three- to four-word vocabulary;
by 18 months, they usually know 25 to 50 words; by
2 years, they may know more than 250 words.
• The nurse should know what typifies speech at certain stages of
childhood.
4
3

44. FACTORS INFLUENCING GROWTH
AND DEVELOPMENT
• Nonverbal Communication
• Young children become very adept at understanding nonverbal
communication.
• They sense anxiety or fear by the rise in pitch of the parent’s
voice.
• Nonverbal symbols include nodding of the head; using direct eye
contact; tapping finger or foot; avoiding eye contact; and sign
language.
4
4

45. CHILD MALTREATMENT
• Child neglect
• Physical
• Emotional
• Child abuse
• Physical
• Emotional
• Sexual
45

46. CHILD MALTREATMENT
CONT’D
• Etiology
• Parental factors
• Child’s factors
• Situational factors
• Clinical manifestations – See Table 31.6
• Nursing interventions – pages 950-952
*Padlet questions
46

47. REVIEW
1. Re-read pages 939-952
2. Review your notes
3. Finish homework
4. Read supplemental readings
5. Skim ahead
47

48. HOSPITALIZATION OF A CHILD
• Hospitalization is often anxiety inducing for children
and their families. Interrupts child's normal
development.
• Preadmission programs – orientation, child life
specialist, prepare toddler days in advance, school
aged understands time ex, "2 weeks" and
adolescents, as far in advance as possible.
• Admission – triage, assessment, obtaining height
+ weight, important for med dose calc
• Hospital policies – family centered
• Developmental support for the child – children might
regress
• Pain management – Wong-Baker FACES, pg. 956, tx
pain with medication if ordered, no indication that
children are at risk of addiction, meds need to be
calculated carefully
• Surgery – age influences fears and concerns
• Parent participation – possibly very anxious, pg. 958
48

49. COMMON PEDIATRIC PROCEDURES
• Bathing
• Feeding
• Safety reminder devices
• Urine collection
• Venipunctures to obtain blood specimens
• Lumbar puncture
• Oxygen therapy
• Suctioning
• Intake and output
49

50. COMMON PEDIATRIC PROCEDURES
• Bathing
• Usually the best time to bathe an infant is before feeding to avoid
stimulating regurgitation or vomiting
• This provides an opportunity for skin assessment
• Check temperature of water
• If umbilical cord is still present, give sponge bath and clean around
cord with alcohol
• Be careful to remove soap, rinse, and dry creases
• Use dry hands to pick up the infant
• The child should never be left in a tub without supervision
• Parents might be nervous about anterior fontanelle, tell them to
wash/shampoo anyway.
• https://www.youtube.com/watch?v=P0eg44MJ-qg
50

51. COMMON PEDIATRIC
PROCEDURES CONT’D
• Breastfeeding
• The mother may wish to continue breastfeeding her
baby who is ill or hospitalized.
• Provide a quiet environment and a comfortable chair
for nursing.
• If the mother is unable to be present for every
feeding, encourage her to use a breast pump; bottles
of breast milk can be frozen and given later by bottle
or tube feeding.
5
1

52. COMMON PEDIATRIC PROCEDURES
CONT’D
• Feedings (continued)
• Formula
• Positioning should be comfortable for the adult
and the infant; infant should be held securely.
• If a burp is not elicited in one position, try
another. (sitting up on lap, across lap, on shoulder)
• After feeding, the infant is positioned on the right
side
5
2

53. COMMON PEDIATRIC
PROCEDURES CONT’D
• Feedings (continued)
• Solids
• Infant should be fed in an infant seat.
• Older infants can be placed in a high chair with a safety
strap.
• Toddlers may resist high chairs; nurse may need to try an
alternative to prevent injury.
• Parents should provide three regular meals and planned
snacks each day so that the child eats about every 2 to 3
hours.
• Children should sit down to eat; choking is more likely if
children eat on the run.
5
3

54. PADDLE QUESTION #1
What is the most accurate method to measure urine
output in an infant?
1. Weigh the diaper before and after the infant voids.
2. Weigh the infant after each wet diaper.
3. Have parents try to catch urine in a plastic cup.
4. Insert a foley catheter for all infants who are not potty
trained.
54

55. COMMON PEDIATRIC
PROCEDURES CONT’D
• Feedings (continued)
• Gavage
• Some infants and children require the passing of a feeding
tube through the nose or mouth, down the esophagus, and
into the stomach.
• To measure for placement: measure from the nose to the
bottom of the earlobe and then to the end of the xiphoid
process or the umbilicus.
• Check placement: aspirate stomach contents, inject small
amount of air and listen with stethoscope on stomach.
• Restraint may be needed to pass the tube.
• Because infants are nose breathers, the mouth is preferred.
5
5

56. COMMON PEDIATRIC
PROCEDURES CONT’D
• Feedings (continued)
• Gavage
• Older children can be asked to swallow as the tube is
placed.
• Once the tube is in place, secure with tape.
• Before feeding, check placement.
• Infants are given a pacifier to associate sucking with
satisfying hunger.
• Allow to flow into the stomach via gravity.
• At the completion of feeding, flush the tube with sterile
water.
• https://www.youtube.com/watch?v=k8aH0TyJYhc 6:50, 14:03
5
6

57. COMMON PEDIATRIC PROCEDURES
CONT’D
• Feedings (continued)
• Gastrostomy
• This is often used in children when passing
a gastric tube is contraindicated or in
children who require tube feeding over an
extended period.
• A tube is inserted into the abdominal wall
and into the stomach and secured with a
purse-string suture.
• Feedings are carried out in the same
manner and rate as in gavage feeding.
• After feedings, the child is placed on the
right side or in Fowler’s position.
• https://www.youtube.com/watch?v=OVIxa6
ku4TM
5
7

58. COMMON PEDIATRIC PROCEDURES
CONT’D
• Feedings (continued)
• Total parenteral nutrition
• A highly concentrated solution of protein, glucose, and other
nutrients is infused intravenously through conventional tubing
with a special filter attached to remove particulate matter and
microorganisms.
• Wide-diameter vessels, such as the subclavian vein, are the
usual sites of infusion.
• Nursing responsibilities include control of sepsis, monitoring
infusion rate, and continuous observation.
5
8

59. COMMON PEDIATRIC
PROCEDURES CONT’D
• Safety Reminder Devices
• At times, for safety, children should be restrained after surgery or
during a procedure or examination.
• This is used only as a last resort.
• The device should be applied correctly, and circulation and skin
integrity must be monitored closely.
• The device should be removed every 2 hours so that the body area
can be exercised.
• Release extremities one at a time so that the child cannot pull out an
IV or NG tube.
5
9

60. COMMON PEDIATRIC PROCEDURES
CONT’D
• Safety reminder devices pg 961
• Types
• Elbow safety
reminder, https://www.youtube.com/watch?v=gaiXDgdin_M
• Mummy safety
reminder, https://www.youtube.com/watch?v=Pj1rhcqQz3Q
• Clove-Hitch safety reminder
• Jacket safety reminder
• Import to remove SRDs every 2 hours to allow for exercise of
body area
60

61. MUMMY RESTRAINT.
6
1

62. PADDLE QUESTION #2
A 16 month old child is admitted to the pediatric floor
after surgery to repair a cleft palate. The child's mother
asks why her child is restrained. The nurse explained that
the elbow SRD is being used to:
1. monitor pressure to the suture line.
2. prevent excessive movement in bed.
3. help to prevent injury to the operative site.
4. reduce the likelihood your baby will fall out of the
bed.
62

63. PADDLE QUESTION #3
An 18 month old is hospitalized for surgery in the
morning. Which intervention is most helpful in relieving
the child's stress?
1. maintaining a normal routine.
2. Providing opportunities for play.
3. encouraging parental presence and rooming-in.
4. Encouraging self-care activities.
63

64. PADDLE QUESTION #4
The most common asymmetry with lateral
curvature of the spine in the adolescent is
known as _____.
64

65. ANSWER
Scoliosis
65

66. REVIEW
1. Re-read pages 952-962
2. Review your notes
3. Finish homework
4. Read supplemental readings
5. Skim ahead
66

67. COMMON PEDIATRIC PROCEDURES
CONT’D
• Urine collection
• Collecting specimen can be a major problem when the child is
not toilet-trained
• Methods of collection
• Suprapubic bladder tap (by qualified health care provider)
• Plastic urine collection bags
• Catheterizations – (used as little as possible)
67

68. SUPRAPUBIC BLADDER
ASPIRATION
6
8

69. COMMON PEDIATRIC
PROCEDURES CONT’D
• Venipunctures to obtain blood specimens
• In infants and young children, a jugular or femoral vein may be used to obtain a
blood specimen
• The nurse’s responsibility is to prepare, position, and restrain the child
• Holding the head or lower extremities absolutely immobile is critical
• Pressure should be applied to the site to prevent the formation of a hematoma
• Sometimes the veins of the extremities, especially the arm and the hand, are
used
69

70. POSITION FOR FEMORAL VENIPUNCTURE
PROCEDURE.
7
0

71. COMMON PEDIATRIC
PROCEDURES CONT’D
• Lumbar puncture
• Explain the procedure and answer any questions
• EMLA, a local anesthetic cream, may be applied to the
lumbar area
• Position the child at the edge of the exam bed, on the
side, facing nurse with neck and legs gently flexed
• Observe for any signs of difficulty
• A toddler may need to have the legs wrapped in a
blanket
• The child should be held securely until the spinal tap
is completed
71

72. A, MODIFIED SIDE-LYING POSITION FOR
LUMBAR PUNCTURE. B, OLDER CHILD IN
SIDE-LYING POSITION.
7
2

73. COMMON PEDIATRIC PROCEDURES
CONT’D
• Oxygen therapy
• Used to improve the child’s respiratory status by increasing the amount of
oxygen in the blood
• Infants and young children receiving oxygen are monitored on an oximeter
• Methods
• Hood and incubator
• Mist tents
• Nasal cannula
Table 31.9 review advantages vs. disadvantages
73

74. OXYGEN IS ADMINISTERED TO AN INFANT
BY MEANS OF A PLASTIC HOOD
(OXY-HOOD).
7
4

75. COMMON PEDIATRIC
PROCEDURES CONT’D
• Suctioning
• Used when secretions are audible in the airway or when signs of
airway obstruction or oxygen deficit are present
• Various devices are used to suction children such as a bulb
syringe or a straight suction catheter
• Depth: approximately 1/4 to 1/2 inch beyond tip of artificial
airway
• Timing: not more than 5 seconds
• Frequency: allow 30 seconds between attempts
75

76. COMMON PEDIATRIC
PROCEDURES CONT’D
• Intake and output
• Many health disorders require accurate monitoring of the amount
of solids and liquids taken in and the amount excreted
• All fluids given to a child are documented on a record kept at the
bedside
• All urine voided is measured before it is discarded; weigh diapers
if appropriate
76

77. COMMON PEDIATRIC
PROCEDURES CONT’D
• Medication administration
• The nurse must know how to compute the dose
correctly and administer it properly
• All computed dosages must be checked by a second
nurse for safety
• The right amount of the right medication must be
given to the right child at the right time and via the
right route right documentation -- six rights
• Observe and document a child’s response to the drug
• Calculating dosages for children consider age, body
weight, and body surface area
77

78. COMMON PEDIATRIC
PROCEDURES CONT’D
• Medication administration
• Routes of administration
• Oral
• Intradermal, subcutaneous, and intramuscular
• Intravenous
• Optic, otic, and nasal
• Rectal
78

79. PADDLE QUESTION #1
Which statement by the new pediatric nurse indicates an
understanding of medication administration to children?
(select all that apply)
• 1. Children and adults are susceptible to toxic
effects of medication at the same rate.
• 2. There are unit doses for children
• 3. BSA is a reliable method of calculating
a children's medication dose.
• 4. The route of choice is always the rectal route.
• 5. The six rights of medication must be
followed when administering medication.
79

80. ANSWER
• Which statement by the new pediatric nurse indicates
an understanding of medication administration to
children? (select all that apply)
• 1. Children and adults are susceptible to toxic effects
of medication at the same rate.
• 2. There are unit doses for children
• 3. BSA is a reliable method of calculating a
children's medication dose.
• 4. The route of choice is always the rectal route.
• 5. The six rights of medication must be followed
when administering medication.
80

81. INTRAMUSCULAR INJECTION
SITES
8
1

82. SAFETY
• Protecting a child from harm is a major issue in
pediatrics
• Anticipatory guidance for parents of infants and toddlers
and health teaching for school-age children and
adolescents are two methods of preventing accidents
• Injuries cause more deaths and disabilities in
children than do all causes of disease combined
• Parents and children should talk and listen to each other
to prevent many accidents
• The adult who is a role model can influence a child
immensely
• Table 31.12 pg. 971
82

83. PADDLE QUESTION #2
The mother of a 6 month old is worried because the
child's grandmother is concerned that the child is "slow"
because she is not yet crawling. What action by the
nurse is most appropriate?
1. Assure the parent that grandmothers are often overly
concerned when it comes to grandchildren.
2. Ask the mother at what age her other children began
to crawl.
3. Refer the mother for additional evaluation because
most children do crawl by 6 months of age.
4. Assure the mother that children develop at their own
rate, but most children do not crawl at age 6 months.
83

84. ANSWER
The mother of a 6 month old is worried because the
child's grandmother is concerned that the child is "slow"
because she is not yet crawling. What action by the nurse is
most appropriate?
1. Assure the parent that grandmothers are often
overly concerned when it comes to grandchildren.
2. Ask the mother at what age her other children began to
crawl.
3. Refer the mother for additional evaluation because
most children do crawl by 6 months of age.
4. Assure the mother that children develop at their own
rate, but most children do not crawl at age 6 months.
84

85. PADDLE QUESTION #3
The nurse is monitoring for signs of dehydration in a 1
year old child who has been hospitalized for diarrhea
and prepares to take the child's temperature. Which
method of temperature measurement needs to be
avoided?
1. Rectal
2. Axillary
3. Electronic
4. Tympanic
85

86. ANSWER
The nurse is monitoring for signs of dehydration in a 1
year old child who has been hospitalized for diarrhea and
prepares to take the child's temperature. Which method
of temperature measurement needs to be avoided?
1. Rectal
2. Axillary
3. Electronic
4. Tympanic
Rectal temperature measurements would be avoided if
diarrhea is present. The use of rectal thermometer can
stimulate peristalsis and cause more diarrhea.
86