Selected Caring Interventions

1
Selected Caring Interventions

• Restraining Methods (1040,1144-1146) Specimen
  Collection Med Administration (1185-1197)

2
Restraint Guidelines

• Make sure restraining is the last resort
• Use least restrictive method for the least amount
  of time
• The parent can minimize the chances of having to
  restrain a child (therapeutic hugging)
• Child in restraint must be checked at least as
  often as protocol requires. Must have documented
  reason and initial and ongoing assessments.

3
Safety Checks

• Make sure it fits properly
• Secure to frame not rails
• Check NV and skin status 15 minutes after
  application and q1h afterwards
• Release q2h for a short, supervised time
• Reassure and restate reasons for restraint

4
Nonbehavioral Restraints

• Needed to ensure safe carebenefit outweighs
  risk. Specifically used in cases of
• Risk of harm from dislodging tubes, wires,
  sutures, airways, oxygen
• Patient confusion, agitation, unconsciousness
• Developmental inability to understand instructions

5
Behavioral Restraint

• Used in situations when there is significant
  risk of patient harming self or others and where
  nonphysical methods have not worked.
• Order must be obtained within the hour
• Child must be continuously observed and
  reassessed every 15 minutes
• If need for restraint lasts less than 30 minutes,
  therapeutic holding is best

6
Types of Restraints

• Jacketfor chairs or to keep patient flat
• Mummyblanket or papoose
• Limbarm, leg, elbow
• Sheets and pillowcases
• Plastic top for crib

7
Therapeutic Holding

• Temporary, secure, comfortable holding position
• Allows close contact with parentin some cases
  parents assist with holding
• Can be used with many types of procedures that
  typically take less than 30 such as IV starts,
  venipunctures, tube insertion, lumbar punctures.
• With some procedures, local anesthesia or oral
  sedatives can also be used.

8
Obtaining Urine Specimens

• For regular UAcollection bag for infants, cup or
  hat for children. Gain cooperation by challenging
  child to show you color of their urine.
• Clean-catch usually reserved for children who can
  follow directions and are potty-trained
• Sterile specimens should be obtained by
  catheterization (may use feeding tube) or bladder
  needle aspiration (MD)
• 24 hour collectionbags, indwelling caths, or a
  child who can be depended on

9
Obtaining Stool Specimens

• Collected for culture, O P, rotovirus, C-diff,
  blood, fat, etc.
• With infants, apply urine bag to prevent
  contamination of stool with urine
• For children, use bedpan or hat. If child also
  needs to void, have child do this first if
  possible to prevent contamination.

10
Obtaining Blood Specimens

• May be taken from finger, heel, arm
• Usually requires therapeutic holding
• With venipunctures, make sure elbow is restrained
• For fingersticks, give child choice of finger
• Allow closeness of parent and sucking sweet
  pacifier for infants who need heelsticks. Warm
  heel x 3 use sides of heel, not middle
• Make sure bandage is applied
• Have 2 try policy with most experienced first

11
Obtaining Respiratory Specimens

• Includes sputum (TB, RSV), throat (strep),
  nasopharyngeal (pertussis), and nasal (RSV)
• Almost always requires therapeutic holding hands
  over head method is very effective
• Usually need to gag child to get good throat
  culture
• Sputum can be obtained by coughing, gastric
  washing, or tracheal suction
• Different collection devices for different sites

12
Medication Administration

• Know action, SEs, and safe dosage ranges
• Be aware of childs immature liver and kidneys
  and less circulating plasma protein that can
  increase chances of toxicity.
• Most dosages are calculated by mg/kg (most
  common) or BSA (most accurate)
• Always check with HCP if dosage is out of range
• Be aware of institutional policies re
  double-checking of dosages
• Make sure to use 2 methods of ID

13
Oral Administration

• Preferred because less invasive however, is less
  predictable than injectable routes
• Usually use liquid forms rather than solids to
  reduce aspiration risk. If liquid not available,
  then crush med unless it is time-released or
  coated
• Syringe is most reliable way to give med may use
  nipple for infant

14
Oral contd

• Do not put in formula or in essential food
• If child is uncooperative, try to find out reason
  and explain to child if developmentally
  appropriate. Sometimes parent may give med.
• If holding is required, avoid putting child
  supine

15
IM Administration

• Use TB syringe for volumes less than 1 mL
• Use 25 to 30g if needle is no longer than 1.
• If longer, use 22-25g to enhance stability.
• May need 20-22g if med is viscous.
• Lengths range from ½ to 1 ½ inches depending on
  size and age. (Table 35.2, p. 1194)
• Always change needle prior to injection.
• Never give injection to sleeping child.

16
IM contd

• Acceptable amounts for injection depend on size
  of child, but vary between 0.5 and 2 mL.
• Holding will be needed to prevent injury so plan
  appropriatelyparent may or may not want to help
• Bunch up or spread, depending on size of child
• Use 90 degree angle to minimize trauma and pain
• Aspiration is no longer recommended, but there is
  no harm in doing it.

17
IM Sites

• Vastus lateralis is preferred site for infants
• Ventrogluteal is acceptable for all ages
• Deltoid can be used beginning at age 3 yrs
• Dorsogluteal is not recommended
• Make sure you know how to measure to locate sites
  (1193)
• What do you do if child wants to see needle?

18
Subq and Intradermal

• Technique and sites are same as adults
• Use 23-25g 3/8-5/8 inch for subq
• Use 25-28g 3/8 to ½ inch for intradermal
• Inject small volumes up to 0.5 mL
• 45 or 90 degree angle for subq
• 10-15 degree angle for intradermal
• No need to aspirate

19
IV Administration

• Be sure you know compatibility, dilution, and
  rate (CDR) of med to be given
• IV rates are slower than adultsusually between
  10 and 50 mL/h
• Double check IV drugs with another nurse
• Always use a pumpits usually a policy
• Some agencies use volume control device, a.k.a
  Buretrol (1200)

20
IV Administration contd

• Angiocath size is usually 22 or 24g
• Hand, foot, and scalp and common sites
• IV starter should be experienced! Some places
  have a policy about of sticks
• Use an illuminator if needed to locate veins
• For emergencies with vascular collapse,
  intraosseous route may be used in children under
  6 years

21
Other RoutesRectal, Optic, Otic, Nasal

• Biggest problem is gaining cooperation
• Rectaluse little finger hold cheeks together
• Opticsame as adults if clenching lids, put drop
  in inner corner
• Oticwarm drops pull pinna down and back in
  children lt 3 yrs up and back gt 3 yrs.
• Nasalif drops, hyperextend neck off of bed with
  spray, angle away from septum