Perry: Maternal Child Nursing Care, 7th Edition
Chapter 39: Pediatric Variations of Nursing Interventions
Key Points
 Informed consent is valid when the person is capable of giving consent (is
over the age of majority and is competent), is supplied with information
needed to make an intelligent decision, and acts voluntarily when exercising
freedom of choice.
 Informed consent is needed for major surgery, minor surgery, diagnostic
tests and medical treatments with an element of risk, photographs for
medical, educational, or public use, removal of the child from the health care
institution against medical advice, release of medical information, and some
cases of postmortem examination.
 Parents have full responsibility for the care and rearing of their minor
children, including legal control over them. As long as children are minors,
their parents or legal guardians are required to give informed consent before
medical treatment is rendered or any procedure is performed.
 An emancipated minor is one who is legally under the age of majority but is
recognized as having the legal capacity of an adult under circumstances
prescribed by state law, such as pregnancy, marriage, high school
graduation, independent living, or military service.
 The major factors in psychologic preparation of the child for surgery are to
establish trust and provide support, parental presence, and giving an
explanation in easy-to-understand terms.
 Preparation for procedures should consider the child’s developmental needs
and cognitive abilities, temperament, existing coping strategies, and previous
experiences.
 Most parents and children want to be together during stressful procedures
and should be offered this opportunity, with guidance on how the parent can
comfort the child.
 In the performance of a procedure, the nurse should expect success, involve
the child when possible in the procedure, provide distraction, and allow for
expression of feelings.
 In giving postprocedural support, the nurse should encourage children to
express their feelings and provide positive reinforcement for completion of
the procedure.
 The use of play activities to provide teaching about necessary nursing and
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medical interventions is an effective tool for use with children.
Stressful times before and after surgery that produce anxiety in children are
the admission process, blood tests, injection of preoperative medication (if
used), transportation to the operating room, the mask on the face during
induction, and the stay in the PACU. Assessment of compliance entails
measuring factors that affect compliance through clinical judgment, selfreporting, direct observation, monitoring appointments and therapeutic
response, pill counts, and chemical assay.
Compliance strategies may be classified as organizational, treatment, and
behavioral.
Skin care is essential to prevent skin breakdown.
Areas that require special attention during bathing in the hospital are the
ears, between skinfolds, the neck, the back, and the genital area.
Mouth care is an integral part of daily hygiene and should be continued in
the hospital.
Knowledge of the ill child’s eating habits and favorite foods can help in
maintaining adequate nutrition.
Control of fever may be accomplished by administration of antipyretics;
hyperthermia is controlled by environmental means (minimum clothing,
increased air circulation, cooling mattress, or cool compresses).
Ensuring safety in the hospital setting is a major concern and can be
achieved through environmental measures, infection control measures, and
safe transportation.
Infection control is based on two systems. Standard Precautions are designed
for the care of all patients to reduce the risk of transmission of
microorganisms from both recognized and unrecognized sources of
infection. Transmission-based precautions add extra interventions for
patients diagnosed with or suspected of having an infection.
Restraints are used cautiously and require medical orders based on ongoing
evaluations.
Proper positioning of infants and small children for procedures is essential to
minimize movement and discomfort.
Factors that affect drug dosage determination are growth and maturation,
age, weight, and BSA.
Before giving a medication, the nurse must check the patient’s name,
medication name, dosage, time of administration, and route ordered.
The family should be taught why the child is receiving the medication and
the possible side effects, as well as the amount, frequency, and length of
time the drug is to be administered.
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 The preferred sites for IM injection in children are the vastus lateralis and
ventrogluteal areas.
 Intermittent venous access is accomplished by a peripheral intermittent
infusion device (PICC), a central venous catheter, or an implanted port.
 Several safety catheters and needleless device systems are available to
reduce the risk of needlestick injuries in patients and caregivers.
 Nursing assessment of fluid and electrolyte disturbances entails
measurement of I&O.
 Some children are unable to take nourishment by mouth because of the
following: anomalies of the throat, esophagus, or bowel; impaired
swallowing capacity; severe debilitation; respiratory distress; or
unconsciousness. Alternative forms of feeding include gavage feeding,
gastrostomy or jejunostomy feeding, and TPN.
 The procedure for giving an enema to an infant or child does not differ
essentially from that for an adult except for the type and amount of fluid
administered and the distance for inserting the tube into the rectum. Because
infants and young children are unable to retain the solution after it is
administered, the buttocks must be held together for a short time to retain the
fluid.
 In the care of children with ostomies, nurses play an important role in family
support and instruction in care of the stoma site.
 Protection of the peristomal skin is a major aspect of stoma care. Well-fitting
appliances are important to prevent leakage of contents.
 Oxygen can be administered by hood, mask, nasal cannula, prongs,
ventilator or face tent.
 Bronchial drainage is indicated whenever excessive fluid or mucus in the
bronchi is not being removed by normal ciliary activity and cough.
Positioning the child to take maximum advantage of gravity facilitates
removal of secretions. Postural drainage can be effective in children with
chronic lung disease characterized by thick mucus, such as cystic fibrosis.
 The focuses of nursing care for a patient with a tracheostomy are
maintaining a patent airway, facilitating the removal of pulmonary
secretions, providing humidified air or oxygen, cleansing the stoma,
monitoring the child’s ability to swallow, and teaching while simultaneously
preventing complications.
 Tracheostomy suctioning involves premeasured insertion of the catheter,
application of suction for no more than 5 seconds then withdrawing the
catheter, and supplemental oxygen before and after suctioning.
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