Week 1: Introduction to Pediatric Nursing
Six Essential Skills of Clinical Judgement (NCJMM)
• Recognize Cues
• Determine which data are important, immediately concerning, or irrelevant
through assessment
• Analyze Cues
• Evaluate client’s history and situation and identify how cues relate to their
condition
• Prioritize Hypotheses
• Consider all possibilities for the client’s condition
• Generate Solutions
• Plan specific evidence-based actions (including actual and potential) for desirable
outcomes
• Take Action
• Determine what actions will address the highest priorities of care and implement
those actions
• Evaluate Outcomes
• Compare actual client outcomes with expected outcomes and decide whether
nursing actions were effective, ineffective or made no difference in the client’s
condition
The Role of the Pediatric Nurse
 Promote, protect and optimize health and well-being
 Establish a therapeutic relationship with the child and their family
 Advocate for the child and their family
 Provide education and anticipatory guidance
 Provide support and counselling
 Collaborate as a member of the interdisciplinary team
 Contribute to nursing research
 Determine the most beneficial and least harmful action
 Support families in their caregiving and decision-making roles
Nurses Ethical Responsibility
• Providing _________ care
• Documentation
• Maintaining confidentiality
• Determining the most beneficial/least harmful action
• Advocating for children
• Keeping up to date with research
Basic Ethic Principles
• Respect for Persons
People are _______ and have the right to make their own choices
•
Nonmaleficence
Obligation to minimize or _________
Discontinuing medications that are causing side effects
• Beneficence
Obligation _______ and promote patient’s well-being
Advocating for abused children
• Justice
People should be treated _______
Respecting ethnic, cultural and religious beliefs
Informed Consent
 A voluntary process that must be free of coercion, fraud or deceit
Includes:
 The illness/condition
 The proposed treatment
 Potential benefits/risks/side effects
 Alternative courses of action
 An explanation of what will happen if treatment is declined
 Signatures
Who can provide informed consent??
 The patient: has the right to refuse or accept any health care
 Substitute decision maker: an identified person who makes treatment decisions for
someone who is incapable of doing so
o Ex: Guardian, attorney, spouse, partner, relative
 Relatives: person related by blood, marriage or adoption
 Spouse: two persons who are married or who have cohabitated for at least one year, or
who are the parents of a child or who have a cohabitation agreement under the Family
Law Act
 Partners: two persons who have lived together for at least one year
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Healthcare providers
o When obtaining informed consent, the nurse is responsible for:
o Ensuring the person is _______ of giving consent
o There is _______ of consent for medical treatment in most of Canada
(Quebec is 14-years-old) (Schonfeld et al., 2022)
o Providing all information to the individual so they can make an informed decision
o Ensuring the individual is acting voluntarily
o Obtaining verbal or written assent to protect the rights of children
Assent
 Included with the parents' consent, demonstrating the child’s understanding
 Not legally required, but ethically appropriate
 Each institution has an age requirement for consent/assent
When obtaining assent, the nurse should:
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Ensure the child understands the nature of their condition
Ensure the child has a basic understanding of what will be expected of them
Assess the child’s willingness to participate in treatment
Provide a signed copy of the assent to the child to keep
Atraumatic Care
 Provision of therapeutic care with the purpose of eliminating or minimizing
psychological and physical distress
o Ex: Anxiety, fear, sleeplessness, pain
 Focuses on the delivery of interventions and procedures
 Overriding goal
What is a major cause of stress from middle infancy through the preschool years that can be
minimized with atraumatic care?
Separation Anxiety
Level of reaction depends on the _____________ stage of the child
a. _______ display goal-directed behaviours
 Plead with parents to stay, physically grab parents, refuse to follow routine, and
sometimes regress developmentally
b. _________ can tolerate brief periods of separation and are able to develop sub-trust in
other adults, but the stress of the anxiety hinders ability to cope
 Refuse to eat, crying quietly for parents, continually asking for parents, withdrawn
c. _________ and ________ experience fear of an unfamiliar environment, and stress
from missing out on activities and being with friends
 Irritability, aggression, withdrawn, boredom
Atraumatic Care
Three major principles for providing atraumatic care to pediatric patients:
1. Minimize separation between the child and their family
Example: maintain familiar surroundings
2. Encourage a sense of control
Example: promote freedom of movement
3. Minimize pain and bodily injury
Example: using numbing cream before IV insertion, maintain parental contact during the
procedure
The Importance of Play
 One of the most vital components of a child’s life
 One of the most effective strategies for managing stress
 Essential for a child’s emotional, mental, and social well-being
 Provides diversion & relaxation
 Lessens the stress of separation
 Helps the child feel more secure
 Provides a means for release of tension
 Encourages interaction and development
Family-Centered Care
Why??
 The family is the constant in a child’s life
• What??
 Utilizing family to plan, deliver and evaluate health care
• How??
 Nurses must conduct a thorough assessment of family dynamic to provide optimal
care
 Nurses recognize that families are experts of their children and support them in
decision-making
Family theories
• Family Systems Theory
The family is a system that is continuously interacting with each other and the environment
A change in one family member creates a change in another
The nurse should assess the family’s ability to accept new ideas and information to
successfully plan strategies
• Family Stress Theory
Focuses on how families react and adapt to unpredictable and preditctable stress
The nurse should assess the stressors the family is experiencing to prevent a state of crisis
from occurring
• Developmental Theory
The family is a small group that interacts with the larger social cultural system
Family change is predictable, occurs over time, and is based off Duvall’s (1977) family life
cycle stages
Nurses should assess how well parents are adjusting to developmental tasks
•
Family Structure
 Persons within a socially recognized status that regularly interact with one another
 Family are constantly being redefined and distributed
 Family structures have evolved to include all forms of family dynamics
 Nurses must be able to meet the needs of children from all forms of family structures and
home situations
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Traditional Nuclear
o Married couple and biological children
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Nuclear
o Two parents and their biological, step, adoptive or foster children
Blended
o At least one stepparent, step-sibling, or half-sibling
Extended
o At least one parent, one child, and one member other than a parent
Single-Parent
o One parent and at least one child living independently
Binuclear
o Jointly parenting after terminating the spousal unit
Polygamous
o Multiple wives or husbands
Communal
o Share services without monetary consideration
LGBTQIA (2SLGBTQI+)
o Legal or common-law tie between two persons and their biological, IVF,
surrogate, foster, or adoptive child
Parenting Styles
 Children learn to act based on their position within their family
 Children’s roles are heavily shaped by their parents' influence
 ______________ parents control their child’s behaviour with rigid rules and stern
punishment – “Do it because I said so”
 Permissive parents have little control over the child, rarely discipline, and often let them
dictate their own activity
 ______________ parents emphasize the reason for rules while respecting the
individuality of each child – a combination of passive and authoritarian
Special Parenting Situations
• Adoptive Parents
• Provide families with resources and support to reduce anxiety by increasing
preparation
• Work on forming an attachment between the child and the parents
• Divorced Parents
• Ensure the child is not neglected or “caught in the middle”
• Regularly assess mental health to prevent poor outcomes
• Single Parents
• Complete a needs assessment to determine gaps in care
• Reconstituted Families
• All family members are required to adjust
• Promote flexibility, support and open communication
• Dual-Earner Families
• Focus on equitable division of time and labour
• Ensure time, scheduling and stress are well managed
•
Foster Parents
• Temporary placement of a child in an approved setting
• Nurses must assess healthcare needs and be actively involved in case management
Family-Centered Care
• Families often experience …
Helplessness
Uncertainty
Fear
Stress
• What is The Nurse’s role?
Prevent/minimize separation from child
Explain everything in simple language
Collaborate on decision-making and the care planning process
Provide preparation for treatments and procedures
Share information on diagnosis, treatment, prognosis and home care
Ensure excessive support is in place
Pediatric Assessment
Caring for the Hospitalized Child
 Preparing the child and their family can significantly reduce anticipatory stress
o Child life specialists  Focus on the psychosocial needs of children
 Perform tours, manage the playroom, arrange for volunteers, toys, explain
procedures to parents and children, distraction
o Orient the child and their family to the room once they are admitted
 Assign an appropriate room on admission
o Consider age, diagnosis, length of stay, past medical history
 Prepare the room before the patient arrives
o Linens, call bell, safety equipment, roommates
 Apply patient ID band and document location
 Conduct assessments based on institutions policies
o Ex: WRH requires an intake assessment on admission, full assessment at start of
shift, q4h focused assessment with VS
Communication
 Utilize telephone triaging if possible
o Focused screening questions
o Be consistent and accurate
 ______________ is a vital component of communication
 Ensure cultural, ethical and legal sensitivities when using an interpreter
 Avoid unsought advice, premature reassurance, and over-talking
o Can block communication as a result of information overload
 Provide ______________
 Use open-ended questions to encourage expression
 Assessment requires ______________, parent, and the nurse’s own observation
Communicating with Children
 Avoid rapid advances and prolonged eye contact
 Communicate through transition objects
 Give children time to speak
 Get at their level
 Use simple, specific and clear words
 Offer choices
 Be honest
 Nonverbal communication conveys the most significant messages
Infants
o Non-verbal communication
o Stranger danger peaks between 6-12 months
o Respond to calm speech and physical touch –
cuddling, rocking
Early Childhood
o Focus communication on them
o Tell them what they can do
o Allow them to touch and examine equipment
o Be direct and concrete
School-Age Children
o Are interested in learning and how to solve
problems
o Focus on providing explanations – how it
works, why it’s used
o Encourage children to communicate concerns
Adolescence
o Fluctuate between adult and child thinking
behaviours
o Common dilemma: two sides to the problem
(parent vs. teen)
o Privacy and confidentiality is essential
Performing a Health History
• Who is the informant?
• What is the chief complaint?
Specific reason for the visit
• What is the present illness?
When did it start and how has it progressed?
• What is the pertinent health history?
Birth, feeding, surgeries, injuries, allergies, medications, immunization, growth and
development*
Health History: Growth and Development
 Key element in determining health status
 Important for identifying concerns about growth and whether child is hitting milestones:
o Can they sit up unsupported? Hold their head up?
o Walk without assistance?
o Have bladder and bowel control?
o Do they have a best friend?
o How do they interact with peers?
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Head circumference: reflection of ______ growth Measured until 36months-old or if head size is questionable
o Measure at greatest frontooccipital (above eyebrows and pinna)
circumference
Length: measurements taken while the child is supine
o Recommended until child is 24-months-old
o Ensure head is midline, grasp the knees together, push down to
fully extendo ry: Growth and Development
Height: measurement taken when standing upright
o Remove shoes, stand tall and straight with head midline and back to device
Weight: scales measure to the nearest 10g
o Always reset to 0
o Children under 36 months should be weighed nude or in a dry diaper
WHO Length & Weight Growth Charts
Health History
• What is the sexual health history?
Essential for an ______________ assessment
Screen for STIs and pregnancies
• What is the family history?
Useful for identifying genetic and chronic diseases
• What is the family structure?
Examine the quality of the relationship between parent and child
Is the child being appropriately cared for?
Are the parents treating the child with respect?
• What is the psychosocial history?
Examine the child’s ability to cope and their perception of self
How does the child handle themselves?
What is their level of confidence?
Health History
 Has your child ever been hospitalized before?
 Is your child on any medication?
 What are your child’s favourite food and drink?
 What are your child’s normal feeding/eating habits?
 What is your child’s normal pattern of elimination?
 How would you describe your child?
 Does your child have any hearing, vision, learning or speech difficulty?
 What religious practices would you like continued in hospital?
Anticipatory Guidance
 Handling a situation _______ it turns into a problem
 Provide information on normal growth and development
 Develop care plans based on needs identified from the family
 Focus on safety and injury prevention
Preparing the Child for a Physical Exam
 Use developmental and chronological age to assess each body system
 Focus on:
o Minimizing stress and anxiety by being systematic in assessment
o Develop a trusting nurse-patient relationship
o Prepare the child before hand
 Ex: Discuss what you are doing, allow them to play with equipment
o Allow the parent to stay and interact, preserving the security
Age
Neonate (<1 month)
30-60
Infant (1- 12 months)
30-53
Toddler (1 – 3 years)
22-37
Preschooler (3 – 5 years)
20-28
School-age child (6 – 12 years)
18-25
Adolescent (13 – 18 years)
12-20
Vital Signs
Respirations
• Respirations  pulse  blood pressure  temperature
• Observe abdominal movements due to diaphragmatic movements
• Count for 1 minute due to irregularities
Pulse
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Rate
Radially in children over 2-years-old
Auscultate the apical pulse for children younger than 2-years-old
Count for 1 minute in infants and young children due to irregularities
Be sure to record behaviour
Compare radial and femoral pulses at least once
Age
Awake Rate
Sleeping
Rate
Neonate (<28 days)
100-205
90-160
Infant (1 month – 12 months)
100-180
90-160
Toddler (1 – 3 years)
98-140
80-120
Preschooler (3 – 5 years)
80-120
65-100
School-age child (6 – 12 years)
75-118
58-90
Adolescent (13 – 18 years)
60-100
50-90
Blood Pressure
 Should be measured at least annually
in healthy children
 Most important factor cuff size
o Bladder width should be 40%
of arm circumference midway
between elbow and shoulder
o Bladder length should be 80100% of arm circumference
 Locations include upper arm, lower
arm or forearm, thigh, calf or ankle
 Orthostatics: sitting, standing, lying
Age
Systolic
Diastolic
Neonate (96 hours)
67-84
35-53
Infant (1 – 12 months)
72-104
37-56
Toddler (1 – 3 years)
86-106
42-63
Preschooler (3-5 years)
89-112
46-72
School-age child (6 – 9 years)
97-115
57-76
Preadolescent (10-12 years)
102-120
61-80
Adolescent (13 – 18 years)
110-131
64-83
Systolic Hypotension Examples
A 4-year-old child considered hypotensive if the systolic reading is what?
A 7-year-old child is considered hypotensive if the systolic reading is what?
A 10-year-child is considered hypotensive if the systolic reading is what?
Temperature
 Oral, rectal, axillary, tympanic
 36.5-37.8oC*
 Rectal temp is considered a core temperature, but must be used with caution to avoid
perforation
o Not typically used over 2 months of age
Pulse Oximetry
 Secure and cover probe to ensure accurate readings
o 95%
Physical Exam: Review Systems- General Appearance
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Skin
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Nutrition, behaviour, personality, interaction with parents and nurse
Posture, position, body movement, hygiene
Behaviour, personality, activity level
Ask yourself:
o Can the child follow commands?
o Is the child easily distracted?
o Is the child making eye contact?
Colour, texture, temperature, moisture, turgor, lesions, rashes
Inspect the hair and scalp for cleanliness
Secondary hair growth in children approaching puberty
Inspect the nails for colour, shape, texture and quality
Lymph Nodes
 Helps to diagnose
 Assess based on chief complaint
 Note size, mobility, tenderness, temperature, and
parents reports of changes in size
Head & Neck
 Observe for shape and symmetry
 Note head control
o Should occur by 4 months and 6 months is worrisome of cerebral injury
 Palpate for sutures, fontanels, fractures, swelling
o Posterior fontanel closes by _____ and anterior fuses between ______________
months
Eyes
 Compare pupils for size, shape and movement
o Should be equal, clear, react to light and accommodate
 Determine the general slant of the eyelids
 Permanent eye colour is established by 6-12 months of age
 Vision screening should occur at least once before 3 years old
o By 4 months children should be able to fixate on an object
o Snellen: child stands 20 feet away and reads the chart
 3 y/o - 20/50; 4 y/o - 20/40; 5 y/o - 20/30
 By 8 years old, the child should see 20/20
Ears
 Observe pinna alignment
o Low set pinna can be indicative of cognitive impairment
 Assess for ear hygiene and educate how to properly clean ears
 Hearing test occurs at birth and again before school starts
Mouth & Throat
Atraumatic care:
 If uncooperative, inspect while child is crying
 Inspect mucous membranes for color, bleeding, moisture
 Inspect for teeth eruption, hygiene, discolouration
 Inspect the tongue for size and mobility
Chest
 Inspect size, shape, movement, symmetry
o Movement of the chest should be symmetrical bilaterally and coordinated with
breathing
 Measure under ribcage, at the nipple line
o Important for infancy and relation to head size
 During infancy the chest’s shape is almost circular
Lungs
 Evaluate respirations for rate, rhythm, depth, and quality
 Note the character of breath sounds (e.g., noisy, grunting)
 Have child sit in parents lap to keep calm
 Respiratory effort is prominently ______________ or diaphragmatic in children
under 7 years of age
Auscultating Lung Sounds
 Best heard if the child inspires deeply
 Atraumatic care: utilizing a pinwheel can encourage deep breaths, warming stethoscope
 It’s best to describe the type sound you hear, instead of labeling it
 Report all abnormal sounds with the location
Heart
 2/3 of the heart lies on the left side
 Children with thin chest walls may have
pulsations visible
 Apical pulse located at:
o __th ICS and LMCL in children younger
than 7-years-old
o ___th ICS and LMCL in children older
than 7-years-old
Abdomen
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Genitalia
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Observe for movement, size, hygiene and hernias
Inspection auscultation palpation
Listen for ___ minutes before declaring absent bowel sounds
Assess for discharge or difficulty urinating
Provide privacy and only expose areas being examined
Back & Extremities
 Normal spine is C-shaped in newborns
 Assess shape and length of bones
 Assess ROM, strength and development of muscles, tone, and temperature between
extremities
 Toddlers are bowlegged due to underdeveloped back and leg muscles
o Toddlers have a ‘toddling’ gait which facilitates walking by lowering the center of
gravity
o By ______ the walking posture is more graceful and balanced
Physical Exam: Review of Systems
NEURO
 Observe child’s posture, body movements, gait and motor skills
 Assess LOC, balance and coordination
 Assessing reflexes is imperative for determining cerebral function
Development
 One of the most essential components of a pediatric assessment
 The earlier developmental difficulties are identified, the sooner strategies can be put in
place to ensure child reaches their potential
 Assess language, communication, motor skills, problem-solving, social skills, decisionmaking
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Pain
Significant problem for children of all ages
Pediatric nurses are essential for preventing and minimizing pain
It can be acute (e.g., immunizations, abrasions, injuries) or chronic (e.g., headaches, IBS)
Assessment should include pain’s impact on sleep, emotional function, physical recovery
and functioning, and satisfaction with treatment
Integral that the pain assessment tool is __________.
Be consistent and use the same measurement to ensure standardization
Pain is influenced by age, developmental level, and cause
Nurses must understand the location, frequency, duration, and aggravating and alleviating
factors for effective pain management strategies
Observational Pain Assessment: FLACC & CRIES
 Utilized when children are unable to verbalize pain and distinguish increments of pain
intensity
o Ex: Children under 3-4-years-old, ICU, PACU
 __________ the child’s behaviour, vocalization and body movements
 FLACC: Face, legs, activity, cry, consolability
o Highest score is 10 (0-2 per category)
 CRIES: Crying, Requires oxygen, Increased vital signs, Expression, Sleeplessness
o Highest score is 10 (0-2 per category)
Pain Assessment: Self-Report Rating Scales
 Select a scale that is appropriate for the child’s age
o Ex: Wong-Baker FACES, Numeric Rating Scale (NRS)
 Wong-Baker FACES is a reliable indicator of pain in children over the age of ___*
o Contains 6 faces that range from 0 (no pain) to 10 (worst pain)
o Explain the scale to the child and have them select which face is most appropriate
for their pain
 NRS typically used in children over 8 years old
o Scale of 0-10, with 10 being the worst pain
o Have the child state their pain
 Utilize the __________ each time to maintain consistency
 Explain using simple language and minimal guiding words
•
•
•
Pain Indicators
Physiologic
T, BP, RR, P
Not always a reliable indicator of pain
Changes in vital signs can be related to behaviour
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•
•
•
•
Behavioural
Vocalize pain “ouch”, “no more”, “bad”
Facial expression
Body movements
Reliable for pain in infants
May not correlate with child’s self-report of pain
Children’s Response to Pain
Pain Management:
Non-Pharmacologic Strategies
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Distraction
o Ex: Blowing bubbles, playing an interactive
game, reading a book
Child life specialists
o Used to help prepare the child for a procedure
to reduce stress
Cuddling/swaddling
Non-nutritive sucking
o Ex: Pacifier
Sucrose in neonates
Comfort positioning
o Ex: Sitting upright in the parent’s lap
•
•
•
Common Pain Medications
Non-Opioids
Ibuprofen: anti-inflammatory, analgesic
Safe dose:10mg/kg q6h
Acetaminophen: antipyretic, analgesic
Safe dose: 10-15mg/kg q4h
Ketorolac: anti-inflammatory (IV), analgesic
Safe dose: 0.5mg/kg q6h
Pharmacologic Strategies
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•
•
•
Always start with __________ (Ex: acetaminophen,
NSAIDs)
Topical local anesthetic (ex: EMLA) can be used for
IV insertion, immunizations, LPs
Opioids are indicated for severe pain, or when pain
is unrelieved by non-opioids
Dose at regular intervals
Use appropriate route
Adapt treatment to child
Piggy-back medication for full coverage
Opioids
Morphine dose: 0.1mg/kg (IV) q1-2 hours
Hydromorphone dose: 0.01 mg/kg (10 times
stronger than Morphine)
Side effects: nausea, vomiting, constipation,
respiratory depression
Safe Dose Examples
1. A child weighing 25lb is admitted with pharyngitis. After staying in the hospital for 3 days, they are being
sent home with PO Amoxil. The physician has ordered 250mg every 8 hours. Safe dose range: 80-90
mg/kg/day. Is this safe??
2. A 40 lb 10-year-old is admitted with bacterial meningitis. 1g IV Ceftriaxone is ordered q24h. Safe dose
range: 50-75 mg/kg/day. Safe??
3. A 7-month-old child weighing 16 lbs is ordered Ibuprofen 70mg PO q6h. Safe dose range 5-10
mg/kg/day. Safe?
Medication Administration
Medication Administration: Safe Dose Ranges
 What makes pediatric medication administration different than adults??
 Often ordered as mg/kg to __________
o Calculated each time a medication is ordered and before a medication is given
o Determine the safe individual dose and daily dose
o Calculated with patient’s weight, ordered dose, and safe dose range
 The nurse is legally liable for administered medication
 A misplaced decimal can result in a 10-fold or greater dosing error
o Ex: 1.0 mg/kg of morphine interpreted as 10mg/kg of morphine
Medication Administration
 Parents often administer medications after the nurse has prepared the medication
o Must stay and supervise/confirm that the child receives the medication
 Offer the form of medication based on the child’s developmental age
o Young children have difficulty swallowing pills and should use liquid suspension
if available
 Ensure an __________ experience
o Mix with juice, offer a chaser, have pharmacy flavour it
Common Medications: Safe Doses
ORAL
SQ
Medication Administration
IM
INTRAOSSEOUS
(IO)
IV
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Focus is on
preventing
aspiration
Ensure oral
formulation is
appropriate for the
child based on age,
developmental level,
and swallowing
ability
Place the syringe
in the side of the
mouth waiting for the
child to swallow
Focus on
education teaching
child and family
Ex: insulin
injections
Common sites of
administration
include upper arm,
abdomen, center third
of anterior thigh
Focus on site
selection and needle
size
Dorsogluteal
muscle __________
for children under 10
Vastus lateralis
most used in infants
Infants have
underdeveloped
muscles
0.5-1ml is the
maximum tolerated
amount per injection
in small children
Used for rapid
access and lifesaving alternative
route for fluids and
medications
Cardiac arrest,
hypovolemic shock
Most often used
in unconscious
children or after
analgesia has been
administered
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Focus on
maintaining site
integrity
Regularly check
the site for patency,
only administer one
antibiotic at a time
 Saline lock: used to
give the child more
freedom
 CVCs: used when
children require
frequent blood
sampling, chemo,
extensive antibiotic
therapy, TPN
Focus on
preventing infection
Regularly assessing
and cleaning site
IV Complications
 IV therapy is difficult to maintain in pediatrics because of:
o Insertion site, vessel trauma, pump pressure, patient’s activity, irritants/vesicant
 Irritant: Causes a local reaction, not tissue necrosis (e.g., clindamycin,
cefotaxime)
 Vesicant: Can cause blistering and tissue necrosis (e.g., chemotherapeutic
agents, vincristine, diazepam)
 Infiltration: accidental administration of __________ into surrounding tissue
 Extravasation: inadvertent administration of __________ into surrounding
tissue
 Phlebitis: inflammation of vessel wall
Nurse’s Responsibility:
Preventing IV Complications
 Avoid placing the ID band on the extremity with the IV to prevent tourniquet effect
 Check the site ___ and ________
o Make sure you are palpating the area, not just looking
 Secure and protect the IV, but ensure the site is still visible
 IV site selection is critical for preventing complications
o Consider the child’s developmental, cognitive, and mobility level
o Start with the most distal side and avoid the favoured hand
o Avoid the foot if children are just learning to walk
o Do not use scalp veins if children are older than 6 months
Managing an IV Complication
1. Immediately ______ the infusion
2. Elevate the extremity and assess the site
3. Notify the provider
4. Initiate the ordered treatment ASAP
5. Remove the IV – after antidote
6. Apply warm/cool compress
Medication Administration Special Considerations
 Measuring I&O is vital and must be from all sources
o ALL diapers MUST be weighed
 Avoid infusion monitor pump fatigue
Summary
 Family-centered care is an essential component of pediatric nursing
 The overriding goal is atraumatic care is to do no harm, which is achieved by
minimizing separation from parents, promoting control and minimizing pain
 Conducting a thorough intake assessment is essential for continuing normal habits and
routines while in hospital
 Complete and document safety checks every hour, including IV monitoring
 Play is the universal language of children
 Communication techniques and responses to pain vary based off developmental stage
 Calculate safe dose before administering medication