Question

Jordan is a 9-year-old boy who is a direct admit for observation. He has had a history of vomiting and diarrhea for 48 hours.

Subjective Data

Has a history of nausea and vomiting for 24 hours.

Has not voided today.

Is unable to tolerate oral fluids.

Objective Data

Vital signs: temp, 37.8º C; pulse, 120 bpm; resp, 24 breaths/min; blood pressure, 110/60 mm Hg

Weight: 34 kg

Hyperactive bowel sounds to auscultation

Questions:

When should the discharge teaching begin for Jordan and his family?

What is the best way to approach Jordan regarding the intravenous (IV) line that has been ordered?

What would be good distractions for a child of Jordan’s age?

Case Study #2

Susan is a 4-year-old girl with a 7-day history of fever and lethargy. Susan’s physician has ordered laboratory work that includes a blood culture.

Subjective Data

Susan has had fever for 1 week.

Her mother has noticed a decreased activity level.

Susan states she is “afraid” of needles.

Objective Data

Weight: 26.1 kg

Vital signs: temp, 39.3º C; pulse, 110 bpm; resp, 40 breaths/min; blood pressure, 108/54 mm Hg; oxygen saturation (O₂ sat) 100%

No abnormal findings on physical examination

Questions:

When should Susan’s nurse explain the procedure to her?

To give Susan some control over this situation, what choices could be given to her?

What actions should the nurse take in this clinical situation? Prioritize the actions.

Answer 1

A sick child is defferent from sick adult, the immature child gets illness easily. Paediatric units are available in most of the hospital which ensures protection from physical dangers& infections.

DISCHARGE TEACHING

Nurses are responsible for the health promotion of children in defferent stages of development & guide the parent to child care.

Hospitalization is an unpleasant feeling not the children as well as the family.

Starting from the minute of admission health care providers have to provide the necessary information to them.

But discharge teaching can begin once the child's vital signs & health become stable.

Here the oarenpa can be taught about;

Follow ups

Early detection of

Warning signs

Gentle handling

Safety measures

Safe play etc

BEST WAY TO APPROACH CHILDREN FOR IV INSERTION

Preparation for insertion of IV line is important for precepreve psychological or emotional trauma

Here the child is coming under school age, so the nurse can explain about the need for the procedure in an understanding way.

Nurse can take help from the parents also for preparing the child. Here along with health team members child can cope up with the traumatic event.

Visual aids can be used for better understanding of the procedure

Sick child should be supported & guided to learn to handle the new experience with the help of family participation during the insertion of IV line.

Child should be explained about the instruments to be used in the procedure & demonstrate it one by one to avoid fear during the process.

He should be told that small pain will be there while inserting the needle & there after he will be ok.

During teaching the child nurse should know about the difference among children based on background, growth level, & degree of illness.

Distraction methods can be used for reducing the pain by changing the child focus

Restraints can be used in case of emergency for non cooperative child to avoid trauma during the procedure

GOOD DISTRACTION METHOD

Rapport with the child should be made from the moment of the first meet to improve co operation

Offering small rewards for being cooperative can be done for the ease of the procedure

Most of the paediatric units will be painted attractive with cartoon characters, the child can be asked about the beauty of the pictures around him & also about his favourite character.

As a school child, he can be asked to tell about his school lie, friends & teachers.

CASE STUDY 2

Here the 4 year old child is prescribed for blood cultures since she has continuous fever for 7 days.

For approaching such children & for safe sampling it is good to consider the children choices about the procedure.

They can be asked to choose to do the procedure on parents lap or special examination room

Calling the child by name to gain the attention & later on the nurse can explain the procedure to the child.

Ask for co operation & it's benefits

Encourage to express the child's feelings & ask questions

Consider the child's understanding level, gain parental support for making it clear.

Before the procedure make sure that the child is psychologically prepared,

FOr Gaining Control Over the Situation:

For safe sampling & avoiding unpleasant experience the nurses can use the following methods during sampling;

Prepare sterile articles & collection bottles (labelled) in advance

Gain child co-operation

Explain the procedure in soft & understanding words

Restraints can be used in case of need

Never tell her that there will not be pain

Tell the child that, a slight pain will arise when inserting the needle