University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors

Names: Date: Area: Group: Student ID:

Vital Signs Body Temperature

1 Indication: To determine the childs temperature on admission as a base for comparing future measurements. To monitor fluctuation in temperature. Equipment : Cotton with alcohol & dry cotton Container for waste Water soluble lubricant. Thermometer 2 3 4 5 Comments

Oral Temperature
Method range Advantages Disadvantages Length of time Age 1. Wash hands. 2. Explain the procedure to the child or to his parents. 3.Check that the child has not just had a cold or hot drink. 4. Clean thermometer with alcohol swab 5. Check thermometer to see the reading is down below 35c. 6. Instruct the child to raise his/her tongue and put thermometer under it, , and ask him to close his lips without biting. 7. Instruct the child to close his/her mouth, hold thermometer for 5 minutes 8. Remove the thermometer and wipe it with dry cotton swabs 9. Read and record temperature. 10. Wash thermometer with soap and water and dry it. .Wash hands .11

Rectal Temperature
Method range Advantages Disadvantages
1

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Length of time Age 1. Wash hands. 2. Explain the procedure to the child and his family. 3. Clean thermometer with alcohol swab 4. Check thermometer to see the reading is down to 35c. 5. Apply lubricant to thermometer. 6. Grasp the infants ankle and placing index finger between the ankle bones. 7. Insert the thermometer bulb into the rectum 2.5cm. 8. Hold for 3 minutes. 9. Remove the thermometer and wipe it with dry cotton swabs. 10. Read and record temperature. 11. Clothe the child. 12. Clean the thermometer with soap and tape water. 13. Dry it and keep in its container. 14. Wash hands. N. B: 1. Rectal temperature should not be used in children who having rectal surgery or receiving chemotherapy. 2. Procedure should be done by rectal thermometer. 3. Measuring rectal temperature is generally unnecessary because of the risk of rectal perforation. Student ID:

Axially Temperature
Method range Advantages Disadvantages Length of time Age 1. Wash hands. 2. Assemble equipment. 3. Explain procedure to the child and infants family. 4. Clean thermometer with alcohol swab 5. Check thermometer to see that reading is down to 35c. 6. Dry the axially area and then Place thermometer under axilla and bring arm across chest. 7. Hold thermometer in place for 10 minutes.
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 8. Remove the thermometer and wipe it with dry cotton swabs. 9. Read and record temperature. 10. Clean the thermometer with soap and tape water. 11. Dry it and keep in its container. 12. Wash hands. Student ID:

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Methods of Measuring Body Temperature In Infants And Children

Method Range Rectal 37.0 37.8c. Advantages 1. Safe for children who are unable to co-operate and may bite the thermometer. 2. Not directly influenced by the ingestion of hot or cold fluids. 3. Method of choice if child has seizure or breathing difficulties receiving oxygen therapy, or has oral surgery. 1. Easily accessible. 2. Replication of thermometer placement is easy. 3. Responds more quickly and regular to changes in arterial temperature than does rectal method. 4. More aesthetically pleasing. Disadvantages 1. Values may be altered by presence of stool. 2. Optional response may be negative. 3. Damage to rectal mucosa may occur. 4. Replication of thermometer placement is difficult. 5. Contra indicated when child has diarrhea and following rectal surgery. 1. Value is ready influenced by ingestion of hot or cold fluids, and oxygen therapy. 2. Requires childs cooperation to keep mouth closed and not to bite the thermometer. 3. Contra indicated if child has oral injuries surgery or under the age of five years. 1. Value is more readily influenced by environmental temperature and air flow. 2. Requires a relatively long period of time to obtain accurate reading.
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Length of time 3 minutes

Age *New born * Infant.

Oral 36.4 37.4c

5 minutes

* More than 6 year's children.

Axillary 35.8 36.6c

1. Safe and easily accessible. 2. Avoids the danger of rectal or colon perforation. 3. Avoids initiating the defecation stimulus. 4. Often recommended for infants.

10 minutes.

Less than 6 years children.

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Pulse
1 Indication: To gather information on the heart rate, pattern of beats (rhythm, rate and strength of pulse). Equipment: Watch with second hand. Stethoscope. Cotton with alcohol. Normal Heart Rate for different ages 2 3 4 5

Action Peripheral Pulse

1. Wash hands. 2. Explain the procedure to the child and his family. 3. Place child in comfortable position. 4. Place the third finger along the appropriate artery and press gently. 5. Count for full minute. 6. Record rate, regularity & fullness. 7. Report for any abnormalities.

Apical Pulse
1. Expose the chest over the apex of the heart. 2. Wipe the ears pieces & diaphragm with alcohol swabs and warm diaphragm. 3. Place the stethoscope between the infants left nipple and sternum between the 4th & 5th ribs. 4. Listen and count for full minute. 5. Remove stethoscope and cover the child chest. 6. Wipe earpieces and diaphragm with alcohol swabs. 7. Record: rate, fullness and regularity. 8. Report any abnormal observation.

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Respiration
Action Indication: To determine respiratory rate and assess respiratory characteristics (rate, rhythm, strength). To evaluate the child response to medication or treatments. Normal respiratory rate Equipment: Watch with second hand. Procedure 1. Remove over cover to observe chest movement. 2. Observe respiratory movement, rate, and depth, pattern and sound. 3. Count the rate for one minute. 4. Record rate, depth, pattern and sound. 5. Report for any abnormality. Normal heart rate (beats per minute) 100-160 90-150 80-140 80-130 80-120 70-110 60-105
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Comments

Age Newborn 15 months 612 months 13 years 35 years 610 years 1114 years

Normal respiratory rate (breaths per minute) 30-50 25-40 20-30 20-30 20-30 15-30 12-20

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 14+ years 60-100 12-20 Student ID:

Blood Pressure
1 Equipment: - Measuring cuff and Stethoscope. -Alcohol swab Formulas of approximate average systolic pressure in relation to childs age. Formula of approximate average diastolic pressure in relation to childs age. Sites for measuring blood pressure Action 1. Assemble the equipment. 2. Wash hands. 3. Review child's previous blood pressure reading 4. Explain the procedure to the child or to his mother. 5. Expose the site of measurement fully by removing clothes. 6. Position the limb at the level of the heart. 7. Place stethoscope ear pieces in ears and be sure sounds are clear, not muffled. 8. With cuff fully dilated, warp cuff evenly around upper arm. 9. Be sure that manometer positioned vertically at the eye level observer (should be no further than 1 ml.) 10. Palpate brachial or radial artery with fingertips of one hand while inflating cuff rapidly to pressure 20mm Hg. Above point at which pulse disappears. 11. Slowly deflate the cuff, nothing when the pulse is first heard (systolic pressure) and when the sound becomes muffled or disappears (diastolic pressure).
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 12. Remove equipment. 13. Hand wash. 14. Record your observation. Student ID:

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Sites for measuring blood pressure: A. Upper arm B. Lower arm C. Thigh D. Calf or ankle. Student ID:

Formulas of approximate average systolic pressure in relation to childs age. Childs Age 1 to 7 years 8 to 18 years Formula Age in years + 90 (2 X Age in years) + 83

Formula of approximate average diastolic pressure in relation to childs age. Childs Age 1 to 5 years 6 to 18 years Formula 56 mmHg Age in years + 52

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Cold Compresses For Fever

1 Purpose: Decrease body temperature. Relief discomfort. Prevent complications. Equipments: Basin with tap water. Small wash clothes. Rubber sheet. Towel Draw sheet or linen to cover the child's chest Degrees of fever (Oral or rectal) Mild fever : 37.8 38.4 c Moderate fever : 38.5 39.5c High fever : 39.6 41.0 Hyperthermia above 41.0c Procedure 1. Wash hands. 2. Prepare all the needed equipment 3. Prepare child & pulsating areas. Which the compresses will be applied on. 4. Place rubber sheet under areas to which compresses will be applied 5. Immerse wash cloth or material for the compresses in the tap water, place wash cloth over pulsating areas. 6. Remove the compresses frequently & replace it with another one 7. Measure patients temperature after 15-30 min 8. Remove compresses after decrease body temperature to the normal level. 9. Clean equipment after use 10. Leave patient clean and dry 11. Wash hands. 12. Record nursing care in the patients card & his last
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: temperature. N.B: If the temperature is not changed repeat the steps from 5-7 for 8 min. Student ID:

Chest Circumference
Action Equipment: 1. A tape measures 2. Cotton with alcohol 1. Remove the childs clothing of upper half. 2. Place on the flat table in A supine position for infant Or stand alone for children 3. Place the tape across the nipple line. 4. Measure midway between inspiration and expiration. 5. Record in the patient chart.

Comments

Head Circumference
Head circumference should be measured: 1. Under 36 months of age. 2. With neurological defects. Equipment: - Measuring tape - Cotton with alcohol -Measure the head at its great circumference; this is above eyebrow and pinna of the, and at the occipital prominence at the back of the skull. Action 1. Note child's last recorded head Circumference, if available. 2. Perform hand washing. 3. Place light drape or paper on flat surface for the child to stand on. 4. Place infant/ toddler in sup 5. Child usually weighted while wearing their under wear or light gown. 6. Record. Comparison between head circumference and chest Circumference.
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Birth. H. C. > CC 12 14 months H. C. = CC 24 months H. C. < CC Student ID:

Height
1 Height is referred to measurements taken when children are standing upright. used over 24 months of age Equipment: Measuring board for old child or, a measuring tape. 1. Remove the childs shoes and socks. 2. Stand as tall and straight as possible with head in midline and the line of vision parallel to the floor. 3. The childs back should be to the vertical flat surface with heels, buttocks and back of the shoulder touching the surface. 4. Any flexion of the knees, lumping of the shoulders or raising of heels of the feet is checked and corrected. 5. Move the board on the top of the head. 6. Read & record. 2 3 4 5 Comments

Height If Such Device Is Not Present

1 N.B: Height can be calculated by these formulae (age more than 2 years x 5 +80) Action 1. Attach a measuring tape to the wall. 2. Place the child adjacent to the tape. 3. Place a three-dimensional object, such as thick book or box on the tape of the head. 4. The side of the book must rest firmly against the wall to form a right angle. 5. Length or stature is measure to the nearest 1 cm. 6. Record. 2 3 4 5 Comments

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Length
1 Length refers to measurement taken when children are in supine position, also refers to recumbent length. Until children are 24 months old, recumbent length is measured. Equipment: Measuring board for infant, dress tape, or metal tape. Action 1. Place the towel on the board. 2. Remove the infant clothing. 3. Place the infant on the center of the board in the supine position. 4. One assistant hold the head against the headboard firmly. 5. Grasp the knees together gently. 6. Push down on knees until the legs are fully extended & hold the legs firmly. 7. Bring the headboard against the soles of the heels firmly. 8. Read and record. 2 3 4 5 Comments

Length If Measuring Device Is Not Available

Action 1. Place the infant on a proper covered hard surface. 2. Push down the knees and head against a firm surface. 3. Make points of the top of the head and heel of the feet by a point. 4. Remove infant from his place. 5. Measure between these two points. 6. Record. 1 2 3 4 5 Comments

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Weight
1 - Weight must be recorded accurately on admission. - Weight of a patient provides a mean of determining progress. - It is necessary to determine the dosage of certain medications. - The way in which the nurse weights the child depends on the age. 2 3 4 5 Comments

Infant Weight
Equipment's: 1. Appropriate sized beam balance scale. 2. Cotton with Alcohol 3. Scale Paper Action 1. Place the scale horizontally on a firm surface. 2. Check to see that scale is balance by sitting it at zero, and noting if the balance registers exactly in the middle of the mark. 3. Close windows and doors to make the patients room warm 4.Wipe the scale with cotton with alcohol 5. Remove the infant clothing. 6. Put a scale paper on the scale. 7. Gently life the infant from his bed and place him in the scale basket. 8. For the safety, hold hand over the body of the infant. 9. Adjust the weight to balance scale by the right hand.
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 10. Read the scale when the infant is lying still. 11. Return the infant to his bed. 12. Record it in the patients chart. 13. Remove and dispose the scale paper. The older infant may be weigh in a setting position Student ID:

Weight of Older Children

Equipment: Standing scale. Paper Action 1. Balance the scale. 2. Place a paper towel on the scale for the child to stand on. 3. Keep child privacy. 4. Child usually weighed while wearing their underpants or light gown. 5. Ask the child to keep erect 6. Remove shoes of the child. 7. Read and record. Once standing height is taken over 24 months, weight can also be done on a standing type scale. NB: - If the child cannot stand for any physical problem, the mother should carry the child and subtract the difference between the mother weight and the mother who carry the child

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Sponge Bath
1
Purposes: 1. To clean the skin and comfort the child. 2. To increase circulation and metabolism. 3. To Observe childs body. 4. To give chance for play and talk with child. 5. To provide an opportunity to note childs growth and development. Equipment: Bowl for warm water Wash cloth or cotton (sponges) at least four wash cloth Soft hair Brush Bath towel Baby clothes Plastic bag Mackintosh Clear water Baby lotion Nail scissors Cotton with alcohol Actions 1. Explain procedure to the mother 2. Wash hands. 3. Close the doors and windows 4. Assemble the equipment at the child bedside. 5. Provide safe environment (Free from drafts). 6. Fill the bowl two-thirds full of water 36.5-40c according to the age and season, check water temperature by thermometer or by elbow joint. (Change the water as needed). 7. Precede bathing from top to bottom. 8. Wipe each eye with moist sponge from the inner to the outer aspect then dry gently each one. 9. Clean the baby face, wipe around mouth and nose then go over her cheeks and forehead, dry with sponge. 10. Clean each ear over and behind only (not inside) 11. Wipe the scalp & dry it.
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2 3

Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Student ID:

Instructors Names: Date: Area: Group: 12. Wipe the neck thoroughly pays attention to creases. 13. Take -off childs clothes 14. Clean hands from fingers then hands and dry well total. 15. Wipe under axially from front to back and dry well. 16. Clean the chest, abdomen, & back, then dry well in one direction. 17. Dress the child clean clothes 18. Clean the lower extremities from bottom to top then dry well. 19. Clean diaper area. Cord Care 1. hand wash 2. position infant supine 3. Inspect the cord closely during the first 24 hours and then daily for any abnormalities. 4. Clean area at base in circular motion with alcohol wipe or cotton ball. 5. Wipe the top of the cord with cotton with alcohol wipe or

cotton ball.
6. Squeeze cotton with alcohol over the tip of the cord. 7. Dress the child clean clothes. 8. Collect equipments and clean the surrounding environment. 9. Wash hands. 10. Record.

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Diaper Care
1 Purpose: 1. Maintain the baby more comfortable by keeping him dry. 2. Maintain healthy skin at diaper area. 3. Observe any abnormal changes in the skin of the diaper area. 4. Inspect the infants body during the procedure. 5. Protection against urinary tract infection.(ascending infection) Equipment: Kidney basin. Warm water. Cotton/sponges or clean wash cloth. Plastic bag. Oil or ointment. Disposable diaper or cloth diaper. Action 1. Wash hands with soap and water. 2. Prepare all the needed equipment. 3 Explain to the parents the procedure in the purpose of teaching them. 4. Put the baby on a mat or changing table. 5. Wipe off the feces with the corner of the unclean diaper and fold the diaper down under the babys legs. 6. With clean wash cloth, clean thoroughly in the creases at the tops of baby's legs and at the base of genitals wiping away from the body. For a female : a. Wipe away feces with wash cloth then using a moist baby clean wash cloth, clean all over her stomach up to her umbilical stump. b. Lift her legs up with a finger between her ankles and wipe the vulva from front to back. For a male:
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Student ID:

a. b.

7. 8. 9. 10. 11.

12. 13. 14.

Instructors Names: Date: Area: Group: Pause for a couple of seconds with the diaper held over his penis. Clean his penis, wiping away from the body. For uncircumcised boy pull the fore-skin back gently clean it then replace the retracted skin to prevent paraphimosis (edema of the glands),then clean scrotum change cloth as needed. Lift the babys legs to clean anus and buttocks, keeping a finger between ankles wipe over the backs of thighs too then remove the diaper , repeat if baby still unclean Dry baby's bottom with a clean wash cloth Apply a barrier of cream or zinc oxide ointment. Place the new clean diaper under the infants buttocks and sides in between his legs. Bring diaper up over abdomen, place front part of diaper next to babys skin bring back of diaper over front tuck it. , being careful to place your finger between the baby and the diaper. Fold diaper so that it does not cover the cord stump. Discard the old diaper, collect your equipments; leave the area clean and tidy. Wash hands.

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Methods of Holding the Child

Lumbar Puncture
1 Purpose: Minimizing their movement and discomfort Action Explain the procedure to the child and to his parents. Put the child in lateral side-lying position. Restrain the child by holding the child with forearm behind the neck and the other behind the thigh. Maintain this flexed position of the back. 2 3 4 5 Comments

1. 1. 2. 3. 1. 2. 3. 4. 5. 6. 7.

Jugular Vein Puncture

Explain the procedure to the child and to his mother. Put the child in a mummy restraining. Put the child supine in a table. Extend the head and shoulder of the child over the edge of the table. Turn the head to one side, a maximum of (60 degrees) from the midline. Encourage crying during the procedure. Check the patient after procedure for oozing, bleeding or evidence of hematoma.

Femoral Vein Puncture

1 2 3 4 5 Comments

Action
1. 2. 3. Explain the procedure to the child and to his parents. Put the child supine on examining table. Put the legs of the child in frog position. (Flexion and abduction of the childs knees).
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Control the childs arms and legs by forearms. Uncovered the site used for the vein puncture. Cover the genital area. Apply pressure on tie site for (10-15) min after withdrawal of blood. Student ID:

4. 5. 6. 7.

Clove Hitch Restraint

Indication: Immobilize arms or legs by attaching a clove hitch tie at the wrist or ankle. Prevent dislodging of (Cannula) from sites in the limb. Equipment: Cotton or dressing and gauze Action Pad the wrist or ankle with cotton or gauze dressing. Tape the dressing. Make double loop. Pick up the loop. Ship the wrist or ankle through the two loops. Tie the ends to the bed springs or frame. 1 2 3 4 5 Comments

1. 2. 3. 4. 5.

6.

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Mummy Restraining
1 Indications : It immobilizes an infant or small child for a short time while a procedure is performed or child is examined. It immobilizes the body, leaving only the head and neck mobile for examination or treatment (e.g. vein puncture, throat examination, gavages feeding). Equipments: Draw sheet or blanket. Safety pins. Action Wash your hands. Explain the procedure to the child and his parents. Place the blanket or sheet flat on the bed. Place the child on the blanket with his shoulder at the fold. Pull the right side of the blanket over the childs right shoulder. Tuck the reminder of the right side of the blanket under the left side of the childs body. Repeat the procedure with the left side of the blanket. Separate the corner of the bottom portion of the sheet and fold it up toward the childs neck. Tuck both sides of the sheet under the infants body. 2 3 4 5 Comments

1. 2. 3. 4. 5. 6. 7. 8. 9.

Modified Mummy Restraining

Purpose: To modify the mummy restraint for chest examination, the folded edge of the blanket is brought
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: over each arm under the back, the loose edge is folded over and secured at a point below the chest to allow visualization to the chest. Special Precautions: Be sure that the childs extremity is in a comfortable position during this procedure. Wash your hands. Explain the procedure to the child and his parents. Open a blanket on crib. Fold the blanket in a rectangle form. Place the child on the blanket with his shoulder at the fold. His arm is positioned comfortably at his side. Fold the blanket over the arm, and tuck it snugly under childs back. Repeat for the other arm. Bring the excess up over the abdomen &leaving chest exposed. Secure sides of blanket behind childs back. Student ID:

1. 2. 3. 4. 5. 6. 7. 8. 9. 10

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Board Restrains Palm Up Method 1 Purpose: Immobilize the extremities by attaching board restrains. Equipment: - Board - Adhesive strips Procedure Place arm palm up on an arm board Place two adhesive strips across the hand in an X fashion, Use 5-cm adhesive tape for the child, 2cm for the infant,) Make a double adhesive strip by using one long and one short Piece of tape, attach them to one another, adhesive sides together. With the short strip touching the childs arm, tape the arm to the arm board at the edge of the antecubital fossa. Tape does not need to be secured directly to the arm. Final double adhesive strip may be placed midway between the hand and the antecubital fossa or above the antecubital fossa. Palm Down Method Procedure Place the arm palm down on to arm board Place the first adhesive strip over the wrist. (Use 5cm width adhesive for the child, 2cm width for the
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Comments

1 2. 3.

4.

1. 2.

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: infant). Secure the second adhesive strip across the proximal end of the phalanges, leaving the thumb mobile. Using a double adhesive strip (see step 3 under palm up Method). Secure the arm just under the elbow. The final piece of tape is placed obliquely over the thumb and, for security, or over the second strip. Adhesive placement for the infant. Student ID:

3. 4. 5. 6.

Lower Extremities with Board Restrain 1 Procedure 1. 2. 3. 4. 5. 6. 7. Put the child in a supine position. Leg is full external or internal rotation on the board Extend the board from the end of the foot to the mid portion of the buttock. Place the second adhesive strip over the heel and across the foot in an X formation Using a double strip of adhesive (see step 3 of palm up method Tap the third strip above the knee On the infant, place one addition strip between mid-way the knee and ankle 2 3 4 5 Comments

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Elbow Restraint
1 Indications: Preventing the child hand from reaching the head or face, e.g. after lip/head surgery, or when vein infusion is in place. Preventing the child hand from scratching in skin disorders. Equipment: A piece of cotton cloth or strips of adhesive tape. Tongue depressors Action Wash hands. Explain the procedure to the child or to his parents. Expose the arm including the elbow area. Make a pocket on the cloth or on the cotton piece. Insert the tongue blades in the pocket of the cloth. Wrap the strain around the arm and secure it with tapes or pins. Special precaution: The tongue depressors should be cut to about 10 cm (4inches) in length if the elbow cuff is to be used for an infant for greatest
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Comments

1. 2. 3. 4. 5. 6.

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: comfort. Student ID:

Table Tub Bath

1 Purpose: 1. To satisfy the need for cleanliness. 2. To help the new mother at home bath her newborn infant. 3. To inspect infant body. 4. For therapeutic purpose as in burned child. 5. To relax the childs muscles before physical therapy. 6. To help remove dressings or crusts or to apply a certain soothing medication to the skin. Equipments: - Baby tub - Bath towel - Wash cloth 2-3 - Mild soap - Childs cloth. - Soft hair brush or comb - Mackintosh. Toy - Pitcher - Cotton Container - Gauze swabs - Baby Oil 2 3 4 5 Comments

Actions
1. 2. 3. 4. Explain the procedure to the childs mother. Check room temperature and free from drafts (close windows and doors). Assemble equipment. Fill the baby tub half to two third full of warm water (37.8)-(40.6c) if there is no water thermometer check it with your wrist.
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Spread the bath towel on the bed or table. Wash hands Place the infant still dressed on the bath towel Wash the infant eye, starting from the far eye, wipe the eye with moist cotton with water only from inner to outer aspect, and then dry it with clean dry cotton in one direction. Water only. Wipe the infants face, forehead, cheeks and mouth (clean inside the mouth if needed and nose with a moist cotton). Soap the scalp; support the infant using the football hold (the baby is supported under the nurses arm and no her hip) first lather your hand with soap then apply it to the scalp The infants head should be held over the wash basin, rinse thoroughly and if possible the ears should be covered with the nurses fingers. Place the infant on the table and dry the head with a part of the folded bath towel. Inspect the ears if any discharge present cleans it with the corner of washcloth. Remove the infants clothes. Lift the baby carefully and gradually into the tub, feet first, using appropriate hold. Quickly soap the infants entire body except the head using another wash cloth paying special attention to body creases, between toes, area under the chin and genitalia (revise the diaper care) Rinse the soap off the infant quickly. Again lift the infant from the tub back to the towel and dry well. Dress the infant; comb his/her hair gently. Clean all used equipment and return to its place. Wash hands. Record time and observations. NB: Allow time for kicking, playing, and talking with the infant to enjoy bathing. Apply lotion or oil to body creases avoids using of
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Student ID:

5. 6. 7. 8.

9. 10.

11. 12. 13. 14. 15. 16.

17. 18. 19. 20. 21. 22.

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: talcum powder. Talcum powder with oil makes a past, which retain body secretions and irritate the skin. It may be inhaled leading to respiratory distress Student ID:

Bottle Feeding
1 Indication: Extra indications to breast-feeding exist. Principles of Bottle Feeding: 1. Persons who prepare the formula must wash hands well. 2. The formula is prepared and bottled immediately before each feeding. 3. Warming the formula is optional. (if it stored in the refrigerator). Equipment: For a fully bottle-fed baby you will need at least eight full-size (250 ml) bottle with suitable nipples. Measuring cup for mixing powder formula. Plastic funnel useful for pouring formula. Plastic spoon stirring formula. Plastic knife for leveling off scope of powder formula. Bottlebrush needed to clean thoroughly inside the bottle. Action Prepare the needed equipment.
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Comments

1.

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Student ID:

Instructors Names: Date: Area: Group: 2. Hand washing by soap and running water. 3. Prepare formula as prescribed. 4. Check amount of formula on straight surface. 5. Let a few drops of formula fall in the inner aspect of your wrist to Test formula for temperature 6. Hold the baby unless contraindicated in a semi up right position, if a baby cannot be removed from the crib, sit the baby, and elevate his /her head, shoulders. 7. Put cotton under the babys chin. 8. Do not contaminate the nipple a much as possible. 9. Stroke the nearest cheek of the baby, or let some drops of formula touches the babys lips. 10. Hold the bottle so that the nipple and neck of the bottle are full of formula. 11. During feeding, hold the bottle firmly so that the baby can pull against it as he/she sucks. 12. Burp the baby halfway through the feeding and at the end by one of the following methods: a. Place a small towel over your shoulder to protect your gown, place the baby firmly against your shoulder and pat the back. b. Place the baby in sitting position put a towel beneath the chin support the chest and head with one hand gently rub the back with the other hand. 13. The feeding should take 15 to 20 minutes, dont hurry the baby or force the infant to feed too much. 14. If the baby doesnt want to let go of the empty bottle, slide the little finger between the baby gums and nipple to release the sucking. 15. Provide mouth care after feeding. 16. Place the baby on the abdomen or on right side position at least one hour. 17. Record the amount type of formula and baby reactions.

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Gavages Feeding
1 Purposes: 1. Introduce fluids, medications that cannot be given by mouth. 2. Carry out diagnostic procedures. 3. Conserve energy of infant, In case of prematurity or illness or congenital deformity or at risk of aspiration. Equipments: 1. A sterile suitable tube selected according to the size of the child and the viscosity of the solution (e.g. usual size for premature 5 French and 8 French for other children). 2. A stethoscope. 3. The solution of feeding. 4. Non allergic tape. 5. Sterile water for lubrication. 6. Container for the fluids. 7. 5ml 10ml syringes. 8. A pacifier. 9. Restraining equipment. 10. Gloves. Measurements: 1. Measuring from the tip of the nose to the tip of the earlobe and then to the end of xiphoid process, alternatively you may also measure from the bottom
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Student ID:

1. 2. 3.

4. 5. 6. 7. 8. 9. 10. a.

b. c. 11. 12. 13. 14 15. 16. 17.

Instructors Names: Date: Area: Group: 2. Measuring from the nose to the ear lobe and then to point midway between the xiphoid process and the umbilicus 3. The same measure from the mouth to insert oral tube. Action Prepare the needed equipment. Hand wash by soap under running water. Explain the procedure to the parent and the child if he can understand. Use on age suitable restraining Place the child supine with head slightly hyperflexed Measure the tube for approximate length of insertion. Mark the point with a small piece of tape. Lubricate the tube by sterile water. Check that the nostrils are patent. A pacifier is used or place the infants finger in his mouth Insert the rounded end of the tube into clearest nostril. Slide the tube backward and inwards gently along the floor of the nose until predetermined mark. Check the position of the tube by using at least two methods (Clamp indwelling tube before using any method): Attach the syringe to the feeding tube and apply negative pressure aspiration of stomach content indicate proper placement (Notify physician if a gastric residue is greater than 25% of the pervious feeding) by the syringe inject a small amount of air 0.5-1m in premature to 5m older children into the tube while listening with a stethoscope over the stomach area and then withdraw air. Emerge the end of the tube into a container containing clean water, the water during breathing if bubbling occur withdraw and reinsert. If the tube is fixed, stabilize the tube by holding or taping it to the cheek by adhesive tape. Check the formula temperature to be as the room temperature. Connect the syringe barrel into the tube. Pour formula into the barrel of the syringe attached to the tube. Raise the syringe barrel 20-25cm from the bed. To start flow, give gentle push with the plunger and allow the fluid to flow into the stomach by gravity. The rate of flow 5-10ml/min in premature, and 10ml/min in older infants and children.
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Student ID:

18. 19. 20. 21. 22. 23. 24. 25.

Instructors Names: Date: Area: Group: Just before the syringe is empty, pinch the tube by fingers. Flush the tube with sterile water or G5% 1-2cm. Clamp indwelling tube & remove the syringe. If the tube is to be removed pinch it firmly and withdraw the tube quickly. Position the baby on right side or abdomen at least one hour. Provide mouth care with gauze and normal saline. Record the amount, type of formula and amount of gastric residue. Remove equipment, leave area clean and tidy.

Gastrostomy Feeding
1 Providing nourishment and fluids via a tube that is surgically induced through an incision made through the abdominal wall into the stomach for those requiring tube feedings for an extended period of time. Equipment - Feeding formula - Pacifier. - Reservoir syringe or funnel - Syringe for aspirating. - Dressing or piece of cotton - Gauze for mouth care - Tape Action 1. Explain to the child or to the family the feeding procedure 2. Wash your hands. 3. Prepare the needed equipment 4. Check residual stomach contents before feeding.
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 5. Attach syringe and aspirate stomach contents. 6. Measure residual stomach contents 7. Residual fluid may be returned to stomach or discarded, depending on amount. 8. Place the child on comfortable position, either flat or with head slightly elevated 9. A pacified can be given. 10. Attach reservoir syringe to tube and fill syringe with feeding fluid to unclamping tube. 11. Elevate tube and syringe to 1012 cm above abdominal wall Do not apply any pressure to start flow 12. Feed slowly taking 20-45 min fill reservoir with fluid before it is empty to avoid instillation of air. 13. When feeding is completed: a. Instill clear water 1-30o of clear water. b. Apply clamp before water level reaches end of reservoir 14. Place the child in comfortable position. 15. Mouth Care 16. Wash your hands 17. Record the feeding time formula content, route of feeding and any changes or abnormality and report to the doctor. Student ID:

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Intramuscular Injections
1 A drug is administered by intramuscular route when: 1. A more rapid action is required than oral. 2. Giving medication into muscle. Equipments: 1. Tray. 2. Appropriate syringe and needle size. 3. Spirit lotion in container and swabs. 4. Prescription sheet. 5. Drug to be administered (vial or ampoule). 6. Sterile saline bottle or ampoule of sterile distilled water. Recommended Injection Sites for children: 1. Ventrogluteal area (any age). 2. Vastus lateralis (for infant and young child). 3. Rectus femoris (for infant and young child). 4. Gluteal region (children who have been walking for at least one year).
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Student ID:

1.

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Instructors Names: Date: Area: Group: 5. Deltoid muscle for older child to administer a small amount of drugs as insulin. 6. It is better to be avoided in childhood and infancy Action Check the medications order (Medications card) accuracy and frequency. It should contains the following, the five rights: The childs name. Name of drug. Time for administration. Route of administration. Dose to be administered. Clarify any discrepancies in the order with the senior nurse or the physician. Arrange the medications cards in logical order for distribution. Wash hands and wear disposable gloves Prepare the drug in suitable syringe, needle, and cotton swabs in a tray far from the child. Attach the needle to the syringe without removing it from its protective covering. Prepare antiseptic swab. Prepare the drug dose. Remove old gloves and wear new one Explain procedure to child and parents. Talk to the child while preparing him/her. Expose patient to a minimum stress, and select proper site according to childs age: Ventrogluteal area (any age), because its sufficiently thick and does not contain major nerves or vessels. Vastus lateralis (for infant and young child). Rectus femoris (for infant and young child). Gluteal region (children who have been walking for at least one year), the musculature itself is poorly developed until the child has been walking for a year or more. Deltoid muscle for older child to administer a small amount of drugs as insulin, it is better to be avoided
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Student ID:

13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26.

Instructors Names: Date: Area: Group: in childhood and infancy, its poorly developed Clean the site with an antiseptic swab using a circular motion from inner to outer. Remove the needle cover. Expel air bubbles unless one is to be left. The muscle mass of the thigh to be injected in firmly grasped in one hand to stabilize the limb and compress the muscle mass for injection with other hand. Insert the needle with proper angle according to the selected muscle by quick, firm movement with minimum injury. Stretch the skin taut between thumb and forefinger. Fix the syringe with left hand and aspirate before injecting if blood is revealed, the needle must be withdrawn and reinserted. Inject the content of the syringe slowly. Press the cotton against the injection site and pull the needle quickly. Move the limb or massage the site with alcohol sponge, if bleeding occurs apply pressure (with dry sponge until bleeding stops) to the site until it stops. Dispose of supplies according to agency procedures. Wash hands. Hold the child and try to please or give him/her any toy according to his age. Record in patients chart name of drug, dose, route, time and signature.

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Intravenous Fluid Therapy

1 Purpose: 1. To restore and maintain the childs fluid and electrolyte balance and body homeostasis when his oral intake is inadequate to serve this purpose. 2. To replace severe fluid loss in emergency situations such as in severe burns, severe hemorrhage and dehydration. 3. To administer medication when other routes are not appropriate. Equipment: 1. I.V. solution The kind of solution is specified by the doctor 2. Tray 3. V. administration set. 4. V. pole.
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 5. Label. 6. Doctors order sheet. 1. 2. Procedure Preparatory Phase Check the infusion fluid which is prescribed by the doctor. Check the following details: a. Childs name, room and bed number. b. Date of prescription. c. Type of prescribed fluid. d. Amount of prescribed fluid. e. Container labeled for I.V. therapy. f. Expiry date of the I. V. fluid. g. Time prescribed for starting the I.V. therapy. h. Time to be taken for completion of I.V. infusion. i. Signature of the medical practitioner. Check the fluid for cloudiness, sedimentation or discoloration. Check the system: the solution, set, cannula and patient Performance Phase Set up intravenous infusion in an area not visible to the child. Inspect the solution and turn the I.V. bottle. Write down data, rooms No; childs names, components, start from, dripping/minute on the label and then put it on the bottle Remove protective cap from spike of infusion set and insert through outlet hole in bottle stopper. Hang I.V. bottle on I.V. pole. Squeeze a drip chamber and fill the drip chamber with one third to half of solution, this volume prevents air bubbles from entering the tube. Remove protective covering from needle adapter and open clamp, and then run solution through, tubing allowing some fluid to flow needle adapter and close clamp dont touch the needle adapter at any place. Student ID:

3. 4. 1. 2. 3. 4. 5. 6. 7.

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Intravenous Fluid Therapy

Cannula Insertion Equipment: 1. Appropriate size of cannula 20-24 are appropriate size for pediatric age The size of the cannula depends on the age and size of the child and the type of fluid to be administered. 2. Tourniquet. 3. Normal saline. 4. Cotton sponges with alcohol and dry cotton sponges. 5. Surgical adhesive tape. 6. Kidney basin. 7. Label. 8. Padded arm board.
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Student ID:

1 2 3 4 5 6 7 8 9 1. a. b. c. d. 2. 3.

4.

5. a. b. c. d. e. f.

Instructors Names: Date: Area: Group: 9. Restraining devices if necessary. 10. Syringe (5 or 10 ml). Select an appropriate vein puncture site. Restrain the child if needed. Tighten tourniquet above the vein where needle will be inserted Cleanse an area of needle insertion with cotton with alcohol. Insert the needle and check for blood return Remove the tourniquet. Connect needle to infusion set and fit the tube. Start to drop and set the I.V. flow rate according to doctors order & calculate the dose. Dispose the equipment properly Follow up phase: follow the system Check the child at least hourly for: Note the color of the skin at the needlepoint. Note the location of the I.V. needle. Check for swelling of the skin at the needlepoint: If in a hand or foot, compare with the opposite extremity. If in the head, look at the face to determine asymmetry. Feel the area around the I.V. site for leakage. Weigh the child at regular intervals, using the same scales each time. Maintain an accurate record of intake and output every 8 hours. Record essential information: Total amount of fluid infused compare with the total amount of fluid intended to be infused. Rate of flow. Apparent condition of the child. Irrigate the I.V. as necessary as follows: Gather equipment syringe with 1-3ml normal saline and several alcohol wipes. Clamp off the solution aspirate first. Disconnect the I.V. tubing at the needle insertion site. Keep it sterile. Connect the syringe to the tubing at the needle insertion site. Slowly inject the normal saline. Disconnect the syringe and reconnect the I.V. tubing to the needle insertion site
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: g. Unclamp the I.V. and regulate the flow of the solution. h. Check frequently to make certain that the I.V. is functioning properly. Student ID:

Cannula Care
Equipments: 1. Dry cotton balls. 2. Syringe with 2 ml saline 3. Cotton with alcohol. 4. Cotton balls soaked with saline 5. Gauze pads. 6. Adhesive tape Action Wash hands. Prepare all equipment. Explain procedure to the child or his/her mother.
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Comments

1. 2. 3.

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Remove old dressing with cotton soaked with saline. Inspect site for presence of any abnormalities. Clean site of insertion to outward by cotton with alcohol. Clean I. V. site by cotton with alcohol. Apply adhesive tape. Remove & clean equipment. Hand wash. Record. Student ID:

4. 5. 6. 7. 8. 9. 10 11

Colostomy Care
1 Objectives: To promote healing of the stoma To provide comfort To teach patient or parents self care Equipment; A tray with: 1. 1 bowl with soap solution (not irritant) or any
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: solution according to hospitals policy. 2. 1 bowl with clear water. 3. Large pieces of gauze. 4. Colostomy bag if available. 5. Zinc oxide ointment or soothing cream. 6. Disposable gloves. 7. Rubber sheet. 8. Towel. 9. Clean cloth. Remember to: 1. Wash hands. 2. Wear gloves. 3. Keep privacy , Close windows and doors to prevent air graft 4. Explain procedure to the child or to his mother. 5. Check Colostomy site. 6. Keep patient in a comfortable position. Action Explain procedure to the child and his mother. Prepare all necessary equipment. Close windows and screen patient. Place disposable container in an easily accessible spot. Protect bed with rubber sheet. Wear disposable gloves Remove any adhesive and cut bandage on each side of colostomy Remove soiled dressing, If no colostomy bag is used If colostomy bag is used, remove it, pulling towards the stoma with clean forceps and dry Pieces of gauze Assess the stoma output for volume, consistency and odor in relation to the type and location of the stoma. Gently and thoroughly wash the skin using warm water and mild soap (not irritant) Assess the stoma and surrounding skin by using gauze. Clean well over and around stoma remove any stools When the stoma became clean, repeat with gauze soaked in clear water. Wipe the Peri-stoma skin with mild soap and water and dry it put zinc oxide, or any soothing cream
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Student ID:

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: If bag is used: a. Measure the circumference of stoma and choose appropriate bag. b. Fix bag on skin applying even, firm pressure tight to stick bag. If bag is not used: Apply a folded cloth over the stoma and secure it with a tape (Tape must be not irritant if available). Remove and clean all equipment. Wash hands. Keep child dry and comfortable. Reassure child, and mother, praise him for cooperation. Record condition of dressing and stoma color of stools and character, time and signature. Student ID:

16.

17. 18. 19. 20. 21. 22.

Enema
Indications: For cleansing these enemas may be used to empty the lower intestine. Isotonic saline or commercially prepared solutions may be used for this type of enema. Therapeutic cool saline is used to reduce the body
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Student ID:

1 2 3

1. 2. 3. 4. 5. 6. 7. a. b.

Instructors Names: Date: Area: Group: temperature of infant with a high fever; barium enema may also used for the reduction of an intussusceptions. Diagnostic the most frequent use of diagnostic enemas is the examination of lower intestinal tract with liquid barium sulfate. Equipments: 1. Container for enema solution. 2. Solution. 3. Rectal catheter, appropriate size. 4. Lubricant. 5. Disposable gloves. 6. Bath thermometer. 7. Bed pan, diaper. 8. Rubber sheet or water proof pad. Remember to The amount of fluid instilled varies with the age and size of the child, also the same as regard length of catheter advancement. Never Force the catheter into anal canal, if a welllubricated catheter does not advance easily stop the enema. Tap water or hypotonic solution should be used with caution. Absorption of large amounts of fluid instilled into the bowel may produce hypo tonicity of the extra cellular fluid and hyponatremia. Action Explain procedure to the child or his/her parent. Wash hands. Prepare all needed equipment. Fill the container with enema with solution warmed to body temperature, unless the purpose is to reduce body temperature. In that case a cool solution is used. Provide for the child privacy, close curtains, around the bed, drape the child with the anus exposed. Put waterproof sheet under the child. Place a bedpan under the childs buttocks; place the child in one of the following positions: The child lies on the left side in the lateral recumbent position with knees draw up to the chest The infant is placed on the back and legs are lifted to
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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: expose the anal orifice(area for insertion) The Sins position is used for the older child, who lies on the left side, with the right thigh flexed bout 45c to the body axis The knee chest position may be used for the older child. The child balances on the knees and chest, resting the head on the forearms *drape the child with the anus exposed. Put on gloves Lubricate the rectal catheter by lubricating jelly with Lidocaine 2%. Introduce the catheter past the anal sphincter to the anal and lower rectum. When the tip of the catheter is in place, elevate the bag and instill the fluid slowly. If the child shows symptoms of distress, does the flow of fluid stooped. Remove tip of catheter and the buttocks is hold together for a few minutes; the child is urged to defecate. Place the child on bed pan or apply clean diaper. Dispose equipment. Wash hands. Praise the patient For his cooperation Record results of enema. Student ID:

c. d.

8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.

Age Infant Small child Large child Adolescent

*Wt. 5-10 kg. 11-30 kg. 31-50 kg. Over 50 kg.

*Amount of fluid 100-200 ml 200-300 ml 300-500 ml 500-700 ml

Length of Advancement 2.5cm 5cm 7.5cm 10cm

Naso/ Oro pharyngeal suctioning

1 Purposes: 1. To maintain patent airway. 2. To facilitate exchange of gasses.
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Equipment: - Suction tubing. - Suction device. - Irrigating solution (sterile water). - Water soluble lubricant or sterile water. - Disposable gloves or sterile gloves. - Oxygen source. - Bag valve device. Suction catheter sizes: Neonate to 18 month 5 -8 French 18 months to 7 yrs 8 10 French 7 to 10 yrs 10 -14 French 11yrs to adult 12- 16 French Negative Suction Pressures: Premature 40-60mmHg Neonates 60 - 80 mmHg Infants 80 - 100 mmHg Children 100-120 mmHg Preparations 1- Assess the childs need for suction by respiratory rate, breath sound and heart rate. 2- Prepare all needed equipment. 3- Done chest physiotherapy (active or passive). 4- Check all equipment functioning. 5-Ventilate the child with 100% oxygen before during and after suctioning. 6- Reassure and calm the child and his relative. Action 1. Wash hands. 2. Turn on suction apparatus and set vacuum regulator to appropriate negative pressure. 3. Select appropriately sized suction catheter. a. Straight catheter is generally recommended for oropharyngeal and nasopharyngeal suctioning. b. Select appropriate catheter diameter. 4. Secure one end of connecting tube to suction machine and place the other end in a convenient location within reach. 5. Open sterile catheter package on a clean surface using the inside of the wrapping as a sterile field. 6. Set up the sterile solution container or sterile basin on the
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Student ID:

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: sterile field. Be careful not to touch the inside of the container. Fill with approximately 100 ml of normal saline or sterile water. 7. Open lubricant and squeeze on to sterile catheter package without touching package. 8. Provide 3 hyperinflation, hyper-oxygenation breaths with a bag valve mask connected to a manual resuscitation bag attached to 100% oxygen 9. Don sterile glove goggles and mask. 10. Pick up suction catheter, being careful to avoid touching the non-sterile surfaces. With the non-dominant hand, pick up connecting tubing and secure the suction catheter to the connecting tubing. 11. Check equipment for proper functioning by suctioning a small amount of sterile saline from the container. 12. Coat the appropriate length of suction catheter with watersoluble lubricant or sterile water by make an approximate measure by measuring the distance from the tragus of the child's ear to tip of the nose. 13. Leave catheter air vent open. 14. For suctioning Nasopharyngeal approach: a. Identify patent nasal passageway. b. Gently insert the catheter through the patent nostril, guiding it medially and downward along the passageway (use same technique when going through nasopharyngeal). 15. For suctioning Oropharynx approach: Gently insert catheter into mouth and advance catheter tip 3 to 4 in. into secretions of the pharynx. 16. Slowly withdraw the suction catheter while rotating it back and forth between dominant thumb and forefinger. Apply intermittent suction of the air vent during withdrawal. 17. Rinse catheter and connecting tubing with sterile water or saline. 18. Suction both sides of mouth and pharynx. 19. Repeat steps 15 through 18 to clear nasopharynx and oropharynx. 20. Monitor patients ECG tracing and heart rate between suction passes. 21. Dispose of catheter and gloves. 22. Reposition patient.
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Student ID:

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 23. Reassess patients respiratory status. 24. Discard remainder of supplies in appropriate receptacle. 25. Wash hands. 26. Dispose of suction canisters and connecting tubing every 24 hours and set up new system. Student ID:

Endotracheal Suctioning
1
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Comments

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Indication: It is performed to remove blood or secretion from the endotracheal tube. Equipment : 1- Suction catheter. 2- Suction tubing. 3- Suction device. 4- Sterile irrigating solution. 5- Sterile gloves mask. 6- Water-soluble lubricant or sterile water. 7- Oxygen source. 8- Bag-valve device. Procedure 1. Explain to the child and the family the need for endotracheal suctioning, as time permits. 2. Note the childs cardiac monitor and pulse Oximetry readings. 3. Wash your hands thoroughly with Betadine, don gloves and mask. 4. Connect suction catheter to the tubing of the suction device and set the suction pressures to the desired negative pressure according to child age 5. Ventilate the child with 100 % oxygen for 3 hyperinflation, hyper oxygenation with a bag valve device 6. Lubricate the appropriate size of catheter with sterile water. 7. Without applying suction, quickly and gently insert catheter into the endotracheal tube and apply suction while rotating the catheter between the thumb and forefinger. and use a septic technique. 8. Apply suction by occluding the on / off port, and gently withdrawing the catheter with a twisting motion. * Limit suction not more than 5 seconds. 9. After withdrawal of catheter, rinse it with sterile water. 10. Ventilate child in-between and after attempts with 100 % oxygen. 11. Monitor childs heart rate, color throughout the procedure. 12. Repeat steps 7-11 as needed. 13. Return child to previous oxygen setting, auscultate anterior lungs bilaterally.
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Student ID:

University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 14. Comfort child during and after procedure. 15. Discard reminder of equipment according to institution policies. 16. Document the childs response to suctioning, the type and amount of suctioned secretions, any changes in heart and respiratory rates Student ID:

Oxygen Therapy Through Simple Face Mask

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 1 Purposes : 1- To prevent or relieve hypoxia. 2- To keep healthy level of tissue oxygenation. Equipment : 1- Oxygen source 2- Flow meter. 3- Humidifier with distilled water 4- Connecting tube (except in using nasal cannula) 5- Selected device for oxygen administration (face mask, nasal cannula, incubator or oxygen hood) Action 1. Wash hands. 2. Attach humidifier to flow meter. 3. Connect flow meter to oxygen source, and check operation of flow meter and humidifier. Set prescribed oxygen flow. 4. Attach oxygen mask to connecting tubing and then to humidifier and flow meter. 5. Turn on oxygen. 6. Place mask on patients mouth and nose, adjust elastic or tubing for a snug fit. 7. Check oxygen flow. 8. Stress fire hazards involved with oxygen administration. 9. Wash hands. 2 3 4 5 Comments Student ID:

Oxygen Therapy Through Nasal Cannula

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: 1 Purposes : 3- To prevent or relieve hypoxia. 4- To keep healthy level of tissue oxygenation. Equipment : 6- Oxygen source 7- Flow meter. 8- Humidifier with distilled water 9- Connecting tube (except in using nasal cannula) 10- Selected device for oxygen administration (face mask, nasal cannula, incubator or oxygen hood) Action 1. Wash hands. 2. Attach humidifier to flow meter. 3. Connect flow meter to oxygen source, and check operation of flow meter and humidifier. 4. Open cannula package and attach to humidifier with care to avoid contamination of cannula nasal tips. 5. Turn oxygen flow meter on to prescribed liter flow/ oxygen concentration prior to applying cannula. Observe that water in humidification container is bubbling. 6. Insert the nasal tips into the nares. Direct prongs posteriorly. 7. Loop the two plastic tubes of the cannula over the ears and under the chin, or place elastic band around the head. 8. Gently adjust the plastic slide until cannula is secure. 9. Wash hands. 2 3 4 5 Comments Student ID:

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Closed incubators / Isolettes 1 2 1. The incubator is used to provide a controlled environment for the neonate. 2. Adjust the oxygen flow to achieve the desired oxygen concentration. a. An oxygen limiter prevents the oxygen concentration inside the incubator from exceeding 40 %. b. Higher concentrations (up to 85%) may be obtained by placing the red reminder flag in the vertical position. 3. Secure a nebulizer to the inside wall of the incubator if mist therapy is desired. 4. Keep sleeves of incubator closed to prevent loss of oxygen. 5. Periodically analyze the incubator atmosphere. Student ID:

Comments

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University of Hail- College of Nursing Pediatric Nursing Practice NURS 432 Summer Semester 2012-2013 Student Name: Instructors Names: Date: Area: Group: Student ID:

Oxygen Hood 1 1. Warmed, humidified oxygen is supplied through a plastic container that fits over the childs head. 2. Continuously monitor the oxygen concentration, temperature, and humidity inside the hood. 3. Open the hood or remove the baby from it as infrequently as possible. 4. Several different designs are available for use. The manufacturers directions should be carefully followed. 2 3 4 5 Comments

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