pediatric practice midterm procedures

7/28/2019 Pediatric Practice Midterm Procedures

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Oral

36.4 37.4c

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.

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.

5 minutes * More than 6

year's

children.

Rectal Temperature1 2 3 4 5 Comments

Indication:

To determine the childs temperature on admission as a base for

comparing future measurements. To monitor fluctuation in temperature.

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Equipment :

Cotton with alcohol & dry cotton

Container for waste

Water soluble lubricant.

Thermometer

Method range

Advantages

Disadvantages

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.

Instructors Signature: Student Signature:

Method

Range

Advantages Disadvantages Length of time Age

Rectal

37.0 37.8c.

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

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

3 minutes *New born

* Infant.

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has seizure or breathing

difficulties receiving

oxygen therapy, or has

oral surgery.

thermometer

placement is difficult.

5. Contra indicated when

child has diarrhea and

following rectal

surgery.

Axially Temperature1 2 3 4 5 Comments

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.

ThermometerMethod range

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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.

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.


Method

Range

Advantages Disadvantages Length of time Age

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.

1. Value is more readily

influenced by

environmental

temperature and air

flow.

2. Requires a relatively

long period of time to

obtain accurate

reading.

10 minutes. Less than 6

years children.

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Apical Pulse1. 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.


AgeNormal heart rate

(beats per minute)1 2 3 4 5 Comments

Newborn 100-160

15 months 90-150

612 months 80-140

13 years 80-130

35 years 80-120

610 years 70-110

1114 years 60-105

14+ years 60-100


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610 years 15-30

1114 years 12-20

14+ years 12-20


Blood Pressure1 2 3 4 5 Comments

Equipment:

- Measuring cuff and Stethoscope.

-Alcohol swabFormulas 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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12. Remove equipment.

13. Hand wash.

14. Record your observation.


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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 theage 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.

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

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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.


Table Tub Bath

1 2 3 4 5 Comments

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

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19. Dress the infant; comb his/her hair gently.

20. Clean all used equipment and return to its place.

21. Wash hands.

22. 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

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


Diaper Care

1 2 3 4 5 Comments

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.

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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:

a. Pause for a couple of seconds with the diaper held over his

penis.

b. 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.7. 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

8. Dry baby's bottom with a clean wash cloth

9. Apply a barrier of cream or zinc oxide ointment.

10. Place the new clean diaper under the infants buttocks and

sides in between his legs.

11. 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.12. Fold diaper so that it does not cover the cord stump.

13. Discard the old diaper, collect your equipments; leave the

area clean and tidy.

14. Wash hands.


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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 upright 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 thebaby 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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Gavages Feeding1 2 3 4 5 Comments

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

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

1. Prepare the needed equipment.

2. Hand wash by soap under running water.

3. Explain the procedure to the parent and the child if he can understand.

Use on age suitable restraining

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Place the child supine with head slightly hyperflexed

4. Measure the tube for approximate length of insertion.

5. Mark the point with a small piece of tape.

6. Lubricate the tube by sterile water.

Check that the nostrils are patent.7. A pacifier is used or place the infants finger in his mouth

8. Insert the rounded end of the tube into clearest nostril.

9. Slide the tube backward and inwards gently along the floor of the nose

until predetermined mark.

10. Check the position of the tube by using at least two methods (Clamp

indwelling tube before using any method):

a. 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)

b. 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.

c. Emerge the end of the tube into a container containing clean water, the

water during breathing if bubbling occur withdraw and reinsert.

11. If the tube is fixed, stabilize the tube by holding or taping it to the

cheek by adhesive tape.

12. Check the formula temperature to be as the room temperature.

13. Connect the syringe barrel into the tube.

14 Pour formula into the barrel of the syringe attached to the tube.

15. Raise the syringe barrel 20-25cm from the bed.

16. To start flow, give gentle push with the plunger and allow the fluid to

flow into the stomach by gravity.

17. The rate of flow 5-10ml/min in premature, and 10ml/min in older

infants and children.

18. Just before the syringe is empty, pinch the tube by fingers.

19. Flush the tube with sterile water or G5% 1-2cm.

20. Clamp indwelling tube & remove the syringe.

21. If the tube is to be removed pinch it firmly and withdraw the tube

quickly.

22. Position the baby on right side or abdomen at least one hour.

23. Provide mouth care with gauze and normal saline.

24. Record the amount, type of formula and amount of gastric residue.

25. Remove equipment, leave area clean and tidy.


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pediatric practice midterm procedures

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