KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCE

‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬

Nursing Department

‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬

Skills Laboratory Number 1 Part 1
Assist with the Assessment of the New born and Preterm Baby and Child

Course: Pediatric nursing

Level 6th level

Semester Two

Name of the student: ……………………………… No Skill Steps vital signs ( Temperature SS) Required frequency: 5 Prepare the equipments & instruments *Thermometer 1. Oral bulb 2. Rectal or stubby bulb 3 Electronic ( Interchangeable oral and rectal probes ) 4. Tympanic probe 5. Gloves Explain the procedure to the patient and family y. assemble the Equipment at the bedside. Oral determination Required * level of performance Performance rating ** 5 4 3 2 1 Comments

1

A

2 3

A

1

4

a. Wash hand b. Select an instrument ( oral ,stubby or electric ) c. If the thermometer has been stored in chemical solution , rinse it with water and wipe it dry with a soft tissue d. *Shake a glass thermometer until the mercury is below the 35.5 c mark .Firmly hold the non-bulb end of the thermometer and briskly snap the hand at the wrist. If using an electronic thermometer , remove from charger and slide cover over probe e. *Place the bulb under the right side of the child tongue .Have the child close mouth around the thermometer (If the child is over the age of 6 years ) f. *Leave the thermometer under the tongue for 3-5 minutes. Stay with the child while thermometer is in place g. *If an electronic thermometer is used, use the oral probe with a disposable plastic probe cover. The thermometer will signal when the peak temperature has been reached h. Remove the thermometer from the mouth and read the temperature i. After use , wipe thermometer with soft tissue , rinse in cold water , and store according to policy Rectal determination a. Wash hand b. Select an instrument ( Rectal /stubby or electric ) and provide privacy for the child c. Rinse, wipe and shake the rectal thermometer as in oral

A A D A A

A
A

A

A

A

A

A

2

temperature. If an electronic thermometer is used , remove from charger and slide cover over probe d. Lubricate the bulb with a water soluble gel Infant 1. place infant prone , spread the buttocks with one hand and insert the thermometer slowly and gently with other hand 2. *Insert the bulb into the rectum about 1/4 1/2 . 3. *If resistance is felt , remove thermometer and choose another route Older child 1. Position child on side , separate buttocks to expose the anal opening 2. *Gently insert the thermometer into the rectum about 111/2 3. *Hold thermometer in place for 3-4 minutes or until electronic thermometer signal is heard 4. *Never leave child alone with a rectal thermometer in place 5. Remove the thermometer in a straight line 6. Wipe it off with a soft tissue .If an using an electronic thermometer 7. Insert probe into base and store in charger

A

A

A A

A A A A A A A A

3

Wash hand 2. Reposition child in a comfortable position and clean thermometer according to the policy 5 Axillary determination 1. remove from charger and place cover on probe 4. well up into the armpit.8. wipe and shake the thermometer as suggested in the procedure for obtaining an oral temperature. Place the bulb under the arm. Bring the child's arm down close to the body and hold in place 5. *Leave in place 10 minutes or until electronic thermometer signal is heard Final assessment A A A A Done Repeat Level of performance A. Read the temperature 9. Ability to perform the activity without supervision B. Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed 4 . Ability to perform the activity under supervision C. Select instrument – follow institution policy concerning whether to use a rectal or oral thermometer 3. *Rinse. Ability to assist with performance of the activity D. If an electronic thermometer is used .

* Place the first.Count the beats for 1 minute Required * level of performance Performance rating ** 5 4 3 2 1 Comments A A D A 2 Older child – Radial rate 1. second or third finger along the child's radial artery and press gently against the radius. 5 .KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICALSCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقة‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 1 Part 2 Assist with the Assessment of the New born and Preterm Baby and Child No 1 Skill Steps vital signs ( Pulse SS) Required frequency: 5 Infant & young child and all cardiac patients – Apical rate 1.*Place the stethoscope between the left nipple and sternum 3.Take the apical rate before any other vital sign measurement is attempted 2.

Ability to perform the activity without supervision B. Rate b.2.Assess rhythm ( Regularity versus irregularity ) . Location felt d.Accurately record the following in the medical record a. Report any changes in pulse characteristics to the physician immediately Final assessment : Level of performance A.*Rest the thumb in opposition to the fingers on the back of the child's wrist 3.Count the arterial pulsations for 30 seconds and multiply by 2 to calculate the rate for one minute . amplitude ( Strength of pulsation ) . Quality of the pulse c.*Apply only enough pressure so that the child's pulsating artery can be felt 4. Knowledge of the activity by observation A A D D D D Done Repeat Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed 6 . palpate the pulse for 1 full minute 5.If the pulse rate is abnormal .& elasticity of the vessel ( Distension of vessel ) while counting the rate 6. Regularity or irregularity of rate e. Ability to assist with performance of the activity D. Ability to perform the activity under supervision C. Activity of child at time pulse is taken 7.

note the rise and fall of the abdomen with each inspiration and expiration In the older child . note the rise and fall of the chest with each inspiration and expiration *Using a watch with a sweep hand .KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OFAPPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . count the respiration for 30 -60 seconds . depending on the age of the child Compare to the average rates at rest Record the findings according to policy Final assessment Required * level of performance A A A A A D Performance rating ** 5 4 3 2 1 Comments Done Repeat Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed 7 . non – threatening manner In the infant .6th level Semester Two Name of the student: …………………………… Skills Laboratory Number 1 Part 3 Assist with the Assessment of the New born and Preterm Baby and Child No 1 2 3 4 5 6 Skill Steps vital signs ( Respiration SS) Required frequency: 5 Approach the child in a quiet .

KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . Place the infant or child in a sitting or recumbent position. The forearm is supinated and slightly flexed 2.6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 1 Part 4 Assist with the Assessment of the New born and Preterm Baby and Child No 1 2 Skill Steps vital signs ( Blood pressure SS) Required frequency: 5 Prepare the equipments & instruments *Stethoscope * Appropriate size cuff * Sphygmomanometer * Doppler blood pressure device * Elastic bandage Auscultation : brachial Artery 1. Remove all clothing from the upper extremity 3. Required * level of performance Performance rating ** 5 4 3 2 1 Comments A A A A 8 . Demonstrate the equipment and procedure to the child using appropriate terminology.

the cuff is deflated and removed from the arm Auscultation : Popliteal Artery 11.* With the palpating digit kept over the artery pressure is released slowly until the pulse is felt. Locate the artery by palpation at the antecubital fossa 7.and the correct size cuff 17. with the stethoscope over the popliteal artery. Place the monitor on a firm . Check equipment for connection and function 5. The end point is recorded as the systolic pressure Doppler 16. Place the correct size cuff around the upper arm with the inflatable portion centered over the blood vessel. After readings have been made . Obtain the monitor . *Slowly release the air valve . The leg is slightly flexed. permitting the column of mercury to fall at a rate of 2-3 mm per heartbeat 10. with the lower edge about 2cm above the popliteal space *13. dual air hose . Place the correct size cuff around the thigh . *The sphygmomanometer cuff is inflated until the radial pulse cannot be palpated 15. Place the stethoscope gently over the artery 9. the subsequent procedure is identical to that for the brachial artery Palpation 14. immobile surface 18. Place the child in prone position 12.2 3 4 4. plug in the monitor and connect the dual air hose to the back of the A A A B B B B B B B D B A A B 9 . The lower edge should be 3 cm above the antecubital fossa 6. *Close the air valve and rapidly inflate the cuff to 30 mm Hg above the expected systolic pressure or until the radial pulse disappears 8.

5 monitor *19. Repeat the procedure at least twice to confirm the reading 29. Apply the cuff snugly to the distal forearm with the outer edge at wrist. Turn the power switch to the ON position 22. Person notified if reading is of concern B B B B A B B B B A D Final assessment Done Repeat Level of performance A. Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed 10 . Place the child in a recumbent position *24. Reading obtained b. Size of cuff used e. Repeat the procedure until flushing is observed in the blanched limb 28. Record the reading Flush ( should be used in newborns or small infants whose pressure is difficult or impossible to obtain by other technique) 23. Wrap the extremity distal to the cuff with an elastic bandage *26. Extremity used c. Screw the pressure cuff's tubing into the other end of the air hose 20. Ability to assist with performance of the activity D. Wrap the correct size cuff around the child's limb 21. the cuff is applied to the distal leg with outer edge at the ankle 25. Upon concluding the blood pressure determination record the following a. Inflate the cuff to 150 -200 mm Hg and remove the elastic bandage *27. Ability to perform the activity under supervision C. If lower extremity pressure is to be determined . Type of method used d. Lower the cuff pressure by 5mm Hg and leave at that level for 3-4 seconds. Ability to perform the activity without supervision B.

using a protective barrier on your hand 4. Place cover sheet on scale *2. Weight baby at the same time A A B A B 11 . Adjust the scale balances to 0 .KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OFAPPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . Record weight on baby's chart. Wear gloves if newborn has not been bathed *3.6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 1 Part 5 Assist with the Assessment of the New born and Preterm Baby and Child N o Skill Steps Weighting & measuring the newborn Anthropometric measurements Required * level of performance Performance rating ** 5 4 3 2 1 Comments 1 2 SS (A) Required frequency: 3 Prepare the equipments & instruments *Scale * Cover sheets * Paper tape measure Weighting 1. or push the appropriate pads on the digital scales .

Place the paper tape under the newborn's head to measure head Circumferences. measuring just above the eyebrows so that the largest area of the occiput is included 10. 9. Compare your finding with the normal range . Wrap the tape around the chest . A A B B B D D A A D D A A A 12 . and extended one leg . Chest circumference is measured at the nipple line . place the newborn in supine position on the crib mattress . Watch that the tape measures remains straight 6. To measure length . with the other hand *5.at nipple level 2. Wear gloves if the newborn has not been bathed *4.3. most infants are 48 to 53 cm in length 8. Wrap the tape around the newborn's head . at umbilical level. Record your finding in the infant's chart To measure chest circumference 1. Place the paper tape measure beside the infant .Place the paper tape under the newborn's abdomen. with the 0 end of the tape against the top of the crib *3. at the nipple line 3. average chest circumference is 30. Measuring *1. most infants are 32-37 cm. Compare your finding with the normal range. Note the circumference and record it in the infant's chart.Place the paper tape under the newborn's chest .5 to 33 cm To measure abdominal circumference 1.Hold the newborn's head straight with one hand . with the hand against the top of crib *2. Note the length and record it in the infant's chart 7.

Ability to perform the activity without supervision B. Wrap the tape around the newborn's. Ability to assist with performance of the activity D. 3.*2. Ability to perform the activity under supervision C. at umbilical level. Note abdominal circumference and record it in the infant's chart Final assessment : Level of performance A. Knowledge of the activity by observation A A Done Repeat Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed 13 .

6 c ) * Mild soap *Cotton balls * Soft washcloth *Diaper * Dry clean clothing * Blanket * No sterile gloves * Alcohol pad (If care for umbilical cord care is indicated) Required * level of performance Performance rating ** 5 4 3 2 1 Comments A 14 .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 1 Part 6 Assist with the Assessment of the New born and Preterm Baby and Child o 1 Skill Steps Bathing an infant or small child SS (A) Required frequency: 3 Prepare the equipments & instruments *Basin with warm water ( 40.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OFAPPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .

Repeat on other side of the face . giving particular attention to the skin folds of the neck. Gently wash one side of the face from forehead to chin. and the external part of the ears. giving added emphasis to skin folds Moisten a cotton ball with water and wipe eyes from inner canthus to outer canthus.Do not use soap on the face Dry infant's face with towel To cleanse the baby's scalp. going around the nose and mouth. Wash between fingers. Soap and rinse head and dry with towel Continue washing ears and neck. Rinse and wring washcloth. Hold baby's head over the basin. Wash trunk and arms. then wipe away soap. behind the ears. Wipe washed areas repeatedly to rinse off soap Remove infant's shirt. Dry washed areas with a towel . Turn infant one on side to wash back Cover infant with a blanket. assemble the Equipment at the bedside. pulse and respiration Wash the child from head to feet. exposing lower half of body. wipe over abdomen & around umbilical cord . Cover ears with thumb and middle finger.* Comb * Baby lotion * Towel 2 3 4 5 6 7 8 Explain the procedure to the patient and family y. Repeat to ensure removal of soap Dry area with towel. Cover trunk after drying Remove diaper. Wash hands Assess the child Take & record temperature . Keep upper half of body covered with blanket Lightly soap washcloth.Work A A D A A A A 9 10 A A 11 A 12 13 14 15 16 A A A D D 15 . repeat with a clean cotton ball on the other eye Wet washcloth & wring. pick up baby securely by sliding hand under the baby until the head is well supported in the palm of the hand.

Redress and position the infant in the isolette or bassinet Document any abnormalities in the skin surface in the medical record a. paying particular attention to skin creases Wash genitalia with cotton balls. white papillae occurring on the nose and chin that are caused by obstruction of the sebaceous glands. use each cotton ball for one stroke only The male genitalia should be washed with cotton balls from penis to anus. Jaundice –yellow discoloration of the skin that appear between the thirds and seventh day of life d. most notably on the upper eyelids . Desquamation – peeling of the skin during the first 2-4 weeks of life b. using a front to back motion. clean around umbilical cord with alcohol swab or sterile applicator Rinse washcloth and wipe soap off body .red localized area of capillary dilatation forming a variety of angiomas . Telangiectatic nevi ( Stork bites ) – flat . these disappear in 1-2 weeks c. these disappear usually by 2 years of age e.17 18 19 20 21 22 23 24 25 down each leg to the foot. Milia –tiny. Wash between toes. Forceps marks – marks left on part of the body here the blades exerted pressure Document the infant's tolerance of the bath process Replace equipments Wash hands A A B B B D D A A Done Repeat Final assessment 16 . Rediaper . Spread apart the female's labia and clean between folds. using long stroking motions. Do not retract the foreskin of the penis Next wash the anus and between the gluteal fold and buttocks Dry lower half of body.

Ability to perform the activity under supervision C. Ability to assist with performance of the activity D. Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed 17 . Ability to perform the activity without supervision B.Level of performance A.

Measure the concentration close to the child's airway c.6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 2 No Skill Steps Oxygen therapy for children Required frequency: 5 ( CS ) Prepare the equipments & instruments Explain the procedure to the child and allow him or her to feel the equipment and the oxygen flowing through the tube . Measure when the oxygen environment is closed b.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ ‫جامعة تبوك المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . if necessary Measure oxygen concentration every 1-2hours when a child is receiving oxygen through incubator hood or tent a.mask Maintain a clear airway by suctioning . Record oxygen concentrations and simultaneous measurements of pulse & respiration Required * Performance rating ** level of 4 3 2 1 performance 5 A A Comments 1 2 3* 4* B B D 18 .

Avoid using oil or grease around oxygen connections b. Have a fire extinguisher available A A A A D 19 . Do not use alcohol or oils on a child in an oxygen tent c. Do not permit any electrical devices in or near an oxygen tent d. Prohibit smoking in areas where oxygen is being used f. Avoid the use of wool blankets and those made from some synthetic fiber because of the hazards resulting from static electricity e.5* 6 7 8 9 Observe the child response to oxygen Organize nursing care so that interruption of therapy is minimal Periodically check all equipment during each tour of duty Clean equipment daily and change it at least once each week Keep combustible materials & potential sources of fire away from oxygen therapy Pt teaching: a.

Do not use masks for comatose infant or children B B B B D Face tent 1. A flow of 8-10 L should be to flush the system and provide a stable oxygen concentration B B 20 . Slow reduce liter flow b.s mouth and nose so that it fits securely . Place the mask over the child . Face tent are available in the adult size only 2. Open air events in incubators 11 Continually monitor the child's response during weaning . Increase pulse rate c. cyanosis D B B Oxygen by mask 1.Secure the mask with an elastic head grip 4. a. Use a mask that is capable of delivering the desired oxygen concentration 3. Remove the oxygen mask at hourly intervals . Observe for restlessness b. wash the face & dry 5. Observe respiratory distress . Choose an appropriate size mask that cover the mouth and nose but no the eye 2.10 Terminate oxygen therapy gradually a.

Remove the child from the mist periodically 5. The flow rate must be set to meet the minute volume requirements of the child and to provide a 100% source of gas.50% can be achieved in well – maintained tents 4. Maintain a tight – fitting canopy. Check the child frequently 4. Oxygen tent 1. Select the smallest tent & canopy that will achieve the desired concentration of oxygen and maintain patient comfort 2. Make certain that the crib sides are up 6. Observe the small infant for signs of over hydration C B B B B B B B B C B A B 21 . Select toys that retard absorption . are washable & will not produce static electricity Croupette 1. Concentrations of 30% . Analyze & record the tent atmosphere every 1-2 hours. 2Change the child's clothing and bed linen when damp cover the child with a cotton blanket 3. provide nursing care through the sleeves or pockets of the tent 5. Promote postural drainage and suction the child as necessary 6.This is an oxygen tent equipped with high – Humidification system.T-bars and tracheostomy mask 1. Pad the metal frame that support the canopy 3. Whenever possible .These devices are used to deliver oxygen to intubated patients 2.

humidified oxygen is supplied through a plastic container that fits over the child's head 2. The incubator is used to provide a controlled environment for the neonate 2. *Warmed . Adjust the oxygen flow to achieve the desired oxygen concentration a. The manufacture's direction should be carefully followed B D B C C C C B B B D Done Repeat Final assessment 22 . Several different designs are available for use. Higher concentrations ( up to 85% ) may be obtained by placing the red reminder flag in the vertical position 3. Periodically analyze the incubator atmosphere 3 Oxygen hood 1. Secure a nebulizer to the inside wall of incubator if mist therapy is desired 4. An oxygen limiter prevent the oxygen concentration inside the incubator from exceeding 40% b. *Continuously monitor the oxygen concentration . Open the hood or remove the baby from its infrequently as possible 4. Keep sleeves of incubator closed to prevent loss of oxygen 5.temperature & humidity inside the hood 3.Incubator oxygen therapy 1.

KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES

‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬

Nursing Department

‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬

Course: Pediatric nursing

Level .6th level

Semester Two

Name of the student: ………………………………

Skills Laboratory Number 3
No Skill Steps Obtaining throat culture (CS) Required frequency: 2 Prepare the equipments * Throat swab * Tongue depressor * Media culture Explain the procedure to the woman & describing the sensation to expect Gather equipment Wash hand ,wears gloves Have child stick out tongue and say “ah” C 6 Depress anterior half of tongue with tongue depressor if necessary C 7* Swab area with exudates or redness , one time only per swab ( Avoid Required * Performance rating ** level of 4 3 2 1 performance 5 A Comments

1

2 3 4 5

B D B

23

8 9 10 11

teeth , tongue , cheeks , lips & palate Be sure parents or nurse comfort child Label , obtain requisition

C A A

Transport to laboratory Document procedure , including description of pharyngeal area if you can see it A D Done Repeat

Final assessment
:
Level of performance A. Ability to perform the activity without supervision B. Ability to perform the activity under supervision C. Ability to assist with performance of the activity D. Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed

24

KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICALSCIENCES

‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬

Nursing Department

‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬

Course: Pediatric nursing

Level .6th level

Semester Two

Name of the student: ………………………………

Skills Laboratory Number 4
No Skill Steps Promoting postural drainage in pediatric patient (IS) Required frequency: 1 Preparatory phase *1. Assess the child's respiratory status a. Obtain a baseline respiratory rate b. Observe for respiratory distress retraction, nasal flaring, and so forth 2. Identify the involved portions of the lung by auscultation , percussion or review of the x ray report 3. Explain the procedure to the child or the parent 4. Make the child comfortable a. Remove constricting clothes b. Flex the child's knee and hips c. Have tissue and an emesis basin available d. Have several pillows available *5.Provide bronchodilator or nebulization therapy prior to the procedure if indicated
Required * Performance rating level ** operformance 5 4 3 2 1

Comments

1

D

B D C

C

25

Ability to perform the activity without supervision B. cup the chest wall for 1-2 minutes *3. Have the child inhale deeply .as he exhales . The spine should be as straight as possible to permit optimal expansion of the rib cage 2. Unless contraindicated . Encourage the child to cough *5. Allow the child to rest for a minute . then repeat cupping vibration and coughing until no more mucus is produced or the child . Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed 26 .s condition indicates that the procedure should be stopped C C B D B Done Repeat Final assessment Level of performance A.2 Performance phase *1. Ability to perform the activity under supervision C.vibrate the chest wall during three to five exhalation 4. Thereat to be drained should be elevated b. then . Ability to assist with performance of the activity D. Place the child in asides of appropriate position a.

KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 5 No Skill Steps Suctioning the tracheostomy (CS) Required frequency: 2 Prepare the equipments  Sterile tracheostomy tube  Twill tape  Scissors  Sterile cotton –tipped applicators  Sterile water  Hydrogen peroxide  Sterile dressing  Sterile suctioning catheters  Sterile gloves  Sterile saline Explain procedure Gather equipment D A Required * Performance rating level of ** performance 5 4 3 2 1 A Comments 1 1 2 27 .

The appearance of the stoma f. Other pertinent data A C C C D C 9 D Final assessment Done Repeat 28 . The relief afforded the patient d. put on sterile gloves Instill 0. The character of the secretions c. The patient's behavior e.3 4 5 6 7 8 Wash hands . some children may need a few breaths via a resuscitation bag Clear the catheter with sterile saline between insertions. child may need to be suctioned more than once * Saline should also be discarded to prevent growth of pseudomonas in standing solution Document procedure a. Time & frequency of suctioning b.5 to 2ml of normal saline into the trachea before suctioning to loosen secretions per institution policy Lubricate the tube with sterile saline and insert the catheter without applying suction Withdraw the catheter in a continuous rotating motion while applying suction ( 5 seconds only ) Allow the child to rest.

KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCE ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 6 No Skill Steps Gastrostomy tube feeding CS ( C ) Required frequency: 3 Require Performance rating ** d * level 5 4 3 2 1 of perform ance A Comments 1 2 3 4 5 Prepare the equipments & instruments *Tray * Warm feeding fluid * Pacifier * Reservoir syringe or funnel * Syringe for aspiration . to flush tube as ordered ( may be up to 15 to 30 Ml) Note : Equipment should be sterile for premature and new born infants Explain procedure Gather equipments Wash hands Position child comfortably . with head lightly elevated if not contraindicated * Provide pacifier to relax a baby * An infant can be held and cuddled during the feeding * An older child can sit in a highchair A A A B 29 .

Remove clamp .( This prevents air from entering the stomach and causing distension ) Elevate receptacle. Allow formula to flow slowly by gravity –Force should never be used Continue to add formula to the syringe before it empties completely * The feeding should take 20 to 25 minutes to complete in order to prevent regurgitation . this needs to be reported to the physician Attach syringe barrel to gastrostomy tube. * Residual is always checked because overloading the stomach can cause reflux & increase the danger of aspiration * If the residual amount or increases . vomiting .Stop feeding if any of these occur and notify the charge nurse Clamp the tube as the final formula or water is passing through the lower part of the syringe Position or hold patient * Hold the patient quietly *Reposition in Fowler's position or in right side to promote gastric emptying Document procedure *Record the type ( gastrostomy feeding ) *The amount given *The amount and characteristics of the residual * How the patient tolerated he procedure * Record on intake & output section Replace equipments Wash hands C C C C D C C D A A Done Repeat Final assessment 30 .or aspiration Observe the signs of respiratory distress .6 7 8 9 10 11 12 13 14 15 Check residual stomach contents by attaching syringe to gastrostomy tube and aspirating. Fill with formula .

6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 7 No Skill Steps Breast feeding the ill or hospitalized infant (SS ) Required frequency: 2 1. Preparatory phase Encourage the mother to continue breast feeding if the infant condition does not contraindicate it Explain to the mother that a. Supplemental artificial formula can be given to the infant if she is not available b.Do not microwave for it may destroy vitamins and nutritional properties Provide the mother & infant with a relatively quiet area that is as private as possible and free from interruption Required * level of performance D Performance rating ** 5 4 3 2 1 Comments 1 2 D 3 D 31 . She can pump her breasts bring in her milk to be given to the infant via bottle when she is not available c.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . Thaw frozen breast milk for use in tepid water . Breast milk can be frozen for up to 6 months ( check the facility specific policy d.

Performance phase * Start feeding and let the breast touch the infant's cheek. Note the presence or absence of the " Let down " reflex during the nursing period The length of feeding time may vary from 5 to 30 minutes let the infant nurse until satisfied. Follow –up phase When the infant has finished feeding * Change diaper if it is wet or soiled * Position the infant on right side in bed A D A B 8 D 9 10 11 12 A D D D 13 C 32 . Instruct the mother *to burp the baby during and at the end of the feeding *One or both breast may be used at each feeding * Once the infant has stopped sucking . * A pillow may be used under the baby for support * The breast may need to be supported by mother other hand 2. The infant should also be hungry Help position the at breast * Put in semi –sitting position with face close to the breast and supported by one arm and hand.instruct mother to put her finger to the corner of the baby's mouth and gently pull 3.4 5 6 7 Provide the mother with comfort armchair or pillow so that she can assume a comfortable position during the feeding * A footstool should also be available so that she can support her feet and the infant The infant should be awake and dry before the feeding is started Dress the infant appropriately so that he or she is not too warm or too cool during the feeding. * Do not hold cheek and try to help infant find the nipple The infant's lips should be out over the areola not just around the nipple before beginning to suck.

Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed NB:-If this step not performed correctly. Ability to perform the activity without supervision B. Ability to perform the activity under supervision C. How baby went to breast c. Ability to assist with performance of the activity D. . Some facilities may have a lactation specialist to visit with the mother Wash hands D 5 A 16 A Done Repeat Final assessment : Level of performance A.*Note if the baby appear satisfied or still seem to be hungry 14 Record descriptively & accurately a. the procedure should be cancelled 33 . breast engorgement ) * promote maternal confidence in handling and nursing her infant *Increase mother's knowledge about the mechanics of breast –feeding. How baby feed ( Weight before & after may be helpful ) b. Breast or breast used ( Which breast was emptied and which breast was nursed from thereafter Provide the new mother with anticipatory guidance for possible problems ( i. Satiety or hunger after feeding d.e.

Hold the bottle at an angle to completely fill the nipple with fluid A D 2 D A 34 . Cradle baby with one hand and arm .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 8 No Artificial or nipple feeding (SS ) Skill Steps Required * level of performance Performance rating ** 5 4 3 2 1 Comments Required frequency: 2 1 Equipment *Sterile nipple and bottle *Sterile formula or feeding fluid 1.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OFAPPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . Performance phase a. Let the baby root for the nipple by touching the corner of mouth with the nipple. Preparatory phase *Baby should be awake & hungry.while supporting baby against your body or lap 2. When the infant open the mouth insert the nipple b. *Change wet or soiled diaper *Check formula for correct type and amount * Sit in a comfortable chair.

Ability to perform the activity without supervision B. What was feed and amount b. If restless. If restless . The bottle should be handled so as to contaminate the nipple or fluid e. How baby sucked and took the feeding . Baby feeding time will vary from 10 to 25 minutes g. Any regurgitation or emesis – Amount and material d. How feeding was tolerate c. Position baby so eye contact can be established during feeding h. Burp the baby at least once during the feeding and at the end of feeding * Place the baby in sitting position in nurse lap . Never prop the bottle or leave the baby unattended during feeding d. Length of time of feeding e. Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed 35 . pick baby up and burp . behavior before .during & following feeding Wash hands A A A A D D A Done Repeat Final assessment : Level of performance A. pick baby Accurate & descriptive recording a.3 4 16 c. Ability to perform the activity under supervision C. tilt slightly forward & gently rub or pat back or abdomen *Place the baby in prone position on nurse's shoulder and gently pat or rub back *Place the baby in prone position on nurse's lap and gently pat or rub back 3. Follow –up phase When the infant has finished feeding * Change diaper if it is wet or soiled * Position the infant on right side in bed *Note if the baby appear satisfied or still seem to be hungry * Check baby in a few minutes. Ability to assist with performance of the activity D.

Place the infant on side or back with a diaper roll placed under shoulders . Preparatory phase 1.A mummy restraint may be necessary to help maintain this position Required * Performance level of rating ** performance 5 4 3 2 1 A Comments D 36 . calibrated reservoir for feeding fluid *Syringe *Stethoscope *Water for lubrication * Tape – hypoallergenic * Feeding fluid .size 5 -14 * Clear . room temperature * Pacifier 1.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OFAPPLIED MEDICL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 9 No 1 Skill Steps Gavages feeding (CS ) Required frequency: 2 Prepare the equipments & instruments *Sterile rubber or plastic catheter *Round –tip .

If the patient swallows .5 -5 ml air into the catheter and stomach * Listen to the typical growling stomach sound with a stethoscope placed over the epigastric region * Aspirate injected air from the stomach B B C C C C C C D B C C B B 37 .2 2. Measure feeding catheter and mark with tape . Gently rotating the tube if resistance is met * If there is no swallowing . measure distance from tip of nose to ear to xiphisternum 3. Test for correct position of the catheter in the stomach * Inject 0. insert the catheter smoothly and Quickly 4. Have suction apparatus readily available 2. Stabilize the patient head with one hand . Once the catheter has been inserted to the premeasured length . insert catheter along forefinger & tilt head slightly forward 3. Performance phase *1. with Lubricate catheter sterile water or saline *2. passage of the catheter may be synchronized with the swallowing * Do not push against resistance. Observe the infant for vagal stimulation ( i.tape the catheter to the patient face 6.e. use the other hand to insert catheter a*Insertion through nares : Slip the catheter into nostril and direct toward the occiput in a horizontal plane along floor of nasal cavity b* Insertion through the mouth : Pass the catheter through the mouth toward the back of the throat * Depress anterior portion of tongue with forefinger . bradycardia { Slow heart rate } & apnea 5.

Food taken too rapidly will interfere with peristalsis causing abdominal distension and regurgitation * Feeding time should last approximately as long as when a corresponding amount is given by nipple . clamp it off withdraw it quickly or keep in place for next feeding 12.5ml / 5-10 min or 15-20 minutes total time 11. return it to stomach and subtract the amount from the total amount of formula to be given 9. with head and chest slightly elevated * Attach reservoir to catheter and fill with feeding fluid * Encourage infant to suck on pacifier during feeding .*Aspirate small amount of stomach content and test acidity by pH tape * Observe and gently palpate for tip of catheter . Discard feeding tube and any leftover solution Follow –up phase 1. withhold the feeding * If small residual of formula is obtained .Hold infant when possible 8. Burp the patient 2. Do not apply pressure * Elevate reservoir 15-20 cm above the patient's head 10 . bradycardia and apnea may still occur B B C C C C C C C C C C C 3 D 38 . The flow of the feeding should be slow.avoid inserting catheter into the infant's trachea 7.The feeding position should be right side lying . the catheter may be irrigated with clear water * Before the fluid reaches the end of the catheter . Place the patient on right side for at least 1 hour 3. Aspirate tube before feeding begins * If over half the previous feeding is obtained . Observe condition after feeding . When the feeding is completed .

during and following feeding Wash hands D A Done Repeat Final assessment Level of performance A. the procedure should be cancelled 39 . Note any vomiting or abdominal distension 5. Time of feeding 2. Type of gavages feeding 3. Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed NB:-If this step not performed correctly. Note infant's activity 4 16 Accurate & descriptive recording 1. Ability to perform the activity under supervision C. Ability to assist with performance of the activity D. Activity before . How the patient tolerated feeding 6. amount retained or vomited 5.4. Ability to perform the activity without supervision B. Type and amount of feeding fluid given 4.

1 meter appropriate size for child *Tape * Ph paper *Reservoir for feeding *possibly an infusion pump *3.6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 10 No Skill Steps Nasojejunal & nasoduodenal feeding (CS ) Required frequency: 2 Prepare the equipments & instruments *Sterile radiopaque silicone or polyvinyl nasojejunal or nasoduodenal tube . Tube is generally inserted by health care provider C Required * Performance level of rating ** performance 5 4 3 2 1 A Comments 1 D 40 . Attach cardiac monitor to infant 2. Preparatory phase 1.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .5 ml normal saline or sterile water * Equipment for nasogastric tube insertion .way stopcock * Syringe – 0. introducer catheter 1.

D5 W initially 2. back. Place the infant on right side with hips slightly elevated gentle restraint or soft mittens may have to be applied *4. Medications may be given via the N-D/N-J tube if prescribe C C C C D C C C C 41 . 4. N-D /N-J feeding can generally be started following this progression 1. *6. 10 French feeding catheter and introducing both through the nostril into the stomach. *The volume of feeding is increased at a slow rate until daily caloric and fluid requirements are being administered 5. Check intestinal aspirate for PH every 1-2 hours .G feeding tube may pass through the other nostril at time & left indwelling. *½-strength formula with low osmolality for 6-12 hours .Higher osmolarity formula for old children. abdominal posteroanterior & lateral x –rays are taken to confirm that tip of catheter is at the ligament. A small N. 3. or abdomen * Once the tube is past the pylorus .Infant may be positioned on right side . *5. Tube is inserted by threading the nasojejunal or nasoduodenal vinyl catheter into a No. *Full strength low osmolality formula for infants & high osmolarity formula for old children.*3. *This is used to check stomach for residual fluid and regurgitation through the pylorus 7 7.

*If intermittent feeding is the method used . Intermittently b. In a continuous slow drip 2. Check for abdominal distension resulting from the infant's inability to handle amount of fluid :  Palpate abdomen  Observe for ripple of intestines  Measure abdominal girth 3-8 h  Check residual formula in jejunum as prescribed b. type . the set up used is similar to the pediatric IV infusion using an infusion pump and small ( 100-250 mL ) closed chamber for reservoir a. Record input every hour. Performance phase 1. the feeding techniques are the same as for ( Gavage feeding ) 3. Fill reservoir as needed. Observe child /infant closely to avoid potential dangers as tube passes the pylorus a. Check emesis for blood and report to physician immediately – may be a sign of necrotizing enterocolitis 2. Close attention to amount . Follow –up phase 1. Be constantly alert for mechanical problems a. with no more than 3 hours worth of feeding fluid.24 h. N-J feeding can be given as follows a. *If slow continuous drip method is used . Check stool for occult blood and ph & urine for glucose every voiding or 4-8 hours to determine tolerance of feeding tube c. concentration and osmolity of feeding fluid is stressed D C C C D A D A C D 42 .2 3 2. Position child /infant in recumbent position 3. Reservoir chamber and tubing should be changed 8.

Any signs of impending infant distress or problems. A mount of residual & characteristics 3. the procedure should be cancelled 43 . Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed NB:-If this step not performed correctly. Ability to assist with performance of the activity D. Check heart rate & blood pressure 4 16 Accurately & describe & record condition of infant and procedure including: 1. Ability to perform the activity under supervision C.b. Wash hands D A Done Repeat Final assessment Level of performance A. Type & amount of feeding given 2. Ability to perform the activity without supervision B.

blood .color .g. The purpose for which it was collected ( e. . bacteria ) & any related information Required * Performance rating ** level of 4 3 2 1 performance 5 A A B A Comments 1 2 3 4* 5* 6* 7 B B B Final assessment Done Repeat 44 .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 11 No Skill Steps Obtaining a stool specimen (SS) Required frequency: 2 Prepare the equipments & instruments *Clean container *Tongue blade Explain the procedure to the child or parent Wash hands well & wear gloves to obtain specimen Obtain stool specimen directly from the diaper ( If it has not been contaminated by urine ) With the tongue blade .or use the tongue blade to receive the specimen from the collection device The specimen is labeled properly and the laboratory slip is attached Some specimens must be sent to the laboratory while they are warm Document procedure a.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .ova. Charts the time . parasites .amount and consistency of the stool b.

6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 12 No Skill Steps Administering an enema ( IS) Required frequency: 2 Prepare the equipments  Disposable irrigation bag with connecting tube and clamp  Funnel or aseptic syringe and pitcher for smaller amount  No 10 to 12 French catheter  Saline solution ( 1 teaspoon of table salt to 1 pint of water )  Lubricant  Toilet paper  Absorbent pad  Bedpan  Extra diapers ( depending on age ) Explain procedure Required * Performance rating level of ** performance 5 4 3 2 1 A Comments 1 2 45 .College instructor Name Sign: KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICALSCIENCES F ‫لمملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .

Discard disposable enema set. clean the buttocks Remove the rubber sheet and incontinence pad D B A B B B B 9 B 10 11 12 13 14 15 B A A Apply a clean diaper if age appropriate. You need assistance to hold the child *Allow the solution to run through the tubing to warm it and to expel air *Lubricate and insert the tube 1-4 inches into the rectum . depending on the age of the child *Administer the prescribed amount of fluid :  120 to 240 ml of infants  240 to 360 ml for 2to 4 years  360 to 480 ml for 4 to 10 years  480 to 720 ml for 11 years –old Remain with the patient while enema is being expelled.up and tubing A Document procedure  Chart time of procedure  Name .3 4 5 6 7 8 Wash hands. Check to see if a stool specimen is desired A Empty and clean the bedpan. Small children may use the potty chair or bedpan Remove the bedpan. wear gloves Assemble the equipment and take it to the bedside * Place the absorbent pad beneath the child. amount and temperature of solution used D 46 . with knees drawn toward the chest. keep bedpan readily available *Position the child on his or her left side.

  Amount and character of result Untoward reaction Done Repeat Final assessment 47 .

vastus lateralis ( middle third ) or ventrogluteal Toddlers and school age children Site selection includes a. Lateral and anterior aspect of the thigh Required * Performance rating ** Comments level of 4 3 2 1 performance 5 A D D B 1 2 3 4 5 C B 48 . Posterogluteal ( Upper outer quadrant ) b.6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 13 No Skill Steps Intramuscular injection (CS) Required frequency: 5 Prepare the equipments Explain to the child where you are going to give the injection ( site ) and why you are giving it * Allow the child to express fears Carry out procedure quickly and gently. Deltoid d. Ventrogluteal c.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES F ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . Have needle and syringe completely prepared and ready before contact with child Infants Selection the acceptable site includes rectus femoris ( mid anterior thigh ) .

Place the child on back 2. *Inject needle perpendicular to the surface on which the child is lying B D B B A B B A B B B 49 . drop finger below the crest. Ventrogluteal 1. toward the knee b. The triangle formed by the iliac crest . Area is a narrow strip of muscle extending along a line from the greater trochanter to lateral femoral condyle below 3. Rectus femoris 1. Place the child in a prone or supine position 2. Place the index finger on the anterosuperior spine 3. Use upper quadrant of the thigh 4.5 cm 3. *Insert needle at a 45 angle in a downward direction . index finger & middle finger is the injection site 4. locate the iliac crest. Place the child in a secure position to prevent movement of the extremity 2. *Do not use a needle more than 2. Insert needle perpendicular to skin 2-4 cm deep –needle parallel to floor c. Vastus lateralis 1. *With the middle finger moving dorsally.6 Administration a.

*Insert needle at a 45 angle in a downward direction . Determine injection site as with an adult 2. toward the knee D B A B B B D B D B B Done Repeat Final assessment 50 . Do not use a needle longer than 2. *Inject needle perpendicular to the skin 2-3 cm deep F. Posterogluteal 1. Let index finger drop at a point midway between the thumb and middle finger to the upper outer quadrant of the buttock * 6. Position the child in a prone position *3.5 cm 2.d. Do not use a needle longer than 2.5 cm 2. Place middle finger on the iliac crest 5.not to the skin E. Insert needle perpendicular to the surface on which the child is lying .Place thumb on the trochanter * 4. *Use the upper outer quadrant of the thigh 3. Deltoid 1. Lateral & anterior aspect of the thigh 1.

5 cm * Padded arm board Required * level of performance A Performance rating ** 5 4 3 2 1 Comments 1 51 .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 14 No Skill Steps Intravenous fluid therapy (CS) Required frequency: 5 Prepare the equipments a.5 cm . 5 to 10 ml – approximately 1/2 -1/3 filled with normal saline * Butterfly needle or catheter of appropriate gauge ( The size of the needle depends on the age and size of the child and the type of fluid to be administered *Alcohol sponge . pump tubing * Microspore filter *Syringe . 2. pump device * IV administration set . dry sponges *Betadine or other antibacterial cleansing solution * Normal saline *Small tourniquet or rubber band * Hypoallergenic tape . 250 ml bottles should be used for purpose of safety * IV pole . Needle method * IV solution ( For small children . 1/2 cm .KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES F ‫لمملكة العربية السعودية المملكة‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .

IV administration set * Alcohol sponges * Hypoallergenic tape . extremity restraint .2 cm . Following product insert . cover sandbags ( The type of restraint depend on the child's age .5 cm *Padded arm board * Dry sponge * Gauze bandage * Sterile cut down tray * Assorted sizes of sterile polyethylene tubing & luer adapter * Normal saline * Tourniquet * Sterile gloves * Restraining devices Preparatory phase 1. Remove the metal seal from IV container without touching the rubber top *5. 1. his level of cooperation & the kind of IV to be started * Safety razor ( If scalp vein is to be used ) b. insert the end of the administration set into the container's opening.2 * Gauze bandage for securing the extremity to the arm board * Restraining devices – bath blanket . Fill the tubing with solution A D B B B 52 . Attach a micropore filter to the end of the infusion tubing that attaches to the needle. IV pole . Use aseptic technique *4. 2. Check the IV fluid for cracks *3. Obtain the IV solution 2. Cut down method * IV solution .

Position the child for comfort 9. Recording on the container or reservoir rate flow a. Return the child to room B B C B A B B B B D 53 . Name of the physician or nurse who started the IV site of administration c. Comfort and reassure the child 6. *6. When applying the tourniquet . Restrain the child as necessary * Infant or young child: restraints may include mummy wrappings . a second rubber band is placed crosswise under it * To remove the tourniquet grasp` the unstretched rubber band . jacket or elbow restraints or small sand bag * Old child : The extremity to be used should be comfortably restrained on the arm board 3 Performance phase *1.Promote the cooperation of the child * Infant : provide with a Pacifier * Old child: explain the procedure and its purpose child for comfort. Reaction of the child to the procedure d. Assist as necessary *3.The persons starting the IV & holding the infant should wear gloves 2. 8.7. Check the restraints at intervals and adjust them as necessary 5.Regulate the IV rate pump 7. pull up & cut the tourniquet 4. Time that infusion began b.

Check for blood return into the tube when the flow of fluid is stopped f. Local reaction * Compromised circulation *Pressure sores * Thromophlebitis b. Check the child at least hourly a. Note the color of the skin at the needle point c. Weight the child at regular intervals .Collect all urine and weight diapers if more accurate measurement of the child's is necessary 2. Feel the area around the site fluid or sponginess or leak age e. Follow up phase 1. Fluid & electrolyte disturbance 1* Maintain an accurate record of intake and out put a. Total the intake and put b. Check function of the pump – rate set versus amount infused 2. Note the location of IV b. Make certain that the child is adequately restrained g. Check for swelling of skin at the needle point d.Describe care fully the amount & consistency of all stool & vomitus c. Observe closely for complication a. using the same scales each time B B B B 54 .4.

3. Change the IV container and tubing 24 h or as per hospital policy D D 55 . apathy or lethargy 3. Record essential information * Reading on the container * Amount of fluid absorbed in the hours * Total amount of fluid absorbed * Rate of flow * Apparent condition of the child 4. Irrigate the IV as necessary * Gather equipment *Clamp off the IV solution * Disconnect the IV tubing at the needle insertion site keep it sterile * Remove the needle from the syringe * Connect the syringe to the tubing at the needle insertion site or stopcock * Slowly inject the normal saline solution * Disconnect the syringe and reconnect the IV tubing to the needle insertion site * Unclamp the IV and regulate the flow of the solution * Check Frequently to make certain that the IV is functioning properly 5. Monitor laboratory electrolytes 4. Report * Decrease skin turgor * Marked increase or decrease in urination * Fever * sunken or bulging fontanelles in an infant * Sudden change in weight or vital signs * Diarrhea * Weakness .

Comfort the child as required k. Disconnect the IV when prescribed or if it has obviously infiltrated a. Record that the IV was discontinued D Final assessment Done Repeat 56 . Gather equipment * Scissors * 4X4 gauze square * Band –aid b. Remove the tape and arm board from the extremity j. Determine the location of the needle e. If a catheter is used .7. Loosen the tape around the needle . depending on age c. check the dressing 4 h and change according to policy 8. Hold the 4x4 lightly over the insertion site and removed the needle quickly and carefully g. Clamp off the flow of the IV fluid d. Apply pressure to the site immediately and hold until bleeding stops h. holding the needle firmly in position ` so that it does not slip out f. apply Band –aid i. Explain the procedure to the child . Note the fluid level on the container or reservoir and complete recording l.

KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES F ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . Put the child on his back . spread the legs and wash each skin fold in genital area Required * level of performance A Performance rating ** 5 4 3 2 1 Comments 1 2 A B 57 .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 15 o Skill Steps Obtaining a specimen for urine analysis ( 1S ) Required frequency: 2 Prepare the equipments * Sterile container * Urine collection bag * Label specimen clearly * Deliver specimen immediately to the lab ( Bacteria may grow at room temperature) Explain the procedure * a. Apply newborn and pediatric urine collection * The skin must be clean and perfectly dry * Avoid oils . baby powder & lotion soap * Application must begin on the tiny area of skin between the anus and genitals * The narrow bridge on the adhesive patch keep feces from contaminating the specimen and help position the collector correctly * b.

stretch the perineum to separate the skin folds and expose the vagina h. remove paper from the upper portion of adhesive patch 3 Use a sterile container or apply a urine collection device B A B B 4 If a bag is used . Secure the diaper over the bag D 5 Check bag every 20 to 30 minutes Label all specimens clearly and attach the proper laboratory slip .allow a few moments for air drying e. Wash the anus last . Collected specimens should be transported in plastic bag ( check institution policy) 7 Document procedure D 6 B D Done Repeat Final assessment 58 . Press adhesive firmly against the skin and avoid wrinkles . Do not use a scrub soap solution d. For girl .c. For boys. begin between the anus and the base of scrotum i. Remove protective paper from the bottom half of the adhesive patch *g.

Head tilt /chin left Standing next to the child. At the same time. gently and call by name Call out for help Position child on his back *Open airway with head tilt / chin life or jaw –thrust maneuver a.6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 16 No Skill Steps Cardiopulmonary resuscitation & air way obstruction (CS) Required frequency: 2 No equipment is needed to provide CPR Identify children at risk and place them near the nurse station Monitor vital signs.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES F ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Nursing Department Course: Pediatric nursing Level . including temperature and level consciousness at least every 4 hours if not more frequently If arrest is suspected . lift the chin with the fingers of the D A D D A Required * Performance rating level of ** performance 5 4 3 2 1 D 1 2 3 4 5 6 Comments 1 C 59 . tilt the child head Back by placing one hand on the forehead and pushing down.

Do not overextend b. Jaw – thrust maneuver From behind the head . place . a. the rescuer covers the child's mouth . other hand. For the infant . creating a mouth to mouth seal . For the child . place the heel of one hand one finger's breadth above the xyphoid notch C C D C 11 12 D B 13 14 15 B B D 16 B B B 60 .7 8 9 10. while pinching the child's nostrils shut Evaluate breaths by watching for the chest to rise and fall *Reposition head and airway if air does not enter freely. place two fingers breath below the nipple line b. observe for movement *If there is no breathing. provide two initial breaths. Provide one breath very 4 seconds for the child *If there is no pulse . place 2-3 finger of each hand under both angles of the lower jaw and left upward While maintaining the open airway . look . listen and feel for breathing Place cheek and ear close to child. Treat for airway obstruction if continued rescue breaths are thwarted Locate & palpate the brachial pulse in the infant Locate and palpate the carotid pulse of the child If there is a pulse. For the infant ( 1year old or younger ) cover both the nose and mouth with rescuer's mouth b. s mouth and nose. proceed with rescue breaths only provide one breath every 3 seconds for the infant. locate finger and hand position for chest compressions a. For the child between 1-8 years of age . Listen and feel for air flow Look at chest and abdomen.

chest thrusts and rescue breaths Call for help Begin CPR if no pulse is palpable.17 *Compress the child is to a depth of 1/2 -1 inch at a rate of 100 compressions per minute. Provide a rescue breath after every fifth compression *Compress the child's chest to a depth of 1 – 1 1/2 inches at a rate of 80 -100 compressions per minute. Continue until trained in advanced life support respond *If airway obstruction is suspected in the infant. Child ( over 1 year of age ) If airway obstruction is suspected in the child . place the child on his or her back on the floor C D D D D 61 . stop CPR & telephone for help Reestablish CPR once help has been called. apply four back blows between the shoulder blades *Turn the infant to his or her back and with the infant's head downward . With the infant's head held downward . Provide a rescue breath after every fifth compression Reassess for spontaneous respirations and pulse after one minute ( 10 cycle of five compressions to one breath ) If no help is immediately available . apply four chest thrusts in the same location for CPR compressions *Open the airway and remove only visible particles C 18 C D 19 20 21 22 D D C 23 C 24 25 26 27 28 29 B Reposition airway and provide two strong rescue breaths Continue alternating back blows . hold the infant on his or her abdomen with legs straddling the rescuer's arm.

above the navel and below the rib cage ( The rescuer may straddle or sit astride the child ) Provide several upward thrusts ( Toward the rib cage ) Open the child's airway. turn head to the side and sweep out visible objects Reposition airway and provide two strong rescue breaths Call for help Continue by alternating abdominal thrusts with rescue breaths until obstruction is relieved Begin CPR if pulse is not palpable B 31` 32 33 34 35 D B B D C 36 D Final assessment : Done Repeat 62 .30 Place the heel of one hand on the child's abdomen at midline .

6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 17 No Skill Steps Administering medication Required frequency: 5 Dropper. Press on the infant's chin to open mouth. *Wash hands. place the syringe to the back and side of the mouth and give the medication slowly . Hold infant's arm with your free arm. squirting the medication from the syringe into the nipple pour the medication from a cup into the nipple. allowing the child to swallow Nipple.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES F ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . *Hold the infant in the cradle position. Squirt the medication to the back and side of the mouth in small amount Syringe. *Hold the infant in the cradle position and stabilize the head against your body. supporting the head and holding the arms. Hold the infant or toddler in the cradle position. * Allow the infant to suck the medication from the nipple * Follow the medication with 2-3 ml of water Required * Performance rating ** level of 4 3 2 1 performance 5 Comments 1 A A 2* B 3* B B B 63 .

preschooler . as the child could easily aspirate Capsules Older children may enjoy swallowing a capsule * Place the capsule on the back of the tongue and have them swallow a lot of fluid. *A cup can be used for the older infant . school age child & adolescent * For the younger patient . * Check with the pharmacist to see which capsules can be opened Nose drops *Hold the infant in the cradle position. * Disguise a disagreeable taste in a small amount of food like applesauce * Syrup is also good for mixing medications that do not dissolve in water * Dilute alcohol –based elixirs with water before administering Chewable tablets Tablets may be chewed by the child or cursed and given in a fruit syrup or applesauce. apparent or child may hold the cup * Stay with the child until the entire dose is swallowed * A spoon is an effective alternative to the medicine cup. * Check with the pharmacist to see if crushing the tablet will affect drug absorption or action * Do not give a child a tablet if he or she resists . toddler . a patient . stabilizing the head with your arm .4* 5 6 7 Medicine cup. and tilting it back slightly * Squeeze the drops into each nostril as you try to comfort & hold the infant in this position for at least 1 minute * Place a toddler's head over a pillow * Squeeze the drops into each nostril * The school age child and adolescent may give themselves their own B B B B B C C C 64 . * Stay with child until all the medicine is swallowed * Some capsules may also be opened & the contents sprinkled on a spoonful of food.

* A cotton pledged placed into the ear canal can prevent the medication from leaking out . * The buttocks should be held tightly together for 5-10 minutes A A A A A A A A A A A A A A A A A A Done Repeat 10 Final assessment Prepared by : Lecturer /Basem masadeh –MSN.D in Nursing education . however . gently insert the suppository into the rectum * Do not insert your finger more than 1/2 inch. * Instill warm drops into the external canal and gently massage the area anterior to the ear * For children over 3 years . *The pinna of the ear is to be pulled down and back. pull the pinna upwards and back * After instillation. * Lubricate the suppository with a water soluble gel * Using a finger cot . 65 . Ph. it must be loose enough to allow discharge to drain from the ear canal Eye drops or ointment * Place the child in a supine position *Restraining him or her as necessary to safely instill the medication * Pull the lower eyelid down and out to form cup. the child should maintain the position for 5-10 minutes. * Drop the solution into cup * The medicine will enter the conjunctiva * Close the eye gently and attempt to keep it closed for a few moments * Ointments are applied along the inner canthus in outward direction * Avoid touching the tip of the dropper or ointment tube to the body part Rectal medications * Place the child in aside –lying or prone position.8 9 medication since they can sniff the medication into the nasal passage Ear drops * Position infants & toddlers on their sides.

gauze bandage . 2. Gather equipment.KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level . adhesive tape and stoknette if available ( For mitt restraint )  Acommercially prepared mitt (For mitt restraint )  Safety pins ( For elbow restraint )  Elbow restraint Jacket Restraint 1. Reassure child that restraint is not a punishment Required * Performance rating level of ** performance 5 4 3 2 1 A Comments 1 2 D A A A 66 . Wash hands 4. Explain purpose of restraints to child and parents. Check physician's order and agency polcy regarding use of restraints. 3.6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 18 No Skill Steps Restraint (CS) Required frequency: 2 Equipement  Jacket ( For jacket restraint )  Large dressing .

Put a padded dressing around the wrist c. Apply commercially made restraints a. Apply elbow restraint over gown sleeves B A A A A B B 4 B B 67 .Place a large folded dressing in patient's palm a.*5.Secure abdomen straps on either sides 3.Secure each tie to unmovable portion of the bed . wash .Cover these dressing by placing stocknette dressings over the hand or elastic bandage . Ensure that patient's gown and jacket are not wrinkled *7. using half bowknt which is easily removed 8. If mitts are worn for several days remove them at least every twelve hours . Check the restraints to make sure that the tongue depressors are intact and in place *2. one is first placed from the back of the hand over the fingers to the palm and the other is then wrapped from side to side around the hand d.Secure shoulder straps to head of the bed 9. using the recurrent pattern e. Secure the strokinette or elastic bandage with adhesive tape *2. Place two large dressings over the hand . Mitt or hand restraint *1. exercise the hand and reapply again Elbow restraint *1. Separate the fingers with a pieces of large dressing b. Place the jacket on the patient gown and tie it from back *6.

3. Warp the restraint smoothly around the arm *6. Using half – bow knot attach the end of restraint to the end of the bed spring 7. Make 2 loop forming finger of 8 A A A A B A B B 4. prepare the equipement  Bandage 5-8 cm wide and 90 –120 cm long  Cotton  Commercially made restraint *2. using safety pins . Make sure that the loops are small to fit patient hands 6. Prepare the equipement  Blanket or sheet  Safety pins or adhesive tape B B B D A 68 . Pick up the two loops *5. Place elbow in the center of restraint 5. Secure the restraint . Apply 2-3 layers of cotton around ankle or wrist 3. Ensure that it is not too tight so not to occlude blood 5 Clove hitch restraint 1. ties or strings *7. Make sure the end of the tongue depressors are covered by padded material 4. Check every two hours and readjust accordingly 6 Mummy restraint 1.

make sure that the infant shoulder touches the upper border of the blanket *4. Tie the strap in half –bow knot B Final assessment Level of performance A.7. Place the net over sides and ends of the crip 3. Ability to assist with performance of the activity D. prepare the equipement * Astretch net with long strap 2. Ability to perform the activity under supervision C. Fold the right side of the blanket over the infant. *2. Ability to perform the activity without supervision B. Fold down one corner of the blanket and place the baby on it the supine position . Lay the blanket or sheet on flat dry surface *3. Secure the tie to bed frame B B B A B A 4. Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed Done Repeat 69 .s body and tuck it under his back leaving the left arm free Crip net restraint 1.

pulse and respiration Cover the patient with a bath blanket or sheet . assemble the equipment at the bedside.Fanfold bed clothes to the foot of the bed .KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OFAPPLIED MEDICAL SCIENCES ‫المملكة العربية السعودية‬ ‫وزارة التعليم العالي‬ Nursing Department ‫جامعة تبوك‬ ‫كلية العلوم الطبية التطبيقية‬ ‫قسم التمريض‬ Course: Pediatric nursing Level .Place a water proof sheet and bath blanket beneath the patient Remove the patient's gown Wash the patient's face and neck with tepid water Required * level of performance Performance rating ** 5 4 3 2 1 Comments 1 A 2 A A A D D A A 3 4 5 6 7 8 70 .6th level Semester Two Name of the student: ……………………………… Skills Laboratory Number 19 No Skill Steps Sponge bath to reduce fever IS (A) Required frequency: 5 Prepare the equipments & instruments *Basin of tepid water ( 29 to 32c ) * Three washcloths towel *Two bath blankets * Waterproof sheet Explain the procedure to the patient and family y. Wash hands Screen the child Take & record temperature .

Expose one area of the body at a time Place moist . untoward reaction . AN infant may be placed on a large towel . If shivering continues . and so forth Check color & pulse. the water temperature should be raised. Use long strokes. beginning with neck . pulse and respiration *Take the patient's temperature within 30 minutes of the time procedures ended and record. *to be sure that the child is tolerating the procedure without adverse effects * If the child begins to shiver. part by part.9 10 11 12 13 14 15 16 17 18 Lift the corner of the bath blanket and bathe the child's body. Replace the hospital gown. the back. covered by receiving blanket Arrange pillow and bedding for the patient's comfort Record temperature. stop the bath Remove the waterproof sheet and blanket. patient's temperature before and after procedure Replace equipments Wash hands A A A B A A D D A A Done Repeat Final assessment 71 . then going to the shoulders . Document procedure Chart : Time procedure began . length of the time administered . folded cloths over blood vessels that lie close to the skin ( Underarms and groin ) Turn the patient and repeat the procedure .

org/parent/general/sick/labtest11.com/health/healthy-baby/PR00041 http://en.com/496647/maternal-newborn-nursing-newborn-measurements-and-vital-signs-flash-cards/ http://www.htm http://kidshealth.org/wiki/Otitis_media http://kidshealth.mayoclinic.com/nursing-notes-reviewer/fundamentals-of-nursing/respiratory-patterns/ http://quizlet.wikipedia.org/parent/system/surgery/g_tube.com/script/main/art.html videos 72 .html http://www.asp?articlekey=138419&ref=137489 http://www.com/care/suction.http://nursingcrib.emedicinehealth.tracheostomy.

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