Nursing Care of a Family When A Child Needs

Diagnostic or Therapeutic Modalities

Your Logo
Topic Outline

❑Specimen Collection
❑Types of feeding
❑Assistance with Elimination
❑Preparation of a Child with Surgery
SPECIMEN COLLECTION

The collection of body

fluids, secretions, and
excretions.
A collaborative nursing
function essential to the
complete assessment of a
child.
Obtaining Blood Specimen

-Never underestimate how

frightening obtaining a blood
specimen can be to a child
-Obtain from somewhere. To
keep the bed a “safe” area.
-Needs good preparation and
support.
 Obtaining Blood Specimen

Capillary Puncture
1. Capillary blood heel or
fingertip punctures - for
glucose and hematocrit
determinations.
2. Use the side of the finger, not
the center,
3. Apply EMLA cream. before
the procedure.
Obtaining Urine
Specimens

1. Clean-Catch
2. 24-hour Urine Specimen
3. Catheterization
4. Supra Pubic Aspiration
1. CLEAN CATCH SPECIMEN
The Infant or Toddler

-Attach
a collecting device.
-Wash and dry the site.
-Keep it out of reach.
-Offer the child something to
drink.
-Transfer the specimen to a
specimen cup by cutting a bottom
corner of the bag.
Preschooler and
Schooler
1. Provide a potty chair if
one is available.
2. Put a urine collection
cap device on a toilet.
3. Offer the child a glass
of water or other fluid.
Adolescent

•Knowledgeable and cooperative.

•Concerned and self-conscious
about body functions.
•Give privacy.
•Providing a good explanation of its
actual purpose.
2. Twenty-Four (24) Hour Urine Specimen

Quantitative analysis- determine

total substances excreted in a day.
-Ask the child to void and discard
specimen.
-Determine time start of collection
and record.
-Save all urine voided for the next
24 hours and place it in one
collection bottle.
-Place in a collection bottle with ice.
 3. Catheterization (School Aged Child)

(#5 or #8) feeding tube is used instead of a

urinary catheter.
U. M. is not as readily observable in infants
and young children as it is in women.
Cleanse the perineum or penis well before
inserting the tube.
An invasive procedure, so children must be
prepared in advance.
4. Supra Pubic Aspiration

Withdrawal of urine by insertion of a

sterile needle into the bladder
through the anterior wall of the
abdomen.
Used to obtain urine for culture in
infants who cannot void on
command.
done by physicians, although nurse
practitioners or nurses in specialty
units may perform it.
Stool Specimen
To be analyzed for blood or ova and
parasites.
For toilet-trained - use a potty seat or
by placing a collector cap device on a
toilet.
Know the word the child uses for stool.
Transfer the specimen to a collection
cup with tongue blades.
STOOL SPECIMEN

For not toilet-trained- scrape stool

from a diaper using tongue blades
and place it in a stool collection
cup.
Some specimens need a
preservative.
Send to the laboratory promptly
(less than an hour).
Do not refrigerate.
Enteral Feedings

Also called nasogastric tube feedings,

For infant who is unable to suck or tires too
easily when sucking, or to an older child who
cannot eat.
Enteral Feeding

In infants, such
feedings are
traditionally called
gavage feedings.

Newborns are nose

breathers, pass a
catheter through the
mouth.
Gastrostomy Tube Feedings

Indication: cannot swallow or

those with esophageal atresia,
severe gastroesophageal
reflux, or esophageal stricture.
An indwelling urinary catheter
(Foley catheter) rather than a
true gastrostomy tube is used.
Gastrostomy Feeding

Should be at room temperature.

Elevate the child's upper trunk 30
to 40 degrees.
Hold an infant in the lap or
placing him or her in an infant
seat.
For an older child, use pillows or
elevate the head of the bed.
Gastrostomy Feeding

After the feeding, flush the tube with a specified

amount of clear water
Keep the child's head elevated for at least 1 hour
after feeding.
If had esophageal surgery, suspend the unclamped
tube in an elevated position. Leaving the tube
unclamped and elevated ensures that if the child
should vomit,
major complications

Obstruction
Observe and report any vomiting, abdominal
distention, or brown or green tube drainage
(duodenal secretions).
Test for residual aspiration fluid.
stomach secretions - acid
duodenal secretions - alkaline
Total Parenteral Nutrition

-most important therapies

for children who have
gastrointestinal illnesses that
prevent proper absorption of
basic caloric or fluid
requirements or respiratory
illnesses that make infants
too exhausted to suck.
Indication of Total Parenteral Nutrition

Chronic diarrhea or vomiting,

Inflammatory bowel disease,
Bowel obstruction,
Anorexia, or
Extreme immaturity
Assistance with Elimination
Assistance with Elimination
Special care for Intestinal Elimination
1. Administration of Enemas
2. Ostomy care.
An enema involves inserting liquid or gas into the
rectum, which is the lower part of the large
intestine. The aim is to empty the bowels, allow for
an examination, or administer medication.
Assistance with Elimination

▪Amounts of enema solutions used are:

Infant: Less than 250 mL (exact amount should be
stipulated by physician's order)
Preschooler: 250–350 mL
School-age child: 300–500 mL
Adolescent: 500 mL
Assistance with Elimination

Enema Size
-Infant - small, soft catheter (#10 to 12 French)
-3 or 4 years old- rest on a bedpan
-Place a pillow under the infant's or young child's
upper body for positioning and comfort.
-Lubricate the catheter generously with a water-
soluble lubricant and insert it only 2 to 3 inches
(5 to 7 cm) in children and only 1 inch (2.5 cm) in
infants.
Assistance with
Elimination - Enema

-hold the solution

container no more
than 1 foot above
the level of the
sigmoid colon (12 to
15 inches above the
bed surface) so the
solution flows at a
controlled rate.
Assistance with Elimination - Ostomy

Providing
- Ostomy Care
-An ostomy is an opening of the
bowel on the surface of the
abdomen. Ostomies in newborns
are created to relieve bowel
obstruction caused by conditions
such as ileal atresia, necrotizing
enterocolitis, and imperforate
anus.
Assistance with Elimination - Ostomy

-
Assistance with Elimination Ostomy
-
Assistance with Elimination - Colostomy

-Wash and dry the stoma and

surrounding skin area well.
-Follow your agency's protocol
for skin care, such as applying
karaya powder, an ointment
such as Desitin, or
-Skin protectant to protect the
skin.
Preparation of a Child for Surgery

▪Preparing a child for surgery is a major responsibility for a child health

nurse.
▪Psychological preparation of both child and parents is aimed at reducing
a child's fears about the procedure and consists primarily of providing
health teaching and opportunities for therapeutic play.
▪Physical preparation includes:
1. restrictions on food and fluid intake before surgery,
2. preparing the incision site on the child's skin, and,
3. arrange for transportation of the child to surgery.
Emotional Preparation

1. Minimize fears common to all children (e.g., fear of

separation, fear of mutilation, or fear of death).
2. Tell a child about the procedure and describing any
specific equipment and techniques that will be used, such
as anesthesia, eye bandages, nasogastric tubes, sutures, or
special aftercare.
3. A teaching plan is essential for explaining all of these
features of surgery to the child.
Physical Preparation

1. Placed on nothing by mouth (NPO) status

for surgery.
2. Preparation of surgical sites varies.
3. Give a great deal of assurance that the
solution being used will not sting but is only
cleaning.
Postoperative Wound Care

Children frequently have a dressing or bandage in

place to cover a surgical incision or sutured
laceration. Such dressings differ from adult dressings
in terms of material, size, and methods used to
secure them.

Keeping a dressing dry Occlusive dressings (hydrogel

sheets, hydrocolloids, or polyurethane films) are
dressings especially designed to provide a healing
surface over a wound. These need to be applied and
removed according to each product's directions.
Transportation

1. Check children's identification bands.

2. Remove barrettes and bobby pins from the child's hair
and check the mouth for loose teeth.
3. Changing to a hospital gown is a terrifying moment.
4. A Child may walk to surgery.
5. A nurse whom the child knows should accompany the
child to the operating room.
THANK YOU!

Your Logo