ATI Proctored Nursing Care of Children

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death and dying: therapeutic communication chapter 11 - allow an opportunity for
anticipatory grieving. consistency among nursing personnel. encourage parents to
remain with client. communicate with the client honestly and respectfully. encourage
independence. provide and clarify information and explainations. encourage physical
contact: address feelings, and show concern empathy and support.
health promotion of adolescents (12-20 years): informed consent chapter 7 - Parents
do not need to give consent for adolescents to get tested for STD
infection control: teaching about methicillin-resistant staphylococcus aureus chapter 11
fundamental - Treat with vancomycin and linezolid. Obtain specimen for culture and
sensitivity for antimicrobial therapy. Monitor to make sure therapeutic levels are
maintained. Complete full course of antibioitics. Avoid overuse
immunizations: recommended schedule for preschool-age child chapter 35 - 4-6
years: DTaP, MMR, IPV
3-6 years: Flue vaccine
immunizations: schedule for infant immunizations chapter 35 - Birth: Hep B
2 months: DTaP, RV, IPV, Hib, PCV, and Hep B
4 months: DTaP, RV, IPV, Hib, PCV
6 months: DTaP, IVP, PCV, Hep B, RV, Hib
6-12 months: seasonal influenza vaccine
death and dying: age-appropriate response to death chapter 11 -
INFANTS/TODDLERS BIRTH TO 3 YEARS
o Have little to no concept of death
o Egocentric thinking prevents their understanding of death (toddler)
o Mirror parental emotions (sadness, anger, depression, anxiety).
o Can regress to an earlier stage of behavior.
PRESCHOOL CHILDREN (3 TO 6 YEARS)
o Egocentric Thinking
o Magical thinking allows for the belief that thoughts can cause an event such as death
(as a result, child can feel guilt and shame).
o View dying as temporary because of the lack of a concept of time and because the
dead person can still have attributes of living (sleeping, eating, breathing).
SCHOOL- AGE CHILDREN (6 TO 12 YEARS)
o Begin to have an adult concept of death (inevitable, irreversible, universal), which
generally applies to older school-age children (9 to 12 years).
o Experience death process, the unknown, and loss of control.
o Fear often displayed through uncooperative behavior.
o Can be curios about funeral services and what happens to the body after death.
ADOLESCENTS (12 TO 20 YEARS)
o Can have an adult-like concept of death
o Can have difficulty accepting death because they are discovering who they are,
establishing an identity, and dealing with issues of puberty.
o Can become increasingly stressed by the prospect of death.
dermatitis and acne: evaluating parent understanding of diaper rash chapter 31 -
Advise parents that their child should avoid bubble baths and harsh soaps
Encourage children to wear long sleeves and pants when there is risk of possible
exposure to irritants
Educate parents to remove an offending agent as soon as exposure takes place
Promptly remove the soiled diaper.
Clean urine the perineal area with a nonirritating cleanser.
Expose the affected area to air.
Use superabsorbent disposable diapers to reduce skin exposure.
Apply a skin barrier, such as zinc oxide. Do not wash it off with each diaper change
fractures: caring for a client who is in 90/90 skeletal traction 27 - o Maintain body
alignment
o Provide pharmacological and nonpharmacological interventions for the management
of pain and muscle spasms.
o Notify provider if the client experiences severe pain from muscle spasms that is
unrelieved by medications or repositioning.
o Assess and monitor neurovascular status.
o Routinely monitor skin integrity and document findings.
o Assess pin sites for pain, redness, swelling, drainage, or odor. Provide pin care per
protocol.
o Assess for changes in elimination and maintain usual patterns of elimination.
o Ensure that all hardware is tight and that the bed is in the correct position.
o Assess and maintain weights so that they hang freely, and the knots do not touch the
pulley. Do not lift or remove weights unless prescribed and supervised by the provider.
o Consult with the provider for an overbed trapeze to assist the client to move in bed.
o Provide range of motion and encourage activity of nonimmobilized extremities to
maintain mobility and prevent contractures.
o Encourage deep breathing and use if the incentive spirometry.
o Promote frequent position changes within restriction of traction.
o Remove sheets from the head of the bed to the foot of the bed and remake the bed in
the same manner.
pain management: rating a child's postoperative pain level chapter 9 - -FLACC (2
months to 7 years): assess behaviors of the child
-FACES (3 years and older): using diagram of six faces
-Oucher (3-13 years): pain on a scale of 0 to 5 using six photographs
-Numeric scale (5 years and older): rate pain on scale of 1-10
-Non-communicating children's pain (3-18 years): behaviors observed for 10 min &
categories scored from 0 to 3
gastrointestinal disorders: menu items for celiac disease chapter 13 Nutrition - Gluton
intolerance. eliminate gluten, wheat, rye, and barley.

Encourage milk, cheese, rice, corn, eggs, potatoes, fruits, veggies, fresh meats, fish,
dried beans.
antibiotics affecting protein synthesis: administration of aminoglycosides chapter 45 -
SELECT PROTOTYPE MEDICATION: Gentamicin
OTHER MEDICATIONS
• Tobramycin
• Neomycin
• Streptomycin
• Paromomycin

USES:
Treats aerobic gram-negative bacilli, such as E.Coli, Klebsiella pneumoniae, Proteus
mirabilis, and Pseudomonas aeruginosa.
• Paromomycin (an oral aminoglycoside) treats intestinal amebiasis and tapeworm
infections.
• Oral neomycin suppresses the normal flora of the GI tract postoperatively in
preparation for colorectal surgery: topically, it treats infections of the eye, the ear, and
skin.
• Streptomycin can treat tuberculosis in combination with other medications, but newer
and safer ones (ethambutol, rifampin, isoniazid) are preferable.
COMPLICATIONS: Ototoxicity, Nephrotoxicity, Intense neuromuscular blockade,
Hypersensitivity.
CONTRAINDICATIONS/PRECAUTIONS:
• Use cautiously in patients with kidney impairment, hearing loss, and myasthenia
gravis.
INTERACTIONS: Penicillin inactivate aminoglycosides when in the same IV solution
NURSING ADMINISTRATION:
• Most aminoglycosides, such as gentamicin and streptomycin (IM Only), are parental.
Neomycin also has oral and topical formulations; tobramycin also has inhalation
formula.
• Base acquisition of aminoglycoside levels on dosing schedules.
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ING, it is only necessary to obtain a blood sample for measuring trough levels.
o DIVIDED DOSES
Peak: 30 min after admin of aminoglycoside IM or 30 min after completion of an IV
infusion.
Trough: Right before next dose.
cardiovascular disorders: evaluating client response to digoxin and understanding of
digoxin administration chapter Pharm - o Withhold for infant if pulse is less than
90/min.
o Withhold if pulse is less than 70/min
o Signs of toxicity: bradycardia, dysrhythmias, nausea, vomiting, anorexia
o Therapeutic serum levels 0.8 -2 mcg/L
pain management: opioid administration chapter 9 - o Give meds routinely vs. PRN in
order to manage pain better.
o Combine adjuvant meds with other analgesics
o Opioids are for moderate to severe pain
o Combining a non-opioid and opioid meds treats pain peripherally and centrally
blood neoplasms: laboratory values to report chapter 40 - anemia (low blood count)
thrombocytopenia (low platelets)
neutropenia (low neutrophils)
leukemic blasts (immature WBCs)
complications of infants: newborn screening results chapter 42 - • Expected range of
phenylalanine in newborns is 0.5-1mg/dL
cystic fibrosis: teaching about diagnostic testing chapter 19 - Blood specimen:
nutritional panel to detect a deficiency in fat soluble vitamins (A, D, E)

Sputum culture for detection of infection.

DNA testing to isolate mutation.

Pulonary function test

-abdominal x-ray to detect meconium ileus
-stool analysis: for presense of fat enzymes. 72 hr sample with documentation of food
intake.
-Sweat chloride test. child must be well hydrated to ensure accurate test results. a
devise that uses an electrical current stimultaes sweat production. Collection of sweat
from two different sites for adequate sample. Expacted reference range is chloride
content less than 40 mEq/L and sodium content less than 70 mEq/L.

Diagnostic confirmation of cystic fibrosis is chloride greater than 40 mEq/L for infants
less than 3 mo of age and greater than 60 mEq/L for all others; sodium greater than 90
mEq/L.
renal disorders: laboratory values to report chapter 26 - • Creatinine should be 0.6 -
1.2.
• BUN should be 6 - 20
chronic neuromusculoskeletal disorders: providing teaching about increased intracranial
pressure chapter 29 - • Teach the client about manifestations of shunt malfunction
and hydrocephalus and when to notify the provider.
MANIFESTATIONS:
• INFANTS: high-pitched cry, lethargy, vomiting, bulging fontanels, and/ or widening
cranial suture lines, increased head circumference.
• CHILDREN: headache, lethargy, nausea, vomiting, double vision, decreased school
performance or learned tasks, decreased LOC, seizures.
cardiovascular disorders: postprocedural care for cardiac catheterization - o Provide
continuous monitoring and SpO2 to assess for bradycardia, dysrhythmias, hypotension,
and hypoxemia
o Assess HR and RR for full minute
o Assess pulses for equality and symmetry
o Assess skin temp and color of affected extremity; a cool extremity with skin that
blanches can indicate arterial obstruction
o Assess insertion site for bleeding or hematoma
o Maintain clean dressing
o Prevent bleeding by maintaining the affected extremity in a straight position for 4 -
8hrs.
o Monitor I&O
o Monitor for hypoglycemia. IV fluids with Dextrose can be necessary
o Encourage oral intake, starting with clear liquids
o Encourage child to void to promote excretion of the contrast medium.
organ neoplasms: teaching about radiation therapy chapter 39 - • Instruct the child
and family not to wash off marks on skin that outline the targeted areas.
• Teach the child and family to wash the marked areas with lukewarm water, use hands
instead of a washcloth, pat dry, and take care not to remove markings. Avoid using hot
or cold water.
• Teach the child and family to avoid use of soaps, creams, lotions, and powders unless
they are prescribed.
• Encourage wearing loose cotton clothing
• Remind child and family to keep areas protected from the sun
• Instruct the family to seek medical care for blisters, weeping, and red/tender skin.
• May be an alteration in bowel elimination
acute and infectious respiratory illnesses: planning care for an infant who has
bronchiolitis chapter 17 - Supplemental oxygen to maintain O2 =>90%.
Encourage fluid intake otherwise give IV fluids.
Maintain airway!
Medications as prescribed. corticosteroid use is controversial. Bronchodilators NOT
recommended. Antibiotic if coexisting bacterial infection is present. CPT not
recommended. Nasopharyngeal or nasal suctioning as needed. Encourage
breastfeeding.
acute and infectious respiratory illnesses: postoperative care for tonsillectomy chapter
17 - POSTOPERATIVE NURSING ACTIONS
• Positioning
o Place in position of comfort
o Elevate HOB when child is fully awake
• Assessment
o Assess for evidence of bleeding, which includes frequent swallowing, clearing the
throat, restlessness, bright red emesis, tachycardia, and/or pallor.
o Assess the airway and vital signs
o Monitor for difficulty breathing related to oral secretions, edema and/or bleeding
• Comfort Measures
o Administer liquid analgesics or tetracaine lollipops and prescribed
o Offer ice chips or sips of water to keep throat moist
o Administer pain medication on a regular schedule
• Diet
o Encourage clear liquids after return of gag reflex, avoiding red-colored liquids, citrus
juice, and milk-based foods initially
o Advance diet with soft, bland foods.
• Instruction
o Discourage coughing, throat clearing, and nose blowing to protect surgical site
o Avoid the use of straws
o Alert patients that there can be clots or blood tinged mucus in vomitus
gastrointestinal structural and inflammation disorders: postoperative care for a cleft
palate repair chapter 23 - • Change the infants position frequently to promote drain
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age and breathing. The patient may be placed on abdomen in the immediate
postoperative period
• Maintain IV fluids until the infant is able to eat and drink
• Clear liquid diet for first 24 hr.
• Avoid placing a straw, tongue depressor, hard pacifier, rigid utensils, hard-tipped sippy
cups, or suction catheters in the infant's mouth after repair.
• Elbow restraints can be used to prevent the infant from injuring the repair
• Close observation for signs or airway obstruction, hemorrhage, and laryngeal spasm
• Face mask to deliver O2
seizures: caring for a child during a tonic-clonic seizure chapter 13 - • Protect from
injury
• Maintain patent airway
• Prepare to suction secretions
• Turn child to side-lying position (decrease risk for aspiration)
• Loosen restrictive clothing
• Do not attempt to restrain child
• Do not attempt to open jaw or insert an airway during seizure activity
• Remove glasses
• Administer O2
• Stay with child
• Note onset, time, and characteristics of seizures
• Allow seizure to end spontaneously
medications affecting urinary output: identifying medication contraindications chapter 19
- • HIGH CEILING LOOP DIURETICS CONTRAINDICATIONS
o Avoid use during pregnancy
o Contraindicated in patients who have anuria (no urine output)
o Use cautiously in cardiovascular disease, diabetes, dehydration, electrolyte depletion,
and gout. Use cautiously in clients taking digoxin, lithium, ototoxic medications, NSAIDs,
and antihypertensives.
• THIAZIDES CONTRAINDIACTIONS
o Avoid use during pregnancy; decreases maternal blood volume and decreases
placental perfusion, causing a compromise in the nutrients supplied to the fetus.
o Do not breastfeed b/c diuretic enters the milk and is harmful to the infant
o Renal impairment
o Use cautiously in cardiovascular disease, diabetes, dehydration, electrolyte depletion,
and gout. Use cautiously in clients taking digoxin, lithium, ototoxic medications, NSAIDs,
and antihypertensives.

• POTASSIUM SPARING DIURETIC CONTRAINDICATIONS

o Hyperkalemia and are taking potassium supplements or another potassium sparing
diuretic
o Severe kidney failure or anuria
• OSMOTIC DIURETIC CONTRAINDICATIONS (MANNITOL)
o Clients who have active intracranial bleed, anuria, severe pulmonary edema, severe
dehydration, and renal failure.
fractures: planning care for a child who has osteomyelitis chapter 27 - o Assist in
diagnostic procedures, such as obtaining skin, blood, and bone cultures
o Assist with joint or bone biopsy
o Administer IV

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