5.ESSENTIAL NURSING CARE FOR HOSPITALIZED CHILDREN.pptx

This is for students who are undergraduate nursing

1. ESSENTIAL NURSING CARE FOR HOSPITALIZED CHILDREN Dr.Abdikarim

2. ESSENTIAL NURSING CARE FOR HOSPITALIZED CHILDREN Learning Objectives After studying the material in this unit, the students will be able to: - Administer drugs for hospitalized children through different routs - Identify indications and use NG-tube feeding - Identify indications and administer Oxygen as ordered - Care for a child under specific conditions

3. Administration of Drugs: The giving of medication to a child is a serious responsibility of a nurse. The need for accuracy in pouring and giving medication is greater than with adult patients. The dose varies with the size, surface area, the age of the child and the nurse has no standard dose as is customary for adult patients.

4. Administration of Drugs: Since the dose is relatively small, a slight mistake in amount of drug given makes a greater proportional error in terms of the amount ordered than with the adult dose. Since the possibility of error is greater in the giving of medication to children than to adults, and since a child’s reaction to a dose ordered by a physician is less predictable than adult’s reaction, the nurse must be alert to recognize undesired effects of the medication given.

5. A) Oral administration: Infants will generally accept the medication put into their mouth, provided that it is in a form which they can swallow. The medication should be given slowly in order to prevent choking. The nurse should sit-down and hold infant or if he cannot be removed from his crib, raises him to sitting position

6. A) Oral administration: There is then less danger of his choking. Medication can be given from syringe, the tip of teaspoon or rubber-tipped medicine dropper. If the medication is immediately vomited, the physician should be notified. The child as young as two years of age can be taught to swallow drugs.

7. A) Oral administration: The child should be told to place the tablet near the back of his tongue and to drink the water, fruit juice, milk offered him in order to wash down the tablet. In younger seriously sick children, tablets crushed and dissolved in water can be given by spoon or through Naso - gastric tube

8. B) Intramuscular Injections: The procedure of using an intramuscular injection is the same as for the adults. In children and infants anterior lateral thigh is often used for IM injection to reduce the risk of vascular and peripheral nerve (sciatic) injuries. The needle used for intramuscular injection must be long enough so that the medication should be given deeply into the muscle tissue in order to be absorbed properly

9. B) Intramuscular Injections:

10. B) Intramuscular Injections:

11. C) Intravenous Administration: When a patient’s gastrointestinal tract can not accept food, nutritional requirements are often met intravenously. Parental administration may include high concentrations of glucose, protein or fat to meet nutritional requirements. Many medications are delivered intravenously, either by infusion or directly into the vein. Because intravenous administrations circulate rapidly.

12. C) Intravenous Administration: The ability to gain access to the venous system for administering fluid and medications is an expected nursing skill in many settings. They are responsible for selecting the appropriate venipuncture site and being proficient in the technique of vein entry. Ideally, both arms and hands should be carefully inspected before a specific venipuncture site is chosen.

13. C) Intravenous Administration:

14. C) Intravenous Administration: The following are considered when selecting a site for venipuncture. • Condition of the vein • Type of fluid/ medication to be infused • Duration of the therapy • Patients age and size • Skill of the health provider

15. C) Intravenous Administration: Possible Sites: • Antecubital –fossa Scalp veins • Femoral Veins • External jaguar Veins

16. PEDIATRIC DRUG CALCULATIONS Unlike adults, in which most medications already have a set dose. In Pediatrics, it is necessary to calculate the dose to be administered according to the weight in Kilograms (Kg) or the Body Surface. The most used Pediatric Medication Dose Calculation is based on the patient’s weight in Kg.

17. PEDIATRIC DRUG CALCULATIONS General aspects for the calculation of Pediatric Dose To calculate the Pediatric Dose of a drug, you need to know 3 essential data: Patient weight (Kg). Drug dosage. Presentation or strength of the drug.

18. PEDIATRIC DRUG CALCULATIONS The strength is  the amount of drug in the dosage form or a unit of the dosage form  (e.g. 500 mg capsule, 250 mg/5 mL suspension). quantity Units Symbol Relationship Mass (weight) kilogram Kg gram g 1 Kg = 1,000 g milligram mg 1 g = 1,000 mg microgram mcg or μ g 1 mg =  = 1,000 μ g

19. PEDIATRIC DRUG CALCULATIONS Volume litre L millilitre ml 1 L = 1,000 ml cubic centimetre cc 1 ml = 1cc

20. Pediatric dose calculation according to weight in kg. The first thing we must do is Calculate the total Dose to be administered of the Medication. Which we obtain by multiplying the Dose by the Weight of the Patient. If for some reason it is not possible to weigh the patient, their weight can be determined using the Ideal Weight Formulas.

21. Calculate the Dose of Paracetamol. For example the Dose of Paracetamol is 10-15 mg / Kg / dose. This means that we can use a dose of at least 10 and a maximum of 15 mg. In this example we will use a 15 mg dose in a child weighing 12 kg. Therefore, the total dose to be administered is: Total dose = (Weight of the patient in kg) x (dose of Drug) Total dose ⇒ (12 Kg) x (15mg) = 180 mg

22. Calculate the Dose of Paracetamol. In this example 180 mg is the total to be given. Before giving the indication we must know the presentation and concentration of the drug. Paracetamol for example can be found in various presentations. As a tablet, as a suppository or as a Syrup. In Pediatrics, most of the medications that are administered orally are preferred in Syrup. Therefore, it is necessary to know the concentration in milliliters (mL) of the drug.

23. Calculate the Dose of Paracetamol. Depending on the brand and manufacture, concentrations may vary.  In the case of Paracetamol Syrup, the most common concentration is 120mg / 5ml. So continuing with the example,  How many mL should we give to our patient? For this we must apply a rule of three.

24. Calculate the Dose of Paracetamol. Or just remember that the total Dose to be administered must be divided by the mg of the medication presentation and the result multiplied by the mL of the medication presentation. mL to be administered = (Total Medication Dose) / (mg of presentation) x (ml of presentation) mL to be administered = (180 mg) / (120 mg) x (5ml) ⇒ (1.25) x (5ml) = 7.5ml every 4-6 hours

25. Calculate Pediatric Antibiotics Dose The process is the same as with most Medications. We must know the patient’s Weight in Kg and calculate the total dose to be administered. The majority of Antibiotics administered by Oral Route come in the form of Syrup. The classic example is Amoxicillin. Which has a dose of 80 mg / Kg / day divided into doses every 8 or 12 hours. Therefore, this dose should be divided by 3 (if it is given every 8 hours) or by 2 (if it is given every 12 hours)

26. Calculate Pediatric Antibiotics Dose If we put it into practice with the patient in the previous example. Which we remember that weighs 12 Kg, then we will have: Total dose = (12 Kg) x (80 mg) = 960 mg. Now we must know the presentation and concentration of the drug. The most common presentations of Amoxicillin are 250mg / 5mL and 125mg / 5mL. In this example we will use the 250mg / 5mL presentation.

27. Calculate Pediatric Antibiotics Dose ML to be administered = (960mg) / (250mg) x (5mL) ⇒ (3.84) x (5mL) = 1.9.2 mL. Remember that 19.2 mL are equivalent to 960 mg of Amoxicillin. The dose to be administered each day. However this should be divided into 2 or 3 takes. So if we indicate it every 8 hours it would remain: mL to be administered every 8 hours = (19.2 mL) / 3 = 6.4 mL every 8 h.

28. Pediatric Dose Calculation in Special Situations Certain Medications may seem a bit more complicated. Trimethoprim / sulfamethoxazole is an antibiotic whose dose is 8mg / Kg / day divided into doses every 12 hours. But its presentation in syrup is (40mg / 200mg / 5mL) which essentially says that it has 40 mg of Trimethoprim and 200 mg of sulfamethoxazole every 5 mL. But when calculating the Pediatric Dose, it is based on Trimethoprim. If we use the same patient from the previous example, then the calculation would be:

29. Pediatric Dose Calculation in Special Situations Total dose = (12 Kg) x (8 mg) = 96 mg. mL to be administered = (96 mg) / (40 mg) x (5mL) ⇒ (2.4) x (5mL) = 12mL mL to be administered every 12 hours = (12mL) / 2 = 6mL every 12 hours.

30. Calculate Pediatric Dose of Intramuscular and Endovenous drugs. A baby should have 175 mg of ampicillin two times each day. The bottle contains 1g of ampicillin and you add 5 ml of water. - How many mg of ampicillin does the baby get each day? =175mg x 2 = 350 mg - How many ml of antibiotic is each dosage? = mL to be administered = (175 mg) / (1000 mg) x (5mL) ⇒ (0.175) x (5mL) = 0.875mL = 0.9ml

31. EXERCISE 1.A baby weighs 3.2 kg. The doctor prescribes Ampicillin 50 mg/kg two times per day. The bottle contains 500 mg of ampicillin and you add 5 ml of water. - How many mg does the baby get in 24 hours? - How many ml should the baby get each dose? 2. A baby is 3 kg . Gentamicin 5mg/kg was prescribed once a day which is 15 mg of gentamicin. The bottle contains 40 mg/ml. How many ml of antibiotic should the baby get? 3. A baby should have 1 mg of Vitamin K. The bottle contains 10mg/2ml. How many ml should the baby get? 4. A premature baby of 1.3 kg starts having apneas and we want to start with Aminophylline inj 10mg/kg. The vial is 250mg/10ml. How many mg should you give?. You dilute it with 5 ml of sterile water and give it over 15 minutes. How many ml do you give per minute?

32. CALCULATING THE DRIP RATE

33. CALCULATING THE DRIP RATE

34. CALCULATING THE DRIP RATE EXAMPLE Calculate the drip rate of 300ml of ringer lactate to be infused over 3 hours using a 20gtt/minute drip set. =300ml / 180 min x 20 drops/ml = 33.3drops/min = 33drops/min

35. Indications and use of NG-tube: Gavage feeding (nasogastric or NG-tube feeding) is a means of supplying adequate nutrition to an infant who is unable or tires too easily to suck or to an older child who can not drink. To prepare for Gavage feedings, the space from the bridge of the infant’s nose to the earlobe to a point halfway between the xiphoid process and the umbilicus is measured against a No 8 or 10 Gavage tube for children over one year measure from the bridge of the nose to the earlobe to the xiphoid process.

36. Indications and use of NG-tube:

37. Indications and use of NG-tube: The tube is marked at this point by a small piece of tape to ensure that it reaches the stomach after it is passed. The tip of the catheter may be lubricated by water. An oil lubricant should never be used.

38. Indications and use of NG-tube: Although the tube is passed into the stomach, it is occasionally passed into the trachea accidentally, oil left in the trachea could lead to lipoid pneumonia, a complication that a child already burdened with disease may not be able to tolerate.

39. Indications and use of NG-tube: Once you are assured that the catheter is in the stomach, attach a syringe or special feeding funnel to the tube. Be certain that the child’s head and chest are slightly elevated to encourage fluid to flow downward into the stomach. Then feed with funnel or syringe and allow it to flow by gravity into the child’s stomach.

40. Indications and use of NG-tube: When the total feeding has passed through the tube, the tube is reclamped securely and then gently and rapidly withdrawn to reduce the risk of aspiration. If the tube is to be remain in place, it should be flashed with 1 to 5 ml of sterile water and cupped to seal out air.

41. Indications and use of NG-tube: Indications for NG tube: • Prematurity • Neurologic disorders • Respiratory distress • Severe protein energy malnutrition • Cleft palate • Severe abdominal distension

42. Resuscitation: Respiratory arrest means that there is no apparent respiratory activity. The child will be unresponsive, pale and dead like. Cardiac arrest follows quickly after respiratory arrest as soon as the heart muscle is affected by the anoxia, which occurs.

43. Resuscitation: The outcome for the child will depend to great extent on the speed with which resuscitation is began. The steps for resuscitation can be remembered as “A, B, C, D” where A is for airway, B for breathing and C is for circulation and D is for drug administration.

44. Resuscitation: These three techniques (clearing the airway, ventilating the lungs, and circulating the blood by cardiac compression) will provide adequate oxygenation to major body organs for an extended period of time (A: clear airway, position, suction (B: bagging, oxygen administration) (C: Cardiac compression, secure IV line) (D –drugs (epinephrine). Details of this section will be discussed next lecture.

45. Oxygen administration: Oxygen administration elevates the arterial saturation level by supplying more available oxygen to the respiratory tract. Nursing care must be planned carefully. Ensure pulse oximetry is available to monitor response to oxygen therapy Note respiratory effort, colour , level of consciousness Check that there is a prescription for oxygen with a stated target saturation range

46. Oxygen administration: • Be able to recognize changes in a patient’s respiratory status. • If blood oxygen levels are not low, oxygen will not treat breathlessness. •Oxygen may be delivered to an infant by use of plastic mask. • This tight fitting plastic can keep oxygen concentration at nearly 100 %. • The amount of oxygen received by the patient is dependent on the delivery device used; ensure appropriate device is selected.

47. Oxygen administration: A nasal catheter used with an oxygen flow of 4 L/ min provides a concentration of about 50 %. Most children do not like nasal catheter because it is irritant; assess the nostrils of the infant carefully when using nasal catheter. The pressure of catheter can cause areas of necrosis, particularly on the nasal septum.

48. Oxygen administration: Oxygen must be administered warmed and moistened, no matter what the route of delivery; dry oxygen will dry and thicken, not loosen secretions. • Oxygen must be administered with the same careful observation and thoughtfulness as any drug. • If concentrations are too low, oxygen is not therapeutic • In concentrations greater than those desired, oxygen toxicity can develop.

49. HOW TO GIVE OXYGEN- through nasal prongs Give oxygen through nasal prongs or a nasal catheter. ■ NASAL PRONGS Place the prongs just inside the nostrils and secure with tape.

50. HOW TO GIVE OXYGEN- through nasal catheter. NASAL CATHETER Use an 8 French gauge size tube Measure the distance from the side of the nostril to the inner eyebrow margin with the catheter. Insert the catheter as shown in the diagram. Secure with tape. Start oxygen flow at 1–2 litres /min to aim for an oxygen saturation > 90%