Objective 42 - dsfasdf PDF

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Objective 3.42.1 Measurements: The length of the average newborn is 46 to 56 cm (19 to 21.5 in). The weight varies from 2722 to 4082 g (6 to 9lb). In the first 3 to 4 days after birth, the infant loses about 5% to 10% of the birth weight. This loss may be as high as 15% for preterm infants. Result from withdrawal from maternal hormones, fluid shifts, and the loss of feces and urine. Vital signs: Daily routine temperature taken by axilla. The newborn’s pulse rate and respirations are counted before the temperature is taken because the infant is apt to cry when disturbed. The apical pulse rate is being obtained from a newborn infant. The newborn’s pulse is irregular and rapid and varies from 110 to 160 beats/min. Nursing interventions: Gentle bulb suctioning of secretions from nose and mouth is performed to clear airways. At birth, the infant may be placed on the mother’s abdomen. The health care provider may initiate suctioning before cutting the cord. A critical factor in the transition of the newborn is maintaining a neutral thermal environment in which heat loss is minimal and oxygen consumption needs are the lowest. Infections that are relatively harmless to an adult may be fatal to the newborn. The infant’s movement and facial expression during crying are observed for symmetry and equality of movement. The head and face should be assessed for trauma, especially if forceps is used. Circumcision care:     

Keep area clean, change diaper Wash area with water; avoid alcohol-containing wipes Do not remove yellow crust from penis Apply diaper loosely to prevent pressure Report redness and bleeding or drainage Observe for at least six wet diaper per day

To maintain the mothers’ own nutrient stores while providing for the infant, the mother needs 500 additional calories each day beyond what her non pregnant diet provided. Every attempt should be made to facilitate maternal-infant contact. As soon as the infant is dried and warmed, and cardiorespiratory function is stable, the infant should be warmly wrapped and placed in the mother’s arms or in skin-to-skin contact with the mother.

Objective 3.42.2 1. Newborns have little neck muscle control. Therefore, you need to support her head and neck. Also, make sure not to press the soft spots on the head 2. Place one hand under the head and another beneath the bottom. Now raise the body to your chest region. You can hold the baby in this position as long as you are comfortable holding the baby’s neck and head. 3. Calmly hold your baby to your chest. Gentle pats on the back might soothe the crying baby. Newborns often sleep up to 16 hours a day or sometimes more. I'm wet. 4. Keeps your baby close to you at night. They are compact enough to fit in any bedroom and designed to be as safe as possible for babies

Objective 3.42.3 We need to set-up the circumcision tray, which include:  Povidone Iodine (1)  Triple Swabstick (1)  60cc Medicine Cup (1)  18 X 26 Inch Fenestrated White Poly-Tissue Drape  1.5 Inch Fenestration (1)  1 X 8 Inch Gauze Impregnated with Vaseline (10)  4 X 4 Inch 8ply Gauze Sponge (1)  #10 Scalpel (1)  4.5 Inch Sharp-Blunt O.R. Scissors (1)  4.75 Inch Adson Forceps with 1 X 2 Inch Teeth Proper aseptic technique: 1. Perform hand hygiene. 2. Identify and gather equipment for procedure. 3. Perform hand hygiene and prepare field: 1. open procedure pack using corners 2. drop sterile equipment into sterile field. 2. Prepare patient – use gloves where appropriate such as when removing a bloodstained dressing. 2. Remove gloves, perform hand hygiene, re-apply new gloves. 2. Perform procedure ensuring all key parts/components are protected: 1. sterile items are used once and disposed into waste bag 2. only sterile items contact the key site 3. sterile items do not come into contact with non-sterile items. 2. Remove gloves and perform hand hygiene. Care of the circumcised penis:  Keep area clean, change diaper  Wash area with water; avoid alcohol-containing wipes  Do not remove yellow crust from penis  Apply diaper loosely to prevent pressure  Report redness and bleeding or drainage  Observe for at least six wet diaper per day

b. c. d. e.

Date Document the date of the circumcision. Time Document the time of the circumcision. Physician performing procedure Document the name of the physician who perform the procedure. Type of clamp used Document the type of clamps used in the circumcision. Outcome of procedure

Objective 3.42.4 Age Heart Rate Respirations

Blood Pressure

Temperature

0 to 12 months 100 to 160 bpm 0 to 60 months 30 to 60 bpm 6 to 12 months 24 to 30 bpm 0 to 6 months 65 to 90/45 to 65 mmHg 6 to 12 months 80 to 100/55 to 65 mmHg All ages 98.6 F normal range is 97.4 F to 99.6 F

Preoperative tests and procedures  Vital sign – approach child carefully, explain, demonstrate; allow more time  Blood Work – Preparation is with age-appropriate restrain  Urinalysis - Preparation is with age-appropriate instruction and collection bag (U-bag)  NPO - Preparation is increase fluid before NPO; length of time varies with age and type of surgery (4-12 hours); no gums or hard candy; supervise hungry ambulatory patients carefully; remove “goodies” from bedside stand  Void before surgery – preferred but not always possible with infants and toddlers Identify client’s needs according to Maslow  Physiological needs: Providing appropriate food meets the client's physiological needs.  Safety Needs: being assured the unit rules will be enforced meets the client's need for safety.  Love and Belonging: Assigning a unit buddy addressed the client's need for belonging.  Self-Esteem Needs: Being complimented by the staff member for a job well done meets the client's need for esteem.  Self-Actualization needs: providing art supplies for the client who likes to paint meets the client's need for self-actualization. Nursing interventions: Separation anxiety occurs in infants age 6 months and older and is most pronounced at the toddler age. All factors relating to pain should be considered. This includes verbal and nonverbal expression of pain. It is important for the nurse to understand that responses of infants and children differ from those adults. Family is the single most important influence in a child's life. From their first moments of life, children depend on parents and family to protect them and provide for their needs.

Infancy

Trust/Mistrust Getting needs met Tolerating frustration in small doses Recognizing mother as distinct from others and self Toddler Autonomy/ Shame and doubt Trying out own powers of speech Beginning acceptance of reality vs pleasure principle

OralityUnderstanding the world by exploring with the mouth

Preconventional/ premoralCannot distinguish right from wrong

Security Patterns of emotional response Organization of sensation

Analitylearning to give and take

Punishment/ Obedience— Performance based on fear of punishment

Mastery space and objects

Sensorimotor stage (birth to 2 years)At birth, responses are limited to reflexes; begins to relate to outside events; concerned with sensations and actions that affect self directly. Preoperational (2 to 7 years)— Child is still egocentric; thinks everyone sees world as self does

3.42.5 For children, the basics of good personal hygiene are:  washing hands  covering their mouth when they cough  having regular baths or showers  brushing and flossing teeth Parents may have to help their child practice good personal hygiene habits. These will become even more important as they grow older and approach puberty. Educate parents to provide fresh fruits and vegetables rather than empty calories such as those found in doughnuts and storebought pastries. Decrease trips to fast-food restaurant. To achieve the benefits of physical activity, children should reach ‘moderate to intense activity, which is characterized as breathing harder, with an increased heart rate while active. Bed rest for each age group varies and differ. It is important to know how much sleep each age group needs.

-Neonates through 3 months of age typically sleep 14 to 17 hours a day -Infants from 4 months of age to 11 months of age should normally sleep about 12 to 15 hours a day -Older infants and toddlers up to 3 years of age should sleep 11 to 14 hours a day -Preschool children from 3 to 5 years of age should sleep 10 to 13 years of age -School age children from 6 to 12 years of age need 9 to 11 hours of sleep each day -Adolescents from 13 to 17 years of age should sleep about 8 to 10 hours of sleep Educate parents and child to make sure the child understands good hygiene and the importance of hand washing after using the toilet and before and after eating. Have the child up to date on their vaccinations. Have the child not share personal items. All patients with skin breakdown and immobile patients should undergo a risk assessment evaluation by a registered nurse upon admission and every 24 hours In addition to teaching about the client's condition and treatments, the nurse should also focus on helping the client and family understand how to prevent complications. The nurse listens carefully to parental concerns and acknowledges the legitimacy of their feelings.

Objective 3.42.6 Skill 15-2: Discharge of client from hospital: Preparation for the patient’s discharge ideally begins on admission because the goal of hospitalization is to return a healthier and happier child to the parents. An approach directed only towards good physical care of the patient’s disease is not sufficient. The nurse must also consider the emotional growth of the child and the education of the patient and family. This will provide a positive learning experience for all involved. If a patient requires specific home treatment, such as hyperalimentation, colostomy care, crutches, special diet, or insulin therapy, instructions are given to the parents gradually throughout their child’s hospitalization. The instructions are written so they can be referred to as need. If the older child is to administer any self-treatment, careful explanations and supervision are required until both patient and parents are confident, they can carry out the procedure safely at home. This may require the participation of home health services. Parents also must be prepared for behavioral problems that may arise after hospitalization. Severe stress may be obvious during the patient’s stay. The services of a children’s counselor are helpful if nightmares and regression occur. Guidance includes the following suggestions:  Anticipate behaviors such clinging, regression in bowel and bladder control, aggression, manipulation, and nightmares.  Allow the child to become a participating family member as soon as possible.  Take the focus off the illness; praise accomplishments unrelated to it.  Be kind, firm, and consistent regarding misbehavior.  Build trust by being truthful.  Provide suitable materials for play such as clay, paints, and doctor and nurse kits.  Allow time for free play.  Listen to and clarify misconceptions about the illness.  Prevent long periods of separation until a sense of security is regained.  Allow the child to visit hospital staff during routine clinic visits if desired. Whenever possible, parents are provided at least 1 days’ notice of their child’s discharge from the hospital so they can make the necessary arrangements.

Objective 3.42.7

1. Use appropriate sources of information  Hospital protocols non-profit organisations.  Identify client knowledge, attitude, or skills needed  If a patient requires specific home treatment, such as hyperalimentation, colostomy care, crutches, special diet, or insulin therapy, instructions are given to the parents gradually throughout their child’s hospitalization. The instructions are written so they can be referred to as need.  If the older child is to administer any self-treatment, careful explanations and supervision are required until both patient and parents are confident, they can carry out the procedure safely at home.  This may require the participation of home health services.  Assess emotional readiness to learn  When parents and child verbalize understanding of reasons why their child was seen and identifying signs and symptoms of their child’s illness.  Identify client strengths  Identify and include the patient and family’s strengths in self-care activities to help increase the patient’s independence. 2. Assist with the diagnosis of learning needs 1. Be realistic  Parents also must be prepared for behavioral problems that may arise after hospitalization. Severe stress may be obvious during the patient’s stay.  The services of a children’s counselor are helpful if nightmares and regression occur.  Validate with client and family  Include family members and enlist their support in reinforcing the importance of adhering to the treatment plan. 3. Develop a teaching plan a. Formulate measurable learner objectives  Provide education of child’s illness to patient’s family, encourage them to ask questions in regards on how to provide their care.  And to seek outside assistance when needed....