ASSOCIATE DEGREE NURSING PROGRAM
NURSING CARE OF CHILDREN Practicum
Methodical Instruction
for
PRACTICAL CLASS # 5 (5 hours)
Theme: Medication administration. Loss and Bereavement. Infectious Diseases in Children. Immunization.
Room No.:
Professional Orientation: Assuring safe administration of medications to children is an important part of providing appropriate pediatric nursing care. Physiological, psychosocial, and cognitive differences between children and adults have implications for pharmacologic intervention with children. Understanding and applying knowledge of these differences will facilitate safe medication administration to children (Pollard, 1998). This is particularly important since research on pharmacologic intervention with children has been fairly limited due to ethical constraints related to informed consent.
When one thinks of loss, separation, or bereavement, the death of a person comes to mind; yet, on average, children experience loss and bereavement through a myriad of situations that are not related to the death of a person. These early experiences are important and help shape an individual’s ability to cope with loss later in adult life.
STUDENT OBJECTIVES
Medication administration
1. Describe pharmacokinetic and pharmacodynamic processes.
2. Discuss age-related differences in pharmacokinetic and pharmacodynamic processes.
3. Discuss the impact of psychosocial and cognitive development on giving medications to infants and children.
4. Discuss special considerations and approaches for safely administering medications to infants and children.
5. Discuss appropriate methods for calculating a pediatric medication dose.
6. Discuss age-appropriate techniques for administering medications to children via the oral/enteral, intravenous, intramuscular, subcutaneous, rectal, ophthalmic, otic, nasal, and topical routes.
7. Describe the advantages and disadvantages of each route of pediatric medication administration.
Loss and Bereavement
1. Describe common situations that can lead to feelings of loss and separation in children.
2. Explain how children of various ages conceptualize death.
3. Explain the process of grief and bereavement.
4. Discuss factors that influence children’s reactions to loss.
5. Discuss the common responses of children to loss.
6. Explain how children respond to the death of a parent or sibling.
7. Discuss strategies to help communities cope with loss due to disaster/traumatic events.
8. Discuss the role of the nurse in providing care to families experiencing a life-threatening illness of a child.
9. Explain why hospice might be a good alternative to hospital care for the terminally ill child.
10. Discuss the importance of self-care for nurses caring for the terminally ill child.
Infectious Diseases in Children. Immunization
1. Describe the mode of infectious disease transmission.
2. Discuss how a child’s developmental level affects the transmission of infectious disease.
3. Discuss the impact of day care and school settings on the incidence of infectious diseases.
4. Describe the etiology, clinical manifestations, treatment, and nursing management of common infectious diseases.
5. Identify measures used to prevent common infectious childhood diseases, including immunizations.
6. Identify the educational needs of families whose child has an infectious disease.
7. Discuss the importance of adhering to the laws and policies related to infectious diseases, including immunizations.
1) Potts, N.L., Mandleco, B.L.; Pediatric Nursing: Caring for Children and Their Families. – Chapters 15, 19, 20. – Pp. 417-452, 537-573.
2) Clinical Manual to Accompany Potts, N.L., Mandleco, B.L.; pp.
3) Wong D.L. and Whaley L.F.. Clinical Manual of Pediatric Nursing. – 3rd edition. – Mosby Company, 1990. – 619 p. – 235 ill.
EXAMPLES OF MULTIPLE CHOICE QUESTIONS
Identify the choice that best completes the statement or answers the question.
____ 1. The nurse working with a pediatrician in the doctor’s office setting knows it is a top priority to properly clean all surfaces and toys touched by the children who come to the office, or make certain they have been properly cleaned, because of which of the following reasons?
|
a. |
Organisms tend to enter the body through the mouth. |
|
b. |
Many organisms remain viable from hours up to several weeks on surfaces. |
|
c. |
The nurse has a responsibility to stop the spread of HIV in the office setting. |
|
d. |
Failure to ensure thorough cleansing can result in malpractice for the nurse. |
____ 2. Which of the following best describes the term vertical transmission?
|
a. |
oral intake of germs that go through the body and are secreted rectally |
|
b. |
when the person contracts the disease or infection while awake and standing |
|
c. |
droplet infection that drops downward into the respiratory tract |
|
d. |
the process of transmitting a disease from one generation to another |
____ 3. Which of the following groups of children are susceptible to infections from staphylococci and Escherichia coli?
|
a. |
adolescents |
c. |
toddlers |
|
b. |
preschoolers |
d. |
newborns |
____ 4. The neonate will more readily absorb which of the following types of medications?
|
a. |
acidic drugs |
c. |
slightly alkaline |
|
b. |
neutral drugs |
d. |
very alkaline |
____ 5. The medicatiourse notices that a 12-year-old overweight boy with considerable adiposity is receiving a larger dose of a lipid-soluble medication than a 10-year-old, average-weight female peer. The nurse realizes that the major reason for this is that:
|
a. |
females require less medication than males |
|
b. |
older children require more medication than younger peers |
|
c. |
lipid-soluble medications have an affinity for fat and can be stored in body fat |
|
d. |
boys have more muscle, which uses more lipid-soluble drug faster |
____ 6. During the first month to 23 months of age, the liver of the neonate is immature. While the liver is immature, medications metabolized by the liver have:
|
a. |
a shorter half-life |
c. |
a longer half-life |
|
b. |
no half-life |
d. |
about the same half-life |
____ 7. The nurse is preparing to give an injection to a preschooler. The nurse has selected the deltoid muscle. What is the maximum amount of solution that the nurse can give in the deltoid of a preschooler?
|
a. |
0.25 mL |
c. |
0.5 mL |
|
b. |
0.05 mL |
d. |
1 mL |
____ 8. The nurse is preparing to give an intramuscular injection to an infant with a small muscle mass. The best angle for giving the injection will most probably be which of the following?
|
a. |
90-degree angle |
c. |
60-degree angle |
|
b. |
75-degree angle |
d. |
45-degree angle |
Answer Section
1. ANS: B
2. ANS: D
3. ANS: D
4. ANS: A
5. ANS: C
6. ANS: C
7. ANS: C
8. ANS: D
PRACTICUM OUTLINE (11:00 am till 13:00 pm)
1. Personal work: Master the next practical skills:
§ Giving intradermal injections
§ Giving IV medication through a heparin-locked line
· Nursing Tip: When giving IV medication through a line that has been locked, the acronym SAS or SASH can help the nurse remember the steps of the procedure.
· S—saline, A—administer medication, S—saline, or
· S—saline, A—administer medication, S—saline, H—heparin.
· Which acronym is appropriate depends on the policy of the institution.
§ Giving IV push
§ Giving IV medication via syringe infusion pump, buretol (metriset, soluset), piggyback, or retrograde.
§ Giving intramuscular (IM) injections
· When injections are necessary, care should be taken to select the appropriate injection site and size of needle based on the child’s size. The needle size selected should be the shortest and smallest gauge possible.
§ Giving subcutaneous (SC) injections
§ Administer Rectal Medication
§ Administer ophthalmic medication
§ Administer Otic Medication
§ Administer Nasal Medication
§ Administer Topical Medication
§ Provide family teaching about safe storage, use, and disposal of medications
Intramuscular Injection Sites
Students discussion (13:15 pm till 14:00 pm)
1. Key Concepts
· Safe drug administration in a pediatric population requires an understanding of physiological differences and their impact on pharmacokinetic and pharmacodynamic processes.
· Approaches to children and techniques of medication administration must be based on growth and development, including physical, psychosocial, and cognitive development.
· Children should be given developmentally appropriate and truthful explanations about medication administration.
· Children experience loss and separation (divorce, moving to a new neighborhood, changing schools) long before they experience the death of a loved one.
· Four components of the concept of death are universality, irreversibility, nonfunctionality, and causality.
· Understanding the concept of death is a gradual process related to the individual’s age, cognitive development, culture, religious belief, and psychological development.
· Children grieve differently than adults; their responses are both physical and psychosocial.
2. Review Questions
1. A 3-year-old has an order for Cefazolin 300 mg IV every 8 hours. He weights 9.8 kg. The recommended dose for Cefazolin is 50-100 mg/kg/24 hours. Calculate the recommended dosage range for this child and compare it with the ordered dose. Is the ordered dose appropriate? If not why not?
2. One day Ronnie, a 7-year-old with a terminal illness, said to the nurse, “I don’t feel better any more, am I going to die? Everyone is acting kind of weird.” Give your response.
3. What information should the nurse give to parents to assist them explain to their 6-year-old child that a grandfather has died?
4. How can the school nurse assist children cope with the death of a classmate?
5. How are children’s reactions to parental separation or divorce similar to that of death?
6. What factors influence a child’s response to the death?
7. How caurses help a community cope with a traumatic event?
8. What are the benefits of hospice care for the terminally ill child and family?
9. Explain why infants and children are more prone to infection than adults.
10. When should caregivers be instructed about immunizations?
11. Identify strategies to facilitate adherence to immunization schedules from infancy through adolescence.
12. Identify the common ways in which infants and children facilitate the spread of infectious disease.
13. Explain why acetaminophen is the drug of choice when treating viral illnesses.
14. What should be included in a plan to teach the staff of a day care center how to prevent the spread of illness?
15. What factors are associated with the spread of STDs in adolescents?
16. Explain why adolescents with herpetic lesions may be at risk for developing HIV infection.
17. Discuss the rationale for reporting certain infectious diseases to the proper health authorities.
3. POP-QUIZ (14:15 pm till 15:00 pm)
WEB RESOURCES
National Maternal and Child Health Clearinghouse (NMCHC) www.nmchc.org
Association for Professionals in Infection Control and Epidemiology www.apic.org
Centers for Disease Control and Prevention www.cdc.gov
Immunization Action Coalition www.iminunize.org
Prepared by Nataliya Haliyash
Sep. 10, 2007
Approved by Department of General Patient Care. Minute #2 from Oct.2, 2007
Revised by Department of General Patient Care. Minute #12 from June 17, 2008.
Revised by Department of General Patient Care. Minute #___ from ____, 200__.
Head of the Department Associated Prof. Svitlana Yastremska,
MD, Ph.D., BSN
