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Does the child track and focus?Drainage?EarsOuter canthus parallel with top of earDon’t stick anything in earNote position of ears on headAssess for any drainage from the ears
Throat/MouthTeething, lost teeth, loose teethOral hygieneSores infection/strep?Physical Exam Variations, Based on AgeTalking to Kids_____________________________________________________________Medication Administration
Physiological differencesoDOSES DIFFERENT FOR PEDSoImmature liver and kidneysoHigher risk for med errors due to different dosages for each patient (weight based) oDifferent concentration of medicationsMorphine – orange = 10mg/mLWhite = 5mg/mLMedication AdministrationOral syringes – tip of syringe, put in side of cheek & dribble little in at a time = less likely to spit out, medipop – pacifier with med adminIf spit up, assess how much taken, call doc to reorderMedication cups – larger volume of med – 8yo needs 20mLPills vs Liquid vs chewableoHow to decide – ask parents what best for themoAsk childoAsk nurse who gave you reportTolerance stubbornCrushedpills in pudding, applesauceoAntibiotics may not come in liquidoTake small corner of pudding, smaller amount with med,then give them the rest to finishMix in baby bottles?oNo, what if baby wont finish whole bottleoDon’t mix ANY meds in bottleCoercion and using Child LifeoCan we ever force child to take medicine if they don’t want to?oYes can force – under 18, minor, can’t make that decisionoParent can refuse for child, but need to explain need medicine to get better! oRewards, threats, child life specialist (prizes, stickers, less traumatic experience), ultimately will hold child down to admin meds.Offer to let parent give (in your presence)
IVsCheck IV every time in room, (hourly) esp when fluids arerunning through it. Can infiltrate quickly & wont always let you knowCan place in the headon an infantHands, armsFeetare acceptable untilthe child is walkingMay need to use protective equipment to guard IV (but must be removable to assess site)oElbow restraints oOut of sight, out of mindPediatric IM InjectionsSite based on child’s size & ageLimit on volumeinjected in one siteOffer choice – would you like this leg or this leg – give VIABLEoptionsMay or may not be able to give the child a choice of injectionlocationVastus lateralis or deltoid
Get another nurse and one to hold, give at same time in thighs…?Comfort Holdsand RestrainingoOften necessary to use restraints to protect medical equipment and/or keep child from injuring himselfoComfort holds are used for painful procedures and allowthe child to be held by parent/nurse while the procedure is completedoDo not do painful or scary procedure in pt’s room – takept to procedureroom & do it there. Children associate pain/fear.