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swellings…) inspection. • Chest (Inspection, Palpation/ Percussion, Auscultations) • CVS (Inspection, Palpation/, Auscultations ) • Abdomen(Inspection, Palpation/ Percussion, Auscultations ) • GUS (Costo-vertebral angle (CVA) tenderness, Suprapubic tenderness, and inspection of external genitalia) • Musculoskeletal system( joint swelling or tenderness or deformity, bone swelling or tenderness, muscles) • Intugementory /skin ( color, lesions ) • CNS( Level of consciousness, reflexes,(motor and sensory )and meningeal Signs Pediatric Nursing and child health care 23 Study Questions 1. What are the essential components of history taking? 2. What are the principles and techniques of physical examination in a small child? 3. What methods can you use when evaluating the body system? 4. What techniques would you use to get information about the sick child? Pediatric Nursing and child health care 24 CHAPTER THREE ESSENTIAL 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 - Identify the need and carryout resuscitation - Care for a child under specific conditions 3.1 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. 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. Pediatric Nursing and child health care 25 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. A) Oral administration: Infants will generally accept the medication put into their mouth, provided that it is in a form which they can deadly 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 or if this is contraindicated elevate his head and shoulders. There is then less danger of his choking. Medication can be given from medication glass, 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. 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 Pediatric Nursing and child health care 26 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. 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. 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
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