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develop. • If newborns are subjected to a Pao2 of over 100-mm/Hg for an extended time, retinopathy of prematurely can occur. 4. Administering Enemas: Enemas are rarely used with children unless a part of preoperative preparation or are required for radiological study. The usual amount of enema solution used are as follows: • Infant: less than 250 ml • Preschooler: 250-350 ml • School age child: 300-500 ml • Adolescent: 500 ml Pediatric Nursing and child health care 31 For an infant: • Use a small soft catheter (no 10 to 12 French) in place of an enema tip. • Infants and children up to ages 3 years or 4 years are unable to retain enema solutions, so they must rest on a bed pan or baby pan during the procedure • Pad the edge of the pan so that it is not cold or sharp. • Place a pillow under the infants or the young child’s upper body for positioning and comfort. • Lubricate the catheter and insert it only 2 to 3 inches (5cm – 7cm ) in children and only 1 inch ( 2.5 cm ) in infants. • Be certain to hold the solution container no more than 12- 15 inch above the bed surface so the solution flows at controlled rate. • If the child experiences intestinal cramping, clamp the tubing to halt the flow temporarily and wait until the cramping passes before instilling any more fluid • If the enema solution is to be retained, such as an oil solution, hold the child’s buttocks together after administration • Tape water is not used because it is not isotonic and causes rapid fluid shifts of water in body compartments, leading to water intoxication. • Normal saline ( 0.9 sodium chloride ) is the usual solution Pediatric Nursing and child health care 32 3.3 Care of child under specific conditions: Fever: Fever in children is common and can have many causes. In many cases you will make the diagnosis of nonspecific virus infection. This may be true, but such a diagnosis is difficult to prove and should never be made without taking a careful history and performing a proper examination in any child with fever. Young children appear to tolerate fever better than adults but some develop convulsions. Remember to ask for any contact with infectious diseases. Think of malaria and take a blood film. If you still do not have a definite cause for the fever, rule out (Malaria, Early measles, Pneumonia, meningitis) A) Features of Febrile convulsions: • Begin between 6 month and 5 years of age • Incidence is 3 % by 5 years of age • Epilepsy develop in 3 % of cases • % are neurologically abnormal • 30 % of cases develop further seizure with fever • Febrile seizures lasting over 30 minutes are more serious • Repeated convulsions may damage the brain. The best treatment is controlling and preventing high fever rather than giving continuous anticonvulsants. Pediatric Nursing and child health care 33 General management of children with fever: a. If the fever is high (over 39 degree centigrade) • Tepid sponging with ordinary water will help to reduce but ice cold water is harmful because it causes constriction of blood vessel in the skin and prevents heat loss. • Antipyretics (paracetamol) 10 –15 mg /kg • Use a fun to increase water evaporation and hence skin cooling and reduction in body temperature. b. Feverish children should never be wrapped in warm blankets. Children must be able to get rid of the heat, otherwise febrile convulsions can be precipitated c. children who have fever need to take extra fluids, so make sure that they have plenty to drink. • If they are too sick to take, give fluids by NG tube • If they are obviously dehydrated, they need intravenous or intraperitoneal infusion • Room ventilation • Re-assess the child for fever later • Attempts should be made to identify and treat underlying causes B) Coma: Coma is a state of unconsciousness from which patient cannot be aroused by any stimulation. • This might be the result of a recent convulsions • Coma can be caused by local damage to the brain by Pediatric Nursing and child health care 34 infection (brain absces, encephalitis, TB. or other types of meningitis) • coma can be caused by abnormal function of the brain cells due to: 1. uremia 2. high blood pressure as in acute glomerulonephritis 3. drugs or poisons 4. hypoglycemia as in malnourished children or diabetics after too much insulin 5. hyperglycemic diabetic
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