Chapter 22: Health Care Adaptations for Child & Family

Health Care Adaptations for Child & Family comprehensively covers the essential health care adaptations required for the nursing care of infants and children, emphasizing that pediatric patients are not simply miniature adults but require specialized approaches due to their unique anatomical and physiological developmental stages. It begins by outlining admission procedures, stressing the critical nature of informed consent, proper patient identification using bracelets, and the implementation of strict safety measures such as keeping crib rails raised and using bubble tops to prevent accidents. The text details protocols for transporting and positioning children, including specific holding techniques like the football hold and the application of mummy restraints or swaddling for safe procedure execution. A major focus is placed on data collection and physical assessment, advocating for a least-invasive-to-most-invasive approach where respiration and heart rate are assessed before traumatic procedures, and defining age-specific norms for vital signs including pulse, respiration, and blood pressure using appropriate cuff sizes. The chapter explains the distinct physiological differences in drug absorption, metabolism, and excretion in pediatric patients—such as immature liver and kidney function—necessitating precise medication dosage calculations based on milligrams per kilogram of body weight or body surface area using a nomogram to prevent toxicity. It provides extensive guidelines for administering medications via various routes, differentiating techniques such as ear drop administration for children under three years versus older children, and identifying the vastus lateralis as the preferred intramuscular injection site for infants to avoid sciatic nerve injury. Furthermore, the text explores nursing responsibilities in specimen collection, including the use of urine bags and proper positioning for lumbar punctures, and details the management of intravenous therapy, total parenteral nutrition, and the prevention of fluid overload using infusion pumps. Key procedures are thoroughly described, including gastrostomy tube feedings, the administration of isotonic saline enemas, and the meticulous care required for tracheostomies to maintain airway patency through proper suctioning and stoma hygiene. The chapter also addresses respiratory support through oxygen therapy methods like mist tents and hoods, alongside emergency interventions for airway obstruction using back blows and chest thrusts for infants versus abdominal thrusts for older children. Finally, it addresses the psychological and physical preparation necessary for pediatric surgery, highlighting the importance of age-appropriate explanations, managing NPO status to prevent dehydration, and postoperative monitoring for complications like shock or pain to ensure a safe recovery.