Chapter 37: Principles and Procedures for Nursing Care of Children

The concept of atraumatic care serves as the overarching framework, prioritizing psychological well-being alongside physical healing through developmentally appropriate communication strategies, therapeutic play interventions, and coordination with child life specialists to mitigate procedural anxiety. A cornerstone practice involves conducting invasive or painful procedures in designated treatment areas rather than the child's hospital room, preserving that space as a secure sanctuary for rest and emotional safety. The chapter addresses critical legal and ethical dimensions, including informed consent protocols, the assent process for school-age and adolescent patients, and documentation requirements that protect both patient autonomy and institutional liability. Safety infrastructure encompasses comprehensive fall prevention strategies, safe patient transport techniques, and judicious application of restraint devices within strict regulatory and time-limited parameters. Infection prevention protocols integrate standard precautions with transmission-based isolation measures tailored to specific pathogens and clinical conditions. Fundamental caregiving procedures include bathing techniques adapted to developmental stage and clinical status, oral hygiene practices that prevent dental disease, and nutritional support ranging from supervised oral intake to formula administration through various enteral access routes including nasogastric, orogastric, and gastrostomy tubes, with emphasis on confirming tube position through radiographic imaging or pH-based assessment of aspirated gastric contents. Vital sign assessment varies by developmental stage, requiring age-specific techniques such as apical pulse palpation in infants and careful blood pressure cuff selection to achieve reliable measurements. The chapter details specimen collection methodologies for urine, stool, and blood samples, management of bowel and bladder elimination including enema administration and ostomy care, and respiratory support encompassing oxygen delivery systems, pulse oximetry surveillance, and aseptic suctioning techniques for tracheostomy maintenance. Perioperative nursing encompasses preoperative fasting guidelines based on age and anesthesia type, family presence during anesthesia induction to reduce separation anxiety, and postoperative monitoring to manage pain effectively and prevent respiratory complications such as atelectasis through mobilization and deep breathing exercises.