Nursing Care of A Child Undergoing Diagnostic Techniques and Other
Nursing Care of A Child Undergoing Diagnostic Techniques and Other
Nursing Care of A Child Undergoing Diagnostic Techniques and Other
Therapeutic Modalities
Objectives:
1. Assess children regarding their developmental stage and knowledge level before beginning
diagnostic or therapeutic procedures.
2. Identify common nursing interventions used in the health care of children to aid diagnosis and
therapy.
3. Evaluate expected outcomes for achievement and effectiveness of care.
Scheduling
Most diagnostic procedures are scheduled on a ambulatory basis.
● Try to arrange for the child to have time for meals and some free play time between
procedures
● If food or fluid must be restricted for procedures, monitor the child’s degree of discomfort
and physiologic need related to this; advocate as necessary for a time lapse between
examinations or improved coordination in scheduling to decrease the time spent without food
or fluid.
Infant- the number of painful or uncomfortable procedures done on infants should be kept to a
minimum to avoid interfering with an infant's developing sense of trust.
– Help parents understand why these procedures are being limited so they do not think their
infant's care is being compromised by so few diagnostic procedures.
Toddler and preschooler- give children at this age short explanations of what to expect, close to
the time of the procedure so that little time can be spent worrying over it.
School age and adolescent- they are interested in the theory and reason for procedures. Do not be
misled into thinking a child age would not appreciate an explanation or a comforting hand on
shoulder during a procedure.
Use of restrain
The purpose of restrain is to keep the child safe during procedure, restraints must always be used
with care, because if improperly applied or used, they can cause more harm than help.
– Check restraint every 15mins to see if they are not occluding circulation
– Remove the restraint every hour so the body part can be exercised.
Providing care after procedure
● After procedure, assess how well a child reacted to the procedure by both observation and
history. Allowing children to explain what happened helps them retrace the procedure in their
mind so they can conquer their fear of it.
● Be certain tissue samples obtained after procedure such as bone marrow aspiration are sent
to the proper department for analysis as soon as possible
● Guard against specimens being dropped or improperly labeled
● If conscious sedation was used, be sure children are wake before they are discharge home or
return to an inpatient hospital unit.
– Protective measures to limit movement may be necessary for restraining children in the
health care setting. They can be a short-term restraint to faclitate examination and minimize
the child's discomfort during special tests, procedures, and specimen collections. Restraints
can also be used for a longer period of time to maintain the childs safety and protection from
injury.
General Considerations
● Protective devices should be used only when necessary and after all other considerations are
exhausted, never as a substitute for careful observation of the child.
● Cannot be used on a continuous basis without an order. Continuous use requires justification
and full documentation of the type of restraint used, reason for use, and the effectiveness of
the restart used. Ongoing monitoring, documentation, and renewal of the order, with the
length of time the restraint will be in place, are required.
● The reason for using the protective device should be explained lo the child and parents to
prevent misinterpretation and to ensure ther cooperation with the procedure. Children often
interpret restraints as punishment.
● Teach the child and family about specific devices they may be using in the hospital (ie, side
rails) and after discharge (ie, mitts, elbow restraints).
● Any protective device should be checked frequenty to make sure it is effective and is not
causing any ill side effects. It should be removed periodically to prevent skin irritation or
circulation impairment. Provide range of motion and skin care routinely.
● Do not cover an IV site with a restraint when possible.
● Protective devices should always be applied in a manner that maintains proper body
alignment and ensures the childs comfort.
● Any protective device that requires attachment to the child’s bed should be secured to the
bed springs or frame, never the mattress or side rails. This allows the side rails to be adjusted
without removing the restraint or injuring the child’s extremity.
● Any require knots should be tied in a manner that permits their quick release. This is a safety
precaution.
● When a child must be immobilized, an attempt should be made to replace the lost activity
with another from of motion. For example, although restrained, a child can be moved in a
stroller, wheelchair, or in bed. When arms are restrained, the child may be allowed to play
kicking games. Water play, mirrors , body games, and blowing bubbles are helpful
replacements.
● Restraints should be removed as soon as the child is no longer considered a danger to self or
others or when medical devices are no longer in place.
1. Electrical impulse studies- are those that include electrical conduction children have special
preparation for studies such electrocardiograms or electroencephalogram because they have
warned not to play with electric wires and may worry about being burned or electrocuted. They can
be reassured that the electricity passes from their body to the machine not the other way around.
Electrodes are attached to the body by paste, which is easily removable. If possible give the child a
portion of the test strip afterward as a souvenir.
2. X ray studies- are used to inspect internal body tissue. These range from the simple x ray to the
more complicated computed tomography scan or dye contrast study.
Flat plate x rays- are used both to diagnose illness and check
them to the x ray department, you will not allowed to stay in the room while the picture is actually
taken. If it is necessary for you to remain the room to restrain a child, do not do this without lead
apron and lead glove protection.
Dye contrast studies- visualize a body cavity some type of radiopaque dye may be swallowed or
injected into the cavity and then examined on x ray. Barium contrast studies, for example, are used
to observe the outline of the Gl tract. Barium may be swallowed to outline the upper Gl tract or
instilled by enema to outline the lower portion. Caution the child that barium even if flavored does
not taste terribly good.
3. Computed tomography- is an x ray procedure in which many views of an organ or body part are
obtained to represent what the organ would look like if it were cut into thin slices. The procedure
may require injection of an iodine-based contrast medium. The machinery is complex, large and
potentially frightening. Children must lie still during the long procedure to avoid creating shadows
on the film. To help them still for an extended period, they may be given a sedative to make them
sleep. You can assure parents that although the radiation exposue from CT scans occurs over long
period, such low doses are used the actual exposure is less than during a regular x ray.
5. Ultrasound -is a painless procedure in which pictures of internal tissue and organs are produced
by sound waves, it is noninvasive, children accept ultrasound easily and may even enjoy watching
the oscilloscope screen during the procedure. The transducer that is used on the body surface to
pick up internal images can be compared to a television camera.
– Explain to parents that ultrasound is not a x ray and appear to have no long term effects, so it
can be repeated over and over for serial determination:
– Tell the child that the gel will be applied to the skin over the body part to be studied to aid
sound conduction. The gel feel cool and sticky
Endoscopy- used as an emergency measure to remove objects such as quarters or safety pins
swallowed by children. The child is NPO for 4 hours before the procedure. They may need sedative
so they can lie quietly
● After the procedure monitor for signs of edema to be not interfer with vital functioning such
as respiration
● Check for gag reflex before offering any fluid
Bronchoscopy- is the direct visualization of the larynx, trachea, and bronchi. It is used to children
who have aspirated a foreign object such as peanut or to take culture and biopsy.
● Before procedure a child is given with atropine by injection to reduce bronchial secretions
and to encourage bronchial relaxation
● A sedative is administered
● Observe respiratory function and airway for at east 4 hours after the procedure
● Assess gag reflex before offering fluid
● An ice bag applied to the neck to help relieve edema
Colonoscopy- is endoscopic exam of the large intestine with a flexible fiberscope inserted through
the anus and advanced as far as the ileocecal valve. Air is then infused to expand the bowel walls.
The technique allows the colon walls to be visualized, photographs can be taken for analysis.
– Before the procedure children are given a clear liquid diet for 24 hours
– They are given isotonic saline laxative that causes diarrhea so the bowel is clean
– Children may pass a great deal of flatus in the first 12 hours because of air introduced during
the procedure
Aspiration studies- removal of body fluid such as lumbar puncture and bone marrow aspiration. A
child may need sedative so he or she can lie quietly.
Blood specimen- when feasible, blood specimen should always be obtained away from a child's
bed. Applying band-aid afterward to cover the needle site provides physical as well as
psychological support.
Venipuncture- the superficial vein of the dorsal surface of the hand or the antecubital fossa. In few
instances, the jugular or femoral vein can also be used. To reduce pain use distraction techniques
such as uing toys with flushing lights, blowing bubbles, or playing a game for toddlers and asking
distraction questions or plaving a movie for school age children
Capillary puncture- are often obtained for glucose and hematocrit determinations. Apply an
anesthetic cream before the procedure to reduce discomfort if needed: however, be careful when
applying this to a finger that the child doesn't lick this off and anesthetize their tongue or throat.
Technique for finger or heel capillary puncture
Procedure:
1. Wash your hands; identify child; explain the procedure.
2. Assess status of puncture site.
3. Analyze appropriateness of procedure, adjust plan to individual circumstances
4. Plan and give health teaching and preparation information as necessary
5. Assemble necessary equipment: gloves, alcohol swab, lancet, collecting capillary blood tube,
dry compress or cotton ball, adhesive bandage
6. Assess the temperature of the selected site. Fingertips and heels must be warm. Warm by
holding finger or heel in your hand for a moment or two. Warming heels or fingers by
immersing them in warm water or covering with a warm compress is not advised.
7. Select the exact puncture site: sides of tip of finger; right or left of medial artery of heel.
Allow child to choose finger if appropriate.
8. Apply gloves. Swab site with alcohol and allow to dry, Puncture with a quick thrusting
8.
movement; wipe away first drop of blood with dry cotton ball.
9. Hold heel or finger lower than proximal extremity; touch capilary tube to blood drop and tip
to encourage flow. Do not squeeze tissue around bandage.
10. After filling required number of blood tubes, apply tiny compress to site; apply adhesive
bandage.
11. Label specimen appropriately and send to proper laboratory for analysis.
12. Evaluate effectiveness; efficiency; cost safety and comfort aspects of procedure; record
procedure and child's reaction.
Adolescent- are usually knowledgeable and cooperative about providing urine specimen.
– Adolescent girl may be embarrassed to mention they are menstruating so be sure to ask
about this before she voids, To prevent having a urine specimen contaminated by menstrual
blood. Ask the girl to wash her perineum well with soap and water and rinse and dry it to
remove menstrual blood.
24 hour urine specimen- to determine how much of a substance is excreted during a full day
– Ask the child to void and discard so that a specific time for the ensuing collection is known.
– Record the start of the collection period as the time of the discarded urine. Save all urine
voided for the next 24 hours and place it in one collection bottle.
– Record the time of the collection as being from the time of the discarded urine to the final
specimen added to the collection.
– To keep the bacterial count to a minimum, 24 hour collection containers are generally kept on
ice; after each voiding, pour the new specimen into the larger container which is kept
refrigerated for the 24 hour period or until it can be transported to the laboratory for analysis.
Clean catch urine-is ordered when urine is needed for urinalysis and culture. The technique for
obtaining a clean-catch urine specimen from older child is the same as for the adult.
– To collect specimen from a young child, ask the child to void. During the child's voiding ask
the parent to collect a "midstream" sample into a sterile container
Suprapubic aspiration-withdrawal of urine from the bladder of a child who is not old enough or in
some other way cannot cooperate enough so that a clean-catch or catheterized specimen can be
obtained. It is done by inserting sterile needle into the bladder through anterior wall of the
abdomen.
Catheterization- infants and young children small feeding tube (#5 or #8) is used instead of urinary
catheter because such a thin tube passes readily through the meatus of even an infant
– Assess the urinary meatus for girls, for uncircumcise boys, gently retract the foreskin until the
urinary meatus is visualized.
– Explain to the parents how it is performed and why it is needed
– Distraction technique such as blowing bubbles or imagery may help the child to relax
– Caution children that the catheter will sting for an instant as it is inserted and they will have to
lie stil until the urine specimen is obtained.
– Offer support and praise to the child
– Preschool boys may need assurance that the procedure has no long-term consequences to
reduce their fear of castration.
Intake-
– Infants who are formula-fed is simply a matter of estimating the kind and amount of fluids
that were swallowed. For breast-fed infants is merely recorded as "breast-fed". If it is
necessary to estimate the amount more loosely than this, an infant can be weighed before
and after feeding
– with preschooler be certain to record fluids ingested during snacks as well as meals. Remind
them that soup, flavored ice such as popsicles and sherbet are liquids and should be
counted.
Output-
– Diapers can be readily used as a method of measuring urine output
– Weigh diaper before it is placed on an infant and record this weight conspicuously. Reweigh
the diaper after it is wet and subtract the difference to determine the amount of urine
present.
– To separate urine from bowel movements, teach older children to void first before trying to
move their bowels.
Temperature- tympanic membrane temperature are ideal for assessment in children because they
register within 2 seconds and therefore cause less fear in a child.
For below 3 years old- pulling down the earlobe to straighten ear canal
Above 3 years old- pulling up the pinna of the child
Pulse rate- apical pulse is taken in children younger than 2 year because their radial pulse is too
faint to be palpated accurately, in infant, the point of maximum intensity, of the point on the chest
wall where the heartbeat can be heard most distinctly, is just above the outside of the left nipple.
Respiratory rate- infants tend to breathe with abdominal muscles, therefore, it is accurate to take
respirations by counting movements of the abdomen as it is to count chest movements. Again, for
accuracy respirations should be counted for 1 full minute.
Blood pressure- included in the routine physical assessment of all children older than 3 years of
age. Be certain to pay attention to the pulse pressure, both unusually wide (more than 50mmHg)
and narrow (less than 10mmHg) ranges may suggests congenital heart disease.