The Great Ormond Street Hospital Manual of Childrens Nursing Practices

Foreword ix

Acknowledgements x

List of contributors xi

Introduction xvii

1 Assessment 1

Introduction 2

Measuring vital signs, height and weight 6

Review of systems 13

Blood pressure 21

References 35

2 Allergy and anaphylaxis 38

Introduction 39

Allergy and the immune response 39

Diagnosis and management of allergy 40

Management of anaphylaxis 41

Food allergy 43

Respiratory allergy 46

Allergens in the healthcare setting 48

Conclusion 51

Key texts 51

References 51

Useful websites 52

3 Biopsies 53

Introduction 54

Liver biopsy 54

Punch skin biopsy 60

Renal biopsy 66

Bone marrow aspirate and trephine 69

References 72

4 Administration of blood components and products 74

Introduction 75

An overview of blood transfusion 75

Administration of red cells 76

Administration of platelets 76

Administration of fresh frozen plasma (FFP) 76

Administration of cryoprecipitate 76

Administration of albumin 80

Administration of immunoglobulin 80

Administration of coagulation factors 86

Conclusion 86

References 86

5 Bowel care 87

Introduction 88

Constipation 88

Treatment of constipation 89

Diarrhoea 91

Transanal colonic irrigation 95

Stoma care 97

References 101

6 Burns and scalds 103

Introduction 104

Common causes of burns in children 104

Overview of anatomy of the skin 104

Classifi cation of burns 104

First aid following a burn 105

Fluid resuscitation for major burns 108

Wound healing and wound care 108

Which dressing? 111

Nutrition 112

Psychological care following a burn 112

References 115

7 Child protection 117

Introduction 118

The hospital setting 118

An individual and corporate responsibility 118

Defining child abuse and neglect 119

The effects of abuse and neglect 120

Sources of stress for families 120

Children with disabilities 121

Difference and culture 122

The legal framework, national and political infl uences 122

Learning from serious case reviews 123

A safeguarding culture 125

Implications for nursing practice 126

The Common Assessment Framework (CAF) 126

Practice guidance for the children’s nurse 127

Professional responsibilities of staff at Great Ormond Street Hospital 127

Procedures for children attending A&E 128

Procedures for children admitted to hospital 129

Fabricated or induced illness: concerns or suspicion 130

Pre-discharge planning procedure 130

A final word – communication with other agencies 131

Acknowledgements 131

References 131

8 Cytotoxic drugs 134

Chemotherapy administration 135

Legislation 135

Consent 135

Safe handling 135

Reconstitution and preparation of

chemotherapeutic agents 135

Personal protective equipment 136

Work practices 136

Safe administration of chemotherapy 136

Routes of administration 138

Intrathecal route 140

References 141

9 Fluid balance 142

Introduction 143

Fluid balance in the ill child 143

Vascular access 149

Haemofi ltration 151

Peritoneal dialysis 158

Interventions 163

References 164

Further reading 165

10 Personal hygiene and pressure ulcer prevention 166

Introduction 167

Bathing 167

Toileting 174

Nappy care 180

Nail care 187

Oral hygiene 189

Eye care 202

Ear care 206

Pressure ulcer prevention 208

Conclusion 216

References 217

Useful websites 220

11 Immunisations 222

Introduction 223

Routine childhood immunisation schedule in UK – 2010 223

Special risk groups 224

Immunity 224

Types of vaccine 225

General considerations 225

Specific diseases and the vaccines 227

Storage and administration of vaccines 231

Ensuring good uptake 231

Vaccine safety scares 233

Immunisation of healthcare professionals 233

Conclusion 234

References 234

Further resources 235

12 Infection prevention and control 236

Introduction 237

Financial burden of hospital acquired infection 237

Freedom of information 238

Bioterrorism 238

The chain of infection 238

Standard precautions 240

Hand hygiene and skin protection 241

Personal protective equipment 245

Isolation nursing 249

Aseptic non-touch technique 257

Management of exposure to blood and body fluids 259

Reporting of injuries, diseases and dangerous occurences regulations 260

Blood spillage 260

Decontamination of equipment and the environment 261

Laundry management 262

Waste disposal 263

Pest control 264

References 264

Further reading 266

13 Intravenous and intra-arterial access 267

Intravenous access 268

Peripheral venous catheters 268

Peripherally inserted central catheters 290

Non-tunnelled short-term percutaneous central venous catheters 292

Tunnelled central venous catheters: Hickman and Broviac lines 292

Implantable ports 293

Removal of central venous catheters: possible complications 309

Arterial lines 310

References 321

Appendix 13.1 Suppliers of stickers and certifi cates 324

14 Investigations 325

General introduction 326

Introduction to radiology 326

General radiology 330

Fluoroscopy 330

Intravenous urography 331

Micturating cystourethrogram 332

Dysphagia swallow using videofl uoroscopy 333

Upper gastrointestinal series 333

Tube oesophagram 334

Barium follow through 335

Barium enema 335

Contrast enema (and Gastrografi n enema) 335

Air enema 336

Tracheobronchography 337

Linogram 338

Ultrasound 339

Computed tomography 339

Nuclear Medicine 340

Magnetic resonance imaging 342

Interventional radiology 342

Collection of microbiological specimens 344

Blood samples 346

Biopsy material 347

Cerebro-spinal fl uid 347

Taking swabs 347

Faeces 350

Fungal samples of hair, nail and skin 351

Gastric washings 351

Naso-pharyngeal aspirate 352

Sputum 352

Urine 353

Vesicular fluid for herpes polymerase chain reaction (PCR) 354

References 355

15 Administration of medicines 357

Introduction 358

Child development considerations 359

Drug calculations 360

Oral administration 364

Enteral tube administration 366

Buccal and sublingual administration 369

Intranasal administration 370

Inhalation administration 372

Rectal administration 376

Injections 378

Intradermal administration 380

Subcutaneous administration 382

Intramuscular administration 384

Intravenous administration 387

Intraosseous administration 387

Intrathecal administration 389

Epidural administration 393

Skin patches administration 393

Acknowledgements 394

References 394

Further reading 395

16 Moving and handling 397

Introduction 398

Legislation 398

Risk assessment 399

Injury 400

Documentation 405

Equipment 406

Restraint and therapeutic holding 412

References 415

17 Neonatal care 416

Introduction 417

Neonatal thermoregulation 417

Vitamin K administration 424

Umbilical care 426

Newborn blood spot screening (formerly Guthrie testing) 428

Phototherapy – neonatal jaundice 431

References 434

18 Neurological care 436

Introduction 437

Neurological observations 437

Seizures 443

External ventricular drainage 447

Lumbar puncture 462

References 464

Bibliography 465

Appendix 18.1 The GOSH Coma Chart 466

Appendix 18.2 Types of painful stimuli 470

Appendix 18.3 Examples of motor responses 470

Appendix 18.4 An example of an algorithm for a convulsing child 471

19 Nutrition and feeding 473

Introduction 474

Nutritional requirements 474

Nutrition from preterm to adolescence 474

Breast feeding 480

Enteral feeding 485

Parenteral nutrition 499

Sham feeding 506

References 509

Supporting breast feeding – some useful addresses 511

20 Orthopaedic care 512

Introduction 513

Neurovascular observations 513

Plaster care 519

Crutches 526

Care of a child in traction 530

Key texts 538

References 538

21 Pain management 539

Introduction 540

General principles of pain management 540

Pain assessment 542

Administration of Entonox 548

Epidural analgesia 554

Patient and nurse controlled analgesia (PCA/NCA) 566

Prevention and management of opioid related complications 570

Sucrose 573

Key texts 574

References 574

22 Palliative care 577

Introduction 578

Assessment of symptoms 578

Nausea and vomiting 579

Constipation and diarrhoea 580

Dyspnoea 581

Anorexia and reduced fl uid intake 582

External haemorrhage 583

Seizures 583

Signs of impending death 584

After the child dies 585

Preparation of the body 591

Moving the child who dies in hospital 593

After care 594

Acknowledgements 596

Key texts 596

References 596

23 Peri-operative care 598

Introduction 599

Preoperative preparation 599

Perioperative care 603

Recovery 606

References 608

24 Play as a therapeutic tool 609

Introduction 610

The development of play in hospital 610

Normal play for development 611

The importance of play for children in hospital 611

Preparation for surgery and procedures 615

Distraction techniques 617

Therapeutic play – 1:1 sessions 620

Key texts 623

References 623

Further reading 624

25 Poisoning and overdose 625

Introduction 626

Non-accidental ingestion and self-harm 626

Common ingestions 627

Initial management following poisoning or overdose 628

Treatment of ingested poisons 629

Gastric lavage 630

References 634

26 Respiratory care 635

Introduction 636

Airway suction 636

Oxygen therapy 642

Chest drain management 648

Key texts and websites 660

References 660

27 Resuscitation practices 663

Introduction 664

Aetiology of cardiorespiratory arrest 664

Airway management 664

Recovery position 668

Advanced airway and breathing management 668

Circulation management 671

Basic life support 676

Choking 681

Cardiorespiratory arrest management 684

Defi brillation 688

Medications in cardiorespiratory arrest 689

Potentially reversible causes of cardiorespiratory arrest 690

Post-resuscitation care 690

Ethical considerations 690

References 691

28 Tracheostomy: care and management 693

Introduction 694

Caring for a newly formed tracheostomy 694

Humidifi cation 699

Management of an established tracheostomy 700

Resuscitation 706

References 714

Appendix 28.1 Tracheostomy tubes for children 715

29 Urinary catheter care 718

Introduction 719

Insertion of indwelling urethral catheters 719

Emptying, drainage and fl ushing 726

Obtaining a catheter specimen of urine 729

References 732

30 Drug withdrawal – prevention and management 734

Introduction 735

Withdrawal prevention 736

Withdrawal assessment 737

Withdrawal assessment tools 738

Management of withdrawal 740

Weaning protocols 741

References 744

Index 746