Distress Simulations

Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.

In a study conducted by Hatfield and Young (2007), 1,727 procedures such as venipuncture, intravenous (IV) catheter placement, intramuscular (IM) injections, urinary catheterizations, and nasogastric tube placement in 1,210 children have been reviewed. Their findings reveal that almost none of the patients received pain management. Although traumatic for the patient, these procedures are considered to be minor by many nurses, and the culture of pain management has not been seen as the standard of care (Hatfield & Young, 2007). Nursing staff is encouraged to change the culture by embracing their role as patient advocate. Every patient deserves a triage pain assessment with ongoing assessments as necessary. Pain control measures must be implemented prior to beginning potentially painful procedures. Discussion must take place between the parents and healthcare staff in order to deliver the best comfort measures on a case-by-case basis.

internal radiation. In teaching the client about the procedure, the nurse would be most accurate in telling the client A. she 'll be in a private room with unrestricted activities. B. a bowel-cleansing procedure will precede radioactive implantation. C. she 'll be expected to use a bedpan for urination. D. the preferred positioning in bed will be semi-Fowler 's. 14. Before administering a tube feeding to a toddler, which of the following methods should the nurse use to check the placement of a nasogastric (NG) tube? A. Abdominal X-rays. B. Injection of a small amount of air while listening with a stethoscope over the abdominal area. C. A check of the pH of fluid aspirated from the tube. D. Visualization of the measurement mark on the tube made at the time of insertion. 15. While assessing a 2-month-old child 's airway, the nurse finds that the child isn 't breathing. After two unsuccessful attempts to establish an airway, the nurse should A. attempt rescue breaths. B. attempt to reposition the airway a third time. C. administer five back blows. D. attempt to ventilate with a handheld resuscitation bag. 16. Which of the following statements summarizes the underlying principle for the development of a parenbchild relationship? A. The parents to-be had good role models in their

PICCs lines have become well recognized as reliable central venous access devices (VADs), with lower potential for complications than short-term central venous catheters. PICCs first gained popularity in the 1980s, and their use has grown steadily since then. They were initially popular in many parts of the United States due to the need for venous access in home care patients. They have grown in popularity because of their reduction in potential complications and costs compared with short-term central venous catheters, and because PICCs can be inserted by registered nurses who have been trained in the procedure.

Femoral arterial and venous access is traditionally the method of choice in infancy. The right and/or the left groins may be used. This port of access provides advantage of being away from the thoracic region for ease of catheter manipulation away from the radiographic cameras surrounding the child’s thorax. Umbilical arterial and venous access can be used in newborn babies up to 7 days of age. Other alternative route for arterial access includes: carotid artery, brachial artery, and axillary artery. On the other hand, alternative venous access includes: internal jugular vein, subclavian vein, axillary vein, and transhepatic venous access. Alternative vascular access (ARVA) is occasionally required due to the lack of femoral vascular patency or the need to position the catheter at a particular trajectory not provided through the traditional femoral access. The use of ARVA is safe and effective for performing a wide variety of interventions across. In addition, its use may improve the results of selected

sedation have continuous BP, ECG, & Pox monitoring done. Nurse J. who was trained in the

Intravenous (IV) catheter Insertion is performed for almost all the children admitted in the hospital. It is estimated that in United States 60-90% of the children hospitalized use IV catheters (Hadaway, 2010, Helm et al., 2015)7. The most common complications of IV catheterization are infiltration

Pediatric pain management is measured subjectively because it is based off of what the patient says or how the nurse interprets the pain scale. Pain is rated using different scales, unfortunately these different scales could yield different results. Nurses are trained to use pediatric pain scales to analyze and treat pain but parents are not supplied with the tools to manage pain when the patient goes home. With 84% of all pediatric surgical procedures performed on an outpatient basis, the importance of teaching parents how to assess for and manage pain has become more important than ever (Rony, Fortier, Chorney, Perret, & Kain, 2010). According to Rony’s et al. (2010) study, it is apparent that pediatric pain is not being treated effectively. The study showed that 58.8% of children were receiving less than the daily recommended does prescribed by the pediatrician (p.1). Results of the study also showed that parents had false assessments on if their child was actually in pain. 36% of parents believed that if their child was in pain, they would cry out for the parent , 30% agreed that their child would always tell them if they are in pain, while 22% said that the child would report their pain immediately (Rony, Fortier, Chorney, Perret, & Kain, 2010, ). Children do not always verbalize when they are in pain. Sometimes the pain can be so intense that a child is unable to talk. If the child catches on to the parents negative perception of pain medications, the child may not

“Two days later, the patient was found unresponsive. The resident ordered stat blood cultures, electrolytes, and

Medical records were reviewed for demographic, clinical, and outcome data. The study found out that 25 children with SMA had 56 general and regional anesthesia cases: 21 (38%) patients had ventilator aid, 14 (25%) had intravenous anesthesia with nitrous oxide, 41 (84%) had epidural opioids, one infant had a spinal anesthesia. Intraoperative complications with 2 (4%) and postoperative complications with 2 (4%). One patient requires unplanned ICU admission, and there were 2 late deaths. Based on the results, the researchers recommended that children with SMA receive care for undergoing or recovering from anesthesia at institutions that gives different and effective approaches to make the patients feel comfortable and secure, a patient-centered hospital, plans extensively in preoperative and postanesthetic critical

Peripheral venous access in infants and children is technically challenging. Not only in children but also in adults veins may be difficult to locate in some cases. Peripheral venous access is usually required for administration of fluids or medications in hospitalized patients. Even for experts, peripheral venipuncture in infants and adolescents is difficult because of small and deeply-located veins. Several devices adjunct to vein identification and catheter insertion have been devised in the attempt to optimize peripheral catheterization.

The epidemiology of phlebitis is less well described for pediatrics than for adults. In addition studies have also failed to show an increased day specific risk of phlebitis for continuous IV cannula beyond second or third day after it was inserted(Webster J, Osborne S, Rickard CM2013)19. The Centers for Disease Control and Prevention (CDC) recommends that cannula should be removed every 72 – 96 hours to reduce the risk of phlebitis, but there have not been such recommendations for children (Andriyani R, Amalia P2013)1.There have been many theories on the pathophysiology of peripheral vein phlebitis. The current concept suggest that cannulation of vein leads to inflammation.(Pedro P, Salgueiro OA, Pedro

In this research report, the report investigates the effect of ketamine, alfentanil, and oral midazolam on preventing agitation in children. Contrary to the previous annotated bibliography, the study investigates anesthesia that would prevent agitation. The study investigated 78 children undergoing urological surgery. Each child was randomly assigned 2 mg/kg ketamine, 10 ug/kg alfentanil or 1 mL of isotonic saline intranasally (Bilgen 2014). Researchers then determined the percentage of times the child would become agitated. The data revealed that agitation decreased most for the group applied with ketamine, and the least for the group applied with isotonic saline. Therefore, the study concludes that applying ketamine is most effective for reducing agitation. Nevertheless, all three anesthesia reduced agitation in children, albeit, in random amounts.