Peds Proceures

CIMS COLLEGE OF NURSING, DEHRADUN
Administration of oral medication.
INTRODUCTION: - Medicine may be defined as a substance used to promote health, to prevent, to

diagnose, to alleviate or cure Diseases.
DEFINITION: -administrating oral medication it is the most common route and the most convenient
route for most patients.
OBJECTIVES:-
1. To prevent the disease.

2. To obtain desired effect of the medication.
3. To cure the disease
4. To promote the health.
5. To give palliative treatment

6. To give symptomatic treatment.
ARTICLE: - A trolley to take different medicine bottles.
A tray containing :-
1) Ounce glass, dropper, medicine glass,
2) Drinking water in a feeding cup,
3) Mortar and pestle
4) Duster
5) Kidney tray
6) Medicine cards & general order book.
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PREPRATION OF
Parent: -Explain about the action of medication.
Child: - A positive, kind, but firm approach w i l l meet the more success than threats stabiles
friendly relationship with child play and talk with child.
Environment:
-proper cleanness,
proper lighting,
free from foul smelling,
wall full with cartoon picture or poster,
play material .
TEPS OF THE PROCEDURE WITH RATIONALE
Prepare the child and family. And identify the child by checking the identification band.
PROCEDURE RATIONLE
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1. Wash hands 1 To avoid cross infection
2 Read the physician order and compare it 2 To ensure safety in the

with the medicine card administration of the medication
3 After reading the medication card take 3 the first safety check to prevent the
the appropriate medicine from the shelf possibility of pouring the wrong
compare the level with the medicine card medicine
4. Omit the medications,
4 It help Prevent wrong dose

5. Take the required medicine from the shelf.
Compare the label with the medicine card. Read
the entire label. Before a medicine ticket 5 Recheck the medicine bottle
is written or a drug administered, the - It helps give correct medication

nurse must calculate the safe dosage Prevent wrong dose
range for the individual child and
-It helps prevent wrong dose
compare it with the dosage
prescribed.
6 It help to prevent contamination

6 Take the suspension tablets and capsules first
into the lid and then into the medicine Glass, so
that the drug will not come in contact.
7. Shake the bottle remove Cap of the bottle, 7 It helps to administered the correct
holding cork between ring and little finger. Hold dose
bottle in the light to check for sediment etc.
8. Take a medicine glass in the left hand and place 8. It helps prevent wrong dose
thumbnail at the level which drug
9. Check drug with medicine chart again 9 . It helps to administered the correct
and then pour into the glass. dose
10. Holding the medicine g1ass at eye level 10 It help to prevent the
again check dosages to see that the lower part of administrate the wronge medication
medicine fails on the thumbnail line.
- Replace stopper in bottle and return it to correct

place, again checking the label.
11. Never pour excess medication back into

11 To prevent the contamination,
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bottle or container, discard it into the Sink.
12 Prepare separate medication for each 12 Proper identification of each medication
patient. Identify the patient with the assures accurate administration of
medicine card by- correct medication to correct patient
- Reading the name on the case paper.

-Holding the child properly by doing the mimics.
13 It help in the easy sallow wallowing of

13. First give little water to drink with the the solid medication
help of spoon and then give Medicines
14. Ensure the medication is taken
one at a time.
14. Stay with the child while he takes the
drug.
15. Give water to drink, after he takes the
medicine. Keep the medicine cup
In the bowl of water.
16. Be sure that the child is able to take

the medication as it is prescribed.
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After care of Patient and Articles –
1. Wipe the face of the Child if necessary,

2. Give him comfortable position
3. Take all articles to utility room Clean the articles with soap and
Water and then replace them to their proper places.
4. Wash hands.
Recording and Reporting –
1. Record Medication, Dose, Route, Time.
2. Record any reaction observed after the administration of the drug.
3. Report any reaction of the patient to the physician and the ward sister.
MEDICATION CARD
PATIENT’S NAME DIAGNOSIS
AGE/ SEX D.O.A.
WARD/BED NO. DR INCHARGE

DATE
S MEDICATION NAME DOSE TIME ROUTE SIGNATURE TO

r.N CALCULATE
o. THE
PAEDIATRIC
DOSAGE: -
Most of the drugs
are available in
the adult dose.
The nurse needs
to know how to prepare the Paediatric dosage.
1) Young’s rule :- (for children over one year of age ) unto 12 years
Age of the child (in years) X Adult dose =Child’s dose
Age of the child (years)+12
2) Clark’s rule :- (According to the weight of the child, therefore it can be used for children of all
ages)
Weight of the child in pounds X Adult’s dose = Child’s dose
150
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3)Fried’s rule :- (For children under 1 year of age)
Weight of the child in pounds X Adult’s dose = Child’s dose
150
CHECK LIST OF ADMINISTRATION OF ORAL MEDICATION

Yes No
ADMINISTRATION OF ORAL MEDICATION

1. Hand washing is done
1. Follow five rights
2. Explaining procedure to child’ parents
3. Prepare the articles
4. Checked the vital sign
5. Follow strict aseptic technique
6. Select correct medication
7. Check the manufacture and expiry date
8. Calculate medication dose
9. Administer drug safely
10. Administer drug on time
11. Took medication tray or cart to patient’s room. Checked

pt bed number against medication card or sheet.
12. Placed patient in sitting position, if the child is able or

not contraindicated.
13. Checked the patient’s identification asked the child name

her parents.
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14. Told the child’s parent what type of medication explained
the actions and how it helps to child.
15. If prepackaged medication was used, read label took

medication out of package and put into medication cup.
16. Take a medicine glass in the left hand and place thumbnail at the
level which drug should be poured to get correct dose.
17. Check drug with medicine chart again and then
Pour into the glass.
19. Holding the medicine g1ass at eye level again check dosages
to see that the lower part of medicine fails on the thumbnail
line.
20. Pour the medicine from the bottle on the side
Opposite to the label
21 Replace stopper in bottle and return it to Correct place,
Again checking the label.
22. First give little water to drink with the help of

Spoon and then gave medicines one at a time.
23. Stay with the child while he takes the drug. Give
Water to drink, after he takes the medicine. Keep
the medicine cup in the bowl of water.
Recording
1. Name of Medication, Dose, Route, Time.
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2. General condition of patient
3. Record any reaction observed after the
Administration of the drug.
4. Name and signature of a staff
CARE OF COLOSTOMY
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INTRODUCTION:- In some childs, cancer or other conditions, such as inflammatory bowel disease,
require the surgical removal of all or part of the colon, rectum, and anus, In such cases, the proximal portion
of the remaining bowel may be redirected through the abdominal wall to the abdominal skin surfaces. When
this surgery is performed, it is referred to as a fecal diversion, because the normal route for feces is altered.
The information that a child requires an colostomy is received with great

concern an apprehension by parents and child prepration of child and parents is necessary for both this
included an nature of procedure types of bag
DEFINITION: -
 STOMA: - The portion of the intestine brought through the abdominal wall is known as a stoma.
 OSTOMY: - It means an opening of an organ or part of body onto the body surface to drain
its contents.
 COLOSTOMY: - it is an opening of the colon onto the abdominal surface to drain the faecal
matter.
Or
 A bowel diversion surgery that brings a segment of the large colon out to the abdominal skin is
called a colostomy.
PURPOSE
1. To Contains drainage and odors for the comfort of the client

and allows accurate assessment of output.
2. To Protects the peristomal skin from excoriation.
3. To Provides visualization of the stoma and sutures during the
postoperative Purposes
4. To prevent leakage.
5. To prevent excoriation of skin and stoma.
6. To observe the stoma and the surrounding skin.
7. To teach the patient and relatives about the care of ostomy and ostomy collection bag.
SCIENTIFIC PRINCIPLES: -
 ANATOMY AND PHYSIOLOGY: - the colon is divided into the caecum, ascending colon,
transverse colon, descending colon, sigmoid or pelvic colon, rectum and anal canal.
The four layers of tissue described as the colon, the rectum and the anal canal. The
arrangement of the longitudinal muscle fibers is modified in the colon. In the sub mucous layer
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there is more lymphoid tissue than in any other part of the alimentary tract, providing non-specific
defense against invasion by resident and other microbes.
 MICROBIOLOGY: - During dressing sterile technique should be maintained to prevent invasion of

bacteria.. Bacteria in the fecal secretions can cause infection in the incisional area and irritate the skin.
Hand washing before procedure is helpful to prevent infection
 CHEMISTRY The Zinc oxide used to prevent excoriation of skin and protect skin from breakdown.
Minimizes leakage by providing a smooth surface for applying the skin barrier.
 PHYSICS: - maintained proper body mechanics, and height of the bed should be adjusted during
the procedure. During cleaning stoma stroke should be gentle.
 PSYCHOLOGY: - Preoperative instructions about colostomy and how it will be managed will
be important for the child and her parents to adjust with a colostomy. They should know that the
colostomy need not alter their life, but its care will become a routine part of their daily activity. They
may be given chances to talk with someone who has a colostomy and has learned to manage
elimination and over come fears. Such conversations will be reassuring and informative.
NURSE'S RESPONSIBILITY IN THE COLOSTOMY
1.Check the name, bed number and other identification of the patient.
2.Check the diagnosis and the purpose of colostomy care.
3.Check the type of colostomy done. Make sure of the proximal and distal loop of the colon.
4.Check the child’s ability for self care.
5.Check the doctor's orders for specific instructions and the precautions, if any, regarding
the colostomy care, movement of the patient etc.
6.Check the understanding of the patient to follow instructions.
Check the articles available in the patient's unit.
PRELIMINARY ASSESSMENT
•Observe color and amount of drainage from stoma.

•Assess existing pouch for leakage, and note appearance of stoma and incision to determine need to
change pouch. A pouch does not have to be changed if it is not leaking and if the skin barrier is intact,
•Inspect condition of peristomal skin for erythema, excoriation, ulceration, or fistulas before selecting
type of skin barrier to apply.
•Note presence of skin folds, creases, scars, and abdominal softness or firmness before selecting pouch.
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EQUIPMENT USE FOR COLOSTOMY CARE
• A clean tray containing
• Cover sheet
• Protective sheet and towel
• Gloves—one pair
• Cotton swabs and gauze pieces
• Washcloth and towel
• Water in a basin
• Soap in a dish
• Disposable ostomy collection bag with clamp
• Stoma measuring guide

• Zinc oxide (siloderm) ointment
• Skin barrier
• Deodorizing solution and dropper
• Kidney tray and paper bag
• Night drainage system (drainage tubing, collection bag and connector) if required.
• Bedpan with cover
PREPARATION OF PATIENT AND ENVIRONMENT
1. Explain the details of this procedure to the child and her parents
2. Gather equipment and place within easy reach.

3. Have the patient assume a relaxed position and provide privacy. The best position may be sitting,
reclining, or Standing.
4. Provide privacy. Remove the undergarments to prevent soiling by the excreta. An old sheet
or dhoti may be given to the patient to wear until the irrigation is over.
5. Ask the child or her parents to observe every step, so that he learns the care of the
colostomy. It is desirable to have a family member be present to learn the procedure.
It is desirable to have some reading material or radio nearby to provide
pleasure and diversion of the patient while waiting for the return flow.
STEPS OF PROCEDURE
1.Provide privacy.
2.Wear disposable gloves.
3.Gently remove old appliance. If disposable, discard. If reusable, set aside for washing.
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4. Wash skin thoroughly around stoma with skin cleanser or soap and water. Rinse skin thoroughly and
blot dry. Rationale: Soap residue or dampness can interfere with pouch adhesion, resulting in leakage.
Blotting the area dry minimizes trauma to the stoma.
5. Observe condition of peristomal Skin, the stoma, and the sutures. Teach the client to make these
observations daily. Observation allows monitoring for complications. The stoma is at risk for necrosis
during the first postoperative week, as evidenced by dark color and lack of bleeding. The peristomal
skin is at risk for breakdown from irritating fecal secretions. Infection is more easily corrected if
detected early.
6.Prepare clean pouch: measure stoma and trace circle larger than stoma on the adhesive paper
backing. Cut the stoma pattern. Pattern cut slightly larger than barrier avoids risk of paper cuts to
stoma and ensures a tight seal with the barrier
7. Prepare skin barrier: measure stoma and cut hole in Barrier the same size as the stoma. Be sure edges
are rounded. Close fit of barrier around stoma prevents fecal secretions from contacting and irritating
the skin.
8.If stoma is located in an abdominal increase or the skin is irregular, use a paste barrier to fill the
irregularity. Minimizes leakage by providing a smooth surface for applying the skin barrier.
9. Apply protective skin barrier.
a. Backing off wafer and center stoma in hole.
b. Place on abdomen, pressing lightly over all areas of the barrier to promote adhesion with skin surfaces
Rationale:- A tight fit will prevent leaking and protect the skin underlying the appliance.
10. Attach drainable pouch to skin barrier. Some equipment attaches by means of a plastic flange that snaps
in place; other models adhere through self-adherent tape that is exposed after protective paper
backing is removed. Tug gently or inspect for secure fit.
12.Frame every edge of the faceplate with hypoallergenic tape to provide reinforcement. This is called "picture
framing."
13.Fold over bottom edge of pouch and clamp.
14.Dispose of old appliance. Clean and store any reusable supplies
15.Wash hands.
16.Document noted observations.
AFTER CARE OF PATIENT AND ARTICLE
• Place the patient in a comfortable Position.
• Ask the patient to inform for any discomfort at the stoma site.
• Remove, clean, dry and replace the supplies.
• If changes of ostomy collection bag procedure have been performed, dispose the bag by burning.
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• If bag is to be reused, take it to the toilet, empty.
• After making sure that the patient is thoroughly clean, help him to wear his clean
dresses.
• Help the patient to get into his bed. Change the dressing of incision using aseptic
technique. Make him comfortable. Tidy up the unit.
• Take all articles to the utility room. Clean all equipments immediately. Rinse them first
in cold water then with warm soapy water. Dry and store them in a convenient place for
the next use.
• Patients are instructed for the care and cleaning of the colostomy bags to prolong
its life and keep it free of odors. Cleaning with soap or detergent with water and exposing
it to fresh air is sufficient.
RECORDING /DOCUMENTATION
• Record the date and time of the pouching system change.
• Note the character of drainage, including color, amount, type, and consistency.
• Document the appearance of the stoma and the peristomal skin.
• Document patient teaching and describe the teaching content.
• Record the patient's response to self-care and evaluate his learning progress.
• Type and size of the bag used.
• Observations with regard to stoma and

the surrounding skin.
• Assessment of the ostomy drainage.
COMPLICATIONS: -
1. Diarrhea
2. Faecal impaction and obstruction
3. Excoriation of the skin
4. Stricture of the stoma
5. Failure to fit the pouch properly over the stoma or improper use of a belt can injure the stoma.
PATIENT TEACHING: -
• Teach spouses or other family members to assist with ostomy management, especially if the
client is elderly, weak, or has poor fine motor skills.
• Provide good nurse-client Communication to help the client develop a positive attitude about
living with an ostomy.
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• Provide the client with the name and phone number of an enterostomal therapist, community
support groups, supply vendor, and other resource people to call if they have questions or
problems after discharge.
CARE OF EYE
INTRODUCTION :- A common problem of eyes are secretion that dry on the lashes as crusts. This
be need to be softened and wiped away under sterile condition.
In newborn, the eye are treated soon after the baby is born to prevent ophthalmia neonatorum. Eye
care prevent spread of infection from one eye to the other and to avoid possible recontamination of the
same eye.
DEFINITION :- Eyes are cleaned from the inner to the outer canthus this prevent the particles and
fluid from draining into the nasolacrimal duct each eye cleaned with separate swabs, swabbing each
eye once only.
OBJECTIVES:-
• To prevent infection
• To maintain eye hygiene
• To maintain normal eye function
• To prepare for administration of eye drops and ointment
• To prevention for ophthalmia neonatorum in newborn.
NURSING RESPONSBILITY:-
• Check the diagnosis of the child
• Check the physician order to see the specific precautions regarding the care of eyes, the child’s
movement and positioning
• Assess the general condition of the child’s ability to follow directions
• Check the articles available in the patient’s unit.
ARTICLES REQURIED FOR THE EYE CARE
ARTICLES PURPOSE
A tray containing :-
Mackintosh and towel To protect the pillow and bed linen
Sterile bowl with sterile cotton swabs To clean the eye
Sterile normal saline or any ordered To clean the eye
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solution
Kidney tray and paper bag To receive the wastes
Clean face towel To wipe the face after the
procedure
PREPRATION OF THE PATIENT UNIT :-
1. Explain the procedure to the child’s parent.

2. Adjust the bed to comfort able working of the nurse.
3. Arrange the articles conveniently on the bed side table
4. Keep the child flat if the condition permits
5. Remove all pillows leaving one soft pillow under the head
6. Protect the pillow and the bed with a mackintosh and towel placed under the head
STEPS OF THE PROCEDURE WITH RATINALE: -
STEPS OF PROCEDURE RATINALE
1. Wash hand To prevent the cross infection
2. Pour sterile saline into the bowl and

wet the cotton swabs
3. Stand in front of the patient clean the

eyes with the sterile swabs. Discard Take the following precaution
the swabs into the paper bag. • Area of the swab touched by the
Continue cleaning till all discharge are fingers should not come in contact
removed from the eyes with eyes

• Squeeze off the excessive water
from the swab
• No pressure on the eye ball
• Gently wipe the lids from the inner
to the outer corner
• One swab for one swabbing
• Separate swabs for each eye
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4. For crushed secretion place a wet
warm gauze piece or cotton swab over Warm compress makes the crusts to
the closed eye. Leave it in the place become soft that it can be removed without
until the crust becomes soft. traumatizing the mucosa
5. When the eye are clean, stop the

Procedure. Wipe the face with the face
towel
AFTER CARE OF THE PATIENT AND ARTICLES:-

• Instill any medications that is ordered if any
• Remove the mackintosh and towel from under the patient’s head
• Adjust the position of the patient’s bed
• Tidy up the bed and make the child comfortable
• Take all articles to the utility room. Replace the articles to proper places
• Wash the hand thoroughly
RECORDING AND REPORTING

Record the treatment with date and time. Record the observation made on the nurse’s record.
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NASOGASTRIC TUBE FEEDING
1. INTRODUCTION.
Nasogastric tube feeding, nasal feeding, or Nasal gavage is the term applied to the process of feeding
the patient by means of a tube introduce directly into the stomach by way of either mouth or nose(The
word gavage comes from the French Gaver, meaning to force feeding of poultry ) this procedure was
used for feeding psychiatric patient formerly. But now it was widely used to give foods to adult who are
unable to take nourishment in the usual way and for weak babies who are not strong enough to suck or
swallow.
2. DEFINITION AND MEANING.

1. The administration of liquid food into a stomach by a Reyle’s tube inserted through the nostrils is
called Nasogastric tube feeding.
2. Nasogastric tube feeding or Gastric gavage is an artificial method of giving fluids and nutrients
through a tube that has been passed into the esophagus and stomach through the nose, mouth or
through an opening made on the abdominal wall.
Naso:- Nasal
Gastric:- Related to stomach.
Tube Feeding: Administration of food material or medication through elongated flexible tube.
3. OBJECTIVES OF THE PROCEDURE.
TO Provide Nutritional Support Using Gastrointestinal Tract.
4. INDICATION./ REASON FOR PROCEDURE:
 When the patient is unable to ingest, chew, or swallow food but is still able to digest and absorb
nutrients, a tube feed is indicated, e.g. unconscious and semi-conscious patients etc.
 When the patient is too weak to swallow food or when the conditions make it difficult to take a
large amount of food orally e.g.: acute and chronic infection, severe burns, malnutrition and
prematurity.
 When the patient is unable to retain food e.g. vomiting, anorexia nervosa etc.
 When the condition of the mouth or esophagus makes swallowing difficult or impossible, e.g. :
surgery of the mouth or throat and esophagus, paralysis of face and throat, fracture of jaw, repair
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of the left palate and the left lip, terminal malignancy etc.
 For a patient who refuses food e.g. patient with depression.
5. ARTICLE REQUIRED FOR PROCEDURE.
Articles Rationale
A tray containing: To protect the bed, linen and garments

• A small mackintosh with
a towel
• A feeding cup with water To rinse the mouth and clean before and
after the feed
• Cotton tipped application, rubber or To clean the nostrils
disposable rubber
• A levine tube or Ryles tube in a bowl To make the tube hard for easy insertion
containing cold water
• A lubricant such as water soluble jelly To lubricate Ryles tube to prevent

or glycerin or liquid paraffin friction between mucous membrane and
tube
• Adhesive plaster and scissors To fix the tube in position
• Gauze pieces in a container To wipe the secretions
• Clean syringe or a funnel To aspirate gastric contents and to give

feeding
• A glass of feed in a bowl of warm To give the feed at the body temperature
water or warm feed
• An ounce glass To measure the fluid intake
• A bowl of water To test the location of the tube
• Stethoscope To test the location of the rube
• Saline or sodabibicarb solution To clean nostrils
• A kidney tray and a paper bag To collect wastes
6. PREPARATION OF THE PATIENT. /UNIT.

•Identify the patient with name, bed No.
•Check the doctor's orders for any specific precautions, regarding movement of the patient,
positioning etc.
•Check the level of the patient's consciousness and ability to follow directions.
•Check the patient's ability to move and maintain a desired position during insertion of the tube.
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•Explain the procedure to the patient to gain confidence and co-operation.
•Screen the patient to provide privacy.
•Place the patient in a sitting or high Fowler's position. If his general condition is weak, raise the
head with extra
pillows.
•Place covered treatment mackintosh over the chest to protect garments and bed linen.
•Give a mouth wash to clean the mouth.
•Clean nostrils if there are secretions or crust formation of nasogastric insertion.
7. STEP OF PROCEDURE WITH RATIONALE.

IMPLEMENTATION:-
Steps Rationale Scientific Nursing
Principles Principles
Wash hands with soap To prevent cross-infection. Soap and water help Principle of safety
and water. in checking the
microorganisms'
growth (principle of
Microbiology,
Physics).
Spread the mackintosh To protect bed linen. Microbiology Safety and

and the towel comfort
Clean the nostril with a To clean nostril. Microbiology Comfort and

cotton-lipped safety
applicator soaked in
saline.
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Take the Ryles tube and To determine Anatomy and Physics Safety and
measure the distance for approximate length of individuality
insertion of the tube the tube to reach the
from bridge of the nose stomach.
to earlobe plus distance
from ear lobe to the tip
of the xiphoid process of
the sternum and mark
with adhesive.
Lubricate the tube for Lubrication reduces Physics Safety

about 2-4 inches with friction between mucous
thin coat of water membrane and the tube.
soluble jelly.
Hold the tube coiled in Nasal septum is deviated Anatomy Safety

the right hand to into the right side.
introduce the tube.
Tilt back the child's head Passage of the tube is Anatomy and Safety and
before inserting the tube facilitated by following Physiology therapeutic
into the nostril and the natural contours of effectiveness
gently pass the tube into the body.
the posterior
Nasopharynx quickly
backwards and
downwards.
When the tube reaches Gag reflex is triggered Anatomy and Safety
the pharynx, the patient by the presence of the Physiology
may gag: allow him to tube. Helps to prevent
rest for a few moments. the aspiration of fluids or
passing the tube into
Trachea.
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Hold the child's head in Flexed head position Anatomy and Safety
a partially flexed position makes swallowing easier Physiology
and advance the tube as and the tube less likely
he swallows sips of to enter the trachea.
water. Swallowing facilitates
passage of the tube by
closing the epiglottis.
Helps in easy passing of
the tube and avoids
coiling it at Pharynx.
Continue to advance the Mark on the tube Physics Safety

tube until it reaches the indicates that it has
previously designated reached the stomach.
mark.
Aspirate for gastric Fluids cannot be freely Anatomy and Safety and
contents with a syringe. aspirated from the lungs. Physiology therapeutic
Glands of mucous effectiveness
membrane lining the
esophagus and stomach
produce mucus, and
gastric juices.
Place the end of the tube If the tube is in trachea Anatomy and Safety
into a bowl of water and air bubbles will coincide Physiology principles
note the rhythm of with the expiration of
escaping bubbles. each breath. Normal
respiration takes place in
lungs. As a result, air
will be expelled out with
expiration.
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Ask the patient to speak. The patient will be Physics Anatomy and Safety
unable to speak or hum Physiology principle
if the tube is in the
trachea. Any injury to
vocal cords of Larynx
causes difficulty in
speech and hum and
sounds will not be
produced.
Confirmation of the Hushing sound will be Physics Safety.

tube's place can be done heard on the stomach
by using a stethoscope. while air is pushed. Air
Take 5-10ml of air and pushed by force
push in produces a hushing
distal end of the tube. sound.
After the tube is in Prevents the patient's Psychology Individuality

place, tape it to the nose vision from being and comfort
/ forehead. Take 5cm of disturbed, prevents
tape, split length-wise tubing from rubbing
and only halfway, attach against nasal mucosa
up split end of the tape
to the nose / forehead
and cross split ends
around tubing.
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Wait for some time A few minutes rest will Anatomy and Comfort
before giving the feed. help to subside the Physiology
peristalsis and prevent
nausea and vomiting.
Peristalsis is stimulated
by any irritation to
stomach or by a bolus of
food.
Before giving the feed Expelling air from the Physics Safety
connect tunnel and tube before the feed is
syringe, pour some given docs not allow the
water through it and fluid to run. Air is lighter
lower the funnel slowly than water, liquid exerts
so as to expel air. pressure because of
their weight.
Hold the funnel or To prevent the damage Physics Safety

syringe 8 inches above of mucus membrane in
the bed. stomach. The height of a
column of fluid
determines the amount
of pressure exerted at
the point of application.
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Slowly introduce feeding To prevent distension, Physics Safety
into the funnel or nausea and excessive
syringe barrel, keep it peristalsis and to
full until total amount prevent air entry into
has been introduced. the stomach. Helps in
preventing injury to
gastric mucosa by
reducing pressure.
When the quantity of To prevent the blockage Physics Safely

feed is over, clear the of tube. As the food
tube by introducing a remains in tube, it
small amount of water. blocks the lumen and
causes obstruction to
flow.
Disconnect funnel or To prevent the leakage Physics Safety

syringe barrel and clamp of gastric fluids back
the tube to prevent from the tube. Fluid
leakage of fluids. flows only when there is
a difference in pressure,
the direction is to the
area of lower pressure.
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Tube may be removed or To prevent aspiration of Physics Safety
left in the place. To contents into trachea.
remove the tube pinch it
b/pulling it out
continuously with a
moderate rapid motion.
Offer a mouth wash, To clean mouth and Microbiology Comfort and

clean face and hands. prevent tartar formation safety
and to moisten the
mouth. As the patient is
not taking food by
mouth there will be less
secretion of saliva and
dryness.
Remove the mackintosh To keep the unit clean Psychology Comfort and
and the towel. safety
Make the patient To give a sense of well- Comfort

comfortable in bed. being, comfort.
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To take the articles to To clean them Microbiology Safety
the utility room. Discard thoroughly. To prevent
water and clean with cross-infection. Helps in
soap and water. Dry checking growth of the
them and replace in micro-organisms.
their proper place.
Wash hands To prevent cross- Microbiology Safety

infection.
Record the time, date, To have good Psychology Safety

amount of feed, nature communication in team Therapeutic
of feed, reaction of the and to maintain fluid effectiveness
patient, if any, in the balance for future
nurse's notes and reference.
intake-output chart.
If the tube is reusable, Usually disposable ones Microbiology and Safety and
clean it with cold water can be discarded. Physics comfort
first then with a warm Rubber tubes arc kept
soapy solution. Pushing ready for the next use.
water several times
through the lumen boil
it, dry it and replace.
Disposable tubes to be
discarded.
26
8. AFTER CARE OF PATIENT AND ARTICLE.
After the procedure replace the article by cleaning thoroughly and ask the child how he felt is there any
partial satisfaction of fulfilling appetite, provide fowlers for a while or if child can able to walk then give
little time to walking this will help for digestion.
9. RECORDING AND REPORTING.
Record the time, Date, Amount of fluid given, toleration. And signature of the nurse who carried out
procedure. Report if any adverse effect or intoleration etc.
10. SUMMARY AND CONCLUSION.
Nasogastric tube feeding or Gastric gavage is an artificial tube feeding through nose, mouth,
oesophagus to the stomach. It should be given by doctor's order only. It has more advantages than
parentral feeding. Gastric gavage may be nasogastric, orogastric and gastrostomy feedings. The
procedures for all these are the same except some points.
As a nurse while proceeding the procedure she must also understand the following points.
 GENERAL INSTRUCTIONS
•Screen the elder child for privacy.

•Tube feeding is given only by the doctor's order.
•If the elder child is conscious, explain the procedure and reassure him/her to win his confidence
and co-operation.
•A rubber tube may be placed in a bowl of ice to cool and stiffen.
•Lubricate the tube with a suitable lubricant preferably with a water-soluble jelly, e.g., mineral oils
(glycerine, liquid paraffin) are used; it should be applied to the minimum with a soft paper or
cotton. (A drop of mineral oil, if
dropped into the respirator)' passage acts as a foreign body because the lung tissue does not absorb
it).
•If the tube is dipped in a liquid or lubricant before insertion, make sure that the blind end is not left
filled with the fluid or lubricant, because this may drop into the larynx and choke the child.
•All equipment used for feeding should be clean. The food has to be prepared, handled and stored
under hygienic conditions because many organisms enter the body through food and drink.
•Every time before giving the feed, make sure that the tube is in the stomach by aspirating a small
quantity of (5 to 10ml) stomach contents.
•While removing the tube, pinch the tube and pull it out gently and quickly so that the fluid may
not trickle down the pharynx.
•During the introduction of the tube, never use force as it may cause injury to the mucous
membrane.
27
•Avoid introducing air into the stomach during each feed by :
-Expelling air from the tube by lowering the tube below the level of the stomach.
-Pinching the tube before the fluid runs into the stomach completely from the syringe.
•Restraints use should be limited to the minimum. For infants and restless children, some form of
restraints may be necessary, but they should not feel that they are punished.
•Feedings may be given at intervals of two, three or four hours and the amount is not exceeding 50
to 100ml per feed. The total amount in 24 hours varies between child to child and weight. If the
drip method is used, the speed of the flow should not exceed 10 to 20 ml per minute. This
minimizes distension, nausea, regurgitation and excessive peristalsis usually associated with too
much and too rapid administration. The food calories should be calculated according to the
condition of the disease.
•Intake and output are to be recorded accurately.
•Watch for complications such as nausea, vomiting, distension, diarrhea, aspiration, pneumonia,
asphyxia, fever, water and electrolyte imbalance. These may be reflected in changes in the skin,
and mucus membrane thirst vital signs, intake and output chart, level of consciousness, body
weight etc.
•Patients receiving tube feeding should receive frequent mouth care to prevent complications of
neglected mouth care.
•Warm the feed to room temperature "before administration.
•Use gloves as per universal precaution.
 TYPES OF GASTRIC GAVAGE

Gastric gavage may be divided as follows, based on the route of insertion and method of
administration: Route of insertion :
•Nasogastric tube feeding: A tube is passed through the nose and oesophagus into the stomach. It is
also called nasal feeding.
•Oro-Gastric feeding: A tube is passed through the mouth and oesophagus. So the food reaches the
stomach.
•Gastrostomy tube feeding: Giving a liquid diet through a tube or catheter, which is introduced into the
stomach through the abdominal wall, is called Gastrostomy feeding (gastro = stomach, ostomy = making an
opening into).
 Methods of Administration
•Continuous Feeding Method: Used for critically ill clients. Continuous drip-feeding helps to minimize
cramping, nausea and diarrhea; the gravity flow of fluid by an infusion pump is used at the rate of 50ml/hr.
28
•Intermittent Feeding Method: Feeding given periodically. Each time 400 ml over 30 minutes duration and
four to five times a day by the drip method.
•Bolus Feeding Method: Pour a prescribed amount of fluid (250-400ml) slowly into the barrel of a
syringe or funnel attached to the end of the tube. The fluid flows by gravity into the stomach.
The gastric gavage procedure is similar for infants, children and adults except for the size of the tube and
the length passed and the amount of feeding given.
Methods of tube feedings :
Nasogastric (NG) feeding Nasoduodenal feeding Nasojejunal feeding
Jejunostomy (JT) feeding Gastrostomy (GT) feeding
RELATED LITERATURES TO THE NEXT PAGE:………
29
COLLEGE OF NURSING BHARATI VEEDYAPEETH, PUNE.
Final Year Msc Nursing [Pediatric Specialty]
STUDENTS NAME:-___________________________DT:__
CHECKLIST FOR NASOGASTRIC TUBE FEEDING
SR. PARTICULARS YES NO N.A

NO
* BEHAVIORAL GUIDES
1. APROACHES THE CHILD/PARENT WITH CONFIDENCE.
2 GIVES A RELAVANT EXPLAINATION INWAYS THAT
CHILD OR PARENT CAN UNDERSTAND.
3. ORIENTS THE CHILD/PARENT THE POSIBLE
DICOMFORT AND TO HIS ROLE DURING THE
PROCEURE.
4. ANTICIPATES CHILDS EMBARSEMENT AND
PROTECTS PRIVACY.
5. MAKES ALLOWANCES FOR INDIVIDUAL
DIFFERENCES IN TOLERANCE OF TREATMENT.
6. SHOW PATIENCE.
7. NOTICES CUES INDICATING CHILD’S DISCOMFORT
AND ATEMPTS TO ALLEVIATE IT.
8. PLACES THE PROCEDURE APROPRIATELY TO
TOLERANCE AND/OR CONDITION OF CHILD.
9. FOCUSSES ATTENTION ON THE PROCEDURE TO
THE EXTENT THAT READINESS TO RESPOND
TO OTHER EVENTS IS LIMITED.
10. INDICATES AWARENESS OF RESPONSIBILITY TO
THE CHILD FOLLOWING THE PROCEDURE.
* FEEDING OBSERVED NOT
OBSERVED
11. ENSURE 30-45DEGREE UPRIGHT POSITION OF
CHILD IF UNLESS CONTRAINDICATED.
12. ENSURE TUBE IS CORRECTLY POSITIONED.
13. CHECK THAT PRESCRIBED FLUID IS AT
APPROXIMATELY NORMAL BODY TEMPERATURE.
14. INTRODUCED ORDER AMMOUNT OF FLUID
THROUGH THE TUBE.
15. INSERTS MININMUM 10 ML OF WATER FOLLOWING
FEED TO FLUSH THE FEED.
TOTAL
N.A = NOT APPLICABLE. POINTS: /15
COMMENTS:
STUDENTS SIGN:-
30
OXYGEN THERAPY IN CHILDREN
11. INTRODUCTION.
Air, water and food are the three essentials of life. Oxygen, the most important component of air,
is vital to all existence. Oxygen is given when there is interference with normal oxygenation of
body tissues. Inhalation is also one of the common routes of administration of drugs. Drugs may
be given by inhalation for either a systemic or a local effect. The systemic effect is produced
immediately, because of the large surface area of lungs and the rich supply of blood vessels. Drugs
used for a local effect may be in the form of medicated steam and fumes. The fumes method is
rarely used.

Oxygen is a colorless, odorless, tasteless and combustible gas. Oxygen therapy is defined as the
administration of oxygen by inhalation from a cylinder, piped in system liquid oxygen reservoir or
oxygen concentration by various methods to relieve anoxemia.

 To facilitate normal metabolism of the tissues.
 To reduce / correct arterial hypoxemia (low concentration of oxygen in the blood) and tissue
hypoxia.
14. SCIENTIFIC PRINCIPLES.

15. Anatomy and physiology: The anatomical structure of respiratory tract is an important
aspect of O2 Administration procedure nurse must know of its basics before initiation of the
procedure for normal alignment.
16. Microbiology: As a procedure is related to human subject there may be a chances of
spreading nosocomial infection so as a nurse she must take care to provide aseptic procedure
17. Pharmacology: some times with oxygen some drugs used in a procedure are mostly
bronchodilator which are the chemical composition and may produce the side effect so the
nurse must aware of pharmacokinetics of the particular drug before administration.
18. Physics: use the body mechanics is important while transferring the oxygen cylinder.
19. Psychology: Nurse must aware of mental status of the child and his parents to provide
anxiety free procedure.

31
The indications for oxygen therapy are as follows:
•Breathlessness or laboured breathing.
•High altitudes.
•Shock and circulatory failure.
•child under anesthesia.
•Children who are critically ill.
•Child with a decreased respiratory capacity.
21. ARTICL REQUIRED FOR PROCEDURE.
Sr.No. Articles Rationale

1. Oxygen cylinder with stand ,or To deliver oxygen.
central supply oxygen with a
To humidify oxygen
flow meter, humidifier / Wolffs
bottle and connecting.
2. A tray containing:
3. a) Nasal catheter / canula / To check the amount of oxygen going
to the patient.
oxygen /flow meter & mask of
an appropriate size clean /
disposable type in a covered
container.
4. b) Water and soluble To lubricate the nasal catheter.

lubricating jelly
5. c) Adhesive tape To attach the nasal catheter.
6. d) A bowl of water To check oxygen flow.
7. e) Swab sticks and normal For cleaning nostrils.
saline in a container.
8. f) No smoking (indicator) To take fire precautions
Preparation of the patient

•Check name, bed No. and other identification marks of the patient.
•Check the diagnosis and the need for oxygen therapy,
•Check doctor's orders for initiation of the therapy and dosage.
•Assess the child for any sign of clinical anoxia.
•Assess the child's vital signs and breathing patterns carefully before starting
32
therapy.
•Explain the need of oxygen therapy; and the sequence of the procedure.
•Gain the patient's confidence.
•Keep the child in a propped up position or Fowler's position.

Steps Rationale Scientific Nursing
Principles Principles
Wash hands Reduces transmission of micro-organisms. Microbiology Safety

Soap and water reduce surface tension
and thus remove dirt and check the
growth of micro-organisms.
Attach canula / catheter mask Prevents drying of nasal and. oral Physics Safety, comfort
to oxygen tubing and mucous membranes and airway
humidified oxygen source secretions. Use of a humidifier prevents
adjusted to the prescribed drying of mucus membranes.
flow rate.
Place lips of canula into the Directs flow of oxygen into the upper Therapeutic
patient's nares. If mask, respiratory tract. Prevents loss of effectiveness.
apply snuggly to face. oxygen. Safety,
economy of
material
Check cannula/equipmcnt Ensures patency of canula and oxygen Safety
every eight hours. flow. Also ensures safe delivery of
prescribed oxygen.
Keep the humidification jar Prevents inhalation of dehumidified Safety and

filled al all times. oxygen. Prevents drying of mucus therapeutic
membranes. effectiveness.
Observe the patient's nares Oxygen therapy can dry nasal mucosa. Safety, comfort
and superior surface of both Pressure on ears from canula
ears and skin breakdown. tubing/elastic can cause skin irritation.
Check the oxygen flow rate Ensures delivery of the prescribed oxygen Safety Therapeutic
and the physician's orders flow rate. effectiveness.
every eight hours.
33
Wash hands before removing Reduces transmission of microorganisms Microbiology. Safely
the oxygen mask pr tube.
Inspect the patient for relief Indicates that hypoxia is Anatomy and Therapeutic
of symptoms associated with reduced/treated. Physiology effectiveness.
hypoxia.
Record procedure in the Documents correct use of oxygen therapy Safety, good
nurse's notes. and the patient's response. workmanship

•Stay with the child till he/she is at ease.
•Keep the child warm and comfortable.
•Evaluate the child’s progress by observing the vital signs and symptoms.
•Watch the child for any deteriorating symptoms after the removal of oxygen
inhalation. Inform the doctor.
•Request for an arterial blood gas analysis at specified intervals to make sure
hypoxia is treated.
•Take all articles to the utility room.
•Clean nasal catheter with cold water, then warm soapy water and finally with clean water (if not
disposable). Boil and store or send for sterilization.

 Record procedure with date, time.
As we sum up the procedure a Nurse also must keep following points in a mind that
Methods of Oxygen Delivery
• Nasal Catheter: Nasal Catheters are used less frequently these days. It involves
inserting an oxygen catheter/simple rubber catheter into the nose upto the nasopharynx. It
needs to be changed at least every eight hours and inserted into the other nostril, it is also
painful and can cause trauma. Thus, it is less desirable.
♦ Nasal Canula : A nasal canula is a simple comfortable device. The two canula, about 1.5
cm (1/2 in) long, m the centre of a disposable tube and are inserted into the nares.
34
•Trans-tracheal Oxygen : In trans-tracheal oxygenation, oxygen is delivered directly into the
trachea via a catheter
(small intravenous-size) into the trachea through a surgical opening in the lower neck.
•Oxygen masks / B.L.B. Mask (Boothby Lovelace and Bulbulian) : Oxygen mask is a device
used to administer
humidified oxygen, it is strapped to fit snugly to the mouth and nose and is secured in place with a
strap.
•Oxygen tent / the Seymour tent: When a patient has facial injuries or for any other reason
cannot tolerate an oxygen mask, then this method can be used. The tent is first flooded with
oxygen and then a flow of 4-5 liters per minute is given. This will maintain a service of 40 % - 50%
in the tent.
General Instructions
•Oxygen should be treated as a drug; the five rights of medication
administration also pertain to oxygen.
•When using an oxygen cylinder or central supply oxygen, use a regulator and
humidifier.
•Every part of the apparatus should be clean to prevent infection.
•Change nasal catheters at least every eight hours or more often to prevent blockage of the nasal
catheter by a mucus plug.
•When oxygen therapy is to be discontinued, it should be done gradually.
•Pay attention to conditions that can interfere with the flow of oxygen from source to the patient.
This may include tubing, loose connections and faulty humidifying apparatus.
•Always keep a spare oxygen cylinder in close vicinity.
•Watch the patients receiving oxygen therapy continuously to detect the early
signs of oxygen toxicity.
•Since oxygen supports combustion, fire precautions are to be taken when oxygen is on flow, e.g.
smoking, use of matches, lighters etc.
Contraindications
•Administer with caution to the patient with COPD (Chronic Obstructive Pulmonary Disease) as
it induces hypoventilation.
•Atelectasis.
•Oxygen toxicity.
•Paraquat poisoning.
35
Match the correct delivery device with your assessment of the patient:
Device F Concentration Indications Considerations
low
Cannula 1-6
Rate Low flow Use in infants who are
liters 24% - obligatory nose breathers or if
44% you do not have a correct size
mask
Simple 6-10 Moderate Must maintain a minimum of 6
mask liters flow 35% - liter flow
60%
Blow by 6-15 Mod. - High Can be used in Use for infants and young
liters flow Depends all children. Use a simple mask,
on flow rate patients corrugated tubing, or 02
and proximity to tubing threaded through the
face bottom of a paper (not
Styrofoam) cup.
Non- 12-15 High flow • Partial airway

rebreather liters 80% - obstruction •
--mask 90% Respiratory distress
• Inhaled poison •
Altered mental
status • Shock •
Trauma
Bag 15 High flow Be familiar with the pop-off

Valve Mask liters = 90% valve and manometer port if
present
36
NEBULIZATION IN CHILDREN
24. INTRODUCTION.
The simplest and most natural route of drug delivery to the lungs is the inhaled one. From the historical
and medical point of view, it was a Greek, Pedanus Discorides, the father of the science of pharmacy,
who, during the first century prescribed inhaled fumigation. Pipes were also used to inhale
hallucinogenic substances. All shamans knew the psychotropic effects of poisonous plants such as
Datura stramonium, especially Red Indians, in their peace calumets; but Indians of Madras used
fumigations of Daturaferox to treat asthma. Since 1803, this therapeutic was imported in Great Britain
and cigarettes with leaves of datura were used by asthmatics until 1992. In the middle of the
nineteenth century, to treat grapevines diseases and in response to the fashion of inhaling thermal
waters, spray technology was developed for the effervescent waters at the thermal spas. The onslaught
of tuberculosis, similar to AIDS a century later, brought back into practice the inefficacious use of
antiseptic aerosol therapy. With the discovery of adrenaline, ephedrine aerosols enjoyed a rebirth. The
perfecting of jet nebulizers by R. Tiffeneau, father of FEV1 and M.B. Wright, father of peak-flow,
allowed a better practice of inhalotherapy. In 1949, the United States, ultrasonic nebulizers made their
first appearance in the form of humidifiers, but doctors were quick to add medications to produce
therapeutic aerosols. After 150 years, with the improvement of nebulizer systems and new nebulized
medications, the nebulization story is still not concluded.

Nebulisation is a process of giving Nebulizer, and Nebulizer is a device for producing fine spray of
liquid. It can be with medicine or without medicine.
To deliver continuous nebulization through a fine droplets of a medicine or plane solution to the child that
are in a closely monitored area in the hospital.
27. SCIENTIFIC PRINCIPLES.

a) Anatomy and physiology: The anatomical structure of respiratory tract is an important aspect
of Nebulisation procedure nurse must know of its basics before initiation of the procedure for
normal alignment.
b) Microbiology: As a procedure is related to human subject there may be a chances of spreading
nosocomial infection so as a nurse she must take care to provide aseptic procedure
c) Pharmacology: Drugs used in a procedure are mostly bronchodilator which are the chemical
composition and may produce the side effect so the nurse must aware of pharmacokinetics of
the particular drug before administration.
37
d) Physics: Compressor of Nebulizer works on principles of physics and the nurse here also must
use the body mechanics.
e) Psychology: Nurse must aware of mental status of the child and his parents to provide anxiety
free procedure.

1. Provide long term bronchodilation for children with serious asthma exacerbation of COPD
bronchitis and pneumonia.
2. Liquefaction of thick secretion.
3. Improvement of clearance of secretion.
29. ARTICLE REQUIRED FOR PROCEDURE.
1. HOPE tm Nebulizer.
2. Oxygen and or / medical air at 50 Psi.
3. Blender, [O2 Analizer] (Optional).
4. Cardiac monitor if indicated and pulse oximeter.
5. Aerosol tubing, mask [ or other delivery device].
6. Sputum cup.
Nurse must take care of following headings
1. Preparation of Environment
Note: Room temperature
Ventilation Clean and tidy Privacy
2. Preparation of Patient
Note: Explanation and reassurance Privacy Position
Comfort Culture
3. Preparation of Equipment
Note: Hand washing
Collect all required equipment prior to commencement.
Check equipment is in working order.
Consider cost and reuse.
Consider if the procedure for the patient is really required.
4. Completion of procedure :
Note: Leave patient clean and comfortable, equipment disposed off and cleaned correctly.
Area left clean and tidy. Hand washing.
5. Documentation
Note: Maintain nursing record.
Ensure replacement of used equipment.
38
PROCEDURE:
A. Therapy must be initiated in either the ER, Critical Care Unit, pediatric area or in an area in which
the patient's EKG may be monitored continuously.
B. The treatment must be reordered every 24 hours by a physician. After an order has been received,
the therapist is to verify the order in the patient's chart.
C. After checking the patient's ID, the therapist is to explain the procedure to the patient and answer
any questions they may have.
D. Wash hands and assess patient's heart rate, breath sounds, respiratory rate,
peak flow, color, use of accessory muscles, patient's oxygen needs (current ABG)
or SaO2.
E. The therapist then sets up a continuous pulse oximeter to establish a baseline and monitor
the patient.
F. Attach flow meter to 50 psi gas source.
G. Attach HOPE1™ to flow meter or blender.
H. Attach corrugated tubing to the HOPE11" Nebulizer output and to the aerosol
mask or other delivery device.
I. PREPARE MEDICATION [ Eg. Albeterol 0.3mgto 0.5mg/kg/hour.]
J. Pour medication into the HOPE Nebulizer reservoir using aseptic technique. K. Set flow meter
to 10 liters per minute and adjust FiO2 per chart or blender to
meet patient needs after attaching appropriate size mask to the patient. L.
Monitor the patient for adverse reactions and check the HOPE Nebulizer Q 30
minutes x 2 hours.
M. To determine approximate use of medication, look at the marks on the side
of the Nebulizer (marks on Nebulizer are in 25 ml increments). Adjust flow
meter by small increments to achieve desired output of 25 ml/hour without
auxiliary flow.
N. When using auxiliary flow, output increases. Mix one more

hour of medication to accommodate increased output.

A. Pulse before, during treatment, Q 30 minutes x 2 hours, then Q
2, and post treatment.
B. Breath sounds before, during and post treatment.
C. Pulse oximeter before, during and post treatment.
39
D. In pediatrics a TCM may be used to monitor patients pre, post and during the treatment to
monitor PaCO2,
E. Peak flow rates before treatment, during treatment Q 1x2, then Q 2 and post treatment.
F. Sputum production.
G. Subjective statements by patient.
H. Patient position, color and level of cooperation.
I. Complications or problems noted during therapy.
J. Electrolyte levels at physician discretion, if patient is receiving beta agonist
therapy > 4 hours.
K. Re-evaluate patient after initial 2 hours for possible decrease in drug dosage level.
l. Ensure replacement of used equipment.

A. Check the patient and document the following information Q 30 minutes for the first 2 hours,
then Q 2 on the Continuous Bronchodilator Therapy Work sheet
1.FiO2.
2.Heart rate.
3.Respiratory rate.
4.Breath sounds.
5.Oxygen saturation/TCM reading or ET CO2.
6.Peak expiratory flow.

7.Side effects and remarks
8.Respiratory Care Practitioner signature
9.Date and time.
10.ABG information.
11.Mental status.
As Nebulizer produces a shower of fine droplets that can be breathed in by blowing compressed air
through a reservoir containing a solution of the bronchodilator drug. Younger children who may find it
difficult to operate an aerosol it is manage best with a compressor Nebulizer which delivers medicine
through a face mask over several minutes. In hospitals, the compressed air or oxygen is used to
nebulize drugs used in the emergency treatment of asthma.
If the child is prone to frequent attacks consider buying a Nebulizer . This is a very handy for use
during an acute attack However a metered – dose inhaler with an easily available spacer device and
40
facial mask is considered better than a Nebulizer for the treatment of acute wheezing in children less
than 2yrs.
As a nurse she also take care of following headings.
HAZARDS:
A- Exhaled aerosol or patient coughing may spread active pulmonary infections.
SAMPLE MEDICATION CALCULATION:

This is a sample calculation. Ideally, when setting up CNBT, the initial fill and dosage should be
for 3 hours.
A. MEDICATION + DILUENT - OUTPUT OF NEBULIZER (25 ml/hr. @ 10 lpm
Albuterol 0.5% (5 mg - 1 ml, 10 mg=2 ml, 15 mg-3 ml, 20 mg=4 ml)
1.Mg/hr of medication ordered x 0.2= ml of medication used per hour.

2.(Output of nebulizer) - (ml of medication) = ml of diluent (normal saline)
3.Multiply diluent and medication times hours you want to deliver, up to 8 hours @ 10 pm
(maximum volume of nebulizer is 220 ml).
CONTRAINDICATIONS:
A. Absence of the above indications.
B. Increased heart rate of >25 beats or as defined by the physician.
TREATMENT COMPLICATIONS:
A. A complete reassessment is indicated any time the patient
vomits. Failure may include, but is not limited to the following.
1.Failure to significantly respond in 8 hours.
2.Decreasing aeration over time or increased wheezing
without a simultaneous increase in operation.
3.Worsening blood gases.
4.Decreasing pulse oximeter readings or an increasing need
for higher FiO2's to maintain the same saturation.
5.Decreasing level of consciousness or decreased ability to

awaken the patient.
6.Increased work of breathing.
7.Anything that leads you to believe, through your patient
assessment, that the patient is getting worse.
B. When treatment failure is suspected, re-evaluate the patient and
contact the physician immediately.
41
NOTES: Nebulization to empty may lead to evaporative concentration of the drug at the bottom of
the nebulizer. When nebulizing for a long period of time, it may be appropriate to change the
medication solution when 10% is left in the bottom of the nebulizer.
Neonatal resuscitation-Protocol
During the intrauterine life the baby gets oxygen through the placenta. As soon as the baby is born,
the respiratory center is stimulated and lungs expand and the baby initiates spontaneous breathing.
Most newborn babies breathe spontaneously after birth and may not require resuscitation measures. If
the newborn does not breathe spontaneously nor has breathing problem then the baby is asphyxiated,
so immediate steps should be taken to resuscitate the newborn. About 5-10% of newborns need
resuscitation. Nearly one million newborns are die because of birth asphyxia. Hence it is essential that
knowledge and skills required for resuscitation be taught to all involved in neonatal care.
INDICATION
Maternal condition- pregnancy induced hypertension, placenta previa or placenta abruptio, prolonged
or obstructed labour, fever in labour, post- term pregnancy, maternal sedation, prolonged rupture of
membrane,
Fetal conditions – umbilical cord around the babies neck, short cord, knot on the cord, prolapsed cord
During or after the birth- premature baby (before 37 weeks of pregnancy) difficult delivery,(breech,
multiple birth, stuck shoulders, vacuum extraction, forceps) meconium in the amniotic fluid, congenital
anomalies.
PREPARATION OF PATIENT
Anticipation and preparation are very important for effective resuscitation. Anticipation of likelihood of
resuscitation is only possible if proper antenatal history and all the maternal documents are available
before delivery, which can help to identifying the high risk infants. It is important to keep resuscitation
articles before delivery. When a baby has asphyxia, you must start resuscitation immediately.
PREPARARTION OF ARTICLES
 Warm environment
 Place to do the resuscitation (resuscitation corner)
 Personnel
 Equipments
42
 Supplies
Keeping a newborn baby in a warm environment saves the baby’s energy for breathing. There are
many ways to keep a baby warm. This includes the baby in a warm room, providing heat by various
means, drying the baby etc.
Warm environment: keep the room warm (at least at a temperature of
25 degree c) and keep it free from air currents.
Providing heat: place the baby under a radiant warmer or use heater or 200 watt bulb above the
baby. For babies needing routine care, use skin to skin contact for providing warm.
Drying the baby: dry immediately after the birth, then remove the wet sheet/cloth and cover the
baby with another warm, dry sheet/or cloth. Resuscitation place
The resuscitation must be done on a flat surface. A table or trolley in the room can be used or it can
be done in a place next to the mother. The place needs to be clean and warm.
Personnel
It is essential that at least one person skilled in neonatal resuscitation should be present at every
delivery. For performing complete resuscitation two persons must be available for ventilation and
chest decompression.
NEONATAL RESUSCITATIONS SUPPLIES AND EQUIPMENTS:
 De Lee trap
 Mechanical suction
 Suction catheters No. 12FG, 14FG
 Feeding tube 6F and 20ml syringe
Bag and mask equipment
 Neonatal resuscitation bag

 Face masks, term and pre term size
 Oxygen with flow meter and tubing
Intubation equipment
 Laryngoscope with straight blades No. 0(pre term) and No. 1 (term)
 Extra bulbs and batteries for laryngoscope
 Endotracheal tube; 2.5, 3, 3.5, 4.mm internal diameter
 Scissors
Medication
 Epinephrine
43
 Naloxone hydrochloride
 Normal saline
 Sodium bicarbonate
 Sterile water
 Miscellaneous
 Watch with second hand
 Linen and shoulder role
 Radiant warmer
 Stethoscope
 Adhesive tape
 Syringe 1,2,10,50ml
 Gauze pieces
 Umbilical catheters
 Three way stopcocks
 Sterile gloves
Routine care
Nearly 90% of newborns are vigorous term babies with no risk factors and clear amniotic fluid.
These babies do not need to be separated from their mothers to receive initial steps. Receive the baby in a
warm and dry sheet. Dry the baby and wrap in another dry and warm sheet covering the head put the baby
on mother’s abdomen while drying. Keep the baby in direct skin to skin contact maintains warmth and
prevent hypothermia. Clear the airway by wiping the baby’s nose and mouth with sterile cloth. At birth you
must make quick assessment and assess/look for following.
 Was the baby born after a full-term gestation?

 Is the amniotic fluid clear of meconium and evidence of infection?
 Is the baby breathing or crying?
 Does the baby have good muscle tone?
If the answer to any of these question is yes then you must give routine care to the baby’s given above
If the answer to these question is no, then you must start the initial steps
Initial steps
 Preventing heat loss

 Positioning
 Suctioning
 Evaluation
44
 Tactile stimulation
 Free flow oxygen
Preventing heat loss
An important step in the Care of the newborn is to prevent the heat loss of body heat. This can be
especially critical in a newborn who needs resuscitation. Even healthy term infants have a limited ability
to produce heat when exposed to a cold environment, particularly during the first 12 hours of life.
Drying the infant
As soon as the baby is placed under the radiant warmer, the baby should be quickly dried to remove
the amniotic fluid to prevent the evaporate heat loss. It is preferable to dry the infant with a pre
warmed towel or blanket. After drying remove the wet towel or blanket from the infant and lay the
infant on another prewarmed towel or blanket. This will further reduce the heat loss.
Using radiant heat source /other means to keep the infant warm
Prevention of heat loss can be achieved by placing the baby under the radiant warmer which should be
switched on manual mode before the delivery of the baby. An overhead radiant heater provides a
suitable thermal environment that minimizes radiant heat loss. It is important to switch on the radiant
warmer so that the infant is placed on a warm mattress. A radiant warmer allowed easy access to the
baby and provides the full visualization of the infant.
If heat source is not available, a lamp with 200w bulbs or a suitably fixed room heater can be used for
keeping the baby warm.
Positioning
Place the neonate on his or her back or side with the neck slightly extended or in shifting position.
Prevent hyperextension or under flexion of the neck since either may decrease air entry. Maintain the
correct position by placing a rolled blanket or towel under the shoulders, evaluating them ¾ to 1 inch.
if the infant has copious secretions coming form mouth, turn the head to the side. This will allow
secretion to collect in the mouth, from where they can be easily removed.
45
Suctioning
If no meconium is present, suction the mouth and nose. The mouth is suctioned first to prevent
aspiration which can happen if nose is suctioned first. A bulb syringe or a mechanical suction can be
used to remove the secretions. Be carefully not to be too vigorous as you suction and do not insert the
catheter deep in the mouth. Stimulation of the posterior pharynx during the first few minutes after the
birth can produce a vagal response, causing severe bradycardia or apnea. If bradycardia occurs stop
suctioning and re evaluate the heart rate.
Evaluation
The infant should be evaluated on the basis of three vital signs
1. Respiration: observe and evaluate the infant respiration by observing the chest movements.
If breathing spontaneous, go on to check the heart rate. If not, begin tactile stimulation. If still no
spontaneous respiration, start positive pressure ventilation (ppv).
2. Heart rate: check heart rate by ascultating the heart or by palpating the umbilical pulsations by 6
seconds. Whatever the number or pulsation multiply by by 10 to obtain the heart rate per minute.
If heart rate more than 100 beats per minute, look for color. If less than 100 beats per minute, initiate
PPV.
3. Color : if the infant is breathing spontaneously and the heart rate is more than 100 beats per
minute, evaluate the infant’s color by looking by cyanosis at lips/ tongue(central cyanosis)
If central cyanosis is present administer the oxygen.
46
Providing tactile stimulation
Both drying and suctioning the infant produces stimulation, which for many babies is enough to induce
respirations. However, if the infant does not have adequate respiration, additional tactile stimulation by
stepping the sole or flicking the heel and / or and quickly rubbing the newborns back (rub twice) may
be briefly provided to stimulate breathing . if you choose to provide tactile stimulation , free – flow
oxygen should be given along with while you are stimulating the infant. Tactile stimulation can be
safely and appropriately provided by following two methods.
 Slapping or flicking the soles of the feet
 Rubbing the infant’s back
 Slapping in back
 Squeezing the rib cage
 Forcing thigh on abdomen
 Using hot or cold compress
 Shaking
One or two slaps or flicks to the soles of the feet or rubbing the back once or twice will usually
stimulate
Using breathing
free – in an
flow oxygen infant with apnea. However, if the infant remains apneic , tactile
Free flow oxygen
stimulation shouldrefers to blowing
be abandoned and oxygen
bag and over
mask the nose ofinitiated
ventilation the baby to enable the baby to breath
immediately.
oxygen enriched
Continued use ofair. Thisstimulation
tactile can be done by infant
in an holding thedoes
who endnot
of respond
an oxygen tube
is not close toand
warranted themay
nose, within a
cupped hand or by holding the oxygen mask over the mouth and nose.
be harmful, since valuable time is being wasted.
Free flow of oxygen is used when an infant has established regular respirations and the heart
rate is greater than 100 beats per minute but central cyanosis persists. In these circumstances free –
flow 100% oxygen at 5 L/min be given. Once the infant becomes pink while breathing room air. If
cyanosis persists despite 100% free – flow oxygen , a trial of bag and mask ventilation may be
indicated.
Bag and Mask Ventilation
47
Objectives: Participants will be able to learn
• When to give positive – pressure (bag and Mask) Ventilation.

• Selection of bag and mask equipments.
• The similarities and differences among flow – inflating bags and self inflating bags and T- piece
resuscitators
• The operation of each device to provide positive pressure ventilation.
• The correct placement of masks on the newborn’s face.
• Identify the indications and contraindication of bag and mask.
Ventilation of Lungs is the single most important and most effective steps in cardiopulmonary
resuscitation of the compromised newborn baby.
Bag and Mask Equipment

Resuscitation bags: Two types
1. Flow inflating bag (Anesthesia bag )
2. Self inflating bag
1. The flow – inflating bag – fills only when gas from a compressed source flows into it. It is
collapsed like a deflated balloon when not in use. It inflates only when a gas source is forced
into the bag and opening of the bag is sealed, as when mask is placed lightly on a baby’s face.
Peak inspiratory pressure is controlled by the flow of incoming gas, adjustment of the flow
control valve and how hard the bag is squeezed. Positive and expiratoratory pressure (PEEP) or
(CPAP) is controlled by an adjustable flow control valve.
Preparation of resuscitation devices for an anticipated resuscitation.
1. Assemble all the necessary equipments.
2. Testing the equipments.
Bag and Mask procedure

Indications: Apneic or gasping following initial stimulation.
• Heart rate < 100 \ min in a spontaneously breathing baby.
• Spontaneously Breathing infant – cyanotic despite free flow oxygen
Contra Indication:
• Diaphragmatic hernia
• Non- vigorous baby born through meconium – stained liquor.
48
Selecting bag and mask equipments: Size of bag (240-750 M1): it deliver a tidal volume of 6-
8 ml per kg.
• Oxygen capability: Oxygen source, Reservoir.
• Safety Features : - Pop off valve , pressure Gauge (optional )
• Mask Size: 0 and 1 (cover chin, mouth nose) Cushioned Edges.
Forming Seal:
• Positioning the infant
• Position of resuscitator
Forming and checking the seal:
• Positioning and holding the mask: Enclose chin, mouth and nose , ensure snuff seal , avoid
pressure over neck and eyes.
• Squeeze the bag with fingertips: Don’t squeeze or empty the bag with whole hand.
• Observe chest movements noticeable rise and fall of chest , shallow and easy breathing
• Rate: 40-60 Breaths per minute. Squeeze – two three squeeze
• Pressure : Increase in heart rate if noticeable rise and fall or chest
• Initial breath pressure 30-40 cm of H20 later 15-20 cm of H20
Improvement assessment
• Increasing Heart rate
• Improving color
• Spontaneous breathing
No improvement \ deterioration
• Chest movement not adequate
• Inadequate seal
• Reapply mask
• Blocked airway : Reposition
Clear Secretion
Ventilate with open mouth
Reliably.
A good resuscitation bag:
• Size 200-750 ML
• Capable of avoiding excessive pressure
• Capable of giving 100% Oxygen
• Appropriate sized mask.
Masks: Cushioned \ non – cushioned marks
Round \ anatomical shaped
49
A mask comes in a variety of shapes, sizes and materials. Selection of mask fro use with particular
newborn’s depends on how well the mask fits to the newborn’s face will achieve a tight seal between
mask and newborn’s face available ; size 0 or 1.
Be sure to have a various sized mask available. Effective ventilation of a preterm baby with term
infant size mask is impossible. Use correct size and correct position of the mask.
Advantages: Delivers 100% Oxygen at al time.
• Easy to determine the adequacy of seal.
• Stiffness of Lungs can be felt.
• Can be used to deliver 100% free flow Oxygen.
Disadvantage: Requires a tight seal to remain inflated.
• Requires a gas source to inflate
• No safety pop – off valve.
• Requires more experience
The self – inflating bag – Fills spontaneously after it is squeezed pulling gas (Oxygen of air
mixture of both) into the bag .
Advantages:
• Does not need a gas source to inflate
• Pressure release valve is there
• Easier to use
Disadvantages:
• Will inflate even if there is not a seal between mask and patients face.
• Requires Oxygen reservoir to provide high Concentration 100% Oxygen
• Cannot be use to deliver free flow oxygen
• Insufficient pressure
• Increasing pressure
Deterioration:
• Check delivery system
• Check Oxygen supply
• Check Oxygen Tubing
Preterm Newborns
• Avoid Excessive chest wall movements (Large tidal volume )
• Monitoring of pressure and avoiding unnecessary high pressure
• CPAP after resuscitation may be helpful.
Bag and mask ventilation procedure

Points to be keep in mind
• Select bag & connect Oxygen source capable of giving 100% Oxygen
50
• Select Appropriate size mask
• Test Bag
- Good pressure
- Pressure release valve working
- Pressure manometer 30-40 cm H20
• Baby need bag & mask ventilation
- Position your self at head end or side of baby
- Position baby’s head in sniffing position
- Position bag and mask properly on baby.
- Begins ventilation at appropriate rate and pressure
- Check easy chest rise during first 2-3 breaths
CHEST COMPRESSIONS
Objectives:
• Identify the indications of chest compression
• Locate the site of chest compression
• Demonstrate technique of chest compression on manikin
Introduction:
The newborn baby’s survival is dependent on his ability to adapt to his extra uterine environment. This
involves adaptations in cardio pulmonary circulation and other physiological adjustments to replace
placental function and maintain homeostasis. Simultaneously newborn has to make adjustment in
respiratory and circulatory system as well as maintain body temperature. These initial adaptations are
crucial to his subsequent well being and should be facilitated by trained and skilled nursing personnel.
The heart circulates blood throughout the body, delivering oxygen to vital organs. When an infant
becomes hypoxic, the heart rate slows and myocardial contractility decreases. As a result, there is a
diminished flow of blood and oxygen to the vital organs. The decreased supply of oxygen can lead to
irreversible damage to the brain, heart, kidneys and bowel. Chest compressions are used to
temporarily increase circulation and oxygen delivery.
Indication of Chest Compression:

The decision to initiate chest compression is based on neonate heart rate. Chest compression is
indicated when heart rate is below per minute after30 seconds of positive pressure ventilation with 100
percent oxygen.
Technique of chest compression:
The neonate should be posited on flat firm surface and neck slightly extended Ensure that neonate’s
back is firmly supported so that heart can be compressed between the sternum and spine. Two trained
personnel are needed i.e one for chest compression and another for positive pressure ventilation.
51
Chest compressions must always be accompanied by ventilation with 100% oxygen ventilation must be
performed to ensure that the blood being circulated during chest compression gets oxygenated.
There are two ways for chest compression:
Two finger method: The tip of the middle and the index finger should be used for compression. Other
hand can be placed under back of the neonate to provide support.
Thump technique: Thumbs of both hands are placed either side by side or one over the other win
fingers encircling the ribcage. The thumbs are used to compress the sternum while fingers provide
support to the back of the chest. The chest should not be squeezed by the hands but sternum
compressed with thumbs.
Site: Lower one third of the sternum i.e the area just below the inter nipple line and above
xiphisternum.
Rate of compression: The sternum should be compressed at the rate of 120 beats per minute and
the ventilation is given at the rate of 40 to 60 breaths per minute. Rate of cardiac massage should be
coordinated with ventilatory support i.e. three chest compression and one breath.
One and two and three and squeeze should be the sequence followed for chest compression and
positive pressure ventilation.
Compress the chest to a depth of one third of the anterior posterior diameter of the chest.
52
Maintained a steady rate and depth of compression.
After 30 seconds of chest and ventilation evaluate heart rate and make your decisions based on the
heart rate.
If heart rate is below 60 per minutes continue chest compression and ventilation
If heart rate is above 60 per minute discontinue chest compression whereas ventilation should be
continued till the heart rate is above 100 per minute and neonate is breathing spontaneously.
Complications
If the technique of chest compression is incorrect it can cause trauma to the heart, lungs or liver.
Excessive pressure over the ribs and xiphoid and lead to fractured ribs , laceration of liver and
pneumothorax.
53
FORMULA FEEDING
Introduction:
Nutrition is an important component of the care of al babies for their survival and proper growth and
development. Full term new born normal babies usually has food sucking reflex and they have breast
feed easily whereas low birth weight babies especially babies who cannot suck breast feed those
require to be fed by watty spoon.
Definition:
Formula feeding is method of giving synthetic milk and nutrients to a new born by using clean and
boiled watty spoon for their proper growth and development.
Purposes:
1. To promote appropriate nutrition
2. To ensure adequate physical growth and should mimic intrauterine growth curves in case of
preterm baby
3. Provide nutrients specially required for preterm to prevent micro and macro nutrient deficiency
and
4. To ensure normal land term neurodevelopment outcomes.
Indication
1. The baby >34 weeks and weight less than 2000 grams.
2. Poor swallowing and sucking reflux.
3. The baby is risk for aspiration
4. Congenital anomalies like cleft lip and cleft palate.
Principles
1. The baby should be fed in upright position and burped after each feeds.
2. The milk should be always directed to the side of the mouth
3. All utensils used for feeding have been boiled in water for at least 10 minutes.
Articles:
Feeding tray contains
- Boiled watty and spoon
- Boiled cooled warm water
- Recommended feeding powder like lactogen , lactose .
54
- Napkin
- Preparation of environment parents and baby.
- Establish rapport with baby’s mother by explaining properly.
- Prepare clean bed well light & ventilation
- Check babies cloth, if it is wet change it.
- Wash hands and prepare feed and cover & keep ready.
Procedure:
1. Wash hands 1. To prevent infection
2. Take boiled Wati spoon with boiled 2. Boiled articles to prevent

water & warm 30 ml. gastrointestinal infection to baby.
3. Take boiled Wati spoon with boiled 3. Boiled articles to prevent

water & warm 30 ml gastrointestinal infection to baby.
4. Add 1 spoon powder in 30 ml of water 4. to avoid lump of powder becoming &

and mix it with spoon evenly. to prepare proper milk
5. Hold the baby gently in lap. To

stimulation just tap the sole of feet.
6. Elevate 30degree head of baby on our 6. To prevent aspiration & milk while
left hand. swallowing
7. Give small quantities & spoon feed to 7. to prevent vomiting

baby to prevent vomiting
8. this provides comfort to the child
8. Let the baby swallow completed then
give other spoon this way slowly feed the
baby.
9. After 10 ml of milk burp the baby 9. It helps to prevent the regurgitation

by holding in an upright position &
support the head and neck while
gently patting or rubbing the back.
55
10. Clean the mouth lips & neck. 10. To keep the baby clean.
11. Place the baby in a bed on the left 11. to prevent vomiting
lateral side to prevent vomiting.
Do not leave a baby on his or

her back immediately after
feeding to prevent
regurgitation aspiration.
After the procedure: care of baby & articles –

1. Clean the mouth , lips neck with water swab gently & dry
2. Make the body comfort & give to mother
3. Take all articles to utility room, wash it thoroughly keep it in proper place After proper boiling
put all the stove & keep it in a proper place
Recording and reporting
1. Record the strength & amount f feed & time on chart
2. Record response of baby tolerated \ not tolerated
100 gm lactose = 495 kcal

1 scope = 4.5gm = 25 kcal
Required cal. Rate & new born 110-165kg /day
56
INTRAVENOUS ADMINISTRATION
A number of medications that are to be given to children require different routs of

administration and once the physician ordered the drug and dosage to be given, it is the duty of nurse
to ensure that it is given properly while observing the five rights and universal precautions of
medication administration.
Definition
The introduction of a fluid or liquid medicine to the body via the veins is termed as I.V infusion.
Purposes
1. To prevent the disease.
2. To restore the fluid volume that is lost from the body due to hemorrhage or diarrhea.
3. To prevent and treat shock and collapse.
4. To promote the health.
5. To give palliative treatment.
6. To give symptomatic treatment.
7. To obtain the desired effect of the medication.
Objectives
1. To administer the medicine in a safe and effective manner.
2. To prevent the injury.
57
3. To treat the disease condition.
4. To obtain the desired effect of medicine.
INDICATION
1. This method is used for giving drugs to children who have poor absorption as a result of diarrhea,
dehydration, or peripheral vascular collapse.
2. Children who need a high serum concentration of drugs.
3. Children those who have resistant infection that require parental medication over an extended time.
4. Children those who need continuous pain relief.
5. Children who require emergency treatment.
SCIENTIFIC PRINCIPLES:
ANATOMY AND PHYSIOLOGY.

 Give proper position to the patient and select the proper vein site.
 Careful selection of the site is important to avoid the injury to the blood vessel.
MICROBIOLOGY.
 Wash your hand thoroughly before and after the procedure to avoid the cross infection.
 Use all autoclaved equipment to prevent entry of infection to the into the body.
 Use autoclaved one syringe one syringe and one needle to each patient.
 Use sterile drugs and sterile water.
 Clean the top of the vial or neck of the ampoule with spirit before putting the needle into the
drug.
 Follow strict aseptic technique.
 One swab is used for swabbing.
PSYCHOLOGY.
 Explain the procedure thoroughly to the patient to win the confidence and co-operation.
 Distracting the patient while putting intracath will minimize the pain.
 Pain is reduced by using sharp needles.
 Maintain the privacy.
 Keep the patient relax both mentally and physically.
58
PHYSICS AND CHEMISTRY.
 Maintain proper body mechanics.

 Fluid tend to flow an area of low pressure so that the solution comes into the syringe.
 Diffusibility and solubility of the drugs also effects absorption.
 Solution having the same osmotic pressure as the blood are absorb more quickly than other
fluids.
 Absorption is slow in sluggish circulation.
 When solution is drawn from an ampoule into a syringe the needle is put into the fluid and the
piston is pulled back thus the pressure in the syringe is lowered.
 The deeper the penetration of the fluid the faster is the rate of absorption.
PREPARATION OF
a. Article:
A tray containing
A sterile bowl with cotton swabs
Spirit in a container
A syringe with medicine
Kidney tray
Mackintosh and towel.
Medicine card and general order book
(Should not take medicine to the syringe in front of children. Prepare the medicine in the
treatment room.)
b. parent:
Parents are told about the procedure, including the reasons for the procedure, what they can expect
during and after the procedure.
They should be offered the opinion of remaining with their child or leaving.
c. child
Explaining to the children what is being done during each procedure and how they can participate helps
to obtain their co operation and reduce their stress.
59
Play always an excellent stress reducing technique, can be employed during the preparation phase.
Allow the children to handle the equipment and to “push” an IV infusion on a toy animal or doll helps
familiarize them with the frightening aspects of the procedure.
c. Environment
Arrange for a quiet, private setting for the child while giving IV injection.
Maintain proper lighting, cleanliness,
The assurance of privacy relieves the child of some anxieties concerning of loss of control in front of
others, it will also helps to avoid subjecting other children to the potentially stress provoking scene.
STEPS OF PROCEDURE WITH RATIONALE.
60
PROCEDURE RATIONALE
1. Wash hands. To prevent cross infection.
2. Check the medicine card with doctors’ order, And It helps to take the correct medication
check the five rights. and prevent the wrong doses.
3. Again check the medicine and medicine dosage It helps to prevent wrong
with another sister. administration.
4. Prepare the IV injection:

a. carefully removes the bottle seal from the Every steps of the procedure requires
top of the bottle, clean the bottle with spirit swab; clean technique to prevent the
holding the bottle upright position and take the contamination.
medicine in the syringe. Keep the syringe in the
sterile tray.
5. Prepare the child, parent. Explain all the It helps to gain the confidence.
procedure.
6. prepare the venupuncture site:
a. keep the hand in a dependent position( lower Gravity impend venous return.
than the patient heart)
b. keep the Mackintosh and towel below the hand. Helps to maintain the cleanliness.
c. remove the stopper from the intra cath, clean the

port of entry with spirit swab, wait for three It helps prevent the entry of micro
seconds. organism.
7. Administer the injection slowly.

After giving injection, close the port of entry with It helps to find out the immediate
stopper and be with the child with 15 minutes. reaction after giving the medicine.
61
AFTER CARE OF CHILD AND ARTICLE
1. Give the child comfort position.
2. Dispose the syringe and needle.
3. Take all articles to utility room and clean the article with soap and water and replace the article in
proper position.
4. Wash hands.
RECORDING AND REPORTING
1. Record medicine, route and time, child response
2. Record and report any reaction observed after administration of drug.
IV CALCULATION
Total volume infused in ml X drops/ml

Flow rate = -------------------------------------------------
Total time of infusion in minutes.
62
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CIMS COLLEGE OF NURSING, DEHRADUN

Administration of oral medication.

INTRODUCTION: - Medicine may be defined as a substance used to promote health, to prevent, to

1. To prevent the disease.

5. To give palliative treatment

ARTICLE: - A trolley to take different medicine bottles.

1) Ounce glass, dropper, medicine glass,

2) Drinking water in a feeding cup,

3) Mortar and pestle

6) Medicine cards & general order book.

Parent: -Explain about the action of medication.

TEPS OF THE PROCEDURE WITH RATIONALE

2 Read the physician order and compare it 2 To ensure safety in the

4 It help Prevent wrong dose

is written or a drug administered, the - It helps give correct medication

6 It help to prevent contamination

- Replace stopper in bottle and return it to correct

11. Never pour excess medication back into

patient. Identify the patient with the assures accurate administration of

medicine card by- correct medication to correct patient

- Reading the name on the case paper.

13 It help in the easy sallow wallowing of

16. Be sure that the child is able to take

1. Wipe the face of the Child if necessary,

AGE/ SEX D.O.A.

WARD/BED NO. DR INCHARGE

S MEDICATION NAME DOSE TIME ROUTE SIGNATURE TO

CHECK LIST OF ADMINISTRATION OF ORAL MEDICATION

ADMINISTRATION OF ORAL MEDICATION

1. Follow five rights

2. Explaining procedure to child’ parents

3. Prepare the articles

4. Checked the vital sign

5. Follow strict aseptic technique

6. Select correct medication

7. Check the manufacture and expiry date

8. Calculate medication dose

9. Administer drug safely

10. Administer drug on time

11. Took medication tray or cart to patient’s room. Checked

12. Placed patient in sitting position, if the child is able or

13. Checked the patient’s identification asked the child name

15. If prepackaged medication was used, read label took

17. Check drug with medicine chart again and then

Pour into the glass.

20. Pour the medicine from the bottle on the side

Opposite to the label

21 Replace stopper in bottle and return it to Correct place,

Again checking the label.

22. First give little water to drink with the help of

The information that a child requires an colostomy is received with great

1. To Contains drainage and odors for the comfort of the client

 MICROBIOLOGY: - During dressing sterile technique should be maintained to prevent invasion of

•Observe color and amount of drainage from stoma.

• Disposable ostomy collection bag with clamp

• Stoma measuring guide

• Bedpan with cover

PREPARATION OF PATIENT AND ENVIRONMENT

2. Gather equipment and place within easy reach.

AFTER CARE OF PATIENT AND ARTICLE

• Place the patient in a comfortable Position.

• Remove, clean, dry and replace the supplies.

• Document the appearance of the stoma and the peristomal skin.