Pediatric Checklist Edited

KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCE
Nursing Department
Skills Laboratory Number 1 Part 1

Assist with the Assessment of the New born and Preterm Baby and Child
Course: Pediatric nursing
Level 6th level
Semester Two
Name of the student: No Skill Steps vital signs ( Temperature SS) Required frequency: 5 Prepare the equipments & instruments *Thermometer 1. Oral bulb 2. Rectal or stubby bulb 3 Electronic ( Interchangeable oral and rectal probes ) 4. Tympanic probe 5. Gloves Explain the procedure to the patient and family y. assemble the Equipment at the bedside. Oral determination Required * level of performance Performance rating ** 5 4 3 2 1 Comments
2 3
a. Wash hand b. Select an instrument ( oral ,stubby or electric ) c. If the thermometer has been stored in chemical solution , rinse it with water and wipe it dry with a soft tissue d. *Shake a glass thermometer until the mercury is below the 35.5 c mark .Firmly hold the non-bulb end of the thermometer and briskly snap the hand at the wrist. If using an electronic thermometer , remove from charger and slide cover over probe e. *Place the bulb under the right side of the child tongue .Have the child close mouth around the thermometer (If the child is over the age of 6 years ) f. *Leave the thermometer under the tongue for 3-5 minutes. Stay with the child while thermometer is in place g. *If an electronic thermometer is used, use the oral probe with a disposable plastic probe cover. The thermometer will signal when the peak temperature has been reached h. Remove the thermometer from the mouth and read the temperature i. After use , wipe thermometer with soft tissue , rinse in cold water , and store according to policy Rectal determination a. Wash hand b. Select an instrument ( Rectal /stubby or electric ) and provide privacy for the child c. Rinse, wipe and shake the rectal thermometer as in oral
A A D A A
A
A
temperature. If an electronic thermometer is used , remove from charger and slide cover over probe d. Lubricate the bulb with a water soluble gel Infant 1. place infant prone , spread the buttocks with one hand and insert the thermometer slowly and gently with other hand 2. *Insert the bulb into the rectum about 1/4 1/2 . 3. *If resistance is felt , remove thermometer and choose another route Older child 1. Position child on side , separate buttocks to expose the anal opening 2. *Gently insert the thermometer into the rectum about 111/2 3. *Hold thermometer in place for 3-4 minutes or until electronic thermometer signal is heard 4. *Never leave child alone with a rectal thermometer in place 5. Remove the thermometer in a straight line 6. Wipe it off with a soft tissue .If an using an electronic thermometer 7. Insert probe into base and store in charger
A A
A A A A A A A A
8. Read the temperature 9. Reposition child in a comfortable position and clean thermometer according to the policy 5 Axillary determination 1. Wash hand 2. Select instrument follow institution policy concerning whether to use a rectal or oral thermometer 3. *Rinse, wipe and shake the thermometer as suggested in the procedure for obtaining an oral temperature. If an electronic thermometer is used , remove from charger and place cover on probe 4. Place the bulb under the arm, well up into the armpit. Bring the child's arm down close to the body and hold in place 5. *Leave in place 10 minutes or until electronic thermometer signal is heard Final assessment
A A
A A
Done
Repeat
Level of performance A. Ability to perform the activity without supervision B. Ability to perform the activity under supervision C. Ability to assist with performance of the activity D. Knowledge of the activity by observation
Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed
KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICALSCIENCES
Nursing Department
Level .6th level
Semester Two
Name of the student:

No
Skill Steps vital signs ( Pulse SS) Required frequency: 5 Infant & young child and all cardiac patients Apical rate 1.Take the apical rate before any other vital sign measurement is attempted 2.*Place the stethoscope between the left nipple and sternum 3.Count the beats for 1 minute
Required * level of performance
Performance rating ** 5 4 3 2 1
Comments
A A D A
Older child Radial rate 1.* Place the first, second or third finger along the child's radial artery and press gently against the radius.
2.*Rest the thumb in opposition to the fingers on the back of the child's wrist 3.*Apply only enough pressure so that the child's pulsating artery can be felt 4.Count the arterial pulsations for 30 seconds and multiply by 2 to calculate the rate for one minute .If the pulse rate is abnormal , palpate the pulse for 1 full minute 5.Assess rhythm ( Regularity versus irregularity ) , amplitude ( Strength of pulsation ) ,& elasticity of the vessel ( Distension of vessel ) while counting the rate 6.Accurately record the following in the medical record a. Rate b. Quality of the pulse c. Location felt d. Regularity or irregularity of rate e. Activity of child at time pulse is taken 7. Report any changes in pulse characteristics to the physician immediately Final assessment : Level of performance A. Ability to perform the activity without supervision B. Ability to perform the activity under supervision C. Ability to assist with performance of the activity D. Knowledge of the activity by observation
A A D
D
Done Repeat
KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OFAPPLIED MEDICAL SCIENCES
Nursing Department
Level .6th level
Semester Two

No
1 2 3 4 5 6
Skill Steps vital signs ( Respiration SS) Required frequency: 5 Approach the child in a quiet , non threatening manner In the infant , note the rise and fall of the abdomen with each inspiration and expiration In the older child , note the rise and fall of the chest with each inspiration and expiration *Using a watch with a sweep hand , count the respiration for 30 -60 seconds , depending on the age of the child Compare to the average rates at rest Record the findings according to policy Final assessment
Required * level of performance A A A A A D
Comments
Done
Repeat
KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES
Nursing Department
Level .6th level
Semester Two

No
Skill Steps vital signs ( Blood pressure SS) Required frequency: 5 Prepare the equipments & instruments *Stethoscope * Appropriate size cuff * Sphygmomanometer * Doppler blood pressure device * Elastic bandage Auscultation : brachial Artery 1. Place the infant or child in a sitting or recumbent position. The forearm is supinated and slightly flexed 2. Remove all clothing from the upper extremity 3. Demonstrate the equipment and procedure to the child using appropriate terminology.
Comments
A A A
4. Check equipment for connection and function 5. Place the correct size cuff around the upper arm with the inflatable portion centered over the blood vessel. The lower edge should be 3 cm above the antecubital fossa 6. Locate the artery by palpation at the antecubital fossa 7. *Close the air valve and rapidly inflate the cuff to 30 mm Hg above the expected systolic pressure or until the radial pulse disappears 8. Place the stethoscope gently over the artery 9. *Slowly release the air valve , permitting the column of mercury to fall at a rate of 2-3 mm per heartbeat 10. After readings have been made , the cuff is deflated and removed from the arm Auscultation : Popliteal Artery 11. Place the child in prone position 12. Place the correct size cuff around the thigh , with the lower edge about 2cm above the popliteal space *13. The leg is slightly flexed, with the stethoscope over the popliteal artery. the subsequent procedure is identical to that for the brachial artery Palpation 14. *The sphygmomanometer cuff is inflated until the radial pulse cannot be palpated 15.* With the palpating digit kept over the artery pressure is released slowly until the pulse is felt. The end point is recorded as the systolic pressure Doppler 16. Obtain the monitor , dual air hose ,and the correct size cuff 17. Place the monitor on a firm , immobile surface 18. plug in the monitor and connect the dual air hose to the back of the
A A A B B B B B B B D B A A B
monitor *19. Screw the pressure cuff's tubing into the other end of the air hose 20. Wrap the correct size cuff around the child's limb 21. Turn the power switch to the ON position 22. Record the reading Flush ( should be used in newborns or small infants whose pressure is difficult or impossible to obtain by other technique) 23. Place the child in a recumbent position *24. Apply the cuff snugly to the distal forearm with the outer edge at wrist. If lower extremity pressure is to be determined , the cuff is applied to the distal leg with outer edge at the ankle 25. Wrap the extremity distal to the cuff with an elastic bandage *26. Inflate the cuff to 150 -200 mm Hg and remove the elastic bandage *27. Lower the cuff pressure by 5mm Hg and leave at that level for 3-4 seconds. Repeat the procedure until flushing is observed in the blanched limb 28. Repeat the procedure at least twice to confirm the reading 29. Upon concluding the blood pressure determination record the following a. Reading obtained b. Extremity used c. Type of method used d. Size of cuff used e. Person notified if reading is of concern
B B B B A B B B B A D
Final assessment
Done
Repeat
10
Nursing Department
Level .6th level
Semester Two

N o
Skill Steps Weighting & measuring the newborn

Anthropometric measurements
Comments
SS (A) Required frequency: 3 Prepare the equipments & instruments *Scale * Cover sheets * Paper tape measure Weighting 1. Place cover sheet on scale *2. Wear gloves if newborn has not been bathed *3. Adjust the scale balances to 0 , or push the appropriate pads on the digital scales , using a protective barrier on your hand 4. Record weight on baby's chart. Weight baby at the same time
A B A B
11
3. Measuring *1. To measure length , place the newborn in supine position on the crib mattress , with the hand against the top of crib *2. Place the paper tape measure beside the infant , with the 0 end of the tape against the top of the crib *3. Wear gloves if the newborn has not been bathed *4.Hold the newborn's head straight with one hand , and extended one leg , with the other hand *5. Watch that the tape measures remains straight 6. Note the length and record it in the infant's chart 7. Compare your finding with the normal range , most infants are 48 to 53 cm in length 8. Place the paper tape under the newborn's head to measure head Circumferences. Compare your finding with the normal range, most infants are 32-37 cm. 9. Wrap the tape around the newborn's head , measuring just above the eyebrows so that the largest area of the occiput is included 10. Record your finding in the infant's chart To measure chest circumference 1.Place the paper tape under the newborn's chest ,at nipple level 2. Wrap the tape around the chest , at the nipple line 3. Note the circumference and record it in the infant's chart. Chest circumference is measured at the nipple line , average chest circumference is 30.5 to 33 cm To measure abdominal circumference 1.Place the paper tape under the newborn's abdomen, at umbilical level.
A B B B D D A
A D D A A
12
*2. Wrap the tape around the newborn's, at umbilical level. 3. Note abdominal circumference and record it in the infant's chart Final assessment :
A A
Done Repeat
13
Nursing Department
Level .6th level
Semester Two

Skill Steps Bathing an infant or small child SS (A) Required frequency: 3 Prepare the equipments & instruments *Basin with warm water ( 40.6 c ) * Mild soap *Cotton balls * Soft washcloth *Diaper * Dry clean clothing * Blanket * No sterile gloves * Alcohol pad (If care for umbilical cord care is indicated)
Comments
14
* Comb * Baby lotion * Towel

2 3 4 5 6 7 8 Explain the procedure to the patient and family y. assemble the Equipment at the bedside. Wash hands Assess the child Take & record temperature , pulse and respiration Wash the child from head to feet. Dry washed areas with a towel , giving added emphasis to skin folds Moisten a cotton ball with water and wipe eyes from inner canthus to outer canthus. repeat with a clean cotton ball on the other eye Wet washcloth & wring. Gently wash one side of the face from forehead to chin, going around the nose and mouth. Repeat on other side of the face .Do not use soap on the face Dry infant's face with towel To cleanse the baby's scalp, pick up baby securely by sliding hand under the baby until the head is well supported in the palm of the hand. Cover ears with thumb and middle finger. Hold baby's head over the basin. Soap and rinse head and dry with towel Continue washing ears and neck, giving particular attention to the skin folds of the neck, behind the ears, and the external part of the ears. Wipe washed areas repeatedly to rinse off soap Remove infant's shirt. Wash trunk and arms. Wash between fingers. Turn infant one on side to wash back Cover infant with a blanket. Rinse and wring washcloth, then wipe away soap. Repeat to ensure removal of soap Dry area with towel. Cover trunk after drying Remove diaper, exposing lower half of body. Keep upper half of body covered with blanket Lightly soap washcloth, wipe over abdomen & around umbilical cord .Work A A D A A A A
9 10
A A
11
12 13 14 15 16
A A A D D
15
17 18
19 20 21 22
23 24 25
down each leg to the foot, using long stroking motions. Wash between toes. clean around umbilical cord with alcohol swab or sterile applicator Rinse washcloth and wipe soap off body , paying particular attention to skin creases Wash genitalia with cotton balls. Spread apart the female's labia and clean between folds, using a front to back motion. use each cotton ball for one stroke only The male genitalia should be washed with cotton balls from penis to anus. Do not retract the foreskin of the penis Next wash the anus and between the gluteal fold and buttocks Dry lower half of body. Rediaper .Redress and position the infant in the isolette or bassinet Document any abnormalities in the skin surface in the medical record a. Desquamation peeling of the skin during the first 2-4 weeks of life b. Milia tiny, white papillae occurring on the nose and chin that are caused by obstruction of the sebaceous glands. these disappear in 1-2 weeks c. Jaundice yellow discoloration of the skin that appear between the thirds and seventh day of life d. Telangiectatic nevi ( Stork bites ) flat ,red localized area of capillary dilatation forming a variety of angiomas , most notably on the upper eyelids , these disappear usually by 2 years of age e. Forceps marks marks left on part of the body here the blades exerted pressure Document the infant's tolerance of the bath process Replace equipments Wash hands
A A
B B B D
D A A Done Repeat
Final assessment
16
17
Nursing Department
Level .6th level
Semester Two
Skills Laboratory Number 2

No Skill Steps Oxygen therapy for children Required frequency: 5 ( CS ) Prepare the equipments & instruments Explain the procedure to the child and allow him or her to feel the equipment and the oxygen flowing through the tube ,mask Maintain a clear airway by suctioning , if necessary Measure oxygen concentration every 1-2hours when a child is receiving oxygen through incubator hood or tent a. Measure when the oxygen environment is closed b. Measure the concentration close to the child's airway c. Record oxygen concentrations and simultaneous measurements of pulse & respiration Required * Performance rating ** level of 4 3 2 1 performance 5 A A Comments
1 2 3* 4*
B B D
18
5* 6 7 8 9
Observe the child response to oxygen Organize nursing care so that interruption of therapy is minimal Periodically check all equipment during each tour of duty Clean equipment daily and change it at least once each week Keep combustible materials & potential sources of fire away from oxygen therapy Pt teaching: a. Avoid using oil or grease around oxygen connections b. Do not use alcohol or oils on a child in an oxygen tent c. Do not permit any electrical devices in or near an oxygen tent d. Avoid the use of wool blankets and those made from some synthetic fiber because of the hazards resulting from static electricity e. Prohibit smoking in areas where oxygen is being used f. Have a fire extinguisher available
A A A A D
19
10 Terminate oxygen therapy gradually a. Slow reduce liter flow b. Open air events in incubators 11 Continually monitor the child's response during weaning . a. Observe for restlessness b. Increase pulse rate c. Observe respiratory distress , cyanosis D B B
Oxygen by mask 1. Choose an appropriate size mask that cover the mouth and nose but no the eye 2. Use a mask that is capable of delivering the desired oxygen concentration 3. Place the mask over the child ,s mouth and nose so that it fits securely .Secure the mask with an elastic head grip 4. Remove the oxygen mask at hourly intervals , wash the face & dry 5. Do not use masks for comatose infant or children
B B
B B D
Face tent
1. Face tent are available in the adult size only 2. A flow of 8-10 L should be to flush the system and provide a stable oxygen concentration B B
20
T-bars and tracheostomy mask

1.These devices are used to deliver oxygen to intubated patients 2. The flow rate must be set to meet the minute volume requirements of the child and to provide a 100% source of gas. Oxygen tent 1. Select the smallest tent & canopy that will achieve the desired concentration of oxygen and maintain patient comfort 2. Pad the metal frame that support the canopy 3. Analyze & record the tent atmosphere every 1-2 hours. Concentrations of 30% - 50% can be achieved in well maintained tents 4. Maintain a tight fitting canopy. Whenever possible , provide nursing care through the sleeves or pockets of the tent 5. Make certain that the crib sides are up 6. Select toys that retard absorption , are washable & will not produce static electricity Croupette 1.This is an oxygen tent equipped with high Humidification system. 2Change the child's clothing and bed linen when damp cover the child with a cotton blanket 3. Check the child frequently 4. Remove the child from the mist periodically 5. Promote postural drainage and suction the child as necessary 6. Observe the small infant for signs of over hydration C B
B B B
B B B B
C B A B
21
Incubator oxygen therapy 1. The incubator is used to provide a controlled environment for the neonate 2. Adjust the oxygen flow to achieve the desired oxygen concentration a. An oxygen limiter prevent the oxygen concentration inside the incubator from exceeding 40% b. Higher concentrations ( up to 85% ) may be obtained by placing the red reminder flag in the vertical position 3. Secure a nebulizer to the inside wall of incubator if mist therapy is desired 4. Keep sleeves of incubator closed to prevent loss of oxygen 5. Periodically analyze the incubator atmosphere 3 Oxygen hood 1. *Warmed , humidified oxygen is supplied through a plastic container that fits over the child's head 2. *Continuously monitor the oxygen concentration ,temperature & humidity inside the hood 3. Open the hood or remove the baby from its infrequently as possible 4. Several different designs are available for use. The manufacture's direction should be carefully followed
B D B C
C C C
B B B D Done Repeat
Final assessment
22
Nursing Department
Level .6th level
Semester Two

No Skill Steps Obtaining throat culture (CS) Required frequency: 2 Prepare the equipments * Throat swab * Tongue depressor * Media culture Explain the procedure to the woman & describing the sensation to expect Gather equipment Wash hand ,wears gloves Have child stick out tongue and say ah C 6 Depress anterior half of tongue with tongue depressor if necessary C 7* Swab area with exudates or redness , one time only per swab ( Avoid Required * Performance rating ** level of 4 3 2 1 performance 5 A Comments
2 3 4 5
B D B
23
8 9 10 11
teeth , tongue , cheeks , lips & palate Be sure parents or nurse comfort child Label , obtain requisition
C A A
Transport to laboratory Document procedure , including description of pharyngeal area if you can see it A D Done Repeat
Final assessment
:
Level of performance A. Ability to perform the activity without supervision B. Ability to perform the activity under supervision C. Ability to assist with performance of the activity D. Knowledge of the activity by observation Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed
24
KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICALSCIENCES
Nursing Department
Level .6th level
Semester Two

No Skill Steps Promoting postural drainage in pediatric patient (IS) Required frequency: 1 Preparatory phase *1. Assess the child's respiratory status a. Obtain a baseline respiratory rate b. Observe for respiratory distress retraction, nasal flaring, and so forth 2. Identify the involved portions of the lung by auscultation , percussion or review of the x ray report 3. Explain the procedure to the child or the parent 4. Make the child comfortable a. Remove constricting clothes b. Flex the child's knee and hips c. Have tissue and an emesis basin available d. Have several pillows available *5.Provide bronchodilator or nebulization therapy prior to the procedure if indicated
Required * Performance rating level ** operformance 5 4 3 2 1
Comments
B D C
25
Performance phase *1. Place the child in asides of appropriate position a. Thereat to be drained should be elevated b. The spine should be as straight as possible to permit optimal expansion of the rib cage 2. Unless contraindicated , cup the chest wall for 1-2 minutes *3. Have the child inhale deeply , then ,as he exhales ,vibrate the chest wall during three to five exhalation 4. Encourage the child to cough *5. Allow the child to rest for a minute , then repeat cupping vibration and coughing until no more mucus is produced or the child ,s condition indicates that the procedure should be stopped
C B D B Done Repeat
Final assessment
26
Nursing Department
Level .6th level
Semester Two

No Skill Steps Suctioning the tracheostomy (CS) Required frequency: 2 Prepare the equipments Sterile tracheostomy tube Twill tape Scissors Sterile cotton tipped applicators Sterile water Hydrogen peroxide Sterile dressing Sterile suctioning catheters Sterile gloves Sterile saline Explain procedure Gather equipment D A Required * Performance rating level of ** performance 5 4 3 2 1 A Comments
1 2
27
3 4 5 6 7 8
Wash hands , put on sterile gloves Instill 0.5 to 2ml of normal saline into the trachea before suctioning to loosen secretions per institution policy Lubricate the tube with sterile saline and insert the catheter without applying suction Withdraw the catheter in a continuous rotating motion while applying suction ( 5 seconds only ) Allow the child to rest. some children may need a few breaths via a resuscitation bag Clear the catheter with sterile saline between insertions, child may need to be suctioned more than once * Saline should also be discarded to prevent growth of pseudomonas in standing solution Document procedure a. Time & frequency of suctioning b. The character of the secretions c. The relief afforded the patient d. The patient's behavior e. The appearance of the stoma f. Other pertinent data
A C C
C D C
Final assessment
Done
Repeat
28
KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCE
Nursing Department
Level .6th level
Semester Two

No Skill Steps Gastrostomy tube feeding CS ( C ) Required frequency: 3 Require Performance rating ** d * level 5 4 3 2 1 of perform ance A Comments
2 3 4 5
Prepare the equipments & instruments *Tray * Warm feeding fluid * Pacifier * Reservoir syringe or funnel * Syringe for aspiration , to flush tube as ordered ( may be up to 15 to 30 Ml) Note : Equipment should be sterile for premature and new born infants Explain procedure Gather equipments Wash hands Position child comfortably , with head lightly elevated if not contraindicated * Provide pacifier to relax a baby * An infant can be held and cuddled during the feeding * An older child can sit in a highchair
A A A B
29
8 9
10 11 12
13
14 15
Check residual stomach contents by attaching syringe to gastrostomy tube and aspirating. * Residual is always checked because overloading the stomach can cause reflux & increase the danger of aspiration * If the residual amount or increases , this needs to be reported to the physician Attach syringe barrel to gastrostomy tube. Fill with formula .Remove clamp .( This prevents air from entering the stomach and causing distension ) Elevate receptacle. Allow formula to flow slowly by gravity Force should never be used Continue to add formula to the syringe before it empties completely * The feeding should take 20 to 25 minutes to complete in order to prevent regurgitation , vomiting ,or aspiration Observe the signs of respiratory distress .Stop feeding if any of these occur and notify the charge nurse Clamp the tube as the final formula or water is passing through the lower part of the syringe Position or hold patient * Hold the patient quietly *Reposition in Fowler's position or in right side to promote gastric emptying Document procedure *Record the type ( gastrostomy feeding ) *The amount given *The amount and characteristics of the residual * How the patient tolerated he procedure * Record on intake & output section Replace equipments Wash hands
C C
C C D C
A A Done Repeat
Final assessment
30
Nursing Department
Level .6th level
Semester Two

No Skill Steps Breast feeding the ill or hospitalized infant (SS ) Required frequency: 2 1. Preparatory phase Encourage the mother to continue breast feeding if the infant condition does not contraindicate it Explain to the mother that a. Supplemental artificial formula can be given to the infant if she is not available b. She can pump her breasts bring in her milk to be given to the infant via bottle when she is not available c. Breast milk can be frozen for up to 6 months ( check the facility specific policy d. Thaw frozen breast milk for use in tepid water .Do not microwave for it may destroy vitamins and nutritional properties Provide the mother & infant with a relatively quiet area that is as private as possible and free from interruption Required * level of performance D Performance rating ** 5 4 3 2 1 Comments
31
5 6 7
Provide the mother with comfort armchair or pillow so that she can assume a comfortable position during the feeding * A footstool should also be available so that she can support her feet and the infant The infant should be awake and dry before the feeding is started Dress the infant appropriately so that he or she is not too warm or too cool during the feeding. The infant should also be hungry Help position the at breast * Put in semi sitting position with face close to the breast and supported by one arm and hand. * A pillow may be used under the baby for support * The breast may need to be supported by mother other hand 2. Performance phase * Start feeding and let the breast touch the infant's cheek. * Do not hold cheek and try to help infant find the nipple The infant's lips should be out over the areola not just around the nipple before beginning to suck. Note the presence or absence of the " Let down " reflex during the nursing period The length of feeding time may vary from 5 to 30 minutes let the infant nurse until satisfied. Instruct the mother *to burp the baby during and at the end of the feeding *One or both breast may be used at each feeding * Once the infant has stopped sucking ,instruct mother to put her finger to the corner of the baby's mouth and gently pull 3. Follow up phase When the infant has finished feeding * Change diaper if it is wet or soiled * Position the infant on right side in bed
D A
9 10 11 12
A D D
13
32
*Note if the baby appear satisfied or still seem to be hungry 14 Record descriptively & accurately a. How baby feed ( Weight before & after may be helpful ) b. How baby went to breast c. Satiety or hunger after feeding d. Breast or breast used ( Which breast was emptied and which breast was nursed from thereafter Provide the new mother with anticipatory guidance for possible problems ( i.e. , breast engorgement ) * promote maternal confidence in handling and nursing her infant *Increase mother's knowledge about the mechanics of breast feeding. Some facilities may have a lactation specialist to visit with the mother Wash hands
16
A Done Repeat
Final assessment
:
NB:-If this step not performed correctly, the procedure should be cancelled
33
Nursing Department
Level .6th level
Semester Two

No Artificial or nipple feeding (SS ) Skill Steps Required * level of performance Performance rating ** 5 4 3 2 1 Comments
Required frequency: 2 1 Equipment *Sterile nipple and bottle *Sterile formula or feeding fluid 1. Preparatory phase *Baby should be awake & hungry. *Change wet or soiled diaper *Check formula for correct type and amount * Sit in a comfortable chair. Cradle baby with one hand and arm ,while supporting baby against your body or lap 2. Performance phase a. Let the baby root for the nipple by touching the corner of mouth with the nipple. When the infant open the mouth insert the nipple b. Hold the bottle at an angle to completely fill the nipple with fluid A D
D A
34
16
c. Never prop the bottle or leave the baby unattended during feeding d. The bottle should be handled so as to contaminate the nipple or fluid e. Baby feeding time will vary from 10 to 25 minutes g. Position baby so eye contact can be established during feeding h. Burp the baby at least once during the feeding and at the end of feeding * Place the baby in sitting position in nurse lap , tilt slightly forward & gently rub or pat back or abdomen *Place the baby in prone position on nurse's shoulder and gently pat or rub back *Place the baby in prone position on nurse's lap and gently pat or rub back 3. Follow up phase When the infant has finished feeding * Change diaper if it is wet or soiled * Position the infant on right side in bed *Note if the baby appear satisfied or still seem to be hungry * Check baby in a few minutes. If restless, pick baby up and burp . If restless , pick baby Accurate & descriptive recording a. What was feed and amount b. How feeding was tolerate c. Any regurgitation or emesis Amount and material d. Length of time of feeding e. How baby sucked and took the feeding , behavior before ,during & following feeding Wash hands
A A A A
A Done Repeat
Final assessment
:
35
KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OFAPPLIED MEDICL SCIENCES
Nursing Department
Level .6th level
Semester Two

No
Skill Steps Gavages feeding (CS ) Required frequency: 2 Prepare the equipments & instruments *Sterile rubber or plastic catheter *Round tip ,size 5 -14 * Clear , calibrated reservoir for feeding fluid *Syringe *Stethoscope *Water for lubrication * Tape hypoallergenic * Feeding fluid , room temperature * Pacifier 1. Preparatory phase 1. Place the infant on side or back with a diaper roll placed under shoulders .A mummy restraint may be necessary to help maintain this position
Required * Performance level of rating ** performance 5 4 3 2 1 A
Comments
36
2. Measure feeding catheter and mark with tape , measure distance from tip of nose to ear to xiphisternum 3. Have suction apparatus readily available 2. Performance phase *1. with Lubricate catheter sterile water or saline *2. Stabilize the patient head with one hand , use the other hand to insert catheter a*Insertion through nares : Slip the catheter into nostril and direct toward the occiput in a horizontal plane along floor of nasal cavity b* Insertion through the mouth : Pass the catheter through the mouth toward the back of the throat * Depress anterior portion of tongue with forefinger , insert catheter along forefinger & tilt head slightly forward 3. If the patient swallows , passage of the catheter may be synchronized with the swallowing * Do not push against resistance. Gently rotating the tube if resistance is met * If there is no swallowing , insert the catheter smoothly and Quickly 4. Observe the infant for vagal stimulation ( i.e. bradycardia { Slow heart rate } & apnea 5. Once the catheter has been inserted to the premeasured length ,tape the catheter to the patient face 6. Test for correct position of the catheter in the stomach * Inject 0.5 -5 ml air into the catheter and stomach * Listen to the typical growling stomach sound with a stethoscope placed over the epigastric region * Aspirate injected air from the stomach
B C C C
C C C
D B C C B B
37
*Aspirate small amount of stomach content and test acidity by pH tape * Observe and gently palpate for tip of catheter ,avoid inserting catheter into the infant's trachea 7.The feeding position should be right side lying , with head and chest slightly elevated * Attach reservoir to catheter and fill with feeding fluid * Encourage infant to suck on pacifier during feeding .Hold infant when possible 8. Aspirate tube before feeding begins * If over half the previous feeding is obtained , withhold the feeding * If small residual of formula is obtained , return it to stomach and subtract the amount from the total amount of formula to be given 9. The flow of the feeding should be slow. Do not apply pressure * Elevate reservoir 15-20 cm above the patient's head 10 .Food taken too rapidly will interfere with peristalsis causing abdominal distension and regurgitation * Feeding time should last approximately as long as when a corresponding amount is given by nipple ,5ml / 5-10 min or 15-20 minutes total time 11. When the feeding is completed , the catheter may be irrigated with clear water * Before the fluid reaches the end of the catheter , clamp it off withdraw it quickly or keep in place for next feeding 12. Discard feeding tube and any leftover solution Follow up phase 1. Burp the patient 2. Place the patient on right side for at least 1 hour 3. Observe condition after feeding , bradycardia and apnea may still occur
B B C C C C C C C C C
38
4. Note any vomiting or abdominal distension 5. Note infant's activity

4
16
Accurate & descriptive recording 1. Time of feeding 2. Type of gavages feeding 3. Type and amount of feeding fluid given 4. amount retained or vomited 5. How the patient tolerated feeding 6. Activity before , during and following feeding Wash hands
A Done Repeat
Final assessment
39
Nursing Department
Level .6th level
Semester Two

No Skill Steps Nasojejunal & nasoduodenal feeding (CS ) Required frequency: 2 Prepare the equipments & instruments *Sterile radiopaque silicone or polyvinyl nasojejunal or nasoduodenal tube , 1 meter appropriate size for child *Tape * Ph paper *Reservoir for feeding *possibly an infusion pump *3- way stopcock * Syringe 0.5 ml normal saline or sterile water * Equipment for nasogastric tube insertion , introducer catheter 1. Preparatory phase 1. Attach cardiac monitor to infant 2. Tube is generally inserted by health care provider C Required * Performance level of rating ** performance 5 4 3 2 1 A Comments
40
*3. Place the infant on right side with hips slightly elevated gentle restraint or soft mittens may have to be applied *4. Tube is inserted by threading the nasojejunal or nasoduodenal vinyl catheter into a No. 10 French feeding catheter and introducing both through the nostril into the stomach. *5. Check intestinal aspirate for PH every 1-2 hours .Infant may be positioned on right side , back, or abdomen * Once the tube is past the pylorus , abdominal posteroanterior & lateral x rays are taken to confirm that tip of catheter is at the ligament. *6. A small N.G feeding tube may pass through the other nostril at time & left indwelling. *This is used to check stomach for residual fluid and regurgitation through the pylorus 7 7. N-D /N-J feeding can generally be started following this progression 1. D5 W initially 2. *-strength formula with low osmolality for 6-12 hours .Higher osmolarity formula for old children. 3. *Full strength low osmolality formula for infants & high osmolarity formula for old children. 4. *The volume of feeding is increased at a slow rate until daily caloric and fluid requirements are being administered 5. Medications may be given via the N-D/N-J tube if prescribe
C C
D C C C C
41
2. Performance phase 1. N-J feeding can be given as follows a. Intermittently b. In a continuous slow drip 2. *If intermittent feeding is the method used , the feeding techniques are the same as for ( Gavage feeding ) 3. *If slow continuous drip method is used , the set up used is similar to the pediatric IV infusion using an infusion pump and small ( 100-250 mL ) closed chamber for reservoir a. Reservoir chamber and tubing should be changed 8- 24 h. Record input every hour. Fill reservoir as needed, with no more than 3 hours worth of feeding fluid. Follow up phase 1. Be constantly alert for mechanical problems a. Check for abdominal distension resulting from the infant's inability to handle amount of fluid : Palpate abdomen Observe for ripple of intestines Measure abdominal girth 3-8 h Check residual formula in jejunum as prescribed b. Check stool for occult blood and ph & urine for glucose every voiding or 4-8 hours to determine tolerance of feeding tube c. Check emesis for blood and report to physician immediately may be a sign of necrotizing enterocolitis 2. Position child /infant in recumbent position 3. Observe child /infant closely to avoid potential dangers as tube passes the pylorus a. Close attention to amount , type , concentration and osmolity of feeding fluid is stressed
C C C
D A
A C D
42
b. Check heart rate & blood pressure
16
Accurately & describe & record condition of infant and procedure including: 1. Type & amount of feeding given 2. A mount of residual & characteristics 3. Any signs of impending infant distress or problems. Wash hands
A Done Repeat
Final assessment
43
Nursing Department
Level .6th level
Semester Two

No Skill Steps Obtaining a stool specimen (SS) Required frequency: 2 Prepare the equipments & instruments *Clean container *Tongue blade Explain the procedure to the child or parent Wash hands well & wear gloves to obtain specimen Obtain stool specimen directly from the diaper ( If it has not been contaminated by urine ) With the tongue blade ,or use the tongue blade to receive the specimen from the collection device The specimen is labeled properly and the laboratory slip is attached Some specimens must be sent to the laboratory while they are warm Document procedure a. Charts the time ,color ,amount and consistency of the stool b. The purpose for which it was collected ( e.g. . blood ,ova, parasites , bacteria ) & any related information Required * Performance rating ** level of 4 3 2 1 performance 5 A A B A Comments
2 3 4*
5* 6* 7
B B B
Final assessment
Done
Repeat
44
College instructor Name Sign:

KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICALSCIENCES F
Nursing Department
Level .6th level
Semester Two

No Skill Steps Administering an enema ( IS) Required frequency: 2 Prepare the equipments Disposable irrigation bag with connecting tube and clamp Funnel or aseptic syringe and pitcher for smaller amount No 10 to 12 French catheter Saline solution ( 1 teaspoon of table salt to 1 pint of water ) Lubricant Toilet paper Absorbent pad Bedpan Extra diapers ( depending on age ) Explain procedure Required * Performance rating level of ** performance 5 4 3 2 1 A Comments
45
3 4 5 6 7 8
Wash hands, wear gloves Assemble the equipment and take it to the bedside * Place the absorbent pad beneath the child. keep bedpan readily available *Position the child on his or her left side, with knees drawn toward the chest. You need assistance to hold the child *Allow the solution to run through the tubing to warm it and to expel air *Lubricate and insert the tube 1-4 inches into the rectum , depending on the age of the child *Administer the prescribed amount of fluid : 120 to 240 ml of infants 240 to 360 ml for 2to 4 years 360 to 480 ml for 4 to 10 years 480 to 720 ml for 11 years old Remain with the patient while enema is being expelled. Small children may use the potty chair or bedpan Remove the bedpan. clean the buttocks Remove the rubber sheet and incontinence pad
D B A B B B B
10 11 12 13 14 15
B A A
Apply a clean diaper if age appropriate. Check to see if a stool specimen is desired A Empty and clean the bedpan. Discard disposable enema set- up and tubing A Document procedure Chart time of procedure Name , amount and temperature of solution used D
46
Amount and character of result Untoward reaction Done Repeat
Final assessment
47
KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCES F
Nursing Department
Level .6th level
Semester Two

No Skill Steps Intramuscular injection (CS) Required frequency: 5 Prepare the equipments Explain to the child where you are going to give the injection ( site ) and why you are giving it * Allow the child to express fears Carry out procedure quickly and gently. Have needle and syringe completely prepared and ready before contact with child Infants Selection the acceptable site includes rectus femoris ( mid anterior thigh ) , vastus lateralis ( middle third ) or ventrogluteal Toddlers and school age children Site selection includes a. Posterogluteal ( Upper outer quadrant ) b. Ventrogluteal c. Deltoid d. Lateral and anterior aspect of the thigh Required * Performance rating ** Comments level of 4 3 2 1 performance 5 A D D B
1 2 3 4 5
48
Administration a. Rectus femoris 1. Place the child in a secure position to prevent movement of the extremity 2. *Do not use a needle more than 2.5 cm 3. Use upper quadrant of the thigh 4. *Insert needle at a 45 angle in a downward direction , toward the knee b. Vastus lateralis 1. Place the child in a prone or supine position 2. Area is a narrow strip of muscle extending along a line from the greater trochanter to lateral femoral condyle below 3. Insert needle perpendicular to skin 2-4 cm deep needle parallel to floor c. Ventrogluteal 1. Place the child on back 2. Place the index finger on the anterosuperior spine 3. *With the middle finger moving dorsally, locate the iliac crest, drop finger below the crest. The triangle formed by the iliac crest , index finger & middle finger is the injection site 4. *Inject needle perpendicular to the surface on which the child is lying
D B B
A B B
A B B
49
d. Posterogluteal 1. Do not use a needle longer than 2.5 cm 2. Position the child in a prone position *3.Place thumb on the trochanter * 4. Place middle finger on the iliac crest 5. Let index finger drop at a point midway between the thumb and middle finger to the upper outer quadrant of the buttock * 6. Insert needle perpendicular to the surface on which the child is lying ,not to the skin E. Deltoid 1. Determine injection site as with an adult 2. *Inject needle perpendicular to the skin 2-3 cm deep F. Lateral & anterior aspect of the thigh 1. Do not use a needle longer than 2.5 cm 2. *Use the upper outer quadrant of the thigh 3. *Insert needle at a 45 angle in a downward direction , toward the knee
D B A B B
D B D B B Done Repeat
Final assessment
50
Nursing Department
Level .6th level
Semester Two

No Skill Steps Intravenous fluid therapy (CS) Required frequency: 5 Prepare the equipments a. Needle method * IV solution ( For small children , 250 ml bottles should be used for purpose of safety * IV pole , pump device * IV administration set , pump tubing * Microspore filter *Syringe , 5 to 10 ml approximately 1/2 -1/3 filled with normal saline * Butterfly needle or catheter of appropriate gauge ( The size of the needle depends on the age and size of the child and the type of fluid to be administered *Alcohol sponge , dry sponges *Betadine or other antibacterial cleansing solution * Normal saline *Small tourniquet or rubber band * Hypoallergenic tape , 1/2 cm , 2.5 cm , 5 cm * Padded arm board Required * level of performance A Performance rating ** 5 4 3 2 1 Comments
51
* Gauze bandage for securing the extremity to the arm board * Restraining devices bath blanket , extremity restraint , cover sandbags ( The type of restraint depend on the child's age , his level of cooperation & the kind of IV to be started * Safety razor ( If scalp vein is to be used ) b. Cut down method * IV solution , IV pole , IV administration set * Alcohol sponges * Hypoallergenic tape , 1.2 cm , 2.5 cm *Padded arm board * Dry sponge * Gauze bandage * Sterile cut down tray * Assorted sizes of sterile polyethylene tubing & luer adapter * Normal saline * Tourniquet * Sterile gloves * Restraining devices Preparatory phase 1. Obtain the IV solution 2. Check the IV fluid for cracks *3. Attach a micropore filter to the end of the infusion tubing that attaches to the needle. Use aseptic technique *4. Remove the metal seal from IV container without touching the rubber top *5. Following product insert , insert the end of the administration set into the container's opening, Fill the tubing with solution
A D B
B B
52
7.Promote the cooperation of the child * Infant : provide with a Pacifier * Old child: explain the procedure and its purpose child for comfort. 8.Position the child for comfort 9. Restrain the child as necessary * Infant or young child: restraints may include mummy wrappings , jacket or elbow restraints or small sand bag * Old child : The extremity to be used should be comfortably restrained on the arm board 3 Performance phase *1.The persons starting the IV & holding the infant should wear gloves 2. Assist as necessary *3. When applying the tourniquet , a second rubber band is placed crosswise under it * To remove the tourniquet grasp` the unstretched rubber band , pull up & cut the tourniquet 4. Check the restraints at intervals and adjust them as necessary 5. Comfort and reassure the child 6. *6.Regulate the IV rate pump 7. Recording on the container or reservoir rate flow a. Time that infusion began b. Name of the physician or nurse who started the IV site of administration c. Reaction of the child to the procedure d. Return the child to room
B C
B A B
B B B D
53
4.
Follow up phase 1. Check the child at least hourly a. Note the location of IV b. Note the color of the skin at the needle point c. Check for swelling of skin at the needle point d. Feel the area around the site fluid or sponginess or leak age e. Check for blood return into the tube when the flow of fluid is stopped f. Make certain that the child is adequately restrained g. Check function of the pump rate set versus amount infused 2. Observe closely for complication a. Local reaction * Compromised circulation *Pressure sores * Thromophlebitis b. Fluid & electrolyte disturbance 1* Maintain an accurate record of intake and out put a. Total the intake and put b.Describe care fully the amount & consistency of all stool & vomitus c.Collect all urine and weight diapers if more accurate measurement of the child's is necessary 2. Weight the child at regular intervals , using the same scales each time
54
3. Monitor laboratory electrolytes 4. Report * Decrease skin turgor * Marked increase or decrease in urination * Fever * sunken or bulging fontanelles in an infant * Sudden change in weight or vital signs * Diarrhea * Weakness , apathy or lethargy 3. Record essential information * Reading on the container * Amount of fluid absorbed in the hours * Total amount of fluid absorbed * Rate of flow * Apparent condition of the child 4. Irrigate the IV as necessary * Gather equipment *Clamp off the IV solution * Disconnect the IV tubing at the needle insertion site keep it sterile * Remove the needle from the syringe * Connect the syringe to the tubing at the needle insertion site or stopcock * Slowly inject the normal saline solution * Disconnect the syringe and reconnect the IV tubing to the needle insertion site * Unclamp the IV and regulate the flow of the solution * Check Frequently to make certain that the IV is functioning properly 5. Change the IV container and tubing 24 h or as per hospital policy
55
7. If a catheter is used , check the dressing 4 h and change according to policy 8. Disconnect the IV when prescribed or if it has obviously infiltrated a. Gather equipment * Scissors * 4X4 gauze square * Band aid b. Explain the procedure to the child , depending on age c. Clamp off the flow of the IV fluid d. Determine the location of the needle e. Loosen the tape around the needle , holding the needle firmly in position ` so that it does not slip out f. Hold the 4x4 lightly over the insertion site and removed the needle quickly and carefully g. Apply pressure to the site immediately and hold until bleeding stops h. apply Band aid i. Remove the tape and arm board from the extremity j. Comfort the child as required k. Note the fluid level on the container or reservoir and complete recording l. Record that the IV was discontinued D
Final assessment
Done
Repeat
56
Nursing Department
Level .6th level
Semester Two

o Skill Steps Obtaining a specimen for urine analysis ( 1S ) Required frequency: 2 Prepare the equipments * Sterile container * Urine collection bag * Label specimen clearly * Deliver specimen immediately to the lab ( Bacteria may grow at room temperature) Explain the procedure * a. Apply newborn and pediatric urine collection * The skin must be clean and perfectly dry * Avoid oils , baby powder & lotion soap * Application must begin on the tiny area of skin between the anus and genitals * The narrow bridge on the adhesive patch keep feces from contaminating the specimen and help position the collector correctly * b. Put the child on his back , spread the legs and wash each skin fold in genital area Required * level of performance A Performance rating ** 5 4 3 2 1 Comments
57
c. Do not use a scrub soap solution d. Wash the anus last ,allow a few moments for air drying e. Remove protective paper from the bottom half of the adhesive patch *g. For girl , stretch the perineum to separate the skin folds and expose the vagina h. For boys, begin between the anus and the base of scrotum i. Press adhesive firmly against the skin and avoid wrinkles , remove paper from the upper portion of adhesive patch 3 Use a sterile container or apply a urine collection device
B A B
If a bag is used , Secure the diaper over the bag
Check bag every 20 to 30 minutes Label all specimens clearly and attach the proper laboratory slip , Collected specimens should be transported in plastic bag ( check institution policy) 7 Document procedure
B D Done Repeat
Final assessment
58
Nursing Department
Level .6th level
Semester Two

No Skill Steps Cardiopulmonary resuscitation & air way obstruction (CS) Required frequency: 2 No equipment is needed to provide CPR Identify children at risk and place them near the nurse station Monitor vital signs, including temperature and level consciousness at least every 4 hours if not more frequently If arrest is suspected , gently and call by name Call out for help Position child on his back *Open airway with head tilt / chin life or jaw thrust maneuver a. Head tilt /chin left Standing next to the child, tilt the child head Back by placing one hand on the forehead and pushing down. At the same time, lift the chin with the fingers of the D A D D A Required * Performance rating level of ** performance 5 4 3 2 1 D 1 2 3 4 5 6 Comments
59
7 8 9 10.
other hand. Do not overextend b. Jaw thrust maneuver From behind the head , place , place 2-3 finger of each hand under both angles of the lower jaw and left upward While maintaining the open airway , look , listen and feel for breathing Place cheek and ear close to child, s mouth and nose. Listen and feel for air flow Look at chest and abdomen. observe for movement *If there is no breathing, provide two initial breaths. a. For the infant ( 1year old or younger ) cover both the nose and mouth with rescuer's mouth b. For the child between 1-8 years of age , the rescuer covers the child's mouth , creating a mouth to mouth seal , while pinching the child's nostrils shut Evaluate breaths by watching for the chest to rise and fall *Reposition head and airway if air does not enter freely. Treat for airway obstruction if continued rescue breaths are thwarted Locate & palpate the brachial pulse in the infant Locate and palpate the carotid pulse of the child If there is a pulse, proceed with rescue breaths only provide one breath every 3 seconds for the infant. Provide one breath very 4 seconds for the child *If there is no pulse , locate finger and hand position for chest compressions a. For the infant , place two fingers breath below the nipple line b. For the child , place the heel of one hand one finger's breadth above the xyphoid notch
C D C
11 12
D B
13 14 15
B B D
16
B B B
60
17
*Compress the child is to a depth of 1/2 -1 inch at a rate of 100 compressions per minute. Provide a rescue breath after every fifth compression *Compress the child's chest to a depth of 1 1 1/2 inches at a rate of 80 -100 compressions per minute. Provide a rescue breath after every fifth compression Reassess for spontaneous respirations and pulse after one minute ( 10 cycle of five compressions to one breath ) If no help is immediately available , stop CPR & telephone for help Reestablish CPR once help has been called. Continue until trained in advanced life support respond *If airway obstruction is suspected in the infant, hold the infant on his or her abdomen with legs straddling the rescuer's arm. With the infant's head held downward , apply four back blows between the shoulder blades *Turn the infant to his or her back and with the infant's head downward , apply four chest thrusts in the same location for CPR compressions *Open the airway and remove only visible particles
18
C D
19 20 21 22
D D
23
24 25 26 27 28 29
B Reposition airway and provide two strong rescue breaths Continue alternating back blows , chest thrusts and rescue breaths Call for help Begin CPR if no pulse is palpable. Child ( over 1 year of age ) If airway obstruction is suspected in the child , place the child on his or her back on the floor C D D D
61
30
Place the heel of one hand on the child's abdomen at midline , above the navel and below the rib cage ( The rescuer may straddle or sit astride the child ) Provide several upward thrusts ( Toward the rib cage ) Open the child's airway. turn head to the side and sweep out visible objects Reposition airway and provide two strong rescue breaths Call for help Continue by alternating abdominal thrusts with rescue breaths until obstruction is relieved Begin CPR if pulse is not palpable
31` 32 33 34 35
D B
B D C
36
Final assessment
:
Done
Repeat
62
Nursing Department
Level .6th level
Semester Two

No Skill Steps Administering medication Required frequency: 5 Dropper. *Wash hands. *Hold the infant in the cradle position and stabilize the head against your body. Hold infant's arm with your free arm. Press on the infant's chin to open mouth. Squirt the medication to the back and side of the mouth in small amount Syringe. Hold the infant or toddler in the cradle position, supporting the head and holding the arms. place the syringe to the back and side of the mouth and give the medication slowly , allowing the child to swallow Nipple. *Hold the infant in the cradle position, squirting the medication from the syringe into the nipple pour the medication from a cup into the nipple. * Allow the infant to suck the medication from the nipple * Follow the medication with 2-3 ml of water Required * Performance rating ** level of 4 3 2 1 performance 5 Comments
A A
2*
3*
B B B
63
4*
Medicine cup. *A cup can be used for the older infant , toddler , preschooler , school age child & adolescent * For the younger patient , a patient , apparent or child may hold the cup * Stay with the child until the entire dose is swallowed * A spoon is an effective alternative to the medicine cup. * Disguise a disagreeable taste in a small amount of food like applesauce * Syrup is also good for mixing medications that do not dissolve in water * Dilute alcohol based elixirs with water before administering Chewable tablets Tablets may be chewed by the child or cursed and given in a fruit syrup or applesauce. * Check with the pharmacist to see if crushing the tablet will affect drug absorption or action * Do not give a child a tablet if he or she resists , as the child could easily aspirate Capsules Older children may enjoy swallowing a capsule * Place the capsule on the back of the tongue and have them swallow a lot of fluid. * Stay with child until all the medicine is swallowed * Some capsules may also be opened & the contents sprinkled on a spoonful of food. * Check with the pharmacist to see which capsules can be opened Nose drops *Hold the infant in the cradle position, stabilizing the head with your arm , and tilting it back slightly * Squeeze the drops into each nostril as you try to comfort & hold the infant in this position for at least 1 minute * Place a toddler's head over a pillow * Squeeze the drops into each nostril * The school age child and adolescent may give themselves their own
B B B B B
64
medication since they can sniff the medication into the nasal passage Ear drops * Position infants & toddlers on their sides. *The pinna of the ear is to be pulled down and back. * Instill warm drops into the external canal and gently massage the area anterior to the ear * For children over 3 years , pull the pinna upwards and back * After instillation, the child should maintain the position for 5-10 minutes. * A cotton pledged placed into the ear canal can prevent the medication from leaking out , however , it must be loose enough to allow discharge to drain from the ear canal Eye drops or ointment * Place the child in a supine position *Restraining him or her as necessary to safely instill the medication * Pull the lower eyelid down and out to form cup. * Drop the solution into cup * The medicine will enter the conjunctiva * Close the eye gently and attempt to keep it closed for a few moments * Ointments are applied along the inner canthus in outward direction * Avoid touching the tip of the dropper or ointment tube to the body part Rectal medications * Place the child in aside lying or prone position. * Lubricate the suppository with a water soluble gel * Using a finger cot , gently insert the suppository into the rectum * Do not insert your finger more than 1/2 inch. * The buttocks should be held tightly together for 5-10 minutes
A A A A A A
A A A A A A A A A A A A Done Repeat
10
Final assessment Prepared by : Lecturer /Basem masadeh MSN, Ph.D in Nursing education ,
65
Nursing Department
Level .6th level
Semester Two

No Skill Steps Restraint (CS) Required frequency: 2 Equipement Jacket ( For jacket restraint ) Large dressing , gauze bandage , adhesive tape and stoknette if available ( For mitt restraint ) Acommercially prepared mitt (For mitt restraint ) Safety pins ( For elbow restraint ) Elbow restraint Jacket Restraint 1. Check physician's order and agency polcy regarding use of restraints. 2. Gather equipment. 3. Wash hands 4. Explain purpose of restraints to child and parents. Reassure child that restraint is not a punishment Required * Performance rating level of ** performance 5 4 3 2 1 A Comments
D A A A
66
*5. Place the jacket on the patient gown and tie it from back *6. Ensure that patient's gown and jacket are not wrinkled *7.Secure each tie to unmovable portion of the bed , using half bowknt which is easily removed 8.Secure shoulder straps to head of the bed 9.Secure abdomen straps on either sides 3. Mitt or hand restraint *1.Place a large folded dressing in patient's palm a. Separate the fingers with a pieces of large dressing b.Put a padded dressing around the wrist c. Place two large dressings over the hand , one is first placed from the back of the hand over the fingers to the palm and the other is then wrapped from side to side around the hand d.Cover these dressing by placing stocknette dressings over the hand or elastic bandage , using the recurrent pattern e. Secure the strokinette or elastic bandage with adhesive tape *2. Apply commercially made restraints a. If mitts are worn for several days remove them at least every twelve hours , wash , exercise the hand and reapply again Elbow restraint *1. Check the restraints to make sure that the tongue depressors are intact and in place *2. Apply elbow restraint over gown sleeves
B A A A A
B B
67
3. Make sure the end of the tongue depressors are covered by padded material 4. Place elbow in the center of restraint 5. Warp the restraint smoothly around the arm *6. Secure the restraint , using safety pins , ties or strings *7. Ensure that it is not too tight so not to occlude blood 5 Clove hitch restraint 1. prepare the equipement Bandage 5-8 cm wide and 90 120 cm long Cotton Commercially made restraint *2. Apply 2-3 layers of cotton around ankle or wrist 3. Make 2 loop forming finger of 8
A A A A B A
B 4. Pick up the two loops *5. Make sure that the loops are small to fit patient hands 6. Using half bow knot attach the end of restraint to the end of the bed spring 7. Check every two hours and readjust accordingly 6 Mummy restraint 1. Prepare the equipement Blanket or sheet Safety pins or adhesive tape B B B D
68
7.
*2. Lay the blanket or sheet on flat dry surface *3. Fold down one corner of the blanket and place the baby on it the supine position , make sure that the infant shoulder touches the upper border of the blanket *4. Fold the right side of the blanket over the infant,s body and tuck it under his back leaving the left arm free Crip net restraint 1. prepare the equipement * Astretch net with long strap 2. Place the net over sides and ends of the crip 3. Secure the tie to bed frame
B B
B A
4. Tie the strap in half bow knot B
Final assessment
Done
Repeat
69
Nursing Department
Level .6th level
Semester Two

No Skill Steps Sponge bath to reduce fever IS (A) Required frequency: 5 Prepare the equipments & instruments *Basin of tepid water ( 29 to 32c ) * Three washcloths towel *Two bath blankets * Waterproof sheet Explain the procedure to the patient and family y. assemble the equipment at the bedside. Wash hands Screen the child Take & record temperature , pulse and respiration Cover the patient with a bath blanket or sheet .Fanfold bed clothes to the foot of the bed .Place a water proof sheet and bath blanket beneath the patient Remove the patient's gown Wash the patient's face and neck with tepid water Required * level of performance Performance rating ** 5 4 3 2 1 Comments
A A A D D A A
3 4 5 6 7 8
70
10 11 12
13 14 15
16
17 18
Lift the corner of the bath blanket and bathe the child's body, part by part. Use long strokes. Expose one area of the body at a time Place moist , folded cloths over blood vessels that lie close to the skin ( Underarms and groin ) Turn the patient and repeat the procedure , beginning with neck , then going to the shoulders , the back, and so forth Check color & pulse. *to be sure that the child is tolerating the procedure without adverse effects * If the child begins to shiver, the water temperature should be raised. If shivering continues , stop the bath Remove the waterproof sheet and blanket. Replace the hospital gown. AN infant may be placed on a large towel , covered by receiving blanket Arrange pillow and bedding for the patient's comfort Record temperature, pulse and respiration *Take the patient's temperature within 30 minutes of the time procedures ended and record. Document procedure Chart : Time procedure began , length of the time administered , untoward reaction , patient's temperature before and after procedure Replace equipments Wash hands
A A
A A D
A A Done Repeat
Final assessment
71
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KINGDOM OF SAUDI ARABIA MINISTRY OF HIGHER EDUCATION UNIVERSITY OF TABUK FACULTY OF APPLIED MEDICAL SCIENCE

Skills Laboratory Number 1 Part 1

Course: Pediatric nursing

Level 6th level

Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 1 Part 2

Required * level of performance

Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 1 Part 3

Required * level of performance A A A A A D

Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 1 Part 4

Required * level of performance

Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 1 Part 5

Skill Steps Weighting & measuring the newborn

Required * level of performance

Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 1 Part 6

Required * level of performance

* Comb * Baby lotion * Towel

Rating ** 5 = Excellent 4 = Very Good 3 = Good 2 = Unsatisfactory 1 = Failed

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 2

T-bars and tracheostomy mask

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 3

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 4

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 5

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 6

Course: Pediatric nursing

Level .6th level

Name of the student:

Skills Laboratory Number 7

Course: Pediatric nursing