FAQ W Ans (Pott19-FAQ)

Frequently Asked Questions

You have recently transferred from a pediatric unit in an urban city to a small community hospital. The procedure for maintaining peripheral lines in the pediatric unit involved using normal saline to flush the intravenous (IV) site. The community hospital’s procedure requires using heparinized saline. You are concerned that the hospital’s procedure is outdated. What can you do?

Controversy continues to exist regarding using normal saline versus heparinized saline. Because there is no specific or recognized standard regarding this policy, you should follow the hospital’s guidelines. However, you may want to have a discussion with the practice standards committee and inquire about their rationale for the current policy. You should also be alert and seek out research studies and national pediatric nursing practice standards to continue to provide best nursing practice to your clients.

As a nursing student, you have been assigned to care for Mary, a 15-year-old client with severe cerebral palsy. She receives her oral medications via a nasojejunal tube. What considerations should you consider when administering her medications?

It is common for pediatric clients who have difficulty swallowing oral medications to receive them via a nasogastric, gastrostomy, or nasojejunal tube. Be sure to check the facility’s policy and the procedure guidelines. After reviewing the policy, determine whether or not the medication can be given via the nasojejunal tube. Some medications, such as liquid antacids, act directly on the stomach and will be ineffective if given via a nasojejunal tube. Some medications that come in tablet or capsule form should not be crushed nor should the powder be removed from the capsule (e.g., time-released capsules). After you determine that the medication can be safely and effectively administered through the nasojejunal tube, it is important to know if the tube is properly placed. Most facility guidelines require that you check the placement of the tube and flush it with water prior to and after administering the medication.

As a nurse working in a pediatric hospital, you will administer many different kinds of medications, such as pain medications, antibiotics, chemotherapy agents, and so on. What physiological considerations for pediatric clients should be noted and may influence the choice and dosage of drugs?

Several physiological differences make children more sensitive to drugs and increase the risk of adverse drug reactions. Differences include body size and composition as well as immature organ systems. Some significant differences are body fluid composition and body systems function. These differences may alter pharmacokinetic and pharmacodynamic processes that determine what drug should be used, as well as its amount and frequencyof dosage.

You are caring for a 13-year-old girl with acute lymphocytic leukemia (ALL) who has been admitted for fever and neutropenia. As you enter her room, you note that smooth river rocks are lined up on the floor under her bed, crystals and other orbs encircle her room, incense is burning, and several large bottles filled with capsules and powders stand on top of her overbed table. Which of these observations should you follow up on more closely, and why?

Although the rocks, crystals, orbs, and incense may be unusual, they most likely are not going to be of concern. However, you should clarify what the capsules and powders are and how they are being used. Many herbal supplements selected for nutritional and health support may interact harmfully with medications ordered for this client. Complications can include altered renal and hepatic function. The child with ALL is already compromised, and additional complications resulting from drug interactions can and should be avoided. Because this family has chosen to use additional and integrative therapies for this child, it will be important to provide education about why they may need to refrain from using the herbs.