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Childrens National MedicalCenter

Cindy Thrasher, RN, CPNRN III

Division of Diagnostic Imaging

& Radiology

1. Evaluate current and emerging trends in three differentpediatric care delivery settings.

2. Analyze clinical practice through use of evidence basedconcepts into the assessment, management, and communicationof nursing care provided to medically complex pediatricpatients.

3. Relate early signs of clinical deterioration and intervene withclinical expertise to prevent or reduce the risk ofcomplications.

4. Examine health systems and care processes to acceleratetreatment time to prepare, communicate and rescue complexpediatric patients.

Objectives

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Practice in motion

Im going to

see the Boss

this

weekend

for the 300th

time!!!!!!!

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Request for PICC line placement 2 week old full term infant with h/o

hydrocephalus and s/p VP shunt placement Infant now presents with 5 day h/o wound

breakdown and leaking clear fluid As per PMD, parent to apply hydrocortisone

ointment and antibiotic cream to incision line

Case # 1

S: 2 week old infant VP shunt infection, NPO forsedation.

B: Admitted for long term ABX treatmentan externalization of VP shunt

A: No acute distress, VS WNL

R: Order to sedate with chloral hydrate 50mg/kg bymouth for PICC line placement

SBAR Report Recd

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Patient On Arrival to Interventional

Radiology

Infant on CR monitor

AF depressed

Somnolent, & Non interactive

Nursing Assessment

Physician OrdersLess than 6 months: Chloral

Hydrate ____mg ( Maxdose:50 mg/kg/dose)

Greater than 6 months:

Chloral Hydrate ____mg (Max

dose: 75 mg/kg/dose)

(Max adult dose 1 gram/dose

or 2gram/24 hours) P.

Chloral hydrate _____mg (25

mg/kg/dose) PO PRN 20minutes after dose if sedation

not achieved.

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Nursing Care Provided

Withheld Sedative- Hypnotic Drug

Used Instead:

Sweeties Sucrose Water packaged

ELMAX topical application of anesthetic

Music Mobile Attached to Crib from

Home

Evidence Based Practice

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Request for MRI18 year Obese female with Downssyndrome, developmentally delayed,H/O pneumonia, FUO, abdominal pain,NPO for several hours, ASA airwayclassification III, non cooperative patientand very upset parent due to lateafternoon appointment and repeated

procedure delays

Case # 2

S: request for abdominal MRI to determine etiology of abdominalpain

B: Downs syndromecongenital cardiac defect, enlarged tonsils, fearful of environment

and mask induction sedationA: Arrived to MRI anxious, somewhat combative, developing

respiratory distress as agitation increased, and based onappearance looked likely to have risks for airway compromise(short neck in flexed position)

R: Sedate patient, plan to reduce stimulation, create non threateningenvironment in partnership the mother. Implement alternativeapproach to basic mask induction.

SBAR

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Anesthesia Bay

Music: Is the Universal Language

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Implemented Distraction TechniquesAdjunctive Procedural Support Music Therapy in the

Healthcare setting

Used family presence and participation in childs careto reduce anxiety and provide developmentally

delayed child with coping strategy

Use of SEVO GAS in the induction phase of sedation

administered by the Anesthesiologist -

Evidence Based Practice

Dr. Becker

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NIKKI & LANCE

Solar Sedation

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Chloral Hydrate- General Monograph Sedative-Hypnotic., Rx Med: PharmaceuticalInformation 2009

Cortellazzi P., Lamperti M., Minati L., Falcone C., Pantaleoni C., Caldiroli D.,Sedation of Neurologically Impaired Children Undergoing MRI : a SequentialApproach. Paediatric Anesthesia. 2007 Jul; 17(7) :630-6

Kain ZN., Caldwell-Andrews AA., Krivutza D.M., Interactive Music Therapy as aTreatment for Pre-Operative Anxiety in Children: A Randomized ControlledTrial. Anesthesia Analogs 2004, 98:1260-1266

Lefrak, L. Burch K. Caravantes R. et al Sucrose Analgesia: Identifying PotentiallyBetter Practices. Pediatrics 2006;118;S197-S202

Walworth D.D., Procedural Support Music Therapy in the Health Care Setting: ACost Effective Analysis. Journal of Pediatric Nursing. Vol. No. 4 (Aug. 2005)

References