evaluation criteria checklist

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University of Hail- College of Nursing

Pediatric Nursing Practice NURS 432

Summer Semester 2012-2013

Student Name: Student ID:

Instructors Names:

Date:

Area:

Group:

Vital Signs

Body Temperature1 2 3 4 5 Comments

Indication:

To determine the childs temperature on admission as a base for

comparing future measurements.

To monitor fluctuation in temperature.

Equipment :

Cotton with alcohol & dry cotton

Container for waste Water soluble lubricant.

Thermometer

Oral TemperatureMethod range

Advantages

Disadvantages

Length of time

Age

1. Wash hands.

2. Explain the procedure to the child or to his parents.

3.Check that the child has not just had a cold or hot drink.

4. Clean thermometer with alcohol swab

5. Check thermometer to see the reading is down below 35c.

6. Instruct the child to raise his/her tongue and put thermometerunder it, , and ask him to close his lips without biting.

7. Instruct the child to close his/her mouth, hold thermometer for 5minutes

8. Remove the thermometer and wipe it with dry cotton swabs

9. Read and record temperature.

10. Wash thermometer with soap and water and dry it.

11.Wash hands.

Rectal TemperatureMethod range

Advantages

Disadvantages

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Length of timeAge

1. Wash hands.

2. Explain the procedure to the child and his family.


4. Check thermometer to see the reading is down to 35c.

5. Apply lubricant to thermometer.

6. Grasp the infants ankle and placing index finger between the

ankle bones.

7. Insert the thermometer bulb into the rectum 2.5cm.

8. Hold for 3 minutes.

9. Remove the thermometer and wipe it with dry cotton swabs.

10. Read and record temperature.

11. Clothe the child.

12. Clean the thermometer with soap and tape water.

13. Dry it and keep in its container.

14. Wash hands.

N. B:

1. Rectal temperature should not be used in children who having

rectal surgery or receiving chemotherapy.2. Procedure should be done by rectal thermometer.

3. Measuring rectal temperature is generally unnecessary because

of the risk of rectal perforation.

Axially TemperatureMethod range

Advantages

Disadvantages

Length of time

Age

1. Wash hands.

2. Assemble equipment.

3. Explain procedure to the child and infants family.


5. Check thermometer to see that reading is down to 35c.

6. Dry the axially area and then Place thermometer under axilla andbring arm across chest.

7. Hold thermometer in place for 10 minutes.

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8. Remove the thermometer and wipe it with dry cotton swabs.9. Read and record temperature.

10. Clean the thermometer with soap and tape water.

11. Dry it and keep in its container.

12. Wash hands.

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Methods of Measuring Body Temperature In

Infants And Children

Method

Range

Advantages Disadvantages Length of time Age

Rectal

37.0 37.8c.

1. Safe for children who are

unable to co-operate and

may bite the thermometer.

2. Not directly influenced bythe ingestion of hot or

cold fluids.

3. Method of choice if child

has seizure or breathing

difficulties receiving

oxygen therapy, or has

oral surgery.

1. Values may be altered

by presence of stool.

2. Optional response may

be negative.3. Damage to rectal

mucosa may occur.

4. Replication of

thermometer

placement is difficult.

5. Contra indicated when

child has diarrhea and

following rectal

surgery.

3 minutes *New born

* Infant.

Oral

36.4 37.4c

1. Easily accessible.

2. Replication of

thermometer placement iseasy.

3. Responds more quickly

and regular to changes in

arterial temperature than

does rectal method.4. More aesthetically

pleasing.

1. Value is ready

influenced by

ingestion of hot orcold fluids, and

oxygen therapy.

2. Requires childs

cooperation to keep

mouth closed and notto bite the

thermometer.

3. Contra indicated if

child has oral injuries

surgery or under the

age of five years.

5 minutes * More than 6

year's

children.

Axillary35.8 36.6c

1. Safe and easily accessible.2. Avoids the danger of

rectal or colon

perforation.

3. Avoids initiating the

defecation stimulus.

4. Often recommended for

infants.

1. Value is more readilyinfluenced by

environmental

temperature and air

flow.

2. Requires a relatively

long period of time to

obtain accurate

reading.

10 minutes. Less than 6years children.

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Pulse

1 2 3 4 5

Indication:

To gather information on the heart rate, pattern of beats (rhythm,

rate and strength of pulse).

Equipment:Watch with second hand.

Stethoscope.Cotton with alcohol.

Normal Heart Rate for different ages

Action

Peripheral Pulse1. Wash hands.

2. Explain the procedure to the child and his family.

3. Place child in comfortable position.

4. Place the third finger along the appropriate artery and pressgently.

5. Count for full minute.

6. Record rate, regularity & fullness.

7. Report for any abnormalities.

Apical Pulse1. Expose the chest over the apex of the heart.

2. Wipe the ears pieces & diaphragm with alcohol swabs andwarm diaphragm.

3. Place the stethoscope between the infants left nipple and

sternum between the 4th

& 5th

ribs.4. Listen and count for full minute.

5. Remove stethoscope and cover the child chest.

6. Wipe earpieces and diaphragm with alcohol swabs.

7. Record: rate, fullness and regularity.

8. Report any abnormal observation.

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Respiration

Action 1 2 3 4 5 Comments

Indication:

To determine respiratory rate and assess respiratory

characteristics (rate, rhythm, strength).To evaluate the child response to medication or treatments.

Normal respiratory rate

Equipment:

Watch with second hand.

Procedure

1. Remove over cover to observe chest movement.

2. Observe respiratory movement, rate, and depth, patternand sound.

3. Count the rate for one minute.

4. Record rate, depth, pattern and sound.5. Report for any abnormality.

AgeNormal heart rate

(beats per minute)

Normal respiratory rate

(breaths per minute)

Newborn 100-160 30-50

15 months 90-150 25-40

612 months 80-140 20-30

13 years 80-130 20-30

35 years 80-120 20-30

610 years 70-110 15-30

1114 years 60-105 12-20

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14+ years 60-100 12-20

Blood Pressure

1 2 3 4 5 Comments

Equipment:- Measuring cuff and Stethoscope.

-Alcohol swabFormulas of approximate average systolic pressure in relation to

childs age.

Formula of approximate average diastolic pressure in relation to

childs age.

Sites for measuring blood pressure

Action

1. Assemble the equipment.

2. Wash hands.

3. Review child's previous blood pressure reading

4. Explain the procedure to the child or to his mother.

5. Expose the site of measurement fully by removing clothes.

6. Position the limb at the level of the heart.

7. Place stethoscope ear pieces in ears and be sure sounds are

clear, not muffled.

8. With cuff fully dilated, warp cuff evenly around upper arm.

9. Be sure that manometer positioned vertically at the eye levelobserver (should be no further than 1 ml.)

10. Palpate brachial or radial artery with fingertips of one hand

while inflating cuff rapidly to pressure 20mm Hg. Above pointat which pulse disappears.

11. Slowly deflate the cuff, nothing when the pulse is first heard(systolic pressure) and when the sound becomes muffled or

disappears (diastolic pressure).

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12. Remove equipment.

13. Hand wash.

14. Record your observation.

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Sites for measuring blood pressure:A. Upper armB. Lower arm

C. Thigh

D. Calf or ankle.

Formulas of approximate average systolic pressure in relation to childs age.

Childs Age Formula

1 to 7 years Age in years + 90

8 to 18 years (2 X Age in years) + 83

Formula of approximate average diastolic pressure in relation to childs age.

Childs Age Formula

1 to 5 years 56 mmHg

6 to 18 years Age in years + 52

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Cold Compresses For Fever1 2 3 4 5 Comments

Purpose:

Decrease body temperature.

Relief discomfort.

Prevent complications.

Equipments:

Basin with tap water.

Small wash clothes.

Rubber sheet.

Towel

Draw sheet or linen to cover the child's chest

Degrees of fever (Oral or rectal)

Mild fever : 37.8 38.4 c

Moderate fever : 38.5 39.5c

High fever : 39.6 41.0

Hyperthermia above 41.0c

Procedure

1. Wash hands.

2. Prepare all the needed equipment

3. Prepare child & pulsating areas. Which the

compresses will be applied on.

4. Place rubber sheet under areas to which compresses

will be applied

5. Immerse wash cloth or material for the compresses in

the tap water, place wash cloth over pulsating areas.

6. Remove the compresses frequently & replace it with

another one

7. Measure patients temperature after 15-30 min8. Remove compresses after decrease body temperature

to the normal level.

9. Clean equipment after use

10. Leave patient clean and dry

11. Wash hands.

12. Record nursing care in the patients card & his last

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temperature.N.B: If the temperature is not changed repeat the steps

from 5-7 for 8 min.

Chest Circumference

Action 1 2 3 4 5 CommentsEquipment:

1. A tape measures

2. Cotton with alcohol

1. Remove the childs clothing of upper half.2. Place on the flat table in

A supine position for infantOr stand alone for children

3. Place the tape across the nipple line.

4. Measure midway between inspiration and expiration.

5. Record in the patient chart.

Head CircumferenceHead circumference should be measured:

1. Under 36 months of age.

2. With neurological defects.Equipment:- Measuring tape

- Cotton with alcohol

-Measure the head at its great circumference; this is above

eyebrow and pinna of the, and at the occipital prominence at theback of the skull.

Action 1 2 3 4 5 Comments1. Note child's last recorded head Circumference, if available.

2. Perform hand washing.

3. Place light drape or paper on flat surface for the child to stand

on.4. Place infant/ toddler in sup

5. Child usually weighted while wearing their under wear or light

gown.

6. Record.

Comparison between head circumference and chestCircumference.

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Birth. H. C. > CC12 14 months H. C. = CC

24 months H. C. < CC

Height

1 2 3 4 5 Comments

Height is referred to measurements taken when children are

standing upright. used over 24 months of age

Equipment:Measuring board for old child or, a measuring tape.

1. Remove the childs shoes and socks.

2. Stand as tall and straight as possible with head in midline and

the line of vision parallel to the floor.

3. The childs back should be to the vertical flat surface with

heels, buttocks and back of the shoulder touching the surface.

4. Any flexion of the knees, lumping of the shoulders or raising

of heels of the feet is checked and corrected.

5. Move the board on the top of the head.

6. Read & record.Height If Such Device Is Not Present

1 2 3 4 5 Comments

N.B: Height can be calculated by these formulae (age more

than 2 years x 5 +80)

Action

1. Attach a measuring tape to the wall.

2. Place the child adjacent to the tape.

3. Place a three-dimensional object, such as thick book or box

on the tape of the head.4. The side of the book must rest firmly against the wall to form

a right angle.

5. Length or stature is measure to the nearest 1 cm.

6. Record.

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Length1 2 3 4 5 Comments

Length refers to measurement taken when children are in

supine position, also refers to recumbent length. Untilchildren are 24 months old, recumbent length is measured.

Equipment:

Measuring board for infant, dress tape, or metal tape.

Action

1. Place the towel on the board.

2. Remove the infant clothing.

3. Place the infant on the center of the board in the supineposition.

4. One assistant hold the head against the headboard

firmly.

5. Grasp the knees together gently.

6. Push down on knees until the legs are fully extended &

hold the legs firmly.

7. Bring the headboard against the soles of the heels

firmly.

8. Read and record.

Length If Measuring Device Is Not AvailableAction 1 2 3 4 5 Comments

1. Place the infant on a proper covered hard surface.

2. Push down the knees and head against a firm surface.

3. Make points of the top of the head and heel of the feet by a

point.

4. Remove infant from his place.

5. Measure between these two points.

6. Record.

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Weight

1 2 3 4 5 Comments

- Weight must be recorded accurately on admission.

- Weight of a patient provides a mean of determiningprogress.

- It is necessary to determine the dosage of certain

medications.

- The way in which the nurse weights the child depends onthe age.

Infant WeightEquipment's:

1. Appropriate sized beam balance scale.2. Cotton with Alcohol

3. Scale PaperAction

1. Place the scale horizontally on a firm surface.

2. Check to see that scale is balance by sitting it at zero,

and noting if the balance registers exactly in the middle of

the mark.

3. Close windows and doors to make the patients room

warm

4.Wipe the scale with cotton with alcohol5. Remove the infant clothing.

6. Put a scale paper on the scale.

7. Gently life the infant from his bed and place him in thescale basket.

8. For the safety, hold hand over the body of the infant.

9. Adjust the weight to balance scale by the right hand.

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10. Read the scale when the infant is lying still.11. Return the infant to his bed.

12. Record it in the patients chart.

13. Remove and dispose the scale paper.

The older infant may be weigh in a setting position

Weight of Older ChildrenEquipment:

Standing scale.Paper

Action

1. Balance the scale.

2. Place a paper towel on the scale for the child to stand on.

3. Keep child privacy.

4. Child usually weighed while wearing their underpants or

light gown.

5. Ask the child to keep erect

6. Remove shoes of the child.

7. Read and record.Once standing height is taken over 24 months, weight canalso be done on a standing type scale.

NB: - If the child cannot stand for any physical problem,the mother should carry the child and subtract the

difference between the mother weight and the mother who

carry the child

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Sponge Bath

1 2 3 4 5 CommentsPurposes:

1. To clean the skin and comfort the child.

2. To increase circulation and metabolism.

3. To Observe childs body.

4. To give chance for play and talk with child.5. To provide an opportunity to note childs growth and

development.

Equipment:

Bowl for warm water

Wash cloth or cotton (sponges) at least four wash cloth

Soft hair Brush

Bath towel

Baby clothes

Plastic bag

Mackintosh

Clear water

Baby lotion

Nail scissors Cotton with alcohol

Actions

1. Explain procedure to the mother

2. Wash hands.

3. Close the doors and windows

4. Assemble the equipment at the child bedside.

5. Provide safe environment (Free from drafts).

6. Fill the bowl two-thirds full of water 36.5-40c according to the

age and season, check water temperature by thermometer or by

elbow joint. (Change the water as needed).7. Precede bathing from top to bottom.

8. Wipe each eye with moist sponge from the inner to the outeraspect then dry gently each one.

9. Clean the baby face, wipe around mouth and nose then go overher cheeks and forehead, dry with sponge.

10. Clean each ear over and behind only (not inside)

11. Wipe the scalp & dry it.

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12. Wipe the neck thoroughly pays attention to creases.13. Take -off childs clothes

14. Clean hands from fingers then hands and dry well total.

15. Wipe under axially from front to back and dry well.

16. Clean the chest, abdomen, & back, then dry well in onedirection.

17. Dress the child clean clothes

18. Clean the lower extremities from bottom to top then dry well.

19. Clean diaper area.

Cord Care

1. hand wash2. position infant supine

3. Inspect the cord closely during the first 24 hours and then daily

for any abnormalities.

4. Clean area at base in circular motion with alcohol wipe or cotton

ball.

5. Wipe the top of the cord with cotton with alcohol wipe or

cotton ball.6. Squeeze cotton with alcohol over the tip of the cord.

7. Dress the child clean clothes.

8. Collect equipments and clean the surrounding environment.9. Wash hands.

10. Record.

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Diaper Care

1 2 3 4 5 Commen

Purpose:

1. Maintain the baby more comfortable by keeping him dry.

2. Maintain healthy skin at diaper area.3. Observe any abnormal changes in the skin of the diaper

area.4. Inspect the infants body during the procedure.5. Protection against urinary tract infection.(ascending

infection)

Equipment:

Kidney basin.

Warm water.

Cotton/sponges or clean wash cloth.

Plastic bag.

Oil or ointment.

Disposable diaper or cloth diaper.

Action

1. Wash hands with soap and water.

2. Prepare all the needed equipment.

3 Explain to the parents the procedure in the purpose of

teaching them.

4. Put the baby on a mat or changing table.

5. Wipe off the feces with the corner of the unclean diaper and

fold the diaper down under the babys legs.

6. With clean wash cloth, clean thoroughly in the creases at the

tops of baby's legs and at the base of genitals wiping away

from the body.For a female :

a. Wipe away feces with wash cloth then using a moist baby

clean wash cloth, clean all over her stomach up to her

umbilical stump.

b. Lift her legs up with a finger between her ankles and wipe

the vulva from front to back.

For a male:

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a. Pause for a couple of seconds with the diaper held over hispenis.

b. Clean his penis, wiping away from the body.For uncircumcised boy pull the fore-skin back gently clean it

then replace the retracted skin to prevent paraphimosis

(edema of the glands),then clean scrotum change cloth asneeded.

7. Lift the babys legs to clean anus and buttocks, keeping afinger between ankles wipe over the backs of thighs too then

remove the diaper , repeat if baby still unclean

8. Dry baby's bottom with a clean wash cloth

9. Apply a barrier of cream or zinc oxide ointment.10. Place the new clean diaper under the infants buttocks and

sides in between his legs.

11. Bring diaper up over abdomen, place front part of diaper

next to babys skin bring back of diaper over front tuck it. ,

being careful to place your finger between the baby and the

diaper.

12. Fold diaper so that it does not cover the cord stump.

13. Discard the old diaper, collect your equipments; leave the

area clean and tidy.

14. Wash hands.

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Methods of Holding the Child

Lumbar Puncture1 2 3 4 5 Comments

Purpose: Minimizing their movement and

discomfortAction

1. Explain the procedure to the child and to hisparents.

1. Put the child in lateral side-lying position.

2. Restrain the child by holding the child withforearm behind the neck and the other behind

the thigh.

3. Maintain this flexed position of the back.

Jugular Vein Puncture

1. Explain the procedure to the child and to hismother.

2. Put the child in a mummy restraining.

3. Put the child supine in a table.

4. Extend the head and shoulder of the child overthe edge of the table.

5. Turn the head to one side, a maximum of (60degrees) from the midline.

6. Encourage crying during the procedure.

7. Check the patient after procedure for oozing,

bleeding or evidence of hematoma.

Femoral Vein Puncture1 2 3 4 5 Comments

Action1. Explain the procedure to the child and to his parents.

2. Put the child supine on examining table.

3. Put the legs of the child in frog position. (Flexion andabduction of the childs knees).

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4. Control the childs arms and legs by forearms.5. Uncovered the site used for the vein puncture.

6. Cover the genital area.

7. Apply pressure on tie site for (10-15) min afterwithdrawal of blood.

Clove Hitch Restraint

Indication: Immobilize arms or legs by attaching a

clove hitch tie at the wrist or ankle.Prevent dislodging of (Cannula) from sites in thelimb.

1 2 3 4 5 Comments

Equipment:

Cotton or dressing and gauze

Action

1. Pad the wrist or ankle with cotton or gauze dressing.

2. Tape the dressing.

3. Make double loop.

4. Pick up the loop.

5. Ship the wrist or ankle through the two loops.6. Tie the ends to the bed springs or frame.

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Mummy Restraining

1 2 3 4 5 Comments

Indications :

It immobilizes an infant or small child for a short

time while a procedure is performed or child isexamined.

It immobilizes the body, leaving only the head and

neck mobile for examination or treatment (e.g. veinpuncture, throat examination, gavages feeding).

Equipments:

Draw sheet or blanket.

Safety pins.Action

1. Wash your hands.

2. Explain the procedure to the child and his parents.

3. Place the blanket or sheet flat on the bed.

4. Place the child on the blanket with his shoulder at the

fold.

5. Pull the right side of the blanket over the childs right

shoulder.

6. Tuck the reminder of the right side of the blanket

under the left side of the childs body.7. Repeat the procedure with the left side of the blanket.

8. Separate the corner of the bottom portion of the sheet

and fold it up toward the childs neck.

9. Tuck both sides of the sheet under the infants body.

Modified Mummy RestrainingPurpose: To modify the mummy restraint for chest

examination, the folded edge of the blanket is brought

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over each arm under the back, the loose edge is foldedover and secured at a point below the chest to allow

visualization to the chest.

Special Precautions: Be sure that the childs

extremity is in a comfortable position during this

procedure.

1. Wash your hands.

2. Explain the procedure to the child and his parents.

3. Open a blanket on crib.

4. Fold the blanket in a rectangle form.

5. Place the child on the blanket with his shoulder at thefold.

6. His arm is positioned comfortably at his side.

7. Fold the blanket over the arm, and tuck it snugly

under childs back.

8. Repeat for the other arm.

9. Bring the excess up over the abdomen &leaving chest

exposed.

10 Secure sides of blanket behind childs back.

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Board Restrains

Palm Up Method

1 2 3 4 5 Comments

Purpose: Immobilize the extremities by attaching

board restrains.

Equipment:

- Board

- Adhesive stripsProcedure

1 Place arm palm up on an arm board

2. Place two adhesive strips across the hand in an Xfashion, Use 5-cm adhesive tape for the child, 2cm

for the infant,)

3. Make a double adhesive strip by using one long and

one short

Piece of tape, attach them to one another, adhesive

sides together. With the short strip touching the

childs arm, tape the arm to the arm board at the edgeof the antecubital fossa. Tape does not need to be

secured directly to the arm.

4. Final double adhesive strip may be placed midway

between the hand and the antecubital fossa or abovethe antecubital fossa.

P alm D own Method

Procedure

1. Place the arm palm down on to arm board

2. Place the first adhesive strip over the wrist. (Use 5-

cm width adhesive for the child, 2cm width for the

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Group:

infant).3. Secure the second adhesive strip across the proximal

end of the phalanges, leaving the thumb mobile.

4. Using a double adhesive strip (see step 3 under palm

up Method). Secure the arm just under the elbow.

5. The final piece of tape is placed obliquely over the

thumb and, for security, or over the second strip.

6. Adhesive placement for the infant.

Lower Extremities with Board Restrain

Comments54321

Procedure

Put the child in a supine position.1.

Leg is full external or internal rotation on the board2.

Extend the board from the end of the foot to the mid portion

of the buttock.

3.

Place the second adhesive strip over the heel and across the

foot in an X formation

4.

Using a double strip of adhesive (see step 3 of palm up

method

5.

Tap the third strip above the knee6.

On the infant, place one addition strip between mid-way the

knee and ankle

7.

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Elbow Restraint

1 2 3 4 5 Comments

Indications:

Preventing the child hand from reaching

the head or face, e.g. after lip/headsurgery, or when vein infusion is in place.

Preventing the child hand from scratching

in skin disorders.

Equipment:

A piece of cotton cloth or strips ofadhesive tape.

Tongue depressors

Action

1. Wash hands.

2. Explain the procedure to the child or to his

parents.

3. Expose the arm including the elbow area.

4. Make a pocket on the cloth or on the cotton

piece.

5. Insert the tongue blades in the pocket of thecloth.

6. Wrap the strain around the arm and secure it

with tapes or pins.

Special precaution:

The tongue depressors should be cut toabout 10 cm (4inches) in length if the elbow

cuff is to be used for an infant for greatest

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comfort.

Table Tub Bath

1 2 3 4 5 Comments

Purpose:

1. To satisfy the need for cleanliness.

2. To help the new mother at home bath her newborninfant.

3. To inspect infant body.

4. For therapeutic purpose as in burned child.

5. To relax the childs muscles before physicaltherapy.

6. To help remove dressings or crusts or to apply acertain soothing medication to the skin.

Equipments:

- Baby tub - Bath towel - Wash cloth 2-3- Mild soap - Childs cloth.

- Soft hair brush or comb

- Mackintosh. Toy - Pitcher- Cotton Container - Gauze swabs - Baby Oil

Actions

1. Explain the procedure to the childs mother.

2. Check room temperature and free from drafts (close

windows and doors).

3. Assemble equipment.

4. Fill the baby tub half to two third full of warm water

(37.8)-(40.6c) if there is no water thermometer checkit with your wrist.

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5. Spread the bath towel on the bed or table.6. Wash hands

7. Place the infant still dressed on the bath towel

8. Wash the infant eye, starting from the far eye, wipe theeye with moist cotton with water only from inner to

outer aspect, and then dry it with clean dry cotton in

one direction. Water only.

9. Wipe the infants face, forehead, cheeks and mouth

(clean inside the mouth if needed and nose with a

moist cotton).

10. Soap the scalp; support the infant using the football

hold (the baby is supported under the nurses arm andno her hip) first lather your hand with soap then apply

it to the scalp

11. The infants head should be held over the wash basin,

rinse thoroughly and if possible the ears should be

covered with the nurses fingers.

12. Place the infant on the table and dry the head with a

part of the folded bath towel.

13. Inspect the ears if any discharge present cleans it with

the corner of washcloth.

14. Remove the infants clothes.15. Lift the baby carefully and gradually into the tub, feet

first, using appropriate hold.

16. Quickly soap the infants entire body except the head

using another wash cloth paying special attention to

body creases, between toes, area under the chin andgenitalia (revise the diaper care)

17. Rinse the soap off the infant quickly.

18. Again lift the infant from the tub back to the towel and

dry well.

19. Dress the infant; comb his/her hair gently.

20. Clean all used equipment and return to its place.21. Wash hands.

22. Record time and observations.

NB:

Allow time for kicking, playing, and talking with

the infant to enjoy bathing.

Apply lotion or oil to body creases avoids using of

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talcum powder. Talcum powder with oil makes a past, which retain

body secretions and irritate the skin. It may be

inhaled leading to respiratory distress

Bottle Feeding1 2 3 4 5 Comments

Indication: Extra indications to breast-feedingexist.

Principles of Bottle Feeding:

1. Persons who prepare the formula must wash

hands well.2. The formula is prepared and bottled

immediately before each feeding.

3. Warming the formula is optional. (if it stored

in the refrigerator).

Equipment:

For a fully bottle-fed baby you will need at

least eight full-size (250 ml) bottle with

suitable nipples.

Measuring cup for mixing powder formula.

Plastic funnel useful for pouring formula.

Plastic spoon stirring formula.

Plastic knife for leveling off scope of powder

formula.

Bottlebrush needed to clean thoroughly inside

the bottle.

Action

1. Prepare the needed equipment.

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2. Hand washing by soap and running water.3. Prepare formula as prescribed.

4. Check amount of formula on straight surface.

5. Let a few drops of formula fall in the inner aspectof your wrist to Test formula for temperature

6. Hold the baby unless contraindicated in a semi upright position, if a baby cannot be removed from

the crib, sit the baby, and elevate his /her head,

shoulders.

7. Put cotton under the babys chin.

8. Do not contaminate the nipple a much as possible.

9. Stroke the nearest cheek of the baby, or let somedrops of formula touches the babys lips.

10. Hold the bottle so that the nipple and neck of the

bottle are full of formula.

11. During feeding, hold the bottle firmly so that the

baby can pull against it as he/she sucks.

12. Burp the baby halfway through the feeding and at the end by one of the following methods:

a. Place a small towel over your shoulder to protectyour gown, place the baby firmly against your

shoulder and pat the back.

b. Place the baby in sitting position put a towel

beneath the chin support the chest and head withone hand gently rub the back with the other hand.

13. The feeding should take 15 to 20 minutes, dont

hurry the baby or force the infant to feed too

much.

14. If the baby doesnt want to let go of the empty

bottle, slide the little finger between the babygums and nipple to release the sucking.

15. Provide mouth care after feeding.

16. Place the baby on the abdomen or on right side

position at least one hour.

17. Record the amount type of formula and baby

reactions.

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Gavages Feeding1 2 3 4 5 Comment

Purposes:

1. Introduce fluids, medications that cannot be given by mouth.2. Carry out diagnostic procedures.

3. Conserve energy of infant, In case of prematurity or illness orcongenital deformity or at risk of aspiration.

Equipments:

1. A sterile suitable tube selected according to the size of the childand the viscosity of the solution (e.g. usual size for premature 5

French and 8 French for other children).

2. A stethoscope.3. The solution of feeding.

4. Non allergic tape.

5. Sterile water for lubrication.

6. Container for the fluids.

7. 5ml 10ml syringes.8. A pacifier.

9. Restraining equipment.10. Gloves.

Measurements:

1. Measuring from the tip of the nose to the tip of the earlobe and

then to the end of xiphoid process, alternatively you may also

measure from the bottom

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2. Measuring from the nose to the ear lobe and then to point midwaybetween the xiphoid process and the umbilicus

3. The same measure from the mouth to insert oral tube.

Action

1. Prepare the needed equipment.

2. Hand wash by soap under running water.

3. Explain the procedure to the parent and the child if he can understand.

Use on age suitable restraining

Place the child supine with head slightly hyperflexed

4. Measure the tube for approximate length of insertion.

5. Mark the point with a small piece of tape.6. Lubricate the tube by sterile water.

Check that the nostrils are patent.

7. A pacifier is used or place the infants finger in his mouth

8. Insert the rounded end of the tube into clearest nostril.

9. Slide the tube backward and inwards gently along the floor of the noseuntil predetermined mark.

10. Check the position of the tube by using at least two methods (Clampindwelling tube before using any method):

a. Attach the syringe to the feeding tube and apply negative pressure

aspiration of stomach content indicate proper placement (Notifyphysician if a gastric residue is greater than 25% of the pervious

feeding)

b. by the syringe inject a small amount of air 0.5-1m in premature to 5m

older children into the tube while listening with a stethoscope over the

stomach area and then withdraw air.

c. Emerge the end of the tube into a container containing clean water, the

water during breathing if bubbling occur withdraw and reinsert.

11. If the tube is fixed, stabilize the tube by holding or taping it to the

cheek by adhesive tape.

12. Check the formula temperature to be as the room temperature.

13. Connect the syringe barrel into the tube.

14 Pour formula into the barrel of the syringe attached to the tube.

15. Raise the syringe barrel 20-25cm from the bed.

16. To start flow, give gentle push with the plunger and allow the fluid to

flow into the stomach by gravity.

17. The rate of flow 5-10ml/min in premature, and 10ml/min in older

infants and children.

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18. Just before the syringe is empty, pinch the tube by fingers.19. Flush the tube with sterile water or G5% 1-2cm.

20. Clamp indwelling tube & remove the syringe.

21. If the tube is to be removed pinch it firmly and withdraw the tubequickly.

22. Position the baby on right side or abdomen at least one hour.

23. Provide mouth care with gauze and normal saline.

24. Record the amount, type of formula and amount of gastric residue.

25. Remove equipment, leave area clean and tidy.

Gastrostomy Feeding

1 2 3 4 5 Comments

Providing nourishment and fluids via a tube that is

surgically induced through an incision made throughthe abdominal wall into the stomach for those requiring

tube feedings for an extended period of time.

Equipment

- Feeding formula

- Pacifier.

- Reservoir syringe or funnel- Syringe for aspirating.

- Dressing or piece of cotton

- Gauze for mouth care- Tape

Action

1. Explain to the child or to the family the feeding

procedure

2. Wash your hands.

3. Prepare the needed equipment

4. Check residual stomach contents before feeding.

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5. Attach syringe and aspirate stomach contents.6. Measure residual stomach contents

7. Residual fluid may be returned to stomach or

discarded, depending on amount.

8. Place the child on comfortable position, either flat or

with head slightly elevated

9. A pacified can be given.

10. Attach reservoir syringe to tube and fill syringe

with feeding fluid to unclamping tube.

11. Elevate tube and syringe to 1012 cm above

abdominal wall Do not apply any pressure to start flow

12. Feed slowly taking 20-45 min fill reservoir withfluid before it is empty to avoid instillation of air.

13. When feeding is completed:

a. Instill clear water 1-30o of clear water.

b. Apply clamp before water level reaches end of

reservoir

14. Place the child in comfortable position.

15. Mouth Care

16. Wash your hands

17. Record the feeding time formula content, route of

feeding and any changes or abnormality and report tothe doctor.

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Intramuscular Injections

1 2 3 4 5 Comments

A drug is administered by intramuscular route when:

1. A more rapid action is required than oral.

2. Giving medication into muscle.

Equipments:

1. Tray.2. Appropriate syringe and needle size.

3. Spirit lotion in container and swabs.

4. Prescription sheet.

5. Drug to be administered (vial or ampoule).6. Sterile saline bottle or ampoule of sterile distilled water.

Recommended Injection Sites for children:

1. Ventrogluteal area (any age).

2. Vastus lateralis (for infant and young child).

3. Rectus femoris (for infant and young child).4. Gluteal region (children who have been walking for at

least one year).

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5. Deltoid muscle for older child to administer a smallamount of drugs as insulin.

6. It is better to be avoided in childhood and infancy

Action

1. Check the medications order (Medications card) accuracyand frequency. It should contains the following, the five

rights:

The childs name.Name of drug.

Time for administration.

Route of administration.

Dose to be administered.2. Clarify any discrepancies in the order with the senior nurse

or the physician.

3. Arrange the medications cards in logical order for

distribution.

4. Wash hands and wear disposable gloves

5. Prepare the drug in suitable syringe, needle, and cottonswabs in a tray far from the child.

6. Attach the needle to the syringe without removing it from its

protective covering.

7. Prepare antiseptic swab.

8. Prepare the drug dose.

9. Remove old gloves and wear new one

10. Explain procedure to child and parents.

11. Talk to the child while preparing him/her.

12. Expose patient to a minimum stress, and select proper site

according to childs age:

Ventrogluteal area (any age), because its

sufficiently thick and does not contain major nerves

or vessels.

Vastus lateralis (for infant and young child).

Rectus femoris (for infant and young child).

Gluteal region (children who have been walking for

at least one year), the musculature itself is poorly

developed until the child has been walking for a yearor more.

Deltoid muscle for older child to administer a small

amount of drugs as insulin, it is better to be avoided

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in childhood and infancy, its poorly developed13. Clean the site with an antiseptic swab using a circular

motion from inner to outer.

14. Remove the needle cover.

15. Expel air bubbles unless one is to be left.

16. The muscle mass of the thigh to be injected in firmlygrasped in one hand to stabilize the limb and compress the

muscle mass for injection with other hand.

17. Insert the needle with proper angle according to the selected

muscle by quick, firm movement with minimum injury.

18. Stretch the skin taut between thumb and forefinger.

19. Fix the syringe with left hand and aspirate before injecting if

blood is revealed, the needle must be withdrawn andreinserted.

20. Inject the content of the syringe slowly.

21. Press the cotton against the injection site and pull the needlequickly.

22. Move the limb or massage the site with alcohol sponge, if

bleeding occurs apply pressure (with dry sponge untilbleeding stops) to the site until it stops.

23. Dispose of supplies according to agency procedures.

24. Wash hands.25. Hold the child and try to please or give him/her any toy

according to his age.

26. Record in patients chart name of drug, dose, route, time and

signature.

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Intravenous Fluid Therapy1 2 3 4 5 Comments

Purpose:

1. To restore and maintain the childs fluid and electrolyte

balance and body homeostasis when his oral intake is

inadequate to serve this purpose.2. To replace severe fluid loss in emergency situations such as

in severe burns, severe hemorrhage and dehydration.

3. To administer medication when other routes are notappropriate.

Equipment:

1. I.V. solution The kind of solution is specified by thedoctor

2. Tray

3. V. administration set.4. V. pole.

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5. Label.6. Doctors order sheet.

Procedure

Preparatory Phase

1. Check the infusion fluid which is prescribed by the doctor.

2. Check the following details:

a. Childs name, room and bed number.

b. Date of prescription.

c. Type of prescribed fluid.

d. Amount of prescribed fluid.

e. Container labeled for I.V. therapy.f. Expiry date of the I. V. fluid.

g. Time prescribed for starting the I.V. therapy.

h. Time to be taken for completion of I.V. infusion.

i. Signature of the medical practitioner.

3. Check the fluid for cloudiness, sedimentation or discoloration.

4. Check the system: the solution, set, cannula and patient

Performance Phase

1. Set up intravenous infusion in an area not visible to the child.

2. Inspect the solution and turn the I.V. bottle.

3. Write down data, rooms No; childs names, components, start

from, dripping/minute on the label and then put it on the bottle

4. Remove protective cap from spike of infusion set and insert

through outlet hole in bottle stopper.

5. Hang I.V. bottle on I.V. pole.

6. Squeeze a drip chamber and fill the drip chamber with one third

to half of solution, this volume prevents air bubbles from

entering the tube.

7. Remove protective covering from needle adapter and open

clamp, and then run solution through, tubing allowing some

fluid to flow needle adapter and close clamp dont touch theneedle adapter at any place.

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Intravenous Fluid TherapyCannula Insertion

Equipment:

1. Appropriate size of cannula 20-24 are appropriate size for

pediatric age The size of the cannula depends on the ageand size of the child and the type of fluid to be

administered.2. Tourniquet.3. Normal saline.

4. Cotton sponges with alcohol and dry cotton sponges.

5. Surgical adhesive tape.6. Kidney basin.

7. Label.

8. Padded arm board.

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9. Restraining devices if necessary.10. Syringe (5 or 10 ml).

1 Select an appropriate vein puncture site.

2 Restrain the child if needed.

3 Tighten tourniquet above the vein where needle will be inserted

4 Cleanse an area of needle insertion with cotton with alcohol.

5 Insert the needle and check for blood return

6 Remove the tourniquet.

7 Connect needle to infusion set and fit the tube.

8 Start to drop and set the I.V. flow rate according to doctors

order & calculate the dose.9 Dispose the equipment properly

Follow up phase: follow the system

1. Check the child at least hourly for: -

a. Note the color of the skin at the needlepoint.

b. Note the location of the I.V. needle.

c. Check for swelling of the skin at the needlepoint:If in a hand or foot, compare with the opposite extremity.

If in the head, look at the face to determine asymmetry.

d. Feel the area around the I.V. site for leakage.

2. Weigh the child at regular intervals, using the same scales eachtime.

3. Maintain an accurate record of intake and output every 8 hours.

4. Record essential information:Total amount of fluid infused compare with the total amount offluid intended to be infused.

Rate of flow.

Apparent condition of the child.

5. Irrigate the I.V. as necessary as follows: -

a. Gather equipment syringe with 1-3ml normal saline andseveral alcohol wipes.

b. Clamp off the solution aspirate first.

c. Disconnect the I.V. tubing at the needle insertion site. Keep itsterile.

d. Connect the syringe to the tubing at the needle insertion site.

e. Slowly inject the normal saline.

f. Disconnect the syringe and reconnect the I.V. tubing to theneedle insertion site

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g. Unclamp the I.V. and regulate the flow of the solution.h. Check frequently to make certain that the I.V. is functioning

properly.

Cannula CareEquipments:

1. Dry cotton balls.

2. Syringe with 2 ml saline3. Cotton with alcohol.

4. Cotton balls soaked with saline5. Gauze pads.

6. Adhesive tape

Action 1 2 3 4 5 Comments

1. Wash hands.

2. Prepare all equipment.

3. Explain procedure to the child or his/her mother.

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4. Remove old dressing with cotton soaked with saline.5. Inspect site for presence of any abnormalities.

6. Clean site of insertion to outward by cotton with

alcohol.

7. Clean I. V. site by cotton with alcohol.

8. Apply adhesive tape.

9. Remove & clean equipment.

10 Hand wash.

11 Record.

Colostomy Care

1 2 3 4 5 Comments

Objectives:

To promote healing of the stoma

To provide comfort

To teach patient or parents self care

Equipment; A tray with:

1. 1 bowl with soap solution (not irritant) or any

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solution according to hospitals policy.2. 1 bowl with clear water.

3. Large pieces of gauze.

4. Colostomy bag if available.5. Zinc oxide ointment or soothing cream.

6. Disposable gloves.

7. Rubber sheet.8. Towel.

9. Clean cloth.

Remember to:

1. Wash hands.

2. Wear gloves.3. Keep privacy , Close windows and doors to prevent

air graft

4. Explain procedure to the child or to his mother.

5. Check Colostomy site.6. Keep patient in a comfortable position.

Action

1. Explain procedure to the child and his mother.

2. Prepare all necessary equipment.

3. Close windows and screen patient.

4. Place disposable container in an easily accessible spot.

5. Protect bed with rubber sheet.

6. Wear disposable gloves

7. Remove any adhesive and cut bandage on each side of

colostomy

8. Remove soiled dressing, If no colostomy bag is used

9. If colostomy bag is used, remove it, pulling towardsthe stoma with clean forceps and dry Pieces of gauze

10. Assess the stoma output for volume, consistency andodor in relation to the type and location of the stoma.

11. Gently and thoroughly wash the skin using warm

water and mild soap (not irritant)12. Assess the stoma and surrounding skin by using gauze.

13. Clean well over and around stoma remove any stools

14. When the stoma became clean, repeat with gauze

soaked in clear water.

15. Wipe the Peri-stoma skin with mild soap and water

and dry it put zinc oxide, or any soothing cream

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16. If bag is used:a. Measure the circumference of stoma and choose

appropriate bag.

b. Fix bag on skin applying even, firm pressure tight tostick bag.

17. If bag is not used:Apply a folded cloth over the stoma and secure it with

a tape (Tape must be not irritant if available).

18. Remove and clean all equipment.

19. Wash hands.

20. Keep child dry and comfortable.

21. Reassure child, and mother, praise him for co-operation.

22. Record condition of dressing and stoma color of stoolsand character, time and signature.

EnemaIndications:

For cleansing these enemas may be used to empty

the lower intestine. Isotonic saline or commerciallyprepared solutions may be used for this type of

enema.

Therapeutic cool saline is used to reduce the body

1 2 3 4 5 Comments

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temperature of infant with a high fever; bariumenema may also used for the reduction of an

intussusceptions.

Diagnostic the most frequent use of diagnostic

enemas is the examination of lower intestinal tract

with liquid barium sulfate.

Equipments:

1. Container for enema solution.

2. Solution.

3. Rectal catheter, appropriate size.4. Lubricant.

5. Disposable gloves.6. Bath thermometer.7. Bed pan, diaper.

8. Rubber sheet or water proof pad.

Remember to

1 The amount of fluid instilled varies with the age andsize of the child, also the same as regard length of

catheter advancement.

2 Never Force the catheter into anal canal, if a well-lubricated catheter does not advance easily stop the

enema.

3 Tap water or hypotonic solution should be used withcaution. Absorption of large amounts of fluid instilled

into the bowel may produce hypo tonicity of the extracellular fluid and hyponatremia.

Action

1. Explain procedure to the child or his/her parent.

2. Wash hands.

3. Prepare all needed equipment.

4. Fill the container with enema with solution warmed tobody temperature, unless the purpose is to reduce body

temperature. In that case a cool solution is used.5. Provide for the child privacy, close curtains, around the

bed, drape the child with the anus exposed.

6. Put waterproof sheet under the child.

7. Place a bedpan under the childs buttocks; place the child in one of the following positions:

a. The child lies on the left side in the lateral recumbent

position with knees draw up to the chest

b. The infant is placed on the back and legs are lifted to

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expose the anal orifice(area for insertion)c. The Sins position is used for the older child, who lies on

the left side, with the right thigh flexed bout 45c to thebody axis

d. The knee chest position may be used for the older child.The child balances on the knees and chest, resting the

head on the forearms

*drape the child with the anus exposed.

8. Put on gloves

9. Lubricate the rectal catheter by lubricating jelly with

Lidocaine 2%.

10. Introduce the catheter past the anal sphincter to the analand lower rectum.

11. When the tip of the catheter is in place, elevate the bag

and instill the fluid slowly.

12. If the child shows symptoms of distress, does the flow

of fluid stooped.

13. Remove tip of catheter and the buttocks is hold together

for a few minutes; the child is urged to defecate.

14. Place the child on bed pan or apply clean diaper.

15. Dispose equipment.

16. Wash hands.17. Praise the patient For his cooperation

18. Record results of enema.

Age *Wt. *Amount of fluid Length of Advancement

Infant 5-10 kg. 100-200 ml 2.5cm

Small child 11-30 kg. 200-300 ml 5cm

Large child 31-50 kg. 300-500 ml 7.5cm

Adolescent Over 50 kg. 500-700 ml 10cm

Naso/ Oro pharyngeal suctioning

1 2 3 4 5 Comments

Purposes:

1. To maintain patent airway.2. To facilitate exchange of gasses.

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Equipment:- Suction tubing.

- Suction device.

- Irrigating solution (sterile water).

- Water soluble lubricant or sterile water.- Disposable gloves or sterile gloves.

- Oxygen source.

- Bag valve device.

Suction catheter sizes:

Neonate to 18 month 5 -8 French

18 months to 7 yrs 8 10 French

7 to 10 yrs 10 -14 French11yrs to adult 12- 16 French

Negative Suction Pressures:

Premature 40-60mmHgNeonates 60 - 80 mmHg

Infants 80 - 100 mmHg

Children 100-120 mmHg

Preparations

1- Assess the childs need for suction by respiratory rate, breath

sound and heart rate.

2- Prepare all needed equipment.

3- Done chest physiotherapy (active or passive).4- Check all equipment functioning.

5-Ventilate the child with 100% oxygen before during and aftersuctioning.

6- Reassure and calm the child and his relative.

Action

1. Wash hands.

2. Turn on suction apparatus and set vacuum regulator to

appropriate negative pressure.

3. Select appropriately sized suction catheter.

a. Straight catheter is generally recommended for oropharyngealand nasopharyngeal suctioning.

b. Select appropriate catheter diameter.

4. Secure one end of connecting tube to suction machine andplace the other end in a convenient location within reach.

5. Open sterile catheter package on a clean surface using the

inside of the wrapping as a sterile field.

6. Set up the sterile solution container or sterile basin on the

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sterile field. Be careful not to touch the inside of the container.Fill with approximately 100 ml of normal saline or sterile

water.

7. Open lubricant and squeeze on to sterile catheter package

without touching package.

8. Provide 3 hyperinflation, hyper-oxygenation breaths with a

bag valve mask connected to a manual resuscitation bag

attached to 100% oxygen

9. Don sterile glove goggles and mask.

10. Pick up suction catheter, being careful to avoid touching the

non-sterile surfaces. With the non-dominant hand, pick up

connecting tubing and secure the suction catheter to theconnecting tubing.

11. Check equipment for proper functioning by suctioning a

small amount of sterile saline from the container.

12. Coat the appropriate length of suction catheter with water-

soluble lubricant or sterile water by make an approximate

measure by measuring the distance from the tragus of thechild's ear to tip of the nose.

13. Leave catheter air vent open.

14. For suctioning Nasopharyngeal approach:

a. Identify patent nasal passageway.

b. Gently insert the catheter through the patent nostril, guiding

it medially and downward along the passageway (use same

technique when going through nasopharyngeal).

15. For suctioning Oropharynx approach:

Gently insert catheter into mouth and advance catheter tip 3 to 4

in. into secretions of the pharynx.

16. Slowly withdraw the suction catheter while rotating it backand forth between dominant thumb and forefinger. Apply

intermittent suction of the air vent during withdrawal.

17. Rinse catheter and connecting tubing with sterile water or

saline.18. Suction both sides of mouth and pharynx.

19. Repeat steps 15 through 18 to clear nasopharynx and

oropharynx.

20. Monitor patients ECG tracing and heart rate between

suction passes.

21. Dispose of catheter and gloves.

22. Reposition patient.

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23. Reassess patients respiratory status.24. Discard remainder of supplies in appropriate receptacle.

25. Wash hands.

26. Dispose of suction canisters and connecting tubing every 24

hours and set up new system.

Endotracheal Suctioning

1 2 3 4 5 Comments

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Indication: It is performed to remove blood or secretionfrom the endotracheal tube.

Equipment :

1- Suction catheter.

2- Suction tubing.

3- Suction device.4- Sterile irrigating solution.

5- Sterile gloves mask.

6- Water-soluble lubricant or sterile water.

7- Oxygen source.8- Bag-valve device.

Procedure1. Explain to the child and the family the need for

endotracheal suctioning, as time permits.

2. Note the childs cardiac monitor and pulse Oximetry

readings.

3. Wash your hands thoroughly with Betadine, don gloves

and mask.

4. Connect suction catheter to the tubing of the suction

device and set the suction pressures to the desired negative

pressure according to child age5. Ventilate the child with 100 % oxygen for 3

hyperinflation, hyper oxygenation with a bag valve device6. Lubricate the appropriate size of catheter with sterile

water.

7. Without applying suction, quickly and gently insert

catheter into the endotracheal tube and apply suction whilerotating the catheter between the thumb and forefinger. and

use a septic technique.

8. Apply suction by occluding the on / off port, and gentlywithdrawing the catheter with a twisting motion.

* Limit suction not more than 5 seconds.

9. After withdrawal of catheter, rinse it with sterile water.

10. Ventilate child in-between and after attempts with 100 %oxygen.

11. Monitor childs heart rate, color throughout theprocedure.

12. Repeat steps 7-11 as needed.

13. Return child to previous oxygen setting, auscultate

anterior lungs bilaterally.

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14. Comfort child during and after procedure.15. Discard reminder of equipment according to institution

policies.

16. Document the childs response to suctioning, the type

and amount of suctioned secretions, any changes in heart andrespiratory rates

Oxygen Therapy Through Simple Face Mask

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1 2 3 4 5 CommentsPurposes :

1- To prevent or relieve hypoxia.2- To keep healthy level of tissue

oxygenation.

Equipment :

1- Oxygen source

2- Flow meter.3- Humidifier with distilled water

4- Connecting tube (except in using nasal

cannula)

5- Selected device for oxygen administration(face mask, nasal cannula, incubator or

oxygen hood)

Action

1. Wash hands.

2. Attach humidifier to flow meter.

3. Connect flow meter to oxygen source, andcheck operation of flow meter and humidifier.

Set prescribed oxygen flow.

4. Attach oxygen mask to connecting tubing and

then to humidifier and flow meter.

5. Turn on oxygen.6. Place mask on patients mouth and nose, adjust

elastic or tubing for a snug fit.

7. Check oxygen flow.

8. Stress fire hazards involved with oxygen

administration.

9. Wash hands.

Oxygen Therapy Through Nasal Cannula

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Instructors Names:

Date:

Area:

Group:

1 2 3 4 5 Comments

Purposes :

3- To prevent or relieve hypoxia.

4- To keep healthy level of tissueoxygenation.

Equipment :

6- Oxygen source

7- Flow meter.

8- Humidifier with distilled water

9- Connecting tube (except in using nasal

cannula)10- Selected device for oxygen administration

(face mask, nasal cannula, incubator oroxygen hood)

Action

1. Wash hands.

2. Attach humidifier to flow meter.

3. Connect flow meter to oxygen source, and

check operation of flow meter and humidifier.

4. Open cannula package and attach to humidifier

with care to avoid contamination of cannula

nasal tips.5. Turn oxygen flow meter on to prescribed literflow/ oxygen concentration prior to applying

cannula. Observe that water in humidification

container is bubbling.

6. Insert the nasal tips into the nares. Direct

prongs posteriorly.

7. Loop the two plastic tubes of the cannula over

the ears and under the chin, or place elastic band

around the head.

8. Gently adjust the plastic slide until cannula is

secure.9. Wash hands.

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Instructors Names:

Date:

Area:

Group:

Closed incubators / Isolettes

1 2 3 4 5 Comments

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 prevents 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 the incubator ifmist therapy is desired.

4. Keep sleeves of incubator closed to prevent loss of

oxygen.

5. Periodically analyze the incubator atmosphere.

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Instructors Names:

Date:

Area:

Group:

Oxygen Hood

1 2 3 4 5 Comments

1. Warmed, humidified oxygen is supplied through a plasticcontainer that fits over the childs head.

2. Continuously monitor the oxygen concentration,temperature, and humidity inside the hood.

3. Open the hood or remove the baby from it as infrequentlyas possible.

4. Several different designs are available for use. The

manufacturers directions should be carefully followed.

evaluation criteria checklist

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