Infermeria pediàtrica / No disponible

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Tratamiento del trastorno por déficit de atención e hiperactividad (tdah). Implicaciones para enfermería / Treatment of attention deficit and hyperactivity disorder (adhd): nursing implications

OBJETIVO. Esta revisión pretende conocer el papel de la enfermera en el tratamiento del TDAH, identificando las opciones terapéuticas más adecuadas entre las intervenciones de enfermería y el tratamiento farmacológico. DESARROLLO. En el TDAH, la labor de la enfermera es responder a las necesidades de las familias acerca de la eficacia de la medicación, el tratamiento de modificación del comportamiento y otras alternativas menos ortodoxas. Se plantean intervenciones de psicoeducación con la familia que favorecen el proceso de recuperación del niño. A través de la Educación para la Salud, la enfermera debe promocionar la combinación del tratamiento comportamental y farmacológico como el único capaz de mejorar la calidad de vida del niño. CONCLUSIONES. Las enfermeras tienen un rol privilegiado por su experiencia en la Educación para la Salud; esto contribuye a que sean un agente competente para proporcionar a las familias información indispensable sobre el tratamiento de la enfermedad. Las escuelas españolas carecen de una figura que represente la salud como una asignatura relevante en el proceso vital, de ahí la necesidad de la enfermera escolar (AU)

OBJECTIVE. This review aims to know the role of the nurse in ADHD treatment, identifying the most appropriate therapeutic options between nursing interventions and pharmacological treatment. DEVELOPMENT. In ADHD, the role of the nurse is to respond family needs about the effectiveness of medication, behavior modification treatment and other alternatives. There are family interventions of psychoeducation that assist the child in the recovery process. Through the education for health, the nurse should promote the combination of behavioral therapy and pharmacological as the only one able to improve child’s quality of life. CONCLUSIONS. Nurses have a privileged role due to its experience in education for health; this contributes to being a competent agent that provides families essential information about the disease treatment. Spanish schools are lacking a figure that represent health as a relevant subject in the vital process, hence the need of the school nurse (AU)

Determining fever in children: the search for an ideal thermometer.

Body temperature measurement is most commonly taken to confirm the presence or absence of fever. Many decisions concerning the investigation and treatment of children are based on the results of temperature measurement alone. Determining the presence of fever in young children is particularly important. A missed fever is serious, but a false-positive fever reading can result in unnecessary septic workups. The axillary, rectal, oral and tympanic membrane sites are most commonly used to record body temperature, and electronic and infrared thermometers are the devices most commonly used. Each site and device has numerous advantages and disadvantages, which are described in this article. The search for the means of measuring body temperature that best combines accuracy, speed, convenience, safety and cost-effectiveness goes on. The infrared thermometer and the tympanic site appear to offer such a combination. Electronic thermometers are also suitable when used orally or at the axilla in newborn babies.

Cuidados enfermeros finalistas. Identificación en un servicio de urgencias pediátrico de atención primaria / Dentification of finalist nursing care in a pediatric emergency department of primary care

Objetivo. Describir la demanda en cuidados en un servicio de urgencias pediátricas de atención primaria para identificar áreas potenciales de atención finalista enfermera. Método. Estudio descriptivo prospectivo en 385 niños de 0 a 14 años seleccionados al azar. Se valoró sexo, edad, motivos de consulta, nivel de urgencia, protocolos de cuidados y tratamientos previos a la atención médica, observación, educación sanitaria, duración y demora en la atención, complicaciones durante la espera y necesidades de derivación. Los cálculos se realizaron con SPSS 17.0. Resultados. La muestra comprendió 380 niños, 63%varones, en edades de 3 (0,5-11) años. La demora en triaje fue de 4 (0-15) minutos y la duración de 5 (2-7). Los motivos de consulta indicaron fiebre 54 (49-59)%, tos 45 (40-50)%, dolor 14 (11-17)%, lesiones en piel/mucosas 13 (10-16)%, vómitos 10 (7-13)%. La distribución por niveles fue para nivel 2 de triaje 5 (3-7)%, nivel 3, 23 (19-27)%, nivel 4, 28 (26-30)% y nivel 5, 44 (39-49)%. Los protocolos de cuidados fueron fiebre 20 (16-24)%, dificultad respiratoria y vómitos/diarreas 7 (4-10)% y, dolor 3 (1-5) %. En un 20% la enfermera inició tratamiento previo a la consulta. Un 22% permaneció en observación. El 20% recibió educación sanitaria. Se produjo un 3% de complicaciones con bajo impacto clínico. El 2% precisó derivación. El 53% de los motivos de consultas clasificados como no graves resultó susceptible de atención finalista por la enfermera. Discusión. Los resultados amplían las perspectivas de abordaje finalista de la enfermera en resolución de problemas de salud. Se identifican tres áreas finalistas: con protocolización mínima, previo desarrollo de protocolos y algoritmos de decisión, y con limitaciones según marco legal vigente (AU)

Objective: To describe the characteristics of care in a pediatric emergency service to identify potential finalist nursing areas. Method: Cross-sectional study in 385 randomly selected patients. Sex, age, municipality of residence, kinship companion, reasons for consultation, level of urgency, care and treatment protocols prior to medical care, observation, health education, delay in care, complications during the wait, duration of care and referral needs is assesed. The calculations were performed using SPSS 17.0. Results: The sample included 380 children, 63% male, ages 3 (0.5-11) years. Delay in triage was 4 (0-15) minutes and the duration of 5 (2-7). The reasons for consultation were fever 54 (49-59)%, cough 45(40-50)%, pain 14 (11-17)%, skin/mucous lesions 13 (10-16)%, vomiting 10 (7-13)%. The level distribution was for 2th triage level 5 (3-7)%, 3th level 23(19-27)%, 4th level 28 (26-30)% and 5th level 44 (39-49)%. Care protocols were fever 20 (16-24)%, respiratory distress and vomiting/diarrhea, 7 (4-10)% and pain 3 (1-5)%. In 20% the nurse start treatment prior to consultation. 22% remained under observation. 20% received health education. There were 3% of complications. The 2% accurate referral. The 53% of the reasons for non-serious inquiries are classified as susceptible finalist care by nurse. Discussion: The results expand the perspectives of finalist nursing areas. Three finalists areas are identified: with minimal protocols, previous protocol development and decision algorithms and, with limitations by actual legal framework (AU)

A história infantil como recurso para a compreensão do processo saúde-doença pela criança com HIV / The children's story as a resource for understanding the health-disease process for children with HIV

O viver das crianças portadoras do vírus do HIV é marcado por especificidades que dizem respeito ao estigma, preconceito e silêncio sobre a condição de saúde, os quais interferem na sua participação no processo terapêutico. A partir desta questão, criou-se uma história infantil cuja temática envolve o processo saúde-doença relacionado ao HIV/ aids na infância. O estudo em pauta, de cunho qualitativo, tem o objetivo de analisar de como a história infantil que aborde questões relacionadas ao HIV/aids (uso contínuo de medicação, sigilo, segredo, efeitos colaterais, exames, internações, entre outros) contribui para a compreensão do processo saúde-doença para a criança com HIV. Realizado no ambulatório de pediatria do Hospital Conceição em Porto Alegre/RS, no período entre maio e dezembro de 2011, o estudo contou com cinco crianças participantes, com idades entre sete e 10 anos, e seus cuidadores. Para a coleta de dados utilizou-se a técnica de grupo focal e entrevista. Os dados foram analisados mediante análise temática de conteúdo em que emergiram duas categorias: 1) Identificação com a história e a relação com o processo saúde-doença das quais derivaram as subcategorias: situações do cotidiano, vivências e perspectivas; 2) Compreensão da história e do processo saúde-doença, com suas subcategorias: conhecimentos prévios, apreensão e somando conhecimentos. Os resultados demonstraram que mediante a contação de histórias é possível conversar com as crianças sobre o processo saúde-doença sem revelar o diagnóstico, levando-as a compreenderem esse processo e a importância do tratamento. A interação com a história, por meio de catarse, permitiu a identificação de suas vidas com as das personagens e com seus projetos de vida. Percebeu-se que a história infantil pode ser um dos recursos para auxiliar pais, demais cuidadores, e profissionais da saúde envolvidos com a aids infantil a iniciar ou desencadear o processo de revelação do diagnóstico para a criança.

A biomedical device to improve pediatric vascular access success.

PURPOSE: to evaluate the effectiveness of a vein-viewing device on the success of venipunctures performed by staff nurses on a pediatric surgical unit. METHOD: this prospective, non-randomized study examined pediatric inpatients from the age of newborn to 17 years requiring vascular access at a tertiary care center in northeast Florida. The number of attempts, age of the patient, and time required to establish successful vascular access using a vein-viewing device were self-reported by nursing staff (experimental group, n = 91, mean age 9 years, range 3 days to 17 years) as well as staff, patient, and parental comments about the device. These data were compared to baseline data (control group, n = 150, mean age 5.7 years, range 11 days to 17 years) previously collected on the same unit without using the device. The outcome variables were first-attempt success rate, the number of attempts per patient, and the time to procedure completion. FINDINGS: when comparing the two groups, the first-attempt success rate increased from 49.3% to 80.2%, the mean number of attempts per patient decreased from 1.97 to 1.29, and the percentage of procedures completed in 15 minutes or less increased from 52.8% to 86.7%. Results were statistically significant for all outcome variables between the two groups and also when re-analyzed in subgroups controlling for age. CONCLUSIONS: use of a vein-viewing device significantly improved first-attempt venipuncture success rate, decreased the number of attempts per patient, and decreased procedure time for the study population. The device was well received by patients, families, and staff.

Seizure precautions for pediatric bedside nurses.

Seizures are a common neurologic disorder of childhood, and many pediatric nurses will care for children with epilepsy during their careers. The term "seizure precautions" is used frequently in nursing practice; however, its definition varies among institutions. Childhood epilepsy has many phenotypes, and while some children require airway clearance and ventilatory support in the event of a seizure, many will not. The bedside equipment for a child with seizures should reflect the patient's symptoms. To that end, an algorithm based on seizure classification and current practice in seizure precautions is presented to aid bedside nurses in safely caring for children with seizures. The algorithm may also be used to assist in educating parents about the safest way to care for their child at home, without sending contradictory messages about different needs for equipment in the hospital and in the home.

Superficie especial del manejo de la presión (SEMP) pediátrica(I). Características e idoneidad / Special therapeutic surfaces for handling pressure in pediatrics (I). Characteristics and competency

Las UPP en la población pediátrica constituyen un efecto adverso demasiado común provocado por la aplicación de las nuevas tecnologías adaptadas al contexto pediátrico. Las Superficies Especiales del Manejo de la Presión (SEMP) suponen una medida preventiva efectiva en la población adulta. Pero el uso de SEMP de adultos en niños constituye un error grave que puede, incluso, perjudicar al paciente pediátrico. Se considera un error por las diferencias entre las medidas antropométricas de los niños y los adultos y el diseño particular de las SEMP de adultos. Para que la población pediátrica se vea favorecida por esta medida preventiva se han de adaptar a sus circunstancias propias. En esta línea, el uso de SEMP estáticas en pacientes de riesgo ha demostrado una mejor relación coste-beneficio, mayor grado de comodidad y mayor grado de seguridad que las dinámicas. Para asignar la más adecuada debemos conocer sus características propias, así como las del paciente pediátrico. El mejor complemento de las SEMP son los dispositivos locales de alivio de la presión, preferiblemente aquellos que cumplen la normativa nacional sobre productos sanitarios(AU)

Bed sores among pediatric patients constitutes an all too common adverse effect provoked by the application of new technologies adapted to a pediatrics context. Special Therapeutic Surfaces for Handling Pressure has proven to be an effective measure among adults. But the use of Special Therapeutic Surfaces for Handling Pressure for adults on children constitutes a grave error which can even be prejudicial for a pediatric patient. This is deemed an error due to the differences in anthropometrical measures between children and adults plus the specific design of Special Therapeutic Surfaces for Handling Pressure for adults. So that pediatric patients are benefited by this preventive measure, this measure must be adapted to pediatrics own specific circumstances. Along this line, the use of static Special Therapeutic Surfaces for Handling Pressure on patients at risk has proven to have a better cost-benefit ratio, a greater degree of comfort, and a greater degree of security than dynamic ones. To apply the most adequate Special Therapeutic Surfaces for Handling Pressure, we need to their specific characteristics as well as those of a pediatric patient. The best complement to Special Therapeutic Surfaces for Handling Pressure Special Therapeutic Surfaces for Handling Pressure are local devices which provide relief to pressure, preferably those which comply with the national norms for health products(AU)

Reliability of a computerized version of the Pediatric Canadian Triage and Acuity Scale.

BACKGROUND: The use of a standardized triage tool allows better comparison of the patients; a computerized version could theoretically improve its reliability. OBJECTIVES: To compare the interrater agreement of the Pediatric Canadian Triage and Acuity Scale (PedCTAS) and a computerized version (Staturg). METHODS: A two-phase experimental study was conducted to compare the interrater agreement between nurses assigning triage level to written case scenarios using either traditional PedCTAS or Staturg. Participants were nurses with at least one year of experience in pediatric emergency medicine and trained at triage. Each of the 54 scenarios was evaluated first by all nurses using either one of the strategies. Four weeks later, they evaluated the same scenarios using the other tool. The primary outcome was the interrater agreement measured using kappa score. RESULTS: Eighteen of the 29 eligible nurses participated in the study. The computerized triage tool showed a better interrater agreement, with a Staturg kappa score of 0.55 (95% confidence interval = 0.53 to 0.57) versus a PedCTAS kappa score of 0.51 (95% confidence interval = 0.49 to 0.53). The computerized version was also associated with higher agreements for scenarios describing patients with the highest severity of triage (kappa score of 0.72 vs. 0.55 for level 1; kappa score of 0.70 vs. 0.51 for level 2). CONCLUSIONS: A computerized version of the PedCTAS showed a statistically significant improvement in the interrater agreement for nurses evaluating the triage level of 54 clinical scenarios, but this difference has probably small clinical significance.

The Health Utilities Index 3 invalidated when completed by nurses for pediatric oncology patients.

When health-related quality of life instruments developed for and validated in 1 respondent group are completed by a different respondent group, findings could be invalid. The purpose of this study was to summarize the instrument outcomes when a widely used health-related quality of life instrument (the Health Utilities Index 3 [HUI3]) created from a population-based strategy was completed by pediatric oncology nurses for their patients during cancer treatment. Fifty-four nurses completed the HUI3 a total of 261 times at 1 to 3 sequential data points (106, 94, and 61, respectively) for pediatric patients who were enrolled on a frontline therapeutic clinical trial for acute lymphoblastic leukemia. Data were collected at 2 children's hospitals. HUI3 scores could not be calculated for 52% to 61% of the nurse reports at each of the 3 data points because of nurses' use of the "do not know" response option. Missing data of this proportion indicate that the nurse serving as a proxy rater independent of directly soliciting responses from the patient will not be able to rate certain attributes of the HUI3 more than half of the time despite having ongoing familiarity with the patient. Because of this, use of the HUI3 by nurse proxies for patients with pediatric acute lymphoblastic leukemia is not recommended.

Handwashing practice and policy variability when caring for central venous catheters in paediatric intensive care.

It has been estimated that there may be as many as 150,000 healthcare associated infections (HCAI) in Australia each year, contributing to 7,000 deaths, many of which could be prevented through the implementation of appropriate infection control practices. Contact with contaminated hands is a primary source of HCAI. Intensive care staff have been identified as one of the least adherent groups of health care professionals with handwashing; they are less likely to practise hand antisepsis before invasive procedures than staff working in other patient care specialties. The study examined the self-reported clean and aseptic handwashing practices of nurses working in paediatric intensive care units (PICUs) across Australia and New Zealand, the patterns in variation between nurses' reported handwashing practices and the local policies, and patterns in the duration of procedural handwashing for specific procedures. A survey was undertaken in 2001 in which participating tertiary paediatric hospitals provided copies of their infection control policies pertaining to central venous catheter (CVC) management; five nurses on each unit were asked to provide information in relation to their handwashing practices. Seven hospitals agreed to participate and 30 nurses completed the survey. The study found an enormous level of variation among and between nurses' reported practices and local policies. This variation extended across all aspects of handwashing practices - duration and extent of handwash, type of solution and drying method used. The rigour of handwashing varied according to the procedure undertaken, with some evidence that nurses made their own risk assessments based on the proximity of the procedure to the patient. In conclusion, this study's findings substantiate the need for standardisation of practice in line with the current Centers for Disease Control and Prevention Guidelines, including the introduction of alcohol handrub.

Comparison of 1- versus 2-person bag-valve-mask techniques for manikin ventilation of infants and children.

STUDY OBJECTIVE: We compare the mean tidal volumes per weight and peak pressures generated by the 1- and 2-person techniques of bag-valve-mask ventilation in a pediatric model. METHODS: This was a prospective, descriptive study in which postgraduate year 1, postgraduate year 2, and postgraduate year 3 pediatric residents, postgraduate year 2 emergency medicine residents, pediatric emergency department nurses, transport personnel, and paramedics were asked to perform 1- and 2-person bag-valve-mask ventilation on infant and child manikins. Participants were randomly assigned a partner and performed both techniques. Tidal volume and peak pressure were recorded every 15 seconds for 3 minutes by a blinded assistant. RESULTS: Seventy participants, 10 in each group, completed the study. Overall, for the infant- and child-manikin groups, the 2-person technique generated higher mean tidal volume per weight than the 1-person technique (infant: 7.2 versus 5.9; child: 8.8 versus 6.1). Overall, the 2-person technique generated higher mean peak pressures than the 1-person technique (infant: 27.4 versus 22.0; child: 27.2 versus 21.8). Similar results were found among all provider groups. Paramedics were the only providers able to generate a recommended median tidal volume per weight of 10 mL/kg in the child manikin group when using either technique and were the only providers, when using the 2-person technique, to generate a mean tidal volume per weight of 10 mL/kg in the infant group. CONCLUSION: Two-person bag-valve-mask ventilation provided greater mean tidal volumes per weight and peak pressures in the infant- and child-manikin model compared with the 1-person technique.

Tracheostomy management.

Even though care of children with tracheostomies may differ between hospitals, there are basic principles and procedures that all nurses should be aware of including how to respond in an emergency.