Pediatric Variations of Nursing interventions

Pediatric Variations of Nursing interventions 150 150 Tony Guo

Pediatric Variations of Nursing interventions

  • General concept related to pediatric procedures
    • Informed consent
      • The person must be capable of giving consent: Age at majority (usually age 18)
      • The person must receive the information needed to make an intelligent decision
      • The person must act voluntarily when exercising freedom of choice
    • Requirements for obtaining informed consent
      • Separate informed permissions must be obtained for each surgical or diagnostic procedure, including
        • Major surgery
        • Minor surgery (e.g., cutdown, biopsy, dental extraction, suturing a laceration [especially one that may have a cosmetic effect], removal of a cyst, closed reduction of a fracture)
        • Diagnostic tests with an element of risk (e.g., bronchoscopy, angiography, lumbar puncture, cardiac catheterization, bone marrow aspiration)
        • Medical treatments with an element of risk (e.g., blood transfusion, thoracentesis or paracentesis, radiotherapy)
      • Other situations that require patient or parental consent include the following:
        • Photographs for medical, educational, or public use
        • Removal of the child from the health care institution against medical advice
        • Postmortem examination, except in unexplained deaths, such as sudden infant death, violent death, or suspected suicide
        • Release of medical information
      • Assent should include:
        • Helping the patient achieve a developmentally appropriate awareness of the nature of his or her condition
        • Telling the patient what he or she can expect
        • Making a clinical assessment of the patient’s understanding
        • Soliciting an expression of the patient’s willingness to accept the proposed procedure
      • Parents have full responsibility for rearing of their minor children, including legal control over them.
      • If children are minors, their parents or legal guardians are required to give informed consent before medical treatment is rendered or any procedure is pre-formed. 
      • If the parents are married to each other, consent from only one parent is require in nonurgent pediatric care. 
      • If parents are divorced, consent goes to who has legal custody.
    • Preparation for diagnostic and therapeutic procedures
      • Psychologic preparation
        • Selecting nonthreatening words or phrases
Words and Phrases to Avoid Suggested Substitutions
Shot, bee sting, stick Medicine under the skin
Organ Special place in body
Test To see how (specify body part) is working
Incision, cut Special opening
Edema Puffiness
Stretcher, gurney Rolling bed, bed on wheels
Stool Child’s usual term
Dye Special medicine
Pain Hurt, discomfort, “owie,” “boo-boo,” sore, achy, scratchy
Deaden Numb, make sleepy
Fix Make better
Take (as in “take your temperature”) See how warm you are
Take (as in “take your blood pressure”) Check your pressure; hug your arm
Put to sleep, anesthesia Special sleep so you won’t feel anything
Catheter Tube
Monitor Television screen
Electrodes Stickers, ticklers
Specimen Sample


  • Age-specific guidelines for preparation
    • Infant: Developing trust and sensorimotor thought
      • Attachment to Parent
        • Involve parent in procedure if desired.
        • Keep parent in infant’s line of vision.
        • If parent is unable to be with infant, place familiar object with infant (e.g., stuffed toy).
      • Stranger Anxiety
        • Have usual caregivers perform or assist with procedure.
        • Make advances slowly and in a nonthreatening manner.
        • Limit number of strangers entering room during procedure.
      • Sensorimotor Phase of Learning
        • During procedure, use sensory soothing measures (e.g., stroking skin, talking softly, giving pacifier).
        • Use analgesics (e.g., topical anesthetic, intravenous [IV] opioid) to control discomfort.
        • Cuddle and hug infant after stressful procedure; encourage parent to comfort infant.
      • Increased Muscle Control
        • Expect older infants to resist.
        • Restrain adequately.
        • Keep harmful objects out of reach.
      • Memory for Past Experiences
        • Realize that older infants may associate objects, places, or people with prior painful experiences and will cry and resist at the sight of them
        • Keep frightening objects out of view.
        • Perform painful procedures in a separate room, not in crib (or bed).
        • Use nonintrusive procedures whenever possible (e.g., axillary or tympanic temperatures, oral medications).
      • Imitation of Gestures
        • Model desired behavior (e.g., opening mouth).
    • Toddler: Developing Autonomy and Sensorimotor to Preoperational Thought
    • Use same approaches as for infant plus the following.
      • Egocentric Thought
        • Explain procedure in relation to what child will see, hear, taste, smell, and feel.
        • Emphasize those aspects of procedure that require cooperation (e.g., lying still).
        • Tell child it is okay to cry, yell, or use other means to express discomfort verbally.
        • Designate one health care provider to speak during procedure. Hearing more than one can be confusing to a child*
      • Negative Behavior
        • Expect treatments to be resisted; child may try to run away.
        • Use firm, direct approach.
        • Ignore temper tantrums.
        • Use distraction techniques (e.g., singing a song with child).
        • Restrain adequately.
      • Animism
        • Keep frightening objects out of view (young children believe objects have lifelike qualities and can harm them).
      • Limited Language Skills
        • Communicate using gestures or demonstrations.
        • Use a few simple terms familiar to child.
        • Give child one direction at a time (e.g., “Lie down” and then “Hold
        • my hand”).
        • Use small replicas of equipment; allow child to handle equipment.
        • Use play; demonstrate on doll but avoid child’s favorite doll because child may think doll is really “feeling” procedure.
        • Prepare parents separately to avoid child’s misinterpreting words.
      • Limited Concept of Time
        • Prepare child shortly or immediately before procedure.
        • Keep teaching sessions short (≈5 to 10 minutes).
        • Have preparations completed before involving child in procedure.
        • Have extra equipment nearby (e.g., alcohol swabs, new needle, adhesive bandages) to avoid delays.
        • Tell child when procedure is completed.
      • Striving for Independence
        • Allow choices whenever possible but realize that child may still be resistant and negative.
        • Allow child to participate in care and to help whenever possible (e.g., drink medicine from a cup, hold a dressing).
    • Preschooler: Developing Initiative and Preoperational Thought
      • Egocentric
        • Explain procedure in simple terms and in relation to how it affects child (as with toddler, stress sensory aspects).
        • Demonstrate use of equipment.
        • Allow child to play with miniature or actual equipment.
        • Encourage “playing out” experience on a doll both before and after procedure to clarify misconceptions.
        • Use neutral words to describe the procedure.
      • Increased Language Skills
        • Use verbal explanation but avoid overestimating child’s comprehension of words.
        • Encourage child to verbalize ideas and feelings.
      • Limited Concept of Time and Frustration Tolerance
        • Implement same approaches as for toddler but may plan longer teaching session (10 to 15 minutes); may divide information into more than one session.
      • Illness and Hospitalization Viewed as Punishment
        • Clarify why each procedure is performed; child will find it difficult to understand how medicine can make him or her feel better and can taste bad at the same time.
        • Ask child thoughts regarding why a procedure is performed.
        • State directly that procedures are never a form of punishment.
      • Animism
        • Keep equipment out of sight except when shown to or used on child.
      • Fears of Bodily Harm, Intrusion, and Castration
        • Point out on drawing, doll, or child where procedure is performed.
        • Emphasize that no other body part will be involved.
        • Use nonintrusive procedures whenever possible (e.g., axillary temperatures, oral medication).
        • Apply an adhesive bandage over puncture site.
        • Encourage parental presence.
        • Realize that procedures involving genitalia provoke anxiety.
        • Allow child to wear underpants with gown.
        • Explain unfamiliar situations, especially noises or lights.
      • Striving for Initiative
        • Involve child in care whenever possible (e.g., hold equipment, remove dressing).
        • Give choices whenever possible but avoid excessive delays.
        • Praise child for helping and attempting to cooperate; never shame child for lack of cooperation.
    • School-Age Child: Developing Industry and Concrete Thought
      • Increased Language Skills; Interest in Acquiring Knowledge
        • Explain procedure using correct scientific and medical terminology.
        • Explain procedure using simple diagrams and photographs.
        • Discuss why procedure is necessary; concepts of illness and bodily functions are often vague.
        • Explain function and operation of equipment in concrete terms.
        • Allow child to manipulate equipment; use doll or another person as model to practice using equipment whenever possible (doll play may be considered childish by older school-age child).
        • Allow time before and after procedure for questions and discussion.
      • Improved Concept of Time
        • Plan for longer teaching sessions (≈20 minutes).
        • Prepare up to 1 day in advance of procedure to allow for processing of information.
      • Increased Self-Control
        • Gain child’s cooperation.
        • Tell child what is expected.
        • Suggest several ways of maintaining control the child may select from (e.g., deep breathing, relaxation, counting).
      • Striving for Industry
        • Allow responsibility for simple tasks (e.g., collecting specimens).
        • Include child in decision making (e.g., time of day to perform procedure, preferred site).
        • Encourage active participation (e.g., removing dressings, handling equipment, opening packages).
      • Developing Relationships With Peers
        • Prepare two or more children for same procedure or encourage one to help prepare another.
        • Provide privacy from peers during procedure to maintain self-esteem.
    • Adolescent: Developing Identity and Abstract Thought
      • Increasing Abstract Thought and Reasoning
        • Discuss why procedure is necessary or beneficial.
        • Explain long-term consequences of procedures; include information about body systems working together.
        • Realize adolescent may fear death, disability, or other potential risks.
        • Encourage questioning regarding fears, options, and alternatives.
      • Consciousness of Appearance
        • Provide privacy; describe how the body will be covered and what will be exposed.
        • Discuss how procedure may affect appearance (e.g., scar) and what can be done to minimize it.
        • Emphasize any physical benefits of procedure.
      • Concern More with Present Than With Future
        • Realize that immediate effects of procedure are more significant than future benefits.
      • Striving for Independence
        • Involve adolescent in decision making and planning (e.g., time, place, individuals present during procedure, clothing, whether they will watch procedure).
        • Impose as few restrictions as possible.
        • Explore what coping strategies have worked in the past; they may need suggestions of various techniques.
        • Accept regression to more childish methods of coping.
        • Realize that adolescents may have difficulty accepting new authority figures and may resist complying with procedures.
      • Developing Peer Relationships and Group Identity
        • Same as for school-age child but assumes even greater significance.
        • Allow adolescents to talk with other adolescents who have had the same procedure.
  • Developmental and cognitive ability
  • Establish trust and provide support
  • Parental presence and support
    • Support parents who do not want to be present in their decision and encourage them to remain close by so that they can be available to support the child immediately after the procedure. 
    • Parents should also know that someone will be with their child to provide support. 
      • This person should inform the parents after the procedure about how the child did.
  • Provide an explanation
    • Age-appropriate explanations
  • Physical preparation
    • Preparing children for procedures
      • Determine details of exact procedure to be performed.
      • Review parents’ and child’s present understanding.
      • Base teaching on developmental age and existing knowledge.
      • Incorporate parents in the teaching if they desire, especially if they plan to participate in care.
      • Inform parents of their supportive role during procedure, such as standing near child’s head or in child’s line of vision and talking softly to child, as well as typical responses of children undergoing the procedure.
      • Allow for ample discussion to prevent information overload and ensure adequate feedback.
      • Use concrete, not abstract, terms and visual aids to describe procedure. For example, use a simple line drawing of a boy or girl, and mark the body part that will be involved in the procedure. Use nonthreatening but realistic models.
      • Emphasize that no other body part will be involved.
      • If the body part is associated with a specific function, stress the change or noninvolvement of that ability (e.g., after tonsillectomy, child can still speak).
      • Use words and sentence length appropriate to child’s level of understanding (a rule of thumb for the number of words in a child’s sentence is equal to his or her age in years plus 1).
      • Avoid words and phrases with dual meanings unless child understands such words.
      • Clarify all unfamiliar words (e.g., “Anesthesia is a special sleep”).
      • Emphasize sensory aspects of procedure—what child will feel, see, hear, smell, and touch and what child can do during procedure (e.g., lie still, count out loud, squeeze a hand, hug a doll).
      • Allow child to practice procedures that will require cooperation (e.g., turning, deep breathing, using incentive spirometry).
      • Introduce anxiety-inducing information last (e.g., starting an intravenous [IV] line).
      • Be honest with child about unpleasant aspects of a procedure but avoid creating undue concern. When discussing that a procedure may be uncomfortable, state that it feels differently to different people.
      • Emphasize end of procedure and any pleasurable events afterward (e.g., going home, seeing parents).
      • Stress positive benefits of procedure (e.g., “After your tonsils are fixed, you won’t have as many sore throats”).
      • Provide a positive ending, praising efforts at cooperation and coping.
  • Performance of the procedure
    • Expect success
      • Approach children with confidence and convey the impression that you expect to be successful
    • Involve the child
      • Permitting choices gives them some measure of control.
        • But don’t state “Do you want to take your medicine now?” leads them to believe they have an option and provides them the opportunity to legitimately refuse or delay the medication.
        • Instead be firm, “It’s time to drink your medicine now.” 
          • Children usually like to make choices, but the choice must be one that they do indeed have (e.g., “It’s time for your medicine. Do you want to drink it plain or with a little water?”).
    • Provide distraction
    • Allow expression of feelings
  • Postprocedural support
    • Encourage expression of feelings
      • Playing with medical objects provides children with the opportunity to play out fears and concerns with supervision by a nurse or child life specialist
    • Positive reinforcement
      • Children need to hear from adults that they did the best they could in the situation—no matter how they behaved. 
      • It is important for children to know that their worth is not being judged based on their behavior in a stressful situation. 
        • Reward systems, such as earning stars, stickers, or a badge of courage, are appealing to children.
    • Play activities for specific procedures
      • Fluid Intake
        • Make ice pops using child’s favorite juice.
        • Cut gelatin into fun shapes.
        • Make a game out of taking a sip when turning page of a book or in games, such as Simon Says.
        • Use small medicine cups; decorate the cups.
        • Color water with food coloring or powdered drink mix.
        • Have a tea party; pour at a small table.
        • Let child fill a syringe and squirt it into mouth, or use it to fill small, decorated cups.
        • Cut straws in half, and place in a small container (much easier for child to suck liquid).
        • Use a “crazy” straw.
        • Make a “progress poster;” give rewards for drinking a predetermined quantity.
      • Deep Breathing
        • Blow bubbles with a bubble blower.
        • Blow bubbles with a straw (no soap).
        • Blow on a pinwheel, feather, whistle, harmonica, balloon, or party blower.
        • Practice band instruments.
        • Have a blowing contest using balloons, boats, cotton balls, feathers, marbles, ping-pong balls, or pieces of paper; blow such objects on a tabletop over a goal line, over water, through an obstacle course, up in the air, against an opponent, or up and down a string.
        • Suck paper or cloth from one container to another using a straw.
        • Dramatize stories, such as “I’ll huff and puff and blow your house down” from the “Three Little Pigs.”
        • Do straw-blowing painting.
        • Take a deep breath and “blow out the candles” on a birthday cake.
        • Use a little paint brush to “paint” nails with water and blow nails dry.
      • Range of Motion and Use of Extremities
        • Throw beanbags at a fixed or movable target or throw wadded-up paper into a wastebasket.
        • Touch or kick Mylar balloons held or hung in different positions (if child is in traction, hang balloon from a trapeze).
        • Play “tickle toes;” have the child wiggle them on request.
        • Play Twister game or Simon Says.
        • Play pretend and guessing games (e.g., imitate a bird, butterfly, or horse).
        • Have tricycle or wheelchair races in a safe area.
        • Play kickball or throw ball with a soft foam ball in a safe area.
        • Position bed so that child must turn to view television or doorway.
        • Climb wall with fingers like a “spider.”
        • Pretend to teach aerobic dancing or exercises; encourage parents to participate.
        • Encourage swimming if feasible.
        • Play video games or pinball (fine motor movement).
        • Play hide and seek: hide toy somewhere in bed (or room if ambulatory), and have child find it using specified hand or foot.
        • Provide clay to mold with fingers.
        • Paint or draw on large sheets of paper placed on floor or wall.
        • Encourage combing own hair; play “beauty shop” with “customer” in different positions.
      • Soaks
        • Play with small toys or objects (cups, syringes, soap dishes) in water.
        • Wash dolls or toys.
        • Pick up marbles or pennies* from bottom of bath container.
        • Make designs with coins on bottom of container.
        • Pretend a boat is a submarine by keeping it immersed.
        • Read to child during soaks; sing with child; or play game, such as cards, checkers, or other board game (if both hands are immersed, move board pieces for child).
        • Sitz bath: Give child something to listen to (music, stories) or look at (View-Master, book).
        • Punch holes in bottom of plastic cup, fill with water, and let it “rain” on child.
      • Injections
        • Let child handle syringe, vial, and alcohol swab and give an injection to doll or stuffed animal.
        • Draw a “magic circle” on area before injection; draw smiling face in circle after injection but avoid drawing on puncture site.
        • If multiple injections or venipunctures are planned, make a “progress poster;” give rewards for predetermined number of injections.
        • Have child count to 10 or 15 during injection.
      • Ambulation
        • Give child something to push:
          • Toddler: Push-pull toy
          • School-age child: Wagon or a doll in a stroller or wheelchair
          • Adolescent: Decorated intravenous (IV) stand
        • Have a parade; make hats, drums, and so on.
      • Extending Environment (e.g., for Patients in Traction)
        • Make bed into a pirate ship or airplane with decorations.
        • Put up mirrors so that patient can see around room.
        • Move bed frequently to playroom, hallway, or outside.
    • Preparing the family
      • General principles of family education
        • Establish a rapport with the family.
        • Avoid using any specialized terms or jargon. 
          • Clarify all terms with the family.
        • When possible, allow family members to decide how they want to be taught (e.g., all at once or over 1 or 2 days). 
          • This gives the family a chance to incorporate the information at a rate that is comfortable.
        • Provide accurate information to the family about the illness.
        • Assist family members in identifying obstacles to their ability to comply with the regimen and in identifying the means to overcome those obstacles. 
          • Then help family members find ways to incorporate the plan into their daily lives.
      • Family preparation for procedures
        • Name of the procedure
        • Purpose of the procedure
        • Length of time anticipated to complete the procedure
        • Anticipated effects
        • Signs of adverse effects
        • Assess the family’s level of understanding
        • Demonstrate and have family return demonstration (if appropriate)
  • Surgical Procedures 
    • Preoperative care
      • Parental presence
      • Preoperative sedation
    • Postoperative care
      • Continuous monitoring
      • Vital signs assessment
        • Potential causes of Postoperative vital sign alterations in children
Alteration  Potential Cause  Comments
Heart rate
Increase Decreased perfusion (shock) Heart rate may increase to maintain cardiac output.
Elevated temperature
Respiratory distress (early)
Medications (atropine, morphine, epinephrine)
Decrease Hypoxia Bradycardia is of more concern in young child than tachycardia.
Vagal stimulation
Increased intracranial pressure
Respiratory distress (late)
Medications (neostigmine [Prostigmin Bromide])
Respiratory Rate
Increase Respiratory distress Body responds to respiratory distress primarily by increasing rate.
Fluid volume excess
Elevated temperature
Decrease Anesthetics, opioids Decreased respiratory rate from opioids may be compensated for by increased depth of respiration.
Blood Pressure
Increase Excess intravascular volume This is serious in premature infants because it increases risk for intraventricular hemorrhage.
Increased intracranial pressure
Carbon dioxide retention
Medication (ketamine, epinephrine)
Decrease Vasodilating anesthetic agents (halothane, isoflurane, enflurane) Decreased blood pressure is late sign of shock because of elasticity and constriction of vessels to maintain cardiac output.
Opioids (e.g., morphine)
Increase Shock (late sign) Fever associated with infection usually occurs later than fever of noninfectious origin. Absence of fever does not rule out infection, especially in infants.

Malignant hyperthermia requires immediate treatment.

Environmental causes (warm room, excess coverings)
Malignant hyperthermia
Decrease Vasodilating anesthetic agents (halothane, isoflurane, enflurane) Neonates are especially susceptible to hypothermia, with serious or fatal consequences.
Muscle relaxants
Environmental causes (cool room)
Infusion of cool fluids or blood


  • Managing pain
  • Respiratory tract infection
  • Patient education
  • Discharge instructions
  • Postoperative Care
    • Ensure that preparations are made to receive child:
      • Bed or crib is ready.
      • Intravenous (IV) pumps and poles, suction apparatus, and oxygen flow meter are at bedside.
    • Obtain baseline information:
      • Take vital signs, including blood pressure; keep blood pressure cuff in place and deflated to lessen disturbance to child.
      • Take and record vital signs more frequently if any value fluctuates.
      • Inspect operative area.
    • Check dressing if present.
      • Outline any bleeding area on dressing or cast with pen.
      • Reinforce, but do not remove, loose dressing.
      • Observe areas below surgical site for blood that may have drained toward bed.
      • Assess for bleeding and other symptoms in areas not covered with a dressing, such as throat after tonsillectomy.
    • Assess skin color and characteristics.
      • Assess level of consciousness and activity.
      • Notify primary care provider of any irregularities in child’s condition.
      • Assess for evidence of pain.
      • Review surgeon’s orders after completing initial assessment, and check that preoperative orders, such as seizure or cardiac medications, have been reordered and can be given by available routes (oral preparations may be contraindicated).
      • Monitor vital signs as ordered and more often if indicated.
      • Check dressings for bleeding or other abnormalities.
      • Check bowel sounds.
      • Observe for signs of shock, abdominal distention, and bleeding.
      • Assess for bladder distention.
      • Observe for signs of dehydration.
      • Detect presence of infection:
        • Take vital signs every 2 to 4 hours as ordered.
        • Collect or request needed specimens.
        • Inspect wound for signs of infection: redness, swelling, heat, pain, and purulent drainage.
  • The child with fever
    • Call Office Immediately If:
      • Your child is younger than 2 months of age.
      • The fever is over 40.6° C (105° F).
      • Your child looks or acts very sick, including a stiff neck, persistent vomiting, purplish spots on the skin, confusion, trouble breathing after you have cleansed his or her nose, or inability to be comforted.
    • Call Within 24 Hours If:
      • The fever is between 40° and 40.6° C (104° and 105° F), especially if your child is younger than 2 years of age.
      • Your child has had a fever for more than 24 hours without an obvious cause or location of infection.
      • Your child has had a fever for more than 3 days.
      • Your child has burning or pain with urination.
      • Your child has a history of febrile seizures.
      • The fever went away for more than 24 hours and then returned.
      • You have other concerns or questions.
  • Safety
    • Environmental factors
      • Electrical equipment
      • Furniture
      • Strangulation
      • Toys
      • Preventing falls
        • Risk factors for hospitalized children 
          • Medication effects: 
            • Postanesthesia or sedation; analgesics or narcotics, especially in those who have never had narcotics in the past and in whom effects are unknown
          • Altered mental status: 
            • Secondary to seizures, brain tumors, or medications
          • Altered or limited mobility: 
            • Reduced skill at ambulation secondary to developmental age, disease process, tubes, drains, casts, splints, or other appliances; new to ambulation with assistive devices such as walkers or crutches
          • Postoperative children: 
            • Risk for hypotension or syncope secondary to large blood loss, a heart condition, or extended bed rest
          • History of falls
          • Infants or toddlers in cribs with side rails down or on the daybed with family members
          • Once children at risk for falls have been identified, alert other staff members by posting signs on the door and at the bedside, applying a special-colored armband labeled “Fall Precautions,” labeling the chart with a sticker, or documenting information on the chart.
        • Prevention of falls requires alterations in the environment, including the following:
          • Keep the bed in the lowest position with the brakes locked and the side rails up.
          • Place the call bell within reach.
          • Ensure that all necessary and desired items are within reach (e.g., water, glasses, tissues, snacks).
          • Offer toileting on a regular basis, especially if the patient is taking diuretics or laxatives.
          • Keep lights on at all times, including dim lights while sleeping.
          • Lock wheelchairs before transferring patients.
          • Ensure that the patient has an appropriate size gown and nonskid footwear. Do not allow gowns or ties to drag on the floor during ambulation.
          • Keep the floor clean and free of clutter. Post a “wet floor” sign if the floor is wet.
          • Ensure that the patient has glasses on if he or she normally wears them.
          • Preventing falls also relies on age-appropriate education of patients. Assist the child with ambulation even though he or she may have ambulated well before hospitalization. Patients who have been lying in bed need to get up slowly, sitting on the side of the bed before standing.
          • The nurse also needs to educate family members:
          • Call the nursing staff for assistance, and do not allow patients to get up independently.
          • Keep the side rails of the crib or bed up whenever the patient is in the crib or bed.
          • Do not leave infants on the daybed; put them in the crib with the side rails up.
          • When all family members need to leave the bedside, notify the staff and ensure that the patient is in the bed or crib with the side rails up and call bell within reach (if appropriate).
    • Infection control
      • Role of Centers for Disease Control and Prevention
      • Standard Precautions
        • Involve the use of barrier protection, such as gloves, goggles, gown, or mask, to prevent contamination from
          • Blood
          • All body fluids
          • Secretions and excretions except sweat, regardless of whether they contain visible blood
          • Nonintact skin
          • Mucous membrane
      • Transmission-based precautions
      • Airborne, droplet, and contact precautions
        • Airborne Precautions
          • In addition to Standard Precautions, use Airborne Precautions for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei. 
          • Examples of such illnesses include measles, varicella (including disseminated zoster), and tuberculosis.
        • Droplet Precautions
          • In addition to Standard Precautions, use Droplet Precautions for patients known or suspected to have serious illnesses transmitted by large-particle droplets. 
          • Examples of such illnesses include the following:
            • Invasive Haemophilus influenzae type b disease, including meningitis, pneumonia, epiglottitis, and sepsis
            • Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and sepsis
            • Other serious bacterial respiratory tract infections spread by droplet transmission, including diphtheria (pharyngeal), mycoplasmal pneumonia, pertussis, pneumonic plague, streptococcal pharyngitis, pneumonia, and scarlet fever in infants and young children
            • Serious viral infections spread by droplet transmission, including adenovirus, influenza, mumps, parvovirus B19, and rubella
        • Contact Precautions
          • In addition to Standard Precautions, use Contact Precautions for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient’s environment. 
          • Examples of such illnesses include the following:
            • Gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug-resistant bacteria judged by the infection control program based on current state, regional, or national recommendations, to be of special clinical and epidemiologic significance
            • Enteric infections with a low infectious dose or prolonged environmental survival, including Clostridium difficile; for diapered or incontinent patients: enterohemorrhagic Escherichia coli O157:H7, Shigella organisms, hepatitis A, or rotavirus
            • Respiratory syncytial virus (RSV), parainfluenza virus, or enteroviral infections in infants and young children
            • Skin infections that are highly contagious or that may occur on dry skin, including diphtheria (cutaneous), herpes simplex virus (neonatal or mucocutaneous), impetigo, major (noncontained) abscesses, cellulitis or decubitus, pediculosis, scabies, staphylococcal furunculosis in infants and young children, zoster (disseminated or in the immunocompromised host)
        • Viral or hemorrhagic conjunctivitis
          • Viral hemorrhagic infections (Ebola, Lassa, or Marburg)
  • Restraining methods
    • Alternative methods: Consider first
      • Diversional activities
      • Parental participation
      • Therapeutic holding
    • Use least restrictive 
    • Behavioral restraints
      • Used when significant risk present
      • Determine cause of behavior first
    • Mummy restraint or swaddle

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