Pediatric nursing
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Sickle cell disease anemia is an inherited blood disorder that affects many people of color in the U. S. Patients with sickle cell disease make abnormal blood cells that tend to clog and occlude blood vessels. ⋯ Hydroxyurea therapy significantly reduces the number of deaths from sickle cell complications. Additionally, hydroxyurea significantly reduces the number of hospitalizations, vaso-occlusive crisis, and acute chest problems; thereby reducing severity of the disease. Pediatric studies also have shown that hydroxyurea can be safely used in children.
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Evaluation of pain and sedation in the PICU patient population is challenging. This article provides an overview of sedation and analgesia assessment tools developed for the critical pediatric patient who is mechanically ventilated and pharmacologically paralyzed. ⋯ No single tool has emerged that can adequately address pain management in the mechanically ventilated pharmacologically paralyzed pediatric patient. Nurses, as an integral part of the health care of critical pediatric patients, should endeavor to develop evidence-based methods for the evaluation of simple yet accurate scales to monitor sedation and pain in the pharmacologically paralyzed pediatric patient.
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Pain assessment of the critically ill sedated patient is a challenge. Children who are critically ill may be unable to articulate pain, and they may have a decreased level of consciousness as a result of their disease state and/or analgesic and sedation medications. The COMFORT Scale (Ambuel, Hamlett, & Marx, 1990) can be used to assess psychological distress of critically ill children. ⋯ Using the COMFORT Scale, the primary investigator and 29 staff nurse participants assessed 55 pediatric patient participants simultaneously, all of whom were intubated, and had normal musculoskeletal function and stable vital signs. A t-test comparing the COMFORT Scale scores obtained by the primary investigator and each nurse participant determined that there was no statistical significance in those COMFORT Scale scores obtained by the primary investigator and staff nurse participants. Data from this study support the reliability of the COMFORT scale when used among pediatric nurses of varied educational backgrounds and experience.
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The review of literature suggests the pediatric population is at risk for skin breakdown and therefore pressure ulcer development. The literature reveals limited information on pediatric skin care issues in comparison to the adult population. ⋯ It is important to have an understanding of the underlying physiology of ulcer formation, the factors responsible for ulcer development, and the factors that put infants and children at risk for developing pressure ulcers. Accurate assessment, documentation, prevention, and treatment are all key factors.
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Diverse settings, diagnoses, and time constraints challenge a small hospital's ability to provide comprehensive care to all dying children and their families. Children who died at a regional hospital in southeast Georgia were studied to document the circumstances under which they died and the palliative and end-of-life care provided. The most common causes of death were injury and circulatory events. ⋯ Seventy-two percent were previously healthy children; 78% were hospitalized for less than 24 hours prior to death. Based on previous medical history and length of final hospitalization, four hospital dying trajectories were defined. Hospital dying trajectories provide a basis for planning comprehensive hospital pediatric palliative and end-of-life care program by identifying the settings, time limitations, and key personnel.