The purpose of this study was to compare upper arm and calf automatic blood pressures (BPs) in a convenience sample of 221 children, ages 1 to 8 years, admitted to a pediatric intensive care unit of a 180-bed teaching hospital in the Mid-Atlantic region of the United States. Subjects were positioned in bed, with the head of bed elevated 30° and extremities resting on the bed. BP cuff size was based on arm and calf circumferences. BPs were measured simultaneously using bedside and portable Spacelabs monitors. Calf BPs were greater than arm BPs in approximately 73% of the sample. Paired t tests show statistically significant differences for systolic BPs and mean arterial pressures. Influence of demographics, agitation levels, medical diagnoses, and current medications was explored. Calf and arm BPs were not interchangeable in acutely ill children, ages 1 to 8 years.
(1) Instillation of a bolus of saline down the endotracheal or tracheostomy tube prior to suction is common nursing practice. The rationale is that saline will thin tenacious secretions and assist in removal of them. This article reviews the research related to the effects of saline instillation and the controversies about its use. Recommendations for practice and future research are made.
The nursing process can be used in the safe and effective delivery of pediatric sedation care. Nurses contribute to the direct care of sedated patients by developing competency and expanding knowledge and expertise within their specialty. While the provision of care to patients and families is of paramount importance, ensuring an environment conducive to delivery of safe, quality care by the healthcare team is another fundamental aspect of nursing. Management of sedation, analgesia, and anxiety in pediatric procedural sedation is an intrinsically multidisciplinary process that involves nursing, physicians, child life specialists, and other healthcare providers. In general, pediatric procedural sedation is a relatively new specialty with limited data on the role of the pediatric nurse in this multiprofessional team. It is an opportunity for nursing to collaborate with other healthcare professionals to establish guidelines and protocols to facilitate optimal patient care and efficiency as well as to share and expand their knowledge base and clinical skill set. Specialty certification and credentialing, team concept values, and the evolving role of the sedation nurse are all elements to consider within pediatric procedural sedation from the nursing perspective.
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