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Nursig care about newborn within the perioperation care.
BENEŠOVÁ, Nikola
The topic of the thesis Nursing Care of Newborns in the Process of Perioperative Care deals with specific and distinct features of such care from the viewpoint of nursing. The main objective was to specify all tasks of nurses in the process of perioperative care and the procedures they use. Last but not least, we focused on how the nursing care differs with regard to the age of newborns. The selected research method was qualitative research using semi-structured interviews with nurses from perinatology centers. The research covered 10 respondents with various levels of education and lengths of practical experience. Nurses most frequently understand the term of perioperative care as the care provided before, during and after a surgery. Most of them actually perform preparation of the child before the surgery and then they provide postoperative care. Only 2 out of the 10 respondents are directly involved in the surgery procedure and thus accompany the newborns throughout the entire process of perioperative care. The care provided before the surgery most often includes identification of the child, checking of its vital functions, involvement in blood collection, including intravenous cannulation, administration of prescribed medication, preparation of the surgical site and communication with the parents. Children are most frequently accompanied by their mothers and nurses need to communicate with them. Nurses transport the child to the operating room, hand the child over and subsequently take it back after the surgery. They also record all those activities in the medical files and in some cases they check signed informed consents. Intraoperative care consists mainly of monitoring of the newborn, assisting to the physician in airway management - intubation and during the entire surgery procedure. The most common surgical procedures performed in children are hernia, bowel and heart surgeries. The nurses also generally mentioned surgeries of developmental disorders. After the surgery nurses usually move the child to the neonatology intensive care unit which is equipped with a ventilator, incubator and all types of medication. They regularly check and record child´s vital functions, monitor the surgical wound and its proximity, intake and excretion, they provide nutrition etc. Nurses also assess the pain, most frequently using the NIPS scale, and they educate the parents. Post-surgery complications occur only sporadically and they include infections, bleeding or abstinence syndrome after administration of opiates. The collected data have shown only one difference relating to the age of newborns who underwent a surgery. Specifically, certain surgeries, e.g. of necrotic enterocolitis, are performed more frequently on less mature newborns. In general, most of the surgeries are performed on prematurely born neonates and extremely immature neonates. When asked what they would like to change or improve in the perioperative care from the nursing point of view the nurses primarily mentioned more contacts between the mother and child and consistent compliance with aseptic procedures. The responding nurses were mostly content, they praised the highly specialized care and the good cooperation between the nursing team and the medical team which consists of pediatricians and specialists. Results of those teams thus contribute to continually decreasing mortality rate of high-risk and pathological newborns and to better quality of life of those children after the surgery.
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Ensuring intravenous lines in children.
BENEŠOVÁ, Nikola
Intravenous cannulation ranks among the basic nursing procedures performed by nurses on everyday basis. The indications for cannulation include particularly infusion therapies, administration of replacement fluids in case of blood loss, anesthesia, long-term administration of antibiotics, parenteral nutrition or monitoring of central venous pressure. In case of children the method prevents frequent unpleasant and painful punctures. Intravenous cannulation is used for peripheral catheterization, central catheterization, umbilical catheterization and PICC. The most frequent is application of peripheral catheters. In absolute majority of cases the procedure is performed by two nurses, while one introduces a catheter and the other holds the child. It should be always made possible for the mother/accompanying person to be present during the procedure. Apart from observation of disinfection, sterility and correct procedure by nurses/ physician, it is very essential to ensure good mental preparation of the child which depends on how much the child is able to understand the provided information. The parent or another accompanying person must be sufficiently instructed in advance about the procedure. In case of introduction of a peripheral catheter in newborns and nurslings no rubber or other tourniquets are used on the limb and the limb is only pressed by the assisting nurse with adequate force. Equally as in adults, visible veins of upper and lower limbs are used for intravenous cannulation but also veins on the child´s head which is a specific place used in little children. Umbilical catheter introduced immediately after the birth is also characteristic for newborns and this procedure can be performed only by a physician, similarly as it is the case with the central catheter. PICC is different in this respect as it can be also introduced by a professionally trained nurse. Aseptic approach is always applied. All catheters must be firmly fixed to prevent their undesired extraction. After the procedure the patient and the puncture area are regularly checked to prevent complications.
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