To summarize the perioperative nursing experience of a child with Berry syndrome who underwent radical surgery. The key points of preoperative care include the prevention of heart failure and vigilance against ischemia and hypoxia in the lower limbs. The key points of postoperative care include maintaining stable cardiac function，preventing pulmonary hypertension crisis，ensuring safe transition during delayed chest closure，paying attention to psychological support，and emphasizing continuous care. After 54 days of careful treatment and nursing care，the child recovered well and was discharged from the hospital. The follow-up was couducted a month after discharge，and the child was good.
Objective To explore the occurrence and influencing factors of delayed nausea and vomiting in children with tumor chemotherapy，so as to provide bases for doctors and nurses to formulate home care plans. Methods A prospective cohort study was conducted，and a toll of consecutive children who received chemotherapy and their caregivers in a tertiary A Children’s Hospital in Zhejiang Province from August to October 2022 were enrolled as the subjects of investigation. Baxter Retching Faces Scale and United States Department of Health and Human Services Common Adverse Event evaluation criteria were used to evaluate the incidence of delayed nausea and vomiting. The influencing factors of delayed nausea and vomiting were collected by questionnaire and analyzed by binary logistic stepwise regression. Results A total of 378 children with tumor chemotherapy were included，of which 229（60.6%） developed delayed nausea and 144（38.1%） developed delayed vomiting. Delayed vomiting mainly occurred 1-2 days after chemotherapy（50.7%）. Logistic regression analysis showed that body surface area，negative emotion，history of delayed nausea and vomiting，and smoking environment were the influencing factors of delayed nausea in children with tumor chemotherapy. Body surface area，history of delayed nausea and vomiting，complicated with respiratory or digestive system diseases，vomiting risk of chemotherapeutic drugs，smoking environment and tumor type were the influencing factors of delayed vomiting in children with tumor chemotherapy （P<0.05）. Conclusion The incidence of nausea and vomiting associated with delayed chemotherapy was high in children with tumor，especially at 1~2 days after chemotherapy. Large body surface area，negative emotion and history of delayed nausea and vomiting are the high-risk factors of delayed nausea in children with tumor chemotherapy；large body surface area，history of delayed nausea and vomiting，complicated with respiratory or digestive system diseases，high vomiting risk of chemotherapeutic drugs and solid tumors are high risk factors for delayed vomiting in children undergoing tumor chemotherapy. It is suggested that medical staff should formulate preventive measures according to relevant risk factors and carry out home care guidance to reduce the incidence of delayed nausea and vomiting in children undergoing tumor chemotherapy.
Objective To investigate the cognition,attitude and practice of pediatric ICU nurses on daily sedation interruption（DSI）,and to provide references for clinical training. Methods Convenience sampling was used to conduct a questionnaire survey among 298 pediatric ICU nurses in 7 tertiary A children hospitals in China in July 2021. The general information questionnaire,questionnaires of knowledge,attitude,and behavior on DSI were self-designed. Results In terms of the cognition of 298 pediatric nurses on DSI,their knowledge score was 4（2,4） out of 10,and a total of 157 nurses（52.68%） said they did not know well or had never heard of DSI. In terms of attitude,their recognition score was 32（27,34） out of 40,and 217 nurses（72.82%） were willing to implement DSI,and 258 nurses（86.58%） wanted systematic training. In practice of nurses,221（74.16%） have not received relevant training,and 159 nurses（53.35%） never or rarely performed DSI. Conclusion Pediatric ICU nurses have a poor grasp of knowledge on DSI,while their recognition toward DSI is high. Their practice needs to be strengthened. Nursing managers should pay full attention to the training needs of pediatric ICU nurses and carry out systematic training on DSI basic knowledge and practical skills,so as to improve DSI practice level of nurses.
Objective To retrieve,evaluate and integrate relevant evidence on the positioning management of preterm infants to provide clinical references. Methods We searched Guidelines International Network（GIN）,National institute for Health and Care Excellence（NICE）,Scottish Intercollegiate Guide Network（SIGN）,National Guideline Clearinghouse（NGC）,Registered Nurses’ Association of Ontario（RNAO）,Joanna Briggs Institute（JBI）,BMJ Best Practice,PubMed,Embase,OVID,Wanfang Database,CNKI,Yimaitong and other websites on all evidence on the positioning management of preterm infants,including guidelines,evidence summaries,best clinical practice manuals,clinical decision-making and systematic reviews,and the search time limit is from the establishment of the databases to August 31,2020. Results Totally 10 articles were involved,including 3 guidelines,5 systematic reviews,1 technical report and 1 clinical decision support. Finally,21 pieces of best evidence about positioning assessment,positioning the preterm infants,positioning equipment and positioning management of exceptional case were summarized. Conclusion This study summarizes the current best evidence on the positioning management of preterm infants and provides an evidence-based basis for standardizing the positioning management of preterm infants. It is recommended that medical staff should consider the clinical situation when applying the evidence,and selectively apply the best evidence to promote health of preterm infants.
To summarize the perioperative nursing experience of a child with congenital left ventricular aneurysm. Key points of preoperative nursing include controlling blood pressure strictly to prevent cardiac rupture，monitoring heart rate and rhythm closely to prevent heart failure，early identifying and treating thromboembolic symptoms. Main points of postoperative nursing include strengthening the management of early sedation and analgesia，strictly controlling the intake and output volume to maintain left ventricular function，maintaining the stability of internal environment to prevent arrhythmia，enhancing home care guidance. After careful treatment and nursing care，the child was discharged smoothly. A month after discharge，the outpatient follow-up showed that the cardiac function of the child was stable while the growth and development was normal.
Objective To construct a risk prediction model for central venous catheter-associated deep venous thrombosis（CADVT） in children with congenital heart disease after surgery,and to verify the prediction effect of the model. Methods A total of 234 children hospitalized in the cardiac care unit of a tertiary first-class pediatric hospital in Zhejiang Province from January to November 2021 were conveniently selected as the model building subjects. According to whether CADVT occurred,they were divided into a CADVT group（53 cases） and a non-CADVT group（181 cases）. Logistic regression analysis was used to establish the risk prediction model. Hosmer-Lemeshow test was used to determine the goodness of fit of the model. The receiver operator characteristic curve （ROC） was used to test the prediction effect of the model,and a nomogram model was drawn. 60 children with congenital heart disease after surgery in the same hospital from December 2021 to February 2022 were selected as the validation group,and Hosmer-Lemeshow test and ROC curve were used for external verification of the model. Results The incidence of CADVT in children with congenital heart disease after surgery was 22.65%. Intubation duration（OR=1.172）,D-dimer concentration（OR=1.169）,fibrinogen concentration（OR=3.888）,days of sedation（OR=1.538）,using of vasoconstrictor（OR=3.554） and pediatric critical illness score（OR=3.308） were its risk factors（P<0.05）. The Hosmer-Lemeshow test showed that χ2=4.456,P=0.814,the area under the ROC curve was 0.957（95%CI：0.930~0.984）,the optimal critical value was 0.813,the sensitivity was 0.962,and the specificity was 0.851. In the external validation,the sensitivity,specificity and accuracy of the model were 0.857,0.870,86.67%,respectively. Conclusion The risk prediction model constructed in this study has good effects,which can provide a reference for clinical evaluation of the risk of CADVT in children with congenital heart disease after surgery.
This paper summarized the postoperative nursing of 3 children with long-gap esophageal atresia undergoing gastrostomy. Key points of care include：continuous low negative pressure suction of proximal esophagus to prevent aspiration pneumonia;good care of diet perfusion,the skin around gastrostomy and the tube;psychological nursing for parents. After careful treatment and care,3 children were successfully treated with delayed esophageal end-to-end anastomosis 4 to 7 months after birth.
The nursing care of a case of Castleman’s disease complicated with paraneoplastic pemphigus was summarized,including the care of impaired skin mucosal integrity,close observation of drug adverse reactions and psychological care. After careful treatments and nursing care,the rash basic scabby scattered in the body of the child and the oral damage were better than before. The child was discharged.
Enhanced recovery after surgery（ERAS） refers to the adoption of evidence-based perioperative optimization measures on the basis of multidisciplinary cooperation,aiming at reducing the physiological and psychological trauma stress of surgical patients,so as to realize the enhanced recovery of surgical patients.This paper summarized the application status of the concept of ERAS in perioperative period of pediatric surgery at home and abroad,including preoperative nursing,intraoperative precision management and postoperative nursing,and pointed out the deficiencies and future development direction,in order to lay a foundation for further research on the perioperative period of enhanced recovery of pediatric surgery in China.
To summarize the infusion management of 15 infants with severe diabetic ketoacidosis for 48 hours. The main measures include：rapid assessment and rapid establishment of venous access,standardized and reasonable rehydration and the application of low-dose insulin, good assessment and monitoring in the process of rehydration,early detection and early intervention of various potential transfusion complications. The ketoacidosis was corrected within 48 hours, and the blood glucose was stable after follow-up treatment.
This paper summarizes the nursing experience of 3 children with blastic plasmacytoid dendritic cell tumor. Nursing points include skin and mucous membrane nursing,medication nursing,illness observation,strengthening of protective isolation,exercises guidance,attention to parents’ psychological intervention and health education. At present,these 3 children are in remission. All the skin lesions have been healed without nursing complications.
The rescue and nursing of a child with anterior mediastinal lymphoma complicated with severe airway obstruction were summarized. The operations include rigorous observation and monitoring of the child’s condition,rapid and effective application of extracorporeal membrane oxygenation under cardiopulmonary resuscitation;close observation of the child’s vital signs during extracorporeal membrane oxygenation,dynamic assessment of airway obstruction symptoms. After careful treatment and nursing,the extracorporeal membrane oxygenation machine was successfully evacuated after 70.5 hours of operation. The child returned to a stable condition on the 7th day of admission and was transferred to the department of hematology for continuous specialized treatment.
Daily interruption of sedation (DIS) refers to the continuous use of sedative drugs in the process, daily for a short time to stop sedative drugs, until the patient gradually awake, can make the corresponding action according to the instructions, and then give the sedation treatment again.The origin and development of daily interruption of sedation（DIS） was introduced in this article,and the implementers,implementation targets,intervention methods and evaluation tools were explained. This article also analyzed and discussed the application effect of DIS in children with mechanical ventilation sedation,and made relevant suggestions,in order to provide references for China to carry out related practices.
Objective Applying the best evidence of peripheral venous catheter dressing fixation and replacement in clinical practice,to standardize the pediatric nursing care procedure for peripheral venous catheter dressing fixation and replacement,and to improve the specialist nursing care quality of intravenous therapy.Methods Computer decision support system,clinical practice guidelines,systematic reviews and original articles related to intravenous infusion were searched. Through literature quality appraisal,2 guidelines and 1 systematic review were included as references for evidence resources and 12 items of evidence were summarized. After feasibility,suitability and clinical significance evaluation,7 items of best evidence were generated,and finally 4 clinical review indicators were formed. Clinical application of evidence was conducted according to the standard procedures of JBI evidence-based nursing center’s clinical evidence practice application system （JBI-PACES）. Data were collected by questionnaire survey,field observation,interviews and nursing records reviewing. Effects of application were evaluated by nurse’s compliance of standard practice,incidence of phlebitis,incidence of unplanned extubation,and catheter indwelling time.Results Three items with poor compliance such as changing dressing for moisture,looseness and/or significant contamination during baseline assessment were significantly improved after the application of best evidence（P<0.001）. The length of catheter indwelling was significantly prolonged（P<0.001）. There was no significant difference in the incidence of phlebitis（P>0.05）. The incidence of unplanned extubation was significant reduced（P<0.001）.Conclusion Application of best evidence for pediatric peripheral venous catheter dressing fixation and replacement can standardize nursing care procedure,extend the indwelling time,reduce the incidence of unplanned extubation,and improve the quality of specialist nursing care for pediatric intravenous therapy.
This article summarized the nursing experience of 143 infants and children with iron deficiency anemia who received intravenous iron agent before operation. The key points of nursing included：proper preparation of liquid medicine,close observation of allergic reaction,rational selection of venous access,active prevention and treatment of phlebitis and leakage,and health education of iron treatment. All infants had no abnormal liver and kidney function during treatment,2 cases had increased heart rate,2 cases had phlebitis and 7 cases had pigmentation around the puncture site. These infants had normal heart rate,phlebitis was improved and pigmentation subsided after intervention. After intravenous iron treatment,the red blood cell count,hemoglobin,hematocrit,average red blood cell volume and average red blood cell hemoglobin of 143 infants increased significantly,and 112 received the surgery successfully after the iron treatment,while 24 continued the iron treatment,and 7 were lost to follow-up.
Objective To study the feasibility and safety of shortening preoperative fasting time and early postoperative food intaking time under the guidance of Enhanced Recovery After Surgery（ERAS） concept in perioperative pediatric patients.Methods Pediatric patients undergoing elective surgery in urology department of a tertiary hospital in Zhejiang Province from November 15,2018,to March 15,2019,were selected and divided into the experimental group and the control group according to the time,in the experimental group,200 patients were treated with an individual diet plan according to the operation time;in the control group,200 patients were treated with traditional preoperative fasting methods. The actual preoperative fasting time and postoperative feeding time were compared between two groups,the clinical manifestation of thirst,hunger,crying,aspiration,postoperative nausea and vomiting,abdominal distension,and parents satisfaction were observed.Results Compared with the control group,the actual preoperative fasting time was significantly reduced in the experimental group（P<0.001）. There was no significant difference in the incidence of aspiration,postoperative nausea and vomiting and abdominal distension（P>0.05）. Perioperative thirst and hunger score,and crying rate in the experimental group were lower than those in the control group,parents satisfaction was higher,and the differences were statistically significant（P<0.01）.Conclusion Applying the concept of ERAS,it is safe and feasible to shorten preoperative fasting time and earlier postoperative food intaking time,which can reduce the discomfort and promote the early recovery of pediatric patients.
