Paediatric Nursing Skills for Australian Nurses

Introduction

The assessment and maintenance of healthy urinary and bowel elimination in infants, children and young people is crucial to maintenance of health. Infants and very young children are developmentally immature, and are therefore incontinent and dependent on an adult to maintain their hygiene and elimination needs. Sometimes, for developmental or physical reasons, children may be delayed in meeting toilet training milestones. There are specific issues related to urinary or bowel elimination, such as delayed toilet training, enuresis, constipation and encopresis, which can cause much distress to children and families. The interventions and skills required by paediatric nurses for managing these issues will be addressed in this chapter.

Paediatric nurses are responsible for recording output of both urine and faeces, and this can be challenging in infants and young children who are not toilet trained or who are unwell and may be uncooperative. Approaches to obtaining specimens or measuring output in children who are too young or not yet toilet trained differ from those used for older children. It is essential when obtaining urine specimens that they are not contaminated if the specimen is being obtained for culture and laboratory confirmation of infection. Some children will require urinary catherisation. This may be an in–out catheter to obtain a specimen, intermittent catheters to aid urinary elimination or a longer term catheter to aid urinary drainage or provide accurate measurement of urinary output in the critically ill child. Children may also have permanent or temporary stomas, and nurses need to be well prepared to provide evidence-based care, and education and support, for the infant, child, young person and their family.

Measurement of output in the paediatric Patient

In any nursing context, it is important for the nurse to assess the fluid balance and hydration status of their patient to detect dehydration (Brown, 2017) or over-hydration; however, in paediatric nursing this takes on greater significance as infants and young children are reliant upon adults to meet their fluid and electrolyte needs, and are more vulnerable to imbalances. This means that paediatric nurses require astute assessment skills to identify physical signs that may indicate changes in homeostasis. One of the crucial tools a nurse will use is the fluid balance chart. The accuracy of this will depend on the accurate recording of input and output.