30-Second Head-to-Toe tool in pediatric nursing: cultivating safety in handoff communication.

Efforts to improve handoff practices among providers during shift changes are needed to augment patient safety, particularly among pediatric patients. To this aim, nurse faculty developed and enhanced a tool to standardize a thinking process for students during their pediatric clinical experience. The 30-Second Head-to-Toe checklist allows for rapid assessment of a child's condition and environment. It offers both students and nurses a consistent system for reducing errors attributable to incomplete or inaccurate information during this critical transition. Students completed checklists for 352 pediatric patients over a period of two years. Identified discrepancies were analyzed. Findings confirmed the importance of a standardized system during shift changes to reduce errors and achieve accurate, consistent communication. Students also reported that using the tool and reviewing it with instructors helped them overcome initial feelings of anxiety and fostered confidence.

Recognizing and diagnosing abdominal migraines.

Abdominal migraine affects 1% to 4% of children and is a variant of migraine headaches. Onset is seen most often between the ages of 7 to 12 years, with girls affected more often than boys. Presenting symptoms include acute incapacitating non-colicky periumbilical abdominal pain that lasts for 1 or more hours. Pallor, anorexia, nausea, vomiting, photophobia, or headache may be associated with the episodes, and a family history of migraine headaches often is noted. The diagnostic process begins with a thorough history and physical examination and often follows a series of exclusions or elimination of other organic causes. Limited research exists regarding treatment options, but they may include pharmacologic intervention and prevention based on lifestyle modifications.

Scurvy: forgotten but definitely not gone.

Scurvy, a disease of vitamin C deficiency, is purportedly rare in the United States yet frequently may be misdiagnosed. Presenting symptoms include bone pain, limping, rashes, or spongy bleeding gingiva. These symptoms mimic many other disorders, which often results in numerous unnecessary, invasive, and expensive procedural investigations. The strongest indication of a scurvy diagnosis is the dramatic response to the administration of vitamin C. This case report demonstrates the complexities involved in determining the cause of one child's symptoms. A thorough nutritional history and a shrewd clinician are essential to the early diagnosis and treatment of scurvy.

Accurately diagnosing commonly misdiagnosed circular rashes.

Rashes are common in the pediatric population yet can be quite problematic for nurse practitioners to diagnose. A thorough history and physical examination, along with some simple procedures, will aid in identifying these skin conditions. Four cases are presented, which may initially prove challenging to diagnose, and symptoms are categorically examined to arrive at the accurate diagnoses. Treatment guidelines, options, and the role of parental education and involvement also are discussed.

Accurately diagnosing commonly misdiagnosed circular rashes.

Rashes are common in the pediatric population yet can be quite problematic for nurse practitioners to diagnose. A thorough history and physical examination, along with some simple procedures, will aid in identifying these skin conditions. Four cases are presented, which may initially prove challenging to diagnose, and symptoms are categorically examined to arrive at the accurate diagnoses. Treatment guidelines, options, and the role of parental education and involvement also are discussed.

Pediatric health care providers' knowledge of pulse oximetry.

Pulse oximetry monitors have become so commonplace in acute health care settings over the last decade that blood oxygen is now considered a "fifth" vital sign. This study assessed the knowledge base related to pulse oximetry technology and clinical interpretation of the data given. A total of 68 participants--nurses, respiratory therapists, and resident physicians at a large general pediatric unit of a children's hospital--completed a survey of open-ended questions. Preliminary analysis revealed that 84% of the clinicians felt they received adequate training; 84% correctly identified what a pulse oximeter measured; 40% correctly identified how a pulse oximeter worked, but only 15% had a correct understanding of the oxyhemoglobin dissociation curve. Clinicians identified a wide range of normal arterial oxygen saturation values and made numerous errors in evaluating saturation readings in hypothetical clinical situations. Although the majority of pediatric staff felt well trained and knowledgeable about pulse oximetry, there was a lack of knowledge of basic principles. The results of this study have implications for basic professional education programs and the orientation and ongoing education of pediatric health care providers.