Nursing management of childhood chickenpox infection.

Chickenpox is an extremely contagious infectious disease caused by varicella zoster virus (VZV). It is a common childhood illness characterised by an itchy vesicular rash and fever, which usually resolves spontaneously without medical intervention. Serious, and rarely fatal, complications can occur, including pneumonia, central nervous system infection, overwhelming secondary bacterial infections, especially with Group A streptococcus, and necrotising fasciitis. Therefore it is crucial that emergency department (ED) nurses can recognise the signs and symptoms that indicate deterioration. This article reviews best practice management of children with chickenpox, gives up-to-date guidance on the safe use of antipyretics, the avoidance of ibuprofen and discusses immunisation against VZV. It also includes implications for nursing practice and a case study that illustrates some of the challenges that ED nurses may encounter.

How to carry out growth assessment in infants and children under two years old.

Rationale and key points Measuring and monitoring growth in infants and young children under two years old is an important part of their clinical assessment in hospital and the community. This article outlines the procedure for measuring growth in infants and children under two years old, and discusses the main factors to consider when undertaking this assessment. ¼ The procedures and some of the data used to monitor the growth of infants and children under two years old differs from those used in older children. ¼ Obtaining growth information for an infant or child involves measuring and recording their length, weight and head circumference. The process of obtaining this information is not necessarily straightforward and errors may occur while measuring and plotting or interpreting data. ¼ Correct use of growth measuring equipment and growth charts is essential to obtain accurate results. Nurses should be able to plot weight, length and head circumference data for infants and children under two years old, and to correctly interpret this data to identify malnutrition and faltering growth. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice when you assess growth in infants and children under two years old. 2. What practical experience you require to consolidate your learning, having read this article. 3. Any learning needs that you have identified that would increase your clinical effectiveness and professional development.

Children discharged against medical advice.

Discharge against medical advice (DAMA) occurs when a patient leaves a clinical setting before the end of treatment and against medical recommendation. The most important aspects of DAMA are to ensure ongoing medical needs are met and that it is documented meticulously. This article describes a recent retrospective case note (audit) study of DAMA in paediatric patients attending a district general hospital, followed by a literature review. It also discusses the legal implications of DAMA and offers some strategies for clinical practice.