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Interaction and comfort
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| F2 talks softly and melodiously with C2 (10 years old) while rubbing his head with his hand. Upon hearing the voice, he looks at her and smiles [...]. Then, the grandmother shaves the child’s hair with a hair clipper, using slow movements interspersed with the affectionate touch of the hand on the head, and says, with the same voice, “You are a beautiful boy”. When listening to it, C2 relaxes and keeps his eyes closed (Fieldwork Note. Observation, Case 2). |
| Developmental care |
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Sing child’s songs with a soft and melodious voice;
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Use recreational activities (storytelling, videos, TV, music, toys with different textures and colors) during interactions with the child;
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Massage during skin hydration after bathing;
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Encourage the visit and permanence of family members;
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Avoid unnecessary interruptions and allow for rest periods;
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Create an environment that resembles home, using personal objects of child and family;
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Maintain a reduced level of stimulation in the child’s unit during rest periods and at night;
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Provide activities that encourage family interaction with the child such as haircuts.
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Comfortation care
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Stimulation care
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Pacification care
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Emancipation care
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Activities of daily living
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| F3 (11 years old) separates the materials for bathing (cotton, gauze, towel, diaper, soap) on the bedside table next to the bed. Then, she removed the oximeter from the right index finger of C3, changed her position from supine to left lateral, took a cotton pad soaked in soap and water, and gently rubbed her back. In response, C3 has minor spasms as the water touches her body. F3 returns C3 to the supine position; repeats the same procedure for cleaning the thorax and abdomen; ends the bath by drying the front and back parts of the body, and dresses her. Performs oral hygiene with brushing, water, and mouthwash (Fieldwork Diary. Observation, Case 3). |
| Modified usual care |
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Change the diaper whenever necessary;
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Avoid exposure, air currents, excess heat or unnecessary cooling during bathing;
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Keep the sheet well stretched to avoid folds;
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Use pillows or pads on parts of the body where there are bony prominences;
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Perform decubitus change every two hours;
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Transfer to the wheelchair if the child’s tolerance.
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Maintenance care
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Restorative care
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Emancipation care
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Compensation care
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Medication administration
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| NT3 repositions C1 (3 years old), placing her in the cradle; places the oximeter sensor on the right hallux and the sock on her feet. She separates the material for drug administration by GTT (tube, filtered water, and medications) and administers it. Then she washes the GTT route with water filtered by gavage (Fieldwork Note. Observation, Case C1). |
| Medication care |
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Check (dose, route of administration, time) of medication before being administered;
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Ensure that the child is not allergic to the prescribed medication to be administered;
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Monitor the child for discomfort and nausea before and after medication administration;
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Check medications that have interactions and change the schedule/scheduling;
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Observe signs of drug intoxication related to the risk of dosage error (weight fluctuation, age change);
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Administer bronchodilators and other SOS medications and as prescribed.
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Restorative care |
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Technological device maintenance
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| NT5 called N3 from the unit to assess the TCT subcannula of C1 (3 years old), who was sleepy. N3 approaches C1 softly, saying, “Hi, princess, let us wake up!”. While she wakes up, N3 prepares the materials (SF 0.9% and flexible rod, fixation lace) for external cleaning of the sub cannula, performing the procedure calmly with the gaze directed to the sub cannula. During the procedure, the girl with a fever remains quiet and prostrate. A few minutes later, C1 opened her eyes slowly and stared at N3, who had finished cleaning. She replaces TCT fixation. In the end, N3, with a soft and childlike voice, calls her a princess. C1 smiles and looks at her! (Fieldwork Note. Observation, Case 1). |
| Technological care |
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Protect TCT from water dispersion;
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Sanitize the hands before and after handling the mechanical ventilator system;
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Use aseptic technique to assemble the mechanical ventilator;
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Protect the Y connection when opening the mechanical ventilator system;
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Change the mechanical ventilator circuit when visibly dirty;
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Pay attention to mechanical ventilator alarms;
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Assess skin integrity around GTT stoma;
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Wash with water after administering diet and medication to GTT and NET;
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Check the presence of leakage of gastric secretion and diet on the button;
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Change NET fixation whenever necessary;
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Be careful not to pull the probe accidentally;
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Check the correct positioning of the tube, examining the oral cavity, if there are gastric residues, or listening to the moment of the injected and aspirated air, according to the institution’s protocol;
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Assess nostril integrity.
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Restorative care |
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Management of oxygenation, nutrition and skin integrity needs
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| By delegation of competence, NT2 prepares the materials available in C2’s bed (10 years) (0.9% SF, probe, gauze, and sterile glove) for lower airway aspiration (LAA) of TCT. Then, she disconnects the mechanical ventilation (MV) tube from TCT and opens the aspiration vacuum system. In response to the vacuum noise, C2 blinks his eyes rapidly. NT2 touches his face affectionately, reassuring him. In response, C2’s eyes blink less when touched. NT2 aspirates once and reconnects the MV tube to TCT. Then, while aspirating the nostrils, C2 reacts by arching the upper lip, and the face turns red. (Fieldwork Note. Observation, Case 2). |
| Technological care |
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Care in maintaining the patency of the lower and upper airways
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Determine the need for airway aspiration (upper and lower) by the presence of secretion and bullous breath sounds;
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Inform the child and family about aspiration, explaining the procedure;
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Monitor the child’s oxygenation condition (SaO2 levels);
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Interrupt tracheal aspiration and offer supplemental oxygen if the child has bradycardia and/or desaturation;
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Observe the type and amount of aspirated secretion. Care with food by technological devices
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Identify the prescribed diet;
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Monitor for the presence of bowel sounds at each diet administration;
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Monitor the child’s water and electrolyte condition;
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Consult other members of the health team to choose the type and nutritional value of enteral nutrition.
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Elevate the head of the bed/crib between 30 and 45 degrees while feeding.
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Check the feeding pumping flow every hour;
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Check gastric residue before each intermittent feeding. Skin care around ostia:
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Examine the skin around the tracheal stoma for secretions, redness, and irritation;
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Clean the area around the tracheal stoma, after bathing, at the end of tracheal aspiration and whenever it is wet;
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Keep the skin around GTT stoma clean and dry;
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Remove secretions from TCT ostia and from GTT implantation, whenever present.
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Compensation care
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Maintenance care
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Restorative care
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Coping with vulnerabilities
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| C2 (3 years old) has been with us for a long time [1 year], and he is super responsive to interactions. We have much affection for him. He talks, sees his response, responds to our commands, and interacts well. Talking to him is a way of minimizing that moment when he is left without a companion. (Interview, N2). |
| Social demand care |
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Determine caregivers’ level of knowledge, acceptance and role;
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Investigate with caregivers the positive and negative points of daily care;
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Support caregivers’ decisions;
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Encourage acceptance of interdependence among family members;
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Monitor family interaction problems with child care;
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Strengthen caregivers’ social network;
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Inform caregivers about health and community service resources;
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Contact the social service to access the Income Transfer Program;
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Expand the social network of coexistence.
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Maintenance care
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Restorative care
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Stimulation care
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Compensation care
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