Diaper Changes

No, letting the patient sit in a soiled diaper will only make the diaper rash worse. Do they not have any diaper rash ointment?

No, letting the patient sit in a soiled diaper will only make the diaper rash worse. Do they not have any diaper rash ointment?

Even Vaseline is an effective barrier cream and low cost. Document and notify your RN clinical supervisor. Unless the child is allergic to the wipes (one we used wash cloths and baby wash/warm water for pericare). I've also seen irritation from certain brands of diapers.

Client has a long hx of diaper rash. PCG wants to use a petroleum based ointment. No zinc oxide. God forbid if I bring a tube from the store. I ticked off the PCG by bringing my personal soap to use.

If it's really bad try to let the baby air dry & be out in the open as much as possible. I know it might be hard but it might cut down on diaper rashes.

Client has a long hx of diaper rash. PCG wants to use a petroleum based ointment. No zinc oxide. God forbid if I bring a tube from the store. I ticked off the PCG by bringing my personal soap to use.

Zinc oxide isn't always more effective than petroleum jelly. Involve your clinical supervisor if the pcg expects you to let a child sit in a soiled diaper for 4 hours. That is not the standard of care and encourages infectious diaper rash and increases the potential for skin breakdown

I'm not justifying allowing your pt to remain in wet diapers, but might your PCG be trying to conserve on diaper usage? Who pays for them?

I think I'm seeing trying to keep costs down ... ?

I talked to PCG. She said the pediatrian said to do this. I have never heard this before. PCG asked me how many diapers am I using. I said 6 to 7 in 12 hrs. She thought that was way too much. She said to coat the baby down with Aquaphor and apply a lotof powder and change in 4 hours. I am not gonna let a child sit in a wet diaper. If I have to hide them in my bag and throw them away at my house I will.

I talked to PCG. She said the pediatrian said to do this. I have never heard this before. PCG asked me how many diapers am I using. I said 6 to 7 in 12 hrs. She thought that was way too much. She said to coat the baby down with Aquaphor and apply a lotof powder and change in 4 hours. I am not gonna let a child sit in a wet diaper. If I have to hide them in my bag and throw them away at my house I will.

Ok that's just gross. Why not call the pediatrician for orders/clarification. That just sounds like a sticky , caked mess. Never mind carrying home dirty, smelly diapers in your bag (which is technically a biohazard). This needs to be documented and clinical supervisor notified.

No parent would let their child sit in a diaper for 4 hours for a healthy child, let alone one with medical issues. Even daycare centers check diapers qh and change at least q2h. Talk to ped directly about that. Q4 hour diaper changes--NEVER!

Changing a diaper doesn't have a timed criteria. For example, my kids could go all night without a change. That said, I used a decent diaper (Walmart's White Cloud brand was cheaper and still quite effective, nearly as good as Pampers or Huggies, in my experience.) Today's disposables draw moisture away from the skin, and my girls were able to put a good 2-4 pees into a diaper before they needed to be changed. That could be anywhere from 1 to 4 hours, depending on when they fed. Never had to use cream on them at all. That said, I would change them immediately for a BM. The only time they ever got a rash was when I accidentally let a BM stay on their skin and it got combined w the next pee.

I would make a lot of phone calls before you do anything.

Most of my clients under age 5 (diapers not covered by Medicaid until age 5 with some exception) especially if can wear a size 6 diaper or smaller, the parents buy Luvs, Walmart white cloud or whatever brand is on sale. It can be as much as 50% less than major brands such as pampers. & huggies. Many manufacturers will offer decent coupons under the auspices of brand loyalty. If cost is the primary issue.

In my agencies, the standard is check q2h & PRN when awake and q4h & PRN if asleep. Some of the 2+ year olds can go all night with a dry diaper regardless of diagnosis, unless overnight feeds or fluids. You document clean & dry or change if needed.

I've never done aquaphor AND powder. Powder is contraindicated for most of my clients as most have BPD, asthma , RAD, CF or other respiratory condition. Just something to think about.

I've seen kids with a rash if not changed q2h. I've seen kids react to specific diaper brands ( my own son would get horrid weaping welts from huggies, and then pampers "baby dry" once they changed the formulation. Turns out he reacted to the desiccant used to keep the child drier). Anything is possible.

I still say contact pedi if mom says that's the physicians recommendation. Contact your clinical supervisor.

If PCG wants a specific diaper regime then perhaps, with pediatrician approval, it should be specified in the 485.