Diaper Changes

[Nibbles1]

I searched my question before posting this. However, I cannot find an amswer that pertains about children. My client has a reddened area on her bottom. I told the PCG this morning about it. PCG stated, "Do not change the babies diaper so often. Change it every four hours from here on out." So, my question is I am suppose to leave the child in a wet diaper for hours now? Wouldn't that make it worse? PCG says it's red from the wipes and rubbing it too often. I have never ever had this problem ever before in PDN. What do you in this situation?

[JustBeachyNurse, LPN]

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.

[caliotter3]

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

Remember to get an appropriate doctor's order for whatever product the mother chooses to go with. Most doctor's are willing to add to the order: "Any barrier product of parent's choice may be used." If the doctor wants only a specific cream, then he will order it that way.

[Nibbles1]

I going to talk to the clinical supervisor tomorrow. I have never had a diaper changing issue before. I always check q 2 hours and if they are wet, I change the diaper, if they are not wet, I check again in one hour. This little one has a looooong hx of yeast infections and diaper rash since day birth as I was told per PCG. It makes absolutely no sense to leave a child in a soppy wet diaper for four hours. I sincerely appreciate everyone's input on this matter.

[Nibbles1]

They were using Pampers and oh my gosh, it was terrible. They switched to a different brand, rash has greatly improved, but it was very red two days ago when I pointed it out the PCG. Money for diapers has not been an issue for this case. This family appears to have money. Both parents are educated and have jobs. Honestly, this is one of the best cases I have ever had. This "diaper issue" just started a few days ago. PCG told me that they told the other nurses prior to telling me. I cannot wrap my head around this thinking.

[SDALPN]

Is it possible that the parent isn't changing the diaper as they should and that's why the child has diaper rash? Something isn't right. Can you call the Dr and ask if that is what was said? We don't usually take instructions from parents...many tell us what they want to and not what the Dr said. There's a reason you feel like anything is wrong with this. Follow your gut.

[brillohead, ADN, RN]

I have a 25yo DD client that I'm constantly battling diaper rash on, including yeasty stuff.

My fave routine is lots of direct air exposure and, provided that it's not a respiratory contraindication, lots of powder. For regular redness, just baby powder, but when things get yeasty, I use Desenex (athlete's foot powder = antifungal!).

But definitely change as soon as you know the dipe is wet. If a reaction to the wipes themselves is a problem, a different brand of wipes or just using washcloths or paper towels and warm water should fix the problem.

[smartnurse1982]

Many of the parents tell me to only change a diaper if its soaking wet. It has a small or medium amount of urine,they do not want them changed.

Since i work at night,their rationale is that they want the child to sleep.

[Nibbles1]

Again thank you everyone for their advice on this topic. DON was not much help on the matter. I am going to check diapers q4 hrs./prn when client is sleeping so I won't disturb client sleeping and document the skin integrity. That's all I can do in this case.

[caliotter3]

Again thank you everyone for their advice on this topic. DON was not much help on the matter. I am going to check diapers q4 hrs./prn when client is sleeping so I won't disturb client sleeping and document the skin integrity. That's all I can do in this case.

Sounds like a plan.