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Special Populations
CAPA Pediatrics, Obstectrics, and Elderly
| Question | Answer |
|---|---|
| Children's physiology differs from adults' in what four area? | - Airway-Breathing-Circulation and Hypo-perfusion-Mental Status |
| Children's airway makes what more difficult | Intubation |
| What is the most common airway obstruction? | The tongue |
| Name differences in children that lead to airway issues | Glottis is high, U-shaped, narrower, and stiffer than adultsIncreased chane for airway edemaTongue is largerReduced airway lumen sizeSmaller nasal passages |
| What increases risk for subglottic stenosis (narrowing and stiffening which increases potential for difficult intubation) | - Croup- Craniofacial Abnormalities- Syndromes |
| Limited intercostals and other accessary muscles in children leads to what problem? | Quick fatigue resulting in respiratory aresst |
| What is the rate for mechanical ventilation in a child? | 20 breathes per minute |
| What is the optimal airwy positioning for an infant? | neutral or "sniffing" position |
| Why is air in the stomach an issue with infants? | Decreases diaphragm movement |
| Functional Residual Capacity in pediatric patients is ????? | Decreased. Alveoli close completely with exhilation - little to no air retained in lungs. |
| To meet oxygen demand pediatric patient's cardiac output is ???? | Increased |
| T/F: BP is a good indicator of shock in pediatric patients | False. Children remain normotensive until 25% of their blood volume is lost. |
| In children what is the FIRST sign of EARLY shock? | Unexplained tachycardia |
| BP changes are an early/late sign of shock | LATE |
| Cardiac dysrhythmias and arrest in children are almost always the result of what? | Respiratory Failure |
| Hypoxia in infants leads to what cardiac rhythm? | Bradycardia |
| 75% of heat loss in an infant is through what? | The head |
| T/F: Infants under 3 months of age are unable to produce heat through shivering. | True |
| Hypothermia physiological results? | Increased metabolism, Increased Oxygen consumption. |
| Hypoxemia, Hypoglycemia, and Metabolic Acidosis are results of what ? | Hypothermia |
| T/F: Infants have an incrased risk of Hypovolemia | FALSE - Stress response increases ADH and Aldosterone production which increases fluid retention. Children are at higher risk for HYPERvolemia. |
| Name GI concerns with children. | Increased salivationIncreased peristalsisImmature lower esophogeal sphincter (GERD) |
| What intervention should the nurse take considering the pediatric patient's GI concerns? | Elevate head of bed or place in side position |
| Developmental Stage?Trust vs Mistrust | Infant |
| Developmental Stage?Autonomy vs Shame and Doubt | Toddler |
| Developmental Stage?Initiative vs Guilt | Preschool |
| Developmental Stage?Industry vs Inferiority | School Age |
| Developmental Stage?Identity vs Role Confusion | Adolecscence |
| What is the FIRST sign of hypoxia in pediatric patients? | Bradycardia |
| T/F: Elderly patients have a decreased residual lung volume | False - elderly patients have a increased residual volume (think COPD - air goes in, does not come out) |
| Elderly have an increased/decreased total lung capacity | Decreased |
| T/F: Elderly have a decreased in alveolar surface area | True - this leads to increased risk of porr oxygenation. |
| Work of breathing in the elderly in increased due to what? | Consistent decline in respiratory muscle strength with age |
| Sensitivity to respiratory depressants in the elderly is ____________ | Increased. |
| Normal myocardial changes in the elderly lead to what organ issue? | Decreased organ perfusion |
| Elderly arterial changes include: | Loss of large artery elasticityCoronary artery disease |
| What is the relationship between CNS and anesthesitics in the elderly? | Decreased anesthestic requirements. |
| Decreased neuronal density and nerve conduction leads to what issue with the elderly? | Loss of memory |
| GI changes in the elderly include: | Decreased salivationDecreased motilityDecreased lower esophogeal tone (GERD)Malnutrition and vitamin deficiencies |
| Normal GI changes in the elderly lead to what issue in the OR and PACU? | Decreased absorption of drugs/nutrients |
| Why is it more difficult to correct electrolyte imbalances in the elderly? | Decreased renal blood flow and GFRDecreased Hepatic |
| What should the PACU nurse monitor in an elderly male? | Urinary retention. All men have an increasingly large prostate with age. |
| Considering normal sensory changes in the elderly what should the PACU nurse assess? | Hearing? Hearing aids? Visual defecits? Tactile defecits? |
| What is kinesthetic learning? | Learning by doing and touching |
| What does the Cognitive Domain of Learning entail? | The learner's knowledge and understanding |
| What does the Affective Domain of Learning include? | Learner's attitudes, emotions, and coping skills |
| What does the Psychomotor Domain of Learning include? | Learners motor skills, ability to perform tasks |
| Considerations when teaching the elderly | Slow the paceEliminate distractionsSensory aids if neededPrinted material |
| What OTC item should be assessed with all patients? | Herbal therapies/supplaments |
| Pregnancy is a state of ____________________. | Compensatory respiratory alkalosis |
| RR, O2 consumptions and Tidal Volume increase in what population? | Obstetric patient |
| Why do pregnant patient have a decreased Functional Residual Capacity? | The uterus displaces the diaphragm |
| Why would a smaller ET tube be needed in a pre-eclamptic patient? | Pre-eclamptic patients may have vocal cord edema. |
| What concerns should the PACU nurse have for a patient who delivers in the Lithotomy position? | Hypoxia. Lithotomy position increases hypoxia because it stops circulation. |
| Why is hypocarbia a concern with OB patients? | Pain may lead to severe hyperventilation (blow off CO2) |
| Hyperventilation/Hypocarbia/Sever alkalosis are pulmonary changes that occur during what? | Labor |
| Why is DIC a concern for post-partum patients? | Pregnancy is a Hypercoagulable state - Increased Coagulation factors. |
| Why is positioning an important nursing intervention with pregnant patients? | Cardiac output changes with position. |
| What position is the most beneficial to mother and fetus? | Left Lateral Side |
| T/F: In a pregnant patient BP increases due to the increased blood volume. | FALSE: Despite the increase in blood volume BP stays the same in obstetrical patients. |
| For anesthesia ALL pregnant women are considered ______________________ | A Full stomach and at risk for aspiration |
| In pregnant women ______ is not a reliable indicator of hypovolemia or shock | BP |
| T/F: Blood loss may reach 35% before hypovolemic shock occurs in a pregnant woman. | True |
| What is an early sign of hypovolemic shock in an OB patient? | Mild tachycardia wihout blood pressure changes |
| How often should the PACU nurse massage the fundus of a post-partum patient? | Every 15 minutes for 1 hour. |
| What medication is usually in an Epidural PCA for laboring women? | Fentanyl or Marcaine/Fentanyl |
Created by:
keviannk
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