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Pediatric Crises

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What are the 3 initial Pediatric Components? Pediatric Assessment Triangle (first impressions) Primary Survey (ABCD assessment) Secondary Survey (vital signs, focused history, detailed,physical exam
what 3 parts does the Pediatric Assessment Triangle consist of ? Appearance, Work of Breathing, Circulation to skin
What is the goal of the pediatric assessment triangle? Determine a chief compliant
What is the single most important assessment factor in the pediatric triangle? Appearance (There are very few false neg, a physiologically sick child will look sick
What does TICLS stand for ? Tone, Interactiveness,Consolability, Look/Gaze,Speech/cry
What should you examine when looking at work of breathing? Body position (tripoding,head bobbing?), rate/effort, retractions noted, noises like grunting, stridor
What are signs of respiratory distress? nasal flaring, retractions, increased breathing rate/depth, tachycardia, grunting, stridor
If a kid appears normal but they have increased work of breathing, what is it? respiratory distress
If a kid does not look normal and they have increased work of breathing, what is it? respiratory failure
What are See-saw respirations? chest draws in, abdomen thrusts out indicator of severe respiratory distress
what is an early sign in children of compensation for circulatory problem? Decreased circulation to skin (vasoconstriction in non-important areas like skin so all of perfusion can got to vital organs
What are you looking at when examining circulation? skin temp, pulse strength, skin color, cap refill(good measure in kids)
After Pediatric triangle assessment, you start: Pediatric Primary survery
What you look at in Pediatric Primary for Airway and Breathing? Airway, resp, tidal vol, lung sunds, pulse ox
What is the order of bad breathing decline in children? Increased resp rate/WOB "not good", retractions"bad", nasal flaring/gruntin"really bad", decreased resp with decreased neuro "worst"
How do you asesss circulation for pediatric primary survery? Assess HR (too fast, too slow, not present)
How many times should you take a BP in child under 3? attempt only once!
How else can you asses circulation during Pediatric Primary Survey? Peripheral pulse, "feel the feet"-cap refill, look to see if pink, warm, dry - any variation of that is bad
What are some positive signs of LOC in children? AVPU, intrested in environment, cooing/babbling, irritable cry
What are some negative signs of LOC in children? moans, grunts, NO response
What do you check with children pupils during assessment? PERRL
What is good sign of muscle tone in children? active
What is a bad sign of muscle tone in children? still
What is not a good sign when examining fontanelles? sunken or bulding
When is the "disability" assessment in the pediatric primary survery helpful? to look at altered level of consciousness if illness or injury is moderate-critical
When is the "appearance" part of the pediatric survery helpful? when injury/illness is mild-moderate
What is it important to keep doing? An ongoing assessment, especially after a procedure was done. look for missed injuries or any changes in condition.
What should you do if you notice a life threatening problem during the pediatric survey? Immediately begin resusitation!
What is Gastrochisis? a congenital Ab wall defect where intestines/other organs develop outside of ab wall to the right of umbilicus
What population does Gastrochisis seem to occur in? Mothers under 20 years of age, however no known cause.
What is the number #1 nursing mgmt of gastrochisis? protect bowel with a silo bag and keep from kinking on itself, so doesn’t occlude vessels, moisture and
What other care is involved in Gastrochisis? Respiratory stabilization Abdominal decompression Thermoregulaton Fluids Antibiotics
How do you care for Gastrochisis post-op? Respiratory support Maintain abdominal decompression Pain management Edema- watch for in lower extremities Skin integrity
What goes on in recovery of Gastrochisis? Baby is NPO for 1-2 (will have a broviac CVC), gastric output will be green (when its clear means have healed), starting feedings slow, monitor site, look for any intolerance
What is a diaphragmatic hernia? Protrusion of abdominal organs through opening in diaphragm. leads to pulmonary hypoplasia. Commonly on left side
What are signs of diaphragmatic hernia? respiratory distress (tachypnea,cyanotic, absent) hours after birth, bowel sounds heard in the chest, concave abdomen, lopsided chest, tachycardic, low BP
How is Diaphragmatic hernia confirmed? chest x-ray, may see on ultrasound in utero
How do you treat Diaphragmatic hernia? ECMO (before sx), Surgery (suture or patch),Intubation and respiratory support Management of hypoxemia Correction of acidosis fluids, Dopamine
What are some nursing interventions for Diaphragmatic Hernia? recognized asap, maintain resp/ iv access, monitor vs for decompensation, pain mgmt, gastric decompression, antibiotics
What is an emergent fever in a child and what may it be indicative of? temperature that exceeds 38 C (100.4 F) rectally in infants less than 3-4 months old, bacteremia or meningitis
What questions do you as parents about fever hx when they get to hospital? is the child active or lethargic, feeding/how may wet diapers?, Vom or Diarhhea? med/immunization hx, were they around other sick? what was temp at home?
What are some diagnostics for fever? CBC/blood cult, UA, lumbar punct, CXR to see of resp compromised
What are some tx for Fever? antibiotics- ampicilin and 3rd gen cephalosp, Antipyretics, fluids
What are nursing assessment/interventions for fever? VS, resp/pulse ox, change on neuro (irritable vs. lethargy, hydration statis, diag test, support parents, look for phys sign of infection
What are risk factors for Shaken Baby syndrome? less than 3 yr (3-8 mo avg), premature, disabled, stepchild, first born, previous abuse. Male babies get it 60% and usually males(80%) who shake them
What are some family/ enviro risk factors for Shaken Baby? Young/single, low education, stress, DV, ETOG/drug use, parent depression, home life unstable
What are some red flags when Shaken Baby comes to hospital inconsistent story,initially does not report trauma, evasive, delay in seeking help, other fractures
Why are babies so vunerable to shaken baby injury? Large head size Thin, pliable skulls Heavy and unstable heads Soft brains Weak musculature (this is also why seats are rear facing so dont get accelaration-decleration injury)
What might shaken babies present with? lethargic, cant lift head, unequal pupils, hard to breathe, not feeding, vomiting, bulging fontanelles, rigid, seizure
What is the clinical picture of the shaken baby? hematoma, intracranial hemorrh,skull fracture, brusing behing eyes, raccoon eyes, detached retina, crushed ribs
What is cardinal sign of shaking? 85% of babies will have retinal hemorrhages
What problems do shaken babies have after? blindness, hearing loss, seizures, impaired intellect, speech/memory problems, cerebal palsy
What is the nursing priority for shaken baby? Care for baby is no. 1, dont try to figure out who did it but be sure to document and also provide education
Things to remember about Shaken Baby syndrome? caused by rapid accelation-decelaration which causes injury. These type of injury cannot happen from bouncing, falls, accidents
What age is Foreign Body Aspiration most common and what do they choke on most commonly? Most common in children ages 1-3 Most common obstructions: Hot dogs, round candy, nuts, grapes, peanut butter, small toys, coins
The severity of FBA is determined by ? location(above or below carina), type of object, extent of obstruction
Foreign body in the air passages will have what symptoms? Choking, gagging, wheezing or coughing
Laryngotracheal obstruction: dyspnea, cough, stridor and hoarseness due to decreased air entry
Bronchial obstruction symptoms: cough, wheezing, asymmetrical breath sounds, decreasing airway entry, dyspnea
Lodged in the larynx symptoms: unable to speak or breathe
What might you see in a child with only a partial foreign body obstruction? Secondary symptoms are seen Persistent respiratory infections Persistent cough which may not be discovered till days/weeks later
treatment for foreign body aspiration? Foreign body is rarely coughed up spontaneously Removed instrumentally by endoscopy Local inflammatory response may make it difficult Food items may have started to decompose
What are some nursing interventions for Foreign Body Aspiration? Recognize the signs, start Back blows and Heimlich maneuver Recognize signs of distress: Cannot speak Becomes cyanotic Collapses
What is the definition of Drowning? death from asphyxia within 24 hours of submersion in wateW
definition of near drowning? survival (even if temporary) beyond 24 hours after a submersion
Do near drowning kids do better in warm or cold water? Cold water due to vasoconstriction
Can salt water harm child drowning? initial tx not affect by water type, salt wont change electolytes but may be concerned about how dirty it is.
Loss of Consciousness and Brain damage happen how soon after drowning? 2 mins, 4-6 mins
Problems for near drowning? Hypoxia, acidosis which leads to cardiac arrest, Primary CNS injury- tissue hypoxa/ischemia
what is "wet-drowning" aspiration? asphyxia relaxes airway which lets lungs take in water.
why does hypothermia happen in near drowning infants and children due to their large surface area relative to body mass, allow resumption or maintenance of cardiac function
Nursing intervention for near-drowning? Respiratory support Mechanical ventilation and blood gas monitoring IVFs Neurological monitoring Family support
What account for majority of head injuries ? Falls(especially from bicycles), followed by MVAs
Why are children more susceptible to head injury? Head is larger in proportion to the body surface area Stability is dependent on the ligamentous rather than bony structure Brain has a higher water content 88% - brain is softer, unmylenization(shear injury), open sutures cause more ICP
What are signs of minor head injury in child minor goose egg, no vomiting, no change in mental status
What are signs of mild head injury in child brief loss of consciousness, vomiting, blurred vision, change in behavior, disoriented.
What are signs of severe head injury in child unequal pupils, open head injury, signs of ICP, bleeding or leaking CSF, motor skills assymetric
What is most cause of ER surgery in child? appendicitis (pain in RLQ)
What is most important for tx of dog bite? clean with saline (antibiotics, wait till sutures heal)
What should you do during assessment/tx of dog bite? find out what happened, does child have tetanus shot? did dog have rabies shot? If not child will need to start rabies shots. Look at depth of wound and start to debride. Check for fever, sepsis, loss of function
What do you do if tooth gets knocked out? hold by tooth, not root and rinse throughly, place in glass of milk or in mouth till you can get to dentist.
Created by: UARN85