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Peds Test # 2
Pediatric assessment, PFT, ABG
| Question | Answer |
|---|---|
| Questions to ask when obtaining Hx of Pediatric Pt | acute, chronic, congenital anomalies, Immunization Hx, Family illness, exposure/living environment |
| History: Long term vent= | predisposed to disease |
| Immunization history to r/o what | disease and to isolate potential exposures |
| What do you look for in the chart? | previous x-rays and lab results |
| Always do a _____ _____ before stimulation of physical exam | visual assessment |
| HR: newborn to 3 mo | mean 140 |
| HR: 3 mo to 2 yr | mean 130 |
| HR: 2yr to 10 yr | mean 80 |
| HR:>10 years | mean 75 |
| Respiratory Rate is higher when ___ | awake |
| RR: age 1 to 5= | 30s |
| RR: age 5 and older= | 20s |
| What 2 things do you assess when taking HR and RR? | pattern and rate |
| 9 factors that influence HR and RR: | fear, anxiety, stress, pain, activity, temp, fatigue, meds, acidosis |
| 12 Additional things to assess | General appearance, LOC, Emotional status, Cyanosis, Perfusion, dyspnea, Clubbing, accessory muscle use, retractions, flaring, grunting, BS |
| In regard to emotional status, when do you allow the child to remain with the parent? | if they have a patent/uncompromised upper airway |
| Clubbing indicates what kind of disease? | chronic |
| What 2 things could cause cough | an irritant of an infection |
| A child is unable to cough up mucus < __ years of age | 6 |
| Things a CXR can diagnose | upper airway obs, foreign body aspiration, lung fields, atelectasis, fluid (chronic or acute disease) |
| 3 Non-invasive monitors used for trending | End tidal CO2, Transcutaneous, Pulse Ox |
| 4 labs usually drawn upon admission to PICU | Blood gas, Glucose, Blood cultures, Electrolytes |
| PFT’s can be done on children age __ and older | 6 |
| 7 Types of patients that might benefit from PFT | Asthma, CF, Scoliosis, CP, Spina Bifida, Cardiac, BPD |
| 5 General considerations for pediatric PFT | change may be result of growth, technical factors, adjustable equipment, unique training, and lab environment-remove fears |
| 4 indications for pediatric PFT | to identify disease (diagnose/quantify severity), monitor course of disease, effectiveness of Tx (bronchodilator), Pre-op planning |
| 4 causes for metabolic acidosis | lactic acid, diarrhea, ketoacidosis, ingestion of toxins |
| What 3 things cause increased lactic acid in blood? | tissue hypoxia, sepsis, cold stress |
| 4 causes of metabolic alkalosis | vomiting, gastric suctioning, certain drugs, electrolyte disorder |
| What 3 drugs/types of drugs cause metabolic alkalosis | NAHCO3, Diuretics, Steroids |
| 4 causes for respiratory acidosis | lung disease, impaired lung motion, apnea, neurologic/neuromuscular |
| 5 causes for Respiratory Alkalosis | Anxiety/fear/pain, CNS, Ventilator induced |
| What is Tracheal Tug? | Suprasternal retractions |
| Retractions of the SCM cause this sign of respiratory distress | head bobbing |
| Why do you use SATs instead of PO2 when assessing oxygenation of an infant? | bc fetal Hgb causes high saturation with low PO2 |
| Roughly ow long does it take for an infant to replace all Fet Hgb with normal Hgb? | 6-8 months |
| Normal range for a Newborns (birth-24hr) ABG values: | pH:7.3-7.4, PaCO2: 30-40; PaO2: 60-90; HCO3:20-22 |
| Normal range for an infant-toddler (up to 2 yrs) ABG values: | pH 7.3-7.4; PaCO2: 30-40; PaO2: 80-100; HCO3: 20-22 |
| >2yrs old ABG values are the same as ___ | adults |
| 4 things to remember when utilizing ABGs to treat children | always consider age of pt, disease, always remember days or months of illness, and always remember that oxygen is toxic to pediatric pulmonary tissue |
| Premature infants have a PaO2 closer to __mmHg | 60mmHg |
| If a patient has a PDA how would you treat? | keep PaO2 high to keep pt from reverting back to fetal circulation |
| Pt's with chronic disease states may never reach "normal" ABG values, a CO2 level of __-__ is often reached before intubation | 50-60 |
| A common cause of BPD is | long term vent use |
| 2 preductal sampling sites | Right radial and cephalic |
| 5 post ductal sampling sites | umbilical, Right and left pedal, and Right and left posterior tibial |
| 1 varaible sampling site | left radial |
| Where is the safe area of the heel for capillary sampling of an infant-<2yrs? | sides of the heels |
| A pt must be at least __ yrs old to perform a fingerstick capillary stick on | 2 yrs old |
| 2 indications for capillary blood gas | unable to obtain ABG (smaller patient), Need only pH and PaCO2 |
| 4 factors affecting accuracy of sample | pressure to puncture site, inadequate warming, excessive crying, poor perfusion |
| Accuracy of capillary blood gas pH is within | .02-.04 |
| Accuracy of capillary blood gas PaCO2 is within | 2.2 mmHg |
| Capillary PaO2 will never read higher than ___ even though actual value may be much higher | 60 |
| Describe how you would obtain a capillary blood gas | use safe area, warm site, wipe with alcohol swab, puncture, wipe off first drop, collect, wrap site, ice sample or run it |
| 2 Complications of Capillary blood gas procedure | cellulitis and scarring |
| 2 common errors when running CBG's | air bubbles, delay causes metabolism(O2 decreases CO2 increases) |
| 4 criteria for an arterial blood gas site | accessible, easy to palpate, easy to stabilize, superficial vessel |
| 3 procedural steps for ABG | assess collateral flow, a butterfly needle may be used, usually drawing otehr labs too |
| 2 complications of ABG draw | hematoma, infection |
| Equipment for patency of Arterial catheterization | infusion pump for children <15kg that is volume measured (1cc/hr heparinized saline drip) or a pressure bag and flush for children >15kg |
| 4 complications of Arterial catheter | bleeding at site, bleeding back into tubing, infection, embolus |
| 3 indications for umbilical artery catheter | freq blood sampling of newborn, Bp monitoring, and exchange transfusions |
| Where on an xray will you see the Umbilical artery catheter? | Low: Lumbar vertebra 3-4; High: Thoracic vertebrae 6-9; left side |
| 4 Complications of umbilical artery catheter | embolus, hemorrhage, infection, perforation |
| 2 indications for umbilical venous catheter | resuscitation and exchange transfusion |
| Placement of umbilical venous catheter on xray | inferior vena cava(5cm or less), right side |
| 3 most common arterial puncture sites in children and infants | radial, pedal, posterior tibial |
| 5 things to ask yourself when assessing a chest x-ray | quality of film?, Correct patient position?, Where is teh tip of ET tube?, What other lines are present?, What do the lung fields look like? |
| How many ribs should be seen on CXR? | 8th - 9th during inspiration |
| What does radiopaque mean? | underexposed, white out, consolidation |
| What is radiolucent? | overexposed, black appearance, free air |
| Other than looking at lung fields what 4 other things would you look for/at? | diaphragm, pleural space, bones and soft tissue |
| To identify chronic changes in a pediatric patient what kind of xray would you look at to see classic signs | lateral neck xray |
| The carina is located at T_-T_ therefore tip of ET tube should not be past T_-T_ | 3-4; 2-3 |
| This gland blends with the cardiac silhouette and is visible until age 2 | thymus |
| If pt has RDS you may see what? | air bronchograms near hilum |
| Why is the right dome of diaphragm higher? | elevation by the large liver |
| Diaphragmatic hernias are __% on the left, look for bowel higher than diaphragm | 90% |
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Dabi2
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