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Peds Test # 2

Pediatric assessment, PFT, ABG

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%
Created by: Dabi2