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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
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| what 3 parts does the Pediatric Assessment Triangle consist of ? | Appearance, Work of Breathing, Circulation to skin
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| What is the goal of the pediatric assessment triangle? | Determine a chief compliant
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| 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
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| What does TICLS stand for ? | Tone, Interactiveness,Consolability, Look/Gaze,Speech/cry
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| What should you examine when looking at work of breathing? | Body position (tripoding,head bobbing?), rate/effort, retractions noted, noises like grunting, stridor
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| What are signs of respiratory distress? | nasal flaring, retractions, increased breathing rate/depth, tachycardia, grunting, stridor
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| If a kid appears normal but they have increased work of breathing, what is it? | respiratory distress
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| If a kid does not look normal and they have increased work of breathing, what is it? | respiratory failure
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| What are See-saw respirations? | chest draws in, abdomen thrusts out
indicator of severe respiratory distress
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| 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
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| What are you looking at when examining circulation? | skin temp, pulse strength, skin color, cap refill(good measure in kids)
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| After Pediatric triangle assessment, you start: | Pediatric Primary survery
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| What you look at in Pediatric Primary for Airway and Breathing? | Airway, resp, tidal vol, lung sunds, pulse ox
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| 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"
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| How do you asesss circulation for pediatric primary survery? | Assess HR (too fast, too slow, not present)
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| How many times should you take a BP in child under 3? | attempt only once!
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| 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
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| What are some positive signs of LOC in children? | AVPU, intrested in environment, cooing/babbling, irritable cry
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| What are some negative signs of LOC in children? | moans, grunts, NO response
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| What do you check with children pupils during assessment? | PERRL
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| What is good sign of muscle tone in children? | active
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| What is a bad sign of muscle tone in children? | still
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| What is not a good sign when examining fontanelles? | sunken or bulding
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| 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
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| When is the "appearance" part of the pediatric survery helpful? | when injury/illness is mild-moderate
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| 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.
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| What should you do if you notice a life threatening problem during the pediatric survey? | Immediately begin resusitation!
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| What is Gastrochisis? | a congenital Ab wall defect where intestines/other organs develop outside of ab wall to the right of umbilicus
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| What population does Gastrochisis seem to occur in? | Mothers under 20 years of age, however no known cause.
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| 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
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| What other care is involved in Gastrochisis? | Respiratory stabilization
Abdominal decompression
Thermoregulaton
Fluids
Antibiotics
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| How do you care for Gastrochisis post-op? | Respiratory support
Maintain abdominal decompression
Pain management
Edema- watch for in lower extremities
Skin integrity
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| 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
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| What is a diaphragmatic hernia? | Protrusion of abdominal organs through opening in diaphragm. leads to pulmonary hypoplasia. Commonly on left side
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| 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
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| How is Diaphragmatic hernia confirmed? | chest x-ray, may see on ultrasound in utero
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| 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
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| What are some nursing interventions for Diaphragmatic Hernia? | recognized asap, maintain resp/ iv access, monitor vs for decompensation, pain mgmt, gastric decompression, antibiotics
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| 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
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| 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?
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| What are some diagnostics for fever? | CBC/blood cult, UA, lumbar punct, CXR to see of resp compromised
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| What are some tx for Fever? | antibiotics- ampicilin and 3rd gen cephalosp, Antipyretics, fluids
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| 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
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| 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
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| What are some family/ enviro risk factors for Shaken Baby? | Young/single, low education, stress, DV, ETOG/drug use, parent depression, home life unstable
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| 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
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| 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)
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| What might shaken babies present with? | lethargic, cant lift head, unequal pupils, hard to breathe, not feeding, vomiting, bulging fontanelles, rigid, seizure
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| What is the clinical picture of the shaken baby? | hematoma, intracranial hemorrh,skull fracture, brusing behing eyes, raccoon eyes, detached retina, crushed ribs
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| What is cardinal sign of shaking? | 85% of babies will have retinal hemorrhages
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| What problems do shaken babies have after? | blindness, hearing loss, seizures, impaired intellect, speech/memory problems, cerebal palsy
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| 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
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| 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
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| 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
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| The severity of FBA is determined by ? | location(above or below carina), type of object, extent of obstruction
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| Foreign body in the air passages will have what symptoms? | Choking, gagging, wheezing or coughing
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| Laryngotracheal obstruction: | dyspnea, cough, stridor and hoarseness due to decreased air entry
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| Bronchial obstruction symptoms: | cough, wheezing, asymmetrical breath sounds, decreasing airway entry, dyspnea
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| Lodged in the larynx symptoms: | unable to speak or breathe
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| 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
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| 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
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| 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
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| What is the definition of Drowning? | death from asphyxia within 24 hours of submersion in wateW
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| definition of near drowning? | survival (even if temporary) beyond 24 hours after a submersion
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| Do near drowning kids do better in warm or cold water? | Cold water due to vasoconstriction
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| 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.
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| Loss of Consciousness and Brain damage happen how soon after drowning? | 2 mins, 4-6 mins
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| Problems for near drowning? | Hypoxia, acidosis which leads to cardiac arrest, Primary CNS injury- tissue hypoxa/ischemia
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| what is "wet-drowning" aspiration? | asphyxia relaxes airway which lets lungs take in water.
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| 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
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| Nursing intervention for near-drowning? | Respiratory support
Mechanical ventilation and blood gas monitoring
IVFs
Neurological monitoring
Family support
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| What account for majority of head injuries ? | Falls(especially from bicycles), followed by MVAs
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| 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
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| What are signs of minor head injury in child | minor goose egg, no vomiting, no change in mental status
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| What are signs of mild head injury in child | brief loss of consciousness, vomiting, blurred vision, change in behavior, disoriented.
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| What are signs of severe head injury in child | unequal pupils, open head injury, signs of ICP, bleeding or leaking CSF, motor skills assymetric
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| What is most cause of ER surgery in child? | appendicitis (pain in RLQ)
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| What is most important for tx of dog bite? | clean with saline (antibiotics, wait till sutures heal)
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| 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
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| 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.
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