Pediatric triangle - Answer- appearance
work of breathing
circulation to skin
General appearance considerations - Answer- Tone
Interactiveness:
... [Show More] drawn to sounds or people. Wants to play
Consolability
Look/Gaze
Speech/cry
Work of breathing: - Answer- Increased work of breathing evidenced by tachypnea, stridor, grunting, retractions, accessory musles, nasal flaring, head bobbing, abnormal positioning
Circulation to Skin - Answer- Observe palor
mottling
cyanosis
Sick, Sicker, Sickest - Answer- Sick: no disruption of any component of PAT but caregivers are concerned
Sicker: one component of PAT is a concern
Sickest 2+ concerns of PAT
2 leading causes of altered mental status in kids - Answer- hypoxia
hypoglycemia
Blood pressure norms - Answer- Hypotension: Less than 70 + (2 x age in years)
Widening pulse pressure = increased ICP
Narrowing pulse pressure = hypovolemic shock
Crying child - Answer- Vigorous = good
weak = sick
high-pitched = increased ICP
"Fussiness" = red flag
Respiratory distress indicated by: - Answer- increased heart rate
skin color changes
incrased work of breathing
wheezing
diaphoresis
abnormal airwa sounds
Respiratory failure signs - Answer- fatigue and become lethargic
hypoxia
hypercarbia
General airway interventions - Answer- Allow child to stay in most comfortable position
Give O2 to maintain it above 92%
O2 does NOT measure ventilation
Croup - Answer- 1-3 days of nasal congestion and fever with sudden onset of barky cough
Treatment: dexamethasone and nebulized epi
Discharge Teaching: oral hydration, get child to cool air or steamy bathroom
Asthma interventions - Answer- albuterol, duo neb and oral steroid
Bronchiolitis/RSV - Answer- Assessment: 1-3 days nasal congestion fever, cough, respiratory distress with wheezing and crackles. Dehydration and tachypnea
interventions: nasla suctioning, fluids
sever: heated, high flow nasal cannula O2
Discharge: lasts 2-3 weeks; nasal suctioning; monitor hydration
treating hypoglycemia - Answer- obtain glucose for anyone who is not awake and alert
treat kids with 2-4ml/kg of D25W
When to perform blood glucose test? - Answer- When the child is not awake and alert or AMS is suspected
Preventing Secondary brain injury in TBI - Answer- prevent hypotension and hypoxia
cuffed vs uncuffed tube - Answer- uncuffed= (age in years/4) + 4
cuffed= (age in years/4) + 3.5
fluid bolus formula - Answer- infant: 10ml/kg
kid: 20ml/kg
normal vitals - Answer- pg 52
blood glucose normal ages 5-11 - Answer- 72-140
Cardiac Assessment - Answer- Trend pulse and pulse pressure
palapate upper and lower extremity pulses
symptoms of CHF - Answer- poor feeding, irritability, fatigue easily with rapid resp rate, increased work of breathing
Ass and Interventions similar to adults
Myocarditis Assessment and treatment - Answer- Assess: consider in anyone with recent viral infection; SOB and crackles; dysrhthmias; heart failure; syncope; elevated liver enzymes
Treat: diuretics; BP support; ECMO; transplant
Hypovolemic Shock - Answer- Tachycardia, tacypnea; AMS; slight increaes in diastolic pressure
Intervention: Stop bleed; give fluids and RBC; balanced therapy; offer pedialyte if not NPO
Cardiogenic shock - Answer- Intervention: expert consult; supportive care to decrease O2 and metabolism demands; slow fluids; treat hpotension while decreasing afterload; vagal maneuver; vasopressors
Obstructive Shock - Answer- Assessment: Cardiac tamponade- muffled heart sounds and pulsluss paradoxus; tension pneumo- asymmetrical chest rise and fall
Intervention: pericardiocentesis; needle thoracentesis; antigoagulation or surgical intervention; treat ductal dependent lesion
Anaphylactic Shock - Answer- remove pathogen
fluids
epi
Neurogenic - Answer- spinal motion restriction
vasopressors
warming measures
Septic - Answer- Fluids
antibiotics
vasopressors
OLD CARTS - Answer- Onset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Treatment
Severity
Pain Scale and appropriate ages of use - Answer- Numeric- 6-17 years
Visual Analog: 5-17
Faces: 4-12
FLACC- nonverbal
Evaluation of child maltreatment - Answer- ask open ended questions
use direct quotes
Sex trafficing risk factors - Answer- limited education
runaway/homeless/foster care
hx of abuse
livining poverty
family dysfunction
disability
substance abuse
LBGT
low self-esteem, depression, social isolation
Human trafficang Assessment screening - Answer- hx: pt doesn;t have ID; doesn't know home address; vague hx of illness; person accompanying is unwilling to leave pt.
persistent/untreated STI
trauma to vagina/rectum
jaw/neck pain
hyper startle reflex
expensive items, clothing, hotel keys
Increased ICP triad - Answer- widening pulse pressure
bradycardia
bulging fontenel
respiratory disress
Febrile seizure - Answer- Temp greater than 100.4 usually occurs after 24 hour onset
if occurs after that 24 hr period consider meningitis
give antipyretic to promote comfort and oral intake. Does not prevent seizures
Avoid ice baths
Seizure Inteventions - Answer- turn pt on side
provide safe environment
check bedside glucose
manage fever as a cause or a result
if seizure lasts longer than 5 minutes consider benzos
give antiboitcs for infection
hyponatremia =3% sodium chloride
Seizure medication - Answer- 5 min: midazolam=intranasal, IM, IV
5-10 min: 2nd dose or phenytoin
15-30 min: phenobarbital, reassess airway, consider intubation
When should the parent cal 911 in for a seizing child? - Answer- child stops breathing
parent cannot feel a pulse
seizure lasts more tahn 5 minutes
child has more than 1 seizure before fully awake
VP shunt issues assessment - Answer- changes in resp rate: apnea or irregular
changes in BP: widening pulse pressure
Changes in HR: bradycardia
fever or signs of shock
redness/edema
Hydrocephalus interventions - Answer- accurate head circumference for monitoring
elevate HOB 30 degrees and maintian head allignment
Give meds: anyipyretics, analgesic, antibiotics, meds to decrease ICP
Difference between stroke and bells palsy - Answer- Pt will be unable to raise an eyebrow or wrinkle the forehead on the affected size w/ bells palsy
stroke usually only involves the lower face
Stroke interetnions - Answer- maintain glucose
control BP
meds: aspirin; anticonvulsants; antigocagulants (embolism)
Symptoms of TBI (concusion) are organized into what four catagories? - Answer- Thininking and remembering
physical
emotional/mood
sleep
Secondary impact syndrome - Answer- 2nd brain injury before the first one is healed. Brain cannot auto regulate CPP
Causes massive brain edema and herniation
proper infnat/toddler head positioning with spinal percautions - Answer- place padding under shoulders of infant to achieve neutral alignment
have parent directly above pt so pt is not turning head
reverse trandeleburg to reduce anxiety
Neurogenic Shock - Answer- Injury above T6 results in bradycardia, hypotension, and vasodilation, thermoregulatory instability
Spinal shock - Answer- flaccid muscle tone below thei njury and decreased sensation at and below the level of injury
kids who do not need a spine board - Answer- compliant child
absence of distracting injury
absence of alcohol
GCS 15
absence of spine tenderness/neurologic findings
Orbital fracture interventions - Answer- topical vasoconstrictor to stop bloody nose
avoid blowing nose
analgesics
ice
elevate HOB
LeFort I - Answer- Edema of maxillary area
lip laceraiton or fractured teeth
edema
maloccluiosn
Le Fort II - Answer- massive facisal edema
nasal swelling with obvious fracture or deformity
maloccluison
CSF rhinorrhea
Lefort III - Answer- massive facial edema
ecchymosis
mobility and depression of zygomatic bones
diplopia from nerve entrapment
ma,occluison
CSF rhinorrhea
midface and nasal fracture interventions - Answer- maintain airway
delay surgery until swelling decreases
avoid straining
bending over
heavy lifting
blowing nose
sleep with head of bed elevated for 3 nights
mandibular fracture test - Answer- have pt bite down on tongue blade
attempt to pull tongue blade out
if pt unable to continuously bite down --> could indicate mandibular fracture
Hyphema interventiosn - Answer- pt on bed rest with HOB at 35-45 degrees
cover eye with shield
steroids and tranexamic acid
Globe injuries - Answer- stabalize object with a shield
assess for fluid leaks
CT or MRI
meds to prevent increase IOP --> prevent vomiting, agitation, pain, antibiotics
Gastroenteritis Assessment and Interventions - Answer- Assessment: increased freqency of loose, fould smelling stools, vomiting, fever/headache/malaise; ab cramping
Intervention: oral rehydration; 2-5ml of oral rehydration solution every 2-5 minutes; increase if tolerated. Goal 50-100mg/kg over 2-4 hrs;
ANTIDIARRHEAL MEDS ARE NT REOMMENDED
colic baby comforting suggestions - Answer- 1. Swaddle
2. Side position for digestion (left)
3. sushing sounds
4. swinging
5. Sucking
Intussusception assessment and intervention - Answer- Assessment: colicky abdominal pain; child inconsolable; draws legs to chest; bomiting and ab distention with palpable sausage-shapped mass
Intervention: air or contrast enema to diagnose and treat --> not with signs of shock;
Swallowing items - Answer- -batteries are ideally removed within 2 hours
-X-ray/CT/US use to diagnose
-keep child NPO
Esophageal Atresia/Tracheoesophageal fistula - Answer- Assess: resp distress; drooling, choking episodes; reccurent resp infection
Post repiar: GErD; resp. illness, dysphagia; feeding issues
diagnosis by trying to insert a OG tube
Rhabdomyolysis assessment and interventin - Answer- Classic triad: muscle pain, weakness, dark urine
Peds: muscle pain, fever, and fivral prodrome
usually caused by infection (under 9yo)
Diagnose: CK>1000
Aggressive hydration; treat problem
hemolytic uremic syndrome Assessment - Answer- damage to kidenys so they can't filter usually form illness
pallor/lethargy
hypertension
diarrhea (bloody); N/V
edema
oliguria/anuria w/ hematuria and proteinuria
low hemoglobin adn hematocrit levles
elevated BUN and creatinine
bruising, purpura
AMS/seizures
HUS interventions - Answer- diagnosis made by triad of anemia, thrombocytopenia, and renal failure
DONT give antibiotic
IV hydration and electrolyte correction
dialysis [Show Less]