12 Health Problems in Toddlers and Preschoolers Flashcards
The result of heat transfer from one site to another. They are caused by excessive heat, but are also related to cold, chemicals, electricity and radiation.
Burn Injury
____ disrupt the skin, which leads to increased fluid loss; infection; hypothermia; scarring; compromised immunity; and changes in function, appearance, and body image.
Burns
_____ and _____ continue to have increased morbidity and mortality when compared to other age groups with similar injuries.
Young children and the elderly
_____injuries in addition to cutaneous burns worsen the prognosis.
Inhalation
Types of Burns
Thermal Burns
Chemical Burns
Electrical Burns
Other Burns
Most common type of burn, usually the result of residential fires, automobile accidents, children playing with matches, improperly stored gasoline, space heater, arson, improper handling of firecracker, scalding accidents, hot irons
Thermal Burns
Result from contact or ingestion, inhalation or injection of acids, alkalis, vesicants or noxious agents used in cleaning products
Chemical Burns
Result from contact or ingestion, inhalation or injection of acids, alkalis, vesicants or noxious agents used in cleaning products
Chemical Burns
Sunburn, cigarette burn, friction or abrasion burn
Other Burns
_____ results from coagulation, protein denaturation, or ionization of cellular components
Tissue destruction
Burns that do not exceed 20% of TBSA according to the Rule of Nines produces a _____
Local response
Burns that exceeds 20% of TBSA according to the Rule of Nines produces a _____
Systemic response
_____ is caused by the release of cytokines and
other mediators into the systemic circulation.
Systemic response
The release of _____ and changes in blood flow, tissue edema, and infection, can cause progression of the burn injury.
local mediators
2 level of response to Burn Injury
Local response
Systemic Response
Edema results from increased capillary permeability forcing water, electrolytes into the interstitial spaces
Local Response
Fluid loss from the burn-injured skin is a result of the _____
inflammatory response
Circulatory alterations cause _____ in the burned area
capillary stasis
_____ develop, leading tissue ischemia and necrosis causing pain and edema
Thrombi
Cardiovascular changes occur, burn shock, tachycardia, tachypnea to compensate for decreasing vascular volume and increased oxygen needs
Systemic Response
_____ may occur with severe edema compromises circulation and entraps nerves
Compartment Syndrome
Respiratory system may be compromised by _____
Smoke Inhalation
Renal changes occur, such as renal vasoconstriction, depressed _____
Glomerular filtration
_____ is greatly increased - can lead to prolonged starvation and extensive energy needs
Metabolism
Elevated _____ because of increased metabolism
body temperature
Prone to _____ due to loss of skin and tissue integrity and immature immune system
infection
Degree of Burns
First, Second, Third and Fourth
Damage is limited to epidermis, causing erythema and pain
First Degree
Epidermis and part of the dermis are damaged, producing blisters and mild to moderate edema and pain
Second Degree
Epidermis and dermis are damaged; no blisters appear, but white, brown or black leathery tissue and thrombosed vessels are visible
Third Degree
Rare and damage extends through deeply charred subcutaneous tissue to muscle and bone
Fourth Degree
This is the immediate consequence of fluid loss and results in decreased perfusion and oxygen delivery.
Hypovolemia
Cardiac output decreases before any significant
change in blood volume is evident.
Decreased cardiac output
Forms rapidly after burn injury
Edema
Circulating blood volume decreases dramatically during burn shock.
Decreased circulating blood volume
Common during the first week of the acute
phase, as water shifts from the interstitial space to the vascular space.
Hyponatremia
Immediately after burn injury _____ results from massive cell destruction.
Hyperkalemia
Loss of skin results in an inability to regulate body temperature.
Hypothermia
Burns that make up _____ or more of TBSA are considered critical and require hospitalization
10%
TBSA
Total body surface area
Children’s larger body surface areas put them at high risk for fluid volume and heat loss leading to _____
Dehydration
To estimate the extent of a burn in a pediatric patient, use the _____
Lund and Bowder chart
The _____is a quick way to estimate the extent of burns in adults through dividing the body into multiples of nine and the sum total of these parts is equal to the total body surface area injured
Rule of Nines
This method recognizes the percentage of
surface area of various anatomic parts, especially the head and the legs, as it relates to the age of the patient.
Lund and Browder Method
The size of the patient’s palm, not including the surface area of the digits, is approximately 1% of the TBSA, and the patient’s palm without the fingers is equivalent to 0.5% TBSA and serves as a general measurement for all age groups.
Palmer Method
Complications of Burns
Respiratory Complications
Sepsis
Burn Shock
Fluid and electrolyte deficits
Hypothermia
Hypermetabolism
Hypovolemic Shock
Infections
Scarring and disfigurement
Contractures
Multisystem organ failure
Treatment for Minor Burns
Removed burned clothing
Clean with mild soap and tepid water
Leave blisters intact
Nothing should be applied except a clean cloth that is treated with antimicrobial ointment or cream
Tetanus prophylaxes is necessary if no history of immunization
Mild analgesic is administered
Moderate to severe burns
Requires treatment at a specialized burn center
Emergency management begins with stopping the burning process and placing the child in horizontal position
Establish and maintain patent airway. Initiate SPR if necessary
Removed burned clothing and jewelries while keeping the child warm
Cover the burn to prevent contamination
Until transported to a medical facility do not let the patient eat or drink anything. IV fluids should be started and oxygen therapy provided at 100%
Initial management in the Burn unit
Maintenance of adequate airway
IV fluid replacement should be started as soon as possible
Intubation and mechanical ventilation may be necessary
Urinary catheter is inserted to measure urine output
NGT is necessary to decompress the stomach, later, may be used to administer TPN
IV pain medication administered
Topical wound cleaning to prevent infection
Tetanus prophylaxis is administered
The acute or intermediate phase begins 48 to 72 hours after the burn injury. _____ and _____ are priorities at this stage.
Burn wound care and pain control
Rehabilitation should begin immediately after the burn has occurred. _____, _____ and _____ remain priorities.
Wound healing, psychosocial support, and restoring maximum functional activity
Occurs most commonly in children between ages 2 to 3 years old
Poisoning
Common agents in childhood poisoning include:
Soap
Cosmetics
Detergents and Cleaners
Plants
OTC Drugs - vitamins, iron compounds, aspirin
Treatment for Acetaminophen poisoning
Activated charcoal
Acetylcysteine
Ingestion of strong alkali such as lye, which is often contained in toilet bowl cleaners or hair care products, may cause burns and tissue necrosis in the mouth, esophagus and stomach
Caustic Poisoning
Do not try to make the child _____ after ingestion because they can cause additional burning as the child vomited
Vomit
_____ may lead to systemic signs of tachycardia, tachypnea, pallor and cyanosis
Loss of blood
Diagnostic Tests for Poisoning
Chest radiograph
Esophagoscopy
Barium Swallow
There is a high possibility that pharyngeal edema will be severe and can obstruct the airway in 20 minutes after burn, _____ may be necessary to provide patent airway
Intubation
Are substances contained in products such as kerosene and furniture polish
Hydrocarbon Ingestion
These substances are volatile, fumes rise from them. Their major effect if respiratory irritating
Hydrocarbon Ingestion
Are frequently swallowed by small children because it is an ingredient in vitamin preparation for pregnancy
Iron poisoning
When ingested, it is corrosive to the gastric mucosa and can cause gastric irritation
Iron poisoning
Signs and symptoms of Poisoning
Nausea and vomiting
Diarrhea
Abdominal pain
After 6 hours, these symptoms fade and the child’s condition appear to improve , however, hemorrhagic necrosis of the GI tract has occurred
By 12 hours, melena and hematemesis are present
Lethargy, coma, cyanosis, coagulation defect and hepatic injury can occur
_____ will be done to remove any pills not yet absorbed
Stomach lavage
A _____ may be given to help the child pass enteric-coated iron pill
cathartic
_____ should not be given - not effective in neutralizing iron
Activated charcoal
If large dose was ingested, Chelating agent must be given - _____ - must be given IV or IM - can be excreted in the urine
Deferoxamine
Interferes with RBC function by blocking the incorporation of iron into the compound that makes up the heme portion of hemoglobin
Lead poisoning
Sources of ingested lead
Paint chips, home glazed pottery, swallowed batteries
Diagnostic test for Lead poisoning
Blood lead determination
Signs and Symptoms of Lead Poisoning
Asymptomatic
Anorexia and abdominal pain
Children with 20 ug/dL may be prescribed with oral chelating agent such as _____
Succimer
Insecticide poisoning when swallowed, _____ may be administered
Activated charcoal
Cholinesterase reactivator - are effective antidote to severe cases
Protapam Chloride
Submersion injury is also knows as the “_____”
Silent Event
_____ is the 3rd leading cause of unintentional injury death worldwide, accounting for 7% of all injury-related deaths.
Drowning
Children, _____ and individuals with increased access to water are most at risk of drowning.
males
Globally, the highest drowning rates are among children _____ years, followed by children _____ years.
1–4, 5–9
In the WHO Western Pacific Region children aged _____ die more frequently from drowning than any other cause.
5–14 years
Abuse is a “_____” behavior.
learned
Most common type of mistreatment: Failure to provide the child’s basic needs and care
Neglect
Two types of Neglect
Physical, Emotional
Contributing Factors of Neglect
- Lack of knowledge by caregiver
- Lack of resources
- Substance abuse
- Can lead to elder abuse
Any physical attack repeated or occurring just once
Physical Abuse
Causes of Shaken baby Syndrome
- Crying baby
- Maternal stress
- Depression
Signs and Symptoms of Shaken baby syndrome
Subdural or retinal hemorrhage without external signs
Individuals who exhibit the characteristics of this syndrome fabricate, exaggerate, or cause illness or sickness, usually of their own child. MSBP is a form of child abuse and can prove fatal.
MUNCHAUSEN SYNDROME BY PROXY
An illness that one person fabricates or induces in another person
MUNCHAUSEN SYNDROME BY PROXY
