242 module 2

Question 1

considerations when assessing children

Answer 1

• They are not small adults!
• Adapt A-E approach
• Different physiology = different normal values
• Use the A – E approach
• The family play a part in the assessment and care

Question 2

describe the paediatric assessment triangle

Answer 2

• Useful for rapidly identifying a sick or deteriorating child
• 3 categories:
• Appearance
• Work of Breathing
• Circulation to skin

• This is a useful too for quickly spotting children who are at risk of / are deteriorating
•
Simple to use – looks at most significant indicators of deterioration

Question 3

paeds assessment triangle appearance

Answer 3

• abnormal tone
• decreased interactiveness
• decreased consolability
• abnormal look/ gaze
• abnormal speech/ cry

Question 4

paeds assessment triangle circulation to skin

Answer 4

• pallor
• motting
• cyanosis

Question 5

paeds assessment triangle work of breathing

Answer 5

• abnormal sounds
• abnormal position
• retractions
• flaring
• apnea/ gasping

Question 6

when is flacc assessment tool used

Answer 6

(infants, toddlers & non verbal children)

Question 7

sections of the flacc tool

Answer 7

face, legs, activity, cry, consolability

0-2 for each

Question 8

what does the wong baker pain assessment tool look like

Answer 8

0, 2, 4, 6, 8, 10 with different faces depicting pain

Question 9

what is the numerical pain rating scale

Answer 9

patient rates pain between 1-10

Question 10

differences in infant airway/ breathing

Answer 10

• Infants are ‘obiligatory’ nose breathers – why might this be important?
• Airways are smaller and shaped differently
• Large tongue & large head – airway considerations for both
• Higher metabolic rate - greater oxygen demand

Airways are cone shaped. Greater risk of obstruction from food or foreign body

Large tongue makes airway insertion difficult

Large occiput means when lying flat and unconscious – airway will obstruct – needs to be kept in neutral

Compared to adults, children require more oxygen. Therefore respiratory disease may cause more harm e.g. bronchiolitis, pneumonia or asthma.

Question 11

what does infants being nose breathers cause

Answer 11

• Infants must breath through their nose

Minor infections e.g. a cold means child will struggle to feed and breath

Question 12

differences in infant circulation

Answer 12

• Lower blood volume
• Able to compensate BP in presence of illness – hypotension a late sign
• Larger surface area – greater ‘insensible’ loss of fluid – greater risk of negative fluid balance
• Limited physiological reserve

Smaller blood volume means a small amount of fluid loss can result in critical harm

Children can compensate their BP very well.

This disguises how sick they are. They can then suddenly decompensate

Insensible loss – sweating, breathing etc. Large surface area with lower circulating volume means they become hypovolaemic more quickly

Question 13

considerations for medication administration in children

Answer 13

• Higher risk of harm to child from a drug error
• Medication errors 3 times more likely in paed setting (Forster, Maher & Patane, 2018)
• Children unable to communicate if side effect present
• Dosages usually calculated by weight
• Calculation errors

Question 14

charting paeds medications considerations

Answer 14

• Paed med chart
• In WA – must be printed on yellow paper
• You may find it on white paper outside of WA or in private healthcare facilities
• READ the document carefully

Special features of paed chart
• Space for documenting the basis of dose calculation (e.g. mg/kg/dose)
• Space for double signing when recording administration

Question 15

what colour syringe for paeds oral dosing

Answer 15

purple

Question 16

paeds pharmacology considerations

Answer 16

• ADME – Absorption, Distribution, Metabolisation, Excretion
• From 1 year Absorption, Distribution & Excretion similar to an adult
• Metabolisation
• Children’s liver clears drug quicker (under 10 years)
• Higher weight based dosage required for effective treatment
• Most drugs have not been tested for use in children
• Need to be alert to adverse reactions

Question 17

• Fractures – what are they?

Answer 17

• A fracture is a break in the continuity of the bone.

* It is the same as a broken bone. The name is not an indicator of severity

Question 18

• Sprains – what are they?

Answer 18

• A sprain is an injury to a ligament

Question 19

• What does a ligament do?

Answer 19

• A ligament joins a bone to a bone

* In a fracture – there is almost always damage to tendon, ligament and muscle

Question 20

• Strains – what are they?

Answer 20

• A strain is an injury to a tendon or muscle

Question 21

• What does a tendon do?

Answer 21

• Tendons join bone to muscle

* In a fracture – there is almost always damage to tendon, ligament and muscle

Question 22

fracture types

Answer 22

• Complete – also know as simple
• Comminuted means more than two broken parts
• Greenstick – usually in children until into puberty – more collagen in bones making them more flexible
• Impacted fractures – most common in hips.
• Depressed fractures – common in skull fractures – concern about it affecting brain tissue

Question 23

stage 1 of fracture healing

Answer 23

•	Stage 1
•	(0-5 hours post inj)
•	Haematoma formation
•	(1-5 days post inj)
•	Phagocytes remove debris and blood clots
•	Granulation tissue spans fracture gap
•

Question 24

stage 2 fracture healing

Answer 24

Stage 2 (Callus formation)
•	(5 days to 4-6 weeks post Inj)
•	Osteoblasts lay down collagen and cartilage

Question 25

stage 3 fracture healing

Answer 25

Stage 3 (Remodelling)
• (6 weeks to 3 months post injury)
• Hard callus enlarges girth of bone
• Medullary cavity formed and normal bone pattern restored

Question 26

what is pain

Answer 26

• An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
International Association for the Study of Pain (IASP, 1994)

OR

Pain is what the patient says it is, existing where and when they say it does (McCaffery, 1968)

Question 27

questt approach to pain

Answer 27

Question the child
Use the age and developmentally appropriate pain-ratingscales
Evaluate behaviour and physiological changes
Secure parental involvement
Take the cause of pain into account
Take action and evaluate result

Question 28

pain assessment tools examples

Answer 28

Self-report-
Behavioural observation pain assessment tools

Preverbal or non-verbal children (e.g. PIPP, Pre-mature Infant Pain Profile; NIPS, Neonatal/Infant Pain Scale;
CHEOPS, Children’s Hospital of Eastern Ontario Pain Scale

Face, Legs, Activity, Cry, Consolability (FLACC)
(NCCPC-R) and the Paediatric Pain Profile (PPP)

Question 29

Paediatric respiratory characteristics that increase risk of compromise

Answer 29

nose breathers,

• narrow airways,
• soft collapsible airways (submucosal gland in airway lager and lower pH of airway lining),
• large tongue adenoids,
• horizontal cartilaginous ribs
• immature intercostal accessory muscles
• less alveolar surface are available for gas exchange
• large head and inability to reposition
• higher metabolic rate
• developmental stage of placing objects into mouth or nose

Question 30

Paediatric cardiovascular characteristics that increase risk of cardiovascular compromise:

Answer 30

immature myocardium

• 70-80mL/kg blood volume
• Ability to maintain BP
• changes from foetal circulation may continue for several weeks
• increased risk of fluid depletion ( large surface area= increased risk of insensible losses)
• limited metabolic and physiological reserve