242 module 2 Flashcards
considerations when assessing children
- 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
describe the paediatric assessment triangle
- 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
paeds assessment triangle appearance
- abnormal tone
- decreased interactiveness
- decreased consolability
- abnormal look/ gaze
- abnormal speech/ cry
paeds assessment triangle circulation to skin
- pallor
- motting
- cyanosis
paeds assessment triangle work of breathing
- abnormal sounds
- abnormal position
- retractions
- flaring
- apnea/ gasping
when is flacc assessment tool used
(infants, toddlers & non verbal children)
sections of the flacc tool
face, legs, activity, cry, consolability
0-2 for each
what does the wong baker pain assessment tool look like
0, 2, 4, 6, 8, 10 with different faces depicting pain
what is the numerical pain rating scale
patient rates pain between 1-10
differences in infant airway/ breathing
- 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.
what does infants being nose breathers cause
• Infants must breath through their nose
Minor infections e.g. a cold means child will struggle to feed and breath
differences in infant circulation
- 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
considerations for medication administration in children
- 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
charting paeds medications considerations
- 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
what colour syringe for paeds oral dosing
purple
paeds pharmacology considerations
- 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
• Fractures – what are they?
- 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
• Sprains – what are they?
• A sprain is an injury to a ligament
• What does a ligament do?
- A ligament joins a bone to a bone
* In a fracture – there is almost always damage to tendon, ligament and muscle
• Strains – what are they?
• A strain is an injury to a tendon or muscle
• What does a tendon do?
- Tendons join bone to muscle
* In a fracture – there is almost always damage to tendon, ligament and muscle
fracture types
- 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
stage 1 of fracture healing
• 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 •
stage 2 fracture healing
Stage 2 (Callus formation) • (5 days to 4-6 weeks post Inj) • Osteoblasts lay down collagen and cartilage
stage 3 fracture healing
Stage 3 (Remodelling)
• (6 weeks to 3 months post injury)
• Hard callus enlarges girth of bone
• Medullary cavity formed and normal bone pattern restored
what is pain
• 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)
questt approach to pain
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
pain assessment tools examples
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)
Paediatric respiratory characteristics that increase risk of compromise
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
Paediatric cardiovascular characteristics that increase risk of cardiovascular compromise:
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
