Care of Pediatrics Flashcards
Care of Pediatrics
What makes pediatric patients different?
!Laryngospasm is fairly common problem
Care of Pediatrics
What is the age classification for neonates?
0-28d of life
44 weeks post conceptual age
HR 90-160 (asleep)
HR 100-204 (awake)
RR 30 - 53
SBP 67- 84
DBP 35 - 53
Care of Pediatrics
What is the age classification for infants?
1-12 months
HR 90-160 (asleep)
HR 100-190 (awake)
RR 30 - 53
SBP 72 -104
DBP 37 - 56
Care of Pediatrics
What is the age classification for toddler?
1-3 years
HR 80-120 (asleep)
HR 98-140 (awake)
RR 22 - 37
SBP 86 -106
DBP 42 - 63
Care of Pediatrics
What is the age classification for pre-schooler?
3-5 years
HR 65-100 (asleep)
HR 80-120 (awake)
RR 20 - 28
SBP 89 -112
DBP 46 - 72
Care of Pediatrics
What is the age classification for school age?
6-12 years
HR 58- 90 (asleep)
HR 75-118 (awake)
RR 18 - 25
SBP 97 -120
DBP 57 - 80
Care of Pediatrics
What is the age classification for adolescent?
13-18 years
HR 50- 90 (asleep)
HR 60- 100 (awake)
RR 12 - 20
SBP110-131
DBP 64 - 83
Care of Pediatrics
What is the pre-operative NPO guidelines for pediatrics?
Clear liquid - 2 hours
Breast milk - 4 hours
Infant formula - 6 hours
Non-human milk - 6 hours
Light meal - 6 hours
Care of Pediatrics
At what age is separation anxiety is highest among pediatric patients?
8 months - 2 years
Separation anxiety is highest
Most difficult for mask induction
Pre-medication/ Pre-induction useful
Care of Pediatrics
At what age is fear of loss of control highest among pediatric patients?
7-11 years (fear of loss of control)
Generally calm with mask induction
Fearful of needles
Care of Pediatrics
When is CPR initiated for bradycardic infants?
HR < 60 for infants (birth to 1 year)
Care of Pediatrics
Where to check pulse for < 2 years old.
Apical pulse
Care of Pediatrics
What are the risk factors for emergence delirium among pediatric patients?
Sevoflurane/ Desflurane anesthesia
Pain
ENT surgery
Male
Pre-op anxiety
Pre-existing behavior
Care of Pediatrics
How to evaluate emergence delirium among pediatric pateints?
Pediatric Anesthesia Emergence Delirium (PAED) score
If score >10 is indicative of the presence of ED
* Child makes eye contact with the provider
* Child’s actions are purposeful
* The child is aware of his/her surroundings
* The child is restless
* Child is inconsolable
Scored from 0-4, where “0” means not at all and “4” means extremely, maximum score is 20
Care of Pediatrics
When to use FLACC behavioral pain scale on pediatric patients?
0-7 years old
(F) Face, (L) Legs, (A) Activity, (C) Cry, (C) Consolability scored from 0 to 2, which results to total score between 0 and 10.
FACES can be used as early as 3 years old
Care of Pediatrics
What pre medication is commonly used in pediatric patients?
Midazolam (Versed)
Care of Pediatrics
What is commonly used dosage of midazolam for pediatric patient?
PO 0.25-1mg/kg (max 20mg)
20-30 minute onset
IV 0.025-0.21 mg/kg
Care of Pediatrics
What is the common side effect of midazolam to pediatric patients?
paradoxical excitation
Care of Pediatrics
What is the advantage of Ketamine vs. other sedative hypnotic agents?
Ketamine
* also has analgesic properties
* lowers postoperative opioid requirements
* promotes spontaneous respirations
When used in small (subanesthetic) doses (0.1 to 0.5 mg/kg), the common side effects (i.e., tachycardia, delirium, hallucinations, nightmares) are minimal. It has been suggested that ketamine always be administered with a benzodiazepine (midazolam) to help reduce the incidence of delirium, hallucinations, and nightmares
When is ketamine used for pediatric patients?
pediatric patients who have behavioral d/o or very distress/ed uncooperative
What is the side effect of ketamine in pediatric patients?
hallucinations/ dysphoria
PONV
DO NOT USE if increased ICP
What is the dosage of ketamine for pediatric patients?
PO 5-10mg/kg
IV 1mg/kg
Care of Pediatrics
What is the dosing of sedation reversal agents for pediatrics?
flumazenil (0.1 mg/kg IV)
naloxone (1 to 10 mcg/kg IV)
Care of Pediatrics
What are the symptoms of laryngeal obstruction for pediatric patients?
In order of appearance
* croupy cough
* hoarseness
* inspiratory stridor
* aphonia
These symptoms are accompanied by increasing restlessness, tachypnea, use of accessory muscles of respiration, retraction of the suprasternal notch and intercostal spaces, and drawing in of the upper abdomen.
Care of Pediatrics
What is postintubation croup?
Caused by glottic or tracheal edema. 1 mm of edema decreases the diameter of the airway by 75%.
Care of Pediatrics
What is the the treatment for tracheal edema?
relieve the obstruction
administer supplemental O2
notify anesthesia provider who will consider
corticosteroid therapy (racemic epinephrine)
cool humidified mist with additional O2 as necessary
Possibel rebound edema, check patient after 1 hour. Consider admission.
Care of Pediatrics
What is laryngospasm?
Laryngospasm - partial or complete obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis, an exaggerated or prolonged laryngeal closure reflex.
Laryngospasm - leading cause of perioperative cardiac arrest from respiratory origin in children.
Care of Pediatrics
What causes laryngospasm?
Contributing factors include the type of surgical procedure such as tonsillectomies, dental work, strabismus repair, hypospadias repair, as well as a history of reactive airway disease; living with household smokers; and recent upper respiratory tract infections.
Care of Pediatrics
How to treat laryngospasm for pediatric patients?
open mandible to adjust jaw
Administered 100% humidified O2
Apply continuous positive pressure by mask
propofol (initial medical treatment to deepen anesthesia and relax vocal cords)
succinylcholine (0.25–1 mg/kg) if all other attempts to break the spasm have been unsuccessful
reintubate if necessary
Posterior oral pharyngeal suctioning can cause additional trauma and should be avoided (or performed very carefully) after the child has been extubated.
Care of Pediatrics
What is stridor?
Partial airway obstruction can lead to stridor during inspiration due to swollen airway
Care of Pediatrics
What is the treatment for stridor?
humidified oxygen
racemic epinephrine nebulized medication, if needed
iv corticosteroid medication if needed
delay discharge to ensure resolution
If wheezing, nebulized albuterol and corticosteroids. Epinephrine for refractory bronchospasm.
What is the general rule for ETT size for pediatric patients?
!Uncuffed ETT must be used until 8 years old to allow slight air leak to be present
Care of Peddiatrics
What is the ETT size for pediatric patients?
Uncuffed - (age in years / 4) + 3.5
Cuffed - (age in years / 4) + 4
What is the dose of zofran for pediatric patients?
0.15mg/kg
Care of Pediatrics
Pediatric pain management
Morphine is gold standard for opioids
PCA as young as 5 years old based on manual dexterity and ability to understand the concept
Erikson’s Stages of Development Theories
Infancy (0-1yr) - Basic trust vs. mistrust
Toddler (2-3yr) - Autonomy vs. shame/doubt
Preschool (3-6yr) - Initiative vs. guilt
School age (6-12yr) - Industry vs. inferiority
Adolescense (12-20yr) - Identify vs. role diffusion
Post procedure, a child experienced laryngeal edema. Symptoms subsided after treatment. The parents are instructed to expect:
- oxygen therapy at home
- discharge after 1 hour of observation
- minimal wheezing upon discharge
- monitoring in PACU for 2-4 hours
monitoring in PACU for 2-4 hours
Care of Pediatrics
What is tonsillar position?
Patient placed in 3/4 prone position (tonsillar position) after intraoral surgical procedure to facilitate adequate drainage of secretions and blood
Care of Pediatrics
What is the recommended staffing for pediatric patients?
Children who are 8 years of age and younger should have a ratio of 1:1 nursing care until the critical elements of care are met and/or parents are at the bedside.
Care of Pediatrics
How do neonates regulate body temperature?
Non-shivering thermogenesis is a physiologic response of the newborn infant during periods of hypothermia with stimulation of the sympathetic catabolism of brown fat with release of energy in the form of heat. Brown fat is primarily located in the neck and chest of the infant.
Care of Pediatrics
What is the optimal position for children to assist with ventilation and intubation, if necessary?
For 6 y/o and older, sniffing position - a folded towel or small pillow placed under the occiput in combination with extension of the head
For infants and younger children, usually the size of the head is large relative to the trunk, and hyperflexion of the neck occurs with lying flat on a bed. Further elevation of the occiput with a folded towel most likely hinders airway management. Mild flexion of the neck with slight extension of the head can be accomplished with the placement of a shoulder roll.
Care of Pediatrics
How to encourage pediatric patients to cooperate taking medication?
Ask “Should I (the nurse) give this to you or should mommy give this to you?” or “Should we do this now or right after your story?” The proper approach to medication administration is as something that has to be done.
Do not ask “Can you take your medicine?” or “Can I give you your medicine?” because when child answers “no” beccause trust is broken in patient - healtchcare relationship because since the child need to take the medicine despite the negative response.
Care of Pediatrics
Developmentaly Delayed patient
