Caring for Infants and Children Chapter 23 Flashcards
Define infant.
A child between the ages of birth to one year.
What are the five developmental categories for pediatric patients?
- Infants
- Toddlers
- Preschool
- School age
- Adolescents
Define toddler.
A child between the ages of 1 and 3 years old.
Define school age.
A child between the ages of 6 and 12 years of age.
Define preschool.
Children ages 3 to 6 are called preschool children.
Define adolescents.
A child between the ages of 12 and 18 years old.
At what age does a child’s body catch up with the size of the head?
6 years old.
The child’s head is proportionately larger and heavier than his body. True, or false?
True
What is most likely to land first in a sudden fall or stop due to its size and weight?
A child’s head.
What is the definition of a child?
A person from the age of one year to the onset of puberty.
Many of the assessment and care techniques used for adults are very different for children. True, or false?
False. Many of the assessment and care techniques used for adults are similar for children, with some modifications.
What techniques are used to treat children?
- Approach them slowly, establish I contact from a safe distance, and ask permission to get closer.
- Let them know that someone will call their parents.
- Get down to it eye level with the child.
- Let children see your face & expressions. Speak directly to them. Speak clearly & slowly so that they can hear & understand you. Keep your voice gentle and calm even when you need to be firm. Try not to raise your voice or talk loudly to a crying or screaming child. Try to maintain eye contact.
- Pause frequently to find out if the child understands what you have said or asked.
- Quickly determine if there are any life-threatening problems &care for them immediately. Avoid moving children, if possible. Movement may cause unexpected pain.
- Begin the physical exam at the feet & work up to the head if there are no critical injuries.
- Always tell the child what you are going to do before each step of your assessment. Take one step at a time. Explain one step, do it, and then explain the next.
- Never lie to children. Tell them if it will hurt when you are examining them. If they ask questions, tell the truth, but reassure them that you are there to help and other people will also help.
- Offer comfort to children by stroking their foreheads or holding their hands. Theybwill let you know if they don’t like it.
- Talk to the child, not just to the parent.
9.
The techniques used for the assessment & care of children are the same as for adults with certain modifications. Those modifications reflect the patient’s differences in age and:
- Physical and intellectual development
- Physical development and emotional response
- Emotional response and sex of the child
- Emotional response and language skills
B. Physical development and emotional response
The most appropriate approach when assessing the pediatric patient is to:
A. Remain at eye-level, explain each step of the exam, & be truthful.
B. Remain at eye level, move to a quiet location, & perform the exam.
C. Move to a quiet location, perform the exam, & call parents.
D. Remain at eye level, & the exam while telling jokes.
A. Remain at eye level, explain each step of the exam, and be truthful.
When assessing infants younger than one year, you must ensure an adequate airway. You must also:
A. Protect the head, & provide care to prevent shock.
B. Protect the head & spine, & provide care to prevent shock.
C. Protect the head & neck, but do not become too emotional.
D. Protect the head & trunk, but do not become too emotional.
B. Protect the head & spine, & provide care to prevent shock.
If you need to clear the airway of an unresponsive infant, you should:
A. Open the mouth & perform a finger sweep.
B. Provide chest thrusts as quickly as possible.
C. Open the mouth, give 2 slow breaths, & perform a finger sweep.
D. Open the mouth, look for obstructions, & perform a finger sweep if you see one.
D. Open the mouth, look for instructions, & perform a finger sweep if you see one.
If you need to perform CPR on an infant, the proper location for chest compressions is:
A. Two finger widths below the imaginary nipple line.
B. One finger width below the imaginary nipple line.
C. Three finger widths below the imaginary nipple line.
D. In the center of the chest between the nipples.
B. One finger width below the imaginary nipple line.
You are caring for a responsive child who is cyanotic and struggling to breathe. You should first: A. Perform a finger sweep B. Arrange for immediate transport C. Begin rescue breathing D. Give two breaths and begin CPR
C. Begin rescue breathing
If parents or guardians are present & their emotional response to the child’s injury hinders your ability to properly care for the child, do all of the following EXCEPT:
A. Ignore them
B. Ask them to assist you with your tasks
C. Have someone tactfully remove them from the scene
D. Have a friend, neighbor, or other EMS responder distract them with questions
A. Ignore them
When examining a child, the strategy that may be perceived by the child as LEAST threatening is to first examine the:
A. Head and neck and then the rest of the body
B. Head, neck, chest, and then the rest of the body
C. Heart and lungs, and then the rest of the body
D. Legs and chest, and then the neck and head
D. Legs and chest, and then the neck and head
All of the following statements are true for child from 3 to 6 years of age (preschool) EXCEPT that day:
A. Do not like to have their clothing removed
B. Have a fear of blood, pain, and permanent injury
C. Believe illness or injury is punishment for being bad
D. Do not care if they are separated from their parents
D. Do not care if they are separated from their parents
All of the following are characteristics of children from 6 to 12 years of age EXCEPT that day:
A. Believe their illness or injury is a punishment for being bad
B. Are modest and do not like to have their bodies touched
C. Have a fear of blood, pain, disfigurement, and permanent injury
D. Are cooperative but like to have their opinions heard
A. Believe their illness or injury is a punishment for being bad
The fontanels on and infant's head do not completely close until about \_\_\_\_\_\_\_\_months of age. A. 15 B. 16 C. 18 D. 12
C. 18
All of the following are unique to a pediatric patients breathing EXCEPT:
A. Infants are generally knows breathers.
B. There is more respiratory movement in the chest than abdomen.
C. They have a less developed and more elastic chest than adults have.
D. The trachea is softer, more flexible, and narrower than an adults.
B. There is more respiratory movement in the chest than abdomen.
Which of the following statements about children is NOT true.?
A. They have a larger skin surface area in proportion to total body mass.
B. They have a constant blood volume regardless of age.
C. Normal vital signs very with the size of the child.
D. Blood pressure will vary depending on age, sex, and height.
B. They have a constant blood volume regardless of age.
All of the following are common medical emergencies for the pediatric patient EXCEPT: A. Respiratory emergencies B. Altered mental status C. Heart attacks D. Seizures
C. Heart attacks
Several different forms of child abuse that usually occur together are sexual, physical, and: A. Psychological B. Neglect C. Social D. Mental
A. Psychological
Infants breathe through the ________.
Nose
What can you use to keep an infant or child’s shoulders in a neutral alignment when managing the airway?
A folded towel under the shoulders.
How should oxygen be administered to infants and children?
- Provide oxygen immediately.
2. Use a pediatric non-rebreather mask or by using the blow by technique.
Children tolerate high fevers better than adults, but a fever that rises rapidly can cause ___________.
Seizures
In an infant or child, signs & symptoms of shock mean:
Shock has progressed and is in the late stages. Provide emergency care immediately.
In situations where you suspect abuse, your obligation is to:
Report any suspicions to the proper authorities.
Due to their inexperience, infants and children are frequent victims of trauma due to their:
Size, curiosity, & a lack of fear.
When the soft spot is sunken, the child may have:
Lost a lot of fluid because illness has caused inadequate fluid intake or diarrhea & vomiting.
A bulging soft spot may mean:
There is increased pressure inside the skull due to trauma or from an illness.
It is normal in a quiet infant to see a heartbeat pulsate in the soft spot. True, or False?
True
Capillary refill time in a child should be:
Less than 2 seconds
What is the weakest area of a growing bone?
The growth plate because it is developing tissue.
What is the average pulse rate per minute and the average respiration rate per minute for a newborn (birth to one month)?
Pulse: 120-160 per minute
Respiration: 30-50 per minute
What is the average pulse rate and the average respiratory rate per minute for an infant (1 month to 1 year)?
Pulse: 80-130 per minute
Respiration: 25-30
What is the average pulse rate and the average respiratory rate per minute for a toddler (1 to 3 years)?
Pulse: 80-130
Respiration: 20-30
What is the average pulse rate and the average respiratory rate per minute for a preschooler (3 to 6 years)?
Pulse: 80-120
Respiration: 20-30
What is the average pulse rate and the average respiratory rate per minute for a school age child (6 to 12 years)?
Pulse: 70-110
Respiration: 15-30
What is the average pulse rate and the average respiratory rate per minute for an adolescent (12 to 18 years)?
Pulse: 60-105
Respiration: 12-20
Blood pressure varies in children and depends on their:
- Sex
- Age
- Height
Boys have a slightly higher blood pressure than girls. True, or false?
True
Taller children have a higher blood pressure than children. True, or false?
True
What are the factors that influence blood pressure in children?
- Time of day. It’s lower during sleeping hours.
- Physical activity. It’s higher during & immediately after exercise or activity; slower during inactive.
- Emotional moods or feelings. Fluctuates when child is afraid angry stressed or happy.
- Physical condition. (type of illness or injury)
A blood pressure cuff should cover about 1/3 of the child’s upper arm to take blood pressure. True, or False?
False cover approx. 1/2 of child’s upper arm
In the prehospital setting it is not necessary to measure blood pressure on a child younger than:
3 years
How do you calculate a child’s blood pressure range?
Upper range: multiply the child’s age in years by 2 and add 90: (age X 2) + 90 = upper limit of systolic blood pressure.
Lower range: multiply the child’s age in years by two and add 70: (age X 2) + 70 = lower limit of systolic blood pressure.
In children, the general impression is an important indicator of the severity of illness. True, or false?
True
What is the pediatric assessment triangle or PAT?
A tool used to perform a general impression of a pediatric patient.
What are the three elements of the PAT?
- Appearance
- Work of breathing
- Circulation/perfusion
What is work of breathing?
The effort that is required for a person to breathe.
Explain the three criteria for performing a PAT.
- Appearance: as you enter the scene and approach the patient, quickly assess the child’s appearance.
- Work of breathing: how much effort is the child exhibiting to breathe?
- Circulation: how well is the child perfusing as evidenced by the presence of pulses and the color of the skin?
What are breathing retractions?
The inward movement of the soft tissues between the ribs when a child breathes in.
Retractions are a sign of __________ __________.
Significant distress. You must bare the chest to see retractions.
The first concern in the care of any patient, especially children, is:
An open and clear airway
What are the three results of a low oxygen level (hypoxia) in children?
- Affects the heart rate (slowing the pulse & reducing oxygen circulating to tissues)
- Affects the brain (decreasing oxygen to cells and causing altered mental status and tissue death)
How do you administer rescue breaths to an infant?
Provide at a rate of one breath every 3 to 5 seconds using a pediatric size pocket facemask or a bag mask device of the correct size.
Do not use flow restricted, oxygen powered ventilation devices (demand valves) on infants and children. True, or false?
True
How often do you take vital signs in children?
Every five minutes for unstable patients & every 15 minutes for stable patients.
A physical exam for child is given in reverse order starting with the:
Toe to head in order to give the child an opportunity to get used to you and your touch.
What is the most common cause of cardiac arrest and infants and children?
Respiratory arrest
What is apnea?
A period of interrupted breathing.
What is SIDS?
Sudden infant death syndrome. The sudden death of an apparently healthy baby during sleep.
What is croup?
An acute respiratory condition common in infants and children that is characterized by a barking type of cough or Strider.
What is epiglottitis?
A Swelling/inflammation of the epiglottis (flap that closes over the trachea when swallowing) that may be caused by a bacterial infection; it may cause airway obstruction.
What are the signs and symptoms of epiglottitis?
It may have a sudden onset in what seems to be an otherwise healthy child. Rapid fever, cold like symptoms, has difficulty swallowing, and is drooling. Children will sit in an upright, tripod position leaning forward with arms based on the edge of the bed or chair with the chin thrust out & the mouth wide-open. This effort to breathe is very tiring for a child. Although rare, epiglottitis is considered life-threatening.
The following is true of asthma EXCEPT:
A. It is a common respiratory condition to children.
B. Most children who have asthma use a medication or inhaler prescribed by their doctors.
C. Signs & symptoms of asthma occur when the small airways in the lungs go into spasm and constrict or become too narrow for air to pass through.
D. Asthma is not a life threatening condition.
D.
D. Asthma is not a life threatening condition.
A more severe form of seizure with violent muscle contractions is called:
Convulsions
Febrille seizures are:
Seizures caused by a high fever.
After a seizure, it is normal for children to be either ______________, or _______________.
Lethargic (drowsy) and difficult to arouse, or
Agitated and combative
What are the common causes of shock in infants & children?
- The loss of large amounts of fluid from diarrhea & vomiting,
- Blood loss,
- Abdominal injuries
- Other trauma
What is decompensated shock?
The inability of the body to function or compensate for low blood volume or lack of perfusion of oxygenated blood to the brain. It develops quickly in children.
Is the body’s normal response to many childhood diseases and infections?
A fever or high temperature
An increased temperature is not necessarily what causes a seizure, but a rapid rise in body temperature can cause one. True, or false?
True
The following are accepted methods of treating a high fever EXCEPT:
A. Place damp, cool cloths on the child’s forehead
B. Cover the child with a towel soaked in tepid water if the fever is the result of heat exposure.
C. Submerge the child in cold water
D. Undress the child down to underwear or diaper but do not allow them to become chilled.
C. Submerge the child in cold water
Children lose a lot of body heat through their heads because the surface area of the child’s head is proportionately larger than the rest of the body. True, or false?
True
What is dehydration?
The loss of needed body fluids.
If a drowning victim has recovered and they are breathing on their own, it is not necessary to transport them to the hospital. True, or false?
False. Always transport.
When does SIDS most often occur in infants?
In the first 3 months of life and may occur up to one year of age.
In what circumstances should you not begin resuscitation?
- If there is obvious stiffening of the body (rigor mortis), or
- If blood has pooled (lividity) along whatever side the child was lying on.
What are the general emergency care steps for an infant or child trauma patient?
- Ensure an open airway. Manually stabilized the head and neck.
- Make sure the airway is clear. Suction if allowed. If necessary provide ventilations.
- Provide oxygen by non-rebreather mask or assist ventilations with a bag mask device with supplemental oxygen as per local protocols.
- Control bleeding by applying appropriate dressings.
- Stabilize suspected fractures.
- Maintain manual stabilization of the patient’s head and neck until the ambulance arrives.
- Arrange for transport as soon as possible.
- While waiting for the EMT’s to arrive or while in route, perform detailed ongoing assessments.
What is the rule of nine percentages for the infant and child?
18% to head and neck, 18% to chest and abdomen, 9% to each arm, 18% to the entire back, 23% for each leg, and 1% to the genital area
How do you treat the child burn victim?
Carefully and quickly care for the burned area with dry, sterile, and nonadherent dressings or sheets. Do not treat with moist dressings as they may chill the child and could speed the shock response. Arrange for transport as quickly as possible.
What is shaken baby syndrome?
A form of child abuse that occurs when an abuser violently shakes an infant or small child creating a whiplash type motion that causes acceleration-deceleration injuries.
If you suspect abuse and the parent or caregiver will not allow the child to be transported, call for law enforcement assistance. True, or false?
True
What is a mandated reporter?
Individuals designated by law to report cases of suspected abuse or neglect.
What is abuse?
The physical or emotional or sexual mistreatment of another person.
What is psychological abuse?
The emotional or verbal abuse that seriously affects a child’s positive emotional development, well-being, and self-esteem.
What is neglect?
The failure of parents or caregivers to adequately provide for a person’s basic physical, social, emotional, and medical needs.
What is sexual abuse?
Inappropriate physical sexual contact or exposure and sexual exploitation by displaying or photographing children for sexual purposes or with sexual intent.
What is physical abuse?
Any form of violent, harmful contact with the child or any disfiguring act performed on the child regardless of the intent of the adult.
