chapter 24: acutely ill children and their needs

Question 1

clinical status

Answer 1

the overall clinical wellbeing

Question 2

higher level of care

Answer 2

increased level of interventions and one on one nursing care

Question 3

safety precautions

Answer 3

used to describe multiple safety measures implemented by the pediatric health care team to keep a child safe

Question 4

providing safety at the bedside

Answer 4

• assess the room of the child for emergency equipment; ensure size is appropriate for the child and that they are fully functioning

Question 5

checklist for preparing for an emergency response includes

Answer 5

• bed in low position with side rails up and call light within the child’s reach
• manual resuscitator bag and masks
• suction set up with tubing and canister
• oxygen, connector, and oxygen delivery system

Question 6

SBAR

Answer 6

situation, background, assessment, recommendation, reading back or restating (SBARR - extra ‘r’ for other pediatric health care institutions

Question 7

cardiopulmonary resuscitation (CPR)

Answer 7

• be prepared to support a young child’s airway by rapid suction, airway support, oxygenation, and possible resuscitation

Question 8

choking emergency

Answer 8

• aspiration, obstruction, and choking are the leading causes of death in children < 1 yr old
• older sibling should not be allowed to feed an infant w/out constant supervision
• the infant’s environment should be frequently surveyed for choking and aspiration risks
• tracheostomy
• clearing a child’s airway
• expect continued airway symptoms after removal of the obstruction

Question 9

child in shock

Answer 9

shock: serious consequence of an acute or critical illness; he clinical outcome of poor perfusion, severe hypovolemia, low systemic vascular resistance (severe hypotention) or systemic venous congestion

Question 10

four types of shock

Answer 10

hypovolemic
cardiogenic
distributive
obstructive shock
- the highest priority in early treatment is to restore oxygenation to the tissues and the brain

Question 11

general management of shock

Answer 11

– position to increase cardiac output
- provide oxygen and prepare for intubation and mechanical ventilation
- protect vascular access
- measure height and weight accurately
- collect specimens for STAT lab analysis
- infuse vascular volume expanders
- administer medications
- closely monitor for responses to interventions
- secure rapid transfer to ICU or place crash cart near child

Question 12

cardiovascular conditions

Answer 12

examples: acute hypercanosis, tet spells (associated w/ tetralogy of Fallot)
- acute life threatening events

Question 13

cyanosis

Answer 13

an episode in which patient becomes suddenly purplish or blue in skin and mucous membranes related to sudden decrease in oxygen

Question 14

central cyanosis

Answer 14

discoloration of the trunk caused by reduced hemoglobin; associated w/ reduced oxygen saturation measurements

Question 15

peripheral cyanosis

Answer 15

decreased cardiac output w/ an accompanying decrease in the peripheral blood flow; may not demonstrate a reduced oxygen sat measurement

Question 16

Tet spells

Answer 16

• acute and sudden central cyanotic spells because of TOF
• requires the immediate application of oxygen
• notify the rapid response team immediately

Question 17

apparent life threatening event (ALTE)

Answer 17

• sudden, acute, and unexpected change in a young’s infant’s breathing pattern, which leads to a color change, apnea, limpness, and often choking or gagging
• also “BRUE” brief resolved unexplained event
• child appears in acute distress or may appear as if they are dead
• requires immediate interventions from advanced pediatric hcp and hospitalization

Question 18

risk factors of cyanosis

Answer 18

• history of cyanosis
• feeding difficulties
• episodes of repeated apnea

Question 19

assessment and interventions for a witnessed ALTE

Answer 19

• conduct a thorough investigation into the cause
• management includes hospitalization w/ monitoring
• family should be taught CPR before hospital discharge
• home monitoring equipment may be ordered

Question 20

child in acute respiratory distress

Answer 20

• requires rapid interventions to maintain an effective airway, air exchange, and breathing pattern

Question 21

early signs of respiratory distress

Answer 21

• nasal flaring
• head bobbing
• anxiety
• lethargy or decreased rate of responsiveness
• retractions
• wheezing and stridor
• increased use of energy and effort needed to breathe
• feeding problems and refusal to eat
• tachypnea and/or hyperpnea
• hypoxia and hypercarbia

Question 22

types of retractions

Answer 22

subcostal
intercostal
suprasternal
sternal

Question 23

late signs of respiratory distress

Answer 23

poor perfusion
bradycardia
decreased air movement and diminished breath sounds
expiratory grunting
apnea
sweating
airway issues

Question 24

epiglottitis

Answer 24

• a life threatening infectious process that has the potential to cause complete obstruction in a child’s airway
• may need to have tracheostomy if antibiotics are not effective in reducing infection & inflammation
• implement critical care support protocols

Question 25

children w/ severe allergies

Answer 25

• ensure children w/ allergies have a prescription and access to an epinephrine injector (epi pen)
• parents must be knowledgeable on administering EpiPen

Question 26

equipment nurse uses should be appropriate for the….

Answer 26

height & weight of pediatric patient

Question 27

Broselow’s tape

Answer 27

a tool used to determine the correct equipment and dosage of medication needed for children of various sizes during an emergency response

Question 28

caring for families present during emergencies

Answer 28

• determine the family’s presence during a code

Question 29

follow the principles in providing care to families of critically ill children

Answer 29

• know the institutional policy
• understand research findings
• offer the opportunity for families to remain present
• discuss the option of being present in a code blue before it happens
• notify nursing supervisor of the family’s wishes
• assess family’s reaction
• provide emotional support
• make referral to social work
• identify decision-maker within the family

Question 30

rapid response teams (RRTs)

Answer 30

• developed to offer family and staff an option to request and receive support from hcp above and beyond those prsent on the floor
• gives nurses support in responding to emergencies in which a pts condition suddenly becomes worse but has not “coded” o gone into cardiopulmonary arrest yet

Question 31

clinical situations that warrants an RRT

Answer 31

airway compromise
grand mal seizures
change in neuro status or level of consciousness
- dehiscence of a wound
- significant fall resulting in actual or potential injury
- unexpected or rapid change in clinical status in which the nurse or family becomes concerned for child’s welfare
- head injuries
- hemorrhage