chapter 24: acutely ill children and their needs Flashcards
clinical status
the overall clinical wellbeing
higher level of care
increased level of interventions and one on one nursing care
safety precautions
used to describe multiple safety measures implemented by the pediatric health care team to keep a child safe
providing safety at the bedside
- assess the room of the child for emergency equipment; ensure size is appropriate for the child and that they are fully functioning
checklist for preparing for an emergency response includes
- 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
SBAR
situation, background, assessment, recommendation, reading back or restating (SBARR - extra ‘r’ for other pediatric health care institutions
cardiopulmonary resuscitation (CPR)
- be prepared to support a young child’s airway by rapid suction, airway support, oxygenation, and possible resuscitation
choking emergency
- 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
child in shock
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
four types of shock
hypovolemic
cardiogenic
distributive
obstructive shock
- the highest priority in early treatment is to restore oxygenation to the tissues and the brain
general management of shock
– 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
cardiovascular conditions
examples: acute hypercanosis, tet spells (associated w/ tetralogy of Fallot)
- acute life threatening events
cyanosis
an episode in which patient becomes suddenly purplish or blue in skin and mucous membranes related to sudden decrease in oxygen
central cyanosis
discoloration of the trunk caused by reduced hemoglobin; associated w/ reduced oxygen saturation measurements
peripheral cyanosis
decreased cardiac output w/ an accompanying decrease in the peripheral blood flow; may not demonstrate a reduced oxygen sat measurement
Tet spells
- acute and sudden central cyanotic spells because of TOF
- requires the immediate application of oxygen
- notify the rapid response team immediately
apparent life threatening event (ALTE)
- 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
risk factors of cyanosis
- history of cyanosis
- feeding difficulties
- episodes of repeated apnea
assessment and interventions for a witnessed ALTE
- 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
child in acute respiratory distress
- requires rapid interventions to maintain an effective airway, air exchange, and breathing pattern
early signs of respiratory distress
- 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
types of retractions
subcostal
intercostal
suprasternal
sternal
late signs of respiratory distress
poor perfusion
bradycardia
decreased air movement and diminished breath sounds
expiratory grunting
apnea
sweating
airway issues
epiglottitis
- 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
children w/ severe allergies
- ensure children w/ allergies have a prescription and access to an epinephrine injector (epi pen)
- parents must be knowledgeable on administering EpiPen
equipment nurse uses should be appropriate for the….
height & weight of pediatric patient
Broselow’s tape
a tool used to determine the correct equipment and dosage of medication needed for children of various sizes during an emergency response
caring for families present during emergencies
- determine the family’s presence during a code
follow the principles in providing care to families of critically ill children
- 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
rapid response teams (RRTs)
- 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
clinical situations that warrants an RRT
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
