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Critical Care Test 1 > Exam 2 Wk3 Pediatrics > Flashcards

Exam 2 Wk3 Pediatrics Flashcards

1
Q

What are common Issues Related to Critical Illness in Children?

A
  • Limited verbal ability compromises problem identification
  • Limited judgement
  • Very important to involve family (There is debate over allowing family in the room during codes)
  • Less physiologic reserve than adults. This is related to structural and functional differences. It predisposes pediatric patients to rapid decline.
  • Suffocation (eg, FBAO) and poisoning are leading causes of death in infants and children
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2
Q

Structural and Functional Differences:

Airway differences

A
  • Larynx is more anterior and cephalad (towards the head)
  • Airway is narrower. So it closes off easily with edema. Also, the right mainstem bronchi is straighter => common area for obstruction (assess for even breath sounds, not decreased esp in R side). So the appropriate size endotracheal tube is necessary. It also may be cuffless due to the narrow airway.
  • Lower tidal volumes
  • Tachypnea may indicate fatigue and not compensation
  • Respiratory arrest more common
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3
Q

Structural and Functional Differences:

Circulatory differences

A

• Smaller circulating blood volume
• Infants and children differ from adults regarding CO. A weak cry or poor tone may indicate altered cerebral perfusion
• Signs of Shock
Early signs = Tachycardia and delayed capillary refill; Neonates may present with bradycardia as an early sign of shock
Late signs = hypotension

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4
Q

Structural and Functional Differences:

Abdominal differences

A

Organs are not as well protected as adults; more prone to trauma.
Organs are easy to palpate in peds.

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5
Q

Emergency Pediatric Assessments are:

A

A - Allergies
M - Medications
P - Past medical history
L - Last meal (Important d/t risk for aspiration)
E - Events (Do you need to call poison control? Give charcoal? Etc)

A - Airway
B - Breathing
C - Circulation
D - Disability (neuro)
E - Exposure
F - Full vital signs
G - Give comfort (Can wrap them up to do treatment)
H - Head to toe
I - Inspect, Isolate
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6
Q

What are common pediatric emergencies?

A

Shock, Trauma, Respiratory problems, Fever, Near-drowning, Reyes syndrome, Poisoning

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7
Q

What are the signs of shock?

A

***Early signs of shock: Tachycardia, mildly delayed capillary refill, irritable, fussiness
Infants: Lethargy, weakness, a sense of malaise, decreased urine output, fussiness, and poor feeding are all nonspecific symptoms that may accompany shock

Late signs: hypotension**

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8
Q

Common Pediatric Emergencies:
Shock

What are the interventions?

A

• mostly related to hypovolemia, may be related to sepsis
• Know signs of shock:
Early signs of shock: Tachycardia, mildly delayed capillary refill, irritable, fussiness; Infants: Lethargy, weakness, a sense of malaise, decreased urine output, fussiness, and poor feeding are all nonspecific symptoms that may accompany shock
Late signs: hypotension*

Management focuses on 
1.	respiratory support, 
2.	volume support 
Isotonic fluid bolus: 10 to 20mL/kg 
boluses repeated till hypotension resolves or fluid overload develops; can overcorrect so know signs of Fluid overload = edema, crackles, etc
3.	 treatment of underlying cause
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9
Q

Common Pediatric Emergencies:

Trauma

A

leading cause of death in children

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10
Q

Common Pediatric Emergencies:
Respiratory Problems

These include?
What are the 4 D’s?

A

Foreign body aspiration, croup, asthma, Epiglottitis, Bronchiolitis (similar to Bronchitis in adults)

*Distress, Dysphagia, Dysphonia, Drooling
May need intubation at this point

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11
Q

Common Pediatric Emergencies:

Respiratory Problems - Foreign body aspiration

A

remove-do not blindly grab

Often includes: Balloons, foods (eg, hot dogs, nuts, grapes), and small household objects are the most common causes of FBAO in children, whereas liquids are common among infants.

It is important to differentiate between mild FBAO (the patient is coughing and making sounds) and severe FBAO (the patient cannot make sounds). Patients with mild FBAO can attempt to clear the obstruction by coughing, but intervention is required in severe obstruction.

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12
Q

Common Pediatric Emergencies:

Respiratory Problems - Croup

A

treat with:

  1. steroids,
  2. nebulized epinephrine (upper airway),
  3. (albuterol for lower airway)
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13
Q

Common Pediatric Emergencies:

Respiratory Problems - Asthma

A

treat with:

  1. nebulized bronchodilator,
  2. terbutaline (similar to albuterol; PO, SQ, nebulized),
  3. atropine,
  4. epinephrine,
  5. O2
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14
Q

Common Pediatric Emergencies:

Respiratory Problems - Epiglottitis

A

treat with:

  1. O2,
  2. Antibiotics,
  3. steroids,
  4. Prepare for possible intubation and/or trach if O2 rates declining, hypotension
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15
Q

Common Pediatric Emergencies:

Respiratory Problems - Bronchiolitis (similar to Bronchitis in adults)

A

treat with:

  1. hydration,
  2. bronchodilators,
  3. steroids,
  4. O2
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16
Q

What are the signs of a pediatric respiratory problem?

4 D’s

A

*Distress, Dysphagia, Dysphonia, Drooling

Dysphagia - can’t swallow
Dysphonia - can’t speak

May need intubation at this point

17
Q

Common Pediatric Emergencies:
Fever

What constitutes fever in a child?

A

> 100.4 F (38 C) degrees taken rectally
100 F (37.8 C) degrees taken orally
99 F (37.2 C) degrees taken axillary

100.4 degrees or greater in less than 3 months, seek care-possible infection

18
Q

Common Pediatric Emergencies:

Near-drowning

A
  • decreased compliance, increased resistance, decreased pulmonary blood flow, hypoxemia
  • Outcome depends on duration, temperature, and resuscitation measures
  • Focus on pulmonary and neurologic assessments
  1. If suspecting cervical spine injury  use cervical collar
  2. Do NOT warm too fast-vasodilation
19
Q

Common Pediatric Emergencies:
Reyes Syndrome

What is Reyes Syndrome? What does it lead to?

A

• linked to Aspirin given to treat a viral illness or infection (flu and chickenpox). Though Aspirin is approved in Children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Any kind of medications with aspirin in

This leads to multisystem failure
• Primarily affects the liver and brain:
• Liver dysfunction: Bleeding and poor clotting, Elevated liver enzymes, Elevated ammonia levels
• Cerebral edema - Increased ICP, Lethargy progressing to coma, Potential for cerebral herniation
• Hypoglycemia
• shock

20
Q

Common Pediatric Emergencies:

Poisoning

A
  • accidental or intentional
  • Treatment depends on type and amount of substance, time since exposure, and clinical presentation
  • Call Poison Control

KNOW Antidotes/Reversals (neutralizes)

  1. activated charcoal with sorbitol;
  2. Mucomyst (acetylcysteine) for acetaminophen (Tylenol)
  3. Chelation (binds metals)
    iron: deferoxamine,
    lead: dimercaptosuccinic acid aka Succimer
21
Q

Pediatric Life Support

A

Cardiac arrest in children usually results from disorders leading to respiratory arrest or shock

Outcomes of cardiac arrest in children are worse than adults

But ABCs are the same!

Interventions include:
Airway management,
vascular access,
resuscitation medications

22
Q

Pediatric Life Support:

Airway Management

A

Use appropriate Airway Device

If using an ETT:
• Be careful of cuff pressure! It can cause permanent tracheal damage. There is often no cuff as the Cricoid cartilage at this age makes the cuff unnecessary. Instead, there will be a strap to keep in.
• End tidal CO2 monitoring
• Limit tracheal tube insertion attempts to 20-30 secs each. Nurses don’t insert, but we do assess. Is it in the right place? Are there lung sounds? Or is it in the esophagus?

Bag-Valve-Mask (BVM)
Do NOT get overzealous with the ventilation!
It causes barotrauma, reduced cardiac output, air trapping, air leak.

23
Q

Pediatric Life Support:

Vascular Access

A

Antecubital area, dorsal hand, saphenous vein
Peds have thin veins so they can blow easily. Look for swelling and edema.

In neonate - physician or NP can quickly insert an umbilical line for access

Intraosseous access - Tibia

24
Q

Pediatric Life Support:

Resuscitation Meds

A

Based on weight

Used length-based resuscitation tape or kilogram conversion chart available on code carts - Broselow System.

May be given IV, IO or ETT

Endotracheal drugs LEAN
1.	Lidocaine 
2.	Epinephrine 
3.	Atropine 
4.	Naloxone 
Note on Endotracheal tube meds – this method is the last resort and the doses will be higher bc going into lung tissue
25
Q

PALS:

Why is it important to follow PALS or NRP guidelines based on the unit you work in?

A

Guidelines allow staff to perform code and give medications while awaiting the arrival of a physician or NP

Neonatal and pediatric codes very different!!

  1. Neo only uses epinephrine and calcium gluconate.
  2. Manual defibrillator-control joules.
  3. Doses are always based on weight

Example of Neonatal Guideline (do not need to know):

a. If the heart rate has not increased to 60/ min or more after optimizing ventilation and chest compressions, it may be reasonable to administer intravascular* epinephrine (0.01 to 0.03 mg/kg).
b. While vascular access is being obtained, it may be reasonable to administer endotracheal epinephrine at a larger dose (0.05 to 0.1 mg/kg)
c. It may be reasonable to administer further doses of epinephrine every 3 to 5 min, preferably intravascularly,* if the heart rate remains less than 60/ min.2,3

26
Q

What are nursing care concerns for pediatrics in critical care?

A

• Must consider developmental level; regression can occur
• May be challenging to meet nutritional needs
Enteral nutrition preferred if the child is unable to take in nutrients orally-OGs, NGs.
G tubes commonly placed.
• Skin breakdown can occur easily-thin skin (not as much adipose tissue)
• Physiologic parameters can change more quickly than adults
• Pain management-FACES scale or nonverbal scale (infants)-Neonatal/Infant Pain Scale

27
Q

What does the nurse need to think about regarding family interaction of pediatric patients in critical care?

A

• Identify coping mechanisms
• Involve family in care, allow family presence
• Provide rest periods, decrease stimulation
• Provide emotional support, security
• What do parents want? Goals?
Are their goals realistic? If not, have a family and med team conference.
• Respect family wishes for the dying child. Provide bereavement support.

Critical Care Test 1 (4 decks)

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