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Child and Adolescent Health > Exam > Flashcards

Exam Flashcards

1
Q

List some vaccine preventable diseases

A 
Diphtheria 
Tetanus 
Measles 
Mumps 
Rubella 
HPV 
Hepatitis 
Herpes Zoster
Poliomyelitis (polio) 
Haemophilus influenzae type b (HIB) 
Pertussis (whooping cough)
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2
Q

What are some vaccine considerations?

A

Seasonal changes
Geographical concerns
Record immunisations on national register

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3
Q

Define immunity

A

The ability of the human body to protect itself from infections

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4
Q

Types of immunity

A

Actively
Passively
Horizontally

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5
Q

Example of passive immunity

A

Newborn babies receive passive immunity to several diseases from antibodies passed across the placenta from their mothers

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6
Q

Example of active immunity

A

Vaccines provide long-term active immunity to disease without the risks associated with the disease

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7
Q

Considerations when giving immunisations

A

Six rights of medication
Consent
Distraction may be needed based on age
Educate parents on side effects and adverse reactions

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8
Q

Route for delivering immunisations

A

Parenteral (intradermal, subcut, IM)

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9
Q

Location for delivering immunisations

A

Vastus lateralis
Deltoid
Gluteal (occasional)

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10
Q

Anticipated reactions to immunisations

A

Links to autism and asthma
Developmental delays
Unanticipated adverse reactions
Allergic reactions - eggs

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11
Q

Define child mortality

A

Number of deaths under one year of age in one year rate per annum

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12
Q

Define child morbidity

A

Percentage of children aged 0-14 in a rate per 100,000 with chronic disease

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13
Q

What are child mortality rates linked with?

A

Economic advantage

SDoH

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14
Q

How much of Australia’s population is comprised of children?

A

20%

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15
Q

Is the percentage of children in Australia increasing or decreasing and why?

A

Decreasing due to more productive population meaning children are being born less often and later in life

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16
Q

Define childhood chronic conditions

A

Functional limitations on normal growth, development and socialisation

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17
Q

List childhood chronic conditions

A 
Asthma
Diabetes
Congenital abnormalities
Genetic conditions
Childhood diseases 
Cancers
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18
Q

Health priorities in paediatrics

A

Obesity
Dental health
Emotional and social wellbeing

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19
Q

Chronic diseases have seeds in childhood (T/F)

A

True

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20
Q

What measurements are needed for a growth assessment?

A

Weight
Length
Height
Head circumference

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21
Q

What does a growth assessment involve?

A

Tracking of weight, length and height on growth chart

Tracking along centile lines shows healthy growth

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22
Q

Percentage of children within 3-97 percentile

A

94%

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23
Q

Percentage of children below 3 percentile

A

3%

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24
Q

Percentage of children above 97 percentile

A

3%

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25
Q

Outline History of Childhood

A

Pre-industrialisation – Mini adults

19th Century – Victorian Puritanism, ‘spare the rod and spoil the child’

Pre World War 1 – Country’s future, health visiting and school nursing began, child development theories emerged

Inter War – Mechanisms of ‘child rearing’, mother-craft classes

Post World War 2 – Child centred child rearing

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26
Q

Define vulnerable

A

Children and young people experience illness differently to adults making them susceptible to harm

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27
Q

Define powerless

A

Children and young people lack political and economic power within society and healthcare that can be due to social structures

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28
Q

Define dependent

A

Children and young people’s level of dependence on adults changes in response to physical, cognitive, developmental, social and experiential changes

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29
Q

A&P of head

A

Large compared to adults
Newborns head exceeds circumference of chest
Anterior and posterior fontanelles

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30
Q

A&P of arms and legs

A

Shorter and underdeveloped at birth
Legs grow rapidly after age 1

Hands and feet are long gangly

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31
Q

Midpoint in length

A

Child is umbilicus

Adult is symphysis pubis

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32
Q

Body length

A

Increases by 50% in first year

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33
Q

A&P of muscles

A

Lack tone, power and coordination

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34
Q

A&P of growth

A

Christmas tree pattern occurs with adolescent growth spurt, pubertal growth spurt

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35
Q

A&P of BMR

A

Reduces over time

Higher oxygen and calorie needs when young

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36
Q

A&P of abdomen

A

Protuberant, circumference exceeds that of the skull and thorax, disproportionate due to large liver and small pelvis

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37
Q

A&P of sinuses

A

Small facial sinuses

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38
Q

A&P of spinal column

A

Anterior curve only
Cervical and lumbar curves develop by holding head up and walking

Spinal cord extends to L3 at birth and L1 at 1 year. Myelination complete and primitive reflexes disappear at 3, neuronal development finishes age 12.

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39
Q

A&P of iliac crest

A

Neonates have imaginary line joining the iliac crests which occurs at S1

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40
Q

A&P of skeletal strength and endurance

A

Increases with age

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41
Q

A&P of thorax and shoulder girdle

A

Displaced upwards towards the neck

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42
Q

A&P of brain

A

Neonate has relatively large brain at 1/10 of weight compared to 1/50

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43
Q

A&P of integumentary system

A

1mm thick at birth, 4% of birth weight.
Functionally matures during early childhood.
Minimal production of sebum.
Eccrine glands functional but immature.

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44
Q

A&P of cardiovascular system

A

Right and left ventricles same size and thickness at birth.
CO regulated by HR and SV.
BP gradually rises.
Total blood volume 70-80mls/kg.
Cardiac muscle fibres increase over childhood.

1 month: right ventricle dominant
4-6 months: left ventricle dominant
four weeks: LV heavier than RV
two months: LV 2x heavier than RV

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45
Q

A&P of respiratory system

A

Trachea is short and soft
Large tongue
High airway resistance
Epiglottis is horseshoe shaped and posterior at 45 degree angle

Infant – diaphragm has 75% Type II muscle fibres

<6 months – obligate nasal breathers, rely on diaphragm, compliant chest wall, outward recoil of thorax is low

5+ years – lung weight increases 3x, lung and alveolar growth and maturation complete by 8 yrs

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46
Q

A&P of hepatic system

A

Neonatal liver is large
Enzyme systems exist but not sensitised.

Increased hepatic metabolic activity at 3 months, peak at 2/3 years, decline with age

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47
Q

A&P of renal system

A

Cannot concentrate urine effectively
Less control of U&E secretion and absorption.
Glomeruli smaller than adults.
Infants ureter is short.

GFR: newborn ~30% of adult, increases quickly during first two weeks, slow to approach adult level by end of first year. Low GFR affects ability to excrete saline and water loads

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48
Q

A&P of fluid Homeostasis

A

Newborn 70–80% water.
TBW decreases with age due to loss of water in ECF fluid.
Fluid turnover 7x adults.
Children higher risk for rapid dehydration.

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49
Q

A&P of digestion

A

Stomach high and transverse.
Intestines shorter.
Liver and spleen susceptible to trauma.
Emptying time shorter.
Gastro oesophageal reflux common until 5 months due to inability coordinate breathing and swallowing.
Gastric pH and volume close to adult range by 2nd day.

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50
Q

Development of thought processes in infancy

A

Infancy: Primarily use non verbal communication

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51
Q

Development of thought processes in preschool

A

Egocentric. Need explanations in concrete terms. Animism can make them fearful. Cannot distinguish between fact and fantasy

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52
Q

Development of thought processes in school aged

A

Start to rely less on what they see and more on what they know

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53
Q

Development of thought processes in adolescence

A

Fluctuate between child and adult thinking and behaviour

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54
Q

Development of thought processes in older infants

A

Attentions are centred on themselves and parents

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55
Q

Functions of the gastrointestinal tract

A

Digestion
Absorption of nutrients and water
Protective barrier against infection
Children’s GI tract is immature until age 8, making them vulnerable.

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56
Q

How is the GIT altered in children

A

Children have a higher metabolism so need more calories and fluid for growth
The intestinal tract in children is larger per body weight compared to adults
Gastric acid secretion reaches adult levels by 10 years of age
Short oesophagus in the infant
First three months pancreatic juice contains low levels of lipase (convert fat into glycerol)

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57
Q

Causes of lower nutritional intake

A

Impairment of normal sucking, chewing and swallowing mechanism
Dyspnoea
Neuromuscular
Anorexia associated with chronic illness
Absorption
Primary appetite disorders
Increased nutritional requirements
Conditions requiring a continuous supply of nutrients

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58
Q

Treatment of lower nutritional intake

A 
Surgical interventions 
Medical interventions
Psychosocial (Behavioural management, CBT) 
Pharmacological 
Special diets (low fibre, lactose free)
Enteral feeding methods 
TPN 
Re-Feeding syndrome
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59
Q

Non organic causes of growth and weight faltering

A 
Feeding problems 
Maternal stress, depression 
Lack of stimulation and under nutrition 
Fabricated or Induced Illness by Carers (MSbP)
Disturbed attachment and bonding 
Anorexia
Bulimia
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60
Q

Organic causes of growth and weight faltering

A 
Inability to feed 
Malabsorption (Crohn’s, CF)
Illness induced anorexia
Impaired nutrient absorption (Coeliac)
Endocrine (hyper/hypothyroidism) 
Miscellaneous (IUGR) 
Genetic (Turners)
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61
Q

Advantages of Breastfeeding

A

Immune properties
Nutritional properties - soluble iron
Reduced incidence of otitis media, GI infections, jaw teeth formation, obesity
Emotional increases attachment
Maternal health reduction in disease occurrence in later life
Reduced risk of atopies - asthma, eczema
Reduces incidence of cows milk allergy and lactose intolerance

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62
Q

Disadvantages of Breastfeeding

A 
Unknown intake
Transmission of infection
Transmission of some drugs
Nutrient inadequacies if mother depleted
Less flexible
Vit K deficiency - only until feeding established 
Emotional upset if unsuccessful
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63
Q

How many children aged 5-17 are overweight or obese

A

A quarter (600,000) of Australian children

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64
Q

Issues associated with child obesity

A

2x as likely to have elevated total cholesterol
4.5x more likely to have raised systolic blood pressure
13x as likely to have hyperinsulinaemia compared with children who fall below the 85th centile.

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65
Q

Why do children need more water?

A

High ratio of ECF to ICF in young children
High caloric expenditure due to increased BMR
Large surface area increases insensible water loss
Increased daily water turnover 15% vs 9%
Immature homeostatic mechanisms

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66
Q

What are the classifications of dehydration?

A

Isotonic dehydration
Hypotonic dehydration
Hypertonic dehydration

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67
Q

What is isotonic dehydration?

A

State in which the solute concentration is identical to that of body fluids: Na between 130 and 145

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68
Q

What is hypotonic dehydration?

A

The solute concentration is below that of normal body fluids: Na < 130

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69
Q

What is hypertonic dehydration?

A

The solute concentration is above that of normal body fluids: Na > 145

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70
Q

What is isotonic fluid?

A

Same osmolarity as serum = stays where its put and does not affect the size of cells

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71
Q

What is hypotonic fluid?

A

Higher osmolarity = fluid is pulled from the cells and the interstitial compartment into the blood vessels

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72
Q

What is hypertonic fluid?

A

Lower osmolarity as serum = fluid shifts out of the blood vessels and into the cells and interstitial spaces

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73
Q

What is percentage is moderate dehydration

A

4-6%

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74
Q

What is Moderate Dehydration (4-6%)

A

CM: tired, restless, irritable, increased thirst, dry mouth and tongue, decreased urine output, minimal or no tears, normal to increased HR, normal to fast RR, cool extremities, capillary refill greater than 2 seconds, recoil on skin less than 2 seconds, sunken eyes

3 to 6 % weight loss (weight usually correlates to how dehydrated the child is - 5% dehydration = loss of 5ml of fluid per 100g

Difficult to get them to drink more fluids.

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75
Q

What is Severe Dehydration (7-10%)

A

Increasingly marked signs from moderate group

CM: Lethargic or unconscious, parched mouth and tongue, minimal or no urine output, increased HR, weak pulse, deep breathing, cool mottled extremities, capillary refill prolonged, diminished skin turgor, deeply sunken eyes

Priorities of management are to identify shock and treat it effectively and rapidly.

Poor drinking or may be unable to drink

Greater than 9% weight loss

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76
Q

What is percentage is severe dehydration

A

7-10%

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77
Q

Effect of electrolytes in children

A

Loss of electrolytes can affect homeostatic systems

Potassium [K+] affects on the heart 
Calcium [Ca] affects nerve transmission 
Phosphorus [P] affects muscle function 
Magnesium [Mg] affects metabolism of CHO 
Sodium [Na] regulates fluid balance
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78
Q

Treatment of acute infectious diarrhoea

A

Do:
Oral Rehydration Therapy
Intravenous Infusion Therapy
Breast milk; Formula milk; Solids

Don’t:
Antiemetics
Antidiarrhoeal agents
Antibacterial agents

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79
Q

Organic causes of Constipation

A

Anatomic malformations: imperforate anus, anal stenosis, pelvic mass
Metabolic and gastrointestinal: cystic fibrosis, diabetes mellitus, coeliac disease, hypothyroidism
Neuropathic: spinal cord problems, neurofibromatosis
Intestinal nerve or muscle disorders: Hirschsprung’s disease, visceral myopathies
Abnormalities of abdominal muscles: gastroschisis, Down’s syndrome
Connective tissue disorders: systemic lupus erythematosus, scleroderma
Drugs: opiates, phenobarbitone, anti hypertensives, antidepressants
Miscellaneous: lead poisoning, vitamin D overdose

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80
Q

Non organic of Constipation

A

Majority cases
Poor dietary management
Developmental problems that complicate toilet training
Emotional abuse, depression and inappropriate toilet training practices in the younger child
Familial tendency and sedentary lifestyle (adolescent)

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81
Q

Management of Constipation

A

Impaction is managed using oral and or rectal medication

Stool softeners are given prior to stimulants

Suppositories or phosphate enemas may be used

Subsequent management requires a programme that is a whole child and family approach
dietary management
maintaining laxative therapy
behaviour modification

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82
Q

Leading cause of death for children under one

A

Perinatal

Congenital

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83
Q

Leading cause of death for children aged 1-14

A

External

Land transport accidents

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84
Q

Leading cause of death for children aged 15-24

A

External

Suicide

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85
Q

Primary survey during cardiac arrest

A

A - airway with C spine control
B - breathing with ventilatory support
C - circulation with haemorrhage control
D - disability with prevention of secondary insult
E - exposure with temperature control

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86
Q

Affect of cardiac arrest on the effort of breathing

A 
Recession 
Respiratory rate 
Inspiratory/expiratory noises 
Grunting 
Accessory muscle use 
Flare of the alae nasi 
Gasping 
Childs position
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87
Q

Affect of cardiac arrest on the efficiency of breathing

A

Chest expansion
Breath sounds and Auscultation
Abdominal excursion

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88
Q

Respiratory inadequacy effects:

A

Heart rate
Skin colour
Mental status

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89
Q

Effects of respiratory inadequacy on heart rate

A

Initially tachycardic

Become tired and start to get bradycardic

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90
Q

Effects of respiratory inadequacy on skin colour

A

Hypoxia produces vasoconstriction and poor skin pallor

By the time central cyanosis is visible in acute respiratory disease the child is close to respiratory arrest

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91
Q

Effects of respiratory inadequacy on mental status

A

Agitated or drowsy

Drowsiness increases and leads to unconsciousness

Generalised muscular hypotonia also accompanies hypoxic cerebral depression

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92
Q

Effects of circulatory inadequacy on other organs

A

Respiratory rate and character
Skin appearance and temperature
Mental status

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93
Q

Signs of cardiac failure

A 
Cyanosis 
Absent femoral pulses 
Gallop rhythm/murmur 
Crepitations in lungs 
Enlarged liver 
Hypotension
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94
Q

Define Decorticate

A

Flexed arms and extended legs

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95
Q

Define Decerebrate

A

Extended arms and extended legs

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96
Q

Warning signs of cardiac arrest

A

Respiration
- Abnormal breathing pattern

Circulation
- Cushings response - hypertension with bradycardia

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97
Q

Signs of cardiac arrest

A

Tachycardic: Children cannot increase stroke volume so heart rate will increase to try to compensate for hypoxia. Pyrexia also increases the heart rate

Tachypnoeic: Chemoreceptors in the medulla oblongata and the aortic and carotid bodies detect changes in blood oxygen and carbon dioxide accumulation. They are responsible for speeding up the respiratory rate in an attempt to excrete carbon dioxide

Marked accessory muscle use: Intercostal, subcostal, sternal recession shows increased efforts of breathing, particularly in younger children due to the compliancy of the chest wall. However as Zachary is 7 it indicates severe respiratory compromise, particularly as he can only answer in single words

Agitated: Carbon dioxide is a toxic cerebral irritant if not reduced Zachary’s, conscious level will deteriorate and he will become drowsy. c/o Pins and needles/tingling.

Exhaustion is a pre terminal sign

Reduced breath sounds: decreased air movement through the lungs

Pyrexial: It is common in this age group for an underlying infection or virus to exacerbate asthma

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98
Q

What is disability

A

acute physiological change

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99
Q

CM of disability

A 
Headache
Neck pain
Temperature of unknown origin
Vomiting
Drowsiness
Dizziness
Altered visual acuity
Changes in appearance of eyes
Loss of motor function or weakness 
Photophobia
Halo
Seizures
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100
Q

Causes of headache in children

A 
Adolescent diagnoses (ethanol, stress)
Raised ICP
BP
Head Trauma
Cerebral haemorrhage
Infection
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101
Q

What GCS score indicates concussion?

A

Less than or equal to 8

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102
Q

Types of seizures

A 
Epilepsy
Generalised seizure
Partial seizure
Status epilepticus
Febrile convulsions
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103
Q

What is epilepsy?

A

common, focal or generalised, cerebral

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104
Q

What is a generalised seizure?

A

whole of brain, loc, incontinence

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105
Q

What is a partial seizure?

A

no loc, changed aura (taste, smell, hallucination)

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106
Q

What is status epilepticus?

A

unresolving, emergency, reduction in blood to brain

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107
Q

What are febrile convulsions?

A

under 5 yrs pyrexiametabolic

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108
Q

What is intracranial pressure?

A

pressure exerted by cranial contents on skull

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109
Q

Intracranial contents consist of:

A

Brain (80%)
Cerebrospinal fluid (10%)
Blood (10%)

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110
Q

Causes of brain injury

A

Structural

  • Neoplasms
  • Closed head injury
  • Open head injury

Metabolic

  • Lack of oxygen
  • Accumulation of wastes (acidosis)
  • Hyperglycaemia (DKA)
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111
Q

Treatment of raised ICP

A 
Group nursing activities 
Quiet dark environment 
Elevate head of bed 
Neuro obs 
Keep head neutral 
Maintain joint function and muscle tone 
Pressure management 
Hydration
Monitor fluids
Sedation
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112
Q

Management of raised ICP

A 
Maintain progressive neurological assessment (Coma scales) 
Maintenance of clear airway
Neutral neck alignment
Group nursing activities 
Hydration (too much worse than too little)
Treat hypotension
Maintain joint function and muscle tone 
Rehabilitation
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113
Q

What is cerebral palsy

A

Non progressive disorder of upper motor neurone impairment resulting in motor dysfunction

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114
Q

Types of cerebral palsy

A

Spastic, dystonic, dyskinetic, athetoid, dysarthria

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115
Q

CM of Meningitis

A 
Neck stiffness (nuchal rigidly) 
Brudzinki’s sign 
Kernig’s sign 
Photophobia 
Petechial rash (non blanching)
Evidence of raised ICP 
Level of consciousness (difficult to wake, lethargic, blank or staring expression)
Opisthotonos
Sudden Fever 
Poor feeding
High pitched cry 
Raised ICP
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116
Q

DX of Meningitis

A

Lumbar puncture
CSF
Full blood count

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117
Q

TX of Meningitis

A 
Neuro observations
Quiet dark room
IV antibiotics
Head circumference
Analgesia
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118
Q

Types of Wounds

A 
Acute (burns)
Chronic (ulcers)
Incision wounds (surgery)
Traumatic wounds (often contaminated, gravel rash)
Ulcers
Stoma wounds
Perineal wounds
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119
Q

Types of wound healing

A 
Primary intention
Secondary intention
Tertiary intention
Skin graft
Flap graft
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120
Q

Describe healing by primary intention

A

Wound union occurs directly without intervention of granulations

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121
Q

Describe healing by secondary intention

A

Union by closure of a wound with granulations

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122
Q

Describe healing by tertiary intention

A

Treatment of a grossly contaminated wound by delaying closure until after contamination is reduced and inflammation subsides

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123
Q

Describe healing by skin graft

A

Patch of skin removed by surgery from one area of the body and transplanted to another area

Used for areas where infection caused large amount of skin loss;burns; cosmetic or reconstructive surgeries with skin damage or skin loss; skin cancer surgery; venousor pressure ulcers; diabetic ulcers that don’t heal; very large wounds; wounds unable to close

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124
Q

Describe healing by skin flap

A

Patch of skin detached but not removed by surgery in one area and attached to another area.

Allows blood supply to remain intact until the flap has taken and established new blood. Later disconnected from the donor site.

125
Q

Causes of burns

A

Thermal
Electrical
Chemical
Radiation

126
Q

Classification of burns

A

SUPERFICIAL: Involves epidermis
PARTIAL THICKNESS: Involves epidermis and some dermis
FULL THICKNESS: Involves epidermis, dermis, subcutaneous tissues, muscle and bone

127
Q

Management of burns

A 
DRSABCDE 
Cool running water 20 minutes
Analgesia 
Assess for concurrent injuries 
Burns assessment and history 
Minor or major 
Wound care 
Admit or arrange follow up
128
Q

What does a high level of Neutrophils indicate?

A

acute infection

129
Q

What does a high level of Eosinophils indicate?

A

allergy

130
Q

What does a high level of Lymphocytes indicate?

A

antibodies

131
Q

What does a high level of Monocytes indicate?

A

chronic infection

132
Q

What does a high level of Basophils indicate?

A

leukaemia

133
Q

Define pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

134
Q

Behavioural indicators of pain

A 
Crying
Irritability 
Facial expressions 
Sleep disturbance 
Etc
135
Q

Physiological indicators of pain

A 
Raised vital signs 
Decreased O2 sats 
Increased muscle tone
Sweating 
Pale or flushed
136
Q

QUESTT Pain Assessment

A 
Question the child 
Use an appropriate pain rating scale 
Evaluate the behaviour and physiological changes 
Secure parents involvement 
Take cause of pain into account 
Take action and evaluate results
137
Q

PQRSTU Pain Assessment

A 
Provoking factors 
Quality 
Region and radiation
Severity
Time 
Understanding
138
Q

Pharmacological interventions for pain

A

Opioids
NSAIDS
Paracetamol

139
Q

Non pharmacological interventions for pain

A 
Sucrose 
Distraction 
Mindfulness 
Acupuncture/pressure 
Massage
140
Q

Consequences of pain to endocrine system

A

↑ stress hormone
↑ metabolic rate
↑ heart rate
↑ water retention

141
Q

Consequences of pain to immune system

A

Impaired immune functions

142
Q

Consequences of pain to cardiac system

A

↑ cardiac rate
↑ systemic vascular resistance
↑ peripheral vascular resistance
↑ coronary vascular resistance → ↑ blood pressure and ↑ myocardial oxygen consumption

143
Q

Consequences of pain to pulmonary system

A

↓ flow and volume → retained secretions and atelectasis

144
Q

Consequences of pain to gastrointestinal system

A

Delayed return of gastric and bowel function

145
Q

Consequences of pain to musculoskeletal system

A

↓ muscle function, fatigue and immobility

146
Q

Infant Response to Pain

A 
Forcefully closed eyes
Lowered brows
Deepened furrow between nose and outer corner of lip
Square mouth
Cupped tongue
147
Q

Describe Neonatal Infant Pain Scale (NIPS)

A

0 Point 1 Point 2 Points
Facial Expression Relaxed Contracted -
Cry Absent Mumbling Vigorous
Breathing Relaxed Different -
Arms Relaxed Flexed -
Legs Relaxed Flexed -
Alertness Calm Uncomfortable -

148
Q

Types of seizures

A 
Epilepsy
Generalised seizure
Partial seizure
Status epilepticus
Febrile convulsions
149
Q

What is epilepsy?

A

common, focal or generalised, cerebral

150
Q

What is a generalised seizure?

A

whole of brain, loc, incontinence

151
Q

What is a partial seizure?

A

no loc, changed aura (taste, smell, hallucination)

152
Q

What is status epilepticus?

A

unresolving, emergency, reduction in blood to brain

153
Q

What are febrile convulsions?

A

under 5 yrs pyrexiametabolic

154
Q

What is intracranial pressure?

A

pressure exerted by cranial contents on skull

155
Q

Intracranial contents consist of:

A

Brain (80%)
Cerebrospinal fluid (10%)
Blood (10%)

156
Q

Causes of brain injury

A

Structural

  • Neoplasms
  • Closed head injury
  • Open head injury

Metabolic

  • Lack of oxygen
  • Accumulation of wastes (acidosis)
  • Hyperglycaemia (DKA)
157
Q

Treatment of raised ICP

A 
Group nursing activities 
Quiet dark environment 
Elevate head of bed 
Neuro obs 
Keep head neutral 
Maintain joint function and muscle tone 
Pressure management 
Hydration
Monitor fluids
Sedation
158
Q

Management of raised ICP

A 
Maintain progressive neurological assessment (Coma scales) 
Maintenance of clear airway
Neutral neck alignment
Group nursing activities 
Hydration (too much worse than too little)
Treat hypotension
Maintain joint function and muscle tone 
Rehabilitation
159
Q

What is cerebral palsy

A

Non progressive disorder of upper motor neurone impairment resulting in motor dysfunction

160
Q

Types of cerebral palsy

A

Spastic, dystonic, dyskinetic, athetoid, dysarthria

161
Q

CM of Meningitis

A 
Neck stiffness (nuchal rigidly) 
Brudzinki’s sign 
Kernig’s sign 
Photophobia 
Petechial rash (non blanching)
Evidence of raised ICP 
Level of consciousness (difficult to wake, lethargic, blank or staring expression)
Opisthotonos
Sudden Fever 
Poor feeding
High pitched cry 
Raised ICP
162
Q

DX of Meningitis

A

Lumbar puncture
CSF
Full blood count

163
Q

TX of Meningitis

A 
Neuro observations
Quiet dark room
IV antibiotics
Head circumference
Analgesia
164
Q

Types of Wounds

A 
Acute (burns)
Chronic (ulcers)
Incision wounds (surgery)
Traumatic wounds (often contaminated, gravel rash)
Ulcers
Stoma wounds
Perineal wounds
165
Q

Types of wound healing

A 
Primary intention
Secondary intention
Tertiary intention
Skin graft
Flap graft
166
Q

Describe healing by primary intention

A

Wound union occurs directly without intervention of granulations

167
Q

Describe healing by secondary intention

A

Union by closure of a wound with granulations

168
Q

Describe healing by tertiary intention

A

Treatment of a grossly contaminated wound by delaying closure until after contamination is reduced and inflammation subsides

169
Q

Describe healing by skin graft

A

Patch of skin removed by surgery from one area of the body and transplanted to another area

Used for areas where infection caused large amount of skin loss;burns; cosmetic or reconstructive surgeries with skin damage or skin loss; skin cancer surgery; venousor pressure ulcers; diabetic ulcers that don’t heal; very large wounds; wounds unable to close

170
Q

Describe healing by skin flap

A

Patch of skin detached but not removed by surgery in one area and attached to another area.

Allows blood supply to remain intact until the flap has taken and established new blood. Later disconnected from the donor site.

171
Q

Causes of burns

A

Thermal
Electrical
Chemical
Radiation

172
Q

Classification of burns

A

SUPERFICIAL: Involves epidermis
PARTIAL THICKNESS: Involves epidermis and some dermis
FULL THICKNESS: Involves epidermis, dermis, subcutaneous tissues, muscle and bone

173
Q

Management of burns

A 
DRSABCDE 
Cool running water 20 minutes
Analgesia 
Assess for concurrent injuries 
Burns assessment and history 
Minor or major 
Wound care 
Admit or arrange follow up
174
Q

What does a high level of Neutrophils indicate?

A

acute infection

175
Q

What does a high level of Eosinophils indicate?

A

allergy

176
Q

What does a high level of Lymphocytes indicate?

A

antibodies

177
Q

What does a high level of Monocytes indicate?

A

chronic infection

178
Q

What does a high level of Basophils indicate?

A

leukaemia

179
Q

Define pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

180
Q

Behavioural indicators of pain

A 
Crying
Irritability 
Facial expressions 
Sleep disturbance 
Etc
181
Q

Physiological indicators of pain

A 
Raised vital signs 
Decreased O2 sats 
Increased muscle tone
Sweating 
Pale or flushed
182
Q

QUESTT Pain Assessment

A 
Question the child 
Use an appropriate pain rating scale 
Evaluate the behaviour and physiological changes 
Secure parents involvement 
Take cause of pain into account 
Take action and evaluate results
183
Q

PQRSTU Pain Assessment

A 
Provoking factors 
Quality 
Region and radiation
Severity
Time 
Understanding
184
Q

Pharmacological interventions for pain

A

Opioids
NSAIDS
Paracetamol

185
Q

Non pharmacological interventions for pain

A 
Sucrose 
Distraction 
Mindfulness 
Acupuncture/pressure 
Massage
186
Q

Consequences of pain to endocrine system

A

↑ stress hormone
↑ metabolic rate
↑ heart rate
↑ water retention

187
Q

Consequences of pain to immune system

A

Impaired immune functions

188
Q

Consequences of pain to cardiac system

A

↑ cardiac rate
↑ systemic vascular resistance
↑ peripheral vascular resistance
↑ coronary vascular resistance → ↑ blood pressure and ↑ myocardial oxygen consumption

189
Q

Consequences of pain to pulmonary system

A

↓ flow and volume → retained secretions and atelectasis

190
Q

Consequences of pain to gastrointestinal system

A

Delayed return of gastric and bowel function

191
Q

Consequences of pain to musculoskeletal system

A

↓ muscle function, fatigue and immobility

192
Q

Infant Response to Pain

A 
Forcefully closed eyes
Lowered brows
Deepened furrow between nose and outer corner of lip
Square mouth
Cupped tongue
193
Q

Describe Neonatal Infant Pain Scale (NIPS)

A

0 Point 1 Point 2 Points
Facial Expression Relaxed Contracted -
Cry Absent Mumbling Vigorous
Breathing Relaxed Different -
Arms Relaxed Flexed -
Legs Relaxed Flexed -
Alertness Calm Uncomfortable -

194
Q

Describe the FLACC pain scale

A

.

195
Q

How do toddlers present pain

A

Limited abilities in localising and expressing pain intensity, and understanding reasons for pain.

Find out word they use to express pain
Point to pain
Faces Pain Scale – common

196
Q

How do 3-8 year olds present pain

A

Have a word for pain
Can articulate detail about presence and location of pain. Less able to comment on quality or intensity.

Colour scales
Faces scales

197
Q

How do school aged children present pain

A

Increased ability to communicate pain
Describe pain: squeezing, stabbing or burning
Respond well to direct questioning

Body outline
Faces scale
Visual analog
Self report

198
Q

How do you evaluate pain in children over 8

A

Use the standard visual analog scale
Numerical rating Scale (NRS)
Same used in adults

199
Q

How does cognitive impairment affect a child’s ability to express pain?

A

Often unable to describe pain
Altered nervous system
Experience pain differently

200
Q

Analgesic used in preterm and term infants

A

Sucrose 24% oral solution
Can be used for procedures such as heel stick, venipuncture, catheterisation, etc.
Dip pacifier in sucrose solution or give via buccal area

201
Q

Cognitive approaches to pain management

A 
Education 
Relaxation, imagery 
Psychotherapy, counselling 
Hypnosis 
Biofeedback 
Music, literature, art, play 
Prayer, meditation
202
Q

Physical approaches to pain management

A 
Massage 
Acupuncture 
Acupressure 
Heat or Cold 
TENS 
Therapeutic exercise
203
Q

Outline Inguinal Hernia

A

Soft tissue bulges through a weak point in the abdominal muscles

A reliable history is sufficient to make the diagnosis, even if the hernia cannot identify

204
Q

Outline Umbilical Hernia

A

Most umbilical hernias close spontaneously within first 3 years of life

Small-diameter umbilical hernias close earlier than large-diameter umbilical hernias

205
Q

Complications of Undescended Testis

A
  • Failure of testicle to produce viable sperm
  • Malignant degeneration of testicle
  • Predisposition to torsion and traumatic injuries
  • Associated inguinal hernia
206
Q

Treatment of Undescended Testis

A

Orchidopexy is performed after 1 year of age

207
Q

Pathogenesis of Acute Appendicitis

A

Obstruction
Increased intraluminal pressure and venous collapse
Ischemia, bacterial proliferation, further inflammation

208
Q

CM of Acute Appendicitis

A

Vague, crampy pain begins in periumbilical region then migrates to right lower quadrant and becomes localised and sharp
Anorexia, nausea, and vomiting
Diminished bowel sounds; localised guarding and point tenderness in RLQ
↑ WBC

209
Q

TX of Acute Appendicitis

A

Intravenous hydration
Broad-spectrum antibiotics
Surgery

210
Q

Why do children under 5 often have a ruptured appendix

A

Unable to provide a clear history of complaints
Uncooperative for performance of physical examination
Uniform response to many illnesses

211
Q

Types of Strabismus

A

Esotropia: Inward turning of the eye
Exotropia: Outward turning of the eye
Hypertropia: Upward turning of the eye
Hypotropia: Downward turning of the eye

212
Q

What is Esotropia

A

Inward turning of the eye

213
Q

What is Exotropia

A

Outward turning of the eye

214
Q

What is Hypertropia

A

Upward turning of the eye

215
Q

What is Hypotropia

A

Downward turning of the eye

216
Q

Define chronic condition

A

Condition that has lasted or will last for six months or more.

217
Q

Common chronic conditions

A 
Asthma 
Diabetes T1
Cancer
Epilepsy 
Congenital abnormalities
218
Q

At what age is asthma often diagnosed?

A

8

219
Q

How is asthma managed?

A

preventers, trigger identification and monitoring

220
Q

Cause of T1 diabetes

A

interaction of genetic and environmental factors

221
Q

Cause of T2 diabetes

A

poor diet and nutrition, obesity and lack of exercise

222
Q

Biochemical criteria for diagnosis of DKA

A

Hyperglycaemia – blood glucose > 11 mmol/L
Ketonaemia
Acidosis – venous pH <7.3 or bicarbonate < 15mmol/L

223
Q

Most common cause of diabetes-related deaths in children and adolescents

A

cerebral oedema

224
Q

DKA is characterised by:

A

hyperglycaemia, metabolic acidosis and increased total body ketone concentration resulting from deficiency of circulating insulin

225
Q

DKA stands for what?

A

Diabetic ketoacidosis

226
Q

What is Hypoglycaemia?

A

BGL low enough to cause symptoms of impaired brain function

BSL <2.6mmol/L

227
Q

What are some congenital disorders

A

Congenital heart disease
Atrial septal defects
Ventricular septal defect

228
Q

What is congenital heart disease

A

Leading cause of death among infants/children under 1 year

229
Q

What is atrial septal defect

A

1:1000 births (blood flows L to R)

230
Q

What is ventricular septal defect

A

15-20% of all CHD (raised volume therefore pulmonary pressure) symptoms of heart failure

Requires surgical repair and support

231
Q

CHD management in children

A

Growth and development – close monitoring
Fluid monitoring – fluid and Na restriction
Nutritional support – breast feeding/EBM via NGT
Pharmacological support – raise cardiac output, contractility and reduce workload
Minimise energy expenditure

232
Q

Difference between epilepsy and febrile convulsions

A

Febrile convulsion - similar features to seizure but last only 10 minutes and resolve without intervention. Won’t occur again within 24 hours

Epilepsy - patients have one or two seizures without being febrile and usually require intervention to resolve. They can last 20-30 minutes

233
Q

What is the Post-Ictal phase

A

Phase following seizure when child may have impaired consciousness level

30-40 minutes. May be affected by medications given to stop seizure

234
Q

Goals of Transitioning Care

A

Better functional outcomes - increased concordance, compliance, improved self-management and knowledge, improved wellbeing

Better access to appropriate health services

Improvement morbidity and mortality rates and reduction in avoidable hospital admissions

235
Q

What is disability

A

Characteristic complex or chronic conditions, functional limitations and high health care use

236
Q

Categories of disability

A

Physical
Intellectual
Developmental
Combination

237
Q

What causes disability

A

Congenital present at birth

  • Structural or functional
  • Chromosomal/environment/hereditary/familial
  • Expected by prior diagnosis or not expected

Acquired after birth

  • Infection – rubella, meningococcal, septicaemia
  • Trauma – accidental, RTA’s, head injuries
238
Q

What are congenital heart defects

A

Chronic condition commonly comorbid with trisomy’s and neural tube defects

Patent ductus arteriosus
Tetralogy of Fallot
Transposition of the great vessels
Coarctation of the aorta

239
Q

What are neural tube defects

A

Physical opening in spinal cord or brain exposing contents

Anencephaly 
Cleft palate - be repaired with plastic surgery 
Paralysis 
Learning disability 
Bladder/bowel complications 
Hydrocephalus
240
Q

What causes Cerebral Palsy

A

Physiological assault during pregnancy
Measles
CMV

241
Q

Symptoms of cerebral palsy

A

May not be diagnosed immediately

Exaggerated reflexes/involuntary movements
Floppy or rigid limbs in baby
Slow growth
Developmental delays

242
Q

Types of cerebral palsy

A

Spastic CP - most common, market by hypertonic muscles and stiff movements

Athetoid CP - marked by involuntary uncontrolled writhing movements

Ataxic CP - marked by hypotonic muscles and poor coordination and balance

243
Q

What is muscular dystrophy

A

Degenerative genetic disorder

Physical wasting leading to:

  • Physical aids
  • Respiratory support
  • GI problems
  • Musculoskeletal pain
244
Q

What is Aspergers syndrome

A

Condition on autism spectrum, with generally higher functioning, may be socially awkward and have all-absorbing interest in specific topics

245
Q

Cause of dwarfism

A

Endocrine disorders, hypothyroidism, growth hormone, congenital pituitary damage, other diagnoses

246
Q

Diagnoses of dwarfism

A

blood test or developmental delay

247
Q

Treatment of dwarfism

A

bone lengthening to optimise growth, pain control, psychological and equity

248
Q

What is protection

A

only when something is going wrong or there is risk of harm or actual harm

249
Q

What is safeguarding

A

early recognition and intervention of problems health promotion

250
Q

Categories of abuse

A 
Physical 
Sexual 
Emotional 
Psychological 
Omission 
Moral abuse?
251
Q

The child protection triangle consists of what?

A

Public
Caregivers
Professionals

252
Q

What is neglect?

A

Persistent failure to meet child’s basic physical or psychological needs likely resulting in serious impairment of child’s health or development

253
Q

What is sexual abuse?

A

Forcing or enticing a child to take part in sexual or lewd activities whether or not they are aware of what is happening

254
Q

Shaken Baby Syndrome causes what?

A 
retinal bleed / blindness 
brain damage 
cerebral palsy 
seizures and epilepsy 
hearing loss 
learning difficulties 
behaviour problems
255
Q

What is mental health?

A

State of mental wellbeing in which children and young people can realise their abilities and reach optimum growth and development

Being able to cope with and bounce back from adversity

256
Q

Mental health disorders in children

A

Attention deficit hyperactivity disorder (ADHD)

Conduct disorders

Autism spectrum disorder (ASD)

Anxiety and depression

Eating disorders

257
Q

What is ADHD

A 
Most prevalent disorder worldwide
Inattention 
Poor anger management 
Hyperactivity and impulsivity 
Low academic outcomes and social incompetence

Tx: hospital admission, behaviour management and medication

258
Q

What are conduct disorders

A

Oppositional defiant disorder and conduct disorder
Argumentative and aggressive
Controlling
Loses temper frequently
Poor anger management and resentment
Deliberately cruel
Affects family, school, communities in adolescence

259
Q

What are autism spectrum disorders

A

Deficits in social functioning
Fixated interests, repetitive behaviours, sensory fixation
OCD
Easily stressed and cannot communicate anxiety
Depression

260
Q

What is anxiety and depression

A

Phobias / social phobias
Generalised anxiety
Causes: loss, bereavement, helplessness (IPV), negative cognitions
Very young children comorbidity: separation anxiety, somatic complaints and behaviour problems
Reflect maternal depressive symptoms
Social outcomes: suffering, stigma, social isolation, discrimination, early death

261
Q

What are some risk factors

A 
Genetic 
Brain damage 
Low intelligence 
Poor social intelligence 
Low self esteem 
Poor quality relationships 
Insecure attachment style 
Harsh or inflexible discipline 
Inadequate supervision 
Parental conflict 
Parental psychopathology 
Bullying 
Poor resources 
Low socioeconomic resources
Discrimination
262
Q

What are some protective factors

A 
High intelligence 
Good general health 
Engaging temperament 
Good social skills 
High self efficacy 
High self esteem 
Warm positive relationship with parents 
Secure attachment style 
Fair consistent discipline 
String involvement with child 
Domestic harmony 
Good mental health of parents 
Strong culture of support 
Good supervision 
Childs rights upheld
263
Q

Changes in A&P in adolescence

A

Heart size increases and doubles in weight but relatively slow growing

Lungs increase in size and diameter but slow growing

Pulse rate drops

Systolic BP increase

Red Blood Cell numbers increase

Neurologically may process information differently

GI tract fully mature

264
Q

Reaction to loss of a parent - 0 to 6 months

A

Displays distress from loss by changing sleeping and eating habits
Reacts to grief reactions of others
Needs continuous loving care

265
Q

Reaction to loss of a parent - 6 months to 2 years

A

Doesn’t understand the permanence of the loss, will ask for the missing parent
May become angry because parent doesn’t come back, disinterest in play and food
Clinging to caregivers and refusal to let them out of sight
Constant loving care is the key

266
Q

Reaction to loss of a parent - 3 to 5 years

A

Asks questions concerning absence of the parent
Anger reaction to unfulfilled wish of parent’s return
Magical thinking - thoughts about life in the cemetery
Clinging to favourite toys
Importance of talking to the child and giving her/him loving attention

267
Q

Reaction to loss of a parent - 5 to 9 years

A

Beginnings of understanding of the finality of death
Grieving manifest in changes in behaviour, school performance, anger reactions
Important to have trusting relationship which allows the child to talk about their grief and distress
At age 9, with maturation of abstract thinking processes, most children have mature understanding of the concept of death

268
Q

Three Stages of Bereavement

A

Protest
- Anger and fear aimed at reattachment to the lost parent

Despair

  • Sadness, distance, unresponsiveness
  • Psychosomatic symptoms or psychological problems
  • Slowly processing the loss

Detachment
- Moves from depression to increased activity and openness to new relationships

269
Q

Reactions and Grief Strategies

A

Regression to an earlier developmental stage
Hyperactivity
Emotional outbursts
Overprotectiveness of the surviving parent
Constructing the deceased parent

270
Q

Stages a dying child goes through

A

Initial awareness of the seriousness of the illness

Learning names of various drugs and medical procedures, perceives that they are seriously ill but will get better

Learns purpose of various medical procedures and perceives that they are always ill but will get better

After series of relapses they perceive that they will never get better

After numerous relapses and remissions understands that they are dying (often associated with leaning about death of a peer with the same disease)

271
Q

Feelings of a Dying Child

A 
Fear and anxiety 
Anger
Sadness
Loneliness and Isolation 
Spiritual needs 
Individual differences
272
Q

Name 3 anatomical anomalies that may indicate Trisomy 21 (Down Syndrome) in a newborn?

A

A single crease across the palm of the hand (Simian Line)
Hypotonia (floppy baby)
Upward slanting eyes (epicanthic fold)
Increased nuchal translucency (wide neck)
Large tongue (and thus poor feeding)
Round face
Small, flattened nose
Excess skin folds on the back of the neck
Cardiac anomalies
Sandal foot (big toes separated from other toes by a space)

273
Q

What is the process of immunising a child?

A 
Follow the 6 rights to medication
Gain consent from parents
Collect equipment and prepare site
Provide age appropriate distraction
Document including batch number 
Educate parents of potential side effects
274
Q

What side effects would you educate parents about with immunisations?

A

Minor swelling and redness at site
Mild fever
Sleepiness
Localised pain

275
Q

How do you measure growth in C&YP and what tools can you use?

A

Looking at the overall tracking of weight and length on centile charts

276
Q

How do you measure development in C&YP?

A

Parent evaluation
Level of communication
Gross motor skills
Fine motor skills

277
Q

What do C&YP need for growth and development?

A

Basic needs which includes:

  • food
  • sleep
  • clothing
  • hydration
  • shelter
  • safety
  • education
  • emotional connections
278
Q

List the emerging health priorities in C&YP

A

Obesity
Poor dental health
Emoltional and social wellbeing

279
Q

How are immunisations monitored in C&YP?

A

Through the national immunisation register

280
Q

When drawing up immunisation what is an important thing to consider for the child?

A

Ensure you draw the immunisation up out of view from the child and parent to avoid anxiety.

281
Q

How many grams per week are babies expected to gain at 2-12 weeks old?

A

200g/week

282
Q

How many grams per week are babies expected to gain at 3-6 months old?

A

150g/week

283
Q

How many grams per week are babies expected to gain at 6-9 months old?

A

100g/week

284
Q

How many grams per week are babies expected to gain at 9-12 months old?

A

50 – 75g/week

285
Q

How would a two year child with a urinary tract infection present?

A 
Can be asymptomatic
Crying and distressed
Fever
Urgency to urinate
Regression in toilet training or bed wetting
Burning or pain when urinating
Anorexia
Pain in abdomen/back/side or generalised pain
Malodourous urine
Cloudy or bloody urine
Unexplained and persistent irritability
Poor growth
286
Q

What are the 3 functions of the GIT?

A

Digestion
Absorption of nutrients and water
Protective barrier against infection

287
Q

List reasons why a C&YP may not be able to meet their nutritional needs:

A
  • Impaired sucking, chewing or swallowing mechanism
  • Dyspnoea
  • Neuromuscular disorder
  • Absorption disruption
  • Increased nutritional requirements
  • Conditions that require continuous supply of nutrients
288
Q

List strategies when caring for a C&YP with obesity:

A

Early intervention
Educate about medical complications of obesity
Involve all family members in the program
Reduce inactivity
Reduce calorie intake
Set realistic goals
Monitor eating and exercising

289
Q

What are the aetiologies of fluid loss:

A 
Diarrhoea
Vomiting
Gastroenteritis
Rotavirus
Haemorrhage
Ostomy drainage
Thermal injuries
290
Q

What are the 3 types of dehydration?

A

Isotonic (the solute concentrate is identical to that of bodily fluids, Na between 130-145)

Hypotonic (the solute concentrate is lower than normal body fluid, Na below 130)

Hypertonic (the solute concentrate is higher than normal body fluid, Na greater than 145

291
Q

What is a hypotonic, isotonic and/or hypertonic fluid?

A

Hypotonic: has lower osmolarity than serum

Hypertonic: has higher osmolarity than serum

Isotonic: same osmolarity as serum

292
Q

List signs of moderate dehydration:

A 
Increased thirst
Dry mouth and tongue
Decreased urine output
3-6% weight loss
Cap refill greater than 2 secs
293
Q

List signs of severe dehydration:

A 
Lethargic
Unconcious
Minimal or no urine output
Greater then 9% weight loss
Increased HR
Weak pulses
Deep breathing
Cool
Mottled extremities
Deeply sunken eyes
294
Q

What is the management of constipation?

A

Oral and rectal medications such as stool softeners, suppositories or phosphate enemas

Dietary management

Behavioural modification

295
Q

What are the non-organic causes of constipation?

A 
Poor dietary management
Developmental problems that complicate toilet training
Emotional abuse
Depression
Sedentary lifestyle
296
Q

What are the simple rules of fluid replacement?

A

Replace:
Blood with blood
Plasma with colloids
ECF with saline

Resuscitate with colloids
Rehydrate with dextrose

297
Q

What are the organic causes of constipation?

A 
Anatomical malformation
Metabolic disorders
Gastrointestinal disorders
Neuropathic disorders
Intestinal nerve or muscle disorders
Connective tissue disorders
Drugs such as opiates
298
Q

Name the top 5 causes of mortality for children aged 1-14 years?

A 
External land transport accidents
Perinatal &amp; congenital conditions 
Cancer
Accidental poisoning 
Cerebral palsy
299
Q

As a part of First Aid relating to burns, which of the following is the most correct?

A) Put burn site under cold running water for 20 minutes

B) Apply moisturiser immediately to the burnt area

C) Apply an ice pack directly to the site

D) Apply a heat pack directly to the site and see medical assistance

A

A) Put burn site under cold running water for 20 minutes

300
Q

What non-pharmacological pain intervention techniques would you use for neonates?

A

Oral stimulation (sucking, pacifier, breastfeeding)

301
Q

What non-pharmacological pain intervention techniques would you use for infants?

A

Touch, stroking, rubbing, patting

302
Q

What non-pharmacological pain intervention techniques would you use for preschool children?

A

puppets, imagination game

303
Q

What non-pharmacological pain intervention techniques would you use for school aged children?

A

Art, colouring, play dough, video games

304
Q

What non-pharmacological pain intervention techniques would you use for teenagers?

A

Guided imagery/hypnosis, computer games, books, heat and cold packs

305
Q

What is the most common diabetes-related cause of death for adolescents and children and what are the characteristics of this condition?

A

Diabetic ketoacidosis (DKA)

Characterised by:

  • hyperglycaemia
  • metabolic acidosis
  • increased ketones
306
Q

Name 2 clinical manifestations of Shaken Baby Syndrome (SBS)?

A 
Retinal bleeding
Blindness
Brain damage
Cerebral palsy
Seizures/epilepsy
Hearing loss
Learning difficulties
Behavioural problems
307
Q

Alex is a 14 year old boy who has attended the GP Clinic where you work as a RN. He is there for a scheduled administration of Gardasil, however, you notice evidence of possible self-harm injuries up his arms. He says that he is not interested in school or social activities and has recently broken up with his girlfriend because of his smoking. He has been brought in to the GP by his aunty as both his parents work away. Use HEADSS Adolescent Psychosocial Assessment to gather a picture of Alex’s protective strengths and psychosocial vulnerabilities than may put him at risk.

A

H – Home (parents working away, possible deficit support structures. Would ask how close he was to his Aunty. Who else lives at home? Anyone he feels he can go to for support)

E – Education, eating, employment, exercise (Not interested in school. Why is this? Is it recent? Any subjects he used to be engaged with? Learning difficulties? Does he have a job? Has he lost weight? Not eating?)

A – Activities, peer relationships, social media (Social – group of friends? Recent split with girlfriend? Is he on social media, if so what are his views on it? Helpful in connecting or isolating and bullying? Does he play any sport?)

D - Drug use, including prescribed medications, cigarettes, alcohol and other drugs (Alex has identified that he is smoking. Does he use drugs/alcohol? Is he on any other medications?)

S – Sexuality and Gender (Alex identified that he has recently broken up with his girlfriend)

S - Suicide and depression, safety and spirituality. (Alex has injuries on his arms – possible self-harm, loss of interest in school & socialising may indicate depression. Possibly susceptible to suicide/further self-harm?)

Identified strengths/protective factors- Aunty, willing to speak to the RN, is engaged with health services

Vulnerabilities/Risk Factors – Parents away, possible evidence of self-harm, recently broke up with girlfriend, doesn’t feel engaged with school/social group, smoking

308
Q

Name and describe the 3 stages of bereavement of the young child dealing with the death of a parent?

A

Protest (Anger & fear aimed at reattachment to the lost parent)

Despair (Processing the loss. Sadness, distance, unresponsiveness. Psychosomatic problems like headaches, enuresis. Psychosocial problems like school-phobia, poor school performance, depression)

Detachment – moves from depression to openness to new relationships and increased activity

Child and Adolescent Health (1 decks)

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