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)
2
Q
What are some vaccine considerations?
A
Seasonal changes
Geographical concerns
Record immunisations on national register
3
Q
Define immunity
A
The ability of the human body to protect itself from infections
4
Q
Types of immunity
A
Actively
Passively
Horizontally
5
Q
Example of passive immunity
A
Newborn babies receive passive immunity to several diseases from antibodies passed across the placenta from their mothers
6
Q
Example of active immunity
A
Vaccines provide long-term active immunity to disease without the risks associated with the disease
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
8
Q
Route for delivering immunisations
A
Parenteral (intradermal, subcut, IM)
9
Q
Location for delivering immunisations
A
Vastus lateralis
Deltoid
Gluteal (occasional)
10
Q
Anticipated reactions to immunisations
A
Links to autism and asthma
Developmental delays
Unanticipated adverse reactions
Allergic reactions - eggs
11
Q
Define child mortality
A
Number of deaths under one year of age in one year rate per annum
12
Q
Define child morbidity
A
Percentage of children aged 0-14 in a rate per 100,000 with chronic disease
13
Q
What are child mortality rates linked with?
A
Economic advantage
SDoH
14
Q
How much of Australia’s population is comprised of children?
A
20%
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
16
Q
Define childhood chronic conditions
A
Functional limitations on normal growth, development and socialisation
17
Q
List childhood chronic conditions
A
Asthma Diabetes Congenital abnormalities Genetic conditions Childhood diseases Cancers
18
Q
Health priorities in paediatrics
A
Obesity
Dental health
Emotional and social wellbeing
19
Q
Chronic diseases have seeds in childhood (T/F)
A
True
20
Q
What measurements are needed for a growth assessment?
A
Weight
Length
Height
Head circumference
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
22
Q
Percentage of children within 3-97 percentile
A
94%
23
Q
Percentage of children below 3 percentile
A
3%
24
Q
Percentage of children above 97 percentile
A
3%
25
Outline History of Childhood
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
26
Define vulnerable
Children and young people experience illness differently to adults making them susceptible to harm
27
Define powerless
Children and young people lack political and economic power within society and healthcare that can be due to social structures
28
Define dependent
Children and young people’s level of dependence on adults changes in response to physical, cognitive, developmental, social and experiential changes
29
A&P of head
Large compared to adults
Newborns head exceeds circumference of chest
Anterior and posterior fontanelles
30
A&P of arms and legs
Shorter and underdeveloped at birth
Legs grow rapidly after age 1
Hands and feet are long gangly
31
Midpoint in length
Child is umbilicus
| Adult is symphysis pubis
32
Body length
Increases by 50% in first year
33
A&P of muscles
Lack tone, power and coordination
34
A&P of growth
Christmas tree pattern occurs with adolescent growth spurt, pubertal growth spurt
35
A&P of BMR
Reduces over time
| Higher oxygen and calorie needs when young
36
A&P of abdomen
Protuberant, circumference exceeds that of the skull and thorax, disproportionate due to large liver and small pelvis
37
A&P of sinuses
Small facial sinuses
38
A&P of spinal column
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.
39
A&P of iliac crest
Neonates have imaginary line joining the iliac crests which occurs at S1
40
A&P of skeletal strength and endurance
Increases with age
41
A&P of thorax and shoulder girdle
Displaced upwards towards the neck
42
A&P of brain
Neonate has relatively large brain at 1/10 of weight compared to 1/50
43
A&P of integumentary system
1mm thick at birth, 4% of birth weight.
Functionally matures during early childhood.
Minimal production of sebum.
Eccrine glands functional but immature.
44
A&P of cardiovascular system
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
45
A&P of respiratory system
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
46
A&P of hepatic system
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
47
A&P of renal system
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
48
A&P of fluid Homeostasis
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.
49
A&P of digestion
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.
50
Development of thought processes in infancy
Infancy: Primarily use non verbal communication
51
Development of thought processes in preschool
Egocentric. Need explanations in concrete terms. Animism can make them fearful. Cannot distinguish between fact and fantasy
52
Development of thought processes in school aged
Start to rely less on what they see and more on what they know
53
Development of thought processes in adolescence
Fluctuate between child and adult thinking and behaviour
54
Development of thought processes in older infants
Attentions are centred on themselves and parents
55
Functions of the gastrointestinal tract
Digestion
Absorption of nutrients and water
Protective barrier against infection
Children's GI tract is immature until age 8, making them vulnerable.
56
How is the GIT altered in children
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)
57
Causes of lower nutritional intake
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
58
Treatment of lower nutritional intake
```
Surgical interventions
Medical interventions
Psychosocial (Behavioural management, CBT)
Pharmacological
Special diets (low fibre, lactose free)
Enteral feeding methods
TPN
Re-Feeding syndrome
```
59
Non organic causes of growth and weight faltering
```
Feeding problems
Maternal stress, depression
Lack of stimulation and under nutrition
Fabricated or Induced Illness by Carers (MSbP)
Disturbed attachment and bonding
Anorexia
Bulimia
```
60
Organic causes of growth and weight faltering
```
Inability to feed
Malabsorption (Crohn’s, CF)
Illness induced anorexia
Impaired nutrient absorption (Coeliac)
Endocrine (hyper/hypothyroidism)
Miscellaneous (IUGR)
Genetic (Turners)
```
61
Advantages of Breastfeeding
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
62
Disadvantages of Breastfeeding
```
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
```
63
How many children aged 5-17 are overweight or obese
A quarter (600,000) of Australian children
64
Issues associated with child obesity
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.
65
Why do children need more water?
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
66
What are the classifications of dehydration?
Isotonic dehydration
Hypotonic dehydration
Hypertonic dehydration
67
What is isotonic dehydration?
State in which the solute concentration is identical to that of body fluids: Na between 130 and 145
68
What is hypotonic dehydration?
The solute concentration is below that of normal body fluids: Na < 130
69
What is hypertonic dehydration?
The solute concentration is above that of normal body fluids: Na > 145
70
What is isotonic fluid?
Same osmolarity as serum = stays where its put and does not affect the size of cells
71
What is hypotonic fluid?
Higher osmolarity = fluid is pulled from the cells and the interstitial compartment into the blood vessels
72
What is hypertonic fluid?
Lower osmolarity as serum = fluid shifts out of the blood vessels and into the cells and interstitial spaces
73
What is percentage is moderate dehydration
4-6%
74
What is Moderate Dehydration (4-6%)
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.
75
What is Severe Dehydration (7-10%)
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
76
What is percentage is severe dehydration
7-10%
77
Effect of electrolytes in children
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
```
78
Treatment of acute infectious diarrhoea
Do:
Oral Rehydration Therapy
Intravenous Infusion Therapy
Breast milk; Formula milk; Solids
Don’t:
Antiemetics
Antidiarrhoeal agents
Antibacterial agents
79
Organic causes of Constipation
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
80
Non organic of Constipation
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)
81
Management of Constipation
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
82
Leading cause of death for children under one
Perinatal
| Congenital
83
Leading cause of death for children aged 1-14
External
| Land transport accidents
84
Leading cause of death for children aged 15-24
External
| Suicide
85
Primary survey during cardiac arrest
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
86
Affect of cardiac arrest on the effort of breathing
```
Recession
Respiratory rate
Inspiratory/expiratory noises
Grunting
Accessory muscle use
Flare of the alae nasi
Gasping
Childs position
```
87
Affect of cardiac arrest on the efficiency of breathing
Chest expansion
Breath sounds and Auscultation
Abdominal excursion
88
Respiratory inadequacy effects:
Heart rate
Skin colour
Mental status
89
Effects of respiratory inadequacy on heart rate
Initially tachycardic
| Become tired and start to get bradycardic
90
Effects of respiratory inadequacy on skin colour
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
91
Effects of respiratory inadequacy on mental status
Agitated or drowsy
Drowsiness increases and leads to unconsciousness
Generalised muscular hypotonia also accompanies hypoxic cerebral depression
92
Effects of circulatory inadequacy on other organs
Respiratory rate and character
Skin appearance and temperature
Mental status
93
Signs of cardiac failure
```
Cyanosis
Absent femoral pulses
Gallop rhythm/murmur
Crepitations in lungs
Enlarged liver
Hypotension
```
94
Define Decorticate
Flexed arms and extended legs
95
Define Decerebrate
Extended arms and extended legs
96
Warning signs of cardiac arrest
Respiration
- Abnormal breathing pattern
Circulation
- Cushings response - hypertension with bradycardia
97
Signs of cardiac arrest
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
98
What is disability
acute physiological change
99
CM of disability
```
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
```
100
Causes of headache in children
```
Adolescent diagnoses (ethanol, stress)
Raised ICP
BP
Head Trauma
Cerebral haemorrhage
Infection
```
101
What GCS score indicates concussion?
Less than or equal to 8
102
Types of seizures
```
Epilepsy
Generalised seizure
Partial seizure
Status epilepticus
Febrile convulsions
```
103
What is epilepsy?
common, focal or generalised, cerebral
104
What is a generalised seizure?
whole of brain, loc, incontinence
105
What is a partial seizure?
no loc, changed aura (taste, smell, hallucination)
106
What is status epilepticus?
unresolving, emergency, reduction in blood to brain
107
What are febrile convulsions?
under 5 yrs pyrexiametabolic
108
What is intracranial pressure?
pressure exerted by cranial contents on skull
109
Intracranial contents consist of:
Brain (80%)
Cerebrospinal fluid (10%)
Blood (10%)
110
Causes of brain injury
Structural
- Neoplasms
- Closed head injury
- Open head injury
Metabolic
- Lack of oxygen
- Accumulation of wastes (acidosis)
- Hyperglycaemia (DKA)
111
Treatment of raised ICP
```
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
```
112
Management of raised ICP
```
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
```
113
What is cerebral palsy
Non progressive disorder of upper motor neurone impairment resulting in motor dysfunction
114
Types of cerebral palsy
Spastic, dystonic, dyskinetic, athetoid, dysarthria
115
CM of Meningitis
```
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
```
116
DX of Meningitis
Lumbar puncture
CSF
Full blood count
117
TX of Meningitis
```
Neuro observations
Quiet dark room
IV antibiotics
Head circumference
Analgesia
```
118
Types of Wounds
```
Acute (burns)
Chronic (ulcers)
Incision wounds (surgery)
Traumatic wounds (often contaminated, gravel rash)
Ulcers
Stoma wounds
Perineal wounds
```
119
Types of wound healing
```
Primary intention
Secondary intention
Tertiary intention
Skin graft
Flap graft
```
120
Describe healing by primary intention
Wound union occurs directly without intervention of granulations
121
Describe healing by secondary intention
Union by closure of a wound with granulations
122
Describe healing by tertiary intention
Treatment of a grossly contaminated wound by delaying closure until after contamination is reduced and inflammation subsides
123
Describe healing by skin graft
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; venous or pressure ulcers; diabetic ulcers that don’t heal; very large wounds; wounds unable to close
124
Describe healing by skin flap
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
Causes of burns
Thermal
Electrical
Chemical
Radiation
126
Classification of burns
SUPERFICIAL: Involves epidermis
PARTIAL THICKNESS: Involves epidermis and some dermis
FULL THICKNESS: Involves epidermis, dermis, subcutaneous tissues, muscle and bone
127
Management of burns
```
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
What does a high level of Neutrophils indicate?
acute infection
129
What does a high level of Eosinophils indicate?
allergy
130
What does a high level of Lymphocytes indicate?
antibodies
131
What does a high level of Monocytes indicate?
chronic infection
132
What does a high level of Basophils indicate?
leukaemia
133
Define pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
134
Behavioural indicators of pain
```
Crying
Irritability
Facial expressions
Sleep disturbance
Etc
```
135
Physiological indicators of pain
```
Raised vital signs
Decreased O2 sats
Increased muscle tone
Sweating
Pale or flushed
```
136
QUESTT Pain Assessment
```
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
PQRSTU Pain Assessment
```
Provoking factors
Quality
Region and radiation
Severity
Time
Understanding
```
138
Pharmacological interventions for pain
Opioids
NSAIDS
Paracetamol
139
Non pharmacological interventions for pain
```
Sucrose
Distraction
Mindfulness
Acupuncture/pressure
Massage
```
140
Consequences of pain to endocrine system
↑ stress hormone
↑ metabolic rate
↑ heart rate
↑ water retention
141
Consequences of pain to immune system
Impaired immune functions
142
Consequences of pain to cardiac system
↑ cardiac rate
↑ systemic vascular resistance
↑ peripheral vascular resistance
↑ coronary vascular resistance → ↑ blood pressure and ↑ myocardial oxygen consumption
143
Consequences of pain to pulmonary system
↓ flow and volume → retained secretions and atelectasis
144
Consequences of pain to gastrointestinal system
Delayed return of gastric and bowel function
145
Consequences of pain to musculoskeletal system
↓ muscle function, fatigue and immobility
146
Infant Response to Pain
```
Forcefully closed eyes
Lowered brows
Deepened furrow between nose and outer corner of lip
Square mouth
Cupped tongue
```
147
Describe Neonatal Infant Pain Scale (NIPS)
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
Types of seizures
```
Epilepsy
Generalised seizure
Partial seizure
Status epilepticus
Febrile convulsions
```
149
What is epilepsy?
common, focal or generalised, cerebral
150
What is a generalised seizure?
whole of brain, loc, incontinence
151
What is a partial seizure?
no loc, changed aura (taste, smell, hallucination)
152
What is status epilepticus?
unresolving, emergency, reduction in blood to brain
153
What are febrile convulsions?
under 5 yrs pyrexiametabolic
154
What is intracranial pressure?
pressure exerted by cranial contents on skull
155
Intracranial contents consist of:
Brain (80%)
Cerebrospinal fluid (10%)
Blood (10%)
156
Causes of brain injury
Structural
- Neoplasms
- Closed head injury
- Open head injury
Metabolic
- Lack of oxygen
- Accumulation of wastes (acidosis)
- Hyperglycaemia (DKA)
157
Treatment of raised ICP
```
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
Management of raised ICP
```
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
What is cerebral palsy
Non progressive disorder of upper motor neurone impairment resulting in motor dysfunction
160
Types of cerebral palsy
Spastic, dystonic, dyskinetic, athetoid, dysarthria
161
CM of Meningitis
```
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
DX of Meningitis
Lumbar puncture
CSF
Full blood count
163
TX of Meningitis
```
Neuro observations
Quiet dark room
IV antibiotics
Head circumference
Analgesia
```
164
Types of Wounds
```
Acute (burns)
Chronic (ulcers)
Incision wounds (surgery)
Traumatic wounds (often contaminated, gravel rash)
Ulcers
Stoma wounds
Perineal wounds
```
165
Types of wound healing
```
Primary intention
Secondary intention
Tertiary intention
Skin graft
Flap graft
```
166
Describe healing by primary intention
Wound union occurs directly without intervention of granulations
167
Describe healing by secondary intention
Union by closure of a wound with granulations
168
Describe healing by tertiary intention
Treatment of a grossly contaminated wound by delaying closure until after contamination is reduced and inflammation subsides
169
Describe healing by skin graft
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; venous or pressure ulcers; diabetic ulcers that don’t heal; very large wounds; wounds unable to close
170
Describe healing by skin flap
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
Causes of burns
Thermal
Electrical
Chemical
Radiation
172
Classification of burns
SUPERFICIAL: Involves epidermis
PARTIAL THICKNESS: Involves epidermis and some dermis
FULL THICKNESS: Involves epidermis, dermis, subcutaneous tissues, muscle and bone
173
Management of burns
```
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
What does a high level of Neutrophils indicate?
acute infection
175
What does a high level of Eosinophils indicate?
allergy
176
What does a high level of Lymphocytes indicate?
antibodies
177
What does a high level of Monocytes indicate?
chronic infection
178
What does a high level of Basophils indicate?
leukaemia
179
Define pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
180
Behavioural indicators of pain
```
Crying
Irritability
Facial expressions
Sleep disturbance
Etc
```
181
Physiological indicators of pain
```
Raised vital signs
Decreased O2 sats
Increased muscle tone
Sweating
Pale or flushed
```
182
QUESTT Pain Assessment
```
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
PQRSTU Pain Assessment
```
Provoking factors
Quality
Region and radiation
Severity
Time
Understanding
```
184
Pharmacological interventions for pain
Opioids
NSAIDS
Paracetamol
185
Non pharmacological interventions for pain
```
Sucrose
Distraction
Mindfulness
Acupuncture/pressure
Massage
```
186
Consequences of pain to endocrine system
↑ stress hormone
↑ metabolic rate
↑ heart rate
↑ water retention
187
Consequences of pain to immune system
Impaired immune functions
188
Consequences of pain to cardiac system
↑ cardiac rate
↑ systemic vascular resistance
↑ peripheral vascular resistance
↑ coronary vascular resistance → ↑ blood pressure and ↑ myocardial oxygen consumption
189
Consequences of pain to pulmonary system
↓ flow and volume → retained secretions and atelectasis
190
Consequences of pain to gastrointestinal system
Delayed return of gastric and bowel function
191
Consequences of pain to musculoskeletal system
↓ muscle function, fatigue and immobility
192
Infant Response to Pain
```
Forcefully closed eyes
Lowered brows
Deepened furrow between nose and outer corner of lip
Square mouth
Cupped tongue
```
193
Describe Neonatal Infant Pain Scale (NIPS)
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
Describe the FLACC pain scale
.
195
How do toddlers present pain
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
How do 3-8 year olds present pain
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
How do school aged children present pain
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
How do you evaluate pain in children over 8
Use the standard visual analog scale
Numerical rating Scale (NRS)
Same used in adults
199
How does cognitive impairment affect a child's ability to express pain?
Often unable to describe pain
Altered nervous system
Experience pain differently
200
Analgesic used in preterm and term infants
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
Cognitive approaches to pain management
```
Education
Relaxation, imagery
Psychotherapy, counselling
Hypnosis
Biofeedback
Music, literature, art, play
Prayer, meditation
```
202
Physical approaches to pain management
```
Massage
Acupuncture
Acupressure
Heat or Cold
TENS
Therapeutic exercise
```
203
Outline Inguinal Hernia
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
Outline Umbilical Hernia
Most umbilical hernias close spontaneously within first 3 years of life
Small-diameter umbilical hernias close earlier than large-diameter umbilical hernias
205
Complications of Undescended Testis
- Failure of testicle to produce viable sperm
- Malignant degeneration of testicle
- Predisposition to torsion and traumatic injuries
- Associated inguinal hernia
206
Treatment of Undescended Testis
Orchidopexy is performed after 1 year of age
207
Pathogenesis of Acute Appendicitis
Obstruction
Increased intraluminal pressure and venous collapse
Ischemia, bacterial proliferation, further inflammation
208
CM of Acute Appendicitis
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
TX of Acute Appendicitis
Intravenous hydration
Broad-spectrum antibiotics
Surgery
210
Why do children under 5 often have a ruptured appendix
Unable to provide a clear history of complaints
Uncooperative for performance of physical examination
Uniform response to many illnesses
211
Types of Strabismus
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
What is Esotropia
Inward turning of the eye
213
What is Exotropia
Outward turning of the eye
214
What is Hypertropia
Upward turning of the eye
215
What is Hypotropia
Downward turning of the eye
216
Define chronic condition
Condition that has lasted or will last for six months or more.
217
Common chronic conditions
```
Asthma
Diabetes T1
Cancer
Epilepsy
Congenital abnormalities
```
218
At what age is asthma often diagnosed?
8
219
How is asthma managed?
preventers, trigger identification and monitoring
220
Cause of T1 diabetes
interaction of genetic and environmental factors
221
Cause of T2 diabetes
poor diet and nutrition, obesity and lack of exercise
222
Biochemical criteria for diagnosis of DKA
Hyperglycaemia – blood glucose > 11 mmol/L
Ketonaemia
Acidosis – venous pH <7.3 or bicarbonate < 15mmol/L
223
Most common cause of diabetes-related deaths in children and adolescents
cerebral oedema
224
DKA is characterised by:
hyperglycaemia, metabolic acidosis and increased total body ketone concentration resulting from deficiency of circulating insulin
225
DKA stands for what?
Diabetic ketoacidosis
226
What is Hypoglycaemia?
BGL low enough to cause symptoms of impaired brain function
BSL <2.6mmol/L
227
What are some congenital disorders
Congenital heart disease
Atrial septal defects
Ventricular septal defect
228
What is congenital heart disease
Leading cause of death among infants/children under 1 year
229
What is atrial septal defect
1:1000 births (blood flows L to R)
230
What is ventricular septal defect
15-20% of all CHD (raised volume therefore pulmonary pressure) symptoms of heart failure
Requires surgical repair and support
231
CHD management in children
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
Difference between epilepsy and febrile convulsions
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
What is the Post-Ictal phase
Phase following seizure when child may have impaired consciousness level
30-40 minutes. May be affected by medications given to stop seizure
234
Goals of Transitioning Care
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
What is disability
Characteristic complex or chronic conditions, functional limitations and high health care use
236
Categories of disability
Physical
Intellectual
Developmental
Combination
237
What causes disability
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
What are congenital heart defects
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
What are neural tube defects
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
What causes Cerebral Palsy
Physiological assault during pregnancy
Measles
CMV
241
Symptoms of cerebral palsy
May not be diagnosed immediately
Exaggerated reflexes/involuntary movements
Floppy or rigid limbs in baby
Slow growth
Developmental delays
242
Types of cerebral palsy
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
What is muscular dystrophy
Degenerative genetic disorder
Physical wasting leading to:
- Physical aids
- Respiratory support
- GI problems
- Musculoskeletal pain
244
What is Aspergers syndrome
Condition on autism spectrum, with generally higher functioning, may be socially awkward and have all-absorbing interest in specific topics
245
Cause of dwarfism
Endocrine disorders, hypothyroidism, growth hormone, congenital pituitary damage, other diagnoses
246
Diagnoses of dwarfism
blood test or developmental delay
247
Treatment of dwarfism
bone lengthening to optimise growth, pain control, psychological and equity
248
What is protection
only when something is going wrong or there is risk of harm or actual harm
249
What is safeguarding
early recognition and intervention of problems health promotion
250
Categories of abuse
```
Physical
Sexual
Emotional
Psychological
Omission
Moral abuse?
```
251
The child protection triangle consists of what?
Public
Caregivers
Professionals
252
What is neglect?
Persistent failure to meet child’s basic physical or psychological needs likely resulting in serious impairment of child’s health or development
253
What is sexual abuse?
Forcing or enticing a child to take part in sexual or lewd activities whether or not they are aware of what is happening
254
Shaken Baby Syndrome causes what?
```
retinal bleed / blindness
brain damage
cerebral palsy
seizures and epilepsy
hearing loss
learning difficulties
behaviour problems
```
255
What is mental health?
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
Mental health disorders in children
Attention deficit hyperactivity disorder (ADHD)
Conduct disorders
Autism spectrum disorder (ASD)
Anxiety and depression
Eating disorders
257
What is ADHD
```
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
What are conduct disorders
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
What are autism spectrum disorders
Deficits in social functioning
Fixated interests, repetitive behaviours, sensory fixation
OCD
Easily stressed and cannot communicate anxiety
Depression
260
What is anxiety and depression
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
What are some risk factors
```
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
What are some protective factors
```
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
Changes in A&P in adolescence
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
Reaction to loss of a parent - 0 to 6 months
Displays distress from loss by changing sleeping and eating habits
Reacts to grief reactions of others
Needs continuous loving care
265
Reaction to loss of a parent - 6 months to 2 years
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
Reaction to loss of a parent - 3 to 5 years
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
Reaction to loss of a parent - 5 to 9 years
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
Three Stages of Bereavement
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
Reactions and Grief Strategies
Regression to an earlier developmental stage
Hyperactivity
Emotional outbursts
Overprotectiveness of the surviving parent
Constructing the deceased parent
270
Stages a dying child goes through
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
Feelings of a Dying Child
```
Fear and anxiety
Anger
Sadness
Loneliness and Isolation
Spiritual needs
Individual differences
```
272
Name 3 anatomical anomalies that may indicate Trisomy 21 (Down Syndrome) in a newborn?
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
What is the process of immunising a child?
```
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
What side effects would you educate parents about with immunisations?
Minor swelling and redness at site
Mild fever
Sleepiness
Localised pain
275
How do you measure growth in C&YP and what tools can you use?
Looking at the overall tracking of weight and length on centile charts
276
How do you measure development in C&YP?
Parent evaluation
Level of communication
Gross motor skills
Fine motor skills
277
What do C&YP need for growth and development?
Basic needs which includes:
- food
- sleep
- clothing
- hydration
- shelter
- safety
- education
- emotional connections
278
List the emerging health priorities in C&YP
Obesity
Poor dental health
Emoltional and social wellbeing
279
How are immunisations monitored in C&YP?
Through the national immunisation register
280
When drawing up immunisation what is an important thing to consider for the child?
Ensure you draw the immunisation up out of view from the child and parent to avoid anxiety.
281
How many grams per week are babies expected to gain at 2-12 weeks old?
200g/week
282
How many grams per week are babies expected to gain at 3-6 months old?
150g/week
283
How many grams per week are babies expected to gain at 6-9 months old?
100g/week
284
How many grams per week are babies expected to gain at 9-12 months old?
50 – 75g/week
285
How would a two year child with a urinary tract infection present?
```
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
What are the 3 functions of the GIT?
Digestion
Absorption of nutrients and water
Protective barrier against infection
287
List reasons why a C&YP may not be able to meet their nutritional needs:
- Impaired sucking, chewing or swallowing mechanism
- Dyspnoea
- Neuromuscular disorder
- Absorption disruption
- Increased nutritional requirements
- Conditions that require continuous supply of nutrients
288
List strategies when caring for a C&YP with obesity:
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
What are the aetiologies of fluid loss:
```
Diarrhoea
Vomiting
Gastroenteritis
Rotavirus
Haemorrhage
Ostomy drainage
Thermal injuries
```
290
What are the 3 types of dehydration?
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
What is a hypotonic, isotonic and/or hypertonic fluid?
Hypotonic: has lower osmolarity than serum
Hypertonic: has higher osmolarity than serum
Isotonic: same osmolarity as serum
292
List signs of moderate dehydration:
```
Increased thirst
Dry mouth and tongue
Decreased urine output
3-6% weight loss
Cap refill greater than 2 secs
```
293
List signs of severe dehydration:
```
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
What is the management of constipation?
Oral and rectal medications such as stool softeners, suppositories or phosphate enemas
Dietary management
Behavioural modification
295
What are the non-organic causes of constipation?
```
Poor dietary management
Developmental problems that complicate toilet training
Emotional abuse
Depression
Sedentary lifestyle
```
296
What are the simple rules of fluid replacement?
Replace:
Blood with blood
Plasma with colloids
ECF with saline
Resuscitate with colloids
Rehydrate with dextrose
297
What are the organic causes of constipation?
```
Anatomical malformation
Metabolic disorders
Gastrointestinal disorders
Neuropathic disorders
Intestinal nerve or muscle disorders
Connective tissue disorders
Drugs such as opiates
```
298
Name the top 5 causes of mortality for children aged 1-14 years?
```
External land transport accidents
Perinatal & congenital conditions
Cancer
Accidental poisoning
Cerebral palsy
```
299
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) Put burn site under cold running water for 20 minutes
300
What non-pharmacological pain intervention techniques would you use for neonates?
Oral stimulation (sucking, pacifier, breastfeeding)
301
What non-pharmacological pain intervention techniques would you use for infants?
Touch, stroking, rubbing, patting
302
What non-pharmacological pain intervention techniques would you use for preschool children?
puppets, imagination game
303
What non-pharmacological pain intervention techniques would you use for school aged children?
Art, colouring, play dough, video games
304
What non-pharmacological pain intervention techniques would you use for teenagers?
Guided imagery/hypnosis, computer games, books, heat and cold packs
305
What is the most common diabetes-related cause of death for adolescents and children and what are the characteristics of this condition?
Diabetic ketoacidosis (DKA)
Characterised by:
- hyperglycaemia
- metabolic acidosis
- increased ketones
306
Name 2 clinical manifestations of Shaken Baby Syndrome (SBS)?
```
Retinal bleeding
Blindness
Brain damage
Cerebral palsy
Seizures/epilepsy
Hearing loss
Learning difficulties
Behavioural problems
```
307
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.
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
Name and describe the 3 stages of bereavement of the young child dealing with the death of a parent?
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
