Jenny Flashcards
1
Q
most common symptoms of obstructive sleep apnea
A
- Loud snoring or noisy breathing during sleep
- Periods of not breathing.
Although the chest wall is moving, no air or oxygen is moving through the nose and mouth into the lungs. The duration of these periods is variable and measured in seconds. - Mouth breathing.
The passage to the nose may be completely blocked by enlarged tonsils and adenoids. - May also speak with a nasal voice.
- Restlessness during sleep.
This occurs with or without periods of being awake. - Excessive daytime sleepiness or irritability.
Because the quality of sleep is poor, the child may be sleepy, hard to wake from a nap, or irritable in the daytime. - Hyperactivity during the day.
May also experience behavioral, school, or social problems.
2
Q
Tonsillectomy
A
Tonsils are two small glands in the back of throat
Help to deal with infections, particularly in childhood
An operation to remove tonsils called tonsillectomy
3
Q
Adenoidectomy
A
Adenoids are small lumps of soft tissue found at the back of nose
The surgical remove of adenoids are adenoidectomy
Tonsillectomy and adenoidectomy done together is commonly referred as T&As.
4
Q
T&As - Signs & Symptoms
A
- Swelling of the tonsils
- Redder than normal tonsils
- A white or yellow coating on the tonsils
- Snorring and difficult in breathing
- Fever
- Recurrent ear infections
5
Q
T&As -Common treatment
A
- Throat cultures to identify infections in the throat
- X-ray to visualize the size of the adenoids
- Blood test: infection
- Surgical procedure
6
Q
T&As -Nursing interventions
A
- Pain management
- humidified O2
- maintain oral intake
- mouth care
- avoid activities
- post-operative review
7
Q
Social Development
A
- Encourage and provide space for physical activity.
- Show your child how to participate in and follow the rules of sporting activities.
- Encourage play and sharing with other children.
- Encourage creative play.
- Teach your child to do small chores, such as setting the table.
- Read together.
- Limit screen time (television and other media) to 2 hours a day of quality programs.
- Expose your child to different stimuli by visiting local areas of interest.
8
Q
Therapeutic communications
A
- Hospitals are alien places to most children and the way in which Jenny is greeted and settled into the paediatric surgical unit can have a significant impact of Jenny and her family. Jenny may react strongly and unpredictably to smells, sounds, people and procedures. She may also be worried about unfamiliar people touching and examining her. Hence, therapeutic communication skills are central to establishing an effective rapport with Jenny and her family, and in developing a trusting partnership.
- Address all family members
- Distract/ divert
- Get to know them/ ask about interests
- Avoid negative words
- Give choices and empower
- Explain the procedure
9
Q
Communicating
A
- Address the parent first to convey trust •Introduce explain who you are, why you are there and if they have any questions
- Do not rush
- Keep calm
- Explain the procedure and involve them in the care
- Demonstrate assessment techniques on parents or doll
- ei: show them the stethoscope and how it works
- Ask parents to bring a familiar toy
- Use positive language
- Keep parent and toddler together and ask for assistance from them
- Do not use yes or no questions
- Use language easy to understand and give straightforward instruction
10
Q
If the child is non compliant:
A
- Make sure the environment is child friendly
- Give choices
- Ask for parents help and comfort
- Take a break
- Ask the child if he/she is scared
Usually tantrum causes are hunger, tiredness, feeling ignored or worries
11
Q
What is Family Centred Care?
A
- Empowers patients and their families and fosters independence
- Supports family care-giving and decision-making
- Respects patient and families’ choices and their values, beliefs and cultural backgrounds
- Builds on individual and family strengths
- Involves patients and their families in the planning, delivery and evaluation of health care services.
12
Q
How can we practice family centred care?
A
- Believing and trusting parents/carers and patients – they are the experts in their child/themselves.
- Introducing yourself each time you walk into the room and explaining what it is you’re going to do.
- Listening to patients and families and giving them an opportunity to discuss any of their questions, anxieties or concerns.
- Discussing which aspects of care the patient or family would like to provide, where it is safe to do so.
Not every patient or parent/carer will want to contribute to patient care in hospital so this needs to be discussed with each patient/family. - Giving the family – including the child or young person –clear, timely information.
Keeping the family informed of their child’s condition and treatment helps alleviate anxiety and also helps them be part of the decision-making. - Asking the family for their view on the patient’s care plan and as appropriate, incorporating their views.
- Making sure the parents/carers and, where appropriate, patients are involved in decisions that are made for care and treatment.
- Accepting and supporting decisions made by families, whenever possible, or explaining why if it isn’t possible.
- Respecting and promoting the rights and responsibilities of patients, parents and carers
13
Q
What are the core concepts of family Centred Care
A
Dignity and respect
Information sharing
Participation
Collaboration
14
Q
FCC - Dignity and respect
A
Staff listen to and respect patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.
15
Q
FCC - Information sharing
A
Staff communicate and share complete, objective and accurate information with patients and families in ways that are supportive and useful. Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision-making
16
Q
FCC - Participation
A
Patients and families participate in care and decision making at the level they choose, with the support and encouragement of staff.
17
Q
FCC - Collaboration
A
Patients, families and staff collaborate in policy and program development, implementation and evaluation, in health care facility design, in professional education, as well as in the delivery of care.
18
Q
PACU Assessments - 4 year old
A
- Assess airway breathing and circulation
- Obtain baseline vital signs, including O2 sats
- Assess neurological status, including level of consciousness and movement of extremities.
- Assess level of pain- last dose, type and current pain rating
- Assess colour and appearance of skin
- Assess urinary status, bladder distention or urge to void
- Position for airway maintenance, comfort and
- Check IV infusion-site, fluid type, orders, patency and amount
- Assess for nausea and vomiting-available emesis bowl and tissues
- Check emotional state of child
- Check presence of family member or carer.
- Check all orders
Have the child drink adequate cool fluids or chew gum, as this reduces spasms in the muscles surrounding the throat. - Give paracetamol syrup as prescribed
- Apply an ice collar around the child’s neck if tolerated
19
Q
Initial assessment – PACU
A
- Tonsillectomy and adenoidectomy increase risk of vomiting by 30-40 %
- -> could be related to anaesthetic
- Following tonsillectomy it is important for the nurse to closely monitor nausea and vomiting in the paediatric patient.
- -> High incidence of vomiting due to the irritation of pharynx and stomach from blood
- The exact incidence of common post-operative complications in children is unknown.
Most common is post operative nausea and vomiting followed by respiratory complications leading to hypoxia. - Cardiac complications are less likely in children without associated congenital cardiac anomaly
- Post operative shivering, agitation and delirum are seen more often in children anaesthetised with newer inhalation agents ie. Sevoflurance
- Urinary retention could be influenced by anaesthetic drugs
20
Q
Respiratory Differences between adult and child
A
Adult
- Longer and wider airways
- Small tonsils and adenoids
- Larger oral cavity and smaller tongue ratio
- Epiglottis small
- Larger airways decrease oedema and swelling
- More rigid muscles in neck
Child
- Shorter and narrower airways
- Larger tonsils and adenoids
- Smaller mouth cavity and larger tongue
- Epiglottis long and swells easily
- Increased risk of oedema
- Neck not rigid and more easily flexed causing occlusion
21
Q
Renal System
A
AKA urinary system or urinary tract• Consists of the kidneys, ureters, bladder, and the urethra• :•
22
Q
Renal System - Purpose
A
- Eliminate waste from the body
- Regulate blood volume
- Regulate blood pressure
- Control levels of electrolytes and metabolites
- Regulate blood pH
23
Q
Function of Renal System - Adult
A
Issues:
Kidney stones (men)
UTI (women)
Bladder sits fully in pelvis
Kidneys are fairly protected with fat layers
Urethra is longer
24
Q
Function of Renal System - Child
A
- During childhood urinary system is still developing: bladder is continuing to grow, still learning how to control output (controlling sphincter muscle)
- Urea synthesis and excretion are slower
- Hydrogen ion excretion, acid secretion and bicarbonate levels are lower
- Kidneys are less able to adapt to sodium deficiencies and excesses
- Born with the complete amount of nephrons for adult years but they are not grown and functioning
- Less able to reabsorb water and sodium – produces very dilute urine
- Bladder sits in abdomen
- Kidneys are more susceptible to trauma as they do not have as much fat padding
25
CARDIAC - CIRCULATION - Adult
* Adult hearts increases heart rate and stroke volume when controlling cardiac output
* Blood volume is lower 65ml to 70ml per kg
* Cardiac disease is more prevalent
* More adult patients are found to be on medication for heart health
* Higher rates of:
Renal dysfunction
Cholestatic livers
Impaired Reponses due to exercise
26
CARDIAC - CIRCULATION - Child
* Children hearts only increase heart rate when controlling cardiac output
* Blood volume is higher 70ml to 75ml per kg
* Due to the decrease in blood volume there is increased risk when children have an injury and blood loss is present
* Higher heart rate
* Higher Oxygen requirements
* Smaller vessels, veins and arteries
* Fluid resuscitation is much healthier then in an adult
27
Vital signs for a 3-5 year old
* Blood pressure is- systolic 89-112 and diastolic is 46-72
* Heart rate-awake 80-120 and sleeping 65-100
* Respiratory rate-20-28
* Temperature-Ear 35.8-38
* SP02- 95
28
How to do the observations
* hands off approach first.
* Observe from doorway before hands on.
* For temperature you would use tempanic as it’s the quickest, easiest and most comfortable for the child
* Use manual BP machine as you can control the pressure of the cuff (cuff size = 2/3 of upper arm)
* Use the brachial artery to find the child's pulse
* If a patient feels unusually cold or hot temp should be assessed immediately
* Pattern, effort and rate of breath should be observed
29
Play therapy
Therapeutic play is used to help meet the emotional needs of children who have an illness or surgery that requires hospitalisation.
Being in the hospital is stressful for children and their families. Sometimes, children feel scared, confused and out of control.
Therapeutic play is used to help children understand and cope with illness, surgery, hospitalization, treatments and procedures.
Play activities to prepare children for medical procedures and learn about his/her surgery
Relaxation and pain management skills
Providing a opportunity for a child to express his/her feelings through normal play
Brother/sister needs:
* Children at home may be worried about their brother or sister who is in the hospital. They may be upset because mom and dad are away from them more than usual.
* Visiting the hospital can also be stressful for brothers and sisters.
Play therapy can help prepare brothers and sisters before they visit so they can understand what they see and how they feel before and after their visit to their sibling in the hospital.
30
Common Post-Operative T & A Symptoms
* Throat pain
Duration 2 weeks ·
* Dehydration ·
* Ear pain
Duration 2 weeks
* Halitosis ·
* Weight loss
* Fever: low grade ·
* Bleeding
A very small amount of bleeding can occur between 6-8 days after surgery, when the scab sloughs off.
This is typically a very small amount and stops in 2-3 minutes.
31
TREATMENT for Post-Operative T & A Bleed
* Keep patient upright and encourage them to spit blood into a bowl; document quantity · Suction should be available if needed Monitoring ·
* Vital signs per nursing protocol
Cardio respiratory monitoring for actively bleeding patients
* Airway management as needed
Rehydration - insert one large-bore IV catheters
* NPO
* IV fluid resuscitation
* Consider O-negative blood as needed
* IV analgesia (no NSAIDs); titrate narcotic dose up as many patients have obstructive sleep apnea (OSA) and are at a risk for airway obstruction ·
* ENT CONSULTATION:
All patients who complain of fresh bleeding from the throat whether or not this has stopped and/or the presence of a clot, require ENT consultation
