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PA 3 (RESP 315 ) > Mod 5 Pediatric Assessment > Flashcards

Mod 5 Pediatric Assessment Flashcards

1
Q

What are some common pediatric respiratory pathologies?

A
  • RSV
  • Croup
  • Asthma
  • Sepsis
  • Cystic fibrosis
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2
Q

What is RSV?

A

A virus that causes bronchiolitis.

  • primarily infects the respiratory epithelial cells, including those lining the upper and lower airways
  • self-limiting viral infection that affects the small airways (bronchioles) in the lungs, primarily in infants and young children
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3
Q

which population group is most affected by RSV?

A

6 months and younger are most vulnerable.

  • Premature infants are at high risk for this disease process
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4
Q

Why is Sepsis in particular hard to manage for pediatrics?

A

When they get an infection, they’re more at risk of hypovolemia and shock, aka they keep getting worse

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5
Q

What are 3 categories you should have in your initial assessment for pediatrics?

A

Kids decompensate quickly, pay attention to:

  • WOB
  • Appearance
  • Circulation
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6
Q

When should you begin CPR for pediatrics?

  • spend sometime reviewing PALs algorithms
A

When the pulse <60/min w/poor perfusion despite oxygenation and ventilation

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7
Q

What are 4 categories for the appearance assessment?

A
  1. Tone
  2. Interactivness
  3. Consolability
  4. Look/gaze/stare/speech/cry
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8
Q

How do you gather a accurate baseline assessment?

A
  • Keep the kid calm
  • Involve the parents
  • Use distractions (like toys)
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9
Q

How do you assess circulation?

A
  • Look at the color of the kid: (Pallor (paleness), Mottling (bruise hexagon pattern), Cyanosis (dusky))
  • Signs of bleeding, bruising suggests injury
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10
Q

What should you do if your pt is unresponsive, not breathing/gasping respirations

A

Yell for help or activate emergency response

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11
Q

When should you give rescue breaths for pediatric pts?

A

If pulse is present, but no breathing or inadequate respirations

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12
Q

When should you proceed to your primary assessment after your initial assessment?

A

If the patient is responsive with no signs of impending resp. failure

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13
Q

What do you evaluate on your primary assessment?

A

ABCDE:

  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
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14
Q

For the primary assessment, what elements do you evaluate for airways?

A

Patency: is the airway open, clear, or obstructed?

  • Movement of chest/abdomen?
  • airflow around mouth/nose
  • bilateral breath sounds
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15
Q

If the airway is obstructed, how can be it be maintained?

A
  • Positioning
  • Insertion of OPA/NPA
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16
Q

What should you do if the airway is obstructed, and not maintainable?

A

Advanced airway (intubate)

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17
Q

For the primary assessment, what elements do you evaluate for breathing?

A
  • RR and Pattern
  • Respiratory effort
  • Chest expansion and air movement
  • Abnormal lung and airway sounds
  • Oxygen saturation by pulse ox
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18
Q

How long should you assess the RR of a small infant/pediatric Pt?

A

30 seconds bc infants may have irregular breathing w/apnea of 10 seconds.

  • Neos are assessed for a full min
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19
Q

What is considered as abnormal RR for pediatric Pts?

A

RR < 10 or > 60

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20
Q

What factors could increase the RR for a pediatric Pt?

A

Fever or pain

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21
Q

What signs indicate that the patients condition is improving?

A

Decreasing RR and improvements in LOC

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22
Q

What are causes for irregular respiratory patterns in pediatric patients?

A

Neurologic problems or Diabetic Ketoacidosis

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23
Q

What are possible sources for Tachypnea in Pediatric patients?

  • How does WOB factor in this resp. pattern?
A
  • Tachypnea with Increasing WOB could indicate type 1 or type 2 resp failure
  • If not with increased WOB, could indicate fever, pain, sepsis, dehydration?
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24
Q

What are possible sources for Bradypnea in Pediatric patients? (6)

A
  • Central nervous system injury
  • Low blood oxygen content
  • Sepsis
  • Hypothermia
  • Drugs that depress resp. drive
  • Neuromuscular disease causing muscle weakness (like muscle dystrophy)
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25
Q

What types of WOB would you typically see with increased respiratory effort?

A
  • Nasal Flaring
  • Retractions
  • Grunting
  • Head bobbing
  • Seesaw respirations
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26
Q

What are seesaw respirations?

  • What is it a impending sign of?
A

Abdominal breathing (not synced w/chest)

  • Inspiration: chest retracts inward and abdomen expands
  • Expirations: chest expands and abdomen moves inward
  • Sign of Diaphragm failing
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27
Q

How does Head bobbing present?

A

Inspiration: chin is lifted and extended

Expiration: chin falls forward

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28
Q

How does Head Bobbing help with respiratory effort?

A

Uses the neck muscles to assist breathing by extending the airway (makes it more patent)?

  • Primarily seen in infants and young pediatrics
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29
Q

What are mild to moderate retractions? (3)

  • where are each located?
A

Subcostal, substernal, and intercostal

30
Q

What are severe retractions (may include mild to mod retractions) (3)

  • Where are they located?
A

Supraclavicular, suprasternal, and sternal

31
Q

What are possible reasons for decreased or unequal chest expansion

A
  • Inadequate effort
  • Airway obstruction
  • Atelectasis
  • Pleural effusion, pneumothorax, hemothorax
32
Q

What breath sounds indicate upper airway obstruction

A

All are audible w/o auscultation

  • Stridor
  • Snoring
  • Barking cough
  • Hoarseness
33
Q

When would you hear wheezes, crackles, and diminished air entry?

A

All indicate differing things, but can only be heard via auscultation

34
Q

What do wheezes indicate?

A
  • Lower airway obstruction
  • Asthma
  • Bronchiolitis
35
Q

What do crackles indicate?

A

Secretions

  • Pneumonia
  • Atelectasis
  • Cystic fibrosis
36
Q

What oxygen saturations would indicate a need for supplementary oxygen on a pediatric patient on room air?

A

Less than 94% on room air

37
Q

When should you escalate interventions past bag mask ventilation for pediatric patients?

A

If they have sats < 90& w/supplemental oxygen.

  • LOC is probably gonna be quite low. get help.
38
Q

What would you assess on your primary assessment for circulation?

A
  • Heart rate
  • pulses
  • Capillary refill time
  • Skin color and temp
  • BP
39
Q

What are asthma medication treatments for children?

  • How does age affect treatment and equipment use?
A

Daily ICS, SABA PRN.

  • Age 1-3: MDI w/spacer, and fitted mask
  • Age 4-5 MDI w/spacer, consider mouthpiece if can make seal
40
Q

What are non pharmalogical methods to manage asthma in children? (2)

A
  • Asthma education and self management (action plan)
  • Consult w/allergist
41
Q

When are PRAM scores used for Asthma?

A

Used mainly in emergency department and wards to guide treatment of acute asthma exacerbations

  • Needs a score < 3 for discharge
  • Validated up to age 17
42
Q

What Heart rate arrhythmias are a sign of life threatening condition?

  • Kids vs Infants?
A

Tachycardias > 180 in infants

AND

Tachycardias > 160 in kids

43
Q

What Heart Rate arrhythmia indicates impending cardiac arrest (potentially)

  • When does it require immediate action?
A

Bradycardia

  • Decreased responsiveness/other signs of poor perfusion need immediate action
44
Q

What are potential causes of bradycardia if the patient is alert, responsive, and has no signs of poor perfusion?

A

Drugs or heart block

45
Q

What does a large difference in central/peripheral pulse indicate?

A

Shock

46
Q

What should you expect when correlating pulses?

A

Slightly stronger central pulse to peripheral.

  • A large difference indicate shock
  • Palpate radial and cartoid artery to correlate
47
Q

What would be reasons for a longer than normal Capillary Refill? (4)

A
  • Dehydration
  • Shock
  • Hypothermia
  • Cold Environment
48
Q

What is hypotension often a sign of?

A

Severe Shock

  • May require immediate airway, breathing, and oxygenation
49
Q

What is considered a poor urine output (u/o) and what is it indicative of?

A

Poor urine output, indicates poor circulation

  • (normal = 1-2 ml/kg/hr)
  • Poor u/o can be a sign of shock and decreased blood flow to the kidneys
50
Q

Why is decreased blood flow bad?

A

It could stimulate the RAA system, which causes vasoconstriction as a compensatory mechanism to maintain blood pressure.

51
Q

How should you monitor pediatric Pts for neurologic function (and potential disability)?

A

Examine:

  • Confusion
  • Irritability
  • Lethargy
  • Agitation alternating w/lethargy
51
Q

What can severe decrease in O2 delivery to the brain result in?

A
  • Decreased LOC
  • Loss of muscle tone
  • Decreased pupillary response
52
Q

What is neurologic function (and disability) assessed with/by? (3)

A
  • AVPU Scale (Alert, Voice, Painful Unresponsive)
  • Pupil size and response to light
  • Blood glucose test (normal < 2.5-3)
53
Q

What are common causes of decreased LOC in pediatrics? (7)

A
  • Decreased blood flow to the brain (shock/intracranial pressure)
  • Brain injury
  • Infection in the brain (meningitis, encephalitis)
  • Hypoglycemia
  • Drug Overdose
  • Hypoxemia
  • Hypercarbia
54
Q

What is the focus of the secondary assessment?

A

Focused on medical history and a focused physical examination.

  • SAMPLE abbreviation for assessment categories
55
Q

What 4 common respiratory emergency categories?

A
  1. Upper Airway Obstruction
  2. Lower Airway Obstruction
  3. Lung Tissue Disease
  4. Disordered control of breathing
56
Q

What could you expect Upper Airway Obstruction to present with?

A
  • Increased inspiratory efforts w/retractions/nasal flaring
  • Abnormal inspiratory sounds (snoring or stridor)
  • Barking Cough
  • Hoarsness
  • Decreased air movement despite increased effort
  • Gurgling respirations (blood secretions in upper airway)
57
Q

What are the 2 most common causes of lower airway obstruction in pediatrics?

A

Asthma and Bronchiolitis

58
Q

What are signs of Lower Airway Obstruction?

A
  • Increased RR and effort (retractions, nasal flaring)
  • Decreased air movement
  • Prolonged expiration
  • Wheezing
59
Q

What are examples of lung tissue disease?

A
  • Pneumonia
  • Pulmonary edema
  • Trauma
  • Allergic reactions
  • Toxins
60
Q

What are signs of Lung Tissue Disease? (6)

A
  • Increased RR and respiratory effort (especially on inspiration)
  • Decreased air movement
  • Grunting
  • Crackles
  • Head bobbing
  • Hypoxemia
61
Q

What are common causes of abnormal breathing patterns?

A
  • Increased ICP
  • Seizures
  • Posisins or drug overdose
  • Neuromuscular disease
  • DKA (in adults)
62
Q

What are potential causes of increased ICP?

A
  • Trauma
  • Brain tumor
  • Infection
  • Hydrocephalus
63
Q

What are signs of Abnormal breathing pattern?

A
  • Normal or decreased air movement
  • Shallow breathing w/inadequate effort
  • Variable or irregular RR and pattern
  • Central apnea
64
Q

When does most Asthma resolve for children?

A

60% of preschool “wheezers” become asymptomatic by age 6

  • Airway remodeling (bad) has been identified in toddlers
65
Q

Which group of kids are most affected by Asthma?

A

Preschoolers have the highest admission rate of ER visits

66
Q

What helps the most in terms of managements for asthmatic children?

A

ICS and early diagnosis

  • Preschoolers respond really well to ICS
  • Exacerbations are best relieved w/SABA’s
67
Q

Which age category is the most challenging to diagnose Asthma in?

A

Children prior to age 6

68
Q

What are suggestive symptoms of Asthma?

  • What evaluations direct the Dx to Asthma? (3)
  • Need to ask about frequency and recurrent
A

Suggestive Symptoms: Wheezes, dyspnea, cough.

The following guide Dx:

  • Atopy (genetic history)
  • PFTs
  • Suggestions by HCP (PRAM score)
69
Q

What is the expected course of events that could occur if RSV causes an infection? (5)

A
  1. Airway inflammation
  2. Mucus production
  3. Airway obstruction
  4. Airway trapping and hyperinflammation
  5. Impaired gas exchange
70
Q

Why are bronchodilators no longer used to treat bronchiolitis?

A

They would not have any affect bc the pathology caused by viral infections. Corticosteroid also have little affect.

  • The best treatment is supportive care and preventive strategies
  • Good hygiene and distance from agents of exposure like smoke are the best preventive strategies
71
Q

What signs are evaluated in PRAM? (5)

A
  1. Suprasternal indrawing
  2. Scalene retractions
  3. Wheezing
  4. Air entry
  5. Oxygen saturation on room air

PA 3 (RESP 315 ) (13 decks)

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