Module 4 Flashcards
Pediatric assessment triagle
Appearance
Breathing
Circulation
Appearance Assessment
TICLS- assessing for adequacy of oxygention
Tone Interactions Controllability Look/gaze Speech/cry
Appearance 6 red flags
Lethargy Blank stare Limp/rag doll No interaction Inconsolability Weak muffled cry
Breathing assessment
Airway, oxygenation and ventilation
WOB
Rate
Breathing Red flags (5)
Abnormal audible breath sounds Increased resp rate Nasal flaring Increased resp effort Tripod or sniffing
Circulation
Inadequate perfusion of vital organs leads to compensatory vasoconstriction to nonessential areas especially skin
Circulation red flags
Pallor
Mottling
Cyanosis
Ashen/grey
PEDs secondary assessment
CIAMPEDS
CIAMPEDS
Chief compliant Immunizations Allergies Medications Pmhx/Parental concern Events surrounding illness Diapers/Diet Symptoms
Airway assessment anatomical differences PEDS
Look listen feel Nose breathers small airway diameter short trachea Big tongue large head and weak neck trachea is soft and flexible Larynx is funnel-shaped
C-spine-flexi neck
Breathing assessment anatomical differences PEDS
Diaphromatic resps- observe belly Fewer and smaller alveoli Less elastic recoil smaller tidal volumes Pliable thoracic cage Weaker intercostal (cant increase TV) use diaphragm to breath
Circulation assessment anatomical differences PEDS
limited SV
heart has small mass so weaker contractions
increased circulation volume/kg
larger % of body is water
Disability assessment anatomical differences PEDS
AVPU susceptible to hypoglycemia Assess fontanelles limited glucagon storage increased metabolic demands more permeable blood-brain barrier
Expose assessment anatomical differences PEDS
large body surface area
immature thermoregulation mechanisms
soft bones
risk for maltreatment
F assessment anatomical differences PEDS
Vitals
Temp- should do a rectal
Weight
Family
Moderate Croup treatment
0.6mg/kg dexamethasone
Position of comfort
Severe croup treatment
0.6mg/kg dexamethasone
Position of comfort
Epi nebs
oxygen
Mild croup
no stridor or chest wall indrawing
Moderate croup
stridor or chest wall indrawing. pt at rest
Severe croup
stridor, indrawing and agitation or lethargy
Croup patho
virus causes generalized airway inflammation and edema of the upper airway mucosa
The subglottic region becomes narrowed causing upper airway obstruction
Croup symptoms (6)
rapid onset worse at night barky cough insp stridor hoarsness resp distress
Bronchiolitis age group
<2 years old
Bronchiolitis signs and symptoms
cough runny nose wheezes crackles increased WOB
Which patients with bronchiolitis is at a high risk for apnea
Kids <48 weeks PCA
6 weeks since birth
Bronchiolitis cause
most often RSV
Bronchiolitis Patho
Lower resp tract infection causes inflammation of small bronchioles
causes airway obstruction in bronchioles due to secretions, thick mucous and edema
hypersecretion acute inflammation of airways edema Necrosis of epithelial cells lining small airways Bronchospasm
Bronchiolitis treatment
supportive care
oxygenate
hydrate
suction
Bronchiolitis red flags
age WOB Rate comorbidities volume status
Asthma
Chronic inflammatory disorder
upper airway hyperresponsiveness
Salbutamol q20-30 mins
Why are peds at risk for volume depletion
increased metabolic needs large body surface area to mass a higher percentage of the body is water (70-80%) loose more fluids when breathing more fluid loss from skin unable to concentrate urine
Bolus
10-20ml/kg
Maintenance fluids
4-2-1 rule
4ml/kg for first 10 kg
2ml/kg for next 10 kg
1ml/kg for remainder
neonate sBP
80 mmHg
1 month to 10 y old sBP
70 +(2xage) mmHg
how do peds patient raise their Cardiac output
increase HR
How do children respiratory compensate
increase resp rate
Why is projectile vomiting a red flag in neonates
pyloric stenosis
Why is grass green emesis a red flag in neonates
intestinal volvulus
Neonate red flags (45 weeks PMA)
weight loss ( can lose 10% but should regain by first week) lethargy Jaundice floppy inconsolable
Fever is a red flag in children of what age
<3months
Why are neonates at an increased risk for sepsis
increased permeable blood brain barrier,
exposure to GBS (Group B Strep) in utero/during delivery
limited ability to localize antigens (immature immune systems).