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NSER 7210 - Theory > Module 4 - Pediatrics > Flashcards

Module 4 - Pediatrics Flashcards

1
Q

What is the first thing to assess in children?

A

PAT
(Pediatric Assessment Triangle)

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2
Q

What are the components of PAT?

A
  1. Appearance
  2. Breathing
  3. Circulation
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3
Q

What is assessed during “Appearance” of the PAT?

A
  • Tone
  • Interactiveness
  • Consolability
  • Look/gaze
  • Speech/cry
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4
Q

What is assessed during “Breathing” of the PAT?

A
  • abnormal airway sounds
  • abnormal positioning
  • retractions
  • flaring
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5
Q

What is assess during “Circulation” of the PAT?

A
  • pallor
  • mottling
  • cyanosis
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6
Q

What might you have to do to help position a child for an airway intervention?

A
  • Place a pad/towel under their shoulders
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7
Q

True or False:
Infants < 6 months are obligate nose breathers

A

True

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8
Q

Why might nasal airways be difficult to place in children?

A

Large adenonoids and tonsils that can be traumatized during insertion
- could lead to bleeding and add to airway problem

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9
Q

How is an oral airway placed on a child? Why?

A

Straight in (no rotation like adults)
- prevent damaged to soft palate, tonsils, or teeth

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10
Q

Children have a (higher or lower) metabolic rate compared with adults

A

Higher
- twice the oxygen consumption
- rapidly deplete O2 stores

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11
Q

Why are retractions seen on children in respiratory distress?

A

Thoracic cage is more pliable and intercostal muscles are underdeveloped
- they collapse rather than expand during respiratory distress

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12
Q

What is the primary muscle of respirations in a child?

A

Diaphragm
- causes children to “belly-breathe”

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13
Q

What is a late sign of decreased cardiac output in children?

A

Hypotension

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14
Q

Why are children at greater risk for dehydration?

A

Greater percent of total body weight in water

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15
Q

How do children compensate for decrease in cardiac output?

A

Increase in HR
- limited ability to increase SV

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16
Q

What is the most accurate route of temperature in children?

A

Rectal

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17
Q

What is the 6th vital sign in children?

A

Weight

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18
Q

If a weight cannot be obtained for a child, what can be used instead?

A

Broselow tape

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19
Q

What are the components of the secondary assessment for children?

A

CIAMPEDS
C = chief complaint
I = immunizations / isolation
A = allergies
M = medications
P = past medical history / parent perception
E = events surrounding illness
D = diet / diapers
S = symptoms associated

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20
Q

What can a depressed fontanelle indicate?

A

Sign of moderate to severe dehydration

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21
Q

What can a tense or bulging fontanelle indicate?

A
  • Increased ICP
  • Hematoma
  • Bacterial Meningitis
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22
Q

Under the BC Infants Act, when can a minor consent for their own medical care?

A
  1. Must demonstrate they have the capacity to make a sound decision
  2. HCP must demonstrate they made reasonable efforts to ensure the treatment is in the minor’s best interest
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23
Q

What is a common upper airway problem in children?

A

Croup

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24
Q

What are the signs and symptoms of croup?

A
  • barky cough
  • inspiratory stridor
  • hoarseness
  • respiratory distress
  • usually worsens at night
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25
Q

What is the treatment for croup?

A
  1. Dexamethasone (0.15 - to 0.6 mg/kg PO = max 12mg)
  2. Nebulised Epinephrine for moderate to severe croup (1mg/mL injectable formulation)
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26
Q

What are some other differentials for Croup?

A
  • Bacterial tracheitis
  • Retropharyngeal, paraphyaryngeal, peritonsillar abscesses
  • Epiglottitis
  • Aspiration of FB
  • Acute allergic reaction
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27
Q

What are two common lower airway problems in children?

A
  1. Bronchiolitis
  2. Asthma
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28
Q

What is Bronchiolitis?

A

Inflammation of the smaller bronchioles caused by a virus (RSV, adenovirus, parainfluenza

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29
Q

What are signs and symptoms of bronchiolitis?

A
  • runny nose
  • cough
  • wheezing
  • crackles
  • increase respiratory effort
  • fever
30
Q

What is the treatment for Bronchiolitis?

A

SUPPORTIVE CARE
- no meds are given!

31
Q

If a child presents with wheezes but no runny nose, what should the child be worked up for?

A
  • Cardiac anomalies
  • Congenital airway abnormalities
  • FB aspiration
32
Q

What is Asthma?

A

Common, chronic inflammatory disorder of the airways associated with airway hyper-responsiveness
- lower airway problem!

33
Q
A
34
Q

What are signs and symptoms of Asthma?

A
  • nasal flaring
  • instercostal, subcostal, suprasteral indrawing
  • tachypnea
  • decreased air entry
  • scalene retractions
  • decrease O2 sats
  • diffuse abdominal pain
  • cough
  • irritability
34
Q

What are some triggers of asthma?

A
  • Viral respiratory tract infecton
  • Exposure to allergens
  • Lack of good control of asthma at baseline
34
Q

What is the treatment for MILD asthma?

A

Salbutamol with spacer

35
Q

What is the treatment for MODERATE asthma?

A
  • Salbutamol Q20 mins x3 doses
  • Corticosteriod (dex, prednisone, prednisolone)
  • Ipratropium
36
Q

What is the treatment for SEVERE asthma?

A
  • Salbutamol nebulized over 60 - 180 minutes
  • Magnesium sulfate
37
Q

What happens if an infant’s HR is < 60 bpm?

A

Call a CODE!

38
Q

Why are pediatric patients at increased risk for dehydration and hypovolemia?

A
  • High metabolic needs
  • larger body surface area
  • higher proportion of water
  • increased insensible / evaporative losses
  • cannot communicate thirst
39
Q

What is the most common cause of dehydration in children?

A

Gastroenteritis

40
Q

What are signs and symptoms of gastroenteritis?

A
  • acute diarrhea
  • nausea
  • vomiting
  • fever
  • abdominal pain
41
Q

How do you calculate hourly maintenance fluids for a child < 10 kg?

A

4 mL/kg/hour

42
Q

How do you calculate hourly maintenance fluids for a child 10-20 kg?

A

40 mL + 2 mL/kg for every kg > 10 kg

43
Q

How do you calculate hourly maintenance fluids for a child > 20 kg?

A

60 mL + 1 mL/kg for every kg > 20 kg

44
Q

What is the hourly maintenence fluid for a child weighing 8 kg?

A

32 mL/hour

45
Q

What is the hourly maintenance fluid for a child weighing 17 kg?

A

54 mL/hour

46
Q

What is the hourly maintenance fluid for a child weighing 24 kg?

A

64 mL/hour

47
Q

What is a sign of shock in children?

A

HR > 160

48
Q

True or False:
Children often present with cold shock vs warm shock

A

True

49
Q

What are red flags for fever in children?

A
  • Fever in a child < 1 month
  • Lethargy, listlessness, toxic appearance
  • Respiratory distress
  • Inconsolability
50
Q

When do febrile seizures commonly appear?

A

Ages 6 months to 5 years

51
Q

What needs to happen if a child has a febrile seizure?

A

Tylenol - if < 15 minutes, no neurologic problems, occurs once in 24 hours
- NO EEG
- NO labs
- NO antiepileptics

52
Q

What can be a sign of abuse in a child < 6 months?

A

Bruises!
No cruise … no bruise

53
Q

If you suspect that a child is maltreated, what do you need to do?

A

Call MCFD
- do NOT need to engage RCMP

54
Q

What age range in children are possessive, have separation anxiety, and are concrete thinkers?

A

Toddlers
(13 months to 2 years)

55
Q

What age range in children are magical thinkers, have big imaginations, are curious, and have little grasp of cause and effect?

A

Preschool
(ages 3-5 years)

56
Q

What age range in children are easily embarrassed, very physically active, understand the concepts of pain, and need to be asked questions directly (not to the parents)?

A

School-aged children
(5-12 years old)

57
Q

What age range in children are taking risks, value independence, value honesty, need to consider mental health and sexual health presentations?

A

Adolescents
(12 - 17 less a day)

58
Q

What is one of the first signs of respiratory distress in children?

A

Tachypnea
- limited ability to increase tidal volume
- increase RR instead

59
Q

What increases oxygen demand in children?

A
  • fever
  • dehydration
  • illness
  • infection
  • physical activity
  • trauma
60
Q

What happens to preload, cardiac perfusion, and oxygen demand during sinus tachycardia?

A
  1. Decreased preload, decreased ventricular filling time = decreased cardiac output
  2. Decreased coronary artery filling time, decreased coronary artery perfusion = decreased cardiac output
  3. Increased myocardial oxygen demand
61
Q

What is the Rule of 50 for dextrose in children?

A

D10 x 5 mL = 50
D25 x 2 mL = 50

62
Q

What is a very important consideration regarding weight based medications in pediatrics?

A

Do NOT pass adult maximums!

63
Q

What is the standard amount of fluid bolus in pediatrics?

A

20 mL/kg

64
Q

What is the formula for daily fluid replacement in children?

A
  • < 10 kg = 100mL/kg/day
  • 10-20 kg = 1000 + 50 mL/kg/day for every kg > 10
  • > 20 kg = 1500 + 20mL/kg/day for every kg > 20
65
Q

What is the daily total of fluid for a child weighing 9 kg?

A

900 mL

66
Q

What is the daily total of fluid for a child weighing 13 kg?

A

1150 mL
(1000 + 150)

67
Q

What is the daily total of fluid for a child weighing 28 kg?

A

1660
(1500 + 160)

68
Q

What is the fluid bolus amount for a child weighing 14 kg?

A

280 mL

69
Q
A

NSER 7210 - Theory (6 decks)

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