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Guidelines > Paediatric Assessment > Flashcards

Paediatric Assessment Flashcards

1
Q

What is the definition of a paediatric patient for the purpose of the CPG’s?

A

Any child up to and including 11 years old is a paediatric.

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2
Q

“Children presenting with abnormal vital signs…”

A

must be transported to hospital.

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3
Q

“In older children, the calculated dose of some drugs may…”

A

correctly exceed that of an adult dose, to adjust for anatomical and physiological changes in a developing child.

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4
Q

Which patients will the RCH accept?

A

Any pt up to and including 15, and is the destination of choice for trauma/burns in this age group.
They will also accept patients up to and including 18 if the pt has relevant past history at the RCH.

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5
Q

If management of a paediatric is not successful or further guidance is required, what specific resources are available for clinical advice?

A

The RCH or PIPER via the clinician.

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6
Q

What are the 3 elements of the paediatric assessment triangle?

A
  1. Appearance
  2. Circulation to skin
  3. Work of breathing
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7
Q

What are the elements of Appearance in the paediatric assessment triangle, and what findings would indicate an unwell child? (5)

A

Tone - still, floppy, quiet
Interactiveness - not interested in surrounding
Consolability - inconsolable
Look/gaze - staring, not engaging in eye contact
Speech/cry - moaning, grunting or quiet

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8
Q

What are the elements of Work of Breathing in the paediatric assessment triangle? (4)

A

Abnormal breath sounds
Abnormal positioning
Retractions
Nasal flaring

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9
Q

What are the elements of Circulation to Skin in the paediatric assessment triangle? (3)

A

Pallor
Mottling
Cyanosis

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10
Q

What is the purpose of the paediatric assessment triangle and what is the action if the patient exhibits abnormal findings?

A

A rapid, first impression assessment to estimate criticality.

If abnormal findings, move to primary survey.

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11
Q

What is the definition and weight of a newborn?

A

Birth to 24hrs - weighs 3.5kg

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12
Q

What is the definition and weight of a small infant?

A

Under 3 months - weighs up to 6kg

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13
Q

What is the definition and weight of a large infant?

A

3 - 12 months

Weighs around 6kg (3m), 8kg (6m) and 10 (12m)kg

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14
Q

What is the definition and weight of a small child?

A

1 - 4 years

Weight = age x 2 + 8

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15
Q

What is the definition of a medium child?

A

5 - 11 years
Weight = age x 2 + 8kg (1 - 9 yrs)
Weight = age x 3.3kg (10 - 11yrs)

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16
Q

What is the normal blood volume of a newborn, and an infant/child?

A

Newborn - 80mL/kg

Infant/child - 70mL/kg

17
Q

What is the normal heart rate, respiratory rate and blood pressure of a newborn?

A

110 - 170bpm
BP >60
RR 25 - 60

18
Q

What is the normal heart rate, respiratory rate and blood pressure of a small infant?

A

110 - 170bpm
BP >60
RR 25 - 60

19
Q

What is the normal heart rate, respiratory rate and blood pressure of a large infant?

A

105 - 165bpm
BP >65
RR 25 - 55

20
Q

What is the normal heart rate, respiratory rate and blood pressure of a small child?

A

85 - 150bpm
>70mmHg
RR 20 - 40

21
Q

What is the normal heart rate, respiratory rate and blood pressure of a medium child?

A

70 - 135 bpm
>80mmHg
RR 16 - 34

22
Q

In the setting of an unwell child, what finding correlates with subsequent ICU admission?

A

Cold hands/feet, mottled skin are an early sign.

23
Q

What note is made about clinical trends for children?

A

They are as important as threshold limits, and children trending negatively should trigger early attention.

24
Q

At what age is respiratory distress associated with a wheeze unlikely to be asthma, why and how does this influence treatment?

A

<2.
Due to underdeveloped smooth muscle in the airways.
Salbutamol unlikely to be effective, only apply O2 if the pt is hypoxaemic.

25
Q

What are some signs of respiratory distress in children?

A 
Tachypnoea
Chest wall retraction
Use of accessory muscles
Tracheal tugging
Abdominal protrusion
26
Q

Why might auscultation be difficult in paediatric patients?

A

Tidal volumes may not be sufficient for auscultation. Consider other aspects of pt presentation.

27
Q

Can a child have a conscious state assessment completed while asleep? What is the AVPU finding if a child is woken but remains drowsy and appears inattentive?

A

No, they must be woken.

V for verbal only.

28
Q

At what age is a modified GCS acceptable?

What are the modifications?

A 
Up to and including 4 years of age use a modified GCS.
Modified Verbal:
Appropriate words/social smile = 5
Cries but consolable = 4
Persistently irritable = 3
Moans to pain = 2
None = 1

Modified Motor:
Spontaneous = 6

All other aspects same.

29
Q

How might pain be communicated by children?

How should pain be documented?

A

Words, sounds, expressions or behaviour such as crying grimacing or guarding - differs with developmental age of child.
Irrespective of age, pain should not be marked unable to rate without some comment to indicate an assessment has been completed.

30
Q

What is a useful adjunct to analgesia for children?

A

Distraction therapy.

31
Q

If pain relief needs to be delivered via method that may be painful for the child, what preparation can be considered prior?

A

Ice pack to the site for 30-60s.

32
Q

What is the RCH preferred pain relief option for paediatric patients?

A

IN Fentanyl is established as a safe and effective analgesic.

33
Q

What are the findings that score 0 points on the FLACC scale? What pain level does this indicate?

A 
Face - no particular expression or smile
Legs - normal position or relaxed
Activity - lying quietly, normal position, moves easily
Cry - no cry
Consolability - content, relaxed

No pain.

34
Q

What are the findings that score 2 points on the FLACC scale? What pain level does this indicate?

A

Face - constant frown, clenched jaw, quivering chin
Legs - kicking or legs drawn up
Activity - arched, rigid or jerking
Cry - crying steadily, screams or sobs, frequent complaints
Consolability - difficult to console or comfort

Moderate to severe pain.

35
Q

At what age is the verbal numerical pain scale appropriate?

A

Children over the age of 6, who have concepts of rank and order.

36
Q

When using the “faces” pain scale, what terms should be used/not used?

A

Use pain/hurt as appropriate to the child.

Do not use sad/happy.

37
Q

Should the “faces” pain scale be used to compare a child’s face to an image?

A

No. It is designed for a child to select which face they feel, not to correlate an image with a patient presentation.

Guidelines (78 decks)

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