Pediatric Emergencies Flashcards
SIDS
- leading cause of deaths in infants under 1 year
- peak incidence 2-4 mos
- varied autopsy findings include: evidence of a struggle or change in position and the presence of blood frothy secretions from the mouth and nares
- occurs more in fall & winter
Sids Infant risk factors
- prematurity, low birth weight, twin or triplet birth
- sleeping on the abdomen
SIDS Maternal/ familial risk factors
- maternal age <20 yrs
- hx smoking
- anemia
- multiple pregnancies
- sibling occurrence
- low socioeconomic status
- poor prenatal care, low weight gain
SIDS parent education
- avoid smoking
- supine sleeping
- bedding: avoid soft, moldable
- discourage bed sharing
- avoid infant overheating in sleep
- pacifier use (new statistic)
SIDS RN Management
- support and empathy
- active listening
Near Drowning
- more prevalent < 4 yrs
- defined as resuscitation & survival for 24 hrs after injury
- most occur in private pools
- a child can drown in 2 inches of water
- toddlers are top heavy: large buckets are dangerous
Near-Drowning RN Management
- Assess cardiopulmonary status
- provide family support
Poisonings
- peak age 2 yrs (most <6 yrs)
- developmental risk factors toddler
- curiosity
- non discriminate taste
- imitate adults
- unaware of danger
Poisonings Assessment
- accurate history, ID poison
- treat child first not the poison
- VS/ ABCs, eval frequently
- be prepared for LOC to change
- instruct parent to bring emesis, stool, etc. to ED
Poisonings Assessment
questions to ask parents
- Amount of substance ingested
- time of ingestion
- change in child’s condition
- treatment administered at home
Poisoning Management
- Gastric lavage
- activated charcoal
- nalaxone HCL (narcan)
- syrup of ipecac not recommended
Poisoning Home Safety Education
- don’t take RX in front of kids, don’t leave it available, don’t refer to it as candy
- use safety containers
- leave RX and cleaning solutions in original bottles
- discard unused medicine
- supervise children constantly
- examine environment form child’s viewpoint
Lead Poisoning (Plubism) sources
- paint
- pottery
- jewelry/ toys
Lead Poisoning s/s
- irritable
- sleepiness, < activity
- N/V/D/ constipation
- > ICP & CNS s/s
Lead Poisoning Dx testing
- Blood lead level > 10 mcg/dL
- CBC- anemia
- X-rays: lead lines
Lead Poisoning Tx
- chelating agents
- hydrate
- ID lead sources
- educate parents
Tylenol Poisoning s/s
Initial: -N/V -sweating, pallor, weakness Latent Period: (after 24 hrs ) -RUQ pain -Jaundice -< LOC
Tylenol Poisoning Dx
-Serum Acetaminophem levels
-liver function
> liver enzymes
> bili
-kidney function
> BUN
> creatinine
-Prolonged PTT
Tylenol Poisoning Tx
- Gastric lavage & activated charcoal
- Antidote: N-Acetylcysteine (Mucomyst)
- Hydration
- Diet
- Na restricted
- high calories
- high protien
ASA Poisoning sxs
GI:N/V, thirst from dehydration
CNS: hyperventilation, LOC changes, tinnitus, seizure, resp. failure, circ collapse
Renal: Oliguria
Hematopoietic: bleeding tendencies
Metabolic: diaphoresis, dehydration, fever, <Na, K, B.S metabolic acidosis
ASA Poisoning Tx
- Gastric levage, activated charcoal
- IV: Na bicarb, elecctrolytes
- Vit K
- Glucose for < BS
- Temp regulation
- Hemodialysis (if not responding to tx)
Child Abuse
NAT
BCS
MSP
NAT: non accidental trauma
BCS: battered child syndrome
MSP: Muchausen Syndrome by Proxy
-illness that 1 person fabricates or induces in another
-perpetrator is seeking attention from medical staff
Child abuse Parental Characteristics
- negative relationship with parents
- social isolation/ no support system
- low self esteem
- increased stress in life
- uniformed of normal growth and development
- lack of knowledge of parenting skills
Child Abuse Child characteristics
- temperament
- position in the family
- additional needs
- activity level
- illegitimacy
- premature
Child Abuse Risk Factors
- child under 3 yrs
- physically or mentally disabled
- unwanted pregnancy
- child is perceived by perpetrator as being different
- premature
- low birth weight
Child Abuse Assessment
- Injuries not congruent w/ development
- Injuries don’t correlate w/ stated cause
- delayed seeking medical care
- conflicting stories about injury
- complaint other than obvious injury
- inappropriate caregiver or child response
Child Abuse RN Assessment
- Bruises or fractures in unusual places various stages of healing
- spiral fracture of arm
- Battle sign: ecchymosis behind ear- skull fx
- bruises caused by objects
- whiplash, bald patches
- STD, genital lacerations
- truancy, running away, self-destructiveness
- Growth and development alterations
NAT RN Interventions
- RNs have a legal responsibility and are mandated by law to report suspected or actual cases of abuse
- clearly and objectively document information obtained in the interview and during the physical assessment
Child abuse RN Interventions
- Nonjudgmental treatment towards parents
- role modeling
- teach growth & dev
- emotional support to child
- initiate protective placement
- documentation
