Pediatric Emergencies

Question 1

SIDS

Answer 1

• 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

Question 2

Sids Infant risk factors

Answer 2

• prematurity, low birth weight, twin or triplet birth

- sleeping on the abdomen

Question 3

SIDS Maternal/ familial risk factors

Answer 3

• maternal age <20 yrs
• hx smoking
• anemia
• multiple pregnancies
• sibling occurrence
• low socioeconomic status
• poor prenatal care, low weight gain

Question 4

SIDS parent education

Answer 4

• avoid smoking
• supine sleeping
• bedding: avoid soft, moldable
• discourage bed sharing
• avoid infant overheating in sleep
• pacifier use (new statistic)

Question 5

SIDS RN Management

Answer 5

• support and empathy

- active listening

Question 6

Near Drowning

Answer 6

• 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

Question 7

Near-Drowning RN Management

Answer 7

• Assess cardiopulmonary status

- provide family support

Question 8

Poisonings

Answer 8

• peak age 2 yrs (most <6 yrs)
• developmental risk factors toddler
  
  • curiosity
  • non discriminate taste
  • imitate adults
  • unaware of danger

Question 9

Poisonings Assessment

Answer 9

• 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

Question 10

Poisonings Assessment

questions to ask parents

Answer 10

• Amount of substance ingested
• time of ingestion
• change in child’s condition
• treatment administered at home

Question 11

Poisoning Management

Answer 11

• Gastric lavage
• activated charcoal
• nalaxone HCL (narcan)
• syrup of ipecac not recommended

Question 12

Poisoning Home Safety Education

Answer 12

• 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

Question 13

Lead Poisoning (Plubism) sources

Answer 13

• paint
• pottery
• jewelry/ toys

Question 14

Lead Poisoning s/s

Answer 14

• irritable
• sleepiness, < activity
• N/V/D/ constipation
• > ICP & CNS s/s

Question 15

Lead Poisoning Dx testing

Answer 15

• Blood lead level > 10 mcg/dL
• CBC- anemia
• X-rays: lead lines

Question 16

Lead Poisoning Tx

Answer 16

• chelating agents
• hydrate
• ID lead sources
• educate parents

Question 17

Tylenol Poisoning s/s

Answer 17

Initial:
	-N/V
	-sweating, pallor, weakness
Latent Period: (after 24 hrs )
	-RUQ pain
	-Jaundice
	-< LOC

Question 18

Tylenol Poisoning Dx

Answer 18

-Serum Acetaminophem levels
-liver function
> liver enzymes
> bili
-kidney function
> BUN
> creatinine
-Prolonged PTT

Question 19

Tylenol Poisoning Tx

Answer 19

• Gastric lavage & activated charcoal
• Antidote: N-Acetylcysteine (Mucomyst)
• Hydration
• Diet
  
  • Na restricted
  • high calories
  • high protien

Question 20

ASA Poisoning sxs

Answer 20

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

Question 21

ASA Poisoning Tx

Answer 21

• Gastric levage, activated charcoal
• IV: Na bicarb, elecctrolytes
• Vit K
• Glucose for < BS
• Temp regulation
• Hemodialysis (if not responding to tx)

Question 22

Child Abuse
NAT
BCS
MSP

Answer 22

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

Question 23

Child abuse Parental Characteristics

Answer 23

• 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

Question 24

Child Abuse Child characteristics

Answer 24

• temperament
• position in the family
• additional needs
• activity level
• illegitimacy
• premature

Question 25

Child Abuse Risk Factors

Answer 25

• child under 3 yrs
• physically or mentally disabled
• unwanted pregnancy
• child is perceived by perpetrator as being different
• premature
• low birth weight

Question 26

Child Abuse Assessment

Answer 26

• 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

Question 27

Child Abuse RN Assessment

Answer 27

• 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

Question 28

NAT RN Interventions

Answer 28

• 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

Question 29

Child abuse RN Interventions

Answer 29

• Nonjudgmental treatment towards parents
• role modeling
• teach growth & dev
• emotional support to child
• initiate protective placement
• documentation