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Pediatrics Flashcards

1
Q

Selection of ambulatory care for pediatrics is dependent on?

A
  • complexity of procedure
  • Anesthesia consideration for safety
  • Pain management
  • Known incidence of complication associated with procedure
  • postoperative monitoring
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2
Q

Non candidates for pediatric ambulatory surgery?

A
  • premature infants with respiratory difficulties
  • apneic episodes
  • feeding difficulties
  • poorly controlled seizures
  • uncontrolled diabetes
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3
Q

Candidates for pedi ambulatory surgery must meet what ASA classification

A

ASA classification scale of Class 1 and II older than six months

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4
Q

Eriksons developmental stage: Neonates

A

First 28 days extrauterine life

premature remains in this category until three months

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5
Q

Eriksons developmental stage: Infant

A
  • 28 to 18 months

- trust vs mistrust

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6
Q

Eriksons developmental stage: Toddler

A

18 to 30 months

autonomy vs shame doubt

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7
Q

Eriksons developmental stage: preschool

A

2.5 to 5 years

imitative vs guilt

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8
Q

Eriksons developmental stage: school age

A

6 to 12

industry vs inferiority

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9
Q

Eriksons developmental stage: Adolescents

A

12 to 16

Identity vs Role confusion

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10
Q

What are the fears and stressors of Infants?

A
  • Self separate from environment
  • Attached to caregivers
  • Make sounds, short words
  • comfort from oral sources ( pacifiers)
  • Comfort being rock and held
  • hospital seen as abandonment
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11
Q

What are the fears and stressors of Toddlers?

A
  • Separation anxiety
  • Being left alone
  • Strange bed or room
  • Loss of comfort of home family and possessions
  • in contact with unfamiliar people
  • painful procedure
  • medical equipment that looks and sound scary
  • feeling helpless
  • communicate in sentences
  • needs familiar objects
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12
Q

What are the fears and stressors of Preschool?

A

fears

  • being away from family and home being left alone
  • having part of body damage
  • needles and shot
  • waking up during surgery
  • pain
  • the dark
  • real and imagined situation
  • thinks their in the hospital because they are in trouble
  • Uses compound sentences
  • provides opportunity for independence
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13
Q

What are the fears and stressors of School Age?

A
  • Being away from school and friends
  • identifying with social group
  • likes to imitate heroes
  • Thinks being in hospital is because they were bad or being punished
  • Having part of body destroyed or injured
  • loss of control
  • pain
  • needles and shots
  • wants honest explanation
  • understand death is permanent
  • after of dying during surgery
  • communicate well verbally and basic writing skill
  • give positive reinforcement for cooperation
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14
Q

What are the fears and stressors of Adolescents?

A
  • Fear loss of privacy
  • Body image important
  • Understand rules, values, ideas
  • Aware of opposite sex
  • Globally communicates verbally in writing
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15
Q

What are the respiratory differences in pediatric pt anatomically?

A
  • Smaller than adults
  • Tongue of infant relative to oropharynx is larger
  • epiglottis is narrower
  • In children less than 10 the narrowest portion of the airway is below the vocal cords at the level of the cricoid cartilage
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16
Q

The larynx of a child is what shape?

A

Funnel shape

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17
Q

What are the consequences of respiratory difference?

A
  • Small amounts of edema or obstruction can significantly reduce pediatric airway diameter and INCREASE resistance to flow
  • Posterior displacement of the tongue may cause severe airway obstruction
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18
Q

*What is the difference between and adult ET tube versus a Pediatric?

A
  • ET in children are UNCUFFED unlike adults and can easily be dislodged resulting in accidental extubation
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19
Q

How is a pediatric pt respiratory rate different?

A
  • Respiratory rate is directly correlated with cardiac rhythm in the child
  • The faster a child breathe the faster the heart rate
  • The slower they breathe the slower the heart rate
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20
Q

What is bradycardia related to in pedi pts?

A

hypoxia

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21
Q

What is the difference between cardiac arrest in children versus adults?

A
  • Cardiac in children is rare and is linked to AIRWAY OBSTRUCTION
  • In adults it is due to ELECTRICAL CONDUCTION
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22
Q

What is the cardiovascular difference ?

A
  • Peds do not have physiologic reservoirs ( blood volume) to rely upon in situations in which shock can occur
  • If shock or airway problems are not rectified rapidly the pediatric pt status will deteriorate two to three times faster
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23
Q

The the normal blood volume in children is?

A

85ml/kg

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24
Q

How are the levels of hemoglobin in children?

A
  • hemoglobin and hematocrit are high in infants up to three months of age after that they approximate adult normal range
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25
Q

Why do infants need glucose?

A
  • Because their glucose stores are rapidly depleted
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26
Q

Why are body temperature regulations different in pedi pt?

A
  • Peds are very sensitive to heat loss due to large surface areas small amounts of subcutaneous fat and poor vasomotor control
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27
Q

How can RNs help maintain normal body temps?

A
  • Increase room temperature
  • Use warming lights
  • Warming device placed on pt
    Follow manufacture’s instruction for use of any and all equipment
28
Q

Pain assessment for peds

A
  • Behavioral observation scale
  • FLACC (face, legs, activity, cry and consolability)
  • To assess a preverbal or non communicative child
29
Q

What pain assessment scale should be used for pt age 3 and up?

A

Wong- Baker Face Scale

30
Q

What pain assessment scale should be used for pt age 7 and up?

A
  • Use 0 to 10 rating scale
31
Q

Ways to help a child in pain?

A
  • Hold or rock pt if appropriate because it will help relax the child
  • Provide glucose in a baby’b bottle reduces pain and relieves anxiety
32
Q

Pediatric medication safety

A
  • weight should be in kg and pounds to decrease medication errors from (estimating)
33
Q

Why are infants more prone to dehydration?

A
  • Infants are prone to dehydration due to immature renal function at birth and limited ability of the kidneys to concentrate urine
  • Do not overload pediatric with fluids*
34
Q

Preoperative Fasting Guidelines for Clear liquids

A

2 hours

35
Q

Preoperative Fasting Guidelines for Breast milk

A

4 hours

36
Q

Preoperative Fasting Guidelines for Infant Formula?

A

6 Hours

37
Q

Preoperative Fasting Guidelines for Non human milk?

A

6 hours

38
Q

Preoperative Fasting Guidelines for light meal?

A

6 hours

39
Q

Informed consent for peds?

A
  • Parents or legal guardian sign for children unless child is emancipated minor as described by law
40
Q

*What are 3 elements of the universal protocol?

A
  • preoperative verification
  • site marking
  • time out
41
Q

Who are an exception to site marking element because skin marks may permanently stain the skin?

A

Neonates

42
Q

Preoperative education for infants include?

A
  • Focusing on parent and caregiver
  • keep babies on their routine
  • Make plans for at least one parent to be with baby
43
Q

Preoperative education for toddler include?

A
  • preparation should take place a day or two
  • interactive play with doll and stuffed animals can help toddler be more secure in hospital environment
  • Keep explanations simple and be careful with your words
  • its not unusual for toddlers to regress
44
Q

Preoperative education for Preschool include?

A
  • Major fear of unknown
  • Children should be told of surgery days prior
  • provide a tour
  • dramatic play is a big part of preschoolers
  • use pictures , stuffed animals or toys to help children understand
  • Tell the truth in simple term and answer all their questions
45
Q

Preoperative education for School Age include?

A
  • Should take place a week or two before surgery preparation too far in advance can produce anxiety
  • Emphasize surgery is not a punishment
  • Have child explain back what is going to happen
  • Give child choices to increase sense of control
  • Allow visits from friends
  • Treat as big kid but may have baby insecurities
  • May feel pain intensely
  • Use common interest to build trust
  • Question child directly and simply
  • Offer limited choices
  • Don’t tell them not to cry
46
Q

Preoperative education for Adolescent include?

A
  • Privacy is much a need for teenager
  • Allow teens to be part of decision making
  • Encourage them to make a list of questions to ask physicians
  • Be truthful may become angry if think you’re keeping secrets from them
  • Identity and peer relationships are key issues
  • Concerned with body image
  • Reaction can be over and under exaggerated
  • Regression behavior is common
  • Concerned with modesty and privacy
47
Q

Important pediatric reminders

A
  • Use simple words
  • use open body language
  • don’t ever intentionally lie to a child
  • if they ask always tell a child if something is going to hurt
  • Explain procedure in simple easily understood terms but not until it is time for the procedure to begin
48
Q

Communication with parents and caregivers

A
  • Treat children as people
  • Learn and use their preferred names
  • Treat every child as if they are the most beautiful child
  • Listen to what the child says
  • Keep children physically and emotionally comfortable as possible
  • Basic and advance pain management is important
  • Try to relieve fear and anxiety as early as possible
49
Q

What are preoperative concerns for pediatrics?

A
  • Non verbal communication
  • A smile is calming
  • get to child’s eye level
  • try not to make the child look at you in an awkward angle
  • for preverbal children use a happy voice and bring the tone up at the end of the sentences
  • Use a soft voice with moderate pace and interrupt only when necessary
  • Use noise like uh hum and I see to encourage children to talk
50
Q

What are intra-operative safety concerns with fluid management?

A
  • For healthy elective patients anesthesia providers start the peripheral IV access line after induction of inhaled anesthetic
  • Central venous access devices, central line, intravenous lines can be inserted for emergency access for fluid resuscitation
  • An intraosseous needle or bon marrow aspiration needle is placed in the anterior aspect of the tibia place a pillow under the knee and secure and stabalize the line for rapid infusion of fluids
51
Q

What are intra-operative safety concerns with airway safety?

A
  • Because of use of uncuffed ET tubes it is imperative to secure and maintain the airway for patient safety, ET tubes can easily dislodge
  • Pediatric code sheet of emergency medication based on pt weight in kilograms and pound have this immediately available for all perioperative team members
  • Never leave child alone safety straps when applicable need to be applieds
  • Make sure child is focus on attention
  • Attention to blood loss is extremely important
52
Q

Keeping pediatric patients normothermic?

A
  • Hypothermia increase oxygen consumption leads to hypoxia respiratory depression , acidosis, hypoglycemic and alters medication metabolism
  • Hypothermia prolongs neuromuscular blocking agents and delays the emergence from anesthetic agents
53
Q

Equipment safety

A
  • Use age and size appropriate for all equipment
  • Use appropriate energy settings per manufacture instruction
  • Defibrillator settings
  • ESU settings
54
Q

Intraoperative concerns: Pediatric foley catheter placement?

A

-Order from physician’s required before placement

55
Q

What are common indications for bladder catheterization?

A
  • To obtain a urine specimen
  • To monitor urine output
  • To relieve urinary retention
  • For genitourinary testing procedure such as cystogram
  • Lengthy surgical procedures
56
Q

Intraoperative pt assessment

A
  • Check for allergies
  • Avoid latex catheters
  • Use silicon catheter if possible
57
Q

How to select appropriate catheter?

A
  • Select appropriate size
  • perform the procedure using sterile technique
  • Position patient for the procedure
  • Provide adequate lighting
  • Sizes go up by weight
58
Q

Straight and indwelling catheter sizes

A 
Neonate- 5-6 F
infant to 3 5-8 F
4-8 yrs 8 F
8 yrs- 10-12 F
puberty 12-14 F
59
Q

Hyperactivity

A
  • Pediatric pt recovering from anesthesia routinely exhibit hyperactive behavior ( excitement phase)
  • It is important to assess the cause
  • Drug response
  • Hypoxemia
  • Pain
  • Awakening in strange surrounding
60
Q

Postoperative concerns

A
  • Check teeth of school age children before and after the procedure especially if loose tooth are present
  • If teeth are removed to prevent accidental dislodgement and possible aspiration be sure the patient is given the tooth before leaving
  • Note the documentation of the tooth removed in anesthesia record
61
Q

Recovery position

A
  • The best position for postop is LATERAL
  • For children who have had intraoral procedures the best position is SEMIPRONE to facilitate drainage of secretion or blood
  • Side rails should be up and padded where necessary
  • An infant may need to be cocooned in a blanket to prevent injury
  • Safety retraints may need to be applied per facility policy to prevent accidental dislodging of tubes and drains
62
Q

Peds with Cancer

A
  • It is common for health care organizations to have policy for “consent on file” consistency of RN assignment can help decrease anxiety
63
Q

Life specialist

A
  • Experts in child development and help pediatric patients cope with hospitalization through play, education, and activities
64
Q

Child abuse and neglect

A
  • RNs considered mandated reporters
65
Q

S/s of child abuse

A
  • Shaken baby syndrome
  • Unexplained fracture and falls
  • Signs of lack of physical and medical care
  • Unexplained or deliberate burns, hairloss, multiple skin injuries
66
Q

Post mortem care

A
    • Trauma is the leading cause of death in pediatric pts

- It is the responsibilty of the physician caring for the pt to communicate to the parents the death of the child

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