Peds Ortho Burns Flashcards
Three tiers of triage
emergent, urgent, non-urgent
Emergent
if not treated immediately will threaten life, limb, sight
Urgent
if not treated in the next 1-2 hours there is potential for significant medical morbidity, pain
Non-urgent
stable but requires care in next 4-6 hours , with NO risk of mortality or permanent functional loss
Three steps of triage
physiology, anatomy, mechanism of injury
Step one
responsiveness, evidence of poor perfusion, abnormal heart rate, resp rate and/or cap refill
Abnormal Heart rate for child < or equal to 5 yo
180 per min
Abnormal Heart rate for child less than or equal to 6 yo
160/min
If patient has RR > 60 , in respiratory distress, or apnea, what are you going to do ?
Send to trauma center with ALS if available (ALS= air lift support)
Examples of anatomy issues that would indicate triage to trauma center
penetrating injuries (head, neck, torso, extremities above elbow and knee), flail chest, difficulty or inability to maintain patent airway, fractures > 1 involving the humerus and/or femur, pelvic fracture, paralysis or evidence of spinal cord injury, amputation above the wrist or ankle, burn w/ major injuries, seat belt mark on torso
What are the 7 mechanisms of injury you would call a trauma center?
ejection from motor vehicle, falls?3x patient height, extrication time ?20 mins w/ an injury, high voltage electrical injury, unrestrained passenger in vehicle roll over, anyone thrown or run over, and front seat passenger w/ deployment of air bag (same side)
If you find someone in cardiopulmonary arrest, respiratory failure, status epilepticus and/or unresponsive, what are you going to do?
bring directly into ED room and immediate resuscitation
What is an emergent case?
Any alteration in LOC, mod-severe dehydration or resp. distress, febrile infant under 3 months. *think emergent-emergency situation
Examples of emergent cases
toxic ingestion, asthma in distress, DKA, r/o sepsis, and suspected abuse
What is an urgent case?
A patient require interventions such as antibiotics, pain meds, sutures, wound repair, cast, febrile child over 3 months.
Examples of urgent cases
minor burn, simple fracture, pneumonia, post seizure, mild resp distress, and simple trauma
What is a non-urgent case? And what are the 7 examples
require little intervention. Upper resp. infection, diaper rash, thrush, impetigo, conjunctivitis, sore throat, and ear infection
average age of pediatric burn patient
32 months
A child is brought into the ED with burn to face, chest, and anterior legs, what do you involve in your assessment?
depth, percentage of body surface area, and involvement of certain body parts
Examples of major burns
face, hands, feet, perianal, anterior chest and circumferencial
What is a circumferencial burn?
A burn that goes all the way around a body part
Burns are the 2nd leading cause of accidental death in children under 15, what is 1st?
automobile accidents
What percent of burns are preventable?
75%
Minor burns
First degree burns. Affect only the epidermis /outer skin. Usually red, painful, dry, with no blisters. Usually heal on their own within a week by cold compresses, lotions/ointments, and NSAIDS or ibuprofen
Example of minor burn
mild sunburn and flash burn (a sudden, brief burst of heat)
Moderate burn
Second degree burns. Involve the epidermis and part of the dermis layer of skin. Burn will appear red, blistered and may be swollen and painful.
How is a moderate burn treated?
If 2nd degree burn does not cover more than 10 percent of skin’s surface, can be treated in outpatient setting with antibiotic ointments, dressing changes 1-2x per day depending on severity of the burn, daily cleaning of the wound to remove dead skin or ointment, and possibly systemic antibiotics
Examples of moderate burns
scald injuries, flames, and skin that briefly comes in contact with a hot object
You are the advice nurse at Kaiser, a patient calls in about her child who was burned by a scalding hot liquid. She describes the skin as dry and leathery, with blackish/whitish skin, and states it does not hurt. What do you advise her to do?
Bring child to ED because child has a severe, third-degree burn
True or False, a partial-thickness burn is considered a major burn if it involves more than 50% of body surface
False, 25%
True or False, a full-thickness burn is considered major if it involves more than 10% of body surface
TRUE
For fluid resuscitation after a burn, what is your goal for UO?
UO= 1cc/kg/hr. Nurse will watch vital signs and use LR for first 24 hours
You are the ED nurse caring for Billy, a child just admitted for a major burn. What are you going to do?
cover with clean DRY sheets, no antiseptic preparation, do NOT break blisters, avoid cold and ice, and tetanus immunization
Intensive wound care, pain control, skin grafting, PT and OT, high caloric requirements, and OT for at least 2 yr are all what?
Burn treatment options
Idiopathic avascular necrosis of femoral head
Legg-Calve-Perthes
S/S of Legg Calve Perthes include:
insidious onset of limp with pain, pain worse with activity, limited/PROM, tenderness over groin, and limited abduction and rotation
Treatment for Legg-Calve Perthes
short period of bed rest, ibuprofen, and possible surgery
In what disease the femoral head slip off growth plate?
Slipped Capital Femoral Epiphysis
T or F, In slipped Capital Femoral Epiphysis, it is more common in boys, majority in 95th percentile (weight), can be uni/bilat, and seen in ages 9-15 yo
TRUE
Painful limp w/ or wo hx of trauma, hip, thigh, or knee pain, leg held in an externally rotated position, and limited abduction and flexion are manifestations of what disease?
Slipped Capital Femoral Epiphysis
Lateral curvature of the spine which is >10 % on x-ray with vertebral rotation
Scoliosis.
True or False, the most common cause of scoliosis is neuromuscular abnormalities such as Cerebral Palsy and Spina Bifida
False, usually idiopathic. However, neuromuscular, congenital skeletal abnormalities, and neurofibromatosis Type I are also common causes.
Scoliosis is most commonly found in what gender and age group?
females, 10-16 yo
You are a school nurse testing girls for Scoliosis. What is the primary test you will use and what will you look for?
Forward bend test, and you are looking for a rib hump
What are some other signs of scoliosis?
depression of shoulder, asymmetry of scapulae, curve of spine, sacral tilt and asymmetry in distance between the arms and body
Back curve of less than 25 degrees =
observation phase
Back curve of 25-45 degrees
Progressive curve, client needs to wear a brace 23 h/day
Back curve of >45 degrees =
surgery
True or False, brace does not straighten the spine, only slows progression
TRUE- it only stops or slows progression
In the spinal fusion surgery for scoliosis, what are nursing care priorities
Foley while epidural in place, NG until bowel sounds return, IV fluids until PO, PCA (check q 1h), log-rolling to change pos q2h, and respiratory care/hygiene
Post-op care of spinal fusion includes:
frequent neuro checks, log-roll for 5days, admin IV fluids and analgesics, oral hygiene (pt. will be NPO), monitor NG tube and bowel sounds, assist with ambulation using a body jacket if needed, possible teacher in the home, and encourage child’s participation inc are to promote self esteem
What tool do we use to classify fractures?
Salter-Harris
Type I fracture
A COMPLETE physeal fracture with or without displacement
Type II fracture
A physeal fracture that extends through the METAPHYSIS, producing a CHIP fracture of the metaphysis, which may be very small
Type III fracture
A physeal fracture that extends through the EPIPHYSIS
Type IV fracture
A physeal fracture PLUS epiphyseal and metaphyseal fracture
Why are fractures in older children common?
they fall during play and are involved in MVAs
Spiral fractures (caused by twisting) and fractures in infants may be related to ____ ____
child abuse
Fractures involving the epiphyseal plate (growth plate) can have serious consequences in terms of ____ of the ____ limb
growth of the affected limb
Mgmt. of a nondisplaced finger fracture
buddy taping
Mgmt. of metatarsals and thumbs
short arm cast
To prevent ischemia and compartment syndrome, what are you going to check for with a patient with a fracture
assess the 5 Ps (pain, pallor, pulselessness, parasthesia, paralysis), check pulses, color, movement/sensation, temp, edema, pain, and child guarding. Report abnormal immediately
True or False, skin traction for fracture reduction should be removed for skin care only
False, skin traction for fracture reduction should not be removed unless health care provider prescribes its removal
Pin sites are sources of infection, what should the nurse do?
monitor for signs of infection. Cleanse and dress pin sites as prescribed.
Using the SIRES pneumonic, how are you going to care for a child has been poisoned?
STABILIZE the child, IDENTIFY the toxin, REVERSE its effects, ELIMINATE the substance, and SUPPORT physically and psychologically
Using the California Penal Code for child abuse, what must happen?
Must call a “Child Protective Agency” as soon as possible to make a VERBAL report of “Reasonable Suspicion” and a WRITTEN report on Dept. of Justice Child Abuse Report Form w/in 36 hours of verbal report. Reporters must give full name. Not reporting=misdemeanor, loss of license, $1000 fine, jail.
Bruises on what areas are suspicious of child abuse?
cheeks, neck, back, upper arms, and abdomen. Bony areas are OK
What is the correct stages of bruise healing
Red>blue>yellow>green>brown>clear
What types of burns are inflicted burns
Immersion burns: doughnut shaped, stocking or glove pattern. Also, contact burns.
Of the skeletal fractures that occur in children < 1 yo, what percent are caused by abuse?
50-70% are abuse
A baby is brought into the ED, he is irritable, lethargic, vomiting, and is going through respiratory changes. All of sudden he has a seizure and becomes unresponsive. What do you suspect?
Shaken Baby Syndrome
Shaken Baby Syndrome
forceful shaking causes shearing injury to bridging veins. Retinal hemorrhages are diagnostic.
