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Med Surg II > Peds Ortho Burns > Flashcards

Peds Ortho Burns Flashcards

1
Q

Three tiers of triage

A

emergent, urgent, non-urgent

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2
Q

Emergent

A

if not treated immediately will threaten life, limb, sight

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3
Q

Urgent

A

if not treated in the next 1-2 hours there is potential for significant medical morbidity, pain

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4
Q

Non-urgent

A

stable but requires care in next 4-6 hours , with NO risk of mortality or permanent functional loss

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5
Q

Three steps of triage

A

physiology, anatomy, mechanism of injury

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6
Q

Step one

A

responsiveness, evidence of poor perfusion, abnormal heart rate, resp rate and/or cap refill

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7
Q

Abnormal Heart rate for child < or equal to 5 yo

A

180 per min

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8
Q

Abnormal Heart rate for child less than or equal to 6 yo

A

160/min

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9
Q

If patient has RR > 60 , in respiratory distress, or apnea, what are you going to do ?

A

Send to trauma center with ALS if available (ALS= air lift support)

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10
Q

Examples of anatomy issues that would indicate triage to trauma center

A

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

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11
Q

What are the 7 mechanisms of injury you would call a trauma center?

A

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)

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12
Q

If you find someone in cardiopulmonary arrest, respiratory failure, status epilepticus and/or unresponsive, what are you going to do?

A

bring directly into ED room and immediate resuscitation

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13
Q

What is an emergent case?

A

Any alteration in LOC, mod-severe dehydration or resp. distress, febrile infant under 3 months. *think emergent-emergency situation

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14
Q

Examples of emergent cases

A

toxic ingestion, asthma in distress, DKA, r/o sepsis, and suspected abuse

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15
Q

What is an urgent case?

A

A patient require interventions such as antibiotics, pain meds, sutures, wound repair, cast, febrile child over 3 months.

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16
Q

Examples of urgent cases

A

minor burn, simple fracture, pneumonia, post seizure, mild resp distress, and simple trauma

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17
Q

What is a non-urgent case? And what are the 7 examples

A

require little intervention. Upper resp. infection, diaper rash, thrush, impetigo, conjunctivitis, sore throat, and ear infection

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18
Q

average age of pediatric burn patient

A

32 months

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19
Q

A child is brought into the ED with burn to face, chest, and anterior legs, what do you involve in your assessment?

A

depth, percentage of body surface area, and involvement of certain body parts

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20
Q

Examples of major burns

A

face, hands, feet, perianal, anterior chest and circumferencial

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21
Q

What is a circumferencial burn?

A

A burn that goes all the way around a body part

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22
Q

Burns are the 2nd leading cause of accidental death in children under 15, what is 1st?

A

automobile accidents

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23
Q

What percent of burns are preventable?

A

75%

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24
Q

Minor burns

A

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

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25
Q

Example of minor burn

A

mild sunburn and flash burn (a sudden, brief burst of heat)

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26
Q

Moderate burn

A

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.

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27
Q

How is a moderate burn treated?

A

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

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28
Q

Examples of moderate burns

A

scald injuries, flames, and skin that briefly comes in contact with a hot object

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29
Q

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?

A

Bring child to ED because child has a severe, third-degree burn

30
Q

True or False, a partial-thickness burn is considered a major burn if it involves more than 50% of body surface

A

False, 25%

31
Q

True or False, a full-thickness burn is considered major if it involves more than 10% of body surface

A

TRUE

32
Q

For fluid resuscitation after a burn, what is your goal for UO?

A

UO= 1cc/kg/hr. Nurse will watch vital signs and use LR for first 24 hours

33
Q

You are the ED nurse caring for Billy, a child just admitted for a major burn. What are you going to do?

A

cover with clean DRY sheets, no antiseptic preparation, do NOT break blisters, avoid cold and ice, and tetanus immunization

34
Q

Intensive wound care, pain control, skin grafting, PT and OT, high caloric requirements, and OT for at least 2 yr are all what?

A

Burn treatment options

35
Q

Idiopathic avascular necrosis of femoral head

A

Legg-Calve-Perthes

36
Q

S/S of Legg Calve Perthes include:

A

insidious onset of limp with pain, pain worse with activity, limited/PROM, tenderness over groin, and limited abduction and rotation

37
Q

Treatment for Legg-Calve Perthes

A

short period of bed rest, ibuprofen, and possible surgery

38
Q

In what disease the femoral head slip off growth plate?

A

Slipped Capital Femoral Epiphysis

39
Q

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

A

TRUE

40
Q

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?

A

Slipped Capital Femoral Epiphysis

41
Q

Lateral curvature of the spine which is >10 % on x-ray with vertebral rotation

A

Scoliosis.

42
Q

True or False, the most common cause of scoliosis is neuromuscular abnormalities such as Cerebral Palsy and Spina Bifida

A

False, usually idiopathic. However, neuromuscular, congenital skeletal abnormalities, and neurofibromatosis Type I are also common causes.

43
Q

Scoliosis is most commonly found in what gender and age group?

A

females, 10-16 yo

44
Q

You are a school nurse testing girls for Scoliosis. What is the primary test you will use and what will you look for?

A

Forward bend test, and you are looking for a rib hump

45
Q

What are some other signs of scoliosis?

A

depression of shoulder, asymmetry of scapulae, curve of spine, sacral tilt and asymmetry in distance between the arms and body

46
Q

Back curve of less than 25 degrees =

A

observation phase

47
Q

Back curve of 25-45 degrees

A

Progressive curve, client needs to wear a brace 23 h/day

48
Q

Back curve of >45 degrees =

A

surgery

49
Q

True or False, brace does not straighten the spine, only slows progression

A

TRUE- it only stops or slows progression

50
Q

In the spinal fusion surgery for scoliosis, what are nursing care priorities

A

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

51
Q

Post-op care of spinal fusion includes:

A

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

52
Q

What tool do we use to classify fractures?

A

Salter-Harris

53
Q

Type I fracture

A

A COMPLETE physeal fracture with or without displacement

54
Q

Type II fracture

A

A physeal fracture that extends through the METAPHYSIS, producing a CHIP fracture of the metaphysis, which may be very small

55
Q

Type III fracture

A

A physeal fracture that extends through the EPIPHYSIS

56
Q

Type IV fracture

A

A physeal fracture PLUS epiphyseal and metaphyseal fracture

57
Q

Why are fractures in older children common?

A

they fall during play and are involved in MVAs

58
Q

Spiral fractures (caused by twisting) and fractures in infants may be related to ____ ____

A

child abuse

59
Q

Fractures involving the epiphyseal plate (growth plate) can have serious consequences in terms of ____ of the ____ limb

A

growth of the affected limb

60
Q

Mgmt. of a nondisplaced finger fracture

A

buddy taping

61
Q

Mgmt. of metatarsals and thumbs

A

short arm cast

62
Q

To prevent ischemia and compartment syndrome, what are you going to check for with a patient with a fracture

A

assess the 5 Ps (pain, pallor, pulselessness, parasthesia, paralysis), check pulses, color, movement/sensation, temp, edema, pain, and child guarding. Report abnormal immediately

63
Q

True or False, skin traction for fracture reduction should be removed for skin care only

A

False, skin traction for fracture reduction should not be removed unless health care provider prescribes its removal

64
Q

Pin sites are sources of infection, what should the nurse do?

A

monitor for signs of infection. Cleanse and dress pin sites as prescribed.

65
Q

Using the SIRES pneumonic, how are you going to care for a child has been poisoned?

A

STABILIZE the child, IDENTIFY the toxin, REVERSE its effects, ELIMINATE the substance, and SUPPORT physically and psychologically

66
Q

Using the California Penal Code for child abuse, what must happen?

A

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.

67
Q

Bruises on what areas are suspicious of child abuse?

A

cheeks, neck, back, upper arms, and abdomen. Bony areas are OK

68
Q

What is the correct stages of bruise healing

A

Red>blue>yellow>green>brown>clear

69
Q

What types of burns are inflicted burns

A

Immersion burns: doughnut shaped, stocking or glove pattern. Also, contact burns.

70
Q

Of the skeletal fractures that occur in children < 1 yo, what percent are caused by abuse?

A

50-70% are abuse

71
Q

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?

A

Shaken Baby Syndrome

72
Q

Shaken Baby Syndrome

A

forceful shaking causes shearing injury to bridging veins. Retinal hemorrhages are diagnostic.

Med Surg II (12 decks)

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