PedsEmergAffectingFactors Flashcards
Explain peds emergencies?
Immature developmental level places the ma higher risk for drowning, poisoning, and injury. Most meds arrest result from respiratory causes or shock. Follow systemic approach: AHA, PALS.
Airway assessment in an emergency?
Position properly. Older infants and toddlers: large occiputs, rolled towel under shoulders. Suspected neck injury: protect the cervicial spine, jaw-thrust
Assess patency, check for teeth, mucus, blood, edema, foreign object, vomit. Is the child able to verbalize? Oxygen and suction.
Breathing in an emergency?
Look, listen: chest rise and fall, quality of respirations, bilateral breath sounds, feel the air on the check, adventitious sounds. Evaluate work of breathing. O2. Assisted ventilation PRN
Circulation in an emergency?
Assess apical and peripheral HR. Look for brachial pulses on infants, and carotids on child/teens. Evaluate perfusion: capillary refill, skin temp/color, BP. CR monitor, assess LOC, IV fluid boluses (20 mL/kg)
How to assess disability in an emergency?
Neuro. Assess LOC, is the child responsive? Evaluate head enface: symmetry, fontanels, skull shape. Assess spontaneous, muscle tone/strength, sensation. Pediatric Glasgow coma scale.
Evaluating exposure in an emergency?
Remove the child’s clothing, examining back, skin, and extremities. Note lesions, lacerations, bruises, rashes. Keep child warm, pain assessment and management
This is typically the primary issue with children. Young children are more at risk due to smaller airways.
Respiratory. Susceptible to illnesses and clothing. Keen assessment skills required.
Airway latency, child’s posture, activity, LOC. Work of breathing, pattern and quality of respirations. Child’s color, breath sounds
Nursing management of child airways?
Maintain patent airway? Upright position, rolled towel beneath shoulders to open airway. Oropharyngeal or nasopharyngeal airway PRN. Assisted ventilation PRN. Provide supplemental O2. Prepare for teach intubation if needed.
Low blood flow leading to impairment of cellular metabolism and death. What is the most common type in children?
Shock. Hypovolemic shock is the most common in children. Inadequate vascular volume is associated with fluid losses. Causes are dehydration, overheating, blood loss. Requires emergent intervention.
Early recognition of dehydration symptoms in children?
VS changes (↑HR, ↑RR, late ↓BP). Mental status and activity changes. Oral mucosa. Decreased urine output (<1 mL/kg/hour). Increased urine specific gravity. Decreased skin turgor. Depressed fontanels (infants). Decreased peripheral perfusion. Lab changes
Assessment of dehydration? Complications?
History: vomiting, diarrhea, decreased intake, fever, DKA, burns. Complications include shock and death. Early treatment is critical.
Nursing management of dehydration in peds?
Restore fluid balance. Mild-mod: 5-10% wt. loss
oral rehydrating solution (ORS)
50-100 mL/kg/4 hours.
Severe: 15% wt. loss
IV fluids → 20 mL/kg NS.
Eliminate cause, meds, dietary alterations, parental education
Health history for shock?
Weight loss, vomiting, diarrhea, decreased oral intake, blood loss, last void, exposures, heart conditions, allergies
Considerations for shock?
Early recognition and intervention. ABCs, O2 supplementation, obtain vascular access quickly, rapid NS replacement (20 mL/kg bolus), reassess for signs of improvement, meds based on the child’s status
Submersion injury in which the child survives. Aspiration of water leads to poor oxygenation, retention of CO2, pulmonary edema within 24-48 hours.
Near drowning. Cerebral anoxia. Renal complications due to altered perfusions.
Increasing desirable behaviors in a child and decreasing undesirable behavior.
Discipline
Age-appropriate, consistent, clear expectations. Involves teaching. Preserves the dignity and self-esteem of the child
How can effective discipline be promoted?
Keep consequence age and situation appropriate. Stay calm but firm when delivering consequence. Praise child for appropriate behavior. Appropriate environment to assist with behavior. Reinforce “bad behavior”, not “bad child.” Set clear, consistent, age-appropriate choices. Maintain consistency in responding to behaviors. Role model appropriate behaviors. Provide age-appropriate explanation of consequence. Administer consequence soon after behavior
Behavior in response to stimuli that is intrinsic and resistant to change. 3 major categories?
Temperament
Easy: even tempered, regular predictable functions (40%)
Difficult: irritable, highly active, intense (10%)
Slow-to-warm-up: moody, less active (15%)
“Fit” of child’s temperament with parent’s is a powerful predictor of family conflict
Rapid history and nursing assessment for near drowning?
Type of water, temperature of water, length of submersion, associated trauma (MVA or diving accident), LOC Assess ABCs (auscultate for crackles indicating pulmonary edema), neuro status, hypothermia
Nursing management of near drowning?
ABCDE. Suction upper airway of particles, emesis, or mucus. Supplemental oxygen. Be alert for need to intubate or provide CPR. Remove all wet clothing. Warm slowly: warm blankets, warm IV fluids. Cervical spine stabilization if injury suspected. Prevention and education of the parents
Health history for a poisoning? Assessment?
Approximate time of poisoning, type of substance and route, resulting symptoms. Was the poison control center called? Treatment given?
ABCs. Assess VS: BP, temperature, respiration changes, neuro status and pupils. Urine and blood toxicology screens, liver function tests, electrolytes/glucose. EKG
Nursing management of poisoning?
ABCDE Frequent VS Possible gastric lavage Possible whole bowel irrigation or dialysis if severe Ongoing assessment for late effects
Treatments for different kinds of poisons?
Activated charcoal for acid or alkali substances
Naloxone (Narcan) for narcotic ingestion
N-acetylcysteine (Mucomyst) for acetaminophen overdose
Chelation therapy for iron intoxication
