Pharmacologic Management of Pt Behavior Flashcards
Advanced behavior guidance techniques.
Protective stabilization
Sedation
General Anesthesia
Benzodiazepine antagonist
Flumazenil
Flumazenil route of administration.
IV
Types of Benzodiazepines
Midazolam
Diazepam
Types of Narcotics for Sedation
Meperidine
Sufentanil
Narcotic antagonist
Naloxone
Naloxone route of administration
IV or IM
Class 0 tonsils
Surgically removed
Class 1 tonsils
Hidden within the tonsillar pillars.
Class 2 tonsils
Extend to the tonsillar pillars
Class 3 tonsils
Extend beyond the pillars.
Class 4 tonsils
Extend to midline
Sedation contraindications
- ASA III or greater
- Pt who can be managed with basic behavior management
- Extensive tx plan
- Recent illness
Complications of sedation
- Airway obstruction
- Seizures
- Allergic reactions
- Failure to sedate
Why no food or drink prior to sedation?
Can vomit and aspirate it causing aspiration pneumonia, or can get laryngospasm (where vocal cords shut and you can’t breathe).
Fasting period for clear liquids.
2 hours before sedation.
Light meal consists of what?
Toast and clear liquids.
Fasting period for breast milk.
4 hours
Fasting period for infant formula, nonhuman milk, and light meals.
6 hours
After the appt, how often should the parent check on breathing and the airway?
Every 3-5 minutes.
What do you do if the sedated child starts snoring after the appointment?
Reposition the head by lifting the chin.
This is likely given in addition to oral sedation.
Local anesthesia
Can give these for pain or fever after sedation.
Tylenol or Motrin
Minimum number of personnel needed in the room for sedation.
2
Practitioner responsibilities.
- Tx patient
- Administer drugs
- Monitor vitals
- Rescue skills for deeper level of sedation.
How often is BP recorded in sedation?
Every 5 minutes
Records respiratory rate.
Precordial stethoscope or capnograph.
Measures amount of expelled CO2
Capnograph
Monitors oxygenation and pulse rate
Pulse oximeter
Are preprocedural prescriptions appropriate for children undergoing sedation?
NO
Intubation procedure
SOAP ME
Suction
Oxygen
Airway equipment
Pharmacy
Monitors
Equipment-AED/Defibrillator
What is intermittently recorded during sedation?
BP and respiratory rate.
What is continuously recorded during sedation?
Oxygen saturation
Heart rate
Child has to stay awake in a quiet environment for how long in order to be discharged?
20 minutes
This group is more vulnerable to the sedation medication’s effects on respiratory drive, patency of the airway, and protective reflexes.
Young children.
This level of sedation has great risk of respiratory or cardiovascular complications.
Deep sedation
There’s partial or complete loss of protective reflexes in this level of sedation.
Deep
1 kg is how many pounds?
2.2
Articaine maximum dose
7 mg/kg
Volume of anesthetic in a carpule.
1.7 mL
Max dose of Articaine
7 mg/kg
Articaine AKA
Septocaine
Percent of Articaine in a carpule
4%
Which Piaget stage of cognitive development is this?
Children begin to use language similar to adults and can form mental symbols and words to represent objects.
Language is concrete and literal, and has limited logical reasoning skills. Children tend to perceive the world from their own perspective or be “egocentric.”
Preoperational (2-5 years)
Which Piaget stage of cognitive development is this?
Children can think about abstractions and hypothetical concepts and reason analytically.
Formal operations (11+ years)
Which Piaget stage of cognitive development is this?
Children demonstrate increased logical reasoning skills and can see the world from different points of view.
They still have a difficult time with abstract ideas and benefit from concrete instructions.
Concrete operational stage (6-11 years old).
Which Piaget stage of cognitive development is this?
Infants use senses and motor abilities to understand the world and there’s little to no meaningful verbal communication other than single word commands.
They are, however, hyperaware of people around them as they reach this age and are perceptive to nonverbal communication.
Sensorimotor Stage (Birth-24 months)
Types of Temperament by Chess and Thomas
Easy
Difficult
Slow-to-warm up
- Biological regularity
- Quick adaptability to change
- Tendency to approach new situations vs withdraw
- Predominantly positive mood/moderate intensity.
Easy temperament
- “Shy”
- Withdrawal tendencies to new things/situations
- Slow adaptability to change
- Frequent negative emotional expressions of low intensity.
Slow-to-warm-up temperament
- Biological irregularity
- Withdrawal tendencies to new things/situations
- Slow adaptability to change
- Frequent negative emotional expressions of high intensity.
Difficult temperament
