PNP Flashcards
Prepare the Room and assign nursing roles
- Length based resuscitation tape
- Pediatric Equipment
- Pediatric protocols and dosing guidelines
- Scale
Don PPE
Consider potential safety threats to the team and the need for decontamination
Your patient has arrived. What would you like to do?
Assess the PAT:
Appearance
Work of breathing
Circulation to the skin
No alteration in the PAT means the child is :
Sick
One alteration in the PAT means the child is:
SickER
Two or more alterations in the PAT means the child is:
SickEST
After the PAT assessment. What do you need to assess next
Assess for obvious uncontrolled external hemorrhage or unresponsiveness/apnea and the need to reprioritize to C-ABC
If obvious uncontrolled external hemorrhage or unresponsiveness/apnea and the need to reprioritize to C-ABC is present. What are the identified interventions?
4
May include, but not limited to, the following:
1. Assessforapulse
2. Control external hemorrhage
3. Initiate chest compressions
- Then reassess.
What is first in the primary survey
Assess level of consciousness using AVPU
Open the airway:
May include, but not limited to, the following:
1.If cervical Spinal injury is suspected ,provide manual cervical spinal stabilization AND demonstrate manual opening of the airway using the jaw-thrust maneuver.
•when no trauma is suspected ,open the airway with a head tilt-chin lift or jaw thrust
When the patient is alert and can cooperate, it is acceptable to ask the patient to open their mouth to assess the airway.
Assess the airway for:
8
- Bony deformity
- Edema
- Fluid
- Foreign objects
- Loose or missing teeth
- Sounds
- Tongue obstruction
- Vocalization
When alterations are found when assessing the airway,what interventions are appropriate?
7
- anticipate the need for intubation.
- insert an oral or nasal pharyngeal airway.
- Place padding under the shoulders or torso.
- position the patient to optimize airway.
- Remove any loose teeth or for an objects.
- suction the airway.
7 Reassess
Assess for breathing effectiveness
8
- breath sounds
- Depth pattern, and rate of respirations.
- Increased work of breathing.
- Open wounds or deformities.
- Skin color.
- Spontaneous breathing.
- Subcutaneous emphysema
- Symmetrical chest rise and fall. 
When alterations are identified in breathing, which interventions are appropriate?
6
- Anticipate the need for a chest tube.
- Anticipate the need for drug assisted intubation.
- Anticipate the need for medication’s.
- Anticipate the need for decompensation of a pneumo-
- Anticipate the need for oxygen.
- Provide bag mask ventilation’s.
Reassess times four
If intubated, assess endotracheal tube placement by identifying which three things?
- Attach a CO2 detector after 5 to 6 breaths, assessed for evidence of an exhaled CO2.
- Simultaneously observe for rise and fall of the chest with the ventilations.
- Auscultation over the epigastrium for gurgling and lungs for bilateral breath sounds.
After identifying endotracheal tube placement, what else are you assessing?
The endotracheal tube position by noting the number at the teeth or gums and secure the tube.
After assessing the ET tube and noting the number at the teeth and gums, what do you need to do next?
Begin, mechanical, ventilation, or continued, assisted ventilation.
Apply pulse ox symmetry and capnography
Assess circulation by identifying three important things.
- Assess capillary refill.
- Inspect and palpate the skin for color, temperature and moisture.
- Palpate, pulses. 
When alterations are found, when assessing circulation, what interventions would be appropriate?
- Obtain IV or IO access
- Drawl labs.
- Facilitate fast exam.
- Apply a pelvic binder.
- Anticipate goal directed therapy for shock.
- Compare, central and peripheral pulses.
- Initiate chest compressions.
- Control hemorrhage.
- Apply cardiac monitor.
- Weigh the patient and administer 20 mL per kilogram for an infant or child 10 to 20 mL per per kilogram of blood 10 mL per kilogram for neonate’s.
Reassess
D- disability
Assess neurologic status using the GCS and assess pupils.
Best eye-opening
best verbal response.
Best motor response.
When alterations are identified while assessing the GCS, which interventions would be appropriate
1 Assess bedside glucose level
2 anticipate the need for drug assisted intubation
3. Anticipate the need for a head CT.
E. Exposure
Remove all clothing and inspect for obvious abnormalities or injuries
Is abnormalities or injuries are identified during exposure, what interventions would be appropriate?
If a transport device is in place, it may be removed
If there are no contraindications to patient may be turned to quickly access the posterior, or it can be deferred until they head to toe and imaging to evaluate, spinal and pelvic stability as indicated
After exposure and inspection, what is appropriate to do next?
Provide warmth using blankets, increased room, temperature, warmed fluids, and warming lights
F: full set of vital signs and family presence
Consider vital signs to initiate any life-saving interventions
G: get adjuncts and give comfort.
What adjuncts would you consider?
- Blood gases.
- Blood glucose.
- Cross type and screen for bleeding.
- Coagulation studies.
- Complete blood counts.
- Cultures and lactic.
- Metabolic panel.
- Pregnancy.
- Toxicology screen
M: attach the patient to the cardiac monitor or reassess the cardiac monitor.
What else would you consider to monitor at this time?
Consider an EKG and frequent blood pressures
N-
Consider the need for an NG or OG
Tube.
O- assess oxygenation and continuous capnography if available
What else would be appropriate to assess at this time?
Increase or decrease rate in the assisted ventilations
Weaning oxygen
P:
Assess pain using inappropriate pain skills and consider non-pharmacologic and pharmacologic comfort measures as well as analgesic medication 
Name some non-pharmacological interventions
- Distraction.
- Family presence
- Repositioning.
- Splinting.
- Verbal reassurance.
H: history and head to toe assessment
Please give me a history using:
Sample
Inspect and palpate, head, face and neck for abnormalities.
Demonstrate removal and application of cervical collar for assessment, if indicated
Inspect and palpate chest for abnormalities
Auscultate, breath and heart sounds
Inspect abdomen and auscultation bowel sounds
Palpate, all for quadrant of the abdomen for abnormalities
Inspect and palpate the flanks for abnormalities
Apply, gentle pressure over iliac crest downward and medially
Apply pressure over the pubis if the crests are stable
Inspect the perineum for abnormalities
Consider how to measure urinary output
Inspect and palpate all four extremities for:
Neurovascular status and abnormalities
Inspect and palpate the posterior surface, unless spinal or pelvic injury exists.
Consider imaging prior to turning the patient
What interventions or diagnostics can you anticipate for this patient
- Antibiotics.
- Consult.
- Head CT.
- Law-enforcement.
- Mandatory reporting.
- Psychosocial support.
- Social services.
- Splinting.
- Tetanus immunization.
- Wound care.
- X-rays or ultrasound
What findings were you continue to reevaluate while the patient is in your care
Vital signs
All identified abnormalities and effectiveness of interventions
Primary survey
Pain
What is the definitive care for this patient?
Consider the need for admission or transferred to a pediatric capable facility
