Section 8 (Chapters 31-34) Flashcards
Pediatric Respiratory Rate
Newborn 30-60 Infant 25-50 Toddler 20-30 Preschool 20-25 School-age 15-20 Adolescent 12-20 Adult 12-20
Airway Differences in Pediatrics
Larger, Rounder Occiput (careful positioning) Proportionally Larger Tongue Long, Floppy Epiglottis Less well-developed tracheal cartilage Narrowing, Funnel-shaped upper airway
Pediatric Pulse Rate
Infant 100-160 Toddler 90-150 Preschool 80-140 School-age 70-120 Adolescent 60-100 Adult 60-100
Lining of inside of uterus.
endometrium
Birth canal.
vagina
cervix (lower 1/3 of uterus)
Area of skin between anus and vagina.
perineum
Disk-shaped structure attached to inner lining of wall of uterus.
Placenta
Abruptio placenta - premature separation of placenta. S/S painful vaginal bleeding in 3rd trimester.
Placenta previa - placenta develops over and covers the uterus. S/S painless vaginal bleeding in 3rd trimester.
When head of fetus descends into the woman’s pelvis.
lightening
Onset of labor
contractions of the uterus
also bloody show - mucus plug discharged from cervix
A woman experiencing her first pregnancy.
primagravida
False labor.
Braxton-Hicks contractions
Contractions not regular and do not increase in intensity or frequency.
Pain is in the lower abdomen, not in lower back and wrapping around to the abdomen.
Any bloody show is brownish, not pink or red.
Hypertensive disorders late in pregnancy.
Preeclampsia - headache, seeing spots, edema of hands or feet, anxiety, hypertension.
Eclampsia - seizures
Lay patient on left side, maintain airway, provide oxygen.
Why patients in 3rd trimester should be transported on left side.
supine hypotensive syndrome
Emergent diabetes during pregnancy.
gestational diabetes
usually resolves after delivery
Umbilical cord around neck.
nuchal cord
gently slide over head or shoulder. Otherwise, tie off both sides of umbilical cord and cut in center.
White, cheesy substance covering neonate.
vernix caseosa
Neonatal heart rate greater than 100 bpm.
Keep warm, transport, assess continuously.
Neonatal heart rate 60 to 100 bpm
Begin assisted ventilation with bag-mask device and 100% O2. Use 30 breaths/minute.
Reassess every 30 seconds until HR and Resp are normal.
Keep warm.
Call fro ALS backup.
Neonatal heart rate <60 bpm.
Begin assisted ventilation with bag-mask device and 100% O2. Reassess at 30 seconds.
Begin chest compressions if rate is still < 60 bpm.
One breath after every 3 compressions.
Reassess every 30 seconds until HR and Resp are normal.
Keep warm.
Call fro ALS backup.
What is the APGAR score?
Appearance
2 - entire infant pink.
1 - body pink, hands and feet blue.
0 - entire infant blue.
Pulse
2 - >100 b/m
1 - <100 b/m
0 - absent pulse
Grimace or Irritability
2 - cries, tries to move foot away from snap against sole
1 - weak cry in response to stimulus
0 - no cry or reaction
Activity (muscle tone)
2 - resists attempts to straighten hips and knees
1 - weak attempt to resist
0 - completely limp, no muscle tone
Respiration
2 - rapid
1 - slow
0 - absent
When to assess APGAR scale?
at 1 and 5 minute post birth.
Typical 7 to 8 score at 1 minute and 8 to 10 at 5 minutes.
Three presentations of birth
vertix (crowning)
breech (buttocks first)
limb (single limb requires rapid transport)
The first year of life.
Infancy
0 - 2 months eating and sleeping
2 - 6 months more often awake, smiles, makes eye contact
6 - 12 months begin to babble, learn to sit, crawl and eventually to stand and walk
The toddler.
Infancy to 3 years.
12 - 18 months begin to walk and explore, may speek 4 to 6 words.
18 - 24 months Running and climbing develop, cling to parents and caregivers, often have special object.
The preschooler.
age 3 - 6 years
Toilet training developed, learn behavior
School age years.
School-age 6 - 12 years.
Concrete thinking, respond sensibly to direct questions, help care for self.
Adolescent
Adolescent 12 - 18 years.
Think abstractly, decision making, morals develop.
Structured assessment tool for rapid general impression of pediatric patient (PAT).
Pediatric Assessment Triangle
Work of breathing.
Appearance (TICLS)
Circulation to skin
Level of consciousness assessment (AVPU).
The AVPU Scale Alert - normal interactiveness for age Verbal - Appropriate response to name Painful - Withdraws from pain Unresponsive - No response to any stimulus
Assess characteristics of appearance (TICLS).
TICLS Mnenomic
Tone - child moves or resists being examined.
Interactiveness - alertness to others, reaches for objects
Consolability - crying consoled by caregiver or EMT
Look or gaze - fixed gaze?
Speech or cry - Strong, spontaneous cry; age-appropriate verbal response.
What are abnormal respiratory sounds?
Stridor - high pitched inspiratory sound, partial upper airway obstruction.
Wheezing - high or low pitched sound during expiration; partial lower airway obstruction
Grunting - Uh sound during exhalation; inadequate oxygen
Absent breath sounds - complete obstruction
Pediatric Glasgow Coma Scale (Eye Verbal Motor).
Eye opening 4 - Open spontaneously 3 - Open to speech (I&C) or sound (I) 2 - Open to pain (I&C) 1 - No response (I&C)
Verbal
5 - Coos, babbles (I) or Oriented conversation (C)
4 - Irritable cry (I) or confused conversation (C)
3 - Cries to pain (I&C) or inappropriate words (C)
2 - Moans to pain (I&C) or incomprehensible words (C)
1 - No response (I&C)
Motor 6 - Normal spontaneous movement (I) or obeys verbal (C) 5 - Localizes pain (I&C) 4 - Withdraws to pain (I&C) 3 - Abnormal flexion (I&C) 2 - Abnormal extension (I&C) 1 - No response (I&C)
Picture scale for pain evaluation.
Wong-Baker FACES Scale
Assessment of blood pressure in children younger than 3 years.
Not assessed, no useful information
Calculate expected blood pressure in child 1 to 10 years.
70 + (2 x child’s age in years) = systolic blood pressure
Elements of assessment process.
- Scene size-up
- Primary assessment
- History taking
- Secondary assessment
- Reassessment
Pregnancy Induced Hypertension (PIH)
BP in pregnant patient above 140/90 at least twice at 6 hrs apart.
Supine Hypotensive Syndrome
When fetus compresses inferior vena cava. Occurs when mother is supine. Dizziness, hypotension, pale skin, altered LOC
Patient: Seated, lying on left side, or elevate right hip or tilt backboard
What are the four elements of the GEMS diamond?
Geriatric patients
Environmental assessment
Medical assessment
Social assessment
A change in mental status marked by inability to focus, think logically, and maintain attention.
Delerium
Curvature of the spine that causes the neck and shoulders to curve forward.
Kyphosis
The highest suicide rate of any age group in the United States.
Older men
Severe abdominal pain with or without vaginal bleeding.
Ectopic pregnancy
Spontaneous abortion.
Delivery of fetus before viability (Week 20-22).
S/S cramping, lower abdominal pain, vaginal bleeding, passage of clots and tissue.
Silent MIs are more common in elderly patients.
Geriatric patient may complain of dyspnea, weakness, abdominal pain, or epigastric pain instead of chest pain.
History risk factors for congestive heart failure in geriatrics.
Hypertension
Previous MI
Coronary artery disease
Presentation of heart failure in geriatrics.
Pulmonary edema and respiratory distress - Left sided failure.
Pedal edema and jugular venous distension (JVD) - Right sided failure.
Dyspnea on exertion, weakness, difficulty breathing at night are common complaints of all geriatric CHF.
Signs and symptoms of pneumonia.
General weakness, fever, cough, and dyspnea.
Life threatening in geriatrics.
Signs and symptoms of pulmonary edema.
Fatigue, chest pain, tachycardia, sudden onset dyspnea, pedal edema in only one leg, low pulse oximetry reading, general feeling of distress.
Ventilation rate after an advanced airway device has been inserted in any patient (all age groups)?
After an advanced airway device (eg, ET tube, multilumen airway, supraglottic airway) has been inserted during cardiac arrest, ventilate the patient at a rate of 8 to 10 breaths/min (one breath every 6 to 8 seconds). This ventilation rate applies to all age groups, except the newborn. Excessive ventilation (eg, hyperventilation) is detrimental because it causes an increase in intrathoracic pressure, which impedes blood flow back to the heart and decreases coronary perfusion.
The six P’s of dyspnea.
Pneumothorax Pneumonia Pump failure Possible foreign body Pulmonary embolis Pulmonary bronchiole constriction
The 3 D’s of Cardiac Tamponade.
Distended jugular veins
Distant heart tones
Decreased blood pressure
Cincinnati Stroke Scale
Ask patient to smile - facial droop
Ask patient to close eyes, hold arms out, palms up - one arm drifts unintentionally
Ask patient to say “The sky is blue in Cincinnati.” - slurred speach, inappropriate word choice
Hypo / Hyperglycemia
Hypoglycemia < 60 mg/dL
Hyperglycemia sustained levels > 120 mg/dL
Above 200 mg/dL, glucose spills into urine; increased urination leads to dehydration.
The 3 P’s of diabetes.
Polyuria - excess urination
Polydipsia - excessive thirst
Polyphagia - excess hunger
Recognize hypoglycemia.
< 60 mg/dL with no symptoms or < 50 mg/dL with symptoms.
Very quickly leads to altered LOC, seizures, comas and death.
Insulin shock is term for severe hypoglycemia.
Sudden unexpected drop in blood glucose.
Taking insulin and forgetting to eat.
Extreme physical activity without adjusting food or insulin.
Insulin overdose.
Causes release of epinephrine to shut down insulin and increase glucagon = leads to cool, dry skin, possible restlessness or irritability, diaphoresis, tachycardia.
