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Special Considerations > Test #2 > Flashcards

Test #2 Flashcards

1
Q

Battery

A
  • Repeated violence
  • This many times is to maintain control
  • To keep fear
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2
Q

Assault

A

Can be physical or non-physical

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3
Q

SANE Nurse

A

Able to do proper exams for woman who have been raped

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4
Q

what is rape?

A

physical penetration,

Tx to SANE nurse.

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5
Q

Red Flag Law

A

if you believe someone is a danger to themselves or someone else, you can report them (60 day limit on weapons).

Court decides if you are able to be stable.

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6
Q

Emotional-Verbal or psychological misuse of another person

A

Includes-Threats, name calling, ignoring, shaming, unfairly, shouting and cursing.

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7
Q

Financial / material exploitation

A

withholding money to exercise control.

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8
Q

Neglect-Failure of a caregiver to provide for the needs of an individual.

A
  • Most common cause of geriatric abuse

- withholding basic human needs.

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9
Q

Who do you report child or elderly abuse to?

A

Hospital and Law Enforcement

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10
Q

What are the cycles of violence?

A

Phase 1-Arguing and verbal abuse
Phase 2-Physical and sexual abuse
Phase 3-Denial and apologizes

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11
Q

what calls do cops get shot on most?

A

Domestic Violence

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12
Q

In Phase 1 of Abuse (arguing and Verbal abuse) - what is seen?

A

Can take place over years, buildup of stress, money is a leading contributor- isn’t the thing, it is finding a catalyst

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13
Q

In Phase 2 of Abuse (Physical and sexual abuse) - what is seen?

A

Build up and build up until there is physical contact and person leaves

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14
Q

In Phase 2 of Abuse (Denial and apologizes) - what is seen?

A

Love is still there or could be retribution. But he comes back apologizes and it won’t happen again (second time is always easier). Cycle continues and evolves and get more intense.

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15
Q

What ages do we ask if pregnant?

A

12-70 yo (always follow up, how do you know.)

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16
Q

Abuse may exacerbate what?

A

exciting medical conditions

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17
Q

What is a common thing that geriatric think when it comes to a house hold?

A

Man controls the woman

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18
Q

parents who beat each other tend to also ____ to kids

A

beat

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19
Q

True or False: children who grow up in abusive homes tend to beat others?

A

True

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20
Q

how many child abuse is happening a year?

A

3 million (about 10,000 die every year)

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21
Q

How many woman are abused each year?

A

2-4 million

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22
Q

What is IPVA in abuse

A

intimate partner violence and abuse

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23
Q

Is it a crime to assault another person physically?

A

Yes
Misdemeanor or a felony depending on:
-Sate Law
-amount of injury inflicted

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24
Q

Estimated how many men are battered a year?

A

200,000

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25
Q

Estimated how many elderly people are abused a year?

A

2 million

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26
Q

what is child abuse and the ages it can occur?

A

child abuse can occur infancy to 18 yo
can be inflated by any care giver.
tends to not be a random person

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27
Q

What is the biggest thing that tells us a kid is being abused?

A

Behavior

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28
Q

What % of woman said their first violence was during abuse?

A

Almost 40% of women say that first time violence was when they were pregnant.

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29
Q

What are the 3 types of child abuse?

A

Physical
Emotional
Sexual
(neglect)

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30
Q

What is the most important thing to do when we get on a child abuse case?

A

Really good physical exam

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31
Q

Neglect

A 
most common form of child abuse
many children suffer more than one type of malnutrition 
dehydration and diarrhea
hair loss
untreated medical conditions
inappropriate, dirty, torn clothing
tired and lethargic
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32
Q

What are some things to look for to see child abuse?

A

bruising on the back of the legs, and on their back, chest

Upper arm bruising is little less common

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33
Q

What are some emotional signs a kid can show that they may be abused?

A
  • they are excessively passive
  • they are overly aggressive (they have fought their whole life and they will fight you too)
  • Don’t look to their parents for reassurance.
  • they are very wary of physical contact
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34
Q

Where would you expect healthy injuries from being a kid?

A
  • Knees, elbows, bruised shins

We must differentiate those differences.

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35
Q

Munchausen’s Syndrome by Proxy

A

People make their kids ill because they enjoy the attention that their kid receives/want attention themselves (attention seeking behavior) The illness/injury may not be done to be fatal but just to injure. (Generally done by women, around 80% of women)

  • may injure the kid to gain attention
  • ## cause the child to be sick
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36
Q

Alopecia

A

sudden hair loss

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37
Q

What causes a scald?

A

Steam

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38
Q

how many should you have with you if you are doing a physical exam on a kid?

A

Two!!! always think about having a witness.

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39
Q

what is key indicator for child abuse?

A

soft tissue injury

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40
Q

what are some the most common burns you will see?

A
  • hot plate
  • light bulb
  • curling iron
  • car cigarette lighter
  • steam iron
  • knife
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41
Q

can kids die from bruising?

A

yes!!!

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42
Q

What is your #1 thing you HAVE to do if you suspect child abuse?

A

Report it

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43
Q

Cultural and medical considerations

A

Things we have to remember from different cultures and how that culture was raised as well as congenital issues?

  • coining
  • Cystic Fibrosis
  • Tetrology of Fallot
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44
Q

Tetralogy of Fallot

A

Tetralogy of Fallot defects cause oxygen-poor blood to flow out of the heart and into the rest of the body. Risk factors include a viral illness such as rubella during pregnancy, maternal alcoholism, or a family history of the condition.
Symptoms include blue-tinged skin and shortness of breath.
Surgery is typically performed the first year of life, followed by ongoing care.

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45
Q

Cystic Fibrosis

A

is an inherited disorder that causes severe damage to the lungs, digestive system and other organs in the body. Cystic fibrosis affects the cells that produce mucus, sweat and digestive juices. These secreted fluids are normally thin and slippery.

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46
Q

Coining

A

Coining is a technique used in treating many illnesses since ancient times. It is a form of dermabrasion therapy still widely practiced in China and South East Asia. This ancient treatment method is employed to rid the body of “heatiness” or “negative energies”

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47
Q

what age is elderly abuse start?

A
  • around 70.
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48
Q

most common elder abuse person is?

A

woman

  • over 75 yo
  • live with the abuser
  • chronic physical or mental impairment
  • socially isolated
  • problematic behavior from the older person
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49
Q

what are the two primary types of elderly abuse?

A
  • inter facility

- who they live with

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50
Q

Profi le of the elder abuser?

A
  • live with victim
  • drug or ETOH users
  • most over age of 50 (sometimes now they can beat since they were first beat)
  • dependent for financial support
  • poor impulse
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51
Q

who is the number one abuser for elder?

A

the child (about 30%)

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52
Q

What are the type of abuse we see with elderly pt?

A
  • Neglect - Lying in their own urine, malnourished, taking their things so that they can move into homes with kids can be considered neglect.
  • Sexual Abuse
  • Abandonment
  • Physical Abuse
  • Emotional-Insults, Threats, Harassment, Humiliation
  • Financial (exploitation, withholding of finances) Social security check, Sudden changes in accounts and financial accounts.
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53
Q

Are we required to report elder abuse?

A

YES.

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54
Q

What is OBRA 1987?

A
  • Right to self-determination, personal and privacy rights, rights regarding abuse and restraints, rights to information, rights to visit, and rights to transfer and discharge.
  • Pt’s have rights, can refuse treatment
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55
Q

Red Flags;

A
  • look at their living environment

- if they are fearful of

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56
Q

Ombudsman

A

one per state

  • advocates for nursing home, residents, relatives, and friends,
  • investigate quality of care
  • reports to licensing authority
  • resource for EMS
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57
Q

What is PACE?

A
  • government program to provide elderly care.

Think Innovage

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58
Q

Intimate Partner Violence and Abuse phases:

A

Phase one: arguing and verbal abuse
Phase two: physical and sexual abuse
Phase three: denial and apologies (“honeymoon phase”)

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59
Q

when does intervention from EMS happen?

A

during phase two and three

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60
Q

what are Mongolian spots?

A

congenital birthmarks seen most commonly over the lumbosacral area. They are bluish-green to black in color and oval to irregular in shape. They are most commonly found in individuals of African or Asian ethnic background.

(looks like a bruise)

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61
Q

why do most men not report abuse?

A
  • humiliation
  • guilt
  • fear to admit loss of control
  • social construct
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62
Q

who is the most abused person?

A

pregnant woman (about 40%)

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63
Q

what age do kids form their closes attachments?

A

age 3

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64
Q

what is sexual assault?

A

Sexual assault-Any unwanted oral, genital, or manual sexual contact

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65
Q

How do you handle sexual assault pt.

A

You have to consider the pt as evidence.

  • don’t let them bath
  • clean up
  • change
  • try to preserve the “crime” scene
  • dont leave the pt alone (chain of evidence)
  • document who was with them
  • SANE nurse will be involved.
  • must be reported.
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66
Q

Do we question the sexual assault victim about the offense?

A

They should not be questioned in detail about the incident.

67
Q

Specific medical questions you should ask sexual assault victim?

A 
Where do you hurt?
Are you bleeding?
You breathing ok?
are you able to swallow ok?
Were you punched or kicked?
questions on any life threats.
68
Q

Psychosocial with sexual assault victims?

A

the trauma of sexual assault creates physical and psychological disorganization. Victims behave in a variety of ways. Victims of sexual assault should not be questioned in detail about the incident. Limit history to elements necessary to provide emergency medical care.

69
Q

some type of injuries of a sexual assault?

A 
bruises around the wrist,
rope burns
sore
mouth injuries
and soft tissue bruising.
bruising around the neck.
70
Q

Stridor

A

upper airway swelling

71
Q

“Nurse-Maid’s Elbow”

A

Picking up by arm or swinging around by arms dislocates elbow=radial head subluxation

72
Q

define anger.

A

Anger is the emotion of control

73
Q

if a sexual assault pt wants to stay and not be transported what should you do?

A
  • call a doc for a refusal

- try and make sure they have a safe person that come stay with them

74
Q

Children in sexual assault

A
  • common
  • usually have frequent contact with assailant
  • assault is often at their home
  • 1 and 10 kids before 18
  • 1 and 7 girls and 1 and 25 boys
  • 7-12% of children
75
Q

Documentation

A
  • what you saw
  • what you heard
  • mechanism
  • what you did
  • how they responded
  • keep your opinions out of it
76
Q

What is our biggest worry about a dehydrated baby?

A
  • they can decompensated very quickly.
77
Q

What makes up the pediatric Triangle?

A
  • Appearance (mental status, muscle tone)
  • Breathing (rate and effort)
  • Circulation (color, cap refil)
78
Q

What does TICLS stand for?

A 
T- tone (activity)
I - interactivity (alertness)
C - consolable (able to be comforted)
L - look (gaze allow movement)
S - speech (strong/weak)
79
Q

What is the most important thing to first think with pediatric airways?

A
  • MAKE IT CLEAR (suction bulbs)

- they are nose breathers (they need to keep it clear)

80
Q

Other than respiratory effects, what is something else you should consider with kids?

A

The kids sugar.

They metabolize much faster.

81
Q

strider

A
  • upper airway
82
Q

wheezing

A
  • broncho constriction
83
Q

Rales

A
  • light watery sound at base of lounges (rice crispy)
84
Q

Rhonchi

A
  • thick course sound (usually have a cough, mucous)
85
Q

what does CAPNO measure?

A

is the measurement of metabolism of O2 in the body, and the release of CO2.

86
Q

What is the fluid dose for Kids?

A

20ml/kg

87
Q

febrile seizure

A

(only occur once per instance), fast rising fever- rate of rise

88
Q

Epilepsy (kids)

A

all other things ruled out or new onset

89
Q

Meningitis (in kids) caused seizure

A

inflammation of meninges causing seizures (look for stiff neck/nuchal rigidity), seizure can’t be broken

90
Q

Diabetic caused seizure

A

not compliant on meds or new onset (High BGL)

91
Q

Head trauma caused seizure

A

abuse, falls

92
Q

Purpura

A

blotchy purple skin (sign of capillaries leaking) its a sign of Sepsis and Meningitis.

93
Q

End Organ perfusion: what is the biggest thing we are looking for?

A

Urine output

94
Q

What is the right urine output for infants and adults?

A

1-2 ml/kg per hour

95
Q

Oliguria

A

the production of abnormally small amounts of urine.

96
Q

< 1 ml/kg/hr of urine output for infants is considered what?

A

Oliguria

97
Q

< .5 ml/kg/hr in Peds is a clinical halmark of renal failure and considered

A

Oliguria

98
Q

What is the lowest a GCS scale can be?

A

3

99
Q

Less than 8 on a GCS scale is a good indication of?

A

intubate

100
Q

If a kid is less than 60 BPM what do you do?

A

CPR

101
Q

if the kid is Brady cardia, what is another thing you should do?

A

O2

102
Q

Asthma

A

Obstruction of lower airway, bronchoconstriction, inc. mucous prod.
inflammation of mucous membranes (air trapping)
It is an exhalation problem

103
Q

Albuterol

A

Sympathomimetic Beta 2 agonist
Infant: 0.05-0.14 mg/kg
2-5 y.o. 0.1-0.15 mg/kg
5 and up: 2.5 mg

Put kid in position of comfort

Consider Rebound: when the neb works, but when stopped they can deescalate very quickly.

104
Q

Atrovent (IPRATROPRIUM)

A

Anticholinergic
0.5 mg / 2.5 ml SVN
Only give one dose

105
Q

METHYLPREDNISONE SODIUM (SOLUMEDROL)

A

Steroid
Decreases the inflammatory response
Pedi: 2mg/kg SIVP

106
Q

If the kid has a very closed airway from broncho constriction, what can we give?

A

Epi - IM
Asthma refractory to Albuterol
Allergic reaction with SOB
0.01 mg/kg IM

107
Q

why do people tripod when they are struggling breathing?

A

To allow us to use all of our accessory muscles. The pecs.

108
Q

what does grunting mean?

A

We are in respiratory distress, and trying to auto peep (to help keep the airway open)

109
Q

What is Peep?

A

Positive end-expiratory pressure

110
Q

What is Laryngotracheobronchitis?

A

Croup

111
Q

Croup is very contagious? (true or false)

A

True

112
Q

What causes croup?

A

Narrowing of larynx to cricoid
Parainfluenza Virus
3 months to 3 yrs

113
Q

Do kids have a high or low fever with croup?

A

lower fever.

114
Q

What are some of the big signs of croup in kids?

A
  • Upper Respiratory Infection
  • Low Grade fever< 102.2
  • Slow onset usually at night
  • Barking cough
  • can get better at night.
115
Q

What med can we give to a kid that has Croup?

A 
Humidified O2
- Keep Comfortable
- Racemic Epinephrine
- SVN  
-0.5 ml of 2.25%
solution in 3ml of saline
116
Q

What does the long term care need for the kid with Croup?

A

Dexamethasone Sodium Phosfate

- Its a steroid that the kid will get in the hospital

117
Q

Racemic Epinephrine

A

Class: Catecholamine, sympathomimetic

-SVN (small volume nebulizer)
-0.5 ml of 2.25% solution
mix in 3ml of saline to give it solution to give it volume to nebulize.

118
Q

What is Bronchiolitis?

A

Respiratory Synctial Virus
Inflammation of lower airways
Usually Self Limiting
December – April

Also known as RSV.

119
Q

What age will Bronchiolitis most likely happen?

A

Under 1 year

120
Q

Signs of a kid having Bronchiolitis?

A
  • Nose Flaring
  • chest wall contractions
  • Hypoxemia and cyanosis
  • Croupy cough
  • Expiratory wheezing, prolonged expiration, rales Tachypnea with apneic and rhonchi episodes
  • Tachypnea with apneic and rhonchi episodes
121
Q

Signs and Symptoms of Bronchiolitis?

A

Wheezing
Tachypnea
Upper respiratory infection
Otitis media (ear infection)

122
Q

what is Otitis Media?

A

Ear infection

123
Q

Treatment for Bronchiolitis?

A

Hi flow O2
Transport
Get the boogers out!

If there is some wheezing you can try and give some albuterol.

124
Q

what is EPIGLOTTITIS?

A

This is a bacterial infection

  • High Fever
  • This is a big airway problem, you must take them to the hospital.
Swelling of the
epiglottis 
- H-influenza B 
- Critical airway
problem 
-Age 3-7 yrs but
not exclusive (adults are being seen with this also.)
125
Q

What are signs and symptoms for Epiglottitis?

A
  • Sudden onset
  • Sore throat
  • High fever
  • Drooling
  • ‘Sniff Position
126
Q

Treatment for Epiglottitis?

A 
Handle gently (especially airway RX)
Keep Sitting

Do not attempt to visualize
Hi flow O2

NO IV (IV only if in resp. failure) This is what can upset a kid.

Watch closely
Prepare for airway control

127
Q

What is Tracheitis?

A
  • this will look like croup, if it gets better its croup, if it does not get better then its Tracheitis.
  • They will have a higher temp. (fever)
  • Bacterial
  • Staphylococcus aureus
  • More common than epiglottitis
  • Commonly seen with pneumonia
  • Do not respond to typical croup treatments
  • Upper respiratory infection that progresses
128
Q

S/S of Tracheitis:

A 
Inspiratory stridor 
Barking cough 
Hoarsness 
Moderate to high fever 
No drooling 
Will not respond to racemic epi
129
Q

Treatment for Tracheitis:

A

Supportive care
Oxygen
Prepare for advanced airway
Smaller tube necessary

130
Q

What do you do for a child or person that has “swallowed” tongue?

A

Adjust their airway, tilt head to sniffing position

131
Q

S/S of someone that has foreign body in their airway?

A
  • Acute respiratory distress
  • Stridor (partial)
  • No air movement (Full Obstruction)
  • Drooling
  • HX of choking
132
Q

What are some things todo to get things out of a persons airway?

A
  • Magills
  • abd thrust
  • keep them calm
  • position of comfort

If you can not get it out, shelve it farther down (right sided) so we can at least vent one side

133
Q

What are some things that we will see with kids with new onset of type 1 Hyperglycemia?

A
  • They will be more irritable
  • Not behaving well
  • They will have:
    • Polyphesia
    • Polydipsia
    • Polyuria
134
Q

Treatment for hypoglycemia?

A

D10

0.5 – 1 g/kg (kids)

135
Q

What is SIDS?

A

Sudden Infant Death Syndrome

136
Q

What causes SIDS?

A 
they really dont know.
Stats show:
- race: non whites
- Social: Lower socioeconomic
- Birth: Premature, low APGAR when born
137
Q

Seizures in kids can look like?

A
  • Younger than 6 years of age:
  • Less complex behaviors, more fragmented
    activity
  • Tonic-clonic and absence seizure extremely
    uncommon in first two years
    -Generally we will not see Tonic-Clonic in newborn (no real muscle mass)
138
Q

What is partial (focal) seizure?

A

limited to one hemisphere

139
Q

Simple partial seizure?

A
  • Awareness is not impacted (able to respond

normally)

140
Q

Complex partial seizure?

A
  • Awareness is impacted (not able to respond

normally)

141
Q

What are Generalized seizure?

A
  • Begin in one hemisphere and rapidly spread
    bilaterally
  • Absence
  • Tonic-clonic
142
Q

What is a status seizure?

A

5 minuets of uninterrupted seizure.

143
Q

will viral or bacterial meningitis kill you?

A

bacterial

144
Q

when do we assume meningitis with a seizure?

A

If the seizure does not stop. (even with treatment)

145
Q

Seizure treatment;

A
  • secure airway
  • O2 (most common cause of death in seizures is anoxia)
  • Valium (0.5 mg/kg)
  • Versed IN 0.02mg/kg
  • D10, 25 (If still post-ictle)
  • Antipyretic (Tylenol)
  • Watch for recurrent seizures
146
Q

What are Ventriculoperitoneal (VP shunts) ?

A

Hydrocephalus
Can drain
- Right atrium
- Pleural space

147
Q

what causes bradycardia in infants?

A

respiratory

148
Q

types of CONGENITAL HEART DEFECTS:

A 
Atrial Septal Defects -9.8%
Patent ductus arteriosus - 9.7%
Ventricular Septal Defects - 30.5%
TGA - 4.2%
Tetrology of Fallot - 5.8%
Other - 16.5%
149
Q

What are some of the One Pill Killers?

A 
Oral hypoglycemia 
Beta Blockers
Calcium Channel Blockers
alpha 2- adrenergic agonist
cyclic antidepressants
opioids
Buprenorphine
150
Q

What kills more kids than anything else?

A

Trauma

151
Q

What is the biggest concern in trauma with kids?

A

Shock (they have less blood volume to compensate)

152
Q

Shock considerations in kids:

A 
 Circulating blood volume
 Body surface area
 Hypothermia
 Cardiac reserve
 Respiratory fatigue
153
Q

Why must we stop hemorrhages in kids!!!!

A

we worry about blood loss.

154
Q

Falls with kids:

A
  • Off balance
  • Lack of nerve development
  • Small feet compared to body
  • Curiosity
155
Q

What type of trauma is a leading cause of death in kids?

A

Motor Vehicle Crash

  • No or improper car seats
  • For gotten pts
  • 37 deaths a year
156
Q

what are Epidural Bleeds?

A
  • fast on set

- arterial (high pressure) bleeds

157
Q

What are subdural Bleeds?

A
  • Slow onset

- venous (low pressure) bleeds

158
Q

what do we do with close head injuries?

A
  • O2
  • get a line if the kid is seizing
  • manage airway
  • spinal immobilization
  • rule out other causes
159
Q

Thoracic Trauma has a very _____ mortality rate?

Why?

A

High

  • their thoracic cavity if very compact and small.
  • Flexible chest wall
  • thoracic and abdominal injuries
160
Q

What are the rule of 9s rule for kids?

good thing to look up

A

Legs- 13.5%

Head- 18%

161
Q

what is ALTE?

A

Apparent Life- Threating Event
- American Academy of Pediatrics recommended removing “life-treating”

  • We no longer use this criteria to determine if we transport the pediatric pt.
162
Q

Now we have, BRUE, what does that stand for?

A

Brief, Resolved, Unexplained Event

  • < 1min
  • < 1 y.o.
  • > = one of the following
  • absent, decreased, irregular breathing
  • cyanosis or pallor
  • altered level of responsiveness
  • marked change in muscle tone

We dont need to transport the kid.

163
Q

what is the difference in low risk and high risk BRUE?

A

Low Risk:
 Age >60 days
 Gestational age >32 wk
 One event only (no repeat or cluster of BRUE)
 No CPR required
 No concerning history (abuse, family hx of
sudden death)  Normal physical exam

High Risk:
 Those that don’t meet low risk criteria
- Go to the hospital

164
Q

If you suspect the pediatric is in cardiac shock what amount of fluid should you consider?

A

5-10 ml/kg

Special Considerations (4 decks)

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