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Advanced MedSurg > Test 4 > Flashcards

Test 4 Flashcards

Peds: GI, Hematology/Oncology, Musculoskeletal, Developmental, Emergency/Disaster, Child Abuse; Burns; Emergency/DIsaster Nursing

1
Q

Often a big issue in infants with cleft lip/cleft palate

A

Feeding difficulty (unable to suck effectively)

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2
Q

Cleft lip repair usually takes place at what age

A

6 to 12 weeks

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3
Q

Most important nursing intervention in cleft lip repair

A

Protect the incision/Prevent tension on suture line (elbow restraints, tape across sutures, place on side/back)

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4
Q

Best way to screen for a cleft palate in infants

A

Look in mouth when crying or palpate the palate with a finger at birth

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5
Q

Position to feed a child with a cleft palate

A

Upright (very important)

Often swallow lots of air, so burp frequently and watch for signs of choking

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6
Q

Children with cleft palates are more at risk for frequent…

A

Ear infections (otitis media)

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7
Q

Techniques for feeding cleft palate infant

A
  1. Sit upright
  2. Use special nipples or devices to decrease reflux
  3. Thicken formula with cereal
  4. Monitor daily weights
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8
Q

Repair of cleft palate usually begins around this age

A

12-18 months (several stages)

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9
Q

After surgery to repair cleft palate, monitor for…

A

Signs of infection
Development of feeding aversions
Parent education need (ability to demonstrate care)

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10
Q

Malformation caused by failure of the esophagus to develop a continuous passage

A

Esophageal Atresia (EA)

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11
Q

Esophagus may or may not form a connection with the trachea

A

Tracheoesophageal Fistula (TEF)

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12
Q

Most common type of EA/TEF

A

C - Proximal Esophageal segment terminates in a blind pouch, distal segment connected to trachea or bronchus by fistula

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13
Q

Clinical Manifestation of EA/TEF

A 
"3 C's"
1. Coughing
2. Choking
3. Cyanosis
Also, excessive drooling, apnea after feeding, abdominal distension
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14
Q

Pre-op Nursing care for a child with EA/TEF includes…

A 
NPO status
Establishment of patent airway
IV fluids
NG/OG tube placement to empty blind pouch
Keep HOB elevated
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15
Q

Signs/Symptoms of Tracheomalacia

A

Barky cough

Intermittent stridor

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16
Q

Saliva-like output in a CT of a child who had surgery for EA/TEF may indicate…

A

Leaks

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17
Q

When educating parents of a patient with EA/TEF, be sure to include…

A

Encouragement of non-nutritive sucking to decrease chances of feeding problems later

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18
Q

The effortless regurgitation of gastric contents (normal in infancy)

A

Gastroesophageal Reflux

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19
Q

Pathologic Reflux - GERD is defined by…

A

Increased number of episodes as related to age associated normals

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20
Q

Complicated Reflux - GERD

A

Pathological reflux with irritability, pain, FTT, aspiration pneumonia, esophagitis, near-miss SIDS, and esophageal stricture

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21
Q

Clinical Manifestations of GERD

A
  1. Excessive, non-bilious vomiting
  2. Esophagitis, irritability
  3. Apnea
  4. Aspiration pneumonia
  5. Weight loss, poor weight gain
  6. Chronic cough
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22
Q

Treatment goal of GERD

A

Protect the esophagus
Prevent apnea
Prevent aspiration

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23
Q

Treatment for children with GERD

A 
Small, frequent feedings
Feed upright
Do not re-feed after spitting up
Do not eat within 2 hours of bedtime
Keep upright for 30 minutes after meals
Use hypoallergenic formula
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24
Q

How much cereal should be added to 1-2 oz of formula when thickening

A

1 teaspoon

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25
Q

Surgery used to treat GERD

A

Nissan fundoplication (wrapping of lower portion of cardia around lower esophagus)

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26
Q

Nursing interventions for child with GER

A 
Avoid use of infant seat
Careful I/O's
Daily weights
Document all emesis, apnea episodes related to feeding
Do all care BEFORE feeding
Hold upright and burp every 1 oz fed
Evaluate parent coping
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27
Q

Symptoms of a GI Obstruction

A 
Colicky, abdominal pain
Abdominal distension, rigidity
N/V, constipation
Dehydration
Decreased bowel sounds
Respiratory distress
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28
Q

Anal malformation without obvious anal opening (may have fistula to perineum or GU system)

A

Imperforate anus

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29
Q

A child with imperforate anus will often require…

A

Temporary colostomy until repair

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30
Q

Congenital aganglionic megacolon that results in mechanical obstruction from inadequate motility of part of the intestine

A

Hirschsprungs Disease

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31
Q

A newborn who fails to pass meconium within 24-48 hours, refuses to feed, has abdominal distension, and bilious vomiting is showing signs of…

A

Hirschprungs Disease

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32
Q

Signs of Hirschprungs Disease in an infant…

A 
FTT
Constipation
Abdominal distension
Diarrhea/vomiting
Enterocolitis
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33
Q

A child with ribbon-like stools and visible peristalsis is showing signs of…

A

Hirschprungs Disease

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34
Q

Treatment of Hirschprungs Disease includes…

A

Stools softeners and removal of the aganglionic portion of intestine
Temporary ostomy is used, then closed when child weighs 20 lbs

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35
Q

Post-op care for Hirschprungs Disease

A

NPO
Monitoring of abdominal girth**
Parental education of ostomy care

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36
Q

Thickening of the pyloric sphincter causing the pyloric channel to become narrow and elongated resulting in dilation, hypertrophy, and hyperperistalsis

A

Pyloric Stenosis

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37
Q

Symptoms of Pyloric Stenosis include…

A

Projectile vomiting**
Olive shaped mass in the epigastric area**
Non-bilious vomiting

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38
Q

Vomiting after correcting of pyloric stenosis is expected to continue 24-48 hours after surgery. True or false?

A

True

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39
Q

Kaleidoscoping of the bowle

A

Intussusception

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40
Q

A child experiencing sudden, acute abdominal pain, current jelly-like stools, and a palpable sausage shape in the upper abdomen is exhibiting signs of…

A

Intussusception

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41
Q

Treatment for intussusception is considered successful when…

A

Child passes brown stool

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42
Q

Remnant of a fetal duct that causes an obstruction

A

Meckel’s Diverticulum

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43
Q

One of the most common causes of abdominal pain and is the most frequent condition that leads to emergent abdominal surgery in children

A

Appendicitis

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44
Q

These are LATE signs of appendicitis

A

Fever and Pain

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45
Q

This symptom is specific for appendicitis (used to differentiate from gastroenteritis)

A

Rebound tenderness

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46
Q

Point on the abdominal wall on the right side where pain is elicited by pressure in acute appendicitis

A

McBurney’s Point

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47
Q

How can you assess a child for peritoneal irritation

A

Have patient walk standing up straight, cough, walk on tiptoes
Palpate for rebound tenderness
Check for Obturator sign
Check for Psoas sign

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48
Q

Patient is supine, flexes the right thigh at the hip with the knee bent and internally rotates the hip

A

Used to assess for peritoneal irritation

Obtruator Sign

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49
Q

Patient lies on left side and extends then flexes the right leg at the hip

A

Used to assess for peritoneal irritation

Psoas Sign

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50
Q

Cause of severe gastroenteritis, most severe in children 3-24 months

A

Rotavirus

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51
Q

How is rotavirus transmitted

A

Fecal-oral route

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52
Q

Symptoms of Rotavirus

A

Frequent, watery, foul-smelling stools that last for 5-7 days
Vomiting and fever for 2 days
Leads to dehydration

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53
Q

Treatment for Rotavirus

A

Fluid replacement

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54
Q

Failure to achieve adequate growth and development

A

Failure to Thrive (FTT)

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55
Q

Cause of rectal itching, most commonly seen in preschoolers

A

Pinworms

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56
Q

A child with rectal itching, an irritated perianal area, decreased appetite, abdominal pain, vomiting, and sleeplessness may be exhibiting signs of…

A

Pinworms

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57
Q

Best prevention of Pinworms

A

Hygiene! (wash hands frequently)

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58
Q

An inherited autosomal recessive disorder that results in sickle shaped red blood cells

A

Sickle Cell Anemia (SCA)

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59
Q

Extremely important in the prevention of Sickle Cell Crisis

A

Hydration!

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60
Q

Risk Factors for Sickle Cell Crisis (Triggers)

A
  1. Hypoxemia
  2. Infection
  3. Dehydration
  4. Fever
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61
Q

Infants with SCA are often asymptomatic early in life due to high quantities of…

A

Fetal Hemoglobin

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62
Q

Symmetric, painful swelling of the hands and feet in infants and small children

A

Hand-food syndrome (finding in SCA)

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63
Q

SCA is characterized by…

A 
Pallor
Hand-foot syndrome
FTT
Acute, painful vaso-occlusive episodes**
Delayed physical and sexual maturation
Increased risk for strep
Shortness of breath, tachycardia
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64
Q

Priapism, necrosis of the femoral head, hematura, and retinopathy are all potential complications of…

A

Sickle Cell Anemia

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65
Q

When caring for a child in Sickle Cell Crisis, the nurse should…

A
  1. Promote rest (decreased O2 consumption)
  2. Pain management
  3. Maintain fluid/electrolyte balance (HYDRATION)
  4. Encourage passive ROM to prevent venous stasis**
  5. Prevent infection
  6. Provide family support
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66
Q

Lack of clotting factors

A

Hemophilia

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67
Q

Hemophilia A (a.k.a. classic hemophilia) results from a deficiency in…

A

Factor VIII

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68
Q

Hemophilia B (a.k.a. Christmas disease) results from a deficiency in…

A

Factor IX

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69
Q

Most common type of internal bleeding in hemophilia patients

A

Hemarthrosis (bleeding into joints)

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70
Q

Hemophilia signs/symptoms

A 
Joint pain and stiffness
Bleeding gums, epistaxis, hematuria, tarry stools
Excessive hematomas and bruising
Decreased ROM and deformitis
Hemarthrosis
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71
Q

Nursing interventions for hemophilia

A

Avoid invasive procedures and rectal temps
Monitor for bleeding
Administer corticosteroids for hemarthrosis
Use NSAIDs with caution (GI bleeding risk)
Observe for factor replacement SE (HA, flushing, alterations in HR or BP, low Na)

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72
Q

Cancer of the blood and bone marrow (most common form of childhood cancer)

A

Leukemia

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73
Q

Most common form of childhood leukemia

A

Acute lymphocytic leukemia (ALL)

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74
Q

This type of leukemia has few or no blast cells

A

Chronic leukemias

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75
Q

Assessment findings in a child with leukemia

A
  1. Bruising, bleeding, frequent nosebleeds
  2. Bone and joint pain
  3. Recurrent infections
  4. Swollen lymph nodes
  5. Fatigue, poor appetite
  6. Hepatosplenomegaly
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76
Q

Definitive diagnosis for leukemia is…

A

Bone marrow biopsy

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77
Q

Nursing considerations for a patient with leukemia

A
  1. Neutropenic precautions
  2. Good nutrition
  3. Rest
  4. Psycho-social considerations
  5. Family education and support
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78
Q

This type of leukemia has the highest overall survival rates

A

Lymphocytic leukemia

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79
Q

When are healthcare personnel required to report child abuse/maltreatment?

A

When there is reasonable cause to suspect that a child is an abused or maltreated child

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80
Q

Normal child bruising areas include…

A

Elbows
Knees
Shins

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81
Q

Suspicious child bruising areas include..

A

Back
Buttocks
Back of thighs
Back of calves

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82
Q

Form of child abuse include…

A
  1. Physical (unexplained bruising/fractures, wary behavior by the child)
  2. Maltreatment/Neglect (poor hygiene, inappropriate clothing, consistent hunger)
  3. Emotional maltreatment (FTT, lagging in physical development, extremes of behavior)
  4. Sexual abuse (painful/itchy genitals, genital bleeding, STDs)
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83
Q

When speaking with a child suspected of abuse be sure to….

A 
Find a private place
Remain calm
Be honest and open
Listen and remain supportive
Emphasize not child's fault
Be non-judgemental ("poker face")
REPORT*
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84
Q

Is certainty or proof required before reporting suspected child abuse?

A

No, only reasonable cause (observations, being told, training)

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85
Q

Within what time frame is an oral report mandated to be submitted on a child suspected of abuse

A

48 hours (only one report required if multiple persons observe the same incident)

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86
Q

Maltreated and abused children are under what age

A

18 years

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87
Q

Failure to report suspected child abuse will result in…

A

Class A misdemeanor

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88
Q

Parents of the suspected child are required to be told that a report is being submitted. True or false?

A

False

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89
Q

Normal intraocular pressure

A

10-21 mmHg

90
Q

Clear liquid between the cornea and iris, and the iris and lens. Drains through the trabecular meshwork.

A

Aqueous Humor

91
Q

Clear, jelly-like fluid that is not replenished

A

Vitreous Humor

92
Q

When eye trauma is suspected, it is important to instruct patient’s not to do this

A

Rub the eye

93
Q

Nursing interventions for a penetrating eye trauma

A

DO NOT REMOVE THE OBJECT

Cover both the affect AND non-affected eye (prevents movement of eyes)

94
Q

Risk factors for a retinal detachment (3)

A
  1. Age
  2. Cataract surgery
  3. Diabetes
95
Q

A patient experiencing light flashes, floaters, and a ring in the field of vision is experiencing symptoms of..

A

Retinal detachment

96
Q

Which herpes eye infection is not treated with steroids?

A

Herpes Simplex Virus Keratitis

97
Q

Atrophy of the optic disc and retinal cells with loss of PERIPHERAL vision, which may advance to loss of central vision if not treated.

A

Glaucoma

98
Q

Most common form of Glaucoma that involves the insidious loss of vision

A

Open Angle Glaucoma

99
Q

Form of glaucoma that involves a bulging lens and excruciating pain

A

Closed Angle Glaucoma

100
Q

Patients with glaucoma should be instructed to inform their doctors of…

A

S/S of infection
Changes in vision
EYE PAIN**

101
Q

Opacity or clouding of the lens

A

Cataract

102
Q

Symptoms of cataract include…

A
  1. Nighttime glare
  2. Reduced vision
  3. Abnormal color perception
  4. Image distortion
103
Q

Patients who recently had cataract surgery should avoid…

A

Bending, coughing, or lifting

104
Q

Most common cause of vision loss in people over 55 that leads to CENTRAL vision loss

A

Age-related Macular Degeneration

105
Q

Yellow exudate of extracellular debris often observed in patients with age-related macular degeneration

A

Drusen

106
Q

What are the two forms of age-related macular degeneration?

A
  1. Dry (Atrophic) - gradual vision loss

2. Wet (Exudative) - rapid progress

107
Q

This form of age-related macular degeneration involves distinct blurred, darkened, or distorted vision

A

Wet (Exudative)

108
Q

Types of Hearing Impairement (3)

A
  1. Conductive
  2. Sensorineural
  3. Mixed
109
Q

Causes of conductive hearing loss include…

A
  1. Perforation of tympanic membrane
  2. Middle ear effusion
  3. Hemorrhage of the middle ear
110
Q

Causes of sensorineural hearing loss include…

A
  1. Damage from noise
  2. Ototoxic Medication
  3. Cranial Nerve VIII damage**
111
Q

Incapacitating vertigo and nystagmus caused by calcium carbonate crystal accumulation. Treatment involves repositioning techniques.

A

Benign Paroxysmal Positional Vertigo (BPPV)

112
Q

Spontaneous disease involving the buildup of fluid in the ear causing fullness, tinnitus, and hearing loss that leads to rupture and severe vertigo

A

Meniere’s Disease

113
Q

Risk factors of Meniere’s Disease (5)

A
  1. Head trauma
  2. URI
  3. Chronic aspirin use
  4. Smoking
  5. Alcohol
114
Q

Diet changes for a patient with Meniere’s Disease involves…

A

Decreased salt intake to decrease fluid retention**

Elimination of caffeine, nicotine, alcohol, high carb foods also

115
Q

Viral URI that causes edema and fluid build-up in the inner ear. Characterized by a bulging, red tympanic membrane and complaints of pain.

A

Otitis media

116
Q

Treatment for Otitis media

A
  1. Antibiotics
  2. Tympanocentesis
  3. Myringotomy
117
Q

Most common form of genetic condition resulting from a variation in chromosome 21

A

Down Syndrome

118
Q

Which type of Down Syndrome chromosome abnormality can be inherited?

A

Translocation

119
Q

Risk factors for Down Syndrome

A

Maternal age over 35

Familial history

120
Q

Characteristics of a Newborn with Down Syndrome

A
  1. Low muscle tone (hypotonia)
  2. Flat facial profile (depressed nasal bridge and small nose)
  3. Oblique palpebral fissures (upward slant to eye)
  4. Epicanthic folds
  5. Dysplastic ear (abnormal shape)
  6. Small mouth (apparent large tongue)
  7. Short neck
  8. Single deep crease across palm, broad hands, short fingers
  9. Deep space between first and second toe
  10. Brushfiled’s spots (white spots on iris)
121
Q

Children with Down Syndrome are more prone to what defects?

A

Cardiac (particularly septal)
Atlantoaxial Instability (neck)
Otitis Media and Hearing loss
Hypotonia

122
Q

Nursing interventions for a child with Down Syndrome

A 
Clear nose prior to feeding
Small, frequent feedings
Prevent constipation (fiber and fluids)
Minimal use of soap
Cool mist vaporizer to keep mucous membranes moist
123
Q

True or False: Children with Down Syndrome should be encouraged to participate in after school activities to develop social skills

A

True

124
Q

Onset of Autism is usually seen before what age?

A

3 years

125
Q

Hallmark sign of Autism Spectrum Disorders (ASD)

A

Impaired social interaction

126
Q

A neurodevelopmental disorder that occurs almost exclusively in females who initially develop normally up to 18 months of age

A

Rett Disorder

127
Q

A female child with deceleration of head growth, stereotypic hand movements, and dementia is exhibiting signs of…

A

Rett Disorder

128
Q

Marked regression in multiple areas of functioning following a period of at least 2 years of apparently normal development

A

Childhood Disintegrative Disorder

129
Q

Individuals with this disorder have better facility with the mechanics of verbal expression, higher levels of cognitive function, and greater interest in interpersonal social activity

A

Asperger Disorder

130
Q

True or False: ASD is more common among children with certain genetic conditions than in the general population

A

True

131
Q

Parents should seek help if their child…

A

Doesn’t play “pretend” games
Doesn’t point at objects to show interest/doesn’t look at objects that are pointed at
Has trouble relating to others/doesn’t have interest in others
Avoids eye contact and wants to be alone
Prefers not to be held or cuddled
Appears unaware when spoken to
Interested in other people, but doesn’t know how to talk/relate to them
Repeats or echo words/phrases (echolalia)
Has trouble expressing needs
Repeats actions
Has trouble adapting to change, unusual reactions to smells/tastes/sounds
Loses skills they once had

132
Q

Red flag for child with ASD

A

Losing skills they once had

133
Q

Nursing interventions for a child with ASD

A 
Cluster care
Maintain routines
Minimize distractions
Advocate
Educate parents about services available
134
Q

The biggest psychological effect of immobilization in children is…

A

Sensory deprivation - leads to feelings of isolation, boredom, and feeling forgotten

135
Q

The primary nursing goal for a child with immobilization is to…

A

minimize the negative effects (sensory deprivation, communication loss, regression)

136
Q

The diet of an immobilized child should be…

A

High protein, high calories
Small, frequent feedings of favorite foods
Mid-range fluid requirements to increase bowel/bladder function

137
Q

The most commonly dislocated joints in children are…

A

fingers and elbows

138
Q

The dislocation or partial subluxation of the radial head caused by a sudden pull or traction on wrist (usually seen in children under 5 years)

A

Nursemaid’s Elbow

139
Q

Most commonly broken bone in children under 10 years old

A

Clavicle

140
Q

Fractures at this location may inhibit bone growth

A

Epiphyseal Plate

141
Q

Two types of Club Foot

A
  1. True club foot - underlying bony deformity

2. Positional - no bone deformity, but may have tightness and shortening of soft tissues

142
Q

Nursing considerations when caring for a child with Club Foot include…

A
  1. Cast care (skin care, circulation)
  2. Parental teaching (monitoring for complications, cleaning)
  3. Encourage/facilitate normal development
143
Q

Abnormal curvature of the spine seen most commonly at the onset of puberty

A

Scoliosis

144
Q

When evaluating a child for scoliosis, the nurse should look for…

A
  1. Asymmetry of shoulder height or scapulas
  2. Asymmetry of hip height
  3. Asymmetry of ribs and flank
145
Q

Surgical management is recommended as treatment for a child with scoliosis if the curvature is…

A

Greater than 45 degrees

146
Q

Biggest reason for non-compliance in the treatment of scoliosis is due to…

A

Body image and unattractive appliances

147
Q

Hip abnormalities that involved a shallow acetabulum, subluxation, and dislocation

A

Dysplasia of the Hip

148
Q

Tests used to determine dysplasia of the hip used in children under 4 weeks of age

A 
Ortolani Test (dislocate hips outwards)
Barlow Test (dislocate hips inwards)
149
Q

Symptoms of Dysplasia of the Hip include…

A
  1. Shorter leg on affected side
  2. Leg on affected side turned outwards
  3. Uneven gluteal folds
  4. Space between the legs appears wider than normal
150
Q

Goal of treatment for a child with Dysplasia of the Hip is…

A

Put femoral head back in socket so that the hip can develop normally

151
Q

This treatment device is worn full-time on babies up to 6 months of age to treat Dysplasia of the Hip

A

Pavlik Harness

152
Q

Group of genetic degenerative diseases characterized by progressive weakness and degeneration of skeletal muscles that control movement

A

Muscular Dystrophy

153
Q

The 3 most common types of muscular dystrophy are…

A
  1. Duchenne (x-linked recessive)
  2. Facioscapulohumeral
  3. Myotonic
154
Q

A child presenting with generalized weakness and muscle wasting affecting the hips, pelvic area, thighs, and shoulders, and has enlarged calves, is exhibiting symptoms of…

A

Duchenne’s Muscular Dystrophy

155
Q

This type of Muscular Dystrophy presents with weakness and wasting of the muscles around the eyes, mouth, and shoulders and usually appears by age 20

A

Facioscapulohumeral Muscular Dystrophy

156
Q

This type of Muscular Dystrophy develops with generalized weakness and muscle wasting with a delayed relaxation of muscles after contraction

A

Myotonic Muscular Dystrophy

157
Q

The goal of treatment for a child with Muscular Dystrophy is…

A

to maintain function for as long as possible

158
Q

An important nursing assessment for a child with Muscular Dystrophy is…

A

Respiratory and cardiac systems (muscle weakness eventually progressive to respiratory and cardiac muscle)

159
Q

Most common types of pediatric emergencies are…

A
  1. Accidental (poisonings, drowning, MVA, bites, wounds)
  2. Respiratory (epiglottitis, Flu, pneumonia, status asthmaticus, FB ingestion)
  3. SIDS
160
Q

The most commonly overdosed medication in children is…

A

Acetaminophen

161
Q

What treatment is given to a child who has overdosed on acetaminophen?

A

Mucomyst given orally

162
Q

A child who has ingested a hydrocarbon (gasoline, kerosene, lighter fluid, paint thinner) should be instructed to induce vomiting. True or False?

A

False - need to be intubated prior to any gastric decontamination

163
Q

A child who has ingested a corrosive substance (cleaners, batteries, bleach, denture cleaner) will exhibit what signs/symptoms?

A

Pain and burning in the mouth
White mucous membranes and edematous lips, tongue
Violent vomiting with hemoptysis, drooling

164
Q

Interventions for a child who has ingested a corrosive substance include…

A

Airway maintenance
NPO status
DO NOT induce vomiting

165
Q

A child presenting with a red rash, itching, and weeping blisters a few days after camping in the woods is exhibiting signs of what type of poisoning?

A

Plant (poison ivy, poison oak, poison sumac)

166
Q

The main cause of drowning in children is…

A

lack of supervision

167
Q

Children should be kept in a rear-facing car seat until what age?

A

2 years

168
Q

Interventions for a child who has been bitten by an animal

A

Cleanse early and a lot
Rabies risk evaluation
Last Td immunization

169
Q

Interventions for a child who has a penetrating wound (nail, fork)

A

Stabilize and do not remove object
Cleanse early and a lot
Last Td immunization
Antibiotic consideration

170
Q

A child presenting with drooling, anxiety, respiratory distress, and the absence of a spontaneous cough (also a potential fever) is exhibiting signs of…

A

Epiglottitis

171
Q

Most important thing to remember when treating a child with Epiglottitis

A

Do NOT put anything in child’s mouth

172
Q

A child presenting with drooling, inspiratory stridor, and anxiety with respiratory distress is exhibiting signs of…

A

Foreign Body Aspiration (hotdogs, coins, buttons, small toys)

173
Q

Death associated with sleeping without signs of suffering

A

SIDS

174
Q

Ways to reduce risk of SIDS in infants

A
  1. Place infant on back to sleep
  2. No second or third hand smoke
  3. Prevent over heating
  4. No soft bedding or covers in the crib
175
Q

Parent education on prevention of pediatric emergencies

A
  1. Use care safety restraints properly
  2. Child proof home (get on their level)
  3. Never leave child unattended by water
  4. Keep medications/cleaning products locked and out of reach
  5. Immunize child and those caring for child
176
Q

This is the most important aspect of emergency nursing

A

Recognition of life threatening illness or injury

177
Q

A five level system/emergency severity index

A

Triage

178
Q

A patient classified as triage ESI Level 1 is…

A

The most unstable. Immediate threat to life.

179
Q

A patient classified as triage ESI Level 2 is…

A

Unstable. Has abnormal vital signs and symptoms that could rapidly progress to life threatening.

180
Q

A patient classified as triage ESI Level 3/4/5 is…

A

Stable with normal vital signs and no threat to life or organs

181
Q

The primary survey in emergency nursing involves…

A 
Identifying life threatening conditions and initiating appropriate interventions
A - Airway
B- Breathing
C - Circulation
D - Disability
E - Exposure/Environmental control
182
Q

The secondary survey in emergency nursing involves…

A

F - Full set of vital signs
G - Giving comfort measures (dependent on situation)
H - History and head-to-toe assessment (clues to cause)
I - Inspection of the posterior surfaces (palpate for deformities, bleeding, lacerations, bruises)

183
Q

A patient presents with a temperature above 99F, is pale, profusely sweating, complaining of thirst, tachycardic, and has an altered mental status. They are exhibiting signs of…

A

Hyperthermia

184
Q

Treatment for hyperthermia includes…

A

Moving patient to a cool area and removing constrictive clothing
Monitoring VS, LOC
Electrolyte replacement and hydration
Education regarding signs/symptoms of heat stroke

185
Q

A patient presenting with a temperature of 95F, is shivering, hypotensive, pale, and has fixed, dilated pupils is showing signs of…

A

Hypothermia

186
Q

Treatment for hypothermia includes…

A

Removing patient from the cold, slowly rewarming
Maintaining ABC’s
Assessing VS, Heart rhythm, glucose
Electrolyte replacement

187
Q

A patient experiencing an acid or alkaline solution poisoning should be given…

A

Water or milk to dilute

188
Q

A patient who is covered with radioactive dust shoudl immediately…

A

Be washed to remove dust

189
Q

How does disaster triage differ from non-disaster triage?

A

Non-disaster triage - Most critically ill is seen first

Disaster triage - Most likely to survive is seen first

190
Q

Priority for a nurse triaging patients in a disaster is…

A

Rapidly determining the seriousness of the injury and likelihood of survival in less than 15 seconds

191
Q

In a nuclear disaster, where are the patients triaged?

A

Outside the hospital

192
Q

Possible bioterrorism agents include…

A

Smallpox

Anthrax

193
Q

The process of removing accumulated contaminants

A

Decontamination

194
Q

Burn victims are initially most at risk for what?

A

Hypovolemic shock from vascular leak

195
Q

Formula for calculating the amount of a fluid a burn victim requires in the first 24 hours

A

Parkland Formula

4cc)(%BSA)(Wt

196
Q

The goal of fluid replacement in burn victims is…

A

Good urine output

197
Q

Should diuretics be used in burn victims to decrease edema?

A

No! Only in special circumstances.

198
Q

What main fluid is used for initial fluid resuscitation in burn victims?

A

Lactated Ringers

199
Q

Three zones of burn wounds

A
  1. Zone of Coagulation - closest to heat source (worst burn area)
  2. Zone of Stasis - surrounding coagulation zone (cell may be salvaged)
  3. Zone of Hyperemia - borders zone of stasis (usually heals spontaneously)
200
Q

A patient comes in with a burn that has erythema and mild discomfort. Which type of burn is exhibited?

A

First-degree

201
Q

A patient comes in with a burn that has blisters, is swollen, and painful. Which type of burn is exhibited?

A

Second-degree

202
Q

A patient comes in with a burn that is waxy-white with some black area, is dry, and is not painful. Which type of burn is exhibited?

A

Third-degree

203
Q

Why do third-degree burns not swell?

A

Loss of skin elasticity. Very high risk for compartment-type syndrome.

204
Q

This is used to determine the amount of surface area of burn on the body

A

Rule of 9’s

205
Q

Which areas of the body are worth 18 in the Rule of 9’s?

A

Posterior Trunk
Anterior Trunk
Full right/left legs

206
Q

Which areas of the body are worth 9 in the Rule of 9’s?

A

Full head

Full right/left arms

207
Q

How much is the perineum area worth in the Rule of 9’s?

A

1

208
Q

Another more accurate way of determining total burn area is to use…

A

Palmar surface area (palm is worth 1%)

209
Q

Methods of treatment for second-degree burns (4)

A
  1. Topical anti-microbials (Bacitracin, Silvadene)
  2. Biological dressings (Pigskin)
  3. Synthetic substances (Biobrane)
  4. Combined dressings (synthetic and biological)
210
Q

Antimicobial most commonly used for minor second-degree burns

A

Bacitracin

211
Q

Why is Xeroflo a better bandage for second-degree burns?

A

Doesn’t stick to the wound when changed

212
Q

How can you tell if pigskin is doing it’s job?

A

Will become translucent

213
Q

Main type of synthetic dressing for burns

A

Biobrane

214
Q

Treatment for a third-degree burn

A 
Skin graft (mesh split thickness)
PT/OT due to loss of elasticity
215
Q

What type of diet should a burn victim have?

A

High protein, high carb diet to meet metabolic demands

216
Q

How is a limb splinted in burn victim?

A

In a position of function, not in a position of comfort

217
Q

Three phases of a burn

A
  1. Resuscitative Phase - large volumes of fluid are being replaced
  2. Acute Phase - wounds identified, treatment started
  3. Rehabilitative Phase - assessing needs and restoring function to patient
218
Q

If a patient comes in with a chemical burn, what is the first intervention?

A

Remove the chemical quickly, flushing skin with copious amounts of water for up to 20 minutes

219
Q

Why is carbon monoxide dangerous?

A

Higher affinity for HgB than O2

220
Q

How are circumferential bandages wrapped on a burn victim?

A

Distal to proximal

Advanced MedSurg (3 decks)

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