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Peds Exam 4 > Trauma part 2 > Flashcards

Trauma part 2 Flashcards

1
Q

What are worried about with spinal injuries?

What is tx focused on?

A

the level because the higher the injury, greater impact of function
- affects respiratory function

The primary issue has happened (again) and so we need to work on the aftermath

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2
Q

Spinal cord injury causes

A

flexion
extension
distraction

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3
Q

T/F

wearing a waist seatbelt without a booster seat or putting seatbelt behind you causes extra risk for spinal cord injury

A

true

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4
Q

How do we assess for spinal injury?

What do we need to be aware of?

A

diagnostic tests like X-ray and CT

Protect the spine during diagnostics
- do C collar for spine. You aren’t allowed to take this off until they’re awake and alert

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5
Q

What positioning is needed for spinal injuries?

How do we move them?

A

midline

log rolling
-which requires another person to stabilize head and neck for safety

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6
Q

Initial treatment for spinal column injury?

What if there’s structure issues like fractures?

A

Steroids - to decrease inflammation and reduce damage from swelling, edema, and pressure.
- reduction of edema to see what the likelihood of functioning is for normal state

Go in and clean it up to decrees risk of bone fx with surgical intervention to prevent further injury

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7
Q

With spinal injuries what might the patient lose?

How do you monitor?

What if there’s hypotension?

A

Loss of Autonomic maintenance responses

  • spinal shock
  • loss of vasodilation

Monitor them very carefully as far as overall response

  • vitals
  • trends
  • fluid changes

If there’s hypotension could mean trauma bleeding somewhere else

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8
Q

Long bones injury description

A

Marked blood loss from fracture that leaves damage to vessels and structures around bones

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9
Q

pelvic fractures need to consider?

A

consider structures beneath the the fx could hurt

- bone movement or splintering essentially

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10
Q

How do we apply compartment syndrome to spinal injury?

P’s to asses this?

A

Spinal injury can cause edema and bleeding into interaction that causes extra pressure and loss of give of the body and so pressure pushes back internally and causes damage

  • assess for paresthesia
  • pallor
  • pain
  • puffiness
  • paralysis
  • pulse
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11
Q

What does Child maltreatment include?

A

Physical abuse or neglect Emotion abuse or neglect

Sexual abuse of childern

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12
Q

Why are children and elderly at higher risk of abuse?

A

Bc they can’t help themselves

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13
Q

Example of how many kids go through maltreatment

A

678k were determined to be victims of maltreatment in 2015

- so there could be more that weren’t reported

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14
Q

Majority of maltreatment cases are what?

what is the other trend?

A

Neglect at 61%

They often can experience more than one tho - neglect, sexual , physical, or emotional
-often 2

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15
Q

T/F

There’s a specific group of people that are abusers

A

false actually no group

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16
Q

How does the decrease of extended family ties impact maltreatment?

How does chronic stress affect maltreatment?

A

That has added to occurrence of maltreatment from lack of support

It increases the risk of maltreatment

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17
Q

How does the use of substances affect maltreatment?

A

The increased alcohol and more substances increases risk of maltreatment

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18
Q

What is corporal punishment? How does this affect maltreatment?

A

Physical punishment like spanking.

It can possibly lead to more abuse.

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19
Q

How does the media and literature affect maltreatment?

A

The level of violence displayed can make it to where there’s more conditioning to accept violence and then it comes out in behaviors.
- the permanence of seeing violence and death doesn’t resonance with us anymore

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20
Q

Which is abuse more likely in:

Old or young parents

types of families

marriage/realtionship situations

isolation of what kind

amount of support

A

young parents

single family

single family with unrelated partner
- the partner isn’t always the abuser tho . it could be the bio parent

social isolation

only a few supportive relationships

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21
Q

alcohol

stress

the cycle

A

substance abuse especially alcohol bc it affects behavior

more stress means less coping and so then it comes out in your own treatment of people

those who have experienced it before turn around do it to their own kid bc they dontknow problem solving skills

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22
Q

esteem

knowledge

A

low self esteem

lack of ability to cope

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23
Q

age of children most abused

term or preterm

A

under age of 1 year bc they cant defend themselves

preterm infants are more likely bc of increased care needs and may have increased financial burden
- parent infant bond may not be normal as well

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24
Q

developmental risk for maltreatment

amount of children

was the pG planned?

A

having disabilities bc it is more stressful

multiples, triplets etc bc that add s more stress

if PG wasn’t planned, it is stressful

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25
Q

common trend of those who do maltreatment

A
  • stressed for whatever reason
  • no coping skills
  • no support from other family to deal with kids
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26
Q

What if the injury and the situation doesn’t match up?

A

consider it could be abuse

- 2 mo old left in center of king size bed and fell off the bed when they were in the center

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27
Q

injury inconsistent with developmental age

A

the child was walking and fell but they aren’t even supposed to be able to walk yet

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28
Q

Adult reluctant to give info

A

Gives a story buts cagy

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29
Q

What if a child comes I more than normal?

A

Could be abuse but it could also be wild kid or anxious parent

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30
Q

Accessing treatment after delayed period for time

A

obvious fx that didn’t get looked at for 3 days alter

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31
Q

Come in with symptoms but no injury

A

comes in w vomiting and abdominal pain but no blow to abdomen

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32
Q

should a child reporting abuse be a sign

What if parent/caregiver reports it

A

yes the child can be honest
- gather info carefully. not every concept of abuse by the child is actually abuse but ask for details

gather details and report suspected abuse

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33
Q

Behavioral indication of abuse in kid

A

Aggressive extreme
Or shy and anxious extreme
different ends of spectrum

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34
Q

fear of caregiver

A

if you notice this this can be a sign

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35
Q

why might a kid be apprehensive with other kids

A

42:45

36
Q

Signs of abuse in older kids

A

running away
drug abuse
gang or cult activity

37
Q

what is emotional abuse

A

when the caretaker has attitudes towards kid that harms development of a sound health personality

38
Q

signs of emotional abuse

A 
rejection
ignoring
blaming
terrorizing 
corrupting the child
contradiction messages
threatening
39
Q

behaviors of child with emotional abuse

habits?

fears?

sleep?

A

biting
rocking
thumb sucking in older kids

anxiety and unrealistic fears

irrational fears , dreads or hatreds

sleep problems nightmares

40
Q

Perpetrator behaviors of sexual abuse

A

Overprotective, jealous individual of child

- doesn’t allow others to interact with kid

41
Q

Signs of sexual abuse health signs

A

STD’s
pregnancy
PID
foreign matter in bladder, rectum , utretha, vagina

42
Q

signs of sexual abuse hints

A

torn, stained, bloody underwear

can’t walk or sit

43
Q

verbal behaviors of kids

A

knowing more about sexual acts and just acting seductive in play

fear of person

44
Q

neglect indicators

A 
poor supervisor/abandoment
lack of necessities like clothing and food
failure to thrive
stealing food
fatigue
extended stays at school
45
Q

why are kids with fatigue a concern

A

if kid is unsupervised are they not on a schedule

46
Q

extended stays at school as neglect

A

parents forget to pick them up

47
Q

kids not coming to school

A

if no one makes a kid go to school then they won’t go

48
Q

why are infant head injuries common?

A

heavy large head, underdeveloped neck that is weak

- bruises on forheads are common but need to know the difference

49
Q

AHT abuse head trauma meaning

A

shaken baby syndrome where the head snaps back and forth that causes damage to brain from bouncing off skull and vessels, nerves are shifted and sheered

50
Q

common manifestations of AHT abuse head trauma

A

bilateral, subdural maybe
subarachnoid hematomas
retinal hemorrhage (1 or 2)
- last 2 are classic

51
Q

where else should you look for AHT signs

A

look at upper arms and rib cage for bruising where they were held

  • can do skeletal x ray
  • look at current and older injuries
52
Q

rib fracture location with AHT

others?

A 
posterior
mid posterior
lateral
anterior
- may not show up on X-ray early on until they try to repair themselves

clavicular/scapula

53
Q

how is AHT figured out or diagnosed?

A 
interviews 
Pred AHT (sort of like a screening tool)
54
Q

what are intentional burns like

A

more surface area
bilateral and patterns
well defined edge

55
Q

signs of water scalding

A

protective areas where the kid withdrew to protect themselves

56
Q

comfortable infant bath degrees

A

100 degrees

57
Q

why is the abdomen a common place for abuse

A

because it is hidden with clothes

58
Q

T/F

a stair fall is common reason for abdominal ages

A

false - the anatomy just doesn’t make sense

59
Q

Signs and symptoms of abdominal injury rt abdominal abuse

A

fever
sepsis
low blood pressure
hypovolemic shock

60
Q

spiral fractures

A

torsion or twisting

61
Q

transverse fracture

A

direct blow or bending

62
Q

why are fractures a cause of concern in kids

A

bc it is hard to break their bones bc they are more flexible

63
Q

what do we need to consider with genital exam for kids suspected of abuse

A

it may make them uncomfortable

- may have to do sedation meds, anesthesia, and analgesics

64
Q

when can forensic kits be gathered for sexual abuse

A

Up to 72-96 hours after abuse

65
Q

female assessment position for sexual abuse

will there be the injuries with sexual abuse?

A

frog legs

no u may not see any
- r/o other causes

66
Q

is abuse by poisoning common

A

no but it can happen

67
Q

body state associated with poisoning

A

persistent acidosis

- can be through vomit or all over the place?

68
Q

What bruising is more from conditions and not abuse?

A

Conditions that make bruising easy

  • leukemia
  • thrombocytopenia can make more bruising
69
Q

why might impetigo be mistaken for abuse

A

it looks like a burn but its an infectious agent

70
Q

osteogenesis imperfecta

A

leads to frequent fractures and so may think it is abuse

71
Q

Mongolian spots

A

can look like bruises

72
Q

Cao Gio scratch the wind and coining

A

rubbing coin in oil on neck, spine, ribs to release bad spirits and restore health
- could leave markings but not abuse

73
Q

Cupping

A

heated rim of a glass applied to skin but it is not abuse

74
Q

Moxibustion

A

Chinese practice cone of wool is ignited and applied to skin as a counterirritation when ill but not abuse

75
Q

when there is a cultural practice that is happening what do you need to consider

A

does it just leave a mark or is it harming harming the kid

76
Q

Caida de Mollera

A

hold chin upside down but not abuse

77
Q

Data gathering for abuse

A

Details and be exact

and ask open ended questions to get them to share info

78
Q

who do you interview first?

A

adults asap and do them seperately

79
Q

dynamics between adult and child

A

note this when it comes to abuse

80
Q

documentation

A

only facts not your opinion , quoatations give charts, and photo

81
Q

confidential admits

A

we leave info of kids ad confidential to protect them and instead give a code
- intensive care unit bc it is easier to supervise there and it is smaller

82
Q

locked units

police

A

Peds units are locked down

police protective custody orders

83
Q

head to toe assessment for documentation

A

is important to get all the information

84
Q

is it just nurses involved with abuse cases?

A

no

social work, DA, law enforcement, home health , SRS

85
Q

misdemeanor for failure to report

A 
class B 
- 1000$ fine or up to 6 months in jail

you must still report even if someone doesn’t
good faith is not a problem

Peds Exam 4 (5 decks)

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