WEEK TEN Flashcards
Peadiatric care considerations
Care has to be age and developmentally appropriate
The child’s primary care giver is included in all planning of care
Paediatric care considerations
Surface area to volume ratio Leads to > heat loss Insensible fluid loss >risk of dehydration/hypothermia < Glycogen stores/>Metabolic rate >risk of hypoglycemic events Fluid requirements based on body weight AGB’s and Eloctrolyte values same as adult (exception of newborn) 02 Delivery adjusted
Paediatric airway considerations
Newborn’s larynx one third diameter of adults Short maxilla and mandible Large tongue Floppy epiglottis Shorter trachea More acute angle of airway
Paediatric breathing considerations
Resp Rate – 40BPM
Poorly developed intercostal/accessory muscles
Tachypnoea – normal response in infants
Slowing of RR may indicate impending collapse – NOT improvement
02 Delivery systems differ
Paediatric oxygen therapy considerations
Nasal Prongs CPAP BiPAP Head Box Adult masks can be used in emergency - inverted
Paediatric airway/breathing assessment
Patency Talking/crying Adventitious sounds Wheeze, stridor, grunting These children need Urgent assessment - ??intubation Resp distress 8yrs Head bobbing Nasal flaring Intercostal/sternal recession Fatigued/flat child – not a good child
Paediatric Airway/breathing conditions
Croup
Acute swelling causing upper airway obstruction
Treat with steroids and nebulised adrenaline
Epiglottitis
Inflammation of the epiglottis
Urgent intubation – nurse upright/supported until ETT
Foreign Body Aspiration
Anything small enough to fit in mouth
Resolution through? Coughing, back blows removal of FB with magill forceps
Broncholitis
Viral – obstruction of small airways resulting in air trapping
Continuous monitoring, SP02 – supportive management
Asthma
Mucosal and immune system dysfunction – Lower resp. tract – inflammation of the airways
Asthma severity assessment (p692), oxygenation, bronchodilation, steroids, magnesium, ? ventilation
Paediatric circulation
Pulses Brachial BP – Age related (p888) Fluid and drugs calculated on weight Urine output 0.5-2mls per hour Calculating child's weight (Age + 4) x 2 Broselow Tape
Hypovelmic shock in children
Commonest form of shock in children, HR not BP
Haemorrhage, trauma, GIT bleeding, burns, peritonitis & diarrhoea.
Responds well to fluid resuscitation
Fluids titrated to maintain adequate cardiovascular function
Septic shock in children
Manifests as hypoxemia, hyperthermia or hypothermic, HR, cap refill, peripheral pulses, cool, mottled, urine output.
Management of shock in children
Assessment ABCDE (rash)
Cardio respiratory monitoring, temperature, urine output, ABG, U&E
Fluid resuscitation, early and aggressive, within first hour, before hypotension develops, O2 therapy
Improve cardiac performance, optimise O2 delivery to tissues
Inotrope/vasopressors (dopamine, dobutamine/adrenaline and noradrenaline)
Elderly considerations
Surgical risk- higher so ICU or HDU admissions
Delirium, sensitive to changes in fluids,
metabolic and nutritional imbalances,
medications and infections
Nosocomial infections, decreased immuno- competence, underlying disease, increased drug adverse reactions
Pain management
Medication use poly-pharmacology,
Depression
Nutrition, physical and social considerations
Intensive care in elderly
Patients may require Intensive care for any of the following: Instability (hypotension/hypertension) Respiratory compromise Cardiac arrhythmias Acute renal failure Multiple organ failure Intensive invasive monitoring Post surgery
