Gastric

Question 1

Why do infants and children have increased risk of dehydration?

Answer 1

They have increased extracellular fluid percentage and relative increase in body water compared to adults.

Increased basal metabolic
Increased ratio of BSA to body mass
Immature renal function
Increased insensible fluid loss through temperature elevation

Question 2

What happens if you leave dehydration unchecked?

Answer 2

shock.

important to act quickly ro prevent hypovolemic shock.

Question 3

Therapeutic Management: Dehydration

Answer 3

restore appropriate fluid balance and prevent complications

Question 4

Risk Factors: Dehydration

Answer 4

Diarrhea
Vomiting
Decreased oral intake
sustained fever
Diabetic ketoacidosis
Extensive burns

Question 5

Nursing Alert** Dehydration

Answer 5

nurse must be able to assess a child’s hydration status accurately and intervene quickly.

Children > risk for hypovolemic shock. Dehydrated children deteriorate quickly and experience shock.

Question 6

Mild: Dehydration

Answer 6

Alert, normal, extremities prink, brisk capillary refill, UO: may be slightly decreased

Question 7

Moderate Dehydration

Answer 7

listless
fontanels: sunken
oral musocsa: mildly sunken 
Skin turgor: decreased
HR: may be increased
CR: delayed
UO: < 1 ml/kg/hr

Question 8

Severe Dehydration s/s

Answer 8

Alert- comatose
fontanels: sunken
eyes: deeply sunken orbits
Oral mucosa: dry
ST: tenting
HR: Increased progressing to bradycardia
BP: normal > hypotension
Extremities: big capillary refill, cool, mottled, dusky
UO: significantly < 1ml

Question 9

Teaching: Dehydration (Mild-Moderate)

Answer 9

ORS should contain 75 mmol and 13.5 g glusecose
Tap water, milk, undilated fruit juice, and broth are NOT appropriate for oral rehydration
Children with mild to moderate dehydration require 50–100 mL/kg of ORS over 4 hours. After reevaluation, oral rehydration may need to be continued if the child is still dehydrated. When rehydrated, the child can resume a regular diet.

Question 10

Risk Factors: dehydration

Answer 10

diarrhea
vomiting
decreased UO
Diabetic ketoacidosis
extensive burns
high fever

Question 11

Nursing Management: dehyrdation

Answer 11

restore appropriate fluid balance and to prevent complications (hypovolemia)

provide oral hydration to children for mild-moderate

Question 12

Teaching: Severe dehydration

Answer 12

receive IV fluids, initially 20ml/ normal saline then reassess hydration status
-maintenence may be ordered.
0evauluate hydration status and appropriateness of IV fluid orders

Question 13

Etiology: Vomiting

Answer 13

forceful explosion of gastric contents through the mouth. Three phases: prodromal: n/c, signs of autonomic system stimulation
Retching
Vomiting

Question 14

Therapeutic Management: Vomiting

Answer 14

slow oral rehydration and it may require adminitration of antiseptics

Question 15

Nursing Management: Vomitting

Answer 15

promote fluid and electrolyte balance.

Oral rehydration is accomplished successfully for most.

Teach caregivers about oral rehydration

Question 16

Nursing Management Vomiting: mild moderate dehydration

Answer 16

withhold oral dfeeding for 1-2 hours after emesis, after which oral rehydration can begin. Give the infant or child 0.5 -2 of ORS every 15 minutes depending on child’s age and size. As improve, larger amounts tolerated

Question 17

What happens if oral rehydration doesn’t work?

Answer 17

Iv fluids will be ordered.
Antiemetics may be used to help control vomiting and ondansetron Is preferred over promethazine b/c < side effects. Educate family about voting and use of antiemitc therapy

Question 18

Nursing Alert** Vomitting

Answer 18

Ginger capsules, ginger tea, and candied ginger are generally useful for reducing nausea and safe for children over 2, w/ no side effects

Question 19

Diarrhea: Patho

Answer 19

most commonly caused by viruses bu may be related to bacterial or parasitic enteropathogens. May be blood or non bloody.
Often occur with antibiotic use.

Question 20

Risk factors:

Answer 20

ingestion of undercooked meats, foreign travel, day care attendance, well water use

Question 21

Theraputic Management: Diarrhea

Answer 21

supportive (maintaining fluid balance & nutrition) Probiotic supplementation may be useful.

Question 22

Labs: Diarrhea

Answer 22

Stool culture: may indicate presence of bacteria

Stool for ova and parasites (O&P): may indicate the presence of parasites

Stool viral panel or culture: to determine the presence of rotavirus or other viruses

Stool for occult blood: may be positive if inflammation or ulceration is present in the GI tract

Stool for leukocytes: may be positive in cases of inflammation or infection

Stool pH/reducing substances: to see if the diarrhea is caused by carbohydrate intolerance

Electrolyte panel: may indicate dehydration

Abdominal radiographs (KUB): presence of stool in colon may indicate constipation or fecal impaction

Question 23

Causes Chronic Diarrhea: Infants

Answer 23

Intractable diarrhea of infancy
Milk and soy protein intolerance
Infectious enteritis Hirschsprung disease Nutrient malabsorption

Question 24

Causes Chronic Diarrhea Toddlers

Answer 24

Chronic nonspecific diarrhea
Viral enteritis
Giardia
Tumors (secretory diarrhea)
Ulcerative colitis
Celiac disease

Question 25

Causes Chronic Diarrhea School age

Answer 25

Inflammatory bowel disease Appendiceal abscess Lactase deficiency Constipation with encopresis

Question 26

Nursing Management: Diarrhea

Answer 26

restoring fluid balance and providing family education

Question 27

Restoring fluid and electrolyte balance:D

Answer 27

Continue child’s regular diet. Intial is focused on restoring balance and then help encourage the child to consume a regular diet to maintain energy and growth

Question 28

Nursing Alert** Diarrhea

Answer 28

avoid foods high in glucose, may worsen diarrhea

Question 29

Providing family education: D

Answer 29

Teach about oral rehydration therapy

finish all prescribed antibiotic therapy

how to prevent occurrences

hand washing techniques and transmission route.

cause= excessive intake of water or fruit juice, teach appropriate fluid intake

Question 30

What is Nephrotic Syndrome?

Answer 30

increased glomerular basement membrane permeability, which allows abnormal loss of protein in the urine. Nephrotic syndrome generally occurs in three forms—congenital, idiopathic, and secondary.

• Finnish descent
• prognosis; poor; rate

Question 31

What is the most common type of NS?

Answer 31

idopatic; minmial change

-onset by 6

Question 32

Complications of NS?

Answer 32

anemia
infection
poor growth
perionitis
thrombosis
renal failure

Question 33

Pathophysiology: NS

Answer 33

Increased glomerular permeability results in the passage of larger plasma proteins through the glomerular basement membrane. This results in excess loss of protein (albumin) in the urine (proteinuria) and decreased protein and albumin (hypoalbuminemia) in the bloodstream. Protein loss in nephrotic syndrome tends to be almost exclusively albumin.

Question 34

What is proteinuria?

Answer 34

excessive loss of protein in urine

Question 35

What is hypoalbuminemia?

Answer 35

low albumin levels

Question 36

What happens in hypoalubumina?

Answer 36

change in osmotic pressure, and fluid shifts from the bloodstream into the interstitial tissue (causing edema). This decrease in blood volume triggers the kidneys to respond by conserving sodium and water, leading to further edema. The liver senses the protein loss and increases production of lipoproteins. Hyperlipidemia then develops as the excess lipids cannot be excreted in the urine

Question 37

What is associated with hyperlipidemia?

Answer 37

associated with nephrotic syndrome may be quite severe, yet cholesterol levels may decrease when the nephrotic syndrome is in remission, only to rise significantly again with a relapse

Question 38

Rf: Nephrotic Syndrome

Answer 38

risk of clotting (thromboembolism) b/c of decreased intravascular volume

risk of developmental serious infection: pneumococcal pneumonia, or sponstenous perionitis, sepsis

Question 39

Steroid- resistance NS may result in

Answer 39

acute renal failure

Question 40

Therapeutic Management

Answer 40

corticosteroids
Intravenous albumin may be used in the severely edematous child. Diuretics are also required in the edematous phase. Long-term therapy is usually required to induce remission. The nephrologist will determine the length of therapy based on the child’s response. Children who have steroid-responsive MCNS generally have a favorable prognosis. Some children with MCNS exhibit a minimal response to steroid therapy or experience remissions and the MCNS is steroid resistant (Cadnapaphornchai & Lum, 2018). Immunosuppressive therapy such as cyclophosphamide, cyclosporine A, or mycophenolate mofetil may be necessary.

Question 41

S/S Nephrotic Syndrome

Answer 41

Nausea or vomiting (may be related to ascites)
Recent weight gain
History of periorbital edema upon waking, progressing to generalized edema throughout the day

Weakness or fatigue Irritability or fussiness

look for anasarca; abdominal ascites, edema/

Question 42

Labs: NS

Answer 42

Urine dipstick will reveal marked proteinuria. Infrequently, mild hematuria is also present. Serum protein and albumin levels will be low (often markedly so). Serum cholesterol and triglyceride levels are elevated. With continued nephrotic syndrome, creatinine and BUN may become elevated

Question 43

Nursing Management NS

Answer 43

promoting diuresis, preventing infection, promoting adequate nutrition, and educating the parents about ongoing care at home. As with other chronic disorders, provide ongoing emotional support to the child and family.

Question 44

Promote Diuresis : NS

Answer 44

Administer corticosteroids as ordered. Tapering or weaning doses are required when the time comes to stop corticosteroid therapy. Administer diuretics if ordered, usually furosemide. Children may develop hypokalemia because of potassium loss as an adverse effect of furosemide. Those children may require potassium supplementation or a diet higher in potassium-containing foods. Monitor urine output and the amount of protein in the urine (by dipstick). Weigh the child daily on the same scale either naked or wearing the same amount of clothing. Assess for resolution of edema. Measure pulse rate and blood pressure every 4 hours to detect hypovolemia resulting from excessive fluid shifts. Enforce oral fluid restrictions if ordered. In cases of severe hypoalbuminemia, intravenous albumin may be administered. Increases in the serum albumin level cause fluid to shift from the subcutaneous spaces back into the bloodstream. A diuretic such as furosemide administered immediately after the albumin infusion allows for optimal diuresis and prevents fluid overload. Refer to Drug Guide 21.1 for the nursing implications related to use of these medications.

Question 45

Preventing Infection: NS

Answer 45

Monitor the child’s temperature. Administer pneumococcal vaccine as prescribed (see Chapter 9 for information on immunizations). Administer prophylactic antibiotics, if prescribed. Delay administering live vaccines until at least 2 weeks after corticosteroid or other immunosuppressive medication therapy ceases. Teach parents that if the child is unimmunized and is exposed to chickenpox, the parents should notify the child’s pediatrician, nurse practitioner, or nephrologist immediately so that the child may receive varicella zoster immunoglobulin.

Question 46

Encourage Nurtition and Growth: NS

Answer 46

Encourage a nutrient-rich diet within prescribed restrictions. Fluid restriction is reserved for children with massive edema. Sodium intake may be restricted in the edematous child in an effort to prevent further fluid retention. Consultation with the dietitian is often helpful in meal planning because many of the foods that children like are high in sodium. Encourage protein-rich snacks. Consult with the child and family in planning meals and snacks that the child likes and will be likely to consume. Use of nutritional supplement shakes may be helpful for some children.

Question 47

Educating Family: NS

Answer 47

Teach parents how to give medications and monitor for adverse effects. Demonstrate the urine dipstick technique for detecting protein and encourage the family to keep a chart of dipstick results. The child may return to school but should avoid contact with sick playmates. If the child is exposed to another child with an infectious illness, explain to the parents that they should monitor temperature and urine dipstick results more frequently to identify a relapse in nephrotic syndrome early so that treatment can begin.

Question 48

Providing emotional Support: Ns

Answer 48

Nephrotic syndrome is often a chronic condition, and children who are responsive to steroid treatment may enter remission only to experience relapse. This cycle of relapse and remission takes an emotional toll on the child and family. Frequent hospitalizations require the child to miss school and the parents to miss work; this creates further stress for the family. The child may experience social isolation because he or she must avoid exposure to infections or because of self-esteem problems. The child may be dissatisfied with his or her appearance because of edema and weight gain, short stature, and the classic “moon face” associated with chronic steroid use. Provide emotional support to the child and family. Encourage them in their efforts to maintain the treatment plan. Introduce the child to other youngsters with chronic renal conditions. Refer families to the National Kidney Foundation, a link to which can be found on , for information about local support groups and resources.

Question 49

What is Acute poststreptococcal glomerulonephritis (APSGN)

Answer 49

condition in which immune processes injure the glomeruli. Immune mechanisms cause inflammation, which results in altered glomerular structure and function in both kidneys. It often occurs following an infection, usually an upper respiratory or skin infection. APSGN is caused by an antibody–antigen reaction secondary to an infection with a nephritogenic strain of group A β-hemolytic streptococcus. APSGN occurs more frequently in males than females and more frequently over the age of 3, peaking around 7 years of age (Varade, 2017). The most serious complication is progression to uremia and renal failure (either acute or chronic).

Question 50

Medical management: APSGN

Answer 50

Treatment is aimed at maintaining fluid volume and managing hypertension. If there is evidence of a current streptococcal infection, antibiotic therapy will be necessary.

Question 51

S/s APSGN

Answer 51

Fever Lethargy Headache Decreased urine output Abdominal pain Vomiting Anorexia

assess: recent pharyngitis, or strep infection, age > 3 or male

Question 52

Lab/ Diagnostic

Answer 52

Assess the child’s blood pressure for elevation, which is common. Note the presence of mild edema. Observe for signs of cardiopulmonary congestion such as increased work of breathing or cough. Auscultate the lungs for crackles and the heart for gallop. The urine dipstick test will reveal proteinuria as well as hematuria. Inspect the urine for gross hematuria, which will cause the urine to appear tea colored, cola colored, or even a dirty green color. Serum creatinine and BUN may be normal or elevated, the serum complement level is depressed, and the erythrocyte sedimentation rate is elevated. Laboratory findings specific to streptococcus include an elevated antistreptolysin O (ASO) titer and an elevated DNAase B antigen titer.

Question 53

Nursing Management: APGN

Answer 53

Administer antihypertensives such as labetalol or nifedipine and diuretics as ordered. Monitor blood pressure frequently. Maintain sodium and fluid restrictions as prescribed during the initial edematous phase. Weigh the child daily on the same scale wearing the same amount of clothing. Monitor increasing urine output and note improvement in the urine color. Document resolution of edema. Provide a careful neurologic evaluation, as hypertension may cause encephalopathy and seizures. Children with APSGN generally are fatigued and choose bed rest during the acute phase. Provide the child with age-appropriate activities and cluster care to allow rest periods. Some children may be managed at home if edema is mild and they are not hypertensive. Teach the family to monitor urine output and color, take blood pressure measurements, and restrict the diet as prescribed. The child cared for at home should not participate in strenuous activity until proteinuria and hematuria are resolved. If renal involvement progresses, dialysis may become necessary.

Question 54

Nursing Alert**

Answer 54

Avoid use of nonsteroidal anti-inflammatory drugs (NSAIDs) in children with questionable renal function, as the antiprostaglandin action of NSAIDs may cause a further decrease in the glomerular filtration rat

Question 55

Burns

Answer 55

a common preventable mechanism of injury among children and adolescents. Young children are at highest risk for burns and the mortality rate from burns is highest in children younger than 5 years of ag

Question 56

Criteria Burn

Answer 56

Partial thickness burns greater than 10% of total body surface area

Burns that involve the face, the hands and feet, genitalia, perineum, or major joints

Full-thickness burns of any size

Chemical or electrical burns (including lightning injury)
Inhalation injury

Burn injury in children who have pre-existing conditions that might affect their care

Persons with burns and traumatic injuries

Persons who will require special social, emotional, or long-term rehabilitative care

Burned children in a hospital without qualified personnel or equipment for the care of children

Question 57

Superficial burns

Answer 57

involve only epidermal, usually heal without caring or other sequelae within 4-5 days.

Question 58

Partial-thickness burns

Answer 58

injury occurs not only to the epidermis but also to portions of the dermis. These burns usually heal within about 2 weeks and carry a minimal risk of scar formation

Question 59

Deep partial-thickness burns

Answer 59

take longer to heal, may scar, and result in changes in nail and hair appearance as well as sebaceous gland function in the affected area. They may require surgical intervention.

Question 60

Full-thickness burns

Answer 60

Result in significant tissue damage as they extend through the epidermis, dermis, and hypodermis. Extensive scarring results, as hair follicles and sweat glands are destroyed. Full-thickness burns require a significant time to heal. If underlying tendons and/or bone are involved, the burn may be termed fourth degree. Contractures and limited function may occur as a complication of full-thickness burns. Skin grafting is usually necessary. Full or partially circumferential burns may result in ischemia from loss of blood flow related to progressive swelling of the area.

Question 61

Therapeutic Management: burns

Answer 61

Therapeutic management of burns focuses on fluid resuscitation, wound care, prevention of infection, and restoration of function. Burn infections are treated with antibiotics specific to the causative organism. If invasive burn damage occurs, surgery may be necessary.

Question 62

Signs of Child Abuse–Induced Burns

Answer 62

Inconsistent history given when caregivers are interviewed separately

Delay in seeking treatment by caregiver
Uniform appearance of the burn, with clear delineation of burned and nonburned area (as with a hot object applied to the skin) In the case of a scald-induced burn, lack of spattering of water but evidence of so-called “porcelain-contact sparing,” where the portion of the child’s skin that was in contact with the tub or sink is not burned (commonly seen with a forced immersion in extremely hot water used as punishment)

Flexor-sparing burns or burns that involve the dorsum of the hand

A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water)

Question 63

nursing alert** burns

Answer 63

Assess the child’s airway, noting whether it is patent, maintainable, or unmaintainable.

Suspect airway injury from burn or smoke inhalation if any of the following are present: burns around the mouth, nose, or eyes; carbonaceous (black-colored) sputum; hoarseness or stridor.

Evaluate the child’s skin color, respiratory effort, symmetry of breathing, and breath sounds.

Determine the pulse strength, perfusion status, and heart rate.

Note extent and location of edema.

Question 64

Nursing Alert**

Answer 64

Due to overlying blistering, it is difficult to accurately distinguish between partial- and full-thickness burns. In addition, in the case of third-degree burns, it is difficult to estimate burn depth during the initial evaluation.

Question 65

Labs/Diagnostic burns

Answer 65

electrolytes and complete blood count are used to measure fluid and electrolyte balance and to determine the possibility of infection, respectively. If wound infection is suspected, culture of the drainage will determine the particular bacteria. Nutritional indices such as albumin, transferrin, carotene, retinol, copper, cholesterol, calcium, thiamine, riboflavin, pyridoxine, and iron may be evaluated when the child has severe or extensive burns. Pulmonary status may be evaluated via pulse oximetry and end-tidal CO2 monitoring, arterial blood gases, carboxyhemoglobin levels, and chest radiography. Fiberoptic bronchoscopy and xenon ventilation–perfusion scanning may be used to evaluate inhalation injury. Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify cardiac arrhythmias, which can be noted for up to 72 hours after a burn inju

Question 66

nursing management ; burns

Answer 66

Focuses first on stabilizing the child. Place the child on a cardiac/apnea monitor, measure the child with the Broselow tape, monitor pulse oximetry, and apply an end-tidal CO2 monitor if the child is ventilated. Further management focuses on cleansing the burn, pain management, and prevention and treatment of infection. Fluid status and nutrition are important components of burn care, particularly in the early stages. Rehabilitation of the child with severe burns is also an important nursing function. Providing child and family education about the prevention of burns as well as care of burns at home is critical

Question 67

Promoting Oxygenation and Ventilation ; burns

Answer 67

nstitute emergency airway management as needed. If the child requires intubation, make sure that the tracheal tube is taped in a very secure manner, as reintubation in these children will become increasingly difficult as the edema spreads. The burned child’s respiratory status warrants vigilant evaluation and reevaluation, as airway edema that is secondary to a burn may not become evident until 2 days after the injury. Administer 100% oxygen via nonrebreather mask or bag–valve–mask ventilation to all children with severe burns. Continue to reassess the child’s pulmonary status, adjusting the interventions as necessary

Question 68

Restoring and Maintaining Fluid Volume ; burns

Answer 68

Fluid calculation based on the body surface area burned (Fig. 23.22)
Use of a crystalloid (Ringer lactate) during the first 24 hours; in smaller children, a small amount of dextrose may be added

Administration of most of the volume during the first 8 hours (amounts and timing of fluid volume resuscitation will vary from child to child)

Reassessment of the child and adjustment of the fluid rate accordingly; fluid requirements greatly decrease after 24 hours and should be adjusted to reflect this.

Administration of a colloid fluid later in therapy once capillary permeability is less of a concern

Monitoring of the child’s urine output as part of ongoing assessment of response to therapy, expecting at least 1 mL/kg/hr

Daily weights obtained at the same time each day (the best indicator of fluid volume status)

Monitoring of electrolyte levels (particularly sodium and potassium) for their return to normal levels

Question 69

Preventing Hypothermia; burns

Answer 69

Due to the loss of the protective dermis, children who are burned are at high risk for hypothermia and secondary infection. Therefore, take care to keep the child warm. Warm intravenous fluids before administration. Maintain a neutral thermal environment and monitor the child’s temperature frequently.

Question 70

Cleansing the burns

Answer 70

Initially, it is very important to stop the burning. Therefore, remove charred clothing. Wash and rinse the burn thoroughly with mild soap and cool water from the tap. Never apply ice. Children who are burned with tar require special care. Remove tar with cool water and mineral oil. Do not routinely remove blisters because they provide a protective barrier; however, debridement is recommended in certain cases where large blisters impede wound care. Wounds that are open require debridement. Debridement involves the removal of loose skin and eschar (dead, charred skin). This procedure is usually performed with sterile scissors and a pair of forceps or with a gauze sponge. Gently cleanse the burned area; there is no advantage to aggressive scrubbing, and this technique only makes the pain more intense for the child. Wear a gown, mask, head covering, and gloves during dressing changes. Debridement is a necessary, but often excruciatingly painful, procedure. Thus, pain management needs of the child are of utmost importance (refer to the pain management section below). When children return for evaluation of a wound that was previously seen in your facility, remove the dressing. Soak the dressing in lukewarm tap water to ease the removal of gauze, which may be stuck to the wound.

Question 71

role; burns

Answer 71

Have all dressing supplies ready.

Provide pain medication as ordered.

Promote good infection control technique among your colleagues.

Assist with restraining young children, using the positions of comfort previously discussed in relation to atraumatic care

. Encourage participation by the child’s parents.

Talk soothingly to the child, explain what you are going to do, and provide distraction during the procedure.

Question 72

Managing pain

Answer 72

Pain management is of the utmost importance, and several options are available for the treatment of burn-related pain. Local anesthesia, sedatives, and systemic analgesics are commonly used. Children who have less severe burns that are managed at home can be given oral medications such as acetaminophen with codeine 30 to 45 minutes before dressing changes. In burns that result in more severe pain, the child should be hospitalized and given intravenous pain control with medications such as morphine sulfate. Midazolam (a sedative) may be used in conjunction with pain medication for pain reduction during dressing changes. Pain may also occur at any time of the day or night, not just in relation to dressing changes. Assess the child’s pain status frequently using an age-appropriate pain assessment scale. Administer pain medications as prescribed and/or use nonpharmacologic techniques to alleviate or decrease the child’s perception of pain.

Immersion in virtual reality computer games before and during burn dressing changes provides an exceptionally powerful form of cognitive distraction

Question 73

Treating Infected Burns

Answer 73

When an infection is suspected, antibiotics are usually started, pending wound culture results. Administer antibiotics as prescribed or antifungals if necessary.

Question 74

Providing Burn Rehabilitation

Answer 74

Physical therapy will usually be initiated in the critical care setting and will continue long after hospital discharge, sometimes throughout life. Positioning, exercise, and range of motion are necessary to maintain joint flexibility. Nurses play a key role in smoothing the transition from the acute care phase of life-saving interventions and frequent dressing changes to normal activities such as school and play. Body image considerations may have a significant impact on the child when he or she returns to school and should be addressed. Children with altered body image as a result of a burn might benefit from regular counseling and group therapy. Parents often need assistance with the behavioral challenges of caring for a child who is recovering from a burn injury.

Question 75

Preventing Burns and Carbon Monoxide

Answer 75

Keep hot water heater temperature lower than 120°F.
Test bath water temperature before bathing children.
Keep children away from open flames, stoves, and candles.
Cook with pots on the inside of the stove with the handles turned in.

Keep children away from the stove while cooking. Place hot liquids out of reach of children.

Avoid drinking hot beverages while holding a child.

Keep curling irons out of reach of children.

Teach older children how to safely get out of the house in case of fire.

Practice fire drills. Teach children to “stop, drop, and roll” if their clothes catch on fire.
Instruct parents about prevention of carbon monoxide poisoning.
All homes should have working carbon monoxide detectors, and batteries should be changed yearly.

Teach parents the signs of carbon monoxide poisoning: headaches, dizziness, disorientation, and nausea. If the carbon monoxide detector sounds, turn off any potential sources of combustion, if possible, and evacuate all occupants immediately.

Do not attempt to reenter the home until a qualified professional repairs the source of the carbon monoxide leak.

Question 76

For First-Degree (Superficial) Burns

Answer 76

Run cool water over the burned area until the pain lessens.

Do not apply ice to the skin.

Do not apply butter, ointment, or cream.

Cover the burn lightly with a clean, nonadhesive bandage.

Administer acetaminophen or ibuprofen for pain.

Have the child seen by the physician or nurse practitioner within 24 hours.
Ongoing care: clean in tub or shower with fragrance-free mild soap; pat or air dry. Apply a thin layer of antibiotic ointment.
Cover with a nonadherent dressing such as Adaptic, and then cover with dry gauze.

Question 77

For More Extensive Burns

Answer 77

Remove clothing only if it comes off easily or if it is still smoldering. Check the child’s ABCs (airway, breathing, and circulation) and perform cardiopulmonary resuscitation (CPR) if necessary. Do not apply butter, ointment, or any other type of cream. Cover the burn with a clean, lint-free bandage or sheet. Avoid applying large, wet sheets, as this can cause the child to become too cold. Do not attempt to break any blisters. If the child appears to be in shock, elevate the legs while protecting the burn and call 911.