Misc

Question 1

Reference FLACC

Answer 1

Merkel et al. 1997

Question 2

Reference opioid guideline

Answer 2

Royal college of anaesthetics 2020

Question 3

How do NSAIDs work?

Answer 3

Reduce inflammation

Block enzyme cycle-oxygenate

Question 4

Reference analgesia ladder

Answer 4

WHO 2022

Use the more intense analgesia in conjunction with mid

Question 5

Symptoms of neonates in pain

Answer 5

1. unusual - cry, intake, nappies
2. green vomits
3. grows
4. floppy
5. reduced awareness
6. pale
7. wheeze
8. blood in nails
9. increased cap refill
10. rash
11. increased temperature

Question 6

Psysiological differences neonates

Answer 6

1. foremen ovals hole close - pressure in left and right atrium
2. ductus arteriuosus close - increased O2 and maternal prostaglandin constrict - can be held open with prostin medication
3. nose breathers - large epiglottis
4. apnoea
5. less fibres and chest wall compliance
6. horizontal ribs
7. poor elastic

Question 7

Priorities of treating neonates

Answer 7

Golden triangle
1. hypothermia - humid incubator, dry and blankets
2. hypoglycaemia - IV access and TPN - commence feeds
3. hypoxia - O2 therapy and positioning prone try to prevent acidosis

Question 8

normal neonate urine output

Answer 8

2ml/kg/hr

Question 9

Reference PEWS

Answer 9

NHS england 2023

Question 10

SBAR reference

Answer 10

Newman et al. 2023

Situation
Background
Assessment
Recommendations

Question 11

Reference advance life support

Answer 11

Resuscitation council 2021

Question 12

Reference Gilick competence

Answer 12

Scott et al. 2020

Question 13

Reference of reasonable adjustments

Answer 13

Equality Act 2010

Question 14

reference neonates pathophysiology

Answer 14

Glasper 2015

Question 15

Priorities treatment trauma

Answer 15

1. IV acccess
2. Blood gas - eg. glucose (4-7)
3. Fluid bolus - 500ml or 100ml for 10kg - 50ml for 20kg - 30ml
4. blood transfusion - SBAR consult with medical staff - blood type
5. manage major wounds
6. tests - x-ray and CT

Question 16

Reference resus fluids adults?

Answer 16

NICE 2013

Algorithm for IV fluids of adults

Question 17

Reference NEWS2

Answer 17

Royal College of Physicians

2022

Question 18

Child physiology airway

Answer 18

1. large head and short neck with inability to support head
2. large tongue
3. easily compressible floor of mouth
4. under 6 months - nose breathers
5. small diameter airway
6. epiglottis horseshoe shaped
7. larynx high and anterior
8. trachea short and soft - cricoid cartilage narrowest portion of neck
9. increased secretions block airway easily

Question 19

Physiology of children effecting breathing

Answer 19

1. diaphragmatic breathing
2. ribs horizontal
3. reduced chest expansion
4. muscle easily fatigue
5. sternum and ribs cartilaginous
6. chest wall soft and intercostal muscles poorly developed
7. increased metabolic rate
8. increased resp demand for xylene compunction and CO elimination
9. lung comp;i acne and. high chest wall compliance
10. small amount of elastic and collagen tissue

Question 20

Physiology of children effecting circulation

Answer 20

1. circulating blood volume higher per weight than adults
2. stroke volume is small and relatively fixed in infants
3. cardiac output is directly related t heart rate
4. by 2 years myocardial function and response to fluid similar to adults
5. after birth systemic vascular resistance starts rising until adulthood

Question 21

reference child vital signs

Answer 21

glasper et al. 2022

Question 22

Vital signs under 1 year old

Answer 22

RR - 30-40
HR - 110-160
systolic - 70-90

Question 23

Vital signs years 2-5

Answer 23

RR - 20-30
HR - 95-140
systolic - 80-100

Question 24

Vital signs 5-12 years

Answer 24

RR - 15-20
HR - 80-120
systolic - 90-110

GLASPER et al. 2022

Question 25

Vital signs children over 12

Answer 25

RR - 12-20 HR - 60-100 Systolic - 100-120

Question 26

Vital signs adults

Answer 26

RR - 12-20 HR - 60-100 Systolic - 100-139 Peate et al. 2021

Question 27

target Oxygen saturations

Answer 27

94-98% (88-92% COPD) BTS 2017 92-96% Chu et al. 2018

Question 28

Priorities of fever found in children

Answer 28

NICE 2007 - last updated 2021 1. Immediate IV fluid bolus of 10ml/kg of 0.9% sodium chloride (2007) 2. Give immediate parenteral antibiotics if shocked, unrousable or show signs of meningococcal disease (2007) 3. Give IV aciclovir if signs suggest herpes simplex encephalitis (2007) 4. Oxygen if saturations under 92% in air (2007)

Question 29

Symptoms fever children need immediate attention

Answer 29

NICE traffic light - 2013 red 1. pa,le, mottled, ashen or blue 2. not responsive to social cues - not wake when roused or stay awake - weak, high pitched cry 3. grunting 4. tachypnoea - over 60bpm 5. moderate or serve chest indrawing 6. reduced skin turgor 7. temperature more than 38 degrees 8. non-blanching rash 9. bulging fontanelle 10. stiff neck 11. focal seizures - reduced LOC - (herpes simplex encephalitis)

Question 30

Reference traffic lights identify risk of serious illness in child

Answer 30

NICE 2013

Question 31

Normal temperature

Answer 31

normothermia 36.5-37.5 (adult and child with 38 being a fever - NICE 2023 - feverish child) NICE 2013 - surgical site infection

Question 32

What NMC professional values to include?

Answer 32

NMC 2018 1. respect and uphold human rights - convention on the rights of children - health care - 1989 2. work in partnership with patient and family 3. encourage and empower 4. communicate clearly

Question 33

Reference - A-E

Answer 33

Resus council 2021

Question 34

reference NEWS2

Answer 34

NHSE 2017

Question 35

Adult fluid maintainance

Answer 35

25-30 ml/kg/day water Include potassium, sodium or chloride and glucose as required. Algorithm adult fluid - NICE 2013