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Pediatrics > Peds deck 2 > Flashcards

Peds deck 2 Flashcards

1
Q

_______________ is a GI condition that occurs in prematurely born neonates with significant morbidity and mortality

A

necrotizing enterocolitis

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2
Q

________________ leads to life long problems like short gut syndrome

A

necrotizing enterocolitis

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3
Q

children must not have clear liquids _______ hours prior to surgery

A

2

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4
Q

infants should not have breast milk _________ hours before surgery; formula &/or g-tube feeds ___________ hours before surgery

A

4; 6

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5
Q

children should fast from light meal (apple sauce, plain toast) ______________ hours prior to surgery

A

7-Jun

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6
Q

children should not have full meal (or fatty meal) ____________ hours prior to surgery

A

8

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7
Q

what are your first line monitors in pediatric surgery

A
  1. sight, hearing, and touch 2. hand should always remain on the bag and continue to look at the patient
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8
Q

specific types of perioperative anxiety in the patient 0-6 months

A
  1. maximum stress for parent 2. minimum stress for infants (not old enough to be frightened of strangers)
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9
Q

specific type of perioperative anxiety in the 6 month - 4 year old (toddler)

A

maximum fear of separation from parents

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10
Q

children ages 4-8 source of perioperative anxiety

A
  1. fear of separation 2. concerned about body integrity
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11
Q

perioperative anxiety source for teens

A
  1. fear of loss of control 2. fear of unknown (awareness, pain) 3. issues regarding self-esteem and body image 4. fear of loss of dignity
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12
Q

different sources of anxiety with pediatric surgery

A
  1. pain 2. fear of needles 3. “white coat” 4. separation from parents 5. previous experiences 6. age
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13
Q

strategies to reduce anxiety in the pediatric patient: “ADVANCE”

A
  1. Anxiety reduction 2. Distraction day of surgery 3. Video modelling and education before surgery 4. Adding parents to child surgical experience and promoting family centered care 5. No excessive reassurance 6. Coaching of parents by researchers to help them succeed 7. Exposure/shaping of the child via induction mask practice
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14
Q

different preoperative medications for anxiolysis/sedation in pediatrics

A
  1. midazolam 2. clonidine 3. ketamine 4. diazepam 5. dexmedetomidine
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15
Q

dose of midazolam in peds for anxiolysis/sedation po

A

0.3-0.5 mg/kg up to max of 15 mg

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16
Q

dose of IV midazolam for pediatric preoperative anxiolysis/sedation

A

0.05-1 mg/kg; max = 2mg

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17
Q

clonidine dose for anxiolysis/sedation

A

4-10 mcg/kg po

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18
Q

dose of ketamine for preoperative anxiolysis/sedation po

A

3-5 mg/kg

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19
Q

dose of ketamine for preoperative anxiolysis/sedation IM

A

4-5 mg/kg

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20
Q

what are the main objectives of preanesthetic medication

A
  1. alleviate anxiety 2. block autonomic (vagal) reflexes 3. reduce airway secretions 4. produce amnesia 5. provide prophylaxis against pulmonary aspiration of GI contents 6. facilitate the induction of anesthesia 7. provide analgesia
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21
Q

dose of preoperative diazepam po

A

0.18-0.5 mg/kg

22
Q

dose of preoperative diazepam IV

A

0.04-0.2 mg/kg

23
Q

dexmedetomidine preoperative dose po

A

1-5 mcg/kg

24
Q

dexmedetomidine IV dose (adjunct)

A

0.2 - 1 mcg/kg

25
Q

what is the most common cause of allergic reaction in pediatrics in the OR

A

latex allergy

26
Q

if allergic to ____________, ____________, _________, and/or ____________ the patient is at HIGH risk for latex allergy

A

banana; avocado; kiwi; chestnut

27
Q

what are the specific anesthesia family hx questions you should ask for peds pt undergoing surgery

A
  1. any complications? 2. any bleeding d/o like sickle cell or hemophilia 3. pseduocholinesterase deficiency 4. MH - also with this ask about MD
28
Q

preop questions about birth and neonatal hx

A
  1. full term vs premie vs micropremie 2. apgar scores and birth weight 3. length of hospital stay 4. supplemental oxygen requirements (oxyhood vs NC vs NCPAP vs ett) 5. apnea monitoring
29
Q

if a child comes in for surgery and less than ______________ weeks postconceptional age you should anticpate them being admitted over night for observation due to risk of apnea

A

56

30
Q

preop respiratory questions/assessment

A
  1. hx of asthma 2. recent respiratory infection? 3. bronchopulmonary dysplasia 4. OSA 5. apnea and bradycardia 6. intubation hx 7. environmental tobacco exposure
31
Q

children exposed to passive smoke experience ___________ & __________ 5x more; and have a 3x higher rate of ____________

A

laryngospasm; bronchospasm; obstruction

32
Q

if pts mom says the child had bronchitis last week, what should you do?

A

postpone the surgery 4-6 weeks for pts with lower respiratory infection (bronchitis, PNA) surgery should be postponed for 4-6 weeks d/t hyperreactivity in the airway

33
Q

anesthetic management for child with recent URI

A
  1. optimize the pt 2. ETT vs LMA (if surgery does not require ETT - use LMA bc less stimulating) 3. ensure adequate hydration 4. anticholinergics to dry up secretions 5. premed bronchodilator 6. extubate deep
34
Q

what type of allergies should you ask about in the preop assessment?

A
  1. to drugs 2. to latex (banana, avocado, kiwi, chestnut) 3. food 4. environmental 5. sensitivities
35
Q

what is one of the biggest sensitivities seen in peds

A

to vancomycin

36
Q

in your preop assessment of the pediatric patient, what would you want to know if they have had an anesthetic before

A
  1. GA vs sedation 2. complications? (PONV, MH, drug reactions) 3. respiratory issues 4. previous anesthesia records are helpful
37
Q

wht is the most common anesthetic complication in pediatrics

A

PONV

38
Q

what is the most common medication related allergy in peds

A

pcn

39
Q

what are the three types of “wheezers” (i.e. asthma)

A
  1. atopic 2. nonatopic 3. transient
40
Q

pt comes in and has asthma, seasonal allergies, eczema, they use their inhaler 1-2 x per month, what type of “wheezer” would they be classified as

A

atopic

41
Q

________________ is a “wheezer” (asthma) where the pt is 3 years old has not wheezed in over a year. Last time they wheezed was when they were sick

A

nonatopic

42
Q

Transient Wheezers

A

tend not to wheeze after the age 3 of life. Wheezed early in life and with colds but not any more

43
Q

if pt presents with asthma, what preoperative questions would you want to ask

A
  1. what type of wheezer (atopic, nonatopic, transient) 2. severity 3. meds and frequency that they use those meds
44
Q

if a pt with asthma comes in, but had a zpack 2 weeks ago, what is your next assessment?

A
  1. need to investigate, they probably had an infection within the last 4 weeks 2. also consider the surgery being done
45
Q

step 1 asthma

A

occasional short acting B2 agonist (albuterol) only need when pollen is out or when they get sick

46
Q

step 2 asthma

A

B2 agonist + inhaled corticosteroids

47
Q

step 3 asthma

A

B2 agonist + inhaled corticosteroids + long acting B2 agonist or increased Inh CS

48
Q

step 4 asthma

A

beta 2 agonist + high dose inhaled corticosteroid + long acting B2 agonist or leukotriene receptor antagonist, theophylline or B2-agonist tablet

49
Q

Step 5 asthma

A

B2A + high dose IC + LABA or LTRA + oral steroids

50
Q

CV pediatric preop assessment

A
  1. murmurs? 2. patent “holes in the heart” (ductus arteriosus, foramen ovale) 3. cardiology reports, echo results 4. exercise tolerance or syncopal episodes? 5. htn?

Pediatrics (15 decks)

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