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Flashcards in Peds Final Deck (43):
0


Glasgow coma scale - The Glasgow Coma Scale assesses eye opening,

1. Eye opening
2. Verbal response
3. Motor response

1

Signs of increased intracranial pressure. Infant verses older child

Separation of cranial features. Poor feeding.
Vomiting.
Irritability.
Headache. Slurred speech.
Lethargy. Bulging Fontenalr.

2

Abscsnce

Blank stair Absence seizures are very brief episodes of altered awareness. The child has a blank expression. Daydream episodes are suggestive of absence seizures, and data about activity associated with the daydreams should be obtained.

3


Atonic Seizures

Atonic seizures cause an abrupt loss of postural tone, loss of consciousness, confusion, lethargy, and sleep.

1st Action to Take when Child has Seizure? Turn the child on their side to prevent ASPIRATION

What will you see in a child after a tonic clonic seizure? Fatigue

4


Tonic Clonic Seizures
1. Ativan is What is one of the 1st drugs given in the ER for a Tonic-clonic seizure?

Tonic-clonic seizures involve sustained generalized muscle contractions followed by alternating contraction and relaxation of major muscle groups.
There is no change in level of consciousness with simple partial seizures. Simple partial seizures consist of motor, autonomic, or sensory symptoms.
1. Cause an abrupt arrest of activity and impairment of consciousness
2. Tonic phase consists of a sustained generalized stiffening of muscles
3. Clonic phase is symmetrical and rhythmic, consisting of alternating contraction and relaxation of major muscle groups
4. Tonic-clonic seizure is followed by a variable period of confusion, lethargy , and sleep (postictal phase)

5

Focal
Status
Status Epilepticus 1. A prolonged seizure lasting more than 30 minutes with no return to a normal level of consciousness
2. Most common form of status epilepticus is generalized status, which has the highest potential for complications and possible death

Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected.
Partial seizures are caused by abnormal electric discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex.
Generalized seizures indicate that the initial involvement is from both hemispheres.
Acquired seizures- A seizure disorder that is acquired is a result of a brain injury from a variety of factors; it does not specify the type of seizure.

6

Loc

Level of consciousness:
The most important nursing observation after a head injury is assessment of the child’s level of consciousness. Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs.

7

Disoriented

1. Awake, alert, oriented, interacts w/ environment
Confused. 1. Lacks ability to think clearly and rapidly
-Usually oriented to person
Delirious 1. Not oriented to person, place, or time
2. Impairment of reality with auditory or visual hallucinations possible
Disoriented Lacks ability to recognize place or person
Lethargic Very drowsy and needs increased stimuli to be awakened
Stupor. Requires vigorous stimulation to arouse
ComaVigorous stimulation produces no motor or verbal response

8

Aspiration

Aspiration

Foreign body aspirations.
1. Latex balloons account for a significant number of deaths from aspiration
2. Occurs most frequently in children younger than 2 years of age
1. Foreign body aspiration is seen most frequently in children ages 6 months to 5 years
1. Most foreign bodies become lodged in the bronchi (Right side)
1. Sudden, violent coughing
2. Gagging
3. Wheezing
4. Vomiting
5. Brief episodes of apnea, and possible cyanosis
Lodge in brochi. Right. Brochi.
Liquid assess for gag reflexes.

Candy. Hot dog. Peanuts. Grape. Raising. Chew gum

9

Head injury

Most Important Thing to assess after head injury is? ....LOC
Second Impact syndrome A second concussion may cause more harm to the brain and may even lead to death
2. Talk with health provider before child returns to activities or sports
Head Injury Can Cause? Change in a child's behavior

10

Tonic Tonic-clonic seizures X3 questions

Tonic seizures
Tonic-clonic seizures involve sustained generalized muscle contractions followed by alternating contraction and relaxation of major muscle groups.
There is no change in level of consciousness with simple partial seizures. Simple partial seizures consist of motor, autonomic, or sensory symptoms.
1. The tonic-clonic seizure is followed by a variable period of confusion, lethargy and sleep (postictal phase)

11

Absence seizures X3 questions

Absence seizure Blank stair Absence seizures are very brief episodes of altered awareness. The child has a blank expression. Daydream episodes are suggestive of absence seizures, and data about activity associated with the daydreams should be obtained.

1. No muscle activity occurs except for upward rolling of the eyes
2. The child has a blank facial expression
3. Only last 5 to 10 seconds or less
-may occur hundreds of times per day
4. Children immediately return to activity they were participating in prior to the seizure ***

12


Atonic seizures X 2 questions

Atomic
Atonic seizures cause an abrupt loss of postural tone, loss of consciousness, confusion, lethargy, and sleep.
1. Cause an abrupt loss of postural tone
2. Child may experience head drop or a drop attack
-fall to the ground, often face down, lose consciousness for a few seconds

13


Dilantin Administrations

Dilantin
Oral care due to meticulous.
IV given normal saline.
Filtered.
Big veins.
good dental hygiene
adequate intake of vitamin D
avoid dairy products

14


IM injections in children by age X 2 questions

Faster.
22 to 25 gauge.
1/2 inch.

Infant. 0. 5. Ml.
Adolescent 3 ml.
90 degree and aspirate.
Vastus laterallas. Or deltoid.

15


Choking in children by age X2

Chocking upright. Side lying.
90% deaths of peds.

16

Eardrops

Ear drops Ears. Pull piña down and back. Younger than 3 years.
Older than 3. Pull pinna up and back.
Hand hygien. Gloveee

17


Priority drugs during a seizure

Ativan or Valium. IV

Lorazepam. Tegetol.

18



Nursing intervention during a seizure

Pad rails.
Safety.low position.
Oxygen.
Abcdes. Immobzasw nake. Nero assessment.

19


Level of Consciousness


Loc

20

Ketogenoc diet

Ketogenic diety. Fat. Protein. No carb.

Comsitspation
Dehydration. Vitamin defficiet. Gall stone.

21


Cardiopulmonary arrest priority 851

Cardio pulmonary

Respiratory stabilization.
Look for skin color. Response to envin. Tach
Decrease peripheral rate are early signs ........hypotension. Late sign.

Bag

22


Emergency triage

Emerge cy triage

Abcdes. Reps. Skin color. Response to environment.

23


Oral medication administration

Oral med
Formula decreases absorption.
Slow gastric emptying and have less gastric acid and have more digestive enzyms

Assess gag reflexes. Prepare using string less that 5 ml.
Cup up to 30 ml put the meds
.....NON essential food.....
Never in formula.

Admi. Upright strkng along side the chick .

24


Abdominal assessment


Inspect
Austate first.
Puercise and
Palate.

Pulses. Brachial. 0-1
Carotid. Femor. 1 above
BlDder empty. Inspect.
Scaphoid. They are malnourished. Listen to one quardrsht for 5 minutes


25

Obtunded X2

Obtunded X2

1. Sleeps unless aroused
2. Once aroused has limited interaction with the environment
3. Answers questions with minimal response

26


Assessing a child’s respiration

Child Resp

Observe abdomen.

30. 60
4 years 20_40
10 yrs 16-22
16 years. 15-20.
Influenced by exercise and emotions
1 full MINUTE

27


Eyedrops X2

After let them look down close eyes for several sec.
Put into conjunctiva sac. Edge of the Lowe lid from the Inner to outer contnus

28

IV line

Assess development level

Not in toddlers foot.
Not in dominant hand.
Scalp used in infants. No valves. Use. House. Boards.

Assess every HOUr of the rate and quantity.






IV line check
10 kg. 100ml/kg /day.
10 to 20 kg 1000 ml/ day plus 50 ml/kg/day.
Over 20 kg. 1500ml/day plus 20 ml/kg/day. M

29


Dental emergency

Dental emergecny
Check for aspiration of the tooth.
Lack of cordinaction

30


Submersion injury/drowning

Airway suction. CPR. Maintain oxygen and circulation
Hypoxia. Panic. No air. Swallow and vomit water. Largia spasm

Electro shift
Celebes Edema
CPR. Air.

31


Triage priority

Triage prior
Abscdes. Initial observation.

32


Assessing pulse per age X2

Pulse per age
Newborn 120 160

80 to 125
70 to 110.
55 to 90. Apical for children younger 2.

33


Fontanel assessment anterior vs posterior


Fontenalr
Posterior close by 2-3 months.
Anterior should be soft flat closed btn 12 to 24 months.

Sunken. Dehydration.
Bulging Icp normal wen child cries

34


Increased intracranial assessment X2


Icp. Blood. Brain increases the rest decreases.

Behavior. Late opening

35


Respiratory distress in the child


RDS retractions

36


Liquid medication administration

Liquid meg

37


Leading cause of child death


Lead cause of child desth
Burns leading for unintentional deaths motor vehicle injustices highest desth

Drowning leading desth of age 1 to 4

Head injuries.

38


Common cause of infant death and injury

Common cause of infant death

Burns leadin cause of unintentional deaths on children 1 to 14. US. Scald burn most common. Kitchen injuries. Lack of super ions

Drowning mostly. 1-4 Motor vehicle. 19

Suffocation.

39


Choking by age X2

Chocking by age

Aspiration of objects. Causing partial or complete obstruction

6 months. Poor swallowing coordination.
Hot dog. Sliced hard can day. Peanut. Grapes. Raisin. Chewing gum.
Balloons not given to infants or young children.

40


Poison

Stabilizing child. Highest intervention. Abcde.

Poison
History and treat the child with innitial signs snd symptoms.

ABCDE. AND stablize the child oxygen.
ALoc intubation the child.

IV wen child in shock.
Sat abd ECG needed.

Give antidote. Charcoal. Dilute never force Child to puke.
BP. Urine and tissue perfusion.

41


Burn assessment priorities


Burn assessment

Assess the temp. To determine rapid heat loss leading to hypothermia.


Pain level.

Airway breathing circulating. Major burn. Assess urine outputs.
Child with 10% burn. Requires fluid resuscitopn.

42


Hourly maintenance

Hourly maintaince

IV site. Rate of onfusion.

10 kg or less 100 mg.

10 to 20 . 1000 ml + 50 ml xkg more.

20 and obove. 1500 + 20 ml x kg