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Peds Exam 4 > Trauma part 2 > Flashcards

Trauma part 2 Flashcards

1
Q

What are worried about with spinal injuries?

What is tx focused on?

A

the level because the higher the injury, greater impact of function
- affects respiratory function

The primary issue has happened (again) and so we need to work on the aftermath

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2
Q

Spinal cord injury causes

A

flexion
extension
distraction

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3
Q

T/F

wearing a waist seatbelt without a booster seat or putting seatbelt behind you causes extra risk for spinal cord injury

A

true

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4
Q

How do we assess for spinal injury?

What do we need to be aware of?

A

diagnostic tests like X-ray and CT

Protect the spine during diagnostics
- do C collar for spine. You aren’t allowed to take this off until they’re awake and alert

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5
Q

What positioning is needed for spinal injuries?

How do we move them?

A

midline

log rolling
-which requires another person to stabilize head and neck for safety

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6
Q

Initial treatment for spinal column injury?

What if there’s structure issues like fractures?

A

Steroids - to decrease inflammation and reduce damage from swelling, edema, and pressure.
- reduction of edema to see what the likelihood of functioning is for normal state

Go in and clean it up to decrees risk of bone fx with surgical intervention to prevent further injury

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7
Q

With spinal injuries what might the patient lose?

How do you monitor?

What if there’s hypotension?

A

Loss of Autonomic maintenance responses

  • spinal shock
  • loss of vasodilation

Monitor them very carefully as far as overall response

  • vitals
  • trends
  • fluid changes

If there’s hypotension could mean trauma bleeding somewhere else

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8
Q

Long bones injury description

A

Marked blood loss from fracture that leaves damage to vessels and structures around bones

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9
Q

pelvic fractures need to consider?

A

consider structures beneath the the fx could hurt

- bone movement or splintering essentially

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10
Q

How do we apply compartment syndrome to spinal injury?

P’s to asses this?

A

Spinal injury can cause edema and bleeding into interaction that causes extra pressure and loss of give of the body and so pressure pushes back internally and causes damage

  • assess for paresthesia
  • pallor
  • pain
  • puffiness
  • paralysis
  • pulse
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11
Q

What does Child maltreatment include?

A

Physical abuse or neglect Emotion abuse or neglect

Sexual abuse of childern

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12
Q

Why are children and elderly at higher risk of abuse?

A

Bc they can’t help themselves

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13
Q

Example of how many kids go through maltreatment

A

678k were determined to be victims of maltreatment in 2015

- so there could be more that weren’t reported

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14
Q

Majority of maltreatment cases are what?

what is the other trend?

A

Neglect at 61%

They often can experience more than one tho - neglect, sexual , physical, or emotional
-often 2

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15
Q

T/F

There’s a specific group of people that are abusers

A

false actually no group

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16
Q

How does the decrease of extended family ties impact maltreatment?

How does chronic stress affect maltreatment?

A

That has added to occurrence of maltreatment from lack of support

It increases the risk of maltreatment

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17
Q

How does the use of substances affect maltreatment?

A

The increased alcohol and more substances increases risk of maltreatment

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18
Q

What is corporal punishment? How does this affect maltreatment?

A

Physical punishment like spanking.

It can possibly lead to more abuse.

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19
Q

How does the media and literature affect maltreatment?

A

The level of violence displayed can make it to where there’s more conditioning to accept violence and then it comes out in behaviors.
- the permanence of seeing violence and death doesn’t resonance with us anymore

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20
Q

Which is abuse more likely in:

Old or young parents

types of families

marriage/realtionship situations

isolation of what kind

amount of support

A

young parents

single family

single family with unrelated partner
- the partner isn’t always the abuser tho . it could be the bio parent

social isolation

only a few supportive relationships

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21
Q

alcohol

stress

the cycle

A

substance abuse especially alcohol bc it affects behavior

more stress means less coping and so then it comes out in your own treatment of people

those who have experienced it before turn around do it to their own kid bc they dontknow problem solving skills

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22
Q

esteem

knowledge

A

low self esteem

lack of ability to cope

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23
Q

age of children most abused

term or preterm

A

under age of 1 year bc they cant defend themselves

preterm infants are more likely bc of increased care needs and may have increased financial burden
- parent infant bond may not be normal as well

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24
Q

developmental risk for maltreatment

amount of children

was the pG planned?

A

having disabilities bc it is more stressful

multiples, triplets etc bc that add s more stress

if PG wasn’t planned, it is stressful

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25
common trend of those who do maltreatment
- stressed for whatever reason - no coping skills - no support from other family to deal with kids
26
What if the injury and the situation doesn't match up?
consider it could be abuse | - 2 mo old left in center of king size bed and fell off the bed when they were in the center
27
injury inconsistent with developmental age
the child was walking and fell but they aren't even supposed to be able to walk yet
28
Adult reluctant to give info
Gives a story buts cagy
29
What if a child comes I more than normal?
Could be abuse but it could also be wild kid or anxious parent
30
Accessing treatment after delayed period for time
obvious fx that didn't get looked at for 3 days alter
31
Come in with symptoms but no injury
comes in w vomiting and abdominal pain but no blow to abdomen
32
should a child reporting abuse be a sign What if parent/caregiver reports it
yes the child can be honest - gather info carefully. not every concept of abuse by the child is actually abuse but ask for details gather details and report suspected abuse
33
Behavioral indication of abuse in kid
Aggressive extreme Or shy and anxious extreme different ends of spectrum
34
fear of caregiver
if you notice this this can be a sign
35
why might a kid be apprehensive with other kids
42:45
36
Signs of abuse in older kids
running away drug abuse gang or cult activity
37
what is emotional abuse
when the caretaker has attitudes towards kid that harms development of a sound health personality
38
signs of emotional abuse
``` rejection ignoring blaming terrorizing corrupting the child contradiction messages threatening ```
39
behaviors of child with emotional abuse habits? fears? sleep?
biting rocking thumb sucking in older kids anxiety and unrealistic fears irrational fears , dreads or hatreds sleep problems nightmares
40
Perpetrator behaviors of sexual abuse
Overprotective, jealous individual of child | - doesn't allow others to interact with kid
41
Signs of sexual abuse health signs
STD's pregnancy PID foreign matter in bladder, rectum , utretha, vagina
42
signs of sexual abuse hints
torn, stained, bloody underwear | can't walk or sit
43
verbal behaviors of kids
knowing more about sexual acts and just acting seductive in play fear of person
44
neglect indicators
``` poor supervisor/abandoment lack of necessities like clothing and food failure to thrive stealing food fatigue extended stays at school ```
45
why are kids with fatigue a concern
if kid is unsupervised are they not on a schedule
46
extended stays at school as neglect
parents forget to pick them up
47
kids not coming to school
if no one makes a kid go to school then they won't go
48
why are infant head injuries common?
heavy large head, underdeveloped neck that is weak | - bruises on forheads are common but need to know the difference
49
AHT abuse head trauma meaning
shaken baby syndrome where the head snaps back and forth that causes damage to brain from bouncing off skull and vessels, nerves are shifted and sheered
50
common manifestations of AHT abuse head trauma
bilateral, subdural maybe subarachnoid hematomas retinal hemorrhage (1 or 2) - last 2 are classic
51
where else should you look for AHT signs
look at upper arms and rib cage for bruising where they were held - can do skeletal x ray - look at current and older injuries
52
rib fracture location with AHT others?
``` posterior mid posterior lateral anterior - may not show up on X-ray early on until they try to repair themselves ``` clavicular/scapula
53
how is AHT figured out or diagnosed?
``` interviews Pred AHT (sort of like a screening tool) ```
54
what are intentional burns like
more surface area bilateral and patterns well defined edge
55
signs of water scalding
protective areas where the kid withdrew to protect themselves
56
comfortable infant bath degrees
100 degrees
57
why is the abdomen a common place for abuse
because it is hidden with clothes
58
T/F a stair fall is common reason for abdominal ages
false - the anatomy just doesn't make sense
59
Signs and symptoms of abdominal injury rt abdominal abuse
fever sepsis low blood pressure hypovolemic shock
60
spiral fractures
torsion or twisting
61
transverse fracture
direct blow or bending
62
why are fractures a cause of concern in kids
bc it is hard to break their bones bc they are more flexible
63
what do we need to consider with genital exam for kids suspected of abuse
it may make them uncomfortable | - may have to do sedation meds, anesthesia, and analgesics
64
when can forensic kits be gathered for sexual abuse
Up to 72-96 hours after abuse
65
female assessment position for sexual abuse will there be the injuries with sexual abuse?
frog legs no u may not see any - r/o other causes
66
is abuse by poisoning common
no but it can happen
67
body state associated with poisoning
persistent acidosis | - can be through vomit or all over the place?
68
What bruising is more from conditions and not abuse?
Conditions that make bruising easy - leukemia - thrombocytopenia can make more bruising
69
why might impetigo be mistaken for abuse
it looks like a burn but its an infectious agent
70
osteogenesis imperfecta
leads to frequent fractures and so may think it is abuse
71
Mongolian spots
can look like bruises
72
Cao Gio scratch the wind and coining
rubbing coin in oil on neck, spine, ribs to release bad spirits and restore health - could leave markings but not abuse
73
Cupping
heated rim of a glass applied to skin but it is not abuse
74
Moxibustion
Chinese practice cone of wool is ignited and applied to skin as a counterirritation when ill but not abuse
75
when there is a cultural practice that is happening what do you need to consider
does it just leave a mark or is it harming harming the kid
76
Caida de Mollera
hold chin upside down but not abuse
77
Data gathering for abuse
Details and be exact | and ask open ended questions to get them to share info
78
who do you interview first?
adults asap and do them seperately
79
dynamics between adult and child
note this when it comes to abuse
80
documentation
only facts not your opinion , quoatations give charts, and photo
81
confidential admits
we leave info of kids ad confidential to protect them and instead give a code - intensive care unit bc it is easier to supervise there and it is smaller
82
locked units police
Peds units are locked down police protective custody orders
83
head to toe assessment for documentation
is important to get all the information
84
is it just nurses involved with abuse cases?
no | social work, DA, law enforcement, home health , SRS
85
misdemeanor for failure to report
``` class B - 1000$ fine or up to 6 months in jail ``` you must still report even if someone doesn't good faith is not a problem

Peds Exam 4 (5 decks)

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