NSER 7210 - Theory > Module 4 - Pediatrics > Flashcards

Module 4 - Pediatrics Flashcards

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1
Q

What is the first thing to assess in children?

A

PAT
(Pediatric Assessment Triangle)

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2
Q

What are the components of PAT?

A
  1. Appearance
  2. Breathing
  3. Circulation
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3
Q

What is assessed during “Appearance” of the PAT?

A
  • Tone
  • Interactiveness
  • Consolability
  • Look/gaze
  • Speech/cry
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4
Q

What is assessed during “Breathing” of the PAT?

A
  • abnormal airway sounds
  • abnormal positioning
  • retractions
  • flaring
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5
Q

What is assess during “Circulation” of the PAT?

A
  • pallor
  • mottling
  • cyanosis
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6
Q

What might you have to do to help position a child for an airway intervention?

A
  • Place a pad/towel under their shoulders
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7
Q

True or False:
Infants < 6 months are obligate nose breathers

A

True

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8
Q

Why might nasal airways be difficult to place in children?

A

Large adenonoids and tonsils that can be traumatized during insertion
- could lead to bleeding and add to airway problem

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9
Q

How is an oral airway placed on a child? Why?

A

Straight in (no rotation like adults)
- prevent damaged to soft palate, tonsils, or teeth

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10
Q

Children have a (higher or lower) metabolic rate compared with adults

A

Higher
- twice the oxygen consumption
- rapidly deplete O2 stores

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11
Q

Why are retractions seen on children in respiratory distress?

A

Thoracic cage is more pliable and intercostal muscles are underdeveloped
- they collapse rather than expand during respiratory distress

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12
Q

What is the primary muscle of respirations in a child?

A

Diaphragm
- causes children to “belly-breathe”

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13
Q

What is a late sign of decreased cardiac output in children?

A

Hypotension

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14
Q

Why are children at greater risk for dehydration?

A

Greater percent of total body weight in water

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15
Q

How do children compensate for decrease in cardiac output?

A

Increase in HR
- limited ability to increase SV

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16
Q

What is the most accurate route of temperature in children?

A

Rectal

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17
Q

What is the 6th vital sign in children?

A

Weight

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18
Q

If a weight cannot be obtained for a child, what can be used instead?

A

Broselow tape

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19
Q

What are the components of the secondary assessment for children?

A

CIAMPEDS
C = chief complaint
I = immunizations / isolation
A = allergies
M = medications
P = past medical history / parent perception
E = events surrounding illness
D = diet / diapers
S = symptoms associated

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20
Q

What can a depressed fontanelle indicate?

A

Sign of moderate to severe dehydration

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21
Q

What can a tense or bulging fontanelle indicate?

A
  • Increased ICP
  • Hematoma
  • Bacterial Meningitis
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22
Q

Under the BC Infants Act, when can a minor consent for their own medical care?

A
  1. Must demonstrate they have the capacity to make a sound decision
  2. HCP must demonstrate they made reasonable efforts to ensure the treatment is in the minor’s best interest
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23
Q

What is a common upper airway problem in children?

A

Croup

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24
Q

What are the signs and symptoms of croup?

A
  • barky cough
  • inspiratory stridor
  • hoarseness
  • respiratory distress
  • usually worsens at night
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25
What is the treatment for croup?
1. Dexamethasone (0.15 - to 0.6 mg/kg PO = max 12mg) 2. Nebulised Epinephrine for moderate to severe croup (1mg/mL injectable formulation)
26
What are some other differentials for Croup?
- Bacterial tracheitis - Retropharyngeal, paraphyaryngeal, peritonsillar abscesses - Epiglottitis - Aspiration of FB - Acute allergic reaction
27
What are two common lower airway problems in children?
1. Bronchiolitis 2. Asthma
28
What is Bronchiolitis?
Inflammation of the smaller bronchioles caused by a virus (RSV, adenovirus, parainfluenza
29
What are signs and symptoms of bronchiolitis?
- runny nose - cough - wheezing - crackles - increase respiratory effort - fever
30
What is the treatment for Bronchiolitis?
SUPPORTIVE CARE - no meds are given!
31
If a child presents with wheezes but no runny nose, what should the child be worked up for?
- Cardiac anomalies - Congenital airway abnormalities - FB aspiration
32
What is Asthma?
Common, chronic inflammatory disorder of the airways associated with airway hyper-responsiveness - lower airway problem!
33
34
What are signs and symptoms of Asthma?
- nasal flaring - instercostal, subcostal, suprasteral indrawing - tachypnea - decreased air entry - scalene retractions - decrease O2 sats - diffuse abdominal pain - cough - irritability
34
What are some triggers of asthma?
- Viral respiratory tract infecton - Exposure to allergens - Lack of good control of asthma at baseline
34
What is the treatment for MILD asthma?
Salbutamol with spacer
35
What is the treatment for MODERATE asthma?
- Salbutamol Q20 mins x3 doses - Corticosteriod (dex, prednisone, prednisolone) - Ipratropium
36
What is the treatment for SEVERE asthma?
- Salbutamol nebulized over 60 - 180 minutes - Magnesium sulfate
37
What happens if an infant's HR is < 60 bpm?
Call a CODE!
38
Why are pediatric patients at increased risk for dehydration and hypovolemia?
- High metabolic needs - larger body surface area - higher proportion of water - increased insensible / evaporative losses - cannot communicate thirst
39
What is the most common cause of dehydration in children?
Gastroenteritis
40
What are signs and symptoms of gastroenteritis?
- acute diarrhea - nausea - vomiting - fever - abdominal pain
41
How do you calculate hourly maintenance fluids for a child < 10 kg?
4 mL/kg/hour
42
How do you calculate hourly maintenance fluids for a child 10-20 kg?
40 mL + 2 mL/kg for every kg > 10 kg
43
How do you calculate hourly maintenance fluids for a child > 20 kg?
60 mL + 1 mL/kg for every kg > 20 kg
44
What is the hourly maintenence fluid for a child weighing 8 kg?
32 mL/hour
45
What is the hourly maintenance fluid for a child weighing 17 kg?
54 mL/hour
46
What is the hourly maintenance fluid for a child weighing 24 kg?
64 mL/hour
47
What is a sign of shock in children?
HR > 160
48
True or False: Children often present with cold shock vs warm shock
True
49
What are red flags for fever in children?
- Fever in a child < 1 month - Lethargy, listlessness, toxic appearance - Respiratory distress - Inconsolability
50
When do febrile seizures commonly appear?
Ages 6 months to 5 years
51
What needs to happen if a child has a febrile seizure?
Tylenol - if < 15 minutes, no neurologic problems, occurs once in 24 hours - NO EEG - NO labs - NO antiepileptics
52
What can be a sign of abuse in a child < 6 months?
Bruises! No cruise ... no bruise
53
If you suspect that a child is maltreated, what do you need to do?
Call MCFD - do NOT need to engage RCMP
54
What age range in children are possessive, have separation anxiety, and are concrete thinkers?
Toddlers (13 months to 2 years)
55
What age range in children are magical thinkers, have big imaginations, are curious, and have little grasp of cause and effect?
Preschool (ages 3-5 years)
56
What age range in children are easily embarrassed, very physically active, understand the concepts of pain, and need to be asked questions directly (not to the parents)?
School-aged children (5-12 years old)
57
What age range in children are taking risks, value independence, value honesty, need to consider mental health and sexual health presentations?
Adolescents (12 - 17 less a day)
58
What is one of the first signs of respiratory distress in children?
Tachypnea - limited ability to increase tidal volume - increase RR instead
59
What increases oxygen demand in children?
- fever - dehydration - illness - infection - physical activity - trauma
60
What happens to preload, cardiac perfusion, and oxygen demand during sinus tachycardia?
1. Decreased preload, decreased ventricular filling time = decreased cardiac output 2. Decreased coronary artery filling time, decreased coronary artery perfusion = decreased cardiac output 3. Increased myocardial oxygen demand
61
What is the Rule of 50 for dextrose in children?
D10 x 5 mL = 50 D25 x 2 mL = 50
62
What is a very important consideration regarding weight based medications in pediatrics?
Do NOT pass adult maximums!
63
What is the standard amount of fluid bolus in pediatrics?
20 mL/kg
64
What is the formula for daily fluid replacement in children?
- < 10 kg = 100mL/kg/day - 10-20 kg = 1000 + 50 mL/kg/day for every kg > 10 - > 20 kg = 1500 + 20mL/kg/day for every kg > 20
65
What is the daily total of fluid for a child weighing 9 kg?
900 mL
66
What is the daily total of fluid for a child weighing 13 kg?
1150 mL (1000 + 150)
67
What is the daily total of fluid for a child weighing 28 kg?
1660 (1500 + 160)
68
What is the fluid bolus amount for a child weighing 14 kg?
280 mL
69
NSER 7210 - Theory
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