What is a thoracic aortic dissection?
This is when there is a tear in the intimal layer of the vessel. This creates a false channel which leads to dissection due to shear force of blood entering this false channel.
What is ARF?
Acute respiratory failure. When the lungs do not provide sufficient gas exchange to meet the body’s need for oxygen consumption, CO2 elimination or both.
The Australasian Triage Scale (ATS) is the most commonly used 5 level triage scale being used. List the 5 levels.
- Immediately life-threatening (imminent risk of deterioration)
- Imminently life-threatening (high risk of deterioration)
- Potentially life threatening or situational urgency
- Potentially serious
- Less urgent
SOAPIE is an aid in triage assessment. List what this mnemonic stands for.
S= subjective data O= objective data A= assessment (to enable formulation of a) P = plan (that is) I = implemented (and) E= evaluated (as to its success)
AMPLE is an aid used in triage assessment. List what this mnemonic stands for.
A = allergies M = medications P = past medical hx L= last for food and fluids ingested E = environmental factors and events leading to the presentation
PQRST is an aid used in triage assessment. List what this mnemonic stands for.
P = provoking or precipitating factors Q = quality and quantity (severity) of the symptom R= region/radiation S= symptoms associated T= time of onset and duration of episode, and treatment.
Indirect evidence of poor systemic perfusion in infants may include? (list at least 4)
- feeding difficulties
- abdominal distension
- fluid imbalances
- hypoglycaemia
- hypocalcaemia
- apnoea
- lethargy
- irritability
the paediatric airway is characterised and differentiated from an adult airway by? List 4
- short maxilla and mandible
- large tongue
- floppy epiglottis
- shorter trachea
- smaller lower airways, less developed with fewer alveoli
- more acute angle angle of airway
- little smooth muscle present in airways
signs of respiratory distress in infants and children up to 8 years of age are?
- head boobing (in infants)
- nasal flaring
- paradoxical chest movement (recessions)
strategies for promoting coping in children of all ages include?
- facilitating parental presence at all times, including during invasive procedures and resuss
- maintaining normal routines and rituals as much as possible, including story time, bedtime routines and presence of favourite toy
- providing appropriate analgesia and sedation as well as non-pharmacological interventions
- providing opportunities for play and activities unrelated to treatment.
why is heated humidification preferred in children?
They have limited respiratory reserve and are prone to airway blockage.
When providing paediatric care what do we need to take into account?
- that the care has to be age and development appropriate
- the child’s primary care giver is included in all planning of care
Describe the needs when providing nursing care to a critically ill infant or child.
- surface area = can lead to heat loss
- volume ratio = risk of dehydration/hypothermia
- they have lower glycogen stores
- higher metabolic rate
- o2 delvery requires adjustment based on age, size and o2 results
- fluid requirements are based on body weight
what are assessing for in an airway/breathing assessment in children?
- airway patency
- talking or crying
- adventitious sounds
- resp distress
- fatigue/flat child
How do we calculate a childs weight?
(age + 4) x 2
How do we manage a child pt who is in shock?
- assessment ABCDE (rash)
- cardio, resp monitoring, temp, urine outpu, ABG, U&E
- fluid resuss (within the 1st hour)
- o2 therapy
- administration of inotrope/vasopressors (dopamine, dobutamine/adrenaline and noradrenaline)
what are the most common admissions for elderly adults?
- arrhythmias
- heart failure
- stroke
- fluid and electrolyte imbalances
- pneumonia
- hip fractures
List some considerations that may be required when nursing an older adult.
- pain management (sensitive to opioids)
- medication use (generally poly-pharmacology)
- depression (often over looked)
- nutrition
- physical and social considerations.
List some age related changes that occur in older adults.
Cardiovascular changes = CO, rate and rhythm, structural changes, circulation
Respiratory = lung compliance decreases
Urinary = functioning nephrons decreases, excretion of toxins decreased
What is the normal resp rate for a child?
40 bpm
What are the common O2 delivery device for infants?
-nasalprongs
- headbox
- BiPAP
List the breathing components of an airway/breathing assessment of a child.
- airway latency
- child talking/crying
- adventitious sounds are detected (intubation??)
how is a child/infant ventilated?
- ETT uncuffed
- suction every 2-6 hrs
- humidify airways
what pulses are checked on children?
Brachial
