Exam (elaborations)
PEDS 602 Pediatric Trauma and Accidental Injury - Chamberlain College of Nursing | PEDS602 Pediatric Trauma and Accidental Injury
PEDS 602 Pediatric Trauma and Accidental Injury - Chamberlain College of Nursing PEDIATRIC TRAUMA & ACCIDENTAL INJURY ACCIDENTS in TRAUMATIC BRAIN INJURIES BY DEVELOPMENTAL STAGE • Infants – MVA, birth trauma, prematurity, shaken, Abuse, fall off table/dropped – bed? (3 ft vs 30 ft) • Toddlers – MVA, fall(window), Abuse, ingestions, drowning • School Age – MVA, moving (bike, pedes), hit with ball/game • Adolescents – MVA, drugs, firearms, blunt or penetrating trauma *includes scalp, skull or brain injuryCONTUSIONS VS CONCUSSIONS • Concussion – Severe blow to the head jostling the brain, causing it to strike the skull – stretch or shear nerve fibers as brain moves within skull (7-10 days recovery) • Contusion- More severe blow to the head that bruises the brain and disrupts neural function– localized and macroscopic (can see “bruise” on CT)-pain that lasts longer than the symptoms of a typical bruise would, tenderness, swelling, trouble bending or using the affected area.OBSERVATION • Report immediately! Observe for any changes in level of consciousness - awaken during night Difficulty in awakening, lethargy, dizziness, confusion, irritability, and anxiety Difficulty in speaking or moving Severe headache VomitingSKULL FRACTURES • Break in the skull that occurs with or without cranial trauma – can be open or closed • Who’s at Risk? • Trauma • Car accidents • Falls • Assaults - - - - - - - - - - - - - - - - - - - - - - - - - - - • Bulging fontanel (ICP or IVH) • Retinal hemorrhage/detachment • Increasing head circumference • FTT • Rib fractures • SeizuresBURNS IN ABUSE • 6-20% of abuse • Suspicion if…. • Near linear • No splash • Glove • Uniform and symmetric • Folds without burns (tuck)SEXUAL ABUSE • Oral/genital fondling or touch • Sodomy • Anal • Rape • Prostitution • View pornography, make movies, take pictures or view nuditySEXUAL ABUSE • Clinical manifestations • Changes • Red FlagsSIDS VS CHILD ABUSE Autopsy No trauma, sk survey negative No other diagnoses, illnesses Previous cyanosis with same parent caretaker Less than 6 mos Death of other siblings Blood in mouth/nosePOSTTRAUMATIC STRESS SYNDROME • Change in neurobehavioral responses – disorganized • Physical withdrawal • Fear- difficult to console- “tightrope” • Aggression, impulsive, changes in sleep • *Change will cause them to relive the traumaNURSING INTERVENTIONS Prevent! PROTECT! Report! 1-800-25-ABUSE RNS ARE MANDATED REPORTORS for SUSPICION!! (no proof necessary)NURSING INTERVENTIONS • Document assessment findings carefully • Minimize fear and anxiety • Therapies that may be used:
