ENPC Questions with complete solutions

ENPC Questions with complete solutions Components in the prioritization of pediatric emergency care (4) PAT, Focused Assessment (objective information), Focused pediatric Hx(subjective information), assignment of an acuity rating decision Pediatric Assessment Triangle : (3) components Appearance. Work of Breathing. Circulation to the skin. This forms the "general impression". If there is an acute disruption in 1 component, child is "sicker". If there is an acute disruption in 2+ components the child is "sickest" Pediatric Assessment Triangle : Appearance Most important. Reflects adequacy of ventilation, oxygenation, brain perfusion, and central nervous system function. Assess for : tone, interactiveness, consolability, look/gaze, and speech/cry. Pediatric Assessment Triangle : Work of Breathing Breathing easy, even, and unlabored or tripod position, nasal flaring, retractions, supraclavicular retractions Pediatric Assessment Triangle : Circulation to the skin Mottling or PWD PQRST for Pain (pg86) Precipitating and palliating factors Quality Radiation Severity, symptoms, and site Time or triggering factors Verbal Report for pain (pg86) Self-report is the most reliable indicatior of pain; however not all pediatric pt are capable or wiling to verbalize their discomfort. What age is the respiratory system considered fully developed? 8 years old Most ______ age __to____, are concrete thinkers and interpret words literally. Where as, most _____ age ___ to ___, are magical and illogical thinkers. They often confuse coincidence with causation, and have difficulty distinguising fantasy from reality. (pg36) Most Toddlers age 1yo to 3yo , are concrete thinkers and interpret words literally. Where as, most Preschoolers age 3yo to 5yo, are magical and illogical thinkers. They often confuse coincidence with causation, and have difficulty distinguising fantasy from reality. Hypotension related to hypovolemia in pediatric trauma patients is a _____ sign and may indicate a loss of ___% to ___% of their circulating blood volume. (pg262) Late sign. 20% to 25% of circulating blood volume 6P's Assessment for Musculoskeletal Trauma (pg 283) Pallor : color different from uninjured Pain Pulselessness Parasthesia Paralysis Poikilothermia Burn Transfer Criteria 1. Partial thickness >10% of BSA 2. Face, hands, feet, genetalia, perineum or major joints 3. Third degree burns in any age group. 4. Electrical burns, including lightning injury, and chemical burns. 5. Inhalation injury. 6. Burn injury in pt with preexisting medical disorders that could complicate tx. 7. Concomitant trauma (such as fx) in which the burn injury poses the greatest risk of morbidity or mortality. 8. Burned children in hospital wo qualified equipment or personnel to care for them 9. Pt who will require special social, emotional, or rehabilitative intervention. If live interpreter not available for 15mins use ________ Language line interpreter Infants are obligate nose breathers. If nose is obstructed ___________ suction nose Opiod antidote Narcan Benzo antidote Romazicon Neutropenic pt with a temperature Don't take rectal temp. No invasive procedures if not necessary. Nonblanchable Rashes of concern Meningocoxcemia Petiachia/Purpura Bicycle accident concerns Did pt strike handle bars? Possible abdominal injury Ribs are more horizontal and provide less protection. Normal Urine Output for child 1 to 2ml / Kg / Hr Differences of child vs adult : BSA, blood volume, glycogen storage, metabolic rate Children have : increased BSA(predispose to temp dysregulation), decreased circulation blood volume(predispose to hypovolemia), decreased glycogen storage(predisoposed to hypoglycemia), Increased metabolic rate. Oral Rehydration for 9month old with mild dehydration. Glucose and sodium solution, every 2 to 5min with 5 to 10ml 6week old infant, no medical hx. eating poorly, vomiting, "hard to wake up", responsive to pain. Anterior fontanel bulging, tachypnic. Diagnostic evaluation expected? Skeletal survey Possible shaken baby syndrome Minimal Acceptable BP's Newborn = 60 Infant = 70 Child = 70 + (2 x age in yrs) All critically ill patients require _____ level glucose due to low glycogen stores Altered Mental Status is considered ______ until proven otherwise decreased cerebral perfusion Decompensated shock in children #1 sign Hypotension Best place for an IV Hand(ask if there is a certain side thumb they suck) Scalp if less than 9months. Not in feet if they walk. Tension Pneumothorax Tx Needle chest decompression 2nd ICS MCL TBI considerations MD has to say when they can return, not the pt or caregiver. Should be a "gradual return to play" Cardiopulmonary Arrest usually from (2) Shock Respiratory Distress Bradycardia pharm treatment Epinephrine (1:10,000), 0.01mg/kg every 3-5min Jump START triage : colors and designation Determined by ability to ambulate, respirations, perfusion, and mental status. Black (dead or unsalvageable) Red (immediate care) Yellow (delayed care) Green (minor or ambulatory) Jump START triage : breathing not breathing -> position upper airway, now breathing = red(immediate) -5 rescue breaths wo breathing, no pulse = black(deceased) Jump START triage : Respiratory rate <15 or >45 = immediate (red) Jump START triage : Pulse If breathing with resp rate 15-45. No pulse = immediate (red) Jump START triage : AVPU If breathing, resp rate 15-45, with palpable pulse. AVPU P(inappropriate), posturing or unresponsive = immediate(red) A,V, P(appropriate) = delayed(yellow) A preschooler has a small laceration that required 2 stitches. The nurse covers the wound with a bandage knowing that it will comfort the child to have it covered. What is the developmental reason for this intervention? A. Preschoolers are magical thinkers and imagine bandages keep their insides from coming out B. Preschoolers fear physical disability and believe a bandage will prevent disability C. Preschoolers explore orally and will likely chew or suck on the stitches if left uncovered D. Preschoolers are concerned with body image and don't want to appear different than peers ... A 7-month-old presents to the emergency department with a complaint of fever. Assessment reveals a patent airway and slight cyanosis around his lips and nail beds. He is alert and interactive. His vital signs are 38.5 °C (101.3 °F), HR 134, RR 32, BP 78/54 mm Hg, and SpO2 84%. The nurse notes a healed surgical scar on his chest. Based on this assessment, what is the nurse's priority? A. Administer ibuprofen to treat the fever B. Begin oxygen via a nonrebreather mask C. Obtain a surgical history D. Ask if the SpO2 is normal for him ... An 11-year-old presents to the emergency department with a complaint of hitting his head while playing soccer. The nurse enters the room and performs an across-the-room assessment. He is staring at the wall. He has no increased work of breathing, and his color is pink. Using the pediatric assessment triangle (PAT), what classification will the nurse assign? A. Well B. Sick C. Sicker D. Sickest ... The pediatric prioritization process components include the focused assessment, focused history, acuity rating decision and: A. the pediatric assessment triangle (PAT). B. developmental characteristics. C. head-to-toe assessment. D. life-saving interventions. ... A 2-year-old is brought to the emergency department by her father when he found her face down in the pool. She remains unresponsive and is breathing shallowly and slowly. Her color is pale. What is the priority? A. Administer 100% oxygen B. Immobilize the cervical spine C. Begin bag-mask ventilation D. Insert an oral airway ... A 2-year-old has a suspected cervical spinal injury. In order to ensure neutral spinal alignment, padding should be placed under which area? A. Shoulders B. Head C. Neck D. Waist ... The nurse is preparing to administer a feeding through a nasogastric feeding tube. The tube position was verified by radiograph after insertion 2 hours ago. How will the nurse verify placement before feeding? A. Instill air and listen over the epigastrium B. Test the pH of the gastric contents C. Observe color of a gastric aspirate sample. D. Repeat the radiograph ... What is the best method to rapidly administer a 20 mL/kg bolus of 0.9% normal saline to a pediatric patient weighing 16 kg? A. A 20-mL syringe with a stopcock B. An infusion pump C. A rapid infuser D. A pressure bag ... Immediately after intraosseous insertion the nurse assesses the infusion and notes that the fluid is not dripping. How should the nurse respond? A. Use an infusion pump to deliver the fluids B. Remove the device and insert in another site C. Advance the device and reassess the flow D. Attempt to aspirate bone marrow ... A 13-month-old presents to the emergency department with a 2-day history of a low-grade fever, increased work of breathing, and tonight developed a barking cough and inspiratory stridor. What condition does the nurse suspect? A. Epiglottitis B. Foreign body aspiration C. Tracheomalacia D. Croup ...