Peds Review #1-KEY
By Deb Martin Lightfoot RN MSN
Pediatric Assessment
1. As the nurse approaches the room of a pediatric patient with pediatric respiratory distress, you hear the patient before you see him. The following are examples of abnormal airway sounds. For each sound indicate if it is an upper or lower airway sound AND give an example of a pediatric situation that would produce these sounds:
Stridor-foreign body obstruction, croup, allergic reactions
Wheeze- RSV, Asthma, Bronchiectasis
Grunting- pneumonia
2. As the nurse approaches this 7 month old patient with respiratory distress the nurse notes that the infant is head bobbing. What does this position this tell you about this patient?
Respiratory distress is progressing to resp failure
3. The infant relies on the diaphragm for breathing. List 2 conditions that would impede the diaphragm.
Hyperinflation from above the diaphragm, ex. Asthma
Hyperinflation below the diaphragm ex, abdominal distension
Lack of innervation of diaphragm from an injury ex. Spinal cord injury
4. The resting metabolic rate in a young infant or child is 2X that of an older child or adult. List 6 conditions that can increase the already accelerated metabolic rate in a 3 year old.
Fever
Illness
Hypo/hyperthermia
Anxiety
Trauma
5. Cyanosis- a late sign of hypoxia-approximately what % of the child’s blood is deoxygenated before cyanosis becomes evident?
This is a late sign of hypoxia; usually about 30% of the child’s hemoglobin is desaturated before cyanosis
6. List five signs of respiratory distress one can observe without touching the child.
Nasal flaring
Retractions, use of accessory mucsles
Adventitious sounds-grunting, wheezing, stridor
Positioning, head bobbing, facial expression
Loc, skin color, resp rate, cyanosis
8. Breath signs in a young child are unreliable when assessing for a pneumothorax. How will the nurse assess the traumatically injured child for a pneumo thorax?
Capnograph
Pulse ox
Lack of chest rise, lack of breath sounds
Difficulty in bagging
Increasing signs of respiratory distress
Signs of injury, MOI
Tracheal deviation is a late sign and may not be obvious in the young child due to short and sometimes fat necks
9. Name 4 physiological/anatomical reasons why a 2 year old could fatigue quickly when in respiratory distress.
Minimal O2 reserves
Minimal glucose reserves
Less metabolic reserves
Noncompliant chest wall-have to work hard with under developed muscles of respiration to increase chest excursion
10. Which is a more ominous sign in the pediatric patient bradypnea or tachypnea? Why?
Bradypnea, significant in the fact that child is “wearing out”, has been sick for awhile and is probably acidotic by now.
11. Gastric distention in the young child can impede his respiratory effort.
List 3 interventions/assessments you can do to decrease the risk of gastric
distention.
OG, NG, gentle ventilations
12. Label each of the following statements as either true or false:
All of these are True!
Definition of shock: Shock is a reduction of amount of O2 available for cellular metabolism. Impairment of cellular metabolism leads to cellular death and tissue hypoxia, which leads to irreversible organ damage. True
There is a direct correlation between the time treatment is started and the child’s outcome, the sooner the recognition and treatment, the better the outcome of the child. True
Hypotension may the last sign that you see before the child’s shock condition becomes irreversible. True
In suspected hypovolemic shock in the young child, if you wait for hypotension to develop in the young child before beginning any interventions you have waited too long. True
13. The nurse is caring for a 2 year old that had had a decrease in LOC, unknown etiology. His heart rate is 45 and he has signs of poor perfusion. Why is bradycardia is an ominous sign of impending arrest in the young child?
As in question # 10: Bradycardia is significant in the fact that child is “wearing out”, has been sick for awhile and is probably acidotic by now. The child has no reserve left.
14. The nurse is assessing the Fontanel of a 6 month old. What are you looking for, and what significance does it have for your assessment?
A depressed fontanel could signify dehydration
A bulging fontanel could signify brain swelling, bleeding
15. Circulating blood volume in the pediatric patient is _ ccs /kg?
Infant = 90ccs/kg
Child = 80cc/kg
16. Young children increase their cardiac out put by?
A. By increasing their heart rate.-
this is the only right answer, due to the relatively “stiff” myocardium, young children are unable to increase their stroke volume to enhance their cardiac output
B. By increasing stroke volume
C. By an increase in BP
17. List 5 signs of poor perfusion in a young child that would help you decide if you should be doing CPR on child with a heart rate <60
Weak or absent distal pulses
Delayed cap refill > 3secs
No “attitude” - LOC
Color: pale cyanotic, mottling
Inadequate respiratory status
18. The nurse is caring for a child from an MVC. The patient is a pale and lethargic 4 year old with a significant seat belt sign noted. This was a head on crash in to a light pole at about 35 miles per hours with significant damage to the GEO. As you assess the child’s color your partner grabs a BP cuff. You note that for hypotension to occur in this young child, she could loose up to approximately what percentage of total her intravascular volume before you would see hypotension?
A. 5-10 %
B. 10-15 %
C. 15-20 %
D. 25-30%, Some resources state a 30-40% of volume before see hypotension in the young child.
19. This child is estimated to weigh about 20kg. How much blood would she have to loose (in mls) before you might see hypotension, based on your above answer.
20 kg x 80ml/kg =1600 mls
25% of 1600=400 mls
30 % of 1600 =480 mls
20. This patient is now unresponsive, cool and clammy with a delayed cap refill time of 3 secs. After obtaining vascular access, how much fluid should be administered?
20mls/kg x20kg = 400mls
21. EMS transport time is delayed due to a train. How much fluid (in mls) will you give this patient that would amount to 40 % of her circulating volume?
40% of 1600 = 640mls
22. Some one forgot to fill the warmer with fluids and now you have to give this
traumatically injured child room temp IV fluids instead of warm fluids. How can this be a detriment to this child’s recovery?
If the child were to begin to shiver, this would significantly increase his metabolic rate and the child could quickly use up e what little O2 and glucose reserves he would have and potentially hasten his demise. Additionally cold can cause blood dyscrasias ( disorders) in the trauma patient. This can complicate the patient’s potential for recovery
23. A 2 month old, weighing 5kg, has fallen out of an infant seat from the kitchen counter. You arrive on scene and estimate a 100cc blood loss from a laceration on his head. 100ccs is what percentage of this child's circulating blood volume?
Infant = 90ccs/kg
Child = 80cc/kg
5 x 90=450ml 100ml of 450 mls is 22%
24. The most common cause of shock in children is?
The correct answer is
Cardiogenic
Obstructive
Distributive
Hypovolemic- hemorrhagic
Hypovolemic- non hemorrhagic,
Commonly from nausea and vomiting and diarrhea
25. What does the “ability to be consoled” tell you about the status of a young child? This information lets you know that the child is incredibly uncomfortable, or sick. Not generally a good sign, Children should be able to be somewhat consoled by their primary caregiver.
26. TRUE or false?
A small child’s outward level of interaction with the environment/caregiver has been shown to be more important than history in predicting how seriously ill the child may be.
27. When exposing the child you must also __
KEEP THEM WARM, & consider their modesty
28. List 5 things to observe for when exposing the child for an assessment.
Signs of injury: bruising, contusions, burns, swellings
Skin color, conditions: Rashes, petechiae
Accessory muscle use
Cleanliness
Difficulty in movement
30. In attempting to obtain a history, the mnemonic “SAMPLE” is useful.
Give an example of a history using this pneumonic:
31. Describe the components of the PAT
a. Neuro assessment: attitude/appearance
b. Work of breathing
c. Signs of circulation
32. This number would be considered too fast for a respiratory rate, too slow for a heart rate and too low for a BP in the pediatric population of all ages
(Hint: this number has a 6 & 0 in it!)
60
33. The nurse is caring for a 4 month old infant with a history of vomiting and diarrhea for 3 days. Last wet diaper was 8 hours ago. Describe an assessment of this child’s perfusion status.
Color, CRT, pulses, attitude, obvious signs of bleeding,
42. Label the disease as Upper airway or Lower airway problem?
Croup-Upper
Epiglottitis-Upper
RSV-Lower
Asthma-Lower
Pneumonia-Lower
Pertussis-Looks like this can be both an upper and lower infection, dependent upon the spread of the disease within the respiratory tracts.
43. Label each Bacterial, Viral, Both, or None?
Croup-V
Epiglottitis-Ba
RSV-V
Asthma-N
Pneumonia-Both, [can also be a fungal, or parasitic cause]
Pertussis-B
44. Which is contagious?
Croup
Epiglottitis
RSV **
Asthma
Pneumonia**
Pertussis **
45. Match signs and symptoms with the appropriate disease
Asthma Epiglottitis Pertussis RSV Croup Pneumonia
Epiglottitis Presents acutely with high fever, sore throat and difficulty swallowing, occurs most often in under immunized children
Croup Gradual onset of cold symptoms, cough that is worse at night, low grade fever
Asthma Most common chronic illness in children
RSV Common cause of bronchiolitis, Infection most common in infants <1 year old
Pneumonia Can occur in any age group, varies in etiology and severity
Pertussis Appear ill and distressed when coughing, normal when no coughing
46. The other name for Pertussis? Whooping cough
7
Revised dml/2017