Pain Assessment/Management
The leading cause of death in children
What is Injuries: MVC, fireworks, playground injuries, poisoning, fire, water, and youth violence
Signs indicative of abuse
Bruises, bilateral black eyes, human bite marks, submersion burns, cigarrette burns, single or multiple fractures, rib fractures, ends of long bones, fractures or breaks inconsistent with age, head injuries (bleeding, swelling), abdomen (small bowel, liver, spleen, pancreas), inconsistent with history or development level, delay seeking care, injury attributed to third party
What is the most common cause for children to become dehydrated?
Gastroenteritis
Signs and Sxs: Nausea and Diarrhea. Test for Rotavirus and C. diff
What is the number one hospitalization for kids
Bronchiolitis.
minimum systolic in kids
60 + 2X age
Ex: 12 y/o
84 minimum systolic in a kid
Primary Prevention for Injuries
Shaken Baby Syndrome
Violently shaking. 25-30% die from the injuries. 75% suffer neuro, cognitive, developmental, or psychological. 60% can develop cerebral palsy.
Signs include: whiplash, cerebral bleeds, bilateral retinal hemorrhages (will see dilated/fixed pupils)
higher basal metabolic rate, higher water requirement, greater surface area per weight, small changes upset balance more easily, renal system is immature, greater insensible water loss through skin and respirations.
What are patients with Cystic Fibrosis at high risk for
Diabetes d/t pancreatic enzymes not being efficient.
What is the minimum hourly output for a kid
1 mL/kg/hr up to 30 kg
List 2 Non-pharmacological and 2 Pharmacological pain managements
What are:
Non-pharm: Distraction, comfort positioning
Pharm: opioids/narcotics, NSAIDS, vapocoolant, EMLA,
Name 3 parental, child, and environmental risk factors for child abuse that
Parental: hx of abuse, substance abuse, domestic violence, unwanted pregnancy, single/teenage parents
Child: prematurity, increased caregiving needs, behavioral disorder, birth - 1 y/o,
Environmental: chronic stress, divorce, poverty, unemployment, alcohol/drug use, frequent relocation
Etiologies and symptoms of overhydration
Etiologies: renal insufficiency, too much water when swimming, infants w/ inappropriate creation of formula, too rapid dialysis
Sxs: warm skin, BP normal or slightly elevated, edema (periorbital for infants),
What chest retraction is most concerning: intercostal, suprasternal, or subcostal
Suprasternal is the most concerning. It is above the sternum
Bolus calculation
Weight (kg) x 20 mL over 20 minutes
Child Life Specialist definition
What is Someone who eases anxiety before medical situations that include distractions. They also aid in situations of family death. They should be seen by patients with chronic pain such as GB, MVC, and Sickle Cell.
Signs of Neglect
lack proper hygiene, inappropriately dressed, bald spots, severe diaper rash, lack of health care (immunizations, dental), failure to thrive, lack of supervision, and abandonment
Diagnostics for F/E imbalance
Electrolyte panel (Na + K)
Urinalysis: glucose, wbc, rbc, color, specific gravity
CBC: hematocrit
VS, Weight, Cap refill, I/O
What type of lung sound is indicated for:
Fluid Volume overload, Asthma, infection, and inflammation
Crackles: fluid volume overload, infection, URI
Wheezes: Asthma (lower airway)
Rhonci: infection
Stridor: inflammation of URI
24 hr Maintenance Fluids Calculation
1st 10kg x 100ml/kg =
2nd 10kg x 50ml/kg =
3rd rest (kg) x 20ml/kg =
add total together
divide by 24 to get hourly
What complements self-report and what is not well-correlated with self-report
Observation of behavior complements self-report
Physiological measures are not well-correlated with self-report. These usually reflect stress reactions.
A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child may have been physically abused?
1. The child shrinks at the approach of adults.
2. The child begs or steals food or money.
3. The child is frequently absent from school.
4. The child is delayed in physical and emotional development.
1. The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns may be a victim of abuse. Maltreatment is considered, whether or not the adult intended to harm the child.
Dehydration symptoms
Crying without tears, low urine output, dry mucous membranes, anterior fontanelle is flat/pressed, tented skin, pale/rutty/cool skin color, elevated BUN and creatine.
Why would you not give albuterol for Croup?
Albuterol does not have significant alpha-1 effect making it ineffective for croup, in addition, its' beta effect could potentially cause vasodilation, and theoretically worsen upper airway edema. Racemic epinephrine is an alpha-1 agonist with rapid onset causing vasoconstriction and thus leading to decreased airway inflammation.
What is the most important thing to monitor during hypokalemia?
Blood Pressure