Pain and Feeding
Name 3 pediatric pain scales
FLACC, CRIES, FACES, Number, Word
What is the most common scoring system used to describe the level of consciousness of a person?
Glasgow Coma Scale
After a 4 day history of diarrhea, a parent says their 6 month old infant no longer produces tears when they cry. What is the likely cause?
Dehydration
A 4 y/o with a recent diagnosis of UTI is readmitted with flank pain. What is the likely cause?
Pyelonephritis
When a child sits forward with hands over their knees, it can be an indicator of severe respiratory distress. This position is referred to as...
tripod position
A 4 m/o is noted to not have a startle response and is not cooing or babbling. What might these be a sign of?
Impaired hearing
A small sac-like structure filled with meninges and spinal fluid often found on the low back.
Meningocele
Drooling, fever, tripod positioning, croaking sound on inspiration are consistent with what croup syndrome?
Acute epiglottitis
A genetic issue resulting in missing nerves in the large intestine muscle cells, causing decreased motility through the large intestine resulting in blockages and potential toxic megacolon.
What is Hirschsprung's disease?
Name 2 of the most common types of leukemia cancers in children?
ALL and AML
ALL-- peak in 2-5 yo, 80% live about 5 years, death usually follows overwhelming infection
AML--more common in adolescents, only 40% live 5 years
At one day of life, an infant's stomach is the size of a cherry and can only hold 5-7ml. How long before an infant can hold 2-5 oz?
Day 30, it is the size of a large egg.
This type of cancer accounts for 6% of cancers in kids. It develops in nerve cells of the embryo and is seen in infants and young children. They can start anywhere, but are mostly found in the abdomen. What is the name of this cancer?
Neuroblastoma
A 15 y/o pt. has a central line for chemotherapy. They come in with a fever of 102.1 F. What are two interventions you expect to do immediately?
1.Draw cultures off of all lumens and one venous
2.Administer fluid bolus.
3.Administer antibiotics.
4.Antipyretic.
A 13 year old surgery patient who weighs 53 kgs, has a urine output of 75ml over the last 4 hours. Is this adequate?
No
Normal UOP is between 0.5 to 1.5 mL/kg/hour
What is the leading cause of hospitalization in children under the age of 2?
Bronchiolitis from RSV
NG tube verification can occur in 1 of 3 methods. What are these verification methods?
1. Gastric ph (preferred)
2. X-ray
3. Auscultation
Steve, a 17 y/o football player is admitted after a head-to-head collision. The patient is diagnosed with a concussion. Under your care, they experience a severe headache, vomiting, and starts falling asleep. You ask the pt to state their name, they say "Bill". What could be the cause of the patient's clinical manifestations?
Increasing intracranial pressure
What is the classic s/s of pyloric stenosis?
Non-bilious, projectile vomiting 30-60minutes after feeds
What is the hourly rate of IV maintenance fluid for a 32 kg patient?
1st 10 kg- (4 ml/hr x kg)
2nd 10 kg (2 ml/hr x kg)
For anything over 20 kg (1 ml/hr x kg)
40 + 20 + 12 ml/hr = 72 ml/hr
A patient with sickle cell anemia is experiencing increased pain in joints, visual disturbances, and swelling of hands. What is happening?
a vaso-occlusive crisis
You have an child with a transpyloric feeding tube. How can this child receive his feedings?
Only with continuous feeds.
A 2 y/o is 1-month status post ventriculoperitoneal shunt placement and presents with fever of 101.7 F. Why are you concerned?
1-2 months after VP shunt placement is greatest risk for infection.
Treat with aggressive antibiotics, possible shunt removal.
Increased WBC, infection, bleeding and bruising, fatigue, bone pain, and decreased RBC and platelets are signs and symptoms of what childhood cancer?
Leukemia
Can also present with low grade fever
A 4 month old, former 34 week premie, presents with an ostomy that does not look normal. "It appears to have grown overnight" states the mom. What has happened? When does it become worrisome?
What is a prolapsed stoma.
Becomes worrisome if stoma turns blue, pale or black, stops draining and becomes painful
A 4 month old is admitted after a new seizure. Name 2 interventions do you expect will be ordered?
Head CT
MRI
EEG
LP