Violence &
Maltreatment
Maltreatment
True or False.
A child comes into the ER who you suspect is being abused by their Aunt. Before calling DCS, you must get permission from the patient's guardian (mom) to report it.
False.
What is the gold standard of treatment for a patient experiencing an asthma exacerbation?
Albuterol
True or False.
When caring for pediatric diabetic patients, you test their blood sugar BEFORE they eat, but give insulin AFTER they eat.
True
What is the first sign of infection in a child with SCD?
Fever
At what age can infants start mushy/baby foods?
4-6 months. Start with rice cereal and then baby foods. Add one food at a time.
What does the total iron binding capacity (TIBC) help us diagnosis?
Iron deficiency anemia.
Remember, iron level will be low and TIBC will be high.
A nurse suspects child abuse. After making sure the patient is safe, what is the nurses first priority?
Reporting abuse to appropriate authorities
True or False.
Most asthma is diagnosed within the first 6 years of life.
True
True or False.
Pediatric patients with diabetes can eat whatever carbohydrate they want as long as they cover it with the correct amount of insulin.
True - Although we want to encourage a healthy diet, technically, a diabetic child can eat whatever carbohydrate they want.
True or False
The reticulocyte count will be decreased in a child experiencing a sickle cell crisis.
False, it will be high.
Why are infants more prone to illness and injury? (List 2 reasons)
Heads are larger than body, bones are softer, carry more body weight as water, abdominal muscles lack tone and strength, can't breathe through this nose until 6 months.... the list goes on!
What sign/symptom is the most concerning to the nurse when observing a patient that came in with respiratory distress?
A.) Restlessness
B.) Tachypnea
C.) Increased respiratory effort
D.) Lethargy
D. Lethargy.
Remember, one of the most crucial signs that a patient is going from distress to failure is the level of consciousness. Drastic changes in LOC are never a good sign.
Name 2 red flags that a child may be experiencing sexual abuse.
- Inappropriate interest or knowledge of sexual acts
-Unexplained genital pain or bleeding
-STD or pregnant < 14 years of age
-Over compliance or excessive aggression
Name 3 potential triggers of Asthma.
Allergies (mold, pet dander, pollen, dust)
Environmental (burning leaves, changing of the season)
Infections/Illness
Smoking
A patient is experiencing dizziness and headaches. The patient complains they are cold, but they are also sweating.
1.) Hyperglycemia OR hypoglycemia?
2.) How do we treat it?
Hypoglycemia
15/15 rule
What is the purpose of hydroxyurea?
Prevents sickle cell crisis by creating fetal hemoglobin
At what age does head lag disappear?
3 to 4 months
Discuss the pathophysiology of bronchiolitis and the most common cause of it.
Inflammation, mucus production, and obstruction of the bronchioles.
Respiratory Syncytial Virus (RSV) is most common cause.
A nurse notes multiple bruises on a 3 year old's knees and shins. Having no other information, should the nurse report this as abuse? Why or why not?
No.
Toddlers, preschoolers, and young school aged children are prone to injuries to their legs due to falling/running into things. Kids can be clumsy as they learn how to walk, run, jump, skip, etc.
Name 3 side effects of Albuterol.
Tachycardia, nervousness, nausea, vomiting, headaches, chest pain
Why can't a patient take a pill (Metformin) if they have type 1 diabetes?
Type 1 diabetics don't create insulin. Pills, like metformin, help increase insulin sensitivity in type 2 diabetics who are insulin resistant. Without insulin, metformin will not work.
Name 3 different ways we treat sickle cell disease.
Antibiotics, IV fluids, blood transfusions, bone marrow transplant, pain medications, oxygen
At what age should a child understand object permanence?
By 9 months
A child was admitted with respiratory distress on your shift. On admission his respiratory rate was very fast for his age. Two hours later, you check on your patient and now his respiratory rate is lower than expected for his age and his breaths are shallow. What would you expect their paCO2 to read when you obtain a blood gas?
A.) Normal PaCO2.
B.) Low PaCO2 (Less than 35).
C.) High PaCO2 (Higher than 45).
D.) It does not matter.
C.) High - patient is breathing slow and shallow. He is not able to blow off CO2, so the blood will show a higher than normal level.
Name 3 factors that put a child at risk for abuse.
Poverty, history of violence in the family or parents were abused as children, child is less than 3 years old, child disability, parental substance abuse, drug use in the neighborhood, poor relationship with parent, no support system.
What is the importance of using a peak expiratory flow meter?
Helps keep a patient's asthma in check:
-Provides baseline measurement for "well controlled" asthma
-Peak flow measurement provides guidance for treatment at home/school/hospital
A female diabetic patient's blood sugar before dinner was 220. She ate 60 grams of carbs. How much rapid acting insulin would you give her?
Orders:
Correction dose --> BS-120/50
Insulin to Carb Ratio --> 1:20
5 units total
220-120/50 = 2 units to correct high blood sugar
60/20 = 3 units to cover the carbs she ate
3+2 = 5 units total of rapid acting insulin for dinner.
Name 4 potential triggers for sickle cell crisis.
dehydration, fever/infection, cold temperatures, stress, low oxygen levels, intense exercise, and high altitudes
What do the five categories of "FLACC" stand for in the FLACC behavioral pain assessment scale?
F-faces; L-legs; A-activity; C-cry; C-consolability
Used for infants and young children that cannot verbalize their pain.
Name 3 things you would implement to promote safety for a patient having a seizure.
STAY WITH PATIENT. Padded bed rails, protect patient's head and airway (turn to side), move objects and furniture out of the way, ease patient down to floor if standing, loosen tight clothing, have suction and O2 at bedside ready for use, provide privacy