Pain Assessment/Management
Child Maltreatment
Fluid and Electrolyte Balance
Gas Exchange
MISC
100

The leading cause of death in children

What is Injuries: MVC, fireworks, playground injuries, poisoning, fire, water, and youth violence

100

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

100

What is the most common cause for children to become dehydrated? 

Gastroenteritis

Signs and Sxs: Nausea and Diarrhea. Test for Rotavirus and C. diff

100

What is the number one hospitalization for kids

Bronchiolitis.

100

minimum systolic in kids

60 + 2X age

Ex: 12 y/o

84 minimum systolic in a kid

200

Primary Prevention for Injuries

What is seatbelts, helmets, caution labels on laundry products
200

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)

200
Why are children more at risk for F/E imbalance than adults

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.

200

What are patients with Cystic Fibrosis at high risk for

Diabetes d/t pancreatic enzymes not being efficient.

200

What is the minimum hourly output for a kid

1 mL/kg/hr up to 30 kg

300

List 2 Non-pharmacological and 2 Pharmacological pain managements

What are: 

Non-pharm: Distraction, comfort positioning

Pharm: opioids/narcotics, NSAIDS, vapocoolant, EMLA,

300

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

300

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), 

300

What chest retraction is most concerning: intercostal, suprasternal, or subcostal

Suprasternal is the most concerning. It is above the sternum

300

Bolus calculation

Weight (kg) x 20 mL over 20 minutes

400

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. 

400

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 

400

Diagnostics for F/E imbalance

Electrolyte panel (Na + K)

Urinalysis: glucose, wbc, rbc, color, specific gravity

CBC: hematocrit

VS, Weight, Cap refill, I/O

400

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

400

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 

500

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. 

500

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.

500

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. 

500

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.

500

What is the most important thing to monitor during hypokalemia?

Blood Pressure