Pediatric Dice Game

1

1

Name 3 pediatric pain scales

rFLACC

Wong-Baker FACES

0-10 Numerical  Scale

2

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

3

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.

4

NG tube verification can occur in 2 of 3 methods.  What are these verification methods?

1. Gastric ph (preferred)

2. X-ray

3. Surgically placed

4. Residual noted

5

You have an child with a transpyloric feeding tube.  How can this child receive his feedings?

Only with continuous feeds.

6

Name 3 items needed at each bedside of a patient with a tracheostomy for airway safety.

2 trachs (same size and one size smaller)

Proper size suction catheters

ambu bag with oxygen

working suction equipment

2

1

What is the most common scoring system used to describe the level of consciousness of a person?

Glasgow Coma Scale

2

A small sac-like structure filled with meninges and spinal fluid often found on the low back.

myleomeningocele

3

This type of cancer accounts for 6% of cancers in kids. It develops in immature nerve cells of the embryo. Mostly 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

4

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, he experiences a severe headache, vomiting, and starts falling asleep. You ask the pt to state their name, he says "Bill". What could be the cause of the patient's clinical manifestations?

Increasing intracranial pressure

5

A 2 y/o is 1-month status post ventriculoperitoneal shunt placement and presents with fever of 101.7 F. What are you most concerned about?

1-2 months after VP shunt placement is greatest risk for infection. Septicemia, bacterial endocarditis, meningitis.

Aggressive antibiotics, possible shunt removal. 

6

 What is the purpose of these sutures?

"Stay" sutures- They are placed with new tracheostomies as a way to open airway cartilage should the trach fall out.

3

1

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

Bolus fluids-10-20ml/kg

2

Drooling, fever, tripod positioning, croaking sound on inspiration are consistent with what croup syndrome?

Acute epiglottitis

3

When an infant is quiet, what should be the first piece of an assessment to be made?

Heart and lung sounds

Anything else might make them cry and you wouldn't be able to hear those sounds

4

What is the classic s/s of pyloric stenosis?

Non-bilious, projectile vomiting 30-60minutes after feeds

5

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

6

What is this used for?

HME device

HME's provide humidification and filtration of air they inhale

4

1

A 4 y/o with a recent diagnosis of UTI is readmitted with flank pain. What is the likely cause?

Pyelonephritis

2

What is a genetic issue that results in missing nerves in the large intestine muscle cells, causing decreased motility through the large intestine? This condition can causes blockages and potential toxic megacolon.

What is Hirschsprung's disease?

3

What is the leading cause of hospitalization in children under the age of 2?

Bronchiolitis from RSV

4

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

5

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?  

 a prolapsed stoma.

Becomes worrisome if stoma turns blue, pale or black, stops draining and becomes painful

6

Name a securement method (not tape) used to discourage patients, young or old, from pulling on their nasoenteric tube?

Nasal Bridle

 

5

1

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

2

Name one of the most common types of leukemia cancers in children?

ALL or 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

3

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?

Draw cultures off of all central line lumens and one venous peripheral. 

Administer fluid bolus. 

Administer antibiotics.

 Antipyretic

4

A patient with sickle cell anemia is experiencing increased pain in joints, visual disturbances, and swelling of hands.  What is happening?

Vaso-occlusive crisis

5

A 4 month old is admitted after a new seizure.  Name 2 of 4 potential procedures you expect could be ordered?

Head CT

MRI

EEG

LP

6

For cancer patients, why is the ANC (absolute neutrophil count) so important?

Neutrophils are a type of white blood cell that play a crucial role 

It is a valuable indicator for how weakened the immune system has become from chemotherapy

A low ANC (<1500ul) indicates a very weakened immune system, making patients more susceptible to infections

A high ANC (above 10,000ul) indicates inflammation, infection or certain types of leukemia

6

1

Your patient is having a seizure. For pediatric patients, name one of two first line medications to stop the seizure? 

IV Ativan

Intranasal Versed

2

Our bodies use insulin to breakdown glucose for energy.  A diabetic person lacks insulin to break down the glucose, therefore uses brown fat for energy. What is a by-product of the brown fat metabolism?

Ketones

3

Night shift reports that your post op Scoliosis repair patient has voided 120ml in the last 8 hours.  She weighs 112 lbs.  Is this normal urine output for her?

No

She should be voiding 0.5-1.5 ml/kg/hr

(minimum of 203-610 for the 8 hrs)

She is dehydrated

4

Name one way to approach a pre-school patient at the beginning of your shift?

Introduce yourself and approach slowly

Speak first with the parents to gain trust

Get on their level/squat down

Offer a toy or something to play with

Use a soft voice

5

What is a Wilms tumor?

A nephroblastoma of the kidney that is usually unilateral.  Typically found in 3-4 yo. Treatment includes a nephrectomy soon after diagnosis.

NEVER palpate the abdomen as it may disseminate cancer cells to other sites in the body!

6

What is happening in Acute Chest Syndrome?

For sickle cell patients, its when sickled Hgb get stuck in the lungs and cause severe pain, potentially leading to respiratory failure.

Treatment:

Oxygen, Hydration, pain management, and blood transfusion