ENPC Questions with complete solutions

ENPC Questions with complete solutions Inconsolable neonate hypoxia Preschooler 3-5yrs likes Nightlights + Bandaids 4 Components of the Pediatric Prioritization Process 1. PAT 2. Focused Hx 3. Focused Assessment 4. Assignment of an acuity rating Pain scale - nonverbal Flacc Pain Scale - 4-7 yrs Faces Pain Scale 8 yrs+ Numerical 0-10 scale PAT Components General appearance Work of breathing Circulation 0 = Sick 1 = Sicker 2+ = Sickest Airway Assessments Tongue Obstruction Loose Teeth Vomit Secretions Blood Edema Airway Interventions Re-position the head to a neural position Open airway - chin lift, jaw thrust Suction secretions - avoiding vagal stimulation Not conscious - consider inserting orophargyngeal airway Breathing Assessment Do I have spontaneous respirations? What is the rate and depth of respiratons? Do I have symmetric chest rise and fall? Breath sounds present, what is their quality? What is the work of breathing - do I have nasal flaring, retractions, accessory muscle use? Interventions breathing Maintain a position of comfort Provide supplemental O2 Not breathing adequately - provide bag mask ventilation AND reassess for the effectiveness of breathing Prepare for endotracheal intubation/RSI Assessment of tube placement, insert gastric tube to reduce abd distention Breathing assessment Do I have spontaneous respiration? Do I have equal chest rise and fall? What is the rate and depth of respiration? What is the work of breathing - is there any nasal flaring, retractions, head bobbing? Circulation assessment Central and peripheral pulse rate and quality Skin color and temperature Capillary refill JVD and tracheal position - trauma Circulation interventions CPR/ALS Control obvious bleeding Obtain IV access Adminster 20ml/kg fluid bolus and reassessment of circulatory assessment Administer blood or blood productions Disability assessment AVPU - awake/alert, verbal, responds to pain, does not respond/unconscious Pupils equal round reactive to light E Exposure and Environmental Control Exposure and Environmental Control Assessment and Interventions Look for obvious skin abnormalities Sources of heat loss Apply warm blankets Provide overhead warming light warm IV fluids/warmed humidified O2 F Full set of vital signs Family presence Focused adjuncts Full set of vital signs HR, RR, BP, SpO2, Temp, Weight (kg) Family Identification of family members and their relationship with the child Needs of the family Assign a healthcare professional to liaison with family/provide family support Facilitate family involvement Focused Adjuncts Dynamic cardiopulomonary monitor BGL Gastric tube Urinary cath Blood samples to lab G Give Comfort Measures Give Comfort Measures Assessment of pain Facilitate family presence to support the child Initiate pain management measures - anaglesics, splints, dressings, ice H Head to Toe Assessment Head to Toe Assessment Inspection Palpation Auscultation techniques for s/s of illness or injury such as rashes, lesions, petechiae, ecchymosis, tenderness Reassessment of airway, breathing, and circulatory status H History MIVT Mechanism of Injury Injuries Vital signs prior to arrival Treatments CIA M Peds C - c/o I - immunizations/exposure to infectious disease A - allergies M - medications P - PMH E - events preceding - onset of illness, treatments prior to arrival D - diapers/diet - last PO intake S - s/s History MIVT CIA M Peds Focused Hx Social Hx Family Hx Refer to social services I Inspect posterior surfaces Inspect posterior surfaces inspect and palpate posterior surfaces log roll to maintain airway and spinal alignment Normal BP formula 90 + (2 x age in years) Min Sys BP 70 + (2 x age in years) What is the most reliable indicator for pain? Self-reporting tools Flacc Faces Legs Activity Crying Consolable Croup Intervention cool mist/O2 Epiglottis s/s High Fever Sudden Onset Muffled Drooling Stridor Keep caregiver with the patient! Decrease stress. RSV Low grade fever Foreign body remain with caregiver to decrease stress bronchiolitits Lots of secretions - need for suctioning RSV is a cause Apnea