Part 2 N173 Final
Card Set Information
Part 2 N173 Final
Hemophilia, Non Intentional Injuries, High risk infants
What is Hemophilia A
a hereditary blood disorder associated with a deficiency in coagulation Factor VIII
How do you get hemophilia
It is a recessive disorder where you mom is a carrier and passes it on to her sons
S/S of hemophilia
excessive bleeding for losing teeth, minor lacerations and injections
When a child has severe hemophilia what will you see?
bleeding that occurs in the muscles and joints (hemarthrosis), especially the knees. Reoccurrence of this bleeding in the same joints will cause:
swelling, pain, bleeding and stiffness
Dx of hemophilia
after circumcision cuz there is prolonged bleeding
but that can be missed so it will be delayed till toddler years since most bleeding occurs in muscles and the joints and we cant see that
will have to wait till they fall and bleed too much
Labs to test for hemophilia
PT, PTT, Fibrin levels, Platelet count
Goal for managing Hemophilia
prevention of excessive bleeding and tissue damage by supplying the body with additional factor VIII which is missing or ineffective
Why aren't blood transfusions given to patients with hemophilia any more?
HIV and Hepatitis risks
What is given to help hemophiliacs? How?
Recombinant Antihemophilic Factor
It is reconsitituted with sterile water and given by IV
Therapies for Hemophilia are starting to be given
prophylactically to delay joint problems
What is given to kids when they are bleeding and how?
Desmopressin Acetate via intranasal spray
What is given to hemophiliacs for nose bleeds and oral clots
Amicar or Cyklokapron
How do you treat bleeding for the hemophiliac?
With a near drowning you will find that the child has
swallowed a lot of water
Swallowing large amounts of fresh water causes
hyponatremia and cerebral edema
Respiratory support for a child that almost drowned cuz they have rales, rhonchi, are at risk for pulmonary edema, atelectasis and pna
suction the oropharynx
Oxygen by mask or bag valve mask
How do you support a childs circulation that almost drowned?
cardiac monitor w/assessments regularly
cover with warm blankets
How do you do a neuro eval on a child that almost drowned?
check pupil reflexes
check response to verbal and tactile stimuli
do they move extremities
How do you decrease ICP in a child that almost drowned
elevate HOB to 30
What fluids will you give if a child almost drowned in fresh water?
How do you help a child recover from acidosis that almost drowned?
How do you remove the fluids swallowed after a near drowning?
gastric tube to decompress
When will you see an infection on a kid that almost drowned?
Infants in an emergency
crying can be stressful for parents
paci as comfort
let parent hold infant as much as possible
reunite parents with infant asap
Toddlers in an emergency
wont like being restricted and will push limits
remove restrictions/restraints as soon as safety permits
don't understand time....so tell about procedure right before
Pre Schoolers in an emergency
Need time between explanation of procedure and completion
Don't use words like stick or cut...scares them
Include parents in treatments....but don't have them restrain the child
May blame themselves for problem/injury
School Age in an emergency
can understand cause of the illness
can understand simple explanations and make decisions about their own care
stress importance of injury prevention behaviors
Adolescent in an emergency
still may not be emotionally mature
age of risk taking...but can be fearful of death
consider themselves invincible
privacy is important so approach them as you would an adult
General poison information to gather....
was the child found ingesting substance
what time did it occur
how did the event occur
where it occurred
any previous episodes
any other medical problems or allergies
Priority management with poisoning
ABC...then prevent and treat shock
Treatment for Tylenol ingestion
Mucomyst IV or PO
Diet-sodium restricted, high calorie and protein
Treatment for aspirin ingestion
Sodium Bicarb for acidosis
What does charcoal do?
Treatment for ingestion of Corrosives....draino, detergents, cleaners
DONT INDUCE VOMITING, LAVAGE or GIVE NEUTRALIZERS...call poison control and follow their recommendations
dilute with water or milk
flood external burns with water
endoscopy to assess burns
Treatment for ingestion of Hydrocarbon...gas, lighter fluid, paint thinners, turpentine, furniture polish
DONT INDUCE VOMITING!!
Describe gastric lavage
mixed with NS or 1/2 NS
protect airway...may gag and vomit
charcoal after lavage
Benefits of charcoal
it binds to the toxin and passes it through the GI system
most effective if done w/in 60min of ingestion
can repeat admin to prevent reabsorption from biliary tract
Tricks for administering charcoal to a toddler
have child sit on parents lap and give w/ oral syringe
mix with chocolate milk
put in a decorated container so child cant see
if refuses....give via NG
When do you use Ipecac? What does it do?
Acetaminophen, ASA, toxic plants, iron containing products
induces vomiting within 30 min and eliminates 30% of ingestion
Who doesn't get Ipecac?
a person with an altered mental status
Primary assessment in an emergency situation
** ABC then go to injury**
Airway assessment in an emergency
positioning for air entry
Breathing assessment in an emergency
increased or decreased work of breathing
use of accessory muscles of respiration
Circulation assessment in an emergency
rate and strength of peripheral and central pulses
Secondary assessment during an emergency
Obtain a history regarding injury
how...fast, far fall, gun, knive
mechanism of injury....circumstances
What happens when a baby gets cold?
oxygen consumption increases
glucose consumption increases
How do we help a baby that cant get warm?
Radiant Warmer for initial stabilization
Place in a flexed position
Skin to Skin contact/Kangaroo Care
What is phototherapy for hyperbilirubinemia?
baby placed under a fluorescent light
exposed skin...uncovered in isolette
Things to monitor on a baby getting phototherapy
look for rashes....turn frequently and NO LOTION
monitor for hyperthermia
assess for bili stools
green, loose, increased frequency
used for hyperbilirubinemia treatment at home...allows infant to be held, changed and fed during therapy
What's difficult about a baby with hyperbilirubinemia?
You cant hold them a lot so it impairs bonding.
Cant even hold during feeds or cares
What will a baby with NEC present with?
abdominal distention (shiny/tight)
decreased bowel sounds
bile stained emesis
Classic sign that a baby has NEC
*air in bowel wall....shows up on x ray
What do I assess for on a patient with NEC
How do I prevent NEC with early detection?
Look at I&O's
measure abd girth
assess gastric residuals
assess for vomiting
**when initiating or increasing feeds, frequently assess them
How do I treat a baby with suspected or actual NEC?
Bowel resection if needed
Assess for signs of sepsis
Watch for signs of impending bowel perf