Part 2 N173 Final

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Author:
foxyt14
ID:
264653
Filename:
Part 2 N173 Final
Updated:
2014-03-05 20:10:23
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Pediatrics
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Description:
Hemophilia, Non Intentional Injuries, High risk infants
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  1. What is Hemophilia A
    a hereditary blood disorder associated with a deficiency in coagulation Factor VIII

    BLEEDING DISORDER
  2. How do you get hemophilia
    It is a recessive disorder where you mom is a carrier and passes it on to her sons
  3. S/S of hemophilia
    • bruise easily
    • epistaxis
    • hematuria
    • excessive bleeding for losing teeth, minor lacerations and injections
  4. 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
  5. 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
  6. Labs to test for hemophilia
    PT, PTT, Fibrin levels, Platelet count
  7. Goal for managing Hemophilia
    prevention of excessive bleeding and tissue damage by supplying the body with additional factor VIII which is missing or ineffective
  8. Why aren't blood transfusions given to patients with hemophilia any more?
    HIV and Hepatitis risks
  9. What is given to help hemophiliacs? How?
    Recombinant Antihemophilic Factor

    It is reconsitituted with sterile water and given by IV
  10. Therapies for Hemophilia are starting to be given
    prophylactically to delay joint problems
  11. What is given to kids when they are bleeding and how?
    Desmopressin Acetate via intranasal spray
  12. What is given to hemophiliacs for nose bleeds and oral clots
    Amicar or Cyklokapron
  13. How do you treat bleeding for the hemophiliac?
    • Rest
    • Ice
    • Compression
    • Elevate
  14. With a near drowning you will find that the child has
    • swallowed a lot of water
    • vomiting
    • aspiration
    • laryngospasm
    • hypoxia
    • seizures
    • brain damage
  15. Swallowing large amounts of fresh water causes
    hyponatremia and cerebral edema
  16. 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
  17. How do you support a childs circulation that almost drowned?
    • pulse ox
    • hydration
    • cardiac monitor w/assessments regularly
    • cover with warm blankets
  18. 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
  19. How do you decrease ICP in a child that almost drowned
    elevate HOB to 30
  20. What fluids will you give if a child almost drowned in fresh water?
    sodium fluids
  21. How do you help a child recover from acidosis that almost drowned?
    sodium bicarbonate
  22. How do you remove the fluids swallowed after a near drowning?
    gastric tube to decompress
  23. When will you see an infection on a kid that almost drowned?
    day 2-5
  24. 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
  25. 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
  26. 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
  27. 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
  28. 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
  29. General poison information to gather....
    • was the child found ingesting substance
    • what time did it occur
    • how did the event occur
    • substance involved
    • where it occurred
    • any previous episodes
    • any other medical problems or allergies
  30. Priority management with poisoning
    ABC...then prevent and treat shock
  31. Treatment for Tylenol ingestion
    • Mucomyst IV or PO
    • IV fluids
    • Diet-sodium restricted, high calorie and protein
  32. Treatment for aspirin ingestion
    • lavage
    • induce vomiting
    • charcoal
    • Sodium Bicarb for acidosis
    • Vitamin K
  33. What does charcoal do?
    decreases absorption
  34. Treatment for ingestion of Corrosives....draino, detergents, cleaners
    DONT INDUCE VOMITING, LAVAGE or GIVE NEUTRALIZERS...call poison control and follow their recommendations

    • maintain airway
    • dilute with water or milk
    • flood external burns with water
    • endoscopy to assess burns
  35. Treatment for ingestion of Hydrocarbon...gas, lighter fluid, paint thinners, turpentine, furniture polish
    • DONT INDUCE VOMITING!!
    • support ventilation
    • admin O2
    • IV fluids
  36. Describe gastric lavage
    • orogastric tube
    • mixed with NS or 1/2 NS
    • protect airway...may gag and vomit
    • charcoal after lavage
  37. 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
  38. 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
  39. 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
  40. Who doesn't get Ipecac?
    a person with an altered mental status
  41. Primary assessment in an emergency situation
    • #1 Airway
    • #2 Breathing
    • #3 Circulation

    ** ABC then go to injury**
  42. Airway assessment in an emergency
    • patency
    • positioning for air entry
    • audible sounds
    • airway obstruction
  43. Breathing assessment in an emergency
    • increased or decreased work of breathing
    • nasal flaring
    • use of accessory muscles of respiration
  44. Circulation assessment in an emergency
    • skin color
    • temp
    • cap refill
    • rate and strength of peripheral and central pulses
  45. Secondary assessment during an emergency
    • Obtain a history regarding injury
    • when
    • where
    • by whom
    • how...fast, far fall, gun, knive
    • mechanism of injury....circumstances
  46. What happens when a baby gets cold?
    • oxygen consumption increases
    • glucose consumption increases

    • acidosis
    • hypoxia
    • hypoglycemia
    • FTT
  47. How do we help a baby that cant get warm?
    • Radiant Warmer for initial stabilization
    • Isolette
    • Place in a flexed position
    • Bundle
    • Skin to Skin contact/Kangaroo Care
  48. What is phototherapy for hyperbilirubinemia?
    • baby placed under a fluorescent light
    • eye patched
    • exposed skin...uncovered in isolette
  49. Things to monitor on a baby getting phototherapy
    • look for rashes....turn frequently and NO LOTION
    • watch hydration
    • monitor for hyperthermia
    • promote nutrition
    • assess for bili stools
  50. bili stools
    green, loose, increased frequency
  51. Ohmeda Biliblanket
    used for hyperbilirubinemia treatment at home...allows infant to be held, changed and fed during therapy
  52. 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
  53. What will a baby with NEC present with?
    • abdominal distention (shiny/tight)
    • bowel loops
    • decreased bowel sounds
    • gastric retention
    • blood stools
    • bile stained emesis
  54. Classic sign that a baby has NEC
    • pneumatosis Intestinalis
    • *air in bowel wall....shows up on x ray
  55. What do I assess for on a patient with NEC
    • sepsis
    • bowel perforation
  56. How do I prevent NEC with early detection?
    • Look at  I&O's
    • measure abd girth
    • assess gastric residuals
    • assess for vomiting
    • OB test

    **when initiating or increasing feeds, frequently assess them
  57. How do I treat a baby with suspected or actual NEC?
    • NPO
    • IV hydration
    • IV antibiotics
    • Bowel resection if needed
    • Assess for signs of sepsis
    • Watch for signs of impending bowel perf

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