NURS356 Exam 3 Study Guide Care of Critically Ill Children Accidents Poisonings Accidents Children 1 cause of death in children Accounts for 1 3 of all pediatric fatalities Most occur in or near home Most are preventable Common pediatric accidents falls ingestion poisoning drowning burns car accidents Promoting Safety Nursing interventions must include teaching safety with children across age span promote safety in the hospital environment giving age appropriate toys looking for sharp edges small pieces make sure they are clean toys and not infected with anything anticipate motor abilities and their curiosity include teaching for home environment school and sporting activities protective gear rest nutrition putting medications up and out of view of children supervise these children Teach safety measures with families seatbelts helmets substances in original packages Tips to Prevent Accidents Keep all medication out of reach out of sight Childproof the home grandma babysitter etc Supervise all children s activities Provide age appropriate toys that are clean Leading cause of poison use of analgesics and cough syrup Use protective equipment such as helmets and pads Aspirin Poisoning ASA inhibits platelet aggregation 60mg year of age up to 10 years kids think they taste good peaks in 2 4 hours toxicity occurs at 200mg kg Assessment RR from metabolic acidosis Fever from stimulating carbohydrate metabolism 1 NURS356 Exam 3 Study Guide blood glucose neuro s s irritable and restless bleeding GI gums in whites of eyes tinnutitis ringing in the ears or altered hearing look for signs of petechiai Interventions airway gastric lavage hydrate you want them to hyperventilate they will need to be intubated these kills be given ipecac if PCC is called overhydrated given calcium and potassium supplements secondary to the increase in hydration and their response biggest risk they can bleed to death before you even know they have aspirin poisoning Acetaminophen Poisoning metabolized in liver normal dose 15mg kg small amount infant Tylenol drops Hepatotoxicity with plasma levels in doses of 150 mg kg assess primarily for GI distress early N V D then they will develop abdominal pain monitor for s s liver damage 24 36 hours after overdose liver function tests starting at 24 hr watch child for jaundice and confusion Coagulation study done Hepatic involvement may last up to 7 days and problems may be permanent Assess for pain in right upper quad Manage airway Antidote mucomyst one loading dose then 17 maintenance doses Awful odor not a lot of compliance Must be diluted Can cause irreversible liver damage life long impact Managing Poisonings Parents should call the poison control center before interventions Number should be always near phone Must identify poison Call first b c not all poisons should be vomited up Treat child first airway VS Gastric decontamination if you know soon enough 2 NURS356 Exam 3 Study Guide Activated charcoal absorbs toxins Ipecac syrup is an emetic so that they throw up Typically given with Tylenol Gastric lavage typically used with aspirin Remove poison from child prevent reabsorption prevent recurrence by looking at household Lead Poisoning Environmental poisoning most common in toddlers Cultural socioeconomic links people in old housing poor communities tended to be more exposed Lead pipes lead paint Houses built in early 1900s 1950 do have lead pieces People that have pottery before 1970s exposure to lead Old toys Paint that peels a curiosity for children Lead circulates with erythrocytes settles into bones teeth Lead replaces calcium in the bones Long term effects doesn t take long Normal level 5 20 g ml Long term neurocognitive behavioral effects from level 25 g ml or higher Effects of Lead Poisoning Results in inhibited hemoglobin production or anemia from bones having the calcium replaced by lead Damages cells of proximal tubules causing kidney problems Impaired calcium function of kidneys GI distress weight loss constipation Peripheral neuritis from calcium release in the blood Level of exposure determines neuro low dose of lead poisoning distractibility impulsivity might call it ADD high dose lead poisoning mental retardation blindness seizures Nursing Considerations Early diagnosis intervention is key Preschools and schools screen kids Peds and clinics screen also Key assessments interventions Monitor kidney function Monitor for complaints of bone pain Diagnosis requires blood lead levels traumatic Oral x rays look for lead deposits in the teeth Lead lines in bones 3 NURS356 Exam 3 Study Guide Can also look at urine analysis Adequate hydration necessary Chelating agent administration EDTA by IV binds w lead and is excreted but also removes calcium so the child will end up getting calcium also DO NOT GIVE IRON AT SAME TIME BAL given IM painful injections bind with lead outpatient EMLA cream given topical anesthetic usually put tegaderm over time numbing property to injection site better compliance with children Managing Pediatric Trauma Pediatric Trauma Considerations Developmental characteristics make children more at risk for injury Infants toddlers get into things pull things on themselves fall into water easier their heads are bigger Larger head larger spleen and liver Easy to have bleeding injuries from a ruptured spleen School age adolescents try different things dares Bone growth outstrips muscle growth much more prone to significant injury Site of injury determines priority interventions Rescuer must consider personal safety priority Emergency Assessment LOC primary assessment AVPU method survey method A alert V respond to verbal stimuli P respond to painful stimuli U unresponsive to any stimulus Then ABC s Control bleeding Vital signs treat for shock Systematic head to toe assessment Reassess LOC reevaluate May need pressure dressings sometimes they may continue to bleed Ensure thermoregulation and that you are keeping them warm Only exception near drowning Near Drowning d t lack of supervision or onset of a seizure commonly 4 NURS356 Exam 3 Study Guide males more likely to have these events in unlikely places like toilet bowl hot tube Jacuzzi swimming pool Survival at least 24 hours after event Pulmonary changes r t length of submersion physiologic response of child degree of hypothermia Shunts down surfactant manufacture Physiologic response depending on whether they are hypothermic or not If they are hypothermic and they fall into cold water we do not