Chapter 50 - Shock, Multiple Organ Dysfunction Syndrome, and Burns in Children

Match the terms with the corresponding descriptions. ______ A. Scald burn ______ B. Contact burn ______ C. Flame burn ______ D. Electrical burn ______ E. Chemical burn 26. Involves flammable liquids such as gasoline.

26. ANS: C PTS: 1 REF: Page 1716 MSC: Flame burns involving flammable liquids, especially gasoline, are most common in older children.

Match the terms with the corresponding descriptions. ______ A. Scald burn ______ B. Contact burn ______ C. Flame burn ______ D. Electrical burn ______ E. Chemical burn 27. Is caused by hot grease.

27. ANS: A PTS: 1 REF: Page 1715 MSC: Scald injuries (e.g., hot water, grease) are most common among young children.

Match the terms with the corresponding descriptions. ______ A. Scald burn ______ B. Contact burn ______ C. Flame burn ______ D. Electrical burn ______ E. Chemical burn 28. Is the result of direct contact with high- and low-voltage current.

28. ANS: D PTS: 1 REF: Page 1716 MSC: Electrical burns are the result of direct contact with high- or low-voltage current.

Match the terms with the corresponding descriptions. ______ A. Scald burn ______ B. Contact burn ______ C. Flame burn ______ D. Electrical burn ______ E. Chemical burn 29. Is caused by a corrosive agent.

29. ANS: E PTS: 1 REF: Page 1716 MSC: Chemical burns occurring at home may be a result of swallowing corrosive agents.

Match the terms with the corresponding descriptions. ______ A. Scald burn ______ B. Contact burn ______ C. Flame burn ______ D. Electrical burn ______ E. Chemical burn 30. Involves cigarette burns and curling irons.

30. ANS: B PTS: 1 REF: Page 1715 MSC: Contact burns may be intentionally inflicted by contact with cigarettes or other hot objects such as curling irons

As the result of the inability to concentrate urine, children are at risk for dehydration before which age? a. 2 years b. 4 years c. 6 years d. 8 years

ANS: A Children younger than 2 years lack the ability to concentrate urine because of the immaturity of the renal system and are therefore at increased risk for dehydration. REF: Page 1719

What is the most common type of shock in children? a. Hypovolemic b. Cardiogenic c. Neurogenic d. Septic

ANS: A Hypovolemic shock, the most common type of shock in children, is associated with a reduction in the intravascular volume relative to the vascular space. REF: Page 1703

Approximately 80% of all hospital-acquired infections in children are a result of which type of organism? a. Bacteria b. Viruses c. Fungi d. Rickettsia

ANS: A In adults and children, approximately 40% of all hospital-acquired infections are linked to gram-negative infections, 40% to gram-positive infections, and 20% to viruses, fungi, or rickettsial microorganisms. REF: Page 1707

What are the primary goals for the treatment of shock? a. Maximizing oxygen delivery and minimizing oxygen demand b. Maintaining hydration and adequate urinary output c. Supporting all facets to the cardiovascular system d. Maintaining all vital signs within normal functioning ranges ANS: A The primary goals of the treatment of shock are maximizing oxygen delivery and minimizing oxygen demand. Although the other options are desirable, they are each associated with the primary goals related to oxygen delivery and demand. PTS: 1 REF: Pages 1710-1711

ANS: A The primary goals of the treatment of shock are maximizing oxygen delivery and minimizing oxygen demand. Although the other options are desirable, they are each associated with the primary goals related to oxygen delivery and demand. REF: Pages 1710-1711

Which statements are true regarding how a child's body compensates for cardiogenic shock? (Select all that apply.) a. Splanchnic arteries are constricted to divert blood from the skin, kidneys, and gut to the heart and brain. b. Peripheral blood vessels are constricted to raise blood pressure. c. Adrenergic responses produce tachycardia to increase cardiac output. d. The renin-angiotensin-aldosterone system is stimulated when renal function decreases. e. Compensation prevents the child from developing hepatic or mesenteric failure.

ANS: A, B, C, D In the early stages of cardiogenic shock, adrenergic compensatory mechanisms produce tachycardia, peripheral vasoconstriction, and constriction of the splanchnic arteries to divert blood flow from the skin, gut, and kidneys to maintain flow to the heart and brain. These compensatory mechanisms may be sufficient to maintain the child's systolic blood pressure and effective coronary artery and cerebral blood flow. However, tachycardia and systemic arterial constriction increase myocardial oxygen consumption. In addition, reduction in gut and kidney blood flow may produce hepatic, mesenteric, or renal ischemia or failure. Decreased renal perfusion stimulates the renin-angiotensin-aldosterone system, as described for hypovolemic shock. REF: Page 1704

The child with septic shock has significant hypovolemia that typically responds to which interventions? (Select all that apply.) a. Aggressive fluid administration b. Antibiotic therapy c. Titration of inotropes d. Vasopressors e. High caloric nasogastric feedings

ANS: A, B, C, D The child with septic shock has significant hypovolemia that typically responds to aggressive fluid administration, antibiotic therapy, titration of inotropes, vasopressors, and vasodilators. Nasogastric feedings are not generally ordered for children with septic shock. REF: Page 1709

Which behaviors in newborns would support the possibility of shock? (Select all that apply.) a. Decreased heart rate variability b. Temperature instability c. Hyperalertness d. Increased muscle tone e. Hypoglycemia

ANS: A, B, E Nonspecific signs of distress in newborns include jitteriness or lethargy with decreased muscle tone, bradycardia or decreased heart rate variability, temperature instability, and hypoglycemia. REF: Page 1700 | Box 49-1

Which statements are true regarding multiple organ dysfunction syndrome (MODS)? (Select all that apply.) a. Diagnosis requires simultaneous failure of at least two organs. b. Primary MODS occurs immediately after the attributing cause. c. Secondary MODS occurs within 3 to 7 days of the initial insult. d. Chronic illness increases a child's risk for MODS. e. Risk factors for MODS include severe or prolonged shock, sepsis, and trauma.

ANS: A, D MODS is the simultaneous failure of at least two organs resulting from a single cause and may be either primary or secondary. Primary MODS is directly attributable to the insult and typically occurs 3 to 7 days after an insult. Secondary MODS typically occurs later and may be associated with the more sequential development of organ dysfunction. Risk factors for MODS include severe or prolonged shock, sepsis, trauma, cardiopulmonary arrest, congenital heart disease, and liver and bone marrow transplantation. Children with chronic diseases have an increased risk for MODS and increased mortality. REF: Pages 1699-1700

Compared with the ebb phase, characteristics of the catabolic flow phase in metabolism after a burn injury in a child include which process? a. Reduced oxygen consumption b. Elevation of catecholamines c. Impaired circulation d. Cellular shock

ANS: B After the resolution of the shock and the restoration of circulating volume, the metabolic response shifts to a catabolic (flow) phase. A state of hypermetabolism ensues, characterized by increased oxygen consumption and the elevation of catecholamines, glucocorticoids, and glucagon. This selection is the only option that accurately compares the characteristics of the ebb and flow phases. REF: Page 1720

In cardiogenic shock, what is the cause of hepatomegaly and periorbital edema? a. Mass vasodilation as a result of chemical mediators released from the myocardium b. Low cardiac output, causing a high central venous pressure c. Tissue damage to the myocardium, causing increased capillary permeability d. Low perfusion of the kidneys, stimulating the renin-angiotensin-aldosterone system to retain sodium and water

ANS: B Evidence of an adequate or high central venous pressure, including hepatomegaly and periorbital edema, is observed in cardiogenic shock. This selection is the only option that accurately identifies the cause of these symptoms. REF: Page 1704

What is the most serious outcome resulting from limited glycogen stores in children who have been seriously burned? a. Poor wound healing b. Increased morbidity c. Decreased immunity d. Loss of adipose tissue stores

ANS: B Glycogen stores are limited in children, making it hard for them to meet the increased energy demands of the burn. This prolonged metabolic dysfunction may lead to the loss of lean body mass. The most serious affect is increased morbidity; that is, the risk of additional illnesses will impede recovery. The remaining options do not represent the most serious outcome of limited glycogen stores resulting from severe burns. REF: Page 1720

To determine a child's response to fluid therapy for shock, the nurse should monitor ______________________. a. Hematocrit and hemoglobin levels b. Urine output and specific gravity c. Blood pressure and pulse d. Arterial blood gases and heart rate

ANS: B Monitoring of the volume of urine output and specific gravity is most useful in determining the child's response to fluid therapy. REF: Page 1711

A prolonged capillary refill time in children is consistent with the development of what type of shock? a. Hypovolemic b. Septic c. Compensated d. Cardiogenic

ANS: B The child with hypovolemic shock demonstrates signs of inadequate blood flow to some tissue beds and some evidence of organ system dysfunction. The infant or child may be irritable or lethargic. Respirations will be rapid and may be labored if shock is severe or associated with myocardial failure. The skin will be mottled, although pallor also may be observed. A prolonged capillary refill time (>2 seconds) is consistent with the development of septic shock. This statement is not necessarily true of the other types of shock. REF: Page 1704

While awake, what is the normal heart rate for toddlers (in beats per minute)? a. 100 to 205 b. 100 to 180 c. 98 to 140 d. 80 to 120

ANS: C Although the other ranges may be normal for some age groups, the normal heart rate range for toddlers during waking hours is 98 to 140 beats per minute. REF: Page 1702 | Table 49-1

What advantage do impregnated silver dressings have for patients with burn injuries? a. Impregnated silver dressings contain natural-occurring collagens. b. They require only one dressing change every other day. c. Removal is less painful. d. Impregnated silver dressings are cost effective.

ANS: C Impregnated silver dressings not only kill bacteria, but most are processed with a special layer, making them less painful to remove. Some of these products can be left on the wound for up to 2 weeks, allowing for less frequent dressing changes. The other options are related to a new extracellular matrix (ECM) product that is now being researched for repair and remodeling of damaged tissues. REF: Page 1722 | What's New box

What type of injury is associated with cellular injury caused by the restoration of blood flow and physiologic concentrations of oxygen to cells that have been exposed to injurious but nonlethal hypoxic conditions? a. Hypoxic b. Hyperoxygenation c. Reperfusion d. Ischemic

ANS: C Reperfusion (reoxygenation) injury is associated with cell damage caused by the restoration of blood flow and physiologic concentrations of oxygen to cells that have been exposed to injurious but nonlethal hypoxic conditions. REF: Page 1710

What is the cause of appropriately 50% of the deaths in children who have experienced a burn injury? a. Immunosuppression b. Hypermetabolism c. Inhalation injury d. Hypertrophic scarring

ANS: C The leading cause of death in children after burn injury, as in adults, is an inhalation injury. Inhalation injuries cause approximately 50% of all deaths in children with burns. Although the other options are factors, they are not responsible for 50% of the deaths. REF: Pages 1715-1716

Which assessment finding would be recognized as a late sign of shock in a child? (Select all that apply.) a. Metabolic (lactic) acidosis b. Cool skin c. Bradycardia d. Prolonged capillary refill e. Hypotension

ANS: C, E Although all of the options are observable, hypotension and bradycardia are recognized as late signs of shock in children. REF: Page 1700 | Box 49-1

What considerations must the nurse take into account when assessing the severity of a burn injury? (Select all that apply.) a. Amount of fluid lost over a 24-hour period b. Circumference of the burn injury c. Depth of the burn injury d. Severity of the injury caused to other body systems e. Percentage of total body surface area involved

ANS: C, E The severity of a burn injury is assessed on the basis of the percentage of the total body surface area involved. Because burn trauma represents a three-dimensional wound, the severity of injury is also assessed in relation to the depth of the injury. Although the other options are considered when planning treatment, the severity of the burn injury, itself, is not based on any of these. REF: Pages 1716-1717

What is the normal range of respirations for an infant (in breaths per minute)? a. 18 to 25 b. 20 to 28 c. 27 to 37 d. 30 to 53

ANS: D Although the other ranges may be normal for some age groups, the normal respiratory range for infants is 30 to 53 breaths per minute. REF: Page 1702 | Table 49-1

Which cytokines are anti-inflammatory mediators? a. Interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-D) b. IL-8, IL-12, and platelet-activating factor c. IL-24, arachidonic acid metabolites, and nitric oxide d. IL-4, IL-11, and colony-stimulating factor

ANS: D Anti-inflammatory mediators include only IL-4, IL-10, IL-11, and IL-13; transforming growth factor-beta; colony-stimulating factors; soluble TNF receptor; IL-1 receptor antagonist; and activated protein C. REF: Page 1707

Bradycardia in young children experiencing shock symptoms often suggests which result? a. Onset of cardiac dysfunction b. Effective management of cardiac dysfunction c. Good management of anxiety d. Cardiovascular collapse

ANS: D Bradycardia often indicates impending cardiovascular collapse or cardiac arrest and is the most common terminal cardiac rhythm observed in children. This selection is the only option that accurately describes the impact of bradycardia on a child. REF: Page 1704

Hypotension is likely to occur when an infant or child is greater than _____ % dehydrated. a. 2 b. 5 c. 7 d. 10

ANS: D Hypotension typically develops when dehydration is greater than 10% in the infant or child or greater than 6% in the adolescent. REF: Page 1703

For children who are experiencing shock, crystalloids and colloids are generally administered in boluses of how many milliliters per kilogram (ml/kg)? a. 5 b. 10 c. 15 d. 20

ANS: D In general, isotonic crystalloids (salt-containing solutions, such as normal saline or lactated Ringer solution) or colloids (protein-containing fluids, such as albumin or blood) are administered in boluses of 20 ml/kg. REF: Page 1711

What causes renal failure after electrical burns in children? a. Cytokines are released after the damaged tissue. b. Immature kidneys are unable to compensate for the electrical burn. c. Cardiac output is reduced. d. Myoglobin is released from damaged muscles.

ANS: D The release of myoglobin may occlude the kidney tubules and result in renal failure. This selection is the only option that accurately describes the correlation between electrical burns and renal failure. REF: Page 1719