More PrepU ch 26 Emergency cards

A 5-year-old girl is breathing spontaneously but is unable to maintain an airway. What action would be the priority?

Inserting an oropharyngeal airway Explanation: Inserting an oropharyngeal airway will help ensure that the child maintains a patent airway. Placing a towel under the shoulders would be helpful for opening the airway if this child were an infant. A tracheal tube would not be appropriate since the child is breathing spontaneously and able to maintain her ventilatory effort. Repositioning her using the head tilt/chin lift won't help if she can't maintain an airway independently.

The nurse has been monitoring the child's vital signs. The child is 7 years old. Calculate the child's minimum acceptable systolic blood pressure. Record your answer using a whole number.

84 Explanation: Use the following formula (according to Pediatric Advanced Life Support [PALS]): 70 + (2 times the age in years) The minimal systolic BP of a 7-year-old is 70 = (2 x 7) = 84.

The nurse plans to educate the parents of a child experiencing septic shock about the purpose of administering dobutamine intravenously to their child. What would the nurse include in this educational plan?

Dobutamine is used to improve cardiac contractibility Explanation: Dobutamine improves the contractibility of the heart muscle during shock. The medication is not an antibiotic. Vasodilation would result in lower blood pressure. Atropine (anticholinergic) increases cardiac output, dries secretions, and inhibits serotonin and histamine.

A 6-year-old girl in shock is receiving dobutamine. What would the nurse most likely do?

Monitor for ventricular arrhythmias. Explanation: Once dobutamine has been administered, the nurse should monitor for the development of ventricular arrhythmias. Monitoring for shortness of breath, dyspnea, or worsening of asthma would be appropriate when administering adenosine. Administering lidocaine requires monitoring for hypotension and seizures. Administering fluids is the priority intervention for any child in shock.

The nurse is caring for a child who is critically ill and requiring fluid resuscitation. Which intravenous fluids are appropriate for use? Select all that apply.

Normal saline Lactated Ringer's Explanation: If the circulation or perfusion is compromised, then fluid resuscitation is necessary. Establish large-bore intravenous (IV) access immediately and administer isotonic fluid rapidly. Lactated Ringer's solution and mormal saline are isotonic solutions. 5% and 10% dextrose in water and 5% lactated Ringer's solutions are hypertonic and not appropriate for use in this scenario.

The nurse notes tachycardia on the cardiac monitor of the pediatric client. What would the nurse further assess for this child? Select all that apply.

Pain Body temperature Oxygen saturation Fluid volume status Explanation: Pain, fever, hypoxia, and hypovolemia are common reasons for the child to be tachycardic. Diarrhea, not constipation, would lead to increased fluid loss and thus be considered as a reason for tachycardia.

The nurse is preparing to insert an oropharyngeal airway. Which action would be most appropriate to determine the proper size?

Placing the airway next to the cheek with tip pointing down Explanation: The nurse determines the correct size by placing it next to the child's cheek with the tip pointing down. An airway that is too large will extend past the angle of the child's mandible and can obstruct the glottic opening when inserted. Measuring the distance from the end of the nose to the tragus of the ear is appropriate for a nasopharyngeal airway. Looking at the child's fifth digit reflects the approximate diameter of the nasopharyngeal airway. Measuring from the tip of the nose to the earlobe to the middle area between the xiphoid process and umbilicus is used to determine the length of a nasogastric tube.

When developing the plan of care for a 10-month-old infant in septic shock, which intervention would the nurse most likely include?

Administering intravenous dopamine as ordered Explanation: Although isotonic intravenous solutions such as saline, blood transfusion, and urinary catheter insertion are important for any child with shock, children experiencing septic shock often require larger volumes of fluid as a result of the increased capillary permeability. Thus, fluid alone may not improve the status of a child with septic shock, necessitating the use of vasoactive medications such as dopamine. Saline is the first choice for restoring fluid volume, but this child will most likely need vasoactive medications. Children in shock from trauma may require blood transfusions to restore volume. Once fluids are given, a urinary catheter will be placed to monitor urine output.

The nurse is assessing the neurologic status of an infant. What would the nurse identify as a nonreassuring finding?

Lack of interest in surroundings Explanation: An infant who is not interested in the environment is a cause for concern. Vigorous crying is a reassuring sign. Making eye contact with the nurse is a reassuring finding. A normal anterior fontanel is soft and flat and would be considered a reassuring finding.

The child's ability to perfuse is poor due to inadequate circulation. The physician writes an order for the child to receive 20 mL of normal saline for each kilogram of body weight. The child will receive the normal saline as a bolus through a central intravenous line. The child weighs 78 lb (35.46 kg). Calculate the amount of normal saline the nurse should administer as a bolus. Record your answer using a whole number.

709 Explanation: Dose should be calculated using weight in kilograms. 35.456 kg x 20 mL/kg = 709.1 mL. When rounded to the nearest whole number = 709 mL.

The nurse is caring for a client who is having an acute attack of asthma that is not responding to standard asthma treatment. Which medication does the nurse anticipate administering?

Ketamine Explanation: The client is demonstrating symptoms of status asthmaticus. Ketamine is an anesthetic agent that improves BP and cause bronchodilation for status asthmaticus. The other medications are not recommended for this situation.

The nurse is caring for a child in an emergency situation. The child has a tracheal tube in place. The nurse is aware that which medications may be given via the tracheal tube if no intravenous access is available. Select all that apply.

Atropine Epinepherine Lidocaine Explanation: Certain emergency drugs for children may be given via a tracheal tube (a tube inserted into the trachea that serves to maintain the airway and facilitate artificial respiration). Use the mnemonic LEAN (lidocaine, epinephrine, atropine, and naloxone) to remember which drugs may be given via the tracheal route. Sodium bicarbonate and glucose may not be given via the tracheal tube.

The nurse is caring for a 10-month-old infant with signs of respiratory distress. Which is the best way to maintain this child's airway?

Inserting a small towel under shoulders Explanation: Inserting a small, folded towel under shoulders best positions the infant's airway in the "sniff" position as is recommended by the American Heart Association (AHA) Basic Cardiac Life Support (BCLS) guidelines. The hand should never be placed under the neck to open the airway. The head tilt chin lift technique and the jaw-thrust maneuver are used with children over the age of 1 year.

The nurse is assessing the respiratory status and lungs of a 6-year-old child. What finding would the nurse report immediately?

Minimal air movement through the lungs Explanation: Minimal or no air movement requires immediate intervention because this child's status is severely compromised. Breath sounds over the trachea typically are high pitched. Breath sounds over the peripheral lung fields are lower pitched. Normally percussion over air-filled lungs reveals resonant sounds.

The nurse is assisting with endotracheal intubation of a 3-year-old child. Once the child is intubated, which assessments should be done? Select all that apply.

Observe for symmetry in the rise and fall of the chest. Observe for the presence of water vapor inside the tracheal tube. Explanation: To assess for correct placement once the tracheal tube is inserted, observe for symmetric chest rise and auscultate over the lung fields for equal breath sounds. Inspect the tracheal tube for the presence of water vapor on the inside, indicating that the tube is in the trachea. To rule out accidental esophageal intubation, auscultate over the abdomen while the child is being ventilated: there should not be breath sounds in the abdomen. Note improvement in the oxygen saturation level via pulse oximetry.

A 4-year-old girl, injured in an automobile accident, is suspected of having a head injury. What would be the priority action?

Opening the airway using the jaw thrust maneuver Opening the airway using the jaw thrust maneuver is the priority. If it cannot be opened successfully using the jaw thrust maneuver, it may be opened using the head tilt/chin lift maneuver. Manual stabilization rather than use of an immobilization device is recommended, but the airway needs to be opened first. Stabilizing the head and neck is secondary to opening the airway. Once the airway is open, ventilation may begin.

A 13-year-old boy has had a near-drowning experience. The nurse notices he has labored breathing and a cough. What is the priority intervention?

Administer 100% oxygen by mask. Explanation: Management of the near-drowning victim focuses on assessing his airway, breathing, and circulation (ABCs) and correcting hypoxemia. Administering oxygen is the primary intervention to assist breathing. It is best to let the child assume the most comfortable position for him. Checking capillary refill time helps determine ineffective tissue perfusion. Providing sedation is an intervention for pain that will be assessed after effective breathing is established.

When assessing a child with a traumatic injury, what would be the priority assessment?

Airway patency and airflow Explanation: When assessing the child with a traumatic injury, the ABCs are assessed first: assess the patency of the airway and establish the effectiveness of breathing, examining the child's respiratory effort, breath sounds, and color; evaluate the circulation, noting pulse rate and quality and observing the color, skin temperature, and perfusion. Once this is accomplished, the nurse assesses for disability (D), rapidly assessing critical neurologic function including level of consciousness, pupillary reaction, and verbal and motor responses to auditory and painful stimuli.

A young child comes to the emergency department. The child's mother reports that he was hit in the head and other body areas with a baseball bat. Upon further examination, the child becomes hypotensive. What does the nurse suspect is happening?

Shock from bleeding points other than the head injury Explanation: Shock with hypotension is rare during an isolated head injury. If a child is in shock, investigate for bleeding points other than the head.

The nurse is assessing a 6-week-old infant in the home setting. The nurse notes the infant has a regular breathing pattern with brief periods of apnea followed by a respiratory rate of 40. What would the nurse further assess in the infant?

Skin color and heart rate Explanation: Infants less than 2 months (or premature), may display periodic breathing. The infant who is experiencing period breathing looks pink and has a normal heart rate and the nurse would not need to intervene further. The infant's birth weight, Apgar scores, lung fields and blood pressure are important to assess, but not specifically to the infant with period breathing.

The nurse is caring for a child with a heart rate of 175 with a pulse. The ECG shows wide QRS complexes with no P waves present. The nurse notifies the physician and expects which orders? Select all that apply.

Synchronized cardioversion IV amiodarone Explanation: The child is presenting with ventricular tachycardia with a pulse. Treatment of this tachyarrhythmia includes synchronized cardioversion, IV amiodarone and treatment of any underlying causes. IV atropine is used to treat bradycardia's not tachycardia's. IV adenosine is used to treat SVT's.

The nurse is caring for a child experiencing a cardiac arrest. The nurse has administered IV epinephrine at 1315. At what time can the nurse administer another dose of epinephrine?

1320. Explanation: Epinephrine may be administered IV, intraosseous (IO) or via and ET tube. During CPR, it may be repeated every 3 to 5 minutes.

The nurse is collecting a brief health history from the parents of a 3-year-old child brought to the emergency department experiencing a cardiac emergency. What questions are appropriate for inclusion? Select all that apply.

"Has your child had any recent illnesses?" "What foods or drugs is your child allergic to?" "Tell me about any coughing or wheezing you may have noticed when your child has been playing lately." Explanation: When a child is being treated for a cardiac emergency a brief health history is needed. This history must highlight possible problems and causes of the illness being experienced. Questions about recent illnesses can show possible links to the cardiac emergency. Information about drug and food allergies is needed as this child will likely need to receive medications and knowing potential allergies is of importance. Wheezing and coughing may signal cardiac or respiratory concerns and should be investigated. The number of children in the home and activities the child enjoys are of interest but are not of emergent value.

A 4-year-old girl has been admitted to the emergency department after accidently ingesting a cleaning product. Which treatment is most likely appropriate in the immediate treatment of the girl's poisoning?

Administration of activated charcoal Explanation: Activated charcoal is the most common treatment for many poisonings and is more effective and safe than induced vomiting or gastric lavage. Rehydration is likely necessary, but this does not actively treat the girl's poisoning.

A child presents to the emergency department via ambulance in critical condition following a traumatic motor vehicle crash. What would the first action of the nurse be?

Assess the child's airway and manage airway patency Explanation: The nurse would first assess and management the airway in a pediatric emergency. Most cardiopulmonary events are precipitated by a respiratory condition. The nurse would move on to assessment of cardiac/circulation after airway. The child's clothes would be removed and the parents updated but that is not the first action of the nurse. The nurse can assess while another staff member works with the parents for consent to treat if the condition is not life-threatening.

The health care team is preparing to intubate a 13-year-old child following a near drowning. Which supplies would the nurse gather for this procedure?

The estimated size tracheal tube and one bigger and one smaller A curved-blade laryngoscope with working light bulb at the end A suction catheter with package open and tip kept sterile Continuous cardiac and pulse oximeter with electrical plugin or battery Explanation: The health care team would utilize a bag-valve mask with oxygen source to ventilate the client before intubation and after unsuccessful intubation attempts. The nurse would gather 3 tracheal tubes (the estimated size and one larger and one smaller) and a curved-blade laryngoscope for an older child/adolescent. Suction should be available and set up prior to the intubation to assist in quickly removing secretions that may cause aspiration. The child who is being intubated should be placed on continuous cardiac and pulse oximeter monitors. The use of a nasal cannula would be inappropriate due to the need for the child to have a higher (100%) oxygen delivery system.