Chapter 51: Nursing Care During a Pediatric Emergency

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

An emergency department nurse is caring for a 5-year-old child who was just brought in by ambulance with partial-thickness (second-degree) and full-thickness (third-degree) burns to their face, neck, and chest. The client is awake and alert. Vital signs: temperature, 97.2°F (36.2°C); heart rate, 148 beats/min; blood pressure, 68/39 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 90% on 2 liters by nasal cannula. The nurse receives prescriptions for the client. Click to highlight the prescription(s) that requires immediate implementation. Prescriptions: -Apply oxygen to maintain oxygen saturations 95% or greater. -Administer 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hour. -Initiate fluid resuscitation per Lund and -Browder chart using Parkland formula with 0.9% saline. -Administer acetaminophen by mouth (PO) 325 mg q6h prn for fever. -Initiate a regular diet as tolerated.

Apply oxygen to maintain oxygen saturations 95% or greater. Administer 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hour. Initiate fluid resuscitation per Lund and -Browder chart using Parkland formula with 0.9% saline.

The nurse is caring for a child who has had an endotracheal tube placed and is hooked to a ventilator. When assessing the child, the nurse notes that they child is exhibiting signs of poor oxygenation. What should the nurse do? Select all that apply. Assess tracheal tube placement. Assess for tracheal tube obstruction. Assess the ventilator equipment, checking to see that all tubing is connected correctly. Assess for decreased body temperature. Assess for the presence of decreased breath sounds on one side of the chest.

Assess tracheal tube placement. Assess for the presence of decreased breath sounds on one side of the chest. Assess for tracheal tube obstruction. Assess the ventilator equipment, checking to see that all tubing is connected correctly.

Which assessment finding would indicate to the health care team that a child would need to be reintubated due to improper placement of the endotracheal tube? Symmetrical chest rise is observed. Breath sounds are heard over the abdominal area. Oxygen saturation rises from 78% to 93% after intubation. There's water vapor on the inside of the tube.

Breath sounds are heard over the abdominal area.

A child is hospitalized with suspected sepsis. The health care provider has prescribed an intravenous fluid bolus of lactated Ringer's solution 15 ml/kg to infuse over 20 minutes. The child weighs 52 lb (23.6 kg). How much fluid should the nurse administer? Record your answer using a whole number.

354

Assessment of a child reveals a tension pneumothorax. The nurse would prepare the child for: intubation needle thoracotomy

needle thoracotomy Explanation: A needle thoracotomy is indicated for tension pneumothorax to relieve the air collected in the space. Intubation is indicated for apnea and in situations in which the airway cannot be maintained. Suctioning would be indicated for excessive airway secretions that influence airway patency. Defibrillation is used to stimulate or alter the heart's electrical rhythm.

A 4-year-old girl injured in an automobile accident is suspected of having a head injury. What would be the priority action? stabilizing the head and neck with a pediatric backboard opening the airway using the jaw thrust maneuver

opening the airway using the jaw thrust maneuver Explanation: 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 9-year-old boy nearly drowned when he fell through the ice while skating on a pond. The child is exhibiting bradycardia. What would the nurse expect to implement to resolve the child's bradycardia? providing 100% oxygen via face mask using a convective air warming blanket

using a convective air warming blanket Explanation: Bradycardia may be resolved by addressing the underlying condition—in this case by relieving hypothermia with a convective air warming blanket. Providing 100% oxygen and then administering epinephrine are primary and secondary treatments for arrhythmias. Giving fluids is an intervention for collapsed rhythms and hypovolemic shock.

The nurse provides frequent and ongoing assessments for the child who is intubated and on mechanical ventilation. What assessment findings would be concerning for the nurse? Select all that apply. The chest rises with each breath of the ventilator. The child's pulse oximeter ranges from 85% to 90%. The breath sounds are greater on the right side. The child's heart rhythm is sinus tachycardia. The child's nail beds are pink with capillary refill.

The child's pulse oximeter ranges from 85% to 90%. The breath sounds are greater on the right side.