pediatric emergency
A 14-year-old girl arrives at the hospital in a comatose state. Her father, who found her comatose in her room, tells you that she has an opiate addiction. Which of the following would confirm that the coma was caused by opiate intoxication?
Both pupils are pinpoints Explanation: Observe the child's eyes for signs of dilated pupils from increased ICP. If both pupils are dilated, irreversible brainstem damage is suggested, although such a finding may also be present with poisoning with an atropine-like drug. Pinpoint pupils suggest barbiturate or opiate intoxication. One pupil dilated or the eye deviated downward or laterally more than the other suggests third cranial nerve compression or a tentorial tear (laceration of the membrane between the cerebellum and cerebrum) with herniation of the temporal lobe into the torn membrane.
The nurse is caring for a 2-year-old who has been rushed to the clinic immediately after swallowing an unknown number of acetaminophen tablets. Which of the following is the priority intervention?
Perform a gastric lavage. Explanation: If the child ingested the pills within the last 60 minutes, a gastric lavage and administration of activated charcoal would be the preferred treatment. If the acetaminophen is in the bloodstream, N-acetylcysteine may be administered
sinus tachycardia
QRS complex is normal. A heart rate below 180 beats per minute is a characteristic of sinus tachycardia. P waves are present with sinus tachycardia. Sinus tachycardia exhibits a beat-to-beat variability in rhythm.
Which medication is used for symptomatic bradycardia unresponsive to ventilation and oxygenation?
atrophine
sprain
ligament injury
strain
muscle-tendon injury
The child has a tracheal tube in place. The nurse is aware which medications may be given via the tracheal tube if no intravenous access is available.
• Atropine • Epinephrine • 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.
The condition of an 11-year-old boy who is on mechanical ventilation begins to deteriorate. What action would the nurse do next?
Check to see if the tracheal tube is displaced. Use the mnemonic DOPE for troubleshooting when the status of a child who is intubated deteriorates. This means checking for displacement and disconnections first. Checking the ventilator, suctioning for obstruction, and examining for signs of pneumothorax would come later
A 4-year-old girl is brought to the emergency room following ingestion of large amounts of acetaminophen (Tylenol). Which of the following interventions does the nurse expect?
Administration of acetylcysteine In the emergency department, activated charcoal or acetylcysteine, a mucolytic agent and also the specific antidote for acetaminophen poisoning, will be administered. Acetylcysteine prevents hepatotoxicity by binding with the breakdown product of acetaminophen so that it will not bind to liver cells. Unfortunately, acetylcysteine has an offensive odor and taste. Administering it in a small amount of a carbonated beverage can help the child to swallow it
After assessing a child's airway, breathing, and circulation (ABCs), what would the nurse do next?
Assess level of consciousness. Explanation: Once the ABCs are completed, the nurse's next step is to assess the child's level of consciousness or disability. This would be followed by removing the child's clothing and diaper (exposure) to assess for underlying signs of illness or injury. Next, full vital signs are taken while facilitating the family presence, followed by giving comfort by managing pain and providing emotional support. The acronym ABCDEFG is a useful reminder of the order of assessment: airway, breathing, circulation, disability, exposure, full vital signs and facilitating family, and giving comfort.
A 10-year-old boy with congenital heart disease is in shock. Which nursing intervention would be most appropriate for this child?
Assessing for pulmonary edema from fluid overload Assessing for pulmonary edema from fluid overload is the most appropriate intervention. Pulmonary edema is rare but may occur in children with preexisting cardiac conditions or severe chronic pulmonary disease. Assessing for changes in mental status and alertness, monitoring urine output, and palpating for improved pulses and capillary refill are valid interventions for managing shock of any kind.
A 3-year-old child has sustained injuries from a fall. Once the airway is secured, what interventions would be next?
Stabilize the cervical spine. Explanation: If head or spine injuries are suspected, then after the airway is opened, the cervical spine must be stabilized to prevent damage. Checking the mouth for debris is part of securing an airway. Administering oxygen and IV access occur after the C-spine is stabilized.
The nurse has administered IV adenosine as ordered to a child with supraventricular tachycardia. Which action would the nurse do next?
Administer a rapid generous saline flush. Explanation: Administration of IV adenosine should be followed immediately by a rapid generous saline flush. Adenosine is given rapidly over 1 to 2 seconds and repeated every 1 to 2 minutes to a maximum dose of 0.3 mg/kg.
glucose reagent strip
Rhinorrhea or otorrhea (clear fluid draining from the nose or ear, respectively) may be noticeable. The fluid is cerebrospinal fluid (CSF) and is a serious finding because it means that the child's central nervous system is open to infection. If it's not clear if the fluid is CSF or rhinitis from an allergy, test the fluid with a glucose reagent strip. CSF will test positive for glucose, whereas the clear, watery drainage from an upper respiratory tract infection or allergy will not.
