204 QUIZ

• ACADEMIC YEAR: 2023 – 2024
• MANIFESTING: #RN2026 #DDCNursing
• Toddler development


  • Gross motor - walking, running, climbing
  • Fine motor - feeding themselves, drawing
  • Sensory/cognitive - seeing, hearing, tasting, touching, and smelling
  • Language/communication - saying single words, then sentences
  • Social/emotional - playing with others, taking turns, doing fantasy plans
• Health problems common in toddlers

  • Burns
  • Poisoning
  • Child Abuse
  • Cerebral Palsy
  • Common injuries - Drowning, Aspiration
• Burns


  Injuries to body tissue caused by excessive heat (greater than 40°C or 104°F)
• 2nd greatest cause of unintentional injury in 1-4 y.o.
• 3rd most common cause of unintentional injury in children 5 to 14 y.o.
• Every day, there are more than 300 children treated in emergency rooms for burn-related injuries
• Types of burns


  • Thermal burns - due to external heat sources eg: Hot metals, scalding liquids, steam, & flames
  • Radiation burns - caused by prolonged exposure to ultraviolet rays of the sun, therapeutic cancer treatments, or nuclear power plant leaks
  • Chemical burns - caused by strong acids, alkalis, detergents, or solvents
  • Electrical burns - from electrical current
  • Friction burns - from direct damage to the cells and the heat generated by friction. eg: falling on or touching a treadmill in motion, rope burn from a rope sliding through the hands
• BURNS - ASSESSMENT


  • Airway
  • Breathing: beware of inhalation and rapid airway compromise
  • Circulation: fluid replacement
  • Disability: compartment syndrome
  • Exposure: percentage area of burn
• RULE OF 9s (ADULTS) - Wallace The Rule of Nines - is the way medical professionals calculate the TBSA (total body surface area)
• LUND AND BROWDER CHART - used to calculate TBSA
• CLASSIFICATION AND DESCRIPTION OF BURNS

  • First-degree burns - superficial, only the epidermis is involved
  • Second-degree burns - partial thickness, involving the epidermis and part of the dermis
  • Third-degree burns - full thickness, involving the epidermis, dermis, and underlying tissues
• Be certain to ask what caused the burn because different materials cause different degrees of burn
• Ask where the fire happened because fires in closed spaces are apt to cause more respiratory involvement than those in open areas
• EMERGENCY MGT OF BURNS

  • MINOR BURNS - Immediately apply cool water to cool the skin, Application of Analgesic – antibiotic ointment and a gauze bandage to prevent infection, Keep dressing dry and change every 2 days
  • MODERATE BURNS - Don't rupture blisters, Apply topical antibiotic (Silver sulfadiazine-silvadene) and dressing to prevent damage and infection, Broken blisters may be debrided
  • SEVERE BURNS - Fluid therapy- LR or PNSS, Systemic antibiotic therapy, Pain mgt – Morphine sulfate IV, Physical therapy- prevent contractures
  • ELECTRICAL BURNS - Clean with antiseptic solution (Half strength Hydrogen peroxide) 1:1, Monitor for airway obstruction, Provide a bland liquid diet
• Debridement


  the removal of dead (necrotic) or infected skin tissue to help a wound heal, also done to remove foreign material from tissue
• BURNS - THERAPEUTIC MANAGEMENT


  • Topical therapy – Silver sulfadiazine, Furacin (If with Pseudomonas)
  • Escharotomy – Cut into the eschar
  • Debridement – Removal of necrotic tissue
  • Grafting- Reduce fluid and electrolyte loss, pain, and infection. Allografting, Xenograft, Autografting
• FLUID SHIFTS AFTER BURN INJURY
• According to the American Association of Poison Control Centers (AAPCC), there are more than 1 million reported poison exposures among children younger than 6 years of age yearly

  
• 90% of the time poisoning occurs in the child's home
• 9,500 children will be hospitalized yearly for unsupervised ingestion of prescription medications
• Poison


  Any substance that is harmful to your body. Can be swallowed, inhaled, injected, or absorbed through the skin
• Poisoning tends to occur when parents are preoccupied or highly stressed
• Usual agents ingested


  • Soap, cosmetics, detergents or cleaners, plants, OTC drugs, vitamins, aspirin, acetaminophen, and prescription drugs
• EMERGENCY MGT OF POISONING AT HOME

  • CALL NATIONAL POISON CONTROL CENTER - What was swallowed, Child's weight and age and how long ago the poisoning occurred, Route of poisoning, Estimation of how much of poison was taken, Child's present condition
  • ADMINISTER ACTIVATED CHARCOAL - Administered to conscious victims only, Give ASAP, Mixed with water, adding a sweet syrup is suggested, Stools will appear black

  
• Acetaminophen poisoning


  Causes extreme permanent liver destruction, After ingestion, the child develops: anorexia, nausea and vomiting, ↑ Sgpt, Sgot, Antidote- Acetylcysteine Or Activated charcoal
• Caustic poisoning


  Ingestion of strong alkalies, such as lye, which is contained in certain toilet bowl cleaners and hair products. Causes burns and tissue necrosis in the mouth, esophagus, and stomach. Don't let the child vomit.
• CAUSTIC POISONING - ASSESSMENT

  • Pain in mouth and throat, Drools saliva bec. of oral edema and inability to swallow, Mouth turns white, Vomits blood, mucus, and necrotic tissue, Tachycardia, tachypnea, pallor, hypotension
• CAUSTIC POISONING - THERAPEUTIC MANAGEMENT

  • Bring the child to the nearest Hospital, Don't administer Activated charcoal, IV Morphine for pain, X-ray, Laryngoscopy and Esophagoscopy, Intubation or tracheotomy

  
• Iron poisoning


  Large amounts of iron are corrosive to the gastric mucosa and lead to severe gastric irritation in the child. Immediate effects: Nausea and vomiting, Diarrhea, Abdominal pain. After 6-12 hours: Melena, Hematemesis, Cyanosis, Vasomotor collapse, Coagulation defects, Hepatic injury, Lethargy and coma
• IRON POISONING - THERAPEUTIC MANAGEMENT


  • Don't give Activated charcoal, Stomach lavage, Administer Cathartics, Administer Maalox or Mylanta – to help decrease gastric irritation and pain, Administer IV or IM Deferoxamine, GI Xray, Liver studies
• Lead poisoning


  Also called Plumbism, From ingestion of contaminated water, paint chips or paint dust, home-glazed pottery, fumes from burning or swallowing batteries. Leads to Hypochromic, microcytic anemia, Kidney destruction occurs, Leads to Encephalitis or inflammation of brain cells (toxic level)
• LEAD POISONING - ASSESSMENT

  • Lethargy, Impulsiveness, Learning difficulties, Blood level of lead >5µg/dl (unsafe level for children)
• LEAD POISONING - THERAPEUTIC MANAGEMENT

  • Lead levels >10-20 µg/100ml will be prescribed dimercaptosuccinic acid (DMSA) or succimer, Lead levels >45µg/100ml will be treated with Dimercaprol (BAL) or edetate calcium disodium (CaEDTA) (Don't give BAL to patients with peanuts allergy or G6PD deficiency)
• Child maltreatment


  Willful injury by one person to another. May be physical, emotional, or psychological, neglect, and sexual maltreatment
• Theories of child maltreatment

  • Special Parent - A parent has the potential to maltreat a child. History of mental illness (10%), Maltreated as children, Unfamiliar with Normal G&D, Socially isolated, Substance abuse
  • Special Child - Children Who Are Maltreated. Parents view child as different, Birth anomaly
  • Special Circumstance - Stress
• Reporting suspected child maltreatment

  • Mandatory reporters – professionals who are mandated by law to report child maltreatment
  • Permissive reporters – encouraged to report suspected child abuse but are not required by law
• Indicators of physical abuse

  • Bruises, burns, head injuries, eye injuries, mouth injuries, human bites, chunks of hair pulled off the scalp, repetitive accidents, multiple wounds or fractures at different stages of healing

  
• Shaken baby syndrome


  Repetitive violent shaking of a small infant by the arms or shoulders, causing a whiplash injury to the neck, edema of the brainstem, or possibly subdural or retinal hemorrhage