Pediatric Critical Care Nursing CCRN
Pediatric Critical Care Nursing Review CCRN
A neonate is admitted to the PICU for suspected meconium aspiration. When given a bottle the child coughs, chokes, and becomes cyanotic. These findings suggest
A. meconium pneumonitis.
B. gastroesophageal reflux.
C. tracheoesophageal fistula.
D. congenital tracheomalacia.
Answer: C. tracheoesophageal fistula.
A tracheoesophageal fistula (TEF) is any abnormal connection between the esophagus and the trachea. TEF is a common congenital abnormality that arises due to failed fusion of the tracheoesophageal ridges during early embryological development. There are numerous TEF types, depending on the location of the defect(s). Tracheoesophageal fistula should be considered in a newborn with copious salivation associated with choking, coughing, vomiting, and cyanosis coincident with the onset of feeding. The prenatal presence of polyhydramnios (an excess of amniotic fluid) is a clue to TEF because the inability to swallow in utero causes amniotic fluid accumulation. To test a neonate for TEF, feed the child a small amount of water. Coughing, or an inability to swallow, both suggest TEF presence.
An irritable infant with poor feeding and intermittent vomiting is admitted for hyperammonemia. This infant is at greatest risk for
A. metabolic alkalosis.
B. cerebral edema.
D. pulmonary edema.
Answer: B. cerebral edema.
There are 2 primary causes of hyperammonemia: 1) inborn errors of ammonia metabolism (e.g., carnitine palmitoyltransferase II deficiency) and 2) hepatic diseases that interfere with ammonia metabolism. Hepatic etiologies include Reye (a.k.a. Reye’s) syndrome and biliary atresia. Regardless of etiology, the accumulation of ammonia (a byproduct of urea metabolism) produces central nervous system damage. Findings associated with hyperammonemia are anorexia, irritability, headache, abdominal pain, vomiting, and fatigue that can progress to lethargy, seizures, coma, and death. Hyperammonemia is a medical emergency. Brain damage and death are the result of cerebral edema, intracranial hemorrhage, and brain herniation.
A child with a tunneled central venous catheter is admitted to the PICU with facial edema, cyanosis, dyspnea, and prominent neck veins. These findings suggest
A. an anaphylactoid response.
B. acute fluid overload.
C. congestive heart failure.
D. superior vena cava syndrome.
Answer: D. superior vena cava syndrome.
Superior vena cava (SVC) syndrome results from obstruction of the SVC due to either external compression of the vessel or some form of internal occlusion. Oncology patients are subject to both etiologies. For example, SVC syndrome can occur in pediatric patients who have a large anterior mediastinal mass that compresses the SVC. The SVC can also be occluded by the presence of a thrombus in the vessel. Primary SVC thrombosis is rare in children with cancer, but can occur as a result of a clot formation around an indwelling central venous catheter and many pediatric oncology patients will have a percutaneously inserted central catheter, tunneled catheter, or implanted catheter.
One week after returning from Girl Scout camp a child presents severely ill with a high fever, seizures, and nuchal rigidity. She is unresponsive to pain. West Nile virus is suspected. Which of the following tests can confirm this diagnosis?
A. Computed tomography
B. Stool for ova and parasites
C. Serum serology
D. Magnetic resonance imaging
Answer: C. Serum serology
Patients with severe West Nile virus (WNV) encephalitis present very similarly to patients with meningitis. A history of potential mosquito exposure should alert health care professionals to the need for further testing. Time from infection to symptom onset is 2 to 15 days. Definitive diagnosis is made by sending both CSF and serum for WNV serology testing. CT scans are not an effective way to identify WNV encephalitis. MRI will show changes, but they are non-specific. Because WNV is a bloodborne virus and not an intestinal parasite, stool ova and parasite testing is not diagnostic. The vast majority of people bitten by a WNV infected mosquito will have no symptoms. A few will have mild symptoms. Very few develop encephalitis.
A child restrained in a booster seat with only a lap belt was involved in a motor vehicle collision 18 hours ago. The patient sustained multiple facial fractures. Initially calm, the child is now moaning and complaining of abdominal pain. The abdomen is tender but not rigid or distended. Vital signs are normal for age. The organ most likely injured is the
A. large intestine.
C. small bowel.
Answer: C. small bowel.
Hyperflexion over a seatbelt, especially an isolated lap belt, acutely squeezes the small bowel (particularly the duodenum), which can cause perforation (popping). Pancreatic injuries are less common. Serious blunt gastric injuries are rare and generally require a direct blow to a full stomach. Solid organ trauma (liver, spleen, kidneys) is associated with significant blood loss that quickly produces abdominal distention and vital sign changes if the capsule is ruptured. Seatbelt-associated duodenal injuries occur more frequently in young children due to their weak abdominal musculature and poor rib protection. Early symptoms include generalized and progressive abdominal pain associated with rebound tenderness, without marked hypotension.
Pediatric Critical Care Nursing Review CCRN
Pediatric Critical Care Nursing Review CCRN®
Pocket Study Guide Volume 1
Serena Phromsivarak Kelly MS RN FNP CCRN CPEN
Laura M. Criddle PhD RN CCRN CPEN CCNS FAEN