Pediatric Emergency Nursing CPEN
Pediatric Critical Care Nursing Review CCRN
A 14-year-old child presents to the emergency department after being splashed in the left eye with battery acid. The priority nursing invention is
A. copious irrigation with water or 0.9% saline solution.
B. bilateral measurement of ocular pH.
C. visual acuity assessment with a Snellen chart.
D. contacting caregivers for permission to treat.
Answer: A. copious irrigation with water or 0.9% saline solution.
Ocular burn severity directly correlates with duration of exposure to the caustic agent; immediate and copious irrigation has the greatest impact on prognosis. If 0.9% saline solution is not available, tap water is recommended. Topical ocular anesthetic agents (e.g., proparacaine) dramatically reduce pain and facilitate patient cooperation. The duration and volume of irrigation is determined by repeated measurement of eye pH (but only in the affected eye), and must be continued until pH remains normal (7.0-7.3) for 30 minutes. Use of a Morgan Lens®, or other eye irrigation system, will minimize interference from blepharospasm, which can be severe. Initially, visual acuity is grossly assessed by asking the patient the number of fingers visible. Although the patient is a minor, do not wait for parental consent to irrigate.
Which of the following pediatric anatomical characteristics has clinical significance for the emergency nurse? Compared to adults,
A. the tongue is small relative to the oropharynx.
B. a child's basal metabolic rate is twice as high.
C. children's neck muscles support the head well.
D. infants consume 50% less oxygen per kilogram.
Answer: B. a child's basal metabolic rate is twice as high.
In the pediatric patient, metabolic and the oxygen consumption rates are twice that of an adult (per kilogram). For this reason, factors that increase metabolic demand (such as fever, agitation seizures, and cold) contribute significantly to respiratory demands. Hypoxia can develop rapidly in the child in respiratory distress. The child's tongue is large in proportion to the oropharynx, and so may easily occlude the airway in a supine position. The young child's neck musculature is weak and does not support the head well, which explains why head-bobbing is a sign of respiratory distress.
A 15-year-old touched a live electrical wire. The child has no pulse and chest compressions have been initiated. The patient’s weight is 50 kg. The electrocardiograph (ECG) shows ventricular tachycardia. The priority intervention is to defibrillate the patient with
A. 50 Joules.
B. 75 Joules.
C. 100 Joules.
D. 150 Joules.
Answer: C. 100 Joules.
For the patient in ventricular fibrillation or pulseless ventricular tachycardia, defibrillate with 2 J/kg (50 kg x 2 J= 100 J). Resume CPR immediately post defibrillation. Repeat defibrillation at 4 J/kg as needed. Amiodarone and epinephrine are appropriate medications for the child in cardiac arrest, but drugs are not the priority intervention. High-voltage electrical events affect every tissue in the body. Neurologic and cardiac complications are the most obvious and immediate manifestations of injury. High-voltage current can produces a wide variety of cardiac injuries including cardiac arrest. However, the most common ECG findings are sinus tachycardia and nonspecific ST-T segment changes. Electrically-injured patients have been known to survive after prolonged cardiopulmonary resuscitation efforts.
A quiet, withdrawn, and afebrile 6-year-old has become increasingly lethargic over the past 2 days. The child is developmentally delayed and has a ventriculoperitoneal shunt. According to caregivers, the patient is usually alert and interactive. The emergency nurse anticipates the initial intervention for this patient will be
A. rapid fluid resuscitation.
B. cardiac and SpO2 monitoring.
C. neurosurgical evaluation.
D. oral endotracheal intubation.
Answer: B. cardiac and SpO2 monitoring.
In this scenario, a history of ventriculoperitoneal (VP) shunt placement, together with the child’s increasing lethargy, suggest VP shunt malfunction. This patient requires careful neurological assessment, and monitoring for potential bradycardia and apnea related to increasing intracranial pressure. Untreated, excess cerebrospinal fluid (CSF) will continue to accumulate, potentially resulting in brain damage. Although neurosurgical evaluation is indicated, it is not the INITIAL intervention. A radiographic study of the shunt will be required to identify the site of malfunction. This procedure may be followed by a shunt tap to remove excess fluid. A CSF specimen may be sent to the laboratory to identify blood or infectious organisms. Fluid resuscitation and endotracheal intubation are not necessary at this time.
A 14-year-old boy walks slowly into the emergency department. The child experienced sudden onset, severe right testicular pain while playing basketball. What intervention does the emergency nurse anticipate first?
B. Surgical detortion
C. Urethral culture
D. Manual detortion
Answer: D. Manual detortion
This scenario presents a classic picture of testicular torsion, which results from congenital malformation of the attachment of the testes. Torsion (twisting) of the testes on the spermatic cord, commonly occurs during physical activity, but may also happen during rest or sleep. Pain onset is rapid and is the result of ischemia because testicular blood vessels are torsed within the cord. Although cases of torsion have been reported in all age groups, incidence peaks between 12-18 years. The affected testis is generally twisted inward, and torsion is more frequent on the left side. Testicular torsion is a true urologic emergency. Manual detorsion is first attempted. If ineffective, surgical detorsion is required. Prolonged ischemia results in testicle loss. After 12 hours, salvage is unlikely and patients may require orchiectomy.
Pediatric Emergency Nursing Review CPEN
Pediatric Emergency Nursing Review CPEN®
Pocket Study Guide Volume 1
Cheryl L. Randolph RN MSN CCRN CEN CPEN FNP-BC
Laura M. Criddle PhD RN CEN CPEN CFRN CCRN FAEN