New to Peds and Private Duty/Home Health, Have Questions

[KR]

Hello All! Before recently venturing into doing pediatric private duty nursing, all I had ever done was adult ICU nursing. When I got hired in July by my company, I had to take a bunch of peds credentialing tests. Thankfully, they had study guides so I passed them with flying colors. Recently, I had to take the yearly test that everyone takes, and I have to repeat the one section. I aced the other sections. We were given no study guides this time. I asked my company after I found out I had to repeat one section, and they referred me to Whaley and Wong Peds text book. So I have that ordered, but it won't be here for at least 5 days. So I am hoping that some of the more experienced Peds/Private Duty nurses would be able to help me figure out a few questions I am stumped on. I will post the questions in bold along with my rationale on the choices. Any help/insight, links, etc would be greatly appreciated!

The pediatric pt with a trach should be monitored by pulse ox:

A-continuously, even during a bath Obviously not correct electrical pulse ox, and water do not mix!

B-continuously, except when being held by a trained caregiverthis seems like a bit of overkill, unless it is ordered that way

C-only when trained caregiver is not in the roomthis could be a possibility, as when trained caregiver is in the room, the pt is under direct observation

D-only when asleep at night or for napsthis could also be a possibility, but am not sure

Potential complications of an overinflated cuff include all of the following except:

A-tracheal ulceration (incorrect, as it can cause this)

B-tracheal esophageal fistula (incorrect, as it can cause this)

C-tracheal leak (correct answer i believe, as tracheal leak would be caused by underinflated cuff or leaking cuff)

D-difficulty swallowing (incorrect answer, as it can cuase this)

Indications for use of an artificial nose include all of the following except:

A-bathing, swimming (incorrect answer, as you would use nose for this)

B-Playing in a sandbox (incorrect answer, as you would use nose for this)

C-Speaking(technically, you would use a Passy Muir valve ideally to speak, but i know the kid i take care of can talk when he has a nose on)

D-warmth and humidification (incorrect answer, as if i was going for warmth and humidification, i would use a mist collar )

Thanks in advance for any help! These few questions I am somewhat stuck on are driving me bananas. And like I said, my peds book won't be here for 5-7 days.

[kids]

Potential complications of an overinflated cuff include all of the following except:

A-tracheal ulceration (incorrect, as it can cause this)

B-tracheal esophageal fistula (incorrect, as it can cause this)

C-tracheal leak (correct answer i believe, as tracheal leak would be caused by underinflated cuff or leaking cuff)

D-difficulty swallowing (incorrect answer, as it can cuase this)

C is the correct answer.

The pediatric pt with a trach should be monitored by pulse ox:

A-continuously, even during a bath Obviously not correct electrical pulse ox, and water do not mix!

B-continuously, except when being held by a trained caregiver this seems like a bit of overkill, unless it is ordered that way

C-only when trained caregiver is not in the room this could be a possibility, as when trained caregiver is in the room, the pt is under direct observation

D-only when asleep at night or for naps this could also be a possibility, but am not sure

Ugh, I hate all their choices because none of them are really right.

I think C is the least wrong.

I'd check your company policy.

Indications for use of an artificial nose include all of the following except:

A-bathing, swimming (incorrect answer, as you would use nose for this)

B-Playing in a sandbox (incorrect answer, as you would use nose for this)

C-Speaking(technically, you would use a Passy Muir valve ideally to speak, but i know the kid i take care of can talk when he has a nose on)

D-warmth and humidification (incorrect answer, as if i was going for warmth and humidification, i would use a mist collar )

The desired answer is C.

Your rational for choosing D is incorrect. An artificial nose is a heat/moisture exchanger (HME), it's purpose is to humidify and warm the air.

I'd suggest looking in the Peds forum, I tacked a bunch of trach/vent stuff there.

[KR]

Thank you for your help and pointing me in the peds forum directions, I hadn't thought to check there. It is greatly appreciated!

[caliotter3]

For the question about pulse oximetry, I've seen the doctor's orders at my peds cases where they usually order pulse check once each shift and continuous monitoring at night while asleep. Have also seen the order read continuous monitoring. Would be interested in seeing what is considered to be the right answer to this one.

[KR]

When I find out the correct answer, I will be sure and share.