Paediatric assignment questions -- please help

[firegenie]

Hi I'm currently working on a paediatric study day assignment. I haven't any experience with neonatal ICU just general ICU with occassional paed admissions which I don't usually take. Could some kind knowledgeable souls help me with a few questions. I'm sorry if they are a little basic. Here goes:

Q Why do we not usually measure an

A Is it because of the blood pressure is lower in babies than adults because of low peripheral resistance? Or is it more than this ? The internet is a nightmare with my slow computer.

Q What differences in children make intravenous access a challenge?

A Is it because of smaller peripheral veins? Chubby limbs? Do they want more of an answer than that? Or is that the wrong answer.

Q How much blood in total, will be required for a culture, biochem, haematology and coag on a child?

A God knows ... Ivé checked a few tubes out ... can't seem to find any unit resource on the subject.

Q A child's head is large and it's neck often unable to support it. In an unrestrained road crash how does this affect the mechanisms of injury?

A I'm too embarrassed to tell you what I think it might be . Actually I'm unsure what they want from this question:o

Q What cervical spine issues are significant in children trauma?

A Is it the same as Adult trauma issues ?

Q Panadol was the first treatment in a febrile child - Why has this changed?

A Has it? Is it because of masking? I mean why not after taking blood cultures?

Q Focal seizures are more significant than generalised seizures. What are the signs of seizures in a paralysed patient?

A Spiked ECG ? Repetitive episodes of tonic sustained eye deviation and clenched hands? Hypertension, tachycardia, increased body temp and increased end tidal CO2 ? I'm not really sure.

Oh well I better box on with the other hundred questions:rolleyes: ... these ones above I've skipped so far because they are holding up the works and Ivé got a lot to do.

I may post some more if I get to my wits end with any of them.:)

[babyNP., APRN]

We *always* check BPs on infants...it's an essential part of assessment! I can't imagine that other units don't check BPs...

Blood for a culture is usually about 0.5-1cc per tube (fungal, aerobic, anaerobic)

Dunno about the rest...good luck!

[firegenie]

Thank you Baby RN for your reply. I boxed on and found a few answers to the questions.

Q Why do we not usually measure an

A I think the Paeds do the initial BPs before they arrive on our unit. We send seriously sick children to Starship in Auckland. So our main admissions are those with Respiratory tract infections etc who often are just monitored overnight and sent back to the wards.

Blood pressure is not accurate in infants under 5yrs and can be painful and distressing. Taking a baseline is sufficient if necessary. Regular measurements are not required. The blood pressure is lower in babies than adults because of low peripheral resistance.

Children can compensate for a 25% blood loss by increasing heart rate and peripheral vascular resistance, which maintains a normal systolic blood pressure, therefore, blood pressure is an unreliable indicator of shock.

Q What differences in children make intravenous access a challenge?

A

* Short neck and chubby arms

* Veins are easily damaged

* Tiny vessels with generous fat covering

Q How much blood in total, will be required for a culture, biochem, haematology and coag on a child?

A I estimated 5-6 mls. I guess the blood culture popped up the amount significantly.

Q A child's head is large and it's neck often unable to support it. In an unrestrained road crash how does this affect the mechanisms of injury?

A

* Can be propelled head first into front passenger, seat back , dashboard or ejected from vehicle.

* Because the head is larger in proportion to the rest of the body children usually have head and neck trauma. Cervical injury The cranium is thinner yet more pliable but can predispose to penetrating injury.

Q What cervical spine issues are significant in children trauma?

A

* C Spine swelling may be seen as retropharyngeal swelling

* 55% of all cord injuries have neurological involvement without a fracture

Q Panadol was the first treatment in a febrile child - Why has this changed?

A

Panadol is for pain not for temperature under 38.C. I was surprised to discover this because the flight nurse manual on our unit states that paracetamol was given for temperature control and to ease discomfit in children. (Those with normal LFT's).

Q Focal seizures are more significant than generalised seizures. What are the signs of seizures in a paralysed patient?

A Spiked ECG, repetitive episodes of tonic sustained eye deviation and clenched hands, hypertension, tachycardia, increased body temp and increased end tidal CO2 are from one study I perused on the net. Another source was sharp increases in HR and Blood Pressure accompanied by pupil dilation.

Oh well I'm nearly finished my assignment it has taken a few weeks with all the heavy shift work and being so tired. I've only got approx 60 questions to go :)