Question Of the Day Friday 04/29

LydiaNN · Apr 29, 2005

Peds! whoot!
A child who was found face down in a water-fileld ditch is brought into the ER. The child, who has a pulse of 50 bpm but no spontaneous respirations, is intubated and bagged with 100% oxygen. The most important nursing measure at this time would be to:
1. Assit the MD in delivering intracardiac meds
2. Suction the ETT, mouth and nasal passages
3. Start an IV line to provide fluid and electrolytes
4. Call the PICU to inform them of the childs admission
Doesn't state the age. Please give rationale. Good luck!

Assuming that the body doesn't need to be re-warmed, I am going to go with 1. Those meds are going to be needed to prevent any further neurological damage. I'm not sure the child's age would matter (except r/t dosage). I'd think the problems caused by near drowning are pretty universal- hypoxia, electrolyte imbalances, low pH, seizures, circulatory, you name it. I have a cousin whose granddaughter tragically nearly drowned, and to tell you the truth, none of these measures helped a whole lot. She survived, but the brain damage has robbed her of all functional skills.

Pocamom · Apr 29, 2005

I am going with #2. ABC's takes the priority. This child was face down, who knows what he/she may of inhaled. After I had suctioned all passages, I would then put in the IV line.

:)

Iluvhospice · Apr 29, 2005

I say #2

Because...

#1. The child has a pulse, so I don't think intracardiac meds would be ordered.

#3. Important - but not priority

#4. Will do, but not necessary if the child isn't breathing!

#2 is priority because the goal of resuscitation is resumption of respiration. Airways must be clear for oxygenation to occur.

mariedoreen · Apr 29, 2005

ABC's = 2

twinmommy+2, ADN, BSN, MSN · Apr 29, 2005

Definatly #2

rogramjet · Apr 29, 2005

#2, first thing we learned in nursing, ABC's, that and blue is bad....

Knowing the ABC's really helped me pass the NCLEX. That was the first thing I looked for. I passed at 101 questions, so I guess it worked.

SmilingBluEyes · Apr 29, 2005

#2 as the others say.

Altra, BSN, RN · Apr 29, 2005

#2 -- with a pulse of 50, there's no indication that cardiac meds are needed immediately

Starting the IV line is obviously important also, and from working in an ER I can safely say that in the real world someone would be doing this WHILE someone else was suctioning, but in a theoretical situation where I have to choose which to do first, I'll go with suctioning.

Aneroo -- this was a great idea to start these threads -- if you need a break I'm sure others of us could pick up & post questions from various NCLEX prep materials, say for a week at a time :)

dave1117 · Apr 30, 2005

As an EMT-P for many years if the pt has a pulse and is being bagged, the next thing to consider is suction any foreign materials out of the airway...of course the people who write nursing questions may disagree, but it does come down to ABC. :uhoh3:

pedi-RN · Apr 30, 2005

I am also going to pick #2. As I prepare to take HESI in 1 week, I am following the ABC's.

LydiaNN · Apr 30, 2005

I don't know why, but somehow I read that the child was brought in EMTs. Probably was thinking of the ETT I read and didn't recheck the options. My reasoning would have been that the airway had been established, but once I saw that absolutely everyone except me said #2, I went back and read it again. Thank God for me, the NCLEX isn't in my future.