Editing Pediatric Nursing – RN Flashcards (section)

== Assessment and physiologic norms ==

;Why is hypotension a late sign of shock in children, and what should the RN act on instead?
:Children maintain cardiac output through tachycardia and intense peripheral vasoconstriction, so blood pressure stays normal until a large volume deficit exists. Act on tachycardia, capillary refill greater than 2 to 3 seconds, cool or mottled skin, weak peripheral pulses relative to central pulses, oliguria, and declining level of consciousness. Once the blood pressure falls, arrest may be imminent.

;State the systolic blood pressure thresholds that define hypotension by age.
:Neonate under 60 mmHg; infant 1 to 12 months under 70 mmHg; child 1 to 10 years under 70 + (2 x age in years) mmHg; child over 10 years under 90 mmHg.

;Why do most pediatric cardiac arrests differ in mechanism from adult arrests?
:Pediatric arrests are usually asphyxial, resulting from progressive respiratory failure or shock, rather than from sudden ventricular fibrillation. That is why airway and breathing are the priority and why prevention of respiratory failure is the highest-value intervention.

;What does a falling respiratory rate in a previously tachypneic child in distress signify?
:Exhaustion and impending respiratory arrest, not improvement. Accompanying bradycardia, a silent chest, and decreasing responsiveness confirm decompensation and require immediate escalation.

;Which fontanel findings are abnormal and what do they suggest?
:A tense, bulging fontanel in a quiet infant suggests increased intracranial pressure. A sunken fontanel suggests dehydration. Transient bulging with crying, coughing, or vomiting is normal. Anterior fontanel open beyond 18 months, or head circumference crossing percentiles upward, suggests hydrocephalus.

;Describe the Cushing response in an infant with increased intracranial pressure.
:Bradycardia, widening pulse pressure (rising systolic with stable or falling diastolic), and irregular respirations. It is a very late, ominous sign. Earlier infant signs are a bulging fontanel, suture separation, high-pitched cry, vomiting without diarrhea, poor feeding, and the setting-sun sign.

;What are the expected urine output ranges by age?
:Infants about 2 mL/kg/hr, children 1 to 2 mL/kg/hr, adolescents 0.5 to 1 mL/kg/hr. Diaper weight is converted at 1 gram equals 1 mL.

;Why is a fever of 38.0 degrees Celsius in an infant under 28 days an emergency?
:Neonates have immature immune function and can be bacteremic or meningitic without localizing signs. A full sepsis evaluation and empiric antibiotics are indicated.