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20 Cards in this Set
- Front
- Back
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Clinical Manifestations of Pain: Physiologic
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Tachycardia
Tachypnea Hypertension Pupil dilation Pallor Increased perspiration Increased muscle tone Decreased vagal nerve tone Increased intracranial pressure |
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Clinical Manifestations of Pain: Behavioral
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Crying or whimpering and groaning
Short attention span Irritability, fussiness Facial grimacing, brow furrowed, chin quivering, eyes slightly closed Protecting the painful area Drawing up knees, fist clenching Lethargic, withdrawn Sleep disturbances |
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Nonpharmacological Methods
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Distraction
Relaxation Guided imagery Positive Self-Talk Thought Stopping Kangaroo Care – skin to skin holding of infant dressed only in diaper |
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Pain Management
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Responses depend on age, stage of development, and situational factors
See text for pain scales: FACES, FLACC, TPPPS, Analgesics: oral, IM, IV topical, PCA Conscious Sedation: a state of depressed consciousness, pain free and sedated. Pentobarbital sodium (Nembutal), Fentanyl, Chloral Hydrate, and Midozolam (Versed), EMLA (lidocaine and prilocaine), LMX (lidocaine) |
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Pain Management
Children |
IV Deloted IV morpheine-for children because muscular development
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Pain Management
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Infants , Toddlers, small children are still developing their concept of pain. IN this group we wanna stick with oral meds.
Drug of choice is opiods. PCA-educate the parent. |
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Pain Management
Topical |
Lidocane
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Conscious Sedation-
Lumbar Puncture |
(lumbar puncture)puts patient in euphoric state where they don’t remember what happended. Groggy but awake enough to follow commands. Usually a cocktail
–Pentobarbital sodium (Nembutal), Fentanyl, chloral Hydrate, and Midozolam (Versed), EMLA (lidocaine and prilocaine), LMX (lidocaine).. Chlorahydrate may not work on some kids give an adult dose. Cancel procedure send back to room. Infants and Toddlers-(less than 3 years of age)- go ahead and tap and move on. Needing a lumbar puncture at this age usually lethargic anyway. |
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Urinalysis
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Needs 10 ml. Not to set for more than 2 hours at room temperature
pH: 4.5 – 8 Specific Gravity: 1.005 – 1.030 Protein, Glucose, Ketones: Negative Crystals: not significant, Casts – occ RBC: 1-2 WBC: 0-4 Children-catherrize, midstream, clean catch, (same thing). Never assume they have collected a specimem before. Low PH-ask child about diet. Meat eaters-more acidic Vegetables-alkaliec Bacteria grow in alkalinic . The younger the child the lower the specific child. 1.000 water would be. Dehydration cal alter urine in times of stress. Traces of protein, glucose, ketones,: being sick is stressful take a deep breath. Occasional crystals, proteins, etc…no big deal. RBC: 1-2 take deep breath WBC: 0-4 take a deep breath cojunt of 10: possible menustrating cath specimen of 10: now you got a problem. WBC count usual indicates infection. IV peak-15-20 IM-45-1hour Respiratory depression-antedote-narcam 14 year T&A admitted. |
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Respiratory depression-
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narcam
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RBC-
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-live 120 days after that reabsorbed.
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Functions of RBC
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Transporting O2 carrying Hgb
Transporting CO2 in the form of sodium bicarbonate Being an acid-base buffer for whole blood |
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RBC
Men |
3.8 – 5.5 mill/cu mm
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RBC
Women |
3.8 – 5.0 mill/cu mm
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RBC
INcreased Decreased |
Increased RBC – chronic lung diseases and children with congenital heart defects with cyanosis
Newborn-higher values decrease as they get to adult values. Increased RBC-give patient oxygen. How do they get lung disease-premis (from respirator) Decreased RBC-kids with ITP Chemotherapy, radiation, not necessarly cancer. Decreased – abnormal loss or destruction of RBC, lack of needed elements or hormones for RBC production, and bone marrow suppression. To assess anemia, look at RBC and Hgb |
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Hgb
Normal Values: |
Child: 11 – 16g/100 ml
Infant: 10 – 17g/100ml Decreased – anemia, hemorrhage and states of hemodilution Increased – polycythemia or states of homeoconcentration Decreased – anemia, hemorrhage and states of hemodilution Increased – polycythemia or states of homeoconcentration |
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Hct
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Separates erythrocytes from plasma
Fastest way to determine the % of RBCs in the plasma Useful only if the hydration of the patient is normal. If elevated Hct truly increase in RBC Hct value generally 3 times the Hgb 1 to 3yrs : 29 – 40% 4 to 10 yrs: 31 – 43% Decreased – overhydration or a true decrease in the RBC Important to assess the magnitude of blood loss 3 times hemoglobyn. Once you give pac cells should only increase Hct 2-3% Critical value > 54% (blood is too thick) clotting. |
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RBC Indices
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Mean red cell hemoglobin (MCH): 27 – 31% has to do with weight of the RBC
Mean red cell hemoglobin concentration (MCHC): 32 – 36% has to do with color determined by saturation with Hgb Mean red cell volume (MCV): 82-92% has to do with average size of RBC RBC Distribution Width – helps assess anemia MCH-Weight-mean cell hemoglobin (looks at 1 red blood cell) microcytosis-lead poisoning, iron deficiency, High-macrocytosis- MCHC- concentration-low hypochromic high-hyperchromic or sperocytotic MCV-size iron deficiency lead poisoning microcytotic pernecious anemia falocemia RDW-round widtch -----best picture of which anemia you have. Physicians job |
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WBC –
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4,500-10,000/mm3
Neutrophils: 50-70 Segs: 50-65 Bands: 0-5 Basophils: .4-1.0 Lymphocytes: 25-35 Eosinophils: 1-3 Monocytes: 4-6 Neuts, eos, and baso are granulocytes Shift to the Left – more bands than segs Lives-10 hours Differential-computer can come up with how many cells there are. Manual-clicker has to be counted Neutrophils-fight and kill bacterias. Segs-mature neutrophils Bands-immature Basophils-histamine allergic stress Lymph-virus, Eosinophils-parasites, allergic reaction Monocytes-clean up WBC count higher does not mean infection, possibly stress and allergic response. Kids sick for 3 hours-Neutrophils go up,seg-up band-up Baso-normal Lymp-normal eosinophil-normal monocytes-normal - At 6 hours neutrophils=bands are activating Baso-up a little lymph-little Eosoniphils-little mon-up At 10 hours-segs down bands-up Baso-up Lymph-up Eosinophils-up Monocytes-up 2 hours 103 temp |
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Platelets
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Range: 150,000-400,000
< 10,000 possibility for intracerebral hemorrhage All autoimmune responses have Platelets up bands greater than segs autoimmune response. ESR- Clotting factor know when platelet count drops between 20 and 30 thousand have spontaneous hemorrhage. Down to 10,000 possibility cerebral hemorrhage. You may have spotted blood in kidneys. Know the criticals have an idea what that # looks like. |
