Pediatric Potpourri 200+ New CPEN Questions - Scott DeBoer

Pediatric Potpourri 200+ New CPEN Questions (eBook)

Certified Pediatric Emergency Nurse Review (3rd Edition Supplement)

Scott DeBoer (Autor)

Julie Bacon, Emily Dawson, Lou Romig, Michael Seaver (Herausgeber)

eBook Download: EPUB

2021 | 1. Auflage
186 Seiten
Bookbaby (Verlag)
978-1-0983-5066-6 (ISBN)

Certified Pediatric Emergency Nurse (CPEN) SUPPLEMENT Do you already have Scott DeBoer's CPEN 3rd Edition e-book? You will definitely want this all-new 200+ question e-book to benefit your CPEN review! Whether you're looking for more pediatric emergency questions to prepare for the CPEN exam, or just want to spend a little time to do a quick refresher of what's new in peds emergency care... this e-book is for you. Questions with detailed rationales cover a little from each body system of your precious pediatric patients.

Here's your chance to experience even more of Scott DeBoer's popular CPEN Review book with a whole new chapter. This e-book is the final chapter from Scott's new 2021 CPEN 4th Edition that is not available in e-book format anywhere but here! Pediatric Potpourri Chapter 12 Supplement is filled with questions and issues facing emergency nurses today. A few new topics include vaping, sexual identity, ECMO, LVADs and more! NOTE: This Pediatric Potpourri e-book plus the CPEN 3rd edition e-book together make up the new 4th edition e-book in its entirety.

111) The trauma team is considering the administration of Tranexamic Acid (TXA) for your pediatric patient. What information would be most important to help the team with the decision?

A)Blood products administered

B)Current blood pressure

C)Estimated amount of blood loss

D)Time injury occurred

D – Tranexamic Acid (TXA) should be administered within three hours of injury. This means when the injured occurred, not when EMS arrived, or the patient arrived at the emergency department. Giving TXA within three hours of the injury reduces mortality from bleeding (that's great!), but giving it after three hours can actually increase mortality (that’s really bad!)

Interestingly, while relatively new to the pediatric trauma world, TXA administration is nothing new in pediatric medical care. It has been used safely and successfully in pediatric cardiac, orthopedic, and craniofacial surgeries for several decades. TXA inhibits the body’s natural fibrinolysis (the process of breaking down clots) thereby reducing bleeding and decreasing the need for blood transfusions. In a multi-trauma patient, all of those are certainly desirable outcomes.

Think of TXA for trauma as the opposite of tPA (tissue plasminogen activator) for strokes. Less than a few hours = Possibility for good things. More than few hours = Bad things (i.e. bleeds) happen. Same idea applies for TXA. Sooner is better. Current recommendations are for it to be given within 3 hours of the injury. In some parts of the world, the first bolus dose of TXA for trauma patients can be given in the EMS/prehospital arena. More and more research supports the practice of giving TXA for bad bleeding associated with trauma. But remember, it must be given early!

The dosing recommendation for adults is simple; they get 1 gm IV/IO over 10-15 minutes. And yes, intraosseous TXA works just fine. The initial bolus is typically followed by an infusion of one gram of TXA over the next 8 hours or until the bleeding stops. The pediatric dosing, as with most meds, is “something per kilo,” and the most common initial dosing recommendations seem to be 10-20 mg/kg over 10-15 minutes, followed by a drip (commonly 2 mg/kg/hr) for at least the next 8 hours or until the bleeding stops. Remember, fluid boluses (normal saline or LR) in babies and kids are 10-20 mL/kg. So, when giving TXA, the initial bolus dose is 10-20 mg/kg.

Let’s look at LVADs...

112) An awake and alert 14-year old female presents to the Emergency Department (ED) triage nurse with complaints of a fever and states that the skin around the driveline exit site of her Left Ventricular Assist Device (LVAD) is reddened. She points out there has also been some yellowish drainage from the site. The patient says she has had some vomiting recently and really hasn’t felt well the last several days. The blood pressure from the automatic cuff reads 60/55. The nurse is unable to palpate a peripheral pulse and the patient shows sinus tachycardia on the monitor. What is the first step the ED nurse should do after assessing the airway?

A)Start CPR as the patient has no palpable pulse

B)Begin the process for an immediate transfer to the adult ICU

C)Obtain a blood pressure with a manual cuff and a Doppler

D)Prepare to immediately administer antibiotics since she is obviously is septic with hypotension and tachycardia

C – This question is all about assessment of the patient. In that respect, the focus needs to be on the patient, not on the extraneous information, and not on the numbers. To paraphrase a familiar admonition, assess the patient, not the numbers. The patient is walking and talking. That alone tells you a lot. So, in this case, it’s important to know that an automatic blood pressure reading may not be terribly meaningful on a patient with a LVAD. To assess the patient’s circulatory status more accurately, take a manual blood pressure with a Doppler. Additional methods to assess perfusion include evaluating skin color/temperature and end-tidal CO2 (which can be monitored via nasal cannula even without supplemental oxygen being administered).

While the patient has no palpable pulse, this does not mean the patient is in cardiac arrest and CPR should not be started. Continuous flow LVAD device patients are most likely pulseless. Additionally, remember that she is awake and alert, so therefore (most likely) not in cardiac arrest! Although admission to an ICU is certainly a possibility, it is not the immediate action. Most facilities prefer to admit (or transfer when appropriate) a 14-year old to a pediatric ICU, ideally one with pediatric cardiac surgery/VAD services.

It is reasonable to assume that the patient may be septic, but administering antibiotics should not be the first option. In this case, in addition to anticipating the need for volume resuscitation (given the history of vomiting and possible sepsis), antibiotics should not be administered until a CBC as well as blood and wound cultures have been obtained. Note: Topical antibiotic ointments such as Betadine, Neosporin, etc. are not routinely recommended by cardiac surgery as these ointments can injure the tissue adjacent to the driveline exit site.

This patient has a continuous flow LVAD which, generally speaking, pulls blood from the failing left ventricle (LV) through a continuous flow pump and pushes the blood out of the pump and into the aorta. Patients with an LVAD have a seriously sick left ventricle and the LVAD may be providing a large majority of the patient’s cardiac output. As such, there will be little to no pulse pressure (difference between systolic and diastolic BP). This is why palpating a pulse on these patients can be nearly impossible and the pulse pressure tends to be really small.

To understand this patient situation more fully, we must understand that the important blood pressure number is not the systolic or diastolic pressures, or even the pulse pressure mentioned above. Since the heart is not creating pressure through pumping, the pressure we are most concerned with is the mean arterial pressure (MAP) which is being maintained by the LVAD.

Unless an arterial line is in place (rarely seen at triage) and with automatic blood pressure machines not always being much help, what's an ED nurse to do? Go back to basics and take a good old-fashioned manual blood pressure (but with a Doppler). For a patient with a LVAD, a manual Doppler BP reflects the patient’s mean arterial blood pressure. The RN should place an appropriately sized BP cuff on the patient’s arm and place the Doppler on the same spot as they would place a stethoscope, over the brachial artery in the antecubital fossa. Inflate the cuff until the Doppler pulse is no longer heard. As the pressure on the cuff is slowly released, the first sound the nurse hears will be the Doppler BP. For the LVAD patient, this is the MAP. With the newer generation of LVADs, it is recommended to perform two doppler blood pressures and then get an average. This is because some newer LVADs (like the Heartmate 3) have alternating rates of RPMs (revolutions per minutes for the LVAD pump). So, in summary for BPs... Use a Doppler and take two BPs. One is good... Two are better... and the average of the two is both the MAP (mean arterial pressure) and the MAP (most accurate pressure)!

In the event that a doppler is not available, an automatic non-invasive blood pressure machine (NIBP) may (or may not) provide a relatively accurate estimation of the MAP.

113) A 15-year-old female with a history of viral cardiomyopathy and a continuous flow Left Ventricular Assist Device (LVAD) presents to the Emergency Department complaining of a three-day course of nausea, vomiting, and abdominal cramping. Her temperature and respiratory rate are normal. The patient reports that it is frequently difficult to obtain BP readings with a non-invasive BP (NIBP) automatic blood pressure machine and recommends using a Doppler. The patient is subsequently diagnosed with gastroenteritis. When the nurse returns to the room, a red flashing alarm has been activated on the LVAD and the words “low flow” are noted on the screen. What is the first intervention that the ED nurse should anticipate?

A)Change the controller

B)Administer a heparin bolus and start at drip based on the patient’s weight

C)Initiate a 0.9% NS or LR bolus

D)Check the patient’s blood pressure

D - This is a low flow state alarm (less than 2.3 liters/minute), so a blood pressure, specifically the MAP (mean arterial pressure) should be obtained first. The MAP will direct you into which treatment path to follow. If the MAP is greater than 90, consult the VAD coordinator and anticipate an order for a...

Erscheint lt. Verlag	1.1.2021
Sprache	englisch
Themenwelt	Medizin / Pharmazie ► Pflege
ISBN-10	1-0983-5066-9 / 1098350669
ISBN-13	978-1-0983-5066-6 / 9781098350666

Haben Sie eine Frage zum Produkt?

EPUB (Adobe DRM)
Größe: 9,3 MB

Kopierschutz: Adobe-DRM
Adobe-DRM ist ein Kopierschutz, der das eBook vor Mißbrauch schützen soll. Dabei wird das eBook bereits beim Download auf Ihre persönliche Adobe-ID autorisiert. Lesen können Sie das eBook dann nur auf den Geräten, welche ebenfalls auf Ihre Adobe-ID registriert sind.
Details zum Adobe-DRM

Dateiformat: EPUB (Electronic Publication)
EPUB ist ein offener Standard für eBooks und eignet sich besonders zur Darstellung von Belletristik und Sachbüchern. Der Fließtext wird dynamisch an die Display- und Schriftgröße angepasst. Auch für mobile Lesegeräte ist EPUB daher gut geeignet.

Systemvoraussetzungen:
PC/Mac: Mit einem PC oder Mac können Sie dieses eBook lesen. Sie benötigen eine Adobe-ID und die Software Adobe Digital Editions (kostenlos). Von der Benutzung der OverDrive Media Console raten wir Ihnen ab. Erfahrungsgemäß treten hier gehäuft Probleme mit dem Adobe DRM auf.
eReader: Dieses eBook kann mit (fast) allen eBook-Readern gelesen werden. Mit dem amazon-Kindle ist es aber nicht kompatibel.
Smartphone/Tablet: Egal ob Apple oder Android, dieses eBook können Sie lesen. Sie benötigen eine Adobe-ID sowie eine kostenlose App.
Geräteliste und zusätzliche Hinweise

Buying eBooks from abroad
For tax law reasons we can sell eBooks just within Germany and Switzerland. Regrettably we cannot fulfill eBook-orders from other countries.