Nursing Care of Pediatric Emergency

AranYa Thaitae Queen Sirikit National Institute of Child Health

Pediatric emergency • Respiratory emergency• Fever group• Anaphylaxis• GI emergency• Neurological emergency• Surgical emergency• Accident• Eye emergency• ENT emergency

Top 5 diseases at ER of QSNICH

0

2000

4000

6000

8000

10000

12000

respiratoryfever group GI accident DHF,DF

2548

2549

2550

Respiratory assessment

1. Physical assessment

2. Oxygen therapy

Physical assessment

Physical assessment

1. Observation - Dyspnea : grunting, flaring, retraction - Cyanosis - Tachypnea, bradypnea - Chest movement

Normal respiratory rate

Age Respiratory rate

2 months2 – 12 months1 – 5 years6 – 8 years

< 60< 50< 40< 30

Physical assessment

2. Ausculation - Aspiratory - Expiratory3. Pulse oxymetry - perfusion - motion4. Arterial blood gas analysis

Nursing Care in Respiratory emergency

1. Airway management 1.1 Open airway using; - head till-chin lift - jaw thrust maneuver 1.2 Clear airway : suction

Indication of suction1. More frequent or congested

sounding cough2. Coarse audible secretions3. Visible secretions4. Increased pressures or decreased

tidal volumes on the ventilator5. Indication by the patient that

suctioning is necessary

Indication of suction

6. Suspected aspiration of gastric or upper airway secretions

7. Otherwise unexplained increase in shortness of breath.

8. Decreased oxygen saturations thought to be related to mucus plugging where oxygen saturations are monitored.

Table of ET Tube & suction

Patient age

ET tube Distance Suction NO.

Premature infantTerm infant6 months1 year2 years4 years6 years8 years10 years12 yearsAdolescent

2.5,3.0 uc3.0,3.5 uc3.5,4.0 uc4.0,4.5 uc4.5,5.0 uc5.0,5.5 uc

5.5 uc6.0 c or uc6.5 c or uc

7.0 c7.0,8.0 c

89 – 10

101112141516171819

5 – 66 – 8

888

101010121212

Complication of suction

1. Hypoxia2. Tissue hypoxia3. Atelectasis4. Hypotension5. Airway constriction

Nursing Care

1. Airway management 1.3 Oropharyngeal airway

Method of insertion oropharyngeal airway

• depress the

tongue with a tongue blade and slide the airway in .  

• Insert  the  airway upside  down  into  the victim’s mouth

• Rotate it 180  ° as it slides into the pharynx

Oxygen therapy

Oxygen therapy• Oxygen may be classified as an

element, a gas, and a drug . Oxygen therapy is the administration of oxygen

at concentrations greater than that in ro om air to treat or prevent hypoxemia (n

ot enough oxygen in the blood).

• Oxygen therapy is beneficial in all types of hypoxia, cyanosis, asphyxia, hypotonia.

Oxygen therapySome of the conditions oxygen therapyis used to treat include:

• Hypoxemia • S evere respiratory distress (e.g., acute

asthma or pneumonia )• Severe trauma • Shronic obstructive pulmonary disease

(COPD, including chronic bronchitis ,emphysema , and chronic asthma)

Oxygen therapy

• pulmonary hypertension • cor pulmonale • acute myocardial infarction (heart

attack )• - -short term therapy, such as post anest

hesia recovery • Oxygen may also be used to treat chro

nic lung disease patients duringexercise.

Oxygen therapy

• Too much O2 can cause respiratory arrest

• A COPD patient in severe distress O2 is limited to two liters a minute by nasal catheter and given O2 under pressure with regulation of O2 and CO2.

Type of oxygen therapy

2 systems• Low flow system• High flow system

Low flow system

• Nasal cannula• Nasopharyngeal catheter• Simple mask• Partial rebreathing mask• Non rebreathing mask

Low flow system

Nassal cannula Simple mask

Low flow system

partial rebreathing

mask

Non-rebreathing mask

High flow system • Venturi masks (mask without bag)• Oxygen hood • tracheostomy collars• Oxygen -T Piece• Tent f ace• Oxygen tent

High flow system

Venturi mask

                         

Low flow system

Oxygen hood

tracheostomy collar

High flow system

• Oxygen t- piece Tent face

High flow system Oxygen tent

Complications from oxygen therapy• Respiratory depression• Oxygen toxicity• Absorption atelectasis are the most

serious complications with overuse of oxygen.

• Perforation of the nasal septum as a result of using a nasal cannula

• Bacterial contamination of nebulizer and humidification systems

Nursing in Oxygen Therapy• Check order for flow rate and oxygen

concentrations required• Place the mask over patient’s nose,

mouth and chin • Check that the - Oxygen is flow freely - Patient is comfortable with freedom

movement

Nursing in Oxygen Therapy

• Observe patient for signs of discomfort

• Monitor and record vital signs

• Monitor Sa02

• Check the patient’s face for signs of pressure mouth and nose for dryness

Nurses’ role

Nurses are responsible for • Assessing patients• Ensuring that oxygen therapy is

initiated as prescribed• Monitoring oxygen delivery

systems• Recommending changes in therapy

Question

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