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ENPC Pre-Course Study Guide
Questions and Complete Solutions
Graded A+
What are the most common pediatric presentations where you work? - Answer: RSV,pneumonia, diarrhea, malnutrition, appendicitis, sports injuries, car accidents, self harm risk, epilepsy What health promotion initiatives are needed in your area? - Answer: HEADS-ED screening tool Nutrition Activity Home safety Personal safety Health safety Physical activity How can health promotion and injury prevention topics be incorporated into routine assessment and care of pediatric patients in the ED? - Answer: Pediatric Readiness 7 areas include: administration and coordination of pediatric care in the ED, competencies, quality improvement, policies, protocols, medication safety, support services, equipment and supplies How do you incorporate patient and family centered care concepts into pediatric patients? - Answer: PFCC Core concepts include: Dignity and respect, information sharing, participation, collaboration Does your facility have a pediatric emergency care coordinator? - Answer: Yes
What opportunities exist at your facility to improve pediatric readiness and care for pediatric patients? - Answer: Pediatric trauma Pediatric facility recognition programs Prehospital Pediatric readiness project Does your facility receive children needing higher level of care, or does your facility typically transfer children requiring higher level of care? Are there formal agreements in place? - Answer: Children that need higher level of care are transferred to PICU. A set of vital signs and transfer form must be completed. In most cases, consent for minors must be obtained by a parent or legal guardian. Are there any exceptions to this rule in your state? What is the policy for obtaining consent? - Answer: Emancipated Minors can consent without a parent or legal guardian in the following cases: Contraception Emancipation Marital status Minor has a child Military service Pregnant Prenatal care Sexual health Substance abuse How can understanding stages of development help you when caring for peds patients of various ages? - Answer: Piagets Cognitive Development Eriksons Psychosocial Development What are some signs of pain that can be observed in children who are nonverbal? - Answer: FLACC NIPS Wong Baker FACES
In most situations there are multiple clinicians caring for a critically ill patient and multiple things are happening at the same time. Why do you think this course puts so much emphasis on PNP systemic approach? - Answer: Add structure and organization to treatment plans What is the procedure at your facility for rapid administration of warmed fluids to a pediatric patient? What equipment and or supplies are used? - Answer: What is the most important and effective intervention for neonatal resuscitation? What are some troubleshooting steps ensuring this intervention is as effective as possible? - Answer: VENTILATING THE NEONATE, effective PPV Troubleshooting: MASK ADJUSTMENT, REPOSITION HEAD AND NECK, SUCTION MOUTH AND NOSE, OPEN THE MOUTH, PRESSURE USING PPV, alternative airway What assessment findings in the neonate may indicate hypoglycemia? - Answer: Sweating POOR FEEDING Weak or high pitched cry Hypotonia What assessment findings in a neonate would indicate congenital heart disease? - Answer: Shock, pulmonary edema, irritability, decreased activity, crying during feedings, decrease in appetite, and poor weight gain, fast or irregular breathing, blue or purple discoloration of skin, heart murmur, hepatomegaly What equipment does your facility have for newborn stabilization and care? - Answer: What are safe haven laws or other options for safe newborn surrender in your country? - Answer: Unharmed newborn infant surrenders to healthcare facility without repercussions to the parent What is the definition of shock? Describe. - Answer: Inadequate tissue perfusion
How can you differentiate compensated, decompensated/hypotensive, and irreversible shock? - Answer: Compensated: blood is shunted to vital organs, causing cool extremities, decreased urine output, and ELEVATED LACTATE LEVEL Decompensated: weak peripheral pulses, altered mental status Irreversible: mottled skin, bradycardia, unresponsiveness List three pediatric differences relevant to shock. Describe the clinical significance of each difference - Answer: How can a lactate level be used to identify and manage shock? - Answer: What are the four types of shock, name one cause for each type - Answer: Hypovolemic: fluid volume depletion Obstructive: pump/pipe obstruction Cardiogenic: heart failure Distributive: systemic vasodilation Name one goal directed therapy for each shock. - Answer: Hypovolemic: prevent fluid loss Cardiogenic: Cardiology consult Obstructive: prostaglandin E infusion Distributive: IM epi, spinal motion restriction, 20 mL/kg bolus What are the most likely causes for pediatric cardiac arrest? - Answer: Think H's and T's You find a child who is unresponsive with no signs of normal breathing and no palpable pulse. What are your initial actions? - Answer: Begin CPR, chest compressions Do you have a pediatric resuscitation teams? Who responds? - Answer:
Does your facility have pediatric cervical collars and pelvic binders? - Answer: In what patient populations is the presence of a fever an urgent concern? - Answer: What are some red flags that cause increased concern in the pediatric patient with a fever? - Answer: What type of characteristics can help distinguish a febrile seizure from other types? - Answer: What methods are used at your facility to measure temperature in peds patients? - Answer: Does your facility have a protocol for identifying and managing pediatric sepsis? - Answer: What are three potentially life-threatening causes of vomiting in peds? - Answer: What are three non-gastrointestinal causes of vomiting in the pediatric patient? - Answer: What associated symptoms may indicate a surgical abdomen in the pediatric patient? - Answer: How would you teach a parent to provide oral rehydration therapy to their child? - Answer: What are for GU emergencies that may present abdominal pain? - Answer: When is it advisable to give a child oral food or fluids? When is it best to keep them NPO? - Answer: How do you obtain a urine specimen from a child who is not toilet trained? Is toilet trained? - Answer: What questions can you ask about sexual health history? - Answer:
At your facility, will pregnancy test results be shared with parents/gaurdian? - Answer: How do you screen for the possibility of an infectious disease? - Answer: What prompts initiation of isolation precautions at your facility? How do you isolate potentially contagious children? - Answer: What findings could indicate more serious cause of a rash? - Answer: What assessment findings can be used to differentiate between the following causes of rashes? Roseola infantum, molluscum contagiosum, varicella, rubeola - Answer: What infectious diseases are reportable? - Answer: What are the two most common causes of altered mental status in a child? - Answer: What questions can you ask to help determine the cause of pediatric altered mental status? - Answer: What toxidromes are you most familiar with? - Answer: How do you treat pediatric hypoglycemia? What concentrations of IV dextrose do you have readily available? - Answer: What unique seizure activity in children is easily missed if you do not know what to look for? - Answer: Does your facility have a PDKA set? At one point do you add dextrose to maintenance IV fluids for a child treated for DKA? - Answer: What pediatric behavioral health resources are available in your area? - Answer:
What documentation influences how you think about the patient or family before you even meet them?
