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ENPC Study Guide Questions
& Answers 100% Correct
1. Pediatric triangle: appearance
work of breathing circulation to skin
2. General appearance considerations: Tone
Interactiveness: drawn to sounds or people. Wants to play Consolability Look/Gaze Speech/cry
3. Work of breathing:: Increased work of breathing evidenced by tachypnea, stri- dor,
grunting, retractions, accessory musles, nasal flaring, head bobbing, abnormal positioning
4. Circulation to Skin: Observe palor
mottling cyanosis
5. Sick, Sicker, Sickest: Sick: no disruption of any component of PAT but care-
givers are concerned Sicker: one component of PAT is a concern Sickest 2+ concerns of PAT
6. 2 leading causes of altered mental status in kids: hypoxia
hypoglycemia
7. Blood pressure norms: Hypotension: Less than 70 + (2 x age in years)
Widening pulse pressure = increased ICP Narrowing pulse pressure = hypovolemic shock
8. Crying child: Vigorous = good
weak = sick high-pitched = increased ICP "Fussiness" = red flag
9. Respiratory distress indicated by:: increased heart rate
skin color changes incrased work of breathing wheezing
treat kids with 2-4ml/kg of D25W
16. When to perform blood glucose test?: When the child is not awake and alert or
AMS is suspected
17. Preventing Secondary brain injury in TBI: prevent hypotension and hypoxia
18. cuffed vs uncuffed tube: uncuffed= (age in years/4) + 4
cuffed= (age in years/4) + 3.
19. fluid bolus formula: infant: 10ml/kg
kid: 20ml/kg
20. normal vitals: pg 52
21. blood glucose normal ages 5-11: 72-
22. Cardiac Assessment: Trend pulse and pulse pressure
palapate upper and lower extremity pulses
23. symptoms of CHF: poor feeding, irritability, fatigue easily with rapid resp rate,
increased work of breathing Ass and Interventions similar to adults
24. Myocarditis Assessment and treatment: Assess: consider in anyone with re- cent
viral infection; SOB and crackles; dysrhthmias; heart failure; syncope; elevated liver enzymes Treat: diuretics; BP support; ECMO; transplant
25. Hypovolemic Shock: Tachycardia, tacypnea; AMS; slight increaes in diastolic
pressure Intervention: Stop bleed; give fluids and RBC; balanced therapy; offer pedialyte if not NPO
26. Cardiogenic shock: Intervention: expert consult; supportive care to decrease O
and metabolism demands; slow fluids; treat hpotension while decreasing afterload; vagal maneuver; vasopressors
27. Obstructive Shock: Assessment: Cardiac tamponade- muffled heart sounds and
pulsluss paradoxus; tension pneumo- asymmetrical chest rise and fall Intervention: pericardiocentesis; needle thoracentesis; antigoagulation or surgical
Characteristics Aggravating factors Relieving factors Treatment Severity
32. Pain Scale and appropriate ages of use: Numeric- 6-17 years
Visual Analog: 5- Faces: 4-12 FLACC- nonverbal
33. Evaluation of child maltreatment: ask open ended questions use
direct quotes
34. Sex trafficing risk factors: limited education
runaway/homeless/foster care hx of abuse livining poverty family dysfunction disability substance abuse LBGT low self-esteem, depression, social isolation
35. Human trafficang Assessment screening: hx: pt doesn;t have ID; doesn't know
home address; vague hx of illness; person accompanying is unwilling to leave pt. persistent/untreated STI
trauma to vagina/rectum jaw/neck pain hyper startle reflex expensive items, clothing, hotel keys
36. Increased ICP triad: widening pulse pressure
bradycardia bulging fontenel respiratory disress
37. Febrile seizure: Temp greater than 100.4 usually occurs after 24 hour onset if
occurs after that 24 hr period consider meningitis
Give meds: anyipyretics, analgesic, antibiotics, meds to decrease ICP
43. Difference between stroke and bells palsy: Pt will be unable to raise an
eyebrow or wrinkle the forehead on the affected size w/ bells palsy stroke usually only involves the lower face
44. Stroke interetnions: maintain glucose
control BP meds: aspirin; anticonvulsants; antigocagulants (embolism)
45. Symptoms of TBI (concusion) are organized into what four catagories?-
: Thininking and remembering physical
emotional/mood sleep
46. Secondary impact syndrome: 2nd brain injury before the first one is healed.
Brain cannot auto regulate CPP Causes massive brain edema and herniation
47. proper infnat/toddler head positioning with spinal percautions: place
padding under shoulders of infant to achieve neutral alignment have parent directly above pt so pt is not turning head reverse trandeleburg to reduce anxiety
48. Neurogenic Shock: Injury above T6 results in bradycardia, hypotension, and
vasodilation, thermoregulatory instability
49. Spinal shock: flaccid muscle tone below thei njury and decreased sensation at and
below the level of injury
50. kids who do not need a spine board: compliant child
absence of distracting injury absence of alcohol GCS 15 absence of spine tenderness/neurologic findings
51. Orbital fracture interventions: topical vasoconstrictor to stop bloody nose
avoid blowing nose analgesics ice elevate HOB
diplopia from nerve entrapment ma,occluison CSF rhinorrhea
55. midface and nasal fracture interventions: maintain airway
delay surgery until swelling decreases avoid straining bending over heavy lifting blowing nose sleep with head of bed elevated for 3 nights
56. mandibular fracture test: have pt bite down on tongue blade
attempt to pull tongue blade out if pt unable to continuously bite down --> could indicate mandibular fracture
57. Hyphema interventiosn: pt on bed rest with HOB at 35-45 degrees
cover eye with shield steroids and tranexamic acid
58. Globe injuries: stabalize object with a shield
assess for fluid leaks CT or MRI meds to prevent increase IOP --> prevent vomiting, agitation, pain, antibiotics
59. Gastroenteritis Assessment and Interventions: Assessment: increased fre-
qency of loose, fould smelling stools, vomiting, fever/headache/malaise; ab cramp- ing Intervention: oral rehydration; 2-5ml of oral rehydration solution every 2-5 minutes;
increase if tolerated. Goal 50-100mg/kg over 2-4 hrs; ANTIDIARRHEAL MEDS ARE NT REOMMENDED
60. colic baby comforting suggestions: 1. Swaddle
2. Side position for digestion (left)
3. sushing sounds
4. swinging
5. Sucking
61. Intussusception assessment and intervention: Assessment: colicky ab-
dominal pain; child inconsolable; draws legs to chest; bomiting and ab distention with palpable sausage-shapped mass
oliguria/anuria w/ hematuria and proteinuria low hemoglobin adn hematocrit levles elevated BUN and creatinine bruising, purpura AMS/seizures
66. HUS interventions: diagnosis made by triad of anemia, thrombocytopenia, and
renal failure DONT give antibiotic IV hydration and electrolyte correction dialysis
blood/platelet transfusion antihypertensives
67. Long bone fracture assessment: pain
reluctance to use extremity deformity/shortening/rotation bony crepitus edema tenderness on palpation delayed cap refill, cool skin six Ps
68. long bone fracture intervention: extenal hemorrhage control
monitor for fat emboli splint deformities -- use temp first pain managment immobilize injured extremity and joints above and below circulation is impaired = impaired alignment prepare for possible closed reduction
69. amputation interventions: use tourniquet for external hemorrhage if uncon-
trolled by direct pressure resus and stabilize consider splinting pain management antibiotic and tetnus
70. care for amputated limb: avoid excessive handling
73. Juvenile idiopathic arthritis assessment: fever spikes about same time
each day transient rash for a few hors morning stiffness and after inactivity edematous joints hepatosplenomegaly anemia and elevated WBC count\pleural and pericardial effusions
74. juvenile idiopathic arthritis interventions: NSAIDs and steroid use
psychological counseling academic counseling PT OT warm baths and heating pads
75. Interventions for frost bite: immediate rewarming over 15-30 minutes
remove constricting, damp clothing and replace it with warm blankets avoid rubbing or causing frictin blood blisters are left intact; fluid extracted from clear blisters splint affected part
76. Hair tournequet assessment and intervetion: crying w/out associated fever or
appearance of some loca reaction by redness and swelling treat pain tpoical antibiotic if skin breakdown wound care to open areas observation for return of circulation
77. Burn intervetnions: Stop burning process- remove clots, jewelry, diapers;
cover with dry sheet; cool burns with room0eimp water prevent exposure: done PPE; brush off as much powder as possible clean minor burns with soap and water wound care as indicated: leave blisters intact; pain meds before debridement fluid replacement: 3mlxkg/% burn; use LR pt wt less than 30kg get 5% dextrose with LR monitor I&O
