TAEM10: Pediatric Emergency

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อาจารย์อรัญญา ไทยแท้

อาจารย์อรัญญา ไทยแท้

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  • 1. Nursing Care of Pediatric Emergency AranYa Thaitae Queen Sirikit National Institute of Child Health
  • 2. Pediatric emergency
    • Respiratory emergency
    • Fever group
    • Anaphylaxis
    • GI emergency
    • Neurological emergency
    • Surgical emergency
    • Accident
    • Eye emergency
    • ENT emergency
  • 3. Top 5 diseases at ER of QSNICH
  • 4. Respiratory assessment
    • Physical assessment
    • 2 . Oxygen therapy
  • 5.
    • Physical assessment
  • 6. Physical assessment
    • Observation
    • - Dyspnea : grunting, flaring,
    • retraction
    • - Cyanosis
    • - Tachypnea, bradypnea
    • - Chest movement
  • 7. Normal respiratory rate < 60 < 50 < 40 < 30 2 months 2 – 12 months 1 – 5 years 6 – 8 years Respiratory rate Age
  • 8. Physical assessment
    • Ausculation
    • - Aspiratory
    • - Expiratory
    • 3. Pulse oxymetry
    • - perfusion
    • - motion
    • 4. Arterial blood gas analysis
  • 9. Nursing Care in Respiratory emergency
    • Airway management
    • 1.1 Open airway using;
    • - head till-chin lift
    • - jaw thrust maneuver
    • 1.2 Clear airway : suction
  • 10. Indication of suction
    • More frequent or congested sounding cough
    • Coarse audible secretions
    • Visible secretions
    • Increased pressures or decreased tidal volumes on the ventilator
    • Indication by the patient that suctioning is necessary
  • 11. 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.
  • 12. Table of ET Tube & suction 5 – 6 6 – 8 8 8 8 10 10 10 12 12 12 8 9 – 10 10 11 12 14 15 16 17 18 19 2.5,3.0 uc 3.0,3.5 uc 3.5,4.0 uc 4.0,4.5 uc 4.5,5.0 uc 5.0,5.5 uc 5.5 uc 6.0 c or uc 6.5 c or uc 7.0 c 7.0,8.0 c Premature infant Term infant 6 months 1 year 2 years 4 years 6 years 8 years 10 years 12 years Adolescent Suction NO. Distance ET tube Patient age
  • 13. Complication of suction
    • Hypoxia
    • Tissue hypoxia
    • Atelectasis
    • Hypotension
    • Airway constriction
  • 14. Nursing Care
    • Airway management
    • 1.3 Oropharyngeal airway
  • 15. 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
  • 16. Oxygen therapy
  • 17. 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 room air to treat or prevent hypoxemia ( not enough oxygen in the blood).
    • Oxygen therapy is beneficial in all types of hypoxia, cyanosis, asphyxia, hypotonia.
  • 18. Oxygen therapy
    • Some of the conditions oxygen therapy
    • is used to treat include :
    • Hypoxemia
    • S evere respiratory distress (e.g., acute asthma or pneumonia )
    • Severe trauma
    • S hronic obstructive pulmonary disease (COPD, including chronic bronchitis , emphysema , and chronic asthma)
  • 19. Oxygen therapy
    • pulmonary hypertension
    • cor pulmonale
    • acute myocardial infarction ( heart attack )
    • short-term therapy, such as post-anesthesia recovery
    • Oxygen may also be used to treat chronic lung disease patients during exercise .
  • 20. 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.
  • 21. Type of oxygen therapy
    • 2 systems
    • Low flow system
    • High flow system
  • 22. Low flow system
    • Nasal cannula
    • Nasopharyngeal catheter
    • Simple mask
    • Partial rebreathing mask
    • Non rebreathing mask
  • 23. Low flow system
    • Nassal cannula
    • Simple mask
  • 24. Low flow system
    • partial rebreathing
    • mask
    • Non- rebreathing mask
  • 25. High flow system
    • Venturi masks (mask without bag)
    • Oxygen hood
    • tracheostomy collars
    • Oxygen T- Piece
    • T ent f ace
    • Oxygen tent
  • 26. High flow system Venturi mask                           
  • 27. Low flow system
    • Oxygen hood
    • tracheostomy
    • collar
  • 28. High flow system
    • Oxygen t- piece
    • Tent face
  • 29. High flow system
    • Oxygen tent
  • 30. 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
  • 31. 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
  • 32. Nursing in Oxygen Therapy
    • Observe patient for signs of discomfort
    • Monitor and record vital signs
    • Monitor Sa0 2
    • Check the patient’s face for signs of pressure mouth and nose for dryness
  • 33. Nurses’ role
    • Nurses are responsible for
    • Assessing patients
    • Ensuring that oxygen therapy is initiated as prescribed
    • Monitoring oxygen delivery systems
    • Recommending changes in therapy
  • 34. Question
  • 35. THANK YOU