NUR244 TOPIC 6 TUTORIAL

Recognising and Responding to the Sick Child

Key Concepts

• Understanding how to recognize and respond to manifestations of illness in children, particularly focusing on signs of severity and urgency.

Structured Assessment of the Paediatric Patient

The Paediatric Assessment Triangle

• A tool for rapid assessment of a child’s condition based on three main components:

  • Airway and Appearance:

  • Assess for abnormal sound patterns such as:

    • High-pitched noises (not typical)

    • Stridor or wheezing

    • Soft whimpers versus noisy or obstructed breathing

  • Observations include:

    • Level of responsiveness (e.g., unresponsive, responds only to pain/voice)

    • Abnormal or absent cry or speech

    • Physical state:

    • Floppy or rigid body posture

    • Lack of movement

    • Eye tracking or fixation absent

  • Breathing:

  • Indicators of respiratory distress include:

    • Nasal flaring

    • Noisy or gasping breaths

    • Abnormal respiratory rate

    • Head bobbing

    • Signs of distress, such as:

    • Perspiration

    • Subcostal and sternal retractions

    • Tripod position or preferred seating

    • Mottling, pallor, cyanosis

    • Absent, weak, or abnormal pulses

    • Delayed capillary refill

    • Abnormal blood pressure

    • Obvious signs of significant bleeding

Primary Assessment A-E

• Evaluation composed of the following assessments:

  • A - Airway:

  • Patency - check for sounds, swelling or bruising, and foreign bodies.

  • B - Breathing:

  • Assess effort:

    • Respiratory rate, nasal flaring, grunting, tracheal tug, subcostal and intercostal recession.

  • Efficacy of breathing:

    • Air entry, chest expansion, oxygen saturation levels.

  • Effects on:

    • Heart rate, skin color, mental status.

  • C - Circulation:

  • Evaluate:

    • Heart rate, pulse volume, capillary refill time, signs of bleeding, blood pressure readings.

  • D - Disability:

  • Use AVPU (Alert, Voice, Pain, Unresponsive) assessment tool to determine level of consciousness.

  • Check for seizures, conditions affecting fontanelles in infants, and blood glucose levels (BGL).

  • E - Exposure:

  • Look for:

    • Temperature, presence of rashes, and other physical indicators.

Other Assessments

• Neurological assessment to evaluate brain function and responsiveness.

• Pain assessment to determine discomfort levels in children.

Case Study: Assessment of Patient - Maggie

• Patient Profile:

  • Name: Maggie

  • Age: 6 months

  • Diagnosis: Bronchiolitis

  • History: Three days of respiratory tract infection, pale and lethargic on assessment, cool to touch.

Observations and Vital Signs

• Respiratory:

  • Cough: Moist with thick, creamy rhinorrhea

  • Respiratory Rate: 55 breaths/min

  • Work of breathing: Moderate intercostal and subcostal recession, tracheal tug.

  • Auscultation: Bilateral wheeze.

  • Oxygen Saturation: 91% in room air.

• Circulation:

  • Heart Rate: 154 beats/min

  • Peripheral Pulses: Present

  • Blood Pressure: 100/52 mmHg

  • Temperature: 37.9ºC

  • Hydration Status: Not feeding well, last wet nappy 6 hours ago.

A to E Findings for Maggie

• A - Airway:

  • Maintains own airway; some thick nasal secretions present which may obstruct nasal breathing.

• B - Breathing:

  • Rate: 55 breaths/min, with increased work evidenced by recession.

  • Wheeze observed and oxygen saturation concerns (91% - impaired gas exchange).

• C - Circulation:

  • Pallor observed, cool peripheries, heart rate elevated; peripheral pulses present.

  • Blood pressure within limits but concerning due to overall assessment.

  • Note reduced urine output and oral intake.

• D - Disability:

  • Lethargic; responds to voice query but uninterested in feeding.

• E - Exposure:

  • Temperature read: 37.9ºC; no rashes present.

Medication Calculations

Caffeine Dilution Example

• Scenario: Single shot of coffee contains 63mg caffeine in 50mL, resulting in a concentration of:

  • $ext{Concentration} = rac{63 ext{ mg}}{50 ext{ mL}} = 1.26 ext{ mg/mL}$

• Required strength: 0.18mg caffeine per mL for a weaker coffee.

• Dilution Calculation: Using formula:

  • $ext{Current concentration} (mg/mL) imes ext{Current volume} = ext{Total volume Required concentration} (mg/mL)$

  • Calculate total volume needed:

  • $1.26 imes 50 = 63 ext{ mg}$ hence required total volume to reduce concentration:

  • Using required concentration of 0.18mg/mL:

  • $ext{Total volume} = rac{63 ext{ mg}}{0.18 ext{ mg/mL}} = 350 ext{ mL}$

Diluting IV Drugs

• For Amoxil brand: 9.2mL of water to be added to achieve a total of 10mL at a concentration of:

  • Required: 50mg/mL, thus:

  • Calculation:

  • $100 ext{ mg/mL} imes 10 ext{ mL} = 20 ext{ mL required volume for 50mg/mL}$

Questions

• Reflect on assessments, diagnosis, treatment efficacy, medication calculations, and collaboration regarding case management strategies.