NU665
Unintentional injuries and prevention - Answers 1. Infants - accidental suffocation, motor vehicle crashes,
drowning
-Back to sleep in own bed in parent's room; review car seat safety guidelines, don't drive under the
influence
2. Ages 1-4 - drowning, falls, MVAs
-Constant supervision around water; personal flotation device; swim lessons at age 4; adequate fencing
around pools; do not leave child unattended near or inside of a vehicle
3. Ages 5-12 - MVAs, drowning, fire/burns
-Car seat safety guidelines; consistent use of seatbelts; swim lessons; adult supervision around water; if
on a boat - life jacket; functioning smoke alarms in house
4. Age 13-19 - MVAs; poisoning, drowning
-Prevent distracted driving, consistent seatbelt use, homes free of firearms, if a firearm is in the home -
store it unloaded and locked with ammunition stored separately
Child maltreatment - Answers 1. Signs
-Repeated injuries that are unexplainable or unusual
-Overly compliant or exhibits exaggerated fearfulness
-Clingy or indiscriminate attachment
-Extremes in behavior (aggressive or passive)
-Wary of physical contact with adults
-Frightened of a parent or another caregiver
-Exhibits drastic behavioral changes in and out of parental or caregiver presence
-Withdrawal from family or friends, poor school performance, depression or sadness, anxiety, aggressive
or destructive behavior, or mistreating an animal or pet
-Suicidal (attempts or plans) or engages in self-mutilation
-Displays sleep or eating disorders
2. Steps to take as a provider
-Must report suspected or known maltreatment to the appropriate agencies - CPS or law enforcement
,Abrasions - Answers -Superficial skin injuries, from falls or friction that involve epidermal trauma
-Findings - determine the extent of the abrasion and the presence of dirt, grime, or other foreign
objects; skin scraped off, oozing of serous fluid and/or blood; pain, swelling, warmth, erythema, and red
streaking of the injured area suggesting a deeper injury or secondary infection
-Interventions - cleansing the wound by scrubbing with soap or an antibacterial cleanser; may be open to
air or may need a small bandage; larger ones should be kept moist; cover larger ones with a sterile
dressing; antibiotic ointment like bacitracin/polymyxin B may be use; wash every 24 hours until a dry
scab; tetanus if significant or has not had one vaccine in 5 years
Animal or snake bite - Answers -Ask about type of animal, domesticated or feral, and location
-The wound should be assessed; ROM and sensory intactness
-Interventions - tetanus booster, rabies prophylaxis; analgesia or anesthesia; debride tissue and remove
foreign matter; with NS, irrigate the wound; if isolated - soak in tap water and iodine; antibiotics for all
human and cat bites (amoxicillin)
-Refer if severe; obtain a surgical consult if there is evidence about nerve, tendon, and/or ligament injury
-Report dog and animal bites to animal control
-Snake - type of snake; severe local reaction after the bite, ecchymosis and swelling with later fluid filled
or hemorrhagic bullae and necrosis; peripheral and central neurological symptoms including numbness,
tingling, diplopia, lethargy, increased salivation, metallic taste in mouth, sweating, n/v, hematemesis,
melena, and hemoptysis; respiratory distress and shock that can lead to death
-Interventions for snack bite - clean, tetanus prophylaxis, pain medication, oral antibiotic therapy with
Augmentin; if unsure about the snake - poison control and observe patient for 3-4 hours
-For people with more than local symptoms (venomous snake)- rapid transportation to a medical center,
referral to medical specialists, antivenin therapy, an treatment for shock and respiratory difficulties
-Nonvenomous - clean, tetanus prophylaxis if necessary, pain medication, augmentin for5 days if wound
contaminated or secondary infection
-If uncertainty about snake - poison control and watch for venomous symptoms for 3-4 hours (severe
local reaction after bite with intense pain, burning, discoloration, edema, hemorrhagic effects,
ecchymosis and swelling with later fluid filled or hemorrhagic bullae and necrosis, neurological
symptoms, salivation, metallic taste in mouth, sweating, and n/v, hematemesis, melena and hemopty
Burns - Answers -Findings - superficial burns are only the epidermis with symptomatic treatment;
example is a sunburn; partial-thickness burns involve involve the epidermis and the dermis; superficial
, partial thickness are red, very painful, mottled, moist, and blistered that heal in 7-14 days; deep partial
thickness - pale, yellow, less painful and weepy , usually scar; full thickness destroy the epidermis and
dermis completely; the skin appears whitish or leathery, dry, nontender, fluid losses occur, skin grafting
needed; full thickness - tendons, nerves, muscle, fascia, bone and need surgery and skin grafting
-Management - determine the need for admission to a burn center; if more than 20% BSA, partial
thickness burns involving more than 10% TBSA, full thickness burns more than 2% TBSA, circumferential
burn, burns overlying joints or critical areas, such as the hands, feet, genitalia, and perineum, full
thickness burns, chemical burns, electrical burns, inhalation injury, suspicion of child abuse or unsafe
home environment, presence of an underlying chronic illness - admission
-Outpatient treatment - superficial burns and partial thickness burns to less than 10% of BSA
Health benefits of exercise for children with asthma - Answers -Participation in aerobic activity has
demonstrated an improvement to the individual's exercise capacity and reduction in their airway
inflammation
Down Syndrome - Answers -These patients have low tone and looser ligaments that place them at
greater risk of compression of the spinal cord causing nerve damage - atlantoaxial instability
-May have changes in ambulation, the ability to use upper extremities, complaints of neck pain, a new
fixed head tilt, bowel or bladder dysfunction, or new unexplained weakness
-Signs - weakness, numbness, neck pain, localized neurologic pain, spasticity, gait difficulties, change in
bowel or bladder function
Hours of sleep per age - Answers -1 week old - 8.25 at night
-1 month old - 8.5 hours
-3 months old - 10 hours
-6 months old - 11 hours
-9 months old - 11.2 hours
-12 months old - 11.7 hours
-18 months old - 11.6 hours
-2 years old - 11.4 hours
-3-5 years old - 12.5 hours
-5-11 years old - 11 hours
Unintentional injuries and prevention - Answers 1. Infants - accidental suffocation, motor vehicle crashes,
drowning
-Back to sleep in own bed in parent's room; review car seat safety guidelines, don't drive under the
influence
2. Ages 1-4 - drowning, falls, MVAs
-Constant supervision around water; personal flotation device; swim lessons at age 4; adequate fencing
around pools; do not leave child unattended near or inside of a vehicle
3. Ages 5-12 - MVAs, drowning, fire/burns
-Car seat safety guidelines; consistent use of seatbelts; swim lessons; adult supervision around water; if
on a boat - life jacket; functioning smoke alarms in house
4. Age 13-19 - MVAs; poisoning, drowning
-Prevent distracted driving, consistent seatbelt use, homes free of firearms, if a firearm is in the home -
store it unloaded and locked with ammunition stored separately
Child maltreatment - Answers 1. Signs
-Repeated injuries that are unexplainable or unusual
-Overly compliant or exhibits exaggerated fearfulness
-Clingy or indiscriminate attachment
-Extremes in behavior (aggressive or passive)
-Wary of physical contact with adults
-Frightened of a parent or another caregiver
-Exhibits drastic behavioral changes in and out of parental or caregiver presence
-Withdrawal from family or friends, poor school performance, depression or sadness, anxiety, aggressive
or destructive behavior, or mistreating an animal or pet
-Suicidal (attempts or plans) or engages in self-mutilation
-Displays sleep or eating disorders
2. Steps to take as a provider
-Must report suspected or known maltreatment to the appropriate agencies - CPS or law enforcement
,Abrasions - Answers -Superficial skin injuries, from falls or friction that involve epidermal trauma
-Findings - determine the extent of the abrasion and the presence of dirt, grime, or other foreign
objects; skin scraped off, oozing of serous fluid and/or blood; pain, swelling, warmth, erythema, and red
streaking of the injured area suggesting a deeper injury or secondary infection
-Interventions - cleansing the wound by scrubbing with soap or an antibacterial cleanser; may be open to
air or may need a small bandage; larger ones should be kept moist; cover larger ones with a sterile
dressing; antibiotic ointment like bacitracin/polymyxin B may be use; wash every 24 hours until a dry
scab; tetanus if significant or has not had one vaccine in 5 years
Animal or snake bite - Answers -Ask about type of animal, domesticated or feral, and location
-The wound should be assessed; ROM and sensory intactness
-Interventions - tetanus booster, rabies prophylaxis; analgesia or anesthesia; debride tissue and remove
foreign matter; with NS, irrigate the wound; if isolated - soak in tap water and iodine; antibiotics for all
human and cat bites (amoxicillin)
-Refer if severe; obtain a surgical consult if there is evidence about nerve, tendon, and/or ligament injury
-Report dog and animal bites to animal control
-Snake - type of snake; severe local reaction after the bite, ecchymosis and swelling with later fluid filled
or hemorrhagic bullae and necrosis; peripheral and central neurological symptoms including numbness,
tingling, diplopia, lethargy, increased salivation, metallic taste in mouth, sweating, n/v, hematemesis,
melena, and hemoptysis; respiratory distress and shock that can lead to death
-Interventions for snack bite - clean, tetanus prophylaxis, pain medication, oral antibiotic therapy with
Augmentin; if unsure about the snake - poison control and observe patient for 3-4 hours
-For people with more than local symptoms (venomous snake)- rapid transportation to a medical center,
referral to medical specialists, antivenin therapy, an treatment for shock and respiratory difficulties
-Nonvenomous - clean, tetanus prophylaxis if necessary, pain medication, augmentin for5 days if wound
contaminated or secondary infection
-If uncertainty about snake - poison control and watch for venomous symptoms for 3-4 hours (severe
local reaction after bite with intense pain, burning, discoloration, edema, hemorrhagic effects,
ecchymosis and swelling with later fluid filled or hemorrhagic bullae and necrosis, neurological
symptoms, salivation, metallic taste in mouth, sweating, and n/v, hematemesis, melena and hemopty
Burns - Answers -Findings - superficial burns are only the epidermis with symptomatic treatment;
example is a sunburn; partial-thickness burns involve involve the epidermis and the dermis; superficial
, partial thickness are red, very painful, mottled, moist, and blistered that heal in 7-14 days; deep partial
thickness - pale, yellow, less painful and weepy , usually scar; full thickness destroy the epidermis and
dermis completely; the skin appears whitish or leathery, dry, nontender, fluid losses occur, skin grafting
needed; full thickness - tendons, nerves, muscle, fascia, bone and need surgery and skin grafting
-Management - determine the need for admission to a burn center; if more than 20% BSA, partial
thickness burns involving more than 10% TBSA, full thickness burns more than 2% TBSA, circumferential
burn, burns overlying joints or critical areas, such as the hands, feet, genitalia, and perineum, full
thickness burns, chemical burns, electrical burns, inhalation injury, suspicion of child abuse or unsafe
home environment, presence of an underlying chronic illness - admission
-Outpatient treatment - superficial burns and partial thickness burns to less than 10% of BSA
Health benefits of exercise for children with asthma - Answers -Participation in aerobic activity has
demonstrated an improvement to the individual's exercise capacity and reduction in their airway
inflammation
Down Syndrome - Answers -These patients have low tone and looser ligaments that place them at
greater risk of compression of the spinal cord causing nerve damage - atlantoaxial instability
-May have changes in ambulation, the ability to use upper extremities, complaints of neck pain, a new
fixed head tilt, bowel or bladder dysfunction, or new unexplained weakness
-Signs - weakness, numbness, neck pain, localized neurologic pain, spasticity, gait difficulties, change in
bowel or bladder function
Hours of sleep per age - Answers -1 week old - 8.25 at night
-1 month old - 8.5 hours
-3 months old - 10 hours
-6 months old - 11 hours
-9 months old - 11.2 hours
-12 months old - 11.7 hours
-18 months old - 11.6 hours
-2 years old - 11.4 hours
-3-5 years old - 12.5 hours
-5-11 years old - 11 hours
