NSG3107 Midterm exam 110 correct solutions.

NSG3107 Midterm exam 110 correct
solutions.
NSG3107 Midterm exam 110 correct
solutions.
Choking (ARM) - ANSWER Assess: gagging, hoarse, no sound, ineffective cough, stridor, cyanosis, LoC,
asymptomatic

Red flags: gagging, wheezing, coughing, vomiting

Manage:

• Recognition of obstruction

• Back blows or chest thrust for infants

• Abdominal thrusts (Heimlich manouvre) in children

• Recovery position after removal

• CPR if required and call emerge services



Preterm infants-normal resp range - ANSWER 40-70rpm



Laryngotracheobronchitis (Croup)-ARM - ANSWER Assess: increased RR and HR, restlessness, increased
work of breathing, pallor, sweating, anoxia and CO2 retention, cyanosis, resp failure, anxiety

Red flags:

- Gradual onset of low grade fever

- Barky brassy seal-like cough worse at night

- Inspiratory stridor

- Hoarseness

Manage:

• Vigilant observation

• High humidity with cool mist (reduces inflammation)

• Breathe cold air 5-10min: open window in winter or refrigerator/freezer (but keep child warm)

• Airway management

• Hydration, orally or intravenously

,NSG3107 Midterm exam 110 correct
solutions.
• If gets worse: nebulizer (racaemic epinephrine widens airway and reduces inflammation/swelling,
steroids reduce swelling, be prepared for intubation



Acute epiglottitis (Croup 2)-ARM - ANSWER Assess: (AIR RAID) airway closed, increased pulse,
restlessness, retractions, anxiety increased, inspiratory stridor, drooling

Red flags: barking cough, tripod, drooling, dysphonia, dysphagia, distress (4Ds)

Manage: medical emergency! Keep sitting up, do not examine throat or cause distress

• Be prepared for intubation

• May need emergency tracheostomy

• Monitor

• Try to keep calm

• Nebulized adrenalin

• IV insertion when safe

• Steroids to reduce edema

• IV antibiotics, then oral for 7-10days



Bronchiolitis (lower airway)-ARM - ANSWER Assess:

• Non-Specific:

- Generally Unwell - may be signs of ear infection

- Poor feeding

- Hypothermia or intermittent fever

- Irritability

• Respiratory signs:

- Runny nose, Cough

- Wheezing

- Increased work of breathing: tachypnea, grunting, chest wall retractions

- Apnoea/bradycardia

- Cyanosis

,NSG3107 Midterm exam 110 correct
solutions.
- Reduced breath sounds, reduced air entry

Red flags: fever for >5days, <3mo, chest pain, can't eat/drink, stiff painful neck with severe headache,
ear pain/draining from ear

Manage:

• ABC

• Ease respiratory efforts

• Promote rest and comfort

• Prevent spread of infection

• Temperature - may be fever...in infant, may be hypothermic

• Promote hydration and nutrition.

• Assess need for family support/education and home care

• Antibiotics if bacterial infection or risk of secondary bacterial infection

• Contact and droplet precautions

• Warm, sweet, and pink

* Breastfeeding is protective factor



Asthma (ARM) - ANSWER Assess: Baby's/Child's compensatory mechanism: breathing faster, wheezing,
coughing at night/with activity

Red flags:

• Wheezing***

• Shortness of breath

• Chest tightness

• Coughing (esp. at night or with increased activity level)

• Chronic: Barrel chest, elevated shoulders, use of accessory muscles

Management:

• Prevention: breastfeeding, not smoking in home, not putting in daycare



Newborn - 3 months - ANSWER 35-55rpm

, NSG3107 Midterm exam 110 correct
solutions.

3 - 6 months - ANSWER 30-45rpm



6 - 12 months - ANSWER 25-40rpm



Young child - ANSWER 20-30rpm



6 - 12 years - ANSWER 14-22rpm



13 - 18 year old - ANSWER 12-18rpm



Chest X-ray - ANSWER Images size and shape of heart, lung, chest wall



Echocardiogram - ANSWER Ultrasound to image size, shape, structure and function of heart, valves, and
pumping action of the heart, valves and great vessels.



Electrocardiogram - ANSWER Records the electrical activity of the heart



Cardiac catheterization - ANSWER Measures pressures in heart and blood vessels. Shows images of the
heart chambers and the great vessels. Can be used therapeutically - to create flow or block a defect.



Magnetic Resonance Imaging (Cardiac CT) - ANSWER Images heart structure in greater detail.



Patent ductus arteriosus (PDA) - ANSWER failure of ductus arteriosus to close within the first few weeks
of life, mostly seen in preterm infants. Blood flows from high pressure aorta to lower pressure
pulmonary artery, left-to-right shunt.

• Increasing respiratory distress due to pulmonary edema (pulmonary artery travels to lungs)

• Increasing apnea and bradycardia

• Bounding pulses