Emergency & Trauma Care for Nurses and Paramedics: Paediatric Emergencies, Disabilities, and The Older Person

See books below
E-text: Emergency & Trauma Care for Nurses and
Paramedics (2nd Edition)
Read Chapter 36, "Paediatric Emergencies".
CP3 7.1 - MULTIPLE CHOICE QUIZ
CP3 7.2 - CASE STUDY QUIZ
You are called to attend a 14-month-old child suffering from fever, diarrhoea and
vomiting. The mother verbalises that the child has not been feeding properly, has
been crying and has not sleep very well for the last 24 hours.
Question 1 of 3
When is antipyretic therapy not recommended for children with fever and why? What
is the focus of fever management among paediatrics?
Antipyretics are contraindicated if the child’s temperature is below 38.3 Celsius. This is
because antipyretics have not been proven to lower body temperature especially if fever is
due to an illness. The main focus in managing fever in paediatrics is to avoid development of
complication as it is believed high temperatures more than 40.0 Celsius can predispose a
paediatric patient to seizures or brain damage. Fever in children is very common as it is
usually the main sign of many infections and childhood illnesses.
Question 2 of 3
Name at least five key elements in taking the history for paediatric presentation.
Taking a pediatric history is different from an adult history because of some components.
Pregnancy and birth history is very important in taking a pediatric history. This is because
some childhood illnesses are related to pregnancy and giving birth. Some congenital
anomalies can be due to maternal health during pregnancy such as rubella infection. Maternal
nutrition during pregnancy affects the outcome of the unborn baby. During birth, the baby
can contract infections especially if aseptic technique is not considered. Infections such as
oral thrush can be acquired during birth if he mothers has untreated vaginal candidiasis
during delivery. Another component is developmental history. This is the stage at which
milestones were achieved such as walking, talking and running. Present school grades are
also important especially in diagnosing mental illnesses. The third component is feeding
history. This includes the breastfeeding period, solids introduced and reasons for introducing
solid food. Children who are exclusively breastfed for more than six months have a lower risk
of frequent infections as their immunity is stronger than those on formula. Another
component is family and social history. Some illnesses such as diabetes are hereditary.
Environmental factors such as pollen grains or dust mites can predispose the already

susceptible children to asthma. Immunization history is also important in pediatric history
taking. If a child does not receive full immunization according to Kepi schedule, he or she is
susceptible to many disease conditions such as tuberculosis, measles and whooping cough.
Question 3 of 3
What is the most important parameter to be collected for actual and potential fluid
and electrolyte imbalance? How would the hospital accurately obtain this data?
The most appropriate parameter for determining fluid and electrolyte imbalance is urine
output. Monitoring fluid intake by the patient and amount of fluids lost through urine,
vomiting and diarrhoea can help estimate any potential sign of fluid and electrolyte
imbalance. If the patient takes too much fluid and does not excrete proportionally, then he or
she is at risk of fluid overload. If the patient is taking too little fluid and losing much, then he
or she is at risk of fluid deficit. The hospital can accurately obtain the data through measuring
the amount of fluids taken by the patient and measuring the output. Output of urine through
catheterization and estimating amount of fluid lost through vomiting and diarrhoea.
Book below
E-text: Emergency & Trauma Care for Nurses and
Paramedics (2nd Edition)
Read Chapter 38, "People With Disabilities".
CP3 7.3 - MULTIPLE CHOICE QUIZ
CP3 7.4 - CASE STUDY QUIZ
Question 1 of 4
After introducing yourself to the patient and their PSW with your name and role, it is then
important that you ask:
A. the PSW to remain outside so that the patient answers without fear of disclosing private
details to the PSW.
B. the PSW to remain with your patient and direct all questions to the PSW.
C. the patient a simple question, such as ‘Where does it hurt?’ to determine their
communication ability.
D. the PSW what the patient’s communication abilities are.

Question 2 of 4
Indicate your correct multiple choice answer, and your reason for this
answer.
Your patient with an intellectual disability has a PSW at all times in his residential
accommodation and a registered nurse visits when he needs assistance with his
healthcare needs. How would you triage the patient?
A. He needs to be urgently assessed and closely monitored.
B. He can wait in the waiting room with his PSW.
C. He should be moved to a quieter area.
D. His triage priority should be determined on physiological parameters as for every
other patient seeking emergency care.
Reason
He can wait in the waiting room with his PSW. This is because a patient with intellectual
disabilities may not have urgent needs of the airway, breathing and circulatory needs. He is
used to staying with his PSW therefore it is more convenient to attend to him when together.
Risk of being violent is also minimal (B).
Question 3 of 4
Indicate your correct multiple choice answer, and your reason for this
answer.
You notice that your patient is slim, of short stature, has an extended face, enlarged
ears and that he sits on the bed with widely abducted legs. These observations are
important because:
A. His elongated face and ears indicate that he may have Marfan’s syndrome,
indicating that he is at risk of aortic dissection and cardiac ischaemia.

B. His facial features, short stature and mobile joints indicate that he may have
fragile X syndrome, indicating that he is more at risk of seizures and mitral
regurgitation with congestive heart failure.
C. His hypermobile hips indicate that he probably has Down syndrome, indicating an
increased risk of thyroid disease, congenital heart disease and dislocated hips.
D. These physical appearance findings, while informative, are unlikely to have much
bearing on his emergency care.
Reason
His facial features, short stature and mobile joints indicates that he may have fragile X
syndrome, indicating that he is more at risk of seizures and mitral regurgitation with
congestive heart failure. Individuals with fragile X syndrome are at risk of having seizures
this is because, people with fragile X syndrome lack the FMR protein. This protein is
responsible for controlling the production of a protein that regulates electrical signals in the
brain cells. Individuals with fragile X syndrome tend to have a hyper excitable nervous
system, which can be displayed through hyperactivity, anxiety epileptic seizure and increased
sensory activity. Mitral valve regurgitation also has been found to occur in people with
fragile X syndrome. This is because of mitral valve prolapse caused by connective tissue
dysplasia in individuals with this syndrome (B).
Question 4 of 4
Indicate your correct multiple choice answer, and your reason for this
answer.
You determine that your patient is unable to indicate that he has pain, as he has no
language abilities. How will you best determine if he has any pain or discomfort?
A. Ask his carer if he has pain.
B. Use a tool to assess facial expression as an indicator of distress.
C. If he appears in distress to you, he is likely to be in pain.
D. Use information provided in his healthcare plan or from his carer to determine his
appearance when content in comparison to when distressed.
Reason
Use a tool to assess facial expression as an indicator of distress (B). This is because patients
express their intensity of pain through facial expression. This can be observed as the patient
can frown or clench their jaws if the pain is intense. The FLACC assessment tool can be used
to identify whether the patient is In pain or not even without the patient answering a single
question. The tool focuses mainly on the facial expression of the patient.
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