Assessment Flashcard 1

B. Rationale: Patients who suffer from blunt force trauma to the head are at risk for developing increased intracranial pressure (ICP). Since the brain is enclosed in a rigid structure, a significant increase in ICP may cause some portion of the brain, such as the uncal area of the temporal lobe, to herniate. Thus, in cases where ICP is suspected, a brief period of hyperventilation decreases the partial pressure of carbon dioxide (PaCO₂ ) in the brain that causes arterial vasoconstriction and subsequently leads to a reduction in cerebral blood flow, cerebral blood volume, and ICP, which reduces the risk of uncal herniation.

C. Rationale: The peak expiratory flow rate (PEFR) reflects the child’s ability to expire air as forcefully as possible, which allows the clinician to evaluate for the amount of airway obstruction present. It is usually performed in patients with acute asthma exacerbations before and after therapy to assess severity and response to treatment. Pulse oximetry is also often evaluated, but it is not a particularly useful indicator for a variety of complex reasons, including the tendency for the SpO₂ to drop in the short term in response to bronchodilators due to a transient ventilator-perfusion mismatch. Many patients presenting with mild to moderate asthma symptoms may not have a low SpO₂ so it is not a sensitive indicator of improvement or lack thereof.

D. Rationale: Septic shock is due to inflammatory factors produced by the body’s immune system in the presence of infection. This causes systemic vasodilation, which compromises blood pressure and tissue perfusion. Following the American Heart Association PALS Systematic Approach Algorithm for the critically ill child, a pulse rate < 60 beats per minute warrants conventional CPR.

D. Rationale: Usually, poor perfusion or oxygenation will present as pallor, cyanosis, or mottled skin. Cyanosis of the lips and fingernails indicates poor oxygenation. However, if a patient has reddish or flushed skin coloration, it may be a sign of fever or shock from anaphylaxis, sepsis, or a toxin. Healthcare providers must be aware that not all patients with poor perfusion present with pallor or cyanosis.

B. Rationale: Hypoxemia is a state or condition where there is reduced oxygen supply to sustain the normal or physiologic functions of the body. It is quantitatively defined as a low partial pressure of oxygen in the arteries, or simply a low oxygen saturation in the arterial blood. This is measured by an arterial blood gas analysis or a pulse oximeter attached to a part of the body that has a thin layer of skin, such as an earlobe or a fingertip. Hypoxemia is defined as oxygen saturation of 94% or below.

B. Rationale: The American Heart Association PALS Systematic Approach Algorithm suggests that the clinician can make an initial impression of the patient based on three factors: appearance, breathing, and circulation.

C. Rationale: To evaluate the patient’s breathing status, we can determine if there is adequate ventilation and perfusion of oxygen-rich blood by monitoring with a pulse oximeter.

C. Rationale: Uncal (transtentorial) herniationoccurs when the medial temporal lobe drops into the posterior fossa through the tentorial opening. The uncus of the temporal lobe is forced into the gap between the midbrain and the edge of the tentorium. The ipsilateral oculomotor nerve is compressed, causing a fixed and dilated pupil, which is reflected as an unequal pupillary light reflex. Subsequently, the ipsilateral posterior cerebral artery collapses due to mass effect, causing an infarct in its distribution. Cortical blindness resulting from this infarct is a false localizing sign because it gives the erroneous impression that the primary lesion is in the occipital lobe. Severe downward and infratentorial displacement of the brainstem may result in hemorrhages that can damage the reticular activating system, leading to focal neurological deficits, erratic respiratory control, and coma.

D. Rationale: Assessing the status of a critically ill child’s circulation involves heart rate and rhythm, pulse, capillary refill time, skin color or temperature, blood pressure, and urine output.

A. Rationale: Normal systolic blood pressure in patients 1 to 10 years old can be calculated as follows:
Normal Systolic BP= 70 mmHg+(age in years ×2 mmHg)
The systolic blood pressure reading lower than the calculated blood pressure indicates that the patient is hypotensive.