Life Threatening Illness

Keilmuan Keperawatan Anak

Objectives
Identify relationship between lifethreatening illness and acute & chronic illness Describe general principles that encourage cooperation in emergency settings List significant development issues when caring for children Define triage & list the most important factors to assess when obtaining an overall impression of an infants or childs condition

Life Threatening Illness

Acute Illness

Chronic Illness

Emergency Care

Palliative Care

End of Life

General Principles
Communicate an attitude of calm confidence. Establish a trusting relationship with the child and family. Encourage caregivers to stay with the child. Tell the truth. Provide incentives & reward Assess the childs unspoken thoughts and feelings.

 The Infant

Growth and development issues in emergency care

Allow the parents to hold the infant Remove any restriction/restraint Include the parents in treatments Help them use coping techniques Sensitive to both verbal & nonverbal cues

The Toddler

Separation & Stranger anxiety Do not respond well to restrictions Fear & fantasy

The Preschooler

The School-age Child The Adolescent

Understand the cause of illness & injury Explore the adult world & develop unique identities

The Family of a Child in Emergency Care

Possibilities:
Their child might die Their child might experience pain The childs body may be permanently altered

Parental Guilt:
Feel responsible for illness/injury Submitting to a painful experience Do not have enough knowledge

Triage
The goals of triage:
Rapidly identify the seriously ill or injured patient Prioritize all patients using the emergency department Initiate therapeutic measures for the patient

Initial observations for triage

Respiratory rate & effort Skin color Response to the environment

Four components of triage

Performing an across-the-room assessment Obtaining a chief complaint Performing a brief history Physical assessment Making the triage decision
Emergent Urgent Nonurgent

Emergency assessment of Infants & Children

Primary assessment
Airway : make sure the airway is open Breathing : check for breathing Circulation : check for pulse Disability : assess level of consciousness
A (alert), V (Verbal), P (Painful), U (Unresponsive)

Exposure : remove clothing/ diaper

Emergency assessment cont

Secondary assessment
Full set of vital sign Give comfort measure Head to toe assessment; (SAMPLE)
Sign & symptoms Allergies Medication taken Prior illness or injury Last meal & eating habits Events surrounding this injury/illness

Inspect the back; isolate

Diagnostic criteria for evaluating pediatric emergency

Complete blood count Type and crossmatch Serum electrolytes Radiographs
Chest Abdomen Bones

Peritoneal lavage

Treatment Modalities
Pediatric Cardiopulmonary Resuscitation Advanced life support
Vascular access Fluid administration Medication Administration Psychosocial Support

Specific Pediatric Emergencies

Shock Trauma Respiratory Emergencies Fever Bites & Stings Anaphylaxis Epistaxis Poisoning Sudden Infant Death Syndrome Child Abuse

Preparation for Transfer

Consider where the child is going for continued care. Arrange for the appropriate mode of transport.
Transport team members Transport protocols The initial call Reassess for & secure a patent airway Send copies of the patients chart.

References
James, Susan R. 2007. Nursing Care of Children: principles & practice. 3rd Ed. Missouri; St. Louis. Bowden, Vicky R., Dickey, Susan B., Greenberg, Cindy S. 1998. Children and Their Families: the continuum of care. Philadelphia; WB. Saunders Company.

Thank You