LEARNING LOG                                          17/05/2024

 

 

PAEDIATRIC EMERGENCIES  (ASSESSING CHILDREN AND YOUNG PEOPLE) 

 

The lesson started with an introduction of the module, followed by the learning outcomes, with the lesson’s aims and objectives.

 

We looked at the paediatric (paeds) assessment ranging from newborn to teenagers, (birth to 19 years). Paeds initial assessment can be done or carried out before touching the patient. Visual clues can be done to determine if the child is sick or not.

 

With regards the appearance, the muscle tone, interaction with the environment, alertness, eye contact, consolability.

 

There are different types of assessment : 

• Clinical assessment – A-E
• Social / emotional assessment
• Physical assessment  
• Environmental assessment
• Family assessment 

Ensure you look at the present(reason for attending)  and past history. 

• The reason for attending 
• The health concerns
• Symptoms
• Pain.

For the past history:

• The relevant to take birth history 
• Previous illness
• Family history

Also consider the –

• age, 
• sex, 
• religion, 
• language. 

• Parental responsibility
• immunisation(are they up to date)
• Medication
• Any allergies

With regards family history,

• employed/ financially stable
• Where do they live
• parents/ sibling(any concerns)
• school/nursery
• Any other healthcare professional, social worker
• Any parental concerns.

 

I learnt that in using the Paediatric Early Warning Sign (PEWS) form, always ensure or consider the Drs/Nurse/Patient concerns. The respiratory rate, and the heart rate. And be mindful of the acronyms wet flag, (weight, energy, tube, fluids, lorazepam, adrenaline and glucose). 

 

The following are the signs and symptoms of allergies:

• Itching
• Urticaria 
• Angioedema,
• Washing,
• Coughing
• Dyspnoea
• Stridor
• Hypotension
• Nausea
• Vomiting
• Tachycardia.

The treatment is ABC, 

Oxygen/ventilation,

 inhaler to name but a few.

 

With regards foreign bodies choking, the signs and symptoms are as follows;

• Difficulty in breathing, speaking, or coughing.
• A red puffy face
• Signs of distress, they may point to their throat or grasp their neck.

The treatment includes:

• Cough out- encourage them to cough and remove any obvious obstructive from their mouth
• Slap it out- if coughing fails to work
• Call 999

Shock – is the failure of circulation of oxygen to tissues resulting in lactic acidosis.

 

The following are the types of shock:

• Hypovolemic – this is due to loss of blood or fluid
• Distributive(septic) – maldistribution of blood.
• Obstructive – reduce to vascular size and limit the blood flow.
• Anaphylactic – shock due to allergies.
• Cardiogenic – primary heat problems.

 

Seizures – seizure is a sudden, uncontrolled burst of electrical activity in the brain that temporarily affects the consciousness.

Febrile convulsion – children cannot maintain their temperature due to underlying conditions.

NOTE- document everything that you see, do not rely on their parents. 

 

The signs and symptoms are as follows:

• Altered mental status,
• Nystagmus
• Convulsion
• Secondary trauma. 

 

The treatments are as follows:

• Oxygen therapy
• Monitor glucose
• Vital signs
• Iv acess
• Administrator benzodiazepines
• Administer midazolam / diazepam
• Suction if necessary
• Recovery position.

 

Cardiac arrest – this is when the heart stops beating suddenly. The lack of blood flow to the brain to other organs can cause a person to lose consciousness, become disabled, or die, if not treated immediately. Therefore it is a medical emergency.

 

The signs and symptoms of cardiac arrest are as follows:

• Sudden collapse
• No pulse
• No breathing
• Loss of consciousness

Sometimes other symptoms occur before a sudden cardiac arrest:

• Chest discomfort
• Shortness of breath
• Weakness to name but a few.

 

                     KSB ADDRESSED.

 

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice. 

K8: Understand how discriminatory behaviour is exhibited. 

K11: Understand the factors that may lead to inequalities in health outcomes. 

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and well-being. 

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care. 

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care. 

K17: Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care. 

K18: Understand and apply the principles and processes for making reasonable adjustments.

K19: Know how and when to escalate to the appropriate professional for expert help and advice. 

K20: Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met. 

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care. 

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health. 

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity. 

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain. 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life..

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld. 

K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies.

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions. 

K29: Understand the different ways by which medicines can be prescribed. 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident.

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident. 

K36: Understand the roles of the different providers of health and care. 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services.

K41: Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it.

K43: Understand the influence of policy and political drivers that impact health and care provision Skills.

 

                                                SKILLS

 

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements 

S2: Keep complete, clear, accurate and timely records. 

S3: Recognise and report any factors that may adversely impact safe and effective care provision.

S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep.

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health. 

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity. 

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain. 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed. 

S31: Act in line with any end of life decisions and orders, organ and tissue donation protocols, infection protocols, advanced planning decisions, living wills and lasting powers of attorney for health. 

S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams. 

S33: Maintain safe work and care environments. 

S34: Act in line with local and national organisational frameworks, legislation and regulations to report risks, and implement actions as instructed, following up and escalating as required.

S35: Accurately undertake risk assessments, using contemporary assessment tools. 

S36: Respond to and escalate potential hazards that may affect the safety of people. 

S37: Participate in data collection to support audit activity, and contribute to the implementation of quality improvement strategies. 

S38: Prioritise and manage your own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members.

 

                                             BEHAVIOURS

 

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences 

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness