Gadar Anak

5/27/2018 Gadar Anak

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Oswati Hasanah, M.Kep., Sp.Kep.An

DEPARTEMEN MATERNITAS-ANAK

PSIK UR 2012


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Sule, mahasiswa keperawatan UR. Ini adalah haripertamanya paraktik di ruang IGD anak. pasienpertamanya pagi ini adalah klien anak, laki-laki, usia 3

tahun, dengan luka di kaki karena terjatuh daritangga. Anak ini menangis kesakitan dan tampaknyatidak bisa menggerakkan kakinya, ia menolak didekati oleh sule, apalagi melihat sule yang berpakaian

putih, memakai masker, membawa seperangkat alatyang belum pernah ia lihat sebelumnya, membuattangisannya semakin kuat. Sejujurnya, sule jugabingung harus bagaimana menghadapi anak dengankondisi seperti ini.


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Kelompok 1

Coba analisa keterampilan apa saja yang harus dimilikioleh sule dalam kasus kegawat daruratan pada anak?

Coba cari berdasarkan literatur apa saja contoh kasusgawat-darurat pada anak

Bagaimana aplikasi konsep atraumatic care dalam kasusgawat-darurat anak?

Kelompok 2

Apa perbedaan penatalaksanaan kasus gawat-daruratpada anak dengan kasus pada orang dewasa?

Bagaimana aplikasi konsep family centere care dalamkasus gawat-darurat anak?


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Communicate an attitude of calm confidence Establish a trusting relationship

Encourage caregivers to stay with the child Tell the truth describing sensation Provide insentives and rewards Assess the child unspoken thoughts and

feelings listen, avoid yes/no respons


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Childs response to emergencies

Primary response is fear Fear of being separated from parents

Fear of being removed from home

Fear of being hurt

Fear of mutilation

Fear of the unknown

Combat the fear with calm, honest approach Be honest - tell them it will hurt if it will

Use approach language


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Infant Toddler

Preschooler School age Adolescence


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Neonatal stage - birth to 1 month

Congenital problems and other illnesses often n

noted Personality development begins

Stares at faces and smiles

Easily comforted by mother and sometimes

father

Rarely febrile, but if so, be cautious of meningitis


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Approach to Neonates

Keep child warm

Observe skin color, tone and respiratory activity

Absence of tears when crying indicates dehydration

Auscultate the lungs early when child is quiet

Have the child suck on a pacifier

Have child remain on the mothers lap


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Ages 1-5 months - Characteristics

Birth weight doubles

Can follow movements with their eyes Muscle control develops

History must be obtained from parents

Approach

Keep child warm and comfortable

Have child remain in mothers lap

Use a pacifier or a bottle


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Ages 1-5 months - Common problems

SIDS

Vomiting and diarrhea/dehydration Meningitis

Child abuse

Household accidents


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Ages 6-2 months - Characteristics

Ability to stand or walk with assistance

Very active and explore the world with theirmouths

Stranger anxiety

Do not like lying supine

Cling to their mothers


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Ages 6-12 months - Common problems

Febrile seizures

Vomiting and diarrhea/dehydration Bronchiolitis or croup

Car accidents and falls

Child abuse Ingestions and foreign body obstructions

Meningitis


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Ages 6-12 months - Approach

Examine the child in the mothers lap

Progress from toe to head Allow the child to get used to you


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Ages 1-3 years - Characteristics

Motor development, always on the move

Language development Child begins to stray from mother

Child can be asked certain questions

Accidents prevail


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Ages 1-3 yrs - Common problems

Auto accidents

Vomiting and diarrhea Febrile seizures

Croup, meningitis

Foreign body obstruction


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Ages 1-3 yrs - Approach

Cautious approach to gain confidence

Child may resist physical exam Avoid no answers

Tell the child if something will hurt


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Tremendous increase in motor development

Language is almost perfect but patients may notwish to talk

Afraid of monsters, strangers; fear of mutilation

Look to parent for comfort and protection


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Ages 3-5 yrs - Common problems

Croup, asthma, epiglottitis

Ingestions, foreign bodies Auto accidents, burns

Child abuse

Drowning Meningitis, febrile seizures


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Ages 3-5 yrs - Approach

Interview child first, have parents fill in gaps

Use doll or stuffed animal to assist in assessment Allow child to hold & use equipment

Allow them to sit on your lap

Always explain what you are going to do


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Active and carefree

Great growth, clumsiness Personality changes

Strive for their parents attention

Common problems

Drowning

Auto accidents, bicycle accidents

Fractures, falls, sporting injuries


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Age 6-12 yrs - approach

Interview the child first

Protect their privacy Be honest and tell them what is wrong

They may cover up information if they were

disobeying


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Ages 12-15 - Characteristics

Varied development

Concerned with body image and veryindependent

Peers are highly important, as is interest in

opposite sex


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Ages 12-15 - Common problems

Mononucleosis

Auto accidents, sports injuries Asthma

Drug and alcohol abuse

Sexual abuse, pregnancy Suicide gestures


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Ages 12-15 - Approach

Interview the child away from parent

Pay attention to what they are notsaying


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Ages 12-15 - Characteristics

Varied development

Concerned with body image and veryindependent

Peers are highly important, as is interest in

opposite sex


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Life threatening

Not life

threatening


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Decide

What can you do to help?

Act Call??

CPR

Obtain code cart Monitor and saturation monitor

Oxygen

Treatments


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Airway Clear

Maintainable simply Head tilt/chin lift (the so-called sniff position)

Jaw thrust

Oral and nasal airways

Unmaintainable Removal of a foreign-body obstruction

Endotracheal intubation

Percutaneous needle cricothyrotomy


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Respiratory rate Effort

Retractions Use of accessory muscles of respiration Nasal flaring Grunting

Air entry/exchange Symmetric chest expansion

Breath sounds Paradoxical breathing Stridor Wheezing


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Color Heart rate Blood pressure

Quality/strength ofperipheral andcentral pulses

Skin perfusion Capillary refill time

Temperature Mottling

End-organ perfusion CNS

Responsiveness(awake, responds tovoice, to pain,unresponsive)

Recognize parents

Muscle tone Pupillary reflexes Posturing

Kidney perfusion Urine output >1 mL per

kg per hour


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Shock Hypovolemic shock

Distributive shock

Cariogenic shock Trauma Ingestion an poisoning Environmenal emergencies

Animal, human, snake bites

Drowning Dental emergencies teeh injured


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Asthma

Bronchiolitis

Pneumonia Croup

Foreign Body


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Predominately during inspiration

Increased RR

Change in voice Hoarse

Seal like cough

Stridor

Poor chest rise

Poor air entry on auscultation


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Most common in children younger than 5 yo Commonly aspirated objects include peanuts, grapes,

coins, small toys, jewelry, balloons and hot dogs Suspect in any child presenting with the acute

respiratory distress with coughing, gagging and stridor especially when there is no history of prodromal

illness

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