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Gadar Anak
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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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Ages 3-5 years - Characteristics
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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Ages 6-12 years - Characteristics
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