Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 52 Nursing Care of a Family When a Child Has an Unintentional Injury

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Traumatic Injury

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Traumatic Injury (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Head Trauma Immediate assessment Immediate management Skull fracture –Assessment –Therapeutic management –Potential complications

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Head Trauma (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Head Trauma (cont’d) Subdural hematoma Epidural hematoma Concussion Contusion

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Head Trauma (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Head Trauma (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Head Trauma (cont’d) Coma –Assessment –Therapeutic management

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Abdominal Trauma Assessment Splenic rupture Liver rupture

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Near Drowning Drowning Near drowning Pathophysiology of drowning Emergency management

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Poisoning Acetaminophen Caustic Hydrocarbon ingestion Iron Lead Insecticide

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Poisoning (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Foreign Body Obstruction Foreign bodies in ear Foreign bodies in nose Foreign bodies in esophagus Subcutaneous objects

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Bites Mammalian bites Snakebite –Assessment –Emergency management

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Thermal Injuries Frostbite –Assessment –Therapeutic management

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Trauma Assessment-pic-1549 Depth of burn-1549 Emergency management –Minor –Moderate burns –Severe burns

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question While visiting a friend, you see an 18-month-old toddler pull a scalding cup of coffee off a table onto himself. Your first action should be to A.pour cool water over the skin area where the coffee spilled. B.remove his shirt and apply burn ointment. C.wrap him in a blanket and rush him to the nearest hospital. D.apply butter to soothe the injured skin.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Pour cool water over the skin area where the coffee spilled. Rationale: Cooling a burn almost automatically prevents further damage.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Trauma (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Trauma (cont’d) Therapy for burns –Topical therapy –Escharotomy –Debridement –Grafting

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The physician of a child with extensive burns tells you an hour after the injury to “monitor him carefully.” Which of the following would be the most important factor to monitor closely? A.Urinary output B.Pupillary reaction C.Intracranial pressure D.Sugar and acetone of urine

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Urinary output Rationale: So much fluid enters a burned area and is lost that cardiovascular pressure can fall, decreasing kidney function. Assessing urine output is important to detect kidney function.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Sulfadiazine (Silvadene) cream is often used to treat burns. Before applying this to a child, you would explain that the drug A.will cause some discomfort when applied. B.helps to keep the burn eschar soft. C.sometimes causes mild but annoying itching. D.may stain the bed linen brown.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Helps to keep the burn eschar soft Rationale: Sulfadiazine reduces the possibility of infection; it keeps the burn eschar soft and prevents cracking and bleeding.