Clinical Problem-Solving Flashcards

Which of the following should the neonatal/pediatric specialist recommend for an 8 year-old child with cerebral atrophy and poor cognitive skills in order to promote bronchial hygiene while delivering a bronchodilator?

Answer: intrapulmonary percussive ventilation

Intrapulmonary percussive ventilation (IPV) delivers small, rapid bursts of air into the lungs, creating oscillations that help mobilize secretions and improve bronchial hygiene. For a child with cerebral atrophy and poor cognitive skills, IPV can be more effective and less dependent on patient cooperation than other methods, while also facilitating bronchodilator delivery directly into the airways.

A 9-year-old child aspirates while eating gummy bears with her twin sister. She was laying on her left side at the time of aspiration. The child is in no apparent distress. The neonatal/pediatric specialist quickly suctions the child. What should the specialist do next?

Answer: Roll the patient to the right side for postural drainage

Since the child aspirated while lying on her left side, the aspirated material is most likely in the left lung. To facilitate postural drainage and help clear the airway, the specialist should roll the patient to the opposite (right) side. This position uses gravity to help move secretions from the affected left lung segment into larger airways for removal.

A 15-year-old patient with asthma presents to the ED in moderate distress. After several hours of treatment, no clinical improvement has occurred. The physician has ordered heliox therapy. Which of the following should the neonatal/pediatric specialist select for delivery of this therapy?

Answer: Non-rebreather mask

Heliox therapy is typically administered via a tight-fitting non-rebreather mask to ensure the delivery of the precise heliox mixture and minimize entrainment of room air. This mask provides a high concentration of the therapeutic gas, which is crucial for reducing airway resistance and improving gas flow in patients with severe asthma who are in moderate distress.

A neonatal/pediatric specialist is called to the ED to administer a bronchodilator to a 7-year-old child with asthma. The child is on oxygen via nasal cannula at 2L/min. Pulse oximetry reveals a saturation of 84%. The specialist finds the end of the oxygen tubing under the chair of the mother at the bedside. The specialist reattaches the tubing and notes that the SpO2 is now 93%. The specialist should?

Answer: Maintain the current oxygen flow

The patient's SpO2 improved from 84% to 93% after reattaching the oxygen tubing, which is within an acceptable and safe range for oxygen saturation. Since the immediate problem (dislodged tubing) has been resolved and the patient's oxygenation is now adequate, maintaining the current oxygen flow is the appropriate action. There is no indication to increase flow or change devices unless the SpO2 drops again.

A 7 year-old child was rescued from a burning building and brought to the ED for treatment. Upon arrival, the child was placed on oxygen via a non-rebreather mask. The neonatal/pediatric specialist notes that when the child inhales, the reservoir bag remains completely inflated. The specialist should?

Answer: Adjust the seal on the face mask

For a non-rebreather mask to function correctly, the reservoir bag should slightly deflate with each inspiration and then reinflate. If the reservoir bag remains completely inflated during inhalation, it indicates that the mask is not forming a tight seal on the patient's face. This allows room air to be drawn in, diluting the oxygen and preventing the delivery of a high concentration. Adjusting the seal is necessary for proper function.