Question 1

Used postoperatively at incision sites&#10;Multiple Choice&#10;Identify the choice that best completes the statement or answers the question.

Accepted Answer

Jackson Pratt drain is used postoperatively at incision sites to drain excess fluid or blood.

Answer: C
 Chest tube is used to drain air, blood, or other fluids from the chest cavity. It is often used after chest surgery or to treat a collapsed lung.

Answer: E
 Foley is a urinary catheter that is inserted into the bladder to drain urine. It is commonly used in hospitalized patients or those with certain medical conditions.

Question 2

An 18-month-old toddler who presents in the Pediatric Intensive Care Unit presents with increased work of breathing, fever, poor feeding, and irritability. This toddler is most likely suffering from which of the following?

A) Burkholderia cepacia
B) methicillin-resistant Staphylococcus aureus
C) respiratory syncytial virus (RSV)
D) vancomycin-resistant enterococci
Short Answer

Accepted Answer

Signs and symptoms of RSV include lethargy, irritability, poor feeding, apnea, nasal discharge, fever, wheezing, rapid breathing, cough, and nasal flaring. RSV is diagnosed via a culture of the child's nasal discharge in conjunction with a chest x-ray. Treatment is supportive for the symptoms, including keeping the infant/child hydrated and using bronchodilators and supplemental oxygen. Severe cases of RSV in immune compromised children may result in an ICU stay and mechanical ventilation until respiratory symptoms subside.

Question 3

An 8-year-old child with a recurrent inoperable brain tumor is admitted to the oncology floor with worsening of symptoms and declining medical status. The pediatric advanced care team has been consulted and is working with the primary medical team and family to determine the course of medical care. Physical therapy was consulted to assess with mobility, positioning, and to provide recommendations for safe discharge to home. What are the goals you would establish in order for them to be discharged to home safely?

Accepted Answer

Goals of involving the pediatric advanced care team in a child's care may include opening up discussions with the family to look at their goals, providing assistance with quality-of-life decisions, managing symptoms, serving as a liaison with homecare or hospice, and meeting the wishes of the child/family for end-of-life care at home or in the hospital.

Question 4

A 4-year-old child with acute lymphoblastic leukemia in the induction phase of treatment presents with the following lab values: Hemoglobin = 7.8 g/100 mm; Platelets = 74,000 mm³; Hematocrit = 28%. What is the most appropriate physical therapy intervention for this child you are seeing with deconditioning?

A) Continue with treatment with strengthening and cardiovascular activities
B) Continue with treatment with cardiovascular activities but hold on strengthening exercises
C) Defer treatment due to the hemoglobin level
D) Defer treatment due to the platelet level

Accepted Answer

Hemoglobin norms vary by age and gender. The norm for a child is 11-13 g/100 mm, whereas the norms for adult males are 13-18 and adult females 12-16 g/100 mm. In the pediatric acute care setting, for children whose baseline falls within the normal ranges, intervention is typically deferred when their hemoglobin level falls below 8 g/100 mm. For those children whose baseline ranges are typically already below 8 g/100 mm, clinical discussions should occur among the medical team on whether interventions are indicated. Although this lab value is a guideline, patient symptoms should be closely monitored. Refer to Table 21.2 for exercise guidelines and activity level in accordance with platelet count.

Question 5

Removes fluid from the pleural cavity

Accepted Answer

A chest tube is used to remove fluid or air from the pleural cavity.

Answer: G 
 A Jackson Pratt drain is used to remove fluid from surgical sites or wounds. It is not used for pleural cavity drainage.

Other options:
A) Arterial line: Used to monitor blood pressure and oxygen levels in the blood. 
B) Broviac: A type of central venous catheter used for long-term intravenous access. 
D) Endotracheal tube: Used to maintain an open airway during anesthesia or mechanical ventilation. 
E) Foley: A type of indwelling urinary catheter. 
F) Gastric tube: Used for enteral feeding or to remove stomach contents.

Question 6

Administers long-term medications such as chemotherapy and can be used for blood draws

Accepted Answer

Broviac is a central venous catheter that is used to administer long-term medications and can also be used for blood draws.

Answer: F 
 A gastric tube is a medical device designed to be inserted into a patient's stomach to administer medication, nutrition, or to remove stomach contents.

Answer: G 
 A Jackson-Pratt drain is a medical device used to remove excess fluid from the body after surgery or injury.

Question 7

A 2-year-old toddler with an extensive past medical history including prematurity (33-week gestation), feeding intolerance, and global delays is admitted to the acute care setting for revision of a g-tube. The family is currently followed at home by early intervention one time a week for physical therapy services. What factors play a role in your consideration for determining acute-care physical therapy treatment frequency?

Accepted Answer

The answer of A 2-year-old toddler with an extensive past...

Question 8

Administers medication and/or nutrition needs

Accepted Answer

A gastric tube is used to administer medication and/or nutrition directly to the stomach.

Question 9

A 15-year-old male adolescent is admitted to the emergency room with a head trauma. He now presents with an external ventriculostomy to monitor intracranial pressure. When working on bed mobility, what should the position of the drain be in relationship to the patient?

A) Above the level of the patient's head
B) Below the level of the patient's head
C) Even with the patient's head
D) The position of the drain does not impact patient care

Accepted Answer

The ventriculostomy set-up consists of a tube inserted by a neurosurgeon running from a ventricle to an external collection device. The external collection device is hung at a specific height in relation to the child's head to allow gravity to facilitate the desired output. For example, a collection device hung below the level of a child's head would allow gravity to assist with drainage of fluid from the head to the device, whereas a collection device hung above the head would require increased pressure within the ventricular system to overcome gravity and allow fluid to drain out of the brain into the collection device. Implications for physical therapists working with children who have ventriculostomies include close monitoring of the child's position in relation to the collection device as well as signs and symptoms of increased and decreased intracranial pressure.

Question 10

A 15-year-old male adolescent is admitted to the emergency room with a head trauma. Which type of imaging is the most efficient way to diagnose the extent of the injury?&#10;A) CT&#10;B) MRI&#10;C) Ultrasound&#10;D) X-ray

Accepted Answer

A CT scan can be completed relatively quickly, in about 15 min; however, the child must lie still for accurate images to be obtained, which can be a problem with infants and children. When a good scan is obtained, CT imaging can be up to 100 times more sensitive than a plain film x-ray. CT imaging is complete with our without contrast depending on the structure being examined (Erkonen, 1998).

Question 11

Supports mechanical ventilation

Accepted Answer

The answer of Supports mechanical ventilation...

Question 12

A 14-year-old with spastic quadriplegic cerebral palsy and significant cognitive impairments is post-op day 1 from a pelvic osteotomy. Upon initial exam, you need to record a pain score. Which is the most appropriate pain scale to use with this individual?

A) CRIES (cry, requires O₂, increased vital signs, expression, sleeplessness)
B) FLACC (Face, Legs, Activity, Cry, and Consolability)
C) Numerical
D) Wong-Baker Faces

Accepted Answer

The answer of A 14-year-old with spastic quadriplegic cerebral palsy...

Deck 14: Pediatric Acute Care Hospital