Chapter 52: Unintentional Injuries in Children Nursing Care

The nursing process for an injured child involves assessing both the physical damage and the intense psychological distress experienced by the child and parents, noting that people under stress may not process information effectively. Crucial initial assessments follow the established priorities of airway, breathing, circulation, and disability (ABCD). Specific critical care areas include head trauma, which encompasses concussions, contusions (brain bruising), skull fractures, and hematomas (subdural or epidural). Immediate and continual neurological assessment is required to detect signs of increasing intracranial pressure (ICP), such as a decreased pulse and respiratory rate coupled with rising blood pressure, often managed with hypertonic intravenous (IV) solutions and elevated head positioning. Abdominal trauma, which is often difficult to detect due to subtle signs, frequently involves splenic or hepatic rupture, requiring careful monitoring for hemorrhage and diagnostics like computed tomography (CT). Management of poisoning requires immediate contact with the National Poison Control Center, as specific ingestions dictate different treatments. For example, activated charcoal is the primary management for many poisons, but it is ineffective for iron poisoning and contraindicated for caustic ingestions. Acetaminophen overdose requires the antidote acetylcysteine to prevent liver damage. Lead poisoning (plumbism) from environmental sources like old paint chips or contaminated dust requires chelation therapy using agents such as edetate calcium disodium (CaEDTA) or succimer if blood levels are elevated, aiming to prevent neurological deficits. Drowning incidents lead to distinct physiological consequences depending on whether salt or fresh water was aspirated, impacting fluid and electrolyte balance, and demanding immediate resuscitation with mouth-to-mouth ventilation and high-concentration oxygen delivery. Thermal injuries are classified by depth (first to fourth degree), with severe burns causing massive fluid shifts leading to hypovolemia in the first 24 hours. Management requires aggressive fluid resuscitation, pain control with IV analgesics like morphine, strict infection control using sterile technique and topical antibiotics (such as silver sulfadiazine), and wound care involving debridement and skin grafting (autografting) to minimize infection and prevent joint contractures. The overall plan of care integrates the six competencies of Quality Safety Education for Nurses (QSEN) to achieve quality maternal and child health nursing outcomes.