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Diabetes insipidus (DI) results from insufficient antidiuretic hormone (ADH), leading to polyuria and dehydration. Management involves fluid replacement to correct volume loss and administration of vasopressin (or desmopressin) to replace deficient ADH.

“Central DI is treated with fluid resuscitation to manage hypovolemia and administration of vasopressin or desmopressin to reduce urinary losses and restore water balance.”

(Referenced from CCRN Pediatric – Direct Care: Endocrine, Water Balance Disorders)

Aldosterone is not indicated in the treatment of central DI. Restriction of fluids is contraindicated, as the patient is losing large volumes of free water.

Intracranial pressure (ICP) above 20–25 mm Hg is abnormal, and 35 mm Hg is a critical level requiring urgent intervention. After sedation and analgesia fail to reduce ICP,osmotic therapy is the next step, withhypertonic salinebeing a frontline choice for its rapid effect in reducing cerebral edema.

“In patients with traumatic brain injury and elevated ICP, first-line therapies include sedation, analgesia, and head positioning. If ineffective, hyperosmolar therapy such as hypertonic saline or mannitol is indicated to decrease cerebral edema and reduce ICP.”

(Referenced from CCRN Pediatric – Direct Care: Neurologic Dysfunction and Intracranial Hypertension Management)

Hypertonic saline pulls fluid from the brain into the vascular space, lowering ICP and improving cerebral perfusion.

The presence ofgrunting, crackles, retractions, and anS3 gallop—withhypotension and tachycardia—is highly suggestive ofcardiogenic shock. These findings indicatepoor myocardial contractility and pulmonary congestion. An S3 gallop is particularly indicative ofvolume overloadin the setting of ventricular dysfunction.

“Cardiogenic shock should be suspected in pediatric patients with signs of respiratory distress (crackles, retractions), an S3 gallop, and poor perfusion. Myocardial failure leads to elevated filling pressures and pulmonary edema.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Types of Shock and Hemodynamic Findings)

Naloxone has ashorter half-lifethan many opioids. After the initial reversal, the opioid's effects canresurge, leading torespiratory depressionand sedation. This is calledre-sedationoropioid re-narcotization. Re-dosing or initiating analoxone infusionmay be required.

“Recurrent sedation or respiratory depression after naloxone administration suggests opioid duration outlasting naloxone’s half-life. Repeat dosing or continuous infusion may be necessary.”

(Referenced from CCRN Pediatric – Direct Care: Multisystem, Opioid Toxicity and Naloxone Pharmacology)

This child presents with classic signs ofacute appendicitispotentially progressing toperitonitis or perforation. The priority is toconsult pediatric surgery immediately, asdelaying surgical evaluation can lead to worsening complications, including sepsis.

“Clinical presentation of acute appendicitis includes right lower quadrant or peri-umbilical pain, nausea, fever, and rebound tenderness. Surgical consultation is the priority in suspected appendicitis.”

(Referenced from CCRN Pediatric – Direct Care: Gastrointestinal, Acute Abdomen and Surgical Emergencies)

This infant displays signs ofearly septic shock, includingtachycardia,fever,normal cap refill, andlow CVP. In thehyperdynamic early phase of septic shock, patients may initially havewarm, flushed skinandbounding pulses, with preserved perfusion before progressing to a decompensated state.

“Septic shock may present with increased HR, fever, and warm extremities in its compensated phase. CVP may be low due to vasodilation and capillary leakage.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Types of Shock and Sepsis Pathophysiology)

An acid-fast bacillus (AFB) is strongly associated withMycobacterium tuberculosis (TB). TB is ahighly contagious airborne disease, and infection control standards require immediate placement in anegative-pressure roomto prevent spread to other patients and healthcare workers.

“Suspected or confirmed pulmonary tuberculosis in a mechanically ventilated patient necessitates immediate airborne isolation using a negative-pressure room. Infection control must be prioritized prior to confirmation of diagnosis.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary Infections and Airborne Isolation Protocols)

PPHNis a condition in which pulmonary vascular resistance remains abnormally high after birth. In this fragile state,handling or stresscan worsen pulmonary vasospasm.Minimal stimulation—such as reducing noise, light, and touch—is critical to preventing exacerbation.

“Infants with PPHN are highly sensitive to stress. Minimal stimulation reduces sympathetic discharge and prevents exacerbation of pulmonary vasoconstriction.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Neonatal Pulmonary Hypertension Management)

Alprostadilis used in ductal-dependent congenital heart lesions, not in primary management of PPHN.

Closed-loop communicationduring hand-offs ensures that vital information isreceived, repeated, and confirmedbetween caregivers. It is the mostdirect and consistent method to reduce communication-related errors, which are a leading cause of preventable harm in hospitals.

“Effective communication, especially during hand-offs, is critical for patient safety. Closed-loop communication improves accuracy, reduces omissions, and is considered a high-reliability practice.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Patient Safety and Communication Standards)

The first step in quality improvement or post-event evaluation—such as after a disaster drill—is tosystematically identify all problems or deviationsfrom expected protocols. Only once the problems are fully defined canroot causes be analyzedand process improvement initiated.

“After-action reviews following drills or emergencies should begin with problem identification. Comprehensive review and categorization of issues precede root cause analysis and protocol modification.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Systems-Based Practice and Quality Improvement)