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NU 374 > Ch. 25 > Flashcards

Ch. 25 Flashcards

1
Q

Infants and children have a proportionately ____ amount of body water than adults.

A

Infants and children have a proportionately greater amount of body water than adults.

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2
Q

Infants and young children require a ___ relative fluid intake than adults and excrete a _____ amount of fluid.

A

Infants and young children require a larger relative fluid intake than adults and excrete a greater amount of fluid.

*This places them at increased risk for fluid loss with illness compared to adults

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3
Q

until age 2 years, what makes up half of the child’s total body water?

A

Until age 2 years, the extracellular fluid, with its larger proportion of sodium and chloride, makes up about half of the child’s total body water.

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4
Q

water loss occurs more rapidly and in larger amounts in children or adults?

A

children

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5
Q

frequent introduction of bacteria from oral fixation and exploration

A

mouth

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6
Q

frequent regurgitation from underdevelopment of the lower esophageal sphincter occurs at what age?

A

< age 1 mo. frequent regurgitation from underdevelopment of the lower esophageal sphincter

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7
Q

stomach: capacity

A

capacity=200 ml (2 mos.); 2,000 (adult); HCL acid levels @ adult level by 6 mos.

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8
Q

intestines have rapid growth spurts at what age?

A

rapid growth spurts in toddler and teenage yrs.

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9
Q

biliary system

A

liver is down (up to 2cm below costal margin); enzyme deficiencies up to at least six mos. of age

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10
Q

fluid balance and loss s/sx

A

rapid H2O loss; large extracellular volume

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11
Q

insensibile loss s/sx

A

fever, ↑ metabolic rate, ↑ BSA contribute to this loss

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12
Q

GI maturity is complete by age ___

A

complete by around age 2 yrs.

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13
Q

health history

A

PMH, PSH, allergies, Family hx, HPI, home interventions, G & D, nutrition, parent/pt perception of problem

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14
Q

physical exam structure

A

least to most invasive

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15
Q

lab testing (require MD order)

A

lytes, O&P, stool cx, OB testing, amylase/lipase

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16
Q

Dx testing (require MD order)

A

KUB, ph probe; upper or lower GI barium testing (aka contrast studies), Manometry

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17
Q

GI assessment: inspection

A

LOC
Skin color and hydration status
Abd. Shape, size, & Symmetry
- ask patient to bend knees (relaxes abd muscles)
Abdominal movements
Ecchymosis
Hernias

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18
Q

GI assessment: percussion

A

All 4 quad
Hyper, Hypo, Regular or Absent (5 min).
Vascular sounds (Renal HTN)
Irritable vs. calm with exam
Use pacifier if needed

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19
Q

GI assessment: auscultation

A

Dullness vs tympany
Liver dullness=2 cm down in babies/toddlers
Dullness with bladder distention

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20
Q

GI assessment: palpation

A

Light followed by deep
Parent lap/distraction/knees
Warm hands, avoid tickling
Note any tender areas
Attempt to reduce hernias
only palpate liver in a newborn or if there is an issue

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21
Q

where would you find an olive?

A

RUQ
concerned about pyloric stenosis

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22
Q

where would you find a sausage-like mass?

A

RLQ
concerned with intussusception

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23
Q

where would you find the liver border?

A

the costal margin

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24
Q

where would you find McBurney’s point?

A

2/3 of the way from the umbilicus to ASIS (anterior superior iliac spine)
this is where appendicitis is felt (pain)

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25
Q

where would you find laparoscopic appendectomy markings?

A

abdominal quadrants
RUQ
for treatment of appendicitis

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26
Q

where would you find herniations?

A

inguinal
umbilical

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27
Q

acute diarrhea

A

Often Infectious (rotavirus, salmonella)
Related to another illness: lactose/gluten intolerance
Related to ABX usage: ABT kills the gut
<14 days of diarrhea

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28
Q

chronic diarrhea

A

> 14 days of diarrhea
dehydration
*IBS
*celiac disease

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29
Q

intractable diarrhea

A

brand new babies have diarrhea for 2 weeks of life due to carbohydrate imbalance (not agreeing with mom’s breastmilk or formula)

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30
Q

chronic nonspecific (irritable colon)

A

common cause of chronic diarrhea in children ages 6-54 months
- loose stools, with undigested food particles, and diarrhea lasting longer than 2 weeks
- poor diet habits and food sensitivities have been linked to chronic diarrhea
- normal growth, no blood in stool, no evidence of malnutrition, no enteric infection

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31
Q

diagnostic evaluation (labs) of diarrhea

A

CBC
electrolytes
stool culture, viral culture, guiac the stool

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32
Q

what are the (3) consequences of FEN loss?

A
  1. metabolic acidosis
  2. dehydration
    3.
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33
Q

therapeutic management of diarrhea

A

Assessment of fluid and electrolyte imbalance
Correction of metabolic acidosis
Rehydration
Maintenance fluid therapy
Reintroduction of adequate diet
Reinforce the Importance of oral rehydration therapy (ORT)
IV

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34
Q

nursing interventions for diarrhea

A

Assessment (and reassessment!
Understand and initiate appropriate treatment for mild, moderate, or severe dehydration
ORS guidelines for rehydration
Replace ongoing stool losses 1:1 with ORS
Give in small amounts frequently (teaspoon, cup, syringe or via NGT)
Continue use of breast milk (little amounts, frequent)
- don’t introduce milk; no BRAT, caffeine (coffee, tea), sugar (juice), citrus)
Education (hand washing, educate where child could have picked it up; Nsg Alert p. 825)
Skin care
Support to family

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35
Q

s/sx of mild dehydration

A

increased thirst
slightly dry buccal mucous membranes

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36
Q

s/sx of moderate dehydration

A

loss of skin turgor, dry buccal mucous membranes, sunken eyes, sunken fontanel, decreased cap refill, decreased urine output, blood pressure drops and HR rises

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37
Q

s/sx of severe dehydration

A

signs of moderate dehydration plus 1 of following rapid thready pulse, cyanosis, rapid breathing, lethargy, coma, no urine output

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38
Q

(mild) rehydration

A

ORS, 50 mL/kg within 4 hours

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39
Q

(moderate) rehydration

A

ORS, 100mL/kg within 4 hours

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40
Q

(severe) rehydration

A

IV RL 40mL/kg until pulse and state of consciousness return to normal, then 50-100mL/kg or ORS

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41
Q

replacement of stool losses

A

1:1 replacement; 1gram lost in stool to 1 mL replaced

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42
Q

determining the degree of dehydration

A

((former weight - current weight) divided by former weight) x 100%

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43
Q

encopresis

A

Repeated voluntary or involuntary passage of feces of normal or near-normal consistency into places not appropriate for that purpose
- child looses the ability to poop
present with pain and abdominal distention with rock-hard stool

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44
Q

encopresis etiology

A

Primary vs. Secondary
May follow psychological stress (school, hospitalized, a change in every day living, potty training, moving, sexual abuse)
May be secondary to constipation (#1 reason) or impaction
- decreased fiber or dehydration
M > F
usually an older child >4 years

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45
Q

encopresis therapeutic management

A

Determine cause
- constipation
- dehydration
- stress
Dietary intervention, management of constipation
Psychotherapeutic interventions

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46
Q

encopresis nursing care management

A

History
Education
Routine with reinforcements
Counseling

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47
Q

how would you obtain a stool sample from an infant?

A

collection bag

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48
Q

how would you obtain a stool sample from a preschooler?

A

pee in a urinal hat
seran wrap in the toilet at home

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49
Q

how would you obtain a stool sample from an adolescent?

A

use a hat or go in a cup

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50
Q

FMR is important because

A

it determines the amount of fluid an individual needs to take in per their weight (kg) to remain hydrated

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51
Q

FMR

A

0-10kg: 100mL/kg
11-20kg: 1000 + 50mL/kg
>20kg: 1500 + 20mL/kg

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52
Q

vomiting

A

forceful expulsion of stomach contents
involuntary regurgitation of GI contents

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53
Q

vomiting etiology

A

> 8
ABT, anxiety (emotions), pain
daycares, germs
can be acute and chronic

54
Q

vomiting pathophysiology

A

medulla activated
- chemoreceptor trigger zone (CTZ)
- vomiting center
- diaphragm
- vomiting

55
Q

vomiting diagnostic evaluation

A

metabolic panel (electrolyte imbalances)
CBC
ultrasound
CT/MRI (brain tumor)

56
Q

vomiting therapeutic management

A

oral rehydration very slowly- little bits, frequently
positioning: on side to prevent aspiration, upright

57
Q

vomiting nursing care management

A
  • assessment of hydration
  • prevent complications with positioning
  • support of the child and family; education
  • handwashing
58
Q

vomiting is commonly spread by

A

daycare

59
Q

can medications be used to treat vomiting?

A

antiemetics
- zofran/ondansetron (serotonin antagonist)- watch for tachycardia

60
Q

vomiting: what would labs look like?

A

sodium: decrease
potassium: decrease
chloride: decrease
glucose: decrease

BUN: increase
CR: increase
Uric acid: increase
CO2: increase (HCO3 increases)

61
Q

treatment of vomiting

A

antiemetics
rest
hydration
treat cause

62
Q

normal sodium range

A

135-145

63
Q

normal potassium range

A

3.5-5

64
Q

normal chloride range

A

101-111

65
Q

normal glucose range

A

64-128

66
Q

normal CO2 range

A

20-29

67
Q

normal BUN range

A

4-18

68
Q

normal creatinine range

A

0.3-0.7
0.5-1.0

69
Q

normal uric acid range

A

2.0-5.5

70
Q

ingestion of foreign substances: pica

A

seen in children; children eat food or nonfood items
food picas
- uncooked cereal/oatmeal, coffee grounds
nonfood picas
- crayons, paint, hair, toys, rocks, clay, play dough

71
Q

physiologic- (nutrition) unmet need

A

kids are craving zinc and iron

72
Q

physiologic- compulsive neuroses

A

ADHD
OCD
autistic children

73
Q

pica: nursing considerations

A

more supervision
teach parents dangers of ingestion (ie lead)
small frequent snacks
lock up whatever they are eating obsessively
lock up toxic things

74
Q

constipation

A

an alteration in the frequency, consistency, or ease of passage of stool

  • may be secondary to other disorders
  • spinal cord injury, CF
  • potty training age- hard stool scares them

*symptom not a disease

75
Q

environmental causes of constipation

A

medications (example-antihistamines, opioids, and iron supplementation)

76
Q

idiopathic or functional constipation

A

may be due to environmental or psychosocial factors (no organic cause)

77
Q

nursing considerations for constipation

A

History of bowel patterns, medications, diet
Educate parents and child
Dietary modifications (age appropriate)
Management of impaction/chronic constipation may require 6-12 months of behavioral/dietary/pharmacologic interventions

78
Q

diet for constipation

A

High-fiber diet
Milk/dairy relationship
Fluids

79
Q

phase 1 treatment of constipation (3-5 days)

A

*oral clean-out method for children older than 4 years
- high-dose mineral oil
- polyethylene glycol
- magnesium hydroxide
*enema clean-out
- milk and molasses
- normal saline solution
- microlax, mineral oil, or hypertonic phosphate
*NG lavage (hospitalization)
- polyethylene glycol electrolyte solution

80
Q

phase 2 treatment of constipation (6-12 months)

A

oral laxatives: polyethylene glycol, mineral oil, lactulose, magnesium hydroxide
high-fiber diet
increased fluid intake
behavioral training- exercising

81
Q

phase 3 treatment of constipation

A
  • gradual tapering of laxatives
  • continue high-fiber diet, fluid intake, behavior modification
82
Q

mineral oil: drug alert

A

must be given carefully to avoid aspiration
- not used in children under 1 year!

83
Q

Hirschsprung’s disease=
congenital aganglionic megacolon

A

Inadequate motility=mechanical obstruction
Absence of ganglion cells in one or more segments of colon-prevents peristalsis
Results in accumulation of stool
Occurs in conjunction with congenital diagnoses

84
Q

prevalence of Hirschsprung’s disease

A

Boys 4:1
family prevalence
downs syndrome patients

85
Q

Hirschsprung’s disease anatomy

A

distended sigmoid colon

86
Q

Hirschsprung’s disease: newborn symptoms

A

no mec, refusing po, bile-stained emesis, abd distention

87
Q

Hirschsprung’s disease: older children

A

FTT, delayed growth, distention, constipation/diarrhea (ribbon-like stools). Enterocolitis (explosive watery diarrhea, fever)

88
Q

Hirschsprung’s disease: surgery

A
  • 9 kg (20#)-2 phase: an end-to-end anastomosis or removal with colostomy, then reversal
89
Q

Hirschsprung’s disease: diagnosis

A

diagnose from history, bowel pattern, contrast studies, anorectal manometry (balloon inserted into rectum to stimulate sphincter), x-ray, biopsy

90
Q

Hirschsprung’s disease: diet

A

Diet modification, softeners, enemas, low-fiber diet

91
Q

Most common emergent surgery in pediatrics

A

appendicitis

92
Q

appendicitis

A

Result of obstruction: stool, parasite infestation, stenosis, tumor
Perforation can occur=life threatening if untreated (peritonitis)

93
Q

appendicitis is most common in

A

Most common: Boys school age yrs., rare before age 2

94
Q

appendicitis nursing assessment

A

Gradual but persistent symptoms
starts with periumbilicus pain
Vague abdominal pain (RLQ)
- mcburney’s point
- psoas sign
- oburator’s sign
- rousing: ask patient to raise their leg and causes pain
Nausea and Vomiting
Loose stools or constipation
Rebound Tenderness
- murphy’s sign
Fever
Posture (stooped)
Elevated WBC, C-reactive protein, ESR

95
Q

perforation symptoms

A

Fever (high-grade)
Guarding persistent, intensifying pain
Sudden pain relief**
Abdominal distention
Rapid shallow breathing
Pallor
Chills
Restlessness/irritability

96
Q

interval appendectomy

A

IV ABTs x 8-12 weeks
Stable appendectomy (laparoscopic)
Return to normal activities in 2-6 weeks

97
Q

emergency appendectomy (laproscopic)

A

Antibiotics are administered preoperatively. When ruptured- antibiotics continue post-op
IV fluids
Drains may be used with perforated
Pain management

98
Q

hypertrophic pyloric stenosis

A

Constriction of the pyloric sphincter
Obstruction of the gastric outlet
Hypertrophy of circular and longitudinal muscles of the pylorus
Unknown cause
seen frequently in full-term first males
can be hereditary- seen in siblings
confused with overfeeding
vomit comes shooting out of the mouth (projectile) and gets worse with each feeding

99
Q

most common condition requiring surgery before 8 weeks of age

A

hypertrophic pyloric stenosis

100
Q

pyloric stenosis s/sx

A

Non-bilious projectile vomiting
Visible peristalsis
Failure to thrive in an infant who is “always hungry”
Dehydration
Metabolic alkalosis

101
Q

pyloric stenosis diagnostic evaluation

A

Olive-shaped mass (right upper quadrant)
Ultrasound- elongated mass pyloric canal

102
Q

pyloric stenosis therapeutic management

A

Pyloromyotomy (laparoscopic)

103
Q

pyloric stenosis nursing care

A

Nursing process (esp. assessment)
Post-op care
Support of infant and family

104
Q

prognosis of pyloric stenosis

A

great prognosis
treat and recover well

105
Q

pyloromyotomy: pre-op

A

NGT ( to make sure that nothing is in the stomach)
IVF
NPO
I/O-strict
Daily weights
VS-routine
Hydration status
Pre/post op teaching

106
Q

pyloromyotomy: post-op

A

Feeding within a few hours post op
Clear liquids (12-24 hr post-op) then formula (1/2 strength) or breastmilk
Pain meds
Comfort measures
Po feeds-small, clear, advance
Incision check q 4 hrs
VS q 2-4 hrs
Teaching!!!!
Back to baseline feeds in 48 hours
d/c within a few days usually

107
Q

intussusception

A

Intestine prolapses and telescopes
Can result in partial or total bowel obstruction
Boys > girls; usually under age 2 (up to age 6)

108
Q

intussusception: onset

A

Abrupt onset, crampy abdominal pain (intermittent, colicky pain)

109
Q

intussusception s/sx

A
  • Sudden vomiting
  • brown stool f/b red current jelly stools ** + OB
  • knee to chest position for comfort
  • Palpable sausage shaped mass RLQ
110
Q

intussusception diagnosis

A

X-ray or U/S to diagnose
Barium enema to reduce…if ineffective surgery is necessary

111
Q

intussusception therapeutic management

A

Least to most invasive
Air enema (radiologist guided)
With or without contrast
Hydrostatic (saline) enema (ultrasound guided)
Surgical reduction and fixation, or
Excision of a nonviable segment of colon

112
Q

intussusception nursing care

A

Fluid/electrolyte balance
Pain management
VS
check for abdominal distention
NGT prn
BS q 4 hrs.
Clears, advance as tolerated
Assess and educate reoccurrence
Seen in CF or celiac kids
initially hypoactive bowel sounds, then active bowel sounds after normal diet is reinstated

113
Q

umbilical hernia

A

Common newborn finding
Typically resolves by preschool (by 5 years)
seen more in african american and hispanic children

114
Q

umbilical hernia nursing care management

A

assessment: color matches the skin tone, goes back in when pushed
wait and see
anticipatory guidance and education to family: going to enlarge when crying, upset

115
Q

how do you perform hernia reduction?

A

push the hernia back into the abdomen

116
Q

reducible hernia

A

hernia with a bulge that flattens out (goes back into the abdomen) when you lie down or push against it gently
same color as skin

117
Q

incarcerated hernia

A

contents cannot be returned to the abdomen, with severe symptoms
red color

118
Q

strangulated hernia

A

hernia contents are ischemic due to a compromised blood supply
no blood supply, twisted, necrotic tissue (deep red/purple)

119
Q

GI dysfunction: IVs

A

fluids
antibiotics

120
Q

GI dysfunction: NGT

A

nutrition
decompression
suction

121
Q

GI dysfunction: Diet

A

NPO
ORT
nutritional modifications

122
Q

GI dysfunction: enemas

A

air
saline

123
Q

GI dysfunction: stool

A

collection
guaiac

124
Q

therapeutic procedures for children with GI dysfunction:

A
  • IV
  • NGT
  • daily weights
  • I/O
  • Diet
  • abdominal circumference
  • enemas
  • surgery
  • incision care
  • stool
  • ostomy
  • indwelling catheter
125
Q

gastroenteritis (organs involved)

A

stomach and small intestine

126
Q

enteritis (organs involved)

A

small intestine

127
Q

colitis (organs involved)

A

large intestine and colon

128
Q

enterocolitis (organs involved)

A

colon and small intestine

129
Q

percentages of dehydration- mild vs. moderate vs. severe

A

mild: 3-5%
moderate: 6-9%
severe: 10% +

130
Q

GI clean out starts where?

A

starts at the top- orally

131
Q

enterocolitis

A

20-60% post-op inflammation from surgery to fix Hirschsprung’s Disease

132
Q

appendectomy (laproscopic) patient education

A
  • use incentive spirometry
  • keep incisions clean and dry
  • no signs of infection: redness, drainage, fever
  • have the patient splint their abdomen with stuffed animal/pillow

NU 374 (18 decks)

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