Exam 1 Flashcards
Sitting up unsupported?
By 8 months
Rolling over?
4 months back to side
5 months tummy to back
Standing
Supported by 9 months, unsupported around 12 month
Cruising
By 11 months
Walking
By 12 months
Separation anxiety
Btwn 4-8 months
Object permanence
9-10 months
Understands “no”; obeys simple commands by?
9-10 months
Introducing solids
4-6 months
Head lag gone by?
At 4 months there should be almost no head lag, totally gone by 5 months
Tripod sitting?
6 months
By 6 months, birthweight has…
Doubled
By 1 year, birthweight has…
Tripled
By one year, height has increased by…
50%
Ie born 20 inches, now 30 inches
Measure head circumference until…
36 months
Posterior fontanel closed by…
2 months
Anterior fontanel closed by…
By 16 months but varies
Neat pincer grasp by…
11 months
Cleft lip vs cleft palate surgery age?
Lip corrected in first month
Palate done after one year
Referrals needed for cleft lip and palate?
Lactation consultant for help feeding
Early intervention to speech therapist
Audiologist bc ear infections
Pediatric dentist
Priorities for infants post op
Elbow restraints Airway mgmt (sit supine, suctioning) Minimize crying
Symptoms at birth for esophageal atresia?
Drooling and frothy mucus
Different presentations of EA?
Esophagus dead ends
Esophagus connects to trachea
Esophagus goes through trachea
Esophagus…..?
Pre-op EA interventions?
Sit upright. Put on NPO. NG tube to suction. Nexium IV to reduce stomach acid. TPN if needed to stabilize.
Expected care post op for EA?
Gastrostomy tube to protect suture healing.
Chest tube to restore negative lung pressure.
TEF?
???
Pyloric stenosis: what happens?
Pyloric muscle hypertrophic»_space; narrowing btwn stomach and duodenum»_space; buildup and vomit»_space; inflammation and edema»_space; complete closure
What side does stomach empty on?
Right
What are clinical symptoms of pyloric stenosis?
Non bilious projectile vomiting
Hyperistaltic waves from left to right
Is pyloric stenosis a surgical emergency?
No. Medical emergency.
Fluid imbalance risks associated with pyloric stenosis?
Bco vomiting, dehydration, metabolic alkalosis, hypokalemia, hyponatremia
Pyloric stenosis interventions?
NG tube
Keep flat with head elevated
Elbow restraints
IV til fluid labs are ok
Intussuption is what?
Telescoping/invagination of passing matter on ileocecal valve»_space; moves valve along»_space; cramping to push valve back out»_space; if can’t resolve, blood supply blocked and tissue necroses»_space; weeps bloody secretions
Cardinal sign of intussuption?
Currant jelly stool
Is intussuption a surgical emergency?
Yes
How is intussuption treated?
Barium enema via Foley catheter
After third time, tissue surgically repaired.
Interventions for imperforate anus?
Initiate IV NG tube to suction I&O Keep site very clean Zinc oxide if opening exists
Other concerns with imperforate anus?
Full exam bc rarely isolated
Appendicitis presents with pain where?
Starts at belly button and moves to lower right side of abdomen (mcburney’s point)
Antibiotic treatment: perforated vs non perforated appendix?
Triple strength if perforated
Nursing interventions for appendicitis post op?
Strict I&O Monitor for return of bowel sounds Dressing change Ambulate to move leftover gas from surgery Cough and breathe Pain management
Etiology of hirschprung’s?
No ganglia in lower intestine, colon.
Pathology of hirschprung’s?
Mega colon»_space; no signal cells that urge voiding»_space; distention, ischemia, necrosis
First sign of hirschprung’s?
Doesn’t pass meconium
Pre-op nursing care for hirschprung’s?
Put on TPN or low fiber, high cal diet
Mark measurements on abdomen to note distention
Saline enema
Colostomy
Cardinal sign of celiac disease?
Stetthorea (white greasy stools bc can’t absorb fat)
What is celiac crisis?
Episode of diarrhea and vomiting that canbe. Brought on by stress
GI lymphoma risk heightened with what condition?
Celiac diet–noncompliance
Colic is diagnosed with how much crying?
More than 3 hrs a day
When does colic resolve itself?
3 months after due date
GERD usually resolves when?
At six months when they sit up
Nursing interventions for severe GERD?
Sit upright Thicken food Small feeds with frequent burping Liquid nexium I&O (document vomiting) Avoid fruits, acid
Malrotation symptoms?
Intermittent bilious vomiting
Abdominal pain and distention
Lower GI bleeding
Malrotation pathology?
Bowel obstructs, small intestine pretzels and cuts off blood supply»_space; necrosis
Nursing interventions for Malrotation?
NPO
I&O
NG tube for suctioning
IV fluids
Is Malrotation a surgical emergency?
Yes
Post op complications with Malrotation
Short gut syndrome
Three types of hernias?
Congenital diaphragmatic hernia
Umbilical hernia
Inguinal hernia
What is osmotic pressure?
The force that pulls water into capillaries
Normal pH?
7.35-7.45
Normal CO2?
35-45
Na
135-145
Normal K+
3.5-5.5
Normal albumin
3.5-5.5
Normal CO3?
22-26
Values indicating respiratory acidosis?
pH less than 7.35
CO2 more than 45
pH 7.3 and CO2 55
What do we suspect?
Respiratory acidosis
Lab values for metabolic acidosis?
PH less than 7.5
Co2 normal btwn 35-45
HCO3 less than 22
Patient presents with pH of 7.3 and CO2 of 40. What do we suspect?
Metabolic acidosis
Metabolics: which is poop, which is vom?
Vom is metabolic acidosis
Pooping is metabolic alkalosis
Respiratory alkalosis labs?
PH over 7.45
Co2 under 35
If pH is 7.5 and CO2 is 25, what do we suspect?
Respiratory alkalosis
In cases of respiratory alkalosis, how do we instruct patients to breathe?
Slowly, or into a bag
Metabolic alkalosis lab values?
PH over 7.45
CO2 normal
hCo3 higher than 26
If pH is 7.55, co2 is 35.45, what do we expect?
Metabolic alkalosis
Hyperkalemia lab values?
K greater than 5.5
What should we be cautious about when diagnosing Hyperkalemia?
Small peds needles can lyse RBCs, giving a false elevated reading
Percentage body weight that’s water in adults vs children vs infants
Adults 50%
Children 65%
Infants 80%
Extra cellular compartment is expanded until what age?
2 years
Hypokalemia lab values?
K less than 3.5
Two causes of hypokalemia?
Being on lasix or digoxin Metabolic acidosis (vomiting)
Clinical symptoms of hypokalemia?
Reported leg weakness
Decreased bowel sounds
What is the specific gravity of children?
1005-1010 bco immature kidneys
Hyper natremic lab values?
Na greater than 145
Hypo natremic lab values?
Na less than 135
Managing hypernatremia?
Give water!
Kids BMR relative to adults?
Much higher than ours!
Minimum urine output for babies?
2-3 ml/kg/hr
Minimum urine output for children?
1-2 ml/kg/hr
Minimum urine output for teens and up?
1 ml/kg/hr
Daily maintenance fluid for 1-10kg child?
100 ml/kg
Daily maintenance fluid for 10-20 kg child?
1000 ml + 50 ml/kg over 10 kg
Daily maintenance for child over 20 kg?
1500 ml + 20 ml/kg over 20kg
Hypotonic dehydration?
Na loss greater than water loss
Hypertonic dehydration?
H2o loss greater than na loss
Degree of dehydration relative to body weight loss?
Mild 5%
Moderate 10%
Severe 15%
What kind of dehydration most common in children? What’s the risk?
Isotonic, hypovolemic shock
Interventions for vomiting?
Mouth care
Small sips
Zofran
Systemic causes of constipation?
Hypothyroidism
Lead poisoning
Drug side effects
Psychosocial
Fluid volume deficit interventions
Give oxygen to ease hearts workload
With pyloric stenosis, how long after surgery might baby vomit?
24-48 hours
Baby shot schedule (6)
2 months / 4 months / 6 months
Hep B Rotavirus Hib+ Polio Dtap Prevnar/pneumococcal
1 year shots
MMR
Varicella
Hep A
Which vaccines are live? Contraindications?
MMR & varicella
Contraindicated with the immunosuppressed.
15 month shots?
Boosters of baby shots
Which vaccines subQ?
MMR & varicella