exam 2 Flashcards
celiac
cannot tolerate gluten (wheat, barley, rye, oats). A protein that causes immune response
Four characteristics
Impaired fat absorption- steatorrhea
Impaired nutrient absorption
Behavioral changes
Crisis- diarrhea, vomiting
Use corn and rice based foods
Dx by blood work, then do upper GI
hepatitis in children
HEP A- fecal-oral. vaccine
Hep B- blood/ body fluids. vaccine
how do patients normally loose water
Skin/resp tract, evaporation, urine/stool
what causes increased fluid needs
Fever, vomiting, diarrhea, DKA, burns, shock, tachypnea, phototherapy
why do babys loose water fast
Kidneys aren’t very efficient. They have a greater body surface area but small body
how is the 4-2-1 rule calculated
normometabolic rate at rest
water and salt lost in equal amounts
isotonic
NS, LR
lose more electrolytes than water
hypotonic solution
from drinking fluids with no salt
lose more water than electrolyes
hypertonic solution
from not drinking enough water, meds
s/s of dehydration
could be mild to severe
Pulse and RR- normal/slight elevated/significantly elevated
Mucus mem- normal, dry, parched
Any tears?
Normal/irritable/lethargic
Slower cap refill
mild weight-loss 3-5%
moderate weight loss 6-9%
severe weight loss 10% or more
mild and moderate treatment of dehydration
oral rehydration
mild- 50mL/kg over 4 hours pedialyte
moderate- 100mL/kg of pedialyte
severe dehydration treatment
IVF
20mL/kg isotonic bolus
we never give a bolus of anything except isotonic
diarrhea most common causes
rotavirus
salmonella
what diet is constipation more likely in infants
formula fed
encorpesis
inappropriate passage of feces
hirschsprung disease
absent ganglioin cells in intestine, decreases the ability of internal sphincter to relax.
s/s constipation, FTT, ribbonlike stool, abd distention
dx by contrast xray
surgical repair to remove aganlionic portion
congenital, seen more in infant boys
forceful ejection of gastric contents
vomiting
different then spitting up or burping
use pedialyte, elevate HOB, withhold food
gastroesophageal reflux
return of gastric contents into esophagus
Seen with preemies bc the sphincter hasn’t formed yet. will spit up when they eat, may have FTT, arching back, pneumonia
other symptoms in children may be cough, stomach pain
Don’t lay flat after eating, especially head
Give meds 30 mins before
Thicken there formula
feed smaller amounts more often
possible surgery- nissen fund.
rickets
vitamin D deficiency
scurvy
vitamin C deficiency
adverse reaction without a immune response
intolerance
recurrent abdominal pain
3+ episodes abdominal pain over 3 months that impacts daily activities
acute appendicitis
most common peds emergency abdominal surgery
RLQ pain (mcburneys point), fever and vomiting come later, elevated WBC
dx by ultrasound and CT
if ruptured pain may subside, risk for peritonitis and sepsis
NPO, Abx before surgery
meckels diverticulum
Stomach tissue develops in colon, makes acid bc it thinks it’s the stomach, which causes a ulcer than bleeding
s/s- painless rectal bleeding, abdominal pain
surgical repair to remove diverticulum
more common in males, typically diagnosed by age 2
UC vs Chrohns
chrohns can be anywhere, UC is in one spot
IBD
chrohns and UC
inflammation causing ulceration
abdominal pain, bleeding, edema, diarrhea, weight loss
increases w stress
do endoscopy, colonoscopy, CT, US
help get right nutrition in, drug therapy, surgery if needed
peptic ulcer disease
most commonly caused by H pylori. can slo be caused by NSAIDs, stress, alcohol
s/s- dull stomach ache, n/v, bloating
dx by upper GI
pain management, meds
when to get surgery for cleft lip
2-3 months of age
Lips get repaired early bc of speech and feeding
baby may need restraints postop
when to get surgery for cleft palate
6-12 months
Palate cant be done until child has transition off a bottle because the roof of mouth has sutures, and suction can rip them out
who is cleft lip/palate more common in
native american populations
esophageal atresia
failure of esophagus to develop continuously, there is a gap
Food will come back up after first feed, aspiration. No food goes to belly, surgery needed
may have excessive saliva on day 1 bc it cant be swallowed since it has no where to go. choking may also be seen
tracheosophageal fistula
failure of the trachea to separate into a distinct structure. maintain patent airway
Some food will go to belly, some will go to lungs via fistula. surgery
what often accompanies tracheosophageal fistula
esophageal atresia
if you have one you likely have both, all food would go to lungs.
often caught with good prenatal care and can be fixed before we give first feeding
what do we want umbilical hernia to be
soft
these typically go away on own
hypertrophic pyloric stenosis
muscle arounds pylorus enlarges and thickens, narrows opening and leads to obstruction.
usually found within first few weeks of life
dx by ultrasound
hypertrophic pyloric stenosis s/s
olive size mass on palpation , projectile vomiting during/after eating, poor weight, dehydration,
hypertrophic pyloric stenosis care
rehydration comes first. do bolus then see if electrolytes needed
pyloromyotomy surgery after
post op- dont feed right away. go on feeding plan
pylorus
valve between end of stomach and start of small intestine
intrasusception
Telescoping of intestine. obstruction, Causes edema and stopping of blood flow. Could cause necrosis
s/s- loud crying, abdominal pain, red “currant jelly” stools, vomiting
DX- us, barium enema
treated -air enema then use contrast dye if that doesn’t work. if that doesn’t work surgery is needed. this problem may be reoccurring if not fixed by surgery.
prevent peritonitis
imperforate anus
no anal opening. surgical repair needed
GU assessment
potty trained? regression?
voiding quality, quantity, freq, urgency, pain
anorexia or weight loss
BP
labs
UA/urine culture
who are UTI mostly seen in
Seen in uncircumcised boys under 3 months
Seen in girls under 12 months and continued thru toddler hood
how many colonies/mL for UTI dx
50k
most important host factor in UTI
urinary stasis
bacteria can grow if bladder is retaining urine
urine collection methods for UTI
Urinary Cath most accurate for under age 2, clean catch for kids potty trained
Have girls sit backward on toilet to help with clean catch
For uncircumcised boys, clean the meatus and retract foreskin
urine collection bag
sticks to patients genitalia region
Less invasive, not completely sterile, can leak
predicative test of UTI
Leukocytes- WBC (infection)
nitrates- bacteria
uti education and meds
meds- penicillin, bactrim, cephalosporins
wipe front to back, no bubble baths, avoid tight clothes, complete emptying, avoid caffeine, void 15-20 mins after intercourse, fluid intake.
irritated urethra makes them more prone to infection
Vesicouretral reflux (VUR)
abnormal flow of urine from bladder to kidneys.
increases risk of UTIs
could be primary or secondary
treated w prophylaxis abx or surgery. goal is not to damage kidney
dx by UA, k&b, US, VCUB
could be grade 1 (mildest) to grade 5 (severe)
If left untreated can lead to bed wetting, constipation, loss of control, high BP, proteinuria, kidney failure
VCUB for VUR
X-rays and contrast dye of bladder when full to look for abnormalities. Use catheter to insert dye, bladder will get Xray in multiple positions, catheter will be removed, child will void and they will take x-rays to look at function of how bladder is being emptied
this will be graded into terms of reflex.
primary vs secondary VUR
Primary reflex- born w a defecting valve. Can be outgrown
Secondary- reflex urinary tract malfunction, like high pressure in bladder
Enuresis (bed wetting)
continued incontinence of urine past potty training
Dx at least 2x week for 3 months after age 5
Rule out other causes like diabetes, sickle cell, UTI, spina bififa, diuretic, emotional factor
Most common in boys and those who sleep deep
meds to help- antidiuretics, tricyclic antidepressants, antispasmodics, desmopressin nasal spray
do a bathroom schedule
primary vs secondary enuresis
Primary- never achieved complete control
Secondary- the child achieved control but lost it
Protrusion of abdominal contents through inguinal canal into scrotum
inguinal hernia
presence of peritoneal fluid in the scrotum
hydrocele
narrowing or stenosis of the preputial opening of the foreskin that prevents retraction of the foreskin over the glans penis
phimosis
Ventral curvature of penis, often associated with hypospadias
chordee
Failure of testes to descend
cryptorchidism
is an exposed or open dorsal urethra
epispadias
hypospadias
urethra meatus is located on the ventral side along the shaft
associated with chordee
Surgical repair. Don’t circumcise these children at birth bc they could use the skin later
Avoided until age 6-12 months
Make sure they can void while they are standing
exstrophy
bladder is external and inside out. this is due to failure of abdominal wall and structures to fuse in utero.
surgery usually at first 72 hours off life
Bladder doesn’t store urine, urine produced by kidneys will drain into a open area
Bladder needs to cover with film to prevent urine seepage and skin irritation. These children will need sponge baths and monitored output.
Goal Is to avoid UTI, regain renal function, gain urine control
may not ever be fully continent and may to to self cath
ambiguous genitalia
mutations in genes early on will lead to various disorders of sex development, making it hard to tell if person is boy/girl
congenital adrenal hyperplasia is most common cause.
surgery based on type/severity
*Psychosocial emergency for family
nephrotic syndrome
increases glomerular permeability to proteins (especially albumin)
protein loss causes decreased osmotic pressure, causing fluid escape=edema.
will see massive proteinuria, albuminuria. urine will be dark/frothy/ Pt may also have weight gain, fatigue
low albumin in blood, we need to replace this, use steroids to suppress immune system, FLUID RESTRICTION
common in ages 2-7
what causes nephrotic syndrome
unknown, associated w immunologic causes like lupus, diabetes, infection, allergies
nursing considerations for nephrotic syndrome
strict i&o
daily weight
assess edema
check f&e
turn frequently. avoid IM injections
high calorie/HIGH protein
LOW salt intake and fluid restriction
corticosteroids
25% albumin admin
glomernephritis
Involves glomeruli- supply blood flow to nephrons, which filter urine. These become inflamed and impair the kidney to do the filtering
occurs after STREP
hematuria, proteinuria, decreased output, edema
do throat culture, blood and urine test
treatment is supportive. need hospitalization for bad BP and UO
RESTRICT sodium and fluids
high calorie, LOW protein
strict I&O
may need diuretics, antihyp
last 3 weeks. most common in ages 4-7
Glomernephritis “HADSTREP”
Htn
ASO titer positive
Decreased GFR
Swelling of face worse in AM
Tea colored urine
Recent strep infection
Elevated BUN/creatine
proteinuria
hemolytic uremic syndrome
child ingests e. coli
endothelial lining of glomerular arterioles become swollen and occluded w platelets, RBC bc damages when they move through, spleen takes them out causing anemia. Kidneys are blocked and cant do there jobs
starts w GI/resp symptoms. later bruising, pallor, hematuria, albumin in urine
can cause hemolytic anemia, thrombocytopenia, acute renal failure.
treatment is supportive, anticipate dialysis
FLUID restriction
common ways children ingest e coli
petting zoos, unpasteurized milk, undercooked meat, contaminated water
acute kidney injury (AKI)
kidneys suddenly do not regulate volume/composition of urine.
usually associated with HUS and glomerulonephritis.
oliguria, low UO, n/v, azotemia, htn, edema
BUN/creatine increases, GFR decreases
often revirsable.
MONITOR NEURO STATIS, sodium drops, toxic symptoms build up. Increase seizure risk
AKI nursing considerations
rule our urinary retention first
strict i&o, monitor electrolytes
control BP, maintain fluid balance and calories
complications are hyperkalemia, htn, anemia, seizures
when do we give transfusion for hgb in AKI pts
hgb <6
chronic kidney disease
diseased kidneys no longer maintain normal structures of bodily fluids. progressive deterioration over months/years
anticipate growth issues
Pallor, fatigue, decreased appetite, headache, nausea, weight loss, facial edema, bruised skin, elevated BP
promote renal function, maintain f&e, treat complications
Dialysis or transplant needed
hemodialysis vs peritoneal
hemo removes blood thru semipermeable membrane circulated outside body
peritoneal removes toxins via the peritoneal membrane
most common issue w renal transplant
rejection. if living donor rejected than a cadaver is used
what do pts need to be on indefinitely after transplant
immunosupressants
lots of side effects- htn, obesity, growth retardation, Cushing syndrome, infection risk
long term effects related to pain
physiological, psychosocial, and behavioral consequences
remember that people deal with pain differently
FLACC scale
used for pain in ages from birth yo 7 years
the most common behavioral pain scale
looks at face expressions, legs, activity, cry, consolability
0 is the best score, 10 is the worst
wong baker faces pain scale
for ages 4-8
6 faces to choose from
at what age can you use numerical pain scale
8 and up
revised flacc scale
for children with cognitive impairments like cerebral palsy
looks at behaviors such as tenseness
ibuprofen dose
10 mg/kg/dose
given every 6 hours
monitor for GI bleed
ketorolac (toradol) dose
1.5 mg/kg/dose
monitor for GI bleed
tylenol dose
10-15 mg/kg/dose
given every 4-6 hours
monitor for liver toxicity
morphine dose
0.05 to 0.1 mg/kg/dose IV
pros of dilaudid (hydropmorphone HCL)
Longer lasting, less side effects than morphine
what drug is 100x stronger than morphine
sublimaze (fentanyl citrate)
diazepam (valium)
for muscle spasms and anxiety
not compatible with NS, mix w sterlie water
midazolam (versed)
sedates them and chills them out
has retrograde amnesia effect!
morphine side effects to monitor for
decreased RR rate
constipation
pruritis
hallucinations
urinary rentention
at what age can a child use PCA
5/6
could be basal rate (continuous) or bolus
set to avoid OD
epidural analgesia
at lumbar level
common meds- morphine, fentanyl, hydromorphone
local anesthetic added- bupivacaine or ropivacaine
***keep dressing dry and clean. infection in this region could cause meningitis
LMX4 4% lidocaine
transdermal analgesia for needle stick pocks
leave on for 30 mins before inserting IV
EMLA- lidocaine and prilocaine
transdermal analgesia for IV sticks
leave on for 60 mins before stick
vapocoolant spray
transdermal analgesia for needle sticks
cold feeling
leave on for 4-10 mins
nonpharm pain management
distraction
relaxation techniques
guided imagery
cutaneous stimulation
containment and swaddling
nonnutritive sucking- sweeties
kangaroo care- skin to skin
priority for OD of narcotics
narcan
how to know if you are giving a incorrect dose of meds to peds
pay attn to weight
when do you assess pain after PO meds
1 hour
when to assess pain after IV meds
30 mins
lewis Blackman act
right to ask for an attending at any time
who can help with coping mechanisms in crises
social workers
what does family need to have good adjustment to childs chronic illness/end of life care
support
5 coping methods children use w chronic illness
- Confidence and optimism*** WE WANT THIS
- Different and withdrawn
- Irritable and act out
- Comply w treatment
- Seek support
where can hospice nurses go
at home, or at hospital
grief
A process- denial, anger, bargaining, depression, acceptance
Highly individual
check on parent, siblings, and even nurses that took care of that pt
can children have aspirin
No
what to do if child OD on tylenol
induce vomiting
give N- acetylcystine, the antidote, which is effective in 8-10 hours
most common substances that cause poisoning in peds
aspirin
acetaminophen
lead
treatment for lead toxicity
dimercaprol and calcium disodium IV, these help excrete the lead
action is taken if lead level above 5mcg/dL
impetigo
caused by staph
vesicular lesions that rupture easily
moist with pruritis
honey colored crust
use burrows solution and topical abx
if severe use oral PCN
cellulitis
caused by strep, staph, haemophilius influenza
skin and SQ tissue inflammation
s/s- erythema, edema, streaking, fever
treated by topical, PO or IV abx
incision and drainage may be needed
mark erythema with sharpie and assess for bettering or worsening
lice (pediculosis capitis)
paraside
lay eggs
treated my permethrin cream, malathion cream
comb out nits
retreat in 7 days for missed nits
eczema (atopic dermatitis)
inflammation of the epidermis
dry skin, may have scaling
rash is due to itching
hereditary
hydrate skin- aquafor, eucerin
steroid prn- triamcinolone
herpes zoster (shinges)
caused by varicella virus
airborne and contact precautions
vesicles
on dermatome, so doesnt cross one side of body
neuralgic pain
meds- antivirals (acyclovir/Zovirax), analgesics
1st degree burn
epidermis (sun burn)
2nd degree burn
epidermis and dermis
most painful
pink/red and shiny
treatment for burns
stop burning process
ABCs
begin fluids asap 1.5x maint. fluids in first 8 hours
debridement
3rd degree burn
epidermis, dermis, SQ
May appear white, black, leathery
cant feel as nerves are ruined
skin graph needed
