Exam #2 Flashcards
Structural GI Disorder:
- can occur in isolation or together
- can be bilateral or unilateral
- requires surgical repair
- these babies are encouraged to be breast-fed as there is more surface area & reduced additional air intake
- baby should be fed upright (45-90 degrees) and intermittently
Cleft Lip & Palate
Structural GI Disorder:
- knot in the groin area
- dangerous as there are more structures nearby
- abdominal or pelvic contents travel to the inguinal canal
- requires reduction & possibly surgery
- 5x more common in boys due to undescended testicles
Inguinal Hernia
Structural GI Disorder:
- more common type seen in premature infants
- GI issues do not typically arise
- surgical repair is commonly done for cosmetic purposes
- occurs due to weakening of the GI muscle
Umbilical Hernia
Treatment for Hernias
Push it back in
- if its affecting them structurally, or pops out every time the child cries, then surgery is considered
Obstructive GI Disorders:
- __________ sphincter is not opening which occurs when the muscle thickens over time (not born w/ it)
- cause is unknown
- what is entering the stomach cannot exit & will come right back up
- higher chance for boy to have it if father had it (unknown why)
- S&S: projectile vomiting, crying, not gaining weight, olive-shaped mass in RUQ
- seen around 3-6 weeks of life
- Dx: ultrasound
- Tx: pyloromyotomy - surgery to snip muscle, take thickened part out, and ensure opening remains
Pyloric Stenosis
Obstructive GI Disorders:
- intestines telescope into itself
- more common in males
- occurs in kids a little older than 3-6 weeks and are intermittently fussy – when the child cries, they bear down and can pop it back out but the telescoping can happen again
- S&S: current jelly stools, acute sudden abdominal pain, sausage-like lump in lower abdomen (typically RLQ)
- Tx: barium or air enema (high risk of bowel perforation) OR surgery (rare)
Intussusception
Obstructive GI Disorders:
- inflammatory disease of the intestinal tract
- life threatening and seen often in the NICU after the first few feeds – high mortality rate
- S&S: feeding intolerance (failure-to-thrive), lethargic, bradycardic, apneic spells, bloody diarrhea
- Tx: surgery to remove that portion of bowel, bowel rest (TPN), antibiotics
Necrotizing Enterocolitis (NEC)
Inflammatory GI Disorders:
- inflammation of the affected organ
- S&S: ABD pain around belly button (RLQ), McBurney Point (rebound tenderness), poor appetite, N/V, fever (typically when perforation occurs), want to be in fetal position
- constipation & __________ present similarly
Appendicitis
Abdominal Wall Defects:
- birth defect due to a herniation of the ABD wall during development – born with their intestines on the outside
- Dx: MSAFP – seen on ultrasound prior to birth
- after C-section, intestines are exposed to air since NOT covered by peritoneal layer
- Tx: wrapping & supporting the intestine (prevent hypothermia & fluid loss), surgical repair, SILO, TPN (bowel rest)
Gastroschisis
Abdominal Wall Defects:
- protrusion of umbilical cord & is sealed by the peritoneal layer – typically the bowels, liver, kidneys, etc. (ALL) are developed outside the body
- Dx: MSAFP
- can be worse as it can take longer to put back in along w/ other complications
Omphalocele
Functional GI Conditions:
- persistent & crying babies that are under 3 months old
- idea for cause is that baby has a lot of gas build-up (fed a lot, not burped enough) – unknown
- S&S: crying episodes lasting 3 hours, more than 3 days, more than 3 weeks; baby will pull legs & arms to a flexed position
- Tx: have parents place baby in safe space after eliminating every other cause & stepping away – shaken-baby syndrome risk
Infantile Colic
Functional GI Conditions:
- excessive loss of fluids due to vomiting & diarrhea
- Causes: viral (most common), diet, meds, toxins
- BRAT diet: bananas, rice, applesauce, toast
- Tx: BRAT, rehydration, as long as dehydration not evident, can be treated at home
Gastroenteritis
Functional GI Conditions:
- difficult or infrequent passage of hard stool
- S&S: hard stool, poor appetite, straining when defecating
- Tx: bowel retraining, nutrition, education (increasing fiber & water)
Constipation
Functional GI Conditions:
- these babies spit-up a lot – need to know vomit vs. spit-up
- they have choking episodes as well as apneic episodes (acid building up)
- S&S: vomiting & regurgitation; fussiness; refusal to eat, choking, apnea, wheezing
- Dx: H&P, pH study or swallow study
- Tx: keep upright while feeding (30min-1hr) and NOT in a car seat, frequent burping, meds (Zantac)
Gastroesophageal Reflux Disease (GERD)
Functional GI Conditions:
- congenital absence of Meissner and Auerbach autonomic plexus in the bowel wall
- S&S: failure to pass meconium within first 48 hrs of life, failure-to-thrive, poor feeding, enterocolitis
- Tx: surgical resection, colostomy, GI irrigation (cannot empty out, need to be flushed)
Hirschsprung Disease (Megacolon)
Hepatic Disorder:
- liver is not working how its supposed to – blockage in bile duct
- can be a congenital defect sometime during fetal development but commonly its an inflammation shortly after birth – idiopathic
- S&S: jaundice, dark urine, light stools, bloated belly (round)
- Tx: Kasai procedure (remove damaged ____ duct & reconnect SM-intestine to liver) – even w/ Tx, most kids require liver transplant; TPN/Lipids & nutritional support
Biliary Atresia
__________ system controls growth & development
endocrine
- child will be shorter in stature & typically require growth hormone in order to grow
- underproduction of cells
- effects ALL of the following parts of the body: reproduction, kidney disease, heart issues, cognitive issues, etc. (every organ in the body)
- S&S: delayed growth (3rd-5th percentile), continue to maintain baby-like facial features, skeletal growth delayed, missed milestones, delayed bodily processes
- Dx: growth evaluation; labs; bone x-ray; brain MRI
- some studies show children in abusive households or are abused can experience delayed growth development
- w/o Tx, affects the entire body and leads to decompensation, and possibly death
HYPO-pituitary (growth hormone deficiency)
- overabundance of cells (gonadotropin) – child develops at much quicker rate (reproductive organs develop much sooner)
- early onset of menarche can be seen as child abuse
- Boy S&S: facial hair, penile growth, masculinity
- Girl S&S: breast development, onset of menarche
- S&S: increase of LH, FSH, and testosterone
- Tx: growth hormone suppressant; psychological care for both child & parent
Pituitary HYPER-function (Precocious puberty)
- these issues are preventable by treating the issue – w/o they can experience serious delays in development
- S&S: delayed growth, inability to tolerate cold, constipation, fatigue, poor feeding
- Tx: now included on newborn screening, meds (Levothyroxine [Synthroid])
Congenital HYPO-thyroidism
- underacting thyroid (autoimmune disorder) that can be caused by genetic or environmental (pollutants) factors
- Risk factors: females, family Hx, radiation exposure, other autoimmune diseases
- S&S: poor temperature regulation (always cold), delayed growth, fatigue, hair loss (older kids), puffy moon-face, brittle nails – goiter (palpate enlarged thyroid)
- Dx: labs (TSH & T4)
Hashimoto
- group of autosomal recessive inherited disorders affecting the adrenal glands
- insufficient supply of enzymes required for production of cortisol & aldosterone
- Cause: deficiency of 21 hydroxylase enzyme
- Boy S&S: large genital, hyper-pigmented scrotum & start puberty at age 2 years
- Girl S&S: in utero develops male sex characteristics, hypotension, hypoglycemia
- S&S: electrolyte imbalance
- Tx: meds (hydrocortisone), psychosocial care for both child & parents
Congenital Adrenal HYPER-plasia
- damage due to autoimmune disorder – damage to gland resulting in releasing cortisol & aldosterone – hard time maintaining electrolyte balances (cannot use for energy, muscle growth, etc.)
- S&S: constantly fatigued, always irritable, constantly losing weight, consistent muscle weakness
- if left untreated: hypotension, kidney failure, and severe abdominal pain – will go into adrenal crisis (stress causes as well)
- Tx: meds
Addison’s Disease
- poorly functioning pancreas leads to excessive glucose – affects major organs (body metabolizes fats for energy)
- autoimmune disorder
- S&S: losing weight, constantly peeing (up at night), always thirsty, constantly eating, fruity breath
- w/ DKA: too much ketones (acid) and presents as lethargic w/ Kussmaul respirations (NOT RESPIRATORY RELATED FOR EXAM)
- Tx: insulin (lifelong maintenance); teach child to carb-count and check glucose levels
Diabetes Mellitus Type I
behavior modification
- set limits
- do not argue, bargain, or negotiate after limits are set
- consistent caregivers matter
- use a low-pitched tone
- redirect the child
- ignore inappropriate behaviors or educate why they are inappropriate
- praise self control & appropriate behaviors
- Onset: infant or early childhood –> may notice developmental delays or loss of previous ability
- Cause: mainly genetic –> possibly environmental (pollutants)
- S&S: communication issues, prefer to be alone (not play w/ others), difficulty interpreting others emotions, repetitive movements or speech patterns, avoid eye contact, sensitive to loud noises, eccentric ways of moving
- Tx: NO cure; goal is to strive for optimal functioning (provide structured environment); family support
autism spectrum disorder
Most common neurodevelopmental disorder of childhood
- Cause: genetic
- S&S: impulsive, hyperactive (cannot sit still), don’t pay a lot of attention, lack of self control (trouble keeping body calm)
- Tx: Meds [methylphenidate, dextroamphetamine; Adderall, Ritalin] & education [meds & school assistance - IEP plan]
attention deficit hyperactivity disorder (ADHD)
any injury intentionally inflicted on a child
physical abuse
sexual activity intended to provide pleasure to an adult
- can lead to inappropriate sexual behavior at a young age (child does not know its inappropriate)
sexual abuse
witnessing abuse
emotional abuse
failure to provide child w/ appropriate needs
- lack of food as punishment
- locked in a room as punishment
- has long-term effects on brain development & behavior
neglect
Long-term impact of child maltreatment –>
- anxiety
- depression
- suicidal ideation
- drug & alcohol use
parent purposely make their child sick so that they can take care of their child (caregiver has mental health issue & requires dependency from another)– don’t want to kill them, but need child to need them
- Warning signs: constant visits; caregiver is the only one talking; variations in past medical Hx (nothing makes sense); Dr. & hospital-shop/hop
Munchausen syndrome by proxy (medical child abuse)
elongated, rigid cells that change shape (doesn’t allow oxygen to adhere well); stick together & start clumping so they get trapped and stuck in vasculature
- Cause: hereditary & genetic
- common in African Americans
- Assessments: pain scale (live in constant pain, 4-6)
- Tx: hydration & oxygenation (preventing VOC); pain management (NSAIDs or Tylenol or in adjunct w/ opioid); minimize risk factors (hypoxia, extreme heat/cold, infection, infarction)
sickle cell disease
recycled every 120 days (4 months)
normal RBC lifespan
recycled every 30 days
sickled cell lifespan
- Cause: significant blood loss; illness; high altitude; continued stress (physical or emotional); dehydration; elevated or severely decreased temperature
- may rate pain 8/10 and be playing on their phone –> different pain tolerance, do NOT blow these kids off
sickle cell (Vaso occlusive) crisis
sudden trapping of blood in the spleen –> recycles sickled cells every month (overworked) and size never decreases back to normal size
- S&S: pain; spleen overworked; spleen enlarged; pale; lethargic
- these kids CANNOT play contact sports EVER
splenic sequestration
body is reacting from viral illness (commonly URI; sometimes GI bug) & is affecting vascular system –> the virus starts attacking the vascular system and starts erupting capillaries (dots = capillaries exploding); some type of inflammation occurring w/ blood leaking into small vessels
- typically affects young children under 10 & typically males
- S&S [NOT life-threatening]: purpura rash, joint pain, abdominal pain, kidney impairment (bloody urine –> kidneys extremely vascular)
- Tx: supportive care –> calm parent, give Tylenol, fluids, patience (several days to overcome)
Henoch-Schoenlein Purpura (HSP)
group of X-linked recessive disorder that results in deficiency in one of the coagulation factors in the blood –> mom passes it down to son (boys only have 1-X, only need 1 from mom)
- deficiency of factor VIII (hemophilia A)
- Tx: give factor VIII (parents need to keep on them at all times); immobilize & elevate joint/affected extremity; prevent injury based on developmental age –> toddlers fall down & hit head; no contact sports when older; driving safety & avoiding piercings/tattoos in adolescents
hemophilia
cancer of the bone marrow caused by an overproduction of abnormal WBCs
- Assessment: bone pain; anemia; low reticulocyte count; bleeding disorder; immunosuppression; pale, unexplained bruising, fatigued, generalized pain
- Most common cause of death: illness/infection
- Tx: ALWAYS starts w/ chemo
leukemia
typically diagnosed between 2-5 yrs and affects the T&B cells
- most common Dx of leukemia in children
- Dx: bone marrow makes too many lymphocytes; low reticulocyte count
- Tx: prevent infection; chemo & radiation; bone marrow transplant (last resort)
acute lymphoblastic leukemia (ALL)
hard to treat & has higher death rate than other type
- these children always have an implanted port = chemo is extremely toxic to vascular system (will kill peripheral vein)
- more common in teen & adult world
- Dx: bone marrow makes too many myeloid cells
- Tx: not as responsive to Tx
acute myelogenous leukemia (AML)
most common solid tumor in children (usually 5-10yrs)
- Cause: unknown
- can take long time to Dx –> very vague symptoms, especially when they’re young (i.e., may occur in conjuncture w/ teething)
- S&S: increased ICP; headache/vomiting ONLY in the morning; new onset seizures w/o Dx; coordination issues
- Dx: CT; MRI; chemo; radiation
brain tumor
tumor is small & hasn’t spread
Stage 1
tumor is large but hasn’t spread
Stage 2
tumor has spread to neighboring lymph nodes
Stage 3
tumor has spread to other organs
Stage 4
has a shape & structure that resembles healthy cells
well-differentiated cancer cells
has a completely different shape and structure than healthy cells
poorly differentiated cancer cells
slow-dividing of tumor cells
low-grade
fast dividing of tumor cells
high-grade
cancer of the bone & soft tissue – typically diagnosed in adolescence and found incidentally due to vague symptoms (dull bone pain progressing over months)
- commonly seen in long bones (femur & humerus)
- S&S: pain that never goes away (w/ Tylenol, RICE)
- cannot remove part of bone for Tx –> radiation, amputation, replaced w/ cadaver bone (at growth peak) or rods (until growth plates close; grow w/ child)
sarcomas
usually in long bones proximal humerus, tibia, and femurs
- Tx: Sx to remove tumor –> chemo before & after
osteosarcoma
also within the bone but is much more aggressive & metastasizes easily, usually in pelvis or femur
- Tx: radiation in addition to chemo & Sx
Ewing sarcoma
renal tumor of unknown cause that grows rapidly
- typically only affects 1 kidney (not both at same time)
- Assessment: nontender mass; abdominal pain; HTN
- Do NOT continue to palpate abdomen once diagnosed –> tumor is very vascular & palpation can cause tumor seeding
- Tx: Sx to remove kidney (no way of just taking tumor); educate on protecting the single kidney (NO CONTACT SPORTS)
Wilms tumor
caused by a rapid increase in temperature, typically caused by a virus
- Dx: elevated temperature & present seizure (tonic-clonic or myoclonic)
- Tx: Tylenol; ibuprofen; rectal diazepam, buccal & IM midazolam, IM lorazepam
- Education: call 911 for seizures lasting more than 5 min or multiple in same day; does NOT mean they will have lifelong seizures
febrile seizures
imbalance between excitatory & inhibitory mechanism
- Tx: meds (Keppra –> reduce or control the frequency); Sx (removal of affected area OR VNS [pacemaker of the brain]; ketogenic diet (low sugar decreases excitability giving less energy); relieve anxiety
epilepsy
3 categories of epilepsy
- Focal: 1 hemisphere of the brain
- Generalized: whole brain
- Unknown: spasm
nursing management for active seizures
- maintain open airway
- turn patient on their side
- ensure safety
- suction/oxygen set-up
birth defects of the spine & brain – will be seen on US (born via C-section)
- folic acid will reduce the risk
- cause is unknown but certain factors adversely affect normal CNS development (lack of folic acid)
neural tube defects (spina bifida)
overarching term for all spinal defects
spina bifida occulta
spinal cord is fine but make sure that sac remains intact
- sac of spinal fluid (cords are NOT in the sac)
- prevent infection –> if you notice any leaking from sac, notify provider immediately
meningocele (spina bifida cystica) - mild
most severe type and child does not have a lot of sensory or motor function below the defect
- cords are WITHIN the sac of the spinal fluid
- diagnosed in utero w/ spinal cord involvement
myelomeningocele (spina bifida cystica) - severe
missing parts or all brain hemispheres, skull, and scalp
- Dx: visualized on US
- Prognosis: usually stillborn or pass within a few hours after birth; brainstem intact allowing infant to breath and have some reflexes
- Management: provide comfort measures; family support; grief support; place infant cap on child immediately
anencephaly
defect of brain & meninges protruding through the skull – collection of fluid at the base of the skull
- Prognosis: Dx in utero (delivered via C-section); Sx needed to correct
- Management: pre- & post-Sx care; monitor for increased ICP (herniation of brainstem) & head circumference; side-lying position; prevent ruptures of sac & infection
encephalocele
displaced cerebellar structure – usually found accidentally when children have head trauma & require imaging
- S&S: maybe walk differently but go on w/ life; headache; neck pain; coughing & laughing make pain worse
- Management: routine imaging & follow-up; S&S of increased ICP and any CNS injuries (new onset seizure, headache, vomiting, etc.); pre- & post-op care
Chiari malformation
results from brain disorder that cause an imbalance in production & absorption of CSF – increased fluid in ventricles = increase in head circumference
- S&S: seizures, macrocephaly, bulging fontanels, increased head circumference, vomiting, headache, lethargy, delayed development
- Tx: VP shunt
- Management: support & educate family; shunt malfunction; assess for complications; children at risk for peritonitis (where shunt drains)
hydrocephalus
rare congenital disorder – large, intertwining bundles of blood vessels in the brain
- S&S: intracranial hemorrhage; seizure; headache; progressive neurologic defects (vision changes, loss of speech, memory, problems)
- Tx: Sx to excise bundles & embolize around area; may need short-term shunt to Tx hydrocephalus
- Management: support; monitor for neurological changes, seizure activity, S&S of ICP or intracranial hemorrhage (stroke)
intracranial arteriovenous malformation (AVM)
premature closure of the cranial sutures (most common is sagittal)
- Cause: unknown
- Tx: Sx if 2 or more close
- Management: measure head circumference, palpate suture lines, helmet
- Education: blood loss, infection risk, swelling (eyes may swell shut post-op), encourage parents to hold child (bond)
craniosynostosis
asymmetry of head shape; torticollis can contribute to severity (twisting of neck to look at something)
- Tx: increase tummy time; helmet; repositioning
- often seen in children who are not held enough AND children in the NICU
positional plagiocephaly
most commonly seen in children ages 2-6yrs
- kids are not good at wiping –> require education about front-to-back wiping
- Cause: E. coli (most common)
- Tx: antibiotics
- S&S: hurts to pee, frequency, itching
urinary tract infections (UTIs)
Most common abnormality for urinary system in children
condition in which urine flows back up the ureters; increased pressure placed upon the kidney can cause renal scarring and lead to HTN later in life and, if severe, renal insufficiency or failure
- Tx: antibiotic prophylaxis; hygiene & voiding practices; serial urine cultures
- grade III, IV, and V usually warrant Sx
vesicoureteral reflux (VUR)
urine backflow is only in the ureters
grade I VUR
urine backflow beings to enter the kidneys
grade II VUR
urine backflow is a lot in the kidneys
grade III VUR
urine backflow covers most of the kidney
grade IV VUR
urine backflow covers all of the kidney
grade V VUR
inflammation of the glomeruli after an illness – often after Strep – immune mechanism causes inflammation which alters glomerular structure
- S&S: painless hematuria; edema; HTN
- Tx: nothing specific – goal is to maintain fluid volume & managing HTN; antihypertensives (Nifedipine), antibiotics (if Strep present), furosemide (Lasix)
acute postinfectious glomerulonephritis
etiology is currently unknown –> kids can get bacteria from undercooked food (i.e., ground beef) OR petting zoos
- Triad of S&S: bloody diarrhea, decreased UOP, pallor, HTN
- Tx: fluids & antibiotics (can lead to nephrotoxicity); blood transfusion
hemolytic uremic syndrome (HUS)
