exam 2 Flashcards
hypoxemia assessment findings
Tachypnea
Pallor
cyanosis
Respiratory distress signs
weak peripherial pulses
Resp distress symptoms
retractions, nasal flaring, grunting, head bobbing, restlessness, stridor, wheezing, rales
First sign of resp illness?
Tachypnea
hypoxemia management
-Provide O2 at the lowest liter flow that corrects the hypoxemia
-Less than 91% requires nursing intervention
-Less than 86% is a life-threatening emergency
-Chest physiotherapy–> promotes mucus clearance by mobilizing secretions
-Suctioning–> always suction the mouth before the nose in kids–> do not want to increase risk of aspiration pneumonia
Hypoxemia priorities of care
o2 therapy
pulse ox
CPT
suctioning
What is Aerosol therapy?
Physical findings of CF (GI)
-decrease pancreatic enzymes=abd distention and thick mucous
-meconium ileus at birth –>difficulty passing stool –> vomiting
-steatorrhea
-FTT
-Vitamin A, D, E, K deficiency
-PMH of respiratory infections
diagnostic for CF
Sweat chloride test
Sodium higher than 90
SCT indication of CF?
> 40 in infants (less than 3mo)
->60 for all ages
CF management (pulmonary)
-airway clearance therapy
-CPT
-aersol therapy
How does dornase alfa help alleviate sx of cystic fibrosis?
-decreases viscosity of mucus and bronchodilators
What medication is given with cystic fibrosis to treat pulmonary sx?
dornase alfa
Croup assessment findings
-barking cough
-inspiratory stridor
-tachypnea
-sudden onset at night
-self limiting (resolves on its own)
-lasts 3-5 days
priorities of croup
-educate families on sx
hospitalization for significant stridor at rest or severe retractions
-cool mist/steamy bathroom
O2—>ox continuous
-hydration
Racemic epinephrine
decrease edema, effects last up to 2 hours and sx may worsen requiring another tx
Chronic Asthma medications
Long-acting bronchodilators/B2-adrenergic Agonist (formoterol) Inhalation corticosteroid (Fluticosone) Mast-cell Stabilizer (Cromolyn) Leukotriene Receptor Antagonists (Montelukast
s/s of asthma
hacking, nonproductive cough, dyspnea, chest tightness, wheezing or crackles
A SILENT CHEST IS A OMNIOUS SIGN (no airmovement)
Status asthmaticus
a prolonged severe asthma attack uncontrolled by typical regimen. LIFE THREATENING
Status asthmaticus symptoms
wheezing or lack of air movement in lungs
labored breathing
accessory muscles
hypoxia
diaphoresis
Status asthmaticus Nursing actions/ Priority of care
Cardioresp monitoring, O2, ABG’s
-admin bronchodilators and anti-inflammtory meds
-prepare for intubation
Status asthmaticus medication management
Theophylline
Mg sulfate Iv
Heliox
Ketamine
Theophylline
anti inflammatory and reverses corticosteroid resistance
Theophylline has a risk for toxicity so we have to frequently monitor?
Blood levels
Mg sulfate
relaxes bronchial muscles, expanding airways
Heliox
mix of Helium and O2—> decreases airway resistance
Ketamine
smooth muscle relaxant
Epiglottis assessment findings
rapid onset (within hours): High fever and toxic appearance
unable to whisper or speak
Lateral neck x-ray +Epiglottis
-Tripod position neck thrust forward.
anxiety
-drooling and dysphagia !!!
NO COUGH
Management of Epiglottis
Focuses on airway maintaince, icu admission
iv abx
-100% NRB mask.
Priorties of Epiglottis
-Never attempt to visualize the throat
-No supine position
-need HOB elevated.
Foreign Body Aspiration assessment findings
sudden onset of cough, wheezing,
stridor: upper airway
Unilateral BS (wheezing & decreased in
R/clear in L)
Foreign Body Aspiration Risk factors
common in ages 6 months-3 years, upper and lower resp.
Foreign Body Aspiration parent education
keep coins, small batteries, latex balloons out of reach
-no popcorn, peanuts until age 3, chop all foods into pieces
Where are most objects aspirated?
right mainstream bronchus because it is at a less acute angle than the left mainstream bronchus.
Dehydration assessment findings
Dehydration Management: oral rehydration
sunken fontanells
decreased LOC
sunken eyes
no tears
dry mm
sudden weight loss
decreased UOP
delayed cap refill
dehydration findings vitals
-electrolyte imbalances
-increased hr
-increased rr
-decreased bp
Rehydration Therapy Oral
attempt 1st. Pedialyte
mild: 50ml/kg in 4 hours
moderate: 100ml/kg in 4 hours
Diarrhea losses: 10ml/kg for each stool
Rehydration IV
20ml/kg of Ns or LR bolus (in addition to maintenance)
Maintenance fluid
100ml/kg–1st
50ml/kg-2nd
20ml/kg for remaining.
24 hours—>24/24
G.E.R.D. managements
Conservative: small frequent feedings, thickened feedings,
meds
Surgical: nissan
Meds: PPI/ h2 receptor antagonist
G.E.R.D. pt education
sit up after meals
G.E.R.D s/s
arching of head an neck during feeding, frequent vomitting, irritability during feeding, wet burps, apnea, ALTE
When should patients with G.E.R.D take their medications?
30 minutes before feeding
PPI’s include
esomprazole, lansoprazole, omeprazole, pantoprazole
H2-receptor-antagonist include
ranitidine, cimetidine, famotidine
What will labs show if patient has GERD?
CBC may show anemia
Hemoccult: positive for blood if chronic esophagitis
complications of GERD
laryngitis, recurrent PNA, asthma, apnea or ALTE
What is ALTE
apparent life threatening event
apparent life threatening event is?
a sudden event where the infant exhibits apnea, change in color, change in muscle tone and choking
physical cues in children
heartburn, abd pain, diff swallowing, chronic cough, non cardiac Cp
emesis with blood or bile
physical cues in infants
arching of head and neck during feeding, irrtiability frequent spitting up or vomitting. Resp issues, FTT, apnea or ALTE
what is HPS and when does it occur?
Hypertrophy of the pylorus muscle causing gastric outlet obstruction.
usually in 1st 3-6 weeks of life
s/s of HPS
foreceful projectile vomitting
hunger soon after vomitting
weight loss
olive shaped movable mass in RUQ
Labs for HPS
Hypochloremia
hypokalemia
metabolic alkalosis
Management for HPS
Laproscopic surgery
IVF NGT
Priority care of HPS
Iv fluids–> correct electrolyte and dehydration
NGT—? decompression NPO, strict I/O
-Wound care
Resume PO feedings in 1-2 days
Hirschsprung’s expected findings newborn
failure to pass meconium, bilious emesis
abd distention
Hirschsprung’s expected findings infant/child
FTT, chronic constipation
Treatment of Hirschsprungs
4 phase surgery with colostomy
Management of Hirschusprungs
high protein high cal diet
accurate I/O
iv fluids and abx
post op teach about stoma care
What should we observe for in Hirschusprungs?
entercolitis
S/s of entercolitis
fever, vomitting, abd distention, explosive diarrhea or rectal bleeding.
NOTIFY IMMED
tx of entercolitis
Broad spectrum abx, IVF resuscitation and rectal washout
Name of surgery for Hirshusprungs
resection and re-anastamosis: done in stages depening on degree of colitis/bowel dilation
What is intussusception
proximal segment of bowel telescopes into a distal portion of bowel. Results in lymphatic and venous obstruction
s/s Intussusception
flare then resolves spontaneous reduction
sudden onset of crampy or severe adb pain, draws knees to chest. v/d
Hallmark sign of Inutssusception
sausage shaped mass in upper mid abdomen. Red current jelly stools
Treatment of Intussusception
IVF/NGT
air enema to correct or surgery if recurrent
What do stools look like in Intussusception?
blood and mucus (red current jelly)
What is important with intussusception?
keep patient NPO
Cleft lip and palet pre op
priority: nutrition and infant parent bonding
-burp infant to expel excess air
-encourage therapeutic techniques
cleft lip and palet post op
Priority: preventing injury to suture line
position on side of supine immediately post op with arm restraints
-avoid straw, spoon anything in mouth
-prevent crying
Risk factors for Cleft
smoking
prenatal infection
folate deficiency
antidepressants and steroid use
Complications of Cleft
Feeding difficulties
Regurgitation
Altered Dentition
Delayed/altered speech
Otitis media/effusion
What is effusion?
fluid build up in the middle ear.
What is heart failure
inability of heart to adequately pump blood to meet metabolic and physical demand of the body
L sided heart failure symptoms
increased work of breathing, tachypnea, wheezing, rales, cough, DOE, feeding difficulties
Right sided heart failure symptoms
hepatomegaly, edema, JVD, periorbital edeam, wt gain
Pathophysiology of coarctation of the aorta (CoA)
-narrowing of the aorta that occurs most often near or beyond the PDA (patent ductus arteriosus)
During CoA, pressure increases near the defect and distal to it. What are assessment findings because of this?
Increased BP in upper extremities and decreased BP in lower extremities
What is most important to assess when suspecting a patient has CoA
all pulses
Key assessment findings for CoA
-full bounding pulses in upper extremities
-weak or absent pulses in lower extremities
-soft or moderately loud systolic murmur at base of left axilla
-frequent epistaxis ; leg pain with activity (older child)
Diagnostics for CoA
-echo: assess extent of narrowing and collateral circulation
-CXR: left sided cardiomegaly, rib notching
-CT, MRI, ECG: PRN
Treatments for CoA
Infants and children: balloon angioplasty
Adolescents: stents
Surgical: repair of defect in children <6 months
What is ventricular septal defect (SVD)
-most common congenital heart defect
-Acyanotic heart failure
Pathophysiology of VSD
-opening between the ventricles causing left to right shunt
-incrased blood flow to RV –> increased blood flow to lungs –> pulmonary artery HTN, right ventricular hypertrophy
complications of VSD
-aortic valve regurgitation and endocarditis
Physical assessment findings for VSD
-most children asymptomatic
-palpable thrill in chest
-CHF symptoms
-HOLOSYSTOLIC HARSH MURMUR (big one) heard alone the left sternal border
What type of CHD is Patent Ductus Arteriosus (PDA)
cyanotic (increased pulmonary flow)
Assessment findings of PDA?
-depends on size of opening
-tachycardia
-diastolic BP typically low due to shunting
-bounding peripheral pulses (from increased CO)
-widened pulse pressure (> 30 mmHg)
-hypoxia/ resp distress (due to pulmonary edema)
-harsh, continuous, machine-like murmur (loudest under left clavicle at 1st/2nd ICS)
Treatment for PDA
Non surgical: admin of indomethacin, insertion of coils to occlude the PED, diuretics, extra calories for infants
Surgical: thoracoscopic repair (ligate vessels)
What is the ‘fatal four’ found in Tertralogy of Fallot
- ventricular septal defect (VSD)
- pulmonary stenosis (R to L shunt)
- hypertrophy of right ventricle
- overriding aorta (hypoxemia)
Clinical features of tetralogy of fallot
-fainting, difficulty breathing, easy fatigue, color changes w/ feeding, crying, activity
-loud, harsh systolic murmur
-polycythemia
-TET spells (blue baby) especially in AM
Specific symptoms of TET spells found in Tetralogy of Fallot
-cyanosis
-hypoxemia
-dyspnea
-agitation
-all the signs lead to anoxia and unresponsiveness
treatment of tetralogy of fallot
-prostaglandins (to keep PDA open to increase pulmonary blood flow)
-surgical repair of R ventricular outflow obstruction and VSD closure
Nursing interventions for tetralogy of fallot
-place infant or child in knee-to-chest position or squatting
-supplemental oxygen
-administer morphine sulfate
-supply IV fluids
-administer propranolol
Is Kawasaki’s disease acquired or congenital
acquired (caused by unknown infectious organism)
Assessment findings for Kawaski’s disease
-High fever 103 F for at least 5 days unresponsive to ABX
-bilateral conjunctivitis (without exudate)
-dry mouth and throat, fissured lips, strawberry tongue, pharyngeal/ oral mucosa edema
-cervical lymphadenopathy
-desquamation (peeling) of fingers, toes and perineal areas; rash over body
-CV: tachycardia, gallop, murmur; note hyperdynamic precordium
Nursing management of Kawaski disease
-administer IVF, IVIG, and PO fluids as ordered
-Acetaminophen (fever) , cool cloths
-DW , strict I&O
-rest and quiet, family support
-lip lubricants and mouth care
-clear liquids and soft foods
Medication management for Kawasaki
-Immunoglobulin (IVIG)
-high dose IV (2g/kg) over 8-12 h
-High Dose aspirin
-80-100 Mg/Kg/day q 6 h
-follow w/ low dose after fever breaks
-indefinite use if aneurysms develop
-additional anti-coag if large aneurysm
What medications are given for heart failure?
Metoprolol
Lasix: used to manage edema
Captopril/ Enalopril
Digoxin
Nursing considerations and side effects of metoprolol
-Monitor HR and BP b4 administering
-SE: dizziness, hypotension, HA
Nursing actions and side effects of Lasix
-Monitor for hypokalemia, monitor BP, monitor I & O, monitor DW
-SE: hypokalemia, NV, dizziness, ototoxicity
Nursing actions for ace-inhibitors
-monitor BP before and after administration
Nursing actions for digoxin?
-count apical pulse 1 full minute
-HOLD IF: <90 infant, <70 child, <60 adolescent
-monitor digoxin levels (0.8-2)
What are signs of digoxin toxicity?
-N/V, anorexia, bradycardia, dysrhythmias
-green yellow halos
Digoxin antidote
-digoxin immune fab
Indications of metoprolol
-decrease HR and BP and promote vasodilation
Indications of Lasix
manage excess fluid and sodium
Indication for captropril
reduce afterload by causing vasodilation –> decreased pulmonary and systemic vascular resistance
Indication of digoxin
decrease contractility of heart muscle
What is the pediatric assessment triangle?
addresses Childs appearance, work of breathing, and circulation to skin
Examples of appearance the nurse should assess for in the pediatric assessment triangle
-abnormal tone
-decreased interactiveness
-decreased consolability
-abnormal look/ gaze
-abnormal speech / cry
Examples of work of breathing the nurse should assess for in the pediatric assessment triangle
-abnormal sounds
-abnormal position
-retractions
-flaring
-apnea/gasping
What is the purpose of Aspirin to treat Kawasaki disease?
prevent clots
Why are clients wit kawaskis disease at risk for dehydration
-painful mouth makes them less likely to drink
-already losing fluids from fever
What is acute rheumatic fever?
-Group A beta hemolytic strep (GAS) ; strep throat
clients with acute rheumatic fever may report a history of?
-sore throat and pharyngitis within past 2-3 weeks
-recent URI
-recurrent skin infection
-fever
-joint pain
What children are likely to acquire acute rheumatic fever
-children who have less access to healthcare
Minor manifestations of acute rheumatic fever
Fever, arthralgia, increased ESR, prolonged PR interval
Major manifestations of acute rheumatic fever
-carditis (w/ valvulitis)
-polyarthritis (multiple joints inflamed/ migratory)
-subcutaneous nodules (firm and painless nodules over knees, wrists, elbows)
-chorea (jerking muscle movements in face hands and feet)
-erythema marginatum (rash on trunk and extremities)
Diagnostic criteria for acute rheumatic fever includes?
-presence of 2 major manifestations
OR
-presence of 1 major and 2 minor
Sinus tachycardia characteristics
fever, pain, fear, fluid loss or hypoxia.
sinus tachycardia in infant characteristics
rate is <220(160-220)
sinus tachycardia management
Focus on underlying cause
-INAPPROPRIATE and dangerous to treat with medications or defib aimed at decreasing heart rate
Sinus tachycardia characteristics in children
<180 (130-180)bpm with a beat-to beat variability, p wave present and normal
QRS normal
SVT characteristics
infants: >220bpm
Children >180 with onset of termination, p wave is flattened, and QRS is normal
SVT management Compensated
Vagal maneuvuers such as ice to face of blowing through a straw that is obstructed
-adeosine if vagal maneuver fails.
Sinus bradycardia characteristics
No cardiac nodal abnormality
p-wave and qrs remain normal on ecg
What causes SVT?
re-entry problem in the cardiac conduction system or genetic abnormalities like WOLFF-Parkinson, WHITE syndrome, or with meds like caffeine or theophylline
Sinus bradycardia <60
life threatening
altered perfusion
hypoxia shock
respiratory compromise
Sustained bradycardia is commonly associated with ___ and is a ___
arrest, ominous sign
SVT management uncompensated
adenosine or synchronized cardioversion
post-streptococcal glomerulonephritis
history
current or past history of recent pharyngitis/strep throat or skin infection
Compensated SVT s/s
tachycardia, Heart rate >220
Abnormal p waves
alert well perfused child
ha, dizzy in older child
post-streptococcal glomerulonephritis physical findings
fever, lethargy, HA, decreased urine output, abd pain, vomitting, and anorexia
Htn edema, urine for gross hematuria
Uncompensated SVT s/s
Tachy, hr>220
abnormal p-waves
signs of shock: aloc, poor perfusion, weak pulse.
post-streptococcal glomerulonephritis
labs and dx
urine dip stick: hematuria and proteinuria
Bun/ Creatinine: increase
ESR: increased
ASO Titer: increased
post-streptococcal glomerulonephritis priority of care
-Monitoring fluid status and managing hypertension
-Maintain sodium and fluid restriction during acute phase
-Daily weights
-Urine output improvement of color
-skin break down
-bed rest
meds for post-streptococcal glomerulonephritis
antihypertensives: nifedipine, labetalol
diuretics
What should we educate our clients and family to do for post-streptococcal glomerulonephritis?
monitor OPand BP and follow diet restrictions
What is post-streptococcal glomerulonephritis?
inflammation resulting in altered GF function (decreased GFR )
Hemolytic uremic syndrome history
Recent episode of acute gastroenteritis watery diarrhea accompanied by cramping that becomes bloody over several days. Possible vomitting
Hemolytic uremic syndrome assessment findings
pallor and toxic appearance
edema and oliguria or anuria
Neuro: irritability, altered LOC, seizures, posturing or coma.
UA of post-streptococcal glomerulonephritis
proteinuria, hematuria, leukocytes, casts
What does the urine look like in post-streptococcal glomerulonephritis?
tea color, cola color or dirty green color
CBC of HUS
CBC: mod-sev anemia
mild-sev thrombocytopenia,
What kind of edema do they have in post-streptococcal glomerulonephritis?
general or periorbital, signs of fluid overload or CHF.
Chem panel of HUS
decreased sodium, increased potassium, increased PO4
Hyponatremia/ Hyperkalemia
ABG of HUS
metabolic acidosis
Patient education of hus
prevention measures: handwashing after everything bahahha
cook to 155
Priority of care HUS
maintaining fluid balance, managing hypertension, acidosis, electrolyte abnormalities
Continued priorities of care for HUS
PRBC and platelets (only for active bleeding or severe thrombocytopenia. IVIG may be considered
REPORT all abnormal findings
What are the three features of hemolytic uremic syndrome?
hemolytic anemia, thrombocytopenia, acute renal failure
Hydrocele
fluid in scrotal sac: usually resolves by 12 months of age: transilluminate
Varicocele
venous varicosity along the spermatic cord
What are other assessments from the history we should pay attention to for HUS?
ingestion of ground beef
visits to water park
public pool
petting zoo
all prior to developing diarrhea
What does the scrotal look like with varicocele?
worm like
What can varicocele cause?
low sperm count and infertility
Management for Compensated SVT
-vagal maneuvers: ice on face / blow through obstructed straw
-Adenosine if maneuvers fail
Uncompensated SVT management
-adenosine or synchronized cardioversion
If we notice our client has sudden weight gain, what is our priority nursing action?
-assess height and weight and compare
-take daily weights
If our client has difficulty eating, what questions should we ask the parent?
Onset of sx, how much they eat, if they tire easily, if there are color changes present
Nursing actions with difficulty feeding?
- limit feedings to 20 min –> remainder via OG / NG
- cut cross in nipple
- semi-upright position
Interventions if our client has a decreased activity level?
-cluster care, frequent rest periods, bathe PRN
If our client has decreased # of wet diapers, what nursing assessments should we perform?
- I and O
- edema
- pulses
- organomegaly
Nursing actions for decreased number of wet diapers
I and o’s, medications
What current/ past Hx will be seen with glomerulonephritis?
-recent pharyngitis/ strep throat or skin infection
What are physical assessment findings of glomerulonephritis
-fever, lethargy, HA, decreased UOP, abd pain, vomiting, anorexia
Will blood pressure be high or low in glomerulonephritis
High –> have HTN
Treatment of hydrocele and varicocele?
surgery to correct spontaneous resolution
Glomerulonephritis causes what kind of edema?
-general or periorbital
-other sx of fluid overload or CHF
Management of hydrocele?
watchful waiting, to observe for spontaneous resolution
What color is urine in glomerulonephritis
-tea color
-cola color
-dirty green color
Management of Varicocele
if no resolution or decreased testicular volume, urologist referral for possible surger
What will be seen on a urine dipstick that indicate glomerulonephritis
-hematuria, proteinuria
Important teaching for Hydrocele and Varicocele
Hydrocele does not interfere with fertility but VARICOCELE can if left untreated.
BUN, creatinine, and ESR will be elevated or decreased in glomerulonephritis?
elevated
Hydrocele physical cues
enlarged painless scrotum decreases in size when lying down. Transilluminate with light source. Fluid renders testes impalpable
What is the priority of care for glomerulonephritis?
-monitoring fluid status and managing HTN
Varicocele physical cues
mass on one or both sides, blueish in color, worm-like spermatic veins and pain with palpitation
What should be restricted in glomerulonephritis during the acute phase
sodium and fluids
What is nephrotic syndrome?
kidney filtration disorder where too much protein (albumin) is filtered out of the blood due to damaged basement membrane of the renal glomerulus
Nursing interventions during glomerulonephritis also include?
-DW
-monitor urine output and color
-monitor skin breakdown
-monitor for renal/ neuropathy changes
-maintain bed rest and cluster care
Nephrotic syndrome most common in?
children (minimal change nephrotic syndrome with onset of age by 6.
What precautions should children with glomerulonephritis be placed on
seizure precautions
Nephrotic syndrome history
Periorbital edema upon waking that progresses to generalized edema throughout the day
FROTHY URINE
What medications are used to treat glomerulonephritis
-ABX for strep
-nifedipine and labetalol
-diuretics
Nephrotic syndrome physical cues
irritability or fussiness
skin stretched, tight appearance, pallor or breakdown
heart and lung sounds related to fluid overload
abd distention and note ascities
What are the three features of hemolytic uremic syndrome (HUS)
-hemolytic anemia, thrombocytopenia, acute renal failure
Nephrotic syndrome nursing management
I/O daily weights, urine protein, sodium restriction when edematous.
Prevent infection: can cause relapse.
What bacteria causes hemolytic uremic syndrome?
e-coli
Nephrotic syndrome labs
Proteinuria
hyperlipidemia
edema
what happens in the kidneys causing hemolytic uremic syndrome?
RBC are destroyed and fibrin clots are formed clogging the kidneys
Medications for Nephrotic syndrome
Diuretics (furosemide), may require K replacement
Corticosteroids (prednisone) take with meals for 4-6 weeks then taper over 2-5 months
What may our clients say in their recent hx that will pinpoint hemolytic uremic syndrome?
-recent acute gastroenteritis
-watery diarrhea
-cramping
-becomes bloody
-possible vomiting
-ingestion of ground beef, visits to water park/public pool/ petting zoo prior to developing bacteria
Side effects of Prednisone
increased appetitie, weight gain, cushings features, mood swings.
Physical assessment findings of hemolytic uremic syndrome?
-pallor and toxic appearance
-edema, HTN, oliguria, anuria
-jaundice and weakness
-dark colored urine
-petechiae, ecchymoses, hematuria, hematoemesis, splenomegaly
Neuro status with hemolytic uremic syndrome will be
-irritable
-altered LOC
-seizures
-posturing and coma
What is Enuresis ?
Bedwetting: continued incontience beyond the age of toilet training
What is hydrocele?
-fluid in scrotal sac
-benign, common in newborns
-usually resolves by 12 months
Primary enuresis
never achieved extended dry periods
What is varicocele?
-venous varicosity along the spermatic cord
-most common in adolescence
-can cause low sperm count or reduced motility –> infertility
Secondary enuresis
Onset after a period of urinary continence
Physical cues of hydrocele?
-enlarged painless scrotum
-size decreases when lying down
-testes impalpable
-transilluminate with light source
Enuresis nursing assessment
daytime or nighttime incontience
urine holding behaviors (squatting dancing staring, rushing to bathroom)
Physical cues of varicocele?
-mass on one or both sides
-blueish in color
-worm like veins
-pain with palpation
Enuresis history
note history of constipation
toilet training history
family disruption and stress and excessive family demands regarding TT.
Large amounts of fluid before HS, caffiene?
night time routine
Management of hydrocele
-‘watchful waiting’ to observe for spontaneous resolution
-surgical correction if no resolving on own
Enuresis interventions
Assist in management of incontinence and promote wellness and prevent complications
Management of varicocele?
-if no resolution or decreased testicular volume urologist referral
-possible varicocelectomy
Enuresis parent education
restrict fluids 2 hours before bedtime
void before going to bed
include child in bed linen changes.
avoid pull ups.
What is nephrotic syndrome?
too much protein (mainly albumin) is filtered out of the blood due to damaged membrane of glomerulus
Medications for Enuresis
Antiduretic (desmopressin)
Nephrotic syndrome is usually idiopathic which means?
it occurs on its own ; usually occurs by age 6
Desmopressin for Enuresis
pill or melt away at bedtime
hold for diarrhea or vomiting
adverse: HA nausea
Children with nephrotic syndrome will show a history of
periorbital edema upon waking that progresses to generalized edema thorughout the day
Phimosis
Foreskin can not be retracted, normal in newborn, pathological if persists
Physical cues of nephrotic syndrome include
-recent, sudden weight gain
-frothy urine
-N/V
-pallor and skin breakdown
-stretched skin
-irritability
-sx of fluid overload (have severe edema)
Paraphimosis
restrictive band behind the glans penis—->incarceration and necrosis
pain or swollen penis
BOTH: irritation, erythmea, edema, or discharge
Do children with nephrotic syndrome have edema, proteinuria, and hyperlipidemia?
yes
Phimosis s/s
uti, irritation, balantis (inflammation of the foreskin)
bleeding in the prepuce on dysuria
Serum albumin will be ___ with nephrotic syndrome, but urine albumin will be ?
deceased ; increased (have proteinuria)
Tx of Phimosis
topical steroid cream BID x1
will cholesterol and lipids be elevated in nephrotic syndrome?
yes
Treatment of Paraphimosis
surgical reduction
will BUN and creatinine be elevated in nephrotic syndrome?
yes IF renal failure is occurring
Priorities of care for Phimosis and paraphimosis
Apply topical steroid medications as prescribed for phimosis with genital retraction of foreskin.
Priority nursing care for nephrotic syndrome include?
-monitoring I and O’s
-monitoring urine protein
-DW
-sodium restrictions
-prevent infection – can cause relapse ; vaccination status
Priority care of paraphimosis
Routine post-op care and pain management of surgical site
teach families appropriate hygiene
What medications are given with nephrotic syndrome>
Prednisone (60 mg/m2/day for 4-6 wks then tapered over next 2-5 months)
Furosemide (diuretics)
Hypospadias
an abnormal urethral opening on ventral surface of penis (below glans penis)
Epispadias
an opening on the dorsal penile surface (above glans penis)
Nursing considerations with prednisone
-take with meals
-can cause increased appetite, weight gain, Cushing’s features, and mood swings
Hypospadias physical findings
urethral opening off center/ not a tip of penis
presence or absence of testicles in scrotal sac (cryptorchidism) or hydrocele or inguinal hernia.
Nursing consideration with diuretics
may require K+ replacement
Hypospadias/ Epispadias main s/s
cannot direct urine stream in standing position
Circumcision should be delayed until repaired.
Children with nephrotic syndrome taking corticosteroids may experience
altered body image
hypospadias treatment
surgically repaired
What education is important to tell families with children that have nephrotic syndrome
-may return to school but avoid sick children
-monitor temp and urine dipsticks to prevent relapse
-how to properly use urine dipstick to monitor for protein
Post op Hypospadias/ Epispadias care
secure urethral stent/drainage tubing. Compression dressing, Double diapering.
What is enuresis?
continued incontinence beyond the age of toilet training
What is primary and secondary enuresis
primary: never achieved extended dry periods
Secondary: onset after a period of urinary continence
Fluid requirements and children with enuresis?
encourage fluids during the day, restrict at least 2 h before bed
Caffeine and chocolate with enuresis
-limit caffeine and chocolate after dinner
What type of toileting schedule should be used for children with enuresis?
ensure child voids before bedtime ; wake up at scheduled intervals to void
Should pull-ups be used in enuresis?
no pull-ups, use a reward system
Children with enuresis that wet the bed should be included in?
bed linen changes in a non-punitive manner
Nursing interventions for enuresis?
-conditioning therapy - alarm sensor
-Kegal/pelvic exercises
What medication is given for enuresis?
antidiuretic (desmopressin)
Nursing considerations for giving desmopressin to treat enuresis?
-give at bedtime
-hold for diarrhea and vomiting
-restrict fluid intake after dinner
-only allow sips of water 1 h b4 taking and 8 h after
Adverse effects of desmopressin?
headache and nausea
What is phimosis?
when the foreskin cannot be retracted, which is normal in the newborn, but pathological later
What is paraphimosis?
serious medical condition causing a restrictive band behind the glans penis, which can cause an incarceration and necrosis of the penile head
What should be applied BID for one month to treat phimosis?
topical steroid cream
If urine is retained in foreskin after voiding during phimosis, what can occur?
irritation, UTI, and balanitis
What is required to correct paraphimosis?
surgical reduction
What can be done to cure both phimosis and paraphimosis?
circumcision
Physical cues for phimosis?
-irritation or bleeding in the prepuce
-dysuria
Physical cures for paraphimosis?
-pain and swollen penis
Irritation, erythema, edema, or discharge from penis are physical cues for both
phimosis and paraphimosis
What is hypospadias?
-when urethra opens on ventral surface of penis
What may happen if hypospadias is left uncorrected
-may cause erectile dysfunction
Physical findings of hypospadias?
-hx of unusual urine stream
-urethral opening off center/ not at tip of penis
-chordee (fibrous band that causes penis to bend downward)
-presence of absence of testicles in scrotal sac (cryptorchidism)
-hydrocele
-inguinal hernia
What is the treatment for hypospasias
surgery
What should be delayed in infants to help treatment for hypospadias
circumcision
Management of GI sx in cystic fibrosis include
-pancreatic enzymes
-high protein and calorie diet
-fluids
-fat-soluble vitamins
