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Final Exam Flashcards

1
Q

esophageal atresia

A

double end street, very small, picked up on sonogram
the upper esophagus does not connect to stomach

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2
Q

Tracheoesophageal Fistula is attributed to?

A

genetics, infection, teratogens but most often no cause is identifiable

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3
Q

what defects are esophageal atresias accompanied with?

A

vertebra, heart, kidneys, musculoskeletal and/or GI systems

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4
Q

nursing assessment of atresia

A

polyhydramnios which is the first sign because fetus is unable to swallow/absorb amniotic fluid in utero → causing accumulation
copious, frothy bubbles of mucus in mouth & nose with drooling (drooling newborn is not common normally)
Abdominal distention develops as air builds up in stomach
INFANT WILL LIKELY HAVE “THE THREE C’s”

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5
Q

the three Cs

A

for atresia
coughing, choking, and cyanosis with feeding

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6
Q

complications of fistula

A

respiratory complications such as pneumonitis and atelectasis
sounds congested
lungs take long to clear
call doc, we don’t diagnose!

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7
Q

nursing management of atresia and fistula

A

Prepare infant & parents for radiographic evaluation: Diagnosis made by XR, US or MRI
Upon diagnosis prepare for surgery if newborn stable
Needs IV, parenteral feedings, and surgery (esp with atresia, can’t absorb nutrients)

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8
Q

preop care for atresia and fistula

A

NPO, Elevate HOB, monitor hydration, administer parenteral IV, assess & maintain patency of orogastric tube (low suction), Oxygen & suctioning available, comfort measures to minimize crying & respiratory distress = non-nutritive sucking, educate parents and document infants condition frequently

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9
Q

postop care for atresia and fistula

A

Closely observe newborn’s body systems to identify complications, administer TPN & antibiotics until esophageal anastomosis is proven intact and patent.
Will be in the hospital for a while
Begin oral feedings, usually within 1 week of surgery
Keep parents informed of infants condition and progress
Assess feedings closely and report any difficulty with swallowing
Provide parental teaching → Demonstrate and Reinforce all teaching prior to infant discharge

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10
Q

omphalocele vs gastroschisis

A

omphalocele has sac
gastroschisis has no sac

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11
Q

omphalocele priorities

A

Bowel malrotation common, displaced organs usually normal
Associated with other anomalies
Heat loss! Keep everything nice and warm

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12
Q

gastroschisis priorities

A

exposure to amniotic fluid causes organs to be thick, edematous & inflamed → significant mortality and morbidity.
Usually seen on ultrasound
Protect the contents! Can’t touch it and introduce bacteria
Abdomen gets put in sterile bag (keeps it moist)
If you put them in a warmer, their bowel gets dry which is bad
Hypothermia and hypoglycemia are issues
Keep the bowel MOIST and STERILE

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13
Q

nursing assessment of gastro and omph

A

Diagnosed on prenatal US - helpful in planning for birth
Note appearance of protrusion and evidence of sac
Inspect sac for presence of organs - usually intestines but can include liver - careful to note any twisting of intestine (can lead to necrosis)
Note color of organs and size of sac
Most often associated with congenital anomalies involving cardiovascular, Genitourinary & Central Nervous System
Usually you have a heads up but if there’s no prenatal care, this is a surprise

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14
Q

nursing management*** of gastro and omph

A

prevent hypothermia! maintain perfusion to abdominal contents by minimizing fluid loss and protecting exposed contents
torso goes in sterile drawstring bowel bag
visualization of contents, reduce heat and moisture loss, allow radiant warmer heat to reach infant
orogastric tube on low suction to prevent distension
IV therapy and abx
monitor fluid status
report change in color or temp

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15
Q

postop care for gastro and omph

A

Surgical repair occurs after stabilization and evaluation - may occur in stages (not easy to repair)
Provide pain management, monitor respiratory & cardiac status, strict I/O monitoring, assess for vascular compromise, maintain orogastric suctioning, document amount and color of drainage, administer medications and treatments
BE ALERT FOR SHORT BOWEL SYNDROME (risk for FTT, malnutrition, etc)

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16
Q

anorectal formations

A

rectum may end in a blind pouch that does not connect to the colon or may have fistulas between the rectum & perineum (Vagina in females & Urethra in males)
BROWN PEE OR VAGINAL SECRETIONS

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17
Q

VACTERL syndrome

A

Vertebral, anorectal, cardiovascular, tracheoesophageal, renal and limb (Anomalies associated with Anorectal malformations)

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18
Q

surgery for high vs low type anorectal malformation

A

High type = Colostomy with revision later in growth
low type = close fistula, create anal opening & reposition of rectal pouch into the anal opening. Biggest challenge is both is finding, using, or creating adequate nerve/muscle structures around the rectum to provide for normal evacuation

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19
Q

nursing assessment of anorectal malformation

A

Observe for anal opening - if anal opening exists, observe for passage of meconium within first 24 hours
Assess for urine output to identify genitourinary problems
Common signs: Intestinal obstruction → Abdominal distension & bilious vomiting
Prepare infant & parents for US & abdominal XR

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20
Q

nursing management of anorectal malformations (preop)

A

Maintain NPO status & provide gastric decompression
Administer IV/antibiotic therapy
Monitor hydration status
Provide full explanation of defect, surgical options, potential complications, typical post-op course & long-term care need to the parents - prepare them for the need for ostomy - SUPPORT!!!!

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21
Q

nursing management of anorectal malformations (postop)

A

Pain relief
Maintain NPO & gastric decompression until normal bowel function restored
Provide ostomy care if applicable
Education of parents, return demonstration of ostomy care

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22
Q

common defects along with cleft lip/palate

A

heart defects, ear malformations, skeletal deformities & genitourinary abnormality

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23
Q

complications of cleft lip/palate

A

Feeding difficulties, altered dentition (teeth may not come in normally), delayed or altered speech development & chronic otitis media

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24
Q

cleft palate

A

Gagging, choking, and nasal regurgitation. Opening in palage contributes to fluid buildup in middle ear (otitis media with effusion) which can lead to infection or if not resolved hearing loss (temporary or permanent)

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25
Q

when are the clefts repaired

A

lip: 2-3m
palate: 6-9m
may need revision as child grows

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26
Q

nursing assessment of the clefts

A

Explore pregnancy risks including smoking, infection, advanced maternal age, use of meds in pregnancy
Inquire about feeding, respiratory difficulties as well as speech development and otitis media at office & hospital visits
Palpate palate with gloved finger to discover mild clefts
Make sure they don’t gag and choke during feedings
Don’t need bottle feedings (but if you do bottle you need a special one)! Breast also works great
Aspirating breast milk > aspirating formula
If they regurgitate milk from their nose, think cleft!
Have them suck finger to make sure they can
Bifid uvula needs further eval (branches off into two)

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27
Q

nursing management of the clefts

A

pain
nutrition (breastfeeding better, prosthodontic device as palate cover)
prevent suture line injury (side lying or supine, arm restraints)
bonding and support

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28
Q

what to avoid after cleft surgery

A

AVOID suction catheter, spoon, straw, pacifier or plastic syringe for cleft palate after revision (no type of additional pressure)

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29
Q

haberman feeder

A

CLEFT!!
LONG NIPPLE BOTTLE

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30
Q

hirschsprung disease

A

motility issue that results in obstruction
failure to pass meconium in 24h
lack of ganglion cells in intestine
more common in males
re-anastomosis of remaining intestine after bad part taken out
surgery occurs in stages
ostomy to let resected bowel heal before joining

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31
Q

nursing assessment of hirschsprung

A

Infant stool pattern is key to identification
If no meconium passed, may need rectal stimulation
Assess risk factors such as family history or Down Syndrome
Inspect abdomen for distention, palpate for presence of stool mass, perform rectal exam to assess tone & presence of stool - in Hirschsprung stool is usually not present However, it is possible that a child with Hirschsprung will have a forceful expulsion of meconium after finger is withdrawn following rectal exam
Barium enema may reveal intestinal narrowing

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32
Q

definitive diagnosis of hirschsprung

A

Rectal biopsy reveals absence of ganglion cells

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33
Q

postop/ostomy care for hirschsprung

A

close observation for enterocolitis
infant may have colostomy or ileostomy
ostomy care and skin breakdown
stool output

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34
Q

S&S of enterocolitis

A

Fever, abdominal distension, chronic diarrhea or explosive stools, rectal bleeding or straining. If noted notify provider immediately; maintain bowel rest, administer IV fluids and antibiotics to prevent shock and possibly death

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35
Q

complications after hirschsprung repair

A

Constipation, incontinence, diarrhea (short bowel)

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36
Q

treatment of Metatarsus Adductus & Clubfoot

A

stretching in mild cases and serial casting in severe cases before 8 months
fix before they start walking

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37
Q

4 categories of clubfoot

A

Postural: Short series of casting
Neurogenic: occurs in infants with myelomeningocele (spina bifida)
Syndromic is often resistant to treatment
Idiopathic occurs in otherwise normal infants

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38
Q

complications of clubfoot

A

deformity, rocker-bottom foot, awkward gait, lateral weight bearing & disturbance to epiphysis

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39
Q

management of clubfoot

A

Starts with weekly manipulation with serial casting, then casting every 2 weeks. Some infants require corrective shoes or bracing. Surgical release of soft tissue may be necessary in some infants - foot is immobilized in a cast for up to 12 weeks after surgery. Ankle-foot Orthoses (AFOs)/corrective shoes used for several years
Teach parents to look for redness, cool toes, skin integrity, etc

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40
Q

nursing assessment of clubfoot

A

family history of deformity or breech position
position of foot at rest
perform aROM
inability to move foot to normal position
XR shows bone abnormality and progress

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41
Q

nursing management of clubfoot

A

Perform neurovascular assessment & cast care
Make sure there’s good blood supply
Provide emotional support
Educate family about cast care and how to use orthotics & braces as prescribed

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42
Q

Developmental Dysplasia of the Hip

A

abnormality of the developing hip that can include dislocation, subluxation and dysplasia of the hip joint
Can be completely dislocated, subluxation is partial dislocation or in dysplasia the acetabulum is shallow or sloping instead of a cup shape.
Can affect one or both hips
More common in females
Breech presentation or oligohydramnios can contribute

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43
Q

complications of hip dysplasia

A

Avascular necrosis of femoral head, loss of ROM, recurrent hip instability, femoral nerve palsy, leg-length discrepancy & early osteoarthritis

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44
Q

nursing assessment of hip dysplasia

A

Obtain health history - family history, in utero risks, in undiagnosed cases older children complain of hip pain
Inspect asymmetry of thigh & gluteal folds (BIG sign)
Observe and document leg length discrepancy & trendelenburg gait, and limited abduction
Palpate through performing Barlow & ortolani tests to feel for a clunk

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45
Q

rule for hip dysplasia

A

WE HAVE 6 WEEKS TO TREAT
US in infants, US or XR in children 6 months & older
Moving the legs, feeling the click, have the child seen! But sometimes they wait until 6 weeks
Clicking can be normal within 1 hour of birth but NOT at 6 weeks
Breech and c section baby HAS to have ultrasound at 6 weeks

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46
Q

nursing management of hip dysplasia (pavlik harness)

A

Early recognition with early harnessing results in improved correction
Harness when started early continues for 3 months
Teach positioning for breastfeeding
Pavlik Harness: Keeps knees flexed & hips abducted to allow hips to grow normally (watch skin integrity!! Pressure ulcers, have a onesie on under this)
Keep harness on for most of the day. Remain compliant!

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47
Q

if pavlik harness doesn’t work?

A

In children older than 6 months or who do not improve with harness, surgical reduction is used
Post operative casting will be followed by bracing and orthotics
Pain management, monitoring for bleeding priority post op
Educate families about cast care and monitoring skin integrity

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47
Q

down syndrome

A

Associated with intellectual disability, characteristic facial features (slanted eyes and depressed nasal bridge) and other health problems such as cardiac defects, hearing and visual impairment, intestinal malformations and increased susceptibility to infections

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48
Q

therapeutic management of down syndrome

A

multiple disciplines: Primary Pediatrician, Cardiologist, ophthalmologist, gastroenterologist, PT, OT, speech, dietitians, psychologists, counselors, social workers, teachers and the parents. Focus is for optimal growth, development & function. Degree of disability & health issues varies greatly

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49
Q

managing complications of DS

A

congenital heart disease
High rate of constipation, celiac, hirschsprung & imperforate anus
some hearing loss - very susceptible to otitis media
eye disease
Obstructive Sleep Apnea
Increased risk of thyroid disease, primarily hypothyroid but can also have hyperthyroid
Increased risk for hematologic issues, anemia, transient leukemia, leukemia & polycythemia
Higher susceptibility to infection
Increased rate of obesity and delayed dental eruptions

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50
Q

Nursing management of DS

A

Promote growth and development
Prevent complications
Promote Nutrition
Poor suck & feeding due to low muscle tone - does usually improve as child develops but it’s a big issue when they’re babies (FTT or insufficient weight gain)
High fiber intake due to lack of muscle tone decreases gastric motility → constipation

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51
Q

neural tube defects

A

Thought to be related to drugs, malnutrition, chemicals, genetics that hinder CNS development
Supplementation with Folic Acid recommended to decrease neural tube defects prenatally
Spina Bifida is used to refer to all neural tube defects affecting the spinal cord. Spina bifida occulta is a defect of vertebral bodies without protrusion of spinal cord or meninges - not visible externally - generally benign.
Look for dimpling, abnormal patches of hair or discoloration of skin at defect site
Spina Bifida Cystica is a more serious defect

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52
Q

meningocele

A

less serious form of cystica
meninges herniate through defect in vertebrae
minor to no neuro defects
surgical correction

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53
Q

nursing assessment of meningocele

A

At delivery assess for external sac protruding from spinal area - mostly in lumbar region but can be anywhere on spine. Assess neurologic status, make sure herniation is covered by skin

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54
Q

nursing management of meningocele

A

Supportive care. Report any leakage of cerebrospinal fluid ASAP. General pre and post operative care, prevent rupture of sac, prevent infection and provide adequate nutrition & hydration. Monitor head circumference due to associated cases of hydrocephalus & ICP

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55
Q

myelomeningocele

A

Most severe form of neural tube defect, the clinical term Spina Bifida refers most often to this defect. Newborn has high risk for meningitis, hypoxia and hemorrhage. In this case the spinal cord usually ends at site of defect which results in absent motor and sensory function beyond that point. Long-term complications are paralysis, orthopedic deformities, and bladder/bowel incontinence.

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56
Q

hydrocephalus and myelomeningocele

A

Hydrocephalus common as CSF flow is blocked - the lower the defect the lower the risk of hydrocephalus

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57
Q

treatment of myelomeningocele

A

Require multiple surgical procedures
Need frequent catheterizations which increases development of latex allergy, frequent UTI, kidney damage due to pyelonephritis & hydronephrosis
Self catheterization
Multidisciplinary approach - neurology, neurosurgery, urology, orthopedics, OT, PT, Rehab, intense nursing care

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58
Q

nursing assessment of myelomeningocele

A

Assess at delivery, note visible external sac, is there leaking CSF, is sac intact, what is newborns general appearance, assess neurologic status and for associated anomalies (hydrocephalus). Flaccid paralysis, absence of DTRs, lack of response to pain or touch stimuli, skeletal abnormalities such as clubfeet, dribbling of urine, and a relaxed anal sphincter may be found
Older children always inspect skin for breakdown and determine motor capabilities

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59
Q

nursing management of myelomeningocele

A

Prevent infection
Keep sac from drying out, prevent trauma or pressure. Use sterile antibiotic soaked gauze.
Infant in warmer, no blankets but keep sac moist
Promote Urinary and bowel Elimination
Sometimes can train through use of timed enemas
Promote adequate nutrition
may prevent holding, may need to feed infant on side
Prevent latex allergic reaction - latex free environment
Maintain skin integrity
prone position - monitor bony prominences, keep infant clean and dry from constant dribbling of urine/stool

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60
Q

myelomeningocele education

A

Teaching starts immediately, focus on positioning, preventing infection, feeding, monitoring for ICP, skin integrity, intermittent catheterization. As child gets older, family becomes experts in child’s care - respect & recognize family’s changing needs - refer for support

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61
Q

congenital heart disease (CHD)

A

will maybe require
cardiac cath or surgery
huge risk in DS
blue babies

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62
Q

complications of CHD

A

Heart failure, hypoxemia, growth restriction, developmental delay, failure to thrive, and pulmonary vascular disease
After birth, the transition from fetal life to newborn circulation causes major shifts in pressure within the chambers of the heart which are
Defects can cause hypoxemia, resulting in clubbing of fingers, polycythemia (excess RBCs), exercise intolerance, hypercyanotic spells, brain abscess & stroke (CVA)

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63
Q

Disorders with decreased pulmonary blood flow

A

Tetralogy of Fallot & Tricuspid Atresia
Expect hypoxemia
SHUNTING FROM RIGHT TO LEFT
low O2 sats, kidneys make more RBCs to compensate, polycythemia makes blood viscous and hard to pump

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64
Q

Disorders with increased pulmonary blood flow

A

PDA, ASD, VSD
Louder sound=smaller hole bc forced blood flow (loud is not always bad)
Can be missed in the first week
Watch for CHF after surgery (too much blood flow to lungs)
SHUNTING LEFT TO RIGHT
heart failure or RV hypertrophy
tachycardia/pnea, feeding issues, NO OXYGEN NEEDED

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65
Q

obstructive disorders

A

SWEATING WHILE EATING!!!
Coarctation of aorta, aortic stenosis, pulmonary stenosis
coarctation: different BPs, not on sonogram, does well then tanks after 2-3w
stenosis: closing/starting to impede blood flow
narrowing of major vessel. increased pressure building up back towards heart, increasing workload

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66
Q

mixed disorders

A

Transposition of great vessels, hypoplastic left heart
Higher mortality rate but more surgery available
mixing of both types of blood
low oxygen blood everywhere, CO decreases, HF
feeding difficulties w cyanosis
SURGERY

67
Q

therapeutic management of CHD

A

surgical intervention, palliative care if we can’t save them, prostaglandin infusion after birth to maintain patency of Ductus Arteriosus to improve pulmonary blood flow

68
Q

cerebral palsy

A

range of non-specific symptoms characterized by abnormal motor pattern and postures caused by nonprogressive abnormal brain function. CP is the most common movement disorder of childhood and is lifelong. symptoms may be seen in infancy or early childhood
Can happen in utero or after birth
Decreased oxygenation to brain which causes damage
Caused by abnormal development or damage to the motor areas of the brain that causes disruption in brain’s ability to control movement & posture

69
Q

management of CP

A

Multidisciplinary
No standard treatment, this is their baseline, just manage where they’re at
Focus is to assist child to gain optimal development & function within the limits of disease
Primary concern is spasticity
PT, OT & Speech therapy are essential services with the earlier the treatment the better
PT focuses on gross motor movements
OT will focus on fine motor skill and also will use AFOs which can prevent deformity, can help mobility, maintain muscle & tendon length & to delay surgery (keeps legs straight)
Speech will help with communication even in non-verbal children through communication boards & electronics

70
Q

assessment of CP

A

Elicit detailed gestational and perinatal events
Be sure to ask about respiratory status due to risk of aspiration pneumonia - cough? Change in resp status?
Concerns for FTT due to feeding issues & weight loss
changes to muscle tone or spasticity?
Infants when supine may scissor crossing of legs or when prone may raise head higher due to arching of back
Primitive reflexes may persist beyond normal than healthy infant***

71
Q

management of CP

A

Focus on promoting growth and development through promotion of mobility and nutrition.
preserve ROM, delay contractures/deformities, provide joint stability, maximize activity and encourage use of adaptive devices.
Assess skin integrity when orthotics/splinting/casting
Pain management

72
Q

nutrition for CP

A

issues with chewing and swallowing due to poor motor control of mouth, tongue and throat leading to poor nutrition and growth. Special diets are needed with soft pureed foods to make swallowing easier. Proper positioning during feeding is essential to reduce risk of aspiration. Speech and OT assist in increasing strength of swallowing and to develop accommodations to increase nutritional intake. If swallowing issues are severe, child may need a g-tube placed

73
Q

early intervention for CP

A

under the age of 3

74
Q

muscular dystrophy

A

progressive muscle weakness and wasting of the voluntary (skeletal) muscles
absence or reduction in muscle protein (spinal cord is fine)
Definitive diagnosis is through muscle biopsy and DNA genetic testing

75
Q

duchenne muscular dystrophy

A

short life expectancy
can live into 30s now
x linked so mostly males affected
First affects hips, thighs, pelvis & shoulders but progresses to cardiac and respiratory muscles (causing short life expectancy)
Late walkers, enlarged calves as toddlers, clumsy in preschool years***. School-age children walk on their toes or the balls of the feet with a waddling gait.

76
Q

intelligence in duchenne

A

intelligence is normal, but many children do have a learning disability (not progressive, it’s just if they’re born with it)

77
Q

management of duchenne

A

No cure, however use of corticosteroids may slow progression of the disease.
side effects: Weight gain, osteoporosis and mood changes. Calcium and Vitamin D supplements help prevent osteoporosis and antidepressants may help with depression from chronic disease and effects of steroid use and muscle wasting. Beta-blockers and ACE inhibitors help decrease workload of the heart.
Braces/orthotics/mobility/positioning aids are needed

78
Q

nursing assessment of muscular dystrophy

A

Determine if child is showing developmental delay specific to muscle tone
If already diagnosed, inquire about progression of disease
Assess for need of assistive or adaptive equipment
Determine skills related to Activities of Daily Living (ADLs)
Look into history of cough, frequent respiratory infections, which occur due to weakening of respiratory muscles

79
Q

physical exam of muscular dystrophy

A

Observe child’s ability to rise from the floor looking for Gower’s Sign, assess gait, and effectiveness of cough. Auscultate lungs and heart - Tachycardia indicates weakening of heart muscle; note adequacy of respiratory effort

80
Q

gower’s sign

A

child can’t just stand back up, needs to do a bunch of maneuvers and climb their arms up their legs

81
Q

nursing management of MD

A

promoting mobility, maintaining cardiopulmonary function, preventing complications, and maximizing quality of life

82
Q

promoting mobility in MD

A

Administer corticosteroids & calcium supplements.
Encourage at least some weight bearing into a standing position to promote circulation, healthy bones and straightness of spine
Perform passive stretching & strengthening exercises, schedule during the day while child has the most energy
Encourage use of orthotics/AFOs

83
Q

maintaining cardiopulmonary function MD

A

Assess respiratory rate, depth & work of breathing. Position child for maximum chest expansion. Teach child and family deep breathing exercises and how to perform chest PT
Intermittent PPV & mechanically assisted coughing will likely be needed by adolescence.
Closely monitor cardiac status - assess for edema, weight gain, or crackles with strict monitoring of intake and output

84
Q

maximizing QOL for MD

A

Discourage long periods of bedrest that increase weakness
Develop schedule to provide appropriate stimulation while avoiding overexertion or frustration
Upper extremity weakness: bike; lower extremity: drawing
Assess educational status & depression symptoms
Administer antidepressants
multidisciplinary support
Provide genetic counseling regarding future pregnancies

85
Q

juvenile idiopathic artritis

A

inflammatory changes in joints causing joining pain, redness, warmth, stiffness & swelling. Stiffness occurs after periods of inactivity especially in the morning after sleeping. Some JIA can affect the eyes and other organs

86
Q

therapeutic management of JIA

A

inflammation control, pain relief, promotion of remission, and maintenance of mobility. NSAIDs, corticosteroids & antirheumatic drugs are prescribed for pain and to prevent disease progression

87
Q

nursing assessment of JIA

A

Note history of irritability & fussiness which can be the first sign of disease in infants or young children. Withdrawal from play or difficulty getting child out of bed are also common.
Fever is present with systemic disease (flare up)
Skin can have an evanescent, pale red, nonpruritic (not itchy) macular/round rash may be present with systemic disease
gait, limping, guarding of joint
possible delayed growth
joint edema, redness, warmth, tenderness

88
Q

nursing management of JIA

A

managing pain and mobility
Promote normal life
Chronic pain and decreased mobility can impact psychosocial status - providing adequate pain relief & meds that slow disease progression are very helpful
Encourage adequate sleep, warm bath before bedtime and warm compresses to affected joints with massage.
Encourage normal school attendance to prevent social isolation**, child may need to leave class early to make it to next class or accommodations for online learning during flares

89
Q

managing pain and mobility for JIA

A

Administer medications to control inflammation and disease progression
Maintain joint range of motion & muscle strength with exercise (PT or OT)
Swimming is excellent to maintain joint mobility with no pressure
Monitor for skin breakdown if using splints

90
Q

inguinal hernia

A

inguinal common in males and preemies
surgically corrected in infancy while umbilical resolve on their own by 3y
chance of incarceration and bowel strangulation (bad!)

91
Q

assessment of hernia

A

Hernias worsen during crying and straining. The provider may try to gently reduce the hernia, the nurse may assist by hold infant/child in place during reduction

92
Q

nursing management of hernia

A

Umbilical hernias rarely need surgical revision, nursing management involves educating parents that hernia is self-limiting and will likely resolve on its own. You can show parents how to gently reduce and advise if child looks like they are in pain or if hernia suddenly is not reducible, infant needs to be seen in ED.
IV in umbilical cord to keep pressure in preemies
black/blue or painful watch out!
Usually other hernias won’t rectify on their own so surgery is necessary

93
Q

hypospadias

A

urethral opening is on ventral side or bottom of penis
epispadias is ventral or top

94
Q

complications of hypospadias

A

Without surgical revision, can cause issues with urinary stream and erectile dysfunction leading to sterility. Thus repair usually occurs between 6-12 months of age
Fertility issues if urethra is at the top
CAN’T get circumsized

95
Q

nursing assessment of hypospadias

A

Inspect penis at birth for urethral placement
Chordee is a fibrous band that causes penis to curve downward
Palpate for testicles in scrotal sac because undescended testes is more common with hypospadias
Check for peehole on bottom of penis

96
Q

nursing management of hypospadias

A

routine postoperative care
Assess urinary drainage from urethral stent or drainage tube, make sure drainage tube is securely taped with penis in an upright position.
Maintain compression dressing that decreases edema & bruising
antibiotics
analgesics or antispasmodics for pain or bladder spasm
Double diapering
have parents DEMONSTRATE ability to irrigate catheter should a mucous plug occur. Tub baths are prohibited until penile dressing removed
Roughhousing, ride on toys or activities that involve straddling are not allowed for 4 weeks

97
Q

cryptochidism

A

undescended testicles
Can be linked to inguinal hernia, testicular torsion, congenital syndromes, testicular cancer/poor semen quality in adulthood.
Surgery if does not descend by 6-12 months of age

98
Q

nursing assessment of cryptorchidism

A

Palpate testes in scrotal sac during newborn assessment and notify provider if unable to palpate teste(s). Sometimes a child may have a retractile testis when it can be brought down into sac and will retract back into inguinal canal - this is not a true cryptorchidism.

99
Q

nursing management of cryptorchidism

A

Orchiopexy is the surgical procedure performed to bring testis down into the scrotal sac by 12 months of age. Post operative observation for signs of bleeding or infection are the main nursing concern.
Infertility because testes aren’t supposed to be warm
If you can milk it down we’re not as worried

100
Q

hydrocele

A

fluid in scrotal sac
resolves by 1y
if inguinal canal not closed, continuous communication of fluid or hernia to move into scrotum
black and blue is BAD
goes away in a week or two
can lead to torsion

101
Q

noncommunicating hydrocele

A

occurs when the canal closes with fluid still trapped in scrotal sac - watch for 12 months and if does not resolve will require surgical drainage, usually outpatient

102
Q

communicating hydrocele

A

changes size

103
Q

nursing assessment of hydrocele

A

Note enlarged scrotum that may decrease in size when lying down.
Inspect for fluid filled appearance
Ask parents if scrotum changes in size

104
Q

nursing management of hydrocele

A

Watchful waiting
If not improvement, refer to urologist
Reassure parents that hydrocele is not associated with infertility
Provide routine postoperative care

105
Q

torsion

A

medical emergency and may occur with hydrocele, cryptorchidism or hernia and is when the testicle twists and causing ischemia and if not treated in time infertility. Occurs most often in boys 12-18 but can occur at any age.

106
Q

S&S of torsion

A

Symptoms include sudden, severe scrotal pain. Patient may have swelling which may appear hemorrhagic or bluish black.
Needs immediate surgical revision to restore blood flow to testicle and to avoid necrosis and gangrene.
Not much time to save testicle!
Post Op care & pain management main nursing concern

107
Q

common symptoms of cancer in children

A

Pallor, fatigue, frequent/severe infection, or easy bruising. When a tumor is present, child may have bone or abdominal pain, pain in other body areas, swelling or unusual discharge

108
Q

risk vs benefit of treating cancer

A

impairs G&D

109
Q

adverse effects of chemo

A

infection, myelosuppression, nausea, vomiting, constipation, oral mucositis (painful sores, don’t wanna eat or drink, DEHYDRATION!), alopecia & pain

110
Q

long term effects of chemo

A

Dental impact, hearing & visual changes, hematopoietic, immunologic or gonadal dysfunction; endocrine dysfunction (altered growth/precocious or delayed puberty), various impacts to cardiorespiratory, GI and GU systems as well as secondary cancers in adolescence/adulthood

111
Q

adverse effects of radiation

A

more localized treatment
fatigue, nausea, vomiting, oral mucositis, myelosuppression, alteration in skin integrity at site***

112
Q

long term effects of chemo

A

r/t area of body where radiation occurred
alterations in growth, hormone dysfunction, vision/hearing alterations, learning issues, cardiac dysfunction, pulmonary fibrosis, hepatic/sexual/renal dysfunction, osteoporosis and development of secondary cancers

113
Q

Hematopoietic Stem Cell Transplantation

A

not first line of treatment
autologous: own cells but higher risk of relapse
allogenic: from donor, often a sibling but they’re not always best match

114
Q

stem cell saving

A

Best if you have multiple children
Should do for both children if you have two
Stem cells are garbage if child has cancer (don’t give cancer child their own stem cells)
Really only works for 80 pound child so around 12 years old

115
Q

risks of HSCT

A

Graft rejection and graft-versus-host disease are the biggest risks but risk of infection, electrolyte imbalance, bleeding, organ/skin/mucous membrane toxicities can occur

116
Q

long term effects of HSTC

A

impaired growth and fertility related to endocrine dysfunction, developmental delay, cataracts, pulmonary/cardiac disease, avascular necrosis of bone, and development of secondary cancers.

117
Q

common nursing analyses in child w cancer

A

Nausea from adverse effects of treatment
Alteration in nutritional status
Constipation from decreased gastric motility
Diarrhea from radiation therapy
Altered tissue integrity
Activity intolerance
Altered physical mobility
Bleeding risk
Risk for infection

118
Q

therapy for cancer

A

Use of acetaminophen over NSAIDS are preferred due to risk of bleeding
Ginger (capsules/tea/candy) is helpful in the treatment of nausea
Foot massage can decrease pain associated with chemo (neuropathy)
Use of a cooling cap during chemo may minimize hair loss

119
Q

leukemia

A

disorder of bone marrow
normal cells replaced w abnormal WBCs
chronic progress slowly

120
Q

management of ALL

A

chemo to eradicate leukemic cells and restore bone marrow function

121
Q

3 stages of chemo treatment

A

Induction, Consolidation, maintenance

122
Q

nursing assessment of ALL

A

Full description of present illness, chief complaint, and health history
take child’s temperature (fever common due to immunosuppression, not first priority though), look for petechiae (bruising easily), purpura, or unusual bruising due to decreased platelet levels. Inspect skin for signs of infection. Auscultate lungs, note adventitious breath sounds that can indicate pneumonia either present at diagnosis or from treatment. Note location and size of enlarged lymph nodes and palpate liver/spleen for enlargement.

123
Q

nursing management of ALL

A

Focus is on managing complications such as infection, pain, anemia, bleeding, hyperuricemia and other adverse effects of treatment. May require blood transfusions. Reducing pain is also a major focus as child has pain due to both disease and treatment - most commonly experience pain of the head, neck, legs and abdomen.

124
Q

relieving pain in ALL

A

Use of distraction techniques, can help take child’s mind of pain. Administer acetaminophen for acute pain. EMLA cream is helpful prior to any punctures as well as applying heat and cold. Finally, narcotics use for severe pain or palliatively
Heat, cold, and massage use gate control theory

125
Q

AML

A

more resistant to treatment so they need more intense bone marrow suppression and prolonged hospitalization
toxicity from treatment is more common and serious
prolonged chemo after remission, HSTC often required

126
Q

nursing assessment of AML

A

health history, common signs and symptoms such as recurrent infections, fever & fatigue. Note skin pallor and salmon-colored or blue-gray papular lesions. Palpate skin for rubbery nodules, lymphadenopathy. Note headache, visual disturbance, signs of ICP such as vomiting indicating CNS involvement and possible brain metastasis

127
Q

nursing management of AML

A

similar to child with ALL. Focus is on managing adverse effects of treatment and prevention of infection

128
Q

lymphoma

A

hodgkin and non-hodgkin

129
Q

hodgkin lymphoma

A

REED STERNBERG CELLS***
link to epstein barr virus
starts in one area of lymph nodes then multiples
compresses nearby structures and invades other tissue
more common in adolescents and young adults

130
Q

classifications of hodgkins

A

Asymptomatic
B symptoms

131
Q

B symptoms

A

fever
night sweats
weight loss (>10%)
be hot, be wet, be skinny!

132
Q

complications of hodgkins

A

liver failure & secondary cancer

133
Q

nursing assessment of hodgkins

A

Explore symptoms of disease including recent weight loss, fever, drenching night sweats, anorexia, malaise, fatigue, or pruritus. Evaluate respiratory status, as the mediastinal mass can compromise respiration. Palpate lymph nodes, hepatomegaly & splenomegaly

134
Q

nursing management of hodgkins

A

address effects of chemo and radiation

135
Q

non-hodgkin

A

mutation of B and T lymphocytes
affects lymph nodes deep in body, spreads to blood
rapidly proliferating malignancy VERY responsive to treatment
long term survival after treatment but we need to pick up on it QUICK

136
Q

complications of non-hodgkins

A

metastasis & development of secondary cancer later in life

137
Q

remission of non-hodgkins

A

induced with chemotherapy and followed with a 2 year maintenance phase of chemo. CNS prophylaxis is used as can easily spread to CNS system
autologous HSCT may be used

138
Q

nursing assessment of non-hodgkins

A

children are usually only symptomatic for a few days or weeks before diagnosis because of the quick progression of disease. Note onset & location of pain or lymph node swelling. Document history of abdominal pain, diarrhea, or constipation. Observe for increased work of breathing, facial edema, or mediastinal mass

139
Q

nursing management of non-hodgkins

A

management of adverse effects of chemotherapy

140
Q

brain tumors

A

low grade (localized, better prognosis)
high grade (more invasive)

141
Q

complications of brain tumor

A

Hydrocephalus, ICP, brain stem herniation, and negative effects of radiation including neuropsychological, intellectual and endocrinologic sequelae
as they grow it exerts pressure on surrounding brain tissue causing ICP, cerebrospinal fluid, or causes edema in the brain.

142
Q

hydrocephalus with brain cancer

A

may require a ventriculoperitoneal shunt

143
Q

for a brain tumor, who gets radiation

A

children over 3y because of long term effects

144
Q

nursing assessment of brain tumor

A

Take full history and chief complaint, common for child to have N/V, unsteady gait, blurred/double vision, seizure, motor abnormality, weakness, swallowing difficulties, personality/behavior change, irritability/FTT/developmental delay in younger children (all r/t pressure in brain)
strabismus, nystagmus, Sunsetting eyes, head tilt, gait disturbance, alteration in sensation or gag reflex. Note cranial nerve palsy, lethargy, irritability, child’s posture and pupillary reaction. DTRs may show hyperreflexia
DECREASED BP WITH INCREASED ICP

145
Q

nursing management of brain cancer (preop care)

A

Monitor for signs of ICP, avoid activities that cause transient ICP, give dexamethasone to decrease intracranial inflammation. Stool softener to decrease straining during BM. Assess LOC, vitals, pupillary reaction.
Educate family on what to expect including possible shunt placement or intubation, ICU tour, address shaving partial or full head of hair

146
Q

postop care for brain tumor

A

fluid restriction bc cerebral edema
vitals, LOC, pupillary reaction
INCREASE IN TEMP=INFECTION, cerebral edema, or hypothalamus disturbance
acetaminophen for fever and sponge baths
assess and treat pain
minimize stimuli
monitor head dressing for CSF/blood
temp restraints, may be combative
PLACE CHILD ON UNAFFECTED SIDE (bc can’t handle secretions) WITH HOB FLAT OR ANGLE PRESCRIBED
DONT ELEVATE FEET
observe for signs of brain herniation

147
Q

S&S of herniation

A

nuchal rigidity, head tilt, sluggish pupils, increased BP with widening pulse pressure, change in respirations, bradycardia, irregular pulse and changes in body temp → NOTIFY PHYSICIAN ASAP if any symptoms appear

148
Q

neuroblastoma

A

a tumor that arises from embryonic neural crest cells and is the most common extracranial tumor in children.
In a very complicated spot, cant remove it, covered by nerve endings or blood vessels/spinal cord, need to do chemo first to shrink it then get rid of it
Most frequently is found in the abdomen, mainly adrenal glands, but can occur anywhere along the paravertebral sympathetic chain in the chest or retroperitoneum
When diagnosed past infancy/early toddlerhood, usually has already metastasized. (past like 1yr)

149
Q

prognosis of neuroblastoma

A

depends on tumor stage, age at diagnosis, location of tumor, and location of metastasis. If metastasis to bone has occurred, prognosis is poor, as well in children whose cancer relapses.
Complications include metastasis or nerve compression that leads to neurologic deficits

150
Q

assessment of neuroblastoma

A

Health history, signs and symptoms will depend on location of primary tumor and metastasis. The parents may notice a swollen or asymmetric abdomen. Note any bowel or bladder dysfunction, especially watery diarrhea, neurologic symptoms (brain metastasis), bone pain (bone metastasis), anorexia, vomiting, or weight loss.

151
Q

physical exam of neuroblastoma

A

Note neck or facial swelling, bruising above eyes, or edema around the eyes (due to metastasis to skull bones). Inspect skin for pallor or bruising (bone marrow metastasis) and document any cough or difficulty breathing. Auscultate lungs for wheezing. Palpate for lymphadenopathy, abdomen for firm and nontender masses. Note if hepatomegaly or splenomegaly present

152
Q

nursing management of neuroblastoma

A

Postoperative nursing care depends on site of tumor removal, usually abdomen. Provide routine care after abdominal surgery.
Care of chemotherapy and radiation side effects
Provide emotional support to child and families, provide referrals for resources to help with coping - usually, tumor is found after metastasis leading to poor prognosis

153
Q

sarcomas (bone tumor)

A

occur in the bone and soft tissue of children. Bone tumors are most commonly diagnosed in adolescence, while soft tissue tumors are more often diagnosed in younger children.
Radiation slows down but you will need amputation
Most common bone tumors in children are Osteosarcoma & Ewing Sarcoma

154
Q

osteosarcoma

A

arises from embryonic tissue that forms the bones and most commonly is found in the child’s long bones such as the proximal humerus, proximal tibia & distal femur

155
Q

complications of osteosarcoma

A

Metastasis, commonly to the lungs and other bones, with recurrence within 3 years often showing in lungs
Surgical removal is required, with chemotherapy both before and after surgery. Radiation is not helpful. Radical amputation may be performed although in adolescence they often will undergo a limb sparing procedure when possible

156
Q

nursing assessment of osteosarcoma

A

obtain health history and note when pain, limp or limitation of motion was first noticed. Dull bone pain may have been present for several months before gait changes. Inspect limb for swelling, palpate for warmth and tenderness

157
Q

nursing management of osteosarcoma

A

Adolescence will be very anxious about amputation, provide support. Provide routine pre and post operative care. Educate regarding proper wound care. Focus is on support, connecting teen with others who have either lost a limb or been treated for similar cancer, support in helping to choose clothing that masks prosthetic

158
Q

ewing sarcoma

A

highly malignant tumor that is more rare and occurs most frequently in the pelvis or femur. 25% of children will show metastasis to the lungs, bone and bone marrow and prognosis is dependent on metastasis. Usually treated with chemotherapy, Radiation, and surgical excision in combination. May receive myeloablative chemo that kills bone marrow so child can get a stem cell transplant

159
Q

nursing assessment of ewing sarcoma

A

Look into history for intermittent pain that progressively worsens, note history of fever and if pain eventually becomes so severe it interferes with sleep.
Ask “when they ______, does it awaken them from sleep?) could be growing pains but requires further evaluation

160
Q

nursing management of ewing sarcoma

A

Before treatment, discourage active play or weight bearing on affected extremity to avoid pathologic fracture at the tumor site. Focus is on addressing adverse effects of treatment. Be open and honest with child, long treatment and hospital course - help child work through psychological impact of diagnosis

161
Q

wilms tumor

A

renal tumor, usually occurs between the ages of 2 to 5 years old. Generally is unilateral but can affect both kidneys. Wilms tumor grows rapidly and is usually very large by time it is diagnosed.
Metastasis most often is to perirenal tissue, liver, diaphragm, lungs, abdominal tissue, and lymph nodes. Prognosis depends on staging, extent of metastasis - survival in stages 1 & 2 is 91%.

162
Q

complications of wilms tumor

A

metastasis or complications from radiation such as liver or renal damage, female sterility, bowel obstruction, pneumonia, or scoliosis

163
Q

treatment of wilms tumor

A

surgical removal of affected kidney (nephrectomy) with chemotherapy and radiation before and after surgery

164
Q

nursing assessment of wilms tumor

A

Health history, parents usually notice abdominal mass and then seek medical attention. Note abdominal pain, usually related to rapid tumor growth. Document history of constipation, vomiting, anorexia, weight loss, or family history of cancer. Often associated with several congenital abnormalities and syndromes

165
Q

physical exam of wilms tumor

A

Measure BP as 25% of children may have hypertension, inspect abdomen for asymmetry or visible mass, observe for associated anomalies, auscultate lungs for adventitious lung sounds associated with metastasis and palpate lymphadenopathy

166
Q

nursing management of wilms tumor

A

Focus is on postoperative care centered around a child undergoing abdominal surgery. Assessment of remaining kidney function is CRITICAL.
Manage adverse effects of chemotherapy and radiation

Peds (4 decks)

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