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Pediatric Nursing Exam 2 > Fluid/Electrolyte Imbalance and GI Disease Objectiv > Flashcards

Fluid/Electrolyte Imbalance and GI Disease Objectiv Flashcards

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1
Q

Calculate daily maintenance fluid requirement

A

Allow 100 ml/kg for first 10 kg body weight

Allow 50 ml/kg for second 10 kg body weight

Allow 20 ml/kg for remaining body weight

Divide by 24

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2
Q

Increased fluid requirement

When does the child need increased fluilds?
6

FTR-VSB

A

Fever (fluid loss through skin, tachypnea)
Tachypnea (insensible loss)
Radiant warmer (preemies)(blue heater in NICU)
Vomiting and diarrhea
Shock
Burns

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3
Q

Decreased fluid requirements

A

Heart failure

Renal failure

Increased ICP (fluids can cause H20 shifts to brain->cerebral edema)

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4
Q

Identify and calculate normal expected urine output for a child

A

Normal urine output: 1-2cc/kg/hour

Minimum urine output = 1 cc/kg/hour

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5
Q

Identify the signs and management of dehydration in children

MILD

A

Slightly thirsty
Decreased urine

everything else is normal

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6
Q

Identify the signs and management of dehydration in children

MODERATE
9
ITT DDS MPO

A

-irritable
-tachycardia
-tachypenia
-dry mucous membrane
-decreased tears
-sunken anterior fontanel (15-18 months)
-moderate thirst
-prolonged cap refill (>2-4 seconds)
-oliguria (decreased urine)

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7
Q

Identify the signs and management of dehydration in children

SEVERE
LTTH-PTA-IPA

A

-lethargic, confused
-tachycardia
-tachypenia
-hypotension
-parched mucous membrane
-tears are absent
-anterior fontanel is deeply sunken
-intense thirst
-prolonged cap refill (>4 seconds)
-anuria (absence of urine)

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8
Q

Therapeutic Management of dehydration

Mild to moderate Dehydration? give when via what? continue to what?

Severe Dehydration?

A

Pedialyte for Mild to moderate Dehydration

Give small amounts frequently (teaspoon, cup, syringe every 5-10 minutes or via NGT)

Continue to breastfeed

Severe Dehydration- Hypovolemic Shock
Give Intravenous Bolus NS or LR

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9
Q

Hypovolemic shock
Most common cause of what?
Can be caused by?
Decreased fluid leads to what?

A

Most common cause of shock in pediatric patient:

Reduction in circulating blood volume r/t blood loss and extracellular fluid (ECF) loss.

Can be caused by:
Trauma
Burns (3rd spacing)
Gastroenteritis- vomiting/diarrhea

  1. Decreased blood/fluid volume
  2. decreased cardiac output
  3. decreased oxygenation and tissue perfusion
  4. organ failure
  5. death
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10
Q

Signs/symptoms of Hypovolemic shock
8

late sign?

A

Mental status- lethargic, unresponsive

Bradycardia

tachypnea

HYPOTENSION (late sign)

prolonged cap refill (3-4 seconds)

decreased peripheral pulse

skin is pale and cool

anuria

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11
Q

Management of hypovolemic Shock
two

A

-Stop the loss

-Replace fluid through IV fluid replacement NS or LR

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12
Q

Septic shock management

What’s crucial for survival?
What to do within 1 hour of arrival?
How do you correct hypovolemia?
How do you correct Vasodilation?
Labs?

A

Early Identification of Septic Shock is crucial for survival

Broad spectrum antibiotic administration (IV) within one hour of arrival

IV fluids 0.9 Normal Saline or Ringers Lactate (Correct Hypovolemia)

Epinephrine or norepinephrine (vassopressors) (Correct Vasodilation)

Labs: Blood culture, CBC, PT/PTT, Electrolytes, Urine culture & sensitivity (before we start antibiotics)

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13
Q

Rotavirus
How is it transmitted?
Most common cause of what?
Is it vaccine preventable?

A

Fecal-oral.

Most common cause of diarrhea in children 5 yrs.

VACCINE PREVENTABLE (e.g. Rotarix).

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14
Q

E. Coli

Transmission?
how/where can you get it?
E. Coli OH157:H7 linked with what?

A

bacteria
Fecal-oral

UNDERCOOKED BEEF
LETTUCE
PETTING ZOOS
produce

E. coli OH157:H7 linked with acute renal failure!!!!*

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15
Q

C.Diff

Transmission?
Results in what?
Not killed by what?
Most effective way to get rid of them?

A

bacteria

Adverse effect of antibiotic use.

Can also be fecal-oral. Results in severe colitis!

NOT KILLED BY ALCOHOL

Most effective way to remove them from hands is through WASHING HANDS - Probiotics

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16
Q

Meconium

What does it look like?
Should be passed when?
Should assess for what? 3

A

First stool

Sticky, greenish-black stool

Amniotic fluid and cells swallowed in utero

**Should be passed within 24 hours of life; if not, assess for:

1) Hirschsprung disease-lack of ganglion cells
2) Hypothyroidism-metabolism slow
3) Cystic Fibrosis -thick mucus

17
Q

Hirschsprung disease

Also called?
Absense of what?
Colon does what?

A

Also called congenital aganglionic megacolon

Absence of ganglion (nerve) cells in colon and rectum

Colon expands - accumulation of stool with distention *surgery needed

18
Q

Signs and symptoms of Hirschsprung disease

How is it diagnosed? three
Confirm diagnoses with what?

A

Delayed meconium passing,
Bilious vomiting
Large stools (older children)

X-ray, barium enema,

Confirm diagnosis with rectal biopsy

19
Q

Gastroesophageal reflux (GER)

healthy baby
Common in who?
How does it reslove?

A

Regurgitation of gastric contents into the esophagus (healthy babies)

Common-50% of infants < 2 months old are reported to have GER

Usually resolves spontaneously by age 1 year (88%)

20
Q

GERD (Gastroesphageal Reflux Disease)
Concern when?
What develops?

A

Tissue damage to esophagus

Concern when Failure to Thrive (FTT)

decreased growth

dysphagia develop

21
Q

Therapeutic Management of GER/GERD

  1. Feeding alterations in infant?
  2. Pharmacologic?
  3. Surgical intervention?
A

Step-approach

  1. Feeding alterations in infant
    Thickening feedings (rice)
    Upright positioning
    Frequent burping during feeds
  2. Pharmacologic : H2 receptor antagonists (Cimetidine, Pepcid)-reduce gastric hydrochloric acid secretion.
  3. Surgical intervention—Nissen fundoplication

(upper portion of stomach (fundus) is wrapped around bottom of esophogus, creates sphincter to prevent acid reflux)

22
Q

Acute appendicitis

Obstruction of what?
1st two pains?
symptoms?

Suspect appendix has ruptured when?

A

Obstruction of appendix

1st intermittent periumbilical crampy pain

2nd - Moves to McBurney’s point (RLQ)

Fever, nausea, diarrhea, vomiting, decreased appetite

Suspect appendix has ruptured if patient has a sudden relief of pain.

23
Q

How is acute appendicitis diagnosed?
two

A

Ultrasound

CT Scan

24
Q

Treatment of acute appendicitis

Non-ruptured?
Ruptured?

A

Non-Ruptured- laparoscopy surgery, IV antibiotics, can go home same day.

Ruptured- Can result in peritonitis - open abdominal surgery- substantial IV antibiotics, longer hospitalization

25
Q

Crohns disease (FISTULA)
what is it?
Symptoms?
Complication?

Ulcerative Colitis (NO FISTULA)

both have same symptoms

A

Inflammation is from from Mouth to anus.

‘skip lesions’

diarrhea
bloody stool
abdominal pain
fatigue
weight loss-malabsorption
growth retardation

Complication: fistula

26
Q

Ulcerative colitis (NO FISTULA)
what is it?

A

Diffuse inflammation of rectum and colon

27
Q

Management: Crohn’s and Ulcerative Colitis

Medication and pain management?

A

Medication:
Anti-inflammatory agents corticosteroids
chemotherapeutic
autoimmune
immunosuppressant
antibody treatment
tumor-necrosing factor
probiotics.

Pain management:
Nutritional supplements
Exercise
Hydration
Quality of life (hospitalizations, separation from family friends)

28
Q

Malformation occurs when?
What does Cleft lip result from?
What does Cleft palate result from?
Associated with what?

A

Malformation occurring during fetal development

Cleft lip results from incomplete fusion of the oral cavity

Cleft palate results from incomplete fusion of the palate

Associated with speech, feeding, and dental problems

29
Q

Management of cleft lip and palate

What is used to feed?
Surgical repair at what age?
post op management?

A

Feeding considerations
-Special Needs Feeder (Haberman)

Surgical repair at 3 months
-Post-op
-Manage pain
-Avoid pacifiers, spoons, sippy cups, and other sucking toys
-Elbow/arm restrains to arms

30
Q

Pathophysiology of (HPS)
hypertrophic pyloric stenosis

What is it?
Develops when?

A

Constriction of the pyloric sphincter with obstruction of gastric outlet

Not present at birth but develops in the first few weeks of birth

31
Q

Clinical manifestations of Hypertrophic Pyloric Stenosis?

What kind of vomiting?
Infant is always what?
what 2 things may occur?
What kind of mass is palpated?
What is the treatment?

A

Nonbilious PROJECTILE vomiting
(30 minutes to an hour after eating)

Infant is “always hungry”

Dehydration may occur

Metabolic alkalosis

Olive-like pyloric mass may be palpated in the upper abdomen

Surgery: Pyloromyotomy

32
Q

Patho of intussusception
Etiology?
Usually involves what?

A

Telescoping of one portion of intestine into another (Intestine then folds into itself)

Etiology unknown

Usually involves the small bowel

33
Q

Clinical manifestations of intussusception

Abdominal pain
What kind of mass is present and where?
How do the stools look?
What do the episodes look like?
Appetite?

How is it diagnosed?

A

*Abdominal pain: intermittent

*Palpable abdominal “sausage like” mass RLQ

*Currant jelly-like stools (mixture of blood and mucus

episodes of pain-infant draws knees to chest, excessive irritability and crying. In between these episodes, infant appears comfortable.

Decreased appetite

Diagnosed:
Clinical Symptoms
Ultrasound

34
Q

Management of intussusception

3

A

Air enema with or without contrast radiologically

Saline enema

Surgery to reduce or remove segment

35
Q

What is Short Bowel Syndrome

A

A malabsorptive disorder

Portions of the bowel damaged or missing

Usually as result of small bowel resection often related to necrotizing enterocolitis (NEC) in premature infant.

36
Q

Management of Short bowel syndrome

Nutritional support?
Monitor for complications associated with what?

A

TPN via enteral line
Enteral feeding

Monitor for complications associated with
central lines (infection)
TPN administration (liver failure)

Pediatric Nursing Exam 2 (4 decks)

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