Midterm Flashcards
RENAL: fx.’s of the renal system
the following are processes seen in those >2 of age:
- formation and excretion of urine
- regulates F&E
- regulates acid-base balance
- regulates BP
- stimulates RBC production in the marrow
RENAL: pediatric variation in renal system
infant’s and child.’s total body H2O constitutes a large fraction of their weight
the 1st 2 y of life the kidneys are less efficient at regulating F&E and acid-base balance [inefficient conservation of F&E]
child. <2 y.o. do not ave the mature innervation of stretch receptors in the bladder wall to maintain bladder control [do not recognize sensation of having to urinate]
the urethra is shorter in child. and the kidneys do not have much fat pads [risk for trauma]
the urethral opening is closer to the anus in girls [risk for infection]
RENAL: enuresis
“bed wetting”
considered enuresis if child is developmentally >5 y.o., occurs 2x/week for >3 m., w/ urgency/ frequency
- stress or diabetes insipidus are risk factors for 2o enuresis
tx: drugs [tofranil (anticholinergic), oxybutynin (same)], bladder trining, fluid restriction in evenings, interruption of sleep to void
RENAL: UTI
most common serious bacterial infection in child. that is the result of bacteria ascending to the bladder via the urethra [commonly, e. coli]
risk factors: infant/ young child. [b/c of shorter urethra], female >1 y.o.; urinary tract obstructions, voiding dysfunction, anatomic differences, susceptibility to infection, urinary retention
s/s: infants [fever/hypothermia, irritability, dysuria, change in urine odor/ color, poor weight gain, anorexia, lethargy], child. [abd. pain, frequency/ urgency, dysuria, enuresis, fever
prevention: teach good hygiene, avoid irritants, cotton underwear, adequate fluid intake, empty the bladder regularly
RENAL: normal urinalysis
pH: 5-9 specific gravity: 1.001-1.035 protein <1-2 color: pale yellow-deep gold clarity: clear amount: 1-2 mL/kg/h no glucose, ketones, hgb, nitrites, casts
RENAL: vesicoureteral reflux
occurs when urine flows from the bladder back into the ureters and renal pelvis
risk factors: incompetent valvular mechanism at the uretervesicular junction, UTI
risks: renal damage
s/s: fever, dysuria, frequency/ urgency, nocturia, hematuria, flank/ abd. pain, UTI
tx: prophylactic antibiotics 1-2 m post-op, establish voiding pattern
RENAL: obstructive uropathy
structural and functional abnormalities of the urinary system that interferes w/ urinary flow
risks: hydronephrosis [accumulation of urine in the renal pelvis b/c of obstruction], UTI, renal insufficiency, kidney damage
s/s: abd. mass/ pain, UTI w/ frequency/ urgency/ dysuria, sepsis, hematuria, incontinence
tx: surgical correction
NI: monitor F&E, discharge teaching for management of urinary drains/ diversions
RENAL: types of urinary diversions
ureterostomy
- ureters outside of the abd. wall
vesicostomcy
- surgical opening into the bladder in which the bladder wall is brought to the surface of the abd.
– seen in child. w/ spona bifida, since innervation o the bladder muscles do not work due to malformation of the spinal cord
ileal conduit
- ureters are removed frrom the bladder and attached to the ileum [acts as a bladder]
RENAL: cryptorchidism
undescended testes
failure of normal prenatal descent of testes during 7th-9th month of gestation
s/s: small/ asymmetrical scrotal sac, absent testes
risks: sterility, testicular cancer
tx: surgery
NI: pain management, wound care
RENAL: phimosis
narrowing or stenosis of the perputial opening of foreskin, preventing retraction of the foreskin over the glans
- may be a normal finding in infants and young child.
risks: balanitis [inflammation of foreskin]
RENAL: hypospadias and epispadias
hypospadias: urethral opening on ventral surface of penile shaft; often w/ chordee
epispadias: urethral opening on dorsal surface
tx: surgery [do not perform circumcision on this infants; skin from foreskin is going to be used for reconstruction purposes]
- goals of surgery: normal voiding, cosmetically appropriate, normal urinary/ sexual fx
RENAL: hydrocele
peritoneal abd. fluid in the scrotal sac that entered via a patent channel from the abd. to groin
can be diagnosed using transillumination of the scrotal sac
risk factors: inguinal hernia, NB
tx: surgical repair if fluid is not reabsorbed by 1 y
RENAL: bladder exstrophy
protrusion of posterior bladder wall through incompletely fused anterior bladder and abd. wall that exposes lower urinary tract structures
often seen w/ epispadias and other GU abnormalities
NI: pre-op [maintain sterility and moisture of area, protect surrounding skin]; requires multiple surgeries [repair, continent diversion, reconstruction of genitalia]; post-op [prevent infection, monitor urinary fx., antibiotics, encourage fluid intake, no “straddle toys for 2 w, no swimming/ baths until stent removed]
RENAL: acute post-streptococcal glomerulonephritis
most common childhood renal disease w/ peak ages of 5-7 y immune complexes get trapped in kidneys > inflammatory response >obstruction of glomerular flow > reduced filtrate production
causes: AGN occurs 1-2 w p/ group A-B hemolytic strep. infection [can be caused by other organisms]
risks: HTN, HTN ENCEPHALOPATHY, SEIURES, CARDIAC DECOMPENSATION FROM HYPOVOLEMIA, inflammation > altered glomerular structure and fx. of kidney, infection > antibody-antigen rx., uremia, ACUTE RENAL FAILURE
s/s: hematuria, mild-moderate edema, HTN [b/c of activation of renin-angiotensin system], pale, lethargic irritable, anorexic
dx: ELEVATED ANTIBODY TITERS/ ESR/ specific gravity/ BUN and creatinine
NI: MONITOR BP/ fluid balance/ mental status [HTN > seizures], med.’s [anti-HTN, loop diuretics, anitbiotics]
RENAL: nephrotic syndrome
autoimmune process that occurs 1 w after an immune assault; may be idiopathic or 2o to glomerular damage [lupus, diabetes]
common in male child. ages 2-3 y
risks: increased glomerular basement membrane permeability [esp. to protein] > abnormal losses; permamnent glomerular damage, peritonitis
s/s: HYPOALBUMINEMIA, PROTEINURIA, HYPERLIPIDEMIA, dark foamy frothy urine, slow weight gain [due to edema (anasarca)], anorexia, irritability
tx: corticosteroids [inflammation], IVIG [autoimmune disease]
NI: fluid restriction if appropriate, strict I&O, daily weights, monitor lab values, diet w/ normal protein and hi kcal and no salt
GI: pediatric variation in GI system
mouth
- very vascular, entry for infections
esophagus
- muscle tone of LES not developed until 1 m > regurgitation
stomach
- capacity much smaller than adult, gastric acid reaches adult level by 6 m [can cause irritation since the stomach of a 6 m. o. is still small in comparison to an adult stomach]
intestine
- infant has 250 cm of small intestines, adults 600 cm
- fetal intestines are outside abd. until 11 w gestation
biliary system
- liver large at birth [palpable], pancreatic enzymes not mature until 2 y. o.
GI: cleft lip and palate
congenital anomaly, most common craniofacial malformation where there is an incomplete fusion of embryonic soft tissues and/or palatal arch
risk factors: maternal smoking/ ETOH use/ folic acid deficiency/ young; use of dilantin, depakote, dioxin during preg.
risks: aspiration, choking, infection
tx: surgery [cheiloplasty for lip, staphylorrhaphy for palate], speech therapy
NI: encourage PO feeds [breast feed]
GI: cleft lip and palate surgery
cheiloplasty, cleft lip repair
- repair usually done when infant is 10 w and weighs 10 lbs
- post-op care: suture line care, avoid sucking or prolonged vigorous crying, keep in supine/ side-lying position, arm restraints [prevent placing hands in mouth]
staphylorrhaphy, cleft palate repair
- post-op care: prone position [prevents aspiration of blood/ drainage from suture], pack wound, soft diet
GI: gastroschisis
herniation of the abd. viscera outside the abd. cavity through a defect in the abd. wall to the side of the umbilicus
risks: heat loss, fluid loss, infection, perforation
NI: pre-op [protect protruding abd. organs; place NG/OG to decompress; thermoregulation, F&E deficits [strict I&O, daily weights], infection], post-op [ventilator care, infection, maintain F&E, long-term TPN, pain control, vascular compromise]
GI: omphalocele
intraabdominal contents herniated through umbilical cord w/ failure of the liver and intestines to return to the and. when the abd. wall begins to close
the defect is enclosed by a translucent sac into which the umbilical cord insects
associated w/ other congenital anomalies
NI: pre-op [protect protruding abd. organs; place NG/OG to decompress; thermoregulation, F&E deficits [strict I&O, daily weights], infection], post-op [ventilator care, infection, maintain F&E, long-term TPN, pain control, vascular compromise]
GI: esophageal atresia and tracheoesophageal fistula
failure of embryonic development and separation of trachea and esophagus
EA: abnormal development of esophagus; TEF: abnormal connection b/w trachea and esopahgus
often part of other congenital anomalies:
- VATER syndrome: Vertebral, Anal, Tracheal, Esophageal, Radial and Renal dysplasia
- VACTERL syndrome: Vertebral. Anal, Cardiac, Tracheal, Esophageal, Renal, Limb
s/s: polyhydraminos in utero, frothy saliva w/ drooling, coughing/ choking/ cyanosis, aspiration of feeding ? aspiration pneumonia
NI: pre-op [NPO, suctioning, NGT to evacuate contents], post-op. [NGT/ GT to suction, PN [PO feed p/ 5-7 days post esophagram], monitor resp. complications
GI: abd. hernias
protrusion of muscle wall or organ through abd. opening
types:
- diaphramatic: medical emergency b/c it prevents development and expansion of lungs; sx.’s: nasal flaring, retractions, low pulse ox., tachypnea/cardia
- umbilical: can be pushed back in
- inguinal: can be pushed back in
risks: constriction of opening > impairment of circulation
tx: surgery
GI: meckel’s diverticulum
most common deformity of the GI system where the omphalomesenteric duct [connects the mid-gut to the yolk sac] fails to atrophy during weeks 5-7 gestation
it leaves an out-pouching that contains gastric/pancreatic tissue; secretes HCl acid/ pancreatic enzymes
s/s: irritation, bright red rectal bleeding [no pain]
tx: surgery
GI: GERD
GER [gastroesophageal reflux] is a normal physiologic process during 1st y of age; GERD is when it occurs p/ 1st y
s/s: poor weight gain, irritability, frequent regurgitation, chest pain, hematemesis [irritation of acid to esophagus], cough, abnormal neck posturing [sandifer syndrome]
risks: mucosal tissue damage, failure to thrive, dysphagia, pneumonia
tx: med.’s [H2RA, PPI’s]; nissen fundoplication [apex of stomach get wrapped around LES to create pressure to prevent backflow]
NI: position appropriately, soften feeds
GI: constipation
defined as an alteration in frequency, consistency or ease of passing stools
a NB should have a meconium movement during the 1st 24-36 h of life
causes: NB [atresia, hypothyroidism, cystic fibrosis, imperforate anus], infant [same + diet], child. [diet, psychosocial]
GI: appendicitis
inflammation occurs b/c of obstruction of appendiceal lumen caused by hard fecal mass, parasite, stenosis, tumor
risk factors: high sugar and low fiber diets
risks: rupture of appendix > fecal/ bacterial contamination of the peritoneum
s/s: RLQ pain [mcburney’s point], rebound tenderness, low grade fever
tx: hydration, surgery, antibioctics [if ruptured]
GI: pyloric stenosis
hypertrophy and hyperplasia of the pyloric muscle
s/s: projectile vomiting, dehydration, failure to thrive, visible left-to-right peristalsis [muscles thicken to force food through], mass right to umbilicus
tx: sx. relief, pyloromyotomy [repair of sphincter]
NI: pre-op [NPO, IV, NGT], post-op. [slow PO feed introduction, post-feeding position]
GI: intussusception
it is an intestinal obstruction where the intestine telescopes into itself
s/s: acute flares of abd. pain, vomiting, abd. mass, late sign [jelly stools,, abd. distention]
risks: cuts off circulation to tissue
tx: enemas, surgical reduction
NI: pre-procedure [NPO/ NGT, assess abd./ stools], post-procedure [assess for reduction of intussusception/ passing of contrast medium, fluid management]
GI: hirschsprung’s disease
congenital absence of autonomic parasympathetic innervation in segment[s] of the colon
s/s: NB [no meconium stool, anorexia, vomiting, abd. distention] child. [failure to gain weight, abd. distntion, constipation, RIBBON STOOLS [FOUL SMELLING]
risks: ENTEROCOLITIS, absent peristalsis in segment affected, collection of bowel > distention > perforation > peritonitis
tx: surgery [anastomoses], temp. colostomy
NI: pre-op [monitor for bowel perforation/ F&E/ abd. distention, antibiotics/ bowel prep.], post-op. [wound/ostomy care, monitor GI system, fluid management]
GI: celiac disease
results from inappropriate immune response to the dietary protein gluten [found in barley, rye, oats]
s/s: common [diarrhea, fatigue, borborygmus (hyperactive bowel sounds), abd. pain/ distention, weight loss, flatulence], uncommon [osteopenia, N/V, iron-deficiency, neuro. dysfunction, constipation]
risks: malignancies
dx: serology antibody screening [check for IgA], genetic testing
GI: biliary atresia
progressive inflammatory process that causes fibrosis of intra-extrahepatic bile ducts > obstruction
s/s: increased bilirubin, CLAY-COLORED STOOLS, failure to gain weight
tx: < 3 m of age [intra-operative cholangiogram], fat-soluble vit.’s supplementation, kasai procedure [segment of intestine is anastomosed to create bile drain]
GI: necrotizing enterocolitis
inflammatory disease of the intestinal tract
s/s: feeding intolerance, abd. distention, BLOODY DIARRHEA, heme + stools
risks: short-gut syndrome
tx: OG/NG tube IV/TPN, antibiotics, bowel rest, surrgery [if perforated]
RESP.: how does a child’s resp. system differentiate b/w an adult one?
chest size and shape - may be barrel-chested abdominal breathing increased rib pliability - muscles are able to work easier shorter and narrower pharynx and airways - increased risk for obstruction and inflammation increased compliance - allows lungs to expand w/ ease but they can also collapse just as easy fewer alveoli - continually increase until puberty surfactant - not present until p/ 34 w gestation obligatory nose breathers apnea - <20 s can be normal
RESP.: otitis media
it is a middle ear infection by HIB or s. pneumoniae
since the eustachian tubes are shorter and horizontal it causes fluid to get stuck and creates breeding ground for infection
risk factors: allergy, 2-hand smoke, supine feeding, reflux of feedings, constant pacifier suckling
s/s: earache, irritability, fever, head rolling, anorexia
tx: antibiotics [allow 48 h for infection to spontaneously go away], analgesics, surgery [indicated recurrent or prolonged infections]
NI: hearing screening [risk for hearing loss], provide teaching on ear care for child.
RESP.: otitis externa
“swimmer’s ear”
an infection of the ear canal [outer ear] that develops in child. whose ears are exposed to persistent, excessive moisture [> loss of cerumen which minimizes bacterial growth]
s/s: PAIN, itching, edema, redness
tx: topical antibiotics/ steroids [for inflammation]; keep dry; no foreign objects
RESP.: tonsillitis
associated w/ pharyngitis
causes: viral, group A beta-hemolytic strep. [GABHS], rheumatic fever, acute glomerular nephritis
s/s: fever, sore throat, hoarseness, dysphagia, mouth breathing, exudate, lympadenopathy
tx: viral [warm gargles, fluids, moisten air, bedrest], bacterial [PCN], tonsillectomy
NI: post-op [lay on abd. or side to decrease risk of aspiration on drainage], assess for secretions [frequent swallowing], avoid red drinks [to distinguish blood], prevent airway obstruction]
RESP.: acute laryngotracheobronchitis
a type of croup
causes: parainfluenza vira, RSV, flu virus, m. pneumoniae
infection and sx.’s are slow progressing
s/s: increasing resp. distress, inspiratory stridor, suprasternal retractions, barking cough
NI: O2, epi. [opens airways], fluid support, rest
RESP.: epiglottitis
a type of croup
s/s: DROOLING, DYSPHAGIA, DYSPHONIA, DISTRESSED RESP. EFFORTS
NI: MAINTAIN AIRWAY; do not leave child unattended until treated, do not stimulate area as it could trigger complete airway obstruction, IV antibiotics [steroids]
RESP.: pertussis [whooping cough]
an acute resp. infection by bordatella pertussis where there is a think, sticky mucus secreted in the throat that makes breathing, eating, drinking difficult
it is highly contagious and has a high morbidity and mortality rate
risk factors: child. < 4 y.o. not immunized w/ DTaP
RESP.: bronchiolitis
an acute viral infection of the bronchioles [most often RSV] where there’s asymmetric air trapping in alveoli and atelectasis, hypercapnia
it is transmitted by droplets
risk factors: fall/ winter [peak]/ spring months; ages 2-5 m
s/s: mild URI to harsh persistent cough, tachypnea, retractions, nasal flaring, wheezing, crackles, poor feeding, fluid depletion
dx: CXR, serum culture
tx: respigam/ synagis [synthetic antibodies to RSV], bronchodilators, antivirals
NI: resp. assessment, O2 therapy, maintain patent airway, elevate HOB, fluids, rest
RESP.: resp. syncytial virus [RSV]
infects the lungs and breathing passages
risks: bronchiolitis [most common], pneumonia
s/s: presents as a common cold [fever, runny nose, decreased appetite, coughing, sneezing, irritable, and decreased activity]
RESP.: pneumonia
causes: infants [GBS, chlamydia], infants [RSV, parainfluenza, steptococcal], child. [mycoplasma, viral]
RESP.: apnea
cessation of breathing > 20 s or shorter if accompanied by bradycardia or cyanosis
this is an acute life-threatening event [ALTE]
normal finding during the 1st week of life
types: central [no effort, no movement; shorter in length], obstructive [effort with no air movement], mixed [longer in length]
RESP.: asthma or reactive airway disease [RAD]
chronic inflammatory disorder of airways due to allergic response
IT IS A TRIAD OF INFLAMMATION, BRONCHOSPASM, AND INCREASED SECRETIONS
allergens/ triggers: insects, animals, irritants foods, med.’s, infection, exercise, cold air
s/s: episodes of COUGH, wheezing, dyspnea, increased work of breathing, restlessness
tx: long-term [anti-inflammatories, steroids], rescue [bronchodilators
NI: maintain airway [hydrate, chest PT, positioning], monitor resp. status, neb. tx. [assess breathing a/ and p/ tx.]; decrease exposure to triggers
RESP.: bronchopulmonary dysplasia [BPD]
chronic lung disease of NB mostly associated w/ prematurity and mechanical ventilation
presence of fibrotic airway, alveolar changes, edema of bronchioles, hypertrophy of bronchial smooth muscle
risks: pulmonary edema/ HTN, CHF
s/s: adventitious resp. sounds, resp. distress, hypoxia, secretions, failure to thrive
tx: O2 and ventilatory support
RESP.: cystic fibrosis
atypical chloride secretion in resp. system and exocrine glands causing thickening of resp. secretion and of GI & GU secretions
risks: hemoptysis, pneumothorax, bacterial colonization, cor pulmonale, intussusception, GERD, diabetes, portal HTN, gallstones, decreased fertility
s/s: resp. [frequent infection, wheezing, dyspnea, cough, barrel chest, clubbing], GI [frothy, greasy, foul-smelling stools; increased appetite; tissue wasting and growth failure; abd. distention; ADEK deficiencies]
dx: genetic testing, sweat test [for Cl], pancreatic enzymes
NI: chest physiotherapy, postural drainage, pancreatic enzyme replacement; hi protein, hi kcal diet; multivit.’s
F&E: why are child. vulnerable to alteration in fluid and electrolyte imbalance
higher portion of water content and greater body surface area
inability to shiver or sweat to control body temp.
greater proportion of fluid, Na, and Cl in the ECF
higher metabolic rate
immature kidneys and GFR
greater insensible water loss
F&E: fluid requirements
increases w/ fever, diarhhea, vomiting, DI, high output renal failure, burns/ shock tachypnea
decreases w/ HF, renal failure, increased intracranial pressure, SIADH
maintenance calculation:
- 1-10 kg [100 mL/kg]; 11-20 kg [1000 mL + 50 mL/kg]; > 20 kg [1500 mL + 20 mL/kg]
– divide total by 24 h to get mL/hr requirements
F&E: potassium [K]
the predominant intracellular electrolyte
influences kidney fx, helps regulate acid-base balance, enzyme rxn.’s, maintains neuromuscular excitability
deficiency
- cause: diuretics, med.’s, CHF, GI losses, nephrotic syndrome, alkalosis
- s/s: muscle weakness, constipation, arrhythmias, cardiac sx.’s occur p/ < 3.0 is reached
tx: replacement therapy
toxicity
- cause: cell destruction; reduced renal fx., metabolic acidosis, severe dehydration, blood transfusion, low insulin levels in diabetes
- s/s: skewed EKG’s, arrhythmia; potential MI
- tx: diuretics, diet changes, insulin [if appropriate]
F&E: sodium [Na]
the most abundant electrolyte in the ECF
influences kidney regulation of body water and electrolytes
deficiency
- free water moves from IV to interstitial space until osmolarity of the compartments are equal
- acute episode > cerebral edema
- causes: dilute formula; increased water replacment, GI fluid loss, diuretic, SIADH, tumor, CNS disorders, adrenal insufficiency
- s/s: anorexia, confusion, lethargy, seizures, cramps, increased reflexes, watery diarrhea
tx: Na replacement over 24 h
toxicity
- when leves are high,, kidneys secrete ADH to retain water
- causes: excessive Na intake, fever, insufficient breast milk intake
- s/s: thirst, lethargy, confusion, seizures
- tx: eliminate the cause of excessive intake, monitor neuro status, monitor neuro status
F&E: calcium [Ca]
imp. for physiological fx., nerve, muscle, secretion of hormones, bone formation, and clotting of the blood
parathyroid hormone is major regulator of plasma Ca concentration
deficiency
- infants are more prone
- causes: inadequate intake, vit. D deficiency, cow’s milk given to infants; hyperphosphatemia
s/s: increase muscle excitability [tetany], seizures, arrhythmias, risk for MI
- tx: Ca and/ or vit. D replacement, avoid cows milk
toxicity
- conditions: malignancy neoplastic disease, immobilization
- s/s: decreased neuromuscular activity, constipation, anorexia, N/V, dry mouth, bradycardia
- tx: increase fluids, monitor ECG
F&E: acid-base balance ranges
pH 7.35-7.45 PCO2 35-45 PaO2 80-100 BD-BE -4 - +4 HCO3 20-23
F&E: maintenance of acid-bas balance
buffers that help maintain normal pH: bicarbonate, proteins
the kidneys helps maintain normal pH by regulating bicarb. and hydrogen ions
the body lowers serum pH by increasing inspirations
F&E: respiratory imbalances
resp. acidosis
- diminished or inadequte pulmonary ventilation
- increased PCO2, decreased serum pH
- seen in head injuries, use of narcotics, CNS infections, chest wall trauma, pneumonia, CF
resp. alkalosis
- increased pulmonary ventilation
- increased serum pH, decreased PCO2
- seen in reflex CNS stimulation from fever, spesis, HF, anemia, overventilation
F&E: metabolic imbalances
metabolic acidosis
- loss of too much biarb. or gain of too much acid
- deccrease in pH, decrease HCO3, increased lactic acid
- seen in diarrhea, high fevers, salicylate ingestion, endocrine, renal and metabolic disorders, CHF, increased metabolic rate
metabolic alkalosis
- loss of too much acid or gain of too much bicarb.
- elevated CO2, urine pH and plasma HCO3
- seen in vomiting or suctioning, diuretic therapy
F&E: dehydration
types:
- isotonic
– common, F&E loss in same proportion as they exist in the body, plasma Na remains normal
- hypotonic
– electrolyte loss > fluid loss
– shock, seizures are frequent
- hypertonic
– water loss > electrolyte loss
– dangerous, requires specific fluid therapy
– seizures, neuro. damage
NI: mild-moderate d. [oral rehydration sol’n. [not water], breast milk, small amounts, no drinks with CHO], severe [MEDICAL EMERGENCY; increase vascular volume then replace losses, LR’s or NSS until sx.’s of dehydration go away]
F&E: vomiting
can be spitting up, regurgitation, projectile, self-limiting [w/ infectious origin]
causes: infections, GI obstruction, increased ICP, toxic ingestions, food intolerances and allergies
F&E: diarrhea
result of abnormality of digestion, absorption, secretion that can involve stomach, small/ large intestines
causes: acute [infectious: e. coli, shigella, salmonella, campylobacter], chronic [malabsorption, allergies, lactose intolerances, parasites
tx: antibiotics [if necessary], rehydrate
F&E: causes of gastroenteritis
viral
- norovirus- most common virus; fecal-oral; s/s [acute-onset vomiting, water non-bloody diarrhea w/ abd. cramps, low-grade fever
- rotavirus- immunization available; s/s [vomiting, diarrhea, moderate fever]
- adenovirus- no virus specific tx; also causes resp. illness
parasitic
- giardiasis- most common parasite; s/s: diarrhea, vomiting, anorexia, poor growth [constipation, loose stools in > 5 y.o.]; tx [furazolidone, quinacrine]
- enterobiasis- s/s [anal itching (scratching cause reinfestation), NO DIARRHEA, restlessness]; oral route]; tx: mebendazole, pyrantel
- interventions: monitor family, wash hands, cut fingernails, diaper hygiene, disinfect diapering areas
HEME: blood forming organs
early production of blood cells [hematopoiesis] in the fetus occurs in the liver until 5 months gestation
bone marrow is the major hematopoietic organ; takes over after 5 months gestation
thymus produces lymphocytes
liver is the 1o source for production of the most blood clotting factors
the spleen creates a balance between blood production and destruction of cells
HEME: anemia
a decrease in the amount of serum Hgb
- there can be a decrease in # of RBC’s, reduction in RBC hgb content, or reduced volume of packed RBC’s
causes: rapid blood loss, slow production of RBC’s
types: iron deficiency, sickle cell, vitamin-deficiency…
s/s: mild [asymptomatic], moderate [fatigue, palpitations, dizziness, pica, CHF, murmur, abd. pain, N/V, H/A, impaired mental status], chronic to severe [growth retardation, delayed sexual maturation]
HEME: iron deficiency anemia
risk factors: low SES, premmie’s, twins or >, adol.
causes: excessive whole mmilk intake in infants, impaired iron absorption, blood loss, inadequate intake or iron
dx: low HH and serum ferritin
tx: correct underlying cause, replace depleted Fe via diet or ferrous sulfate, frequent rest periods
HEME: sickle cell anemia
normal Hgb is partially or completely replaced by abnormal Hgb S causing the sickle-shaped RBC
types: vaso-occlusive, sequestration, aplastic crisis
risk factors: hypoxia, increased need for O2 [trauma, fever, stress], increased blood viscosity [from dehydration]
risks: rigidity of cell, occlusion of cap. blood flow > engorgement and tissue ischemia, hypoxia
risk factors: afro.-ame.’s
dx: blood from um. cord, NB screening, genetic testing
tx: HYDRATION, O2, rest, pain management, antibiotics
NI: monitor s/s of infection and neuro/ cardio/ resp. complications
HEME: vaso-occlusive crisis v splenic sequestration crisis v aplastic crisis
all are types of aplastic anemia
vaso-occlusive crisis
- common; SEVERE PAIN, fever, arthralgias; stasis of blood w/ clumping of cells > ischemia > MI
splenic sequestration crisis
- LIFE THREATENING; blood pools in spleen; profound anemia, hypovolemic shock, liver/ splenic congestion
aplastic crisis
- diminished production and increased destruction of RBC’s; triggered by viral infection or depletion of folic acid; profound anemia, pallor, bone marrow depression, dyspnea
HEME: thalassemia
anemia results from defective synthesis of Hgb, structurally impaired RBC’s and shortened life of RBC’s
risks: chronic hypoxia [H/A, bone pain, anorexia, epitaxis
s/s: beta [protruding forehead, maxillary prominence, wide-set eyes, flattened nose], CHR, hepatosplenomegaly, fibrotic pancreas, decrease bone mineralization, fractures, jaundice
dx: NB screen, CBC, fam. hx.
types: alpha, beta
- beta has four sub-types: minor, trait, intermediate, MAJOR [“COOLEY ANEMIA”; REQUIRES TRANSFUSION TO SURVIVE]
tx: beta major [normalize Hgb, transfusions, splenectomy [hemolysis site], BM transplant]
HEME: hemophilia
a group of hereditary bleeding disorders that result from deficiencies of specific clotting factors
types: A, B, von willebrand disease
s/s: mild-moderat ebleeding, spontaneous hemarthrosis, easy bruising
dx: prolonged PTT, decreases in factor IX and VIII, genetic testing
tx: factor replacement, DDAVP [vasopressin], gene therapy
NI: when bleeding [elevate site above heart, immobilize site, avoid bleed aggravating therapies]
NI: avoid rectal temp.’s/ NSAIDS, venipuncture [use peripheral finger sticks], IM inj., use only electric razor
HEME: hemophilia A v hemophila B v von willebrand disease
all are types of hemophilia A - classic; factor VIII deficiency B - "x-mas disease"; factor IX deficiency v.w.d. - v.w. factor [a plasma protein, carrier for factor VIII] deficiency
HEME: hemarthrosis
blood in the joint
it is a sx. of hemophilia
tx: immobilize joint, promote vasoconsstriction, pain management, restrict weight bearing and excessive movements x 48 h [begin ROM exercises p]
HEME: idiopathic thrombocytopenia purpura [ITP]
autoimmune disorder where there is an increased destruction of platelets despite normal platelet production
risk factors: viral infection
s/s: easy bruising, multip. ecchymoses, petechiae of mucous membrances/ sclera, hematuria/ tar stools
dx: decrease platelet count, anti-plt. antibodies, BM aspiration
tx: IVIG [reduces autoimmune response], steroids [inflammation], splenectomy [if med.’s fail]
NI: monitor plt. count/ bleeding/ neuro. status
HEME: henoch-schonlein purpura
condition that develops in association / viral/ bacterial illness
risks: nephrotic syndrome
s/s: vasiculitis [IgA deposits] in skin, get and kidneys
tx: sx. relief [corticosteroids]
HEME: lead poisoning
can be inhaled or ingested w/ 10 mcg/dL of blood
risk: renal [damages proximal tubule cells], hematologic [synthesis of heme], and neuro. [increases membrane permeability] systems
tx: chelaton therapy [binds and removes lead from circulating blood but not in bones] + Ca disodium edetate + succimer
NI: monitor kidney fx [lead excreted via kidneys]
prevention: adequate Ca and F, small frequent meals [heavy metals absorbed more in high acid env’t.]
