Module 2 Kiddos Flashcards
Diagnostic eval of appendicitis
Mcburney point, CBC, UA, CT/MRI
Therapeutic mgnt of appendicitis
ruptured appendix can occur w/in 48 hr, peritonitis, ileus
surgery
What are the complications of Meckel diverticulum (congenital malformation), an extra potch in the GI tract
PAINLESS ANAL BLEEDING
currant jelly stool
abd pain
bleeding
obstruction
inflammation
This mf need surgery fr fr trust trust
Describe the dx eval of IBD
ESR, CBC, CRP, Stool samples, biopsy, endoscopy, colonoscopy
what causes IBD
gut microbiome, environmental factors, stress, autoimmune
what is the management of IBD
induce and maintain remission
HIGH PROTEIN HIGH CAL
Sx options- subtotal colectomy, ileostomy
what are some meds for IBD
mesalamine, olsalazine, steroids, immunomodulators
Skip lesions are associated with what IBD
Crohn’s
S/S of IBD
joint pain, weight loss, anorexia, rectal bleeding
what can cause hepatitis
Epstein- Barr
CMV- no pregnant people around if positive
chemicals
drugs
what are the special precautions for hepatitis
special drug dosing
acute hepatitis s/s
jaundice, fatigue, malaise, RUQ pain, n.v
biliary atresia can lead to what
biliary fibrosis -> obstruction
persistent jaundice for 2 weeks leads to a suspicion of what
biliary atresia
what does the stool of biliary atresia
grey stools (absence of bile)
these mf are also super itchy
what is the management of biliary atresia
nutritional support
Kasai
what are some tests for biliary atresia
cbc, liver, TORCH, US, Hida,
parvovirus B19 is the cause of what disease
fifths disease (red cheeks)
Cleft lip/palate happens when
embryonic development
when is surgery for the repair of the cleft lip/palate recommended
2-3 months; at minimum before 12 months of age due to the possible affect ont the speech
cleft palate can be breastfed. true of false
FALSE- nook nipples with wide base,
cleft lip can be breastfed. True or false?
TRUE- SNS feeding system
what are education points for parents of cleft lip/palate
no pacifiers, no straw, NO SUCTION
hypertrophic pyloric stenosis s/s
PROJECTILE VOMITING 30-60 MIN AFTER THEY FEED
can be bilious or not
US- olive-like mass
metabolic alkalosis
after surgery what is expected for hypertrophic pyloric stenosis
vomiting for 24-48 hr
intussusception s/s
SEVERE PAIN
kids tend to curl up into ball
cramping, abd mass, currant jelly stools
management of Intuss
hydrostatic reduction- the sx was successful when you have normal brown stools
what are 4 characteristics of celiacs
steatorrhea
general malnutrition
ABD distension
secondary vitamin definitely
rare to see in AA and Asian
more likely to get if already autoimmune
celiac disease is AKA
gluten-induced enteropathy
celiac sprue
Nursing ed for diet in a pt with celiac
AVOID HIGH FIBER AND LACTOSE (severe mucosal damage) if bowel is inflammed
what is the minimum piss in a day for a kiddo
3 times a day
fever and vomiting with no cold symptoms can lead to a suspicion of what
UTI
what is lower UTI involving
urethra and bladder
upper is ureters, renal pelvis, calyces, renal parenchyma
if a boy has UTI s/s but doesn’t have one what is the cause of these s/s
constipation
what is phimosis
stenosis of foreskin around the glans of the penis DONT TRY TO MOVE THAT FORESKIN
Phimosis leads to balanitis. what is it
bacterial/fungal infection
Tx- steroid cream BID x one month
hydrocele resolves on its own. T or F
true; it is the presence of peritoneal fluid in the scrotum
if it persists past 12 months then sx is an option, no straddle toy
what are some mgmt of cryptorchism
orchiopexy (sx) after 6 mnth of age ->decrease risk of torsion. no straddle toy for 2-4 weeks
hypospadias is managed by how
surgery 6-12 months (NO CIRCUMCISION)
bladder spasms are managed with oxybutynin
what is a chordee
the ventral curve of PENIS
When is testicular torsion most common
13 years
S/S of testicular torsion
swelling, pain, warm, immobile, n/v, ABSENT CREMASTERIC REFLEX
in epididymitis the cremaster reflex is present
When does sex differentiation occur in gestation
7 wks
S/S of congenital adrenal hyperplasia (CAH)
adrenal insufficiency, hypoglycemia, hypovolemia, hyponatremia, hyperkalemia
What are the different types of ambiguous genitalia
bilateral cryptorchidism, perineal hypospadias with bifid scrotum, clitoralmegaly, posterior labial fusion
primary enuresis
secondary enuresis
primary- always been pissing
secondary- new onset of pissing in bed
when is a medical eval recommended for enuresis
1 time a month for three months
managment of eruresis
rule of organic causes, elimination of fluids after evening meals, bedwetting alarm, meds (desmopressin, oxybutynin, tofranil), avoiding caffeine or sugar, no shaming or scolding
desmopressin s/e
HA, nausea, hyponatremia
Nephrotic syndrome s/s
2-7 years age
albumin is lost in urine
massive protein in the urine
facial edema in the morning
abd swelling, diarrhea/anorexia
management of nephrotic
corticosteroids are first-line (behavioral issues, decreased immune, weight gain, Cushing, cyclosporine, salt restriction, fluid restriction)
educate about pneumonia vax
what is the cause of acute glomerulonephritis
pneumococcal, streptococcal and viral infections
s/s of acute glomerulonephritis
cola/tea/cloudy/smoky urine
3+4+ protein in urine
hematuria
facial edema that spread to extremities
high BP
increased BUN, Cr
test for acute glomerulonephritis
throat culture, ASO titer, chest x ray
hemolytic uremic syndrome (HUS) is the most common cause of what in kiddos
AKI
what is associated with diarrhea in children
rickettsia (tick), e coli, pnemoccoci, sheglla
management of HUS
dialysis, FFP, Blood transfusion
AKI principle feature
oliguria
complications of AKI
hyperkalemia, water intoxication, hyponatremia, HTN(antihypertensive drug), seizure, anemia, seizure
the diet recommended for AKI
high carb low fat
CKD
more than 50% of kidney function is gone
manifestation of CKD
increase BUN, Cr
h2o and Na++ retention
hyperkalemia
Ca and Phos disturbance
anemia
metabolic acidosis
diet for CKD
low protein, vitamin D (suppression of parathyroid hormone)
what is the most dangerous form of dehydration
hypertonic dehydration (Na+=>150)
what is the percentage of water loss that is considered severe in infants and children
> 10% in infants
6% in children
what are the s/s of dehydration
change in loc, decrease tear production, decrease elasticity of skin, decreased urine, increase HR, decrease BP
EARLIEST SIGN- INCREASED HR AND DRY MM
What is the tx of dehydration
Oral rehydration (ORT/ORS)- pedialyte or sugar free gatorade or Powerade
Iv fluids
what do we educate the parent about for a child that is dehydrated and need to rehydrate however they refuse to drink
syringe, squirt every 5-10 min
what can acute diarrhea be associated with
URI, UTI, Antibiotic
chronic diarrhea is classified by having it for how long and what is the possible cause
> 14 day is considered chronic
caused by gastroenteritis, rotavirus, Crohns, UC
when a parent asks about how long the diarrhea can last how long do you respond with
10 days so be concerned about skin integrity and dehydration
what can cause gastroenteritis
E. coli, rotavirus(mild to moderate grade fever), salmonella, c diff (antibiotic use)
what is the difference of salomella and e coli stool and s/s
what is something a pt should avoid when having diarrhea and is dehydrated
caffeine
how should we instruct a parent with a dehydrated infant to rehydrate them
rotate between breast milk and pedialyte. for formula babies get a lactose free one and rotate as well
if meconium is not passed within 24-36 hrs of life what is suspected
hirschprungs, hypothyroidism, or meconium plug
then thermometer rectal stimulation or glycerin suppository
how long does it take for infants to adapt to solid foods in their bowl
weeks
what kind of fruit make you poop
the ones that start with p
peaches plum pears ect
what are common causes of constipation in childhood
trying to hold it too often, nutrition, stress
can boys have UTI s/s but actually is constpation
yes; true
when doing a “three day clean out” using miralax and Senna (or other stimulant laxative ; is it recommended to go to school
hell nah. man they going to be shitting big shits fr fr
what is s/s of hirschsprung
poor feeding, vomiting, distending, can lead to enterocolitis
what are the diagnostic eval of Hirschsprung
xray, barium enema, anorectal manometric exam, rectal biopsy to confirm
what are some post op nursing thing to look out for after surgery to fix a hirschsprung
monitor fluid and ion, s/s of shock and bowel perforation
N/V, increase tenderness and increased abd distention, cyanosis
biled emesis can be caused by what
small bowel obstruction
curled emesis/ early emesis is caused by what
poor gastric emptying or high obstruction
what age is gastroesophageal reflux (GER) most common
4 months of age
trigger for GER
coughing sneezing overeating
s/s of GER
fussy after eating, chest burn, cough,
should we medicate GER?
no; as long as the patient is not losing weight
can last up to a year
if yes then H2 blockers, PPIs (30 min before feed)
what are the stressors of hospitalization for kiddos
separation anxiety(more so toddlers)
lack of control (temper tantrum, magical thinking)
interruption of routine
Loss of autonomy
fear of permanent injury, death
illness viewed as punishment
separation of peer group
what are risk factors that increase vulnerability to stressors of hospitalization
difficult temperament
lack of fit between child and parent
age (6 month-5yr, male)
male gender
below average intelligence
repeat hospitalization
parental reposes to stressor
disbelief anger guilt (sudden onset of illness)
fear anxiety (the seriousness of illness)
frustration (related to the need of info, chronic illness)
depression
sibling reaction to hospitalization
loneliness, fear worry
anger, resentment, jealously
guilt
preventing and minimizing separation in the hopistal
family centered care
parents are not visitors
familiar items from home
presence (being close, talking quietly)
cultural beliefs
normalizing hospital environment include what
maintain child routine
freedom of movement
time structuring
self care
school work
friends and visitors
provide opportunity of play
positioning for femoral venipuncture, extremity venipuncture, lumbar puncture, bone marrow biopsy
femoral- frog leg position (supine)
extremity- stabilization (wrap the baby tightly)
Lumbar position- side lying or flexed (HA is common)
bone marrow/aspiration- frog leg
med admin
oral- mix with apple juice or sauce (SMALL AMOUNT, HOUSE HOLD TEASPOON VARIES ALOT SO WE TEACH ABOUT A SRINGE)
IM injection (<1mL TB syringe) avoid Doral gluteal for children under 10 for danger of hitting the sciatic nerve
how to put on a collection bag for a clean catch
start from the perineum and move up
Its okay for a scrotum in the bag
if you suspect UTI you can Cath them
what are to be included for pain assessment
pain intensity- behavior, self reporting
satisfaction of tx
symptoms and adverse affects
emotional respons
economic factors
what is recurrent pain
reoccurs every three months or more. frequently
what is chronic pain
3 months or more
what are some pain rating scale
FACES (Wong baker)
CRIES
NIPS
FLACC
COMFORT (unconscious neonate)
Numeric scale
pediatric pain questionaire
young vs old infant pain response
young - cry, rigid, grimace, thrashing
older- may withdraw
younger child vs school age pain response
younger- loud cry, and screaming attempts to push away
school age- stall tactics young child behaviors
adolescents pain response
less vocal protest, less motor activity
what is most effective non-pharm technique for need related pain
distraction and hypnosis
pharmacologic two step approach is what
children >3month
start with non opioid 1st
morphine is opioid of choice
codeine is not recommended for children under 12
when can a child have fent
> 12 years
what two opioids go into PCA
morphine or hydromorphone
how do you use refrigerant spray
dab on cotton ball and dab
what are the coanalgesic drugs
diazepam, midazolam, amitriptyline, gabapentin
s/s of cancer
pain, prolonged fever, easy bruising, swollen lympnodes, white eye refelx, wt loss, mass or swelling, HA
when is a tumor best removed from sx
when it is encapsulated
nursing considerations for chemotherapy
free flowing IV line, stop immediately if infiltration, known to cause anaphylaxis (monitor for a hour after )
what is the major consideration for HSCT
they have to wipe out the immune system, so there is no back up you are officially fucked not even cooked
how do you calculate absolute neutrophil count
ANC= total # of neutrophils (polys, seg, and band) and multiply by WBC
when an infection is suspected in a cancer pt what is given
broad spectrum (bacterium a self drug) until cultures come back
what are the most lethal organisms to cancer pt
varicella, HSV, herpes zoster, RSV, FLU, CMV, pseudomonas, staph,
when a pt is anemic do we restrict activity
NAH they can go as tolerated
what is given for N/V in cancer
promethazine (phenergan), prochlorperazine (compazine)
metoclopromide (regaln)
weed
give antiemetic within 30 min to one hour prior to chemo regularly for 24 hr after
what are extrapyramidal side effects
muscle twitching, agitation, grimacing usually from phenergan, compazine
why do you not give viscous lidocaine to kids
risk of aspiration
nurse intervention for stomatitis
bland, moist, soft diet
chg or salt or bicarb mouth wash
sucralfate, diphenhydramine, maalox (magic mouth wash)
relax eating pressures
stool softeners warm sitz baths
are wigs tax deductible
yes
neurological effects of cancer
decreased bowel innervation, foot drop and weakness, numbness of extremities
what is a possible complication from HCST
Graft vs host disease
what nurse education would you give for a pt receiving HCST
no live vax, siblings can receive, if they received a vax 2 weeks prior they will need to be revax
s/s of leukemia
cold that won’t go away, weight loss, petechia, hepatospleenomegaly
when Is a leukemia pt considered in remission
lest than 5% of blast cells in bone marrow
when is leukemia most common
boy>girl 2-3 yr old
when is Hodgkins lymphoma most common
15-19 yr
s/s of Hodgkins lymphoma
painless enlargement of lymph nodes (cervical and clavicular), nonproductive cough, unexplained abd pain, fever, anorexia, nausea, weight loss, pruritus
what are diagnostics for Hodgkins
CBC, ESR, CRP, CXR, MRI, PET, +Reed stern burg cell (multinucleate immune cells)
non-hodgkins s/s
burkitt lymphoma is associated with this disease
similar to Hodgkins s/s but lymphoid tissue compression of various organs may cause obstruction
s/s of brain tumors
depends on location size and rate of growth
HA on wakening up, vomitting not r/t to eating, nystagmus, ataxia, dysarthria, DI, delayed/ precocious puberty, growth failure
T or F? Brain tumors are common in kids
true but rule out other organic causes of s/s like glasses, screen, dehydration, sleep
what is the gold standard for diagnostics for brain tumors
MRI but CT can be used if not available
nursing intervention for post op brain surgery
s.s of IICP(pupils, loc, bp, HA, agitation, photophobia, coma, posturing, vomiting without nausea
never move on the side of the craniotomy
if starts vommiting Make them NPO
where does osteosarcoma happen
in the long bones
s/s localized bone pain, palpable mass, limping, resist activity
what is the tx of osteosarcoma
limb salvage, ambutation
this does not respond to radiation
where is Ewing sarcoma
shaft of long bone, pelvis, femur, tibia, ulna, vertebrae, sacalpula, rib, skull
radiation is effective
s/s of wilms tumor
swelling or mass in abd, in deep in flank, nontender
ONCE WE CONFIRM THE DIAGNOSIS DONT PALPATE THE ABDOMEN
vincristine s/e
causes ileus, monitor bowel sounds
what diagnostics for films tumor
abd studies, CBC to rule out polycythemia, US, CXR, chest CT
s/s of retinoblastoma
leukocoria (cat eye reflex), strabismus, blindness
metastasis is rare is retinoblastoma. T or F
TRUE
what s/s is common for HIV/AIDS
recurrent infection (yeast, uti)
what diagnostics are used for HIV/AIDS
RNA/DNA, HIV culture
18month or older need ELISA test
HIV infant prophylaxis is mother is positive
IgG (no MMR vax bc it is not effective) , bacterium
