objective 10.5 Flashcards
obstruction at the lower end of the stomach (pylorus) caused by an
overgrowth (hypertrophy) of the circular muscles of the pylorus or by
spasms of the sphincter
hypertrophic pyloric stenosis (HPS)
what are the manifestations of HPS?
Projectile vomiting is outstanding symptom from force or pressure being
exerted on the pylorus
Vomitus contains mucus and ingested milk
Occurs right after feeding
Infant is constantly hungry and will eat again immediately after
vomiting
Dehydration (sunken fontanelle, inelastic skin & dec. urination)
Olive-shaped mass may be felt in upper right quadrant of abdomen
what is the nsg care preoperatively for HPS?
- IV fluids (I&O critically important)
- Infant is burped before and during and post feedings to remove any gas
accumulated in the stomach - Place child on right side after feeding, fowlers position preferred
- If infant vomits usually nurse refeeds infant
- Chart feeding time, amount, emesis time, amount, appearance
- Daily Wt
what is the nsg care postoperatively for HPS?
VS
IV fluids
Monitor surgical site
provide feedings as prescribed by surgeon (usually after recovery from
anesthesia)
* oral feedings of small amounts of clear liquid that gradually increases to
breastmilk or formula, as tolerated (3-6 hrs post- glucose, water or
electrolytes, 48 hrs post start full feeds)
* Avoid overfeeding
document intake and output
Proper positioning
*Most common reason for emergency abdominal surgery in childhood
*Initial pain usually periumbilical and increases within a 4-hour period
*When inflammation spreads to peritoneum, pain localizes in RLQ (point of
tenderness) of abdomen (McBurney’s point)
*may become gangrenous or rupture
*Can lead to peritonitis and septicemia
appendicitis
what are the characteristic symptoms of appendicitis?
- Guarding
- Rebound tenderness
- Pain on lifting thigh while in supine position
- Pain/Tenderness in RLQ (known as McBurney’s Point)
Protrusion of part of the abdominal
contents through the inguinal canal in the
groin
inguinal hernias
◦ Protrusion of a portion of the intestine
through the umbilical ring
◦ Appears as a soft swelling covered by skin,
which protrudes when infant cries or
strains
umbilical hernias
A fissure or opening in the upper lip, can occur on one or both sides
* Occurs in 1 in 600 births
* Can be accompanied by Cleft Palate
* Congenital anomaly, more common boys than girls
* It is a result of the failure of the maxillary and median nasal
processes to unite during embryonic development, usually between
the seventh and eighth weeks of gestation
cleft lip
what is the preop care for cleft lip?
- Signs of infection reported
- Elbow immobilizers
- syringe or cup feeding
what is the postop care for cleft lip?
- Prevention of crying/ sucking for 7 to 10 days
- Feeding- upright position, with dropper, slowly to prevent
aspiration, position in car seat or on right side propped to enhance
digestion - Pain relief/sedation
- Emotional needs
- Prevent infection/injury
what is the treatment & nsg care for cleft palate?
- Union of the cleft through surgery
- Improved feeding, speech and dental development
- Nurture a positive self image
- Nutrition
- Oral Hygiene- keep clean, follow feedings by water
- Speech
- Diversion- crying is prevented if possible
- Complications- Ear infections & dental Decay
- Failure of the hard palate to fuse at the midline
- Forms a passageway between the nasopharynx and the nose
- Complicates feedings and leads to infectionsof the
respiratory tract and middle ear that can result in hearing
loss. - Speech difficulties later in life
cleft palate
Also known as gluten enteropathy and
sprue
Leading malabsorption problem in
children
Symptoms not evident until 6 months to
2 years of age when foods containing
gluten are introduced
Wheat, barley, oats, and rye
celiac disease
what is the treatment of celiac disease?
Also known as gluten enteropathy and
sprue
Leading malabsorption problem in
children
Symptoms not evident until 6 months to
2 years of age when foods containing
gluten are introduced
Wheat, barley, oats, and rye
Occurs whenever fluid output exceeds fluid intake
Children under 2 years have more water loss via
surface areas via kidneys
Newborn’s total wt is approx. 77 % water
Metabolic rate is much higher in children
therefore more waste must be diluted in order to
be excreted
Results= rapid fluid turnover & dehydration occurs
quickly in infants vs adults
dehydration
what is the nursing care of dehydration?
Maintenance fluid therapy or Deficit therapy
Intake and Output (knowing what average output should
be is important (table 28.3)
VS
Daily Weight
Check Skin and Fontanelles, mucous membranes and
level of consciousness
Table 28.4 Estimation of Dehydration
May require hospitalization for IV
what can failure to thrive be classified by?
- inadequate caloric intake
- inadequate absorption
- increased metabolism
- defective utilization
what is the nursing care of failure to thrive?
◦ Multidisciplinary approach
◦ Educate & Support caregiver & child (even if neglect
is suspected)
◦ Nutritional Replenishment
◦ Assign same nursing staff to child may inc. nurturing
& interaction with infant & parent
- Sudden increase in stools from the infant’s normal pattern , with a fluid consistency
and a color that is green or contains mucus or blood - Classified as:
- Acute Sudden, Chronic, Infectious
diarrhea
what are the manifestations of diarrhea?
- Stools watery & explosive; may be yellowish-green
- Listlessness, refusal to eat, weight loss, possible fever & vomiting
- Dehydration; evidenced by sunken eyes & fontanels; dry skin, tongue, & mucous
membranes; less frequent urination
what is the nursing care for diarrhea?
*Treatment focus on identifying & eradicating the cause
*Reduce solid foods
*Oral rehydration solution- small frequent feedings
*Breastfeeding encouraged
*Mild diarrhea in older children may be treated at home
under a health care provider’s direction
Infectious diarrhea , involves inflammation of the stomach and
intestines
gastroenteritis
involves an infammation of the colon
colitis
involves an inflammation of the colon and small intestines
enterocolitis
most common cause among children
ravirus
what is the treatment and nursing care of gastroenteritis?
- Focus on identifying and eradicating cause
- Oral rehydrating solutions (ORS), I&O
- Frequent skin care
- Principles of cleanliness & Infection(hand hygiene, proper food handling)
- Daily Wt.
- Observe for dehydration
- Contact Precautions
Results when the lower esophageal sphincter is relaxed or not competent,
which allows stomach contents to be easily regurgitated into the esophagus
gastroesophageal reflux
what is the S&S of gastroesophageal reflex?
Vomiting, weight loss and failure to thrive, irritation to esophageal tract,
irritability (unable to feel nutritionally satisfied), aspiration
what is the treatment care of gastroesophageal reflex?
- Teaching to parents about: careful burping, avoiding overfeeding and
proper positioning - Upright position after feeding (30 to 40 degrees)
- Medication may be needed for more severe cases
Infection of the mucous membranes of the mouth cause by the fungus
Candida
thrush
what are the manifestations for thrush?
- White patches resemble milk curds on the tongue, inner gums, and oral
mucosa, Painless but can’t be wiped away - Anorexia may be present
what is the nursing care for thrush?
- Local antifungal suspensions (Nystatin) – apply with applicator onto
oral mucosa 3-4 X/day - Should disappear within a few days with proper treatment
- Use of standard isolation in newborns with disposable bottles,
nipples, pacifiers preferred
Most common endocrine disorder of childhood
Chronic metabolic condition in which body is unable to use
carbohydrates properly because of a deficiency of insulin
* Insulin deficiency leads to impairment of glucose transport
* Body unable to store and use fats properly
* Decrease in protein synthesis
diabetes mellitus
“juvenile onset”
* Most common metabolic disorder of childhood
* Absolute or complete insulin deficiency
* Autoimmune condition that causes destruction of beta cells in the
pancreas
* New cases highest in 5 – 7 yr old’s & 11 – 13
* More difficult to manage in childhood because of growing , energy
expenditure, varying nutritional needs
* Initial diagnosis may be determined when the child develops
ketoacidosis
type 1 IDDM
“Adult Onset”
* Insulin resistance or decreased production
type II NIDDM
what are the symptoms of type I IDDM?
- Classic Triad of presenting symptoms:
1. Polydipsia: excessive thirst
2. Polyuria: frequent large amts urination
3. Polyphagia: constantly hungry - Symptoms appear more rapidly in children
- Onset of lethargy, weakness & wt. Loss, irritability, bedwetting, dry skin,
yeast infections (in adolescent girls) - Symptoms may go unnoticed until an infection or coma.
- Lab findings: Glucosuria & Hyperglycemia, elevated HgbA1C
what is the diagnostic test for DM?
- Random Blood Glucose
- Blood drawn at any time, no preparation; results should be within normal
limits for both diabetic & nondiabetic patients - Fasting Blood Glucose
- If greater than 7.0 mmol/L on 2 separate occasions, and the history is
positive, the patient is considered as having DM and requires treatment - Glycosylated hemoglobin (HgbA1c)
- Pending on age (target values may be 7-8% or less)
- Values above 10% indicate poor control
- See Box 31.1
Hypoglycemia @ night & AM blood
glucose levels
Child wakens at night or has frequent
nightmares
Early morning sweating & headaches
Needs less insulin NOT more
Result of chronic Insulin use
somogyi phenomenon
Early am blood elevation of glucose
levels without preceding hypoglycemia
Response to growth hormone
secretion that occurs in early AM
dawn phenomenon
what are the treatment goals of type I IDDM?
- Ensure normal growth and development through
metabolic control (meds, diet,exercise) - Enable the child to live with a chronic illness and
have a happy and active childhood - Prevent Complications
Also referred to as diabetic coma, even though patient may not
be in one
*May result from a secondary infection and patient not following
proper self care
*May also occur if disease proceeds unrecognized
*Ketoacidosis is the end result of the effects of insulin deficiency
diabetes ketoacidosis (DKA)
what is the for management/pt teaching type I IDDM?
- Diet
- Exercise
- Skin Care
- Foot Care
- Infections
- Emotional Upsets
- Urine Checks
- Glucose –insulin
imbalances - Travel
- Follow Up Care
- Illness or Surgery
