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Mat-Child Nursing > objective 10.5 > Flashcards

objective 10.5 Flashcards

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1
Q

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

A

hypertrophic pyloric stenosis (HPS)

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2
Q

what are the manifestations of HPS?

A

 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

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3
Q

what is the nsg care preoperatively for HPS?

A
  • 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
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4
Q

what is the nsg care postoperatively for HPS?

A

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

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5
Q

*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

A

appendicitis

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6
Q

what are the characteristic symptoms of appendicitis?

A
  • Guarding
  • Rebound tenderness
  • Pain on lifting thigh while in supine position
  • Pain/Tenderness in RLQ (known as McBurney’s Point)
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7
Q

Protrusion of part of the abdominal
contents through the inguinal canal in the
groin

A

inguinal hernias

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8
Q

◦ 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

A

umbilical hernias

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9
Q

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

A

cleft lip

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10
Q

what is the preop care for cleft lip?

A
  • Signs of infection reported
  • Elbow immobilizers
  • syringe or cup feeding
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11
Q

what is the postop care for cleft lip?

A
  • 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
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12
Q

what is the treatment & nsg care for cleft palate?

A
  • 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
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13
Q
  • 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
A

cleft palate

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14
Q

 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

A

celiac disease

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15
Q

what is the treatment of celiac disease?

A

 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

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16
Q

 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

A

dehydration

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17
Q

what is the nursing care of dehydration?

A

 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

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18
Q

what can failure to thrive be classified by?

A
  1. inadequate caloric intake
  2. inadequate absorption
  3. increased metabolism
  4. defective utilization
19
Q

what is the nursing care of failure to thrive?

A

◦ 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

20
Q
  • 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
A

diarrhea

21
Q

what are the manifestations of diarrhea?

A
  • 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
22
Q

what is the nursing care for diarrhea?

A

*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

23
Q

Infectious diarrhea , involves inflammation of the stomach and
intestines

A

gastroenteritis

24
Q

involves an infammation of the colon

A

colitis

25
Q

involves an inflammation of the colon and small intestines

A

enterocolitis

26
Q

most common cause among children

A

ravirus

27
Q

what is the treatment and nursing care of gastroenteritis?

A
  • 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
28
Q

Results when the lower esophageal sphincter is relaxed or not competent,
which allows stomach contents to be easily regurgitated into the esophagus

A

gastroesophageal reflux

29
Q

what is the S&S of gastroesophageal reflex?

A

Vomiting, weight loss and failure to thrive, irritation to esophageal tract,
irritability (unable to feel nutritionally satisfied), aspiration

30
Q

what is the treatment care of gastroesophageal reflex?

A
  • 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
31
Q

Infection of the mucous membranes of the mouth cause by the fungus
Candida

A

thrush

32
Q

what are the manifestations for thrush?

A
  • White patches resemble milk curds on the tongue, inner gums, and oral
    mucosa, Painless but can’t be wiped away
  • Anorexia may be present
33
Q

what is the nursing care for thrush?

A
  • 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
34
Q

 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

A

diabetes mellitus

35
Q

“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

A

type 1 IDDM

36
Q

“Adult Onset”
* Insulin resistance or decreased production

A

type II NIDDM

37
Q

what are the symptoms of type I IDDM?

A
  • 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
38
Q

what is the diagnostic test for DM?

A
  • 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
39
Q

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

A

somogyi phenomenon

40
Q

Early am blood elevation of glucose
levels without preceding hypoglycemia
Response to growth hormone
secretion that occurs in early AM

A

dawn phenomenon

41
Q

what are the treatment goals of type I IDDM?

A
  1. Ensure normal growth and development through
    metabolic control (meds, diet,exercise)
  2. Enable the child to live with a chronic illness and
    have a happy and active childhood
  3. Prevent Complications
42
Q

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

A

diabetes ketoacidosis (DKA)

43
Q

what is the for management/pt teaching type I IDDM?

A
  • Diet
  • Exercise
  • Skin Care
  • Foot Care
  • Infections
  • Emotional Upsets
  • Urine Checks
  • Glucose –insulin
    imbalances
  • Travel
  • Follow Up Care
  • Illness or Surgery

Mat-Child Nursing (21 decks)

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