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PAEDS > paeds lect 4.1 & 4.2 > Flashcards

paeds lect 4.1 & 4.2 Flashcards

1
Q

Preoperative investigation for children

A
  • complete blood count
  • c-reactive protein (CRP)
  • electrolytes
  • prothrombin time (PT/PTT)
  • group and cross match (GXM)
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2
Q

Preoperative teaching (psychological prep) for children

A
  • practise coughing and deep breathing exercise
  • use of incentive spirometer
  • early ambulation– getting out of bed
  • pain management
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3
Q

List the 3 consents for prep. for surgery

A
  1. procedural/surgery consent
  2. anesthetist consent
  3. blood transfusion consent
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4
Q

Pain management for post-op pain

A
  • Local: topical formulations (AMETOP gel/ EMLA cream)
  • Nonopioids: oral paracetamol, ibuprofen, ketamine, glucose
  • Opioids: morphine
  • Epidural analgesia
  • Patient controlled analgesia (PCA) for > 7 years old
  • Alternatives (eg. distraction therapy)
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5
Q

List out “CRIES” –pain scale for neonates

A 
C- Crying
R- Requires O2
I- Increased vital signs
E- Expression
S- Sleeplessness
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6
Q

Symptoms of head injury

A
  • loss of consciousness
  • headache
  • focal deficits
  • ↑ intracranial pressure
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7
Q

What part of the hematoma requires immediate surgery when injured?

A

Epidural – between skull and dura

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8
Q

4 types of conscious level chart (CLC)

A
  1. glasgow coma scale
  2. pupillary assessment
  3. vital signs
  4. limb movement
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9
Q

Indication for congenital heart defects’ surgery

A
  • defects causing obstruction to flow
  • defects involving the great arteries
  • palliative (Blalock Taussiq shunt)
  • correction of structural defects : cardiopulmonary bypass machine is NEEDED in an open heart
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10
Q

Where is the radio-opaque catheter inserted during cardiac catheterization?

A

Via femoral vein to right atrium

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11
Q

At what age is surgery for cleft lips and cleft palate done respectively?

A

cleft lips: usually 1-3 months of age

cleft palate: 6-18 months of age

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12
Q

Nursing management for cleft lips and cleft palate

  1. _______ referral
  2. ensure adequate _______ & prevent a _______
    - - hold child in _______ position, _______ away from the cleft, towards the _______ and back of the mouth
  3. post repair feeding
    - - cleft _____: clear feeds at __h w special feeder
    - - cleft _____: feed only for _______ before _______ diet + oral hygiene
A
  1. speech therapist referral
  2. ensure adequate nutrition & prevent aspiration
    - - hold child in semi-upright position, direct formula feed away from the cleft, towards the buccal and back of the mouth
  3. post repair feeding
    - - cleft lip: clear feeds at 4h w special feeder
    - - cleft palate: feed only for a few days before pureed diet + oral hygiene
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13
Q

What does inappropriate relaxation or failure of pyloric sphincter contraction lead to?
And what do they result from?

A

Lead to: ↑ gastic or abdominal pressure

Result of: reflux of gastric contents

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14
Q

Characteristics of pyloric stenosis (an uncommon condition in infants that blocks food from entering the small intestine.)

A
  • immediate post-feeding forceful/projectile nonbilious vomiting
  • hungry aft vomiting
  • weight loss/dehydration
  • cyanotic & apneic episode
  • aspiration w recurrent respiratory tract infection
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15
Q

Management of pyloric stenosis

A

Surgery– pyloromyotomy

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16
Q

When does Hirschsprung’s disease occur.

And what does it result in?

A
  • when there is absence of nerves to aganglia of the intestines
  • this results in mechanical intestinal obstruction due to inadequate motility**

** the absence of propulsive movement causes accumulation of intestinal contents and distension of bowel proximal to the defect

17
Q

Assessment of Hirschsprung’s disease

A
  • signs of enterocolitis in neonates & infants
  • bowel function– frequency & characteristic of stools
  • abdominal distension – measurement of abdominal girth
  • respiratory difficulty associated with distention
18
Q

What is the surgical management of Hirschsprung’s disease

A

Removal of aganglionic, non-functioning segment of colon

19
Q

3 stages of Hirschsprung’s disease surgery

A
  1. Temporary colostomy before surgery to allow bowl to rest and allow child to gain weight
  2. Abdomino-perineal pull-through about 9-12months later
  3. Closure colostomy about 3 months after the pull-through procedure
20
Q

Pre-op and post-op care for Hirschsprung’s disease

A

Pre-op:

  • keep NBM, IV hydration
  • correct any electrolyte abnormalities
  • NGT insertion for stomach decompression

Post-op:

  • NBM, initiate oral intake gradually once bowel function is established
  • homecare nurse referral: ostomy care
21
Q

What will happen if treatment of Intussusception is delayed for more than 24hrs??

A

strangulation may occur leading to necrosis, haemorrhage, perforation, peritonitis and shock

ALL MAY LEAD TO DEATH

22
Q

How does intussusception begin (a serious condition in which part of the intestine slides into an adjacent part of the intestine)

A

Invagination typically begins with hyperperistalsis in an intestinal segment.

Peristalsis continues to pull the invaginated segment, intestinal oedema and obstruction occur

23
Q

S&S of intussusception

A

Classic triad:

  • severe paroxysmal colicky/intermittent abdominal pain, causing child to scream & draw his knees to abdomen
  • bilious vomiting
  • “currant jelly” stools (contains blood & mucus)– late manifestation

Others:

  • tender distended abdomen
  • lethargy
  • apnoea
24
Q

Treatment of intussusception

A
  • contrast enema: using air, barium or water soluble contrast for diagnosis or a therapeutic treatment
  • laparotomy / laparoscopy
25
Q

Post-op nursing management of intussusception

A
  • adequate nutrition according to the child’s age and nutritional requirements eg. parenteral nutrition
  • clear fluid intake aft surgery
  • monitor: naso-gastric tube drainage, bowel elimination status, abdominal distention & bowel sounds
26
Q

Treatment of appendicitis

A

Laparoscopic or open surgery

27
Q

Pre-op management for appendectomy

A
  • NBM immediately
  • IV fluid
  • pain management once diagnosis confirmed
  • prep for surgery
28
Q

What does hernia commonly arise from (occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia)

A

arises from congenital anomalies

29
Q

Most common type of hernia

A

Umbilical hernia
– incomplete closure of the umbilical ring result in protrusion of portions of the omentum and intestine through opening

30
Q

Monitor for complications of head injury

A
  • ↑ ICP
  • Vital signs (Cushing’s Triad)
  • Observe for CSF/ blood drainage from nose or ears
  • If not contraindicated (eg. Spinal Collar), keep head up 15-30 degrees
  • Pain management
  • Provide child & family teaching
31
Q

For correction of structural defects—is Cardiopulmonary Bypass needed?
Closed heart:
Open heart:

A

Closed heart: not needed

Open heart: needed to oxygenate and circulate blood w/o using heart or lungs

32
Q

Complications of congenital heart defect

A
  • failure to thrive
  • cyanosis
  • fatigue
  • breathlessness
33
Q

Sign & symptoms of GI defects

A
  • anorexia
  • nausea & vomiting
  • diarrhea or constipation
  • abdominal pain
  • recent weight gain or loss
  • blood in stool

PAEDS (6 decks)

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