paeds lect 4.1 & 4.2 Flashcards
Preoperative investigation for children
- complete blood count
- c-reactive protein (CRP)
- electrolytes
- prothrombin time (PT/PTT)
- group and cross match (GXM)
Preoperative teaching (psychological prep) for children
- practise coughing and deep breathing exercise
- use of incentive spirometer
- early ambulation– getting out of bed
- pain management
List the 3 consents for prep. for surgery
- procedural/surgery consent
- anesthetist consent
- blood transfusion consent
Pain management for post-op pain
- 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)
List out “CRIES” –pain scale for neonates
C- Crying R- Requires O2 I- Increased vital signs E- Expression S- Sleeplessness
Symptoms of head injury
- loss of consciousness
- headache
- focal deficits
- ↑ intracranial pressure
What part of the hematoma requires immediate surgery when injured?
Epidural – between skull and dura
4 types of conscious level chart (CLC)
- glasgow coma scale
- pupillary assessment
- vital signs
- limb movement
Indication for congenital heart defects’ surgery
- 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
Where is the radio-opaque catheter inserted during cardiac catheterization?
Via femoral vein to right atrium
At what age is surgery for cleft lips and cleft palate done respectively?
cleft lips: usually 1-3 months of age
cleft palate: 6-18 months of age
Nursing management for cleft lips and cleft palate
- _______ referral
- ensure adequate _______ & prevent a _______
- - hold child in _______ position, _______ away from the cleft, towards the _______ and back of the mouth - post repair feeding
- - cleft _____: clear feeds at __h w special feeder
- - cleft _____: feed only for _______ before _______ diet + oral hygiene
- speech therapist referral
- 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 - 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
What does inappropriate relaxation or failure of pyloric sphincter contraction lead to?
And what do they result from?
Lead to: ↑ gastic or abdominal pressure
Result of: reflux of gastric contents
Characteristics of pyloric stenosis (an uncommon condition in infants that blocks food from entering the small intestine.)
- immediate post-feeding forceful/projectile nonbilious vomiting
- hungry aft vomiting
- weight loss/dehydration
- cyanotic & apneic episode
- aspiration w recurrent respiratory tract infection
Management of pyloric stenosis
Surgery– pyloromyotomy
When does Hirschsprung’s disease occur.
And what does it result in?
- 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
Assessment of Hirschsprung’s disease
- signs of enterocolitis in neonates & infants
- bowel function– frequency & characteristic of stools
- abdominal distension – measurement of abdominal girth
- respiratory difficulty associated with distention
What is the surgical management of Hirschsprung’s disease
Removal of aganglionic, non-functioning segment of colon
3 stages of Hirschsprung’s disease surgery
- Temporary colostomy before surgery to allow bowl to rest and allow child to gain weight
- Abdomino-perineal pull-through about 9-12months later
- Closure colostomy about 3 months after the pull-through procedure
Pre-op and post-op care for Hirschsprung’s disease
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
What will happen if treatment of Intussusception is delayed for more than 24hrs??
strangulation may occur leading to necrosis, haemorrhage, perforation, peritonitis and shock
ALL MAY LEAD TO DEATH
How does intussusception begin (a serious condition in which part of the intestine slides into an adjacent part of the intestine)
Invagination typically begins with hyperperistalsis in an intestinal segment.
Peristalsis continues to pull the invaginated segment, intestinal oedema and obstruction occur
S&S of intussusception
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
Treatment of intussusception
- contrast enema: using air, barium or water soluble contrast for diagnosis or a therapeutic treatment
- laparotomy / laparoscopy
Post-op nursing management of intussusception
- 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
Treatment of appendicitis
Laparoscopic or open surgery
Pre-op management for appendectomy
- NBM immediately
- IV fluid
- pain management once diagnosis confirmed
- prep for surgery
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)
arises from congenital anomalies
Most common type of hernia
Umbilical hernia
– incomplete closure of the umbilical ring result in protrusion of portions of the omentum and intestine through opening
Monitor for complications of head injury
- ↑ 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
For correction of structural defects—is Cardiopulmonary Bypass needed?
Closed heart:
Open heart:
Closed heart: not needed
Open heart: needed to oxygenate and circulate blood w/o using heart or lungs
Complications of congenital heart defect
- failure to thrive
- cyanosis
- fatigue
- breathlessness
Sign & symptoms of GI defects
- anorexia
- nausea & vomiting
- diarrhea or constipation
- abdominal pain
- recent weight gain or loss
- blood in stool
