Pediatrics Flashcards
What teachings are important to include in the primary health care needs of a child with a disability?
Make sure parents know normal milestones, so they know what is abnormal
When does grief become abnormal?
When it causes the sufferer to neglect other parts of their life
What mile stones should occur at 6 weeks?
Infant recognizes faces, social smile, turns head from side to side, and begins to get some head control
By what point should an infant have full head control?
3-4 months
By what point should an infant sit up by themselves?
5-6 months
By what point do most infants begin to crawl?
10-11 months
By what point should an infant begin to walk?
12 months
What does the birth weight do by six months?
Doubles
What does the birth weight do by 12 months?
Triples
When does the posterior fontanel close?
2 months
When does the anterior fontanel close?
18 months
When should an infant start to speak?
12 months
What stage does Erikson say infants are in?
Trust vs. Mistrust
At what age will an infant develop separation anxiety?
7-8 months
What toys are appropriate for an infant?
Rattles, blocks, or anything bright and noisy
How old is a toddler?
1-3 years
At what age should a toddler reach 50% of their adult height?
2 years
When should a toddler throw a ball overhand?
18 months
When should a toddler kick a ball?
2 years
When should a toddler feed himself with a spoon?
2 years
Why do toddlers have temper tantrums?
They are developing a sense of autonomy and independence
How long should the sentences of a 2 year old be?
2-3 words
When should a toddler be potty trained?
2 years
What toys are appropriate for a toddler?
Crayons and pull-push toys
When should a child be screened for obesity?
1-3 years old
When should a child learn to tie his shoes?
5 years
Why does colorblindness become evident in childhood?
Because they are learning colors and shapes
What is Erikson’s stage for a child?
Initiative vs. Guilt
What do children see a hospitalization as?
Punishment
How should a child be spoken to in the hospital?
Explain everything you can to them
What toys are appropriate for a 3-6 year old in the hospital?
Coloring books, dolls, and blocks
What stage does Erikson think a school-aged child is in?
Industry vs. Inferiority
What toys are appropriate for a school-aged child?
Board games and card games
What does Tanner’s developmental scale show?
Puberty stages
When does adult thinking develop?
15 years
What stage does Erikson think adolescents are in?
Identity vs. Role Confusion
The nurse is caring for an 8-year-old child who has a chronic illness. The child has a tracheostomy, and a parent is rooming-in during this hospitalization. The parent insists on providing almost all of the child’s care and tells the nurses how to care for the child. When planning the child’s care, the primary nurse should recognize that the parent is:
The expert in care of the child
Denial is a common reaction to the diagnosis of a disability or chronic illness. The nurse knows that the use of denial as a defense mechanism:
Is a necessary cushion to prevent disintegration
The potential effects of chronic illness or disability on a child’s development vary at different ages. Which is a threat to a toddler’s normal development?
Hindered mobility
A 9-year-old child has several physical disabilities. His father explains to the nurse that his son concentrates on what he can, rather than cannot do and is as independent as possible. The nurse’s best interpretation of this is that:
The child is using an adaptive coping style
The nurse notes that the parents of a critically ill child spend a large amount of time talking with the parents of another child who is also seriously ill. They talk with these parents more than with the nurses. The nurse should recognize that the:
Parent-to-parent support is valuable
Parents ask the nurse for advice when telling their 4-year-old about a grandmother’s death. The nurse’s best response involves teaching the parents that the child’s concept of death is:
Temporary
A 5-year-old girl’s sibling dies from sudden infant death syndrome. The parents are concerned because she showed more outward grief when her cat died than she is showing now. The nurse should explain that:
The death may be so painful and threatening that the child must deny it for now
A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on knowledge that:
Large doses of opioids are justified when there are no other treatment options
The nurse is caring for a child dying from cancer. Physical signs that the child is approaching death include:
A change in respiratory pattern
Several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is:
Appropriate because it can assist in the resolution of personal grief
A terminally ill male adolescent is being admitted to the hospital due to lack of pain relief. When communicating with this patient about his feelings on death, the nurse should incorporate which actions into the plan of care?
Reassure the adolescent that the illness is not a result of him not cleaning his room and allow the adolescent to participate in the treatment decisions as much as possible
When planning a child safety health fair presentation addressing causes of death in children, the nurse should include which topics?
Sexually transmitted infection prevention for 15 to 19 years old; gun safety for 10 to 14 year olds; information on bullying and violence prevention for 15 to 19 year olds
What is the average IQ?
90
What are the requirements for a diagnosis of intellectual disability?
Subaverage IQ, impairment in 2 of 10 adaptive skills, and younger than 18
What are the adaptive skills?
Communication, home living, community use, leisure, health and safety, self-care, social skills, academics, work, and self-direction
How can intellectual impairment be prevented?
Folic acid
What are the clinical manifestations of Down’s syndrome?
Square head, small mouth, wide, slanted eyes, low ears, hypotonia, flat nose
What physical problems are children with Down’s syndrome at greater risk for?
Congenital heart disease, hypothyroidism, and leukemia
What is Fragile X syndrome caused by?
An abnormal gene on the lower end of the long arm of the X chromosome
What are the types of hearing loss?
Conductive, sensorineural, and mixed
What are the types of visual impairment?
Refraction, myopia, hyperopia, strabismus, and amblyopia
What is the nursing priority for a baby with vision loss?
Promote parent-child attachment
Which infectious disease can cause blindness?
Rubella
The primary goal in caring for the child with cognitive impairment is to:
Promote optimal development
The parents of a cognitively impaired child ask the nurse for guidance with discipline. The nurse’s BEST response is:
“Behavior modification is an excellent form of discipline.”
The genetic testing of a child with Down syndrome (DS) showed that it was caused by translocation. The parents ask about further genetic testing. The nurse’s BEST response for the parents is:
“The parents can be tested themselves because the child’s condition might be hereditary.”
A 2-week-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold; that “He’s like a rag doll. He doesn’t cuddle up to me like my other babies did.” The nurse’s best interpretation of this lack of clinging or molding is that it is:
The result of the physical characteristics of Down syndrome
The parents of a child with fragile X syndrome want to have another baby. They tell the nurse they worry that another child might be similarly affected. The MOST appropriate nursing action is to:
Explain that prenatal diagnosis of the syndrome is now available
A 6-year-old child has difficulty hearing faint or distant speech. His speech is normal, but he is having problems with his school performance. This hearing loss would MOST likely be classified as:
Slight
Early detection of a hearing impairment is critical because of its effect on areas of a child’s life. The nurse should evaluate further for effects of the hearing impairment on:
Speech development
A child in the clinic exhibits reduced visual acuity in one eye despite appropriate optical correction. The nurse expects the child’s health care provider to diagnosis the child with:
Amblyopia
A 5-year-old male child has bilateral eye patches that were put in place after surgery yesterday morning. Today he can be allowed to get out of bed. The MOST important nursing intervention is to:
Orient him to his immediate surroundings
Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age?
Social interaction; Inability to maintain eye contact; Language as used in social communication
The nurse working in an outpatient eye clinic should report which clinical manifestations to the health care provider out of concern for retinoblastoma?
White eye reflex; Strabismus; Red, painful eye, often with glaucoma; Sever permanent visual impairment
What are the phases of separation anxiety?
Protest phase, despair phase, and detachment phase
At what age does a child remember pain?
2-3 years
Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety?
Clings to parent
The most consistent indicator of pain in infants is:
Facial expression of discomfort
The psychosexual conflicts of preschool children make them extremely vulnerable to:
Bodily injury or pain
The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, “Do it later, O.K.?” The nurse should:
Start the IV line because unlimited procrastination results in heightened anxiety
A 4-year-old child will be having cardiac surgery next week. The child’s parents call the hospital, asking about how to prepare her for this. The nurse’s BEST response is to inform the parents that:
Children who are prepared experience less fear and stress during hospitalization
A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child’s bath, he asks for mommy. The nurse’s BEST reply is:
“Mommy will be here at lunch”
The nurse working in an outpatient surgery center for children should understand that:
Families need to be prepared for what to expect after discharge
When completing a health history on a hospitalized child, the nurse should assess for which factors that can commonly affect the parents’ reaction to the child’s illness?
Previous experience with illness or hospitalization; Available support systems; Medical procedures involved with treatment; Previous coping abilities; Cultural and religious beliefs
When admitting a child to the inpatient pediatric unit, the nurse should assess for which risk factors that can increase the child’s stress level associated with hospitalization?
Lack of fit between parent and child; Below-average intelligence; Age; Gender
The nurse is discharging a young child from the hospital. The nurse should instruct the parents to look for which posthospital child behaviors?
Tendency to cling to parents; Demands for parents’ attention; New fears such as nightmares; Jealousy toward others; Anger toward parents
What drugs are generally used to anesthetize children?
Benzodiazapine and propovol
What are the alternatives to restraining a child?
Diversional activities, parental participation, and therapeutic holding
Where are specimen collected from children?
Heels
Why are IVs for children always on a smart pump?
Because it helps to preserve the IV access site
What type of inhaler is appropriate for all children?
Metered-dose with a spacer
How should oxygen be administered to a child?
It should always be humidified
What size ET tube should be used on a child?
The size of the ET tube should match the diameter of the child’s pinky finger
How are tube feeds administered to a child?
Bolus
How are Gavage feeding tubes checked for placement?
Air bolus
Why should cold water enemas not be given to children?
They can cause shock
The preferred site for an IM injection in a child is:
Vastus lateralis
The nurse needs to take the blood pressure of a preschool boy for the first time. Which action would be BEST in gaining his cooperation?
Permitting him to handle equipment and see the dial move before putting the cuff in place.
It is time to give a 3-year-old boy his medication. Which approach is MOST likely to receive a positive response?
“It’s time for your medication now. Would you like water or apple juice afterward?”
The nurse is doing preoperative teaching with a child and his parents. The parents say that he is “dreading the shot” for premedication. The nurse’s response should be based on the knowledge that:
Preanesthetic medication should be “atraumatic,” using oral, existing intravenous, or rectal routes
A 10-year-old female child requires daily medications for a chronic illness. Her mother tells the nurse that she is always nagging her to take her medicine before school. What is the MOST appropriate nursing action to promote the child’s compliance?
Establishing a contract with her, including rewards
A 7-year-old female child has a fever associated with a viral illness. She is being cared for at home. The nurse should recognize that the principal reason for treating fever in this child is:
Relief of discomfort
Standard Precautions for infection control include that:
Gloves are worn to change diapers when there are loose or explosive stools
The nurse is preparing a plan to teach a mother how to administer 1½ teaspoons of medicine to her 6-month-old child. The nurse should recommend using:
A plastic syringe (without needle) calibrated in milliliters
Several types of long-term central venous access devices are used. A benefit of using an implanted port (e.g., Port-a-cath) is that it:
Does not need to limit regular physical activity, including swimming
The nurse observes erythema, pain, and edema at a child’s intravenous (IV) site with streaking along the vein. What should the nurse do FIRST?
Immediately stop the infusion
The best explanation for why pulse oximetry is used on young children is that it:
Is noninvasive
When is bronchial (postural) drainage generally performed?
Before meals and at bedtime
The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What should be the NEXT action by the nurse?
Try to insert a smaller-sized tube
A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after the child receives his gastrostomy feeding, there is often a backup of formula feeding into the tube. As a result, the nurse should:
Leave the gastrostomy tube open and suspended after feedings
Informed consent is valid when:
A person is over the age of majority and competent; information is provided to make an intelligent decision; the choice exercised is free of force, fraud, duress, or coercion
When caring for a child with an intravenous (IV) infusion, the most appropriate nursing interventions are to:
Use an infusion pump with a microdropper to ensure the prescribed infusion rate; check IV fluids and infusion rate with another licensed professional; observe the insertion site frequently for signs of infiltration
What are the signs of respiratory distress in a child?
Obtunded, retracted, lethargic and inconsolable
Why are preterm babies at risk for alveolar collapse?
They have too little surfactant
What anti-viral is used to treat RSV?
Ribavarin
Who is at risk for developing RSV?
Children over 6 weeks but under 2 years
What is the causative agent for ear infections?
Haemophilus influenzae
What needs to be avoided in a child with RSV?
Dehydration
What are the signs and symptoms of RSV?
High fever, expiratory wheezing and cyanosis
Why does the infection rate increase in children 3-6 months old?
They lose the immunity from their mother
When is RSV season?
Winter and spring
When is infection-related asthma season?
Cold weather
When are mycoplasmal infections common?
In the fall and winter
What is seen in newborns instead of a fever?
A drop in temperature
What are the nursing priorities for children with respiratory infections?
Ease respiratory effort, promote rest and comfort, prevent the spread of infection, reduce temperature, promote hydration and nutrition, and provide support and reassurance
How can the flu be prevented in infants?
Vaccinate mom during the pregnancy
What are children with streptococcal pharyngitis at risk for developing?
Rheumatic fever
How is acute streptococcal pharyngitis treated in a child?
Tylenol, antibiotics, and fluid
Which type of wheezing is most ominous in children?
Inspiratory and expiratory
Why are tonsillectomies no longer performed unless there is an emergency?
It is very easy to hemorrhage after
When is a child at risk for hemorrhage post-tonsillectomy?
24-48 hours, then 5-14 days
When is surgical intervention necessary for children with otitis media?
When the build-up of fluid will not resolve on its own
What virus causes mononucleosis?
Epstein-Barr
What is the diagnostic test for mononucleosis?
Blood tests
What organs need to be periodically checked for a pediatric patient with mononucleosis?
Spleen and liver
What nursing care is needed for children with mononucleosis?
Steroids, proper nutrition and supportive care
What does mononucleosis usually follow?
A previous infection
Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress
Croup
When is Croup more common?
Winter
What respiratory organs does Croup affect?
Larynx, trachea, and bronchi
What causes Croup?
H. influenzae type B
What does the severe cough cause children to do?
Stop breathing
What are the signs and symptoms of epiglottitis?
Drooling, tripod positioning, anxiousness, flushed face and wheezing
How is epiglottitis treated?
Steroids and the intubation or tracheotomy
What causes epiglottitis to worsen?
Crying and anxiousness
What are the manifestations of laryngotracheobronchitis?
Inspiratory stridor, suprasternal retractions, “barking” cough, hypoxia, and respiratory acidosis
How is LTB managed?
Maintain airway, maintain hydration, and nebulize with oxygen, steroids, and epinephrine
When does spasmodic laryngitis occur?
At night
What is the distinguishing sign of bacterial tracheitis?
Thick, purulent secretions that result in respiratory distress
Which respiratory disease is a possible precursor to asthma?
Spasmodic laryngitis
Why are cough suppressants rarely used in children?
There is an increased risk of pneumonia
What does bacterial pneumonia look like on an x-ray?
Consolidated
What does viral pneumonia look like on an x-ray?
Inflammation and mucous throughout lungs
What causes mycoplasmic pneumonia?
Inhaled substances
Who is pertussis common in?
Infants under 2 months
What is the treatment for pertussis?
Antipyretics, fluids, oxygen and supportive care
When is pertussis most common?
Spring and summer
What is the hallmark of TB?
Juicy cough
How is TB diagnosed?
Three sputum samples
What drug prevents the development of TB?
INH
What drug is used to treat TB?
Rifampin
What age group is most at risk for foreign body aspiration?
1-3 years
What children are most at risk for aspiration pneumonia?
Children with feeding difficulties, like a cleft lip or palate
How can aspiration pneumonia be prevented?
Hold head up high while feeding
Respiratory distress and hypoxia within 72 hours of a serious injury or surgery
Acute Respiratory Distress Syndrom
What causes ARDS?
An overreaction of the immune system
How is ARDS treated?
High pressure ventilation
What indicates smoke inhalation?
Singed nasal hairs and soot in nasal cavity
How is smoke inhalation treated?
Administer humidifying oxygen at 100%
How is asthma diagnosed?
Peak flow meter
What is the goal for children with asthma?
To maintain normal activity levels
What drugs are used for asthma maintenance?
Advair and singulair
What needs to be taught about asthma maintenance drugs?
They cannot be abruptly stopped
What is the side effect of too much theophylline?
Seizures
How is status asthmaticus treated?
IV steroids and SQ epinephrine
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates:
Soothing inflamed mucous membrane
It is important that a child with Group A ß-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent:
Acute rheumatic fever
When caring for a child after a tonsillectomy, the nurse should:
Watch for continuous swelling
A 4-year-old girl is brought to the emergency room. She has a “froglike” croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should:
Notify the physician immediately and be prepared to assist with a tracheostomy or intubation
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C. The nurse suspects croup and should recommend:
Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing
An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to:
Prevent respiratory syncytial virus (RSV) infection
A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to:
Assess the severity of asthma
A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a:
Spacer
One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection:
Can trigger an episode or aggravate an asthmatic state
An immediate intervention when an infant chokes on a piece of food would be to:
Position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades
Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include:
Lung function; frequency of symptoms; frequency and severity of exacerbations
A 5-year-old child is brought to the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions?
Vital signs; medical history; assessment of breath sounds; emergency airway equipment readily available
Abdominal pain or cramping that is manifested by loud crying and drying the legs up to the abdomen
Colic
When does colic resolve?
12-16 weeks
What are colicky babies at risk for?
Inadequate bonding and abuse
What are the causes of failure to thrive?
Inadequate caloric intake, inadequate absorption, increased metabolism, defective utilization, and poor parenting
What percentile does the child have to fall below for a diagnosis of failure to thrive?
5th
What are the nursing interventions for colic?
Gripe water, reglan, gas-x, put the baby over knee, walking, burping, pressure
What are the nursing interventions for SIDS?
Put the baby on its back with nothing in the crib, hard pacifiers, support
What are the nursing interventions for FTT?
Hold, cuddle, supplemental food, observe parenting
How can motor vehicle injuries be prevented?
Proper restraint of the child
What type of burn is the most common in children?
Scalding
How can burns be prevented?
Turn pot handles, turn water temperature down and smoke detectors
What are the signs of bacterial meningitis?
Extremely high fever, inconsolable child, and lethargy
Why should a child never be given aspirin?
It can cause a brain herniation
What are the signs of ADHD?
Inattention, hyperactivity, and impulsivity
What causes school phobia?
A fear of failure
What reproductive disorders can occur in male children?
Infection, hematuria, gynecomastica, precocious puberty, STIs, and testicular torsion
What reproductive disorders can occur in female children?
Amenorrhea, dysmenorrhea, and STIs
What is the main concern for a child with bulimia?
Fluid and electrolyte imbalance
How is congenital hypothyroidism diagnosed?
Neonatal screenings
What are the signs of congenital hypothyroidism in early infancy?
Depressed nasal bridge, short forehead, puffy eyelids, large tongue, thick/dry/mottled skin, coarse/dry/lustless hair, abdominal distention, umbilical hernia, hyporeflexia, bradycardia, hypothermia, hypotension, anemia, widely paten cranial sutures, prolonged jaundice and consitpation
What are the outcomes of untreated congenital hypothyroidism?
Permanent cognitive impairment
What are the metabolic effects of PKU?
FTT, vomiting, immobility, hyper-reactivity and erratic behavior
What two formulas are prescribed for infants with PKU?
Phenex-1 for infants and Phenex-2 for children and adults
What foods are high in phenylalanine content?
High protein foods, sweeteners, nuts, eggs, and fish
What are the three classic signs of diabetes?
Polyphagia, polydipsia, and polyuria
What are the signs of hypoglycemia?
Nervousness, pallor, tremulousness, palpitations, sweating, hunger, weakness, dizziness, headache, fatigue, irritability, loss of coordination, seizures and coma
What glucose level is considered to be hypoglycemic?
Under 60 mg/dL
What glucose level is considered to be hyperglycemic?
Over 250 mg/dL
What are the signs of hyperglycemia?
Confusion, thirst, weakness, fatigue, nausea, vomiting, abdominal pain, flushed, weak pulse, ketosis
What is the priority nursing care for children with ketoacidosis?
Administer fluids, electrolytes and insulin
What is the purpose of bronchodilators?
They relax the smooth muscles of the airways
What are the physical assessment findings for a child with asthma?
Inflammation, wheezing, breathlessness, chest tightness, cough, dyspnea, and itching
When does a cough occur for children with asthma?
At night or in the early morning
What nutritional support should be provided to a child with CF?
High fat and high calorie diet
What are the seven signs of respiratory distress in a pediatric client?
Restlessness, tachypnea, tachycardia, diaphoresis, nasal flaring, chest wall retraction, and wheezing/grunt
What position does a child with epiglottitis assume?
Tripod
Why are IV fluids important for a child with increased respiratory rate?
To prevent dehydration
Children with chronic otitis media are at risk for developing what problem?
Impaired hearing
What systems are involved in Cystic Fibrosis?
Thickened mucous gland secretions, elevated sweat electrolytes, increased enzymatic constituents of saliva and autonomic nervous system abnormalities
Why do children with CF have so many infections?
Their thickened mucous secretions act as a trap
What systems are predominantly affected in patients with CF?
Respiratory tract and pancreas
How is CF diagnosed?
Sweat chloride test
What kind of a cough do patients with CF present with?
Dry, non-productive
What is generally the first sign of CF?
Meconium ileus
What do the stools of a patient with CF look like?
Bulky, frothy, and have a foul odor
Why are children with CF chronically dehydrated?
They are not taking in fluids and have a high insensible loss
What kind of electrolyte imbalances do patients with CF have?
Hyponatremia, hypochloremia, and hypoalbuminemia
Why do patients with CF have chronic hypoxia?
Their bronchial epithelium gets destroyed with chronic infections, leading to a decreased O2/CO2 exchange
Why can the pancreatic enzymes of patients with CF not get to the duodenum?
Their thick secretions block the ducts
What digestive problems do patients with CF have?
Impaired digestion/absorption of fat and protein
What is the priority in caring for patients with CF?
Airway
Why should patients with CF exercise?
To strengthen their lungs
How should pancreatic enzymes be administered?
With food
What should patients with CF avoid?
Dairy
What does the diet of a patient with CF look like?
High protein, high calorie
When should chest PT be done for patients with CF?
Prior to meals or no sooner than 1 hour after meals
What are some symptoms of renal system dysfunction in children?
Very high fever, foul smelling urine, dry diapers and a change in demeanor
Why are uncircumcised boys under 3 months at high risk for UTIs?
Lack of knowledge on how to care for penis
If a pediatric patient has febrile symptoms associated with a UTI, what does that indicate?
Pyelonephritis
Infection in the upper urinary tract and kidneys
Pyelonephritis
Inflammation of the bladder
Cystitis
Bacterial illness; urinary pathogens in the blood
Urosepsis
Why is E. coli generally responsible for UTIs?
It is the primary bacteria in the stool
What is the single most important contributing factor for UTIs in children?
Stasis
How are UTIs treated?
An antibiotic, generally bactrim
A complication of a UTI in which the urine back up above the obstruction
Hydronephrosis
What is causing an increase in hypo and epispadias?
Hormones taken during pregnancy, particularly estrogen
Protrusion of abdominal contents through inguinal canal into scrotum
Inguinal hernia
How is an inguinal hernia treated?
Surgery
Fluid in scrotum
Hydrocele
How is a hydrocele treated?
Surgery if spontaneous resolution does not occur within one year
Narrowing or stenosis of perpetual opening of foreskin
Phimosis
How is phimosis treated?
Manual retraction or circumcision
Urethral opening located behind glans penis or anywhere along ventral surface of penile shaft
Hypospadias
How is hypospadias treated?
Surgery
Ventral curvature of penis, often associated with hypospadias
Chordee
How is chord treated?
Surgical release of fibrous band cueing deformity
Meatal opening located on dorsal side of penis
Epispadias
How is epispadias treated?
Surgery
Failure of one or both testes to descend normally through inguinal canal
Cryptochidism
How is cryptochidism treated?
Administration of hcG or surgery
Eversion of posterior bladder though anterior bladder wall and lower abdominal wall
Exstrophy of pladder
How is exstrophy of bladder treated?
Surgery
What are the signs and symptoms of nephrotic syndrome?
Proteinuria, hypoalbuminemia, hyperlipidemia, edema, massive urinary protein loss and increased blood pressure
What is the hallmark of nephrotic syndrome?
Proteinuria
What is the pathophysiology of nephrotic syndrome?
The glomerular membrane becomes permeable to proteins, causing a fluid shift from the plasma to the interstitial spaces
How is nephrotic syndrome managed?
Reduce the excretion of proteins and the fluid retention in the tissues
What kind of diet does a patient with nephrotic syndrome need?
High protein and fluid restrictions
What is the hallmark of glomerulonephritis?
Oliguria
What infectious agent generally causes acute glomerulonephritis?
Streptococcus
What are the signs and symptoms of glomerulonephritis?
Oliguria, edema, hypertension, hematuria, and proteinuria
Where is edema seen in children with glomerulonephritis?
Eyes and face
What drugs are used to treat nephrotic syndrome?
Steroids
What kind of diet should a patient with glomerulonephritis have?
Low sodium and fluid restrictions
How should the edema of glomerulonephritis be managed?
Daily weights, accurate input and output and daily abdominal girth measurements
Endothelial lining of the small glomerular arterioles becomes swollen and occluded with deposits of platelets and fibrin clots, damaging the RBCs
Hemolytic-Uremic Syndrome
What are the signs and symptoms of hemolytic-uremic syndrome?
Anemia, thrombocytopenia, renal failure
How is hemolytic-uremic syndrome treated?
Dialysis, FFP, and plasmapheresis
Malignant renal and intraabdominal tumor of childhood
Wilms’ tumor
What causes a Wilms’ tumor?
Embryonic cell mass
What are the signs and symptoms of a Wilms’ tumor?
Abdominal mass, hematuria, fatigue, malaise, hypertension, weight loss, and fever
How is a Wilms’ tumor treated?
Surgery, chemo, and radiation
What should nurses and doctors not do if a Wims’ tumor is suspected?
Palpate the abdomen
Kidneys suddenly unable to regulate volume and composition of urine
Acute Renal Failure
What is the principle feature of acute renal failure?
Oliguria
What are the signs and symptoms of ARF?
Oliguria, azotemia, metabolic acidosis, and electrolyte disturbances
How should the dehydration of ARF be treated?
Administer 10 mL every 10 minutes in a syringe
What does ARF generally follow?
Illness and severe dehydration
What laboratory measurements are taken to diagnosis ARF?
Creatinine and BUN
How is ARF treated?
Treat the underlying cause
What is the most dangerous complication of ARF?
Hyperkalemia
How is hyperkalemia treated?
K-exalate
How is anemia treated?
Erythropoetin
What is the first sign of cardiac involvement in patients with ARF?
Loss of energy, then crackles in lungs
Which type of dialysis is preferred in children?
Peritoneal
What is the pathophysiology of Chronic Renal Failure?
Nephrons are being destroyed at a rapid rate
How should CRF be managed?
Promote maximal renal function and maintain the fluid and electrolyte balance
What should the diet of a CRF patient be?
Low in protein
What can occur after dialysis?
Post dialysis disequilibrium syndrome
What are the three branches of the endocrine system?
Pituitary, thyroid and adrenal
What deficiency does hypopituitarism cause?
Growth hormone deficiency
When should GH replacement be administered?
At night
Why are x-rays so important in determining hypopituitarism treatment?
They determine if growth plate closure has occurred
When is growth hormone replacement therapy ended?
When growth rates are less than one inch per year
What does hyperpituitarism cause?
Giantism or acromegaly
What features undergo overgrowth in patients with acromegaly?
Head, lips, tongue, jaw, nose, paranasal and mastoid sinuses, and teeth
What could be the cause of hyperpituitarism?
Tumor on pituitary gland
What is the treatment for hyperpituitarism?
Removal or radiation of gland and then lifetime hormonal replacement
Sexual development before age 9 in boys or 8 in girls
Precocious Puberty
How is precocious puberty treated?
Leuprolide to slow prepubertal growth to normal rates
What is the prinicple disorder in the posterior pituitary gland?
Diabetes Insipidus
What causes diabetes insipidus?
Hyposecretion of ADH
What are the signs and symptoms of diabetes insipidus?
Uncontrolled diuresis, decreased energy, lethargy, stupor, polyuria, and polydipsia
Why do children with diabetes insipidus dehydrate?
They can’t get to water or drinks when they are thirsty
How is diabetes insipidus treated?
Hormone replacement and Vasopressin
What causes SIADH?
Oversecretion of ADH by the posterior pituitary
What are the signs and symptoms of SIADH?
Anorexia, nausea/vomiting, irritability, personality changes, fluid retention and hypotonicity
What hormones does the thyroid gland secrete?
Thyroxin, Triiodothyronine, and Calcitonin
How is SIADH managed?
I/Os, seizure precautions
What kind of diet should a patient with SIADH have?
Low sodium
What are the signs and symptoms of juvenile hypothyroidism?
Mental decline, constipation, sleepiness and myxedematous skin changes
Why is juvenile hypothyroidism not common?
It usually results in a spontaneous miscarriage
What is the treatment for juvenile hypothyroidism?
Oral thyroid replacement therapy
When should oral thyroid meds be taken?
30 minutes before breakfast
What is the sign of an overdose of thyroid medication?
Tachycardia
Hypertrophy of the thyroid gland
Goiter
What causes a congenital goiter?
Mother takes anti-thyroid meds during pregnancy
Why is immediate surgery required in infants with goiters?
It could block the airway
What are the signs of Hashimoto disease?
Symmetrically large, firm and movable thyroid gland
How is Hashimoto disease treated?
Oral thyroid hormone replacement
Why is surgery contraindicated in patients with Hashimoto disease?
Because it is usually self limiting
What are the signs of Graves Disease?
Enlarged thyroid and exophthalmos
What is the treatment of Graves Disease?
Anti-thryoid meds, subtotal thyroidectomy, or ablation with radioiodine
What are the anti-thyroid meds?
Propylthiouracil and methimazole
What is used to treat a thyroid crisis?
Propranolol
What are the nursing interventions for kids with hyperthyroidism?
Quiet, calm environment with rest periods, increased metabolic needs
What are the clinical manifestations of hypoparathyroidism?
Dry, scaly skin, brittle hair, thin nails, tetany, tingling, spasms, headache, seizures, moody, depression, confusion, and memory loss
What can cause hyperparathyroidism?
Adenoma or chronic renal disease
What is the heralding sign of hyperparathyroidism?
Constipation associated with hypercalcemia
What are the three groups of steroids?
Glucocorticoids, mineralocorticoids, and sex steroids
What are the symptoms of acute adrenocoritcal insufficiency?
Irritability, headache, abdominal pain, hyperpyrexia, cyanosis, and seizures
When do the symptoms of Addison disease display?
After 90% of the tissue is gone
How is Addison disease treated?
Replacement of cortisol and aldosterone
Why is treatment of Addison disease so difficult?
Dosing has to be adapted based on activity and circumstance
What causes Cushing syndrome?
Excessive circulating free cortisol
What is the Cushingold appearance?
Excessive hair growth, moon face, red cheeks, weight gain, pendulous abdomen, red striae, poor wound healing, and ecchymosis
What is done to diagnosis Cushing syndrome?
Imaging or pituitary gland and sella turcica and measurement of bone density
How is Cushing syndrome treated?
Surgery, then replacement of GH, ADH, TH, gonadotropins and steroids
When should steroids be administered?
Early morning on alternative days with food
What does congenital adrenal hyperplasia result in?
Ambiguous genitalia
How is congenital adrenal hyperplasia treated?
Administer glucocorticoids and assign sex to the child
Adrenal tumor that secretes catecholamines
Pheochromocytoma
How is a pheochromocytoma diagnosed?
Hypertension, severe headache
Total or partial deficiency of the hormone insulin
Diabetes mellitus
What is the pathophysiology of DM?
The deficiency of insulin doesn’t allow glucose to enter the cell, so it remains in the blood, leading to hyperglycemia
What is the pathophysiology of ketoacidosis?
Body breaks down alternate forms of energy because it can’t get to the glucose, lowing serum pH
What does diabetic ketoacidosis result from?
Dehydration, electrolyte imbalance, acidosis, and coma
What should a child’s glucose be?
<126 mg/dL
What should a child’s A1c be?
<7%
How is diabetes mellitus managed?
Nutrition, exercise, and insulin therapy
What screening should diabetics routinely have?
Eye tests
What can a child eat in a hypoglycemic crisis?
Peanut butter, cheese, crackers, skittles
What are the early signs and symptoms of increased intracranial pressure?
Headache, diplopia, irritability, confusion, arching, neuro-cry, lethargy, inconsolable, photophobia, projectile vomiting, tense fontanels
What are the three parts to the Glascow scale?
Eye opening, verbal response, motor response
What reflexes indicated neurological health in an infant?
Moro, tonic neck, and withdrawal reflexes
At what Glascow level does the airway need protection?
8
What vital signs are altered with increasing pain?
Heart rate, respiratory rate, and blood pressure are increased, oxygen saturation is decreased
Paralytic to make ventilation easier
Vecuronium
What is the antidote for Fentanyl?
Narcan
What is the antidote for Midazolam?
Romazacon
How should a comatose child be positioned?
High head of bed with no flexion in the neck or hip
How long does cerebral hypoxia have to last to cause permanent brain damage?
4 minutes
Why is CO2 retention bad?
It causes vasodilation, increased cerebral blood flow and increased ICP
How are increased levels of CO2 treated?
Bag the patient down
Why is the risk of aspiration increased in a comatose child?
The gag and cough reflexes are minimal
What are the nursing considerations for patient with increased ICP?
Avoid neck vein compression, elevate head of bed, eliminate or minimize environmental noise
What kind of nutritious state impedes wound healing?
Negative nitrogen balance
How can a negative nitrogen balance be avoided?
IV administration of fluids and parenteral nutrition
What medications are used to treat increased ICP?
Corticosteroids, sedatives, and paralytic agents
How should increased ICP be managed?
Thermoregulation, stimulation
What kind of elimination problems do patients with increased ICP have?
Constipation
Why should patients with increased ICP be cooled?
To decrease oxygen and metabolic need
Head injury with short period of unconsciousness, followed by activity
Epidural hematoma
Head injury with no loss of consciousness
Subdural hematoma
What kind of bleed is associated with an epidural hematoma?
Quickly accumulating arterial lead
What kind of bleed is associated with a subdural hematoma?
Venous leak
When does a subdural hematoma become evident?
7-10 days after the initial injury
A transient and reversible alteration in neurologic or cognitive function with or without loss of consciousness resulting from trauma to the head
Concussion
What follows a concussion?
Amnesia and confusion
Visible bruising
Contusion
Tearing of tissue
Laceration
Bruising at the point of impact
Coup
Bruising at a site far removed from the point of impact
Contrecoup
Which type of skull fracture is associated with raccoon eyes?
Basilar
What is included in post concussion syndrome?
Seizures, hydrocephalus, amnesia, and learning disabilities
What needs to be frequently assessed for patients with head trauma?
Vital signs, neurologic status, and LOC
What is the pathophysiology of drowning?
Hypoxia, aspiration, and hypothermia
What are the common presenting symptoms of a brain tumor?
Headache, ataxia, neuro-cry, projectile vomiting, and inconsolability
Most common malignant extra cranial solid tumor of childhood, developing in the adrenal gland or retroperitoneal sympathetic chain
Neuroblastoma
What is the priority in treating a neuroblastoma?
Locate primary site and sites of metastasis
How is a neuroblastoma treated?
Surgery, radiation, chemo, bone marrow transplant and stem cell rescue
Which vaccine prevents bacterial meningitis?
Hib
What precautions are required for patients with bacterial meningitis?
Droplet
When does bacterial meningitis generally occur?
Late winter and early spring
How is bacterial meningitis managed?
Isolation precautions, antimicrobial therapy, hydration restriction, control of temperature
What are the signs and symptoms of nonbacterial meningitis?
Headache, fever, and malaise
How is nonbacterial meningitis treated?
Symptomatic management
What are the vectors for encephalitis in the US?
Mosquitoes and ticks
What are the signs and symptoms of encephalitis?
Malaise, fever, headache, dizziness, stiff neck, nausea/vomiting, ataxia, speech difficulties
How is rabies treated?
Vaccine, globulins, though cleansing of the wound
Toxic encephalopathy associated with other characteristic organ involvement, particularly the liver
Reye’s Syndrome
What are the signs and symptoms of Reye’s syndrome?
Fever, profoundly impaired consciousness, and disordered hepatic function
What do most causes of Reye’s syndrome follow?
Viral illnesses, like chicken pox
How is Reye’s syndrome diagnosed?
Liver enzymes
Two or more unprovoked seizures
Epilepsy
How are seizure disorders managed?
Drug therapy, ketogenic diet, vagus nerve stimulation, and surgical therapy
When should the anterior fontanel close?
18 months
When should the posterior fontanel close?
2 months
What is the treatment for hydrocephalus?
Ventriculoperitoneal shunt
A group of permanent disorders of the development of movement and postures, causing activity limitations that are attributed to non progressive disturbances that occurred in the enveloping fetal or infant brain
Cerebral Palsy
What are the signs of Cerebral Palsy?
Delayed gross motor development, alterations in muscle tone, abnormal postures, and hyperreflexes
What toxin can be injected for treatment of Cerebral Palsy?
Botulinum toxin A
When do neural tube defect occur?
3-4 weeks after conception
What causes neural tube defects?
Folic acid
What specific type of allergy occurs with neural tube defects?
Latex
Which muscular atrophy is called “floppy infant syndrome”?
Werdnig-Hoffmann disease (Type 1)
What does Type 1 Muscular Atrophy look like?
Frog position, weak cry, cough, generalized weakness
Where do patients with Type 1 Muscular Atrophy have active movement?
Fingers and toes
Muscle weakness and atrophy, with decreasing ability to ambulate
Kugelberg-Welander disease
Progressive muscle weakness, wasting and contractors with hypertrophic calf muscles
Duchenne Muscular Dystrophy
What do patients with Duchenne Muscular Dystrophy die from?
Cardia or respiratory failure
What are the signs of Duchenne Muscular Dystrophy?
Waddling gait, frequent falls, Gower sign, Lordosis, enlarged thigh and upper arm muscles, and mild to moderate mental impairment
How is Duchenne Muscular Dystrophy treated?
Range of Motion, bracing, ADLs
How is Guillain-Barre syndrome treated?
Support, airway management, steroids, IVGG, plasmapheresis
What kind of diet should a patient with Guillain-Barre syndrome have?
High protein
How often should patients receive the tetanus vaccine?
Every 10 years
How does the exotoxin Clostridium tetani enter a human?
Through a wound, especially puncture or crush wound or burn
What is the heralding sign of tetanus?
Muscle stiffness, especially in face, head, and neck
What is the incubation period for tetanus?
3-8 days
How is tetanus treated?
Vaccine, IVGG, fluid and electrolyte monitoring, Pavulon
What does Pavulon do?
Relaxes muscles
How do infants get botulism?
Honey
What are the signs and symptoms of botulism?
Weakness, dizziness, headache, diplopia, speech difficulties, vomiting, progressive, life-threatening respiratory paralysis
How is botulism treated?
IVGG
How should spinal cord injuries be treated?
Immobilization
What kind of shunt is present in cyanotic defects?
Right to left
What kind of shunt is present in acyanotic defects?
Left to right
What kind of heart defect makes itself known first?
Cyanotic
How are heart defects noticed in children?
They sound like murmurs
How are heart defects diagnosed in children?
Echo, EKG, Cardiac Cath, and Chest X-ray
What are the general signs of cardiovascular dysfunction in children?
Poor feeding, tachypnea, tachycardia, activity intolerance, developmental delays
Where should the blood pressures of a child with cardiovascular problems be taken?
All four extremities
What laboratory tests should be taken in children with cardiovascular dysfunction?
Creatinine and BUN
After cardiac procedures, what needs to be monitored?
Vital signs, fluid intake, and pulses
What are the acyanotic defects?
Atrial septal defect, ventricular septal defect, and patent ductus arteriosus
What are the cyanotic defects?
Obstruction of pulmonary blood flow, Tetralogy of Fallot, and Tricuspid atresia
Why does CHF occur in children?
Structural abnormalities
How is CHF treated?
Improve cardiac function, remove excess fluid and sodium, decrease cardiac demand and improve tissue oxygenation
How can cardiac demand be decreased in infants and children?
Lots of rest, no crying, help them to feed
Condition in which arterial oxygen tension is less than normal
Hypoxemia
What are the nursing considerations for children with hypoxemia?
Prepare patient and family for invasive procedures
How is bacterial endocarditis prevented?
Prophylaxis treatment 1 hour before procedures
What disease does rheumatic fever follow?
Strep throat
What does rheumatic heart disease affect?
Joints, skin, brain, serous surfaces, and heart
How is rheumatic heart disease treated?
Penicillin, prednison, and aspirin
What are the clinical manifestations of pulmonary artery hypertension?
Dyspnea with exertion, chest pain, and syncope
Abnormalities of the myocardium in which the ability of the muscle to contract is impaired
Cardiomyopathy
What is the most common cause of cardiomyopathy?
Post viral illness
Total heart replacement
Orthotopic transplantation
Piggyback heart replacement
Heterotopic transplantation
What generally causes hypertension in children?
Renal disease, cardiovascular disease, or endocrine or neurologic disorders
What are the signs of Kawasaki Disease?
Fever, desquamation of the palms and soles, bilateral conjunctival inflammation, strawberry tongue, polymorphous rash, and cervical lymphadenopathy
How does Kawasaki Disease affect the cardiac system?
It causes coronary artery aneurysms to develop
How is Kawasaki Disease treated?
IVGG and aspirin
What are the early signs of shock?
Apprehension, irritability, narrowing pulse pressure, thirst, pallor, diminished urinary output, unexplained mild tachycardia, and decreased perfusion of the hands and feet
What is the nursing role for a patient in shock?
Maintain airway, restore fluid volume, and administer vasopressors while keeping child flat with legs raise, calm, and warm
What are the causes of childhood anemia?
Depletion of RBCs or Hgb or both
What are the effects of anemia on the circulatory system?
Hemodilution, decreased peripheral resistance, increased turbulence, cyanosis, and growth retardation
How is anemia treated?
IV fluids, oxygen therapy, and bed rest
How can iron deficiency anemia be prevented in children?
Iron-Fortified cereals and formulas
What are the side effects of iron supplements?
Constipation
How should iron supplements be given?
Through a straw and with orange juice
What causes sickle cell anemia?
Sickled RBCs
Why is sickle cell anemia dangerous?
Sickled RBCs can’t flow through vasculature
How can sickle cell crises be prevented?
Adequate hydration
When a child is in a sickle cell crisis, what is the nursing intervention?
Hydrate and pain relief
How is sickle cell disease monitored?
Reticulocyte counts
Why are vaccines so important for children with sickle cell?
They reduce infections that can lead to crises
How can RBC synthesis be stimulated?
Folic acid
Deficiencies in the rate of production of glob in chains in the Hgb
Thalassemia
What is there an abundance of in the bone marrow of patients with thalassemia?
Erythrocytes
What do patients with thalassemia present with?
Severe anemia and growth failure
How is thalassemia treated?
Blood transfusion
What is the complication of blood transfusion?
Hemosiderosis
What is hemosiderosis?
Iron overload
How is hemosiderosis treated?
Iron-chelating drugs like deferoxamine
What is the side effect of deferoxamine?
Excess urination
What are the signs of aplastic anemia?
Profound anemia, leukopenia, and thrombocytopenia
How is aplastic anemia treated?
Immunosuppressive therapy or bone marrow transplant
What is the nursing care for patients with aplastic anemia?
Neutropenic precautions
What clotting factor is deficient in hemophilia type A?
Factor 8
What clot tin factor is deficient in hemophilia type B?
Factor 9
Where does bleeding occur in pediatric hemophiliacs?
Into the joints
What is the treatment for hemophilia?
Replacement therapy, desmopressin, and aminocaproic acid
What does aminocaproic acid do?
Prevents clot destruction
How can the bleeding of a hemophiliac be controlled?
RICE
How is ITP treated?
It is usually self-limiting, but treated with IVIG and Anti-D antibodies
What does ITP generally follow?
Upper respiratory or other infection
What are the characteristics of ITP?
Thrombocytopenia, purpura, and normal bone marrow
What pathological processes are affected in DIC?
Hypoxia, acidosis, shock, and endothelial damage
What is the pathophysiology of DIC?
Excessive amount of thrombin are generated and fibrinogen is converted rapidly to fibrin; so there are lots of clots in the tissues but the good clots are rapidly destroyed by excess fibrin
How is DIC treated?
Platelet or FFP transfusion, IV heparin
What kinds of diseases can severe or recurrent epistaxis indicate?
Leukemia, thrombocytopenia, or hemophilia
What organs are most affected by leukemia?
Liver and spleen
What leukemia is most common in childhood?
ALL
What are the symptoms of leukemia?
Bruising, bleeding from nose and gums, fever
Where can bone marrow aspirations be taken from?
Sternum
Where do bone marrow biopsies have to be taken from?
Iliac crest
Why is a lumbar puncture necessary for children with ALL?
To determine if the cancer has passed the blood brain barrier
What are the complications of leukemia?
Myleosuppression, infection, hemorrhage, and anemia
Where does Hodgkin’s Lymphoma metastasis to?
The spleen, liver, bone marrow, or lungs
How is Hodgkin’s Lymphoma generally found?
On physical exam because it presents as a unilaterally enlarged lymph node
How is Hodgkin’s Lymphoma treated?
Radiation and chemo
Which type of lymphoma is worse?
Non-Hodgkins
How is HIV managed in children?
Anti-virals
A defect characterized by the absence of both humoral and cell mediated immunity
Severe Combine Immunodeficiency Diease
What is Wiskott-Aldrich Syndrome classified by?
Thrombocytopenia and eczema
What is generally the first sign of a blood transfusion problem?
Increased temperature
How is HSCT used to treat hematologic disorders?
As a rescue treatment
What are the types of HSCT?
Allogenic or Autologous
Removal of blood and the separation of blood into its components
Apheresis
What types of vitamins do patients with CF need?
A, K, E, and D (fat soluble)
What are the types of malnutrition?
Kwashiorkor and Marasmus
Protein and energy malnutrition
Kwashiorkor
General malnutrition of both calories and protein
Marasmus
What are the signs of food intolerance?
Anaphylaxis, abdominal pain, diarrhea, cough, wheeze, and atopic dermatitis
What are the causes of pediatric dehydration?
Insensible fluid loss, increased renal excretion, GI tract dysfunction, ketoacidosis, and burns
Dehydration in which water and salt are lost in equal amounts
Isotonic
Dehydration in which electrolyte deficit exceeds water deficit
Hypotonic
Dehydration in which water loss exceeds electrolyte deficit
Hypertonic
How is diarrhea managed?
I/Os and rehydration
How soon is the meconium passed?
24-36 hours after birth
If the meconium is not passed within 24-36 hours of birth, what could be the problem?
Intestinal atresia, stenosis, Hirschsprung disease, hypothyroidism, meconium plug or meconium ileus
How is constipation treated?
Age appropriate dietary modifications
What is the pathophysiology of Hirschsprung Disease?
Absence of ganglion cells in the intestine, causing fecal matter to build up
What are the characteristics of Hirschsprung Disease?
Distended abdomen, feeding intolerance, delay in passage of meconium, ribbon-like stools
How is Hirschsprung Disease treated?
Surgery
What kind of diet should patients with Hirschsprung Disease have?
Low residue
What is the primary cause of GERD?
Inappropriate relaxation of the LES
What are the symptoms of GERD?
Vomiting, crying, arching back, weight loss
What is the treatment for GERD?
Avoidance of foods and Nissan Fundoplication
How should infants with GERD be fed and sleep?
Elevated 30 degrees
What are the two most common intestinal parasites in the US?
Giardiasis and Pinworms
What are pinworms treated with?
Flagyl and vermectum
What is the diagnostic test for appendicitis?
McBurney’s point test
What are the signs of appendicitis?
Radiating pain, inconsolability, vomiting, and anorexia
What is the treatment for appendicitis?
Surgery
What is the pathophysiology of Meckel Diverticulum?
Remnant of the fetal omphalmesenteric duct remains in the diverticulum
What are the characteristics of Meckel Diverticulum?
Painless, bloody, “currant jelly” stools; shock, anemia, and pain
What is the treatment for Meckel Diverticulum?
Surgery, correction of complications
What is the nursing care for patients with Meckel Diverticulum?
Monitoring vital signs, recording blood lost in stools, IV fluid and NG tube
What diseases are included in IBD?
Ulcerative colitis and Crohn’s disease
What is the pathology of IBD?
Inflammation of the colon and rectum
What are the characteristics of IBD?
Rectal bleeding, pain, nausea, vomiting, anorexia, growth delay, weight loss, rashes, joint pain
How is IBD treated?
Symptomatic relief, salicylates, and long term steroids
What is the nursing care for patients with IBD?
Maintain high protein, high calorie diet
What is contraindicated in patients with appendicitis?
Laxatives, enemas, and heat
What bacteria generally causes PUD?
H. pylori
How is PUD treated?
Antacids, histamine receptor antagonists, PPIs, and an antibiotic (triple therapy)
How is Hepatitis A transmitted?
Fecal-oral
How is Hepatitis C transmitted?
Blood
How is Hepatitis B transmitted?
Blood
For which forms of hepatitis is IVIG recommended?
A and B
What is the heralding sign of hepatitis?
Jaundice
What is the most effective way to prevent the transmission of hepatitis?
Hand washing
How is cirrhosis treated?
Liver transplant
What is the pathophysiology of biliary atresia?
Bile duct fibrosis that eventually leads to ductal obstruction
What are the characteristics of biliary atresia?
Jaundice, dark urine, light stools, hepatomegaly, distention, pruritus, growth failure
How is biliary atresia treated?
Hepatic portoenterostomy (Kasai procedure)
What is the nursing care for patients with biliary atresia?
Nutritional therapy and comfort measures
When does a cleft lip or palate occur?
4-10 weeks of gestation
What are the characteristics of a cleft lip or palate?
Poor feeding and inability to latch
How are a cleft lip and palate treated?
Surgery
What is the nursing care for a cleft lip?
Keep hands away from repair, protect skin integrity, cleanse site
Why should formula never be left on a cleft lip surgical site?
It contains lots of sugar which feeds bacteria
What is the nursing care for a cleft palate?
Avoid object in mouth, use a large, long nipple
How should a baby with a cleft palate be fed?
Slowly, with often bur pings, in an upright position
At what age is a cleft lip surgical repair performed?
2-3 months
At what age is a cleft palate surgical repair performed?
6-12 months
What is the pathophysiology of TEF?
Esophagus is not a continuous passage
What are the signs and symptoms of TEF?
Excessive salivation and drooling, coughing, choking, and cyanosis
How is TEF treated?
Surgery
What is the nursing care for a patient with TEF?
Maintenance of a patent airway, prevention of aspiration, and frequent suctioning
Protrusion of a portion of an organ through an abnormal opening
Hernia
What is the most dangerous hernia?
Strangulated inguinal hernia
What are the characteristics of hernias?
Dysphagia, poor feeding, FTT, vomiting, and neck contortions
What is the treatment for a hernia?
Surgical reduction and repair
What is the nursing care for infants with hernias?
Monitor CV and respiratory status, cluster care, and maintain NG suction, oxygen and IV fluids
What is the pathophysiology of pyloric stenosis?
Thickening of pylorus muscle due to hypertrophy and hyperplasia
What are the characteristics of pyloric stenosis?
Olive-like mass, projectile vomiting, peristaltic waves, and fluid and electrolyte imbalance
What is the treatment of pyloric stenosis?
Pyloromyotomy
What is the nursing care for pyloric stenosis?
NPO with IV fluids of dextrose and electrolyte replacement, daily weights
What is the pathophysiology of intussusception?
Bowel invagination, causing ischemia and pouring of mucus into the intestines
What are the characteristics of intussusception?
Abdominal pain, abdominal mass, and bloody “currant jelly” stools
How is intussusception treated?
Pneumoenema or surgical intervention
What is the nursing care for a patients with intussusception?
Monitor stools, administer pneumoenema, maintain NPO
Abnormal rotation of intestine around superior mesenteric artery during embryologic development
Malrotation
Twisting of intestine around itself, thereby compromising blood supply to the intestines
Volvulus
What complications are associated with malrotation and volvulus?
Necrosis, peritonitis, perforation and death
What is the nursing care for patients with anorectal malformations?
Axillary temps only
What are the characteristics of malabsorption syndromes?
Chronic diarrhea and malabsorption or nutrients possibly resulting in failure to thrive
What are patients with celiac disease sensitive to?
Gluten
What are the characteristics of celiac disease?
Steatorrhea, general malnutrition, abdominal distention, and secondary vitamin deficiencies
What are the causes of short bowel syndrome?
Necrotizing enterocolitis and gastroschisis
What are the characteristics of gastroschisis?
No peritoneal sac covers the exposed bowel
What are the characteristics of gastroschisis?
Intestines stick through umbilicus
What is the treatment of gastroschisis?
Surgical repair
What is the nursing care for patients with gastroschisis?
Keep sac covered, maintain thermoregulation, antibiotics, check for lower extremity pulses and bowel sounds after surgery
How do children inject lead?
Paints, soils, and batteries
How is lead poisoning treated?
Chelation therapy (Calcium EDTA), Ipecac
When is calcium EDTA contraindicated for lead poisoning?
When there is inadequate kidney perfusion
