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NURS 132 OB/Peds > Peds Exam 2 > Flashcards

Peds Exam 2 Flashcards

1
Q

What are the S x S of FTT?

A
  • < 3-5% weight
  • Development can be delayed
  • Muscle mass can ⬇
  • Abdominal distention
  • Behavior
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2
Q

What is an important feeding approach to remember w/ a FTT child?

A

Be persistent when offering to eat.

  • Add new foods slowly
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3
Q

What are some criteria in concerns to FTT feeding approaches?

A
  • Vitamin & mineral supplements

- High calorie formula (24 kcal/oz versus reg. 20kcal/oz

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4
Q

When can a cleft lip be surgically repaired?

A

Between 3-6 months of age.

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5
Q

When can a cleft palate be surgically repaired?

A

Between 6-24 months of age.

  • Early repair enables better feeding
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6
Q

What other medical occurrence is associated w/ cleft lip and palate?

A

Otitis media

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7
Q

What can be done after feeding to prevent the occurrence of Otitis Media?

A

Follow Feedings w/ water

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8
Q

What are some key points in concerns to cleft lip/palate post surgery?

A
  • Monitor carefully to prevent aspiration
  • Clean the suture line frequently
  • May need to use syringe w/ rubber to feed
  • Position upright during and after feedings
  • Rinse mouth w- water after feedings
  • Keep away pacifiers, straws…
  • Do not brush teeth for 1-2 weeks
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9
Q

What is the definition of Gastroenteritis?

A

Acute inflammation of the stomach and intestines accompanied by vomiting and diarrhea.

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10
Q

What are the S x S of Gastroenteritis?

A
  • Vomiting
  • Diarrhea
  • Irritability
  • Nausea
  • Electrolyte imbalance
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11
Q

What would a diagnostic test most likely reveal w/ Gastroenteritis?

A

Neutrophils and RBCs on stool specimen very indicative of bacterial gastroenteritis.

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12
Q

What is the most common cause of Gastroenteritis?

A

Rotovirus = vaccine available

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13
Q

What nursing assessments are performed w/ Gastroenteritis?

A

1) ⬆ fluid requirements w/ fever
2) Observe for S x S of dehydration
3) NO antidiarrheal for acute diarrhea

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14
Q

How would rehydration be handled in the event of dehydration caused by Gastroenteritis?

A

1) Oral Rehydration Therapy
2) IV fluids = LR or 0.9% NaCl
- -> after improved status:
- D5 0.45% NaCl twice the hourly maintenance rate
3) KCl replacement only after adequate urine output established
4) Food as soon as rehydrated and tolerating PO

  • Avoid plain water not to cause hyponatremia.
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15
Q

What type of diets are preferable after Gastroenteritis?

A

1) ABCs Diet =
- Applesauce
- Bananas
- Carrots (strained)

2) BRAT Diet =
- Bananas
- Rice
- Applesauce
- Toast

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16
Q

What are the possible diagnostic tests for Lactose Intolerance?

A
  • Clinitest of stool

- Breath hydrogen testing

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17
Q

What can be included in a lactose intolerant patient’s diet?

A

1) Enzyme replacement (LactAid, Dairy Ease)
2) High calcium content foods =
- egg yolks
- green leafy vegetables
- dried beans
- cauliflower
- molasses

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18
Q

What is the definition of Hirschsprung Disease? (Congenital Aganglionic Megacolon)

A

Hirschsprung disease is characterized by the absence of ganglion cells in segment of colon.
As a result =
- Stool accumulate proximal to the defect
- Bowel obstruction
- Potential Entercolitis

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19
Q

What are the S x S of Hirschsprung Disease?

A
  • Constipation in 1st month
  • Pellet like or ribbon foul smelling stools
  • FTT
  • Abdominal distention
  • Palpable fecal mass
  • Visible peristalsis
  • -> Can result in:
  • Chronic constipation
  • Bowel obstruction
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20
Q

What are the S x S of a bowel obstruction secondary to Hirschsprung disease?

A
  • Abdominal pain + distention
  • Refusal to feed or suck
  • Bile stained vomitus
  • If presence of Entercolitis the S x S =
  • explosive, watery diarrhea
  • fever
  • toxic
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21
Q

What assessments are performed pre-op for Hirschsprung’s?

A
  • Weight loss/gain
  • Nutritional intake & bowel habits
  • High calorie w/ high proteins and low fiber
  • Abdominal measurements
  • Monitor fluid and electrolytes
  • if severe NPO & TPN
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22
Q

What OR and post-op interventions are performed w/ Hischsprung’s?

A
  • Bowel resection or temp colostomy
  • NPO until NG to LIS
  • No rectal temperatures
  • Fluid and electrolyte monitoring
  • Colostomy care
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23
Q

What is Hypertrophic Pyloric Stenosis?

A

The pyloric sphincter hypertrophies resulting in narrowing the pyloric canal.

  • -> Obstructs gastric emptying
  • -> Develops in the first few weeks
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24
Q

What are the S x S of Hypertrophic Pyloric Stenosis (HPS)?

A

1) Projectile vomiting (1/2 to 1h after eating)
2) Palpable olive-like mass in RUQ
3) Deep peristaltic waves in stomach
4) FTT
5) When severe = dehydration + metabolic alkalosis

  • Vomit is non-bilious because content coming from stomach only
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25
Q

What is an Intussusception?

A

Proximal bowel segment telescopes into a more distal segment.
–> Can turn into necrosis = gangrene

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26
Q

What are the S x S of Intussusception?

A

1) Sudden acute abdominal pain (colicky)
2) Stools = Red currant jelly-like
3) Palpable sausage-shaped mass RUQ
4) Vomiting = bile-stained
- -> Can lead to Peritonitis if untreated

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27
Q

What are the treatments for Intussusception?

A

1) Hydrostatic reduction –> barium or air enema
2) Surgery =
- manual reduction
- resection of non viable areas of bowels

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28
Q

What is Gastroesophageal Reflux Disease (GERD)?

A

= Return of gastric contents I to the esophagus due to relaxation of the lower esophageal sphincter.

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29
Q

What patients are most at risk for GERD?

A

1) Premature babies
2) Bronchopulmonary dysplasia
3) TEF or EA repair
4) Scoliosis
5) Asthma
6) CF
7) CP

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30
Q

What are the 2 types of GERD?

A
  • Physiologic

- Pathologic

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31
Q

What are the characteristics of physiologic GERD?

A
  • Painless emesis after meals
  • Rarely occurs during sleep
  • No FTT
  • -> pharmacologic + medical management
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32
Q

What are the characteristics of pathologic GERD?

A
  • FTT
  • Aspiration pneumonia, asthma
  • Apnea, coughing + choking
  • Frequent emesis
  • -> may require surgery + pharmacologic tx
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33
Q

What are the S x S of GERD w/ infants?

A

1) Spitting up + forceful vomiting
2) Crying, stiffening
3) Weight changes (may ⬇ because of FTT)
4 Respiratory: cough + wheezes
5) Hematemesis + OM
6) Apnea or ALTE (Apparent Life Threatening Event)

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34
Q

What are the S x S of GERD w/ children?

A

1) Chronic cough
2) Heartburn
3) Abdominal pain
4) Non-cardiac chest pain
5) Dysphasia
6) Nocturnal asthma
7) Recurrent pneumonia

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35
Q

What interventions could help infants’ feeding w/ GERD?

A
  • Thickened formula
  • Small frequent meals
  • Burp infant often
  • HOB 30 *
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36
Q

What interventions could help toddler’s feeding w/ GERD?

A
  • Feed solid foods first

- Follow w/ liquids

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37
Q

What is a particular sleeping recommendation for an child < 1 year old w/ GERD?

A
  • Sleep in right side position
  • -> may help stomach emptying
  • HOB 30 *
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38
Q

What medications are recommended to manage GERD?

A

ANTACIDS

1) H2 Antagonists = ranitidine, cimetidine, famotidine
2) Mucosal protectants = sucralfate
3) Prokinetic Agents = metoclopramide
4) Proton Pump Inhibitors = omeprazole

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39
Q

What complications can occur if GERD is not well managed?

A
  • Esophageal strictures
  • Laryngitis
  • Recurrent pneumonia
  • Anemia
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40
Q

In what occurrences will a surgical intervention be necessary w/ GERD?

A

1) Recurrent pneumonia
2) Apnea
3) Esophagitis
4) FTT
5) Failed medical Tx
6) Nissen fundoplication = gastric fundus encircles the distal esophagus

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41
Q

What are the possible surgical complications w/ GERD?

A
  • Breakdown of the wrap
  • Gas-bloat syndrome
  • Infection
  • Retching
  • Dumping syndrome
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42
Q

What are TEF and EA?

A
  • Tracheoesophageal Fistula
  • Esophageal Atresia

–> Can occur together or separately

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43
Q

What is the definition of TEF and EA?

A

Malformation that results in failure of the esophagus to develop as a continual tube during the 4th and 4th weeks of gestation.

  • Higher incidence in =
  • premature infants
  • low birth weight
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44
Q

What is the most important nursing intervention w/ TEF and/or EA?

A
  • Keep pt supine with HOB 30 degree + NPO
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45
Q

What are the S x S of TEF?

A

1) Excess saliva + drooling
2) Coughing
3) Choking
4) Cyanosis
5) Vomiting
6) ⬆ respiratory distress after feedings
7) Abdominal distention

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46
Q

What surgical interventions can be performed to treat TEF or EA?

A

1) Fistula ligation

2) Atresia anastomosis

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47
Q

What are some post-op considerations w/ surgical Tx of TEF or EA?

A
  • Respiratory assessment
  • Tubes = G-tube, NG, chest tubes
  • Non-nutritive sucking (pacifier) = to keep stimulation
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48
Q

What is the definition of Meckel Diverticulum?

A
  • A fibrous band connecting the small intestine to the umbilicus.

–> Most common GI anomaly

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49
Q

What are the S x S of Meckel Diverticulum?

A

1) Painless rectal bleeding
2) Abdominal pain
3) Intestinal obstruction signs

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50
Q

What causes Appendicitis?

–> located at McBurney’s point

A
  • Hardened fecalith
  • Swollen lymphoid tissue
  • Parasite
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51
Q

What are the S x S of Appendicitis?

A

1) RLQ pain (starts before vomiting)
2) Fever
3) Rigid abdomen = guarding
4) ⬇ or absent bowel sounds
5) Vomiting = can have bile
6) Constipation or diarrhea
7) Anorexia
8) ⬆ pulse
9) ⬆ shallow respirations
10) Pallor
11) Lethargy
12) Irritability
13) Stooped posture

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52
Q

How can the RN assess for suspected Appendicitis?

A

1) Symptoms develop slowly (12 h)
2) Presence of pain, anorexia, or nausea + vomiting + fever
3) If pain precedes vomiting = suspect Appendicitis
If vomiting before pain = suspect Gastroenteritis
4) Pain may be generalized and focused on RLQ later

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53
Q

What is Rovsing’s sign in concerns to Appendicitis?

A
  • When pushing on LLQ, pain will appear on RLQ.
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54
Q

What are some confirming diagnostic tests for Appendicitis?

A
  • CT scan
  • Ultrasound
  • ⬆ WBCs
  • CRP = C-reactive protein (> in 12 h of infection)
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55
Q

What are some nursing assessments in concerns to Appendicitis?

A
  • Allow pt to assume a position of comfort
  • Assessment for classic abdominal symptoms
  • Pain
  • If sudden spike of fever and relief of pain may indicate perforation.
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56
Q

What are the pre and post-op nursing interventions w/ Appendicitis?

A

1) Pre-op =
- Do not stimulate the bowels –> could cause perforation
2) Post-op =
- IV antibiotics
Non perforated –> Cefepime
Perforated –> Meropenem

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57
Q

What are the S x S of a post-op abscess w/ Appendicitis?

A

1) ⬆ pain
2) Restlessness
3) Irritability
4) ⬇ ambulation

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58
Q

What maintains the ICP (intracranial pressure)?

A

The balance of the following =

1) Brain tissue
2) Blood
3) Cerebrospinal fluid

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59
Q

What factors influence the ICP?

A

1) Pressures =
- Arterial
- Venous
- Intraabdominal (Valsava)
- Intrathoracic
2) Posture
3) Temperature
4) Blood gases (CO2 + O2 exchange)

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60
Q

How is the ICP regulated and maintained?

A

1) Normal compensatory adaptations:
- Alteration of CSF
- Displacement of CSF into subarachnoid space
2) Ability to compensate is limited:
- If volume ⬆ continues, ICP ⬆

61
Q

What are the S x S of ICP?

A

1) Headache =
- often continuous (worst in am because flat supine)
- time exacerbates
2) Vomiting =
- not preceded by nausea
- projectile
3) LOC changes =
- irritability
- confusion
- ⬇ responsiveness
- difficulty following commands (wiggle toes, hold up 2 fingers)
4) Pupil changes (response to light)
5) Cushing’s triad (response) =
- bradycardia
- ⬆ BP
- abnormal respiratory pattern
6) ⬇ motor function + reflexes
7) Posturing =
- decorticate (extremities to core)
- decerebrate (extremities extended + pronated)
8) Flaccid response to pain (sternal rub)
9) Babinski sign

62
Q

What can be assessed when suspecting ICP?

A

Glasgow Coma Scale (GCS)

  • Eye 4
  • Verbal 5
  • Motor 6
  • -> Score ranges from 3 to 15
63
Q

What are the S x S noticed on infants w/ ICP?

A

1) Bulging fontanel
2) ⬆ head circumference
3) Cranial sutures
4) High pitched cry
5) Poor feeding
6) Vomiting
7) Irritability/ Restlessness

64
Q

What are the S x S noticed on children w/ ICP?

A

1) Headache (worst in am)
2) Diplopia
3) Mood swings
4) Slurred speech
5) N/V (especially in am)
6) Altered LOC
7) Papilledema

65
Q

What nursing interventions can be performed to relief ICP?

A

1) Adequate oxygenation =
- ABG analysis
- O2 therapy
- May require ventilator

2) Drug therapy =
- Mannitol (osmotic diuretic)
- Corticosteroids (inflammation)
- Barbiturates (anti-anxiety)
- Anti-seizure drugs

66
Q

What is the definition of bacterial Meningitis?

A

1) Acute inflammation of meningeal tissue =
- Always arachnoid mater + cerebrospinal infection
2) Medical emergency =
- Untreated mortality rate near 100% (quick onset)

67
Q

How is bacterial Meningitis contracted?

A

Organisms enter CNS from respiratory tract or bloodstream =

  • through wounds of skull or fx sinuses
  • often secondary to viral respiratory disease
68
Q

What are the clinical manifestations of bacterial Meningitis?

A

1) Inflammation response ⬆ CSF production w/ moderate ⬆ ICP
2) Purulent secretions spread to other areas of brain through CSF
3) If concurrent encephalitis present –> ⬆ ICP becomes problematic

69
Q

What are the S x S of bacterial Meningitis?

A

1) Fever
2) Severe headache
3) Nuchal rigidity (neck)
4) Nausea, vomiting
5) Positive Kernig’s sign
6) Brudzinski’s sign (flex neck –> hip flex)
7) Photophobia
8) ⬇ LOC
9) S x S of ⬆ ICP
10) Coma (poor prognosis)
11) Seizures (1/3 of cases)

  • Kernig’s sign =
  • Elevate + flex leg
  • Extend leg
  • If pain reported = positive sign
70
Q

What are some possible complications w/ bacterial Meningitis?

A
  • Acute ⬆ of ICP
  • Residual neurological dysfunction (cranial nerves + hearing loss)
  • Acute cerebral edema (–> brady❤, CN palsy, coma, death)
71
Q

How can bacterial Meningitis be diagnosed?

A

1) Blood culture
2) Lumbar puncture (analysis of CSF)
3) X-rays of skull
4) CT scan
5) MRI

  • No lumbar puncture if ICP is too high - Assess fundus of eyes first.
72
Q

What are some nursing interventions performed w/ bacterial Meningitis?

A
  • Vaccination against resp infections
  • Early Tx of resp infections
  • Prophylactic antibiotics
  • Position of comfort
  • Pain + seizure medications
  • Antibiotics + steroids
  • Darken room
  • Cool cover for eyes
  • Monitor hydration
73
Q

What are the most common causes for viral Meningitis?

A

1) Enterovirus
2) HIV
3) HSV

74
Q

What is Reye Syndrome (RS)?

A

Acute rapidly progressing encelophalopathy.

75
Q

What are the clinical manifestations of Reye Syndrome?

A

1) Liver dysfunction
2) Cerebral edema + ⬆ ICP
3) Hypoglycemia
4) Shock

76
Q

What is Reye Syndrome associated with?

A
  • Influenza
  • Chickenpox
  • Aspirin + Salicylate intake w/ virus illness
77
Q

How is Reye Syndrome possibly diagnosed?

A

1) Liver function tests
2) Liver biopsy
3) Lumbar puncture
4) Serum ammonia level (⬆)
5) Coagulation time

78
Q

What are the S x S of Reye Syndrome?

A

1) Loss of neurological function
2) N/V
3) Cerebral edema
4) Liver dysfunction

79
Q

What are the different stages of Reye Syndrome?

A 
I = lethargic, confused, follows command
II = stuperous, agitated, delirious
III = unresponsive coma, decorticate posture
IV = brain stem dysfunction - decerebrate posture
V = flaccid, seizures, respiratory arrest
80
Q

How is Reye Syndrome clinically managed?

A
  • Mainly supportive care
  • ⬆ ammonia levels = Neomycin
  • ⬇ ICP = Mannitol, corticosteroids, HOB 15-30*
  • Vitamin K
  • Seizure precautions
81
Q

What are the 3 different types of Spina Bifida?

A

1) Spina Bifida Occulta = Invisible, no S x S, defect in bony spine.
2) Menigocele = No neuro S x S, spinal defect, sac-like protrusion contains no spinal nerves.
3) Myolomenigocele = Neuro S x S, spinal defects, sac-like protrusion contains meninges, spinal fluid and spinal nerves.

82
Q

What causes these different types of Spina Bifida?

A

1) Insufficient Folic acid in maternal diet
- 70% could be prevented if had taken a daily 400 mcg before and during pregnancy.
- 30% etiology unknown: possible genetics or environmental.

83
Q

How is Spina Bifida diagnosed?

A

1) In utero = AFP, Amniocentesis
2) Physical exam
3) CT
4) MRI

84
Q

What are the necessary assessments w/ a Spina Bifida patient?

A

1) Inspect sac at birth + determine if intact
2) Inspect lumbosacral area for dimpling
3) Assess head circumference + fontanel = hydrocephalus if ⬆ CSF
4) Assess extremity movement
5) Infection risk

85
Q

What are the nursing interventions in concerns to Spina Bifida?

A

1) Cover sac w/ sterile (NS) nonadherent dressing until surgery
2) Protect sac from injury = keep infant in prone position w/ surveillance

86
Q

What is the definition of Hydrocephalus?

A

Abnormal accumulation of CSF w/in the ventricles of the brain.

87
Q

What are the causes of Hydrocephalus?

A

1) Spina Bifida = most common
2) Meningitis complications
3) Obstruction of CSF flow between the ventricles

88
Q

What are the S x S of Hydrocephalus w/ infants?

A

1) Irritability, lethargy
2) ⬆ head circumference
3) Bulging fontanels
4) ⬆ suture lines
5) High pitched cry

89
Q

What are the S x S of Hydrocephalus w/ children?

A

1) ⬇ LOC
2) Irritability
3) N/V
4) Headache = worst in am
5) Unequal pupil response
6) Seizures
7) Personality change

90
Q

What are the characteristics of Ventriculoperitoneal Shunt?

A
  • Shunt is inserted into ventricle
  • Tubing is tunneled through skin to peritoneum
  • Shunt valve opens at a predetermined ventricular pressure and it drains excess CSF from ventricle to peritoneum
  • Shunt valve closes when pressure fails below the threshold level
91
Q

What is the post-op care involved w/ a VP shunt?

A

1) Assess dressing for blood and CSF drainage
2) ICP assessment
3) Position on unoperated side
4) HOB position per MD order =
- facilitate CSF drainage
- avoid too rapid of drainage
5) Assess abdominal distention =
- peritonitis + Ileus

92
Q

What are certain complications that could arise w/ a VP shunt?

A

1) Infection =
- ⬆ temp
- N/V
- poor feeding
- redness/ tenderness along shunt tract
2) Separation or migration of tubing
3) Obstruction resulting in ⬆ ICP

93
Q

What is the definition of Cerebral Palsy?

A

A non progressive injury to the motor centers causing neuromuscular problems of spasticity or dyskinesia (involuntary movements).

94
Q

What are the associated problems w/ Cerebral Palsy?

A
  • Mental retardation
  • Seizures
  • Level of function varies widely
  • Pts can be verbal but often non-verbal
95
Q

What are the classifications of CP?

A

1) Spastic (most common) =
- hypertonic, poor posture, balance + coordination
- may involve 1 or both side
2) Dyskinetic/ Athetoid =
- abnormal involuntary movements
- early life: flaccid and limp
- later life: slow writhing motions
3) Ataxic =
- wide bases gait
- rapid repetitive movements + ⬇ fine motor control

96
Q

What are the S x S of CP?

A

1) Persistent reflexes after 6 months
2) Developmentally delayed
3) Poor suck, tongue thrust
4) Spasticity
5) Scissoring of legs
6) Involuntary movements
7) Seizures
8) Sensory alterations: visual, hearing…

  • If cannot communicate does not mean they do not understand!
97
Q

What some nursing interventions involved w/ CP?

A

1) Prevent aspiration during feedings =
- position upright + support lower jaw
2) Medications to manage symptoms =
- anticonvulsants
- muscle relaxants (Baclofen)
3) Prevent and treat contractures
4) Assistive devices

98
Q

What is the definition of a Urinary Tract Infection?

A

Infection of bacterial, viral, fungal origin that occurs in the urinary tract.
–> Females more prone due to short urethra

99
Q

What are the S x S of a UTI in infants?

A

1) Fever or hypothermia
2) Irritability
3) Dysuria (crying when voiding)
4) Change in urine odor or color
5) Feeding difficulties

100
Q

What are the S x S of a UTI in children?

A

1) Abdominal or suprapubic pain
2) Voiding frequency + urgency
3) Dysuria
4) New or ⬆ incidence of enuresis
5) Fever

101
Q

What is the definition of Pyelonephritis?

A

Upper UTI that involves the ureters, renal pelvis and renal parynchema.

102
Q

What are the S x S of Pyelonephritis?

A

Same as UTIs plus:

1) High fever, chills
2) Back pain
3) Costovertebral angle tenderness
4) N/V
5) Appears sick (toxic)

103
Q

What are the diagnostic methods w/ urinary illnesses?

A
  • Urinalysis
  • Urine culture
  • VCUG = voiding cystourethrogram
  • Ultrasound or CT
104
Q

What are the nursing interventions involved w/ UTIs?

A
  • Assess fluid and electrolyte status
  • Antibiotics = IV or PO
  • Renal impairment = falsely low specific gravity
105
Q

What is Vesicoureteral reflex?

A

The upper openings in the bladder coming from the kidneys do not properly shut when voiding. As a result, urine will flow back up toward the kidneys and create an infection.

106
Q

What are the diagnostic tests for Vesicoureteral reflex?

A

1) Hx of UTIs
2) VCUG (Voiding Cystourethrogram) =
- Dye into bladder via catheter
- X-rays taken before, during and after voiding
- Visualize bladder, urethra reflux

107
Q

How is Vesicoureteral reflex treated?

A

1) Most can be treated medically = Grades I- III
2) Low dose antibiotics
3) Frequent urine cultures
4) Surgically - Criteria =
- Grades IV and V
- Recurrent UTI (w/ AB Tx)
- Noncompliance w/ AB (antibiotics)
- Intolerance to AB
- VUR after puberty in females

108
Q

What are the implications after surgical intervention w/ VUR?

A

1) Reimplant the ureters into bladder
2) Stents into ureters
3) Foley
4) Post-op antibiotics until normal VCUG =
- 3 months
- 1 year
- 3 years

109
Q

What is the definition of Glomerulonephritis?

A

Inflammation of the glomeruli of the kidneys, usually in response to group A beta-hemolytic streptococcal infection of the skin or pharynx.

  • If strep is not well treated => can turn into Glomerulonephritis
110
Q

What are the clinical manifestations of Acute Postinfectious Glomerulonephritis (APG)?

A

1) Hematuria = mild-gross (tea color)
2) Periorbital and ankle edema = ⬆ in a.m
3) ⬇ urine output
4) Febrile/Lethargic
5) Abdominal pain
6) Headache
7) HTN
8) ⬆ protein in urine
9) > BUN + > Creatine

–> Risk for pulmonary edema

111
Q

What are the different diagnostic tests available for APG?

A

1) ESR + lipid levels ⬆ in 40% of cases

2) Positive ASO titter confirms strep infection

112
Q

How can APG be treated?

A
  • Diuretics = Lasix
  • Antihypertensives
  • Antibiotics
113
Q

What are some nursing interventions in concerns to APG?

A
  • Daily weight + strict I & O
  • Assess BP
  • Respiratory assessment
  • Prevent skin breakdown = edema ⬆ risk
  • Low Na diet (or none)
  • Limit fluid if ordered
  • Encourage rest in acute phase
114
Q

What is a characteristic of Nephrotic Syndrome (NS)?

A

It is an autoimmune process caused by a domino effect w/ liver stimulation.

115
Q

What are the clinical manifestations of Nephrotic Syndrome?

A

1) Edema
2) Massive proteinuria (frothy urine)
3) Hypoalbuminemia
4) Hyperlipidemia
5) Fatigue + abdominal pain
6) Normal BP!
7) Anorexia

116
Q

What are the proper treatment for Nephrotic Syndrome?

A

1) Corticosteroids = ⬆ dose to ⬇ proteinuria
2) Diuretics = ⬇ edema
3) Possible albumin administration
4) Antibiotics (prophylactic)
5) No added salt diet
6) Fluid restriction (if severe edema)

117
Q

What are some patient teaching tips in concerns to the corticosteroids to treat the NS?

A

Common side effects =

  • ⬆ appetite
  • hyperglycemia
  • ⬇ resistance to infection

Precaution =
Meticulous aseptic technique to prevent infection (Candidiasis)

118
Q

What is Wilms Tumor?

A

Nephroblastoma = left embryonic tissue enclosed creating a tumor that can metastasize if untreated.

119
Q

What are the S x S of Wilms Tumor?

A

1) Non-tender, firm, flank mass
2) Often asymptomatic
3) Abdominal pain (especially when felt)
4) Vomiting
5) Microscopic - gross hematuria
6) Anemia
7) HTN

120
Q

What are the possible diagnostic tests in concerns to Wilms Tumor?

A
  • Physical assessment I.D mass
  • Abdominal ultrasound
  • Evaluation for metastasis = CT + MRI
121
Q

How is Wilms Tumor clinically managed?

A
  • Don’t palpate flank or abdomen once felt once
  • Surgery
  • Chemotherapy
  • Radiation
122
Q

What are some characteristics of Wilms Tumor?

A
  • Survival rate = > 90%

- Recurrence = 50%

123
Q

What is the definition of Hypospadias?

A

It is a congenital defect that results in the urethral opening on ventral side of penis.

124
Q

What are the S x S of Hypospadias?

A

1) Abnormal meatus placement
2) Altered voiding stream
3) Chordee = ventral curvature of penis
4) May occur w/ =
- Undescended testes
- Inguinal hernia

125
Q

How is Hypospadias treated and clinically managed?

A

1) No circumcision (to save skin used later in surgery)
2) Surgical correction before 3 years of age
3) Post-op =
- Monitor urine output
- Catheters (Foley, suprapubic or urethral stent)

126
Q

What is Developmental Dysplasia of Hip (DDH)?

A

Abnormality in the development of the proximal femur, acetabulum or both.
–> unknown cause + ⬆ risk w/ Caucasian females

127
Q

What are the known risk factors w/ DDH?

A
  • Family Hx
  • First pregnancy
  • Oligohydramnios
  • Breech presentation
  • Maternal hormones = relaxes baby joints
  • Twins
  • Large size
128
Q

What are the diagnostic tests for DDH?

A
  • Physical exam
  • Ultrasound (2 weeks of age)
  • X-rays (> 4 months)
129
Q

What are the S x S of DDH?

A

1) Asymmetry of gluteal folds
2) Leg length discrepancy
3) Hip abduction limitation
4) Positive Ortolani sign (click w/ abduction)
5) Pain
6) Positive Trendelenberg sign = pelvis tilts down on side opposite to affected leg.

130
Q

How is DDH clinically managed?

A

1) Between 0 and 6 months of age –> Pavlik harness =
- Wear 24 h/day
- Adjust straps w/ growth
- Assess for skin irritation (often)
2) > 6 months of age = closed or open reduction w/ hip spica cast application

131
Q

What are the nursing interventions for post-op spica cast care?

A

1) Neurovascular assessment of extremities
2) Assess cast for drainage and bleeding
3) Assess respiratory system (cast constriction)
4) Pain management
5) Skin assessment

132
Q

What is the definition of Clubfoot?

A

Congenital deformity of the foot that is twisted out of shape or position.

133
Q

What are the 2 different types of Clubfoot?

A

1) Equinus = Bent downward

2) Varus = Bent inward w/ angulation towards the midline

134
Q

What can be the causes of Clubfoot?

A
  • Familial
  • Crowding in uterus
  • Maternal smoking during pregnancy
  • Amniocentesis
  • > risk in boys
  • > risk in twins
135
Q

How is Clubfoot clinically managed?

A
  • Manipulation + serial casting (changed weekly)
  • Corrective shoes + splints
  • Surgery
  • -> Outcome = foot may always be slightly smaller and stiffer
136
Q

What is Scoliosis?

A

Lateral curve of the spine.

137
Q

What are the known causes of Scoliosis?

A

1) Neuromuscular disease (Cerebral Palsy)
2) Trauma
3) Tumors
4) Vertebrae infections/disorders

138
Q

What are the S x S of Scoliosis?

A

1) Hips at angle uneven w/ shoulder height
2) Pants/ skirts length discrepancy
3) Respiratory dysfunction (w/ severe curvature)

139
Q

How is Scoliosis clinically managed?

A

1) Bracing: 25-35 degree =
- Milwaukee brace
- Wear 23 h/day
- Wear T-shirt under to prevent skin breakdown
- Assess skin frequently
2) Spinal fusion if > 40 degree angle

140
Q

What is the proper nursing care for a spinal fusion (w/ Scoliosis)?

A
  • Prepare pt for foley, NG, chest tubes
  • Review pain management PCA
  • Log-roll and avoid twisting trunk
  • Neurovascular assessments (lower extremities)
  • Assess incision site for blood and CSF
  • Body jacket used when ambulating
141
Q

What is Juvenile Rheumatoid Arthritis or Juvenile Idiopathic Arthritis?

A

Group of chronic autoimmune inflammatory diseases affecting joints and other tissues =
–> Wearing down and damage to the articulate cartilage
(> incidence w/ girls)

142
Q

What are the S x S of JRA?

A

1) Joint swelling, stiffness, redness
2) Joint pain
3) Joints warm to touch
4) Mobility limitations
5) Fever, rash, malaise
6) Mild - severe in presentation
- -> Can lead to risk of Uveitis = Eye disorder (blindness)

143
Q

What are the 3 different types of JRA?

A

1) Pauciarticular = 4 or fewer joints (greater risk for Uveitis)
2) Polyarticular = 5 or more joints
3) Systemis = any number of joints involved w/ high fever, rash, pericarditis, hepatosplenomegaly, lymphadenopathy.

  • Poorest prognosis = Polyarticular and systemic
144
Q

How is JRA clinically managed?

A
  • NSAIDs (Ibuprofen, Naproxen)
  • Cytotoxic drugs ( Methotrexate) when NSAIDs not effective alone
  • Corticosteroids (Prednidone) = small dose
  • Antirheumatic drugs
145
Q

What is the proper nursing care when treating JRA?

A

1) Moist heat to joints before exercise
2) Rest acutely inflamed joints
3) Splint joints for sleep to ⬇ pain and prevent flexion deformities
4) Exercise heated pool (pace activity)
–> 60% can recover
40% still have symptoms

146
Q

What is Muscular Dystrophy?

A

A group of inherited disorders w/ progressive degeneration of symmetric skeletal muscle groups.
–> Affects mostly boys (inherited from mom)

  • Duchenne muscular dystrophy is the most common
147
Q

What is the Duchenne Muscular Dystrophy life expectancy?

A

Between teen years and early 20’s

148
Q

What are the S x S of Duchenne Muscular Dystrophy (DMD)?

A

1) Early onset (3-5 years)
2) By 9-11 years old = loss of independent ambulation
3) Progressive muscle weakness
4) Calf muscle hypertrophy
5) Waddling gait
6) Lordosis
7) Winged scapulae
8) Gowers sign =
- difficulty rising
- child walks up legs using hands to stand up
9) 30% mentally delayed
10) Respiratory + cardiac difficulties later in disease

  • By age 10 = most are in wheel chairs
149
Q

How is DMD clinically managed?

A
  • Maintain muscle function as long as possible
  • ROM keeps joints flexible
  • Splints and braes to prevent contractions
  • Encourage child to be independent
  • Respiratory support = intermittent pressure ventilation
  • Support groups for DMD

NURS 132 OB/Peds (4 decks)

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