Peds Exam 2 Flashcards
What is the purpose of the duodenum?
where digestion takes place
What are the 2 enzymes that aid in digestion?
amylase (saliva, digests carbs)
lipase (enhances fat absorption)
trypsin (breaks down protein into polypeptides and some amino acids)
What are some differences in A&P in the GI system?
GI is immature at birth
Liver function is immature at birth and for next few weeks
GI structure becomes more mature in life in second yr
What is the function of the stomach?
secretes hydrochloric acid and digestive enzymes to break down fats (gastric lipase) and proteins (pepsin)- little absorption
What is the function of the small intestine?
digestion is completed here by pancreatic enzymes, bile, and small intestine enzymes
What is the function of the large intestine?
water absorption
What is the function of the liver?
bile production, detoxification, glycogen storage and breakdown, vitamin storage
What is the function of the gallbladder?
stores bile
What are subjective items to ask about in the GI assessment?
lifestyle and family factors diet elimination patterns mental status auscultation percussion and palpation Labs
What are some of the physiologic differences of pediatric patients?
minimal saliva decreased stomach capacity reverse peristalsis increased gastric emptying time large intestine is relatively short (=decreased water absorption, stools softer with greater water loss during diarrhea meaning they are at a higher risk of dehydration)
What are the important numeric values we need to know for stomach capacity of pediatric patients?
newborn - 10-20ml
1 yr - 210-360ml
adolescent - 1500ml
What is a cleft lip and cleft palate?
congenital malformation (failure of maxillary processes to fuse) occurring during weeks 6-12 gestation varying degrees of severity most common craniofacial deformities overall in US multifactoral causes
What is the first sign of a possible cleft lip/palate?
formula coming from the nose
How do you treat a cleft palate/lip?
surgical correction (early correction to stimulate pleasure when sucking)
lip repair usually by 12 weeks
palate repair usually by 6-24 mo to maximize speech
What are some complications of cleft lip/palate?
cosmetic speech and hearing feeding orthodontic otolaryngology
Explain a cleft lip
opening between the nose and lip
apparent at birth
should be documented during a newborn assessment
assess a child’s ability to suck and swallow
cleft lip repair is done in first month of life
special feeding techniques is surgery is delayed
What is some pre-operative nursing care for a cleft lip/palate?
feeding
facilitate bonding
growth and monitoring
logan bar (protects surgical repair)
How should feeding be done on a cleft lip/palate?
upright position (to prevent aspiration)
breastfeeding if possible
haberman nipple
frequent burping
What are some post-operative aspects of cleft lip/palate?
restraint
feeding
suture care
referrals
Explain the post-operative aspects of cleft lip/palate regarding restraints?
“no,no” for at least 6-8 days, longer with palate repair, remove one at a time every two hours for 15min, for babies– swaddling is perfect
Explain the post-operative aspects of cleft lip/palate regarding feeding?
no straws, pacifiers, spoons, fingers by mouth for 7-10 days, use shorter nipple, can feed with side of spoon for older children, advance diet as tolerated
Explain the post-operative aspects of cleft lip/palate regarding suture care?
lip protective device (Logan Bar) to prevent tension of suture site
no brushing for 1-2 weeks, clean suture line with water after each feed
do not place on stomach
no oral temps, no tongue depressants
What is some nursing management for cleft lip/palate ?
prevent injury to the suture line
promote adequate nutrition
encourage infant-parent bonding
providing emotional support
Explain esophageal atresia and tracheoesophageal fistula?
they are congenital malformations in which the esophagus terminates before it reaches the stomach and or a fistula is present that forms an unnatural connection with the trachea
foregut fails to lengthen, separate and fuse into 2 parallel tubes (at 4-5 weeks gestation)
assc with maternal polyhydraminos (fetus can not swallow and absorb amniotic fluid in utero)
What are the 3 C’s of EA and TF?
coughing, choking, cyanosis
What are manifestations of EA/TF?
coughing, choking, cyanosis
excessive oral secretions
respiratory distress
NG tube cannot be passed into the stomach
child needs NG tube to suction oral secretions which might land in a blind pouch
What are some nursing management techniques of TEF?
initiate NPO
elevate HOB
monitor hydration status
assess and maintain orogastric tube/prevent aspiration
O2 and suctioning equipment readily available
What is a pyloric stenosis?
results from hypertrophy of circular muscle that surrounds pylorus causing obstruction of gastric emptying
What are some of the manifestations of pyloric stenosis?
projectile vomiting 30-60 min after feeding at about 2 weeks of age
movable, palpable, olive-shaped mass
dehydration with metabolic alkalosis
What is a big sign of pyloric stenosis?
Vomiting after feeding
What are some preoperative nursing interventions for pyloric stenosis?
Assess for dehydration and acid/base imbalance
examine/listen to abdomen
Is/Os
Oral care
TREAT DEHYDRATION AND ELECTROLYTE STATUS BEFORE SURGERY
What are some postoperative nursing interventions for pyloric stenosis?
feeding according to OR protocol
pedialyte normally 4-6 hours after then advancing to full strength breast milk or formula
teach parents the signs of problems post surgery
What is gastroschisis?
a congenital defect of the ventral abdominal wall, characterized by herniation of abdominal viscera outside the abdominal wall (usually to the right of the umbilicus)
the organs are not contained by a membrane
occurs in week 11 of gestation
multifactoral causes
What is omphalocele?
protrusion of abdominal contents through the abdominal wall at the function of the umbilical cord
may include intestines, stomach, liver
organs covered by a thin transparent layer of amnion
occurs at 11 weeks of gestation
multifactoral causes
How do you overall manage omphalocele and gastroschesis?
must return bowel to abdomen
if defect is large, will be done with silastic pouch or silo
TPN dependent
large potential for infection
What is the nursing management of newborn omphalocele and gastroschisis?
minimize fluid loss
protect the exposed abdomen contents from trauma/infection
postoperative care
surgical repair for both are done in stages
What is intussusception?
the invagination of one portion of the intestine into another causing obstruction – ischmia — puss – bleeding etc
most common cause of intestinal obstruction in children under the age of 2
S/s of intussusception
severe pain
lethargy
currant-jelly stools, gross blood (pussy, red, stool)
sudden onset of intermittent cramps or abdominal pain (paroxysml)
Manifestations of intussusception
sudden onset of pain, draw up their lets, vomit
currant jelly stools
sausage shaped abdominal mass that can be palpated
extreme paroxysmal pain
assess for shock
Treatment of intussusception
US guided saline, barium, air enema to reduce
no response? surgical emergency to avoid bowel necrosis
laparoscopy
(if burst - will feel better for a moment then go into hypovolemic shock)
What is malrotation/volvulus ?
twisting of intestine
obstruction of feces
occurs d/t intestinal malrotation
What are the manifestations of malrotation/volvulus?
pain, vomiting, signs of obstruction
SURGICAL EMERGENCY
What is Hirschprung’s Disease?
aganglionic (without nerves in your colon) megacolon
absence of ganglion cells in the rectum and upward to the colon
absence of ganglionic innervation leading to no peristalsis waves
What are the manifesations of Hirschprungs?
delayed passage of meconium
signs of obstruction
ribbon-like stool
What is the treatment for Hirschprungs?
stool softeners surgical removal of the aganglionic segment assess for enterocolitis complete bowel cleansing bowel sterilization IV abx pain management, Is/Os VS, colostomy care its a two stage surgery
What is an anal stenosis?
a thickened and constricted anal wall
s/sx = characteristic ribbon-like stools
can have stool in urine or stool in vagina
What is anal atresia?
imperforated anus
physical exam reveals absent opening
failure to pass meconium
can have stool in urine or stool in vagina
What is Meckle’s Diverticulum?
most common congenital malformation of GI tract
like a fecal duct
is a pouch on the lower part of the intestine that is present at birth
may contain tissue that is identical to tissue of stomach or pancreas (secreting stomach acid= pain)
What is an umbilical hernia?
protrusion or projection of an organ or a part of an organ through the muscle wall of the cavity that normally contains it
imperfect closure of the umbilical muscle ring
is reduceable and resolves by 3-4 yrs
surgery if s/sx of strangulation or increased protrusion
What is encopresis?
the soiling of fecal contents into the underwear beyond the age of expected toilet training (4-5 years of age)
can be secondary to other disorders
What is the most important determinant of the percent of total body fluid loss in infants and children?
weight
What is the best plan of action for oral rehydration?
rehydration of 75-90meq of sodium per liter
give 40-50 ml/kg over 1st four hours
maintain hydration with sol of 40-60 meq sodium per liter
keep daily vol maintenance hydration less than 150 ml/kg/day
What is oral candidiasis?
fungal infection of the oral mucosa
children at risk include
immune disorders using corticosteroid inhalers, chemo for cancer
antibiotic use
may get from breastfeeding mom
How do you treat oral candidiasis?
nystatin
fluconazole
What is GER?
the backward flow of stomach contents up into the esophagus or the mouth
happens to everyone
babies get small amts of GER and is normal and almost always goes away by 18 months
What is GERD?
occurs when complications from GER arise like failure to gain weight, bleeding, resp problems, or esophagitis
immaturity of the cardiac sphincter
What are the manifestations of GERD?
fussiness 30-60 min after a meal, poor growth
< 2 months have it, peaks at 4 months when LES matures and resolves by one year
What is the treatment for GERD?
smaller feeding thickening of formula keep upright before and after feedings burping find a nipple that makes a good seal to prevent air in mouth
What are some pharmacologic treatments for GERD?
prokinetics (given with meds that inhibit acid = metoclopramide)
antacids
H2blockers - 1st line (tidine) - turns off 70% of acid producing
PPIs - 2nd line (prazole) - turns off 100% of acid producing
What are some malabsorption disorders?
lactose intolerance
short bowel syndrome
celiac disease
What is lactose intolerance?
absence or deficiency of lactose leads to inability to digest lactose
more common in asians, native americans, african americans
frothy diarrhea with abdominal pain and distention
avoid milk based products, soy,
needs Calcium and Vit D supplementation
What is short bowel syndrome?
results from decreased mucosal surface area, usually resulting from a small bowel resection
prognosis has advance with TPN and nutrition
administer and monitor nutritional therapy
What is celiac disease?
gluten-induced enteropathy and celiac sprue - immunologic disorder in which gluten causes damage to the small intestine
What are the four characteristics of celiac disease?
steatorrhea
general malnutrition
abdominal distention
secondary vitamin deficiencies
Where are RBCs produced?
in bone marrow of long bones, that increase with age,
also produced in vertebrae, sternum, ribs
What is the RBC’s function?
to transport oxygen to the tissue
What stimulates RBC production?
a decrease in circulating 02 which causes kidneys to produce erythropoietin
What is avg live span of RBC?
120 days
What does the spleen do?
removes damaged or aging RBCs
How is the pediatric hematological system different than adults?
life span of erythrocytes in neonates is shorter
by 2 months, erythropoiesis increases leading to rise in hgb
fetus has higher O2 carrying capacity
reach adult hgb by puberty
What is the pathophysiology of IDA?
Iron is necessary for synthesis of hgb
low iron = low hgb = low O2 ability - low O2 to cells
How long can maternal hgb last?
up to nine months in a newborn
AAP recommends iron supplementation for all preterm infants
What are some manifestations of IDA?
pale (especially mucous membranes and conjunctiva) tachycardia tachypnea fatigue irritability
Things to know about administration of iron
give in 3 doses between meals with vitamin c rich foods to facilitate absorption
give through a straw to avoid staining teeth
brush teeth/rinse
avoid with milk (inhibits absorption)
will turn stool green/tarry
cont for 3 mon after H&H is normal
What is sickle cell disease?
inherited autosomal recessive disease
in 1st 5 yrs is the time highest for mortality
mostly african american, mediterranean, indian, middle eastern decent
What is the pathophysiology of sickle cell disease?
during increased metabolic needs or decreased O2, the cells sickle and cannot move freely through vessels causing stasis and sticking causing halts of blood flow
tissue distal to blockage becomes ischemic resulting in acute pain and cell destruction, vascular occlusion
What are manifestations of sickle cell disease?
sickling of RBC delayed growth and puberty pallor jaundice fatigue acute splenic sequesrtation priapism - painful erection doesnt go away
no symptoms in early infancy due to fetal hgb stores which have higher O2 carrying capacity
What is acute splenic sequestration?
large amts of blood pool in the spleen causing signs of hypovolemic shock
What is the treatment for sickle cell disease?
immunizations, penicillin prophy for children less than 6, flu vaccine
transfusions if necessary
gene therapy/ stem cell therapy
What should you do in a sickle cell crisis?
pain mgmt - narcotis like morphine
adequate hydration
oxygenation to prevent further sickling
MONITOR FOR FEVER - 1st sign of bacteremia
What are the types of sickle cell crisis?
vaso-occlusive
acute sequestration
aplastic
What is a vaso-occlusive sickle cell crisis?
severe pain in extremities, chest, and abdomen, CVA
give fl, O2, pain mgmt
What is acute sequestration sickle cell crisis?
spleen enlarges and blood pools in it causing lower bl vol and shock
common around 2-3 yr old
What is aplastic sickle cell crisis?
profound anemia requiring transfusion, normally brought on by an illness such as cancer
What is the pathophysiology behind hemophilia?
sex-linked recessive trait causing a decrease in factor 8 coagulation activity (mom carries the trait)
What are the manifestations of hemophilia?
dx at circumcision shortly after birth w prolong PTT and decrease in factor 8
bleeding or bruising easily at injection site
hemarthrosis - bleeding at joints causing swelling, pain, and joint limitation (get arthritis in your 20s)
How do you treat and what are the nursing considerations with hemophilia?
infuse factor 8
prevent injury with pads non-contact sports no aspirin immunization to avoid infection regular exercise to avoid joint immobilization
What is the purpose of the lymphatic system?
to drain fluid and cellular waste products, filter and strain out invading organisms, and cancerous cells
What is the purpose of lymph nodes?
they produce WBCs called lymphocytes which protect against bacteria and viruses
What are s/sx of childhood cancer?
may be subtle and look like childhood illness dx may be delayed unusual mass or swelling pallor fatigue localized pain or limping prolonged unexplained fever frequent vomiting eye or vision changes excessive weight loss
What are the different stages of cancer?
one - tumor not extented to surrounding tissue
two - local spread
three - spread to local lymph nodes
four - spread systemically
What are the effects of chemo?
depends on med hair loss, n/v/d stomatitis/dermatitis renal and neurotoxicity immunosuppresion anaphylaxis extravasation give IV benedryl
What is chemo based on?
chemo is based on body mass, kids can tolerate chemo much better than adults
Nursing things to recognize in kids with cancer
fever is normally only indication
monitor bleeding- platelets less than 20000
asses for anemia
assess for absolute nuetrophil count - normally less than 500 (neutrophils make up 70% of WBCs
wipe down toys
assess for tumor lysis syndrome
Goals of teaching for kids with cancer?
avoid live virus vaccines
EMLA for veinipunctures
prevent infection
prevent and recognize hemorrhage
admin platelets (no rectal temps and skin punctures)
conserve energy
need hydration
prevent food aversion and or constipation
monitor for neurotoxic signs (weakness, numbness, walking difficulties, jaw pain)
manage body concerns like alopecia
GROUP NURSING ACTIVITES
What is the pathphysiology of leukemia?
alteration in genetic make up of WBC that prevents maturation, these immature cells (blasts) crowd out all normal cells
most common cancer in childhood
What is ALL?
Acute lymphoid leukemia that affects cells in the lymphatic system (lymphoblasts) 75% of all leukemias
better prognosis
What is AML?
acute myelocytic leukemia and affects the myoblasts, less common, worse prognosis
What are some s/sx of leukemia?
insidious onset
persistent fever
increased bruising (thrombocytopenia)
anemia from low RBCs (usually 1st symptom)
infection from increase in bands (leukopenia)
bleeding from decreased platelets
the blast baby cells have no function
cause hyperplastic of the bone marrow
What is the treatment for leukemia?
allopurinol and IVF to flush WBC and decrease in uric acid
chemo over first month
CSN prphy therapy with intrathecal methotrexate, cytarabine, and hydrocortisone
maintenance for 2-3 yrs
bone marrow transplants
What is lymphoma?
Hodgkins Disease
neoplasm of lymphoid cells in lymph glands
only a group of lymph nodes
dx lymph node biopsy
What are s/sx of lymphoma?
large multinucleated cells - reed/sternberg cells
paianless, firm lymphadenopathy in supraclavicular region
fever
night sweats
weight loss
What is non-Hodgkin’s lymphoma?
similiar to hodgkins except spread is viz blood strem and not lymph blood
malignant disorder of the lymphocytes either B or T
dx with bone marror biopsy
What are the s/sx of an infant brain tumor?
irritable enlarged HC bulging fontanel vomiting lethargy FTT and loss of milestones
What are the s/sx of a child brain tumor?
vague headache personality change change in school performance fatigue clumsiness HALLMARK SIGN IS HA AND MORNING VOMITING
What is the pathophysiology of osteosarcoma?
epiphysis of a bone is a common site normally during growth spurt (towards the ends of the bone)
most common in males between 15-19
secondary neoplasm (cancer later in life)
turn about surgical procedure
What is Ewing sarcoma?
tumor sites in diaphysis (midshaft)
peak between 10-20 yrs
pain with increasing intensity
soft tissue swelling
What is Wilm’s tumor?
nephroblastoma
embryonic tumor affecting the kidney that originates between renoblasts
btw 2-5
What are the s/sx of nephroblastoma?
large, non-tender abdominal mass CROSSES MIDLINE hematuria swelling/pain in abdomen fever DO NO PALPATE (most curable solid tumor in children)
What is rhabdomyosarcoma?
malignancy of striated muscle
occurs most often periorbitally, sinuses or bladder
sysmtoms assc with site
What is Von Willebrand disease?
deficiency in VW factor
problem with platelet coagulation
ddavp is used for treatment of hemophilia and VW disease as it increases both factors
What are functions of the urinary system?
maintains balance hormonal functions stimulates production of erythropoietin production of renin (that reg BP) metabolism of vit D in active form excretes waste functionally immature until puberty
What are the differences between adult and peds GU with regards to kidney, urethra, GFR, bladder capacity, reproductive organs?
kindney - large in relation to stomach
urethra - shorter (higher chance of UTI)
GFR - slower in infant, risk for dehydration
bladder - 30ml in newborn, increases to adult size by 1 yr
What is GFR?
the process of filtering blood as it flows through the kidneys
What is tubular resorption?
necessary fluids, electrolytes, proteins, and blood cells are retained
What is tubular secretion?
waste products and fl filtered out
What do the kidneys need to work properly?
unimpaired renal blood flow
adequate GFR
normal tubular function
unobstructed urine flow
What is bladder exstrophy?
extrusion of bladder outside of body
failure of abdominal wall to close during fetal dev.
surgery in several stages
COVER W/WET STERILE GAUZE POST-DELIVERY AND PREPARE FOR SURGERY
What is hydrocele?
painless swelling of scrotum d/t collection of fluid
What is phimosis?
inability to retract prepuce at an age when it should retract (3yrs)
What is testicular torsion?
rotation of the testicle that interrupts its blood supply
What is cryptorchidism?
undescended or hidden testes
one or both fail to descend through inguinal canal into the scrotal sac
observe and surgery b/f 15mon (orchidopexy)
What is hypospadias?
often occurs in conjunction with congenital inguinal hernias, undescended testes, chordee
the urethral meatus may be located anywhere along the course of the ventral surface of the penile shaft
What is epispadias?
often occurs with bladder exstrophy
the meatal opening is located on the dorsal surface of the penile shaft and may be at the level of the bladder neck
What is hydronephrosis?
obstruction of the ureteropelvic junction of other parts of the ureter causes dilation of the kidney
the pelvis and calyces of kidney are dilated
can occur as a congenital defect, result of obstructive uropathy or secondary to VUR
What are the s/sx of hydronephrosis?
in mild-mod cases, there may be none and can resolve in first yr of life
abdominal mass
s and sx similiar to UTI
can be assc with vesicoureteral reflux
severe? extreme pain, bleeding, infrections
need surgery
What is VUR?
vesicoureteral reflux
backflow of urine from bladder into the kidneys
a valvelike like mechanism at the junction of the ureter and bladder prevents urine reflux into the ureters… when there is a defect at the vesicoureteral junction = VUR results
prevents complete emptying and creates reservoir for bacterial growth
What is a VCUG
voiding cystourethrogram is an x-ray examination of a child’s bladder and lower urinary tract that uses fluroscopy and a contrast material
VUR can cause infected urine to cause pylonephrities
What are disorders of urinary elimination?
UTIs (most common GU disorder of children)
Enuresis
What is the patho behind a UTI?
bacteria enter urethra and ascends the urinary tract
E. coli (Gram neg) causes approx most all UTIs in females
What causes a UTI?
incomplete bladder emptying irritation by bubble baths poor hygiene VUR urinary tract obstruction
What are the s/sx of a UTI for children under 2?
V/D irritability poor PO intake malodorous urine oliguira constipation
What are complications of a UTI?
risk of renal failure
- UTI under age 1
- delay in dx
- anatomic or neurologic obstruction
- recurrent episodes of upper UTI
What are the s/sx normally of a UTI?
abdominal pain enuresis freq/urgency pain/buring with urination (dysuria) hematuria lethargy or irritability poor feeding patterns cloudy, foul-smelling uring
What is enuresis?
repeated involuntary voiding by a child who has reached an age which bladder control is expected (5-6yr old)
nocturnal vs diurnal
What is the difference between primary, intermittent, and secondary enuresis?
primary- child has never had a dry night, attributed to maturational delay and small functional bladder
intermittent- child has occasional nights or periods of dryness
secondary- child begins bedwetting who has been reliably dry for 6-12 months, assc with stress, infections, and sleed disorders
How do you treat enuresis?
multitreatment approach is best
limit drinks before bed, void before bed
1/3 of nocturnal treated with meds
behavior interventions
What is nephrotic syndrome?
kidneys lose a significant amt of protein in the urine resulting in low blood levels of protein
What are s/sx of nephortic syndrome?
proteinuria hypoalbuminemia hyperlipidemia (from activation of clotting factors and lipids in the liver b/c of low serum albumin levels) edema excessive clotting factors low serum sodium
Who does primary nephrotic syndrome effect?
MCNS peaks btw ages 2-3 syndrome rare after 8 more common in boys some forms may progress to ESRD
What are clinical manifestations of nephrotic syndrome?
oliguira, dark frothy urine normo to hypertensive thrombosis anorexia, abd pain, n/v/d pallor, shiny skin w prominent veins, brittle hair, edema, skin breakdown resp distress and pulmonary congestion
How do you treat nephrotic syndrome?
PREDNISONE depends on cause of disease corticosteriods diuretics ACE inhibitors antithrombolitics NSAIDS
What do you teach parents about nephrotic syndrome?
monitor daily protein in urine with daily dipsticks
understand relapses do occur
no added salt
monitor weight
no s/sx of disease for 2 yrs = disease free
What is acute poststrep glomerulonephritis?
GABHS infection response
body responds to strep bacteria by formin antibodies which combine w. bacterial antigens to form antigen-antibody complexes
complexes get trapped in the glomerulus and cause inflammatory response
