PEDS- Exam 3 Flashcards
Diabetes mellitus is what
a metabolic deficiency of insulin
Type 1 diabetes is characterized by
destruction of pancreatic beta cells
Type 2 diabetes is characterized by
it is a chronic condition characterized by insulin resistance and/ or insufficient insulin production
What is a type 1 diabetic dependent on
insulin because they will not be able to produce their own
Risk factors for type 1 diabetes
genetic predisposition, autoimmune factors, environmental triggers
Expected findings of diabetes type 1
hypoglycemia ( cold and clammy you need some candy), hyperglycemia (high and dry sugar high)
Tell me the findings for hypoglycemia
blood glucose less than 60
hunger, lightheaded, cool skin, diaphoresis (cool skin)
tachy.
neuro
headache
difficulty in thinking
slurred speech
tell me the findings for hyperglycemia
blood glucose greater than 250
thirst
polyuria
n/v
dry mucous
weak pulse
warm dry
neuro
confusion
weakness
diminished reflexes
telltale sign of type 1 in DKA
fruity breath
Diagnostic test for diabetes type 1
fasting blood glucose ( 126 or more after an 8-hour fast)
oral glucose tolerance test (200 mg or more in the 2-hour sample)
Random blood glucose ( 200 mg or more with symptoms of diabetes
education for fasting blood glucose
ensure an 8-hour fast (only water), postpone antidiabetic medications until after the test
education for oral glucose tolerance test
balanced diet for 3 days before fasting for 8 hours
initial fasting blood glucose drawn
consume specified glucose, blood glucose levels drawn every 30 min for 2 hours
monitor for hypoglycemia
Diabetes type 1 treatment
only treatment is insulin
insulin pump, insulin injections
Diabetes type 1 nursing education
-rotate injection sites, which helps maintain a consistent absorption rate
-inject at 90-degree pinch
- when mixing insulin draw short insulin first followed by long-acting
Diabetes type 1 complication
DKA - ketone accumulation in the blood urine and lungs
-Hyperglycemia >330
-glycosuria glucose in urine
-acidosis
- fruity breath
diabetes type 1 nursing consideration
-provide isotonic fluid
-blood glucose approaches 250 add glucose to IV fluids to maintain levels between 120-240
-MMonitor glucose and potassium
-administer sodium bicarbonate for acidosis
-maybe provide oxygen
Growth hormone disorder deficiency
not enough GH -> slowed growth in children ->metabolic effects in adults
growth hormones deficiency risk factors
structural factors (tumors, traumas)
heredity disorders
deficiencies of TSH or ACTH
most often idiopathic
Growth hormone excess
too much can lead to gigantism or acromegaly in adults
GH deficiency expected findings
-short stature but proportional height and weight
- delayed closure of growth plates
- delayed teeth/ underdeveloped jaw
-increased insulin sensitivity
-standard deviation might have growth rate slower than whats expected
GH excess expected findings
before closing of epiphyseal plate
-excessive height and rapid growth
-longer limbs due to continued growth of limbs
-larger heads and feet
-prominent forehead and jaw
after closing the epiphyseal plate
-thickened skin
-deep voice
-excessive sweating and body odor
-headaches and vision problems
-sleep apnea also due to enlarged organs
labs and diagnostic for GH deficiency
plasma insulin, gh stimulation, skeletal survey
labs and diagnostic for GH excess
elevated IGF-1 levels are a key indication of GH excess
oral glucose tolerance test (gold standard!! Normally GH levels lower after glucose but in excess they remain elevated)
prolactin levels
MRI
Nursing care for both GH-deficient and excess
-Height ! and weight tracked
-measure every 6 months under 3 and yearly over 3
-address psychosocial concerns
-encourage realistic age-appropriate goals
Patient education for both GH-deficient and excess
-minimal side effects of meds with proper dosing
- supports muscle growth and self-esteem
-injection teaches subcutaneous
- frequency 6-7 times a week
- important to adhere
-reassess need in early adulthood
What is the medication used for GH
somatropin
administered via subcutaneous
use cautiously in children receiving insulin
Tay Sachs + risk + findings
rare genetic disorder
caused by a deficiency of enzyme Hex-A
Risk
autosomal recessive
Ashkenazi jew descent
Findings
developmental delays
muscle weakness
increased startle reflex
cherry spot on the retina
seizures
vision/hearing loss
Phenylketonuria
inherited disorder newborn lacks enzyme phenylalanine hydroxylase cant convert into tyrosine leads to accumulation causing cognitive impairment
Phenylketonuria risk factor and expected findings
risk: pku inherited as an autosomal recessive trait
finding
-growth failure
-frequent vomiting
-irritability
-musty odor to urine
-microcephaly
-heart defects
- blue eyes, fair skin, blonde hair
Labs for tay sachs
genetic testing for mutations in the HEXA gene, enzyme activity assays to check hex-a levels in blood or tissue, prenatal testing for at risk families
Labs for PKU
Newborn metabolic screen: blood spot analysis after the newborn has ingested a source of protein (2 days of birth)
Guthrie test: confirms dx. when blood spot analysis is positive
Tay sachs nurisng care
no cure for tay sachs, manage symptoms, provide supportive care
care teams
PKU nursing care
dietary: low phenylalanine formula start restrictions 7-10 days of birth
limit intake: 20-30 mg/kg of body weight
-check levels regularly aim for 2-88 mg levels
Complications for Tay Sachs
no cure
blindness, paralysis, cachexia, seizure death (3-5)
complications for PKU
cognitive impairment, hyperactivity, bizarre behavior, head-banging, seizures
Galactosemia
rare- affects the body’s ability to metabolize galactose (sugar in milk)
inherited autosomal recessive
treatment - dietary management
early diagnosis an dietary management can prevent severe complications
Maple Syrup Urine Disease
autosomal recessive, enzyme cant metabolize BCCA
treatment for MSUD - dietary low protein, some cases a liver transplant
early diagnosis and effective dietary management can lead to healthy lives
Celiac disease
the autoimmune disorder affects the small intestine, triggered by the consumption of gluten, protein in wheat barley, and rye. damages lining of small intestines
Celiac disease risk factors
genetics, autoimmune, down syndrome, turner syndrome, infections, environment
Celiac Disease expected findings
digestive issues, growth problems (short)
unexplained weight loss
fatigue
skin issues
behavioral changes
celiac disease labs
ttg-iga
egd
biopsy
Celiac disease nursing considerations
GI issues, dietary guidance, label reading, education on nutrition and cross contamination, possible emotional support
Hypertrophic pyloric stenosis and risk factors
thickening of the pyloric sphincter creates an obstruction. typically happens in the first few weeks of life, blocks food causes vomiting
findings: dehydration, failure to gain weight, projectile vomiting/blood-tinged vomiting - treatment surgery
risk factor: genetics
Hypertrophic pyloric stenosis labs and diagnostics + therapeutic procedure
blood testing, ultrasound
treatment: pyloromyotomy
Hypertrophic pyloric stenosis
nursing considerations pre-op and post-op
Pre
-IV fluids for dehydration, NG for decompression, NPO, I&O, Daily Weight
Post
- vital signs, Iv fluids, monitor daily weights and I&O, pain meds, observe for infection, clear liquids 4-6hr after surgery, 24 hours after advance to breast miilk as tolerated
Hirschsprung’s disease
a birth defect where certain segments of colon lack nerve cells
risk factors: genetic predisposition
Hirschsprung’s disease findings
- blocked colon, can lead to megacolon
newborn- failure to pass meconium , vomiting bile, abdominal distention
infant- failure to thrive, constipation
child-undernourished, anemic appearance, abdominal distention, foul smelling ribbonlike stool , visible peristalsis
Hirschsprung’s disease labs & diagnostic
blood electrolytes, CBC, Rectal biopsy to confirm no ganglion cells
Hirschsprung’s disease pre and post op consideration
pre
improve nutritional status until surgery, high protein, high calorie, low fiber
provide electrolyte and fluid replacement
post
usual plus possible ostomy care
Complication of Hirschsprung’s disease
Enterocolitis :inflammation of the bowel,
Nursing actions for Hirschsprung’s disease
monitor vitals, assess abdominal girth, monitor for manifestations of sepsis, peritonitis, shock, manage fluids
measuring abdomen: level of umbilicus at widest point of abdomen
Intussusception
proximal segment of bowle telescopes into more distal segment, results in lymphatic and venous obstruction causes edema in area
- common in ages 3 months to 6 years . with progression increased mucus into intestine will occur
Dx. ultrasound
Intussusception expected findings
-abdominal pain, screaming with drawing knees to chest , *stools mixed with blood and mucus that resemble red currant jellly!
Intussusception nursing consideration
-Enema, iv fluids correct and prevent dehydration, ng tube
goal to create pressure in intestine and pushes bowel into normal position
Cleft lip/ palate Pathology
cleft lip- incomplete fusion of the oral cavity during intrauterine life `
cleft palate- incomplete fusion of palates during intrauterine life
Cleft lip/ palate risk factors
family hx. ,genetic, maternal health (diabetes), ! folate deficiency during pregnancy! exposure to alcohols, cigarette smoke, anticonvulsant, retinoids
Expected findings cleft lip/ palate
cleft lip is visible separation from upper lip toward nose
cleft palate visible or palpable opening of the palate connecting the mouth and the nasal cavity
procedures for repair cleft lip/palate done at what age
cleft lip: repair typically done between 2 to 3 months of age, revisions are usually required in severe defects
cleft palate: repair is typically done between 6-12 months most require second surgery
Cleft post op
position on back or upright or on side to protect repair possible elbow restraint. Make sure we check for gag reflex before eating. if they need oxygen make sure its mask and not nasal cannula
complications of cleft lip/palate
ear infection, feed in upright position, monitor temperature
more common with cleft palate
-dental problems, possible speech therapist, seek early dental care
Appendicitis
inflammation of the vermiform appendix caused from obstruction of lumen, average client is 10 years old
if they refuse to jump they most likely have appendicitis. *pain in RLQ (McBurney’s point)
Expected findings appendicitis
Rigid board like abdomen , decreased or absent bowels , fever, abdominal pain rlq McBurney’s point
Appendicitis Labs and considerations
CBC, Urinalysis, WBC elevated
-prepare child and family for surgery using developmentally appropriate techniques
-do not apply heat
-avoid laxatives and enemas
Appendicitis non ruptured procedure
laparoscopic surgery
pre - antibiotics, iv fluids
post- asses resp status, assess bowel sounds and bowel function
Appendicitis ruptured procedure
laparoscopic or open surgery
Pre- IV fluids, NG tube, Iv antibiotics
Post- ABC’s. low suction NG tube , maintain NPO, assess for peritonitis
Appendicitis complications peritonitis expected findings
fever, sudden relief from pai after perforation, *followed by a diffuse increase in pain
Peritonitis complication of appendicitis Nursing Care
-give pain meds, manage Iv fluids, psychosocial support
Acute GI Infection -Acute diarrhea
Occurs suddenly and is caused by infections (viral bacterial or parasitic) antibiotic use, or laxative use. Typically resolves within 14 days if dehydration doesn’t occur
Acute GI Infection Chronic Diarrhea
longer than 14 days
conditions like, malabsorption, food allergies, or inflammatory bowel disease
expected findings for acute GI infection
fatigue, malaise, change in stool pattern, weight loss, thirsty, dark urine, poor appetite
Acute Gi Infection Viral vs. Bacterial
Viral: rotavirus
Bacterial: C.Diff, E.Coli
Acute Gi infection Dx. and medications
stool sample
medications - metronidazole: C.Diff
Tinidazole
Nursing Consideration and education for Acute GI infection
no rectal temperature, baseline height and weight, alert school and keep kiddo home
education: Avoid juices, sodas, gelatin, broth, caffeine, skin care, immunization
Isotonic
Stays where you put it
Hypotonic
Cell swells as water is pulled in (Hippo) more water than salt ( extracellular to intracellular outside cell to inside cell)
*Hyponatremia
Hypertonic
cells shrink as water is pushed out (think thin) more salt than water (intracellular to extracellular inside cell to outside cell)
*Hypernatremia
Dehydration differences
due to body surface area and age there will be differences in how quickly the child will be and what the expected findings will be we want to catch it when its mild not severe
