T3 U6 GASTRIC Flashcards
what is the normal BUN range?
5-18
what is not true regarding VUR (Vesicoureteral reflux)?
they’d present with gross hematuria
what s/sx does Vesicoureteral reflux (VUR) have?
UTI symptoms
- Flank pain
- Fever
- N/V
What can 2ndary Vesicoureteral reflux
Hydronephrosis
GERD management
small freq feeding
HOB elevated
thickened food
GERD meds?
PPI (omeprozole)
infant fluid output?
2-3ml/kg per hr
toddler/preschool fluid output?
2ml/kg per hour
school age fluid output?
1-2ml/kg per hour
adolescent fluid output?
0.5-1ml/kg
BUN vs Creatine - which is most sensitive?
Creatine
3 staple s/sx of UTI?
Fever
Poor Feeding
V/Diarrhea
Urine related s/sx of UTI?
Enuresis
–
Dribbling urine (Pain w/ me)
–
Dysuria
infection risk for UTI?
pyelonephritis
what actions can increase risks for UTI? & what group @ risk
Poor hygiene
Prolonged bath/bubble bath
Newborns/low birth weight
what part of urine culture is highly sensitive/indicative of UTI?
Nitrates (show up pink)
diagnostic test for VUR
VCUG radiograph
what color would Hematuria urine be?
Tea-colored/brownish
why can’t you give motrin until 6+m
Liver/pancreas arent mature till them
diabetic polyuria can lead to ______ which then can cause ________?
DKA
Dehydration
what is a late s/sx of dehydration?
Hypovolemic shock
primary intervention for dehydration?
Iv fluids
- Oral rehydrating solution (Pedialyte)
how do you know rehydration is restored?
Diaper increased (1g = 1mL)
Increased tears
normal K value?
3.5 - 5.5
creatinine value?
0.3-0.7 mg/dL
Ca lab values?
9-11 (8.8-10.8)
Cl lab value?
90-110
Na lab value?
135-145
K lab value?
3.4-4.7
fluid output requirement for PT weighting 0-10kg?
100mL/Kg
fluid output requirement for PT weighting 11-20kg?
1000mL +50mL/kg
(for each Kg over 10)
fluid output requirement for PT weighting greater than 20kg?
15000mL +20mL/kg
(for each kg over 20)
medicine for bacterial cause of acute diarrhea?
Metronidazole
diet for acute diarrhea?
BRAT
Bread
Rice (plain)
Applesauce (no apple juice)
Dry toast
should you give immodium to diarrhea pt?
No,
want to get the causative organisms out
Hirshsprungs disease is what? & what does it cause
absence of ganglion cells in colon
Inadequate motility of intestine
s/sx of hirschsprung’s disease?
Failure to pass meconium
Ribbon like stool (older children)
Failure to thrive
chronic constipation
what complication can hirschsprung’s disease cause?
Enterocolitis: Explosive bowel movement
“gold standard” diagnostic for hirschsprung’s disease?
Barium enema
potential side effect of barium enema?
Constipation
management of hirschsprung’s disease?
NG tube: Remove saliva/stomach contents
IV fluids
Pain control
Education of colostomy care
important edu for colostomy care for hirschsprung’s disease?
if not pooping = call PCP
this is temporary colostomy
what is Pyloric Stenosis?
constriction of sphincter w/ gastric outlet obstruction
Pyloric Stenosis causes what when baby feeds?
vomit every feed (projectile)
what would present with Pyloric Stenosis?
A palpable olive shaped mass (!!)
Projectile vomiting (!!)
Insatiable appetite
Not pooping
if a PS patient presents with hypotension, sunken eyes/fontanels & tachyC - what do you advise?
-This is an emergency - they can go into Metabolic Acidosis
(dehydration s/sx + PS = bad)
- Start EKG
Edu about Pyloromyotomy procedure
- NPO before w/ NG tube
- Monitor V/S
- Vomiting for first 24-36hr post op is NORMAL (!!)
- Begin feeds 6 hr post op - w/ or w/o bowel sounds
what should a pt call dr for post op of Pyloromyotomy procedure?
Vomit past 48 hr
what is Intussusception?
portion of bowel slides into next (telescope) = obstruction
description of pain for Intussusception
comparable to child birth, kidney stones, appendicitis
pain relief when abdo relax - but cycles
s/sx of Intussusception?
Pulls legs/knees towards chest
Fever
Not wanting to eat
JELLY STOOLS (raspberry/currant color)
what does the mass associated with Intussusception look like?
sausage shaped
gold standard diagnosis of Intussusception?
Barium enema
examples/manifestations of failure to thrive?
Abdo distention
Scaling skin
Alopecia
Spoon shaped nails (NOT CLUBBING)
growth rate diagnosis of failure to thrive?
4th percentile or less
timing of appendicitis pain onset to rupture?
36-72 hr
Abdominal pain description for appendicitis?
Periumbilical pain - Is often first symptom (!)
- Wakes kid @ 4hr intervals
RLQ pain (Staple sign)
child reactions to appendicitis pain?
Pain when release palapation
shuffling feet
other s/sx of appendicitis?
Mucus like stool (Diarrhea is atypical)
High fever with perforation
edu + s/sx of appendicitis perforation?
Abdominal pain suddenly relieved w/i intervention
Notify physician ASAP
how to diagnose appendicitis?
Ask PT to jump
Slap bottom of feet
No single lab test confirms
appendectomy edu?
NPO for 24 OR until peristalsis return
Progression of activity over 2 week
Walk is great
Passing gas > bowel movement
edu about perforation post op?
may have drains
IV abx
what is rectal atresia?
Closure of rectal passageway
when is surgery performed for R. Atresia?
immediate
what is R. Stenosis?
constriction of rectal passage
& not always present @ birth
s/sx of rectal stenosis?
Ribbon like stool
Vomiting
Abdominal distention
Difficulty passing stool
what is imperforate anus?
Absence of rectal opening
S/sx of imperforate anus?
Presents as fitsula/connection from rectum to perineum
Wont pass meconium
Increased Peristalsis
Surgery for rectal stenosis
Manual dilation by various sizes of steel rods
surgery for higher anatomical defects?
2 stage repair
1: Recession/create temp colostomy
2: Closing colostomy & connecting blind pouch
post op management of rectal malformations?
Developmentally appropiate play
NG decompression
PO feedings post peristalsis
edu about rectal malformations?
potential delayed toilet training
increased need for dietary fiber
what vitamins cant celiac’s absorb?
ADEK
which vitamin might a celiac PT be deficient in?
D
s/sx of celiac
Non specific anorexia
Abdominal distention/bloat
Steatorrhea
Anemia
diagnosis for celiac?
Serological markers
Bowel Biopsy before eliminating gluten
GF diet can’t have?
Wheat, rye, oat & barley
when does GER become GERD
when tissue damage occurs
lasts longer than 18m
at risk group for GER/GERD?
Premature babies - muscles aren’t fully developed
GER/GERD s/sx?
Apnea
Aspiration pneumonia
Dyshphagia
Halitosis (!!)
edu for parents about feeding r/t GERD?
Positioning child up right (not higher than 45d)
Remain upright 15m after feeding
Small frequent feedings
Frequent burping
medicine for GERD?
PPI (-azole)
Prilosec
surgical management for GERD?
Nissen
Taken upper portion of stomach & wrap around esophagus = prevent reflux
What is the priority nursing action for a PT with fever & severe foul smelling diarrhea w/ abdominal distention/firmness?
+ what is the diagnosis
Start IV to provide fluid maintenance
(this is Hirschsprung disease – enterocolitis)
s/sx of enterocolitis
fever
severe foul smelling diarrhea
abdo distention
daily assessment for short bowel syndrome?
weight
I&O
Specific gravity
classic triad of symptoms for pyloric stenosis
vomiting
weight loss
dehydration
