Test 2 Flashcards
What are the pediatric differences in the GI system?
small stomach capacity. increased peristalsis. relaxed cardiac sphincter. decreased enzymes. distention from gas. immature liver.
What are structural disorders of the GI system?
cleft lip and palate
pyloric stenosis
intussusception
What are malabsorption disorders of the GI system?
celiac disease
What are motility disorders of the GI system?
acute diarrhea
What issues can cleft lip/palate cause?
feeding difficulties dental deformities speech problems otitis media hearing problems
What is some preop nursing care of cleft lip/palate?
support parents modified feeding or NPO age-appropriate preoperative education discuss surgical expectations multidisciplinary team support
How do you facilitate feedings with cleft lip/palate?
special feeders encourage breast feeding allow extra time for feeds burp frequently upright position 30 min post feed
What is post op nursing care for cleft lip/palate?
pain management, maintain suture line, nutritional support, home care teaching
What are symptoms of pyloric stenosis?
occasional emesis -> projectile vomiting visible peristaltic waves palpable olive-sized mass hyperactive bowel sounds dehydration, electrolyte imbalances
What is the nursing care for pyloric stenosis?
meet fluid and electrolyte needs - IVFs.
minimize weight loss - daily weights, I&Os, IVFs. post op, small frequent feedings. do not rock or play for 30 minutes after feeds
promote comfort - pain management, don’t life legs to change diaper
prevent infection - incision care, monitor temp & RR
What is intussusception?
portion of intestine prolapses and telescopes back
most common in infancy and in males
What are symptoms of intussusception?
abrupt onset. acute pain. vomiting -> bilious. brown stool -> reddish currant jelly. palpable abdominal mass
How is intussusception diagnosed?
abdominal xray/ultrasound
How is an intussusception treated?
contrast air or barium enema
stomach decompression
possible surgery
What is celiac disease?
gluten-sensitive enteropathy. immunologic disorder - intolerance of gluten
What are signs and symptoms of celiac disease?
chronic diarrhea, impaired growth, abdominal distention. decreased appetite, decreased energy, muscle wasting.
How is celiac disease diagnosed?
fecal fat, duodenal biopsy, clinical improvement, special serum antibodies.
How do you treat celiac disease?
gluten free diet
What to teach with celiac disease?
allowed foods, risks of noncompliance
What are some grains that contain gluten?
barley, bran, couscous, farina, graham flour, orzo, rye, semolina, wheat, wheat brain, wheat germ, wheat starch.
What is the concern with acute diarrhea?
alters fluids & electrolyte balance
rapid dehydration in infants & small children -> hypovolemic shock and death
What is the treatment for acute diarrhea?
slow losses and rehydrate with adequate electrolytes/nutrition
What is the nursing care for acute diarrhea?
prevent dehydration.
provide rehydration fluids
family support & teaching
What are pediatric differences for the GU system?
small bladder capacity, add 2 to their age = ounces bladder can hold
In the GU system, under the age of 2, children are less efficient at… ?
electrolyte and acid-base balance
excretion of drugs from body
concentrating urine
What are diagnostic procedures for GU disorders?
cystoscopy diuretic renogram intravenous pyelogram voiding cystourethrogram lab tests - BUN, creatine, urinalysis
What do you assess in the GU system?
urine characteristics
pain or discomfort
edema
appearance of genitalia
What is the normal urine output for infants?
2 mL/kg/hr
What is the normal urine output for children?
0.5 to 1 mL/kg/hr
What is the normal urine output for adolescents?
40 to 80 mL/hr
What is hypospadias or epispadias?
abnormal location of urethral meatus in males
How do you diagnose hypospadias or epispadias?
prenatal US or observation
How do you treat hypospadias or epispadias?
surgery
What is the nursing care of hypospadias or epispadias?
protect surgical site
encourage fluids
double diapering - second diaper catches urine from stent
What are the medications post op of hypospadias or epispadias repair?
analgesics, prophylactic antibiotics, and anticholinergics to reduce bladder spasms
What is cryptorchidism?
failure of testicle to descend
What are complications of cryptorchidism?
infertility & malignancy - testicular cancer
When do testicles usually descend?
spontaneously by 3 months
What is post op teaching for cryptorchidism?
no tub baths x2 days
keep clean & dry
avoid straddling on hip or straddle toys x 2 weeks
What is primary enuresis?
never dry, infants.
delayed neuromuscular maturation
small bladder capacity
What is secondary enuresis?
stress, UTI, DM, sleep disorder
What is nocturnal enuresis?
bedwetting
What is the treatment of enuresis?
fluid restriction, bladder exercises, timed voiding, enuresis alarms, reward systems, medications.
What are medications used for enuresis?
desmopressin - nasal spray with antidiuretic effect
imipramine - anticholinergic, reduces bladder spasms
oxybutynin - for urgency
What is nephrotic syndrome characterized by?
edema - protein loss -> osmotic pressure change retain sodium and water massive proteinuria hypoalbumninemia, hypoproteinemia altered immunity
What are symptoms of nephrotic syndrome?
increased edema, anorexia, weight gain from retaining fluid, HTN, irritability
How do you diagnose nephrotic syndrome?
history, symptoms, labs
What medications are used with nephrotic syndrome?
corticosteroids 12 weeks diuretics - relieves edema antihypertensive antibiotics - risk for infection iv albumin - replace low albumin levels
What are interventions for nephrotic syndrome?
monitor side effects of meds prevent infection prevent skin break down meet nutritional and fluid needs promote rest support and home care teaching
What is acute glomerulonephritis?
most common inflammation of glomeruli of kidney
What is acute glomerulonephritis a response to?
group A beta-hemolytic streptococcus or strep throat
What are characteristics of acute glomerulonephritis?
history of strep infection signs emerge 10-21 days after immune complex reaction on glomerular capillary wall decreased GFR, RBC excreted Ha, H3O retained -> edema
What are signs and symptoms of acute glomerulonephritis?
acute pain, usually asymptomatic, tea colored urine
What labs diagnose acute glomerulonephritis?
BUN, Creatine, GFR
What is the treatment of acute glomerulonephritis?
relief of symptoms & supportive care
bed rest, treat edema, HTN
What is the nursing care for acute glomerulonephritis?
monitor fluid status prevent infection prevent skin break down meet nutritional needs provide emotional support teaching needs
What are some pediatric differences in the brain and spinal cord?
not well protected from trauma
nerve impulse development rapid
brain growth continues until age 5-8
myelination incomplete at birth
What are pediatrics more at risk for?
brain injury, skill fracture, neck injury, and compression fractures
What is hydrocephalus?
a structural defect of the brain, enlarged ventricles due to too much CSF.
can be congenital or acquired
What is the diagnostic tests for hydrocephalus?
signs/symptoms of increasing ICP - increase in head circumference. older child - HA, vomiting, irritable
What is the treatment for hydrocephalus?
remove obstruction or create bypass
ventriculoperitoneal shunt
ventriculoatrial shunt
What are complications of surgery for hydrocephalus?
shunt malfunction or failure
infection
What is pre-op nursing care for hydrocephalus?
position carefully & reposition frequently
support head a& neck, HC checks daily
skin care: prevent breakdown
feedings - prone to vomiting
monitor for s/s of increased ICP
What is post-op nursing care for hydrocephalus?
positioning - flat for 24 hours, gradually rise. fed on side.
aseptic technique
monitor for shunt malfunction, infection, increase ICP
teaching
What is meningomyelocele (or spina bifida)?
spinal fluid-filled meningeal sac
How must meningomyelocele be treated?
surgery in 24-48 hours of birth
How is meningomyelocele diagnosed?
may be diagnosed prenatally
CT, MRI, and Xray
What decreases the chance of meningomyelocele ( spina bifida)?
adding folic acid to diet of pregnant woman
What are clinical manifestations of meningomyelocele?
spinal fluid filled meningeal sac
hydrocephalus - 85% associative
seizures
lowest - mild weakness, bowel, & bladder issues
highest - paralysis of legs, weakness, and sensory loss of trunk, loss of bowel, bladder control
What causes neonatal abstinence syndrome?
maternal drug use
What are symptoms of neonatal abstinence syndrome?
withdrawal.
effects CNS, ANS, GI tract
How to treat neonatal abstinence syndrome?
reduce effects of withdrawal- phenabarbitol, klonadine, bundle baby, reduce stimuli.
What is cerebral palsy?
a movement & posture disorder. caused by an assault on the immature brain.
What is the focus of therapy for cerebral palsy?
want them as independent as possible
What are common learning disabilities?
dyslexia - reading
dyscalculia - math
dysgraphia - writing
dyspraxia - motor skills
What is the goal in treating learning disabilities?
maximize learning potential
maintain healthy self-esteem
What is the goal of treating children with disabilities?
maximize child’s potential
What scale is used to assess level of consciousness?
Glasgow coma scale
What is a late cardiac sign of increased ICP?
bradycardia
What urinary problem is associated with spina bifida?
neurogenic bladder
What is spasticity?
hypertonia with uncontrolled movement seen in cerebral palsy
What is athetosis?
constant involuntary writhing motions seen in cerebral palsy
What are the respiratory differences in pediatrics?
airway is smaller in diameter and shorter increased airway resistance fewer alveoli for gas exchange cartilage more flexible increased oxygen consumption large tongue and epiglottis
What is included in a respiratory assessment?
respiratory effort, color, position of comfort, behavior change, breath sounds, cough, vital signs, O2 saturation, family history.
What are symptoms of respiratory distress in children?
nasal flaring, grunting, retractions, restlessness, anxiety, fearful affect, diaphoresis, decreased O2 saturation, behavioral changes, and general cyanosis.
What are symptoms of hypoxia?
early - Restlessness, Anxiety, Tachycardia/Tachypnea
late- Bradycardia, Extreme restlessness, Dyspnea
What are symptoms of hypoxia in children?
Feeding difficulty, Inspiratory stridor, Nasal flaring, Expiratory grunting, Sternal retractions.
What is the treatment for respiratory distress?
start oxygen
position of comfort
bed rest
calm environment
What are diagnostic tests for respiratory disorders?
bronchoscopy, imaging studies, sleep studies, pulse ox, spirometry/pulmonary function tests, sweat chloride tests, arterial blood gases
What are characteristics of impaired gas exchange?
abnormal ABGs (hypoxia, hypercapnia)
decreased O2 sat
altered LOC
dyspnea
What are characteristics of ineffective airway clearance?
adventitious breath sounds ineffective or absent cough inability to remove secretions diminished breath sounds sputum production
What are characteristics of ineffective breathing pattern?
low rate, depth, minute volume
use of accessory muscles
nasal flaring
orthopnea, dyspnea
What are respiratory interventions?
oxygen humidity incentive spirometer chest physiotherapy suction medications CPAP, or ventilator
What are some respiratory medications?
bronchodilators - reverse or prevent bronchospasm
anti-inflammatory agents - reduce inflammation
antimicrobials
What are some acute respiratory conditions?
otitis media
tonsillitis
bronchiolitis
croup syndromes
What is otitis media?
inflammation of middle ear
related to E tub dysfunction
can lead to hearing impairment
What are risk factors for otitis media?
male children, day care centers, allergies, pacifier use, exposure to tobacco smoke, multiple siblings, cleft lip/palate
What are symptoms of otitis media?
tympanic membrane very red, may be bulging
irritability, and pulling at ear
n/v, FEVER
What is the treatment of otitis media?
observation
analgesics
antibiotics
myringotomy/tympanostomy tubes
What is tonsillitis?
inflammation of tonsils
What are symptoms of tonsillitis?
frequent throat infections, breathing and swallowing difficulties, persistent redness of tonsils. sleep apnea. nasal stuffiness. discharge & postnasal drip.
cough
What is the treatment for tonsillitis?
antibiotics, surgery - watchful waiting
What is bronchiolitis?
lower airway inflammation often caused by RSV. excessive mucus plugs airway
resembles pneumonia on xray
October to march
risk for respiratory failure
What is the treatment of bronchiolitis?
maintain droplet isolation humidified oxygen for O2 sats <90% CR nad puls ox monitors nasal suctioning before feeds nebulized salene treatments - loosens secretions reduce anxiety fluids
What is croup syndrome?
upper air way inflammation
What are clinical manifestations of croup syndrome?
inspiratory stridor
seal-like barking cough
hoarseness
worse at night
What are the four classic “D” signs of epiglottitis?
Dysphonia, Dysphagia, Drooling, Distressed respiratory effort with stridor
What is Bronchopulmonary dysplasia (BPD)?
chronic lung disease of newborn
What increases the risk for BPD?
use of ventilator and oxygen
less than 28 weeks gestation
less than 1000 grams
PDA, MAS
What are the symptoms of BPD?
increased respiratory effort and O2 need failure to thrive right-sided heart failure growth & development delays impaired cognition pulmonary dysfuction
What are medications for BPD?
bronchodilators corticosteroids diuretics potassium chloride - replace K with diuretics Palizumab (Synagis) pneumococcal vaccine at age 2
What is cystic fibrosis?
autosomal recessive genetic disorder of the exocrine glands.
affects transport of Cl & Na across cell membranes
results in very thick mucus which obstructs ducts of multiple organs
What are clinical manifestations of cystic fibrosis?
chronic, moist productive coughf frequent respiratory infections adventitious breath sounds chronic sinus infections clubbing and a barrel chest poor weight gain/ FTT bulky, smelly stools, partial small bowel obstruction infertifility
What are diagnostic tests for cystic fibrosis?
newborn screaning for trypsinogen
chromosome mutation analysis
sweat chrloride test - normal <40
What is the treatment of cystic fibrosis?
maintain respiratory function control inflammation and infection reduce mucus accumulation promote optimal nutrition prevent intestinal blockage
What are medications for cystic fibrosis?
broncodilators dornase alfa - aerosol ( pulmozyme) hypertonic saline ibuprofen antibiotics pancreatic enzymes multivitamins, iron Vitamins A, D, E, K
What are signs of asthma?
frequent coughing
wheezing, maybe only with auscultation
bronchoconstriction, airway swelling, mucus production
What is asthma?
chronic inflammatory disease. normal protective mechanisms of the lungs overreact to a trigger
What is the clinical therapy for asthma?
medications, hydration, education, and support
What is the goal of treating asthma?
maintain control long term
use least amount of medication
reduce risk of adverse effects
