Test #4

Question 1

Types of dehydration are there?

And what are they?

Answer 1

Isotonic (most common), electrolyte and water depletion are balanced, loss is from ECF compartment, Na=130-150

Hypotonic – electrolyte loss exceeds water loss, more severe symptoms with smaller volume loss, Na<130

Hypertonic – most dangerous - can kill you ,water loss in excess of electrolyte loss, can be caused by hyperosmolar fluid replacement, can cause seizures and coma

Question 2

How to Evaluating extent of dehydration:

Answer 2

skin turgor, urine output (may be due from diarrhea, difficult to tell if they are urinating), presence of tears (crying but no tears), LOC(how alert are they), fontanels (exam in a semi upright position - sunken fontanels)
Can be described as a % of body weight lost

Question 3

Diagnostic evaluation for dehydration

Answer 3

Determine degree of dehydration based on weight and clinical signs
Determine type of dehydration based on history, labs
Initial plasma Na and Co2, as well as other electrolytes

Question 4

Therapeutic management for dehydration

Answer 4

Oral Rehydration (ORS) – if alert, stable and not in danger

If vomiting, give small amts frequently to overcome losses

Parenteral fluid therapy - especially if low blood pressure - late finding of dehydration
expand ECF volume to restore circulation

Replace ongoing losses

Transition to oral feedings

Question 5

Nursing considerations for

Answer 5

Accurate, ongoing reassessment, accurate I&O

Question 6

Vomiting

Answer 6

Nonbilious (bile drains to more distal intestine) and bilious types (disorder of motility or a more distal physical blockage)
Often accompanied by nausea

Nursing management
Accurate assessment of vomiting and amount of fluid loss
Establish proper feeding techniques-burping properly, not overfeeding, help paste the baby bc they can’t do it on their own
Offer oral glucose electrolyte fluids - pedialyte

Question 7

Diarrhea

Answer 7

In developing countries, 20% of all deaths are related to diarrhea and dehydration
Acute infectious diarrhea has a variety of causative organisms

Bacterial: shigella, salmonella

Viral: rotavirus - often found in infants, norovirus

Ova and parasites: giardia- found in water parks

Various types: Acute- parenteral IV needed, chronic, intractable, nonspecific diarrhea
Diarrheal disturbances
Gastroenteritis, enteritis, colitis
Rotavirus infection – most common
Bacterial pathogens – e.coli, salmonella, shigella
Antibiotic-associated etiology

Question 8

Diarrhea

Therapeutic management

Answer 8

Therapeutic management
Oral rehydration therapy vs IV rehydration - if diarrhea often with oral rehydration,but vomiting is usually IV due to the fact that they may just throw it back up
Prevention – vaccine - for rotavirus, hand washing, food prep - not cutting raw chicken with lettuce, clean water, good personal hygiene
Nursing considerations: Accurate weight and I&O, Careful skin care

Question 9

what is the most common type of aquiration of diarrhea as an infant?

Answer 9

rotavirus

Question 10

what is the most common way to adquire giardia?

Answer 10

waterparks

Question 11

what is isotonic dehydration?

Answer 11

where the dehydration of both water and electrolyte is the same amount

Question 12

what is hypotonic dehydration?

Answer 12

electrolyte loss is greater than water loss, potassium level lower than 130

Question 13

what is hypertonic dehydration?

Answer 13

water loss grater than electrolyte loss,
most dangerous, can potienitally kill you
do not replace water in a fast speed, may cause brain swelling

Question 14

what is the difference between nonbilious and bilous type of vomiting?

Answer 14

nonbilious is from above the intestine and bilous is from the intestine

Question 15

diarrhea wise, who more commonly adquires shingella and who more commonly adquires adquires salmonella?

Answer 15

shingella is more common in toddlers and salmonella is more common in infants

Question 16

when is the most common age of rotavirus ?

Answer 16

3-24 months

Question 17

what is the diarrhea loss replacement ratio?

Answer 17

1:1

Question 18

what is the difference between idiopathic (functional) constipation and chronic constipation?

Answer 18

idiopathic has no known cause

chronic constipation may be due to environment or psychosocial factors

Question 19

what is first meconium? and why is it important?

Answer 19

it’s baby’s first bowel movement, and it should be within 24 to 36 hours of life

Question 20

what are the possibilities of condition if first meconium is not passed?

Answer 20

hirschsprung disease, hypothyroidism and/or meconium plug/meconium ileus (cystic fibrosis)

Question 21

what are the potential cause for constipation in infants?

Answer 21

the mother’s constant change between formula and breast milk, causing stomach to be irritated and unable to digest properly.

Question 22

what is encopresis

Answer 22

an inappropriate passage of feces, often with soiling, may be often result to stress
ie. new babysitter, etc

Question 23

what does constipation have in relevance to UTI

Answer 23

big stool may cause obstruction causing urine not released properly, causing infection

Question 24

what are nursing intervention for constipation?

Answer 24

increase dietary fiber, have kids drink less milk and eat less cheese

Question 25

what is hirschsprung disease?

Answer 25

mechanical obstruction from inadequate motility of the intestine.
absence of ganglion cells in colon

its more common in male and children with down syndrome

Question 26

where does hirschsprung disease usually affect

Answer 26

the loarge intestine (colon)

usually involve therectum and some part of the distal colon

Question 27

what are some of the clinical manifestation of hirschsprung disease?

Answer 27

distended abdomen
accumulation of stool
failure of internalanal sphincter to relax

Question 28

diagnostic evaulation of hirschsprung disease are..?

Answer 28

x ray and barium enema
anorectalmanometric examination - measures the pressure in the rectum, checking that there isn’t missing peristalsis happening

if positive then rectal biopsy is done

Question 29

what are the two stages of hirschsprung disease

Answer 29

temporary ostomy - clip ganglionic is out, once internal healing is done, they take the top section and pull it through the rectum and make a new rectum
(pull through procedure)

Question 30

what is GER?

Answer 30

gastroesophageal reflux
which is the transfer of gastric contents into the esophagus
prevalence 50% for infants under 2 month

Question 31

how to diagnose GER?

Answer 31

history and physical
UGI to rule out anatomic abnormalities - have the individual npo and empty stomach, and then feed dye into the individual through xray to see how high the baby is able to reflex the feeding
(however it may not happen everytime)

Question 32

what are nursing managment for GER?

Answer 32

small frequent feedings
thickened feeds (makes it heavier so it will stay down)
elevate HOB
meds to reduce gastric acid secretion - zantac, remedeine
surgical management - nissan fundoplication

Question 33

what is nissan fundoplication?

Answer 33

where the stomach is wrapped around the esophagus, so when the stomach is digesting, it closes the esophagus.

Question 34

what are the possible complication of nissan fundoplication?

Answer 34

break down of the warp
small bowel obstruction
gas bloat syndrome
infection
retching
dumping syndrome

Question 35

what is intussusception?

Answer 35

telescoping of one portion of the intestine into another, typically occurs from age 3 month to 3 years.
more in boys and patient with cystic fibrosis

Question 36

what are the classic syndrome of intussusception?

Answer 36

intense sporadic abdominal pain, palpable abdominial mass, bloddy stools (currant jelly, raisin looking)

Question 37

what happens in intussusception?

Answer 37

ileum telescope inside ascending colon, obstructing passage of intestine contents, causes bleeding and thus causes currant jelly stools

blood vessels become trapped between layers, blood flow decreases, which causes edema, strangulation of bowel, and causes gangrene, sepsis, shock and eventually death

Question 38

what is recurrent abdominal pain (RAP)?

Answer 38

abdominal pain that may be psychogenic cause or by a disease state,
often when the child has it, the mother has it too

Question 39

what is functional abdominal pain

Answer 39

intermittent or continuous pain that occurs at least once a week for two months

Question 40

what is abdominal migraine?

Answer 40

discreet paroxysmal episode of severe dull, periumbilical pain

Question 41

when are the most often occurance of acute appendicitis?

Answer 41

happens average to 10 year olds and individuals before puberty

Question 42

what are the diagnostic evaluation of acute appendicitis?

Answer 42

pain at McBurney’s point

rebound tenderness of the abdominal

Question 43

where is the McBurney’s point?

Answer 43

located two third the distance from the umbilicus to the right anterior iliac spine

Question 44

when do you need to surgically close the cleft lip and cleft palate by?

Answer 44

lip closure by 2-3 month, and palate closure by 6-12 month (before 12-18 month speech learning period)

Question 45

what is esophageal atresia and tracheoesophageal distula?

Answer 45

it is the failure of the esophagus to develop as a continuous passage separate from the trachea