TLO 2.3 Nutrition and Fluid Balance - Child Flashcards

Question

Pyloric Stenosis diagnostic tools

Answer 1

``` History Clinical findings US of pyloric channel Upper GI if US negative Laboratory findings reflect fluid and electrolyte depletion ```

Answer 2

Weight on admission H and P Observe for signs of dehydration Signs of electrolyte imbalance Ab assessment for distention, tenderness, bowel sounds, presence of pyloric mass Assess family for knowledge deficit regarding diagnosis, treatment, support, ability to participate in care

Answer 3

``` NPO Weight, daily IV fluids VS I/O Labs Elevate HOB NG tube: amount, color, type of drainage Skin/mouth care Respiratory distress ```

Answer 4

Pyloromyotomy: incision of pyloric muscle to release obstruction Laparoscopy: shorter surgical time, rapid postop feeding, quicker d/c ``` Post-op: feeding 4-6 hr post op small amounts of clear fluid breast/formula as tolerated monitor I/O daily weight ```

Answer 5

Chromosomal variation that result in child's inability to digest gluten (gliadin) Immune mediated enteropathy of proximal small intestine Resulting in severe GI mucosal changes that continue on exposure Teach about diet (no wheat, rye, barley, oats) Replace with corn or rice Vitamin supplements may be needed, especially fat soluble and folate

Answer 6

Unknown Inherited predisposition with environmental factors Genetic markers is almost 100% of cases

Answer 7

Inflammatory reaction is activated by gluten Cytokines released contribute to intestinal damage Fat, calorie, carb and vitamin deficiencies

Answer 8

Immunoglobulin A (IgA) deficiency, IgG is used Jejunal biopsy for ulceration in GI Monitoring reaction to a gluten free diet Symptoms often relieved in 1 wk after gluten free diet

Answer 9

``` 3-6 mo after introduction of grains to diet Diarrhea: steatorrhea (greater amounts of fat in feces, characterized by frothy foul smelling fecal that floats) Growth failure Ab distention Vomiting Anemia Irritability Anorexia Muscle wasting Edema Folate deficiency **Crisis: profuse watery diarrhea and vomiting ```

Answer 10

Teach diet restriction (no wheat, barley, rye, oats) Monitoring of all food labels -gluten and lactose free diet -diet high in calories and protein with simple carbs -avoid high fat, high fiber foods Monitor weight, growth Physician monitoring: anemia, osteomalacia (softening of bones, def in Vit D and calcium) Teach disease process, life long condition Refer to support group

Answer 11

Infants/toddlers: >2-3 ml/kg/hr Preschoolers/young school age: >1-2 ml/kg/hr School age/adolescents: 0.5-1 ml/kg/hr

Answer 12

Bacterially safe Always fresh Correct temperature Maturation of the GI tract, immune factors lower gastroenteritis, neonatal necrotizing enterocolitis, celiac disease Antibodies against otitis media, resp illness: RSV, pneumonia, UTI, bacteremia and bacterial meningitis Decrease allergies Decreased incidence of SIDS Protective affect against childhood lymphoma/diabetes Enhanced cognitive development Analgesic effect for painful procedures (heel stick)

Answer 13

Formula: 85-100 kcal/kg/day - birth to 6 mo: weight doubles between 4-7 mo - 6-12 mo: weight triples

Answer 14

Vitamin D deficiency (risk for rickets) 400 IU of vit D: shortly after birth until taking 1 L/day of fortified formula Cobalamin (vit B12) deficiency Contributes to infant neurologic impairment Caused by inadequate maternal ingestion

Answer 15

Goat's milk Skim or low fat milk Condensed milk Raw or pasteurized milk from any source

Answer 16

Consult with pediatrician prior to starting, usually around 4-6 mo Infants cannot easily digest foods Higher incidence of food allergy associated with early start Iron fortified cereal until 18 mo Introduce 1 food at a time Detect allergies/intolerance Finger food introduced 8-10 mo

Answer 17

``` Finger foods, 8-10 mo, encourage self feeding Healthy foods Nutritional snacks 2x day Growth rate slows Appetite decreases Weight quadruples by 2.5 yr Double height at age 2 Multivitamin only if poor dietary intake Nutritious foods- My Plate -fruits 100% juice, 4-6 oz/day -vegetables -whole grains -low fat dairy and nonfat dairy (milk 16-24 oz/day) -fish, beans, lean meats ```

Answer 18

``` Frequent small meals Healthy foods and snacks Focus on weekly food intake vs daily Increase Kcals Nutritional considerations same as toddlers Gain 2-3 kg per year Birth weight doubles by 4 yr ```

Answer 19

Encourage food pyramid Monitor adequate intake Supplement as needed ``` Nutritional issues Milk replaced by soft drinks Fast food Body image Busy schedule Eat away from home more frequently Peer pressure ```

Answer 20

Females: 10-14 yr Weight gain 7-25 kg 95% of height by menarche Males: 11-16 yr Weight gain 7-30 kg 95% of height by 15 yr

Answer 21

Younger the child, higher the proportion of water content in their body to body mass Younger the child, higher the proportion of extracellular fluid to intracellular body fluid Extracellular body fluid is more easily depleted than intracellular body fluid. This leaves the child at higher risk for fluid depletion when they get sick Younger children can't tell their caregivers that they are thirsty

Answer 22

Primary form in children Electrolyte and water are lost in approx. equal amounts Loss from extracellular compartment -reduces the plasma volume and circulating blood volume -affects skin, muscles and kidneys Shock is greatest risk to life Sodium remains 138-145 mEq/L

Answer 23

Dehydration occurs when electrolyte deficit exceeds the water deficit (sodium <135 mEq/L) Shock if frequent finding

Answer 24

Dehydration result from water loss in excess of electrolytes loss Most dangerous and requires specific fluid therapy (intake of large amounts of solute or high protein NG feedings) Serum sodium >150 mEq/L

Answer 25

``` History of acute or chronic fluid loss Clinical symptoms Weight Serum electrolyte levels -decreased bicarb, K+, glucose -sodium level may be normal in Isonatremic Urine specific gravity >1.020 ```

Answer 26

Goals: correct fluid and electrolyte imbalance treat underlying cause

Answer 27

Teach parents prevention of dehydration -extra fluid during hot weather, avoid overdressing -rest periods after high energy play Treat fluid replacement (Pedialyte) -plan water in large amounts is dangerous Monitor weight Monitor I/O -stools/emesis: frequency, type, amounts, consistency Monitor VS

Answer 28

Food allergy or hypersensitivity - reactions involving immunologic mechanisms - usually immune globulin E (IgE) - reaction immediate or delayed - mild to severe= anaphylactic reaction Food intolerance - reactions involving known or unknown nonimmunologic mechanisms - i.e. lactose intolerance

Answer 29

Systemic - anaphylactic - growth failure Gastrointestinal - ab pain - vomiting - cramping - diarrhea Respiratory - cough - wheezing - rhinitis - infiltrates Cutaneous - urticaria (hives) - rash atopic dermatitis

Answer 30

``` Health history Elevated IgE Skin tests Radioallergosorbent test (allergy test done on blood) Anaphylaxis occurs in 5-30 min Asthma symptoms: wheezing, dyspnea Death can occur w/o treatment ```

Answer 31

Body mass index >95th percentile for youth of the same age and gender Most common nutritional problem among US children

Answer 32

Intake of high caloric, fatty foods Lack of outside physical activity Inactivity related to television, computers and video games -63% of 8-18 yr have TV in room, watching average of 4 hours per day -minority and low socioeconomic status populations watch over 4 hours/day

Answer 33

``` Psychosocial Pulmonary GI Renal Musculoskeletal Neurological Cardiovascular Endocrine Diabetes HTN ```

Answer 34

``` Parental education Do not use food as reward Scheduled meals/snacks Healthy choices Preplan meals Avoid fast food Be a role model Plan activities with children Routine pediatrician check ups ```