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Pediatrics > Week 2 Care of pediatric clients with GI/GU dysfunction > Flashcards

Week 2 Care of pediatric clients with GI/GU dysfunction Flashcards

1
Q

How do F/E imbalances differ in children?

A

They are more frequent

They don’t adjust as quickly

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2
Q

What is the total body water percent of a newborn?

A

75%

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3
Q

What is the total body water percent of an infant

A

65%

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4
Q

What is the total body water percent of a child

A

60%

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5
Q

How do infants BSA’s differ from adults?

A

they are 2-3 times larger than that of an adult or older child

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6
Q

How is an infants GI tract different?

A

Its longer

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7
Q

What are the implications of a longer GI tract in infants?

A

They are more prone to diarrhea and thus higher risk for FVL

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8
Q

What is important to consider about an infants kidney function?

A

Their kidneys are immature until 2 years of age. This increases the risk of drug toxicity

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9
Q

Infants have a higher BMR. What does this mean for fluid volume?

A

They run hotter and breath faster so they have larger insensible water loss from skin and lungs

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10
Q

When a pediatric patient is dehydrated, what happens to LOC?

A

They become lethargic

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11
Q

When a pediatric patient is dehydrated, what happens to B/P

A

It is low

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12
Q

When a pediatric patient is dehydrated, what happens to pulse

A

its high

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13
Q

When a pediatric patient is dehydrated, what happens to skin turgor. Where is it assessed?

A

it becomes poor. Assess on abdomen or sternum

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14
Q

When a pediatric patient is dehydrated, what happens to mucus membranes?

A

They become dry

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15
Q

When a pediatric patient is dehydrated, what happens to Urine output

A

It drops

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16
Q

When a pediatric patient is dehydrated, what happens to Thirst?

A

its high

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17
Q

When a pediatric patient is dehydrated, what happens to Fontanels?

A

They become sunken

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18
Q

When a pediatric patient is dehydrated, what happens to Extremities?

A

Cap refill becomes slow

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19
Q

When a pediatric patient is dehydrated, what happens to respirations?

A

they change

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20
Q

When a pediatric patient is dehydrated, what happens to weight?

A

drops

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21
Q

When a pediatric patient is dehydrated, what happens to tears?

A

Absent

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22
Q

What are the common causes of dehydration in young children/infants?

A
  • Loss of sodium containing fluids
  • Radiant heaters
  • Adrenal insuff. 3rd spacing
  • Diuretics
  • Excessive exercise
  • Burns
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23
Q

If a child is being given ORT and is vomiting what is to be done?

A

Keep up with the ORT. even if its down for a few minutes it still helps

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24
Q

if giving juice or soda for ORT what needs to be done?

A

Dilute it to half strength

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25
Q

Should ORT include only water?

A

No, some sugar is needed to absorb na

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26
Q

In pediatric patients, mild dehydration is characterized by what traits? How is it treated?

A

40-50ml/kg or 5% weight loss

Treated with ORS @50ml/kg

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27
Q

In pediatric patients, moderate dehydration is characterized by what traits? what is the treatment?

A

60-90 ml/kg loss or (6-9%)

Replace with 100ml/kg ORS

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28
Q

in pediatric patients, severe dehydration is characterized by what traits? How is it treated?

A

100ml/kg lost (10% or more)

Replace with IV and ORS

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29
Q

After what age is specific gravity used as an assessment in children

A

2 years old

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30
Q

What are the three most common pediatric GI motility disorders?

A
  • Diarrhea/Gastroenteritis
  • Hirschsprung’s disease
  • Gastroesophageal Reflux
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31
Q

Describe acute Diarrhea/Gastroenteritis

A

It has a sudden onset. Often caused by infections both viral or bacterial. It’s normally self-limiting if it’s not causing dehydration

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32
Q

What is a common viral cause of acute Diarrhea/Gastroenteritis in infants? How is it prevented?

A

Rotavirus

there is a vaccine

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33
Q

What is the common cause of acute viral Diarrhea/Gastroenteritis in children over 2?

A

the norwalk virus

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34
Q

Diarrhea/Gastroenteritis is considered chronic after how many days?

A

14

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35
Q

with chronic Diarrhea/Gastroenteritis, there is a very high risk of

A

Malabsorption

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36
Q

One condition that can cause malabsorption r/t the food we eat is ____

A

Lactose intolerance

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37
Q

Chronic Diarrhea/Gastroenteritis can be caused by poor management of ___

A

Acute Diarrhea/Gastroenteritis

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38
Q

When a child presents with chronic Diarrhea/Gastroenteritis what are some questions to ask?

A

Do they have allergies, IBS, or are they lactose intolerant?

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39
Q

How is Diarrhea/Gastroenteritis diagnosed?

A

Based off of history and severity.

  • If other diseases are present
  • Other symptoms present
  • Hx of ABO use
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40
Q

How is Diarrhea/Gastroenteritis treated?

A

For acute, it’s often watchful waiting

The key is to assess and treat fluid imbalances using ORT/ORS

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41
Q

What are not to be given to children with Diarrhea/Gastroenteritis

A

Antidiarrheals, clear liquids, or the BRAT diet

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42
Q

What kind of diet should a child with Diarrhea/Gastroenteritis have?

A

whatever they can tolerate

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43
Q

How do you prevent Diarrhea/Gastroenteritis?

A

Hand hygiene especially after diaper changes

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44
Q

What is some good anticipatory guidance for parents with young children prone to Diarrhea/Gastroenteritis

A

Keep ORS on hand so you don’t have to go to the store later

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45
Q

What does a CBC test?

A

Blood counts. Specifically Hemoglobin, Hematocrit, WBC’s and platelets

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46
Q

What does a BMP test?

A

Sodium, Chloride, BUN, Potassium, HCO3, creatinine, and glucose

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47
Q

What does the CMP test?

A

Everything in the BMP plus Calcium, albumin, total protein, ALP, ALT, AST, and Bilirubin tests. (these are liver tests)

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48
Q

What is in the electrolyte panel?

A

CMP plus Blood gasses and osmolality

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49
Q

What is Hirschsprung’s disease?

A

Congenital aganglionic megacolon

Basically, a large colon with portions of it that have no innervation (no motility)

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50
Q

Hirschsprung’s disease occurs in _____ births

A

1/5000

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51
Q

Hirschsprung’s disease accounts for ____ of all neonatal colon obstructions

A

33%

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52
Q

Hirschsprung’s disease is ____ more times common in males

A

3-4

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53
Q

75% of Hirschsprung’s disease is limited to the ____ area

A

Rectosigmoid area

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54
Q

What are the six assessments for Hirschsprung’s disease. Which one is key?

A
  • Bilious vomiting
  • Chronic constipation/ab. distention
  • FTT
  • Ribbon-like, foul-smelling stools and a palpable fecal mass this is key
  • Enterocolitis
  • Hx, x-ray, rectal biopsy
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55
Q

What are some characteristics of enterocolitis?

A

Fever, Watery diarrhea, toxic appearance

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56
Q

What is the treatment for Hirschsprung’s disease?

A

Resection

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57
Q

Childen with Hirschsprung’s disease have less fecal matter contact on their bottom and therefore ______

A

Their bottoms are more sensitive and require more skin care

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58
Q

After an infant has a bowel resection, they usually receive a temporary_____

A

colostomy depending on the location

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59
Q

What is Gastroesophageal reflux (GER)?

A

The return of gastric contents in the lower esophagus through the lower esophageal sphincter caused by TRLES

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60
Q

What is TRLES

A

Transient relaxations of the lower esophageal sphincter

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61
Q

What is the most common esophageal disorder in infants?

A

GER

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62
Q

When does GER usually begin to improve?

A

around 6-12 months when the esophagus begins to elongate and the LES moves below the diaphragm

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63
Q

What are the main manifestations of GER

A
  • Resp. disorders (aspiration)
  • Esophagitis
  • Strictures (narrowing of the esophagus)
  • Malnutrition
  • FTT
  • Bleeding (with GERD)
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64
Q

How often does GER occur in infants?

A

5/1000 or 1/200live births. Males 3x’s

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65
Q

How often does GERD occur in infants

A

1/300

66
Q

What four conditions cause an infant to be at higher risk for GER?

A

Premature birth, Cystic Fibrosis, Cerebral palsy, asthma

67
Q

What are the main assessments for GER

A
  • Vomiting and regurgitation of formula and mucus
  • Crying are irritable
  • FTT
  • Aspiration
  • Apnea
68
Q

What are the interventions for GER?

A
  • Thickened foods
  • Position upright for 20-30 min after feeding
  • Give H2 antagonists, proton pump inhibitors
  • Avoid citrus
  • Nissen Fundoplication
69
Q

How can GER affect development?

A

It can cause issues in bonding with the parent during feeding. The infant may lose trust

70
Q

What are the two main inflammatory disorders of the GI system in pediatrics

A
  • Acute appendicitis

- Inflammatory Bowel disease

71
Q

What is the most common reason for abdominal surgery in children?

A

Acute appendicitis

72
Q

How many cases of Acute appendicitis happen a year?

A

60-80k

73
Q

The average for Acute appendicitis is?

A

10 years

74
Q

Acute appendicitis occurs in _______ of kids under 14

A

4/1000 or 1/250

75
Q

What ratio of inflamed appendices rupture?

A

1:3

76
Q

What is the most frequent subject of malpractice suits and 5th most expensive source of claims for ED MD’s

A

Failure to Dx Acute appendicitis

77
Q

What is the pathophysiology of Acute appendicitis

A

An obstruction of the vermiform appendix or inflammation caused by bacteria, virus, trauma, or parasites

78
Q

Where does Acute appendicitis pain begin?

A

The periumbilical region

79
Q

What are the assessment signs of early Acute appendicitis

A

Periumbilical pain, Fever, vomiting, dec appetite

80
Q

What are the assessment signs of Acute appendicitis after the early phase

A

Pain moves to McBurney’s point, WBC begin to elevate with a left shift in Neutrophils

81
Q

What are the signs of fully developed Acute appendicitis

A

Muscle rigidity, guarding, rebound tenderness

82
Q

If a patient presenting with signs of Acute appendicitis suddenly reports the pain has stopped what does this indicate.

A

That the appendix has likely ruptured and is now a medical emergency

83
Q

How can you palpate the abdomen in a case of suspected appendicitis in a way that reduces trauma?

A

With the stethoscope

84
Q

Should you use heat packs or enemas if you suspect appendicitis?

A

No, they can cause additional inflammation or trauma

85
Q

_____ contributes to the 30-60% perforation rate in appendicitis

A

Delayed Diagnosis

86
Q

What are the infant assessments for appendicitis

A
  • Hip-flexion(eases the pain)
  • Irritable
  • Whimpering not crying(because crying hurts)
87
Q

How is appendicitis diagnosed?

A

Ultrasound, CT scan

88
Q

What are the two types of Inflammatory Bowel Disease?

A

Ulcerative Colitis and Crohns Disease

89
Q

When does Ulcerative Colitis usually begin?

A

adolescence/young adult

90
Q

Is there a cure for inflammatory bowel disease?

A

No

91
Q

What are the signs of Ulcerative Colitis?

A

Chronic and recurring Bloody diarrhea, and pain/cramping relieved with BM. Along with no other systemic signs

92
Q

Where is Ulcerative Colitis limited to and what does it affect?

A

The colon and rectum

affects the mucosa and submucosa

93
Q

When does Crohns Disease usually begin?

A

Adolescence/ young adult

94
Q

what are the signs of Crohns Disease

A

Cramps, diarrhea, wt loss

95
Q

Where does Crohns Disease occur and what does it affect?

A

The entire GI tract and affects all layers of the bowel

Can cause fistulas (abnormal fibrous connection between organs)

96
Q

What are the three main (general) interventions for Inflammatory Bowel diseases

A
  • Mediation and nutritional management
  • Emotional support (body image, home, and school)
  • Community referrals
97
Q

What are the two main pediatric Malabsorption syndromes?

A

Celiac Disease and Short Bowel Syndrome

98
Q

Celiac Disease is often secondary to ____

A

Cystic Fibrosis

99
Q

What is the Patho of Celiac disease?

A
  • Unable to digest the gliadin component of gluten
  • Ingestion of gluten causes damage to mucosal villi causing an immune response
  • The villi flatten and atrophy, thus decreasing absorptive surface of intestines
100
Q

Celiac Disease in children commonly occurs at _____ years

A

1-5

101
Q

What are the S/S of Celiac disease?

A
  • FTT
  • Chronic Steatorrhea
  • Vomiting, Irritability, Abd pain
  • Muscle wasting, distended abd, delayed dentation
  • Fatigue
  • Abnormal coagulation (Vit K deficiency)
102
Q

How do we test for celiac disease?

A
  • Small Bowel Biopsy

- Serologic tests (IgA deficiencies)

103
Q

If someone with celiac disease removes gluten from the diet, how long until villi heal and return to normal?

A

6 months

104
Q

If someone with celiac disease removes gluten from the diet, when with Growth normalize?

A

1 year

105
Q

What is short bowel syndrome?

A

Decreased ability to digest and absorb regular diet caused by shortened intestine due to extensive resection.

106
Q

How severe is short bowel syndrome?

A

It depends on the extent and location of the resection

107
Q

What are the issues that come from ileum resection?

A
  • Diarrhea w/loss of bile salts, fluid, and electrolytes

- restricted fat absorption

108
Q

What are the issues that come from colon resection?

A

Impaired F/E management

109
Q

What are the issues that come from Jejunum resection?

A

The remaining bowel compensates

110
Q

What are some of the interventions for severe short bowel syndrome?

A
  • 3 stages of TPN

- Home care or prolonged hospitalization

111
Q

What is an issue that arises from the home care of a child with TPN?

A

Catheter sepsis. (kids are dirty and central line care needs to be well done)

112
Q

What are the two main obstructive GI disorders common in pediatrics

A
  • Intussusception

- Hypertrophic pyloric stenosis

113
Q

What is Intussusception?

A

When one segment of the bowel telescopes(prolapses) into the lumen of the adjacent segment.

114
Q

What does the occurrence of Intussusception peak?

A

3-9 months

115
Q

How common is Intussusception?

A

1-4/1000 births. boys 2x

116
Q

What percent of Intussusception is secondary to another pathology?

A

10%

117
Q

What are the classic 4 signs of Intussusception?

A

Colic, Intermittent abd pain, vomiting, current jelly stools

118
Q

What are the other sigs of Intussusception beyond the classic 4?

A
  • Sudden onset
  • Lethargy
  • Listlessness
  • A sausage shaped mass in the RUQ or mid Upper abd
119
Q

What are the interventions for Intussusception?

A
  • Barium enema

- Correct Dehydration

120
Q

What is Hypertrophic Pyloric Stenosis?

A

When the pyloric sphincter hypertrophies, narrowing gastric outlet

121
Q

When is Hypertrophic Pyloric Stenosis normally diagnosed?

A

2-8 weeks old

122
Q

What is normally the first sign of Hypertrophic Pyloric Stenosis?

A

the infant was a good eater and then suddenly began vomiting formula increasingly over time.

123
Q

What kind of vomit is common with Hypertrophic Pyloric Stenosis?

A

Projectile

124
Q

What are the symptoms of Hypertrophic Pyloric Stenosis?

A

Vomiting, Dehydration, Irritable, lethargic, fewer smaller stools,
-Olive-shaped mass palpable

125
Q

How can you tell when the infant is about to projectile vomit?

A

You can see peristaltic waves

126
Q

How is Hypertrophic Pyloric Stenosis diagnosed?

A

Ultrasound

127
Q

How is Hypertrophic Pyloric Stenosis treated

A

Pyloromyotomy or Laparoscopy followed by fluids to treat dehydration
vomit may continue for a few days after

128
Q

What are the 5 common GU tract disorders in pediatric clients?

A
  • UTI/Pyelonephritis
  • Glomerulonephritis
  • Nephrotic Syndrome
  • Polycystic Kidney disease
  • Vesicoureteral Reflux
129
Q

Describe the function of the kidneys of an infant (under 2)

A
  • Cant dilute or concentrate urine well
  • Cant concentrate or excrete sodium well
  • Urine is less acidic
  • Cant handle solute free water
  • The younger the infant the higher the BMR and the more metabolic waste to filter
130
Q

what percent of children get a febrile UTI before they are 2?

A

10%

131
Q

When does the occurrence of pediatric UTI’s peak? Why?

A

2-6 years old.
Potty training=poor peri care = more bacteria
Also anatomy- Female urethra is 2-4cm

132
Q

What organism causes 80% of UTI’s?

A

E. Coli

133
Q

How do UTI’s Present in infants?

A
  • Fever
  • Weight loss
  • N/V
  • FTT
  • Increased voiding lots of wet diapers that stink
  • Smelly urine
  • Persistant diaper rash
134
Q

How do UTI’s present in older children?

A
  • Increased frequency
  • Pain
  • abdominal pain
  • Hematuria
  • Fever
  • Chills
  • Flank pain
  • incontinence
  • Urine Odor
135
Q

What are the interventions for a UTI?

A
  • ABO
  • Identification of the causative factor
  • Increase fluid intake
  • Prevention
136
Q

What is pyelonephritis?

A

Inflammation of the renal parenchyma

can be caused by untreated UTI

137
Q

What is Vesicoureteral Reflux?

A

Abnormal retrograde flow from the bladder to ureters

138
Q

What is the most common post infection of strep?

A

Acute Glomerulonephritis

139
Q

What is Acute Glomerulonephritis?

A

Kidney tubules get clogged by strep antigens clumped with antibodies. This results in

  • Edematous Glomeruli
  • Decreased Plasma Filtration
  • Circulatory Congestion and edema
140
Q

What is a sign of Acute Glomerulonephritis that can be seen specifically in the mornings?

A

Periorbital Edema

141
Q

When does strep associated Acute Glomerulonephritis usually occur?

A

2 weeks after poor or untreated strep

142
Q

What are the assessment signs for Acute Glomerulonephritis?

A
  • Orbital edema
  • Anorexia
  • Hematuria
  • Decreased output of dark urine
  • Strep infection within the past 10-21 days
143
Q

What are the interventions for Acute Glomerulonephritis

A
  • Limit activity
  • Watch Sodium and Potassium levels
  • Give hypertensives/ABO’s
  • Monitor for F/E especially FVE
144
Q

What is Nephrotic Syndrome?

A

A syndrome of the kidney characterized by Edema, massive proteinuria, and hyperlipidemia

145
Q

What causes Nephrotic Syndrome?

A

Things that affect kidney function

146
Q

What are some other characteristics of Nephrotic Syndrome?

A
  • Weight gain
  • Abd pain
  • Gradual onset
147
Q

What are the interventions for Nephrotic Syndrome?

A
  • Bedrest
  • Corticosteroids
  • Diuretics
  • Albumin
148
Q

What are some risks involved with Nephrotic Syndrome

A
  • Infection
  • FVE
  • Skin integ if on bedrest
  • Malnutrition
149
Q

What is polycystic kidney disease?

A

It is a genetic disorder that causes the collecting ducts in the kidneys to dilate and form cysts.
The Cysts grow with the child and ultimately replace much of the functional tissue in the kidney

150
Q

What syndrome is polycystic kidney disease associated with?

A

Autosomal recessive PDK Potter facies

151
Q

If polycystic kidney disease is present in both kidneys it will cause_____

A

end-stage renal disease

152
Q

polycystic kidney disease also affects the ___ glands. This leads to ____ and ____ issues

A

Adrenal

Bp regulation and Growth

153
Q

What is the treatment for polycystic kidney disease?

A
  • Support
  • ABO’s
  • F/E correction
  • HTN meds
  • Growth hormone
154
Q

Many children with polycystic kidney disease develop _____ by 10 years of age

A

ESRD

155
Q

What is Hypospadias?

A

When the urethra is on the bottom of the head of the penis

156
Q

What is Epispadias?

A

When the urethra is on the top of the head of the penis

157
Q

What is Chordee?

A

Permanent bend in the penis

158
Q

What is Phimosis?

A

A tight constriction of the foreskin

159
Q

What is Cryptorchidism? (UDT)

A

a condition in which one or both of the testes fail to descend from the abdomen into the scrotum.

160
Q

What is hydrocele?

A

Fluid accumulation in the scrotum

161
Q

When is the optimal time to fix external GU defects? Why

A

between 6-15 months

  • They won’t remember
  • They won’t have body image issues
  • Potty training won’t be disrupted

Pediatrics (20 decks)

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