Week 3 Content Flashcards
6-12 y.o
AT this time Immunizations should be up to date.
They are given for catch up situations and customized to each child at this point.
Consult the CDC for __________ scheduling
AT this time Immunizations should be up to date.
They are given for catch up situations and customized to each child at this point.
Consult the CDC for “catch up” scheduling
6-12 y.o Anticipatory Guidance - Healthy Lifestyle
- Fruit, Veggies, Whole Grains, Lean Meats and Fish
- ↑Water, ↓ Juice, ↓Cola, ↓Processed
- Activity (exercise) ___ min day
- Limit Screen Time to ___ hours (quality) screen time/day
- Fruit, Veggies, Whole Grains, Lean Meats and Fish
- ↑Water, ↓ Juice, ↓Cola, ↓Processed
- Activity (exercise) 60 min day
- Limit Screen Time to 2 hours (quality) screen time/day
6-12 y.o Anticipatory Guidance cont.
- First teeth come in about age __
- Brush teeth x2 /day
- _______ safety
- Helmets
- Water Safety
- ________ safety
- First teeth come in about age 6
- Brush teeth x2 /day
- Traffic safety
- Helmets
- Water Safety
- Firearm safety
School Age-Adolescent Growth: Tanner puberty scale
6-12 y.o theories
SOCIAL - Erikson’s _________________
COGNITIVE - Piaget’s _____________
SOCIAL - Erikson’s Industry Vs Inferiority
COGNITIVE - Piaget’s Concrete Operational Phase
Erikson—SOCIAL - Industry vs Inferiority
They like to do and accomplish
Example: Need to be __________ in Academic and Social Demands
Children who are encouraged and commended by parents and teachers develop a feeling of __________ (industry) and belief in their abilities.
Those who receive little or no encouragement from parents, teachers, or peers will ______ their ability to be successful and feel inferior
They like to do and accomplish
Example: Need to be Successful in Academic and Social Demands
Children who are encouraged and commended by parents and teachers develop a feeling of competence (industry) and belief in their abilities.
Those who receive little or no encouragement from parents, teachers, or peers will doubt their ability to be successful and feel inferior
Piaget—Cognitive - Concrete Operational Phase - 7-12 years
Decreased Egocentrism and Increased Importance in ____________
Can put themselves in the “shoes of others”
Can understand what someone else is _______________
Decreased Egocentrism and Increased Importance in Relationships
Can put themselves in the “shoes of others” Can understand what someone else is going through
School Age: CARE ISSUES
Respect Privacy
DIRECT STRAIGHT FORWARD :Explanation of All procedures is IMPORTANT
Can learn from verbal explanations as well as pictures and brochures
Benefits from handling medical equipment
PAIN: Wong Baker Faces Until about Age 9
Numbers 1-10 Scale when able to ___________ the concept
understand
Pain Rating Scales
Use of Numbers Pain Scale 9 years and up
- May be better to substitute the word pain with “ouch or hurt”
- Mistake to say “on a scale of 1-10”don’t forget that _____ equals no pain!
- Another mistake is to say that 10 is the worst pain you have ever had… should be the worst you can _________.
- May be better to substitute the word pain with “ouch or hurt”
- Mistake to say “on a scale of 1-10”don’t forget that zero equals no pain!
- Another mistake is to say that 10 is the worst pain you have ever had… should be the worst you can imagine.
CAPILLARY REFILL TIME > 2 SECONDS
Decreased or Compromised Blood flow to Extremity – Can Cause Vascular ischemia to tissues
- Decreased _______________
Depressed Heart function (sick heart muscle)
Hypovolemia (loss of blood or fluid)
Vasoconstriction (cold, or meds like Epinephrine)
-Restricted ______________
Compartment Syndrome-
Medical device too tight (Cast, Tape)
Pressure (bed surfaces, medical devices)
- Decreased Cardiac Output
Depressed Heart function (sick heart muscle)
Hypovolemia (loss of blood or fluid)
Vasoconstriction (cold, or meds like Epinephrine)
-Restricted Blood Flow
Compartment Syndrome-
Medical device too tight (Cast, Tape)
Pressure (bed surfaces, medical devices)
RESTRICTED BLOOD FLOW TO EXTREMITY DUE TO INJURIE/FRACTURES/CAST
–Perform Neurovascular Checks
5 Ps
CSM assessment- CIRCULATION, SENSORY, MOVEMENT
–Check for swelling
–Monitor Pain
–Perform Neurovascular Checks
5 Ps
CSM assessment- CIRCULATION, SENSORY, MOVEMENT
–Check for swelling
–Monitor Pain
ASSESS 5 P’S - CSM
*Pain
*Pallor (color)
*Pulselessness (circulatory) C
*Paresthesia (sensory) S
*Paralysis (motor) M
COMPARTMENTAL SYNDROME
Progressive decrease in __________ __________ resulting from increased pressure from edema (swelling) or bleeding that presses on tissues and vessels.
Causes compromised _________. If not treated can result in permanent nerve and vascular damage and potential need for amputation.
Progressive decrease in tissue perfusion resulting from increased pressure from edema (swelling) or bleeding that presses on tissues and vessels.
Causes compromised circulation. If not treated can result in permanent nerve and vascular damage and potential need for amputation.
COMPARTMENTAL SYNDROME- CAN ALSO BE CAUSED BY ___________ AFTER A
FRACTURE
BLEEDING
FRACTURES IN THE INFANT AND SMALL CHILD
- Fractures common in children- ___% of all injuries in children are fractures
- Infancy/toddler/preschool– ______ trauma, MVA, child ______ (twisting, rough handling, pulling)
- School age/Adolescents ______, MVA, _______ injuries, falls
- Small child with multiple fractures at varied stages of healing warrants investigation for ______
- Fractures common in children-15% of all injuries in children are fractures
- Infancy/toddler/preschool– birth trauma, MVA, child abuse (twisting, rough handling, pulling)
- School age/Adolescents sports, MVA, bike injuries, falls
- Small child with multiple fractures at varied stages of healing warrants investigation for abuse
EPIPHYSEAL FRACTURES
- ___________ plate weakest point of long bones
- Normally heals quickly and completely
- Risk of damage to growth plate
- Early identification critical to minimize growth problems and deformities
Epiphyseal
COMPLICATIONS OF FRACTURES
* __________ impairment
* ______ compression
* _____________ syndrome
* Epiphyseal damage
* Non union or malunion of bone
* Osteomyelitis
* Pulmonary emboli
* Shock hypovolemia
- Circulatory impairment
- Nerve compression
- Compartment syndrome
- Epiphyseal damage
- Non union or malunion of bone
- Osteomyelitis
- Pulmonary emboli
- Shock hypovolemia
SKIN TRACTION FOR FRACTURES
Restores Tension to Surrounding Tissues
__________ fracture
Decreases _____
Helps ________ the bone
Usually applied in ED temporarily waiting __________
Restores Tension to Surrounding Tissues
Stabilizes fracture
Decreases Pain
Helps realign the bone
Usually applied in ED temporarily waiting surgery
_______TRACTION
A type of skin traction that is widely used for femoral, hip, and acetabular fractures
BUCK’S
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)
- Abnormal development of the femoral head in the _________
- Wide range of abnormal development of the hip leading to hip _________
- Hip instability occurs in _____% of term babies
- Treatment required because of possibility of a limp, constant pain, impaired mobility later in life, early arthritis
- Abnormal development of the femoral head in the acetabulum
- Wide range of abnormal development of the hip leading to hip instability
- Hip instability occurs in 1 to 2% of term babies
- Treatment required because of possibility of a limp, constant pain, impaired mobility later in life, early arthritis
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) ETIOLOGY
Exact cause unknown
↑ Risk
* 80% ________
* Left hip most common
* Intrauterine position
* First born
* Breech birth
Exact cause unknown
↑ Risk
* 80% female
* Left hip most common
* Intrauterine position
* First born
* Breech birth
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) DIAGNOSE
Infant
* Positive _______ & _______ tests (.>2 months of age will not detect)
* Unequal folds of skin on buttock and thighs
* Limited abduction of affected hip
* Unequal leg lengths
Older child
* Limp on affected side
* Trendelenburg sign-pelvis dips when walking or standing to maintain balance
Ortolani and Barlow
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) MANAGEMENT: 0 TO 6 MONTHS
Therapy: Positioning legs in flexed abducted position
(1) Dynamic splinting: _____ ______ Worn continuously for 2- 3 months until hip stable
- Straps checked every 1 to 2 weeks for adjustment Improper application can lead to
femoral nerve palsy and avascular necrosis femoral head
Pavlik harness
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) MANAGEMENT: 6 TO 18 MONTHS
- (2) Gradual reduction by ______ ________ for 3 weeks
- Used more commonly in Europe and Asia than US.
Bryant traction
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) MANAGEMENT cont.
(3) * ________ necessary if splinting and traction are not successful
* Closed/open reduction under anesthesia
* Hip spica cast for 3 months
Surgical
NURSING PLAN/ INTERVENTIONS - DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)
- Perform post operative care
- Assess vital signs
- Check cast for ____________ & __________
- Perform ____________ ___________ of extremities,
- Pain Management
- Promote respiratory hygiene
- Teach family cast care for when child goes home
- Perform post operative care
- Assess vital signs
- Check cast for drainage and bleeding
- Perform neurovascular assessment of extremities,
- Pain Management
- Promote respiratory hygiene
- Teach family cast care for when child goes home
_______ Cast
Heavier
Cheaper
Used mostly for splints
NO WATER will dissolve edges and lead to more potential to rub skin
_________ cast
Lighter
More durable
More expensive
Still should not get wet because the padding underneath is not water proof
Plaster Cast
Heavier
Cheaper
Used mostly for splints
NO WATER will dissolve edges and lead to more potential to rub skin
Fiberglass cast
Lighter
More durable
More expensive
Still should not get wet because the padding underneath is not water proof
PLASTER CAST SPLINT
Allows for __________ without compromising circulation of extremity, after a day or 2 a complete cast can then be applied
swelling
Scoliosis & 2 types
- A lateral curvature of the spine of > ___ degrees
- ___________ Scoliosis :Most common kind- start to screen age 10 does have a genetic component
- __________: Caused by conditions like Cerebral Palsy, Spina Bifida, Musculodystrophy due to Impaired ability to control muscles that support the spine
- A lateral curvature of the spine of > 10 degrees
- Idiopathic Scoliosis :Most common kind- start to screen age 10 does have a genetic component
- Neuromuscular: Caused by conditions like Cerebral Palsy, Spina Bifida, Musculodystrophy due to Impaired ability to control muscles that support the spine
Screening Assessment for scoliosis
Most commonly seen in _________ ages 10 to 15
Physical exam
* Asymmetry of the height of shoulders, hips and scapular shapes when standing
* Asymmetry of ribs and flanks with bend at the waist
* Twist to evaluate flexibility of curve
X-ray of spine to measure curve
Most commonly seen in females ages 10 to 15
Physical exam
* Asymmetry of the height of shoulders, hips and scapular shapes when standing
* Asymmetry of ribs and flanks with bend at the waist
* Twist to evaluate flexibility of curve
X-ray of spine to measure curve
Adams Forward Bend Test
[don’t need to know for test]
Screening [scoliosis]
- Early detection increases the chance of ________ rather than surgery
- AAP recommendation is for scoliosis screening to be done by primary care practitioner
- Early detection increases the chance of bracing rather than surgery
- AAP recommendation is for scoliosis screening to be done by primary care practitioner
Scoliosis treatment depends on the severity of curvature and risk of progression
* Less than 30 degrees-monitor, ___________
* Moderate 30 to 45 degrees-__________
* Severe > 50 degrees- _____________
Scoliosis treatment depends on the severity of curvature and risk of progression
* Less than 30 degrees-monitor, exercise
* Moderate 30 to 45 degrees-bracing
* Severe > 50 degrees-spinal rods
Severe scoliosis can lead to diminishing _____ capacity, pressure on the ______, restricted physical activities, cosmetic and emotional factors
Severe scoliosis can lead to diminishing lung capacity, pressure on the heart, restricted physical activities, cosmetic and emotional factors
Scoliosis - Bracing does not correct curve, but can slow or stop ____________
Teach application of Boston brace
* Wear ___ hours per day
* Wear T-shirt under brace to decrease irritation
* Check skin for signs of irritation
* Suggest clothing modifications to camouflage brace
* Daily ___________ to prevent atrophy of spinal and abdominal muscle
* Plan ways of improving self-concept
Scoliosis - Bracing does not correct curve, but can slow or stop progression
Teach application of Boston brace
* Wear 23 hours per day
* Wear T-shirt under brace to decrease irritation
* Check skin for signs of irritation
* Suggest clothing modifications to camouflage brace
* Daily exercises to prevent atrophy of spinal and abdominal muscle
* Plan ways of improving self-concept
Scoliosis- Operative Management
Positioning of Patient in OR for Spinal Surgery:
Procedure takes 6-8 hours
Scoliosis PAIN
Originates from: vertebrae, intervertebral disc, ligaments dura, nerve root sleeves, facia and muscles
Post op: Mechanical irritation from hardware and post op inflammation
Intensity of Pain directly related to how many vertebra involved
Originates from: vertebrae, intervertebral disc, ligaments dura, nerve root sleeves, facia and muscles
Post op: Mechanical irritation from hardware and post op inflammation
Intensity of Pain directly related to how many vertebra involved
Scoliosis Post-operative Nursing Care
Pain management
Note: prior to skin incision in OR Intrathecal Morphine and Bupivacaine is injected; Usually wears off early next morning post op day 1
Patient Controlled Analgesia – initiated post op.
FIRST: Morphine, Fentanyl or Dilaudid started IV continuously with a PCA dose q 8-10 min. Reassess frequently
Pain management
Note: prior to skin incision in OR Intrathecal Morphine and Bupivacaine is injected; Usually wears off early next morning post op day 1
Patient Controlled Analgesia – initiated post op.
FIRST: Morphine, Fentanyl or Dilaudid started IV continuously with a PCA dose q 8-10 min. Reassess frequently
Post-op scoliosis
PAIN MANAGEMENT: ___________ Results in ↓ use of opioids
* Usually 1 day of PCA w/ continuous amt of narcotic with rescue dosing q 8-10 min
* Second: When able to tolerate POs
* –add PO narcotic- Oxycodone (Percocet)
-discontinue continuous infusion on PCA
- keep rescue IV lock out on PCA 10-15 min
-add non narcotic pain medications
IV ________ can be started 48 hours after Surgery: Ketorolac (Toradol) (< 5 days of use)
___________ - especially good for nerve pain, such as burning, shooting or stabbing pain.
PAIN MANAGEMENT: Multimodal Results in ↓ use of opioids
* Usually 1 day of PCA w/ continuous amt of narcotic with rescue dosing q 8-10 min
* Second: When able to tolerate POs
* –add PO narcotic- Oxycodone (Percocet)
-discontinue continuous infusion on PCA
- keep rescue IV lock out on PCA 10-15 min
-add non narcotic pain medications
IV NSAIDS can be started 48 hours after Surgery: Ketorolac (Toradol) (< 5 days of use)
Gabapentin- especially good for nerve pain, such as burning, shooting or stabbing pain.
Side effects of NSAIDs
________ dysfunction
Risk of __________
Gastric Ulceration
______ toxicity
Platelet dysfunction
Risk of hemorrhage
Gastric Ulceration
Renal toxicity
NSAIDs
– Ketorolac (Toradol)
– Ibuprofen (Motrin)
– Ketorolac (Toradol)
– Ibuprofen (Motrin)
Scoliosis post-op DRESSING
- Inspect Q 2 hours with _________ turning
- Only change if ________ with drainage
- Remove dressing around post op day 4
- Sutures removed around post ofp day 10
- Inspect Q 2 hours with log roll turning
- Only change if saturated with drainage
- Remove dressing around post op day 4
- Sutures removed around post ofp day 10
IMMOBIlITY Consequences
–High potential for ______ breakdown
–_________ (Incentive Spirometer)
–Turn q ___ hours
–Log rolling to prevent damage to spinal fusion
–Antiembolism stockings (prevent thrombosis)
–Ambulate as early as possible
–High potential for skin breakdown
–Atelectasis (Incentive Spirometer)
–Turn q two hours
–Log rolling to prevent damage to spinal fusion
–Antiembolism stockings (prevent thrombosis)
–Ambulate as early as possible
Scoliosis Post op care continued
- Post-op ________ a rare risk
- Check peripheral CSM as ordered
- Keep _____ for 12 hours
- Sit up in bed POD 1, dangle POD 2, out of bed POD 3
- Post-op paralysis a rare risk
- Check peripheral CSM as ordered
- Keep flat for 12 hours
- Sit up in bed POD 1, dangle POD 2, out of bed POD 3
Log rolling for 5 days
* Requires __ or more persons
* Client is moved to side of bed with _______
* Client is moved in simultaneous motion, maintaining straight spine
* Pillows arranged to maintain alignment
- Requires 2 or more persons
- Client is moved to side of bed with sheet
- Client is moved in simultaneous motion, maintaining straight spine
- Pillows arranged to maintain alignment
Scoliosis post-op
Potential for ___ dysfunction
* Assess return of bowel function
* Constipation common
* Paralytic ileus possible (requires NG tube)
Potential for ____ dysfunction
* Foley catheter
* Urine retention due to narcotics ,
* ↓uop due to renal hypoperfusion in OR
* Strict I and O; maintain fluid balance
Potential for GI dysfunction
* Assess return of bowel function
* Constipation common
* Paralytic ileus possible (requires NG tube)
Potential for GU dysfunction
* Foley catheter
* Urine retention due to narcotics ,
* ↓uop due to renal hypoperfusion in OR
* Strict I and O; maintain fluid balance
Scoliosis post-op Discharge teaching
Caution against adding Tylenol to some pain meds that may have ________ as a component.
______ worn for several months until fusion stable
May need home schooling
Encourage strategies to promote self esteem
Caution against adding Tylenol to some pain meds that may have Tylenol as a component.
Brace worn for several months until fusion stable
May need home schooling
Encourage strategies to promote self esteem
Pediatric patients metabolize meds differently because of differences in renal excretion and hepatic metabolism ( leads to higher risks of drug ________ )
toxicity
Peds- _________ ________ also not fully functional; may effect drug activity in one of two ways: either by changing the effective concentration of the drug at its site of action or by changing the rate at which the drug is eliminated, thus affecting the length of time for which effective concentrations are maintained.
Protein binding
Pain management - _________
-Sucrose produces analgesia through both endogenous opioid and non opioid pathways
-Taste receptors important so place on tongue or buccal surface
-Non nutritive sucking (pacifier) helps after
SUCROSE
Tootsweet- ____% sucrose soln in single dose container
24
Sucrose for pain used for -
heel sticks
venipuncture
Immunizations
Dressing changes
In combo for more painful procedures
LP (local lidocaine creams)
Circumcisions (use nerve blocks too)
16-19 month immunizations
heel sticks
venipuncture
Immunizations
Dressing changes
In combo for more painful procedures
LP (local lidocaine creams)
Circumcisions (use nerve blocks too)
16-19 month immunizations
Tylenol : Acetominophin
PO: ______ mg/kg q 4-6 hours
MAX dose < 2 years of age 60mg/kg/24 hours
> 2 years of age 75mg/kg/24 hours
IV Tylenol V acetaminophen (Ofirmev®) is >1000 times more expensive than oral acetaminophen and is therefore restricted to patients who are absolutely NPO. According to the majority of available evidence, IV acetaminophen has not demonstrated superiority over oral acetaminophen for pain or fever control.
10-15
NSAIDS
*Nonsteroidal anti-inflammatory drug i.e. Ibuprofen, Motrin, Advil
*Interfere with production of __________
*Onset 30min-1hr peak 1-2 hr
*Side effects: stomach upset
*Nonsteroidal anti-inflammatory drug i.e. Ibuprofen, Motrin, Advil
*Interfere with production of prostaglandin
*Onset 30min-1hr peak 1-2 hr
*Side effects: stomach upset
Ibuprofen
-Avoid in infants < ___ months of age
- PO dosing ______ mg/kg every 6-8 hours
400 mg max per dose
40mg/kg/24 hours
-Avoid in infants < 6 months of age
- PO dosing 10-15 mg/kg every 6-8 hours
400 mg max per dose
40mg/kg/24 hours
Ketorolac (Toradol)
IV NSAID
- Use for less than 5 days. Increased risk of renal and other side effects after this. (interstitial nephritis- inflammation of kidney tissue)
- Monitor ______________ & __________ before giving
- Effects on platelet adhesion and aggregation may prolong bleeding time.
- IV dose 0.5 – 1.0 mg/kg/dose q 6-8 hours
Max 30 mg dose
Max 40mg/kg/24 hours
renal function and platelets
The term equianalgesia, meaning “approximately equal analgesia,” refers to the doses of various opioid analgesics that are estimated to provide the _________________
same pain relief.
Fentanyl- quicker onset but ________ lasting.. But note that at steady state, slow elimination from tissue can lead to prolonged half-life. Use for short procedures:
Fentanyl patches are also available but NOT FOR _______ PAIN- FDA warning that deaths have occurred with misuse. Baseline opioid need must be known and covered to corresponding fentanyl patch
Fentanyl- quicker onset but shorter lasting.. But note that at steady state, slow elimination from tissue can lead to prolonged half-life. Use for short procedures:
Fentanyl patches are also available but NOT FOR ACUTE PAIN- FDA warning that deaths have occurred with misuse. Baseline opioid need must be known and covered to corresponding fentanyl patch
Morphine
-Most widely studied of opioids
- Metabolized liver, excreted kidneys
- Mean elimination half-life following a single dose can be 2.6 to 14 hours
- Neonates less than 40 weeks ( babies born early) have longer elimination half lives
- Concurrent illness can impact morphine clearance and lead to accumulation of metabolites (ie renal disease)
-Most widely studied of opioids
- Metabolized liver, excreted kidneys
- Mean elimination half-life following a single dose can be 2.6 to 14 hours
- Neonates less than 40 weeks ( babies born early) have longer elimination half lives
- Concurrent illness can impact morphine clearance and lead to accumulation of metabolites (ie renal disease)
Hydromorphone: Dilaudid
- 5-7 times more potent than morphine
- IV, POs
- Often thought to have ___________ as side effect versus morphine.
Dosing:
PO 0.03 - 0.08 mg/kg/dose Q4-6
IV 0.01 mg/kg/dose Q4-6
less pruritus
Opioid Narcotics Only offered PO
- Oxycodone- Percocet
- OxyContin- (extended release Oxycodone _______ ______)
- Hydrocodone- Vicodin
NEVER crush
Narcotic Side effects
- Potential ________ Depression
- Sedation
- Urinary _________
- Constipation
- Nausea ________
- Puritis
- Dizzyness
- Dry Mouth
- Potential Respiratory Depression
- Sedation
- Urinary Retention
- Constipation
- Nausea Vomitting
- Puritis
- Dizzyness
- Dry Mouth
Changing route of pain meds
With opioids and converting the oral to IV or IV to oral change is not always one to one
For example 1 mg of IV morphine equals 3 mg of oral morphine so THE _____ DOSE WILL BE GREATER THAN THE IV DOSE IN THIS EXAMPLE
ORAL
Pyloric Stenosis
__________ of the pyloric canal; the sphincter (circular muscle of the pylorus) hypertrophies to twice the normal size
Narrowing of the pyloric canal; the sphincter (circular muscle of the pylorus) hypertrophies to twice the normal size
Pyloric Stenosis
- ________ non-bilious, non-bloody, progressively worsening
- Hungry, fretful infant
- Weight _____
- Dehydration
- Metabolic alkalosis
↓sodium and
↓potassium - Olive shaped mass in __________ quad of abdomen
- Vomiting non-bilious, non-bloody, progressively worsening
- Hungry, fretful infant
- Weight loss
- Dehydration
- Metabolic alkalosis
↓sodium and
↓potassium - Olive shaped mass in upper right quad of abdomen
Preoperative care for pyloromyotomy
* Administer IV _____ and correct electrolytes
* ______ daily, monitor I & O
* Provide small, frequent feedings
* Prepare family for ______:
* (prognosis excellent)
Postoperative care
* Continue Maintenance IV fluids
* Start small oral feedings with _________ replacement solution start usually 4 to 6 hours
* Position on right side in semi-Fowler position after eating
* Burp frequently
* Weigh daily,
* Strict I & O
Preoperative care for pyloromyotomy
* Administer IV fluids and correct electrolytes
* Weight daily, monitor I & O
* Provide small, frequent feedings
* Prepare family for surgery:
* (prognosis excellent)
Postoperative care
* Continue Maintenance IV fluids
* Start small oral feedings with electrolyte replacement solution start usually 4 to 6 hours
* Position on right side in semi-Fowler position after eating
* Burp frequently
* Weigh daily,
* Strict I & O
Intussusception
- Child under 1 year of age
- Acute _________ abdominal pain
- Screaming “bloody murder” with legs drawn up to abdomen
- Vomiting
- Currant jelly stools (_______ & ______)
- Child under 1 year of age
- Acute intermittent abdominal pain
- Screaming “bloody murder” with legs drawn up to abdomen
- Vomiting
- Currant jelly stools (blood and mucus)
Intussusception
- __________ of part of the intestine into another part of the intestine
- Partial to complete bowel obstruction occurs
- Blood vessels become trapped in the telescoping bowel causing _______
- Usually 2 to 36 months old
- Cause not well understood: infections?
- __________ intervention is needed
- Telescoping of part of the intestine into another part of the intestine
- Partial to complete bowel obstruction occurs
- Blood vessels become trapped in the telescoping bowel causing necrosis
- Usually 2 to 36 months old
- Cause not well understood: infections?
- Emergency intervention is needed
Bowel Obstruction and Perforation
Monitor bowel __________:
* Fever
* Severe abdominal pain and tenderness
* Abdomen distension
* Nausea and vomiting
Monitor for _______ _____ 2ndary to Perforation
* Tachycardia,
* Poor perfusion with weak pulses, increased capillary refill
* Tachypnea
* Decreased urine output
* Hypotension (due to bacteria from intestines in peritoneum)
Monitor bowel perforation:
* Fever
* Severe abdominal pain and tenderness
* Abdomen distension
* Nausea and vomiting
Monitor for Septic Shock 2ndary to Perforation
* Tachycardia,
* Poor perfusion with weak pulses, increased capillary refill
* Tachypnea
* Decreased urine output
* Hypotension (due to bacteria from intestines in peritoneum)
Bowel Obstructionand Perforation
Prepare family for emergency intervention
Treated with ________ _______ or air contrast enema, success rate over 80%, 10% reoccur within 24 hours,
if not successful, surgery necessary and temporary colostomy
barium enema
Cleft Lip and Palate
* Malformations of the face and oral cavity that seem to be multifactorial hereditary
origin
* Cleft lip is readily apparent
* Cleft palate is assessed at birth for all infants.
* Cleft lip repaired ______ months
* Cleft palate repaired _______ months to age to minimize speech impairment
- Malformations of the face and oral cavity that seem to be multifactorial hereditary
origin - Cleft lip is readily apparent
- Cleft palate is assessed at birth for all infants.
- Cleft lip repaired 2 to 3 months
- Cleft palate repaired 9 to 18 months to age to minimize speech impairment
Cleft Lip and Palate
- Difficulty __________ & ____________
- Typical parent and family reactions to a child with obvious malformations such as cleft lip or palate are guilt, disappointment, grief, sense of loss and anger
sucking and swallowing
Cleft Lip and Palate
- Inform family about _______ option
- In newborn period, assist with feeding
- Feed in upright position Feed slowly with frequent burping
- Use soft, large nipples (special needs nipple), prosthetic palate
- Support mother’s breast feeding if possible
- Inform family about surgical option
- In newborn period, assist with feeding
- Feed in upright position Feed slowly with frequent burping
- Use soft, large nipples (special needs nipple), prosthetic palate
- Support mother’s breast feeding if possible
Cleft Lip and Palate Postoperative care
Maintain ______ _______
* Proper positioning for mucus drainage, elevate head of bed 30 degrees
* Remove oral secretions carefully with bulb syringe or soft suction set
Protect _______ ______
* Apply elbow restraints
* Minimize crying to prevent strain on lip suture line
Maintain patent airway
* Proper positioning for mucus drainage, elevate head of bed 30 degrees
* Remove oral secretions carefully with bulb syringe or soft suction set
Protect surgical site
* Apply elbow restraints
* Minimize crying to prevent strain on lip suture line
HISCHPRUNG’S Disease – Mega Colon
Congenital
* Absence of autonomic parasympathetic ________ cells in distal portion of colon
and rectum
* Common with Down’s Syndrome
* A lack of ________ in the area of the colon where the ganglion cells are of the bowel
Congenital
* Absence of autonomic parasympathetic ganglion cells in distal portion of colon
and rectum
* Common with Down’s Syndrome
* A lack of peristalsis in the area of the colon where the ganglion cells are of the bowel
Nonpharmacological methods to relieve pain
