Week 5, Class 1 (9/27) Flashcards
Types of cleft lip and palate
Cleft lip/palate pre op considerations
Assess ability to suck and feed
Obtain baseline weight
Inspect lip and palate with gloved finger
Instruct proper feeding care
Isolate cleft lip pre op considerations
Encourage breastfeeding
Use wide based nipple for bottle feeding
Squeeze infants cheeks together to decrease gap during feeding
Cleft lip and palate post op considerations
Keep infant pain free to decrease crying and stress on repair
Avoid infant sucking on nipple or pacifier
Daily weights
Observe family interaction with infant
Cleft lip post op considerations *(in red)
Position infant on back and upright or on side
Apply elbow restraints
- should be removed per protocol to assess the skin, allow limb movmt, and provide comfort
Use water or diluter hydrogen peroxide to clean incision site
Apply Abx ointment prn
Gently aspirate secretions of mouth and nasopharynx to prevent respiratory complications
Cleft palate post op considerations *(in red)
Change positions frequently to facilitate drainage and breathing
Place infant side lying position immediately
IVF until able to eat or drink
AVOID straw, tongue depressor, hard pacifier, rigid utensils, hard tipped sippy cups, or suction catheters in mouth
Elbow restraints
Close observations of airway obstruction, hemorrhage, and laryngeal spasm
Face mask to deliver O2 if needed.
Cleft lip/palate complications
Ear infections and hearing loss
Speech and language impairment
Dental problems
Important points for cleft lip/palate *(in red)
Protect surgical site
-minimize crying to prevent strains on lip suture line
-maintain Logan Bow to lip if applied
-cleansing surgical site (may have antibiotic ointment x3 days)
-elbow restraints ( assess limb movmt periodically)
Infant GERD signs and symptoms
Spitting up or forceful vomiting
Irritability , Excessive crying
Blood in vomitus
Arching of the back
Stiffening
Respiratory problems, apnea
FTT
Child GERD signs and symptoms
Heartburn
Abdominal pain
Difficulty swallowing
Chronic cough
Non-cardiac chest pain
Complication of GERD
Aspiration pneumonia ( stomach contents)
GER considerations
Small frequent meals
Thickened formula with 1tsp-1tbsp. Rice cereal per 1oz formula
AVOID foods that cause reflux
-caffeine, citrus, peppermint, spicy, fried
Position child with HOB elevated after meals
Surgical intervention for GERD
Nissen fundoplication. Gastric fundus is wrapped around lower 2-3cm of esophagus
Pyloric stenosis assessment findings
Projectile vomiting occurs within minutes after eating (3rd-6th week)
Palpable olive shaped mass in RUQ of the abdomen
Usually occurs in male infants
Metabolic alkalosis
What is a pyloromyotomy ?
Laparoscopic surgery for pyloric stenosis
Allows for proper drainage from the stomach into the intestines
Intussusception
Telescoping of one part of the intestine into the other
Partial to complete obstruction of the bowel
Intussusception assessment findings
Currant jelly stool (mixed blood and mucus)
-important to ask what stools look like
Acute, intermittent abdominal pain
Movable sausage shaped mass in RUQ
Hirschsprung disease/ signs and symptoms
Absence of ganglion cells in colon
S/s: vomiting bile, failure to pass meconium in first 24-48 hours of life, abdominal distention, palpable fecal mass, foul smelling ribbon like stool
What can cause metabolic alkalosis?
Projectile vomiting
NG tube suctioning
Lab value that indicates UTI
Nitrites
What is responsible for 80% of GI disorders or defects
E coli
What is the most common organism associated with the development of a UTI
E. Coli
What increases the risk for febrile UTI?
Vesicoureteral reflux
What is Phimosis?
Narrowing of opening of foreskin
Can lead to dribbling urine pattern
Phimosis management
** Urologic emergency**
Compromises arterial circulation
Do not forcefully retract foreskin
What is Anorchism?
Total absence of testis
What do you need to avoid with Epispaidas?
Circumcision
What is Epispadias ?
Exposed or open dorsal urethra
What do you need to avoid with Hypospadias?
Circumcision
What do you test for with disorders of sex development?
Laboratory testing for karyotype
Nephrotic syndrome clinical manifestations
Normal to low BP
Decreased albumin in the urine
Serum albumin decreased
Fluid shifts from plasma to interstitial spaces
Facial and periorbital edema that improves throughout the day
Lab test for for Nephrotic syndrome
Proteinuria up to 15 grams in 24 hour period
Increased specific gravity
Hypoalbuminemia
Low total serum protein, low albumin
Low serum sodium (hyponatremia)
Therapeutic management for nephrotic syndrome
Corticosteroids- Prednisone
Diuretics- Furosemide
Interventions for nephrotic syndrome
Daily weights
Strict I&O
Salt and fluid restriction
Abdominal girth measurement
Avoid large crowds
Adhere to medication regimen
Acute glomerulonephritis assessment findings
Hypertension (mild to severe)
Smoky, cloudy, tea colored urine
Proteinuria (increased amount of proteins reflects increased severity of renal disease)
Renal failure lab findings
Elevated serum phosphorus level
- phosphorus cannot be excreted
Decreased serum calcium levels
-not enough vit D absorb calcium
Anemia
- lack of erythropoietin made by kidneys
Acute kidney injury treatment
Treat the underlying cause
What is the preferred method of dialysis for children?
Peritoneal dialysis
What does hemodialysis achieve?
Rapid correction of fluid and electrolyte abnormalities
