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NURS 3512 acute & chronic > Week 6 Peds > Flashcards

Week 6 Peds Flashcards

1
Q

What are 4 ways that children’s GI system are different than adults?

A
  1. smaller stomach
  2. LES not fully developed until 1 month old
  3. under 6 months oral intake is primarily liquid
  4. Increased risk for dehydration
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2
Q

How many mL can newborn stomachs hold?

A

10-20 mLs

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3
Q

How many mL can 2 month olds hold?

A

200 mLs

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4
Q

What does an under developed LES cause in newborns?

A

reflux/regurgitation

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5
Q

What are children MOST at risk for?

A

dehydration

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6
Q

What are 3 reasons children are at higher risk for dehydration?

A
  1. Can’t tell us when they are thirsty
  2. increased metabolic rate
  3. higher surface area compared to weight
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7
Q

What is a child’s TFI (total fluid intake) based on?

A

child’s DAILY weight

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8
Q

What are infants’ output based on?

A

number of wet diapers a day
(6 is goal)

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9
Q

What are the 9 common GI issues in children?

A

1.Acute Appendicitis
2. congenital abnormalities
3. Dehydration
4. GERD
5. Inflammatory bowel disease (IBD)
6. Liver disease (hepatitis/cirrhosis)
7. Nutritional disturbances (less in Canada)
8. Obstruction- intussusecption
9. Peptic Ulcer disease

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10
Q

What are 4 examples of GI congenital abnormalities in children?

A
  1. Abdominal hernias
  2. Cleft lip or palate
  3. Congenital esophageal atresia (no connection to stomach)
  4. Hirschprungs disease
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11
Q

What’s the main reason kids end up with dehydration?

A

Gastroenteritis

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12
Q

What is the number one reason for mortality and morbidity in children?

A

Gastroenteritis

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13
Q

What are the causes of gastroenteritis?

A

Viruses and bacteria
- Rotavirus (common)
- norovirus
- E. Coli
- Salmonella
- C diff

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14
Q

What are the symptoms of Gastroenteritis?

A

N&V
diarrhea
fever
malaise

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15
Q

What are the risks associated with dehydration from gastroenteritis?

A

1.Loss of electrolytes
2.acid-base imbalance (metabolic acidosis)
3.hypovolemic shock

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16
Q

What are the first 3 signs of dehydration in children?

A
  1. thirsty- baby cries all the time
  2. urine output reduced
  3. dry mucous membranes - very dry lips
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17
Q

What are the signs of mild dehydration?

A
  1. <5% body weight loss
  2. normal vitals
  3. increased thirst
  4. slightly dry mucous membranes
  5. slightly decreased urine output
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18
Q

What are the signs of moderate dehydration?

A
  1. 5-10% body weight loss
  2. increase HR
  3. decreased skin turgor
  4. Sunken fontanel/eyes
  5. Delayed cap refill
  6. Listless
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19
Q

What are the signs of severe dehydration?

A
  1. > 10% body weight loss
  2. HR increase, BP decrease
  3. Lethargic
  4. Comatose
  5. Cool mottled extremities
20
Q

When an infant first comes in, we don’t have a baseline. What do we have to rely the most on to determine dehydration?

A

Symptoms

21
Q

What is the first vital sign change of dehydration in children?

A

increase HR

22
Q

What vital sign shows us that the child will soon become severely dehydrated?

A

BP decrease

23
Q

How many mL/kg do we rehydrate in mild dehydration?

A

50 mL/kg over 4 hours ORS

24
Q

How many mL/kg do we rehydrate in moderate dehydration?

A

100mL/kg over 4 hours with ORS

25
Q

How many mL/kg do we rehydrate with NS or ringer’s lactate in severe dehydration?

A

20-40 mL/kg IV for 1 hour

26
Q

What can you give infants in place of breast milk/formula in severe dehydration as long as they are alert?

A

electrolytes and water

27
Q

What antiemetic can be given to infants ?

A

Ondansetron

28
Q

What labs do we check with dehydration in children?

A

CBC, Electrolytes

29
Q

What 4 things do we check in a child with dehydration?

A
  1. LOC & vitals
  2. hydration status/skin turgor
  3. I&O - stool & wet diapers (infants)
  4. Daily weights
30
Q

When is a good time to feed an infant who has not been eating due to dehydration?

A

As soon as it is tolerated - as soon as they get an appetite

31
Q

What is the most common cause of emergency abdominal surgery in kids?

A

Appendicitis

32
Q

What age is appendicitis most common in?

A

ages 10-18

33
Q

What are the symptoms of appendicitis?

A
  1. Pain
  2. Fever
  3. vomiting
  4. elevated WBC
34
Q

What are some strategies for assessing a nervous child with appendicitis?

A
  1. allow the child’s hand to be over yours so they are in control
  2. ask them to do activities like jump up and down or climb up on a stretcher (irritates the peritoneal area and indicates pain)
  3. assess least painful area and end with most painful
35
Q

Where does appendicitis pain usually start?

A

belly button & moves to right lower abdomen

35
Q

What meds do we give for non-ruptured appendix pain in kids/teens?

A

Tylenol first
morphine second
ketorolac third

36
Q

How do we know if an appendix has ruptured?

A

peritonitis (rigid abdomen)

37
Q

What do we monitor for with appendicitis?

A

infection

38
Q

What 3 things do we do pre-op for a ruptured appendix?

A
  1. rehydrate
  2. Antibiotics
  3. Prep for surgery (NPO)
39
Q

What is the #1 issue in cleft lip/palate and why?

A

Feeding issue because babies create suction to eat

40
Q

What are the 5 issues with cleft lip/palate and why?

A
  1. Feeding- no suction
  2. Ear infections d/t fluid getting into nasal cavity
  3. Gums disrupted - teeth issues
  4. Body image
  5. speech impairment
41
Q

how old are infants when they surgically repair cleft lip?

A

2-3 months old

42
Q

how old are infants when they surgically repair cleft palate?

A

before 12 months

43
Q

What are 2 strategies to help babies with cleft lip/palate drink?

A
  1. breastfeeding - squeeze baby’s cheeks together to decrease width of cleft
  2. Bottle feed - special nipples
44
Q

What are some cleft post- op interventions for babies ?

A

analgesics
NPO then clear fluids then breast/bottle feeding then soft diet
Protect the sutures site- petroleum jelly on lips especially
Elbow immobilizers
Syringe feeding (no sucking for 7 days sometimes)
Oral packing/dressing- remove 2-3 days

NURS 3512 acute & chronic (29 decks)

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