Week 6 Peds Flashcards
What are 4 ways that children’s GI system are different than adults?
- smaller stomach
- LES not fully developed until 1 month old
- under 6 months oral intake is primarily liquid
- Increased risk for dehydration
How many mL can newborn stomachs hold?
10-20 mLs
How many mL can 2 month olds hold?
200 mLs
What does an under developed LES cause in newborns?
reflux/regurgitation
What are children MOST at risk for?
dehydration
What are 3 reasons children are at higher risk for dehydration?
- Can’t tell us when they are thirsty
- increased metabolic rate
- higher surface area compared to weight
What is a child’s TFI (total fluid intake) based on?
child’s DAILY weight
What are infants’ output based on?
number of wet diapers a day
(6 is goal)
What are the 9 common GI issues in children?
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
What are 4 examples of GI congenital abnormalities in children?
- Abdominal hernias
- Cleft lip or palate
- Congenital esophageal atresia (no connection to stomach)
- Hirschprungs disease
What’s the main reason kids end up with dehydration?
Gastroenteritis
What is the number one reason for mortality and morbidity in children?
Gastroenteritis
What are the causes of gastroenteritis?
Viruses and bacteria
- Rotavirus (common)
- norovirus
- E. Coli
- Salmonella
- C diff
What are the symptoms of Gastroenteritis?
N&V
diarrhea
fever
malaise
What are the risks associated with dehydration from gastroenteritis?
1.Loss of electrolytes
2.acid-base imbalance (metabolic acidosis)
3.hypovolemic shock
What are the first 3 signs of dehydration in children?
- thirsty- baby cries all the time
- urine output reduced
- dry mucous membranes - very dry lips
What are the signs of mild dehydration?
- <5% body weight loss
- normal vitals
- increased thirst
- slightly dry mucous membranes
- slightly decreased urine output
What are the signs of moderate dehydration?
- 5-10% body weight loss
- increase HR
- decreased skin turgor
- Sunken fontanel/eyes
- Delayed cap refill
- Listless
What are the signs of severe dehydration?
- > 10% body weight loss
- HR increase, BP decrease
- Lethargic
- Comatose
- Cool mottled extremities
When an infant first comes in, we don’t have a baseline. What do we have to rely the most on to determine dehydration?
Symptoms
What is the first vital sign change of dehydration in children?
increase HR
What vital sign shows us that the child will soon become severely dehydrated?
BP decrease
How many mL/kg do we rehydrate in mild dehydration?
50 mL/kg over 4 hours ORS
How many mL/kg do we rehydrate in moderate dehydration?
100mL/kg over 4 hours with ORS
How many mL/kg do we rehydrate with NS or ringer’s lactate in severe dehydration?
20-40 mL/kg IV for 1 hour
What can you give infants in place of breast milk/formula in severe dehydration as long as they are alert?
electrolytes and water
What antiemetic can be given to infants ?
Ondansetron
What labs do we check with dehydration in children?
CBC, Electrolytes
What 4 things do we check in a child with dehydration?
- LOC & vitals
- hydration status/skin turgor
- I&O - stool & wet diapers (infants)
- Daily weights
When is a good time to feed an infant who has not been eating due to dehydration?
As soon as it is tolerated - as soon as they get an appetite
What is the most common cause of emergency abdominal surgery in kids?
Appendicitis
What age is appendicitis most common in?
ages 10-18
What are the symptoms of appendicitis?
- Pain
- Fever
- vomiting
- elevated WBC
What are some strategies for assessing a nervous child with appendicitis?
- allow the child’s hand to be over yours so they are in control
- ask them to do activities like jump up and down or climb up on a stretcher (irritates the peritoneal area and indicates pain)
- assess least painful area and end with most painful
Where does appendicitis pain usually start?
belly button & moves to right lower abdomen
What meds do we give for non-ruptured appendix pain in kids/teens?
Tylenol first
morphine second
ketorolac third
How do we know if an appendix has ruptured?
peritonitis (rigid abdomen)
What do we monitor for with appendicitis?
infection
What 3 things do we do pre-op for a ruptured appendix?
- rehydrate
- Antibiotics
- Prep for surgery (NPO)
What is the #1 issue in cleft lip/palate and why?
Feeding issue because babies create suction to eat
What are the 5 issues with cleft lip/palate and why?
- Feeding- no suction
- Ear infections d/t fluid getting into nasal cavity
- Gums disrupted - teeth issues
- Body image
- speech impairment
how old are infants when they surgically repair cleft lip?
2-3 months old
how old are infants when they surgically repair cleft palate?
before 12 months
What are 2 strategies to help babies with cleft lip/palate drink?
- breastfeeding - squeeze baby’s cheeks together to decrease width of cleft
- Bottle feed - special nipples
What are some cleft post- op interventions for babies ?
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
