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PEDS > Week 8 > Flashcards

Week 8 Flashcards

1
Q

Gastrointestinal Assessment - bowel movements (7)

A
  • frequency
  • colour
  • regularity
  • consistency
  • discomfort
  • constipation/diarrhea
  • none any change in any of the above
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2
Q

Gastrointestinal Assessment - abdomen inspection (3)

A
  • shape
  • abdominal distension
  • infants - umbilical hernia
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3
Q

Gastrointestinal Assessment - abdomen auscultation

A
  • bowel sounds in all four quadrants (hyper, hypo, absence etc)
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4
Q

Gastrointestinal Assessment - abdomen palpation (3)

A
  • soft or firm
  • pain or tenderness (guarding/grimacing/crying)
  • describe any masses palpated (location, shape, size, consistency)
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5
Q

Gastrointestinal Assessment - nutrition (5)

A
  • tolerance of feedings (spitting up, emesis, frequent resp illness)
    • colour and frequency of emesis
    • during feed or post feed spit ups or projectile
    • note amount of intake, frequency of feedings, growth
  • weights to monitor growth/ins and outs (diarrhea or vomit it can be hard to accurately measure)
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6
Q

Gastrointestinal differences

A
  • abdominal distension can cause resp distress
  • coordinated suck and swallow ability develops by 34 gestation
  • coordinated oral pharyngeal movements for swallowing develop after 2 months
  • stomach capacity increases from 10-20 mLs to up to 3 Ls (adolescence)
  • infants and children may have palpable liver edge below right costal margin
  • infants intestine is highly permeable, allowing uptake of protective immunoglobin from human milk
  • stool frequency is highest in infancy and decreases to adult frequency by age 4
  • defecation is involuntary and reflex in infancy, voluntary - 18mo-4years
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7
Q

Constipation (2)

A
  • 5% of paediatrician visits
  • rarely signifies a serious disease –> signifies poor quality of life for patient and parents, health care costs
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8
Q

Frequency of poops - infant

A
  • 3-4 stools per day
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8
Q

Frequency of poops - infant

A
  • 3-4 stools per day
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9
Q

Frequency of poops - toddler

A

2-3 stools per day

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10
Q

Frequency of poops - age 4 and up

A

adult daily pattern

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11
Q

Constipation - definition

A

infrequent passage of hard uncomfortable stools that are distressing to the child

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12
Q

Constipation - causes (5)

A
  • inadequate hydration
  • low fibre diet
  • slow intestinal transit
  • minimal activity level (inactivity)
  • behavioural factors
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13
Q

Constipation - cause by age - infancy

A
  • when breastfed infant is transitioned to formula or whole milk, purreed to solid foods
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14
Q

Constipation - cause by age - trend

A
  • any age, most commonly presents during period of transition
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15
Q

Constipation - cause by age - toddlers

A

when toilet training begins

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16
Q

Constipation - cause by age - school

A

using a toiled away from home (school, summer camp, etc)

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17
Q

Constipation - load over time

A
  • larger stool load in rectum causing further stretching and potential thinning of the rectal wall
  • left untreated, can lead to complications
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18
Q

Constipation - complications

A
  • enuresis
  • frequent UTIs
  • rectal prolapse
  • pelvic dyssynergia
  • hirschsprung
  • hypothyroidism
  • opiod narcotics
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19
Q

Constipation - treatment - education (3)

A
  • talk to parents and child about constipation:
  • its influence on lower GI function and overflow
  • fecal incontinence
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20
Q

Constipation treatment - clean out/disimpaction

A
  • high dose oral laxatives
  • enemas
  • manual disimpaction
  • nasogastric admin of bowel cleansing agent
    • preferred method is via oral route
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21
Q

Constipation treatment

A
  • patient education
  • clean out/disimpaction
  • maintinance
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22
Q

Constipation treatment - maintenance (4)

A
  • laxative therapy to ensure regular passage of soft, appropriate sized stools
  • eliminate painful defacation
  • treatment phase can last months to years, close follow up
  • PEG 3350 = drug of choice (polyethylene glycol 1 g/kg/day)- hard to convince kid sometimes as it tastes bad
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23
Q

Diarrhea - acute gastroenteritis - world picture (5)

A
  • common ilness
  • 1.5 million outpatient visits yearly
  • developing - common cause of mortality under 5 years
  • american younger than 5 = 2 episodes per year
  • 10% of all pediatric hospital admissions
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24
Q

Diarrhea - definition (3)

A
  • passage of 3 or more loose or watery stools per day (or more frequent passage than normal for individual)
  • a CHANGE from the norm
  • frequent formed stools is NOT diarrhea, passing of pasty stools in breastfed infants is NOT diarrhea
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25
Q

Diarrhea - clinical classifications (3)

A
  • acute diarrhea, lasting several hours or days
  • acute bloody diarrhea (dysentary)
  • persistant diarrhea (14 days or longer)
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26
Q

Acute gastroenteritis - clinical manifestation (5)

A
  • diarrhea
  • vomiting
  • fever
  • anorexia
  • abdominal cramps
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27
Q

Dehydration S and S - normal or minimal loss (6)

A
  • mental status: well and alert
  • thirst: normal
  • normal HR, pulse, breathing, eyes, tears, cap refill, urine output
  • mouth and tongue: moist
  • instant skin recoils
  • warm extremities
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28
Q

Mild to moderate dehydration (7)

A
  • mental status: fatigued or restless or irritable
  • thirst: eager to drink
  • normal to increased HR, breathing
  • normal to decreased pulse quality, sunken eyes, tears, cap refill, urine output
  • mouth and tongue: dry
  • skin recoils <2 seconds
  • cool extremities
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29
Q

Severe dehydration (7)

A
  • mental status: apathetic, lethargic, unconscious
  • thirst: drinks poorly, unable to drink
  • increased HR, breathing (fast and deep)
  • decreased pulse quality (Weak), sunken eyes, no tears, poor cap refill, minimal urine output
  • mouth and tongue: parched
  • skin recoils >2 seconds
  • cool mottled cyanotic extremities
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30
Q

Diarrhea - treatment

A
  • most likely viral
  • early fluid replacement (at home) such as Oral Rehydration Solution( pedialyte)
  • ORS great for mild and even moderate dehydration
  • IV rehydration for severe or failed moderate ORS replacement
  • maybe give gravol or other anti nausea (caution because can cause decreased LOC)
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31
Q

Fluid replacement therapies - minimal or no dehydration (3)

A
  • rehydration therapy not needed
  • replace loss with
    • <10kg = 60-120 mL ORS per diarrheal stool or emesis
    • > 10kg = 120-140 mL ORS per diarrhea stool or emesis
  • nutrition - continue as normal
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32
Q

Fluid replacement therapies - mild to moderate dehydration

A
  • rehydration therapy = ORS 50-100 mL/kg over 3-4 hours (3)
    – replace loss with
    • <10kg = 60-120 mL ORS per diarrheal stool or emesis
    • > 10kg = 120-140 mL ORS per diarrhea stool or emesis
  • nutrition - continue as normal
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33
Q

Fluid replacement therapies - severe dehydration (5)

A
  • Rehydration therapy = normal saline in 20 mL/kg body weight IV until perfusion and mental status improves (up to 3 times)
  • replace loss with
    • <10kg = 60-120 mL ORS per diarrheal stool or emesis
    • > 10kg = 120-140 mL ORS per diarrhea stool or emesis
    • if unable to drink, give via NG
    • give 5% dextrose in normal saline
  • nutrition - continue as normal
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34
Q

Gastroesophageal reflux (GER) (3)

A

passage of gastric contents into esophagus
- normal physiologic process in healthy infants and children
- may cause distress for caregivers and patients

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35
Q

Gastroesophageal reflux disease (GERD) (2)

A
  • passage of gastric contents into esophagus resulting in troublesome symptoms or complications for the infant, child, adolescent
  • not for the caregiver ALONE
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36
Q

Epidemiology of GER

A
  • common occurrence in healthy infants or children
  • 50% in infants younger than 3 months
  • 67% infants at 4 months
  • less common after 12 months
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37
Q

Reflux symptoms (3)

A
  • heartburn
  • epigastric pain
  • regurgication
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38
Q

Reflux symptoms prevalence (school aged)

A

7%

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39
Q

Reflux symptoms prevalence (adolescence)

A

8%

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40
Q

Pediatric populations at increased risk for GERD (6)

A
  • neuro impairment
  • obesity
  • lung disease (esp CF)
  • esophageal atresia
  • prematurity
  • congenital cardiac defects
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41
Q

Infant GERD Signs and Symptoms - GI (3)

A
  • regurgitation
  • feeding difficulties
  • hematemesis
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42
Q

Infant GERD Signs and Symptoms - extra-intestinal (6)

A
  • failure to thrive
  • wheezing
  • stridor
  • persistent cough
  • apneaALTE
  • irritability
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43
Q

Children GERD Signs and Symptoms - GI (7)

A
  • heartburn
  • vomiting
  • regurgitation
  • feeding difficulties
  • dysphagia
  • chest pain
  • hematemesis
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44
Q

Children GERD Signs and Symptoms - extra-intestinal

A
  • persistent cough
  • wheezing
  • laryngitis
  • stridor
  • chronic asthma
  • recurrent pneumonia
  • dental erosions
  • anemia
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45
Q

Infant GERD - treatment (3)

A
  • lifestyle modifications
  • change in nutrition, feeding practices, positioning
  • large volume feeds promote regurgitation, low volume cause insufficient intake…. add rice cereal to formula or human milk may decrease amount of regurgitation by thickening the formula (increase caloric concentration)
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46
Q

Child GERD - treatment (4)

A
  • lifestyle modifications
  • dietary modification
    • avoid meals with high fat content
    • avoid tobacco and alcohol
    • avoid caffeine, chocolate, spicy foods
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47
Q

Treatment of GERD - pharmacological (4)

A
  • antacids (quick relief)
  • histamine-2 receptor antagonists (decrease acid production, infants)
  • proton pump inhibitor (suppress gastric acid production, irreversible binding)
  • prokinetic agents (stim more rapid emptying of stomach)
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48
Q

GERD - kids with neuro impairment

A

increased severity and complications
- chronic supine positioning, swallow dysfunction, abnormal sensory integration, constipation, abnormal muscle tone, skeletal abnormalities
- ppi, pro-kinetics, surgery
- change in feeds (G tube feeds to continuous J tube, venting G tube)

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49
Q

Appendicitis - pain in

A

RIGHT LOWER QUADRANT - mcBurneys point

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50
Q

Hirschsprung’s disease (5)

A
  • congenital megacolon
  • congenital absence of ganglion cells in the myenteric and submucosal plexuses of the intestine
  • presents as abnormalities of intestinal motility that manifest mostly as colonic obstruction
  • absence of ganglion cells = disrupts inhibitory parasympathetic nerves
  • lack of normal inhibitory activity = tonic contraction of segment = obstructive symptoms, dilation/hypertrophy of proximal colon
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51
Q

Hirschsprung’s disease - diagnosis (3)

A
  • radiographic, functional, histologic studies
  • single contrast barium enema
    • demonstrates a transition zone = condition, though absence of a
      transition does not rule out the condition
  • familial relation based on length of affected segment, more common in African American people, can be isolated birth defect, or comorbidity (down syndrome)
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52
Q

Appendicitis - pain in

A

RIGHT LOWER QUADRANT - mcBurneys point

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53
Q

Hirschsprung’s disease - presentation (5)

A
  • enterocolitis, major cause of morbidity and mortality with HSD, occurs in children younger than 2
  • abdominal distension
  • explosive watery stools
  • fever
  • hemodynamic isntability (hypovolemic shock)
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54
Q

Hirschsprung’s disease - treatment (4)

A
  • surgery = treatment of choice
  • various procedures = remove most or all of aganlionic segment to reanastomose normal proximal bowel to distal rectum or anal canal
  • GOAL = establish regular and spontaneous defecation
  • although many have good outcome, up to 30% remain constipated or never develop fecal continence
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55
Q

Intassusception (3)

A
  • invagination or telescoping of one portion of intestine into another
  • results in obstruction, inflammation, edema
  • decreased blood flow = ischemia, perforation, peritonitis, shock
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56
Q

Intassusception - complications

A
  • ischemia
  • perforation,
  • peritonitis,
  • shock
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57
Q

Intassusception - manifestation (7)

A
  • sudden onset of crampy abdominal pain
  • inconsolable crying and drawing up of knees
  • bliious emesis and lethargy
  • red, currant jelly stools
  • tender and distended abdomen
  • palpable sausage shaped mass in RUQ
  • potentially life threatening
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58
Q

Intassusception - treatment

A
  • air enema
  • may have ischemia and requrire surgical resection
  • go home in a couple hours, may redevelop in a couple days
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59
Q

Cleft lip and palate - G + D

A
  • failure of maxillary processes to fuse with elevations on frontal prominence (6 week gestation)
  • union of upper lip = 7-8 week
  • develop of soft and hard palate
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60
Q

Cleft lip and palate

A
  • occur singly or in combination
  • cleft lip apparent at birth
  • cleft palate less obvious if no cleft lip and may involve just soft palate or both soft and hard palates
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61
Q

Cleft lip and palate - cause (6)

A
  • environmental and genetic
  • responsible gene unknown
  • associated with chromosomal abnormalities (TEF, omphalocele, trisomy 13, skeletal dysplasias)
  • drugs (phenotioin, valporic acid, thalidomide
  • pesticides
  • folic acid deficiency
  • alcohol ingestion and smoking
62
Q

Cleft lip and palate - diagnosis (2)

A
  • can be diagnosed by ultrasound (14-16 weeks)
  • or upon birth
63
Q

Cleft lip and palate - impacts on patient (4)

A
  • feeding (
  • speech
  • hearing
  • dentition
64
Q

Cleft lip and palate - repair process - 2-3 months (2)

A
  • lip sutured together with stabilizing device put in place to prevent tension on suture line
  • minimize crying
65
Q

Cleft lip and palate - repair process - 6-12 months (3)

A
  • early repair promotes formation of taste buds
  • normal speech to develop
  • plastics, orthodontics, ENT, speech language pathology
66
Q

Cleft lip and palate - repair process - long term problems (3)

A
  • prone to reccurent otittis media –> hearing loss/ myrigotomy
  • misaligned mandible and maxilla (malformed/missing teeth)
  • speech difficulties (compensatory speech pattern)
67
Q

Esophageal atresia and tracheoesophageal fistula (TEF) - what

A
  • 1/4000 live births
  • failure of trachea and esophagus to separate into 2 distinct structures
  • 4/5 week of gestation
68
Q

Esophageal atresia and tracheoesophageal fistula - manifestations (7)

A
  • frothy saliva in mouth and nose,
  • drooling,
  • cyanosis,
  • chocking,
  • coughing,
  • sneezing
  • risk of aspiration
69
Q

Esophageal atresia (EA) and tracheoesophageal fistula (TEF) - anatomy

A
  • in the most common EA and TEF, uper segment of esophagus ends in blind pouch connected to trachea, the fistula connects the lower segment to the trachea
70
Q

Types of EA and TEF

A

5 types (A to E)

71
Q

Type A TEF/EA

A

EA alone

72
Q

Type B TEF/EA

A

EA with proximal TEF

73
Q

Type C TEF/EA

A
  • EA with a distal fistula
  • most common (85%)
74
Q

Type D TEF/EA

A
  • EA with proximal and distal fistula
75
Q

Type E TEF/EA

A

TEF alone

76
Q

TEF/EA - treatment

A

emergency surgery!

77
Q

TEF/EA - pre op care (5)

A
  • surgical emergency - surgery ASAP with NG tube
  • HOB slightly raised to minimize aspiration
  • Maintain patent airway, NP suction PRN
  • continuous/low intermittent suction
  • NPO, IV fluids and antibiotics
78
Q

TEF/EA - post-op care

A
  • IV fluids and antibiotics
  • pain management
  • complete immobilization of neck/head*****
  • at risk for reflux and aspiration
  • may need more surgeries r/t strictures
79
Q

Pyloric stenosis -

A

projectile vomiting
peanut sized and shape mass
obstruction of circular muscle of pyloric canal
palpateable

80
Q

Genitourinary assessment - 3

A
  • expected urine output
  • urine characteristics
  • pain or discomfort
81
Q

Expected urine output - infants

A

2cc/kg/hour

82
Q

Expected urine output - children

A

0.5-1cc/kg/hr

83
Q

Expected urine output - adolescents

A

0.5 cc/kg/hr

84
Q

Urine characteristics (7)

A
  • hx of UTIs
  • frequency
  • urgency
  • dysuria
  • strength of stream/dribbling
  • odour/dark/cloudy/bloody
  • potty trained?
85
Q

Genitourinary assessment - pain or discomfort (3)

A
  • pain or burning
  • flank or abdominal pain
  • scrotal or testicular pain
86
Q

Genitourinary Assessment

A
  • apperance of genetatlia
87
Q

Genitourinary Assessment - appearance of genitatalia

A
  • neonates - location of urethra
  • crotum large or underdeveloped/rugae present/ are both testes palpable
  • discharge of any kind
  • rashes
88
Q

Reproductive assessment - female (6)

A
  • where appropriate: ectopic, pelvic inflammatory disease, pregnancy as cause of symptoms
  • lest menstrual period/changes
  • pain during intercourse or post intercourse bleeding if sexually active
  • lesions, swelling, discoloration of external genetalia
  • urethral or vaginal discharge
  • sense of pelvic relaxation
89
Q

Reproductive assessment - male

A
  • testicular pain/swelling
  • discharge from penis, itching
  • lesions, swelling, discoloration of external genitalia
90
Q

Genitourinary function - g + d (6)

A
  • all nephrons present at birth (continue to enlarge)
  • most renal growth occurs in first 5 years of age
  • efficiency of kidnes increases with age (esp after age 2)
  • urine output/kg higher in infancy
  • Shortness of urethra –> UTI
  • reproductive system functionally immature until puberty
91
Q

Genitourinary function - kid vs adult (5)

A
  • nephrons smaller in kids
  • GFR is less in infants, same as adults by age 2
  • infants less able to manage electrolyte and acid-base balance
  • urine output higher in infancy
  • reproductive system immature until puberty
92
Q

Urinary tract infection - description (2)

A
  • involves lower or upper urinary tract
  • acute or chronic (recurrent or persistent)
93
Q

UTI - common populations (3)

A
  • uncircumsized males <3 months
  • females <12 months have highest prevelance
  • incidence increases in teen girls who are sexually active
94
Q

UTI symptoms - infant (!1)

A
  • unexplained fever
  • failure to thrive
  • poor feeding
  • vomiting and diarrhea
  • fever
  • hypothermia
  • sepsis
  • irritability or lethargy
  • strong smelling urine
  • persistent diaper rash
  • renal tenderness
95
Q

UTI - older children (<2 years) (9)

A
  • fever
  • poor appetite
  • dysuria
  • urgency or hesitancy
  • increased frequency
  • enuresis or new-onset incontinence
  • abdominal tenderness or lower abdominal pain, flank pain
  • hematuria
  • strong smelling urine
96
Q

Upper UTI - pylonephritis symptoms (8)

A
  • high fever
  • chills
  • abdominal pain
  • nausea
  • vomiting
  • flank pain
  • costovertebral angle tenderness
  • moderate to severe dehydration
97
Q

UTI - Clinical therapy - young infants (<2 months) (2)

A
  • parentral antibiotics until 24 hours afebrile
  • switch to oral antibiotic matching organism sensitivity for 10-14 days
98
Q

UTI - Clinical therapy - children (over 2 months) (6)

A
  • oral antibiotics prescribed 7-14
  • give parenteral antibiotics initially if child appears toxic/cannot tolerate oral meds
  • length of treatment varies by meds
  • analgezics like tylenol used
  • review voiding habits if age appropriate and work with child and family
  • encourage fluids
99
Q

UTI - recomended medications (3)

A
  • sulfamethoxazol-trimethoprim
  • a second or third generation cephalosporin
  • amoxicilin davulanate
100
Q

Upper UTI treatment

A
  • IV antibiotics given initially, then transitioned to oral antibiotics matching organism after child is afebrile for 24-36 hours and 7-14 days of therapy
  • rehydration, antipyretics, analgesics
101
Q

UTI - etiology/pathophysiology (2)

A
  • Urinary stasis (abnormal anatomy, abnormal function = infrequent voiding)
  • vesicouretral reflux (backflow of urine from bladder to ureters = bacteria) = structural abnormality
102
Q

Kidney damage and UTIs (5)

A
  • utis can cause kidney damage
  • <1 year of age
  • delay in effective antibiotics for upper UTI
  • anatomic or neurologic obstruction
  • recurent episodes of upper UTI
103
Q

Kidney damage and UTI - diagnosis (2)

A
  • Urine specimin (dipstick and C&S (midstream, catheter, suprapubic, urine bag)
  • Radiologic studies (renal ultrasound first, voiding cytourethrogram later, DMSA)
104
Q

Kidney damage and UTI - management (2)

A

antibiotic therapy
- use follow-up cultures 48-72 hours, monthly for 3 months, q3 months for 6 months, then annually

105
Q

Hypospadias and Epispadias - what

A
  • failure of urethral folds to fuse completely
  • diagnosis made at birth
  • do NOT circumsise
  • repaired surgically before kindergarten
  • placement of urethral meatus at end of glans penis to collect urinary stream
  • improve physical apperance (preserve sexually adequet organ)
106
Q

Hyposadias - what

A
  • urethral meatus anywhere on ventral surface (underside)
  • often occurs with congenital chordee
107
Q

Epispadias - what

A
  • meatal opening on dorsal surface
  • often occurs with exstrophy of bladder
108
Q

Hyposadias and Episadias - post op management (5)

A
  • protect surgical site from injury (pressure dressing); maintain urethral stent
  • fluid intake to maintain urine output and accurate I&O
  • catheter 2-7 days post op
  • pain and bladder spasm management (analgesics, anticholonergic, antibiotics, oxybutinin)
  • Discharge teaching (avoid bath until stent removed, antibiotic ointment)
109
Q

Nephrotic syndrome - symptoms (6)

A
  • abdominal pain and bloating
  • flu-like symptoms, no fever
  • one “pee”/day that is frothy
  • drinking ++
  • U/A - large amount of proteins, no RBC
  • elevated BP
110
Q

Nephrotic syndrome - lab values (5)

A
  • proteinuria
  • hypoalbumenia
  • edema
  • hyperlipidemia
  • altered immunity
111
Q

Nephrotic syndrome - etiology (3)

A
  • congenital
  • autosomal recessive
  • extremely rare
112
Q

Nephrotic Syndrome - classifications

A
  • primary
  • seconodary
113
Q

Primary Nephrotic syndrome - etiology

A
  • kidney is main or only organ involved
  • results from disease (e.g. glomerulonephritis)
114
Q

Secondary Nephrotic syndrome - etiology

A
  • caused from systemic disease (diabetes, lupus, sickle cell anemia), drugs, or toxins
115
Q

Nephrotic syndrome - prevelance (4)

A
  • predominantly seen in preschool child
  • boys>girls in childhood, equal in adolescence
  • rare <6months, uncommon over 1 year
  • glomeruli appear normal or show minimal changes
  • nonspecific illness, usually URTI precedes manifestation 4-8 days (precipitating factor)
116
Q

Nephrotic syndrome - manifestations (symptoms) (7)

A
  • periorbital edema on waking that resolves during day
  • weight gain (clothes dont fit)
  • urine decreased, foamy or frothy
  • edema - ascites, pleural effusion, labial or scrotal swelling
  • may have increased BP
  • sign of malnutrition (protein loss) hair change, pallor, shiny skin
  • irritable, lethargic, fatigue, susceptible to infection
117
Q

Diagnostic tests for nephrotic syndrome

A
  • history
  • physical, characteristic symptoms
  • lab (serum albumin, urinalysis, BUN, creatinine)
118
Q

nephrotic syndrome - diet recommendations (3)

A
  • diet continues as normal for age
  • do not restric protein intake unless in renal failure
  • ‘no added salt” if massive edema or during corticosteroid period
119
Q

nephrotic syndrome - medications (4)

A
  • corticosteroid therapy - 95% have complete remissions
  • IV albumin
  • Immunosuppressant therapy
  • diuretics
120
Q

nephrotic syndrome - Nursing management (10)

A
  • strict I&O
  • urine dip for protein
  • daily weight
  • vital signs (BP)
  • medications (side effects of coricosterioids, hypertension and FVO from albumin)
  • prevent infection
  • prevent skin breakdown
  • nutritional and fluid needs
  • promote rest
  • emotional support
121
Q

Renal Failure (2)

A
  • kidneys unable to excrete waste & concentrate urine (Azotemia, oliguria, uremia)
  • can be acute or chronic
122
Q

Acute Renal Failure

A
  • sudden onset
  • rapid rise in BUN
  • Neonates with asphyzia, shock, sepsis; post op complication of cardiac surgery, drug toxicity
  • usually reversible
123
Q

Chronic Renal failure (3)

A
  • gradual onset
  • progressive, irreversible
  • rare in children
124
Q

Acute Renal Failure - Clinical manifestations (6)

A
  • gross hematuria
  • headache
  • edema
  • severe hypertension
  • lethargy
  • N+V
125
Q

Chronic Renal Failure - Clinical manifestations (9)

A
  • fatigue, malaise
  • poor apetite
  • prolonged unexplained N+V
  • failure to thrive
  • poor school performance
  • complicated emuresis
  • chronic anemia
  • hypertension
  • unusual bone disease
126
Q

Nursing management - acute renal failure (5)

A
  • maintain fluid balance (daily weight, I&O, BP, labs, fluid restriction)
  • medications (monitor toxicity)
  • nutritional needs (TPN, enteral feeds, diet restrict Na K PO4)
  • prevent infeciton
  • emotional support
127
Q

Appendicitis - pathophysiology (5)

A
  • accumulation of secretions and mucus within appendix
  • appendiceal distension
  • direct tenderness RLQ
  • NV
  • Diarrhea
128
Q

Small bowel obstruction + appendicitis (4)

A
  • constipation
  • inability to pass gas
  • bloating, loss of appetite
  • abdominal distension
129
Q

Peritonitis + appendicitis (4)

A
  • rebound tenderness RLQ
  • contributes to Rosving sign
  • Bloating (loss of appetite)
  • abdominal distension)
130
Q

Appendicitis - age

A

10-19 y/o

131
Q

S+S of appendicitis (5_

A
  • abdominal pain
  • fever
  • N/V
  • anorexia
  • migratory pain in RLQ, tenderness, guarding
132
Q

Pathophysiology - Chron’s disease (7)

A
  • affects any part of GI tract from mouth to anus
  • damaged areas appear in patches next to healthy tissue
  • may involve multiple layers of walls of GI tract (mucosa to serosa)
  • begins with inflammation and abscess that progress to tiny ulcers
  • mucosal lesions develop deeper and menetrate between mucosal edema (coblestone bowel)
  • commonly affects ileum, +colon, illeum alone, or just colon
  • transmural spread of inflammation leads to edema and thickening of bowel wall
  • discontinuous involved areas
  • inflammation –> hypertrofy of bowel, fibrosis, stricture formation –> bowel obstruction
133
Q

Chron’s vs ulcerative colitis (4)

A
  • Chrons = entire GI tranct (UC = colon and rectum)
  • Chrons = crypt abscess, granulomas, perianal problems (UC = no perianal issues)
  • chrons = discontinuous (UC = continuous)
  • Chrons = transmural spread (UC = inflammation of mucosa and submucosa)
134
Q

IBS - common age group diagnosis (2)

A
  • 15-35 y/o
  • diagnosed earlier = better disease progression
135
Q

How is IBS diagnosed (3)

A
  • combo of endoscopy (Chron’s) and colonoscopy (UC)
  • evaluate medical history to rule out other causes
  • blood tests, stool tests, imaging oF GI
136
Q

IBS - care plans

A
  • nutrition (reduce lactose, caffeine, high fiber, high fat, lean protein, etc),
  • anxiety
  • fluid defecit (vitals, respiratory, integumentary, renal assessment, administer fluids, daily weights, etc.
137
Q

Chron’s disease mecdications (3)

A
  • corticosteroids
  • immunodulators
  • aminosalicylates
138
Q

Surgical intervensiona - chron’s (3 situations)

A
  • intestinal obstrucitons
  • fistulas
  • absesses
139
Q

Testicular torsion - what (4)

A
  • tissues around the testicles twist around the spermatic cord
  • circulation is cut off to testical and can cause necrosis
  • impact male of adolescent age
  • urological emergency
140
Q

testicular torsion - causes (3)

A
  • testicles not strongly attached to scrotum
  • trauma around scrotum
  • vigourous physical activity or sleep
141
Q

Types of testicular torsion

A
  • extravaginal torsion
  • intravaginal torsion
142
Q

Extravaginal testicular torsion

A
  • tunica vaginalis has abnormally long attachment to testes
  • rotation is external, tunica vaginalis is also torted
143
Q

Intravaginal testicular torsion

A
  • most frequent
  • rotation occurs within tunica vaginalis
144
Q

Testicular torsion - Signs and symptoms (7)

A
  • sudden severe pain in scrotum adn lower abdomen (unilaterally)
  • N/V
  • dizziness
  • swelling of testicle
  • redness or darkening of testicle
  • affected testicle moves higher in scrotal position
  • absent cremastreric reflex
145
Q

Testicular torsion diagnosis (3)

A
  • physical assessment
  • blood and urine test
  • ultrasonography
146
Q

Testicular torsion - Treatment

A
  • untwist spermatic cord surgically
  • use stitches to attach both testicals to scrotal wall to prevent future torsion
  • urologic emergency - 4-6 hours after start of torsion, testicle is saved 90% of time, this decreases to 50% at 12 hours, and 10% at 24 hours
147
Q

Pyloric stenosis

A
  • the pyloris is thickened and food is unalbe to move from stomach to Small intestine resulting in forceful vomiting leading to dehydration
148
Q

Causes of pyloric stenosis (3)

A
  • unknown
  • could be genetic or environemntal
  • not present at brith but develops afterwards
149
Q

S+S of pyloric stenosis (6)

A
  • weight loss
  • ravenously hungry despite vomiting
  • lack of energy
  • fewer BM
  • constipation
  • dehydration
150
Q

Diagnosis of pyloric stenosis (5)

A
  • physical exam (palpate for abnormal pyloris, feels like an olive)
  • blood tests (dehydration, electrolyte imbalance)
  • ultrasound
  • x-ray
  • upper GI series (child drinks barium solution to see if it moves through small intestine
151
Q

Nursing care for pyloric stenosis (2)

A
  • adequet nutrition and food (rehydrate IV, give thickened fluid, feed slowly)
  • promote mouth care (dehydration, NPO before surgery, pacifyer)
152
Q

Treatment of pyloric stenosis

A
  • surgical - pylomotomy to make chanel from stomack to small intestine, exellent recovery
  • non surgical if contraindicated
153
Q

Medications for pyloric stenosis (3)

A
  • IV atropine/Oral atropine
  • acetaminophen or ibuprofen
  • IV fluids

PEDS (9 decks)

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