Week 8 Flashcards
Gastrointestinal Assessment - bowel movements (7)
- frequency
- colour
- regularity
- consistency
- discomfort
- constipation/diarrhea
- none any change in any of the above
Gastrointestinal Assessment - abdomen inspection (3)
- shape
- abdominal distension
- infants - umbilical hernia
Gastrointestinal Assessment - abdomen auscultation
- bowel sounds in all four quadrants (hyper, hypo, absence etc)
Gastrointestinal Assessment - abdomen palpation (3)
- soft or firm
- pain or tenderness (guarding/grimacing/crying)
- describe any masses palpated (location, shape, size, consistency)
Gastrointestinal Assessment - nutrition (5)
- 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)
Gastrointestinal differences
- 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
Constipation (2)
- 5% of paediatrician visits
- rarely signifies a serious disease –> signifies poor quality of life for patient and parents, health care costs
Frequency of poops - infant
- 3-4 stools per day
Frequency of poops - infant
- 3-4 stools per day
Frequency of poops - toddler
2-3 stools per day
Frequency of poops - age 4 and up
adult daily pattern
Constipation - definition
infrequent passage of hard uncomfortable stools that are distressing to the child
Constipation - causes (5)
- inadequate hydration
- low fibre diet
- slow intestinal transit
- minimal activity level (inactivity)
- behavioural factors
Constipation - cause by age - infancy
- when breastfed infant is transitioned to formula or whole milk, purreed to solid foods
Constipation - cause by age - trend
- any age, most commonly presents during period of transition
Constipation - cause by age - toddlers
when toilet training begins
Constipation - cause by age - school
using a toiled away from home (school, summer camp, etc)
Constipation - load over time
- larger stool load in rectum causing further stretching and potential thinning of the rectal wall
- left untreated, can lead to complications
Constipation - complications
- enuresis
- frequent UTIs
- rectal prolapse
- pelvic dyssynergia
- hirschsprung
- hypothyroidism
- opiod narcotics
Constipation - treatment - education (3)
- talk to parents and child about constipation:
- its influence on lower GI function and overflow
- fecal incontinence
Constipation treatment - clean out/disimpaction
- high dose oral laxatives
- enemas
- manual disimpaction
- nasogastric admin of bowel cleansing agent
- preferred method is via oral route
Constipation treatment
- patient education
- clean out/disimpaction
- maintinance
Constipation treatment - maintenance (4)
- 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
Diarrhea - acute gastroenteritis - world picture (5)
- 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
Diarrhea - definition (3)
- 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
Diarrhea - clinical classifications (3)
- acute diarrhea, lasting several hours or days
- acute bloody diarrhea (dysentary)
- persistant diarrhea (14 days or longer)
Acute gastroenteritis - clinical manifestation (5)
- diarrhea
- vomiting
- fever
- anorexia
- abdominal cramps
Dehydration S and S - normal or minimal loss (6)
- 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
Mild to moderate dehydration (7)
- 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
Severe dehydration (7)
- 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
Diarrhea - treatment
- 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)
Fluid replacement therapies - minimal or no dehydration (3)
- 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
Fluid replacement therapies - mild to moderate dehydration
- 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
Fluid replacement therapies - severe dehydration (5)
- 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
Gastroesophageal reflux (GER) (3)
passage of gastric contents into esophagus
- normal physiologic process in healthy infants and children
- may cause distress for caregivers and patients
Gastroesophageal reflux disease (GERD) (2)
- passage of gastric contents into esophagus resulting in troublesome symptoms or complications for the infant, child, adolescent
- not for the caregiver ALONE
Epidemiology of GER
- common occurrence in healthy infants or children
- 50% in infants younger than 3 months
- 67% infants at 4 months
- less common after 12 months
Reflux symptoms (3)
- heartburn
- epigastric pain
- regurgication
Reflux symptoms prevalence (school aged)
7%
Reflux symptoms prevalence (adolescence)
8%
Pediatric populations at increased risk for GERD (6)
- neuro impairment
- obesity
- lung disease (esp CF)
- esophageal atresia
- prematurity
- congenital cardiac defects
Infant GERD Signs and Symptoms - GI (3)
- regurgitation
- feeding difficulties
- hematemesis
Infant GERD Signs and Symptoms - extra-intestinal (6)
- failure to thrive
- wheezing
- stridor
- persistent cough
- apneaALTE
- irritability
Children GERD Signs and Symptoms - GI (7)
- heartburn
- vomiting
- regurgitation
- feeding difficulties
- dysphagia
- chest pain
- hematemesis
Children GERD Signs and Symptoms - extra-intestinal
- persistent cough
- wheezing
- laryngitis
- stridor
- chronic asthma
- recurrent pneumonia
- dental erosions
- anemia
Infant GERD - treatment (3)
- 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)
Child GERD - treatment (4)
- lifestyle modifications
- dietary modification
- avoid meals with high fat content
- avoid tobacco and alcohol
- avoid caffeine, chocolate, spicy foods
Treatment of GERD - pharmacological (4)
- 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)
GERD - kids with neuro impairment
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)
Appendicitis - pain in
RIGHT LOWER QUADRANT - mcBurneys point
Hirschsprung’s disease (5)
- 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
Hirschsprung’s disease - diagnosis (3)
- radiographic, functional, histologic studies
- single contrast barium enema
- demonstrates a transition zone = condition, though absence of a
transition does not rule out the condition
- demonstrates a transition zone = condition, though absence of a
- familial relation based on length of affected segment, more common in African American people, can be isolated birth defect, or comorbidity (down syndrome)
Appendicitis - pain in
RIGHT LOWER QUADRANT - mcBurneys point
Hirschsprung’s disease - presentation (5)
- 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)
Hirschsprung’s disease - treatment (4)
- 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
Intassusception (3)
- invagination or telescoping of one portion of intestine into another
- results in obstruction, inflammation, edema
- decreased blood flow = ischemia, perforation, peritonitis, shock
Intassusception - complications
- ischemia
- perforation,
- peritonitis,
- shock
Intassusception - manifestation (7)
- 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
Intassusception - treatment
- air enema
- may have ischemia and requrire surgical resection
- go home in a couple hours, may redevelop in a couple days
Cleft lip and palate - G + D
- 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
Cleft lip and palate
- 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
Cleft lip and palate - cause (6)
- 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
Cleft lip and palate - diagnosis (2)
- can be diagnosed by ultrasound (14-16 weeks)
- or upon birth
Cleft lip and palate - impacts on patient (4)
- feeding (
- speech
- hearing
- dentition
Cleft lip and palate - repair process - 2-3 months (2)
- lip sutured together with stabilizing device put in place to prevent tension on suture line
- minimize crying
Cleft lip and palate - repair process - 6-12 months (3)
- early repair promotes formation of taste buds
- normal speech to develop
- plastics, orthodontics, ENT, speech language pathology
Cleft lip and palate - repair process - long term problems (3)
- prone to reccurent otittis media –> hearing loss/ myrigotomy
- misaligned mandible and maxilla (malformed/missing teeth)
- speech difficulties (compensatory speech pattern)
Esophageal atresia and tracheoesophageal fistula (TEF) - what
- 1/4000 live births
- failure of trachea and esophagus to separate into 2 distinct structures
- 4/5 week of gestation
Esophageal atresia and tracheoesophageal fistula - manifestations (7)
- frothy saliva in mouth and nose,
- drooling,
- cyanosis,
- chocking,
- coughing,
- sneezing
- risk of aspiration
Esophageal atresia (EA) and tracheoesophageal fistula (TEF) - anatomy
- 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
Types of EA and TEF
5 types (A to E)
Type A TEF/EA
EA alone
Type B TEF/EA
EA with proximal TEF
Type C TEF/EA
- EA with a distal fistula
- most common (85%)
Type D TEF/EA
- EA with proximal and distal fistula
Type E TEF/EA
TEF alone
TEF/EA - treatment
emergency surgery!
TEF/EA - pre op care (5)
- 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
TEF/EA - post-op care
- IV fluids and antibiotics
- pain management
- complete immobilization of neck/head*****
- at risk for reflux and aspiration
- may need more surgeries r/t strictures
Pyloric stenosis -
projectile vomiting
peanut sized and shape mass
obstruction of circular muscle of pyloric canal
palpateable
Genitourinary assessment - 3
- expected urine output
- urine characteristics
- pain or discomfort
Expected urine output - infants
2cc/kg/hour
Expected urine output - children
0.5-1cc/kg/hr
Expected urine output - adolescents
0.5 cc/kg/hr
Urine characteristics (7)
- hx of UTIs
- frequency
- urgency
- dysuria
- strength of stream/dribbling
- odour/dark/cloudy/bloody
- potty trained?
Genitourinary assessment - pain or discomfort (3)
- pain or burning
- flank or abdominal pain
- scrotal or testicular pain
Genitourinary Assessment
- apperance of genetatlia
Genitourinary Assessment - appearance of genitatalia
- neonates - location of urethra
- crotum large or underdeveloped/rugae present/ are both testes palpable
- discharge of any kind
- rashes
Reproductive assessment - female (6)
- 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
Reproductive assessment - male
- testicular pain/swelling
- discharge from penis, itching
- lesions, swelling, discoloration of external genitalia
Genitourinary function - g + d (6)
- 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
Genitourinary function - kid vs adult (5)
- 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
Urinary tract infection - description (2)
- involves lower or upper urinary tract
- acute or chronic (recurrent or persistent)
UTI - common populations (3)
- uncircumsized males <3 months
- females <12 months have highest prevelance
- incidence increases in teen girls who are sexually active
UTI symptoms - infant (!1)
- unexplained fever
- failure to thrive
- poor feeding
- vomiting and diarrhea
- fever
- hypothermia
- sepsis
- irritability or lethargy
- strong smelling urine
- persistent diaper rash
- renal tenderness
UTI - older children (<2 years) (9)
- 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
Upper UTI - pylonephritis symptoms (8)
- high fever
- chills
- abdominal pain
- nausea
- vomiting
- flank pain
- costovertebral angle tenderness
- moderate to severe dehydration
UTI - Clinical therapy - young infants (<2 months) (2)
- parentral antibiotics until 24 hours afebrile
- switch to oral antibiotic matching organism sensitivity for 10-14 days
UTI - Clinical therapy - children (over 2 months) (6)
- 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
UTI - recomended medications (3)
- sulfamethoxazol-trimethoprim
- a second or third generation cephalosporin
- amoxicilin davulanate
Upper UTI treatment
- 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
UTI - etiology/pathophysiology (2)
- Urinary stasis (abnormal anatomy, abnormal function = infrequent voiding)
- vesicouretral reflux (backflow of urine from bladder to ureters = bacteria) = structural abnormality
Kidney damage and UTIs (5)
- 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
Kidney damage and UTI - diagnosis (2)
- Urine specimin (dipstick and C&S (midstream, catheter, suprapubic, urine bag)
- Radiologic studies (renal ultrasound first, voiding cytourethrogram later, DMSA)
Kidney damage and UTI - management (2)
antibiotic therapy
- use follow-up cultures 48-72 hours, monthly for 3 months, q3 months for 6 months, then annually
Hypospadias and Epispadias - what
- 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)
Hyposadias - what
- urethral meatus anywhere on ventral surface (underside)
- often occurs with congenital chordee
Epispadias - what
- meatal opening on dorsal surface
- often occurs with exstrophy of bladder
Hyposadias and Episadias - post op management (5)
- 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)
Nephrotic syndrome - symptoms (6)
- 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
Nephrotic syndrome - lab values (5)
- proteinuria
- hypoalbumenia
- edema
- hyperlipidemia
- altered immunity
Nephrotic syndrome - etiology (3)
- congenital
- autosomal recessive
- extremely rare
Nephrotic Syndrome - classifications
- primary
- seconodary
Primary Nephrotic syndrome - etiology
- kidney is main or only organ involved
- results from disease (e.g. glomerulonephritis)
Secondary Nephrotic syndrome - etiology
- caused from systemic disease (diabetes, lupus, sickle cell anemia), drugs, or toxins
Nephrotic syndrome - prevelance (4)
- 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)
Nephrotic syndrome - manifestations (symptoms) (7)
- 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
Diagnostic tests for nephrotic syndrome
- history
- physical, characteristic symptoms
- lab (serum albumin, urinalysis, BUN, creatinine)
nephrotic syndrome - diet recommendations (3)
- 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
nephrotic syndrome - medications (4)
- corticosteroid therapy - 95% have complete remissions
- IV albumin
- Immunosuppressant therapy
- diuretics
nephrotic syndrome - Nursing management (10)
- 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
Renal Failure (2)
- kidneys unable to excrete waste & concentrate urine (Azotemia, oliguria, uremia)
- can be acute or chronic
Acute Renal Failure
- sudden onset
- rapid rise in BUN
- Neonates with asphyzia, shock, sepsis; post op complication of cardiac surgery, drug toxicity
- usually reversible
Chronic Renal failure (3)
- gradual onset
- progressive, irreversible
- rare in children
Acute Renal Failure - Clinical manifestations (6)
- gross hematuria
- headache
- edema
- severe hypertension
- lethargy
- N+V
Chronic Renal Failure - Clinical manifestations (9)
- fatigue, malaise
- poor apetite
- prolonged unexplained N+V
- failure to thrive
- poor school performance
- complicated emuresis
- chronic anemia
- hypertension
- unusual bone disease
Nursing management - acute renal failure (5)
- 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
Appendicitis - pathophysiology (5)
- accumulation of secretions and mucus within appendix
- appendiceal distension
- direct tenderness RLQ
- NV
- Diarrhea
Small bowel obstruction + appendicitis (4)
- constipation
- inability to pass gas
- bloating, loss of appetite
- abdominal distension
Peritonitis + appendicitis (4)
- rebound tenderness RLQ
- contributes to Rosving sign
- Bloating (loss of appetite)
- abdominal distension)
Appendicitis - age
10-19 y/o
S+S of appendicitis (5_
- abdominal pain
- fever
- N/V
- anorexia
- migratory pain in RLQ, tenderness, guarding
Pathophysiology - Chron’s disease (7)
- 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
Chron’s vs ulcerative colitis (4)
- 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)
IBS - common age group diagnosis (2)
- 15-35 y/o
- diagnosed earlier = better disease progression
How is IBS diagnosed (3)
- combo of endoscopy (Chron’s) and colonoscopy (UC)
- evaluate medical history to rule out other causes
- blood tests, stool tests, imaging oF GI
IBS - care plans
- nutrition (reduce lactose, caffeine, high fiber, high fat, lean protein, etc),
- anxiety
- fluid defecit (vitals, respiratory, integumentary, renal assessment, administer fluids, daily weights, etc.
Chron’s disease mecdications (3)
- corticosteroids
- immunodulators
- aminosalicylates
Surgical intervensiona - chron’s (3 situations)
- intestinal obstrucitons
- fistulas
- absesses
Testicular torsion - what (4)
- 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
testicular torsion - causes (3)
- testicles not strongly attached to scrotum
- trauma around scrotum
- vigourous physical activity or sleep
Types of testicular torsion
- extravaginal torsion
- intravaginal torsion
Extravaginal testicular torsion
- tunica vaginalis has abnormally long attachment to testes
- rotation is external, tunica vaginalis is also torted
Intravaginal testicular torsion
- most frequent
- rotation occurs within tunica vaginalis
Testicular torsion - Signs and symptoms (7)
- 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
Testicular torsion diagnosis (3)
- physical assessment
- blood and urine test
- ultrasonography
Testicular torsion - Treatment
- 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
Pyloric stenosis
- the pyloris is thickened and food is unalbe to move from stomach to Small intestine resulting in forceful vomiting leading to dehydration
Causes of pyloric stenosis (3)
- unknown
- could be genetic or environemntal
- not present at brith but develops afterwards
S+S of pyloric stenosis (6)
- weight loss
- ravenously hungry despite vomiting
- lack of energy
- fewer BM
- constipation
- dehydration
Diagnosis of pyloric stenosis (5)
- 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
Nursing care for pyloric stenosis (2)
- adequet nutrition and food (rehydrate IV, give thickened fluid, feed slowly)
- promote mouth care (dehydration, NPO before surgery, pacifyer)
Treatment of pyloric stenosis
- surgical - pylomotomy to make chanel from stomack to small intestine, exellent recovery
- non surgical if contraindicated
Medications for pyloric stenosis (3)
- IV atropine/Oral atropine
- acetaminophen or ibuprofen
- IV fluids
