Week 9 TUES Flashcards
Peds elimination
How to diagnose a UTI
Get a urine culture
A child is taking an antibiotic for UTI and has a white coating covering her mouth. Is this concerning
Can be, it is not unusual for fungal infections to occur while taking antibiotics
- but they can spread and become a secondary infection
What is the plan of care for a child with the rotavirus
- maintain IV Fluids
What is a way to help prevent preschoolers from getting a uti?
teach them to wipe front to back and never hold urine in
The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse is most likely to describe the stool as having what quality?
A. Greasy
B. Clay-colored
C. Currant jelly-like
D. Firm
C!
Currant jelly-like is a common s/s of intussusception
A child required significant bowel resection following a bowel perforation. After recovering from the post-op period, what will the nurse expect to be included in this patient’s long-term plan of care? Select all that apply.
A. Antibiotics
B. Immunosuppressants
C. Vitamin supplements
D. Total parenteral nutrition
E. Laxatives
A, C, D
pg. 1610
Obstructive Uropathy is a _____1_____disorder and the therapeutic management includes_____2_____.
Options for #1: Acute, Chronic, Structural, Acquired
Options for #2: Antibiotics, Surgical Repair, Dialysis, Intravenous Fluids
- Structural
- Surgical Repair
Which of the following features are considered part of the “triad” of Hemolytic Uremic Syndrome? Select all that Apply.
A. Hemolytic Anemia
B. Edema
C. Diarrhea
D. Thrombocytopenia
E. Urinary Tract Infection
F. Acute Renal Failure
A, D, F
- triad of HUC
the removal of waste products from the body through the skin, lung, kidneys, and intestines via the process of perspiration, expiration, urination, defication
elimination
what parts of the GI system are different from children to adults
- mouth
- esophagus
- stomach
- intestines
- biliary system
- fluid balance and losses
primary functions of the GI system
- digestion, elimination, secretions
Nursing GI assessment
- health hx
- physical exam; inspect, auscultate, percussion, palpation
- lab and diagnostic testing; occult blood, rbs, WBC, ect
Acute GI disorder in peds
intussusception
Chronic GI disorder in peds
short bowel syndrome
T or F the GI tract is from mouth to anus?
TRUE
- from ingestion to elimination
What GI disorder is; intussusceptiona proximal segment of the bowel “telescopes” into more distal segment resulting in obstruction
intussusception
T or F intussusception is the least common cause of intestinal obstruction is infants and young kids
FALSE; it is the MOST common cause!
most common cause of intussusception
often unknown in children
Possible complications of intussusception
- edema, vascular compromise, and potentially partial or total bowel obstruction
Risk factors for intussusception
- siblings w intussusception
- intestinal malformations already diagnosed
Nursing assessment intussusception
Health hx;
- description of present illness
physical exam;
- palpate abdomen for the presence of a sausage-shaped mass in the upper midabdomen
lab/ diagnostic tests;
- air or barium enema
Common s/s of intussusception
- sudden onset of intermittent, crampy, severe abdominal pain esp after eating
- guarding, crying, putting legs up - vomiting, diarrhea
- currant jelly stools; gross blood, hemoccult pos stools
- lethargy
- s/s will typically flare and regress
Nursing management of intussusception
- IV fluids and antibiotics
- lab tests; WBC, electrolytes
- post op care of child
- emotional support and education for the family
Therapeutic management for intussusception
- barium enema is successful at reducing a large percentage of intussusception cases
- if unsuccessful> reduced surgically
- if bowel necrosis occurs> bowel resection
Syndrome of nutrient malabsorption and excessive intestinal fluid and electrolyte losses
Short Bowel syndrome
Risk factors for Short Bowel syndrome
- massive small intestinal loss or surgical resection
Possible complications of Short Bowel syndrome include
- bacterial overgrowth
- vitamin deficiency
- poor intestinal motility
Therapeutic management of Short Bowel syndrome
- antibiotics; treat bacterial overgrowth
- antidiarrheals
- vit and mineral supplements
- TPN/Lipids
- slow to oral foods
Nursing assessment of Short Bowel syndrome
health hx;
- note past history of bowel disease or resection
physical exam;
- diarrhea is primary symptom, hydration status, inspect stool, wt loss
lab/diagnostic tests;
- electrolyte to evaluate hydration status, liver function tests
Nursing management of Short Bowel syndrome
- encouraging adequate nutrition; strict I&O, assess stool, consult / dietitian, monitor s/s of infection
- promoting effective family coping
Common s/s of Short Bowel syndrome
- diarrhea> #1
- wt loss
- dehydration
- nutritional deficiency
GU differences in children vs adults
- structural differences; kidneys are large and less protected from injury and urethra is shorter in children
- urinary concentration is higher in children
- urine output is more frequent in children> less bladder capacity
- reproductive organs are not mature in children
Alterations in urinary elimination occur as a result of
- infectious processes
- trauma
- neurologic deficit
- genetic influence
GU assessment
- health hx> hydration status, # of wet/poopy diapers
- physical exam; inspection, auscultation, percussion, palpate> kidneys impact cardiac system and can cause murmurs
- labs and diagnostic test> BUN, creat, flank pain
Most common bacterial infection
Urinary tract infection
How to prevent UTI’s in children
- girls wipe front to back
- cotton underwear
- ease constipation
- avoid bubble baths> high risk kids
- encourage hydration
Structural GU disorder in peds
Obstructive uropathy
Acquired GU disorder in peds
hemolytic-uremic syndrome
Obstruction at any level along the upper or lower urinary tract
obstructive uropathy
possible complications of obstructive uropathy
recurrent UTI’s, renal insufficiency, progressive damage to the kidney
Nursing assessment for obstructive uropathy
Health hx;
- description of present illness and chief complaint
physical exam;
- palpate the abdomen for the presence of an abdominal mass(hydronephrotic kidney) and assess BP
lab/ diagnostics;
- prenatal ultrasound
Risk factors for obstructive uropathy
- chromosomal abnormalities
- anorectal malformations
- ear defect
Common s/s of obstructive uropathy
- frequent UTI’s
- change in urinary pattern
- fever
- flank or abdominal pain
- hematuria
- urinary frequency and urgency
- dysuria
Therapeutic management of obstructive uropathy
Surgical correction;
- specific to the type of obstruction
consists of removing the obstruction and reimplantation of the ureters
- occasionally results in a urinary diversion
Nursing management of obstructive uropathy
post op care;
- monitor I &O, assess urine for color, clarity, clots, pain management, encourage fluids once child can tolerate them
Family education;
- child may be d/c’d w/ vesicostomy or drainage tubes> pus/ blood know what is normal/abnormal
What GU disorder is characterized by hemolytic anemia, thrombocytopenia, and acute renal failure and is typically the result of a diarrheal illness
hemolytic uremic syndrome
T or F features of HUS are primarily caused by microthrombi and ischemic changes w/in the organs
TRUE!!
- small obstruction> acclusion> kideny can’t function properly> renal failure
Possible complications of HUS
- chronic renal failure
- seizures and coma
- rectal prolapse
- cardiomyopathy
-CHF - acute resp distress syndrome
Nursing assessment for HUS
Health hx;
- decreption of present illness and cheif complaint
physical exam;
- pallor, toxic appearance, edema, oliguria
- elevated BP
- tenderness in the abdomen
- neuro involvement> irritability, seizures, alter LOC
Lab and diagnostics;
- urinalysis> blood, protein, pus
- serum labs> elevated BUN, Cr, anemia and thrombocytopenia, hyponatremia, hyperkalemia, hyperphosphatemia, leukocytosis, increased bili
Risk factors of HUS
- ingestion of ground beef
- visits to water parks or petting zoos
- not washing hand properly
Common s/s of HUS
- watery diarrhea
- cramping
- vomiting
Therapeutic management of HUS
- no known treatment can stop the progress of the syndrome once it has started
- ease s/s and prevent complications
- maintain fluid balance
- correct hypertension, acidosis, and electrolyte abnormalities
- replenish circulating rbcs> transfusion
- provide dialysis if needed
Nursing Management of HUS
- close observation and monitoring the child’s status> often ICU
- institute and maintain contact precautions to prevent spread of e. coli
fluid volume status; - strict I&O, IV infusions and diuretics as ordered, assess BP> hypertensive as prescribed, monitor for bleeding> possible blood transfusions
preventing (future) hemolytic- uremic syndrome - proper handwashing!! thoroughly cook all meets, wash fruits/ veggies, drink properly treated water
