Welsh Study Guide 1

Question 1

What is a cleft lip? Cleft palate?

Answer 1

A cleft lip is the failure of the maxillary and medium processes to fuse. A cleft palate is a midline fissure of the palate where the two sides don’t fuse together.

Question 2

Who is most at risk for a cleft lip/palate?

Answer 2

Asians and Native Americans

Question 3

When is surgery recommended for a cleft lip/palate?

Answer 3

At 3 months for a cleft lip and at 6-18 months for a cleft palate.

Question 4

What are postop considerations for a surgery for cleft lip/palate? What is a Logan bar?

Answer 4

1 is NO ORAL TEMPERATURES!

• No pressure on suture line (NO pacefiers or anything they have to suck on)
• You have to take care of the suture line so the patient will often have to have their arms restrained. You will clean the suture line with 1/2 normal saline and peroxide with cotton-tipped swabs. You will provide them with activities that protect the suture line (i.e. read to them)
• a LOGAN BAR is a small metal bar that goes across the suture line to protect it from trauma.

Question 5

Why is support important?

Answer 5

The parents will deal with guilt, shock and feelings of insufficiency. You’ll want to encourage bonding with the child. You’ll also want to put them in touch with supportive services. The #1 thing is to make sure they are bonding with the child.

Question 6

What is a TEF? What are they at high risk for?

Answer 6

Tracheoesophogeal Fistula. They are at a high risk for aspiration. Protect the airway by suction, positioning, and feeding them IV or TPN>

Question 7

What are the three “C’s”? S/S?

Answer 7

Coughing, Choking, Cyanosis. He said to remember these.

Question 8

Treatment for TEF?

Answer 8

Closure of the fistula and ng tube.

Question 9

What is pyloric stenosis? S/S? DX?

Answer 9

It is a thickening of the sphincter and cause an obstruction in the pyloric sphincter of the lower stomach. S/S: PROJECTILE VOMITING. DX: olive shape tumor

Question 10

How should they lay (if they have pyloric stenosis)?

Answer 10

On their right side to assist the fluid in passing the pyloric valve.

Question 11

What is Hirschsprung’s disease? Cause? Who’s at risk?

Answer 11

Megacolon.

Question 12

S/s per age (for Hirschsprung’s)?

Answer 12

infant: inadequate weight gain and foul smelling stools.
Children: chronic constipation, palpable fecal masses and stools will be ribbon-like. (This was a test question last semester).

Question 13

Treatment (for Hirschsprung’s)? Preop? Postop? Why a two part surgery?

Answer 13

Disection and removal of the affected section. They will get a colostomy and will probably have the bowel repaired at the age of 6-15 months. Pre op: Assess abd girth, assess bowel sounds, NG tube, NO TAP WATER ENEMAS (but they can have other kinds of enemas). Post op: Assess bowel sounds, abd girth, distention, care for the ng tube and colostomy, strict I/O. IT IS A TWO PART SURGERY BECAUSE YOU WANT THE BOWEL TO HEAL UP BEFORE RECONNECTING IT.

Question 14

Why no tap water enemas?

Answer 14

Cerebral edema can occur. Cardiac congestion can also occur.

Question 15

What is intussusception? Main s/s? Tx?

Answer 15

Telescoping of the intestine back into itself. It basically folds back onto itself. This was a test question last semester. S/S: Jelly like stools composed of blood and mucus. TX: Barium enema. If that doesn’t work you can do surgery.

Question 16

What are the two main types of hernias? Risk factor?

Answer 16

Umbililcal and Diaphragmatic. Risk factors: Low Birth Weight

Question 17

When are hernias treated surgically?

Answer 17

When they become strangulated.

Question 18

What are the s/s of a diaphragmatic hernia?

Answer 18

RESP DISTRESS. (GI contents are protruding up into the diaphragm and preventing the lungs from fully expanding). They will have a sense of being full even if they do not eat.

Question 19

Post op care for a diaphragmatic hernia?

Answer 19

Elevate the head! (you want them to be able to breath as easily as they can) Fowler’s (but not high fowlers). He said make sure they can breathe and that this is the main thing. Watch for signs of resp distress.

Question 20

What is an imperforate anus? s/s? tx?

Answer 20

Closed butt hole. There is no opening. YOU DO NOT TRY TO GET A RECTAL TEMPERATURE. S/S: no bowel movements. TX: Surgical Repair.

Question 21

Postop care for an imperforate anus?

Answer 21

No solid food. Lay them on the side. No pressure should be on the rectum. Skin care. Watch for s/s of infection.

Question 22

What is omphalocele? Preop care?

Answer 22

Pooching of the intestines. The abdominal contents go through the abdominal wall (usually near the umbilicus). Preop care: DO NOT RUPTURE. MOIST STERILE GAUZE. This was a previous test question.

Question 23

How is thrush treated?

Answer 23

Swish and Swallow of Nistatin.

Question 24

Where are pin worms found? TX? For who?

Answer 24

They’re found around the rectal opening (Uranus. lol) TX: Vermox (you do not need to know dosage, but do know it is used). Everyone is treated who needs it. Also, you’ll have to change out anything that is shared in the family. Linens, clothing, etc.

Question 25

What is gastroenteritis? Causes? Transmission?

Answer 25

Inflammation of the intestinal tract and stomach. Causes: Virus, Bacteria. Transmission: Rotovirus transmits person to person. Salmonella (bacteria) transmits through contaminated food. E. Coli is fecally transmitted.

Question 26

What medicine is used to treat gastroenteritis?

Answer 26

Donnagel (antidiarreal)

Question 27

Why no rectal temps in a patient with gastroenteritis? What kind of diet? Precautions?

Answer 27

Because they already have diarrhea. You don’t want to stimulate the sphincter. They will be on a clear liquid diet (no carbonated drinks, no caffeine and no acidic juices). Precautions: Standard precautions

Question 28

How is appendicitis dx?

Answer 28

It is diagnosed by REBOUND TENDERNESS (I think this was a test question)

Question 29

What is McBurney’s point?

Answer 29

Right Lower quadrant.

Question 30

What is GER? Who is it most common in? Tx?

Answer 30

Gastroesophogeal Reflux (formally called GERD, I think). It is most common in premature infants. TX: Depends on severity. Less severe: small frequent meals, positioning. For small children: elevate head of bed. More severe: medications- H2 antagonists (Zantac, which inhibits gastric secretions. He said to remember this), PPI (Prilosec or Prevacid which decrease secretions of gastric acids).

Question 31

Why are regular bowel habits encouraged? Why use positive reinforcement?

Answer 31

To prevent constipation. Positive reinforcement is used to encourage them to have a consistent toileting schedule.

Question 32

What is encopresis? Who is at risk? Limit what?

Answer 32

Patient involuntarily craps themselves. People with stressors in their life (birth of a sibling, bullying, etc.). Limit milk, prunes and fruit juices. Those thins makes them go.

Question 33

How do you decrease embarrassment?

Answer 33

Don’t embarrass them and have a change of clothes ready for them.

Question 34

Know fluid requirements for weights! Slide 45 Calculations for >20kg!

Answer 34

See slide 45. (or page 659)

Question 35

What is FTT? Two types? Causes? S/S?

Answer 35

Failure to Thrive. Two types: Organic (caused by medical causes such as cardiac disease, endocrine disorders, etc) and Non-Organic (parent-child relationship, economic problems, poor support system, etc). S/S: Weight Loss, poor muscle tone, delayed developmental milestones, avoidance of eye contact, skin breakdown, they might stare at people (even though those are contradictory- it could be either/or)

Question 36

Treatment for FTT? Follow up?

Answer 36

Hospitalization. Removal from the environment they are in. You will try to “catch them up”. You will give them a high calorie diet. EVERYBODY will be involved (outside agencies, physical therapists, etc). You’re trying to set up support systems for them. Follow up is important to make sure they continue to grow/flourish.

Question 37

What is most common cause of death and injury for 1-4 y/o?

Answer 37

Poisoning.

Question 38

Treatments for poisoning? Antidotes?

Answer 38

Depends on what they take. Antidotes can include: mucamist (for tyleonl), bicarb (for antidepressants), EDTA (for lead poisoning), NARCAN (for narcotics).

Question 39

How do you prevent poisoning?

Answer 39

Lock up medications, keep them out of reach of children. Keep them away from grandparents. This was a test question. If Grandma has a child come over, what do they need to be doing? Answer: lock up cleaning supplies.

Question 40

What causes lead poisoning? S/S? Tx?

Answer 40

Most often caused by old lead paint. S/S: LEAD LINES (lines in bones and in the mucosa and fingernails). TX: EDTA for levels greater than 70. Succimere for levels less than 70.

Question 41

What is most common with toddlers? Tx?

Answer 41

Swallowing foreign objects (such as coins, peanuts, etc). TX: heimlich maneuver if it is stuck, if it is already in their system they can either excrete it out or have surgery.

Question 42

What is hypospadias? Best time to treat? Post op concerns?

Answer 42

A hole on the bottom of the mushroom tip or shaft. Best time to treat is 6-9 months. Post Op concerns include: Adequate Urinary output. The BIGGEST THING IS THAT YOU DON’T WANT THEM TO HAVE BLADDER SPASMS.

Question 43

Tx of bladder spams? Side effects?

Answer 43

Ditropan treats bladder spasms. Side effects include: facial flushing, dry mouth, constipation.

Question 44

What is epispadias? Common with?

Answer 44

Hole on the top of the mushroom tip or shaft. Common with bladder extrophy.

Question 45

What is phimosis? Two types? Tx?

Answer 45

Unable to retract foreskin. Two types: 1) physiological and 2) pathological. Physiological is when they were born that way. Pathological means it was caused by some secondary event. Tx: manual stretching or circumcision (both under anesthesia).

Question 46

What is exstrophy of the bladder? When treated? Postop care?

Answer 46

When the bladder is outside the body. It is treated within 48 hours of birth. Post op care: antibiotics. Watch for s/s of infection. They will also likely have ditropan to control bladder spasms.

Question 47

What is VUR?

Answer 47

Vesicordalurethral Reflux (spelling). It is where urine backs up into the kidneys from the bladder.

Question 48

What is hydrocele? When tx? How?

Answer 48

Collection of fluid in tunica vaginis (scrotum?). Treated in 12-18 months if it hasn’t already subsided. It is treated by draining the fluid through an incision.

Question 49

What is cryptorchidism? Usual tx?

Answer 49

Undescended Testes. Usually treated by allowing it to descend on its own. Sometimes treated by surgery. …And THAT is cryptorchidism in a nutshell.

Question 50

What is a Wilm’s tumor? What happens to organs? At risk for?

Answer 50

A tumor that arises in the kidney. It applies pressure to nearby organs and cuts off circulation. The patient is at risk for necrosis. YOU WILL NOT DO ANY KIND OF KIDNEY TESTS. YOU DON’T WANT TO TRAUMATIZE THE KIDNEYS. HE SAID, “HINT, HINT”.

Question 51

What is sign of Nephrotic syndrome? S/S? Tx?

Answer 51

Massive proteinurea and Peri-orbital swelling, swolen abdomen, high B/P. He said to remember this. TX: corticosteriod and antibiotic therapies. I get the feeling this might be a select all that apply.

Question 52

What is enuresis? Tx?

Answer 52

Involuntary wetting yourself. Usually happens at 5-7 years of age. TX: bedwetting alarms, limiting fluids before bedtime. Medication- tofranil (anticholonergic)

Question 53

What is the most common GU disorder? Who’s affected more? Why?

Answer 53

UTI (urinary tract infection). Females are affected more because they have a shorter urethra and sometimes can have poor personal hygiene.

Question 54

Most common cause of UTI? Teaching for females?

Answer 54

E. Coli. Caused by females not wiping from front to back.

Question 55

What is cyctitis? Pyelonephritis?

Answer 55

Cyctitis is an inflammation of the urinary bladder.Pyelonephritis is an infection of the kidney.

Question 56

Focus on the following questions:

Answer 56

5, 7, 9, 15, 24, 25 28, 29, 30, 34, 35, 42, 43, 44, 45, 46, 48, 49, 50, 51, 53, 54