PEDS Exam 2

Neonatal conditions, respiratory, endocrine, neuro

What is respiratory distress syndrome? (RDS) and what are the risk factors?

Results from surfactant deficiency in the lungs.

Risk factors: Pre-term babies, C-section, Nuchal cord, Meconium aspiration.

What are the assessment findings of RDS? how do you know if its worsening?

• Tachypnea (RR greater than 60 bpm)

• Dyspnea

• Crackles

• Retractions

• Expiratory grunt

• Nasal flaring

• Cyanosis or pallor

It’s worsening when the patient becomes unresponsive and or flaccid (floppy)

What are the diagnostic tests for RDS?

ABG labs (will show respiratory acidosis b/c patient is holding onto Co2)

CXR (chest x-ray)

Patient is hypoxic

How to manage RDS

• Suction as needed

• Ventilator support

• Nitric oxide (helps with pulmonary dilation and relaxes smooth muscle)

• Thermoregulation

• Mouth and skin care

• Decreased stimuli

• Artificial surfactant (always check ABG before and after)

What are the possible complications of RDS?

• Pneumothorax

• Retinopathy

• Bronchopulmonary dysplasia

• Infection

• Intraventricular hemorrhage

What is Bronchopulmonary dysplasia? (BPD)

• Causes some form of alveoli damage

• Need for supplemental oxygen for at least 28 days after birth

• More common in infants less than 28 weeks gestation or less than 1000 g

• Respiratory distress = BPD

What are the assessment findings of BPD?

• Inability to wean from O2 or ventilator

• Signs of respiratory distress

• Failure to thrive

• Intermittent bronchospasms, mucus plugging, and chronic air trapping

• Decreased pH Increased Co2, Respiratoy acidosis

How to manage BPD?

Diagnosis

• O2 or vent dependence

• CXR

Treatment

• Tracheostomy (long term fix)

• Wean off vent/O2 source

• Humidified O2

• Fluid restriction

• Increased calorie intake

• CPT (chest physiotherapy)

• Bronchodilators

Abdominal wall defects: Omphalocele

Intestines on the outside of the body with a clear sac around them

Abdominal wall defects: Gastroschisis

Intestines are on the outside of the body but no clear sac/ membrane around it

How to manage abdominal wall defects post birth

• Directly following birth, overexposed abdominal content and membranes with saline-soaked pads and a plastic drape

• This prevents excess water loss, drying, and temp instability

• Followed by surgical closure

• If primary closure is not possible, a silo is created to help the intestines go back in.

Pre-op Nursing considerations for abdominal wall defects

• Infection is a constant threat before surgery

• IV antibiotics

• Nutrition

• Careful w/ positioning

• NO PRONE

• Viscera should be protected with wet saline pads

• Decompress GI tract

• Fluid replacement

• Heat and fluid loss watch out for!

Post-op Nursing considerations for abdominal wall defects

• Careful positioning to prevent disturbance of silastic material

• Heat and fluid loss are major concerns for thermoregulation

• Fluid and nutritional replacement is critical

• Post op monitoring for complications and assessment of bowel function

Possible complications for abdominal wall defects

• Infection

• Evisceration

• Bowel perforation

What is Necrotizing Enterocolitis? (NEC) and what are the risk factors?

There is no known exact cause; it is an inflammatory disease of the digestive tract.

Risk factors

• Intrauterine growth restriction

• Premature

• Shock

• Respiratory distress

What are the assessment findings of NEC?

• Abdominal distention

• Bloody stool

• Periods of apnea

• Hypotension

• Lethargy

• Decreased urine output

• Poor feeding

What are possible reasons for NEC?

• Ischemia

• Hypoxia

• Feeding

• Bacteria

• Immature GI tract

How to diagnose NEC, Labs , and possible complications

Diagnosis

STOP FEEDING IMMEDIATELY

• X-ray shows a sausage-shaped dilation of the intestine progressing to marked distention

• Soapsuds appearance

Labs

• Anemia

• Leukopenia or leukocytosis

• Metabolic acidosis

• Electrolyte imbalance

• Blood cultures = Bacteria

Complications

• Short bowel

• Failure to thrive

• Sepsis

Management of NEC

• Main goal is to prevent it from happening or worsening

• NG tube for decompression (NOT feeding)

• Measure abdominal girth =Q4-Q8

• Serial X-rays =Q4-Q6

• Vitals

• Gastric residual and bowel sounds

• Avoid rectal temps

• Position supine, no pressure on abdomen, no diaper.

• Slow re-feeding; don’t start for 7-10 days after

• Start very small

What is Precocious puberty and it’s causes

Early puberty

• Girls less than 8 and boys less than 9

Causes

• Idiopathic

• Congenital

• Neoplasms

• Trauma

Complications of Precocious puberty and management

Complications

• Early closing of growth plates

Management

• Luteinizing hormone-releasing hormone → to prevent premature closing of growth plates

• Monthly injections

• Stop treatment when people reach normal puberty age

• Psychosocial support → may feel down or upset b/c treatment so provide support

Congenital Hypothyroidism causes and assessment findings

Causes

• Trisomy 21

• Mom used anti-thyroid

Assessment findings

• Hypotonic

• Cool extremities

• Mottling

• Difficulty feeding

• Lethargy

• Constipation

• Hoarse cry

• Enlarged tongue

Congenital Hypothyroidism Diagnosis and Treatment

Diagnosis

• Newborn screening

• Labs

Treatment

• Levothyroxine

• Too much med = Hyperthyroidism, increased HR, irritability, decreased sleep, fever, diaphoresis.

• Too little med = Hypothyroid, fatigue, sleepy, decreased appetite, constipated

Hyperthyroidism assessment

• Graves disease

• Peaks at age 12-14

• Can be mistaken for ADHD

Assessment findings

• Goiter

• Exophthalmos

• Tachycardia

• Irritable

• Diaphoresis

• Fatigue

• Weight loss

• Fatigue

• Short attention span

• Emotional lability