exam 3 peds

Rotavirus

Most common cause of acute diarrhea

Acute Diarrhea effects

Excessive Fluid and electrolyte loss in the stool

Acute Diarrhea assessment (think dehydration)

Skin turgor, membrane moisture, recent travel, perineal skin quality

Diarrhea prevention

hand hygiene, cook food properly, correct food handling

diarrhea priority interventions

Administer Pedialyte (Restore electrolyte imbalance). Least to most invasive methods for rehydration.

Cleft Lip Population

Males, Asians, and Native Americans

Cleft Lip/Palate RF

smoking, gestational diabetes, use of certain medications, lack of folate

Cleft Lip/Palate Diagnosis

Ultrasound during pregnancy

Physical Observation

Cleft Lip Feedings

Long Nipple

Haberman's Feeder

Cleft Palate Feedings

Short Nipple

Haberman Feeder

Cleft Lip/Palate Feedings

Feed Upright, Burp Often

Cleft Lip/Palate repairs

Lip- 3 months or younger

Palate- Around six months, always before 18 months

Cleft Lip/Palate repair priority

Protect sutures with Logan's Bow

Apply Petroleum Jelly to the Operative Site

GENTLE Elbow Restraints?

Cleft Lip/Palate Post-Op Feeding Tips

"Feed with syringe or dropper until surgical site is healed."

Maintain same method used pre-operatively.

intussusception

Intestine folding into itself, telescoping.

intussusception RF

Cystic Fibrosis, Males, less than 18 months

intussusception s/s

Pulling Legs to Chest

JELLY LIKE STOOLS MIXED W BLOOD

Vomiting

SAUSAUGE SHAPED MASS in RUQ

intussusception Symptom triad

Episodic Abdominal Pain with Vomiting q. 5-30 min

Screaming and Drawing up Legs

Stool with blood

intussusception diagnosis

barium enema (#1) or surgery (last resort)

Or ultrasound

Air enema is strictly therapeutic

intussusception pre-operative care

NG-Tube

Monitor for Brown Stool Passing (Notify PCP)

intussusception Fever

Fever > 99.5 = bad

Failure to Thrive

a condition in which babies do not grow and develop properly due to deficit in caloric intake

Failure to Thrive Diagnosis

Weight is below the 5th percentile

Failure to Thrive Expected Labs

Decreased Albumin (Normal 4.5-9g/dl)

Failure to Thrive Nursing Requirements

Notify CPS

Appendicitis

lumen of the appendix becoming blocked by fecal matter, lymphoid tissue, tumor, parasite, etc.

Appendicitis s/s

RLQ abdominal pain or cramping, nausea, vomiting, chills, low grade fever

Appendicitis Pain stops suddenly

Notify PCP ASAP, a rupture could have occured

Appendicitis Post-operative Care

NPO 24/hrs

Appendicitis Perforation/Rupture Care

Antibiotics

Appendicitis Nursing Priority

Monitor for Peritonitis

Hirshsprungs Disease AKA

aganglionic disease

Hirshsprungs Disease

Lack of ganglionic cells resulting in decreased motility and mechanical obstruction of the bowels

Hirshsprungs Disease cause

birth defect

Hirshsprungs Disease s/s

No meconium within 48 hours birth

Ribbon Like Stools

Abdominal Distension

Vomiting Bile, constipation

Failure to Thrive

Palpable Fecal Mass

Hirshsprungs Disease Diagnosis

X-Ray

barium Enema

Hirshsprungs Disease treatment

removal of ganglionic section, colostomy, anastomosis

Hirshsprungs Disease Pre-operative care

NPO and NG-Tube

Hirshsprungs Disease Priority

Celiac Disease

Auto-immune disorder, which affects small bowel mucosa and can lead to malabsorption of foods. No gluten.

Celiac Disease will...

not present until gluten is introduced to the diet

Celiac Disease Population

Women

Celiac Disease S/s

Failture to Thrive

Steatorrhea

Abdominal Distension / Bloating

Constipation

Celiac Disease diet should avoid..

BROWN

Barley, Rye, Oats, Wheat, and NOTHING THAT DOESNT SAY GLUTEN FREE.

They should always read labels.

Celiac Disease diet can include

Corn, Rice, and Millet. Simple carb diet.

Celiac Disease diet should...

Supplement calories, vitamins, and minerals

like, ADEK Vitamins

high Calorie, high protein diet

Can those with celiac disease eat gravy/canned soups?

No.

Avoid gravy and canned soups.

Celiac Disease can lead too...

Bruising due to lack of vitamin K

Isotonic Dehydration

Sodium and Water leave at the same rate.

Most Common type of dehydration

Isotonic dehydration

Isotonic Dehydration greatest risk

Hypovolemic Shock

Hypotonic Dehydration

Losing more sodium than water

In which type of dehydration are physical symptom more severe?

Hypotonic Dehydration

Treatment for Hypotonic and Isotonic Dehydration

Administer 1/2 D5 NK20

Dehydration s/s

Skin turgor

Dry mucous membranes

Lower urine output and concentrated

Sunken eyes & fontanles

Weakness

Hypotension

Tachycardia

Increased respiratory rate

Hypertrophic Pyloric Stenosis

-hypertrophy of the pyloric sphincter causing tightening of the opening from the stomach to the small intestine

-enlarged muscles that don't open

-stomach pushes so hard to fit food through sphincter but ends up projectile vomiting

Hypertrophic Pyloric Stenosis Population

Caucasian

First Born Males

Hypertrophic Pyloric Stenosis s/s

"Insatiable Feedings"

Projectile Vomiting

Weight LOSS

Dehydration- tachycardia

Constipation

Palpable OLIVE mass in RUQ

Irritable from Hunger

Hypertrophic Pyloric Stenosis Diagnosis

ultrasound revealing olive shaped mass

Hypertrophic Pyloric Stenosis Treatment

Surgery ASAP if electrolytes are balanced

Hypertrophic Pyloric Stenosis Pre-Operative Care

NPO, Consent, NG- Tube

If dehydrated electrolytes must be corrected prior to surgery.

Hypertrophic Pyloric Stenosis Post-Operative Care

Monitor I & O's

Vitals

How soon can a child with pyloromyotomy eat post-op?

Must wait six hours

pyloromyotomy food reintroduction AS TOLERATED

The baby will not move to the next level until they can tolerate TWO of these feedings.

Pedialyte 15ml q. 2 hours

1/2 strength formula 15ml, two feedings

30ml formula 2 feeds

45 ml two feeds

60 ml two feeds

pyloromyotomy vomiting for 24 hours post-op

Expected

pyloromyotomy vomiting for 48 hours post-op

Notify PCP

What do you do it a baby who underwent a pyloromyotomy vomits?

Nothing, clean up baby, let them recover for a moment, keep feeding

Rectal Atresia

closed rectal passage, may appear to be normal opening upon first inspection

Rectal Atresia s/s

No stool

Rectal Atresia treatment

Surgery ASAP

Rectal Atresia diagnosis

X-ray, MRI, Ultrasound, IV pyelogram

Rectal Atresia Pre-Operative Care

Get Consent, NPO, IV

Rectal Atresia post-operative care

PO feedings can begin as soon as bowel sounds are heard

Can not leave Hospital until they have bowel movement

Rectal Atresia Surgery

Bowel Resection and Colostomy, then closure of colostomy and bowel repair "anastomosis"

gastroesophageal reflux disease (GERD)

Excessive relaxation of the lower esophageal spinchter, which allows the reflux to occur

gastroesophageal reflux disease (GERD) s/s

"it burns/stings"

Halitosis

Chronic Cough

Wheezing

Refusal to Feed

Regurgitation

gastroesophageal reflux disease (GERD) diagnosis

Barium Swallow

24 hours intraespohgeal pH monitor

endoscopy with biopsy to tell which type

gastroesophageal reflux disease (GERD) Medication

Proton Pump Inhibitors (PPI) 30 minutes prior to meals or daily in the morning on an empty stomach

"-prazole"

gastroesophageal reflux disease (GERD) Care

thicken formula with cereal for infants

plain diet for children

Remain upright after meals

Provide Smaller, More frequent meals

What do you do if your infant has halitosis?

Wipe their mouth/tongue

What is the most common cause of UTIs?

E. coli

UTI

Contamination of the periurethral area with bacteria that results in colonization of the urethra and bladder

UTI Parents are refusing catheter for their child, what do you do

Notify PCP

UTI RF

Women, Uncircumcised males, urinary stasis, vesicoureteral reflux, anatomic abnormalities, poor hygiene, chronic perineal irritation

UTI Labs

Urine Analysis or Culture

Expect increased WBC

UTI Sample Collection

Clean Catch Method

In-and-out catheterization

Suprapubic Aspiration (Least Preferred due to pain)

Bag (Least preferred due to contamination odds)

UTI Sample Collect Nursing Priority

Must send urine sample to lab ASAP. Within 10 minutes of collection.

UTI Teachings

Hand hygiene, Wiping technique, Cotton underwear, Avoid Tight clothing, avoid baths, empty bladder regularly, avoid constipation.

Teach s/s of infection

vesicoureteral reflux

Backflow of urine from the urinary bladder to the ureters and sometimes the kidneys

vesicoureteral reflux s/s

Looks like a UTI, but with a fever.

Nausea and Vomiting

vesicoureteral reflux can...

Cause UTIs and Kidney Infections

Kidney infection results in distention of the kidneys, damaging kidneys.

vesicoureteral reflux diagnosis

voiding cystourethrogram (VCUG) + renal imaging

X-ray while urinating, no metal

vesicoureteral reflux treatment

May need long term antibiotics or surgery

vesicoureteral reflux post-operative or post treatment care

Urine culture every 2-3

vesicoureteral reflux primary

Born with it

vesicoureteral reflux Secondary

Obstruction from abnormal tissue fold within the urethra

vesicoureteral reflux Assessment

Assess BP because long term kidney disease can cause hypertension

Voiding Cystourethrogram (VCUG) Pre-procedure Care

Assess for Shellfish Allergy, reaction to Dye

Voiding Cystourethrogram (VCUG)

patient should be supine or lithotomy; inserting foley

acute glomerulonephritis

Inflammation of the glomeruli often following a strep infection

(Filtration system sucks, so they retain fluid)