Exam 3 Peds

Exam 3 Assessment

  • Most important aspects:
      - Clinical exam and observation (across abdominal area)
      - Intake and Output (I : O)
        - Strict I : O tracking including:
          - Color
          - Shape
          - Girth
      - Nutritional assessment (Ns):
        - Accurate weight-height ratios
      - Abdominal assessment:
        - Distention, peristalsis observations
        - Abdominal symptoms (ASX) and ova (presence of parasites)
      - Stool and urine labs:
        - Stool analysis, urine analysis, bacterial culture
        - Bowel habits monitoring

Diagnostics Procedures

  • Diagnostic imaging:
      - X-ray (plain films)
      - UGI/LGI imaging
      - Ultrasound, CT, and MRI to assess how patients are reacting to treatment

  • Energy level assessment related to constipation in young children (specifically 3 years old)
      - Considered symptoms rather than a disease
      - Diagnosis of constipation if:
        - Fewer than 3 stools per week
        - Alteration in the frequency or consistency of stools
        - Affects daily activities and lessens ease of stool passage for at least 2 weeks
        - Secondary to other disorders

Dietary Modifications for Constipation

  • Recommended changes include:
      - High-fiber diet
      - Awareness of possible structural causes:
        - Strictures, ectopic anus, Hirschsprung disease
      - Avoidance of mineral oil use
      - Potential dietary triggers: dairy, certain antacids, diuretics, antiepileptics
      - Laxatives such as Miralax or lactulose may be indicated
      - Importance of fluids: primarily water intake
      - Consideration of systemic disorders affecting bowel health:
        - Hypothyroidism, hypercalcemia, chronic lead poisoning
      - Focus on foods that promote regularity:
        - Corn, apples, beans, beets, blackberries, carrots, and legumes such as lentils
        - Dietary fibers from foods like spinach, oranges, pears, peas, raisins, and wheat flour

Encopresis (Fecal Incontinence)

  • Defined as the involuntary passage of stool into undergarments

  • Commonly linked to chronic constipation
      - Behavioral or psychosocial factors may contribute

Hirschsprung Disease

  • Description: A congenital condition characterized by aganglionic megacolon leading to mechanical obstruction due to inadequate motility of the intestine

  • Incidence: 1 in 5000 live births, 4 times more common in males

  • Affected areas: Typically restricted to the internal sphincter, rectum, and sigmoid colon (short-segment disease)

  • Clinical manifestations include:
      - Loss of rectosphincter reflex
      - Feeding intolerance and bilious emesis
      - Delayed passage of meconium (beyond 48 hours post-birth)
      - Symptoms of enterocolitis and abdominal distention

Diagnostic Imaging for Hirschsprung

  • Diagnostic procedures:
      - X-ray
      - Contrast enema
      - Anorectal manometric exam
      - Rectal biopsy for confirmation of diagnosis

Management of Hirschsprung Disease

  • Surgical intervention is necessary depending on the extent and location of the obstruction

  • Procedures may include resection with a pull-through surgical approach and temporary ostomy management

Gastroesophageal Reflux (GERD)

  • Definition: The transfer of gastric contents into the esophagus, with GERD indicating more severe and prolonged incidences

  • Occurs frequently and is often classified as physiologic in infants
      - Resolution is typically spontaneous by age one
      - Medications: H-2 blockers, PPIs taken 30 minutes before meals
      - Dietary modifications:
        - Avoid offending foods, weight loss, thicker feeding formulas, and frequent burping
      - Surgical options like Nissen fundoplication may be indicated in severe cases

Irritable Bowel Syndrome (IBS)

  • Description: A functional gastrointestinal disorder characterized by recurrent abdominal pain and alternating diarrhea and constipation

  • Management focuses on maintaining regular bowel habits and symptom relief

Celiac Disease

  • Definition: Gluten-induced enteropathy also known as celiac sprue causing malabsorption

  • Symptoms include frequent diarrhea, failure to thrive (FTT), steatorrhea (fatty, foul-smelling stool), and general malnutrition

Pica Disorder

  • Definition: Excessive eating of non-food or unprepared food substances
      - Types:
        - Non-food pica (ingestion of clay, soil, stones, etc.)
        - Physiological: Linked to unmet nutritional needs
        - Psychological: Compulsive behavior
      - Associated deficiencies include iron and zinc

Risks and Safety Concerns Related to Pica

  • Leading causes of accidental death may result from ingestion of harmful substances

  • Risk factors include airway obstruction and gastrointestinal injuries

  • Diagnostic methods: X-ray, endoscopy for assessing ingested materials

Appendicitis

  • Description: Inflammation of the appendix secondary to obstruction of its lumen

  • Peak incidence: Typically in children aged 10 years

Clinical Manifestations of Appendicitis

  • Symptoms to watch for include:
      - Colicky, cramping pain
      - Periumbilical pain migrating to the right lower quadrant (RLQ)
      - Fever, nausea, and vomiting, indicating possible perforation

  • Diagnostic tools: Physical examination, labs, urinalysis, and imaging such as CT or ultrasound

Management of Appendicitis

  • Therapeutic approaches involve surgical removal of the appendix

  • Post-operative care and assessment are critical to prevent complications

Inflammatory Bowel Disease (IBD)

  • Description: A term encompassing ulcerative colitis (UC) and Crohn's disease (CD) with no known cure

  • Pathophysiology:
      - Both conditions are chronic inflammatory diseases, often with stress identified as a contributing factor

Clinical Characteristics of IBD

  • Signs and symptoms:
      - Diarrhea, abdominal pain, weight loss, fatigue
      - Presence of rectal bleeding (in UC) or anal fissures and strictures (in CD)

  • Diagnostic evaluations: Endoscopy and colonoscopy, stool evaluations

Management Strategies for IBD

  • Focus on diet modifications and symptom relief with a goal of achieving long-term remission
      - Corticosteroids may be used during acute flares

Crohn's Disease

  • Pathophysiology: Characterized by discontinuous inflammation affecting any part of the GI tract

  • Clinical manifestations include diarrhea, cramps, and systemic features such as skin inflammation

  • Management may require surgical resection, although this does not offer a cure

Hypertrophic Pyloric Stenosis

  • Definition: A narrowing of the pyloric sphincter leading to gastric outlet obstruction
      - Symptoms present in infancy characterized by projectile vomiting and visible abdominal peristalsis
      - Management typically involves surgical pyloromyotomy

Intussusception

  • Definition: A condition where one segment of the intestine telescopes into another, which can be caused by lesions in the intestine

  • Characteristic symptom: Currant jelly-like stools

  • Management can include air enema or surgical intervention

Types of Hepatitis

  • Classifications:
      - Hepatitis A: Fecal-oral transmission
      - Hepatitis B: Perinatally transmitted
      - Hepatitis C: Parenteral exposure leading to chronic liver disease

Tracheoesophageal Fistula (TEF)

  • Description: A congenital defect where the esophagus does not develop into a single uninterrupted passage

  • Management includes surgical intervention and potential G-tube usage for feeding

Gastroschisis

  • Definition: A condition where the bowel herniates through a defect in the abdominal wall

  • Management: Maintenance of a sterile environment, fluid management, and thermoregulation are critical

Cardiac Anatomy and Flow

  • Overview of blood flow: From the superior vena cava to the right atrium, through the tricuspid valve to the right ventricle, and out through pulmonary arteries to lungs before returning to left atrium and systemic circulation through the aorta

Congenital Heart Defects

  • Atrioventricular septal defect (ASD): Characterized by increased pulmonary blood flow and potential for heart failure without intervention

  • Ventricular septal defect (VSD): Most common defect resulting in extra blood flow through the pulmonary system

Patent Ductus Arteriosus (PDA)

  • Definition: A condition where the ductus arteriosus fails to close after birth, leading to increased pulmonary circulation and potential heart failure

  • Treatment includes medications to close the PDA or surgical intervention

Coarctation of the Aorta

  • Description: A narrowing of the aorta potentially leading to hypertension in the upper body and inadequate perfusion to the lower body

Aortic Stenosis (AS)

  • Definition: Narrowing at the aortic valve leading to increased workload on the left ventricle

  • Management includes monitoring symptoms and potential surgical intervention for valve replacement

Tetralogy of Fallot (TOF)

  • Description: A complex condition characterized by VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy

  • Management strategies include surgical repair and a focus on avoiding tet spells with positioning techniques

Tricuspid Atresia

  • Definition: A condition where the tricuspid valve does not form properly, preventing blood flow to the right ventricle

  • Management often requires maintaining a patent ductus arteriosus until surgical intervention

Transposition of the Great Arteries

  • Description: A serious defect where the aorta and pulmonary artery are switched, leading to poor oxygenation of blood

  • Management often includes immediate surgical repair to correct the positioning of the vessels

Hypoplastic Left Heart Syndrome

  • Definition: A condition where the left side of the heart is underdeveloped, requiring staged surgical interventions

Post-procedure Interventions for Cardiac Patients

  • Importance of monitoring vital signs, managing complications, and providing family support postoperatively

Cardiovascular Nursing Interventions

  • Chest tube monitoring for color and output, recognizing signs of cardiac tamponade, and infection prevention related to potential endocarditis

Kawasaki Disease

  • Description: An acute systemic vasculitis that can lead to serious cardiac complications; marked by persistent high fever, strawberry tongue, and hand/foot edema

  • Treatment typically involves IVIG and aspirin to prevent cardiac sequelae