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nursing 241

dehydration fluid output>fluid intake
cause of dehydration vomiting, diarrhea, fever, burns, tachypnea
infants more vulnerable to dehydration bc....... relatively greater bsa relative to body mass, higher bmr, immature kidneys (cannot dilute or concentrate urine), inc fluid requirements
two types of diarrhea acute. less than 14 days. chronic. longer than 14 days
hx of diarrhea fever, travel, daycare, vomiting, meds, ingestions, stool character
assessment of dehydration and diarrhea MM's, weight loss, skin, fontanelles
treatment of diarrhea ORT!!! vomiting is NOT a contraindication for ort
treatment for intractable diarrhea of infancy hydralized protein (easier to digest bc it is partially digested already)
celiac disease body's inability to absorb gluten found in wheat, rye, barley, and oats
treatment for celiac disease STRICT gluten free diet. lots of teaching needs to be done
celiac crisis profuse diarrhea usually unexplained
appendicitis acute obstruction of outflow (fecolith-dry, hardened stool), increased pressure leads to blood vessel compression, then ischemia, ulceration, inflammation, necrosis
complication of appendicitis after necrosis, RUPTURE which can cause peritonitis
s/s of appendicitis abd cramping, rlq pain b/w anterior superior iliac crest and umbilicus, bent over posture
hypertrophic pyloric stenosis thickened pyloric sphincter narrows pyloric channel that makes it hard for food to pass to duodenum
s/s of hps projectile vomit, hyperperistalsis (working overtime to try and get food to pass), non-bilius, 30-60 mins after feeding, risk for fvd, metabolic alkalosis, hypochloremia, ftt, very hungry, weight loss, uncomfy
tx of hps pyloromyotomy preop: emphasis on hydration. postop: glucose water or ort 4-6 hrs after surgery, advance as tolerated
intussusception inversion of 1 portion of intestine within another
s/s of intussesception sudden abd pain, vomiting, lethargy, red curreny jelly life stools
tx of intussesception radiographic enema. diagnostic or therapeutic
cl&cp may have speech impairment, problems with soft palate and nasopharynx, improper tooth alignment, hearing impairment, eustacian tube malfunction (inc risk for otitis media. uri reqs immediate attn)
nursing interventions cl&cp family support, handling infant, emphasize the positive, encourage child to talk and utilize throat muscles
cheiloplasty accustom child to needs of early postop period - DO NOT want child laying on face. need to protect surgical site
palatoplasty avoid placing objects in mouth. ok to lay on tummy, better on side
tracheoesophageal fistula/esophageal atresia failure of esophagus to develop as a continuous passage. infant may breathe saliva and fluids from stomach into the lungs and aspirate. child cant swallow and digest food safely - surgical emergency
s/s of tef/ea coughing choking cyanosis - 3 c's
tx of tef/ea litigation of fistula preop: npo, continuous suction, elevate hob, iv fluids postop: gastrostomy drainage, iv fluids, antibiotics, tpn
hernias abdominal (umbilical, omphalocele, hastrochisis), diaphragmatic, hiatal, inguinal
diaphragmatic hernia intestines and other abd organs enter thoracic cavity. manifests as acute resp distress, cyanosis, scaphoid abd
tx of dhernia after birth child will need ventilation. ecmo. position child on affected side to max oxygenation. DO NOT put bag and mask o2 bc they can swallow air into gut, making it bigger
hiatal hernia protrusion of stomach through esophageal hiatus
s/s hiatal hernia dysphagia, ftt, frequent unexplained resp problems
tx of hiatal hernia nonpharm, pharm, lastly surgery
tx of inguinal hernia if not be reducible, then herniography - process of repair by using fascia or mesh.. most common complication is the inability to void
cholecystitis inflammation of gall bladder. interferes with bile drainage into duodenum. may be calculous or acalculous
s/s cholecystitis pain, tenderness, rigidity upper right abd referred pain to R shoulder, vague fullness in ruq after eating fatty foods
tx of cholecystitis nonpharm, pharm, then surgery if nothing works (diet low in fat, ng suction, rest, iv fluids, analgesics, antibiotics, ercp, eswl)
hirschsprungs disease aganglionic: absence of ganglion cells in one or more segments of the colon megacolon: accumulation of stool with distention of the colon
Created by: eileenrx