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210 Ped Ch. 45
GI Dysfx
| Question | Answer |
|---|---|
| Kwashiorkor vs Marasmus | Kw: protein malnutrition with big belly, lose hair, dermatitis Ma: overall wasting |
| What percentiles do you want to have children land in with wt/bp | 5th-95th |
| What is diff with children in BSA, BMR,kidney fx, fluid req, ECF | BSA - larger, more insensible losses BMR: higher, HR: 110-160 Kidney: don't concentrate urine Fluid: higher req. more ECF |
| Mild dehydration percentage? moderate? severe? | mild: 5%, moderate: 10%, severe: 15% isotonic: Na level 130-150norm hypo - <130 Na hyper - cerebral changes |
| What is best measure for dehydration? | body wt |
| Formula for daily maintenence fluid req | child wt in kg allow 100ml/kg first 10kg body wt allow 50ml/kg second 10kg allow 20ml/kg for remaining wt Divide total amt by 24 hr to get ml/hr |
| Chid weigh 32kg Child weigh 8.5kg Child weigh 14kg | 1000ml + 500 + 240 = 1740ml/24hr 850ml/24hr 1000ml + 200 = 12--ml/24hr |
| Acute vs chronic diarrhea | acute: sudden incr freq & change in consistency, infectious chronic: more than 14 days, malabsorption, IBS, food allergy, lactose intolerance |
| gastroenteritis/enteritis/colitis/enterocolitis | stomach & sm int/sm int/colon/colon or int |
| what is intractable diarrhea of infancy? Chronic nonspecific diarrhea(CNSD)? | ID: occur first few mos of life last >2wks CNSD: 6-54mos of age, undigested food particles |
| Therapeutic mgmt for diarrhea? What to avoid? | 1. assess F&E 2. rehydrate first with oral (ORT) Avoid: fruit juices/carbonated/gelatin/ broth/ BRAT diet |
| How much ORT is best in first 4 hrs | 40-50ml of pediatlyte not to exceed 150ml/kg/day |
| diff types of constipation: idiopathic, chronic, obstipation, encopresis | obstipation: extreme long intervals encopresis: constipation wtih fecal soiling |
| First meconium passed when? If not, check for Hirschprung Dis, hypothyroidism, meconium plug, meconium ileus | first 24-36h Hirschprung: obstruction from inadequte motility, absence of ganglion cells in colon, found in sigmoid/rectum area, possible enterocolitis |
| Nsg mgmt for constipation for infant? childhood? | inf: incr carb in formula child: incr fiber/fluid |
| S/s infant wtih Hirschprung? s/s enterocolitis? | s/s: no meconium/refuse to feed, bilious vomit/abd distention complications: rupture of stomach/resp issues ent: explosive diarrhea, fever |
| s/s childhood Hirschprung? How to confirm diagnosis? What is tx? | s/s child: more chronic, constipation, ribbon-like stool, visible peristalsis Diag: rectal biopsy shows lack of ganglion cells |
| Tx for Hirschprung? nsg preop care? post op? | Surgery: ostomy then pull thru procedure. Pre: bowel prep, antibiotics post: stoma care, diaper placement |
| Vomiting drugs for nausea | antiemetics: ondansetron(zofran), promethazine(phenergan), trimethobenzamide(tigan) cause drowsy |
| what is first in priority to assess w/ vomiting | aspiration |
| What is def of GER? Therapeutic mgmt? | gastric contents into esophagus, can turn into GERD Mgmt: sm freq feed thickened to weigh food down/positioning Med tx: Reglan |
| Surgicial tx for GER post nsg mgmt? | Nissen fundoplication: wrap stomach around LES to tighten sphincter post: NG with low int suction, assess bowel snds |
| What two organisms cause parasitic disease most? | pinworms: airborne, most common helminthic, tape test fist in morn b4 poop..tx: mebendazole giardiasis: daycare hygiene, most common parasitic...tx metronidazole |
| Diagnostics for acute appendicitis NEVER do? post op? | incr WBC, fever, pain(McBurney pt), vomit, assess for peritonitis IV fluids, antibiotics, NG suction NEVER: apply heat, enema, laxative(incr motility and risk of perforation) |
| A congenital disorder: Meckel Diverticulum is? | outpouching of wall of sm int in some children at birth. |
| s/s of Meckel Diverticulum Tx: | painless rectal bleeding(current jelly poop), abd pain, s/s of obstruction tx: Meckel scan(scintigraphy) then surgical removal |
| IBD includes two disorders? Main nsg concern? | Crohns: mouth to anus, all layers of bowel wall ulcerative colitis: colon nsg: growth & dev. thru nutrition/induce remission/reduce stresses |
| Med mgmt for IBD? Diet? | aminosalicylates: antiinflammatory steroids diet: (not fiber)high protein, high calorie: eggnog, milkshake, pudding/custard |
| PUD Peptic Ulcer Disease cause? diagnotic? | PUD caused by stress or h pylori both altering lining of stomach and mucus secretion diag: endoscopy with biopsy for h pylori |
| Tx for PUD? | Antacids/antisecretory to suppress gastric acid(tagamet..), PPI to block production of acid, antibiotics for h pylori, acetaminophen |
| Hep A? B? C? | A: fecal-oral, immunization B: blood, mother-baby so vaccine at birth C:risk for nurses, interferon/ribovarin |
| What is biliary atresia? | Missing biliary duct so bile build up in blood - jaundice - lead to cerebral damage then cirrhosis. s/s: pale stool, dark urine, jaundice in sclera. pruritus |
| Cleft Palate/lip(more common) Tx, what first? nsg considerations? | congenital: effect of env or genetic Tx: treat lip b4 palate, protect suture with Logan bow no tongue blades nsg: aspiration, nutrition, speech |
| Esophageal Atresia? TEF tracheoesopageal fistula | defect b/n trachea & esophagus, see frothy saliva nsg: aspiration so three C hazards: coughing/choking/cyanosis |
| Hernias main concern? Gastroschisis? | strangulation, blockage gast: born with int outside abd |
| HPS hypertrophic pyloric stenosis | projectile vomiting, see "olive" visible at umbilical, visible peristalsis, irritable tx: surgery(pyloromyotomy: open pyloric channel) risk for dehydration |
| Intussusception? Malrotation? Volvulus? | Int: part of bowel invaginates into another part s/s: triad(abd pain/mass, bloody stools(currant jelly poop) Mal: abnormal rotation Vol: twisted int |
| Anorectal malformations: imperforate anus? cloacal exstrophy? | imp: anus in wrong place cloaca: hard to tell sex of baby....find ovaries to determine |
Created by:
palmerag
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