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210 Ped Ch. 45

GI Dysfx

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