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 |