PEDS MT1
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| Family Centered Care | an approach to health care that shapes health care policies, progams, facility design, and day to day interactions among patients, families, physicians, and other healthcare professionals- family is constant, address needs of family, involve family
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| 3 phases of separation anxiety | protest phase, despair phase, detachment phase
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| protest phase | child cries and is inconsolable in grief for parent. May reject alternate caregivers, desperate clinging, attempts to escape
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| despair phase | sad, lonely, uninterested in food and play ; superficial calm, withdrawn
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| detachment phase | child might have appeared to have adjusted. Increased activity and interest. Transient attachment to nurses, indifferent to parents on return
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| separation anxiety in toddlers | verbally plead for parents to stay, physically attempt to secure or find them, temper tantrums
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| separation anxiety in preschoolers | tolerate separation for brief periods but stress of illness makes them less able to cope
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| separation anxiety in school age children | better able to cope, but stress of illness may increase need for parents. React more to separation from usual activitie and peers (lonely, isolated, bored, depressed)
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| separation anxiety in adolescents | loss of peer group contact is emotional threat
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| Reactions experienced by all children in hospital | Fear, Anger, Guilt, Sadness
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| How to prevent separation anxiety | let family stay, parent participation, bedside reporting, complement/augment parents caregiving functions
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| how to minimize separation anxiety | daily routine, allow child to cry, provide support through physical presence, in detachment, maintain contact with childs family, familiar surroundings, remove frightening stimuli, maintain usual contacts
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| Erikson- Infants 0-1 | trust vs mistrust
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| Erikson Toddlers 1-3 | autonomy vs shame and doubt
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| Erikson Preschoolers 4-7 | initiative vs guilt
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| Erikson School Age 8-12 | industry vs inferiority
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| Erikson Adolescent 13+ | ego identity vs confusion
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| Restraints | any method, physical or mechanical which restricts a person’s movement, physical activity, or normal access to his or her body
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| medical surgical restraints | • used for: risk for interruption of therapy, risk of harm if tubes are dislodged or removed, patient confusion/agitation/unconsciousness
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| o behavioral restraints | risk of patients physically harming themselves or others because of behavioral reasons and when nonphysical interventions fail
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| - standard precautions: | o use barriers (gloves, masks, gowns, etc) to prevent contamination from blood, bodily fluids, secretions, excretions, nonintact skin, mucous membranes
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| - Transmission Based Precautions | used with patients with documented or suspected infection or colonization with highly transmissible pathogens for which additional precautions are needed (airborne, droplet, contact)
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| preparing child for isolation | show mask, gloves, gown, encourage dress up, show face before putting stuff on
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| Urine Specimens- older children/adolescents | bedpan, urinal, or can be trusted to follow directions for colletion in bathroom. Provide paper bag for disguising container, ask about menses
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| Urine Specimens- toddlers/preschoolers | may not be able to void on demand/in unfamiliar places or may be newly potty trained. Give fluids and wait until they are ready to void. Use words like peepee
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| urine specimens- infants/not potty trained | urine collection bag, double diaper
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| oral meds | preferred, ease of administration, measure tsps by 5ml/tsp, crush tablets if not coated, divide only if scored. If not scored, dissolve and take up correct dose
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| IM meds | vastus lateralis; have someone help hold down child, carry extra needles. tell them they are getting medicine under skin, carry out quickly and skillfully
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| SubQ meds | lateral aspect of upper arm, abdomen, center third of anterior thigh
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| Reasons for getting IV meds | poor absorption, need high serum concentration of drug, resistant infections that require parenteral meds over extended period, need continuous pain relief, emergency tx
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| advantage to NG/OG/gastronomy tube | PO meds can be given around the clock without disturbing child
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| Indications for rectal meds | when oral route is difficult or contraindicated- vomiting
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| Administering Eye drops | place child supine or sitting with head extended and ask child to look up, use one hand to pull the lower lid downward, apply solution or ointment to small conjunctival sac
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| Administering Ear meds | pull pinna down and back (<3 yo) or up and backward (>3 yo), administer drops through speculum with child prone or supine and head turned to appropriate side
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| Administering Nasal Meds | • Extend head well over edge of bed or pillow (child should remain in this position for 1 minute)
• Insert nasal spray into naris vertically then angle to avoid trauma to septum
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| Pain Assessment | Under 4: flacc scale (facial, legs, activity, cry, comfort), 4-5 and older: FACES, 8 and older: numeric
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| Shock | circulatory failure; tissue perfusion that is inadequate to meet the mtabolic demands of the body, which results in cellular dysfunction and eventual organ failure
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| 3 physiological consequences of shock | hypotension, tissue hypoxia, metabolic acidosis
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| causes of shock | inadequate blood volume or inadequate oxygen carryign capacity of blood, inappropriate blood volume distribution, impaired heart contractility, obstructed blood flow
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| compensatory mechanisms in shock | fluid mobilized from extracellular compartments, increased SNS activity(vasoconstriction, increased contractility), release of catecholamines (vasoconstriction/shunting), ADH, corticosteroids, aldosterone, anaerobic metabolism (acidosis), tachypnea
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| why is skin clammy and cold in shock? | catecholamines produce vasoconstriction, reduce blood flow to skin, kidneys, muscles, splanchnic viscera and shunt to heart and brain
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| patho of metabolic acidosis in shock | impaired tissue perfusion/oxygen depletion causes cells to use anaerobic metabolism, which causes build up of lactic acid
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| why do you breath fast (tachypnea) in shock? | lungs try to compensate for metabolic acidosis
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| 3 things to manage shock | 1) Ventilation
2) Fluid Administration/Cardiac Support
3) Vasopressor Support
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| Managing Shock: ventilation | oxygen, intubation
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| Managing Shock: fluid administration/cardiac support | Isotonic crystalloids (LR or NS, IV boluses 10-20 ml/kg over 10-15 minutes). Colloids (albumin to incrase CO and volume), blood if blood loss
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| Managing Shock- vasopressor support | exogenous catecholamines (dopamine, epi), calcium chloride, sodium bicarb for metabolic acidosis
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| hypovolemic shock | systemic drop in intravascular blood volume beyond childs physiologic ability to compensate
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| signs of sever dehydration | marked tachycardia, weak distal pulses, narrow pulse pressure, tachypnea, hypotension, decreased LOC
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| Cardiogenic Shock | impaired cardiac muscle functioning that leads to decreased cardiac output (ineffective ventricular filling or insufficient forward flow)
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| Distributive shock | vasogenic shock; results from vascular abnormality that produces maldistribution of blood supply throughout the body (neurogenic, anaphylactic and septic)
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| neurogenic shock | massive vasodilation resulting from loss of sympathetic tone (spinal cord injuries)
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| anaphylactic shock | hypersensitivity reaction that causes massive vasodilation and capillary leak
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| septic shock | decreased cardiac output and derangements in peripheral circulation in response to severe, overwhelming infection
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| obstructive shock | caused by cardiac tamponade, tension pneumothorax, ductal dependent congenital heart lesions, massive pulmonary embolism
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| ADH | secreted in response to increased serum osmolarity and or decreased blood volume- increases water reabsorption by kidneys to increase blood volume and corrct hyperosmolality, decreases urine production
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| diabetes insipidus | - decreased permeability of the renal distal tubules and collecting ducts with resulting decreased water reabsorption (ADH deficit (neurogenic) or vasopressin receptor insensitivity (nephrogenic))
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| Manifestations of Diabetes insipidus | increased urine output, hypernatremia, dehydration, poluria, polydipsia, enuresis, excessive thirst with bedwetting, irritability/crying that is relieved with water
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| Treatment of DI | vasopressin replacement: vasopressin tannate, aqueous lysine vasopressin, desmopressin acetate. Fluid replacement, should wear emergency med alert id band
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| vasopressin tannate | IM/SubQ, 48-72 hour coverage
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| aqueous lysine vasopressin | nasal spray, 8-12 hour coverage
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| Desmopressin Acetate (DDAVP) | intranasal, 6-24 hour coverage, administered 2x daily
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| Syndrome of Inappropriate ADH (SIADH) | - ADH excess: increased permeability of the renal distal tubules and collecting ducts with resulting increased water reabsorption and decreased urine production
o Intravascular volume overload
o Dilutional hyponatremia
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| Treatment of SIADH | fluid restriction, loop diuretics and NaCl supplementation (for severe hyponatremia)
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| Diabetic Ketoacidosis | most complete state of insulin deficiency
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| DKA Triad | hyperglycemia (>200), ketosis (0.3-7.0), acidosis (ph <7.3)
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| Manifestations of DKA | polyuria, polydipsia, tachycardia, hypotension, poor perfusion (dehydration), lethargy, depressed LOC (shock, cerebral edema), tachypnea (acidosis), acetone/fruity breath (excretion of ketones), abdominal pain (pancreatitis), dry mouth, N/V, weight loss
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| Nursing Management of DKA | 1) ABCs!--> oxygen, volume replacement (slow to prevent cerebral edema), 2) Insulin Replacement IV, 3) Correct Acidosis- sodium bocarb
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| Monro-Kelley Doctrine | because the brain, CSF, and cerebral blood volume are encased in a rigid skull, any increase in volume in any of the 3 must be met with wither a decrease in volume of one of the other components or an increase in the pressure within the brain
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| Elevated Intracranial Pressure | occurs when the volume of brain tissue increases beyond the limit permitted by compression of veins and displacement of CSF
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| Manifestations of increased ICP | headache, N/V, personality changes, irritability, fatigue, double/blurred vision, seizures, pupils sluggish, fixed and dilated, LOC deteriorates from drowsiness to coma
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| Medical Tx of increased ICP | sedation, CSF drainage, osmotic diuretics (mannitol)
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| nursing interventions- increased ICP | position to avoid neck compression, minimize pain/stress, minimize environmental noise
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| cerebral edema | edematous brain is softer than normal and overfills the cranial vault (space occupying)- can cause herniation
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| brainstem herniation syndrome | depressed LOC, decreased pupil reactivity, cranial nerve palsies, characteristic posturing (decerebrate or decorticate), CUSHINGS TRIAD
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| cushings triad | hypertension, bradycardia, irregular respiration (indicative of brainstem herniation)
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| Intraventricular Catheter/ Extraventricular Drain | catheter in lateral ventricle that measures ICP and provides continuous drainage of CSF to reduce pressure
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| Normal ICP level in infants | 2-6 mmHg
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| normal ICP level in young children | 3-7 mmHg
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| normal ICP level in older children and adults | 0-10 mmHg
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| Central Venous pressure | measurement of hydration
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| CVP indicative of dehydration | 0-2
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| ideal CVP (adequately hydrated) | 8-12
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| CVP indicative of overhydration | 12-20
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| Glascow Coma Scale | assesses LOC with eye opening, verbal response (smiling, crying, interaction), and motor response
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| Unaltered LOC- GCS score | 15
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| GCS score indicative of coma | <8
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| GCS score indicative of deep coma/death | 3
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| Nasal Cannula | no minimum flow, max flow 5L, 40% FiO2
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| Simple Mask | min flow 5L, max flow none (consider changing at 8 L), FiO2 35-60%
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| Venturi Mask | min flow dependent, max flow dependent on FiO2, FiO2 settings from 24-55%
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| Heated High Flow Nasal Cannula | used to deliver a heated concentration of gas at a higher flow than normal nasal cannula
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| Trach Collar | min flow 5L, no max flow, FiO2 28-100
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| Partial Rebreather Mask | min flow: 2/3 of bag full on inspiration, min 5 L but normal >10L, FiO2 >60%
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| Non Rebreather Mask | min flow: 2/3 of bag full on inspiration, min 5 L but normal >10L, FiO2 >80%
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| Normal Value of pH | 7.35-7.45
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| Normal Range of CO2 | 35-45
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| Normal Range of HCO3 | 22-26
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| normal Range of PaO2 | 80-100
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| Normal Range of Base | -2 to +2
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| Drugs used for intubation | versed (benzo, sedation/amnesiac/anesthesia), vecuronium (neuromuscular blockade), fentanyl (analgesic)
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| Cleft Lip | embryonic structures around the primitive oral cavity do not fuse completely. Unilateral or bilateral, complete or incomplete
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| Cleft Palate | occurs when primary and secondary palatine plates fail to fuse during embryonic development
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| Cheiloplasty | surgery for cleft lip, done at about 10 weeks of age
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| Palatoplasty | plastic surgery for cleft palate, typically performed at 9-15 months
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| Long term problems with cleft lip/palate | speech impairment,recurrent ear infection, extensive orthodontics, compensatory speech patterns
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| feeding infant with cleft lip/palate | slowly feed in upright position, frequently burp, use special feeding devices, gavage feedings if necessary, psychosocial support to parents
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| pyloric stenosis | thickening of cicular muscle at pylorus that leads to narrowing and elongation of pyloric canal, producing an outlet obstruction and compensatory dilation, hypertrophy, and hyperperistalsis of stomach
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| manifestations of pyloric stenosis | projectile vomiting, dehydration, growth failure, olive shaped mass in epigastrum
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| tx for pyloric stenosis | preop hydration with IV fluids and correction of metabolic alkalosis, decompress stomach with NG tube, pyloromyotomy
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| hirschsprung disease | absence of ganglion cells in affected areas of the intestine resulting in a loss of the rectosphincteric reflex, internal sphincter does not relax causing obstruction
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| s/s of hirschsprung disease- newborns | abdominal distention, bilious vomiting, failure to pass meconium, refusal to feed
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| s/s of hirschsprung disease- infants | abdominal distention, constipation, diarrhea, growth failure, signs of enterocolitis, vomiting
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| s/s of hirschsprung disease- children | abdominal distention, constipation, easily palpable fecal mass, ribbon like foul smelling stools, undernourished anemic appearance, visible peristalsis
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| treatment for hirschsprung disease | bowel resection, renanastamosis, colostomy
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| ulcerative colitis | inflammation limited to colon and rectum, involves continuous segments along length of bowel with varying degrees of ulceration, bleeding, and edema
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| s/s UC | bloody diarrhea/occult fecal blood, abdominal pain, growth failure, anemia, weight loss
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| crohns disease | chronic inflammation to any part of the GI tract from the mouth to anus; ulcerations, fibrosis, adhesions, stiffening of bowel wall, stricture formation, fistulas affecting bowel wall in discontinuous fashion
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| s/s crohns disease | diarrhea, abdominal pain with cramps, fever, weight loss, extraintestinal symptoms
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| treatments for ulcerative colitis | subtotal colectomy and ileostomy, ileoanal pull through, total colectomy
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| treatment of crohns disease | segmental intestinal resections, partial colonic resection
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| nursing interventions for crohns disease | diet teaching (hi cal, hi pro, small frequent meals), coping with stress, adjusting to chronicity, preparing for possibility of surgery, drugs, ileostomy care
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| intussusception | proximal segment of bowel telescopes into a more distal segment, compresses lymphatics and veins. Pressure increases, when pressure equals arterial pressure, arterial pressure, blood flow stops causing ischemia and pouring of mucous into intestine
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| s/s intussusception | crampy, abdominal pain, inconsolable crying, abdominal distention, red currant like stools, sausage shaped mass in RUQ, irritability, lethargy, constipation, etc
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| treatment for intusussception | pneumoenema, ultrasound guided hydrostatic (saline) enema, surgical reduction
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| UTI | presence of a significant amount of microorganism in urinary tract
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| cystitis | bladder infection
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| pyelonephritis | kidney infection
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| urethritis | urethra infection
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| signs and symptoms of UTI- newborns | nonspecific
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| s/s of UTIp children | classic s/s: enuresis/daytime incontinence, fever, foul smelling urine, frequency and urgency, dysuria, hematuria
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| s/s of UTI- adolescents | frequency and painful urination of a small amount of urine that may be grossly bloody, no fever
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| hypospadias | congenital condition in which urethral opening is below glans penis or on the ventral side of the penile shaft
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| s/s hypospadias | urethal opening below glans penis or on ventral side, penis looks abnormal, urine stream appears to be in abnormal direction, chordee
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| chordee | ventral curvature of the penis
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| surgical repair of hypospadias | done at 6-12 months, dont circumsize
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| acute glomerulonephritis | inflammation of glomeruli that hinders the kidney from filtering urine
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| AGN- cause | group A beta strep
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| s/s AGN | antecedent strep infection, cola/tea colored urine, decreased urinary output, hypertension, loss of appetite, periorbital edema
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| treatment of AGN | decreased K+, protein, Na+ diet, fluid restriction, antihypertensives and diuretics
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| nephrotic syndrome | autoimmune process that causes glomerular injury, massive loss of protein in urine (proteinuria), hypoalbuminemia, hyperlipidemia, edema
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| nephrotic syndrome- patho | increased glomerular permeability to protein, loss of albumin in blood decreases oncotic pressure and loss of fluid into interstitial space (edema/ascites), reduced fluid volume stimulates RAA and ADH, tubular reabsorption of sodium and water increases
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| s/s nephrotic syndrome | weight gain, puffiness of face and eyes, swelling of abdomen and lower extremities, labial or scrotal swelling, generalized edema, decreased urine output, pallor, fatigue
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| treatment of nephrotic syndrome | dietary restriction of salt, corticosteroids, immunosuppressants, diuretics
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| down syndrome | genetic disorder, trisomy 21, recognized in prenatal to newborn periods, causes birth defects, intellectual disabilities, distinct facial features
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| autism spectrum disorders | complex neurodevelopmental disorders of unknown etiology with genetic basis. Affects communication skills, social interactions, behavioral patterns
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