NSG-434 Exam 2 questions n correct
answers
dehydration - ANS ✔-A common body disturbance in infants and children - total output of fluid
exceeds total intake
-Degrees of dehydration related to percentage of body weight:
•Mild dehydration: loss of less than 5% in infants and 3% in children
•Moderate: loss of 5%-10% in infants and 3%-6% in children
•Severe: loss of more than 10% in infants and 6% in older children
-Other predictors of fluid loss:
•Change in level of consciousness: irritable with moderate dehydration; lethargic with severe
dehydration
•Altered response to stimuli
•Decreased skin elasticity and turgor
•Prolonged cap refill
•Increased heart rate (usually earliest sign)
•Sunken eyes and fontanels
•Mottling
-Lab tests:
•Serum bicarbonate
•Urine specific gravity and BUN are unreliable assessments
Therapeutic Management:
,-Mild - moderate:
•Oral rehydration over 4 to 6 hours
-Severe:
•IV fluids to expand fluid volume and replace deficits
diarrhea - ANS ✔-Diarrhea involves:
•The stomach (gastroenteritis)
•The small intestines (enteritis)
•The colon (colitis)
•The colon and intestines (enterocolitis)
-Acute diarrhea:
a sudden increase in frequency and a change in consistency of stools, often caused by an
infectious agent in the GI tract
-Chronic diarrhea: an increase in stool frequency and increased water content with a duration of
more than 14 days
-Most pathogens that cause diarrhea are spread by the fecal-oral route from person to person
•Close contact (day care centers)
-Rotavirus is the most important cause of serious gastroenteritis among children
-Most children are infected with rotavirus at least once by 5 years of age
Therapeutic Management:
-Oral rehydration therapy
-Early reintroduction to a normal diet is recommended
Care Management:
-Education regarding s/s of dehydration
-Skin care to prevent excoriation
,-Education regarding prevention measures
-Give kids a BRAT diet (bland, rice, applesauce, toast), scrambled eggs, jello, pudding, soup, etc.
constipation - ANS ✔-An alteration in the frequency, consistency, or ease of passing stool
-Often associated with:
•Painful bowel movements
•Blood-streaked or retained stool
•Abdominal pain
•Lack of appetite
•Stool incontinence
Causes:
-Structural disorders: Hirschsprung's disease, strictures
-Systemic disorders: hypothyroidism, hypercalcemia
-Medications: antacids, diuretics, antiepileptics, antihistamines, opioids, iron supplements
-Spinal cord lesions
-Management: high fiber diet, exercise, regular toileting habits after meals, stool softeners,
emotional support - helping child to feel in control
encopresis - ANS ✔-Repeated and involuntary defecation in a child older than 4, may be the
result of constipation
-Frustrating for parents and child
-Can lead to social withdrawal
Hirschsprung disease - ANS ✔-Lack of innervation often in lower portion of bowel, no peristaltic
waves causing chronic constipation above this area, megacolon
, -Rectal sphincter fails to relax: ribbon-like stool from passing through the narrow segment
-Etiology: both genetic and environmental factors, but the exact etiology is unknown
-Most commonly observed in neonates - 4x more common in males
-Absence of ganglion cells in the rectum or in the colon
-Abnormal or absent peristalsis
-Total absence of spontaneous bowel evacuation
Clinical Manifestations:
-Neonate: failure to pass meconium within 24-48 hours of birth, bilious vomiting
-Infancy & childhood: constipation, recurrent diarrhea, ribbon-like, flat, foul-smelling stool,
failure to thrive
-Rectal biopsy to detect absence of ganglion cells is definitive diagnosis
Treatment:
-One-stage surgical treatment: transanal pull-through
-Colostomy (temporary) and then removal of aganlionic section
-If the proximal bowel is not extremely distended (possible with early diagnosis), when the
infant is between 6 to 12 months (or 8 to 10 kg) the surgeon will perform a rectal pull-thru
procedure in which all the aganglionic bowel is removed and the normal bowel is reconnected
to the anus.
-If a transanal pull-thru is not possible, then the surgeon will perform a removal of the defective
bowel and colostomy to decompress the bowel and divert the fecal contents.
-The colostomy allows the dilated and hypertrophied portion of the bowel to regain normal
tone and size (takes approximately 3 to 4 months)
-Post‐op: assess site, NPO until bowel sounds return, IV fluids, may require daily anal dilations
answers
dehydration - ANS ✔-A common body disturbance in infants and children - total output of fluid
exceeds total intake
-Degrees of dehydration related to percentage of body weight:
•Mild dehydration: loss of less than 5% in infants and 3% in children
•Moderate: loss of 5%-10% in infants and 3%-6% in children
•Severe: loss of more than 10% in infants and 6% in older children
-Other predictors of fluid loss:
•Change in level of consciousness: irritable with moderate dehydration; lethargic with severe
dehydration
•Altered response to stimuli
•Decreased skin elasticity and turgor
•Prolonged cap refill
•Increased heart rate (usually earliest sign)
•Sunken eyes and fontanels
•Mottling
-Lab tests:
•Serum bicarbonate
•Urine specific gravity and BUN are unreliable assessments
Therapeutic Management:
,-Mild - moderate:
•Oral rehydration over 4 to 6 hours
-Severe:
•IV fluids to expand fluid volume and replace deficits
diarrhea - ANS ✔-Diarrhea involves:
•The stomach (gastroenteritis)
•The small intestines (enteritis)
•The colon (colitis)
•The colon and intestines (enterocolitis)
-Acute diarrhea:
a sudden increase in frequency and a change in consistency of stools, often caused by an
infectious agent in the GI tract
-Chronic diarrhea: an increase in stool frequency and increased water content with a duration of
more than 14 days
-Most pathogens that cause diarrhea are spread by the fecal-oral route from person to person
•Close contact (day care centers)
-Rotavirus is the most important cause of serious gastroenteritis among children
-Most children are infected with rotavirus at least once by 5 years of age
Therapeutic Management:
-Oral rehydration therapy
-Early reintroduction to a normal diet is recommended
Care Management:
-Education regarding s/s of dehydration
-Skin care to prevent excoriation
,-Education regarding prevention measures
-Give kids a BRAT diet (bland, rice, applesauce, toast), scrambled eggs, jello, pudding, soup, etc.
constipation - ANS ✔-An alteration in the frequency, consistency, or ease of passing stool
-Often associated with:
•Painful bowel movements
•Blood-streaked or retained stool
•Abdominal pain
•Lack of appetite
•Stool incontinence
Causes:
-Structural disorders: Hirschsprung's disease, strictures
-Systemic disorders: hypothyroidism, hypercalcemia
-Medications: antacids, diuretics, antiepileptics, antihistamines, opioids, iron supplements
-Spinal cord lesions
-Management: high fiber diet, exercise, regular toileting habits after meals, stool softeners,
emotional support - helping child to feel in control
encopresis - ANS ✔-Repeated and involuntary defecation in a child older than 4, may be the
result of constipation
-Frustrating for parents and child
-Can lead to social withdrawal
Hirschsprung disease - ANS ✔-Lack of innervation often in lower portion of bowel, no peristaltic
waves causing chronic constipation above this area, megacolon
, -Rectal sphincter fails to relax: ribbon-like stool from passing through the narrow segment
-Etiology: both genetic and environmental factors, but the exact etiology is unknown
-Most commonly observed in neonates - 4x more common in males
-Absence of ganglion cells in the rectum or in the colon
-Abnormal or absent peristalsis
-Total absence of spontaneous bowel evacuation
Clinical Manifestations:
-Neonate: failure to pass meconium within 24-48 hours of birth, bilious vomiting
-Infancy & childhood: constipation, recurrent diarrhea, ribbon-like, flat, foul-smelling stool,
failure to thrive
-Rectal biopsy to detect absence of ganglion cells is definitive diagnosis
Treatment:
-One-stage surgical treatment: transanal pull-through
-Colostomy (temporary) and then removal of aganlionic section
-If the proximal bowel is not extremely distended (possible with early diagnosis), when the
infant is between 6 to 12 months (or 8 to 10 kg) the surgeon will perform a rectal pull-thru
procedure in which all the aganglionic bowel is removed and the normal bowel is reconnected
to the anus.
-If a transanal pull-thru is not possible, then the surgeon will perform a removal of the defective
bowel and colostomy to decompress the bowel and divert the fecal contents.
-The colostomy allows the dilated and hypertrophied portion of the bowel to regain normal
tone and size (takes approximately 3 to 4 months)
-Post‐op: assess site, NPO until bowel sounds return, IV fluids, may require daily anal dilations
