NSG 3600 Exam 3 Review Guide Questions and Answers

NSG 3600 Exam 3 Review Guide Questions and Answers Rotavirus Most common cause of acute diarrhea Acute Diarrhea effects Excessive Fluid and electrolyte loss in the stool Acute Diarrhea assessment (think dehydration) Skin turgor, membrane moisture, recent travel, perineal skin quality Diarrhea prevention hand hygiene, cook food properly, correct food handling diarrhea priority interventions Administer Pedialyte (Restore electrolyte imbalance). Least to most invasive methods for rehydration. Cleft Lip Population Males, Asians, and Native Americans Cleft Lip/Palate RF smoking, gestational diabetes, use of certain medications, lack of folate Cleft Lip/Palate Diagnosis Ultrasound during pregnancy Physical Observation Cleft Lip Feedings Long Nipple Haberman's Feeder Cleft Palate Feedings Short Nipple Haberman Feeder Cleft Lip/Palate Feedings Feed Upright, Burp Often Cleft Lip/Palate repairs Lip- 3 months or younger Palate- Around six months, always before 18 months Cleft Lip/Palate repair priority Protect sutures with Logan's Bow Apply Petroleum Jelly to the Operative Site GENTLE Elbow Restraints? Cleft Lip/Palate Post-Op Feeding Tips "Feed with syringe or dropper until surgical site is healed." Maintain same method used pre-operatively. intussusception Intestine folding into itself, telescoping. intussusception RF Cystic Fibrosis, Males, less than 18 months intussusception s/s Pulling Legs to Chest JELLY LIKE STOOLS MIXED W BLOOD Vomiting SAUSAUGE SHAPED MASS in RUQ intussusception Symptom triad Episodic Abdominal Pain with Vomiting q. 5-30 min Screaming and Drawing up Legs Stool with blood intussusception diagnosis barium enema (#1) or surgery (last resort) Or ultrasound Air enema is strictly therapeutic intussusception pre-operative care NG-Tube Monitor for Brown Stool Passing (Notify PCP) intussusception Fever Fever 99.5 = bad Failure to Thrive a condition in which babies do not grow and develop properly due to deficit in caloric intake Failure to Thrive Diagnosis Weight is below the 5th percentile Failure to Thrive Expected Labs Decreased Albumin (Normal 4.5-9g/dl) Failure to Thrive Nursing Requirements Notify CPS Appendicitis lumen of the appendix becoming blocked by fecal matter, lymphoid tissue, tumor, parasite, etc. Appendicitis s/s RLQ abdominal pain or cramping, nausea, vomiting, chills, low grade fever Appendicitis Pain stops suddenly Notify PCP ASAP, a rupture could have occured Appendicitis Post-operative Care NPO 24/hrs Appendicitis Perforation/Rupture Care Antibiotics Appendicitis Nursing Priority Monitor for Peritonitis Hirshsprungs Disease AKA aganglionic disease Hirshsprungs Disease Lack of ganglionic cells resulting in decreased motility and mechanical obstruction of the bowels Hirshsprungs Disease cause birth defect Hirshsprungs Disease s/s No meconium within 48 hours birth Ribbon Like Stools Abdominal Distension Vomiting Bile, constipation Failure to Thrive Palpable Fecal Mass Hirshsprungs Disease Diagnosis X-Ray barium Enema Hirshsprungs Disease treatment removal of ganglionic section, colostomy, anastomosis Hirshsprungs Disease Pre-operative care NPO and NG-Tube Hirshsprungs Disease Priority Celiac Disease Auto-immune disorder, which affects small bowel mucosa and can lead to malabsorption of foods. No gluten. Celiac Disease will... not present until gluten is introduced to the diet Celiac Disease Population Women Celiac Disease S/s Failture to Thrive Steatorrhea Abdominal Distension / Bloating Constipation Celiac Disease diet should avoid.. BROWN Barley, Rye, Oats, Wheat, and NOTHING THAT DOESNT SAY GLUTEN FREE. They should always read labels. Celiac Disease diet can include Corn, Rice, and Millet. Simple carb diet. Celiac Disease diet should... Supplement calories, vitamins, and minerals like, ADEK Vitamins high Calorie, high protein diet Can those with celiac disease eat gravy/canned soups? No. Avoid gravy and canned soups. Celiac Disease can lead too... Bruising due to lack of vitamin K Isotonic Dehydration Sodium and Water leave at the same rate. Most Common type of dehydration Isotonic dehydration Isotonic Dehydration greatest risk Hypovolemic Shock Hypotonic Dehydration Losing more sodium than water In which type of dehydration are physical symptom more severe? Hypotonic Dehydration Treatment for Hypotonic and Isotonic Dehydration Administer 1/2 D5 NK20 Dehydration s/s Skin turgor Dry mucous membranes Lower urine output and concentrated Sunken eyes & fontanles Weakness Hypotension Tachycardia Increased respiratory rate Hypertrophic Pyloric Stenosis -hypertrophy of the pyloric sphincter causing tightening of the opening from the stomach to the small intestine -enlarged muscles that don't open -stomach pushes so hard to fit food through sphincter but ends up projectile vomiting Hypertrophic Pyloric Stenosis Population Caucasian First Born Males Hypertrophic Pyloric Stenosis s/s "Insatiable Feedings" Projectile Vomiting Weight LOSS Dehydration- tachycardia Constipation Palpable OLIVE mass in RUQ Irritable from Hunger Hypertrophic Pyloric Stenosis Diagnosis ultrasound revealing olive shaped mass Hypertrophic Pyloric Stenosis Treatment Surgery ASAP if electrolytes are balanced Hypertrophic Pyloric Stenosis Pre-Operative Care NPO, Consent, NG- Tube If dehydrated electrolytes must be corrected prior to surgery. Hypertrophic Pyloric Stenosis Post-Operative Care Monitor I & O's Vitals How soon can a child with pyloromyotomy eat post-op? Must wait six hours pyloromyotomy food reintroduction AS TOLERATED The baby will not move to the next level until they can tolerate TWO of these feedings. Pedialyte 15ml q. 2 hours 1/2 strength formula 15ml, two feedings 30ml formula 2 feeds 45 ml two feeds 60 ml two feeds pyloromyotomy vomiting for 24 hours post-op Expected pyloromyotomy vomiting for 48 hours post-op Notify PCP What do you do it a baby who underwent a pyloromyotomy vomits? Nothing, clean up baby, let them recover for a moment, keep feeding Rectal Atresia closed rectal passage, may appear to be normal opening upon first inspection Rectal Atresia s/s No stool Rectal Atresia treatment Surgery ASAP Rectal Atresia diagnosis X-ray, MRI, Ultrasound, IV pyelogram Rectal Atresia Pre-Operative Care Get Consent, NPO, IV Rectal Atresia post-operative care PO feedings can begin as soon as bowel sounds are heard Can not leave Hospital until they have bowel movement Rectal Atresia Surgery Bowel Resection and Colostomy, then closure of colostomy and bowel repair "anastomosis" gastroesophageal reflux disease (GERD) Excessive relaxation of the lower esophageal spinchter, which allows the reflux to occur gastroesophageal reflux disease (GERD) s/s "it burns/stings" Halitosis Chronic Cough Wheezing Refusal to Feed Regurgitation gastroesophageal reflux disease (GERD) diagnosis Barium Swallow 24 hours intraespohgeal pH monitor endoscopy with biopsy to tell which type gastroesophageal reflux disease (GERD) Medication Proton Pump Inhibitors (PPI) 30 minutes prior to meals or daily in the morning on an empty stomach "-prazole" gastroesophageal reflux disease (GERD) Care thicken formula with cereal for infants plain diet for children Remain upright after meals Provide Smaller, More frequent meals What do you do if your infant has halitosis? Wipe their mouth/tongue What is the most common cause of UTIs? E. coli UTI Contamination of the periurethral area with bacteria that results in colonization of the urethra and bladder UTI Parents are refusing catheter for their child, what do you do Notify PCP UTI RF Women, Uncircumcised males, urinary stasis, vesicoureteral reflux, anatomic abnormalities, poor hygiene, chronic perineal irritation UTI Labs Urine Analysis or Culture Expect increased WBC UTI Sample Collection Clean Catch Method In-and-out catheterization Suprapubic Aspiration (Least Preferred due to pain) Bag (Least preferred due to contamination odds)