NSG 3600 PEDS EXAM 3 Questions and Answers

NSG 3600 PEDS EXAM 3 Questions and Answers acute diarrhea causes - Rotavirus - Diet/food - Infection - Medication - ANTIBIOTICS - Toxic substances What are you worried about with acute diarrhea? - Dehydration( look at skin turgor) - Electrolyte imbalance Interventions for Acute Diarrhea - Give Pedialyte - IV fluids, NO FRUIT JUICE - Electrolytes, START with bland, soft food Prevention for Acute Diarrhea - Handwashing - Proper Food handling Cleft lip and palate Meaning - Facial malformation during embryonic development - Native American/ Asian Male Cleft lip and palate risk factors - Smoking - Gestational Diabetes - Use of certain meds - Lack of folic acid prenatal Cleft lip and palate interventions - Haberman feeder - Promote bonding between family - Burp infants often - No- Nos ( elbow restraints: take off every 1-2hrs) - Apply petroleum jelly to operative site - Feed with syringe/ dropper until surgical site is healed Intussuspection - Intestines folding into itself causing an obstruction normally at the ileocecal valve Intussuspection Risk Factors - Males less than 18 months - Cystic Fibrosis Intussuspection signs and symptoms - Current jelly stool -Sausage shaped mass in RUG - pulling legs to chest - Vomitting Intussuspection Systom triad - Stool with blood - Screaming with drawing up legs - Paroxysmal episodic abdominal pain with vomitting every 5-30 minutes. Intussuspection Dx - BARIUM ENEMA - Abdominal ultrasound Intussuspection Intervention - Monitor for signs of perforation, peritonitis and shock. - coach and reeda stool and if patient passed stool alert pcp. - If child has surgery: NPO, NGT, IV fluids - Fever greater than 99.5 is very bad, alert PCP. - Moniotor for infection failure to thrive a condition in which infants become malnourished and fail to grow or gain weight for no obvious medical reason Failure to thrive symptoms - weight 5th percentile, length WNL - decreased or lack of subcutaneous fat - pale skin - developmental delays - Decreased albumin levels appendicitis inflammation of the appendix appendictis s/s - Periumbilical pain - RLQ pain Appendictis Interventions - Monitor VS - If Pain stops CALL THE PCP, IT COULD HAVE RUPTURED -NPO 24hrs post op - Monitor for peritonitis( stiff tender abdomen) Hirschsprung disease absent ganglion cells in submucosal/myenteric plexus rectosigmoid ( meaning there's a blockage that stops peristalsis from occurring). - Common in Down syndrome kids Hirschsprung Symptoms - inability to pass stool meconium within the first 24-48 hours, - visible reverse peristalsis, - ribbon-like stool in older kids - Newborn failure to thrive, hirschsprung dx and tx DX - X-ray , Anorectal biopsy - Barium Enema TX - Removal of aganglionic section - Colostomy - Anastomosis Hirschsprung Intervention - NPO and NGT pre-op - Teach parents colostomy care - Monitor for Enterocloitis s/s- explosive bloody bm, distended abdomen and fever - Also think cystic fibrosis celiac disease disease caused by sensitivity to gluten celiac signs and symptoms -Anorexia -Diarrhea -Constipation -STEAOTORRHEA -Abdominal pain -Abdominal bloating -Abdominal distention -Weight loss Celiac Dx/Tx Dx: Small bowel biopsy, serological markers. Tx: Gluten free diet: THINK BROWN - Barley -Rhye -Oats -Wheat -Nope They can subsititue for rice, millet, quinoa. Celiac Interventions - Teach parents how to read labels -Supplemental calories, vitamins, mineral -Supplement ADEK vitamins -High calorie and high protein diet Hypertrophic Pyloric Stenosis (HPS) constriction of the pyloric sphincter, palpable as an olive-like mass in the upper abdomen - Caucasian males are most at risk Hypertrophic Pyloric Stenosis S/S - PROJECTIVE VOMITTING - olive-shaped mass URQ - failure to gain weight -dehydration - always hungry Hypertrophic Pyloric Stenosis dx and tx DX - Ultrasound -Palpation of mass TX - Surgery immediately - CORRECT THE ELECTROLYTE BEFORE SURGERY: so if patient is dehydrated you can't start surgery. Hypertrophic Pyloric Stenosis Intervention - Monitor I&O -NPO, NGT before surgery - Start feeding 6hrs after surgery even with no bowel sounds -Vomitting for more than 48hrs must be reported to PCP -Vomitting for the first 24hrs is normal Rectal atresia a complete obstruction (inability to pass stool) and requires immediate surgical intervention Rectal atresia interventions - GET CONSENT FOR SURGERY -PO feeds begins after bowel sounds - Can't leave the hospital until they have a BM: so give stool softeners, get them walking and give fluids. GERD (gastroesophageal reflux disease) - acid reflux, - stomach contents move up the esophagus because the lower esophageal sphincter (LES) isn't functioning well. GERD s/s - SPITTING UP - Crying - Arching back - FTT - Respiratory difficulties GERD dx and tx DX - Upper GI series, PH MONITORING, Barium swallow TX - Normally leaves before age 1 - Meds: H2 antagonists or Proton Pump Inhibitors (PPI: GIVE 30MINS BEFORE MEALS OR DAILY IN THE MORNING ON AN EMPTY STOMACH) GERD interventions - Thicken formulas with rice cereal - Plain diet for kids to avoid irritants - Remain upright after meals - SMALLER FREQUENT MEALS -Frequent burping of child - Observe for signs of aspiration UTI MEANING Bacterial infection UTI risk factors -female -uncirmised males - poor hygiene -vesicoureteral reflux UTI S/S frequency/ urgency burning pain when voiding hematuria fever UTI DX and Tx - Culture and sensitivity: collect urine and send to the lab within 10 mins - Ultrasound -VCUG TX -Antibiotics UTI Intervention and teaching - Teach parents about proper perineal care -Hand washing - Cotton underwear: avoid tight clothing - Teach parents signs of infection - Empty bladder regularly vesicoureteral reflux backflow of urine from the bladder into the ureters and sometimes the kidney - CAUSES RENAL DAMAGE vesicoureteral reflux s/s - UTI Symptoms -Enuresis - fever -ENLARGED KIDNEYS ON DIAGNOSTIC TEST vesicoureteral reflux DX and TX DX - VCUG -Radiograph -IVP -X-ray when urinating: REMEMBER NO METALS TX -Antibiotics