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37 Cards in this Set
- Front
- Back
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Definition of constipation
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not passing 3 stools per week and hard/painful stool
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Definition of Encopresis
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fecal soiling from leaking of stool from distended rectum
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Causes of encopresis
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fecal retention
damage to corticospinal tract voluntary action from anxiety or passive-aggressive behavior |
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Etiologies for constipation
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drugs: anticholinergics, barium, bismuth, iron, opiates, Ca/Al antacids
excessive milk ingestion/lack of fiber in diet lead ingestion HIrschsprung disease: no nerve to the colon, not able to pass stool to the colon hypothyroid infant botulism intestinal obstruction of strictures. |
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Goals of treatment of constipation in children
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maintenance regimen goal to produce 1-2 soft stools a day
Find cause and treat |
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When to send a child to an MD for constipation
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constipation last for >2wks
if pts <3 yrs of age delayed passage of meconium fever, vomiting, blood in stool, failure to thrive, anal stenosis, impaction, abdominal distension, weight change, recurring |
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What not to use in constipated children
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mineral oil
corn syrup caution use of sodium phosphate or magnesium hydroxide product in renal pts honey due to risk of botulism avoid enemas in infants |
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Contraindication of bulk laxative to treat constipation
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obstruction/impaction, esophagus narrow
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Onset of action for bulk laxative
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2-3 days
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Appropriate age for bulk laxative
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>6 yrs old - sometimes MD use in children less than 6 yrs old.
Not effective for opiate constipation |
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SE of bulk laxative
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diarrhea, constipation, abdominal cramps, bronchospasm, allergic reactions.
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Onset for stool softener
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1-3 days
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Dose for stool softener in pediatric pts
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5mg/kg/day divided into 1-4 doses
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Contraindication of stimulants in children
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Do not use in <6 yrs old.
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Onset of action of stimulants
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works in 6-12 hrs
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Usage of stimulants in constipated children
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opioid-induced constipation
can cause dependence, abdominal pain and cramps |
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Saline usage in children
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used for acute bowel evacuation
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Saline onset of action
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1-6 hrs
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Hyperosmotic agents used for constipation in children
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Glycerin suppository
Miralax |
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Glycerin supp usage in constipation
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OK got infants <6mos not responding to manual stimulation, but need to see MD.
Only evacuate lower bowel works in less than 1hr not for chronic use |
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Miralax usage for constipation
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labeled for >17 yrs
works in 1-3 days contraindication: obstruction/impaction, bowel perforation SE: urticaria, diarrhea, bloating, cramping, gas, nausea |
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Goal of treatment of chronic constipation and encopresis in children
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complete disimpaction
sustained evacuation restore normal colorectal tone |
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Treatment options of chronic constipation and encopresis
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drugs
behavior modification counseling |
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Drugs for bowel evacuation for chronic constipation and encopresis
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enemas: at least for 2 days
at home miralax: Q6hr until stool clear hospital admit to administer Golytely: may take up to 24 hrs |
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Maintenance therapy for chronic constipation and encopresis
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Miralax 07 to 1.52 mg/kg/day divided BID
Lactulose: 5 - 10 ml Qday and increase to max 45 ml BID Weaning |
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Education points for parents for constipation
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Unhurried potty time
Diet/water recommendation Medication information |
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When to see MD if children have diarrhea
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if children less than 3 yrs old
see dehydration/weight loss fever severe stomach pain blood in stool, black stools last >48 hrs lethargic no urine output |
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Severity of dehydration
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Mild: <5% fluid deficit
moderate: 10% fluid deficit severe: 11-15% fluid deficit |
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Diarrhea mainstay treatment
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oral rehydration therapy
keep eating |
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Oral rehydration therapy for diarrhea
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effective for mild-moderate dehydration
give 5-10 ml q5-10 mins as tolerated Do not stop eating or breastfeeding |
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Diet during diarrhea
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regular diet
avoid food high in sugar and fat |
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Loperamide to treat diarrhea -contraindication
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not recommended for <2yrs
no use infectious diarrhea. Use only for 48 hrs |
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Loperamide SE
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dizziness, rash, NV, constipation, cramps, urinary retention
warn parents: sedation and dry mouth |
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Bismuth contraindication
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pts <3 urs old
avoid in influenza and chicken pox caution if child on aspirin |
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Bismuth side effects
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weakness, anxiety, slurred speech, loss hearing, tinnitus
black tongue and stool |
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Max dose for bismuth
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8 doses per day
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Points of education for parents about diarrhea
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keep eating
Do not use OTC anti-diarrheal meds wash hands frequently wash soiled laundry separately in water wash toys call peditrician if it doesn't get better |
