Nur 106- Gi, Musculoskeletal & Endocrine

Front 1

• Affects 1 in 800. More
common in boys
• Etiology: hereditary,
environmental, teratogenic
factors.
• Readily apparent
• Degree affected may vary
from small notch to
complete separation

Back 1

Cleft Lip

Front 2

Occurs around

Back 2

7 weeks
gestation

Front 3

Surgical closure @ ____ months.
OR
by RULE OF _____ lbs and
Hgb of ____ g/dL

Back 3

1‐2 months
10:10
10g/dL

Front 4

Cleft lip diagnosed by

Back 4

visual
assessment

Front 5

Cleft palate diagnosed by

Back 5

palpation of palate

Front 6

until sutures
removed, no what?

Back 6

No sucking and try to
prevent crying

Front 7

What is important to remember about the suture line?

Back 7

-Keep suture line clean and dry to prevent infection,
promote healing, and less
scaring

Front 8

Clean suture line with?
after?

Back 8

sterile water after feeding

Front 9

______ to ease strain on
suture line.

Back 9

Logan bar

Front 10

May have ___.
Do not put in __________.

Back 10

Elbow restraints
prone position

Front 11

• 1‐2800 affected. More girls affect
• May involve soft palate alone to hard palate
• Nurse is to be sure parents understand that a
successful corrective surgery is available
• Promote bonding: Include parents in care

Back 11

Cleft Palate

Front 12

Surgical repair between

Back 12

6‐18mo (Average 1 year)

Front 13

May have collaboritive care with?

Back 13

Plastic surgeon, ENT, Nutritionist, Speech Therapy,
Orthodontist, Pediatrician

Front 14

What are 3 important assessments you should make with a cleft palate?

Back 14

• Assess degree of cleft
• Assess Respiratory status
• Assess ability to suck (will see difficulty with sucking
and swallowing)

Front 15

What about with feedings-Nursing Interventions?

Back 15

• Assist with feeding: head upright/special
nipples/ESSR
• Continuous monitoring during feeding
• Remove oral secretions carefully

Front 16

When not feeding...

Back 16

place
on side to prevent
aspiration of secretions

Front 17

• Ineffective airway clearance
• Alt. Nutrition‐Less than Body Requirements
• Potential for Alt. in parenting
• Risk for infection
• Pain
MAJOR NURSING DIAGNOSES FOR?

Back 17

Cleft Palate

Front 18

Nursing Care Post‐Op
Cleft Lip Cleft Palate Includes:

Back 18

-Maintain patent airway.
-Lung assessment before/after
feeding

Front 19

What are NO NO's for Post-Op care of pts with Cleft Lip Cleft Palate?

Back 19

-NO ORAL TEMPS or red juice
-No straws, pacifiers, spoons, or fingers around mouth
for 7-10 days
-give liquids from side of cup or from spoon
-No toothbrushes for 1 to 2 weeks

Front 20

Nursing Care Post‐Op
Cleft Lip Cleft Palate:

Back 20

• PROTECT SURGICAL SITE!!!
• Monitor weight to ensure gaining
• Assess pain
• Resume feedings as ordered (begin with Clear liquid)
• Care of site after feeding

Front 21

Esophageal Atresia with
Tracheoesophageal Fistula:

Back 21

• Clinical and Surgical
Emergency
• Assessment
– Three C’s of TEF
• Choking, coughing, cyanosis
• Plain water at birth

Front 22

• Management/Nursing Care:

Back 22

– Surgical
correction(thoracotomy)
– Monitor Resp. status
– Remove excessive secretions
– Maintain NPO
– IVF
– O2 as needed

Front 23

Esophageal Atresia with Tracheoesophageal
Fistula Plan of Care Includes:

Back 23

• Elevate infant
– anti‐reflux position 30 degree incline
– At risk for aspiration pneumonia
• NPO(non‐nutritive sucking ok….pacifier)
• IVF’s
• Provide gastrostomy care/feedings
• Education/Family involved in care

Front 24

Narrowing of pyloric canal: pyloric
muscle enlarged

Back 24

Pyloric Stenosis

Front 25

Assessment Findings Include:

Back 25

– Characteristic projectile
vomiting (bile free)..usually
after 14 days of life
– Hungry, fretful, irritable,
dehydration
– Weight loss/failure to gain
weight
– Dehydration, Metabolic
alkalosis
– Palpable olive‐shaped mass in
RUQ
– Visible peristaltic waves

Front 26

Will have low ___ lab values.

Back 26

Low NA+ & K+

Front 27

Diagnosis:

Back 27

US/UGI delayed
Emptying

Front 28

May require ___ intervention such as?

Back 28

surgical intervention:
Pylorotomy

Front 29

Nursing Care:

Back 29

– Monitor respiratory status
– Hydration status
– IVF’s, electrolytes
– Daily WT
– I/O
– small frequent meals(clears) then
NPO prior to surgery
– Burp Freuently

Front 30

Post op feedings:

Back 30

• Resumed 4‐6hrs after surgery
• small frequent feeding with
electrolytes solution or glucose

Front 31

Postop Position:

Back 31

– R side/Semi‐Fowler’s after feeding

Front 32

• Also called Hirshsprung’s Disease
• Congenital 1 in 500
– Is the absence of parasympathetic
ganglion cells in distal portion of
colon and rectum

Back 32

Congenital/Aganglionic Megacolon

Front 33

Assessment Findings:

Back 33

– Lack of peristalsis
– Fecal contents accumulate
– Mechanical obstruction
– Distended abdomen
(Constipation alternating with
diarrhea)
– Ribbon like stools

Front 34

Suspected in newborn who:

Back 34

fails to pass meconium within 24
hours

Front 35

Management/Nursing Care
• Correction‐

Back 35

series of surgical interventions.
– E.G: Temporary colostomy with reanastamosis and closure later

Front 36

Pre‐op care:

Back 36

– Bowel cleansing
– Observe for bowel perforation
• Abdominal distention
• Vomiting
• Increased abdominal tenderness

Front 37

Post‐op care:

Back 37

• NPO
• Routine ABC’s (axillary temps)
• Monitor colostomy..note stoma color
• Monitor bowel function
– Bowel sounds
– abdominal circumference
• NGT to intermittent suction
• Teach family ostomy care

Front 38

Telescoping of a portion of bowel
into colon
• Partial or complete bowel
obstruction.

Back 38

Intussusception

Front 39

Assessment:

Back 39

– Current jelly stools
– Sausage shaped mass in RUQ
– Child may present screaming
with legs drawn up
-– Vomiting

Front 40

Usually occurs in infant ____.

Back 40

less than 1 yr/old

Front 41

________ to reduce intussception.

Back 41

• Barium enema

Front 42

• Will see unusual anal dimpling
• Suspicion in newborn for failure to pass
meconium in 24 hrs
• Meconium appearing from perianal fistula or
in urine

Back 42

Imperforate Anus

Front 43

______ helps to diagnose

Back 43

first temp rectally

Front 44

• Protrusion of an organ through abnormal
opening
• Results in organ constriction and impaired
blood flow

Back 44

Hernias

Front 45

• Abdominal content protrude
into thoracic cavity through
an opening in the diaphragm

Back 45

Diaphragmatic Hernia

Front 46

Assessment Findings:

Back 46

• Findings depend on severity
– diminished/absent breath
sounds
– bowel sound may be heard
over chest
– Cardiac sounds may be
heard on right side of chest
– Dyspnea, cyanosis, nasal
flaring, retractions
– Sunken abdomen and
barrel chest

Front 47

• Protrusion of abdominal
structure(stomach)
through the esophageal
Hiatus

Back 47

Hiatal Hernia

Front 48

Diagnosis-
Assessment Findings:

Back 48

Fluoroscopy-
– Dysphagia
– Failure to thrive
– Vomiting
– GER

Front 49

– Manage GER symptoms Medication:

Back 49

Zantac, Prilosec

Front 50

• Soft, skin covered
protrusion of intestine
around umbilicus
• Easily reduced
• See in more in:
– Premature infants
– And African American infants
more often

Back 50

Umbilical Hernia

Front 51

Most Spontaneous closure
by _____.

Surgery only if:

Back 51

1 yr

– Causes symptoms
– Persist past 5 years
– Becomes strangulated
– Continues to grow

Front 52

• Monilial (yeast) infection of
mouth
• May or may not have
symptoms
– White coating in oral cavity
– Fussy and gassy

Back 52

Thrush

Front 53

Treatment:

Back 53

– If breast fed: treat mother
and baby
– Anti‐fungal cream to nipples
after feeding
– Nystatin orally x 7 days
– Careful hand washing to
prevent spread

Front 54

Infectious Gastroenteritis
• Cause:

Back 54

-Virus, bacteria or
parasite
– Ingest contaminated
food/water
– Person to person (most
frequent transmission)

Front 55

Big S/S of Infectious Gastroenteritis?

Back 55

Tenesmus (constant feeling of need to
pass stool)

Front 56

Pt c Infectious Gastroenteritis
Diet:

Back 56

NPO, Pedialyte 1‐3 tsp q 10‐15 minutes,
• No juices, carbonated drinks, or milk while
infectious

Front 57

• Diet when NOT dehydrated:

Back 57

– Breast Milk/Formula at full strength
– NO high fat high sugar
– Yogurt or lactobacillus supplement
-ORT

Front 58

5‐10 mL (_______/_______)every 2 minutes when vomiting.
Not vomiting offer fluids every _____.

Back 58

(pedialyte/rehydralyte)
30 minutes

Front 59

• Diet with mild to moderate
dehydration:

Back 59

– 50‐100 mL/kg over 3‐4 hrs in addition to
replacing fluid from vomiting and
diarrhea
– Once rehydrated resume regular diet

Front 60

• Blockage leads to
Inflammation & infection
of the appendix
• Bacteria in blocked
appendix multiply causing
ulceration of mucosa and
possibly rupture
• Most common reason for
surgery in childhood

Back 60

Appendicitis

Front 61

Assessment Findings:

Back 61

– Generalized abd pain
that increases in
intensity and localizes in
RLQ at McBurney’s point
– N/V
– Fever
– Anorexia
– Diarrhea or acute
constipation
– ↑ WBC

Front 62

Diagnosis:
Treatment:

Back 62

– US
– Surgical removal
(appendectomy)
– Laproscopic
– Open incision if
perforation occurs

Front 63

• Worms that live as parasites in the human
body
• They are NOT your average worm!

Back 63

Helminths Infection

Front 64

Hookworm
• Transmission:

Back 64

– Skin penetration from
direct contact with
contaminated soil

Front 65

Manifestations:

Back 65

– Dermatitis
– Anemia
– Malnutrition

Front 66

Treatment:

Back 66

– Pyrantel
– Treat Entire Family

Front 67

Pinworm
• Transmission:

Back 67

– Ingestion/inhalation
of eggs

Front 68

Manifestations:

Back 68

– Nocturnal anal itching
– Sleeplessness

Front 69

Treatment:

Back 69

– Pyrantel pamoate
– Mebendazole
– Treat entire family

Front 70

Roundworms
• Transmitted

Back 70

– Ingested Eggs from
contaminated soil or food
– Transmitted from
contaminated toys/other
vectors via fingers to mouth

Front 71

Manifestations:

Back 71

– Abdominal pain
– Abd Distention/Obstruction

Front 72

Treatment (entire family):

Back 72

– Antihelmenths
• Mebendazole
• Pyrantel pamoate

Front 73

Tapeworm
• Transmission:

Back 73

– Ingestion from handling
infected beef or pork

Front 74

Manifestations:

Back 74

– May be asymptomatic
– Segments seen in stool
– Abd pain
– Nausea
– Anorexia
– Weight loss

Front 75

• Treatment:

Back 75

– Praziquantel

Front 76

• Regurgitation of gastric
contents back into the
esophagus
• Caused by:

Back 76

Gastroesophageal Reflux (GER)
incompetent
cardiac sphincter
• Repeated episodes
damages esophageal
mucosa

Front 77

• Gastric fundus is wrapped
around the distal esaphagus

Back 77

Nissen fundoplication

Front 78

Management/Nursing Care:

Front 79

infrequent
difficult passage of dry
hard stool

Back 79

• Constipation:

Front 80

fecal soiling
or incontinence (r/t
constipation)

Back 80

• Encopresis:

Front 81

Clinical Sign of Fluid and Electrolyte Imbalance:

Back 81

MILD MODERATE SEVERE
Weight loss 3‐5% 6‐10% >10%

Front 82

General Appearance:

Back 82

Infants Fussy, thirsty, alert Fussy, restless, thirsty
Lethargic but arousable
Drowsy to comatose, Not
arousable, gray, limp, cold,
sweaty

Front 83

Older children-General Appearance:

Back 83

Thirsty, restless, alert Thirsty, restless,
postural hypotension
Apprehensive, comatose,
cold, mottled, cyanotic

Front 84

Monitoring For Shock
• Early S/S:

Back 84

– Changes in HR
– Change in sensorium
– Skin color changes

Front 85

• Late S/S:

Back 85

– Changes in BP

Front 86

Daily maintenance IVF based on weight in kg-

Back 86

– 100 ml/kg for 1st 10 kg
– 50 ml/kg for 2nd 10 kg (up to 20 kg)
– 20 ml/kg remaining of kg
– Then divide total amount by 24 hrs
– This will be the rate in ml/hr

Front 87

• Minimum urine output by age:
– Infants & Toddlers

Back 87

> 2‐3 mL/kg/hr

Front 88

– Preschoolers & Young school age

Back 88

> 1‐2 mL/kg/hr

Front 89

– School Age & Adolescents

Back 89

0.5‐1mL/kg/hr

Front 90

Weigh diapers
1 gram=

Back 90

1 mL

Front 91

Management/Nursing Care of Poisoning/Foreign Bodies:

Back 91

• Assess victim
• Terminate exposure
• Identify poison
• Call poison control
• Remove poison/Prevent absorption
– Syrup of Ipecac (if indicated by poison control)

Front 92

Do not induce vomiting if...

Back 92

patient has absent
gag reflex Or if poison is corrosive.

Front 93

-Place child in ___ position.
-Administer....

Back 93

side‐lying, sitting or kneeling
position

activated charcoal with cathartic
usual dose 1gm/kg

Front 94

• Persistent abdominal pain characterized by:
– loud crying
– drawing up legs to abdomen
– lasting greater than 3 hrs.

Back 94

Colic

Front 95

• Possible causes:

Back 95

– Too rapid feeding, excessive air
– Overeating, milk allergy
– Parental tension, or smoking

Front 96

Medications:

Back 96

Simethicone