Nur 125 Peds Test 2: Gi & Respitory

Front 1

Your patient weighs 13 pounds 3 ounces. What is the volume required for 24 hour fluid maintenance?

Back 1

600 ml

Front 2

Your patient weighs 35 pounds 4 ounces. What is the volume required for 24 hour fluid maintenance?

Back 2

1300 ml

Front 3

Your patient weighs 66 kg. What is the volume required for 24 hour fluid maintenance?

Back 3

1960 ml

Front 4

List 5 (or more) assessments that would be performed to diagnose dehydration in an infant.

Back 4

Assess:
Skin (color, warmth, turgor)
capillary refill
heart rate
blood pressure
peripheral pulses
fontanels
mucous membranes
presence of tears when crying
weight loss
intake and output
serum electrolyte results
urine specific gravity (older child)
LOC
(p. 733)

Front 5

Dehydration is classified as mild when weight loss is less than ______%, moderate if the weight loss is between _____% and _____%, and severe if the weight loss is greater than ____%.

Back 5

mild < 5%
moderate 5% - 10%
severe > 10%
p.730)

Front 6

What is the first choice for treatment for mild dehydration in children?

Back 6

Oral rehydration therapy such as Pedialyte (p.732)

Front 7

What treatment is used for severe dehydration or when vomiting is uncontrollable?

Back 7

IV therapy (p. 732)

Front 8

What type of dehydration is most common in children?

Back 8

Isotonic dehydration

Front 9

True or False? Potassium should not be added to IV if child is not voiding at least 1mL/kg/hr.

Back 9

True

Front 10

Why should caffeinated soda not be given to a dehydrated child?

Back 10

Caffeine is a diuretic which will worsen the dehydration

Front 11

True or False? Because the BRATT diet is low in calories, fat, and protein, its use is recommended for children who are dehydrated.

Back 11

False

Front 12

True or False: Stomach emptying time decreases as the child gets older.

Back 12

False

Front 13

True or False: Peristalsis is greater in an infant than in an older child

Back 13

True

Front 14

True or False: Infants are deficient in some digestive enzymes until 4-6 months of age.

Back 14

True

Front 15

True or False: Stomach capacity is 10-20 mL at birth and is about 200 mL by one month

Back 15

True

Front 16

GER

Back 16

-GER in infants usually improves by 6-12 months of age
-GER occurs 3 times more frequently in boys than girls
-Inappropriate relaxation of the lower esophageal sphincter allows gastric contents to return into the esophagus
(pg 1118)

Front 17

True or False? The best position to place an infant with GER is sitting in an infant seat.

Back 17

False
Sitting position increases reflux.
Prone position is best (only while awake)
(p. 1120)

Front 18

List 4 ways that GER is treated.

Back 18

-Small, frequent feedings, (thickened with rice)
-Positioning (prone)
-Medications (Zantac, Prilosec,Tagamet, Reglan)
-Surgery (Nissen fundoplication – fundus wrapped & sutured around esophagus)
(p. 1120)

Front 19

HPS
(hypertrophic pyloric stenosis)

Back 19

-Hypertrophy of the muscles of the pyloric sphincter cause the opening from the stomach to the intestines to narrow, prevents emptying of gastric contents into duogenum, therefore causing an obstruction.
-occurs more boys than girls
-Exact cause is not known; environmental factors, allergies, genetic predisposition suspected.
-Spitting/vomiting usually develop 2nd/3rd weeks of life
-projectile vomiting develops
-may have palpable olive-shaped mass

Front 20

True or False? Vomiting from GER usually contains bile.

Back 20

False

Front 21

What is the main concern with HPS?

Back 21

Dehydration

Front 22

Diagnosis of HPS can sometimes be made by palpation. Where would you palpate, and what would the obstruction feel like?

Back 22

Palpate the epigastric area, above and to the right of the umbilicus (right upper quadrant).
The obstruction will feel like an olive-shaped mass.
(p. 1104)

Front 23

Besides palpation, list two other methods used to diagnose HPS.

Back 23

Ultrasound (most common)
Upper GI series
(p. 1104)

Front 24

True or False? Vomit containing bile, and small bowel movements are signs of HPS?

Back 24

False
Bowel movements will be small, but vomit will not contain bile.

Front 25

True or False? Surgery is the preferred treatment for HPS.

Back 25

True
(p. 1106)

Front 26

Nursing care for children with cleft lip or cleft palate preoperatively focuses on caregiver support, preventing aspiration and infection, and ensuring adequate nutrition. What is ESSR?

Back 26

ESSR is a method used to ensure adequate nutrition from bottle feeding.
E = Enlarge (opening of nipple)
S = Stimulate (rub nipple on lower lip)
S = Swallow
R = Rest

Front 27

After cleft lip repair, an infant should be placed on their backs and arm restraints are often used. Why?

Back 27

After surgery, protection of the operative site is required.
Placing the infant on their back prevents them from rubbing their face against anything.
Arm restraints prevent them from pulling at sutures.
(p. 1094)

Front 28

True or False? Cleft palate repair is usually not done until the child is 12-18 months old and is able to drink from a cup.

Back 28

False
Lip Repair 6-12 wks
Palate repair 6-18 months
Varies by surgeon
palate repair done early to protect formation of tooth buds, infant develops more normal speech pattern, decreases adverse effects

Front 29

Telescoping of one portion of the intestine into another is called _____.

Back 29

Intussusception
(p. 1107)

Front 30

Intussusception

Back 30

-Occurs most frequently in 3mon-6yr old boys and has a sudden onset.
-A sausage-shaped mass may be palpable in the right upper quadrant.
-Intussusception is a medical emergency; If untreated, it can lead to necrosis, perforation, and death.

Front 31

True or False? Ribbon-like stools are a characteristic symptom of intussusception.

Back 31

False
"Red jelly currant stools" are a sign of intussusception
(ribbon stools are Hirschsprung's)
(p. 1108)

Front 32

What is the treatment of choice for Intussusception?

Back 32

-non-surgical hydrostatic reduction using barium or air enema (barium or air being forced through the bowels causes the telescoped section of the intestine to return to its correct position)
(p. 1109)

Front 33

Caregivers for a child who has been treated for Intussusception should be taught by the nurse to watch for signs of intestinal obstruction and recurrence.
What are some of the signs they should watch for?

Back 33

-Increasing abdominal pain
-Abdominal distention
-Blood in stools
-Bile stained vomiting (occurs in later phases)
-Decreased or absent stools

Front 34

Hirschsprung's Disease

Back 34

-congenital aganglionic megacolon
-Caused by the absence of parasympathetic nervous system ganglion cells in large intestine, which prevents peristalsis
-no peristalisis = mechanical obstruction
-Associated with Down syndrome
-Dilation (hypertrophy) of the normal section of the bowel occurs proximal to the defect (before the defect, not after it)

Front 35

What are the primary manifestations of Hirschsprung’s Disease in the newborn?

Back 35

-Failure to pass meconium within 24-48 hours of birth
-Abdominal distention
-Bile stained vomitus
-Refusal to feed
-Intestinal obstruction
-ribbon stools or pellet-like
-palpable fecal mass
-failure to thrive
(p. 1126)

Front 36

True or False? A sign of Hirschsprung’s disease in children is red jelly-like stools

Back 36

False
Stools may be pellet shaped or ribbon-like
(red jelly stools are intussusception)
(p. 1126)

Front 37

What is the number one cause of death related to Hirschsprung’s Disease?

Back 37

Enterocolitis (Inflammation of the small intestine and colon that progresses rapidly leading to perforation of the bowel and sepsis)
(p.1126)

Front 38

True or False? Children are at greater risk for perforation (rupture) of the appendix because the walls of their appendix are thinner than adults

Back 38

True

Front 39

What are some of the signs and symptoms of appendicitis?

Back 39

-Abdominal pain that begins around the umbilicus and moves to the right lower quadrant
-anorexia
-Nausea & Vomiting
-Normal or slightly elevated temperature (<101°)
-WBC may be elevated
(p. 1135)

Front 40

True or False? Nausea and vomiting that precedes abdominal pain often indicates appendicitis.

Back 40

False
With appendicitis, pain almost always precedes anorexia, nausea, and vomiting.
If the nausea and vomiting occurs before the pain, the cause is usually gastroenteritis

Front 41

Celiac disease is a malabsorption syndrome due to intolerance of gluten. Where is gluten found?

Back 41

Gluten is a protein found in: BROW
barley
rye
oats (in US b/c processed on wheat machinery)
wheat

Front 42

What is steatorrhea?

Back 42

Steatorrhea is large amounts of unabsorbed fats being excreted in the stools, and is one of the signs of Celiac Disease.

Front 43

True or False? Physiological factors that increase the risk for respiratory problems in children include small airways, fewer alveoli, and increased chest compliance.

Back 43

True

Front 44

Inward movement of the soft tissues of the chest wall during inspiration is called _________.

Back 44

Retractions

Front 45

True or False? Because a child has smaller airways than adults, the child’s metabolic and oxygen needs are much less than the adult.

Back 45

False
Oxygen consumption is much higher for a child because of increased basal metabolic rate

Front 46

True or False? Inadequate dental hygiene can make children prone to tonsillitis.

Back 46

False

Front 47

True or False? Second hand smoke and pacifier have been linked with otitis media

Back 47

True

Front 48

Why are children under 3 years old more vulnerable to otitis media?

Back 48

Their Eustachian tubes are shorter, wider, and straighter, and more horizontal than those of older children and adults.

Front 49

The primary complication from otitis media is conductive hearing loss and related speech problems. List two less common complications of otitis media.

Back 49

Meningitis and Septicemia

Front 50

_____ is a high pitched wheeze produced by a high obstruction (obstruction of the trachea or larynx) that can be heard during inspiration and/or expiration.

Back 50

Stridor
(str-high-dor = high obstruction)

Front 51

__________ are adventitious lung sounds caused by the passage of air through fluid or moisture.

Back 51

Crackles (also called rales)
(snap, crackle, pop - has to pass through milk/fluid)

Front 52

__________ are the sounds heard when air passes through narrowed passages and can be heard in children with lower airway obstruction.

Back 52

Wheezes
(wheeze has a 'z' - low in the alphabit = low in airway)

Front 53

Acute Epigiottitis

Back 53

-a life-threatening bacterial infection
-causes inflammation of tissue around epiglottitis
-can lead to complete airway obstruction
-It is sometimes classified as a croup syndrome
-Children often assume a “tripod” position to assist with breathing
-Life Threatening!
-depressing the tongue is contraindicated (may cause complete airway obstruction)
-most common ages 2-7

Front 54

How is laryngotracheobronchitis (LTB) different from epigottitis?

Back 54

LTB is a viral infection.
Epiglottitis is a bacterial infection.
LTB will have a hoarse barking cough.
Usually no cough is present with Epiglottitis (may hear stridor)
LTB is not a life-threatening emergeny.
Epigottitis is a life-threatening emergency.

Front 55

Bronchiolitis is an acute infection of the bronchioles. What is the most common cause of Bronchiolitis?

Back 55

RSV (Respiratory Syncytial Virus)

Front 56

_________ _________ is an exocrine gland dysfunction characterized by abnormal levels of sodium and chloride (“salty tasting babies”) and extremely thick mucous secretions that damages many of the body’s systems, and eventually leads to death.

Back 56

Cystic Fibrosis

Front 57

True or False? Children with Cystic Fibrosis are at increased risk for pulmonary colonization of bacteria that release toxins and cause inflammation in the airway.

Back 57

True

Front 58

True or False? Males with Cystic Fibrosis are almost always sterile.

Back 58

True

Front 59

Name the most common diagnostic test used to diagnose CF

Back 59

Sweat chloride test

Front 60

What are some of the clinical manifestations of CF?

Back 60

Chronic respiratory infections (cough, sputum production)
Pneumothorax
Hemoptysis (coughing up blood)
Clubbing of the nails
Insulin deficiency
Steatorrhea
Vitamin deficiencies (fat soluble vitamins K A D E)

Front 61

________ is the most common pediatric chronic illness, and is characterized by chronic inflammation, bronchoconstriction and bronchial hyperresponsiveness.

Back 61

Asthma

Front 62

Expiratory wheezing is a classic manifestation of asthma. What are some other manifestations?

Back 62

Chronic cough
Dyspnea (shortness of breath)
Wheezing
Recurrent chest tightness
intercostal retractions
Tachypnea & labored breathing
Chest pain
Irritability
Restlessness
Use of accessory muscles
Nasal flaring
head bobbing(young children)
pulsus paradoxus
Tired b/c of effort to breath
Orthopnea (difficulty breathing when lying flat)
-in severe cases Diaphoresis, Cyanosis, Pallor, and Growth and development retardation

Front 63

What does a peak flow meter do?

Back 63

-helps identify when obstruction occurs
-measures peak expiratory flow rates (the fastest speed at which air is forced from the lungs during expiration)
-measured in liters per minute
-helpful in determining the extent of a child’s asthma

Front 64

Transmitted by contaminated poultry & pets, especially turtles & reptiles

Back 64

Salmonella
(salmonella sounds like salamander, a reptile)

Front 65

Most common cause of nosocomial & community outbreaks of gastroenteritis in children 6 months to 2 years

Back 65

Rotavirus

Front 66

Associated with undercooked hamburger as well as interpersonal transmission

Back 66

E. Coli

Front 67

Surgical repair usually considered only when medical therapy fails

Back 67

Gastroesophageal Reflux
(GER)

Front 68

Abdominal circumference often measured along with vital signs to monitor abdominal distention

Back 68

Hirschsprung & Intussusception

Front 69

Projectile vomiting develops within 4-6 wks after birth

Back 69

Pyloric Stenosis

Front 70

Olive-shaped mass palpable in RUQ

Back 70

Pyloric Stenosis

Front 71

Symptoms associated with variations in lower esophageal sphincter pressure such as occurs with gastric distention, delayed gastric emptying.

Back 71

Gastroesophageal Reflux

Front 72

Also called congenital ananglionic megacolon

Back 72

Hirschsprung Disease

Front 73

Physical Factors to incorporate in an assessment of fluid volume deficit for an infant with possible dehydration

Back 73

weigh child (& calculate loss)
measure I&O
review urine specific gravity
LOC
pulse rate & quality
skin turgor
mucous membranes
resp rate & quality
BP
thirst
fontanel
capillary refill

Front 74

Side effects of increased sodium (Hypernatremia)

Back 74

thirst
decreased LOC:
confusion
lethargy
coma
seizures

Front 75

Side effects of decreased sodium (Hyponatremia)

Back 75

(normally, more Na outside cell - a decrease causes fluid to shift to inside the cells)
Muscle Weakness
Cerebral Edema (cells swell)(headache)
Seizures
Also:
anorexia
decreased LOC:
lethargy
confusion
coma

Front 76

Tonsillitis
Definition

Back 76

Infection or inflammation of palatine tonsils (hypertrophy)

Front 77

Causes of Tonsillitis

Back 77

Group A Beta hemolytic strep
-bacterial
-or viral

Front 78

Signs & Symptoms of Tonsillitis

Back 78

- Frequent sore throat infections (5x in 1yr)
-problems breathing
-problems swallowing
-Redness
-enlargement of cervical lymph nodes

Front 79

Treatment of Tonsillitis

Back 79

Antibiotics, analgesics, antipyretics, rest
Surgical: focus on care r/t fluid

Front 80

Why are children are at risk for Tonsillitis?

Back 80

-large amount of lymphoid tissue in pharyngeal cavity
-Tend to have URI
-around other children that are infected
-immature immune sx more seceptible to a mo invasion
-hand mouth activity

Front 81

Post Op Care for Tonsillitis

Back 81

. Monitor bleeding of site & frequent swallowing (primary concern b/c of risk for hemorrhage)*Call Dr ASAP
2. FVD r/t ↓ intake b/c of throat pain when swallowing
3. Pain Level
4. Infection
-Position on abdomen or side for drainage of secretions
-once fully awake child can sit up
-suctioning done gently, prn
-Remind child NOT to cough or blow nose

Front 82

Tonsillitis:
"Don'ts" after surgery

Back 82

- avoid red/brown liquids/foods they interfere w/assessment of bleeding
-no straws
-no spicy foods
-no citrus beverages
-no ibuprofen
-no vigorous exercise for 1st wk

Front 83

Tonsillitis:
"Dos" after surgery

Back 83

-drink cool fluid
-chew gum
-Tylenol elixir
-ice collar
-eat soft foods

Front 84

What are some causes of Acute Otitis Media
(AOM)

Back 84

Most common causative organisms are:
-H. flu
-S. pneumonia
RTI’s cause swelling of Eustachian tube mucus membranes
-Enlarged Adenoids obstruct the E. tubes
-Pacifier use raises soft palate & organ-isms enter easier
-Breathing in second hand smoke dries the E. tubes out & increase risk for infection
-Peak incidence is for children 6-12 months old
-Upper respiratory infection often precedes OM

Front 85

Acute Otitis Media
(AOM)
Definition

Back 85

-Middle Ear Bacterial Infection or inflammation in middle ear from pathogens transferred from the nasopharynx
-Bulging or ↓ mobility of tympanic membrane

Front 86

Acute Otitis Media
(AOM)
Signs & Symptoms

Back 86

-Red tympanic membrane
-ear pain & fever
-anorexia
-enlarged lymph nodes
-hearing loss
-tug on ear, drainage on pillow
-fussy, irritable, tired
-diarrhea & vomiting

Front 87

Acute Otitis Media
(AOM)
Treatment

Back 87

Tx with Tylenol, motrin or after 48-72hr try antibiotics.

Front 88

Acute Otitis Media
(AOM)
At risk groups

Back 88

-6mo to 1 yr
-daycare kids
-kids with allergies
-bottle propped when in bed
-exposure to cig. smoke (dries tubes out)

Front 89

Otitis Media w/Effusion
(OME)
Definition

Back 89

Collection of fluid in the middle ear behind the tympanic membrane
-NOT INFECTED W/BACTERIA
-NO INFLAMMATION

Front 90

Otitis Media w/Effusion
(OME)
Treatment

Back 90

-Can be chronic >3mo
-Associated with HEARING LOSS
- >4mo: myringotomy w/ tympanostomy tubes recommended (incision in eardrum)
-careful observation of hearing acuity development assessment

Front 91

Epiglottitis
Causes

Back 91

-Staph
-Strep
**HIB**
RAPID ACUTE ILLNESS (PT GOES TO OR & INTABATED)
-Don’t stick anything ↓ throat in a pt with epiglottitis

Front 92

Epiglottitis
Treatment

Back 92

EMERGENCY!!! Keep child calm
-First take child to OR, intubate to maintain airway
-then MD can culture subglottic tissue in OR
-*Culture is done after endotracheal tube has been inserted and child is stabilized
-Start antibiotics before cultures back! May have to change type
-ALERT: Avoid throat cultures and inspection with tongue blades: Laryngospasm!!! Can irritate area and swell & cause airway obstruction
-fluids
-supportive care
-equipment on hand for emergency tracheotomy
-maintain adequate staffing (PICU)
-Secure airway
-oxygenate
-prophylactic Rifampin to family members

Front 93

Croup

Back 93

-Starts as RTI (present late fall, early winter)
-common for 6mo - 6yr
-lasts 4 days
-barking cough
-acute edema of laryngeal & subglottic area
-epiglottis & trachea swells

Front 94

Acute Spasmodic Laryngitis
(Spasmodic Croup)

Back 94

-The Good – Less serious
-3mo–3yr (don’t get after 3yrs of age)
-Viral
-Sudden onset
-Peaks at night, resolves by morning, Midnight or twilight croup

Front 95

Acute Spasmodic Laryngitis
(Spasmodic Croup)
Major Symptoms

Back 95

-URI
-No fever
-mild resp. distress
-croupy cough
-stridor
-dyspnea
-restlessness
-symptoms will waken child and disappear during the day

Front 96

Acute Spasmodic Laryngitis
(Spasmodic Croup)
Management

Back 96

-Cool fluids
-cool air
-position upright
-Meds: None
*associated with allergies

Front 97

Acute Laryngotracheo Bronchitis
(LTB)
Major Symptoms

Back 97

URI progresses to:
-stridor
-barking cough
-hoarseness
-low grade fever
-Dyspnea
-restlessness
-irritability
-labored Resp

Front 98

Steroids helpful with Croup

Back 98

-Oral:
Dexamethasone
prednisone (can crush tablets and use in jelly or applesauce)
-Nebulized:
Budesonide (Pulmicort respules)
-IV:
Solumedrol (real serious cases)

Front 99

Bronchiolitis
(RSV) Resp Syncytial Virus
Description

Back 99

-Viral or bacterial inflammation of the bronchioles (*virus invades mucous cells of small bronchioles, cells die/clump together & clog airway)
-95% have this by Age 3
-Peak age 2-6mo
-125,000 admits
-4,500 death/yr (babies <6mo)

Front 100

What causes Bronchiolitis?

Back 100

RSV is the most common cause Bronchiloitis
-transmitted by direct contact with resp secretions/contamin.surfaces (12hr)
-kids with serious illness at risk, lungs scar don’t heal
-common in winter months Nov-Mar

Front 101

Bronchiolitis
(RSV) Resp Syncytial Virus
Signs & Symptoms

Back 101

-URI
-stuffiness
-cough
-fever
-progressing to lower resp tract
-symptoms ↑ to rhinitis
-low grade fever
-wheezing
-labored breathing
Severe cases:
-Rapid, shallow respirations
-nasal flaring
-marked retractions
-crackles &/or rhonchi
-cyanosis and ↓ breath sounds

Front 102

Bronchiolitis
(RSV) Resp Syncytial Virus
Treatment

Back 102

For RSV:
-Isolate
–contact precautions
-Oxygen
-Hydration
-Meds
-humidified ox (thins mucous out)
-IV or oral fluids
-Value of steroids
Best MEDS
-Racemic Epi (bronchodilator)
-Bronchidialtor (neb route used)
-Postural drainage & CPT
LIFE THREATHENING RSV
–Ribavirin (only used in ICU)

Test Question
1st use Bronchodialter
2nd use chest PT
*need to open lungs/airways to allow secretions to be able to come up
*Goal is to loosen secretions
Labs: ELIZA, Assay, chest xray

Front 103

Bronchiolitis
(RSV) Resp Syncytial Virus
Prevention

Back 103

Monocional antibody SYNAGIS
-used to prevent RSV
- given to HR kids by IM during peak RSV months
-BEST PREVENTON HAND WASHING

Front 104

Rhonchi

Back 104

Coarse low pitched sounds
Thick secretions w/respiratory illness
lower airway

Front 105

Crackles (rales)

Back 105

High pitched popping sound during inspiration
-Hair rubbing noise (aveoli pop open)
-Thin watery secretions
-A lot of fluid in lungs
-audible in children with bronchiolitis
-lower airway

Front 106

Wheezes

Back 106

-High pitched musical sound
-Narrowing of airways
-Bronchoconstriction of soft tissue swelling
-lower airway

Front 107

Stridor

Back 107

-high pitch, seal like barking cough & hoarseness
-Narrowed airway around trachea & larynx
-upper airway obstruction
1. croup
2. partial foreign body obstruction
3. Extubated (had an intubation tube for awhile)

Front 108

Asthma
Cause

Back 108

Exposure to a trigger causes: Inflammation which causes:
1. airway bronchoconstriction
2. airway soft tissue swelling
3. mucus production
-Airway remodeling: chronic Inflammatory ▲’s w/ smooth Muscle hypertrophy, thickening of membranes

Front 109

Common Triggers of Asthma

Back 109

-exercise
-infections
-allergens (mold, dust, pollen furry pets, birds, cockroach droppings)
-fragrances
-food additives
-pollutants(2nd hand smoke, weather changes)
-emotions
-anxiety

Front 110

Asthma
Medications

Back 110

Short Acting Beta Agonists Bronchodilators (given 1st)
-Albuterol (oral or neb)
-Xopenex (neb) NO ↑ HR
Anticholingerics: Inhibits bronchoconstriction & ↓ mucus production
-Atrovent
Corticosteroids: diminish airway Inflammation & obstruction, enhance effects of beta agonists
-Prednisone (po)
-Prednisolone (po)
-Methylprednisolone (IV) Acute Asthma:
1st drug given is Short Acting Bronchodilator

Front 111

Asthma
Treatment

Back 111

Medications:
-directly to lungs, less SE
Hydration (oral or IV fluids)
Education
Support of parents/children
*GOAL IS ASTHMA CONTROL
*bronchodilators SE
-elevated HR, but will ↓ in 30min

Front 112

Determine daily maintenance fluid requirements for a child based on weight

Back 112

-1st 10 kg: maintenance 100 mL of fluid/kg -2nd 10 kg: maintenance 50 mL of fluid/kg -For remaining kgs, maintenance is 10 mL of fluid/kg -Remember this is maintenance only, if infant/child is dehydrated, a bolus of fluid will be need to restore fluid & electrolyte levels, & then maintenance can begin

Front 113

Risk for fluid volume deficit r/t ...

Back 113

-Fever
-Failure to drink enough fluid
-NPO status
-Overuse of diuretics or enemas
-NG suctioning
-Vomiting / diarrhea
-Dehydration
-Increased respirations
-Hemorrhage

Front 114

Clinical Manifestation of MILD Dehydration

Back 114

- <5% loss of body wt
-pale, cool skin
-decreased skin turgor
-flat anterior fontanel
-slight thirst
-tears present
-normal/dry mucous membranes
-normal/slightly increased pulse
-BP normal
-decreased urine output

Front 115

Clinical Manifestation of Moderate Dehydration

Back 115

-5-10% loss of body wt
-dusky grayish skin
-decreased skin turgor
-depressed anterior fontanel
-moderate thirst
-decreased tears
-dry & sticky mucous membranes
-increased weak pulse
-decreased BP (NOT a reliable indicator)
-oliguria (little output)

Front 116

Clinical Manifestation of Severe Dehydration

Back 116

- >10% body wt loss
-mottled skin
-markedly decreased skin turgor
- very sunken fontanel
- intense thirst
-no tears
-parched, cracked mucous membranes
-rapid thready pulse
-low BP
-axotemia (no urine output)
-lethargic

Front 117

Why is K+ not administered in IV fluid until pt voids?

Back 117

-kidneys are responsible for excreting K+. -If the pt has not voided, we don’t know if the kidneys are working properly, & infusion of K+ prior to voiding may cause hyperkalemia, which is a serious problem (more serious than hypokalemia)

Front 118

Common causes of diarrhea

Back 118

-viruses (rotavirus, Norwalk, Adenovirus)
-bacteria (shigella, salmonella, E. coli, Colstridium dif., campylobacter)
-parasites (giardia,cryptosporidium)

Front 119

Rotavirus

Back 119

a virus that destroys/damages epithelial cells in intestinal lining -usually self limiting -MOST COMMON CAUSE OF GASTERENTERITIS in children < 2 yo -occurs in winter months -transmitted fecal-oral route -wash hands

Front 120

Shigella

Back 120

-spread person-person or by ingestion of contaminated food -prevention will require proper food handling techniques

Front 121

Salmonella

Back 121

-transmitted via contact w/ infected animals & food products (pet turtles, hamsters, cats, dogs, poultry, eggs, and milk)
-prevention: don’t eat raw foods (eggs)
-do not contaminate raw fruits & veggies w/ poultry, etc.
-always wash hands after contact w/ animal feces
-always wash hands after handling reptiles, as they are particularly prone to carry salmonella

Front 122

E. Coli

Back 122

-found in uncooked meat (esp. hamburger) -separate raw meat from ready to eat foods -wash hands counters & utensils w/ hot soapy water after they touch raw meat -drink pasteurized milk, juice, cider -wash fruits & vegetables thoroughly -alfalfa sprouts & seeds may not be decontaminated -drink only treated water (not out of streams, lakes or swimming pool)

Front 123

What is Oral Rehydration Therapy (ORT)

Back 123

-the treatment of choice for children w/ mild or moderate dehydration
-The solution should contain glucose, sodium, potassium & bicarbonate
-Pedialyte, Lytren, Infalyte and Resol are commercially available
-Popular liquids such as soft drinks, fruit juices, broth, & athletic drinks, Gatorade, Powerade should NOT be used for rehydration
-Homemade solutions can be made per WHO recipie

Front 124

ORT for mild dehydration

Back 124

-give 50 ml/kg ORS in 4 hours -replace each loss from diarrhea w/ an additional 10 ml/kg & reassess q 2 hrs. -resume foods, esp. CHO, avoid fats & simple sugars

Front 125

ORT for moderate dehydration

Back 125

-give 100 ml/kg ORS -replace losses over 4 – 6 hrs -replace each loss from diarrhea & vomit w/ an additional 10 ml/kg -reassess hourly, treat in supervised setting

Front 126

Is ORT appropriate for severe dehydration?

Back 126

NO

Front 127

What is ENCOPRESIS?

Back 127

-Constipation with fecal soiling
-More chronic & serious form of constipation
-Watery colonic contents leak around the hard fecal masses and pass through the rectum
-Condition often confused with diarrhea.

Front 128

What is CONSTIPATION?

Back 128

-the difficult passage of stool or infrequent passage of hard stool, associated with straining, abdominal pain, or withholding

Front 129

Hirschsprung’s Disease Therapeutic Management

Back 129

-surgical treatment: aganglionic segment is resected or removed & normal bowel is anastomosed to the rectum
-May be done between 6-15 mos. of age or wt of 18-20 lbs. (can be a 1 or 2-step procedure if temporary colostomy is created)
-laparoscopic-assisted pull-through: enter body through anus & pull affected segment of bowel through the opening (no major abdominal surgery, & fewer complications)

Front 130

Hirschsprung’s Disease Nursing Care

Back 130

Pre-op:
-assess fluid & electrolyte status
-last BM & clean bowels (enemas)
-NPO
-NG tube
-IV fluids & electrolytes to prevent dehydration
-oral & IV antibiotics
-wt
-vital signs
-lab work
Post-op:
-maintain patency of NG tube
-monitor BS & for distention
-colostomy care

Front 131

Intussusception Pathophysiology

Back 131

-An obstructive disorder that occurs when one segment of bowel telescopes into the lumen of an adjacent segment of intestine
-The walls of the bowel press against each other & compromise blood & lymph flow, leading to inflammation, edema, & bleeding
-causes blood & mucus in stool ( “currant jelly”)
-Complete bowel obstruction develops, causing abdominal distention & vomiting
-May lead to necrosis & perforation, even death if untreated
-Occurs most often at ileocecal valve.

Front 132

Intussusception Diagnostic evaluation

Back 132

-sudden onset of acute abdominal pain, colic
-Ultrasound: reliable & least invasive
-Barium or air contrast enema
-Abdominal X-ray will identify free air in abdomen. (Ruptured bowel)
-Surgery required if perforated, have peritonitis, or hydrostatic reduction not successful

Front 133

Intussusception Treatment

Back 133

-hydrostatic reduction with barium, water-soluble contrast, or air enema (less risk of perforation) -Surgery if evidence of perforation, peritonitis, or if hydrostatic reduction is not successful.

Front 134

Intussusception Nursing Management

Back 134

Pre-op:
-NPO
-NG tube
-IV fluids
-monitor v/s for changes
-assess abdominal pain
-examine & record all stools
Post-op:
-observe passage of stool & barium
-monitor for recurrence of intussusception

Front 135

Gastroesophageal Reflux Pathophysiology

Back 135

-reflux of stomach contents into the esophagus due to inappropriate relaxation of the lower esophageal sphincter
-most common GI disorder in infants, esp. premies & those with neuro issues.

Front 136

Gastroesophageal Reflux Signs & symptoms

Back 136

-vomiting
-regurgitation of undigested formula & mucus
-irritability & crying (from reflux = pain)
-difficulty feeding, food avoidance & malnutrition
-occult blood loss (esophagitis causes bleeding whic will be brown in stool from being digested)
-respiratory distress (aspiration)

Front 137

Gastroesophageal Reflux Diagnostic evaluation

Back 137

-Clinical history & physical exam
-Upper GI to detect anatomical abnormalities
-Endoscopy to visualize esophagus
-18-24 hr esophageal pH probe study(only used with challenging cases due to high cost)

Front 138

Gastroesophageal Reflux Treatment

Back 138

-Dietary modifications: small, frequent, thickened feedings (rice in formula)
-positioning therapy (flat prone or elevated prone)
-Medications:
Prokinetic Agents:
(Propulsid, raglan)
H2 Receptor Antagonists
(Zantac, Tagamet)
Proton-pump Inhibitors
(Prilosec)
-Surgery: Nissen Fundoplication- tightening of the LES

Front 139

Gastroesophageal Reflux Nursing Management

Back 139

-in-depth assessment of feeding pattern, positioning with feeding, & burping frequency
-obtain height, weight, & head circumference (plot on growth chart to assess growth problems)
-assess baseline respiratory status (Breath sounds, RR, effort), due to increased risk for aspiration
-educate caregiver (dietary modification, positioning, med. admin., & developmental needs of infant (and on surgery if performed)

Front 140

Pyloric Stenosis Signs & symptoms

Back 140

-spitting/vomiting @ 2-3 wks of age & later becomes projectile
-acts hungry & eats again immediately after vomiting
-poor wt. gain, or wt. loss
-dehydrated
-irritable & lethargic
-may lead to metabolic alkalosis

Front 141

Pyloric Stenosis Diagnostic evaluation

Back 141

-History & physical palpation of olive-shaped mass in epigastrum, above & to the right of umbilicus
-upper GI
-Abdominal ultrasound (highly accurate)

Front 142

Pyloric Stenosis Treatment

Back 142

-surgery: pyloromyotomy (Fredet-Ramstedt procedure)
-has high success rate & is considered curative

Front 143

Pyloric Stenosis Nursing Management

Back 143

Pre-op:
-NPO
-assess hydration status (fontanels, tears, m/m, turgor, wt. compared to birth wt.)
-strict I & O
-bowel sounds
-observe for pain & discomfort
-NG tube
Post-op:
-maintain fluid balance
-admin analgesics
-monitor incision site for infection
-admin IV fluids until full feedings are tolerated
-strict I & O
-pain assessment

Front 144

Assessment of appendicitis

Back 144

-pain (location, onset and intensity)
-changes in behavior (refusing to play & decreased appetite)
-vomiting
-relief from pain if perforated (followed by increased intensity, abdominal distention, guarding, decreased or absent bowel sounds, elevated temp and shock-like symptoms)

Front 145

Preop assessment of appendicitis

Back 145

-NPO
-IV to replenish fluids (electrolyte balance)
-pain meds

Front 146

Postop care of appendicitis

Back 146

-administer antibiotics x 24 hrs
-promote comfort (meds, diversion)
-maintain intake (IV, then DAT)
-Prevent atelectasis (TCDB, walk/play)
-prevent infection or recognize early

Front 147

Perforated appendicitis

Back 147

-drains from incision site or site open to heal by secondary intention
-IV antibiotics x 7-10 days
-NPO
-NG tube suction
-IV fluids
-pain meds

Front 148

Associated problems which may occur even with good anatomic closure of cleft-lip & cleft palate

Back 148

-feeding problems
-speech development problems
-dental problems
-ear & hearing loss problems
-developmental problems

Front 149

Preop care & associated problems for the child with cleft-lip & cleft palate

Back 149

-provide support for caregiver
-preventing aspiration & infection
-ensuring adequate nutrition
-Recognize that shock, anger, guilt, frustration and depression normal for caregiver
-demonstrate acceptance of the baby & encourage holding/touch
-show before/after photos of successful surgeries
-teach feeding problems such as poor suction, prolonged feeding time, nasal regurgitation & inadequate weight gain

Front 150

Postop care & associated problems for the child with cleft-lip & cleft palate

Back 150

-Major emphasis is protection of the operative area
-Metal strip (Logan Bow) applied to upper lip & taped to cheeks to prevent tension on suture line
-Infant on back or side with arm or elbow restraints to prevent touching or pulling site
-Administer adequate pain medication
-Team approach to follow up care (plastic surgeon, speech therapist, etc.)

Front 151

Signs & Symptoms of Celiac Disease

Back 151

-irritability
-listlessness
-weight loss
-abdominal bloating
-pain
-diarrhea
-unexplained anemia
-failure to thrive
-muscle wasting
-delayed puberty or menses
-in adulthood is associated with thyroid disease, diabetes & osteoporosis.

Front 152

What are the developmental variations that increase the pediatric populations’ risk for acquiring a respiratory systems dysfunction?

Back 152

-Small airways
-fewer alveoli
-increased chest compliance
-Higher metabolic demands that require more oxygen

Front 153

Pediatric Differences in Airway

Back 153

-Small airway: trachea & lower airway 1/3 to 1/2 of the adult’s airway
-Small change significantly increase airway resistance
-fewer alveoli for gas exchange
-greater compliance/flexibility of chest wall in infants (distress may cause retractions)
-increased basal metabolic rate (increases O2 needs)

Front 154

The infants alveoli

Back 154

-an infant has a more limited alveolar surface for gas exchange, in relation to height & weight. -By 3-8 yrs, they will have almost the same of the adult.

Front 155

Higher metabolic demands of the infant

Back 155

-require more oxygen with limited oxygen stores
-leads the infants or younger children to get hypoxic quickly and develop respiratory distress.

Front 156

Prevention measures for the child with otitis media

Back 156

-Minimize exposure to second-hand smoke (irritates the Eustachian tube)
-Feeding practices: NO horizontal positioning during bottle feedings b/c this allows formula to trickle into Eustachian tube
-Immunizations

Front 157

What are the complications of otitis media?

Back 157

-conductive hearing loss -related speech problems (less common complications include abscess formation in the tissues adjacent to the middle ear, meningitis, and septicemia)

Front 158

Abnormal breath sounds in children

Back 158

-Stridor -Wheezing -Crackles -rhonchi

Front 159

Wheezing

Back 159

-air through narrowed airway -high pitched musical sound -audible lower airway obstruction.

Front 160

Classic manifestation of acute epiglottitis

Back 160

-abrupt onset
-respiratory distress (nasal flaring, retractions, inspiratory stridor before complete occlusion)
-fever > 102.2
-dysphagia (difficulty swallowing)
-dysphonia (muffled, hoarse or absent voice sounds
-drooling (from edema/pain)
-agitation (irritable, restless)
-classic tripod position (child sits upright & leans forward, chin is thrust out & mouth is open to attain the best airway possible)
-no spontaneous cough

Front 161

Laryngotracheobronchitis (LTB)

Back 161

-a type of croup caused by a slowly progressive virus in which swelling occurs along the trachea & bronchi

Front 162

LTB diagnosis

Back 162

-child’s history
-physical examination
-chest film
-WBC with differential count

Front 163

Laryngotracheo-bronchitis (LTB)
Treatment

Back 163

-corticosteroids (anti-inflammatory reduces airway edema)
-cool fluids (thin secretions & facilitate removal)
-rest & comforting measures (reduces metabolic demands)
*best tx is steroid & Heilox & 02
***Pts DO NOT benifit from mist/humidifiers***

Front 164

Pathophysiology of CF

Back 164

-genetic disease
-autosomal recessive gene mutation on Chromosome #7 (both parent must carry the CF gene in order for the child to be born with CF)
-Both parents carriers but don’t have = chance of child with CF is 25%
-50% chance will only be a carrier & 25% chance will not have CF or carry gene
-1 in 2500 born with CF per year
-exocrine gland dysfunction
-abnormal levels of Na & Cl
-Cl moves out of cells & is lost through skin
-Na is retained & reabsorbed
-result of abnormal Na/Cl causes increase in mucus (amount and thickness) & leads to an increased risk of lung infections & obstruction in other body systems

Front 165

The GI tract/genitourinary system & CF

Back 165

-sticky mucus blocks the pancreatic ducts (no enzymes get out)
-lack of enzymes needed to aid digestion results in auto digestion of the pancreas
-Pancreatitis & DM are common complications
-pts may experience meconium ileus at birth (typically the 1st sign of CF
-newborn does not have meconium BM because thick & lodged, surgery to remove the blockage is indicated)
-other problems that may occur are rectal prolapse, gastroesophageal reflux, hepatic diseases, & infertility (more so in boys then girls).

Front 166

Chronic respiratory infections & CF

Back 166

-cough
-sputum production
-hyperinflation of the alveoli
-bronchiectaisi
-eventually pulmonary insufficiency & death

Front 167

CF complications resulting from airway obstruction & tissue damage

Back 167

-Pneumothrorax
-hemoptysis (coughing up blood)
-atelectasis (collapse of a portion of lung, usually because of surfactant depletion)

Front 168

CF complication resulting from chronic hypoxia

Back 168

Clubbing

Front 169

How is CF diagnosed?

Back 169

-Medical history
-Physical examination
-Lab tests (look for effects of the disease in specific body organs)
-Chest films (show bronchiectasis: a lung condition characterized by irreversible dilation & destruction of the bronchial walls) & (pneumothorax: a collection of air or gas in the pleural cavity)
-Sweat tests (#1 way to diagnosis: positive if 60mEq/L or greater: test measures amt salt in their sweat)
-DNA analysis

Front 170

CF Interventions / Collaborative interventions

Back 170

1. Chest PT
2. Nebulizer meds are used to thin secretions & to possibly give antibiotics. Dnase is used to decrease mucus viscosity aka pulmozyme, TOBI
3. Breathing exercises (IS, TCDB)
4.Antibiotics- 1st try oral then go to PICC/ Central line for long term IV abx.

Front 171

CF Teaching to families

Back 171

1. give enzyme before each meal & snacks
2.Vitamin supplements- Fat soluble vitamins – ADEK and typically iron as CF patients are usually iron deficient
3. diet high in calories, fat & protein. Recommended that the diet exceed 150% of the RDA
4. increase fluids & salt intake especially if hot, sweating, or have a fever. (Most babies have extra salt added in their bottles!)
5. assess for intestinal obstruction & rectal prolapse

Front 172

Asthma

Back 172

a chronic respiratory illness /chronic inflammatory disorder of the airway

Front 173

Asthma airway obstruction & air trapping leads to what?

Back 173

-ventilation/perfusion alterations
-an increased work of breathing
-hypercapnia
-hypoxemia
-(If left untreated, respiratory failure & death)

Front 174

What is RAD?

Back 174

RAD = (reactive airway disease) = small babies are diagnosed this for insurance purposes, instead of asthma.

Front 175

What do asthma triggers/allergens stimulate?

Back 175

-an increase in circulating IgE, mast cells, and macrophages
-cause the release of other substances such as histamine, basophils, eosinophils, neutrophils, platelets, T lymphocytes, and prostaglandins
-result is bronchoconstriction, mucosal edema, & increased mucus production.

Front 176

Asthma Treatment/Prevention

Back 176

-Avoidance of triggers (primary means of preventing symptoms of asthma)
-Regular peak flow monitoring
-Medications
-Family education (best defense!!) teach about affects of meds & importance of avoiding triggers
-On-going follow-up
-Rapid access to medical care
-Adequate sleep & nutrition
-Relaxation & warm-up exercises

Front 177

ED/hospital care of Asthma

Back 177

-Hydrate
-Oxygenate/ventilate
-Treat infection

Front 178

Asthma: Acute Relief Meds

Back 178

- Short-acting beta agonists-bronchodilators:
1. Albuterol (proventil, ventolin)
▪Oral & nebulized
▪Side effects: ↑ heart rate, jittery, shakiness
2. Levalbuterol (xopenex)
▪Nebulized
▪less S.E of ↑ heart rate

Front 179

Asthma: Adjuncts to Quick Relief/Rescue Meds

Back 179

1. Anticholinergics: Improve smooth muscle tone & aid effectiveness of beta-agonists. Inhibits bronchoconstriction & decreases mucus production
e.g. pratropium (Atrovent) (inhaled)
2. Corticosteroids: Diminish airway inflammation and obstruction, enhance effects of beta-agonists.
e.g. Methylprednisolone (IV), Prednisolone (po), Prednisone (po).

Front 180

Asthma: Long Term Control Meds

Back 180

1. Long-term Controllers-preventive e.g. ▪ Long-acting bronchodilators ▪ Mast Cell inhibitors ▪ Inhaled corticosteroids ▪ Leukotriene modifiers ▪ Allergy shots 2. Long-Acting Bronchodilators e.g. ▪ Formoterol (Foradil) ▪ Salmeterol (Serevent) ▪ Albuterol-sustained (Vospire) ▪ Methylxanthines (theophylline) Relaxation of smooth muscle in airway. Used for nocturnal symptoms and prevention of exercise-induced bronchospasm.

Front 181

Purpose of the peak flowmeter

Back 181

-Measures the fastest speed (in liters/min) at which the air is forced from the lungs during expiration, peak expiratory flow rates (PEFR)
-PEFR is lowered during acute asthmatic episodes because of impaired expiration & air trapping that occurs as a result of airway obstruction
-There are zones on the peak flow meter to determine the level of asthma

Front 182

Peak Flowmeter Zones/Level of asthma

Back 182

-Green: 80-90% of personal best (at top of gauge) -Yellow: 50-79% of personal best (middle range of gauge) -Red: <50% of personal best (bottom of gauge)

Front 183

Why is it important to measure the PEFR when the pt is well?

Back 183

to get a baseline for determining effectiveness of expiration

Front 184

Why should PEFR be measured before & after bronchodilator use?

Back 184

to determine effectiveness of medication

Front 185

Possible ND for a child with RSV (bronchiolitis)

Back 185

-Impaired Gas Exchange (excess/deficit in oxygenation and/or co2 elimination at the alveolar capillary membrane (something has changed the function of your alveoli, like you've been working too long in a coal mine or something)
-Ineffective Breathing Pattern (inspiration and/or expiration that does not provide adequate ventilation (like hyperventilating and for some reason no one has a paper bag in their pocket)
-Ineffective Airway Clearance (r/t air trapping and increased mucous production) (inability to clear secretions or obstructions from respiratory tract to maintain a clear airway.(like an asthmatic))

Front 186

Interventions for a child with RSV (bronchiolitis)

Back 186

-Humidified O2 (to improve sats and loosen secretions)
-Bronchodilators (help open the airways)
-Corticosteroids
-Ribavirin (may decrease severity of illness, only given to at-risk populations)
-More frequent monitoring of VS
-Assess breath sounds for clearing
-CPT (to loosen secretions) and suctioning (to help remove them)
-Raise HOB 30 degrees (improved chest expansion)
-Continuous pulse ox
-Cardio-respiratory monitor
-Contact isolation
-Possible antibiotics if develop secondary bacterial pneumonia
-IVFs
-Mechanical ventilation for those who have progressed to respiratory failure
-Caregiver education

Front 187

Clinical manifestations of constipation

Back 187

-hard, small stools passed at regular intervals or large masses of stool at intervals of days to weeks
-abdominal pain and/or distention develop
-child may be irritable
-loss of appetite
-often a palpable mass is felt on examination

Front 188

Diagnositic tests of Hirschsprung Disease

Back 188

History
Rectal Exam
Barium enema or UGI (upper GI series)
Rectal biopsy (definitive diagnosis)

Front 189

What is the difference in GER & GERD?

Back 189

-GER, is occasional relux expected in newborns because of immature GI system
-GERD is a reoccuring problem that a pt does not grow out of.

Front 190

Increased Potassium

Back 190

causes cardiac problems
may be sign of kidney disorder, dehydration with decreased urine output, or lysis of RBC from injury (released K)

Front 191

Decreased Potassium

Back 191

causes cardiac problems

Front 192

What are the GI differences in Infants?

Back 192

-decreased stomach capacity (smaller, more frequent feedings)
-increased peristalsis (reflux common)
-LES tone is decreased (reflux common)
-increased stomach emptying rate
-increased metabolic rate

Front 193

GI differences that relate to Fluid & electrolyte balance.

Back 193

-increased ECF until 2yo (F&E lost quickly, adjust slowly)
-Increased insensible fluid loss per body surface area
-increased BMR
-Ineffecient kidneys (can't concentrate/dilute urine or conserve/excrete Na

Front 194

How does urine change in the dehydrated pt?

Back 194

-color may darken
-specific gravity increases
-smell becomes stronger
-amount decreases

Front 195

What are some changes in serum lab values in the dehydrated pt?

Back 195

-Bun increases to 20-30's
-Hg remains the same while Hct increases
-Creatinine remains the same

Front 196

Gastroenteritis: Definition

Back 196

-Inflammation of lining of stomach & intestines with rapid onset of diarrhea
-may be associated with fever, vomiting, abdominal pain, wt loss, electrolyte imbalance
-usually self limiting

Front 197

How is Gastroenteritis transmitted?

Back 197

-fecal/oral
-ingestion of contaminated foods
-contact with contaminated animals
-injestion of parasite cysts

Front 198

What causes Gastroenteritis?

Back 198

Viruses, bacteria, parasites
Common causitive agents include Rotavirus, Salmonella & E. Coli

Front 199

How do you diagnose Gastroenteritis?

Back 199

-History (travel, food prep)
-Stool culture if > 24hr
-Blood tests (for electrolytes)
-physical exam (wt loss, dehydrated, toxic appearance)

Front 200

What is the management of diarrhea with dehydration?

Back 200

-assess fluid & electrolyte imbalance
-rehydrate
-maintain fluid therapy
-reintroduce adequate diet

Front 201

What is the best monitor of improvement with Dehydration?

Back 201

Weight

Front 202

What foods should the pt avoid when they have Gastroenteritis? Why?

Back 202

-Fruit juices (high in sugar, apple juice draws water to bowels)
-Caffeineated soda (high in sugar, increases peristalsis, diuretic)
-Beef/chicken broth (sodium draws out water)
-Bratt diet (not enough nutrients)
-high fat foods (hard to digest)
***If we don't feed the gut, it becomes unable to digest other foods***

Front 203

Does Diarrhea result in metabolic acidosis or alkalosis?

Back 203

Acidosis
(you are losing base when you excrete)

Front 204

Does Vomiting result in metabolic acidosis or alkalosis?

Back 204

Alkalosis
(you lose acidic gastric contents when you vomit)

Front 205

GI malabsorption syndrome

Back 205

Celiac Disease

Front 206

How do you diagnose Celiac Disease?

Back 206

-biopsy of small bowel (atrophic villi found - is a definitive dx)
-IgA testing
-gluten free diet resolves s/s

Front 207

What are some common causes of constipation & encopresis?

Back 207

-dietary (lack of fiber)
-structural disorders
-metabolic/endocrine disorders
-nerogenic disorders
-medications
-suppressing the urge to defecate

Front 208

What are some treatments for constipation and encopresis?

Back 208

-cleanse the bowel (enemas, stool softeners, digital removal)
-modify diet
-establish a regular defecation pattern

Front 209

An x-ray shows air in the abdomen. What might this mean?

Back 209

Perferation!

Front 210

A GI motility disorder

Back 210

Hirschsprung Disease

Front 211

Obstructive GI disorder

Back 211

Pyloric Stenosis
Intussusception

Front 212

The ileocecal valve is the common site for what disorder?

Back 212

Intussusception

Front 213

A GI inflammatory disorder

Back 213

Appendicitis

Front 214

What is Appendicitis?

Back 214

-an inflammation of the vermiform appendix
-most common cause of surgery in children
-kids often rupture within 48 hr of first s/s

Front 215

Pathophysiology of Appendicitis

Back 215

An obstruction causes edema & compression of vessels. This causes inflammation, ischemia, ulceration & infection. Untreated, progresses to perforation & peritonitis

Front 216

How is Appendicitis diagnosed?

Back 216

-History/presentation
-Labs
-Ultrasound

Front 217

Where are aspirated contents usually found?

Back 217

On the Right!

Front 218

Areas to include in a respiratory assessment

Back 218

-Chest symmetry, movement, retractions
-Skin color
-Type & effort of breathing
-auscultate side to side, front to back

Front 219

Retraction Sites

Back 219

Supraclavicular (above clavicles)
Suprasternal (above sternum at base of neck)
Intercostal (between ribs)
Substernal (below sternum/xiphoid process)
Subcostal (look at a picture)

Front 220

Rhonchi

Back 220

-course, low pitch sound associated with thick secretions
-associated with bronchiolitis
-lower airway

Front 221

Breath sounds of the lower airway

Back 221

Rhonchi, Wheezes, Crackles

Front 222

Breath sounds of the upper airway

Back 222

Stridor

Front 223

True or false? Infants are obligate nose breathers?

Back 223

True
They prefer to breathe through their nose.

Front 224

Respiratory rates for ages 1-2 years old

Back 224

20-40 resps per minute

Front 225

Signs & symptoms of respiratory distress

Back 225

-nasal flaring
-mouth open wide
-head bobbing
-use of accessory muscles
-color (pale/cyanotic skin/mucosa)
-grunting
-tachypnea
-mottled skin
-decreased LOC

Front 226

What is hypoxia?

Back 226

decreased O2 to tissues

Front 227

What is hypoxemia?

Back 227

decreased O2 in blood

Front 228

What is hypercapnia?

Back 228

increased CO2 in blood

Front 229

When does respiratory failure begin?

Back 229

When O2 & CO2 reach abnormal levels and hypoxia occurs.

Front 230

Oxygen therapy

Back 230

-by nasal cannula
-by mask
-humidified O2 decreased risk of infection & dryness & loosens secretions
-weaning: check q 15min

Front 231

Upper airway infections include ...

Back 231

Pharyngitis
Tonsillitis
Otitis Media
Epiglottitis
Croup

Front 232

Lower airway infections include ...

Back 232

Bronchiolitis
Pneumonia
Tuberculosis