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48 Cards in this Set
- Front
- Back
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4 Types of Vomiting
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Spitting up
Regurgitation Vomiting Projectile vomiting |
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5 Causes of vomiting in the infant and child.
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Improper feeding techniques
Infection Dietary problems Motion sickness Psychological causes (unpleasant odors, sights, and fright) Obstruction of GI tract |
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Where is the vomiting center located
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reticular core of the medulla
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Signs and symptoms of vomiting.
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Can happen at any time
Forceful, often projectile Smells very sour, appears curdle, yellow, bloody Child may cry, hurts, pain, before & after Continues until the stomach empties, then dry heaves Amount is a full stomach content |
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Diagnostic procedures that may be done to determine an organic cause of vomiting.
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CBC
Electrolytes BUN urine tests ABG's blood culture glucose X-Rays |
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The main aims of treatment for the infant and child who has been vomiting.
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Position to prevent aspiration
Rinse mouth/brush teeth after vomiting Begin small amount of ORT; 5-10 ml q 1-5 minutes More liberal fluids once vomiting stops; progression as tolerate to regular food Antiemetics |
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Define gastroesophageal reflux.
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relaxation or incompetence of lower esophageal sphincter, permitting reflux of gastric contents into the esophagus
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GERD etiology.
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Unknown; common in premature infants, children with neurological impairment and following some kinds of esophageal surgery
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Signs and symptoms of GERD
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vomiting
weight loss/ FTT increased appetite respiratory problems-asthma recurrent otitis media bleeding |
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Diagnostic tests used for GERD.
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Barium swallow
radionuclide intra-esophageal pH probe monitoring |
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Medical/Surgical management of GERD.
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thickened feedings with cereal
small volume feedings slow feedings burp often during feedings upright, prone when awake supine when asleep (30 degree angle) tucker sling |
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Formulate a plan of care for the infant and child with GERD.
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Alteration in nutrition: less than body requirements r/t vomiting
Fluid volume deficit r/t vomiting Knowledge deficit of home care r/t lack of prior experiences (CPR training) |
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Define diarrhea.
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increase number of stools, a decrease in their consistency with an increase fluid content and a tendency for the stools to be greenish in color
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Diarrhea etiology.
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primary cause is bacterial, viral, parasites and fungus invasion of the GI tract
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Lab exams used in diagnosing diarrhea.
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CBC
CMP x-rays for bowel abnormalities stool culture guaiac test/ hemoccult stool pH (litmus paper or dipstick reagent paper) reducing substances |
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Pathophysiology of diarrhea.
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prostaglandins are released, causing cramping and increase peristalsis
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Methods of treatment of diarrhea.
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ORT
regular diet as soon as rehydrated lactobaccilus supplementation no OTC antidiarrheal drugs skin care prevention |
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How is the vomiting center stimulated to cause vomiting.
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The center receives stimuli from:
- Higher cortical center -Chemosensitive trigger zone -Reflux excitement |
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Higher cortical center
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caused by psychologic disorders due to unpleasant sights, odors, and frights
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Chemosensitive trigger zone
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stimuli from chemical and drug toxins, infections, radiation, IICP, and inner ear infections
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Reflex excitement
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caused by vagal and sympathetic nerves resulting from GI disturbances and viscera
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Signs and symptoms of regurgitation.
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Occurs with feeding
Little force, runs out of mouth Looks like what just went; formula, breast milk Not painful Occurs once per feedings Amount (1-2 teaspoons) |
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GERD medications
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Reglan
Tagamet Zantac Pepcid Prilosec |
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Differences between the child and the adult in their need for fluid balance
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Fluid balance comprises a greater fraction of infant's total weight; reaches adult % at 2 years
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Normal fluid requirement for pediatric patient:
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100mL/kg/day
1000mL + 50mL/kg/day (each additional kg >10kg) 1500mL + 20mL/kg/day (each additional kg > 20kg) |
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Dehydration definition
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occurs whenever the total output of fluid exceeds the total intake.
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Examine the need for water balance in infant and children
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Infants excrete 1/2 of their ECF; adults excrete only 1/6
Child less than 2 years don't concentrate urine; immature kidneys increase respiratory rate; increase water loss , evaporation if an infant & small child doesn't eat or drink, he loses 8% of weight/day greater metabolic rate, more waste to excrete, requires more water |
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3 Types of Dehydration
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Isonatremic dehydration
Hypernatremic dehydration Hyponatremic dehydration |
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Isonatremic dehydration
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most common; water and electrolytes lost in equal portions
Na stays WNL |
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Isonatremic dehydration treatment
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rapidly over 24 hours
1/2 in 1st 8 hours 1/2 over the next 16 hours |
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Hypernatremic dehydration
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Na level > 150
water is lost in greater proportion than electrolytes |
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Hypernatremic dehydration treatment
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slowly over 48 hours ( water and some Na 1/4 NS)
reduce Na no more than 12 mEq/L each 12 hours |
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Hyponatremic Dehydration
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Na level < 135
disproportional high losses of electrolytes relative to fluid lost |
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Hyponatremic Dehydration treatment
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rapidly over 24 hours
1/2 in 1st 8 hours 1/2 over the next 16 hours |
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Cleft lip
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unilateral or bilateral failure of maxillary process to merge with medial nasal elevation
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Cleft palate
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failure of mesodermal masses of the lateral palatine process to meet.
can occur in area of nasal septum, lateral or medial palates or uvula |
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Cleft Lip/Palate pathophysiology
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during the 7-8 week of fetal life, processes that form the upper lip fuse
the palate fuses at 7-12 weeks |
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discuss surgical correction of cleft lip
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Cheiloplasty surgery
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what determine when cleft lip may be repaired
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done at 2-3 days of age to 4 weeks
free of oral, respiratory or systemic infections |
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what determine when cleft palate may be repaired
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6-24 months, usually by 1 year
degree of deformity size of child width of oropharynx |
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complications of surgery for both defects
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ear infection
difficult feeding, breathing, hearing tube feeding until treatment |
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when does tracheoesophageal fistula occur
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when there is failure in separation of primitive esophageal and tracheal tubes before the
8th week of gestation h/o polyhydramnios |
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fistula
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incomplete fusion of the lateral wall of the foregut leads to incomplete closure of the laryngotracheal tube
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atresia
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deficient growth of entodermal cells of the dorsal walls
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3 major types of tracheoesophageal atresia/fistula
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Type A – Esophageal atresia: consists of a blind pouch at each end with no communication to the trachea.
Type C – Esophageal atresia, distal TE fistula: proximal esophageal segments terminates in a blind pouch and the distal segment is connected to the trachea or bronchus at or near bifurcation Type E – Trachea-esophageal fistula: normal trachea and esophagus are connected by a common fistula |
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S/S of esophageal stresia
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drooling
feedings will come back up abdominal distension |
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esophageal fistula
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vomiting
abdominal distension choking coughing death if untreated |
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Surgical correction for TEF
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may need temporary esophagostomy and gastrostomy
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