Nursing Test 5

Front 1

Nephrotic syndrome Nephrosis

Back 1

Glomerulus becomes increasingly permeable to protein, Albumin that leaks through the membrane and is lost in the urine is Hyperalbuminuric. Causes low serum Albumin

Front 2

Nephrotic syndrome Nephrosis

Sings and symptoms

Back 2

Weight gain-child slowly over days or weeks, clothes fit tightly, edema
• Decreased urine output
• Urine-protein-CARDINAL SYMPTOM-greater than +3 on urine dipstick

Front 3

What is Hirschsprung’s Disease

Back 3

Mechanical obstruction caused by inadequate motility of part of the intestine

Front 4

Sings and Symptoms of Hirschsprung’s Disease

Back 4

Intestinal obstruction and failure to pass meconium at birth What to look for – mom complains of ribbon like stools, abd cramping, distented abd, child very constipated, diarrhea may need

Front 5

Treatment of Hirschsprung’s Disease

Back 5

Tx - Surgical- x 2 remove aganglionic bowel
First, temporary ostomy created to relieve obstruction and allow the bowel to return to normal size
Second, when child weighs 20lbs.pull end of normal bowel through the rectum and close ostomy

Front 6

What is • Intussusception

Back 6

Telescoping of one portion of the intestine into another

Front 7

Sings and symptoms of intussusception

Back 7

classic jelly stool – sauge palpation. Sudden onset of pain to child

Front 8

Treatment of Intussusception

Back 8

air enema , Non-surgical hydrostatic reduction by barium enema as long as no perforation

Front 9

When does Intussusception occur

Back 9

Occurs between the ages of 3mths.-5 years

Front 10

When is Intussusception resolved

Back 10

Resolved problem when child has normal stool.

Front 11

Imperforate anus

Back 11

forms of malformation without an obvious anal opening

Front 12

Signs and symptoms of Imperforate anus

Back 12

child doesn’t pass meconium stool
• No stool 24 hours after birth
It’s not unusall w/ impact anus to have stool in urine

Front 13

Treatment of Imperforate anus

Back 13

Manual dilations-begun by MD, continued by RN and by parents at home
Larger malformations corrected by surgery

Front 14

Nursing interventions for Imperforate anus

Back 14

IV feedings, NG tube and abdominal decompression until peristalsis
Post Surgery-anal area clean after surgery

Front 15

Appendicitis

Back 15

Inflammatory disorder of the blind sac at the end of the cecum

Front 16

sings and symptoms of Appendicitis

Back 16

rt lower quaderant pain start around umbilicus, mabie vomiting, nausea, fever
Elevated WBC, rebound tenderness
If a pt has terrible pain w/ appenditis, and pain ends suddenly could be sing of a perforation / Rupture.

Front 17

McBurney point for id of Appendicitis / Peritonitis

Back 17

located at a point midway between the anterior superior iliac crest and umbilicus

Front 18

Tx for Appendicitis, Peritonitis

Back 18

If not ruptured laprocopic surgery, If ruptured antibiotic then surgery.

Front 19

Nursing Int for Appendicitis

Back 19

antibiotics continue for 7 to 10 days
• NG suction-until intestinal activity returns
• Npo until bowel sounds post op.
• NO LAXATIVES, ENEMAS OR HEAT-stimulates bowel motility and increases risk of perforation

Front 20

Cystitis

Back 20

Infection is in the lower urinary tract and involves the urethra to the bladder

Front 21

Pyelonephritis

Back 21

is an upper urinary tract infection that involves the ureters, renal pelvis,and renal parenchyma (membrane

Front 22

S + S of UTI

Back 22

painfull urination, frequent urination, cloudy urine
Strong smelling urine, may burn

Front 23

Etiology of UTI

Back 23

urinary stasis, back flow of urine, sexual activity, move common in females
Old people can be confused by UTI.
Constipation may cause urinary statis

Front 24

Nursing for UTI

Back 24

Teach avoid irritate bladder like caffine, carbination, tomatos,
Wipe front to back, avoid bubble bath,
• Increased fluid intake promotes flushing of the bladder and lowers the concentration of organisms

Front 25

Nephrotic syndrome

Back 25

Hyperalbuminuria-proteins, especially albumin, lost in urine when glomerular membrane becomes permeable to proteins

Front 26

Hypoalbuminemia

Back 26

(serum blood)-reduction of serum albumin level in blood, fluid is pulled into interstitial spaces especially abdomen causeing (ascites)

Front 27

S + S Nephrotic syndrome

Back 27

Weight gain over days! edema, stomach distended. 2-7 yrs old, males more common blood work Albumin low, protein low. High albumin in urine, high cholesterol

Front 28

Tx Nephrotic syndrome

Back 28

Low salt diet and fluid restrictions, Antibiotics,
• Infuse albumin as ordered but watch for fluid shifts as it causes hypertension and volume overload
• Corticosteroids are the first line therapy-Prednisone, 7-21 days then tapered

Front 29

Glomerulonephritis-APSGN

Back 29

Acute post streptococccal glomerulonephritis due to Streptococcal Streph Throat

Front 30

S + S Glomerulonephritis-APSGN

Back 30

Dark colored urine due to gross hematuria “tea-colored”
• Periorbital edema and facial edema worse in morning
Hypertension

Front 31

Nursing Considerations-Nephrotic Syndrome-MCNS

Back 31

Examine urine for albumin
Daily weight
Measurement of Abdominal girth
Assessment of edema-eyes,
Strict I and O

Front 32

Treat Severe APSGN

Back 32

hematuria-seizure precautions and IV equipment at bedside
• Take BP at least every 4 hours and report abnormalities
• Give Antihypertensive drugs

Front 33

treatment of HyperThyroid

Back 33

Diet-high protein, high carbohydrates and high calorie; RESTRICT COFFEE AND CAFFEINE , Bedrest, Radiation therapy of thyroid-treatment of choice-iodine is taken up by thyroid and destroys cells, results 6-8wks.

Front 34

Post op Thyroid surgery

Back 34

keep in semi-fowler’s position to promote venous return from the head and neck and to decrease oozing into the incision--- watch for signs of hemorrhage

Front 35

CHVOSTEK’S SIGN

Back 35

Elicitation: Tapping on the face at a point just anterior to the ear and just below the zygomatic bone
Postitive response: Twitching of the ipsilateral facial, muscles, suggestive of neuromuscular excitability, caused by hypocalcemia

Front 36

TROUSSEAU’S SIGN

Back 36

Elicitation: Inflating a sphygmomanometer cuff above systolic blood pressure for several minutes
Postitive response: Muscular contraction including flex-ion of the wrist and metacarpophalangeal joints, hyperextension of the fingers, and flexion of the thumb on the palm, suggestive of neuromuscular excitability caused by hypocalcemia

Front 37

Hyper Thyriod causes what?

Back 37

 Thyroid enlargement ----goiter and Graves disease

Front 38

S + S Hypo Thyroid

Back 38

 Fatigue and lethargy, sleeps for long periods
 Weight gain
 Coarse hair- Alopeci
 Puffy eyelids

Front 39

Diagnostics for Hypo Thyroid

Back 39

 TSH-elevated
 Decreased T3 and T4
 ECG-sinus bradycardia

Front 40

Diagnostics for Hyper Thyroid

Back 40

Increased T3 and T4-in blood
TSH-from pituitary low or undetectable
ECG-atrial fibrillation

Front 41

Hypo thyroid Treatment

Back 41

Diet-high fiber, high protein, low calorie
 Thyroid hormone replacement-Synthroid, lifelong
 Possible surgery-if goiter present

Front 42

Hypo thyroid nursing Int

Back 42

Encourage pt. to express feelings of depression
Encourage mental stimulation and physical activity
Provide warm environmentintolerant to cold

Front 43

Severe complication of HypoThyroid

Back 43

myxedema = Vital signs reflect bradycardia and hypotension

Patient becomes stuporous and hypothermic

Front 44

Severe complication of HyperThyroid

Back 44

Thyroid storm
hypermetabolism;onset abrupt with initial symptoms including tachycardia, vomiting and stupor

Front 45

Cushing’s

Back 45

Hyperactivity of the adrenal cortex that results in excessive secretion of glucocorticoids, particularly cortisol

Front 46

S+S Cushings

Back 46

Moon face, exes hair, thin extremities, ecchymosis, protruding ABd, Blood chemistry-increased cortisol, decreased potassium (unexplained), hyperglycemia (DM is common)

Front 47

Medical Tx Cushing's

Back 47

diet low sodium, low carb, low cal, high potasium, high protein Diuretics

Front 48

Addison’s

Back 48

Chronic hypo activity of the adrenal cortex, resulting in insufficient secretion of glucocorticoids (cortisol) and mineral corticoids (aldosterone)

Front 49

S + S of Addison’s

Back 49

= bronzed skin, nipples + buccal mucosa, GI-nausea, weight loss, diarrhea
 Hypotension-orthostatic blood pressure

Front 50

Blood chemistry of Addison’s

Back 50

increased K, increased BUN, Decreased ( HCT, Hgb, glucose, cortisol, aldosterone, )

Front 51

Medical Tx Addison’s

Back 51

Life long supplements for Glucocorticoids + Mineralcortiods

Front 52

Diet for Addison's

Back 52

Diet-high carbohydrate, high protein, high sodium, low potassium in small frequent feedings before therapy; after therapy high potassium and low sodium

Front 53

Nursing INT Addison's

Back 53

Maintain diet, stress reduced environment, Adminmeds 2/3 in AM, 1/3 in PM.

Front 54

Addisonian Crisis

Back 54

Marked hypotension, cyanosis, abdominal cramps, diarrhea, costovertebral tenderness, fever, confusion, coma, arrhythmias, hypovolemic shock and renal failure

Front 55

Tx of Addisonian Crisis

Back 55

Emergency medication = Tx = Solu-Medrol IM

Front 56

Hyperpituitarism (Acromegaly)

Back 56

Hypersecretion of growth hormone by the anterior pituitary gland; if after growth plates close bones increase in thickness and width

Front 57

S+S Hyperpituitarism (Acromegaly)

Back 57

Deepening of voice, protruding jaw, widehands and feet.

Front 58

How do they Diagnos Hyperpituitarism (Acromegaly)

Back 58

Enlarged pituitary on CT scan , X-rays reveal thickened long bones and skull
Causes-benign adenomas and GH secreting tumors

Front 59

Tx of Hyperpituitarism

Back 59

Surgery anterior pituitary gland must be on life long replacement therapy of glucocorticoids, thyroid and sex hormones