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69 Cards in this Set
- Front
- Back
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RSV
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- respiratory syncytial virus
- gives older children flu like symp, but may give infants difficulty breathing - contact precaution |
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HSV
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- herpes simplex virus
- herpes - contact precaution |
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body lice
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- pediculosis
- contact precaution |
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scabies
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- mites that burrow under skin, causing rash and intense pruritis
- contact precaution |
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Illnesses with contact precaution
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- multi drug resistant bacteria
- resp - RSV, parainfluenza - skin - HSV, impetigo, pediculosis, scabies - entereic - C. diff, Shigella, rotavirus |
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rotavirus
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- enterovirus causes severe diarrhea in children
- contact precautions |
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Illnesses requiring droplet precautions
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- H. influenzae type b
- pneumonia, diptheria - inflenza, mumps, rubella |
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illnesses requiring airborne precautions
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- measles, varicella, TB, rubella
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low urine output aka
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oliguria
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VS signs of dehydration
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- much like shock - body tries to compensate for decreased perfusion
- inc HR - dec BP - inc respirations |
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infant sign of dehydration
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- sunken AF
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signs of dehydration
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- inc HR, BP, deep rapid Resp
- absent tears, eyes sunken - mucus membrances dry - AF sunken - JVD not visible when supine - oliguria/anuria - high urine spec gravity - turgor, capillary refill **weight loss** |
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normal sodium limits for children
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130-150 mEq/L
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kinds of dehydration
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- isotonic, hypotonic, hypertonic
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isotonic dehydration
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sotonic
- water and sodium lost in equal amounts - since no change in osmolarity, mostly ECF is lost - hypovolemic shock - Na is within normal limits |
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hypotonic dehydration
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hypotonic
- electrolyte loss greater than water loss - ECF moves into ICF to equilibrate, shock symp with smaller losses in fluid - serum sodium < 130 |
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hypertonic dehydration
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hypertonic
- water loss greater than electrolyte loss (or high influx of electrolytes) - ICF shifts to ECF - neuro changes - hyperreflex, irritable, change LOC - serum sodium >150 |
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What can be used to rehydrate children
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ORT - oral rehydration
- oral route preferred - pedialyte - fluids with electrolytes - juice, soda, caffeinated beverages not preferred - formula not used either due to loss of lactase from GI - you can nurse |
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how much fluid should you give a child after they have been rehydrated?
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- stool losses should be replaced on 1:1 basis with ORS
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reasons for IV fluid therapy rather than oral
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- severe dehydration
- severe vomiting - inability to drink (lethargic, etc) - gastrodistention - indicates problem with absorption/digestion |
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priority nursing when admitting infant or child with dehydration
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- weight loss
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diarrhea may develop secondarily to
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- upper respiratory infection
- urinary tract infection - antibiotics/laxatives |
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manifesations of diarrhea
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- dehydration
- electrolyte imbalance - metabolic acidosis - lots of bicarb used to buffer the acids produced |
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contraindication with anti-diarrheal drugs
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- not with infectious diarrhea
- slows clearing time for organism |
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lab tests for diarrhea
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- CBC - left shift for infection
- Hct, Hgb, BUN, creatinine, urine specific gravity elev with dehydration - stool test for occult blood (creatinine more about kidney function - not affected) |
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left shift in CBC
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- left shift indicates the relative increase of immature leukocytes in the blood
- aka increase of band% (baby white cells) - sign of infection - normal is 2-6% |
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creatinine vs BUN
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- creatinine from creatine breakdown
- doesn't change, made at steady rate - indicates function of kidneys - BUN comes from breakdown of proteins, producing urea - indicates dehydration or kidney function |
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what to avoid with diarrhea
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BRAT diet
- banas, rice, applesauce, toast - low nutrition, high carb, low elec Juice, soda, jello - high carb, low elec caffeine - mild diuretic chicken beef broth - too much sodium, not enough carb |
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Infant has not pooped for 5 days. Infant is breast fed.
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- breast fed babies may not poop for a week, and it is normal
- breast milk is so readily absorbed by the body, so not much residual |
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diseases associated with constipation
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- hirschsprung disease
- stricutres - hypothyroidism |
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infant has constipation. has recently changed from breast milk to cow's milk.
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- increasing solid foods to diet may help
- cereal, vegetables, fruits |
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school age child has constipation. parent teaching?
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- common cause is fear of using public bathrooms
- holding it in leads to constipation |
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aganglionic colon causing lack of motility
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hischsprung disease
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treatment of hischsprung disease
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surgery
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hischsprung disease clinical manifestations
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image: olive with toothpicks in it
- in neonates, failure of meconium to pass within 48h, , abdominal distention - also refuses to eat, bilious vomiting - infants will have a failure to thrive, constipation, and abdominal distention - cildren will have abdominalm distention, will look undernourished, constipation with ribbon-like foul smelling tools |
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treatement for hischsprung disease
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- first, ostomy is put into place to return colon to normal size
- then surgery - Soave endorectal pull-through procedure |
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Soave endorectual pullthrough procedure
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- treatment for Hischsprung disease
- removing aganglionic portion - pulling end of normal bowel to rectum |
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complications and therapy post-Soave pull through procedure
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- anal stricutre and incontinence
- may need dilation or bowel retraining therapy |
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bilious vomiting implies
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- impaired motility or there is a distal physical obstruction
- otherwise, vomiting will be nonbilious (drains into colon) |
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causes of vomiting
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- obstruction
- infection - inc ICP - food intolerance, allergies, anorexia, metabolic, psychogenic |
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what types of studies may be ordered with child with vomiting
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hydration statys
- electrolytes - creatinine, BUN ABG |
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management of vomiting
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- usually self limitiing, no treatment necessary
- may assess for dehydration, nutrtion - antiemetics |
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GER backgound info
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- relaxation of LES - lower esophageal sphincter
- common in infants, but usually resolves on its own by 1yoa - GER becomes GERD when there is FTT, bleeding or dysphagia - associated with respiratory symptoms - aspiration pneumonia, apnea, laryngo/bronchospasms |
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diagnostics GERD
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- history usually sufficient
- upper GI series (barium swallow) - X rays determine anatomic abnormalities - 24h intraesophageal pH study - endoscopy with biopsy assess severity of esophagitis, strictures - scintigraphy - may help find cuase of reflux |
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when is treatment for infants necessary for GERD
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- only until there are respiratory symptoms
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therapeutic management for GERD
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Foods to avoid
Lifestyle - weight loss - smaller frequent meals - thickening of food for infants Positioning - elevate infant hob 30 deg 1 hr after eating Pharm - H2 receptor antag - tagamet, zantac - proton pump inhibitor - pantoprazole, prilosec surgery - Nissen fundoplication |
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HPS background
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- pyloric sphincter thickens and elongates, narrowing pyloric channel
- obstruction causes hyperperistalsis to overcome obstrction Etiology - more common in caucasians - genetic component |
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HPS symptoms
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- nonbilious projectile vomiting
- hunger even after vomiting - dehydration |
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HPS assessment and diagnostic findings
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Assessment
- olive shaped lump in epigastrum, slightly R of umbilicus (RUQ) - visible peristalsis from L to R across epigastrum Diagnosis - AUS - abdominal ultrasound to visualize hypertrophied pyloris - Upper GI if AUS didn't reveal Lab findings - dehydration - dec K, Cl, Na, inc BUN - metabolic alkalosis |
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Management of HPS
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pyloromyotomy - incision of pyloris, increasing size of pyloric channel
- excellent prognosis |
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Acute appendicitis symp
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- classically, pain first presents in umbilical area, then nausea
- then RLQ pain (McBurney's point) and fever and vomiting |
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McBurney's point
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- halfway between anterior superior iliac crest and the umbilicus
- appendicits pain can be most intense here |
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Appendicitis patho
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- fecal matter or pinworms obstructs appendix, and pressure increases within due to blockage
- inc pressure causes ischemia, subsequ ulceration - fecal contamination leads to infection, necrosis, and possibly rupture - fecal leakage into peritoneum leads to peritonitis |
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contraindications for appendicitis
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- rebound tenderness - not reliable, and very painful
- administration of laxatives, heat, or enemas --> inc motility and increases risk of perforation |
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Diagnosis of appendicits
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- primarily history - pain pattern
- referred pain with light percussion indicates peritoneal irritation - CT scan Lab studies - WBC >10000, inc C reactive protein, inc band, left shift - HCG and pelvic exam for girls to r/o ectopic pregnancy |
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managment of appendicitis
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unruptured
- rehydration, antibioitics, appendectomy ruptured - antibiotic, IVF, NG suction - irrigation of peritoneum - continue antibiotics, IVF and NG suction |
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signs of peritonitis (from appendicitis)
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- severe pain, fever, inc WBC
- referred pain with percussion of abdomen - sudden relief of pain, followed by inc in pain (rupture) - absent bowel sounds |
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Meckel Diverticulum
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- fetal remnant leads to little stomach in GI (outpouching or fistula containing acid)
- may be asymptomatic - commonly causes painless rectal bleeding, abdominal pain, dark red "currant jelly" stools (mucus and blood) |
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Cleft lip/palate risk factors
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- genetics
- teratogens --- phenytoin (dilantin) - anticonvulsant- 10x --- smoking - 2x more likely --- alcohol, steroids, retinoids |
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Cleft L/P feeding
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- because of decreased ability to suction, feeding may be impaired
- keep in upright position to avoid aspiration/infection (OM) - ESSR method - enlarge nipple, stimulate suck reflex, swallow appropriately, rest - burp frequently due to inc air intake while feeding - noisy feeding is normal breastfeeding - place breast deep in mouth to create seal for suction |
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Cleft L/P postop concerns
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cheiloplasty (CL)
- do not place prone - Saline/antibiotics for suture Palatoplasty (CP) - place prone to facilitate breathing - avoid any objects in mouth or foods that may damage repair |
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complications of Cleft lip/palate
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- aspiration
- ear infections - speech and language delay - dental problems |
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intussusception background and classic symptoms
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- bowel invaginates/telescopes
- more common in males and CF patients symptoms - periodic abdominal pain - red currant stools - sausage like abdominal mass in RUQ |
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intussusception patho
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- telescoping causes obstruction of stool and of blood
- may lead to infarction and perforation - lymphatic and venous congestion causes seepage into instinal lumen, causing red currant jelly stools |
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managment of intussusception
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- air enema- inflate bowel with air
- may resolve itself (brown stool) |
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Gavage feeding
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- aka tube feeding - OG or NG
- infant should be held and given a pacifier to associate physical contact and sucking motion with the feeding - feeding in upright position keeps tube in place - warm formula to Rtemp before administering |
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Nasoduodenal and nasojejunal tubes
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- given to children at high risk for regurgitation or aspiration
- only given cont feedings, not bolus |
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gastrostomy
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- skin level devices = tube doesn't stick out.
- position child on right side or Fowler's after feedings |
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ostomy
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young children
- wear onesies - keep hands busy, give toys while changing bag preschoolers - help with supplies and cleaning older children and adolescents - total responsibility |
