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118 Cards in this Set
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What is happening with PDA?
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Opening between the pulmonary artery (PA) and Aorta
Oxygenated blood shunted from Aorta →→PA ↑↑ Systemic resistance Blood shunted to LA → LV → PA = ↑↑ Pulmonary Congestion Back up to LA & LV = LV Hypertrophy |
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What are the clinical signs for PDA?
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Soft - harsh systolic newborn murmur
Machinery type systolic and diastolic murmur in older children ↑ RR & moist Breath sounds Bounding pulses ↑ HR Widened pulse pressure Large difference between the systolic and diastolic pressure |
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What is therapy for PDA?
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Indomethacin (indocin)
Prostaglandin inhibitor promotes vasoconstriction and closure of PDA 3 Dose maximum q 12 hours Ligation of Ductus Arteriosus Close connection to prevent return of oxygenated blood to lungs No open heart surgery |
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What is Coarctation of the Aorta?
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Narrowing of the aorta right after arch
↑↑Pressure proximal to narrowing ↑↑ BP upper body, arms & head Bounding pulses & warm, ruddy skin JVD ↓↓Pressure distal to narrowing ↓↓ BP lower body & legs Weak pulses & cool, pale skin Difference of 20mm for systolic BP |
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What are the clinical signs for Coarctation of the Aorta?
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↑↑ BP in arms ↓↓ BP legs
Weak or Absent femoral pulses Headache, blurred vision and nose bleeds ↑↑risk for stroke Older kids leg pain on exertion RT ↓ blood |
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What is the treatment for Coarctation of the Aorta?
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Prostaglandin E – keep PDA open
Surgery Resect coarcted portion and reanastomosis |
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What is Transposition of Great Vessels (TGA)?
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Two separate circulations!
Aorta arises from RV Unoxygenated blood enters aorta →Systemic Pulmonary artery (PA) arises from LV Oxygenated blood enters PA → recycled lungs → Pulmonary veins → LA No Oxygenated blood in systemic circulation! |
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What are clinical signs for Transposition of Great Vessels (TGA)?
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Depends on type and size of associated defects
Severely cyanotic at birth minimal communication between 2 systems Large septal defects or PDA Less cyanotic but may have CHF symptoms ↑↑ HR, ↑↑ RR and cardiomegaly Fatigue when feeding ↓↓ Intake ↓↓Output = Edema |
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What is therapy for Transposition of Great Vessels (TGA)?
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Prostaglandin E1 (Prostin VR or Alprostadil)
Vasodilator Relaxes smooth muscle of ductus arteriosus Keeps PDA open Provides mixing of oxygenated and deoxygenated blood to systemic circulation. “Rashkind procedure” Cardiac cath to create ASD Maintains mixing of blood Arterial switch procedure usually performed in first few weeks of life |
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What is Tetralogy of Fallot?
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Involves four cardiac defects
VSD Blood shunted RV→ LV Pulmonary Stenosis ↓↓ blood to PA Overriding Aorta Sits over VSD RV Hypertrophy ↑ pressure from stenosis |
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What are the clinical signs for Tetralogy of Fallot?
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First cry hypoxic and cyanotic
↑↑ Activity = ↑↑ Hypoxia and ↑↑ Cyanosis Pulse oximeter in low 70’s ↑↑ Pulmonary stenosis = ↑↑ Cyanosis ↑↑ HR, ↑↑ RR Tire easily can’t finish feedings = ↓↓ Intake Chronic O2 deficit → Polycythemia ↑↑ # RBC’s to supply 02 to body ↑↑ Risk of CVA or embolism with dehydration |
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What is the therapy for Tetralogy of Fallot?
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Prostaglandin E1
Maintain PDA ↑↑ Pulmonary perfusion Surgery Patch the VSD Open stenotic pulmonary valve Heart Transplant with severe defects |
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What are clinical manifestations of Tetralogy of Fallot?
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Tet” Spells
↑↑ Activity or ↑↑ Crying = ↓↓ blood flow to brain ↑↑ hypoxia, cyanosis and fainting Squatting compensatory action Knee chest position ↓↓femoral blood flow ↑↑blood flow upper body Clubbed fingers Mental retardation |
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What is Kawasaki disease?
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Most common acquired heart disease in children <8 years of age
Acute febrile & multi-system disorder Autoimmune Skin, mucous membranes, lymph nodes Vasculitis √cardiac complications ↑↑ incidence near fresh H2O Late winter/early spring |
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What are the clinical signs for Kawasaki disease?
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Fever >5 days
Febrile seizures Cervical lymphadenopathy >1.5 cm Bilateral non-exudative conjunctivitis Strawberry tongue Dry, red, cracked lips Truncal rash Erythema & edema of palms and soles “Shedding skin” Desquamation from fingers ↑ WBC ↑ ESR ↑Plts Cardiac sequella Pericarditis Myocarditis Arrhythmias Coronary Artery Aneurysm If untreated 15-25 % develop MI |
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what is the treatment for Kawasaki disease?
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IV Immune Globulin (IVIG)
↓↓ the incidence of coronary aneurysm <3% Single dose IVPB over 24 hours ↑↑Dose ASA (100 mg/kg/day) √ thrombocytosis Bed rest ↓ O2 Demands Petroleum jelly to lips √ CHF: ↑HR ↑RR dyspnea crackles Strict I & O Tepid sponge bath Complete and spontaneous recovery in 3-4 weeks! |
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What is Rheumatic Fever?
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Autoimmune response to
Group A β Hemolytic Strep Caused by untreated /partially treated group A strep pharyngitis Symptoms appear 2-6 weeks after infection Diffuse inflammatory & collagen disease connective tissue, joints subcutaneous tissue Brain, heart and blood vessels |
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What are the symptoms that diagnose Rheumatic Fever?
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Carditis
Cardiomegaly, murmur RT Mitral regurgitation valvulitis (Endocardium → Pericardium), ↑ HR Ashkoff bodies Hemorrhagic lesions in heart Polyarthritis Reversible and migratory knee → shoulder → elbow Subcutaneous nodules 1 cm non-tender swelling over bony prominences. Erythema marginatum Red macular wavy rash with clear center Chorea “ St. Vitus dance” Involuntary movements of extremities and face ↑ c anxiety ↓ c rest |
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What are tests that diagnose Rheumatic Fever?
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↑CPR (C-Reactive Protein)
↑ESR +Throat culture ↑ ASO titer >333 Anti-streptolysin reflects lysis of RBC ↑ 7 days p onset Max. level 4-6 weeks +BC EKG = prolonged P-R interval |
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What is the treatment for Rheumatic Fever?
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Complete bed rest 2-6 weeks
Gradual activity Medications- Antibiotics PCN & Prophylactic RX q Month IM Erythromycin for PCN allergy ASA -joints Prednisone – valvular inflammation Nutrition ↑ protein ↑ carbs ↑ fluids |
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What is Subacute Bacterial Endocarditis (SBE)?
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Infection of valves and inner lining of heart
High risk patients = congenital heart disease Bacteremia Strep Viridians- most common 70%, Staph Aureus 20%, Candida Albicans 10% Enters blood stream via teeth, gums, tonsils, UTI. Slow & insideous onset Attaches to congenital anomalies or prosthetic valve sites Vegetations Bacteria, fibrin and plt thrombi grow on endocardium Invade Aortic and Mitral valves ↑↑ turbulent blood flow and break off as embolism spleen, kidney, CNS, lung and skin. |
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What are the clinical signs for Subacute Bacterial Endocarditis (SBE)?
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Fever- low grade, intermittent or unexplained
Anorexia- malaise. “feel like getting the flu” Murmur New or change in previous murmur Cardiomegaly Splenomegaly Osler nodes- Red, painful nodules at finger tips Janeway’s spots Painless, hemorrhagic areas on palms and soles Splinter hemorrhages thin black lines under nails Petechiae on oral mucous membranes HA, ↓↓motor coordination = CVA!! |
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what tests diagnose Subacute Bacterial Endocarditis (SBE)?
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CBC with differential
BC = identifies the agent ↑↑ ESR CXR = cardiomegaly ↓ RBC = anemia EKG = prolonged PR interval Echocardiogram |
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What is treatment for Subacute Bacterial Endocarditis (SBE)?
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Bed rest
High dose (Meningitic) Antibiotics PCN, Gentamycin, Ampicillin IV therapy 4-6 weeks √ med SEs- √ hearing √ renal status Serial BC Counsel parents regarding antibiotic prophylaxis a & p invasive procedures |
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What is the pathophysiology of sickle cell?
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Vaso-occulusion
Sickle Shaped cells stack up Lodge in small vessels ↓ blood flow Tissue Hypoxia ↑Viscosity of blood = ↓blood flow ↓ O2 & ↑ metabolic end products Tissue Ischemia Edema & necrosis @ site Infarction Brain, Kidneys & Liver |
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What are clinical signs for sickle cell?
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First sign
Fetal hemoglobin (HgB) is depleted HgS hemoglobin is now dominant Low Hgb: 5-9 Hct: 15-30 Pallor Jaundice ↑ RBC’s destroyed RT ↓life span Frequent URI’s Generalized weakness Hepatosplenomegaly Acutely ill RT ↓O2 and Dehydration ↑ Stress or ↑infection (URI GI GU) ↑ Temp - Dehydration ↑ BMR ↑ O2 consumption leads to tissue hypoxia Abdominal pain- Thrombosis to liver and spleen Severe bone pain RT sickled joints Hematuria and diuresis RT renal ischemia Seizures RT Brain thrombosis/CVA Acute Chest Syndrome Severe chest pain SOB, ↑ HR ↑ RR Pulmonary congestion |
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What is the treatment for sickle cell?
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Bone Marrow Transplant = ↑Prognosis
O2 humidified Hydration ↑ PO intake 2.5 -3 L/day ✔ I & O Pain control PCA , MSO4, Fentenyl ASA No Demerol ( Metabolite = ↑↑ seizures) Folic acid ↑RBC PRBC Transfusions weekly (Hgb <10) Splenectomy (kids <5 years) Prevents Splenic Sequestration Massive entrapment of sickled cells in spleen HYPOVOLEMIC SHOCK!!! |
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What is Sickle Cell Disease?
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Defective HgB chain (HgS)
RBC’s are sickle shaped Unable to carry O2 RBCs have a shorter life span 16-30 days |
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What is Iron Deficiency Anemia?
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Inadequate supply of dietary iron (Fe)
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What are the different causes of Iron Deficiency Anemia (Infant vs adolescent)?
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Infants
↑ risk @ 6 months Fetal Fe stores are depleted ↑ milk consumption & ↓↓ protein/solid intake Adolescents ↑ growth spurt poor nutrition ↑ blood loss c menses |
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What are the clinical signs of Iron Deficiency Anemia?
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Tachycardia
Pallor Infants chubby and white Hypoxia Muscle weakness Fatigue ↓Alertness Irritability HA Dizziness Koilonychia Spoon shaped fingernails Glossitis ↓Hgb <10 Hct <30 ↓ Ferritin <7, ↓Serum Fe <30 ↑TIBC (Total Iron Binding Capacity) >350 |
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What is the treatment for Iron Deficiency Anemia?
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Fe supplement
(2-3 mg/kg/day) Give between meals with acidic fluids. Takes at least 4 months to replace loss SE: Stains teeth, black tarry stools Dextran (parental iron) Z-track deep IM -buttocks only Nutrition Green leafy vegetables, whole wheat, beans, shellfish, egg yolk, Organ meats, |
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What is Hemopillia?
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Lacks Factor VIII (AHF)
AHF Anti hemolytic Factor Severe & spontaneous bleeding Not trauma induced Sex linked recessive-X chromosome Mom transfers diseases to boys Girls are carriers |
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What are the clinical signs of Hemopillia?
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1st indication at circumcision
Crawling = ↑ bruises on pressure areas Hemarthrosis Bleeding into joint cavities (synovial space) Early sign = stiffness, tingling or achy Warmth, redness, swelling ↓ ROM & function Alkylosis of joint Spontaneous bleeding Epistaxis, loose baby teeth, Hematuria Spinal Cord Hematoma = paralysis Intracranial Hemorrhage = Death |
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What is the treatment for Hemopillia?
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Recombinant Factor VIII (IV)
Purified, reconstitute a use DDAVP (1-deamino-8 D Arginine Vasopressin) Synthetic form of vasopressin Control bleeding = RICE Apply pressure x 15 mins (NO Peaking!) Splint & immobilize area x 24 hours Pain meds Tylenol Corticosteroids Opiods Exercise PT to strengthen joint muscles |
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What is patient teaching for the patient with Hemopillia?
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Genetic testing
All female members Injury/Bleeding prevention Soft rugs, soft toothbrush, electric razor Review S/S Internal Bleeding: √ hematuria √ black tarry stools Cerebral : HA, slurred speech, LOC Venipuncture Kids >8 years can self administer ↑ Independence and accountability Community Education Medical Alert Tag Notify all organizations, friends Quiet activities, non-contact sports National Hemophilia Foundation |
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What are the facts about Acyanotic Defects?
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L →R side shunt of oxygenated blood
↑ Pulmonary blood flow Pulmonary congestion Heart is ineffective pump Children prone to CHF Prophylactic administration of antibiotics needed |
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What are the facts about Cyanotic Defects?
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Unoxygenated blood enters systemic system
“Right to Left shunt” (R→ L) Blood is shunted from venous to arterial ↑↑ CHF and hypoxic episodes Now classified as: ↓↓ Pulmonary blood flow or Mixed blood flow defects |
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What is aortic stenosis?
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narrowing of aorta backing up of blood
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Aortic Stenosis is what type of defect?
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Acyanotic
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What does Aortic Stenosis Result in?
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Pulmonary Congestion
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What are the facts about digoxin?
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Action -cardiac glycoside
↑ Contactility of heart = ↑ efficacy = ↑ CO Slows down SA node = ↓ HR Digitalization Loading Dose = 30-40 mcg/kg/dose ÷ (½, ¼, ¼) Maintenance dose = 4-5 mcg/kg/day ÷ q 12 |
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What are nursing interventions for giving digoxin?
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√ Apical pulse for one full minute before giving med. Hold med if:
Infant <100 Toddler <90 Preschool <70 School age <60 √ I and O and √ K+ level ↓↓ K+ = ↑↑ Dig toxicity √ Serum Digoxin level (0.5-2ng/dl) Digoxin Toxicity (>3ng/dl) vomiting (earliest sign), nausea (↓↓ Po intake) lethargy and bradycardia Administer with 2 RN’s Review order & √ HR parameters √ Dosage and calculation √ Actual dose in syringe a administering |
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What is Lasix and what does it do?
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1mk/kg/dose
Blocks reabsorption of Na+ H2O @ loop of Henle ↑↑↑ loss of Na+, K+ and H2O |
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What are some nursing interventions for giving Lasix?
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√ Weight
Same time, scale and amount of clothing = None! √ I and O weigh all diapers √ skin tugor on sternum (tenting= dehydrated) √ Serum electrolytes K+, Na+, BUN and Creatine Administer K+ supplements KCL, Slo-K, K-Lor, K-Dur K+ level affects Digoxin efficacy! |
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what stage of erickson are children 3-5?
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Initiative vs. Guilt
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initiative vs. Guilt characteristics?
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Ability to learn & play.
Development of “can do attitude” Behavior becomes goal directed, competitive and imaginative. Imitate parents & gender roles. Proud when accomplish new goals. When criticized show feelings of guilt. |
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developmental skills of a 3 year old?
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Walking, running and jumping well @ 36
900 word vocabulary/3-4 word sentence Copy a circle and cross Builds a tower of 9 blocks Ride tricycle, walk stairs alternating feet Pour from pitcher Asks a lot of questions |
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developmental skills of a 4 year old?
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1,500 word vocabulary/4-5 word sentence
Can copy a square Very noisy, talkative Exaggerates stories Loves Rhymes & songs Names 3 colors Hop on one foot Catch a ball with both hands, throws overhand ↑ Self-Care: Brushes teeth Gets dressed ↑ Cooperation |
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developmental skills of a 5 year old?
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2,100 word vocabulary/6-8 sentence
Copy diamond and triangle Prints name Draw person with 6 parts Head, body, 2 arms & 2 legs Talk constantly Names 4 colors Skip & Hop on alternating feet Walks backwards Hits a ball Ties shoes & manage big zippers |
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what are 3-5 yr old devel. task expectations?
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Large and small muscle coordination
Uses initiative with a conscience Becomes a participating family member Settles into a daily routine Dental & personal Hygiene Sleep |
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major preschool age safety issues?
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MVA #1
drowning and falls dont really understand danger you should provide safety education |
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preschool health concerns: eyes
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Visual acuity and depth perception fully developed by age 7
Vision testing begun at 3 years |
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whats the expected screening charts for preschoolers?
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3years allen card images
>4 use E chart |
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Expected vision for 4 and 5 year olds?
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4yrs: 20/30-20/40
5yrs: 20/20-20/30 |
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Strabismus
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↓ Coordination of EOM
Eyes are not aligned One or both eyes can turn |
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Amblyopia "Lazy Eye"
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Only uses 1 eye for vision
No binocular vision ↓ vision in the deviated eye Distorted visual field Can develop if strabismus is not treated early If left untreated → Blindness in deviated eye |
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Amblyopia "Lazy Eye" treatment
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Patch normal eye x 24 hours/day
Deviated eye must work possible Surgery |
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Hearing screening
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Early detection = better outcome
Mandatory newborn hearing screenings Routine Audiometry screening by age 3 Various tones @ various frequencies Standard volume (usually 20 db) Normal hearing ranges from 10 → +15 By age 5 hearing is fully developed |
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what are the causes of Sensorineural (Nerve deafness?
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Infections: CMV, Rubella, Herpes, Meningitis
Heredity Prematurity (Hypoxia) Ototoxic meds |
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Sensorineural (Nerve deafness) treatment
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Hearing Aids- worn ASAP to help facilitate language development
Cochlear implants = Controversy American sign language ↑ communication |
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What are conductive hearing impairments?
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Middle hearing loss affected by
inflammation, obstruction or damage OME/OM Cerumen impaction Perforation Temporary & restores to prior hearing level |
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what are the treatments for conductive hearing impairments?
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Antibiotics for infection
Myringotomy & Tympanostomy tubes |
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Biological Development
School Age 6-12 years? |
Growth slows down
Weight: 5 - 6 lbs/year Height: 1 - 2 inch/year Average 6 year old 46 lbs & 45 inches |
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what is the erickson stage for children 6-12?
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Industry vs Inferiority
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characteristics of industry vs. inferiority?
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Interest in doing work
Learn and solve problems ↑ accomplishment RT ↑ motivation Desire to master & do well in everything If they don’t they will feel inferior. Reinforce that they cannot do well in everything |
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Developmental skills of a 6 year old?
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Period of Transition
Self centered Normal to cheat at board games Impulsive ↑Activity RT ↑coordination ↑Dexterity = drawing & writing |
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Developmental skills of a 7 year old?
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Quiets down
Solitary play Attentive Sensitive listener Modest (Need Privacy) Companionable |
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Developmental skills of a 8 year old?
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Fluctuating Behavior
↑Graceful movements ↑Interest in nature Very self-critical |
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Developmental skills of a 9 year old?
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↑ Independence
Refined eye-hand control Musical instruments Best friend Collections Well organized ↑Physical complaints with stress May have boy/girl relationship but won’t admit |
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what are the developmental skills of a 10 year old?
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↑ Stamina
Budgets time ↑ Energy Enjoys family activities ↑ Appetite |
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what are the developmental skills of a 11 year old?
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Moody
Strict superego-conscience Strong morals/values Best behavior is away from home |
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what are the developmental skills of a 12 year old?
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↑ Personality integration
↑ Self discipline ↑ Self control Tactful Mutual understanding with parents |
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what are the developmental tasks of the school age child?
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↓ Dependence on family
↑ Neuromuscular skills Must adjust to changes in body image Develop positive attitude |
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What are the 3 cardinal signs of ADHD?
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Inattention
Impulsiveness Hyperactivity |
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what are some affects of having ADHD?
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Unable to self regulate & inhibit behaviors
↓ Academic Performance RT ↑ Distractible & ↓ Task completion ↓ Self Esteem = ↓ Peer relationships ↑ Risky Behavior = ↑ Substance Abuse & MVA Sequela: Conduct, Mood & Anxiety Disorders |
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What is the etiology of ADHD?
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familial tendency,
Toxins (Pb), meds, food allergies, lead, smoking, alcohol, sugar ↓Neurotransmitters: ↓ NE, ↓ DA and ↓ 5-HT |
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guideline to diagnose ADHD?
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Based on report by parent
Onset By age 7 Symptoms must last >6 months have 6/9 symptoms listed Must affect 2/3 areas (home, school, social situations) |
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What are health/ injury problems of school age child?
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Generally not a sick age
Injury Prevention MVC remains # 1 Sports Burns Access to Guns |
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What is Autism Spectrum Disorder ASD?
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Complex neurodevelopmental disorders
Core deficits in 3 areas: Social Interaction Verbal & nonverbal communication Restricted interests, repetitive behaviors & resistant to change Affects prenatal & postnatal brain development NO correlation with MMR vaccine |
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what are ASD Clinical Signs?
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Inappropriate social behavior
Unable to maintain eye contact Avoid body contact Lack emotional reciprocity Impaired expressive & receptive language skills Delayed echolalia Inability to sustain or initiate conversation Repetitive behaviors: Opening & closing doors, flipping light switches, H2O play, shredding paper, prefer item movements & ritualistic behaviors Insist on “sameness” Self-Stimulatory behaviors: Finger licking, hand flapping, body rocking, run in circles Deep pressure stimulation-crawl into tight spaces Self-injury RT ↟↟ Pain Threshold, aggressive behaviors GI Symptoms- Constipation ➔ Mega rectum |
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what are some ASD treatments?
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Developmental screening, Physical exam, multidisciplinary approach, Early intervention programs, Highly structured and intensive behaivior modification programs (Promote positive reinforcement
Increase social awareness of others Increase verbal communication skills Decrease unacceptable behavior), Use brief, concrete communication, Minimal holding & eye contact to avoid outbursts, Gradually introduce new situations Medications, Atypical antipsychotic- Risperidone,↡ behavioral symptoms only |
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What is scoliosis?
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Abnormal lateral curvature
>10% of the spine Severe type can ↓ thoracic capacity ↑ risk for osteopenia Develops in preadolescent growth spurt Higher risk in females 85% |
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About Structural/Congenital/Neuromuscular scoliosis?
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Muscle or bone deformity
congenital or result of neuromuscular disorders S shaped curved with vertebral rotation Asymmetric thoracic cavity scapula, breasts, shoulders and hips ↑ deformity during periods of growth |
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therapy for Structural/Congenital/Neuromuscular scoliosis? (Braces)
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Milwaukee Brace worn 23 hours a day, boston brace low profile most widely used, providence brace used only at night= increased compliance
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therapy for Structural/Congenital/Neuromuscular scoliosis? (Surgery)
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Harrington Rod-
internal spinal fixation- “flat back” post-op immobilization required Lugue Segmental System- flexible wires threaded through spine- no post-op immobilization required, ↑ risk for nerve damage Spinal fusion for severe scoliosis Iliac bone graft |
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what are S/S of Varicella?
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Low grade temp, Anorexia, Rash in outbreaks occur in crops at increased temp of like 104, very itchy (pruitic)
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What is therapy for varicella?
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Palliative
Antihistamines (benadryl) Antipyretics (Calamine lotion) Acyclovir ↓ # of lesions-when given within 24H of rash mostly for high risk pt’s Varicella zoster immune globulin (VZIG) given within 96 hours for high risk pt’s Strict isolation in hospital |
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Some info about Lice
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Highly contagious infestation of scalp
“itchy” from crawling mites and saliva ↑ @ occipital area ↑ @ night √ Environment Stuffed animals Bedding Clothing (fur) |
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What are the therapies for lice?
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Rid/Nix-Permethin 1 %
One application Kills lice and nits. Not for kids < 2 years Kwell- Lidane Two applications Repeat in 7-10 days after eggs hatch |
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Info about adolescence?
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12-18 years of age.
Self-sufficient Puberty Period of physiological changes. Sex organs mature, menses, spermatozoa |
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what erickson stage are adolescents in?
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Identity vs. role confusion
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What are characteristics of identity vs role confusion?
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Individuality
Internal Stability Achieve Sense of Self Occupation/Future Goals Social Development FRIENDS!! >> Family Peer pressure Recognition via group identity Dating groups vs. individual Sexual intimacy |
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What are the Developmental tasks for the adolescent
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Accept body changes
Achieve satisfying sex-related role Achieve independence & warm relationship with parents Develop mature set of values, work ethic & occupation |
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Common health probplems for adolescents?
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Cardiac, Drug use, Pregnancy and STD's, Depression and suicude
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about Sulfasalazine?
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Antiseptic & Anti-inflammatory
↓ bacterial count in bowel 1/3 dose sm intestines & 2/3 dose lg intestine Interferes with absorption of folic Acid Need Folic acid supplements Antidiarrheal Paragoric (Tincture of opium) ↓ Frequency of stools & delays transit in intestines Not recommended in infectious diarrhea |
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What is Intussusception?
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Telescoping of bowel into itself
↑ Risk between 3-12 months old Males 3 x > risk than females Pushes bowel inward = obstruction Stops peristalsis completely No bowel sounds distal to obstruction ↑ Incidence @ ileocecal valve |
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What are the S/S of Intussusception?
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Palpable sausage mass in RUQ
Sudden acute abdominal pain Colicky, wavelike intermittent pain Draw-up knees in pain with guarding Hyperactive BS proximal to obstruction ↑ Peristalsis before obstruction Distended abdomen and ↑ tender with palpation Constipation no feces or flatus passed Jelly stools ↑ pressure on bowel walls, ischemia and blood Fecal vomiting and dehydration (↓H2O ↓Na ↓ Cl) Lethargy & Shock Initially ↑ HR ↑ BP, then ↓ HR ↓ BP ↓ Temp & clammy |
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What is the therapy for Intussusception?
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Barium Enema
Diagnostic and curative 85% Forces bowel out Do not do if you suspect ischemia or strangulated /infarction of bowel Surgery Resect all affected areas & re-anastomose No colostomy needed Same care as for Hirschprungs |
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everything about Perforation?
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Medical Emergency!
High temp 104 Rigid (board like) abdomen ↑ Abd. distention Diffuse pain or sudden relief of RLQ pain Very sick appearing STAT OR! Need 7-10 days triple antibiotics post op |
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what is the therapy for appendicitis?
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Pre-op
NPO, IV antibiotics & no pain meds! No enema! √ Abdomen Distention via girth Bowel sounds Stool pattern Post-op √ s/s infection, obstruction/ileus Pain management ATC x 1st 24 H Splinting, cough and deep breathing Early ambulation NPO until positive bowel sounds & passing flatus |
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What is Celiac Disease?
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Gluten Induced Enteropathy
2nd to CF & possible genetic component ↓ incidence when solids are delayed until 6 months Inability to digest gliadin or protein part of wheat, barley, rye and oats ↑ accumulation of toxic substance Glutamine damages mucosal cells → villi atrophy ↓↓ absorptive surface of small intestine Lifelong Dietary modification needed to prevent chronic symptoms |
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What are Clinical Signs of Celiac Disease?
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Usually @ 9 months
Need 3-6 months after introduction of grains Drop on growth chart <25 % Steatorrhea Abdominal distention/pain Anorexia Irritability & Uncooperative Muscle wasting in legs & buttocks ↓Vitamin A, D, E & K = Anemia |
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What is the therapy for Celiac Disease?
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Serum Antiglidian Antibody (AGA)
Newer test - Tissue Transglutaminase (tTG) Jejunal biopsy Flat surface and ↓↓ # of villi ↓ ↓ Absorption Fecal collection 72 hours √ stetorrhea Gluten free Diet –Lifelong Therapy No Wheat, Barley, Rye or Oats No prepared foods, pizza, pasta, hot dogs, cold cuts, bread Only Corn or Rice In 1 week Rapid improvement ↑ appetitite and ↑ weight Symptoms are gone, this is diagnostic |
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What is Hirschprung’s Disease?
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Congenital Aganglionic Megacolon
Absence of ganglion cells in distal area of colon No innervation → no peristalsis → ↑ distention = megacolon Mechanical obstruction RT ↓ Motility No relaxation of internal rectal sphincter No evacuation of stool, liquids or flatus! 25% of all cases of neonatal intestinal obstruction Males 4x > females |
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Hirschprung’s Disease S/S Infant?
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Do not pass meconium in 1st 24 hours.
Abdominal distension Bilious vomiting Not tolerating feedings Failure to Thrive Palpable fecal mass |
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Hirschprung’s Disease S/S older child?
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Chronic constipation
Recurrent distension Diarrhea alternates with constipation ↑ # of episodes = ↑ mortality Visible peristalsis Ribbon-like & foul smelling stools Malnourished & anemic |
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How to diagnose Hirschprung’s Disease?
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Anorectal Exam
Tight internal sphincter & no stool Sudden release of gas and stool Barium enema Distinct change in distal portion of colon Very distended to saw toothed appearance Won’t pass barium Full Thickness Rectal Biopsy Definitive diagnosis shows absence of ganglionic cells |
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What is the treatment for Hirschprung’s Disease?
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Mild: Rare
Treat chronic constipation with stool softeners and cleansing enemas Moderate:Surgery Remove aganglionic portions of bowel Temporary colostomy Proximal stoma = functional stoma (Stool) Distal stoma = mucous or H2O drainage NPO until positive bowel sounds Diet ↑ Protein ↑ Calories Gradually ↑ Volume & consistency Reverse Colostomy @ 2-3 months or 8-10 kg Re-anastomose both ends |
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What is a UTI?
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Ascending infection
Bacteria → urethra → bladder (cystitis) Bladder → ureters → kidney (pyelonephritis) Fecal bacteria causes 80% UTI’s Peak incidence @ 2-6 years of age without structural problems |
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What are the signs and symptoms of the UTI?
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Burning
Frequency Dysuria Suprapubic, flank or abdominal pain Incontinence Foul smelling urine Fever Infants may present with high fever, “chills”, vomiting, diarrhea or irritability |
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What tests are used to diagnose UTI??
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UA and C & S to identify organism
Clean catch or bagged urine Area must be cleaned properly! Urinary catheterization or supra-pubic tap. Sterile procedure! Repeat C&S after medication completed To verify med was effective |
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Therapy for UTI?
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Antibiotic
Analgesic ↑ Hydration 2 – 4 liters/day Acidic juices: cranberry and OJ Encourage frequent voiding Appropriate hygiene Wipe from front to back No bubble baths |
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Hypospadias
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1-300 births
10-15% have 1st degree relative Urethral opening located behind glands on ventral (underside) surface “Kids wet their sneakers” ↑↑ Severity closer to body wall |
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Epispadias
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Rarer than hypospadias
Urethral opening located behind glans penis on dorsal (upper) surface “Kids wet their faces |
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Treatment for hypospadius and epispadius?
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No circumcision!
May use foreskin for repair later Urology consult Reconstructive surgery @ 6-18 mos Testosterone prior to ↑ penile size Indwelling catheter → leg bag Home care instructions important |
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Cryptochidism
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Failure of 1 or both testes to descend abdomen→ inguinal canal→ scrotal sac
Inguinal hernia and small scrotal size Retractile testes- “Reducible” Overactive cremasteric reflex. Manually can be brought down to scrotal sac. |
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Cryptochidism treatment
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Wait for 1st birthday for spontaneous descent
75% spontaneously descend HCG 1000 units IM x 3 doses Facilitates descent Surgery-orchioplexy Bring testes into scrotal |
