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40 Cards in this Set
- Front
- Back
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Appendicitis
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begins as dull steady pain in periumbilical area progresses over 4-6 hours and localized to right lower quandrant low grade fever, nausea, anorexia sudden pain may indicate rupture - leads to peritonitis diagnosis- clincal s/s, increase wbc, abdominal sonogram, exploratory lap. rebound pain or tenderness rlq and mcburneys point |
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imperforate anus
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incomplete development/ absence of anus failure to pass meconium stool absence or stenosis of the anal rectal canal anal membrane external fistula to the peritoneum |
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hirschsprung's disease |
newborn - failure to pass meconium, anorexia, vomiting-may be bilious, abdominal distention older infant/child- failure to gain weight, abdominal distention, constipation, fecal masses, ribbon stools, foul smelling diagnosed- rectal biopsy, surgical removal of involved segments, anastomosis or rectal pull-through. |
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hirschsprungs disease |
minitor for bowel perforation monitor vs monitor fluid and electrolytes monitor abdominal distension admin of antibiotics bowel prep= saline enemas, bowerl sterilization by enema or po - not in neonate!! |
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hd |
-wound and ostomy care monitor gi system ng tube bowel sounds abdominal appearance fluid management discharge teaching long term complications |
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differences in body water content
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newborn = 70-80 % one year old = 64% adult = 60% |
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metabolic rate
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have greater production of metabolic waste that must be excreted by the kidneys because water is needed by the kidneys to excrete these waste, a large urinary volume if formed each day |
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body surface area differences |
larger quanities of fluids to be lost in insensible perspiration through the skin- fever bsa of preterm infants is 5 x as great newborn is 2-3 times a great/ older child adult the proportionately longer gi tract is another source of fluid loss, especially from diarreah |
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types of dehydration |
based on osmolality and serum sodium concentrations |
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isotonic dehydration |
cause- acute gi loss , diarrhea, vomiting incidence - 70% aim of therapy - restore, volume quickly, watch for fluid overload |
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hypertonic dehydration |
causes fever, hyperventilation, increased electrolyte solutions, decreased intake aim of therapy : replace h2o and some sodium incidence - 20% |
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hypotonic dehydration
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shock may occur, serum sodium less than 130 meq/l cause- chronic diarrhea, ileostomies, high water intake, sugar, water, tea incidence 10% aim of therapy - give more sodium than h20 |
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tx |
initated for vomiting and diarreah pedialyte 50-100 ml/kg over 4 hours |
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tx |
iv therapy intiated and maintained for febrile condition dehyration weight loss severe vomiting, diarrhea rotavirus iv meds |
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pyloric stenosis |
junction of stomach and duodenum |
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pyloromyotomy |
an incision through the muscle fibers of the pylorus |
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cleft lip
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unilater complete bilateral complete |
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cleft palate
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bilateral compelte lip and palate incomplete cleft palate |
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cleft lip and cleft palate
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feeding respiratory distress bonding preop incision area nutrition |
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cleft lip |
post op care - positioning restrain with soft elbow restraints to keep child from touching repair site - remove every 2 hrs x 10-15 mins monitor surgical site provide analgesias for pain |
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cleft palate |
post op concerns for these children - |
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cleft lip/ cleft palate
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clinical issues hearing, speech, plastic surgery |
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intussusception |
telescoping of intestines into self often ileum into cecum into colon cuts off circulation to tissue |
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intussusception |
50 % occur in 3-12 month olds, 50% in 1-2 year olds episodes of acute abdominal pain with intervals of no pain vomitting abdominal mass- sausage like later0 currant jelly stools, abdominal distention |
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intussusception
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barium enema, air enema or water soluble contrast enema under pressure sometimes reduces the invagination surgical reduction |
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intussusception
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pre-op- npo/ngt abdominal assessment risk for bowel perforation assess stools post procedure assess for reduction of intussception monitor for passing of contrast medium fluid management teaching - risk for recurrence |
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post op care laparotomy |
iv fluids pain management |
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gastrochisis |
viscera outside abdominal cavity small defect - immediate surgical repair large defect - gut is slowly returned to cavity over 28 days or longer |
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abdominal wall defects |
primary closure vs prosthetic silo impaired ventilation vascular compromise and bowel necrosis infection maintain fluid and electrolytes long term tpn via cvc/picc pain control |
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healthy people 2020 |
weight and height can help determine overall health |
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nursing assessment |
blood pressure tissue turgor mucous membranes body temp fontanelle under 2 yrs tears cap refill time urine volume and concentration normal output: infants 1ml/kg/hr child 0.5ml/kg/hr weight changes - used to calc the % of fluid volume |
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essential information
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weight loss or gain of 1kg (2.2lbs) in 24 hours = 1 liter fluid loss/gain |
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daily maintenance fluid requirements |
allow 100 ml/kg for first 10 kg allow 50 ml/kg for second kg allow 20ml/kg for remainer of weight on kg devide total by 24 hours to obtain rate in ml/hr |
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common gi test/ labs |
xray barium enema barium swallow esophageal ph probe colposcopy anus to ileum upper endoscopy mouth to jejunum stools for ova, parasites, bacteria, blood electrolytes, serum amylase, lactose tolerance, serum lipase, liver fxn test |
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nursing diagnosis |
diarrhea constipation risk for impaired skin integrity imbalanced nutrition : less than body requirements pain ineffective breathing pattern risk for caregiver role strain disturbed body image |
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Icteric |
Yellow in color May indicate liver is not functioning correctly. Seen in sclerae |
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Protuberant |
Bulging outward abdomen May indicate ascites fluid retention gaseous distention or tumor |
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Rebound tenderness |
Pain upon release of pressure during palpation. Can be warning sign of appendicitis |
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Cholestasis |
Impairment of bile flow. |
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Steatorrhea |
Fatty stools |
