objective 10.5 Flashcards by Kaitlyn Dominie

obstruction at the lower end of the stomach (pylorus) caused by an
overgrowth (hypertrophy) of the circular muscles of the pylorus or by
spasms of the sphincter

hypertrophic pyloric stenosis (HPS)

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what are the manifestations of HPS?

 Projectile vomiting is outstanding symptom from force or pressure being
exerted on the pylorus
 Vomitus contains mucus and ingested milk
 Occurs right after feeding
 Infant is constantly hungry and will eat again immediately after
vomiting
 Dehydration (sunken fontanelle, inelastic skin & dec. urination)
 Olive-shaped mass may be felt in upper right quadrant of abdomen

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what is the nsg care preoperatively for HPS?

IV fluids (I&O critically important)
Infant is burped before and during and post feedings to remove any gas
accumulated in the stomach
Place child on right side after feeding, fowlers position preferred
If infant vomits usually nurse refeeds infant
Chart feeding time, amount, emesis time, amount, appearance
Daily Wt

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what is the nsg care postoperatively for HPS?

VS
IV fluids
Monitor surgical site
 provide feedings as prescribed by surgeon (usually after recovery from
anesthesia)
* oral feedings of small amounts of clear liquid that gradually increases to
breastmilk or formula, as tolerated (3-6 hrs post- glucose, water or
electrolytes, 48 hrs post start full feeds)
* Avoid overfeeding
 document intake and output
Proper positioning

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*Most common reason for emergency abdominal surgery in childhood
*Initial pain usually periumbilical and increases within a 4-hour period
*When inflammation spreads to peritoneum, pain localizes in RLQ (point of
tenderness) of abdomen (McBurney’s point)
*may become gangrenous or rupture
*Can lead to peritonitis and septicemia

appendicitis

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what are the characteristic symptoms of appendicitis?

Guarding
Rebound tenderness
Pain on lifting thigh while in supine position
Pain/Tenderness in RLQ (known as McBurney’s Point)

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Protrusion of part of the abdominal
contents through the inguinal canal in the
groin

inguinal hernias

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◦ Protrusion of a portion of the intestine
through the umbilical ring
◦ Appears as a soft swelling covered by skin,
which protrudes when infant cries or
strains

umbilical hernias

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A fissure or opening in the upper lip, can occur on one or both sides
* Occurs in 1 in 600 births
* Can be accompanied by Cleft Palate
* Congenital anomaly, more common boys than girls
* It is a result of the failure of the maxillary and median nasal
processes to unite during embryonic development, usually between
the seventh and eighth weeks of gestation

cleft lip

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what is the preop care for cleft lip?

Signs of infection reported
Elbow immobilizers
syringe or cup feeding

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what is the postop care for cleft lip?

Prevention of crying/ sucking for 7 to 10 days
Feeding- upright position, with dropper, slowly to prevent
aspiration, position in car seat or on right side propped to enhance
digestion
Pain relief/sedation
Emotional needs
Prevent infection/injury

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what is the treatment & nsg care for cleft palate?

Union of the cleft through surgery
Improved feeding, speech and dental development
Nurture a positive self image
Nutrition
Oral Hygiene- keep clean, follow feedings by water
Speech
Diversion- crying is prevented if possible
Complications- Ear infections & dental Decay

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Failure of the hard palate to fuse at the midline
Forms a passageway between the nasopharynx and the nose
Complicates feedings and leads to infectionsof the
respiratory tract and middle ear that can result in hearing
loss.
Speech difficulties later in life

cleft palate

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 Also known as gluten enteropathy and
sprue
 Leading malabsorption problem in
children
 Symptoms not evident until 6 months to
2 years of age when foods containing
gluten are introduced
 Wheat, barley, oats, and rye

celiac disease

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what is the treatment of celiac disease?

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 Occurs whenever fluid output exceeds fluid intake
 Children under 2 years have more water loss via
surface areas via kidneys
 Newborn’s total wt is approx. 77 % water
 Metabolic rate is much higher in children
therefore more waste must be diluted in order to
be excreted
 Results= rapid fluid turnover & dehydration occurs
quickly in infants vs adults

dehydration

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what is the nursing care of dehydration?

 Maintenance fluid therapy or Deficit therapy
 Intake and Output (knowing what average output should
be is important (table 28.3)
 VS
 Daily Weight
 Check Skin and Fontanelles, mucous membranes and
level of consciousness
 Table 28.4 Estimation of Dehydration
 May require hospitalization for IV

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what can failure to thrive be classified by?

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inadequate caloric intake
inadequate absorption
increased metabolism
defective utilization

what is the nursing care of failure to thrive?

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◦ Multidisciplinary approach
◦ Educate & Support caregiver & child (even if neglect
is suspected)
◦ Nutritional Replenishment
◦ Assign same nursing staff to child may inc. nurturing
& interaction with infant & parent

Sudden increase in stools from the infant’s normal pattern , with a fluid consistency
and a color that is green or contains mucus or blood
Classified as:
Acute Sudden, Chronic, Infectious

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diarrhea

what are the manifestations of diarrhea?

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Stools watery & explosive; may be yellowish-green
Listlessness, refusal to eat, weight loss, possible fever & vomiting
Dehydration; evidenced by sunken eyes & fontanels; dry skin, tongue, & mucous
membranes; less frequent urination

what is the nursing care for diarrhea?

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*Treatment focus on identifying & eradicating the cause
*Reduce solid foods
*Oral rehydration solution- small frequent feedings
*Breastfeeding encouraged
*Mild diarrhea in older children may be treated at home
under a health care provider’s direction

Infectious diarrhea , involves inflammation of the stomach and
intestines

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gastroenteritis

involves an infammation of the colon

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colitis

involves an inflammation of the colon and small intestines

enterocolitis

most common cause among children

ravirus

what is the treatment and nursing care of gastroenteritis?

* Focus on identifying and eradicating cause * Oral rehydrating solutions (ORS), I&O * Frequent skin care * Principles of cleanliness & Infection(hand hygiene, proper food handling) * Daily Wt. * Observe for dehydration * Contact Precautions

Results when the lower esophageal sphincter is relaxed or not competent, which allows stomach contents to be easily regurgitated into the esophagus

gastroesophageal reflux

what is the S&S of gastroesophageal reflex?

Vomiting, weight loss and failure to thrive, irritation to esophageal tract, irritability (unable to feel nutritionally satisfied), aspiration

what is the treatment care of gastroesophageal reflex?

* Teaching to parents about: careful burping, avoiding overfeeding and proper positioning * Upright position after feeding (30 to 40 degrees) * Medication may be needed for more severe cases

Infection of the mucous membranes of the mouth cause by the fungus Candida

thrush

what are the manifestations for thrush?

* White patches resemble milk curds on the tongue, inner gums, and oral mucosa, Painless but can’t be wiped away * Anorexia may be present

what is the nursing care for thrush?

* Local antifungal suspensions (Nystatin) – apply with applicator onto oral mucosa 3-4 X/day * Should disappear within a few days with proper treatment * Use of standard isolation in newborns with disposable bottles, nipples, pacifiers preferred

 Most common endocrine disorder of childhood  Chronic metabolic condition in which body is unable to use carbohydrates properly because of a deficiency of insulin * Insulin deficiency leads to impairment of glucose transport * Body unable to store and use fats properly * Decrease in protein synthesis

diabetes mellitus

“juvenile onset” * Most common metabolic disorder of childhood * Absolute or complete insulin deficiency * Autoimmune condition that causes destruction of beta cells in the pancreas * New cases highest in 5 – 7 yr old's & 11 – 13 * More difficult to manage in childhood because of growing , energy expenditure, varying nutritional needs * Initial diagnosis may be determined when the child develops ketoacidosis

type 1 IDDM

“Adult Onset” * Insulin resistance or decreased production

type II NIDDM

what are the symptoms of type I IDDM?

* Classic Triad of presenting symptoms: 1. Polydipsia: excessive thirst 2. Polyuria: frequent large amts urination 3. Polyphagia: constantly hungry * Symptoms appear more rapidly in children * Onset of lethargy, weakness & wt. Loss, irritability, bedwetting, dry skin, yeast infections (in adolescent girls) * Symptoms may go unnoticed until an infection or coma. * Lab findings: Glucosuria & Hyperglycemia, elevated HgbA1C

what is the diagnostic test for DM?

* Random Blood Glucose * Blood drawn at any time, no preparation; results should be within normal limits for both diabetic & nondiabetic patients * Fasting Blood Glucose * If greater than 7.0 mmol/L on 2 separate occasions, and the history is positive, the patient is considered as having DM and requires treatment * Glycosylated hemoglobin (HgbA1c) * Pending on age (target values may be 7-8% or less) * Values above 10% indicate poor control * See Box 31.1

Hypoglycemia @ night &  AM blood glucose levels Child wakens at night or has frequent nightmares Early morning sweating & headaches Needs less insulin NOT more Result of chronic Insulin use

somogyi phenomenon

Early am blood elevation of glucose levels without preceding hypoglycemia Response to growth hormone secretion that occurs in early AM

dawn phenomenon

what are the treatment goals of type I IDDM?

1. Ensure normal growth and development through metabolic control (meds, diet,exercise) 2. Enable the child to live with a chronic illness and have a happy and active childhood 3. Prevent Complications

Also referred to as diabetic coma, even though patient may not be in one *May result from a secondary infection and patient not following proper self care *May also occur if disease proceeds unrecognized *Ketoacidosis is the end result of the effects of insulin deficiency

diabetes ketoacidosis (DKA)

what is the for management/pt teaching type I IDDM?

* Diet * Exercise * Skin Care * Foot Care * Infections * Emotional Upsets * Urine Checks * Glucose –insulin imbalances * Travel * Follow Up Care * Illness or Surgery

objective 10.5 Flashcards

(43 cards)