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Peds > Week 6 > Flashcards

Week 6 Flashcards

1
Q

urinary tract infections

A
  • one of the most common conditions of childhood
  • may involve lower u.t. or upper
  • upper UTI (acute pyelonephritis) can lead to renal scarring, hypertension, and end-stage renal disease
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2
Q

anatomic and physical factors

A
  1. structure (short urethra) of the lower u.t.
  2. single most important contributing factor is urinary stasis (incomplete emptying of bladder)
  3. reflux (bladder urine into ureters), anatomic abnormalities, dysfunction of the voiding mechanism or bladder compression
    Graded. 1,2,3: resolve on own. 4,5,6: surgery
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3
Q

UTI clinical manifestations: infancy

A
  • poor feeding, vomiting
  • FTT
  • frequent urination (hard to pick up on)
  • foul-smelling urine
  • pallor, fever
  • persistent diaper rash
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4
Q

UTI clinical manifestations: childhood

A
  • abdominal pain
  • frequency and urgency on urination
  • dysuria
  • poor appetite, vomiting
  • growth failure
  • excessive thirst
  • enuresis, incontinence
  • swelling of face, pallor
  • fatigue, back pain
  • blood in urine
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5
Q

nephrotic syndrome

A
  • most common presentation of glomerular injury in children
  • mostly under 10yo. idiopathic.
  • some cases congenital/genetic and secondary to lupus
    Characteristics
  • proteinuria (massive urinary protein loss)
  • frothy and foamy urine
  • hypoalbuminemia
  • hyperlipidemia
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6
Q

nephrotic syndrome: clinical manifestations

A
  • weight gain (edema)
  • facial edema (especially when waking up)
  • abdominal swelling
  • diarrhea (edema in intestinal mucosa)
  • anorexia
  • easily fatigued
  • decreased urine volume
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7
Q

nephrotic syndrome: treatment

A
  • goal: reduce excretion of urinary protein, reduce fluid retention
  • corticosteroids (watch out for long term s/e)
  • dietary restrictions: low salt diet
  • fluid restrictions and diuretic therapy in severe cases
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8
Q

nephrotic syndrome: nursing management

A
  • monitor fluid retention or excretion
  • strict I/O
  • urine examination for protein (u/a dipstick)
  • daily weight and measurement of abdominal girth
  • monitor VS (increased risk for infection)
  • parent education: relapse can occur. early detection key.
  • s/s nephrotic syndrome (edema)
  • urine dipsticks at home
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9
Q

acute glomerulonephritis

A
  • most are post-infectious (strep)
  • occurs 10-21 days after strep infection in strains that cause immune complexes to deposit in glomerular basement membrane, causing glomeruli to become edematous, occluding capillary lumen.
  • most common in winter and spring
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10
Q

acute glomerulonephritis: clinical manifestations

A
  • edema (esp. periorbital)
  • HTN
  • Hematuria
  • Proteinuria
  • loss of appetite
  • decreased urinary output
  • progresses to lower extremities and then to ascites
  • cola or tea colored urine
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11
Q

Wilm’s tumor

A
  • nephroblastoma
  • malignant renal and intraabdominal tumor
    Clinical presentation:
  • increasing abdominal girth on one side
  • hematuria
  • hypertension
  • fatigue
  • weight loss
    therapeutic management
  • surgical removal
  • chemo/radiation
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12
Q

Wilm’s Tumor: nursing considerations

A
  • no abdominal palpation: can cause spread of cancer cells
  • pre/post op: monitor BP closely. risk for HTN
  • surgery performed 24-48 hours after diagnosis
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13
Q

clinical manifestations of GI dysfunction

A
  • FTT
  • colic
  • spitting up/regurgitation
  • nausea, vomiting, diarrhea, constipation
  • abdominal pain, distension, GI bleeding
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14
Q

etiology of diarrhea

A

rotavirus

  • most common viral cause
  • new vaccine helping reduce incidence
    bacterial: more likely to have bloody diarrhea
  • salmonella: food borne and person to person
  • e. coli: food borne
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15
Q

prevention of diarrhea

A
  • most diarrhea is spread by the fecal-oral route
  • teach personal hygiene
  • clean water supply/protect from contamination
  • careful food preparation
  • handwashing
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16
Q

management of diarrhea

A
  • assess for and prevent complications
  • NO antimotility agents
  • NO antibiotics
  • ORT (oral rehydration therapy) to prevent dehydration
  • early and gradual reintroduction of nutrients. whatever child wants to eat, but avoid milk products.
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17
Q

ORT

A
  • safer, less painful, less costly than IV fluids
  • enhances and promotes reabsorption of water and sodium
  • reduces vomiting, diarrhea, duration of illness
  • can be given if vomiting: small amounts. spread out in sips over time.
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18
Q

fluid balance in infants and children

A

rate of basal metabolism
- higher bmr in infants and children
- elevations in bmr: i.e. fever
- greater fluid requirements than adults
- need more water to excrete solutes than adults
status of kidney function
- infants: immature kidney function: cannot concentrate urine

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19
Q

types of dehydration

A

Isotonic: most common in children
- water and salt are lost in equal amounts
- primary form of dehydration in children
Hypotonic
- electrolyte deficit exceeds water deficit
Hypertonic
- water loss exceeds water deficit

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20
Q

dehydration: clinical manifestations

A
  • weight loss
  • rapid pulse
  • decreased blood pressure
  • decreased peripheral circulation
  • decreased urinary output (want at least 4 wet diapers per day)
  • increased specific gravity (concentration)
  • decreased skin turgor
  • dry mucous membranes
  • absence of tears
  • sunken fontanel in infants
21
Q

dehydration: diagnosis and treatment

A
  • most accurate diagnosis is acute weight loss
  • usually based on clinical manifestations
    treatment
  • severity dependent
22
Q

dehydration: management

A
  • hospitalization with IVF if ORT not sufficient
  • assessment: skin turgor, mucous membranes, fontanels
  • intake and output: 1g wet=1mL urine
  • daily weight
  • vitals
  • admin of IVF: possible K supplementation, monitor i/o
  • lab values
  • skin care
  • specimen collection
  • nutritional assessment
23
Q

daily maintenance fluid requirements

A
  • allow 100ml/kg for first 10kg
  • 50ml/kg second 10
  • 20ml/kg remaining body weight
24
Q

Hirschsprung Disease

A
  • congenital aganglionic megacolon
  • mechanical obstruction from inadequate motility of intesting
  • more common in males and Down syndrome
  • absence of ganglion cells in colon
25
Q

Hirschsprung Disease: patho

A
  • aganglionic segment usually includes the rectum and proximal colon
  • accumulation of stool with distention
  • failure of internal anal sphincter to relax
  • enterocolitis may occur
26
Q

Hirschsprung Disease: clinical manifestations

A

newborn
- no meconium 24-48 hours after birth (should have stool w/i first 24 hours)
- refusal to feed; vomit; distention (LRQ)
Infant
- FTT; constipation; distention (RLQ); v/d
Child
- constipation; ribbon like stool; distention; palpable mass; FTT

27
Q

Hirschsprung Disease: diagnosis and treatment

A
  • x-ray after enema
  • confirm diagnosis with rectal biopsy
    treatment
  • surgery
  • may require temporary ostomy
28
Q

Hirschsprung Disease: nursing management

A 
Preop
- NPO
- bowel prep
- antibiotics
Postop
- assessment
- ostomy care
- diet per orders (bland diet)
Discharge
- ostomy care and teaching
- return for second surgery
29
Q

GER

A
  • defined as transfer of gastric contents into the esophagus
  • occurs in everyone
  • frequency and persistency may make it abnormal
  • may occur without GERD (disease process)
  • GERD may occur without regurgitation
  • resolves spontaneously
  • more common in children with Down’s; CF and muscular dystrophy
30
Q

GER: clinical manifestations

A
  • infants: regurgitation, vomiting, crying, irritability, poor feeding, URI
  • preschool: regurg, URI, wheezing, poor po intake, Sandifer syndrome (arching back & neck and lifting chin, clearing throat)
  • older children: heartburn, esophagitis, hoarseness, epigastric pain.
31
Q

GER: treatment

A

Pharm: to reduce gastric HCl secretion
- H2 receptor antagonist: Zantac, Tagement
- PPI: Nexium, Prevacid
Surgical Correction
- Nissen fundoplication: suture fundus of stomach behind esophagus

32
Q

Acute appendicitis

A
  • inflammation of veriform appendix
  • obstruction
  • most common condition requiring surgery
33
Q

Acute appendicitis: clinical manifestations

A
  • right lower quadrant pain
  • McBurney’s Point: press deeply, pain on release
  • periumbilical pain
  • fever
  • vomiting
  • anorexia
  • irritable, uncomfortable, apprehensive
  • sudden relief from pain could occur after perforation
34
Q

Acute appendicitis: management

A
  • surgical removal
  • laparoscopy vs. laparotomy
  • pre and post op surgical care: including AB therapy, possible NG tube
  • pain management (pain goes away after rupture)
35
Q

Cleft lip and/or Palate

A
  • facial malformations that occur during early embryonic development
  • the lip and/or palate do not fuse
  • may appear separately or together
  • etiology: associated with chromosomal anomalies, heart defects, ear malformations, skeletal deformities, genitourinary abnormality
  • also associated with maternal smoking, prenatal infection, advanced maternal age, medications during early pregnancy (anticonvulsants, steroids)
36
Q

cleft lip/palate: management

A
  • surgical closure of lip precedes correction of palate
  • ongoing management with plastic surgery, craniofacial specialists, oral surgery, dental and orthodontist, audiology, ST, psychology
  • feeding issues: use bottles with specialized nipples
37
Q

cleft lip/palate: post surgical care

A
  • prevent injury to suture lines
  • place infant in supine or side lying (may require restraining hands)
  • avoid putting items in the mouth (suction catheters, spoon, straws, pacifiers, plastic syringe)
  • prevent child from crying: administer pain meds, cuddle, rock (crying can cause sutures to come out)
38
Q

Hypertrophic Pyloric Stenosis

A
  • hypertrophy of the pylorus causing constriction of pyloric sphincter with obstruction of gastric outlet
  • develops and presents in the first 2-5 weeks of life (more common in males)
39
Q

Hypertrophic Pyloric Stenosis: clinical manifestations

A
  • projectile vomiting
  • needs to be re-fed
  • can result in dehydration, electrolyte imbalance, and poor weight gain
  • palpable olive shaped mass URQ
  • sonogram to officially diagnose
40
Q

Hypertrophic Pyloric Stenosis: management

A
  • surgical correction

- Nissen fundoplacation

41
Q

Intussusception

A
  • telescoping or invagination of one portion of intestine into another
  • occasionally due to intestinal lesions
  • often cause is unknown
  • contraindication: rotavirus
42
Q

Intussusception: clinical manifestations

A
  • colicky abdominal pain (knees toward belly): acute pain
  • abdominal mass “sausage shaped”
  • “currant jelly stools” from edema, mucous, irritation and leaking of blood
  • vomiting
43
Q

Intussusception: nursing care

A
  • assessments
  • NPO
  • lab work
  • preop status
  • NG tube for decompression
  • assess for normal stool: indicates resolution
44
Q

Celiac disease

A
  • aka gluten-induced enteropathy and celiac sprue

- four characteristics: steatorrhea, general malnutrition, abdominal distention, secondary vitamin deficiencies

45
Q

Celiac disease: patho and diagnosis

A
  • autosomal recessive disorder
  • exposure to gluten causes inflammatory response in intestinal mucosa, atrophy of intestinal villus
  • results in malabsorption
    diagnosis
  • symptoms and clinical presentation; biopsy of small intestines; immunologic and genetic studies
46
Q

Celiac disease: clinical manifestations

A
  • FTT
  • chronic diarrhea
  • abdominal distention/pain
  • steatorrhea (foul smelling, large, pale, oily, frothy stools)
  • short stature
  • vomiting
  • delayed puberty
  • vitamin deficiencies
  • anemia
47
Q

Iron deficiency anemia

A
  • the most common hematologic disorder of childhood
  • decrease number of RBCs and/or low Hgb concentration
  • decreased o2 carrying capacity of blood
    consequences:
  • fatigue, pallor, change in activity, school performance, possible growth restriction and cyanosis
48
Q

Iron deficiency anemia: education

A
  • many toddlers are overweight due to excessive milk and/or juice ingestion (both are poor sources of iron)
  • calcium interferes with absorption of iron
  • iron supplements should be given between meals and with citrus fruits or juice (prune, tomato, orange)
  • oral iron will turn stools a tarry green or black color
  • liquid iron may stain teeth. brush after admin.
  • ferrous sulfate causes constipation. citrus helps absorption.

Peds (6 decks)

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