exam 2 Flashcards
Specific diets for different conditions: GI
Appendicitis: NPO for surgery
Celiac Disease: Foods Allowed:
Potato, soy, rice or bean flour
Cornmeal, flax, quinoa
Plain, fresh, or frozen fruits and vegetables
Meat, fish, beans, peanut butter, nuts
Milk and milk products (unless made with gluten additives)
Butter, margarine, salad dressings, sugar, honey, jelly, marshmallows ground coffee, tea
Foods to Avoid
Wheat products: rye, barley, oats, durum flower, farina
Creamed or breaded vegetables, canned backed beans, some French fries
Malted milk, flavored or frozen yogurt
Meats or poultry prepared with gluten or fillers, some egg substitues
Commercial salad dressings, prepared soups, condiments, sauces, nondairy cream substitutes, licorice
Biliary Atresia: Give A, D, E, K
GERD: smaller more frequent feedings
childhood obesity risk factors and treatments
..
appropriate nursing interventions for GERD
Smaller, more frequent feedings
Keeping child upright for 30 min after feeds
Administer proton-pump inhibitors
Educate parents on both pharm and non-pharm interventions
care of the patient with appendicitis
Observe for pain be suddenly relieved without intervention
Monitor temperature
Keep NPO for surgery
Administer IV pain meds
Post-op care may include IV antibiotics (if perforated)
classic s/s of various GI disorders
Appendicitis: Abdominal pain- RLQ N/V Fever small frequent soft stools when pain goes away- they have perforated
Meckel's Diverticulum: Bleeding Anemia Abdominal pain (when obstruction occurs) Abdominal distention Hypoactive bowel sounds
Biliary Atresia: Jaundice Clay colored stool Failure to thrive Enlarged liver/spleen Elevated bilirubin, aks phos, liver enzymes
Pyloric Stenosis Projectile vomit- fresh milk Weight loss Progressive dehydration Lethargy
Celiac Disease Diarrhea Steatorrhea (fatty stools) Constipation FTT Abdominal distension or bloating Irritability Dental disorders Anemia Delayed onset of puberty
Intussusception Sudden onset of intermittent abdominal pain Knees drawn up Vomiting and diarrhea Currant-jelly stools Lethargy Sausage-shaped mass in upper abdomen
Gastroesophageal Reflux (GER) Vomiting or regurgitation FTT Irritability Respiratory symptoms Dysphagia or refusing to eat Abnormal neck posturing Abdominal pain
Caring for child with Meckel’s Diverticulum
Diagnostic Tests Abdominal x-rays Meckel scan Stool tests (for color, consistency, and blood) CBC
IVF for NPO status
PRBCs if anemia is present
Prepare child and family for surgery if indicated
Pain control
Cleft palate/cleft lip pre-op and post op
Protect the suture line!!! Use elbow restraints Position child in supine or side-lying Avoid spoons, straws, pacifiers, or PO syringes May breastfeed, may need special nipple for bottle feeding Pain medication and keeping child calm Lip: Lay on Back Palate: Lay on Stomach
Increased ICP manifestations/treatment
Intervene quickly to prevent long-term damage or death!
Symptoms
Headaches
Morning emesis with immediate relief
Complaining of blurry or double vision
Progress to seizure activity
herniated brain is the worst case from intracranial pressure
infant: Head enlargement Anterior fontanel—tense, bulging, non-pulsatile Scalp veins dilated Cranial sutures separated “Bossing” of frontal bone “Setting-sun” eyes Changes in LOC/irritable/lethargic Opisthotonos Poor feeding Shrill, high pitched cry Developmental delay Seizures Periodic/Irregular breathing is an ominous sign, precedes apnea
Older Child: Headache, Nausea/Vomiting Ataxia Strabismus/Diplopia Pupil response to light—sluggish or unequal Papilledema Changes in LOC Potential Intellectual Impairment Seizures
Manifestations/treatment/teaching: seizures, spina bifida, cerebral palsy, meningitis
seizures
Types
Focal/Partial- 60% of seizures, impairment of consciousness, localization, and progression of the seizure, one hemisphere of the brain
General- absence and tonic/clonic seizures, affects the whole brain
Unknown- epileptic spasms where it is unclear whether the mod of onset is general or focal
Primary treatment- anticonvulsants
Secondary treatment- surgery, Nurse will do preop/postop care and discharge teaching
Education- help families cope, explain the importance of medication adherence, oral care (Dilantin)
Observe and report seizure activity
Time, oxygenation status, safety, take in everything, do not restrain, ease to the ground if standing
Danger- seizure lasting 30 minutes or so many seizures that the child cannot recover
Febrile seizures:
Treatment- identify cause of high temperature and treat
Spina Bifida
Defect without protrusion of the spinal cord or meninges.
These children don’t typically need immediate medical intervention
Benign and asymptomatic
Will note a dimple, patch of hair, or discoloration of skin
Education of presence and monitoring of symptoms of tethered cord
Cerebral Palsy
Mobility- critical to development in the child with CP. Treatment could include physiotherapy, pharmacological management, or surgery. PT/OT are very involved and include the parents on the process.
Nutrition- May have difficulty eating and swallowing r/t poor mouth, tongue, and throat control. They need more time and support. Special diets such as soft or pureed. Manual support of the jaw and proper positioning to help with chewing and swallowing and to prevent choking and aspiration. All efforts will be exhausted, barring the child isn’t suffering, before going to a feeding tube.
Support and Education- Lifelong disorder that based on severity could include daily intensive therapy from caregivers, encourage respite care, understand that when a child is admitted that it is a chance for the family to take a break. Try to not judge when they are gone. Education requires help from social work, parents, teachers, and support staff.
Meningitis
Can lead to brain damage, nerve damage, deafness, stroke, death
Must act fast!
Deterioration over 24 hours
Diagnosis with an LP and administer antibiotics after sample has been collected
Examination
Opsithotonic position (infant) or c/o neck pain
Positive Kernig and Brudzinski
Rash- petechial, vesicular, or macular
Interventions- aimed at reducing ICP and maintain perfusion, treating volume deficits, controlling seizures, and prevent injury from altered LOC
Isolation- Droplet isolation for first 24 hours after initiation of antibiotics, then standard precautions
Otitis media: cause, treatment, education
Inflammation of the middle ear with presence of fluid
Follows upper respiratory infection- strep and influenza infections most common
Complications- hearing loss, expressive speech delay, perforation, meningitis (EXTREME!)
Antibiotics vs observing, analgesics
Trisomy 21: characteristics, G&D, education
The structures of the face are very distinct. You also will note that the nasal passages are smaller. In infants the depressed bridge of the nose leaves them a small nasal passage. With the protruding tongue and mouth open most of the time, keeping secretions clear is important. Dry mucous membranes will make eating and babbling/talking a challenge.
single palmer crease, short 5th finger that curves here separated 1st & 2nd toes
widel
Promotion of nutrition
Diffuclty with suck and feeding due to lack of muscle tone, small mouth, large tongue, underdeveloped nasal bone, and chronically stuff nose
Bulb syringe, humidification, and changing position will help with feeding, breast feeding is usually possible and the antibodies help with fighting infection
No need for special diets unless they have an underlying GI disease like celiac
What dietary restrictions or additions are there for the following disorders? Galactosemia, PKU, Diabetes, Salt wasting CAH.
Galactosemia: No milk products, no breast milk, soy based formula
PKU: Special formula
Breast feed if mom is following PKU diet
DM1: carb control
DM2: Less trans-fats, more fruit/veggies, balanced, incorporate fav foods, portion size, exercise
Limit bad sugars
Salt wasting CAH: salt
What does the nurse need to emphasize with medication teaching for the following endocrine disorders? Congenital hypothyroidism, Diabetes, CAH, Growth hormone deficiency, precocious puberty
Congenital Hypothyroidism: Education: s/s hyper/hypo, lifelong supplements, medications, not changing meds
DM1:
Teaching skills (glucose checks & admin. Insulin & nutrition
Administer insulin based on 1. Glucose levels, 2. For meals
Have parent check sugars in night after sports
DM2: Education on lifestyle modifications
CAH: Ambiguous genitalia: provide comfort to parents, encourage parent bonding, explain in simple terms
Non-salt: receives life-long supplements
Medications for Salt-Wasters
Need aldosterone replaced also
Florinef Acetate oral once a day
Also need an injectable form of cortisone ie Solu-cortef on hand to administer if child is vomiting and cannot keep medication down or when experiencing severe stress
Increased dietary salt encouraged
Medic Alert Bracelet
GH Deficiency: GH injections: sites, give at night (body naturally secretes at night)
Educate how to give it, very expensive
Precocious puberty: Dress according to dev stage, peers of same age
LHRH analogs or synthetic hormones that block the body’s production of the sex hormones.
Given IM once every 4 weeks. Usually see no side effects.
Girls: decrease in breast size or at least no more development
Boys: the penis and testicles may shrink back to normal size.
Height will also slow down to the expected rate before puberty
Discontinue when puberty is expected
How would the nurse’s approach to teaching a newly diagnosed diabetic four year old differ from a ten year old and a 17 year old?
Toddler: cake icing (not the best option) carb followed by protein or carb & protein (protein sandwich, nuggets, chocolate milk)
Fear of needles, strangers, picky eaters
Teen: scars, not fitting in, appearance
School age: rewards, games, sports
Teen: thinking of appearance, they think they are invincible- starting experimenting with drugs & alcohol, consider their mindset
What advice would you give to a Type 1 Diabetic who wanted to join a soccer team?
What advice would you give to a Type 2 Diabetic who wanted to join a soccer team?
DM1: Have parent check sugars in night after sports (bottom out), Cells utilize blood glucose more effectively
Exercise lowers blood sugar
Helps insulin to enter the cell more readily
Insulin requirement is reduced
Always carry a carbohydrate source to treat hypoglycemia or take before exercise to prevent
DM2: hell yeah
What careful considerations does the nurse need to make when talking with parents of a child diagnosed with precocious puberty?
Provide support and anticipatory guidance
Dress and activities should be appropriate for chronological age
Sexual interest usually match’s child’s age
After puberty, child is no longer different from peers
Child is fertile if untreated. No form of contraception is recommended unless the child is sexually active
Teach parents and child injection procedure if needed
How would you teach the mother of a newly diagnosed baby with congenital hypothyroidism about how to recognize s/s of hyperthyroidism and hypothyroidism?
HYPO prior to 6 weeks: Poor feeding Lethargy Prolonged neonatal jaundice Respiratory difficulty & bradycardia Constipation Hoarse cry Large fontanels
after 6 weeks: Depressed nasal bridge Short forehead Puffy eyelids Large tongue Course dry lusterless hair Large fontanels and wide cranial sutures Umbilical Hernia Abdominal distension Hypothermia
What would you suggest to a mother who wants to breast feed her newborn recently diagnosed with PKU? What about a mother with a baby who has galactosemia?
PKU:
Special formula
Breast feed if mom is following PKU diet- NO phenylanine herself
Galactosemia:
No milk products, no breast milk, soy based formula
