Exam #2 Flashcards by Breanna Lawler

Structural GI Disorder:

can occur in isolation or together
can be bilateral or unilateral
requires surgical repair
these babies are encouraged to be breast-fed as there is more surface area & reduced additional air intake
baby should be fed upright (45-90 degrees) and intermittently

Cleft Lip & Palate

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Structural GI Disorder:

knot in the groin area
dangerous as there are more structures nearby
abdominal or pelvic contents travel to the inguinal canal
requires reduction & possibly surgery
5x more common in boys due to undescended testicles

Inguinal Hernia

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Structural GI Disorder:

more common type seen in premature infants
GI issues do not typically arise
surgical repair is commonly done for cosmetic purposes
occurs due to weakening of the GI muscle

Umbilical Hernia

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Treatment for Hernias

Push it back in
- if its affecting them structurally, or pops out every time the child cries, then surgery is considered

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Obstructive GI Disorders:

__________ sphincter is not opening which occurs when the muscle thickens over time (not born w/ it)
cause is unknown
what is entering the stomach cannot exit & will come right back up
higher chance for boy to have it if father had it (unknown why)
S&S: projectile vomiting, crying, not gaining weight, olive-shaped mass in RUQ
seen around 3-6 weeks of life
Dx: ultrasound
Tx: pyloromyotomy - surgery to snip muscle, take thickened part out, and ensure opening remains

Pyloric Stenosis

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Obstructive GI Disorders:

intestines telescope into itself
more common in males
occurs in kids a little older than 3-6 weeks and are intermittently fussy – when the child cries, they bear down and can pop it back out but the telescoping can happen again
S&S: current jelly stools, acute sudden abdominal pain, sausage-like lump in lower abdomen (typically RLQ)
Tx: barium or air enema (high risk of bowel perforation) OR surgery (rare)

Intussusception

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Obstructive GI Disorders:

inflammatory disease of the intestinal tract
life threatening and seen often in the NICU after the first few feeds – high mortality rate
S&S: feeding intolerance (failure-to-thrive), lethargic, bradycardic, apneic spells, bloody diarrhea
Tx: surgery to remove that portion of bowel, bowel rest (TPN), antibiotics

Necrotizing Enterocolitis (NEC)

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Inflammatory GI Disorders:

inflammation of the affected organ
S&S: ABD pain around belly button (RLQ), McBurney Point (rebound tenderness), poor appetite, N/V, fever (typically when perforation occurs), want to be in fetal position
constipation & __________ present similarly

Appendicitis

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Abdominal Wall Defects:

birth defect due to a herniation of the ABD wall during development – born with their intestines on the outside
Dx: MSAFP – seen on ultrasound prior to birth
after C-section, intestines are exposed to air since NOT covered by peritoneal layer
Tx: wrapping & supporting the intestine (prevent hypothermia & fluid loss), surgical repair, SILO, TPN (bowel rest)

Gastroschisis

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Abdominal Wall Defects:

protrusion of umbilical cord & is sealed by the peritoneal layer – typically the bowels, liver, kidneys, etc. (ALL) are developed outside the body
Dx: MSAFP
can be worse as it can take longer to put back in along w/ other complications

Omphalocele

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Functional GI Conditions:

persistent & crying babies that are under 3 months old
idea for cause is that baby has a lot of gas build-up (fed a lot, not burped enough) – unknown
S&S: crying episodes lasting 3 hours, more than 3 days, more than 3 weeks; baby will pull legs & arms to a flexed position
Tx: have parents place baby in safe space after eliminating every other cause & stepping away – shaken-baby syndrome risk

Infantile Colic

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Functional GI Conditions:

excessive loss of fluids due to vomiting & diarrhea
Causes: viral (most common), diet, meds, toxins
BRAT diet: bananas, rice, applesauce, toast
Tx: BRAT, rehydration, as long as dehydration not evident, can be treated at home

Gastroenteritis

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Functional GI Conditions:

difficult or infrequent passage of hard stool
S&S: hard stool, poor appetite, straining when defecating
Tx: bowel retraining, nutrition, education (increasing fiber & water)

Constipation

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Functional GI Conditions:

these babies spit-up a lot – need to know vomit vs. spit-up
they have choking episodes as well as apneic episodes (acid building up)
S&S: vomiting & regurgitation; fussiness; refusal to eat, choking, apnea, wheezing
Dx: H&P, pH study or swallow study
Tx: keep upright while feeding (30min-1hr) and NOT in a car seat, frequent burping, meds (Zantac)

Gastroesophageal Reflux Disease (GERD)

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Functional GI Conditions:

congenital absence of Meissner and Auerbach autonomic plexus in the bowel wall
S&S: failure to pass meconium within first 48 hrs of life, failure-to-thrive, poor feeding, enterocolitis
Tx: surgical resection, colostomy, GI irrigation (cannot empty out, need to be flushed)

Hirschsprung Disease (Megacolon)

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Hepatic Disorder:

liver is not working how its supposed to – blockage in bile duct
can be a congenital defect sometime during fetal development but commonly its an inflammation shortly after birth – idiopathic
S&S: jaundice, dark urine, light stools, bloated belly (round)
Tx: Kasai procedure (remove damaged ____ duct & reconnect SM-intestine to liver) – even w/ Tx, most kids require liver transplant; TPN/Lipids & nutritional support

Biliary Atresia

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__________ system controls growth & development

endocrine

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child will be shorter in stature & typically require growth hormone in order to grow
underproduction of cells
effects ALL of the following parts of the body: reproduction, kidney disease, heart issues, cognitive issues, etc. (every organ in the body)
S&S: delayed growth (3rd-5th percentile), continue to maintain baby-like facial features, skeletal growth delayed, missed milestones, delayed bodily processes
Dx: growth evaluation; labs; bone x-ray; brain MRI
some studies show children in abusive households or are abused can experience delayed growth development
w/o Tx, affects the entire body and leads to decompensation, and possibly death

HYPO-pituitary (growth hormone deficiency)

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overabundance of cells (gonadotropin) – child develops at much quicker rate (reproductive organs develop much sooner)
early onset of menarche can be seen as child abuse
Boy S&S: facial hair, penile growth, masculinity
Girl S&S: breast development, onset of menarche
S&S: increase of LH, FSH, and testosterone
Tx: growth hormone suppressant; psychological care for both child & parent

Pituitary HYPER-function (Precocious puberty)

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these issues are preventable by treating the issue – w/o they can experience serious delays in development
S&S: delayed growth, inability to tolerate cold, constipation, fatigue, poor feeding
Tx: now included on newborn screening, meds (Levothyroxine [Synthroid])

Congenital HYPO-thyroidism

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underacting thyroid (autoimmune disorder) that can be caused by genetic or environmental (pollutants) factors
Risk factors: females, family Hx, radiation exposure, other autoimmune diseases
S&S: poor temperature regulation (always cold), delayed growth, fatigue, hair loss (older kids), puffy moon-face, brittle nails – goiter (palpate enlarged thyroid)
Dx: labs (TSH & T4)

Hashimoto

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group of autosomal recessive inherited disorders affecting the adrenal glands
insufficient supply of enzymes required for production of cortisol & aldosterone
Cause: deficiency of 21 hydroxylase enzyme
Boy S&S: large genital, hyper-pigmented scrotum & start puberty at age 2 years
Girl S&S: in utero develops male sex characteristics, hypotension, hypoglycemia
S&S: electrolyte imbalance
Tx: meds (hydrocortisone), psychosocial care for both child & parents

Congenital Adrenal HYPER-plasia

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damage due to autoimmune disorder – damage to gland resulting in releasing cortisol & aldosterone – hard time maintaining electrolyte balances (cannot use for energy, muscle growth, etc.)
S&S: constantly fatigued, always irritable, constantly losing weight, consistent muscle weakness
if left untreated: hypotension, kidney failure, and severe abdominal pain – will go into adrenal crisis (stress causes as well)
Tx: meds

Addison’s Disease

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poorly functioning pancreas leads to excessive glucose – affects major organs (body metabolizes fats for energy)
autoimmune disorder
S&S: losing weight, constantly peeing (up at night), always thirsty, constantly eating, fruity breath
w/ DKA: too much ketones (acid) and presents as lethargic w/ Kussmaul respirations (NOT RESPIRATORY RELATED FOR EXAM)
Tx: insulin (lifelong maintenance); teach child to carb-count and check glucose levels

Diabetes Mellitus Type I

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behavior modification

- set limits - do not argue, bargain, or negotiate after limits are set - consistent caregivers matter - use a low-pitched tone - redirect the child - ignore inappropriate behaviors or educate why they are inappropriate - praise self control & appropriate behaviors

- Onset: infant or early childhood --> may notice developmental delays or loss of previous ability - Cause: mainly genetic --> possibly environmental (pollutants) - S&S: communication issues, prefer to be alone (not play w/ others), difficulty interpreting others emotions, repetitive movements or speech patterns, avoid eye contact, sensitive to loud noises, eccentric ways of moving - Tx: NO cure; goal is to strive for optimal functioning (provide structured environment); family support

autism spectrum disorder

*Most common neurodevelopmental disorder of childhood* - Cause: genetic - S&S: impulsive, hyperactive (cannot sit still), don't pay a lot of attention, lack of self control (trouble keeping body calm) - Tx: Meds [methylphenidate, dextroamphetamine; Adderall, Ritalin] & education [meds & school assistance - IEP plan]

attention deficit hyperactivity disorder (ADHD)

any injury intentionally inflicted on a child

physical abuse

sexual activity intended to provide pleasure to an adult - can lead to inappropriate sexual behavior at a young age (child does not know its inappropriate)

sexual abuse

witnessing abuse

emotional abuse

failure to provide child w/ appropriate needs - lack of food as punishment - locked in a room as punishment - has long-term effects on brain development & behavior

neglect

Long-term impact of child maltreatment -->

- anxiety - depression - suicidal ideation - drug & alcohol use

parent purposely make their child sick so that they can take care of their child (caregiver has mental health issue & requires dependency from another)-- don't want to kill them, but need child to need them - Warning signs: constant visits; caregiver is the only one talking; variations in past medical Hx (nothing makes sense); Dr. & hospital-shop/hop

Munchausen syndrome by proxy (medical child abuse)

elongated, rigid cells that change shape (doesn't allow oxygen to adhere well); stick together & start clumping so they get trapped and stuck in vasculature - Cause: hereditary & genetic - common in African Americans - Assessments: pain scale (live in constant pain, 4-6) - Tx: hydration & oxygenation (preventing VOC); pain management (NSAIDs or Tylenol or in adjunct w/ opioid); minimize risk factors (hypoxia, extreme heat/cold, infection, infarction)

sickle cell disease

recycled every 120 days (4 months)

normal RBC lifespan

recycled every 30 days

sickled cell lifespan

- Cause: significant blood loss; illness; high altitude; continued stress (physical or emotional); dehydration; elevated or severely decreased temperature - may rate pain 8/10 and be playing on their phone --> different pain tolerance, do NOT blow these kids off

sickle cell (Vaso occlusive) crisis

sudden trapping of blood in the spleen --> recycles sickled cells every month (overworked) and size never decreases back to normal size - S&S: pain; spleen overworked; spleen enlarged; pale; lethargic - these kids CANNOT play contact sports EVER

splenic sequestration

body is reacting from viral illness (commonly URI; sometimes GI bug) & is affecting vascular system --> the virus starts attacking the vascular system and starts erupting capillaries (dots = capillaries exploding); some type of inflammation occurring w/ blood leaking into small vessels - typically affects young children under 10 & typically males - S&S [NOT life-threatening]: purpura rash, joint pain, abdominal pain, kidney impairment (bloody urine --> kidneys extremely vascular) - Tx: supportive care --> calm parent, give Tylenol, fluids, patience (several days to overcome)

Henoch-Schoenlein Purpura (HSP)

group of X-linked recessive disorder that results in deficiency in one of the coagulation factors in the blood --> mom passes it down to son (boys only have 1-X, only need 1 from mom) - deficiency of factor VIII (hemophilia A) - Tx: give factor VIII (parents need to keep on them at all times); immobilize & elevate joint/affected extremity; prevent injury based on developmental age --> toddlers fall down & hit head; no contact sports when older; driving safety & avoiding piercings/tattoos in adolescents

hemophilia

cancer of the bone marrow caused by an overproduction of abnormal WBCs - Assessment: bone pain; anemia; low reticulocyte count; bleeding disorder; immunosuppression; pale, unexplained bruising, fatigued, generalized pain - Most common cause of death: illness/infection - Tx: ALWAYS starts w/ chemo

leukemia

typically diagnosed between 2-5 yrs and affects the T&B cells - most common Dx of leukemia in children - Dx: bone marrow makes too many lymphocytes; low reticulocyte count - Tx: prevent infection; chemo & radiation; bone marrow transplant (last resort)

acute lymphoblastic leukemia (ALL)

hard to treat & has higher death rate than other type - these children always have an implanted port = chemo is extremely toxic to vascular system (will kill peripheral vein) - more common in teen & adult world - Dx: bone marrow makes too many myeloid cells - Tx: not as responsive to Tx

acute myelogenous leukemia (AML)

most common solid tumor in children (usually 5-10yrs) - Cause: unknown - can take long time to Dx --> very vague symptoms, especially when they're young (i.e., may occur in conjuncture w/ teething) - S&S: increased ICP; *headache/vomiting ONLY in the morning*; new onset seizures w/o Dx; coordination issues - Dx: CT; MRI; chemo; radiation

brain tumor

tumor is small & hasn't spread

Stage 1

tumor is large but hasn't spread

Stage 2

tumor has spread to neighboring lymph nodes

Stage 3

tumor has spread to other organs

Stage 4

has a shape & structure that resembles healthy cells

well-differentiated cancer cells

has a completely different shape and structure than healthy cells

poorly differentiated cancer cells

slow-dividing of tumor cells

low-grade

fast dividing of tumor cells

high-grade

cancer of the bone & soft tissue -- typically diagnosed in adolescence and found incidentally due to vague symptoms (dull bone pain progressing over months) - commonly seen in long bones (femur & humerus) - S&S: pain that never goes away (w/ Tylenol, RICE) - cannot remove part of bone for Tx --> radiation, amputation, replaced w/ cadaver bone (at growth peak) or rods (until growth plates close; grow w/ child)

sarcomas

usually in long bones proximal humerus, tibia, and femurs - Tx: Sx to remove tumor --> chemo before & after

osteosarcoma

also within the bone but is much more aggressive & metastasizes easily, usually in pelvis or femur - Tx: radiation in addition to chemo & Sx

Ewing sarcoma

renal tumor of unknown cause that grows rapidly - typically only affects 1 kidney (not both at same time) - Assessment: nontender mass; abdominal pain; HTN - ***Do NOT continue to palpate abdomen once diagnosed --> tumor is very vascular & palpation can cause tumor seeding*** - Tx: Sx to remove kidney (no way of just taking tumor); educate on protecting the single kidney (NO CONTACT SPORTS)

Wilms tumor

caused by a rapid increase in temperature, typically caused by a virus - Dx: ***elevated temperature & present seizure (tonic-clonic or myoclonic)*** - Tx: Tylenol; ibuprofen; rectal diazepam, buccal & IM midazolam, IM lorazepam - Education: ***call 911 for seizures lasting more than 5 min or multiple in same day; does NOT mean they will have lifelong seizures***

febrile seizures

imbalance between excitatory & inhibitory mechanism - Tx: meds (Keppra --> reduce or control the frequency); Sx (removal of affected area OR VNS [pacemaker of the brain]; ketogenic diet (low sugar decreases excitability giving less energy); relieve anxiety

epilepsy

3 categories of epilepsy

- Focal: 1 hemisphere of the brain - Generalized: whole brain - Unknown: spasm

nursing management for active seizures

- maintain open airway - turn patient on their side - ensure safety - suction/oxygen set-up

birth defects of the spine & brain -- will be seen on US (born via C-section) - folic acid will reduce the risk - cause is unknown but certain factors adversely affect normal CNS development (lack of folic acid)

neural tube defects (spina bifida)

overarching term for all spinal defects

spina bifida occulta

spinal cord is fine but make sure that sac remains intact - ***sac of spinal fluid (cords are NOT in the sac)*** - prevent infection --> if you notice any leaking from sac, notify provider immediately

meningocele (spina bifida cystica) - mild

most severe type and child does not have a lot of sensory or motor function below the defect - ***cords are WITHIN the sac of the spinal fluid*** - diagnosed in utero w/ spinal cord involvement

myelomeningocele (spina bifida cystica) - severe

missing parts or all brain hemispheres, skull, and scalp - Dx: visualized on US - Prognosis: usually stillborn or pass within a few hours after birth; brainstem intact allowing infant to breath and have some reflexes - Management: provide comfort measures; family support; grief support; ***place infant cap on child immediately***

anencephaly

defect of brain & meninges protruding through the skull -- collection of fluid at the base of the skull - Prognosis: Dx in utero (delivered via C-section); Sx needed to correct - Management: pre- & post-Sx care; monitor for increased ICP (herniation of brainstem) & head circumference; side-lying position; prevent ruptures of sac & infection

encephalocele

displaced cerebellar structure -- usually found accidentally when children have head trauma & require imaging - S&S: maybe walk differently but go on w/ life; headache; neck pain; ***coughing & laughing make pain worse*** - Management: routine imaging & follow-up; S&S of increased ICP and any CNS injuries (new onset seizure, headache, vomiting, etc.); pre- & post-op care

Chiari malformation

results from brain disorder that cause an imbalance in production & absorption of CSF -- ***increased fluid in ventricles = increase in head circumference*** - S&S: seizures, macrocephaly, bulging fontanels, increased head circumference, vomiting, headache, lethargy, delayed development - Tx: VP shunt - Management: support & educate family; shunt malfunction; assess for complications; children at risk for peritonitis (where shunt drains)

hydrocephalus

rare congenital disorder -- large, intertwining bundles of blood vessels in the brain - S&S: intracranial hemorrhage; seizure; headache; progressive neurologic defects (vision changes, loss of speech, memory, problems) - Tx: Sx to excise bundles & embolize around area; may need short-term shunt to Tx hydrocephalus - Management: support; monitor for neurological changes, seizure activity, S&S of ICP or intracranial hemorrhage (stroke)

intracranial arteriovenous malformation (AVM)

premature closure of the cranial sutures (most common is sagittal) - Cause: unknown - Tx: Sx if 2 or more close - Management: measure head circumference, palpate suture lines, helmet - Education: blood loss, infection risk, swelling (eyes may swell shut post-op), encourage parents to hold child (bond)

craniosynostosis

asymmetry of head shape; torticollis can contribute to severity (twisting of neck to look at something) - Tx: increase tummy time; helmet; repositioning - often seen in children who are not held enough AND children in the NICU

positional plagiocephaly

most commonly seen in children ages 2-6yrs - kids are not good at wiping --> require education about front-to-back wiping - Cause: E. coli (most common) - Tx: antibiotics - S&S: hurts to pee, frequency, itching

urinary tract infections (UTIs)

***Most common abnormality for urinary system in children*** condition in which urine flows back up the ureters; increased pressure placed upon the kidney can cause renal scarring and lead to HTN later in life and, if severe, renal insufficiency or failure - Tx: antibiotic prophylaxis; hygiene & voiding practices; serial urine cultures - grade III, IV, and V usually warrant Sx

vesicoureteral reflux (VUR)

urine backflow is only in the ureters

grade I VUR

urine backflow beings to enter the kidneys

grade II VUR

urine backflow is a lot in the kidneys

grade III VUR

urine backflow covers most of the kidney

grade IV VUR

urine backflow covers all of the kidney

grade V VUR

inflammation of the glomeruli after an illness -- often after Strep -- immune mechanism causes inflammation which alters glomerular structure - S&S: painless hematuria; edema; HTN - Tx: nothing specific -- goal is to maintain fluid volume & managing HTN; antihypertensives (Nifedipine), antibiotics (if Strep present), furosemide (Lasix)

acute postinfectious glomerulonephritis

etiology is currently unknown --> kids can get bacteria from undercooked food (i.e., ground beef) OR petting zoos - ***Triad of S&S: bloody diarrhea, decreased UOP, pallor, HTN*** - Tx: fluids & antibiotics (can lead to nephrotoxicity); blood transfusion

hemolytic uremic syndrome (HUS)

Exam #2 Flashcards

(80 cards)