Exam 2 Flashcards Preview

Peds > Exam 2 > Flashcards

Flashcards in Exam 2 Deck (56):
1

Gastroenteritis

-2ND to URI as cause of illness in children
-LARGEST single cause of death of children in 3rd world countries

2

Differences in GI in children

-Stomach capacity SMALLER
-GI motility faster
-Digestive enzymes not present until 4-6 mo (susceptible to gas and abdominal distention)
-Water

3

Children differences related to SURFACE AREA

-Greater surface area in relation to body mass
-Greater fluid loss due to insensible loss

4

Factors Responsible for Fluid and Electrolyte Differences Between Adults and Children

-Percentage and distribution of body water
-Body surface area
-Rate of basal metabolism
-Status of kidney function

5

Children differences related to METABOLIC RATE

*Significantly higher than adults
-Increase in heat production
-Increase in production of metabolic rate
(so insensible fluid loss and increased need for water for excretion)

6

Children differences related to KIDNEY FUNCTION

*Functionally immature at birth
-Urine concentration and dilution
-Sodium retention and excretion
-Urine acidity

7

Children differences related to FLUID REQUIREMENTS

*Ingest and excrete a greater amount of fluid
-per kg of body weight

8

Children differences related to IMMUNE SYSTEM

*Immature immune system
-more vulnerable to pathogens
-cause alterations in fluid and electrolytes

9

S/s of dehydration in children

-poor skin turgor
-dark urine
-decreased urine output
-no tears when crying
-tacky tongue
-increased HR
-dry mucous membranes

10

Formulas for Calculating Children I and O Needs

Output: 1-2 cc/kg hour
Intake:
Up to 10 kg: 100 ml/kg
10-20 kg: 1000 ml plus 50 ml/kg for anything over 10 kg
Over 20 kg: 1500 ml plus 20 ml/kg for each kg over 20 kg

11

How FOOD INTAKE can cause diarrhea

-composition
(high CHO formula or food intake has an osmotic pull of water into the GI lumen)
-introduction of new food
(may have difficulty digesting a food that is new)
-allergy
(to formula, food; esp. milk)

12

How ANTIBIOTICS can cause diarrhea

-alters normal flora causing increased growth of
organisms

13

How EMOTIONAL DISTURBANCES can cause diarrhea

-anxiety
-tension
-fatigue

14

How MALABSORPTION SYNDROME can cause diarrhea

-Lactose Intolerance
-Impaired disaccharide activity
-Cystic Fibrosis

15

How INFECTIONS OUTSIDE THE GI TRACT can cause diarrhea

-URI (upper resp infection)
-OM (otitis media)
-UTI

16

How STARVATION can cause diarrhea

-first PO intake is not well accepted by the body and moves quickly through the GI tract

17

How FEEDING TECHNIQUES can cause diarrhea

-too much
-too concentrated
-too much water

18

Another cause of diarrhea

GI infections

19

Common viral agents

-Rotavirus
-Norwalk virus

20

Common bacterial agents

-Escherichia coli
-Salmonella
-Shigella
-Yersinia enterocolitica
-Campylobacter jejuni
-Vibrio cholera
-Clostridium difficile

21

Ova and parasites

-Giardia lamblia
-Cryptosporidium
-Amoeba
-Intestinal Worms

22

how check for ova and parasites

-Swab rectum
-Scotch tape (for pinworms)

23

What may accompany diarrhea and increase risk of dehydration

vomiting

24

How to calculate percentage of weight loss

Subtract the child's present weight from the original weight to find the loss THEN divide the loss by the child's original weight

25

Hypotonic dehydration

dehydration-electrolyte deficit exceeds water deficit
(Na less than 130 mEq/L)

26

Isotonic dehydration

most common in children (Na is normal)

27

Hypertonic dehydration

water loss greater than electrolyte loss
(Na greater than 150 mEq/L)

28

Nursing Responsibilities:Hospitalization

-FLUID AND ELECTROLYTE REPLACEMENT -ANTIBIOTIC THERAPY
-ISOLATION IF NEEDED
Enteric (fecal)
Universal precautions
-ASSESSMENTS
Weights
I and O
Urine specific gravities

29

Severe dehydration

-IV therapy (normal saline boluses=10-20 cc/kg repeated 2-3 x) THEN replacement IV fluids

30

Oral rehydration at home

-Ricelytes
-Pedialytes
-Unsweetened jello
-No fruit juices
P-rogress to soft complex CHO foods
-No greasy or spicy foods

31

shock

circulatory failure

32

process of shock

inadequate tissue perfusion ---> cellular dysfunction ---> organ failure

33

signs of shock

-hypotension (late sign)
-tachycardia
-decreased urine output
-adventitious breath sounds
-tissue hypoxia
-metabolic acidosis

34

types of shock

-hypovolemic shock
-distributive shock
(neurogenic, anaphylactic, septic)
-cardiogenic shock
-obstructive shock

35

hypovolemic shock

-blood loss
-plasma loss (burns or peritonitis)

36

s/s of hypovolemic shock

-ECF loss (diarrhea, dehydration)
-decreased BP
-increased HR
-decreased central venous pressure
-poor cap refill

37

cardiogenic shock

-heart pumping fails
-decreased cardiac output

38

causes of cardiogenic shock

-Cardiac Surger
-Dysrhythmias (AV block, SVT)
-Primary Pump Failure
-Myocarditis
-Cardiomyopathy
-Heart failure

39

distributive shock (vasogenic shock)

Vascular problem that prevents Blood from being distributed properly

40

types of distributive shock

-Neurogenic
-Anaphylactic
-Septic

41

neurogenic shock

-Loss of sympathetic nervous system tone
(Happens in Spinal Cord injuries)
-massive vasodilation

42

anaphylactic shock

-hypersensitivity reaction
-massive vasodilation and capillary leakage

43

s/s of anaphylactic shock

RESPIRATORY:::
Stridor
Cough/Wheeze
Rhinitis
CUTANEOUS:::
Flushing
Urticarial(hives)
Angioedema
CV:::
Tachycardia
Arrhythmia
Hypotension
Hypovolemia
GI:;;
N/V/D
Abdominal Pain
CNS::
Impending Doom
LOC change
Seizures
Headache

44

Med for anaphylactic shock

Epinephrine

45

septic shock

-Massive vasodilation and capillary leakage and maldistribution of blood.
-Circulating toxins –> Body releases inflammatory
mediators --> cellular dysfunction –>
leading to organ shutdown.

46

obstructive shock

The problem is mechanical – There is a road block

47

causes of obstructive shock

-Tension Pneumothorax
-Cardiac tamponade
-Pulmonary embolism
-Congenital Heart Lesion

48

s/s of compensated shock

-Apprehension
-Iritability
-Normal B/P
-Narrowing pulse pressure
-Thirsty
-Pale
-Decreased UOP
-Mild Tachycardia
-Decreasing peripheral perfusion

49

s/s of hypotensive (uncompensated) shock

-Chills / Fever
-Increased vasodilation
-May have warm extremities initially
-Tachypnea
-Oliguria
-Cool, pale extremities
-Change in LOC
-Tissue hypoxia leading to organ death
-Metabolic acidosis
-DIC

50

treatment of shock : oxygenation and ventilation

-Administer O2 as ordered
-Intubation (Lung rest)
-Blood gases
-Oxygen Saturation
-PH monitoring

51

treatment of shock: improve heart function

-Vasopressors =produces vasoconstriction
-Inotropes = stimulates and strengthen heart contractions

52

treatment of shock: fluid administration

-Isotonic Crystalloid (NS or LR)
-Bolus at 20ml/kg over 5 to 20 min
-Blood Products
-Colloids=Volume stay in the vascular space better (Albumin)
-FFP to correct coagulopathies

53

toxic shock syndrome caused by

Staphylococcus bacteria

54

causes of toxic shock syndrome

-Sinusitis
-Pneumonia
-Catheter Infections
-Skin Infections
-Wound Infections
-Nasal Packing
-Contraceptive Diaphragms
-IUDs

55

s/s of toxic shock syndrome

-Sudden temp of 38.9C (102F) or higher
-Vomiting & Diarrhea
-Macular Erythroderma
-Hypotension (late sign)
-Desquamation of palms (late sign)

56

failure to thrive

-not growing adequately or is losing weight without an obvious reason
-a sign of growth failure due to malnutrition
-not a disease or a diagnosis
-a nutrition problem caused by the child’s inability to obtain calories or to use calories required for growth.