PEDS GI Flashcards

Question

How many teaspoons per pound over how many hours for Mild dehydration: Moderate dehydration

Answer 1

Mild dehydration: replace with 5 tspns/pound over 4 hours | Moderate dehydration: replace with 10 tsp's/pound over 4 hours.

Answer 2

Mild dehydration: 50 ml/kg over 4 hours | Moderate dehydration: 100 ml/kg over 4 hours

Answer 3

Symptoms that may be present in newborns and infants include: ``` Difficulty with bowel movements Failure to pass meconium shortly after birth Failure to pass a first stool within 24 - 48 hours after birth Infrequent but explosive stools Jaundice Poor feeding Poor weight gain Vomiting Watery diarrhea (in the newborn) ``` Symptoms in older children: ``` Constipation that gradually gets worse Fecal impaction Malnutrition Slow growth Swollen belly ```

Answer 4

within 24 - 48 hours. | If not passed can lead to Hirschsprung's disease

Answer 5

Children with Hirschsprung's disease are missing the nerve cells (ganglion cells) within the wall of their colon or rectum. These cells are responsible for the normal wave-like motion of the bowel (peristalsis). This lack of ganglions causes stool obstruction. Hirschsprung's disease is a congenital disease. That means a person is born with it. The disease may also be hereditary, which means a parent can pass it to a child.

Answer 6

Abdominal X-ray. A diagnostic test which may show a lack of stool in the large intestine or near the anus and dilated segments of the large and small intestine. Barium enema. A procedure performed to examine the large intestine for abnormalities. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and dilated intestine above the obstruction. Anorectal manometry. A test that measures nerve reflexes which are missing in Hirschsprung's disease. Biopsy of the rectum or large intestine. A test that takes a sample of the cells in the rectum or large intestine and then looks for nerve cells under a microscope.

Answer 7

Enterocolitis: Infection or inflammation of the intestines continues to be the major cause of complications in Hirschsprung’s disease. Symptoms may worsen over the course of hours and include "explosive", foul smelling or bloody diarrhea, abdominal distension, lethargy and fever. If a rectal exam is performed there may also be an "explosive" release of gas or stool. In some cases of enterocolitis, bacteria can enter the blood stream from the bowel to cause sepsis, a problem that can be fatal.

Answer 8

The correct answer is B. The other options are expected clinical manifestations in patients with appendicitis. Option B indicates a complication; the patient is showing signs of dehydration secondary to the vomiting, anorexia, and decreased oral intake. This type of question asks the nurse to find something in the answer choices that requires an action or intervention.

Answer 9

Physical Findings: Depends upon the stage of appendicitis 1. Observe child—may be motionless, with legs flexed 2. Tenderness localized to RLQ; intense at McBurney’s point, halfway between umbilicus and anterior superior iliac crest 3. Rebound tenderness 4. Rovsing’s sign—pain RLQ with left-side pres- sure; highly indicative of appendicitis in children 5. Local, right-sided tenderness or mass on rectal examination 6. Won’t jump/difficulty ambulating 7. Obturator sign—rotating thigh may produce pain in RLQ 8. Complete examination to rule out other causes of abdominal pain, especially throat, chest, testicles 9. Perforation and peritonitis within 24 to 48 hours a. Rigidity b. Higher fever c. Pain improves d. Generalized tenderness e. Increased vomiting f. 40% incidence in young children

Answer 10

Rovsing’s sign—pain RLQ with left-side pressure; highly indicative of appendicitis in children and adults

Answer 11

Obturator sign—rotating thigh may produce pain in RLQ (think of orbiting/rotating) Appendicitis

Answer 12

Rebound tenderness: Where pain is felt on the release of applied pressure upon the abdomen. felt on peritonitis and appendicitis positive Blumberg sign: pain worse on release of hand.

Answer 13

Pain with right thigh extension. The patient is asked to lie on the unaffected side and extend the other leg at the hip against the resistance of the examiner's hand. A positive psoas sign is abdominal pain with this maneuver indicating appendicitis

Answer 14

McBurney’s point: 1/3rd or halfway between umbilicus and anterior superior iliac crest. Involuntary guarding or Pain at this point or tenderness when palpating indicates appendicitis.

Answer 15

1. Pain at McBurney's point. 2. Positive Psoas sign 3. Positive Obturator sign 4. rebound tenderness 5. Rovsings sign or Blumberg sign Labs: Elevated WBC 10,000 to 20,000 ESR elevated

Answer 16

Ultrasound in children and CT in adults (less radiation to children)

Answer 17

Surgical treatment, prognosis very good. | pain management and wound healing from surgery outpatient.

Answer 18

The Markle sign or jar tenderness heel tap/slap test is a clinical sign in which pain in the RLQ of the abdomen is elicited by dropping from standing on the toes to the heels with a jarring landing. It is found in patients with localised peritonitis due to acute appendicitis.

PEDS GI Flashcards

(42 cards)