Flashcards in Peds Midterm Week 4 Deck (41):
What environmental factors contribute to cleft lip and palate?
Maternal smoking, ETOH, Folic Acid deficiency
What drugs or chemicals contribute to cleft lip and palate?
Phenytoin (Dilantin), Valproic Acid (Depakote)
Thalidomide, Diosin (a pesticide from burning trash)
What are nursing considerations for cleft lip/palate?
Risk for altered parenting
Risk for aspiration
Risk for altered nutrition: less than body requirements
Risk for infection
What is cheiloplasty and when should it be performed on the infant?
Cleft lip repar, 10 wks, 10 lbs
What is appropriate post-op care w/ cheiloplasty?
1. Suture line care (p. jelly, diluted peroxide, saline, 2. Logan Bow or butterfly)
3. Avoid sucking or vigorous crying
4. SUPINE OR SIDE-LYING POSTION WITH ARM RESTRAINTS
What are long term considerations for cheiloplasty?
staged repair (multiple surgeries
What is STaphylorrhaphy?
Cleft Palate repair, 6-18 months
What post-op care is important in cleft palate repair?
Prone (immediate recovery)
Protect (suture line)
What are the LT considerations for cleft palate repair?
Middle ear infections
What is Gastroschisis and what causes it?
herniation of the abdominal viscera outside the abdominal cavity thru a defect in the wall to the side of the umbilicus.
Caused by: young moms, smoking, OTC (tylenol, sudafed and aspirin)
What is Omphalocele? what is it associated with?
intraabdominal contents herniated THROUGH the umbilical cord; enclosed by a translucent sac that umbilical cord inserts into.
Associated with congential anomalies such as Edwards Syndrome, Trisomy 18/21
mom >30 years old
What manifestations are seen with Esophageal Atresia and Tracheoesophageal Fistula?
Polydramnios in utero
frothy saliva, drooling
coughing, choking cyanosis, reflux thru nose, aspiration of feedings
What are post-op respiratory complications with EA and TEF surgery?
What is the danger of a hernia?
constriction which causes impaired circulation
What is Meckels Diverticulum?
outpocketing pouch with gastric or pancreatic tissue that secrets HCl or panc enzymes and causes irritation, ulceration or abscess.
MOST COMMON CAUSE OF RECTAL BLEEDING
What is the key indicator of Meckels divertiuclum?
Bright red rectal bleeding with no pain
What is the cause of gastroesophageal reflux?
dysfunction of the lower esophageal sphincter and delay in gastric emptying
What are the S/s of GERD?
Weight loss or poor weight gain
Heartburn or Chest pain
What is Obstipation?
What is Encopresis?
1. long intervals b/w stools
2. constipation with fecal soiling
What is the peak age for appendicitis?
10 to 12 years
What is pyloric stenosis and what is the key characteristic?
hypertrophy and hyperplasia of the pyloric muscle causing food not to go down GI tract and results in metabolic acidosis.
Key sign: PROJECTILE VOMITING
What are the key S/s of intussuception?
1. 50% occur in 3-12 month olds and 50% in 1-2 year olds.
2. Episodes of acute abdominal pain with intervals of no pain associated with peristalsis
3. Later- CURRANT JELLY STOOLS and abdominal distention
What is the treatment for intussuception?
Barium, air or water soluble contrast enema under pressure sometimes reduces the invagination; other wise SURGICAL REDUCTION
What is Hirschsprung's Disease?
Congenital Aganglionic Megacolon: absence of Parasympathetic innervation of the colon results in abscence of peristalsis.
Associated with failure of internal sphincter to relax. All causes collection of bowel contents, distention of bowel, injury to the bowel wall and enterocolits
How does Hirshcrprungs Disease manifest in the newborn? older infant or child?
infat: fails to pass meconium, anorexia, vomitin
older infant/child: fails to gain wt, abd distention, constipation and fecal masses
RIBBON STOOLS THAT ARE FOUL SMELLING
What does Celiac Disease result from?
the bodies inability to digest gliadin which is protien part of wheat, rye, barley and oats.
What does celiac manifest in (stool)?
Steatorrhea (fatty stools), foul, floating feces
Malabsorption of protein and carbs
What should pt with celiac disease be assessed for?
osteoporosis due to malabsoprtion of fat soluble vitamins.
Assess for calcium deposits - abdominal pain
Irritibility from anemia
needs endoscopy to diagnose
What is biliary atresia?
obstruction or absence of the extrahepatic bile ducts. causes bile to be trapped in liver causing jaundice and cirrhosis.
What are the S/s of biliary atresia?
clay colored stools (lack of conjugated bili in intestines)
increased bili in blood
failure to gain weight
What procedure can be done to allow bile to flow from the liver in the infant with biliary atresia?
What other conditions does biliary atresia cause that the nurse needs to assess for?
bleeding (PT and vit k)
How is naturally acquired active immunity achieved?
Contract the disease
How is naturally acquired passive immunity acheived?
get antibodies from mom thru placenta
Ex. IgG antibody passed to fetus
How is artificially acquired active immunity achieved?
immunization- antibody production stimulated w/o clinical disease (Ag is given as vaccine)
What is a Passive immunization?
administration of pooled antibodies.
Ex. IVIG or IG
Hep A and B (HBIG), RSV, Rabies, VZIG
Provide 3 examples of live, attenuated vaccines.
Provide 3 examples of Inactivated vaccines.
What does "live attenuated" mean?
a live organism was grown under suboptimal conditions which results in a live vaccine with reduced virulence.
What is a "recomginant" vaccine?
an organism has been genetically altered for use in the vaccine
Ex. Hep B or acellular Pertussis