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Flashcards in Test 2 Deck (120):
1

What are the pediatric differences in the GI system?

small stomach capacity. increased peristalsis. relaxed cardiac sphincter. decreased enzymes. distention from gas. immature liver.

2

What are structural disorders of the GI system?

cleft lip and palate
pyloric stenosis
intussusception

3

What are malabsorption disorders of the GI system?

celiac disease

4

What are motility disorders of the GI system?

acute diarrhea

5

What issues can cleft lip/palate cause?

feeding difficulties
dental deformities
speech problems
otitis media
hearing problems

6

What is some preop nursing care of cleft lip/palate?

support parents
modified feeding or NPO
age-appropriate preoperative education
discuss surgical expectations
multidisciplinary team support

7

How do you facilitate feedings with cleft lip/palate?

special feeders
encourage breast feeding
allow extra time for feeds
burp frequently
upright position 30 min post feed

8

What is post op nursing care for cleft lip/palate?

pain management, maintain suture line, nutritional support, home care teaching

9

What are symptoms of pyloric stenosis?

occasional emesis -> projectile vomiting
visible peristaltic waves
palpable olive-sized mass
hyperactive bowel sounds
dehydration, electrolyte imbalances

10

What is the nursing care for pyloric stenosis?

meet fluid and electrolyte needs - IVFs.
minimize weight loss - daily weights, I&Os, IVFs. post op, small frequent feedings. do not rock or play for 30 minutes after feeds
promote comfort - pain management, don't life legs to change diaper
prevent infection - incision care, monitor temp & RR

11

What is intussusception?

portion of intestine prolapses and telescopes back
most common in infancy and in males

12

What are symptoms of intussusception?

abrupt onset. acute pain. vomiting -> bilious. brown stool -> reddish currant jelly. palpable abdominal mass

13

How is intussusception diagnosed?

abdominal xray/ultrasound

14

How is an intussusception treated?

contrast air or barium enema
stomach decompression
possible surgery

15

What is celiac disease?

gluten-sensitive enteropathy. immunologic disorder - intolerance of gluten

16

What are signs and symptoms of celiac disease?

chronic diarrhea, impaired growth, abdominal distention. decreased appetite, decreased energy, muscle wasting.

17

How is celiac disease diagnosed?

fecal fat, duodenal biopsy, clinical improvement, special serum antibodies.

18

How do you treat celiac disease?

gluten free diet

19

What to teach with celiac disease?

allowed foods, risks of noncompliance

20

What are some grains that contain gluten?

barley, bran, couscous, farina, graham flour, orzo, rye, semolina, wheat, wheat brain, wheat germ, wheat starch.

21

What is the concern with acute diarrhea?

alters fluids & electrolyte balance
rapid dehydration in infants & small children -> hypovolemic shock and death

22

What is the treatment for acute diarrhea?

slow losses and rehydrate with adequate electrolytes/nutrition

23

What is the nursing care for acute diarrhea?

prevent dehydration.
provide rehydration fluids
family support & teaching

24

What are pediatric differences for the GU system?

small bladder capacity, add 2 to their age = ounces bladder can hold

25

In the GU system, under the age of 2, children are less efficient at... ?

electrolyte and acid-base balance
excretion of drugs from body
concentrating urine

26

What are diagnostic procedures for GU disorders?

cystoscopy
diuretic renogram
intravenous pyelogram
voiding cystourethrogram
lab tests - BUN, creatine, urinalysis

27

What do you assess in the GU system?

urine characteristics
pain or discomfort
edema
appearance of genitalia

28

What is the normal urine output for infants?

2 mL/kg/hr

29

What is the normal urine output for children?

0.5 to 1 mL/kg/hr

30

What is the normal urine output for adolescents?

40 to 80 mL/hr

31

What is hypospadias or epispadias?

abnormal location of urethral meatus in males

32

How do you diagnose hypospadias or epispadias?

prenatal US or observation

33

How do you treat hypospadias or epispadias?

surgery

34

What is the nursing care of hypospadias or epispadias?

protect surgical site
encourage fluids
double diapering - second diaper catches urine from stent

35

What are the medications post op of hypospadias or epispadias repair?

analgesics, prophylactic antibiotics, and anticholinergics to reduce bladder spasms

36

What is cryptorchidism?

failure of testicle to descend

37

What are complications of cryptorchidism?

infertility & malignancy - testicular cancer

38

When do testicles usually descend?

spontaneously by 3 months

39

What is post op teaching for cryptorchidism?

no tub baths x2 days
keep clean & dry
avoid straddling on hip or straddle toys x 2 weeks

40

What is primary enuresis?

never dry, infants.
delayed neuromuscular maturation
small bladder capacity

41

What is secondary enuresis?

stress, UTI, DM, sleep disorder

42

What is nocturnal enuresis?

bedwetting

43

What is the treatment of enuresis?

fluid restriction, bladder exercises, timed voiding, enuresis alarms, reward systems, medications.

44

What are medications used for enuresis?

desmopressin - nasal spray with antidiuretic effect
imipramine - anticholinergic, reduces bladder spasms
oxybutynin - for urgency

45

What is nephrotic syndrome characterized by?

edema - protein loss -> osmotic pressure change
retain sodium and water
massive proteinuria
hypoalbumninemia, hypoproteinemia
altered immunity

46

What are symptoms of nephrotic syndrome?

increased edema, anorexia, weight gain from retaining fluid, HTN, irritability

47

How do you diagnose nephrotic syndrome?

history, symptoms, labs

48

What medications are used with nephrotic syndrome?

corticosteroids 12 weeks
diuretics - relieves edema
antihypertensive
antibiotics - risk for infection
iv albumin - replace low albumin levels

49

What are interventions for nephrotic syndrome?

monitor side effects of meds
prevent infection
prevent skin break down
meet nutritional and fluid needs
promote rest
support and home care teaching

50

What is acute glomerulonephritis?

most common inflammation of glomeruli of kidney

51

What is acute glomerulonephritis a response to?

group A beta-hemolytic streptococcus or strep throat

52

What are characteristics of acute glomerulonephritis?

history of strep infection
signs emerge 10-21 days after
immune complex reaction on glomerular capillary wall
decreased GFR, RBC excreted
Ha, H3O retained -> edema

53

What are signs and symptoms of acute glomerulonephritis?

acute pain, usually asymptomatic, tea colored urine

54

What labs diagnose acute glomerulonephritis?

BUN, Creatine, GFR

55

What is the treatment of acute glomerulonephritis?

relief of symptoms & supportive care
bed rest, treat edema, HTN

56

What is the nursing care for acute glomerulonephritis?

monitor fluid status
prevent infection
prevent skin break down
meet nutritional needs
provide emotional support
teaching needs

57

What are some pediatric differences in the brain and spinal cord?

not well protected from trauma
nerve impulse development rapid
brain growth continues until age 5-8
myelination incomplete at birth

58

What are pediatrics more at risk for?

brain injury, skill fracture, neck injury, and compression fractures

59

What is hydrocephalus?

a structural defect of the brain, enlarged ventricles due to too much CSF.
can be congenital or acquired

60

What is the diagnostic tests for hydrocephalus?

signs/symptoms of increasing ICP - increase in head circumference. older child - HA, vomiting, irritable

61

What is the treatment for hydrocephalus?

remove obstruction or create bypass
ventriculoperitoneal shunt
ventriculoatrial shunt

62

What are complications of surgery for hydrocephalus?

shunt malfunction or failure
infection

63

What is pre-op nursing care for hydrocephalus?

position carefully & reposition frequently
support head a& neck, HC checks daily
skin care: prevent breakdown
feedings - prone to vomiting
monitor for s/s of increased ICP

64

What is post-op nursing care for hydrocephalus?

positioning - flat for 24 hours, gradually rise. fed on side.
aseptic technique
monitor for shunt malfunction, infection, increase ICP
teaching

65

What is meningomyelocele (or spina bifida)?

spinal fluid-filled meningeal sac

66

How must meningomyelocele be treated?

surgery in 24-48 hours of birth

67

How is meningomyelocele diagnosed?

may be diagnosed prenatally
CT, MRI, and Xray

68

What decreases the chance of meningomyelocele ( spina bifida)?

adding folic acid to diet of pregnant woman

69

What are clinical manifestations of meningomyelocele?

spinal fluid filled meningeal sac
hydrocephalus - 85% associative
seizures
lowest - mild weakness, bowel, & bladder issues
highest - paralysis of legs, weakness, and sensory loss of trunk, loss of bowel, bladder control

70

What causes neonatal abstinence syndrome?

maternal drug use

71

What are symptoms of neonatal abstinence syndrome?

withdrawal.
effects CNS, ANS, GI tract

72

How to treat neonatal abstinence syndrome?

reduce effects of withdrawal- phenabarbitol, klonadine, bundle baby, reduce stimuli.

73

What is cerebral palsy?

a movement & posture disorder. caused by an assault on the immature brain.

74

What is the focus of therapy for cerebral palsy?

want them as independent as possible

75

What are common learning disabilities?

dyslexia - reading
dyscalculia - math
dysgraphia - writing
dyspraxia - motor skills

76

What is the goal in treating learning disabilities?

maximize learning potential
maintain healthy self-esteem

77

What is the goal of treating children with disabilities?

maximize child's potential

78

What scale is used to assess level of consciousness?

Glasgow coma scale

79

What is a late cardiac sign of increased ICP?

bradycardia

80

What urinary problem is associated with spina bifida?

neurogenic bladder

81

What is spasticity?

hypertonia with uncontrolled movement seen in cerebral palsy

82

What is athetosis?

constant involuntary writhing motions seen in cerebral palsy

83

What are the respiratory differences in pediatrics?

airway is smaller in diameter and shorter
increased airway resistance
fewer alveoli for gas exchange
cartilage more flexible
increased oxygen consumption
large tongue and epiglottis

84

What is included in a respiratory assessment?

respiratory effort, color, position of comfort, behavior change, breath sounds, cough, vital signs, O2 saturation, family history.

85

What are symptoms of respiratory distress in children?

nasal flaring, grunting, retractions, restlessness, anxiety, fearful affect, diaphoresis, decreased O2 saturation, behavioral changes, and general cyanosis.

86

What are symptoms of hypoxia?

early - Restlessness, Anxiety, Tachycardia/Tachypnea
late- Bradycardia, Extreme restlessness, Dyspnea

87

What are symptoms of hypoxia in children?

Feeding difficulty, Inspiratory stridor, Nasal flaring, Expiratory grunting, Sternal retractions.

88

What is the treatment for respiratory distress?

start oxygen
position of comfort
bed rest
calm environment

89

What are diagnostic tests for respiratory disorders?

bronchoscopy, imaging studies, sleep studies, pulse ox, spirometry/pulmonary function tests, sweat chloride tests, arterial blood gases

90

What are characteristics of impaired gas exchange?

abnormal ABGs (hypoxia, hypercapnia)
decreased O2 sat
altered LOC
dyspnea

91

What are characteristics of ineffective airway clearance?

adventitious breath sounds
ineffective or absent cough
inability to remove secretions
diminished breath sounds
sputum production

92

What are characteristics of ineffective breathing pattern?

low rate, depth, minute volume
use of accessory muscles
nasal flaring
orthopnea, dyspnea

93

What are respiratory interventions?

oxygen
humidity
incentive spirometer
chest physiotherapy
suction
medications
CPAP, or ventilator

94

What are some respiratory medications?

bronchodilators - reverse or prevent bronchospasm
anti-inflammatory agents - reduce inflammation
antimicrobials

95

What are some acute respiratory conditions?

otitis media
tonsillitis
bronchiolitis
croup syndromes

96

What is otitis media?

inflammation of middle ear
related to E tub dysfunction
can lead to hearing impairment

97

What are risk factors for otitis media?

male children, day care centers, allergies, pacifier use, exposure to tobacco smoke, multiple siblings, cleft lip/palate

98

What are symptoms of otitis media?

tympanic membrane very red, may be bulging
irritability, and pulling at ear
n/v, FEVER

99

What is the treatment of otitis media?

observation
analgesics
antibiotics
myringotomy/tympanostomy tubes

100

What is tonsillitis?

inflammation of tonsils

101

What are symptoms of tonsillitis?

frequent throat infections, breathing and swallowing difficulties, persistent redness of tonsils. sleep apnea. nasal stuffiness. discharge & postnasal drip.
cough

102

What is the treatment for tonsillitis?

antibiotics, surgery - watchful waiting

103

What is bronchiolitis?

lower airway inflammation often caused by RSV. excessive mucus plugs airway
resembles pneumonia on xray
October to march
risk for respiratory failure

104

What is the treatment of bronchiolitis?

maintain droplet isolation
humidified oxygen for O2 sats <90%
CR nad puls ox monitors
nasal suctioning before feeds
nebulized salene treatments - loosens secretions
reduce anxiety
fluids

105

What is croup syndrome?

upper air way inflammation

106

What are clinical manifestations of croup syndrome?

inspiratory stridor
seal-like barking cough
hoarseness
worse at night

107

What are the four classic "D" signs of epiglottitis?

Dysphonia, Dysphagia, Drooling, Distressed respiratory effort with stridor

108

What is Bronchopulmonary dysplasia (BPD)?

chronic lung disease of newborn

109

What increases the risk for BPD?

use of ventilator and oxygen
less than 28 weeks gestation
less than 1000 grams
PDA, MAS

110

What are the symptoms of BPD?

increased respiratory effort and O2 need
failure to thrive
right-sided heart failure
growth & development delays
impaired cognition
pulmonary dysfuction

111

What are medications for BPD?

bronchodilators
corticosteroids
diuretics
potassium chloride - replace K with diuretics
Palizumab (Synagis)
pneumococcal vaccine at age 2

112

What is cystic fibrosis?

autosomal recessive genetic disorder of the exocrine glands.
affects transport of Cl & Na across cell membranes
results in very thick mucus which obstructs ducts of multiple organs

113

What are clinical manifestations of cystic fibrosis?

chronic, moist productive coughf
frequent respiratory infections
adventitious breath sounds
chronic sinus infections
clubbing and a barrel chest
poor weight gain/ FTT
bulky, smelly stools, partial small bowel obstruction
infertifility

114

What are diagnostic tests for cystic fibrosis?

newborn screaning for trypsinogen
chromosome mutation analysis
sweat chrloride test - normal <40

115

What is the treatment of cystic fibrosis?

maintain respiratory function
control inflammation and infection
reduce mucus accumulation
promote optimal nutrition
prevent intestinal blockage

116

What are medications for cystic fibrosis?

broncodilators
dornase alfa - aerosol ( pulmozyme)
hypertonic saline
ibuprofen
antibiotics
pancreatic enzymes
multivitamins, iron
Vitamins A, D, E, K

117

What are signs of asthma?

frequent coughing
wheezing, maybe only with auscultation
bronchoconstriction, airway swelling, mucus production

118

What is asthma?

chronic inflammatory disease. normal protective mechanisms of the lungs overreact to a trigger

119

What is the clinical therapy for asthma?

medications, hydration, education, and support

120

What is the goal of treating asthma?

maintain control long term
use least amount of medication
reduce risk of adverse effects