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Questions and Answers
What is the recommended fluid intake rate for older children suffering from dehydration?
Which of the following is a reason to stop PPIs or antacids prior to pH monitoring for GERD?
What is a common preparation for a child undergoing endoscopy?
During an MRI, which safety concern must be addressed regarding the child?
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Which type of diarrhea is typically characterized by equal losses of water and electrolytes?
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What can indicate a worsening renal state in a child?
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Which imaging technique is used to determine the presence of reflux in the urinary system?
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What is the normal pH range for urinalysis?
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What is the recommended action if urine specimens cannot be sent to the lab within one hour?
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What is the most common ascending infection in children that originates from the urinary system?
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What is the primary purpose of standard precautions in infection control?
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Which of the following diseases is primarily transmitted via airborne transmission?
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What type of precautions are implemented in addition to standard precautions for infection control?
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Which practice is NOT included as part of respiratory hygiene/cough etiquette?
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Under what circumstance should gowns and gloves be used during patient care?
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What is a common misconception regarding hospital-acquired infections?
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Which of the following is an example of contact transmission?
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When is it particularly important for healthcare providers to use gowns during patient care?
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What is a primary concern regarding abdominal distension postoperatively?
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Which symptom would indicate that a newborn may have Gastroesophageal Reflux Disease (GERD)?
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What should be taught to parents regarding medication for GER/GERD management?
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What is the recommended approach for feeding babies with GER?
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What is a common complication of untreated Gastroesophageal Reflux Disease (GERD)?
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Which sign is indicative of appendicitis in a patient?
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What management step is necessary for a child with Meckel diverticulum before surgery?
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What symptom is NOT typically associated with hypertrophic pyloric stenosis?
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Which intervention is essential postoperatively for a child after appendicitis surgery?
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What dietary modification could benefit a child with GER/GERD?
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What is the best way to monitor for infection post-op in a surgical patient?
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What should be avoided when managing ostomy care in an infant?
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Which diagnostic tool is commonly used to assess for abdominal issues such as appendicitis?
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What is a key characteristic of pyloric stenosis upon physical examination?
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What is the most common organism responsible for urinary tract infections (UTIs)?
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Which symptom is indicative of an upper urinary tract infection (pyelonephritis)?
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What is the primary characteristic of nephrotic syndrome?
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What should be monitored to manage hypertension in a child with acute glomerulonephritis?
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Which condition involves the abnormal backflow of urine from the bladder into the ureters?
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Which technique is preferred for accurately obtaining a urine sample in young children when clean catch is not feasible?
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What is the main purpose of sensitivity testing in the context of UTIs?
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What is the first-line antibiotic commonly used for uncomplicated cystitis?
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What is the most common initial management for a child diagnosed with nephrotic syndrome?
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Which of these urinary tract anomalies may require surgery if the testicle has not descended by 6 months of age?
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After which infection is acute poststreptococcal glomerulonephritis most commonly seen?
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What indicates a potential obstruction in the urinary tract on imaging studies?
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What discharge instruction is important for a child undergoing surgery for hypospadias?
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Study Notes
Infection Control Concepts
-
Standard Precautions: Apply to all patients.
- Hand hygiene: Wash hands before and after patient care.
- Safe injection practices: Use sterile needles and syringes.
- Respiratory hygiene/cough etiquette: Cover mouth and nose when coughing or sneezing.
- Gown and gloves: Wear when there is a risk of exposure to blood or bodily fluids.
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Transmission-based precautions: Used in addition to standard precautions.
-
Airborne: Transmission through the air, droplets that have evaporated.
- Examples: Varicella, measles, TB.
- Negative pressure room: Air inside the patient's room is vented outside, diluting airborne particles.
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Droplet: Transmission from large particles contacting mucous membranes.
- Examples: Mumps, influenza, pertussis, epiglottitis.
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Contact: Direct contact, skin-to-skin.
- Indirect: Transfer of organisms from contaminated objects in the environment.
- Examples: RSV, Varicella, skin conditions (impetigo, scabies, lice).
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Airborne: Transmission through the air, droplets that have evaporated.
Urinary Tract Infections
-
Common causes:
- Upper UTI: Pyelonephritis.
- Lower UTI: Cystitis.
- Pathogens: E. coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, Enterococcus faecalis, Staphylococcus aureus, Candida albicans, Streptococcus agalactiae.
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Frequency:
- Most common bacterial disease in children.
- Account for more than 8 million office visits per year.
- Result in more than 100,000 people hospitalized annually.
- Greater than 15% of patients who develop gram-negative bacteria die.
- One-third of gram-negative bacteria infections originate in the urinary tract.
UTIs
- Alteration of defense mechanisms increases the risk of UTIs
- Organisms are usually introduced via ascending route from urethra
- Bloodstream or lymphatic infection also possible
- Medical equipment like catheters and stents can introduce organisms
- Common nosocomial infection
- Usually caused by E. coli
- Seldom caused by Pseudomonas
- Usually caused by urologic instrumentation
- Clinical Manifestations
- Dysuria
- Frequent urination (>q 2hr)
- Urgency
- Suprapubic discomfort or pressure
- Cloudy urine, possibly with blood or sediment
- Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis)
- Be aware of no symptoms or vague symptoms - could only have a fever, decreased appetite, or fatigue
- Pediatric Manifestations
- Assess child's appearance - are they ill? Do they have a fever?
- Assess height, weight, and BP
- Monitor diaper changes, ideally every half hour for better visibility
- Urine dipstick can be used for assessment
- Symptoms include frequency, fever, odiferous urine, blood-tinged urine, and occasionally asymptomatic generalized sepsis
UTI Diagnostic Studies
- Dipstick - identifies nitrates, WBCs, and leukocyte esterase
- Microscopic urinalysis for confirmation
- Culture to determine empirical findings
- Urine collection methods
- Clean catch - for children who can follow instructions
- U bag
- Specimen obtained via catheterization or suprapubic needle aspiration for more accurate results
- May be necessary when clean catch cannot be obtained
- Best time to collect urine sample: first thing in the morning, urine is more concentrated
- Sensitivity testing determines susceptibility to antibiotics
- Imaging studies for suspected obstruction - IVP or abdominal CT
UTI Collaborative Care Drug Therapy – Antibiotics
- Antibiotics are begun after obtaining a urine sample
- Change antibiotic if lab results indicate the organism isn't reactive to the current antibiotic
- Uncomplicated cystitis - short-term course of antibiotics
- Complicated UTIs - long-term treatment
- Commonly used antibiotics
- Bactrim (TMP-SMX)
- Amoxicillin
- Cephalexin
- Gentamycin, carbenicillin
- Pyridium - changes urine color (reddish orange), but soothes urinary tract mucosa
- Combination agents (Urised) used to relieve pain – preparations with methylene blue tint
UTI Collaborative Care Drug Therapy for Repeated UTIs
- Prophylactic or suppressive antibiotics
- TMP-SMX given daily to prevent reoccurrence
- May need prophylactic antibiotics if recurrent UTIs
Vesicoureteral Reflux (VUR)
- VUR - retrograde/backflow of urine from bladder into ureters
- Primary reflux - anomaly
- Secondary reflux - obstruction in the bladder
- Graded from least to most severe
- Increases potential for infection
Acute Pyelonephritis – Etiology and Pathophysiology
- Caused by various organisms
- Urosepsis - systemic infection from urologic source
- 15% of children can die from this
Glomerular Disease: Acute Glomerulonephritis (AGN)
- Teach parents to administer full course of antibiotics for Strep to prevent glomerulonephritis
- Ranges in severity from mild to severe
- Symptoms
- Proteinuria
- Hematuria (tea colored urine)
- Oliguria - decreased urine output
- Edema
- Hypertension
Types of Glomerulonephritis
- Most are post-infectious
- Pneumococcal, streptococcal, viral
- May be a distinct entity or manifestation of a systemic disorder
- SLE
- Sickle cell disease
- Others
Glomerulonephritis Symptoms
- Generalized edema
- Due to decreased GFR
- Begins with periorbital edema
- Then lower extremities, pulmonary, and ascites
- HTN due to increased ECF
- Oliguria
- Hematuria - bleeding in upper urinary tract = smoky urine
- Proteinuria - increased amount of protein = increased severity of renal disease
Acute Poststreptococcal Glomerulonephritis (APSG)
- Often associated with prior hx of strep throat
- Onset 5-12 days after other infections
- Noninfectious renal disease - autoimmune
- Often group A beta-hemolytic streptococci
- Most common in children 6-7 years old
- Uncommon in children younger than 2 years old
- Can occur at any age
- Prognosis
- 95% - rapid improvement to complete recovery
- 5% to 15% - chronic glomerulonephritis
- 1% - irreversible damage
Nursing Management of APSG
- Daily weights, Is and Os, measure abdominal girth and document
- Manage HTN - loop diuretics, thiazides
- Ace inhibitors, Ca channel blockers, beta blockers
- Nutrition - regular diet recommended unless increased edema (then no salt added)
- Bed rest isn't necessary or a requirement but kids don’t feel well, so they self-restrict
- Antibiotic ordered if strep continues, otherwise not used
Nephrotic Syndrome
- Common occurrence in glomerular injury
- Not a disease, but a clinical state of proteinuria, low albumin in blood, hyperlipidemia
- Characteristics
- Proteinuria
- Hypoalbuminemia
- Hyperlipidemia
- Edema
- Massive urinary protein loss
Types of Nephrotic Syndrome
- Minimal change nephrotic syndrome - little structural change to glomeruli
- Also called - idiopathic nephrosis, nil disease, uncomplicated nephrosis, childhood nephrosis, minimal lesion nephrosis
- Can be congenital
- Considered chronic, 80% have complete remission with steroid treatment
- 20% will continue to have relapses until adulthood
Changes in Nephrotic Syndrome
- Glomerular membrane
- Normally impermeable to large proteins
- Becomes permeable to proteins, especially albumin
- Albumin lost in urine (hyperalbuminuria)
- Serum albumin decreases (hypoalbuminemia)
- Fluid shifts from plasma to interstitial spaces
- Hypovolemia
- Ascites
Nephrotic Syndrome Management
- Supportive care
- Rest and quiet activities appropriate for age
- Diet - regular diet if remission, if edema then sodium restriction
- No evidence to support high protein
- Steroids at time of dx, decrease proteinuria
- Prednisone has least number of side effects
- Drug alert: all steroids
- Concerned about obesity, GI bleeding, bone loss, infections
- Monitor for side effects
- Some children don’t respond to steroids, then use Cytoxan
- Diuretics - decrease fluid overload
Family Issues
- Family support
- Kids are at home during relapse unless severe edema or proteinuria
- Do they have the support they need?
- Notify if worsening symptoms
- Social isolation - tired, don’t feel well, no energy, immunosuppressed, change in physical appearance due to edema (self-esteem)
Nephrotic Syndrome Nursing Interventions
- Ensure adequate fluid intake (patients with urinary problems may think fluid intake will make them more uncomfortable)
- Dilutes urine, making the bladder less irritable.
- Flushes out bacteria before they can colonize.
- Avoid alcohol, caffeine, citrus juices, chocolate, and spicy foods.
- Discharge to home instructions
- Follow up on urine specimens or cultures as needed
- Recurrent symptoms typically occur in 1 to 2 weeks after therapy
- Encourage adequate fluid intake even after clearing the infection.
- Low-dose, long-term antibiotics to prevent relapses or reinfections
- Explain rationale to enhance compliance
- Aseptic technique during catheterization
- Avoid unnecessary catheterization and early removal of indwelling catheters
- Prevents nosocomial infections
- Wash hands before and after contact
- Wear gloves for care of the urinary system
- Routine and thorough perineal care for all hospitalized patients
- Avoid incontinent episodes by answering the call light and offering a bedpan at frequent intervals
Defects of the Genitourinary Tract
- Phimosis
- Narrowing of the preputial opening of the foreskin
- Prevents retraction of the foreskin over the penis
- Normal finding in babies and young boys
- Reassure parents that this is normal
- Will go away and disappear as the child grows
- Hydrocele
- Fluid-filled mass in the scrotum
- Swollen, enlarged, painful, red, pressure at the base of the penis
- Diagnosed by shining a light to illuminate fluid-filled area
- Does light travel through?
- Resolves by 1 year of age, then surgery
- Post op
- Temporary swelling and discoloration of the scrotum
- If dressing is used, remove by 2-3 days, then bathe
- Avoid straddle toys for 2-4 weeks
- If older boy, avoid strenuous activity for 1 month
- Cryptorchidism
- One of the testes does not descend down due to a narrow canal, lack of sensitivity to maternal hormones, or congenital defect of gonads
- Concerns: testes fail to descend, higher temperature in the abdomen, so an increased risk of infertility and malignancy
- Usually descend spontaneously by 3 months, if not, an orchiopexy is performed
- Remove testes from the abdomen into the scrotum
- Performed before 6 months of age
- Prevents infection and pain control
- Epispadias and hypospadias
- Congenital defects, the urethral meatus is in an abnormal location
- Epispadias
- Tip of penis is on top of the shaft
- Hypospadias
- Tip of penis is on the bottom of the shaft
- Occurs with downward curvature of the penis, and associated with cryptorchidism
- Diagnosed visually at birth or using US
- Surgery done at 6-12 months to minimize psychological effects
- Child should have an adequate urinary stream at the end of surgery
- Dorsal foreskin may be used for this surgery, so the child should not be circumcised before surgery
- Post op
- Protect surgical site from injury
- Wrapped in dressing, stent in place
- Fresh blood on the dressing and stent can happen immediately post op - not afterwards
- Over the next few hours, urine should become less bloody
- Slight blood tinge for a few days
- Stent shouldn’t get accidentally pulled out - medical restraints used
- Adequate fluids for adequate urine output to keep the stent patent
- If no urinary output within 1 hr, concern that the stent is obstructed
- Pain control - caudal nerve block
- Anticholinergic for bladder spasms
- Antibiotics until stent comes out
- Discharge instructions
- Double diapering: use two diapers, first diaper collects stool, the outer diaper collects urine
- Prevent injury
- No bathing until the stent is out
- No straddle toys or straddling on the hip for at least 2 weeks - hold the child in another way
- Call the hospital if fever, urine that comes out any other way, bright red bleeding
- Chordee
- Can occur in conjunction with epispadias/hypospadias
- Hooked or crooked condition of the penis
- Can be corrected surgically
- Exstrophy of the bladder
- Posterior bladder pushes out through the lower abdominal wall
- Females: split clitoris
- Boys: short penis
- Usual inguinal hernias and cryptorchidism
- Surgical repair to repair the abdominal wall
- Pre op
- Cover the exposed bladder with plastic wrap or a transparent dressing to keep the mucosa moist until surgery
- Avoid abduction of legs
- Maintain good alignment and provide psychosocial support
- Post op
- Monitor Is and Os
- Urine is blood-tinged initially
- Expected output in weight in kgs
- Administer medications: antibiotics, analgesics, and muscle relaxants
- Prevent complications
- Avoid leg abduction
- Observe for: wound infection, UTI, obstructions, increased bladder spasms, decreasing urine output, bright red blood
- Obstructive uropathy and posterior urethral valves
- Malformation of the urinary tract, obstruction
- Abnormalities resulting in urine backflow into the kidneys
- Patho – several congenital lesions
- Obstruction may occur in either the upper or lower urinary tract
- Common sites of obstruction - ureteropelvic valve, ureterovesicular junction, posterior urethral valve
- Risk of renal failure, especially if bilateral kidney involvement
- Malformation of the urinary tract, obstruction
Obstruction Sites in the Urinary System
- Post op care
- Accurate Is and Os
- Pain management
- Incision care
- Diaper placement
- Ostomy care
- Observe for signs of infection
GU Surgeries: Psychosocial Issues
- Self-esteem - changes in appearance, functioning, incontinence
- Self-confidence
- Sexual identity
- Sexual functioning - fertility
Benefits and Complications of Circumcision
- Benefits
- Decreased incidence of UTI, sexually transmitted infections, AIDS, and penile cancer
- In female partners a decreased incidence of cervical cancer
- Complications
- Alterations in the urinary meatus
- Unintentional removal of excessive amounts of foreskin
- Damage to the glans penis
Enuresis: Two Types
- Primary
- Child has never had a dry night
- Maturational delay, small functional bladder
- No psychological cause
- Secondary
- Child who has been reliably dry for at least 6 months begins bed wetting
- Stress, infections, sleep disorders
- Treatment
- Multi-approach
- Fluid restriction
- Bladder training
- Timed voiding
- Enuresis alarms
- Reward system
- Medications – desmopressin, oxybutynin, imipramine
Testicular Torsion
- A testicle is abnormally attached to the scrotum and twisted
- Requires immediate surgery because ischemia can result if the torsion is left untreated, leading to infertility
- May occur at any age but most commonly occurs in boys aged 12 to 18 years
Alterations in GI Function
Gastrointestinal Structure and Function
- Development of the GI tract
- Meconium - first fecal material passed by the newborn after birth
- Contains residue of swallowed amniotic fluid
- Expelled shortly after birth
- Shows that the GI tract is patent
- Swallowing
- For the first 3 months, automatic reflex, no voluntary control
- By 6 months, swallow, able to hold food in the mouth, able to spit food out
- Starting on solid foods
- Meconium - first fecal material passed by the newborn after birth
- Digestion
- Chemical digestion - GI secretions produced by the stomach and small intestine
- Hydrochloric acid, water, electrolytes
- Mechanical digestion - churning food
- Peristalsis - moving food down with muscle contractions
- Chyme - partially digested food along with acidic substances
- Chemical digestion - GI secretions produced by the stomach and small intestine
- Absorption
- Small intestine - pump and osmosis
- Large intestine - completes absorption of water and sodium
- Colonic bacteria - synthesize vitamin K, B12, and some of the vitamin B complex
- Bacteria can affect the color, odor of stool, and amount of gas
Clinical Manifestations
- Failure to thrive - with some GI disorders of kids, the child stops growing (no longer accelerating) or remaining below the 5th percentile for height and weight
- Very small, not as tall or weigh as much as they should
- Could come with a developmental delay
Assessment of GI Function
- Known GI disease or trying to rule it out
- Malabsorption - not absorbing nutrients, affects growth
- Fluid and electrolyte disturbances - diarrhea? 1-2mL/kg/hr for newborn and 1mL/kg/hr for older kids
- MRI
- Really loud, sounds like banging on the wall
- Ensure they are safe
- Have to hold very still
- Large magnet - visualizes internal body structure
- More enclosed than a CAT scan
- May use contrast dye here too
- Can offer headphones with no magnet in it
- Make sure no metal on child - jewelry, earrings
- May need sedation to hold still
Endoscopy
- Visualizes the GI tract - see abnormalities, lesions
- If need biopsy
- Need sedation
- pH monitoring for GERD
- What is the acidic pH of GI secretions?
- What is the severity of the reflux?
- NPO for 4 hours before the tube is inserted - check medications child has been on
- Antacids or PPIs need to be stopped 24 hours before pH monitoring is done
- Sometimes stopped up to 7 days before - interferes with the pH
Stool Sample
- WBCs
- Ova and parasite
- Bacterial cultures
- Fecal fat
- Stool pH
- Rotazyme (rotavirus)
- Blood
Dehydration
- Volume depletion, fluid volume deficit
- Seen in kids with diarrhea - losing fluids and not replenishing orally
- Isotonic diarrhea, hypotonic diarrhea, hypertonic diarrhea
- Are water and electrolytes lost in equal amounts? Or one more than the other?
- Usually isotonic
- Are water and electrolytes lost in equal amounts? Or one more than the other?
- Mild/moderate/severe dehydration
- Use weight initially as baseline - how much weight has been lost?
Postoperative Care for Gastroschisis
- Monitor for signs and symptoms of infection: fever, pain, redness, swelling, drainage.
- Measure abdominal distention, any increase is worrisome.
- Teach ostomy care for stage one patients: pouch adhering to stoma, assessing skin site, no adhesive enhancers.
- Newborn skin is thin and prone to damage, do not use adhesive enhancers, as it could strip the skin and increase the risk of latex allergy.
- Support the family and refer them to ostomy support groups.
- Discharge instructions: family knows s/s of infection, obstruction, malnourishment, ostomy care, and procedures involved in a takedown.
Gastroesophageal Reflux (GER)
- Can occur at any age.
- Gastric contents reflux into the esophagus, irritating the lining.
- Reflux may occur without GERD (tissue damage).
- GERD can occur without regurgitation (spitting up).
- Frequency and persistency can make it abnormal.
- Physiologic until 1 year of age.
- Becomes pathologic with failure to thrive, no more growing, bleeding, or dysphagia.
- Usually due to relaxation of the lower esophageal sphincter.
- Signs and Symptoms: spit up, regurgitation, vomiting, hunger, irritability, crying, eating a lot/refusing feedings, failure to thrive (poor weight gain).
- Look for respiratory changes as aspiration of gastric contents can occur.
- Diagnosis: duration of symptoms, abnormal physical exam findings, gastric acidity assessment, endoscopy with biopsy (looking for changes in esophageal cells which can increase the risk of Barrett’s esophagus).
- Assess gastric emptying time.
Complications of Gastroesophageal Reflux (GERD)
- Reflux coming into the esophagus or oropharynx.
- Most often in premature infants, those with neurologic conditions, asthma, cystic fibrosis, and cerebral palsy.
- Assessing for abnormalities: laryngitis, hoarseness, pneumonia, anemia, Barrett’s esophagus, FTT/poor growth.
Therapeutic Management of GER/GERD
- Conservative approach: avoid foods that cause reflux (spicy, fried, caffeine, citrus fruits/juices).
- Small frequent meals rather than 3 large meals.
- For babies: thicken formula (add 1 teaspoon of rice cereal per 1 ounce of formula).
- After feeding: HOB elevated, keep infant upright.
- Sleep supine (on back, not on belly).
- Frequent burping during feeds.
- Avoid overfeeding.
- With severe GERD, surgery may be needed (Nissen Fundoplication).
- Candidates for surgery include persistent respiratory symptoms, frequent aspirations, and no response to management.
- Surgery creates a one-way valve by wrapping the fundus around the esophageal sphincter.
- Severe cases: G-tube may be needed for 6-8 weeks or longer after surgery for feeding.
Nursing Management: GER/GERD
- Teach parents to hold infant/cuddle during feeds and keep them in an upright position.
- Weigh babies daily.
- Small frequent feeds, thickened formula, and split nipple.
- Elevate HOB.
- Encourage non-nutritive sucking (especially with G tube and J tube feedings).
- Educate about G tube and J tube care.
- PPIs or H2 blockers decrease hydrochloric acid secretion and can increase lower esophageal tone.
Acute Appendicitis
- Obstruction of the lumen of the appendix in the RLQ.
- Average age of onset is 10 years.
- Signs and Symptoms: RLQ pain (guarding the RLQ, pain is greatest at McBurney’s point), rebound tenderness, nausea, vomiting, anorexia.
- When there is no pain at all, the appendix may have ruptured. Signs of rupture include pallor.
- Diagnosis: abdominal ultrasound, lab test (elevated white blood cells), elevated C reactive protein (inflammatory marker).
- Assessments: atraumatic care, administer antibiotics, and manage pain.
- If rupture occurs: longer length of stay, longer antibiotic course, more extensive wound care, and pain management.
- Post-operative Care: encourage splinting with a pillow, do not apply heat or ice to the surgical site, NGT to low wall suction, monitor VS and temperature, monitor for return of bowel sounds, good pain management, NPO (why they need NGT), diet returns as bowel sounds do.
Meckel Diverticulum
- Outpouching of the lower part of the intestine.
- Congenital, a leftover piece of the umbilical cord.
- 2% of the population, 2:1 ratio males to females.
- Commonly located within 2 feet of the ileocecal valve, 2 cm in diameter, and 2 inches in length.
- Two types of ectopic tissue: pancreatic and gastric.
- Common before the age of 2.
- Some are asymptomatic, others have abdominal pain and bloody/mucus stool.
- Diagnosis: detect the location of the outpouching in the lower intestine.
- Preoperative Care: transfusion with packed RBCs, IV hydration, supplemental O2, antibiotics, and monitor stool and blood lost.
- Surgery removes the outpouching.
- Postoperative Care: administer O2, pain management, IV hydration, antibiotics for infection, assess for bowel sounds (NPO until they return) and NGT to wall suction.
Paralytic Ileus
- Impaired motility, acquired or born with.
- Signs and Symptoms: pain, nausea, vomiting, abdominal distention, change in stool pattern from baseline.
Hypertrophic Pyloric Stenosis
- Enlarged pylorus muscle causes narrowing of the pylorus and obstruction.
- Common cause of gastric outlet obstruction in babies.
- Occurs within the first few weeks of life (1 week to 5 months).
- Signs and Symptoms: spit out a lot, regurgitation, non bilious vomiting ½ hour to 1 hour after feeding, projectile vomiting, waves of peristalsis on abdomen, always hungry, palpate olive-shaped mass to the right of the umbilicus (enlarged hypertrophy muscle), dehydration, metabolic alkalosis can occur.
- Diagnosis: abdominal ultrasound.
- Preoperative Care: correct fluid and electrolyte imbalances, monitor intake and output.
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Test your knowledge on important topics in pediatric gastroenterology and urology, including fluid intake for dehydrated children, safety during imaging procedures, and infection control measures. This quiz covers common practices and protocols that healthcare professionals should be aware of when treating young patients.
