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Questions and Answers
Which nursing intervention is essential for a child with esophageal atresia or tracheoesophageal fistula?
What symptom is commonly associated with hypertrophic pyloric stenosis?
Which diagnostic method is most appropriate for intussusception?
What is a potential complication of inguinal hernia in children?
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What is the primary treatment for biliary atresia?
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In nephrotic syndrome, what abnormality is often seen in urinalysis?
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Which nursing intervention is important for a child with acute glomerulonephritis?
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What is a common symptom of hemolytic uremic syndrome?
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What is a key symptom of water intoxication in children?
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Which of the following is a benefit of circumcision?
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What is a significant characteristic of fluid balance in infants?
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What nursing intervention is essential before performing a Barium Enema?
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What is a common symptom associated with GERD in infants?
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Which type of dehydration is characterized by a loss of water and electrolytes equally?
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What is a vital intervention for managing Hirschsprung Disease?
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What symptom is NOT typically associated with Urinary Tract Infections (UTIs) in infants?
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What type of feeding is high in protein, glucose, vitamins, and minerals?
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What increased risk is associated with ERCP procedures?
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What is an appropriate nursing intervention for infants with acute gastroenteritis?
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What is an essential nursing intervention during appendicitis management?
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Study Notes
Water Balance in Infants
- Infants have a higher fluid intake and output compared to their size.
- This makes them more susceptible to fluid disturbances, especially insensible losses (through skin).
- Their large body surface area contributes to fluid loss through the skin.
- Higher metabolic rates lead to greater production of metabolic waste, further increasing fluid needs.
- Immature kidneys are less efficient at excreting waste, making them more vulnerable to fluid imbalances.
Diagnostic Testing
- Barium Enema
- Used to visualize the colon.
- Requires a liquid diet 24 hours before the procedure.
- Bowel preparation and increased fluids are necessary to pass the barium.
- The procedure lasts 60 to 90 minutes.
- Barium Swallow
- Used to visualize the upper gastrointestinal tract.
- Requires proper positioning and increased fluids to pass the barium.
- The procedure lasts 2 hours or more.
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Requires informed consent and sedation.
- Patients should be positioned on their side to prevent aspiration.
- Assess allergies to iodine, as the procedure uses contrast.
- A risk factor is ERCP-related pancreatitis.
Gastrointestinal Disorders
- Gastroesophageal Reflux Disease (GERD)
- Symptoms include: burning, coughing, vomiting, apnea, epigastric pain, and Sandifer syndrome.
- Nursing interventions include: administering medications 30 minutes before meals, thickening formula, feeding upright, and providing small, frequent feedings.
- Acute Gastroenteritis
- Symptoms include: diarrhea, abdominal pain, fever, nausea, and vomiting.
- Nursing interventions focus on supportive care and preventing dehydration.
- Dehydration
- Types of dehydration include: isotonic, hypotonic, and hypertonic.
- Dehydration severity can be categorized as: mild, moderate, and severe (shock and oliguria).
- Therapeutic management includes oral rehydration solutions (ORS) and IV fluids as needed.
Feeding Types
- Total Parenteral Nutrition (TPN)
- A high-calorie solution administered via a central line.
- Provides protein, glucose, vitamins, and minerals.
- The bag should be changed every 24 hours, and electrolytes and glucose levels must be monitored.
- Ostomy
- Reasons for ostomy surgery include: imperforate anus, anorectal malformation, necrotizing enterocolitis, and Hirschsprung's disease.
- Nursing interventions include: post-operative care, stoma care, and monitoring fecal drainage.
Specific Conditions and Nursing Interventions
- Appendicitis
- Symptoms include: right lower quadrant (RLQ) pain, fever, nausea, and vomiting.
- Nursing interventions include: monitoring pain levels, incision care, and incentive spirometry.
- Hirschsprung Disease
- Symptoms include: failure to pass meconium, abdominal distension, and constipation.
- Treatment involves surgery, including a temporary ostomy and pull-through procedure.
Urinary Tract Infections (UTI)
- Symptoms include: poor feeding, vomiting, fever, frequent urination, and abdominal pain.
- Therapeutic management includes: antibiotics (amoxicillin, Bactrim), adequate fluid intake, and avoidance of irritants (caffeine, alcohol, citrus).
Gastrointestinal Disorders (continued)
- Esophageal Atresia and Tracheoesophageal Fistula
- Symptoms include: abdominal distension, respiratory distress, choking, and drooling.
- Nursing interventions include: pre- and post-operative care, elevating the head of bed (HOB), suction at bedside, monitoring for respiratory distress, and educating families about staged surgical repair.
- Hypertrophic Pyloric Stenosis
- Symptoms include: projectile vomiting, palpable mass, weight loss, and dehydration.
- Nursing interventions include: monitoring intake and output, incision care, and providing emotional support for families.
- Intussusception
- Symptoms include: abdominal pain, currant jelly stools, vomiting, and drawing up legs.
- Diagnosis involves ultrasound, barium or air enema, and surgical intervention if necessary.
- Inguinal Hernia
- Commonly presents with pain, fever, vomiting, and a tender groin mass (strangulation is a possible complication).
- Treatment includes surgical intervention and incision care.
- Necrotizing Enterocolitis
- Symptoms include: distended abdomen, bilious emesis (vomiting), stool positive for blood, and poor temperature regulation.
- Nursing interventions include: stopping feedings, administering IV fluids, using an NG tube, and providing antibiotics.
Biliary and Liver Disorders
- Biliary Atresia
- Symptoms include: jaundice, acholic stools, dark urine, hepatomegaly, and poor absorption of fats and fat-soluble vitamins.
- Diagnosis requires elevated bilirubin levels, liver biopsy, and ultrasound.
- The Kasai procedure, antibiotics, and monitoring for signs of liver failure are key components of treatment.
- Malrotation and Volvulus
- Symptoms include: bilious vomiting, abdominal distension, and fussiness.
- Diagnosis involves an upper GI series and abdominal X-ray.
- Nursing interventions include: NPO status, IV fluids, surgical education, and monitoring bowel sounds.
Urinary Disorders
- Vesicoureteral Reflux (VUR)
- Increases the risk of pyelonephritis (kidney infection).
- Symptoms include: high fever, vomiting, and chills.
- Treatment includes prophylactic antibiotics, urine cultures every 2-3 months, and surgical management for higher grades of reflux.
- Nephrotic Syndrome
- Symptoms include: proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
- Diagnosis requires urinalysis (heavy proteinuria), serum cholesterol testing, and renal ultrasound.
- Nursing interventions include: a low sodium diet, fluid restrictions, strict intake and output monitoring, diuretics, and steroids.
- Acute Glomerulonephritis
- Symptoms include: painless hematuria, proteinuria, hypertension, and edema.
- Nursing interventions include: monitoring blood pressure, managing edema (daily weights, abdominal girth), a low sodium diet, and vigilance for infections.
Reproductive and Genitourinary Disorders
- Cryptorchidism (Undescended Testes)
- Symptoms include: no palpable testes in the scrotum.
- Treatment involves surgical intervention (orchiopexy).
- Hypospadias
- Symptoms include: urethral opening on the ventral side of the penis.
- Avoid circumcision, as the foreskin may be needed for repair.
- Hydrocele
- Symptoms include: collection of fluid in the scrotum, usually resolving by age 1.
- Hemolytic Uremic Syndrome (HUS)
- Symptoms include: hemolytic anemia, thrombocytopenia, renal injury, bloody diarrhea, pallor, and bruising.
- Treatment involves supportive care, antihypertensives, dialysis, plasmapheresis, and blood transfusions.
Feeding and Nutrition
- Oral Rehydration Therapy (ORT)
- The preferred treatment for mild to moderate dehydration.
- Administer 50-100 mL/kg of ORS over 4 hours.
- Offer small amounts (1-2 teaspoons every 1-2 minutes) to tolerate even with vomiting or diarrhea.
- Water Intoxication
- Occurs after ingesting large amounts of fluid or inappropriately prepared formula.
- Symptoms include: decreased serum sodium and central nervous system (CNS) symptoms.
Miscellaneous Pediatric Considerations
- Stool Sample Collection and Transport
- Used to identify GI bleeding, infection, malabsorption, ova, and parasites.
- Nurses are responsible for proper labeling, storage, and handling of stool specimens.
- Circumcision
- Benefits include: reduced risk of urinary tract infections (UTIs) and easier hygiene.
- Risks include: infection, bleeding, inadequate skin removal, and urethral meatal injury.
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Description
This quiz covers vital concepts regarding water balance in infants, highlighting their unique physiological traits and fluid needs. It also delves into essential diagnostic testing procedures like Barium Enema and Barium Swallow, emphasizing their preparation and purpose.
