peds-exam-3-exam-review-for-peds-exam-three.pdf

lOMoARcPSD|37366852 PEDS EXAM 3 - exam review for peds exam three Nursing Practice – Children’s Health (Galen College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by any coll...

lOMoARcPSD|37366852 PEDS EXAM 3 - exam review for peds exam three Nursing Practice – Children’s Health (Galen College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Realrecognize Real ([email protected])  lOMoARcPSD|37366852 Peds Exam 3: GI- `Infants have a smaller stomach capacity. `Liver and pancreases do not mature until about 6 months. `No solids until about 4 months. `Pancreatic lipase doesn’t start producing until about 1, they can’t absorb the fats like in cow’s milk `Breastfed infants usually have watery stool, formula have more formed. `Toddlers have a decreased appetite and metabolic rate to infants. `Do not force foods, but give them options `Always use least invasive techniques to most when assessing GI. `Children are ticklish so you may need to palpate through clothing. `Abdomen assessment: Inspection, Auscultation, Percussion and Palpitation. ~Dehydration: CM- Tachycardia, Hypotension, Decreased Tears, Weight loss, Thirst, Irritability, sunken eyes, and fontanelles. Therapeutic MGT- Fluid replacement, electrolyte management, safety considerations. *Fluid Maintenance Requirements: -Intake: (Intake is daily) *0-10kg. 100ml/kg of body weight *11-20kg. 1000ml+50ml/kg for each kg>10 *>20kg. 1500ml+20ml/kg for each kg>20 -Output: (output is hourly) Hourly output is 1-3ml/kg/hr *Know Sodium and Potassium, BUN and Creatinine. - BUN 5-18 - Creatine 0.3-0.7 - Sodium 135-145 - Potassium 3.4-4.7 ~Cyclic Vomiting Syndrome: intense N/V. 5 attacks total or 3 attacks over 6 months. Could be menstruation, diet, dietary changes. -CM: Vomiting 24-48 hours, at night or morning, headache, vertigo, **same cycle each time and return to baseline in between attacks. -DX: Rule out other conditions and lab studies. -Prevention: Balanced nutrition, sleep/rest, avoid triggers, stress management. -Therapeutic: Supportive management, fluid replacement, rest, pharmacotherapy -Education: Increase exercise, balance diet, good hydration, sleep routines, avoid triggers. ~Acute Diarrhea: increase bowel movements. From diet, allergies, toxins, infections, medications. -DX: History, Physical exam in abdomen and perineum -Prevention: Good hand hygiene, food handling -Therapeutic: metconazole if it is bacteria, lactobacillus, monitoring I&O, monitor electrolytes, IV and PO fluids, Daily weight. Downloaded by Realrecognize Real ([email protected])  lOMoARcPSD|37366852 ~Chronic Diarrhea: 3 or more stools passed per day for 14 days or longer. CM: abdominal distention, hyperactive bowel, weight loss, dehydration, perineal irritation, blood in stool. DX: stool for C&s and Occult blood test. Prevention: hand hygiene, proper food handling, care of clothes, limit exposure. Therapeutic: prevention, hydrate, underlying cause, reduce fruit juices, daily weight, I&O ~Cleft lip and cleft palate: more predominant in native American males. CM: can be unilaterally or bilaterally, with or without hard and soft palate, uvula can contain cleft DX: Examination of the mouth Therapeutic MGT: Maintain nutrition, use of special nipple (Hagerman feeder), Promotion of bonding, surgical repair of cleft palate (may need multiple, site care, elbow splints, pain control) and consults (Speech, dentistry, audiology, dietician.) Use longer nipple when feeding. *Surgical: Lip repaired around 3 months and palate is around 18 months. NOTHING IN THE MOUTH! ~Hirschsprung’s Disease: No ganglion cells in colon, inadequate modality of intestine. CM: Failure to pass meconium, failure to thrive, poor feeding, chronic constipation, vomiting, abdominal obstruction, diarrhea, ribbon like stool in children. Complications: Enterocolitis and explosive bowel. Fever, abdominal distention. DX: Intestinal Biopsy, Radiographic studies, Barium enema Therapeutic: NG tube, Iv fluids and electrolytes, Pain control, Surgery and Post-operative care (resection and risk for short bowel syndrome) Education: Colostomy care, Referral to community resources ~Pyloric Stenosis: Obstruction of gastric outlet and constriction of pyloric sphincter CM: Projectile vomiting, insatiable appetite, weight loss, dehydration, olive shaped mass DX: ultrasound, palpate mass, abdominal x-ray, upper GI Therapeutic: Signs of dehydration, NPO prior to surgery, pyloromyotomy procedure, pain control, monitor vitals, prevent post op infections, feedings begin within 6 hours after surgery with a pyloric feeding protocol and vomiting may occur until right after surgery. ~Intussusception: one portion of bowel slides into the next, much like the pieces of a telescope, creating an obstruction. CM: Acute Abdominal pain, pull legs toward abdomen, pain relieved once abdomen relaxes, vomiting, fever, dehydration, abdominal distention, lethargy, currant jelly stool. DX: Hx of symptoms, Sausage shaped mass, Barium enema Therapeutic: Monitor for signs of perforation, peritonitis, and shock, pain control, barium or air enema, vitals, iv fluids given, surgical repair, education on feedings and dehydration. ~Failure to Thrive: failure to meet age-appropriate weight gain. Below 5th percentile. DX: tracking growth rate demonstrates lack of adequate progress, lack of cognitive and emotional development, physical examination, laboratory evaluation (Chem panel, CBC, Iron Panel) CM: diarrhea/constipation, vomiting, recurring infection abdominal distention, loss of Subq fat, dehydration, evidence of abuse or neglect, scaling skin, edema, alopecia, spoon shaped nails, labial fissures, respiratory compromise, inability to be comforted Prevention: Pre and Post-natal care and education Collaborative Care: Education on feeding, support for family, psychological and emotional needs, community resources, CPS Downloaded by Realrecognize Real ([email protected])  lOMoARcPSD|37366852 ~Appendicitis: inflamed appendix, lumen becomes obstructed, possible rupture. CM: periumbilical pain, right lower quadrant pain, vomiting, anorexia, stool changes, high fever. DX: WBC, Abdominal radiograph, CT Therapeutic: Physical, appendectomy (I&O, wound care, pain control, NPO status, IV antibiotics, NGT) Education: wound care, s/s infection, pain management, activity progression, nutritional intake ~Anorectal Malformations: Abdominal or arrested development of GI system CM: Rectal Atresia, Rectal Stenosis, Imperforate anus DX: PE, Xray, MRI, Ultrasound, IV pyelogram, Rectal Biopsy Therapeutic: NPO prior to surgery, IV fluids, Pain control, manual dilation, two stage repair. Education: Colostomy Care, Wound Care Anal dilation. ~Celiac Disease: malabsorption with unknow etiology CM: Anorexia, Irritability/fatigue, weight loss, diarrhea/constipation, abdominal distention or bloating, steatorrhea DX: Symptoms, Serological markers, biopsy. Prevention: Reduce symptoms. Dietary education ~GERD: Transfer of gastric contents into esophagus, GERD when tissue is damaged CM: Irritability and fullness, dysphagia, or refusal to eat, choking chronic cough, wheezing, apnea, wight loss, respiratory infections. DX: H&P, GI series, PH monitoring Prevention: proper formula separation, feeding, positioning during and after feeding Therapeutic: Steps to manage reflux, pain control, Nissen fundoplication, mint ~Foreign Body Ingestion DX: H&P, Imaging Prevention: Educate Parents and caregivers, avoid giving nuts, uncooked carrots, avoid coins, marbles, button eyes, give age-appropriate toys. Therapeutic: Monitor vital signs, NPO status, explain procedure, education on prevention, respiratory support, post op pain control, remove obstruction, medical management, surgery, Heimlich maneuver. GU: *A child with a GU condition may have altered growth and development mastery such as potty training. Provide education to them and families and monitor and fluid balance. ~Clean catch must be to the lab in 10 minutes, and you must have a dr order. ~UTI: urinary tract infiltrated by microorganisms (Girls are more at risk) CM: poor feeding, fever, VID, malodorous urine, abd pain, enuresis, flank pain, dribbling urine. DX: Ultrasound and C&S VCUG Prevention: hand hygiene, no bubble baths, cotton loose clothes, wiping front to back, no wet bathing suits. therapeutic: Vital signs, assessment, antibiotics. Education: handwashing and perineal care. ~Vesicoureteral Reflux: Urine backflows. CM: UTI, Flank/abd pain, enuresis, fever, N/V Downloaded by Realrecognize Real ([email protected])  lOMoARcPSD|37366852 DX: IVP and VCUG Prevention: treat UTI’s therapeutic: prevent UTI, VCUG Care Antibiotic, intervention *VCUG CARE* Get consent, allergies to iodine or shellfish? Take off jewelry -foley catheter with dye and imaging, lots of fluids. ~Acute Glomerulonephritis: Caused by strep CM: gross hematuria, periorbital edema, HTN, headache, ascites. DX: ASO titer therapeutic: antibiotics diuretics, strict I&O, daily weight, dietary restrictions (restrict sodium), vitals Q4, treatment of strep and impetigo. ~Hemolytic Uremic Syndrome: Caused by ARF from ingesting beef with e coli and other bacteria. CM: gastroenteritis, URI, hematuria, proteinuria, pallor, decreased urine output, splenohepatomegaly, dehydration, seizures. DX: increased BUN, creatinine, potassium, monitor glucose, decreased calcium and increased phosphorus, thrombocytopenia therapeutic: dialysis, monitor LOC, can increase ICP, monitor for CHF, bleeding, HTN, strict I&o, daily wight, EEG, monitor electrolyte. ~Nephrotic Syndrome: Most common in children (allergies, cancer, infection, idiopathic) Kidneys become impermeable and allow too much protein output. CM: edema, anorexia, proteinuria, diarrhea, vomiting, decreased albumin. DX: look for protein in urine, hypoleukemia, hyperlipidemia Therapeutic: I&O, daily weight, monitor proteinuria, steroids in high doses for longtime, and taper (no live immunizations) diuretics. Education: urine dipstick at home and no live vaccine. ~AKI: treatable but life threatening caused by pre-renal (decreased cardiac output, dehydration, sepsis, GI loss) intrarenal (intrinsic, glomerulonephritis) post renal (obstruction, tumor) Pg: 804 Table 23.7 *Pre- NO kidney perfusion *Intra- Injury or infection *Post- Obstruction, tumor Prevention: identify reason and fix CM: tachycardia, hypovolemia, decreased skin turgor, edema, ascites DX: determine cause, P&H, lab work, renal biopsy, hyperkalemia, metabolic acidosis, hyponatremia, hypocalcemia, hyperphos, hypermagnesemia, hyperuricemia. therapeutic: increase renal perfusion, V fluids, labs. Education: nephrology referral, renal replacement therapy, holistic care. ~Chronic Kidney disease: CKI/CKD, increase 2 years of age, maybe at risk for end stage renal disease Genetic counseling- African Americans are more at risk and progress easier. HTN and diabetes are 2/3 cases and the number one cause Complication: HTN, anemia, growth failure, metabolic bone disease Prevention: early assessment, monitor growth CM: Bedwetting, Failure to thrive, N/V, headache, HTN, decreased urine. DX: urinalysis, labs, radiographs. therapeutic: dietician, postural care, replacement therapy. Downloaded by Realrecognize Real ([email protected])  lOMoARcPSD|37366852 *Peritoneal dialysis: using peritoneum as membrane to filter blood. ABD cath used, can be done at home. -Complications- peritonitis, cath dysfunction, pain, pulmonary complications, fluid, and electrolyte imbalances. -therapeutic- renal diet, sterile procedures, decreased sodium. Education: fluid coming out should be clear, not cloudy *Hemodialysis: vascular access to filter blood, few times a week Uses dialyzer, cannot be done at home. -Complications: Hypotension, infection, muscle cramps, fluid shift, hypervolemia, anemia, monitor potassium. -Therapeutic: access is clean and safe. *Enuresis: involuntary discharge of urine form previously trained (usually not diagnosed until 5-6) response to stress. -CM: Urgency, foul smell, stress. -Therapeutic: DDAVP, voidance or fluids, bed, bladder alarms. *Hypospadias/ Epispadias- Hypo-urethral opening located behind the glans penis or anywhere alone VENTRAL side. Epi- Urethral Opening on DORSAL surface CM: urinary incontinence, curvature. Therapeutic: no circumcision until usually corrected 6 months or more. Pain management. Sponge baths until dressing is off. Education: observe for UTI. NEURO: -Can occur at any time in growth and development ad may lead to poor long-term development. Sometimes you’re born with them sometimes they’re secondary. ~Increased Intracranial Pressure: ICP is the pressure of the CSF in the subarachnoid space between the skull and brain. *Decreased cranial profusion, pressure on brainstem. CM: #1 sign for any change is change in LOC. *Infants: Irritability, poor feeding, high pitched cry, tense and budging fontanels, cranial sutures separated, eyes setting- sun sign, scalp veins distended *Children: Nausea, vomiting, headache, irritability, papilledema, memory loss, seizures, diplopia, drowsiness. Therapeutic: Monitor V/S, LOC, reflexes, pupil reaction. (15 min if unstable, 2-4 hours. If stable.) Pediatric GSC, Position HOB at 15-30 degrees, head, and neck midline, check for gag and swallow reflexes, caution with suction, avoid hypotonic IV solutions, monitor for fever. Treat pain, environmental control, seizure precautions or meds, meds to decrease edema, (Mannitol, or Lasix) sedation if needed with ICP probes. *GCS* 9-15: unaltered state of consciousness. 4-8: coma… less than 8 intubate. Downloaded by Realrecognize Real ([email protected])  lOMoARcPSD|37366852 ~Seizures: electrical disturbance in brain, Generalized or patrial. Febrile is the most common cause of a first- time seizure. CM: Loss of consciousness or awareness, motor signs, stiffing of the body. DX: Neuro assessment and testing, CT/MRI. EEG, PET scans, new onset- neoplasm possible Therapeutic: HX of antecedent events and characteristics. Seizure priorities (airway mgt and safety) Antiepileptic drug therapy, serum levels require monitoring. Growth decreases drug serum levels. Surgical intervention, excision of located seizure. Education: CPR and emergency procedures. Med education. Day care/school fully informed. Adolescents may drive (dependent on the state) ~Meningitis: Inflammation of the CSF and meninges due to infection. Can be septic/bacterial or aseptic/viral. CM: Fever, HA, stiff neck Kernig: Thigh to abd, knee at 90 degrees, passively extend… pain in leg. Brudzinski: Passive flexion of the neck to chest and brings hip up… pain or resistance. *Infant-18 months: tense, bulging fontanelle, increased head circumference and high-pitched cry. *All children: decreased LOC, photophobia, irritability, anorexia, emesis, seizures. DX: Lumbar puncture: chemistry, cell counts, culture, gram stain. Blood cultures -infected CSF (bacterial)= cloudy, increased protein, decreased glucose, and CSF pressure *Get puncture and start antibiotics immediately do not wait. Prevention: immunizations Therapeutic: assess neuro status and response to therapy, environmental control, antibiotics, seizure precautions, NSAIDS ~Encephalitis: Inflammation of brain tissue, usually caused by HSV1 and mosquito borne viruses CM: Confusion, Ham Nuchal Rigidity, High fever, Photophobia, Lethargy, Seizures, Coma. DX: Hx, exposure to possible sources, testing: MRI/CT, CSF analysis, EEG and lab work. Brain biopsy is definitive. Prevention: protection from vendors and bug spray Therapeutic: Seizure precautions, neuro assessment, viral origin-antiviral meds (acyclovir), bacterial origin- narrow spectrum antibiotic. Antipyretics, anticonvulsants, analgesic, and anti-inflammatory. ~Reye’s Syndrome: Results in ICP, causes accumulation of fat to organs. Primarily in 4–14-year-olds. (Typically Flu and Varicella) CM: Restlessness, vomiting, drowsiness, seizures, loss of consciousness. DX: history of recent viral illness and use of acetylsalicylic acid (Aspirin), Liver biopsy, Serum tests Prevention: avoid use of ASA during viral illnesses. Therapeutic: Neuro assessment, seizure precautions, assess airway, admin and monitor O2. Education/DC: parent education, read all labels on OTC meds. No aspirin under 19. ~Spina Bifida: Neural Tube fails to close in early fetal development. CM: Symptoms vary based on lesion location. Neuro deficits, impaired bowel or bladder function. -Dimple or tuft of hair on back= tethered cord -Meningocele= protruding sac with meninges and CSF -myelomeningocele= meninges, CSF, and spinal cord elements. DX: prenatal 12-14 weeks of gestation and elevated alpha- fetoprotein level. Therapeutic: Must be delivered by c section. Assess sac- prevention of infection and injury. Cover defect with sterile dressing moistened with sterile saline. Position prone, no diaper, asses ortho function. Assess voiding and stool, monitor for hydrocephalus, early signs of infection, monitor perineal and skin irritation, monitor pain, latex free environment, surgical care. PROTECT THE SAC. Education/discharge: Downloaded by Realrecognize Real ([email protected])  lOMoARcPSD|37366852 ~Hydrocephalus: accumulation of the cerebrospinal fluid in the intracranial vault and spinal cord. Can be congenital and after surgical closure of myelomeningocele. CM: Age, cause, rate, head enlargement, prominent forehead, difficulty holding the head upright, increased ICP s/s DX: imaging: CT, MRI, US, increasing head circumference therapeutic: head circumference assessment, monitor for increased ICP, Shunt placement, Preop: give antibiotic. Post-op: assess ICP, v/s, monitor head, assess fontanelles, monitor seizures and lethargy, position on non- operative side with head no higher than 30 degrees. Monitor for infection. Education and Discharge: Teach s/s of infection and of shunt malfunction. NO contact sports. ~Ventriculoperitoneal Shunt: Relieves on the brain by removing CSF from head and draining into abd. CM: HA, Vomiting, lethargy, irritability, swelling or redness along shunt tract, decrease in school performance, seizures. Treatment: antibiotics, shunt removal. Education: may need to be replaced as they grow. ~Cerebral Palsy: Most common physical disability due to brain injury before development is complete. Prenatal, perinatal, postnatal risk factors, wide range of disability, 4 types (spastic (most common), ataxic, athetoid or dyskinetic, and mixed. CM: Vary depending on area of brain involved and extent of damage. Muscle rapidity, muscle spasticity, poor control of posture, ataxia, speech difficulties, breathing difficulties, bowel and bladder incontinence, vision, and sensory impairments, learning disabilities, attention, and behavior problems. DX: based on clinical symptoms and developmental delay. Imaging: CT, MRI, Cerebral US. therapeutic: splints and braces, assistive devices, frequent rest periods to reduce spasms, enroll in school, education for parents on maintaining a safe environment, feeding supervision and support actions. Medication to reduce skeletal muscle spasms Lioresal delivered intrathecally via implanted pump. Neurolytic agent nerve block injections Antianxiety medications *Baclofen * pg. 693 Table 20-5 Intrathecal right into the spinal cord. Antiseizure medications. Surgical Care: improves joint stability and balances muscle power. Education: Expected growth and development, early detection of deterioration, symptoms of infection. ~TBI: Injury to the brain. CM: Scalp laceration, altered LOC, seizures. DX: Imaging; CT and MRI, EEG, ICP, CPP Prevention: Injury prevention education and anticipatory guidance. HEADWARE therapeutic: Airway priority, assessment with GCS, palpate for fracture, Basal scull fracture no NG tube (tube may enter brain through the fracture) or suction, quiet non stimulating, relief of high ICP, seizure meds. Education: instructions to details, rehab team, and support. Basal scull FX: raccoon eyes, and battle sign (bruising behind ears or bruising behind) ~Abusive Brain Trauma.: Shaken baby syndrome. CM: rotational forces and angular deceleration to brain. Absence of external trauma. Varies depending on the severity. Delays. Downloaded by Realrecognize Real ([email protected])  lOMoARcPSD|37366852 Diagnosis: CT, MRI, Ocular funduscopic exam. Prevention: Teach parents to cope with crying baby. therapeutic: initiate respiratory and cardiovascular support, assess increased ICP, seizure monitoring/prevention and seizure meds, adequate fluid, and nutritional intake. Education: Realistic expectations for recovery and resources. Chronic: ~a condition lasting longer than 3 months or recovery is slower than anticipated. (Cancer, diabetes, ASTHMA) -may feel different than others, try to keep a normal life as much as possible. -more predisposed to developmental delay and growth failure. ~Infant- poor bonding, disruptions in normal growth and development -nursing measures: comfort measures, visual and auditory stimulation, safe crib practices, minimalizing pain. ~Toddler- Pain, anxiety, separation, speech, and physical development -nursing measures: PT, OT, Speech, encourage parents to stay 24 hours. ~Preschooler- Magical thinking and nightmares, regression is common. -nursing: explain procedures honestly, normal home schedule as much s possible. ~School age: Separation from pers, anger and anxiety’s -nursing: explain at age-appropriate levels. Pain management. Include peers. Watch nonverbal actions. ~Adolescent- Dependence on caregivers, lack of privacy. Maladaptive coping -nursing: open lines of communication, give choices, involve peers. Downloaded by Realrecognize Real ([email protected])