Nuggets for exam 3

  1. Priority assessment for a child with Intussusception
    • shock and sepsis (fever, increased HR, LOC, BP, respiratory distress)
  2. What diagnoses and fixes Intussusception
    bariums swallow or air enema
  3. What urine specific gravity notes dehydration?
  4. How do you know that Intussusception has been corrected?
    passage of barium and no more currant bloody stools
  5. congenital malformation of the abdominal wall where intestines are outside the abdominal cavity.....

    How fix?

    intestines will be swollen, place them in a silo and let gravity decrease the swelling....then shove them back in to abdomen
  6. abnormal rotation of the bowel
  7. For a child with SBS what do we monitor closely?
    growth and watch for nutritional defects through labs
  8. Child with SBS should eat a diet high in
  9. Priority assessment for a child with SBS
    • F&E balance
    • Malabsorption/diarrhea
    • Skin breakdown/diaper rash
    • Malnutrition/FTT
    • Bacterial overgrowth
  10. Nutritional deficits in a child with SBS
    • bile salt malabsorption
    • V. B12
  11. How do you know a child with SBS has bacterial overgrowth?

    • foul smelling diarrhea stool
    • bad breath

    oral flagyl
  12. Nutritional management for a child with SBS
    TPN to Enteral nutrition

    want to get them to Enteral asap so the intestines learn how to absorb nutrients
  13. H2 blocker
  14. PPI
    Protonix or Prevacid
  15. Anti motility agents that decrease diarrhea
    Lomatil or Imodium
  16. Problem for kids with SBS
    they are on TPN then enteral feeds....they do not learn how to suck or swallow so they have an aversion to eating.

    Must provide opportunities for oral stimulation so this doesn't happen
  17. Teaching for celiacs
    diet restrictions.
  18. Kids with celiacs are at risk for
    fractures....have osteoporosis
  19. How do you dx celiacs
    gluten free diet....will feel better in 1 week
  20. Sign that a kid has celiacs
    foul smelling diarrhea and FTT...can see it at 9-12 mo

    • abd distention
    • vomiting
    • anemia
    • irritable
    • muscle wasting
  21. What should celiacs kids eat
    corn and rice
  22. Main goal for treatment of a child with Biliary Artesia
    allow for normal G&D till a liver is available for transplant
  23. What are your priority assessments and treatments for a child with biliary artesia?
    How's their nutrition-MCT oil, TPN, V. ADEK

    Portal HTN? Ascites and variceal bleeding
  24. How do you manage portal htn?
    • control bleeding by giving V. k
    • restrict salt intake
    • diuretics
  25. Biliary artesia is a life threatening illness so what do we need to assess?
    family stress
  26. 6 Nursing interventions to focus on
    for biliary artesia
    • nutritional support
    • skin care
    • development stimulation
    • continued assessments
    • education
    • emotional support
  27. TPN given to kids with biliary artesia
    • Pregestimil
    • Portagen
  28. What med helps kids with biliary artesia with pruritus?
  29. What med promotes bile flow so a child with biliary artesia doesn't get gall stones
  30. Green vomit
    bile + intestinal obstruction
  31. Vomit with a fecal odor
    lower intestinal obstruction or peritonitis
  32. Vomit with bright red blood
    hasn't had contact with gastric juices
  33. Result of lots of vomiting....s/s
    metabolic alkalosis

    confusion, tremors, twitchy, more N/V
  34. Labs to run on a child with continuous vomiting
    • CBC
    • electrolytes
    • BUN
    • Glucose
    • Urine specific gravity
    • Infection cultures
    • ABG
  35. What is your primary focus for management of a child that is vomiting
    detect and treat the cause with the secondary intent of preventing complications
  36. S/S of dehydration
    • few diapers...non for more than 6-8 hrs
    • child +2-3 mo has no tears when cries
    • dry sticky inside of mouth
    • high pitched cry
    • difficulty awakening
    • Increased RR, or hard time breathing
    • sunken fontanel
    • sunken eyes with dark circles
    • abnormal skin color, temp or dryness
  37. Who is at risk for having things go bad fast from dehydration?
    baby under 6 mo. old
  38. Priority question to ask a parent with a kid with GERD?  Why?
    Do they have any hx of respiratory illness?

    they are likely to have complications and possible death due to respiratory distress
  39. What are the interventions while feeding a baby with GERD?
    hold upright and minimize handling after feeds.....give them a paci when crying cuz encourages swallowing and soothes
  40. How do you minimize reflux?
    • small feeds q 2-3 hrs
    • breast milk or pre digested formula with rice cereal
    • frequent burping
    • meds
    • bottles with X nipple
    • daily weights
  41. How do you know a baby possibly has EA or TEF?
    • with first feeds
    • cant swallow
    • have regurg
    • vomit
    • have unexplained cyanosis
  42. Key assessment for a baby with EA or TEF
    risk for aspiration and respiratory distress
  43. Management of a baby with EA or TEF
    • Keep supine with HOB elevated
    • NG tube in place w/suction of secretions every 5-10 min
    • IV fluids
    • radiant warmer with humidified O2
    • *measure abdominal girth*
  44. Post Op management for a baby with EA or TEF
    • monitor resp. status
    • fluids/nutrition
    • thermoregulation
    • monitor chest tube
  45. What do you teach a parent of a baby with EA or TEF
    How to G tube feed
  46. #1 priority for managing a baby with a cleft
    modification of feeding techniques to allow for G&D.

    special bottles, nipples and devices
  47. What is a complication of the cleft palate?
    chronic otitis media that can lead to long term hearing loss
  48. Parent teaching for a baby with a cleft
    • feed slowly with breaks in upright position
    • burp often
  49. After a cleft repair the babies will have No Nos....what do I do?
    remove 1 at a time q 2h for 10-15 min
  50. How do you clean a babies teeth after a cleft repair?
    wash their mouth with water for first 1-2 weeks
  51. Who is needed for support treatments for a child with a cleft?
    • orthodontist
    • OT
    • audiologist
  52. S/S that a child has a pyloric sphincter
    • previously healthy
    • projectile vomit
    • olive shaped mass RUQ
    • irritable and hungry after feeds
  53. Big problem for a child with a pyloric sphincter
    dehydration and metabolic alkalosis
  54. Priority management of a child with a pyloric sphincter
    #1-correct the F&E problem so they can have surgery

    • NG tube for decompression
    • Raise HOB to decrease risk of aspiration
  55. Post op care for a child after a pylormymotomy
    start feeds as soon as bowel sounds are present....with pedialyte
  56. Who commonly gets Hirschprungs?
    Downs kids
  57. Describe stools of a baby with Hirschprungs
    • pellet
    • ribbon
    • foul smelling
  58. 3 ways to DX Hirschprungs
    rectal exam showing tight internal sphincter and no stool then explosive gas

    Barium enema with no passage of barium

    rectal punch biopsy showing no ganglion cells confirms dx
  59. Pre op management for a child with Hirschprungs
    Neomycin antibiotic to sterilize the bowel and prevent infection

    • monitor VS
    • measure abdominal circumference
  60. Most common abuse
  61. Who's most likely to abuse?
    Isolated mom over 39yo
  62. Who is most likely to be abused?
    White kids 0-4 years old
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Nuggets for exam 3