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Priority assessment for a child with Intussusception
- DEHYDRATION
- shock and sepsis (fever, increased HR, LOC, BP, respiratory distress)
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What diagnoses and fixes Intussusception
bariums swallow or air enema
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What urine specific gravity notes dehydration?
1.030
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How do you know that Intussusception has been corrected?
passage of barium and no more currant bloody stools
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congenital malformation of the abdominal wall where intestines are outside the abdominal cavity.....
How fix?
Gastroschisis/Omphalocele
intestines will be swollen, place them in a silo and let gravity decrease the swelling....then shove them back in to abdomen
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abnormal rotation of the bowel
Malrotation/Volvulus
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For a child with SBS what do we monitor closely?
growth and watch for nutritional defects through labs
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Child with SBS should eat a diet high in
PROTEIN
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Priority assessment for a child with SBS
- F&E balance
- Malabsorption/diarrhea
- Skin breakdown/diaper rash
- Malnutrition/FTT
- Bacterial overgrowth
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Nutritional deficits in a child with SBS
- bile salt malabsorption
- V. B12
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How do you know a child with SBS has bacterial overgrowth?
Treatment
- foul smelling diarrhea stool
- bad breath
oral flagyl
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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
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Anti motility agents that decrease diarrhea
Lomatil or Imodium
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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
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Teaching for celiacs
diet restrictions.
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Kids with celiacs are at risk for
fractures....have osteoporosis
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How do you dx celiacs
gluten free diet....will feel better in 1 week
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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
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What should celiacs kids eat
corn and rice
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Main goal for treatment of a child with Biliary Artesia
allow for normal G&D till a liver is available for transplant
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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
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How do you manage portal htn?
- control bleeding by giving V. k
- restrict salt intake
- diuretics
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Biliary artesia is a life threatening illness so what do we need to assess?
family stress
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6 Nursing interventions to focus on
for biliary artesia
- nutritional support
- skin care
- development stimulation
- continued assessments
- education
- emotional support
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TPN given to kids with biliary artesia
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What med helps kids with biliary artesia with pruritus?
Questran
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What med promotes bile flow so a child with biliary artesia doesn't get gall stones
Actigal
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Green vomit
bile + intestinal obstruction
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Vomit with a fecal odor
lower intestinal obstruction or peritonitis
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Vomit with bright red blood
hasn't had contact with gastric juices
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Result of lots of vomiting....s/s
metabolic alkalosis
confusion, tremors, twitchy, more N/V
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Labs to run on a child with continuous vomiting
- CBC
- electrolytes
- BUN
- Glucose
- Urine specific gravity
- Infection cultures
- ABG
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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
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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
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Who is at risk for having things go bad fast from dehydration?
baby under 6 mo. old
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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
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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
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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
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How do you know a baby possibly has EA or TEF?
- with first feeds
- cant swallow
- have regurg
- vomit
- have unexplained cyanosis
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Key assessment for a baby with EA or TEF
risk for aspiration and respiratory distress
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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*
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Post Op management for a baby with EA or TEF
- monitor resp. status
- fluids/nutrition
- thermoregulation
- monitor chest tube
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What do you teach a parent of a baby with EA or TEF
How to G tube feed
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#1 priority for managing a baby with a cleft
modification of feeding techniques to allow for G&D.
special bottles, nipples and devices
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What is a complication of the cleft palate?
chronic otitis media that can lead to long term hearing loss
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Parent teaching for a baby with a cleft
- feed slowly with breaks in upright position
- burp often
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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
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How do you clean a babies teeth after a cleft repair?
wash their mouth with water for first 1-2 weeks
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Who is needed for support treatments for a child with a cleft?
- orthodontist
- OT
- audiologist
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S/S that a child has a pyloric sphincter
- previously healthy
- projectile vomit
- olive shaped mass RUQ
- irritable and hungry after feeds
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Big problem for a child with a pyloric sphincter
dehydration and metabolic alkalosis
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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
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Post op care for a child after a pylormymotomy
start feeds as soon as bowel sounds are present....with pedialyte
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Who commonly gets Hirschprungs?
Downs kids
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Describe stools of a baby with Hirschprungs
- pellet
- ribbon
- foul smelling
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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
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Pre op management for a child with Hirschprungs
Neomycin antibiotic to sterilize the bowel and prevent infection
- monitor VS
- measure abdominal circumference
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Most common abuse
neglect
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Who's most likely to abuse?
Isolated mom over 39yo
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Who is most likely to be abused?
White kids 0-4 years old
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