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Prittyrick
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1. Pyloric stenosis nx intervention
- o preop
- o - npo
- o - weigh daily
- o - monitor VS
- o - i&o
- o - complication
- o - provide small frequent feeds with HOB up
- o - burp freq
- o - position on r side to prevent aspiration
- o Post op
- o - small freq feeds w/ electrolytes solution at first
- o - advance to regular foods as tolerated
- o - pacifer for comfort
- o - position of r side to help flow thru pyloric valve
- o - clean incision as ordered
- o - monitor for vomiting
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2. Intestinal disorder
- o intussusception
- o necrotizing entercolitis
- o appendicitis
- o celiac disease
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3. intussusception
- o def: invagnation of bowel segment into itself, most commonly at ileocecal valve. usually occurs at 6 months of age. 3 times more likely in males than females. medical emergency
- o cause: unknown, possibly associated with lead point (something in bowel) meckel's diverticulum or polyps, hyperactive peristalsis, abnormal bowel lining
- o Path: swelling on one side. it gets occulded and causes parts of the bowel to die
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4. Intussusception complication, assessment, dx
- o comp: bowel obstruction, strangalation of intestine, gangrene, shock, bowel perforation, peritonitis, death if treatment delay > 24hr
- o assessment: colicky pain (comes and goes)., red current jelly stools with mucous and blood, abdomen distended/tender with sausage shaped mass, emesis with bile or fecal matter
- o dx: abd x-ray wbc incre, air or barium enema
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5. Intussussception med manage, surgery, nx intervention
- o medical management: IVF, NG tube non operative reduction (air or barium enema), surgery
- o indication for surgery: failure of non operative reduction, reoccurrent intuss, shock or sepsis
- o Intervention:
- o - prepare enema and monitor for return stools or need for surgery
- o - monitor temp/vs, I&O and NG tube
- o - post op- antibiotics, monitor incision, monitor for return of bowel sounds, emotional support for the family
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6. Necrotizing enterocolitis (NEC)
- o def: acute bowel inflammation with necrotic patches. inc risk for paralytic ileus, perforation and peritonitis. develops in approx 5% in NICU
- o cause: ischemia to the bowel. babies with extremely low birth weight, abd extended, bloody stools, bililous vomiting
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7. NEC complication, assessment, dx
- o comp: grave condition in the immature infant, possible death. prognosis not sure until baby is feeding normal with bowel problems
- o Assessment: signs appear in the first week of life. abdominal distension, firm, bloody stools, diarrhea, bilous vomiting (bc of blockage), apnea episodes, signs of blood loss, variable temp
- o dx: abdominal rx-ray, in abd girth measurement
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8. NEC med management nx intervention
- o med management: stop PO feedings, maintain IVF or parenteral feedings, antibiotics, handle abd gently, possible temporary colostomy, surgically removal of the necrosed bowel
- o - for perforation- peritoneal drain, laparotomy to remove fecal secretions from abdomen
- o Nursing intervention: monitor VS, admin antibiotic, maintain IVF or parentanel feedings, prevent perforiation, I&O, ongoing assessment including measuring abd girth and monitoring bowel sounds
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9. Appendicitis
- o def: inflammation and obstruction of the blind sac at the end of the cecum. most common abd surgery in children
- o cause: by harden fecal mass, stricture viral infection
- o complication: ischemic bowel. gangrene, bowel perforation, peritonitis
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10. appendicitis Assessment, dx, med management, nursing intervention
- o assessment: anorexia, diffused abd pain, tenderness the localize in the RLQ at mcburney's point, rebound tenderness, decre bowel sounds, N/V fever
- o dx, incr wbc, incre immature, CT. cxr to r/o pneumonia
- o med manage: appendetomy, antibiotic, IVF
- o nursing intervetion:
- o - post op: position in semi fowler's or r side lying to decr pain, monitor drains, NG tube to lower wall suction, oral nutrition when bowel sounds return, antibiotics and pain meds.
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11. appendix rupture
- o appear acutely ill
- o wbc > 20,000
- o position in semi fowler position
- o IVF hydration
- o warm soaks at incision to promote drainage of infectious material
- o monitor incision and abd closely for changes
- o if peritonitis develops insert NG tube IV antibiotics
- o signs of peritonitis: rigid abdomen, shallow respiration (cause deep breathing puts pressure on the abd which cause pain, fever
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12. Celiac disease
- o def: characterized by poor food absorption and intolerance of gluten (proteins found in grains like wheat, barley, oats, rye)
- o cause: gluten intolerance, immunoglobulin A deficiency
- o path: decrease in amt/activity of enzymes in intestinal mucosal cells, causes villi in proximal small intestine to atrophy and cause decre intestinal absorption
- o complication: lymphoma of small intestine
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13. Celiac disease assessment
- o Steatorrhea (fatty stools) older kids, float
- o chronic diarrhea
- o anorexia
- o generalized malnutrition/FTTcoagulation difficulty d/t malabsorption of fat souluble vita ADEK
- o abd pain intolerance
- o irritabilty
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14. Celiac disease, dx, med management, nx interventions
- o dx hypocalcemia, hypoalbuminemia, hypothrombiema, decre HBG, incre fat in stool, celiac screening
- o med management: gluten free diet, should include soy, corn, rice, potato, breast milk, soy formula, fresh fruits, folate supplement Vita A and D in water soluble form
- o Nursing intervention: eliminate gluten from the diet
- o - encourage the things they can eat
- o - breast milk and soy formula
- o - replace vitamin and calories small frequent meals
- o - monitor steatorrhea
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15. disorder of lower bowel
- o hirschsprung disease
- o imperforate anus
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16. hirschsprung disease
- o def: abstinence of ganglionic cells in segment of colon. missing nerve cells in colon, peristalsis stops and stool builds up. you end of mega colon
- o cause: congenital issue or it could be because of nothing
- o path: stools will build up
- o complication severe constipation, entercolitis (severe diarrhea, hypovolemia shock death
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10. appendicitis Assessment, dx, med management, nursing intervention
- o assessment: anorexia, diffused abd pain, tenderness the localize in the RLQ at mcburney's point, rebound tenderness, decre bowel sounds, N/V fever
- o dx, incr wbc, incre immature, CT. cxr to r/o pneumonia
- o med manage: appendetomy, antibiotic, IVF
- o nursing intervetion:
- o - post op: position in semi fowler's or r side lying to decr pain, monitor drains, NG tube to lower wall suction, oral nutrition when bowel sounds return, antibiotics and pain meds.
- 11. appendix rupture
- o appear acutely ill
- o wbc > 20,000
- o position in semi fowler position
- o IVF hydration
- o warm soaks at incision to promote drainage of infectious material
- o monitor incision and abd closely for changes
- o if peritonitis develops insert NG tube IV antibiotics
- o signs of peritonitis: rigid abdomen, shallow respiration (cause deep breathing puts pressure on the abd which cause pain, fever
- 12. Celiac disease
- o def: characterized by poor food absorption and intolerance of gluten (proteins found in grains like wheat, barley, oats, rye)
- o cause: gluten intolerance, immunoglobulin A deficiency
- o path: decrease in amt/activity of enzymes in intestinal mucosal cells, causes villi in proximal small intestine to atrophy and cause decre intestinal absorption
- o complication: lymphoma of small intestine
- 13. Celiac disease assessment
- o Steatorrhea (fatty stools) older kids, float
- o chronic diarrhea
- o anorexia
- o generalized malnutrition/FTTcoagulation difficulty d/t malabsorption of fat souluble vita ADEK
- o abd pain intolerance
- o irritabilty
- 14. Celiac disease, dx, med management, nx interventions
- o dx hypocalcemia, hypoalbuminemia, hypothrombiema, decre HBG, incre fat in stool, celiac screening
- o med management: gluten free diet, should include soy, corn, rice, potato, breast milk, soy formula, fresh fruits, folate supplement Vita A and D in water soluble form
- o Nursing intervention: eliminate gluten from the diet
- o - encourage the things they can eat
- o - breast milk and soy formula
- o - replace vitamin and calories small frequent meals
- o - monitor steatorrhea
- 15. disorder of lower bowel
- o hirschsprung disease
- o imperforate anus
- 16. hirschsprung disease
- o def: abstinence of ganglionic cells in segment of colon. missing nerve cells in colon, peristalsis stops and stool builds up. you end of mega colon
- o cause: congenital issue or it could be because of nothing
- o path: stools will build up
- o complication severe constipation, entercolitis (severe diarrhea, hypovolemia shock death
- 17. Hirschsprung disease assessment dx, med management, nursing intervention
- o assessment: failure to pass meconium, and stool, liquid ribbon type stools. feel distention and stool mass, bilous vomiting cause stool not moving thru, irritablity, lethargy, FTT, weight loss, dehyrdration
- o dx: rectal biopsy- looking for those ganglion cells, abd x-ray
- o medical management: surgical dissection of affected portion
- o nursing management:
- o - pre op: IVF, vs, administer enema
- o - post op: monitor I&O, stoma care, monitor for bowel sounds, start PO feed after the return, no rectal temps. parent ed, wound care, constipation, explosive stools
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