155 FINAL EXAM OBJECTIVES

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robertkonkright
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155 FINAL EXAM OBJECTIVES
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2013-05-06 17:39:37
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Pediatric Nursing
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Key Terms and Objectives For Family Processes Final
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  1. LP1 PRINCIPLES OF LABOR AND DELIVERY
    1(A)-E(Q2): Summarize how the components of the birth process (Passenger, Passageway, Powers, and Psyche) can affect, positively or negatively, the course of labor.

    1(A)-F: Summarize how the nursing care of the client changes during each of the four stages of labor.

    1(A)-H: Distinguish, through assessment, normal from abnormal maternal and fetal responses to the labor process.

    1(A)-I: Evaluate fetal monitor tracings for fetal heart rate, variability, and periodic changes (accelerations and decelerations).

    1(B)-I(Q2): Ascertain nursing care for the mother and family experiencing a postpartum complication (hemorrhage, puerperal infection, thrombophlebitis, urinary system disorder, cardiac system disorder, reproductive system disorder, mastitis and emotional/psychological complications).
  2. The 4 P's
    • Powers
    • Passage (Pelvic Structure)
    • Passenger (Position, Lie, Station)
    • Psyche (Mothers ability to handle Stressors)
  3. Stages of Labor
    • 1st Stage: Onset of labor to 10cm dialated. Contains 3 phases - Latent (0-3cm), Active (4-7cm, & Transition (8-10cm)
    • 2nd Stage: Complete Dialation to the birth of the baby
    • 3rd Stage: Birth of the baby to the birth of the placenta
    • 4th Stage: Birth of the placenta until Vital Signs stabilize
  4. COMPONANTS OF A POSTPARTAL ASSESSMENT
    • B-Breasts
    • U-Uterus
    • B-Bladder
    • B-Bowels
    • L-Lochia
    • E-Epesiotomy (Redness, Edema, Ecchymosis, Discharge, Approximation of Wound Edges)
    • H-Homan's Sign
    • E-Emotional Status
    • B-Bonding
  5. Nursing Care for Postpartal Complications
    Postpartal Hemmorhage
  6. Danger Signs of Labor for Mother
    • Hypertensive crisis (Especially with Oxytocin)
    • Shock from loss of blood
    • Placenta Abruptio (Pain during resting phase between contractions)
    • Placenta Previa
    • Rupture/Prolapse of uterus (Pain during resting phase between contractions)
  7. Danger Signs of Labor For Fetus
    • Decelerations & Accelerations
    • Prolapse of Umbilical cord (Will cause variable Decelerations, can become late decelerations if more problems develop)
    • Presentation Problems (Breech, Face, Shoulder)
    • Posterior (Face up) position (Not favorable for labor, causes more back pain because babys head reflex is to press down on mothers back) Occiput Anterior (Face Down) is most favorable position for labor
  8. Decelerations & Accelerations
    • Early Decelerations: Occurs with head compression, mirrors contractrion, no intervention needed
    • Variable Decelerations: Caused by cord compression, short duration (no more than 10-20 seconds), usually v or u shaped, usually occurs at the peak of contraction, relieved when muscles relax and head comes off the cord. Position changes may help.
    • Late Decelerations: Usually starts at the peak of contractions, goes beyond the contraction. 5 nursing interventions needed for Late Decelerations- 1 Turn on side, 2 Administer Oxygen, 3 Stop Oxytocin (If they dont respond to position change or Oxygen), 4 Increase fluids to increase blood flow to the fetus, 5 notify the doctor
    • Accelerations: 15 beats above baseline & at least 15 seconds in duration.
  9. Oxytocics during the 4th stage of labor
    • Example: Oxytocin (Pitocin)
    • Used to contract uterus and stop hemorrhage
  10. LP2 NORMAL NEWBORN EXPERIENCE
    2-1 (Q2):Identify normal and abnormal physical findings during assessment of the newborn.

    • 2-4(Q2): Identify normal parameters for temperature, pulse,
    • respiration, and blood pressure.

    2-7(Q2): Describe the physiological adjustment that the newborn makes to extrauterine life.

    2-8: Interpret the Apgar score as part of the newborn assessment for well-being.
  11. Normal Newborn Parameters
    • Temprature: 97.7-99.3 F (Based on practice rather than the textbook
    • Pulse: 110-160/Minute
    • Respiration Rate: 30-60/Minute
    • Blood Pressure: 60-80/40-50mmHg Dont worry about this for final?
  12. Physiologic Adjustments of Newborn to Extrauterine Life
    • Establishing Respirations
    • Cardiovascular Changes (Don't worry about shunts)
  13. Apgar Score
    • Each of the following categories have a possible score of 2.
    • Appearance:
    • 0=Blue All Over
    • 1=Acrocyanosis
    • 2=No Cyanosis
    • Pulse:
    • 0=Absent
    • 1=<100
    • 2=>100
    • Grimace:
    • 0=No Response to stimulation
    • 1=Grimace/Weak Cry When Stimulated
    • 2=Strong Cry or Pull Away When Stimulated
    • Activity:
    • 0=No Muscle Tone
    • 1=Some Flexion
    • 2=Flexed arms & legs that resist extension
    • Respirations:
    • 0=Absent
    • 1=Weak,irregular, or gasping
    • 2=Strong Lusty Cry
  14. LP3 NEWBORN AT RISK
    • 3-5 (Q4): Care Plans for the following complications of preterm infants:
    • 5(A): Respiratory Distress Syndrome
    • 5(B): Transient Tachypnea of the Newborn (TTN)
    • 5(C): Meconium Aspiration Syndrome
    • 5(E): Hemolytic Disease of the Newborn: Rh Incompatibility & ABO Incompatibility

    3-7: Identify precautions that need to be taken for a newborn of a diabetic mother.

    3-8: Describe the assessment, nursing diagnoses, outcomes, and interventions for the newborn of a drug dependent mother.

    3-9: Identify the clinical manifestations of the newborn with Fetal Alcohol Syndrome (FAS) and the therapeutic management of the syndrome.
  15. Rh & ABO Incompatibilities
    • Administer RhoGAM
    • Hemolytic Diseases cause Jaundice earlier on
    • Physiologic Jaundice: Caused by the natural breakdown of Red Blood Cells (Hyperbilirubinemia)
    • Pathologic Jaundice: Caused by a secondary disease process such as Hemolytic Disease
  16. Transient Tachypnea of Newborn
    • Fluids left over in the lungs so the infant needs to cry more and breathe deeper to get rid of fluids
    • Usually happens with c-sections because fluids are not pressed out while in the birth canal
    • Monitor Oxygen Saturation Levels
  17. Meconium Aspiration
  18. Newborn of Mother with Gestational Diabetes Mellitus
    • At increased risk for Hypoglycemia
    • Shoulder Dystocia Injuries occur often due to babies being Large for Gestational Age
    • Assessment:
    • Check for hematomas/bleeding
    • Jaundice
    • Hyperbilirubinemia
    • Check Blood Sugar
    • Assure that the child is feeding so that they can get rid of bilirubin
  19. Fetal Alcohol Syndrome
    • Clinical Manifestations:
    • Therapeutic Management:
    • Symptoms of Withdrawl:
  20. LP5 HIGH RISK PREGNANCY
    5-5: Describe gestational trophoblastic disease (GTD) also called hydatidiform mole (“molar pregnancy”) including definition, etiology, pathophysiology, clinical manifestations, therapeutic management.

    • 5-6 (Q4): Discuss the following complications as they relate to pregnancy including pathophysiology maternal/fetal effects, prevention, and therapeutic management:
    • 6(A): Placenta Previa
    • 6(B): Abruptio Placentae
    • 6(D): Preterm Labor
    • 6(F): PIH/Preeclampsia/Eclampsia/HELLP
    • Syndrome

    • 5-9 (Q2): Discuss the following illnesses & problems that may occur during pregnancy including maternal/fetal effects, prevention, medical management, and nursing care:
    • 9(I): Cardiovascular Disorders
    • 9(J): Endocrine Disorders/Gestational Diabetes
  21. LP6 CHANGES IN PREGNANCY & PRENATAL CARE
    6-8 (Q2): Identify the physiological changes that will occur to the woman’s body during pregnancy.

    6-13: Identify the routine lab work that is completed during the initial prenatal exam.

    6-16 (Q2): Describe interventions that can be taken to help the pregnant woman cope with the discomforts of early, middle, and late pregnancy.

    6-17: Identify the danger signs of pregnancy and what instructions to give the pregnant woman.

    • 6-21: Describe the components of a healthy diet for the pregnant woman and foods that are good sources for these
    • components.
  22. LP7 REPRODUCTIVE HEALTH
    7-3: Summarize the significant changes in the growth & development of the fetus at 4, 6, 12, 16, 20, 24, 28, 36, and 40 weeks’ gestation.

    • 7-4: Discriminate between the signs, symptoms, and
    • nursing management of women with dysmenorrhea and premenstrual syndrome.

    • 7-5: Compare the advantages, disadvantages, and
    • effectiveness of the various methods of contraception available today.

    • 7-6: Delineate basic gynecologic screening procedures
    • indicated for will women.

    • 7-7: Consider the physical and psychological aspects and
    • clinical treatment options of menopause when caring for menopausal women.

    • 7-12: Compare the prevention, causes, treatment options,
    • and nursing care of women for the common sexually transmitted infections and
    • vaginal infections.

    • 7-13: Relate the implications of pelvic inflammatory
    • disease (PID) for future fertility to its pathology, signs and symptoms, treatment, and nursing care.
  23. LP9 GROWTH & DEVELOPMENT (PEDS)
    9-3: Summarize the developmental theories of Freud, Erikson, Piaget, and Kohlberg.

    9-6 (Q2): Demonstrate anticipatory guidance that can be provided by the nurse for each stage of development.

    9-7 (Q2): Contrast the developmental milestones for physical, cognitive, emotional, and social development throughout childhood and adolescence.

    9-10 (Q2): Ascertain communication strategies and approaches to use with children of all ages.
  24. LP10 CARDIOVASCULAR-RESPIRATORY (PEDS)
    • 10-6 (Q4): Care Plan for the following congenital heart defects:
    • 6(A): Ventricular septal defect (VSD)
    • 6(B): Atrial septal defect (ASD)
    • 6(C): Patent ductus arteriosus (PDA)
    • 6(G): Tetralogy of Fallot (TOF)

    10-13: Correlate the etiology, pathophysiology, clinical manifestations, medical management, and nursing management for disorders of the upper respiratory tract.

    10-14: Correlate the etiology, pathophysiology, clinical manifestations, medical management, and nursing management for disorders of the lower respiratory tract.

    10-15: Analyze medications commonly used to treat cardiovascular and respiratory disorders, including actions, side effects, and nursing implications.
  25. LP12 MUSCULOSKELETAL-NEUROLOGICAL (PEDS)
    12-2: Summarize the acute neurological assessment and variations related to growth and development.

    • 12-3: Care Plan for:
    • A- Increased intracranial pressure
    • B- Hydrocephalus
    • C- Neural tube disorders
    • D- Cerebral palsy
    • E- Bacterial meningitis
    • I- Febrile seizure

    12-4: Diagram growth and development of the bone and stages of bone healing.

    12-5:Correlate assessment and diagnosis of Musculoskeletal dysfunction.

    12-6: Summarize the nursing care of children in casts and/or in traction.

    12-7: Summarize common fractures in children.

    • 12-8:Care Plan for:
    • A- Clubfoot
    • B- Developmental Hip Dysplasia
    • C- Osteogenesis Imperfecta
    • D- Legg-Calve-Perthes Disease
    • F- Scoliosis, Torticollis, Kyphosis, Lordosis
    • G- Muscular Dystrophies
    • H- Osteomyelitis
  26. Diagram growth and development of the bone
  27. PHYSICAL EFFECTS OF IMMOBILIZATION ON SKELETAL SYSTEM
    • PRIMARY EFFECT: Bone demineralization- Osteoporosis, hypercalcemiaSECONDARY EFFECT: Negative calcium balance, Pathologic Fractures, Calcium Deposits, Extraosseous bone formation (especially at hip, knee, elbow, & shoulder), Renal Calculi NURSING CONSIDERATIONS: In paralysis, use upright posture on tilt table, Handle extremities carefully when turning and Positioning, Administer calcium-mobilizing drugs (diphosphonates) if ordered, Ensure adequate intake of fluid; monitor output, Acidify Urine, Promptly treat UTI's
    • PRIMARY EFFECT: Negative Calcium balance SECONDARY EFFECT: Life-threatening electrolyte imbalance NURSING CONSIDERATIONS: Monitor blood levels of Calcium electrolytes, Provide electrolyte replacement as indicated
  28. PHYSICAL EFFECTS OF IMMOBILIZATION ON METABOLISM
    • PRIMARY EFFECT: Decreased Metabolic Rate SECONDARY EFFECT: Slowing of all systems, decreased food intake NURSING CONSIDERATIONS: Mobilize as soon as possible, Perform active & passive resistance & Deep breathing exercises, ensure adequate food intake, provide high-Protein diet 
    • PRIMARY EFFECT: Negative Nitrogen Balance SECONDARY EFFECT: Decline in Nutritional State, Impaired Healing NURSING CONSIDERATIONS: Encourage Small, Frequent feedings with protein and preferred foods, prevent pressure areas PRIMARY EFFECT: Hypercalcemia↦ SECONDARY EFFECT: Electrolyte Imbalance NURSING CONSIDERATIONS: See nursing considerations for skeletal System
    • PRIMARY EFFECT: Decreased production of Stress Hormones SECONDARY EFFECT: Decreased Physical & emotional coping capacity NURSING CONSIDERATIONS: Identify etiologies of stress, Implement appropriate interventions to lower physical and psychosocial stresses
  29. PHYSICAL EFFECTS OF IMMOBILIZATION ON GASTROINTESTINAL SYSTEM
    • PRIMARY EFFECT: Distention caused by poor abdominal muscle tone SECONDARY EFFECT: Interference with respiratory movements NURSING CONSIDERATIONS: Use abdominal binder if indicated, monitor bowel sounds, Encourage small, frequent feedings
    • PRIMARY EFFECT: Distention caused by poor abdominal muscle tone SECONDARY EFFECT: Difficulty in feeding in prone position NURSING INTERVENTIONS: Sit in upright position if possible
    • PRIMARY EFFECT: No Specific Event SECONDARY EFFECT: Gravitation effect on feces through ascending colon or weakened smooth muscle tone may cause constipation NURSING CONSIDERATIONS: Carry out bowel training program with hydration, stool softeners, and mild laxatives if necessary
    • PRIMARY EFFECT: No specific Event SECONDARY EFFECT: Anorexia NURSING INTERVENTION: Stimulate appetite with favored foods
  30. STAGE 1 BONE HEALING
    • HEMATOMA FORMATION
    • PHYSIOLOGIC EVENTS AT TIME OF IMPACT:
    • Fracture, Injury to Soft Tissue envelops site, periosteal tissue torn, vessels rupture
    • PHYSIOLOGIC EVENTS AT 3-5 MINUTES:
    • Bleeding from bone & Tissues into area between & around bone fragments
    • PHYSIOLOGIC EVENTS AT FIRST 24 HOURS:
    • Hematoma forms & Clots; fibrin assists in clotting periosteal membrane to aid in repair
    • Clot provides fibrin network for cellular invasion
    • Granualation tissue forms by fibroblasts & new capillaries
    • Osteoblastic activity simulated
    • NURSING INTERVENTION: Monitor Hemoglobin & Hematocrit!
  31. STAGE 2 BONE HEALING
    • CELLULAR PROLIFERATION:
    • PHYSIOLOGIC EVENTS AFTER 24 HOURS:
    • Blood supply increases, bringing available calcium, phosphate, & fibroblasts
    • PHYSIOLOGIC EVENTS FOR NEXT FEW DAYS:
    • Hematoma becomes granulation tissue, which forms into a framework for bone forming substances
    • Fibroblasts convert to Osteoblasts (Bone-Forming Cells)
    • PHYSIOLOGIC EVENTS FOR NEXT 2-3 DAYS:
    • Halisteresis (Softening of bone ends) 1/8-1/4 inch; absorption of bone cells
  32. STAGE 3 BONE HEALING
    • CALLUS FORMATION
    • PHYSIOLOGIC EVENTS FOR DAYS 6-10
    • Fibroblasts form into granulation tissue; form bone in areas adjacent to surface of bone shaft; form cartilage at surfaces more distal to blood supply
    • Provisional callus develops, bridging fracture ends; holds bone together but will not support body weight
    • PHYSIOLOGIC EVENTS FOR DAYS 14-21
    • True Callus develops, seen on radiographs; forms more than needed, but with remodeling, excess callus absorbs.
    • cartilage differentiates to bone tissue.
  33. STAGE 4 BONE HEALING
    • OSSIFICATION:
    • PHYSIOLOGIC EVENTS FOR WEEKS 3-10
    • Callus forms into bone, which grows beneath periosteum of fragments; fuses fracture defect (Knits together)
    • Also called Union Stage.
  34. STAGE 5 BONE HEALING
    • CONSOLIDATION & REMODELING:
    • PHYSIOLOGIC EVENTS AFTER 9 MONTHS
    • Bone Marrow cavity restored
    • Compact bone formed according to stress patterns
    • Remodeling according to Wolff's Law (How the bone heals)- Counter Traction and Traction on the bone will promote healing towards opposite ends to unionize
    • Fracture line always visible on radiographs
    • NURSING CONSIDERATIONS: Teach parents that it is normal to feel a callus under the skin for a long time (approximately 9 months) The bone will need to remodel & repair before the callus goes away
  35. WOLFF'S LAW
    • Explains of how the bone heals:
    • Counter-traction & traction on a bone will promote bone healing towards the opposite ends to unionize
  36. Correlate assessment & diagnosis of Musculoskeletal dysfunction
    Do not need to know torticollis or compartment  syndrome for exam?
  37. Summarize the nursing care of children in casts and/or in traction
  38. Summarize common fractures in children
    • Fractures are very rare in children under 12 months old because their bones are pliable
    • If a fracture occurs in a 12 month old child Be alert to possible child abuse Question the parent to see if their explanation of the injury matches the clinical findings (X-Rays)↦ If not, Notify CPS
  39. Care Plan for: CLUBBED FEET
  40. Care Plan for: Developmental Hip Dysplasia
  41. Care Plan for: OSTEOGENESIS IMPERFECTA
  42. Care Plan for: Legg-Calve-Perthes Disease
  43. Care Plan for: Scholiosis
  44. Care Plan for: TORTICOLLIS
    (Don't need to know for exam?)
  45. Care Plan for: KYPHOSIS
  46. Care Plan for: CORDOSIS
  47. Care Plan for: MUSCULAR DYSTROPHIES
  48. Care Plan for: OSTEOMYLITIS
  49. Summarize the acute neurological assessment and variations related to growth & development
    Know normals of Neurovascular assessment so that you can identify what is not normal.
  50. Care Plan For: Increased Intercranial Pressure
    • Signs/Symptoms:
    • High Pitched Cry
    • Extreme Irratibility
    • If Fontanelles arent closed (Bulging, seperation of suture lines, increased head circumfrence from shift to shift)
    • Headache
    • Seizures
    • Hydrocephalus (Late Stage Sign, due to buildup of Pressure caused by Myelomeningitis. Cardinal sign is sunset eyes)
    • Posturing:
    • Decorticate: Everything pulled into the core of the body
    • Decerebrate: Everything extended from the core of the body
    • Obtose: C-shaped posturing with Meningitis
    • Positive Brudzinski's Sign
    • Positive Kernig's Sign
  51. Sunset Eyes
  52. Positive Brudzinski's Sign
    Head Flexes up when Knees are flexed upward
  53. Positive Kernig's Sign
    Severe Stiffness of the hamstring when leg is brought up toward chest, unable to straighten leg
  54. Decorticate Posturing
  55. Decebrate Posturing
  56. Obtose Posturing
  57. Care Plan For: Hydrocephalus
  58. Care Plan For: Neural Tube Disorders
  59. Care Plan For: Cerebral Palsy
    • Caused by Anoxia
    • Damage at the time of incident will be life-long, but will not progress or worsen
    • NURSING CONSIDERATION: The goal of treatment is to get the child to maximize capabilities & sustain those capabilities
  60. Care Plan For: Bacterial Meningitis
    • Know Lumbar Puncture Procedure
    • Exam questions will be easily answered by what you saw in simulations & based on what was discussed in class
  61. Care Plan For: Febrile Seizures
  62. LP13 GASTROINTESTINAL-GENITOURINARY (PEDS)
    • Objectives:
    • 13-2 Describe assessment strategies for altered gastrointestinal function.

    • 13-4 Discuss nursing strategies to help provide altered means of nutrition and elimination
    • 13-5 Care Plan for:
    • A- Structural defects
    • B- Infectious/inflammatory disorders
    • C- Motility disorders
    • E- Disorders of malabsorption

    • 13-6 Describe the mode of
    • transmission, clinical manifestations, treatment, and nursing care of the common
    • intestinal parasites.

    • 13-8 Care Plan for the following
    • anomalies of the urinary tract:
    • A- Nephrotic Syndrome (Nephrosis)
    • B- Acute Poststreptococcal Glomerulonephritis
    • F- Hypospadias and Epispadias
  63. GI ASSESSMENT
    • On page 2 of GI Handout
    • Nausea & Vomiting Within Last 24 Hours?
    • Complete a diet assessment of the past 7 days
    • Questions to Ask:
    • Have feedings changed?
    • What is the child eating?
    • Is anyone else sick in the family?
    • CBC(WBC): Esonophils increase when there is a parasitic infection (worms) if there is no allergic reaction. If there is a parasite infection, ask the doctor if he would like a stool sample
    • Know the differences in GI Function (Page 1 of GI hand out)
    • The first 4-6 months of an infants life they do not produce enzymes necessary to digest and absorb foods. Careless introduction of food prior to 6 months may result in development of allergies, malabsorption syndromes, and other problems with GI system.
    • Avoid water in an infants diet because it fills the belly with non nutritive space.
  64. Altered Means of Providing Nutrition & Elimination (Handout Pages 3-5)
    • Calories/Oz of formula = 20
    • Accurate daily weights (Including diaper weights) need to be performed for I/O. 1g of diaper weight = 1 mL of urine output
    • Urine Specific Gravity: >1.020 = Dehydration, <1.020 = hydrated
    • Elevate Head of Bed when there is a feeding problem to prevent GERD
    • Position Patient with Pyloric Stenosis on their Right Side
    • Sham Feedings: Make sure suck reflex stays intact and is strong
    • Enemas: Always add salt to lukewarm water (Never give a straight tap water enema because it diffuses water into the child's body which can cause water toxicity)
  65. Structural Defects Of GI System
    • Know these three:
    • Esphageal Artesia (With or Without Fistula)
    • Pyloric Stenosis
    • Cleft Lip/Cleft Palate
  66. Infectious Inflammatory Disease
    • IID's Cause Infection & Inflammation
    • Pinworms can cause appendicitis
    • Usually treated with antibiotics
    • Gastroenteritis S/Sx: Nausea, vomiting, & (Diarrhea due to infection)
    • A Stool Sample will likely be ordered
  67. Stool Specimens
    • Reducing substance: Detection of CHO malabsorption by measuring the reducing substance present in the stool, increased values indicate malabsorption (e.g. Sugars, Fat in Stool)
    • Stool pH: Measures acidity of stool (Stool turns acidic with malabsorption of sugars)
    • Stool Fat: Useful measure of malabsorption (Lab must know fat content of food ingested prior to testing)
    • Stool trypsin: A pancreatic enzyme (Normally found only in the stool of an infant- its absence in an infant could indicate cystic fibrosis (COLLECT BEFORE ANTIBIOTICS OR CONTRAST)
    • Stool Culture: to determine presence of pathogenic bacterial/organisms (Salmonella, Shigella, Gardia, Rotavirus, Parvovirus)
    • Stool for Ova & Parasites (O&P): Stool must be freshly examined or placed in fixation solution
    • Pinworm Test: Scotch tape Test (S/Sx: perineal itching & restlessness at sleep) PINWORM INFECTION CAN LEAD TO APPENDICITIS!
    • Occult blood: Blood Loss
    • Intravenous Pyelogram: Done before any other exam!
  68. Motility Assessment
    • Bowel Sounds
    • Abdominal Girth/Distention
    • Pain
    • Light Palpation
    • I/O
    • 7 Day Diet History
    • Additional Stuff In Packet: Assessment topics, Perioperative assessment and Care
  69. Hirschprung's Disease
    • Definition: Peristalsis is not occuring due to missing ganglionic cells in the bowel
    • Initial Treatment: Diet & Laxatives
    • Surgery to reanastomose the bowel back together will be required if Diet & Laxatives doesn't fix the problem
    • A temporary colostomy may be created
  70. Intussusception
    • Definition: Small bowel telescopes back into the large bowel & gets trapped (at ileoceccal valve)
    • Treatments:
    • Barium Enema (Osmolality of the barium helps distend the bowel to push it back down)
    • May need subsequent surgery if barium doesnt correct the issue and the issue reoccurs within 24 hours
  71. Disorders of Malabsorption
    • Cystic Fibrosis
    • Celiac Disease (Gluten Induced Enteropathy)
    • Lactose Intolerance
    • Phenylketonuria (PKU)
    • Any disease process causing diarrhea
  72. Common Signs & Symptoms of all Malabsorption Syndromes/Diseases Causing Diarrhea
    • Weight Loss
    • Abdominal Distention
    • Diarrhea
    • Steatorrhea (Excess Fat in Stools)
    • Abdominal cramps & Pain
    • May have vomiting
    • Low serum protein and Vitamins A,D,E,&K
    • Electrolyte Imbalances
  73. Celiacs Disease (Gluten Induced Enteropathy)
    1553
    • May be related to introduction of foods in the diet before 6 months of age which results in more allergies & more problems with digestion & absorption
    • Assessment: See common SS/Sx of all Malabsorption Syndromes
    • Diagnostic Test: Biopsy of intestinal mucosa (Shows Changes from normal)
    • Fatty stool analysis
    • Foods which contain Gluten: Wheat, rye, oats, Barley
    • Gluten Free Foods: rice, corn, soy
    • Suppliments of vitamins, iron, & Calories are usually required.
  74. Phenylketonuria (PKU)
    • Definition: An Autosomal Recessive disease commonly passed down from mother to baby, which results in the body's inability to break down protein & Phynylalanine
    • Dietary Restrictions: Phynylalanine, Artificial Sweeteners, Protein (Especially Meat)
    • Dietary Needs: Special Formula called Logenolac for infants PKU client will eat mostly fruits, vegetables, & some cereal
    • Excess Phynylalanine in pregnant mothers diet may lead to mental retardation of the infant
  75. Dietary Restrictions by Disease Type
    • Celiac Disease: Wheat, Rye, Oats, & Barely
    • Phenylketonuria: Phynylalanine, Artificial Sweeteners (Foods which contain them)
    • Lactose Intollerance: Milk & Milk Products
    • Cystic Fibrosis:
  76. Dietary Needs by Disease Type
    • Celiac Disease: Supplimental Vitamins, Increased Iron, higher calorie foods
    • Phenylketonuria: Special Formula for Infants called Lofenolac, fruits, vegetables & some cereals
    • Lactose Intollerance: Calcium & Vitamin D
    • Cystic Fibrosis:
    • Nephrosis: High Protein, Low Sodium, well balanced (CHO & Fat content need to be high enough to prevent body from using protein for energy) Low sodium. Offer small proportions of favorite foods. Water does not need to be restricted.
  77. Genitourinary Alterations
  78. Nephrosis (Idiopathic Nephrotic Syndrome)
    • Pathology & Etiology: A chronic renal disease (No known cuase or cure) Increased permeability (leakage) to/of protein. Age of onset is often presents during the preschool years, but is characterised by periods of being symptomatic and asymptomatic.
    • S/Sx:
    • Weight gain (greater than expected, slowly progressive over several weeks)
    • Edema, initially perirorbital then eventually Total Body Edema (anasarca) with acites & labial or scrotal swelling
    • Decreased Urine Output (Dark & Foamy)
    • Pale skin tone
    • Irratbility/fatigue
    • Anorexia, vomiting & diarrhea
    • Slightly Decreased Blood pressure (late stage)
    • Increased susceptibility to infection
    • Diagnostic Labs:
    • Protein (Will be high in urine-Proteinuria)
    • Albumin (Will be low-Hypoalbuminemia)
    • LDL/HDL Total (Will be high-Hyperlipidema)
    • Treatment:
    • Bedrest during the acute stage of illness
    • Oral Prednisone
    • Antibiotics (For secondary infections
    • immunosuppresive therapy (Cyclophosphamide)
    • Well balanced diet high in protein
    • Nursing implications:
    • Administer meds & take VS
    • Daily Weights & Abdominal girth
    • Strict I/O, Specific gravity, & urinalysis for protein with each void
    • Assess edema/presence of skin breakdown
    • Do not add salt to foods
    • Offer small portions of preferred foods that are allowed
    • Conserve energy (Diversional activities while on bedrest)
    • Maintain skin integrity
    • Prevent respiratory tract infections by elevating HOB and checking for Ascites (Abdomenal Distention which causes respiratory stress)
    • Child should not have vaccinations or immunizations for 3 months after immunosuppresive therapy
  79. Acute Post-Streptococcal Glomerulonephritis (APSGN)
    • Caused by recent strep or staph infection
    • Diagnostic Test: ASO titer (to assess for recent Strep Infection)
  80. Hypospadias
    Urethral opening lies on the bottom of the shaft of the penis. Do not circumcise! (Extra tissue needed for repair)
  81. Epispadias
    Urethral opening lies on top of the shaft of the penis. Do not circumcise! (Extra tissue needed for repair)
  82. LP14 IMMUNE-ENDOCRINE (PEDS)
    • Objectives:
    • 14-1 Describe the normal immune response

    14-3 Care Plan for various congenital, acquired, and infectious immunologic health problems

    14-4 Outline the normal anatomy and physiology of the endocrine system and identify the pediatric variations.

    • 14-5 Care Plan for:
    • A- Hypo/Hyperpituitarism
    • B- Hypo/Hyperthyroidism
    • C- Diabetes mellitus
    • D- Delayed and Precocious puberty
  83. The Immune Response In Children
    • Children under 2 years of age have a slower immune system & have a more difficult time managing infections
    • Infants should lay on a clean surface (If you set them on the floor, be sure to set them on a clean blanket)
    • Teach children to not put anything that has dropped on the floor in their mouth
    • Keep children's hands out of their mouth to prevent transmission of parasite infections and other Fecal-Oral route infections
  84. IMMUNOGLOBULINS
    • Definition: A class of proteins & Antibodies
    • Formed due to exposure to antigens (foreign substances) & allergens
    • Humoral immunity stems from B-Lymphocytes
    • IgM-First Responder (Primary response requires 48-72 Hours)
    • IgG- Created by IgM(Response takes 24 hours for any exposure that occurs after the first response, where IgM previously responded). Higher titer for antibody levels in system with each infection. Will pass through the placenta to the baby & with breast feeding
  85. LP15 MED INFO & DOSAGE CALC

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