Nuggets for Exam 3

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Nuggets for Exam 3
2014-02-22 11:11:35
Nuggets remember

Nuggets for GI, Abuse
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  1. Herniation of abdominal contents outside of the abdominal cavity....??
    How fixed?

    intestines will be swollen so put them in a silo and by gravity the swelling will lessen.  At that time it can be pushed back in.
  2. Abnormal rotation of the bowel....
  3. Assessment for SBS
    • F&E imbalance
    • Malabsorption
  4. A person with SBS should eat
  5. How do you know a person with SBS has a bacterial overgrowth?
    • foul smelling diarrhea stools
    • bad breath

    Oral Flagyl
  6. Big problem with babies with do we solve it?
    they have been TPN or enteral feeds so they have never eaten and develop an aversion to food. 

    We need to have speech and OT teach the parents how to eat and we start with providing sucking opportunities while they are receiving TPN or enteral feeds
  7. anti motility agent to decrease diarrhea
    Lomatil or Immodium
  8. PPI
    Protonix or Prevacid
  9. H2 Blocker
  10. Intusseception priority assessment
    • looking for dehydration, shock and sepsis
    • (fever, increased HR, LOC, BP, resp. dist)
  11. What the urine specific gravity for a dehydrated person?
  12. Goals for managing a child with SBS
    • F&E balance maintained
    • Nutritional support so they have normal growth and development....TPN to Enteral

  13. What do people with Celiacs need to eat?
    corn and rice
  14. DX of celiacs
    foul smelling stool with significant growth delay....FTT can be seen at 9-12 months
  15. Vitamins for a person with Celiacs
    water soluble and folate
  16. Children with celiacs are at risk for....
  17. 2 goals for treatment of child with biliary artesia
    #1 allow for normal growth and development till a liver for transplant is available

    #2Watch for portal HTN, ascites and variceal bleeding
  18. How do you provide good nutrition for a child with biliary artesia?
    • TPN
    • MCT oil
    • v. ADEK
  19. How do you manage portal htn?
    • control bleeding by giving V. K regularly
    • restrict salt intake
    • diuretics
  20. Biliary artesia is a life threatening disorder so make sure....
    assess the family for stress
  21. 6 nursing interventions for biliary artesia
    • nutritional support
    • skin care
    • development stimulation
    • continued assessments
    • education
    • emotional support
  22. Examples of TPN given to kids with biliary artesia
    • Pregestimil
    • Portagen
  23. Medication that helps with pruritis
  24. Med that promotes bile flow so the child with biliary artesia doesn't get gall stones
  25. green vomit
    bile + intestinal obstruction
  26. vomit with fecal odor
    lower intestinal obstruction or peritonitis
  27. Vomit with bright red blood
    hasn't had contact with gastric juices
  28. If a person vomits a lot they will have....
    metabolic alkalosis

    • confused
    • twitchy
    • hand tremor
    • more N/V
  29. If a child has had continuous vomiting what labs will be run?
    • CBC
    • electrolyte study
    • glucose
    • urine specific gravity
    • infectious cultures
    • ABG
  30. For a child who is vomiting what is the primary focus?
    detect and treat the cause of the vomiting, with the secondary intent of preventing complications
  31. How do you watch for dehydration?
    • few wet diapers....none in 6-8 hrs
    • no tears when a baby older than 2-3 mo
    • dry/sticky inside of mouth
    • high pitched cry
    • difficulty awakening
    • Increased RR/hard time breathing
    • sunken fontanel
    • sunken eyes with dark circles
    • abnormal skin color, temp or dry
  32. If a child has GERD a big question to ask is.....why?
    do they have any hx of respiratory illness (pna, asthma, apnea)

    They are at high risk for complications from respiratory distress
  33. How do you minimize GERD with feeds?
    hold upright for feeds and keep them upright after.....but minimize handling after too
  34. How do you minimize reflux
    • sm feeds q2-3 hrs
    • breast milk or pre digested formula with rice cereal
    • frequent burping
    • meds
    • bottles with X
    • daily wts
    • if they vomit a lot assess for dehydration
  35. Sign that a newborn may have esophageal artesia or tracheoesophogeal fistula?
    • with first feeds a baby cant....
    • swallow
    • has regurgitation
    • vomits
    • unexplained cyanosis
  36. Crucial assessments for baby with EA or TEF
    risk for aspiration and respiratory distress

    looking for excess secretions, choking, cyanosis
  37. Management of a baby with EA or TEF Pre op
    • keep infant supine withHOB elevated
    • NG tube in place and aspirate q5-10 min
    • IV fluids
    • radiant warmer with O2
    • measure abdominal girth
  38. Post op management of a baby with EA or TEF
    • respiratory status?
    • thermo regulation
    • fluids and nutrition
    • monitor chest tube
  39. Teaching for parents of a baby with EA or TEF
    g tube feeds
  40. Priority management for a baby with a cleft palate/lip
    modify feeding techniques to allow for growth and development

    special bottles, nipples and devices
  41. Big complication from cleft palate/lip?
    chronic otitis media that can lead to long term hearing loss
  42. What do you teach parents who has a baby with a cleft palate/lip?
    • feed slowly
    • with breaks
    • feed upright
    • burp often cuz swallow air
  43. Babies have No No's on after a cleft repair....rules
    remove 1 at a time q 2h for 10-15 min
  44. Do you brush a kids teeth after a cleft repair?
    Not in the first 1-2 weeks....wash the mouth out with water
  45. Support treatments for a child with a cleft
    • orthodontist
    • OT
    • Odiologist
  46. Main assessment for a child with pyloric stenosis
    dehydration and metabolic alkalosis
  47. When do you see pyloric stenosis?
    it develops over time....healthy at birth
  48. Priority management for a child with pyloric stenosis?
    correct F&E imbalances so they can go to surgery
  49. What do we do to manage a child with pyloric stenosis
    • NG tube for decompression
    • raise HOB to decrease risk for aspiration
    • V-check freq, amt, color, consistency, proj
    • s/s dehydration
    • labs-K, Na, Chl
  50. Signs that a child has pyloric stenosis
    • previously healthy
    • projectile vomit
    • olive mass RUQ
  51. After having a pyloromymotomy for pyloric stenosis how do you advance diet?
    once bowel sounds are present with small amounts of oral electrolytes-pedialyte
  52. Who commonly has Hirschprungs?
    downs kids
  53. S/S that a baby has Hirschprung
    • didn't pass meconium w/in 24 hours of birth
    • prone to constipation or stool infrequency during 1st mo
  54. Describe stools of a baby with Hirschprungs
    • pellet
    • ribbon like
    • foul smelling
  55. 3 ways to ID Hirschprungs
    rectal exam showing tight internal sphincter & no stool then explosive gas

    barium enema...but don't expel barium

    rectal punch biopsy confirms by absence of ganglion cells
  56. Therapeutic management pre op for a baby with Hirschprungs
    Neomycin antibiotic to sterilize the bowel and prevent infection

    • monitor VS
    • measure abdominal circumfrence
  57. Therapeutic Management Post Op for a baby with Hirschprungs
    NPO till bowel sounds are present or they pass gas
  58. Most common form of abuse
  59. Who is most likely to abuse
    moms over 39 yo that are isolated
  60. What age does most abuse occur?
    0-4 yo
  61. Ethnic child who is most likely to be abused