Nuggets for Exam 3
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Herniation of abdominal contents outside of the abdominal cavity....??
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.
Abnormal rotation of the bowel....
Assessment for SBS
- F&E imbalance
A person with SBS should eat
How do you know a person with SBS has a bacterial overgrowth?
- foul smelling diarrhea stools
- bad breath
Big problem with babies with SBS...how 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
anti motility agent to decrease diarrhea
Lomatil or Immodium
Intusseception priority assessment
- looking for dehydration, shock and sepsis
- (fever, increased HR, LOC, BP, resp. dist)
What the urine specific gravity for a dehydrated person?
Goals for managing a child with SBS
- F&E balance maintained
- Nutritional support so they have normal growth and development....TPN to Enteral
PROVIDE SUCKING OPPORTUNITIES SO THEY DONT GROW AN AVERSION TO EATING
What do people with Celiacs need to eat?
corn and rice
DX of celiacs
foul smelling stool with significant growth delay....FTT can be seen at 9-12 months
Vitamins for a person with Celiacs
water soluble and folate
Children with celiacs are at risk for....
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
How do you provide good nutrition for a child with biliary artesia?
How do you manage portal htn?
- control bleeding by giving V. K regularly
- restrict salt intake
Biliary artesia is a life threatening disorder so make sure....
assess the family for stress
6 nursing interventions for biliary artesia
- nutritional support
- skin care
- development stimulation
- continued assessments
- emotional support
Examples of TPN given to kids with biliary artesia
Medication that helps with pruritis
Med that promotes bile flow so the child with biliary artesia doesn't get gall stones
bile + intestinal obstruction
vomit with fecal odor
lower intestinal obstruction or peritonitis
Vomit with bright red blood
hasn't had contact with gastric juices
If a person vomits a lot they will have....
- hand tremor
- more N/V
If a child has had continuous vomiting what labs will be run?
- electrolyte study
- urine specific gravity
- infectious cultures
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
How do you watch for dehydration?
- few wet diapers....none in 6-8 hrs
- no tears when cry....in 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
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
How do you minimize GERD with feeds?
hold upright for feeds and keep them upright after.....but minimize handling after too
How do you minimize reflux
- sm feeds q2-3 hrs
- breast milk or pre digested formula with rice cereal
- frequent burping
- bottles with X
- daily wts
- if they vomit a lot assess for dehydration
Sign that a newborn may have esophageal artesia or tracheoesophogeal fistula?
- with first feeds a baby cant....
- has regurgitation
- unexplained cyanosis
Crucial assessments for baby with EA or TEF
risk for aspiration and respiratory distress
looking for excess secretions, choking, cyanosis
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
Post op management of a baby with EA or TEF
- respiratory status?
- thermo regulation
- fluids and nutrition
- monitor chest tube
Teaching for parents of a baby with EA or TEF
g tube feeds
Priority management for a baby with a cleft palate/lip
modify feeding techniques to allow for growth and development
special bottles, nipples and devices
Big complication from cleft palate/lip?
chronic otitis media that can lead to long term hearing loss
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
Babies have No No's on after a cleft repair....rules
remove 1 at a time q 2h for 10-15 min
Do you brush a kids teeth after a cleft repair?
Not in the first 1-2 weeks....wash the mouth out with water
Support treatments for a child with a cleft
Main assessment for a child with pyloric stenosis
dehydration and metabolic alkalosis
When do you see pyloric stenosis?
it develops over time....healthy at birth
Priority management for a child with pyloric stenosis?
correct F&E imbalances so they can go to surgery
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
Signs that a child has pyloric stenosis
- previously healthy
- projectile vomit
- olive mass RUQ
After having a pyloromymotomy for pyloric stenosis how do you advance diet?
once bowel sounds are present with small amounts of oral electrolytes-pedialyte
Who commonly has Hirschprungs?
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
Describe stools of a baby with Hirschprungs
- ribbon like
- foul smelling
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
Therapeutic management pre op for a baby with Hirschprungs
Neomycin antibiotic to sterilize the bowel and prevent infection
- monitor VS
- measure abdominal circumfrence
Therapeutic Management Post Op for a baby with Hirschprungs
NPO till bowel sounds are present or they pass gas
Most common form of abuse
Who is most likely to abuse
moms over 39 yo that are isolated
What age does most abuse occur?
Ethnic child who is most likely to be abused
What would you like to do?
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