PEDS Elimination

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  1. Constipation and Encopresis: What is it?
    Constipation is the infrequent and difficult passage of stools.

    • Encopresis is fecal incontinence, can develop secondary to constipation
    • -Abd is distended and can lose muscle function causing encopresis
  2. What causes constipation?
    change in diet, dehydration, lack of exercise, stress, pain from fissures, excessive milk intake
  3. Nursing assessment for constipation
    Bowel habits: hx of soiling events: frequency, duration, intensity, poor bladder control

    Stool habits: frequency, consistency, methods used to stool (meds)

    Diet: fiber, veggies, fruits, juices, water

    Other symptoms: bloating, pain or cramping, abd distention, palpable fecal mass, decreased bowel sounds, anal fissures, rubbing at butt, odor
  4. NI for constipation: bowel cleansing
    Disempaction first: can be traumatic for child. Make dx by xray

    • NS enemas, stool softeners, laxatives
    • If use of fleet laxatives watch for hypernatremia and hyperpoisphatemia
  5. NI for Constipation: Bowel retraining
    • Need to retrain rectal tone
    • Want to keep stools soft when retraining
    • 6-12 months approx to retrain
    • Stressful on family

    • Older than 1- Mineral oil: cold, mix with ice cream/choc milk
    • 6-12 months- lactulose, milk of magnesia
    • Infants- barely cereal, prune juice, sometimes lactulose
  6. NI for Constipation: Dietary Changes
    • Increase fiber
    • Limit milk
    • Increase water
  7. NI for Constipation: Emotional support
    • -Help parents get good habits
    • -Need to change retention habit (sit on toilet after meals for 10 mins but no longer)
    • -Keep behavioral chart
    • -Positive rewards
    • -No negative reinforcement
    • -Allow discussion of feelings: encourage self care, extra clothes in case of habits
  8. Constipation goal
    • 2-3 soft stools per day without pain
    • Medications slowly withdrawn over 3-6 months
  9. Appendicitis
    Inflammation and infection in the vermiform appendix

    Most common in children but can happen at any age

    Healthy child could be in the hospital for possibly the first time
  10. Appendicitis assessment
    Fever and chills, progressively getting higher

    • Pain: progresses in intensity and becomes localized to lower right quadrant, Mc Burney's point.
    • If appendix perforates, child will feel relief, but other symptoms will increase
    • Abdominal tenderness; gaurding

    GI symptoms: N/V, anorexia, diarrhea, rigid abd after perforation

    Lab results: 15-20 WBC

    Radiographic results: abd ultrasound shows enlarged appendix. CT with contrast not usually done but can show fluid filled and inflammation
  11. NI Uncomplicated Appendicitis
    Pre-Op: NPO, pain meds, cold packs, NO HEAT, IV fluids, teaching

    Post-Op: plain, early ambulation, resume regular diet after bowel sounds heard, D/C in 24-48 hours
  12. NI Perforated Appendix
    Pre-Op: NPO, NG tube, pain meds, cold packs, NO HEAT, IV fluids, IV antibiotics, teaching, anxiety

    Post-Op: NG tube, slowly advance diet, IV abx 5-14 days (pic line normally used), care for JP or penrose drains (monitor color, decreases after 24-48 hours), watch for abd abscess formation (about 72 hours after): fever, pain, increased abd girth, N/V
  13. IBD: Chrohn's
    • Teens, early 20s
    • Entire intestinal tract
    • Transmural involvement
    • Fistulas common
    • Remissions and exacerbations

    • Abd pain
    • non bloody diarrhea
    • fever
    • Palpable abd mass
    • Anorexia
    • Severe weight loss
    • Significant growth impairement
  14. Ulcerative Colitis
    • 15-40 yr olds
    • Colon, rectum upward
    • Mucosa and submucosa
    • fistulas rare
    • remissions rare

    • Usually no abd pain
    • Blood diarrhea
    • No masses
    • Moderate weight loss
    • mild growth impairment
  15. IBD Assessment
    Diarrhea acct, dehydration, growth failure, vitamin deficiencies, anemia

    Psychosocial: anxiety, depression, fears about being social, low self esteem
  16. IBD: Medications
    Steroids: long term consquences (affects growth)

    Immunosuppressives: methotrexate, cyclosporine, 6-MP

    Antibiotics: falgyl, ciproflaxacin
  17. NI-IBD: Nutrition support
    • -Avoid mill products, hypoallergenic, low fiber, low fat, low residue, high protein

    • -May need NG or G-tube
    •         elemental diets: peptamen, vivonex

    • -May need TPN: nutritional support is important, usually have protein, fat, carb, vitamin deficits
  18. NI-IBD: Education
    • -Will probably be doing initial teaching.
    • -Home management
    • -Self care management as a major goal
    • -Support groups help with education and emotional support

    CAMP MAGIC for emotional support
  19. Intussusception: what is it?
    • IN=Into
    • Part of a section of the intestine gets sucked into the distal bowel

    • Pediatric emergency!
    • Can cause necrosis and sepsis
  20. Intussusception Assessment
    Sudden onset, crying, pulling legs up, severe pain... paroxysms of pain initially then moves to constant pain

    Classic Signs: currant jelly stool (bloody mucus), sausage shaped abd mass
  21. Intussusception: NI
    Air insufflation: hydration, NPO, NG tube if distended, passage of normal stool, resume reg diet, go home

    Barium enema: same as above + watch for passage of barium

    Surgical Intervention: NPO, NG tube, feed when bowel sounds return, pain meds
  22. What is Hirschprung's Disease?
    • AKA: aganglionic megacolon
    • -Absence of ganglion cells in the rectum/colon
    • -Ganglion are nerve cells that form from top to bottom of the rectum/colon
    • -Can be short or entire bowel
    • - Will never have nerve cells in that section
  23. Hirschprung: Assessment
    Newborn: failure to pass meconium

    Infancy: ribbon stools

    Older child: ribbon stools, constipation
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PEDS Elimination
2015-03-06 05:45:35
Peds elimination nursing
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