Peds Study Guide Exam 2 (GI, GU, Endocrine, Neuro, Heme/Immune)
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1. Dehydration – diarrhea and vomiting (from powerpoint)
a. Dehydration
i. Clinical Manifestations:
1. CRT greater than 3 seconds, dry mucous membranes, absence of tears, sunken fontanels, lethargy, weight loss, rapid weak pulse (1st to respond), low BP (last to respond)
ii. Urine output need...
kim 1 dehydration – diarrhea and vomiting from powerpoint a dehydration i clinical manifestations 1 crt greater than 3 seconds
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Peds Study Guide Exam 2 (GI, GU, Endocrine, Neuro,
Heme/Immune)
Kim
1. Dehydration – diarrhea and vomiting (from powerpoint)
a. Dehydration
i. Clinical Manifestations:
1. CRT greater than 3 seconds, dry mucous membranes, absence
of tears, sunken fontanels, lethargy, weight loss, rapid weak
pulse (1st to respond), low BP (last to respond)
ii. Urine output needs to be 1mL/kg per hour for anyone under 30kg.
iii. Dehydration Criteria (% of body weight lost)
1. Mild dehydration=5% of total body weight
2. Moderate=10% of total body weight
3. Severe=15% of total body weight
iv. Nursing Interventions
1. Assessment should include body weight, skin color, temp & turgor,
CRT, presence of thirst sensation, fontanels in infants
v. Vomiting:
1. So there is nothing really in the powerpoint or ATI specifically on
vomiting….I guess just know that it can cause dehydration and
to monitor I&O and F&E status. Can be associated with
metabolic alkalosis.
vi. TB (chapter 26)
1. Question #: 20
2. ATI book (chapter 22): question 1
2. Inflammatory bowel disease – Ulcerative Colitis and Crohn’s
a. Kaur said she’s taking this topic out since it wasn’t in the powerpoint or
discussed in lecture.
3. Necrotizing enterocolitis (NEC) (from Powerpoint)
a. Acute inflammatory disease of the bowel. Usually occurs 4-10 days after
initial feeding. Seen in preterm and high risk infants!
b. Due to stasis in the GI tract, decreased blood supply leads to ischemia
→bacterial proliferation (HUGE PROBLEM!)
c. S/S
i. Distended abdomen, bloating, gastric residual that is bile tinged,
occult blood in stool, lethargy, poor feeding, pale skin, and
bradycardia and hypotension (which are s/s of sepsis!)
d. Treatment
i. DC the feedings to rest the bowel
ii. Gastric tube used to decompress
iii. Abx used to treat sepsis
, Peds Study Guide Exam 2 (GI, GU, Endocrine, Neuro,
Heme/Immune)
iv. Sx may be indicated to remove necrotizing tissue
e. Nursing Care
i. Monitor VS and gastric residuals
ii. Eval stool and abdominal girth
iii. Re-establish feeding (breast milk) and monitor tolerance
4. Hirschsprung’s disease (ATI book and powerpoint)
a. Lack of ganglionic cells in the segments of the colon resulting in ↓motility and
mechanical obstruction. No peristaltic waves in the affected portion of the
bowel causing obstruction and distention.
b. S/S
i. Failure to pass meconium w/i 24-48 hrs after birth
ii. Episodes of vomiting bile, poor feeding
iii. Abdominal distention/constipation
iv. Foul smelling, ribbon like stool!
c. Surgical removal of the affected portion is needed. Temporary colostomy may
be required
d. Nursing Interventions
i. High protein, high calorie, low fiber diet
ii. Educate parents on colostomy care.
e. TB (chapter 26)
i. Question #: 6, 7, 8, 9, 38 39
ii. ATI book (chapter 23): question 2
iii.
5. GERD (ATI book and powerpoint)
a. Primarily due to an incompetent LES, gastric contents regurg into
esophagus. Peak incidence is around 4 mo. old, usually resolves by 1 yr.
b. S/S
i. Spitting up, forceful vomiting, aspiration may lead to resp.
Signs, ulceration and bleeding
c. Nursing Management
i. Offer small, frequent feedings.
ii. Thicken formula with rice cereal
iii. Position the child with head elevated after meals. At least an hour at a
30° angle.
iv. Can administer antacids before meals or at bedtime.
Ranitidine commonly used.
v. Nissen fundoplication sx used for patients who have severe cases.
vi. TB (chapter 26)
1. Question #: 10, 11, 24, 25, 41, 46, 47. SATA #: 1, 5, 11
, Peds Study Guide Exam 2 (GI, GU, Endocrine, Neuro,
Heme/Immune)
2. ATI book (chapter 23): question 5
Mae
6. Appendicitis/Appendectomy (ATI/other version of PPT in portal)
a. Etiology/Pathophysiology:
1. Inflammation of the vermiform appendix caused from an obstruction
of the lumen of the appendix
2. Obstruction causing inflammation and ischemia → can rupture
→ peritonitis
3. Average client age is 10 years
b. S/S:
1. Abdominal pain in the RLQ
2. Decreased or absent bowel sounds
3. Fever
4. Lethargy
5. Tachycardia
6. Diarrhea or constipation
7. Rapid, shallow breathing
8. Anorexia
9. Possible vomiting
10. “Colicky, cramping, abdominal pain around the umbilicus”
c. Lab tests:
1. CBC
2. Urinalysis
d. Diagnostic Procedures:
1. Computed tomography scan shows an enlarged diameter of appendix,
as well as thickening of the appendiceal wall
2. Including pain: “McBurney’s point”
e. Management:
1. Surgery, antibiotics, IV fluids, pain meds with caution, antipyretics,
antiemetics
f. Nursing care:
1. **Avoid applying heat to the abdomen, enemas or laxatives
g. Therapeutic Procedures
1. Appendectomy: treatment for simple or perforated appendicitis
2. Laparoscopic procedure: provides quick recovery for simple appendicitis
a. Laparoscopic surgery: removal of the non ruptured appendix
b. Laparoscopic or open surgery: removal of the ruptured appendix
h. Complications:
1. Peritonitis (inflammation of the peritoneal cavity)
i. TB (Chapter 26)
i. Question #: 13, 14, 15, 48 and SATA #: 9
, Peds Study Guide Exam 2 (GI, GU, Endocrine, Neuro,
Heme/Immune)
7. Cleft lip and palate
a. Etiology/Pathophysiology:
1. Lip: visible separation from the upper lip toward the nose
2. Palate: visible or palpable opening of the palate connecting the
mouth and the nasal cavity
b. Risk Factors:
1. Family history
2. Environmental factors: exposure to teratogens, alcohol,
smoking, medications & low folic acid
3. Other syndromes (ATI)
c. S/S:
1. Feeding difficulties
2. Speech difficulties
3. Recurrent otitis media (related to altered structure)
d. Medical
management:
1. Surgical closure
2. Surgery, speech therapy
3. Cleft lip: repair is done b/w 2-3 mo of age
4. Cleft palate: repair is done b/w 6-12 mo of age
e. Nursing Interventions:
1. Ensure adequate intake of food and fluids without aspiration
2. Special feeding devices may be used
3. Frequent burping is necessary
4. Assist parents in dealing with the diagnosis
f. Procedure nursing care:
1. Pre-op:
- assess ability to suck, position the infant upright while cradling
the head during feeding, use a wide-based nipple for bottle
feeding (only for isolated cleft lip), burp the infant frequently,
2. Post-op:
- ABCs, wound care, monitor for bleeding, clear liquid to soft diet,
**AVOID having the infant suck on a nipple or pacifier b/c it can
damage the surgical site
- For cleft lip: apply elbow restraints to keep the infant form
injuring the repair site
- For cleft palate: change the infant’s position frequently to
facilitate drainage and breathing. The infant may be placed on the
abdomen in the immediate post-op period.
g. TB (Chapter 3, 8)
i. Chapter 3 Question #: 18
ii. Chapter 8 Question #: 21, 22, 26 & SATA #: 4
8. Esophageal atresia/Tracheoesophageal fistula
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