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NURS 629 Exam 4 With Questions And Answers @ 2023
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NURS 629 Exam 4 With QuestionsAnd Answers @ 2023
What is physiological jaundice? - Answer -occurs when baby accumulates bilirubin
-secondary to immature liver in newborns
-Risk factor is prematurity
What level is conjugated hyperbilirubinemia? - Answer serum conjugated bilirubin
concentration greater than 1 mg/dL if the total bilirubin is less than 5.0 mg/dL or more
than 20% of the total bilirubin if the the total bilirubin is greater than 5 mg/dL (p. 862
AAP book)
What is breastfeeding jaundice? - Answer -due to poor intake that causes lack of stools
and urine output
-common in first week and resolves once milk comes in and infant is feeding well-more
stools and urinary output
-peaks around 2-3 weeks
How do you diagnose jaundice? - Answer -dx with a bili level of 5 mg/dL
-12 mg/dL threshold for all newborns having jaundiced appearance
-direct/indirect bili levels
-CBC
-reticulocyte count
-use of bilitool.org
How do you treat jaundice? - Answer increased intake, longer feeding
indirect sunlight
phototherapy
IV fluids
Bili lights
Biliblanket
What are other causes of jaundice? - Answer abnormal blood cell shapes (like sickle
cell)
Rh incompatibility
cephalohematoma
polycythemia (increased RBCs, SGA infants, twins)
infection
specific enzyme disorders
,What is biliary atresia? - Answer -life-threatening condition causing a blockage of bile
ducts inside or outside of liver
-leads to build-up of toxins (like bilirubin)
-malabsorption of fat-soluble vitamins A,D,E,K
-scaring of the liver, loss of tissue, cirrhosis
-not inherited
What are the two types of biliary atresia? - Answer fetal- noted in womb (other defects
like heart, spleed, intestines)
perinatal- appears 2-4 weeks after birth
What causes biliary atresia? - Answer -infection after birth (cytomegalovirus or
rotavirus)
-autoimmune disorder
-developmental issue in womb
-exposure to toxic substances
What are symptoms of biliary atresia? - Answer jaundice
dark urine
light to white stools
poor wt gain and growth
How do you diagnose biliary atresia? - Answer any infant with jaundice present 2-3
weeks after birth
-direct and indirect serum bilirubin
-LFTs
-abdominal x-ray
-abdominal US
-liver bx
How do you treat biliary atresia? - Answer -surgery (Kasai procedure), small intestine is
attached directly to the liver to allow bile to flow into the small intestine bypassing the
cystic, hepatic, and common bile duct.
-liver transplant
What are risk factors for dehydration? - Answer GI virus
NVD
What are s/sx of dehydration? - Answer -sunken fontanels
-tachycardia and decrease cap refill >2-3 seconds
-decrease urine output is sensitive but nonspecific
-increase in urine specific gravity
-decrease BP- late finding=more than 10% fluid loss
How do you treat dehydration? - Answer -if minimal, mild, moderate- oral rehydration
, -if severe (drowsy, cold extremities, lethargic, sunken/dry eyes, very depressed anterior
fontanel, no tears, dry mouth/tongue, very decreased skin turgor, rapid/sometimes
impalpable pulse, decreased/unrecordable pulse, deep/rapid respiratory rate, markedly
reduced urine output) - IV fluids
What is emesis? - Answer vomiting=symptom
must distinguish from regurgitation in infants
integrated response to noxious stimuli-coordinated by CNS
What is acute emesis? - Answer short-term
abrupt onset
episodic
What is recurrent emesis? - Answer -at least 3 episodes over 3 months
-chronic
-relatively mild but occurs frequently
What is cyclic emesis? - Answer -recurrent, intense episodes
-periods of being asymptomatic
How do you treat emesis? - Answer NPO for 1-2 hrs
**rehydrate with small/frequent amounts of clear liquids
avoid dairy and solids for 4-6 hrs and then add bland foods slowly
What are causes of diarrhea? - Answer -primarily viral (most common) or bacterial
-bacterial pathogens are usually C. difficile, salmonella, Giardia, Campylobacter
**always serious in infancy due to small ECF reserve, and can dehydrate quickly
Patho of diarrhea - Answer 1. retention of water w/in the intestine (malabsorptive
syndrome, lactose intolerance)
2. excessive secretion of water and electrolytes into the intestinal lumen (cholera, e.
coli, chrohn's, laxatives)
3. release of protein and fluid into the intestinal mucosa (ulcerative colitis, Crohn's.
infections)
4. altered intestinal motility resulting in rapid transport through the colon (IBS,
scleroderma)
What is acute diarrhea? - Answer most likely to be an infectious agent
sudden onset
frequent, loose, watery stools
bloody stools
abdominal cramping
thirst
decreased urination
dizziness
fatigue
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