Nurs 346: GastroIntestinal

A child presents with intermittent abdominal pain, severe anorexia, and diarrhea. The child's height and weight are significantly behind standards for age. There is skin breakdown in the anal region. The nurse explains that this presentation is consistent with which diagnosis? A. Crohn's Disease B. ulcerative colitis C. Hirschsprung Disease D. Food poisoning

A. Crohn's Disease Intermittent abdominal pain, anorexia, diarrhea, growth delays, and perianal lesions are characteristic of Crohn disease. In ulcerative colitis, the pain is continuous with bloody diarrhea, but anorexia, weight loss, and growth delay are mild. Food poisoning is an acute condition and may result in weight loss but not growth delays. In Hirschsprung disease the bowel lacks nerve innervation, so it lacks motility and fecal output.

s/s and treatment of Acute Lymphoblastic Leukemia

Abnormal lymphoblasts grow rapidly and replace normal cells in the bone marrow, which expands causing joint and bone pain. s/s: Fever, bruising, fatigue, enlarges liver, bone pain Diagnostics: CBC - low Hgt, Hgb, platelets , Lumbar puncture (tests spinal fluid for leukemic cells) Complication of spreading to the CNS (s/s: headache, seizures, coma)

common nursing interventions for children with cancer

Administer antiemetics Avoid spicy food, encourage choices especially high calorie foods (meat, dairy, eggs, lentils) , NG tube feeds common Ensure enough fluid intake, provide stool softeners or laxatives Keep lips lubricated, use magic mouthwash, administer pain medications Avoid rectal temperatures, apply pressure when getting needle sticks, avoid IM injections if possible, careful teeth brushing Asses for fever or signs of infection, treat with antibiotics, maintain good hand hygiene, avoid rectal temperatures, isolation, avoid exposures to communicable diseases (chickenpox etc),

The nurse is educating a parent about the treatment for a child's tinea cruris. What medication class would the nurse include in the teaching plan? antifungal corticosteroid antibiotic antihistamine

Antifungal

A 4-month-old infant is experiencing dermatitis in the diaper area. What treatments will be beneficial to this condition?

Apply ointment with vitamin A to the diaper area. Allow the diaper area to air dry. Apply petroleum jelly to the diaper area. Use ointments containing zinc on the diaper area.

treatment of leukemia - what are the stages

Chemotherapy, Bone marrow transplant 1.) Induction: Rapid induction of complete remission, 3-4 weeks, give Oral steroids, IV vincristine, IM L-asparaginase, daunomycin (high risk) 2.)Consolidation (intensification): Strengthen remission, and reduce leukemic cell burden. Give High-dose methotrexate, 6-mercaptopurine; possibly cyclophosphamide, cytarabine, asparaginase, thioguanine, epipodophyllotoxins 3.) Maintenance: Eliminate all residual leukemic cells, 2-3 years Give, Low dose: daily 6-mercaptopurine, weekly methotrexate, intermittent IV vincristine, and oral steroids 4.) CNS prophylaxis: Reduce risk of development of CNS disease, Given periodically in all stages, Intrathecal chemotherapy; cranial radiation is used infrequently

s/s of myasthenia gravis

fatigue and weakness; difficulty chewing, swallowing, or holding up the head; or pain with muscle fatigue. Inote complaints of double vision. Observe the child for ptosis (droopy eyelids) or altered eye movements from partial paralysis. Note increased work of breathing. Laboratory testing may involve the edrophonium (Tensilon) test

Function of granulocytes: Neutrophils

fight infections (from bacteria, fungus ect.)

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? providing age-appropriate activities grouping nursing care following guidelines for reverse isolation encouraging the child to share feelings

following guidelines for reverse isolation

What causes antibiotic resistance?

improper or excessive use of antibiotics Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance

Function of granulocytes: Eosinophils, Basophils

involved in allergic responses

Nursing interventions for JID

managing pain, maintaining mobility, and promoting a normal life. administer NSAIDs, corticosteroids, and disease-modifying antirheumatic drugs. Maintain joint range of motion and muscle strength via exercise (physical or occupational therapy). Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. Teach families appropriate use of splints prescribed to prevent joint contractures. Monitor for pressure areas or skin breakdown with splint or orthotic use.

medicine used to treat pinworms

mebendazole or vermox keep finger nails short, treat whole family, wash bed linens, avoid touching anus, avoid sharing objects, take warm/got shower. wash hands/body with soap

medicine used to treat scabies

permethrin (elimite)

umbilical hernia - is surgery needed?

protrusion of the intestine through a weakness in the abdominal wall around the umbilicus (navel) wont need surgery, hernia will most likey close on its own Incarceration is extremely rare, but when it does occur, the child will report abdominal pain, tenderness, or redness at the umbilicus The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of skin maceration. This includes taping a quarter over a reduced umbilical hernia and the use of "belly bands" (Palazzi & Brandt, 2019).

Anemia - iron deficiency treatment, s/s

seen in patients with heavy menstrual periods pallor, fatigue, SOB, weakness spooning of the nails -concave nails treat with Iron supplements, adequate oxygen, Blood transfusion of packed RBC

A pediatric client is admitted to the hospital. The primary health care provider suspects a problem with the child's immune system. The nurse anticipates preparing this client for which test initially?

serum blood testing

medicine used to treat lice

special shampoo - pediculicide - permethrin special hair salons

Treatments for cancer

surgery, radiation, chemotherapy, stem cell transplant, imported port

s/s and treatment of Neuroblastoma (cancer that forms in Neuroblasts, tumor is often seen in the adrenal glands (abdomen)) what is a hallmark sign?

swollen, asymmetrical abdomen, firm, non-tender mass on abdomen Treated with chemotherapy and radiation (not given to patients in stage one) surgical removal of tumor in abdomen

inguinal hernia

the protrusion of a small loop of bowel through a weak place in the lower abdominal wall or groin s/s painful bulging mass in lower abdomen - will need surgical repair Tell the parents that if the child's inguinal hernia becomes hard, discolored, or painful (evidenced by inconsolable crying), they should immediately call the physician or nurse practitioner to determine the next course of action (office visit or emergency room visit)

Guillain-Barré syndrome main s/s

weakness and paralysis Nursing management is supportive: help with ROM

A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? mucositis vital signs bleeding infection symptoms

infection symptoms

The parents of a child recently diagnosed with atopic dermatitis voice concern to the nurse that their child may develop asthma at some point. How should the nurse respond? "I am not sure why you think a skin disorder would lead to asthma?" "I can understand your concern. We will closely monitor your child for asthma development." "If your child starts having respiratory difficulties, be sure to let your health care provider know." "All children with atopic dermatitis develop both asthma and hay fever, so we will monitor your child for both conditions."

"I can understand your concern. We will closely monitor your child for asthma development." Atopic dermatitis (eczema) is one of the disorders in the atopy family (along with asthma and allergic rhinitis [hay fever]). About 30% to 35% of children who have atopic dermatitis will also develop allergic rhinitis (hay fever) and/or asthma. Therefore, the child will be monitored for the development of asthma.

s/s of intussusception treatment?

- bilious vomiting - sausage shaped mass in RUQ - progressive distension/tenderness/lethargy - If not reduced, perforation/shock may occur. -"current jelly stool" - blood and mucus in stool -child will scream and hug up knees air enema to release, surgical repair

Treatment of sickle cell disease

- pain management - avoid triggers - give supplemental oxygen - minimize organ damage - rest and fluids - stem cell transplant

Side effects of chemotherapy

-Hair loss -Dry mouth/mouth sores -Difficulty swallowing -N/V -Diarrhea *[GI tract replicate often] -Fatigue -Bleeding -Susceptibility to infection -Foggy brain aka "chemo brain" - Mucositis is when your mouth or gut is sore and inflamed.

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for: early meningitis. platelets. leukemic cells. early development of septicemia.

. leukemic cells.

Key notes for managing a fever- what med should not be given

Assess temp every 4-6 hrs, 30-60 minutes after antipyretic has been give tylenol 15mg/kg/dose ibuoprofen 10mg/kg/dose avoid dressing patient in warm, binding clothes do not give aspirin (risk of reye syndrome)

IVIG nursing implications

Do not mix with IV meds/fluids do not shake IVIG do not give IM or SQ Assess BUN and Creatinine

side effects of radiation

Fatigue Nausea, Vomiting, Anorexia Mucositis Xerostomia Skin Reactions Bone Marrow Depression

GERD medications

H2 blockers: cimetidine {Tagamet} ranitidine {Zantac} - decreases the amount of acid produced by the stomach Prokinetics : esomeptazole {Prilosec} pantoprazole {Protonix}, reglan

s/s and treatmemt of Hemophelia, what is the goal, precautions, what medication is given

Hemophilia- X-linked recessive disorder results in a deficiency in one of the coagulation factors in the blood. Carrier mothers give to sons- males only. Most common is Hemophilia A. usually an inherited bleeding disorder in which the blood does not clot properly s/s: warm, painful, swollen, joints, unexplained bleeding in rare cases, bleeding may occur (nosebleeds) Goal: prevent bleeding from occurring Teach: child not to play intense contact sports, have toddler wear helmet Medication: give factor VIII by iv push, give slowly

What is the number one complication of burns?

Infection

The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child's heart is beating very fast. What action by the nurse is indicated? Make an appointment for the child to be seen by the physician within 24 hours. Inquire about any changes in the child's normal routine. Instruct the child be brought to the emergency department promptly. Inquire about when the child's last dose of medication was taken.

Instruct the child be brought to the emergency department promptly. Myasthenia gravis is an autoimmune disorder that is characterized by weakness and fatigue. There is no cure. The disease may be aggravated by stress, exposure to extreme temperatures, and infections, resulting in a myasthenic crisis. Myasthenic crisis is a medical emergency with symptoms including sudden respiratory distress, dysphagia, dysarthria, ptosis, diplopia, tachycardia, anxiety, and rapidly increasing weakness. The symptoms reported are consistent with a crisis and prompt care is indicated. Waiting 24 hours to have the child seen by the physician is not appropriate. Questions about changes in routine and medication compliance may be asked but the first priority is to have the child seen.

What are examples of live vaccines? who can not get live vaccines

MMR, varicella, rotavirus, and influenza (intranasal) guillian barre syndrome, HIV

What complication occur with Osteosarcoma? what treatment will not work

Metstasis - especially to the lungs, radiation

S/S of appendicitis

Persistent RLQ Pain, pain in umbilical region, rupture of appendix: sudden severe pain N/V low grade fever, high grade if ruptures

Sickle cell disease/crisis- s/s, treatments, nursing interventions-

Prevent crisis - Pain control, oxygen, adequate hydration (iv fluids), folic acids, pain meds, hematopoitic stem cell transplant symptoms: Anemia (low RBCs), pain, acute chest syndrome), weakness, fatigue treat with erythropoietin

signs and symptoms of infection

Purulent drainage, pain, redness and edema, fever, chills, increased pulse and resp. rate, and increased WBC count. fatigue

Complications of Sickle cell disease

RBCs are sickle celled shaped, they are rigid, and clump together and lead to a vaso occlusive crisis, which can lead to tissue hypoxia and ischemia - lead to tissue death (infarction) complications: vaso occlusion, spenic sequestration (too many blood cells in spleen - leads to enlargement of spleen), priapism, Acute chest syndrome (clumping of cells in the lungs) s/s Pain (mainly in joints)

s/s of Myasthenic crisis. is there a cure? what aggravates it?

Signs and symptoms of myasthenic crisis include severe muscle weakness, respiratory difficulty, tachycardia, and dysphagia no cure. aggravated by stress

The nurse is providing education to a 16-year-old who has recently been diagnosed with myasthenia gravis. Which statement(s) by the adolescent indicates an understanding of the information provided? Select all that apply. "Attending public school will likely no longer be possible." "Getting a flu shot will be important." "I am going to incorporate a short nap into my daily routine." "It can take several months to cure this disease." "It is important I avoid triggers."

a. "I am going to incorporate a short nap into my daily routine."c. "Getting a flu shot will be important."d. "It is important I avoid triggers." Myasthenia gravis is an autoimmune condition characterized by weakness and fatigue. Management involves avoiding triggers such as stress and illness. Taking a flu shot will aid in avoidance of influenza which can be dangerous for someone with this disease. Fatigue is a concern and rest periods should be incorporated in to the teens schedule. There is no cure for the condition. There will need to be modifications in the teen's normal routine but attending public schools is possible.

s/s and treatment of Osteogenic sarcoma

aka Osteosarcoma - cancer of the bone, occurs mainly in white male adolescents - affects the long bones, humorous, tibia, femur treatment: Chemotherapy, Amputation (Radiation is not helpful) s/s: dull bone pain, limp/gait changes

medicine used to treat lyme disease

amoxicillin, doxycycline, erythromycin

How to prevent sickle cell crisis

avoid cold climate, dehydration, and high altitudes

Superficial burn (1st degree)

burn involving only epidermis, causes redness and swelling but no blisters, no edema, blanches with pressure, painful ex is sunburn

A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? a. The risk for rejection is much less with this type of transplant." b. "You'll need to have an incision in your hip area to instill the cells." c. "You won't need to receive the high doses of chemotherapy before the transplant." d. "We'll need to have a match to a donor."

d. "We'll need to have a match to a donor."

What kind of diet should a person with anemia have? (iron deficiency) what food/ drink should they avoid due to poor iron value

diet high in iron- foods such as red meat, tuna, salmon, eggs, tofu, enriched grains, leafy greens, dried beans, peas and fruits avoid cows milk

Medication to treat JIA

methotrexate

function of monocytes

phagocytosis; develop into macrophages in tissues, fight bacteria

function of lymphocytes

produce antibodies, (immune response) , respond to viral infections- measles, rubella, chickenpox)

Signs and symptoms of Hirshsprung's Disease

ribbon like stool

Signs and symptoms of cholinergic crisis

severe muscle weakness, sweating, increased salivation, bradycardia, and hypotension.

s/s and treatment of Wilms tumor - Hallmark sign? what should the nurse avoid doing

Aka Nephroblastoma- cancerous tumor originating in the cells of the kidney- renal tumor Hallmark sign - hypertension (nurse should measure BP frequently), visible mass on the abdomen. Nurses should avoid palpating the abdomen as the tumor is highly vascular and soft- palpating might cause metastasis Treatment: Surgical intervention-removal of kidney and tumor, , chemotherapy, radiation

Major complications of luekemia

Anemia secondary to decreased RBC production Bleeding secondary to decreased platelet production Infection secondary to neutropenia

medications for crohns disease, s/s of crohns

Antibiotics (usually metronidazole and ciprofloxacin) Methotrexate: sometimes used to manage severe Crohn disease Anti-tumor necrosis antibody therapy: widely used for children with Crohn disease; s/s :delayed sexual deveolpment, fever, weight loss, poor growth, abdominal cramping,

Treatment of myasthenic crisis

Anticholinesterase medications such as pyridostigmine, corticosteroids and other immunosuppressants. plasmapheresis, IVIG, and thymectomy

Risk factors of dehydration

Diarrhea Vomiting Decreased oral intake Sustained high fever Diabetic ketoacidosis Extensive burns

The nurse is preparing to administer IVIG to a child who has not received the medication before. What medication should the nurse expect to administer prior to the infusion?

Diphenhydramine Premedication with diphenhydramine or acetaminophen may be indicated in children who have never received IVIG, have not had an infusion in more than 8 weeks, have had a recent bacterial infection, have a history of serious infusion-related adverse reactions, or are diagnosed with agammaglobulinemia or hypogammaglobulinemia. Aspirin, ibuprofen and prednisone would not routinely be administered prior to IVIG

What do you premedicate with before giving IVIG? what med should you have on standby

Diphenhydramine and tylenol Epinephrine

Nursing interventions for extensive burns

Promoting oxygenation and ventilation (non rebreather) Restoring and maintaining fluid volume Preventing hypothermia Cleansing the burn Preventing infection Managing pain with a-traumatic care Treating infected burns Providing burn rehabilitation

s/s of celiac disease

- Fatty stools (steatorrhea) - Diarrhea -constipation -weight loss, failure to thrive - Abdominal distension - poor muscle tone -wasted extremities - Bloating -Anemia

Signs of severe dehydration treatment of severe dehydration treatment of mild dehydration

1.) Alert to comatose mental status, sunken fontenls, sunken eyes, dry oral mucosa, tenting skin turgor, increased HR, progressing to bradycardia, Normal BP, progressing to hypotension, Cool, mottled, or dusky, significantly delayed capillary refill 2.) IV rehydration therapy - 20 mg/kg bolus at a time, if cardiac history then 10mg/kg ( assess heart and lung sounds before/after) 3.) oral rehydration therapy - pedialyte, give slowly 5-10 ml every 5-10 minutes (50-100mls over 4 hours) , give popsciles

A nurse is reviewing the laboratory test results of a 3-year-old child. Which absolute neutrophil count would the nurse identify as indicating neutropenia? 2.0 2.5 1.0 1.5

1.0

S/S of GERD in infants

Emesis/spitting up after feeding, arching back with feedings, gagging, hiking, smacking, irritability with feeding, poor weight gain, apnea, aspiration pneumonias Recurrent vomiting or regurgitation Weight loss or poor weight gain Irritability in infants Respiratory symptoms (chronic cough, wheezing, stridor, asthma, apnea) Hoarseness/sore throat Heartburn or chest pain Abdominal pain Palpation of abdomen may incuce vomiting

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease? what is used treat it

Hirschsprung disease, surgical repair, requires an ostomy

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? "My child's stools are darker than usual." "I mix ferrous sulfate with milk in a bottle." "I brush my child's teeth once every day." "My child takes ferrous sulfate after meals."

I mix ferrous sulfate with milk in a bottle."

Medications to treat Guillain Barre syndrome and Myasethenia Gravis

IVIG anticholinesterase - pyridostig,one

A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case? Short-bowel/short-gut syndrome Intussusception Volvulus with malrotation Necrotizing enterocolitis

Intussusception

Pauciarticular (oligoarticular) s/s

Involvement of four or fewer joints; quite often the knee is involved. Eye inflammation, malaise, poor appetite, poor weight gain polyarticular affects the small joint

Sign of Measles (Roseola)

Koplick spots

Which intervention is best to use with the 6-year-old who has developed stomatitis (oral mucositis) as a side effect of chemotherapy? Use lidocaine rinses Limit foods to cool, clear liquids Have the child freely choose desired foods and beverages Practice frequent, gentle oral hygiene

Limit foods to cool, clear liquids

A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant?

Lower Right

s/s and treatment of Neutropenia (abnormally low WBCs - neutrophils) - what are the precautions

Neutrophils fight infection ANC below 500= greatest risk Neutropenic precautions: Private room, hand hygiene, no raw fruits/veggies, no live plants/flowers, must wear mask, monitor for signs and symptoms of infections Neutrophils are used to fight infections, when low there is a high chance of bacterial infections. Chemo cause destruction of these cells from 7-28 days after administration. Teach parents to look for s/s of infection, too wash hands

Impetiego

Staphylococcus typical cause. Begins as a macule to vesicle. Ruptures leaving a moist erosion. Exudates dries and forms the characteristic honey colored crusts. Pruritic. Treated with local antibiotic and softening of crusts with a Burrows solution removal prior to application of antibiotic Oral antibiotics if larger spread Nursing major focus is prevent spread of infection, teach family to administer medications

Nuring management/intervention for GERD

Teach CPR to families appropriate positioning, such as elevating the head of the bed and keeping the infant or child upright for 30 minutes after feeding. Smaller, more frequent feedings Prokinetic agents (metoclopramide, reglan maintain patent airway do not put infants on swings frequent Burping thickening formula -use of oatmeal may be healpful

A child will receive IV immunoglobulin (IVIG). The nurse assesses the child every 15 minutes for the first hour of infusion for symptoms of anaphylaxis. Which symptom(s) would indicate to the nurse that anaphylaxis is occurring? Select all that apply. The child's blood pressure begins to elevate. The child's temperature begins to elevate. Inspiratory wheezes are heard on auscultation. The child's face is flushed. The child appears increasingly anxious

The child's blood pressure begins to elevate. The child's face is flushed. The child appears increasingly anxious fever, chills

Nursing management of Myathenia Gravis

The goals of nursing management include the prevention of respiratory problems and providing adequate nutrition. Administer anticholinergic or other medications as ordered- give 30 mins before eating, Encourage appropriate stress management and avoidance of extreme temperatures.

The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing action is priority? The nurse follows contact precautions. The nurse applies topical antibiotics to the lesions. The nurse applies elbow restraints to the infant. The nurse soaks the skin with warm water.

The nurse follows contact precautions.

What to assess for patient with dehydration

When did the the N/VD start, how frequently a How much are you urinating- how much are you urinating Consistency of stool How much are you vomitting What did you eat or drink

partial thickness burn (second-degree burn)

a burn involving the epidermis and dermis that usually involves blisters; moist painful, does not blanche when pressure is applied, appears red and swollen Deep partial thickness - does not form blisters