Pediatrics Exam 4

What are the clinical manifestations of a TEF or EA?

-newborn with frothy saliva in mouth and nose -choking and coughing -cyanosis and apnea -stomach distention -aspiration

What are some home care instructions of an infant with SBS?

-nonnutritive sucking -oral stimulation -small amounts of oral feeding as prescribed

Which TEF-EA is classified as TYPE A: 1. a blind pouch with no communication to the trachea 2. upper segment of esophagus opens directly into trachea (risk of aspiration) 3. proximal esophageal segment ends in a blind pouch and distal end is connected to trachea 4. trachea and esophagus are connected by a fistula

1. 1. a blind pouch with no communication to the trachea

What are three ways to medically manage CDH?

1. ECMO - extra-corporeal membrane 2. high frequency ventilation 3. surgical repair of diaphragm

Progression of MRSA can cause what two things?

1. cellulitis 2. sepsis

What are two ways to diagnose intussusception?

1. rectal exam showing mucus and blood 2. barium enema

What are three long term complications of a cleft palate?

1. speech problems 2. URI's 3. hearing loss

What is normal urine output for an older child/adult

30 cc/hr

What is a normal pH in a urine analysis?

4.8-7.8

What is done in a rectal biopsy?

A small portion of large intestine is removed and examined for absence of ganglion cells

What else could easily occur in an infant with cleft lip/cleft palate?

Chronic ear infections

***Cobblestoning of mucosa: Crohn's or ulcerative colitis?

Crohn's

Segmental, asymmetric distribution of lesions (skip areas): Crohn's or ulcerative colitis?

Crohn's

HSV limited to children between 6 months and 3 years

HSV 6/7

Clinical manifestations include a very large, hard inflamed lump

MRS

What is the medical management of hypertrophic pyloric stenosis?

Surgery - pyloromyotomy

What is the treatment for hirschsprung disease?

Surgical removal of the aganglionic part of the bowel to restore normal motility

How do prokinetics reduce GERD?

They increase LES pressure and the rate of gastric emptying Ex. reglan

What is a pyloromyotomy?

They make a longitudinal incision through circular muscle of the pylorus into the submucosa which releases restriction and establishes adequate passageway

***Intestinal bleeding is common: Crohn's or ulcerative colitis?

Ulcerative colitis

Which part of the GI system does ulcerative colitis affect?

Ulcerative colitis involves inflammation of the mucosa and submucosa of the colon and rectum

What is the gold standard when it comes to diagnosing VUR?

VCUG - voiding cystourethrogram

How is chickenpox spread?

airborne

HSV 3 is aka

chickenpox

Tinea means

fungal infection

What is a repogle catheter?

used to remove secretions in an EA before surgery

Elevated skin lesion containing fluid

vesicle

Warm, red, raised lesion (hives, urticaria, allergic reaction)

wheal

What time of year does AGN commonly occur?

winter

What is the pathophysiology of Hirschsprung disease?

-absence of ganglion cells in parts of the colon causes lack of nerve stimulation, decreased ability of the internal sphincter to relax (decreased peristalsis), and accumulation of intestinal contents (megacolon)

What are some long term complications of gastroschisis?

-bowel adhesions -bowel obstruction -severe GERD

What are some clinical manifestations of AGN?

-edema (weight gain) -dark-colored urine (hematuria) -oliguria -proteinuria -hypertension

What are some clinical manifestations of a UTI in a young child?

-enuresis (especially at night) -abdominal pain -vomiting -fever -strong-smelling urine -dysuria -frequency -urgency

What are the clinical manifestations of Hirschsprung disease in a newborn?

-failure to pass meconium within 24-48 hours after birth -refusing food, vomiting, abdominal distention

Which foods decrease LES pressure and should be avoided to prevent GERD?

-fatty foods -chocolate -tomato products -carbonated beverages

What are some clinical manifestations of a UTI in an infant?

-fever -FTT -vomiting/diarrhea -abdominal distention -jaundice -strong odor to urine

Which foods increase gastric acid secretion and should be avoided to prevent GERD?

-fruit juices -citrus products -spicy foods

What results would you get from a urine analysis done on a patient with AGN?

-hematuria wi/ RBC casts -proteinuria -increased specific gravity

What is a typical diet for a patient with Crohn's or ulcerative colitis?

-high protein -high calorie -iron and folic acid supplements

What is the therapeutic management of cryptorchidism?

-hormone therapy -orchiopexy

What are the major concerns with a gastroschisis?

-infection -heat and fluid loss from exposed viscera

What is a grade five VUR?

-into renal pelvis -major dilation

What is a grade three VUR?

-into renal pelvis -mild dilation

What is a grade four VUR?

-into renal pelvis -moderate dilation

What is a grade two VUR?

-into renal pelvis -no dilation

What is a grade one VUR?

-into ureters only -no dilation

What are some things you could do to help your infant with feeding?

-keep them upright -smaller, more frequent amounts (increase calories per ounce) -use longer nipples

What are four major signs of nephrotic syndrome?

-massive proteinuria -hypoalbuminemia -hyperlipidemia -edmea

What position should you place a patient that has just had cleft lip surgery?

-supine or side lying

What makes up the upper urinary tract?

-ureters -renal pelvis -calyces -renal parenchyma

What makes up the lower urinary tract?

-urethra -bladder

What are three pharmacologic treatments of GERD?

1. antacids/histamine receptor antagonists (zantac, pepcid) 2. proton pump inhibitor (prilosec) 3. prokinetic (reglan)

Diarrhea is the main symptom of short bowel syndrome (SBS) and as a result the two big things we need to watch for are:

1. dehydration 2. malnutrition

***How can we prevent necrotizing enterocolitis?

1. hold oral feedings for 24-48 hours if history of birth asphyxia 2. give breast milk rather than formula

What two things are used with a patient who has just had cleft lip surgery?

1. logan bow (two wires that pull the cheeks together) 2. elbow/arm immobilizers

What are the three types of nephrotic syndrome?

1. minimal-change nephrotic syndrome (MCNS) 2. secondary 3. congenital

What two things should you look for as a nurse caring for a patient with possible imperforate anus?

1. passage of meconium 2. presence of stool in urine or vagina

What are three clinical manifestations of VUR?

1. persistent/recurrent UTI 2. renal disease 3. poor growth

What are four major clinical manifestations of hypertrophic pyloric stenosis?

1. projectile vomiting - contains milk/formula but NO bile 2. visible gastric peristalsis 3. olive-shaped mass in epigastrium just to the right of the umbilicus 4. FTT

What two diagnostic tests are used to test for Hirschsprung disease?

1. rectal biopsy 2. barium enema

What two things would be seen on x-ray of a patient with necrotizing enterocolitis?

1. sausage-shaped dilation of intestine and bubbly appearance of thickened bowel wall (pneumatosis intestinalis) 2. pneumoperitoneum

What are four nonpharmacologic treatments for GERD?

1. small frequent feedings and frequent burping 2. avoid foods that make acid reflux worse 3. thickening of feeds 4. positioning of the infant

***What are five clinical manifestations of intussusception?

1. sudden episode of acute, colicky abdominal pain (screaming and drawing up knees to chest) 2. intervals where the child is comfortable 3. vomiting 4. sausage-shaped mass in RUQ 5. Jelly-like stool (stool mixed with blood and mucus)

What is a normal specific gravity in a urine analysis?

1.016-1.022

When is surgical repair usually done for a cleft palate?

12-15 months

What age does ulcerative colitis peak at?

15-20 years

Which of the following urine analysis results is abnormal? 1. specific gravity = 1.019 2. pH = 5.4 3. protein, glucose, and ketones present 4. RBC count <1

3. protein, glucose, and ketones present

The nurse should carefully observe the infant with a tentative diagnosis of pyloric stenosis for: 1. Quality of cry 2. Quality of stool 3. Signs of dehydration 4. Coughing and gagging after feeding

3. signs of dehydration

A nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? 1. Bloody diarrhea 2. Hypotension 3. A hemoglobin level of 12 mg/dL 4. Rebound tenderness

4 - rebound tenderness indicates peritonitis which is serious and needs to be reported

At what week gestation are the esophagus and stomach identified?

4 weeks gestation

Which TEF-EA is classified as TYPE E: 1. a blind pouch with no communication to the trachea 2. upper segment of esophagus opens directly into trachea (risk of aspiration) 3. proximal esophageal segment ends in a blind pouch and distal end is connected to trachea 4. trachea and esophagus are connected by a fistula

4. trachea and esophagus are connected by a fistula (risk of aspiration)

The nurse is providing education to a family whose child was just diagnosed with Gastroesophageal Reflux. Which of the following do the caregivers need to know regarding safety at home? a) Keep the child in an upright position for an hour after feeding b) Lying flat on the right side will alleviate symptoms c) Avoidance of certain foods d) Diet changes are never necessary if the child is on medication

A and C

What is done in a barium enema?

A small tube is placed in rectum and barium contrast is pushed into the large intestine (this tells us the transition zone)

What is the haberman feeder?

A specially designed bottle and nipple with a one way valve that adjusts the flow of formula for babies with sucking problems

How is peristalsis difference in a pediatric patient vs. an adult patient?

Children have faster peristalsis and infants can have reverse peristalsis (causing regurgitation)

Frequent recurrences:; Crohn's or ulcerative colitis?

Crohn's

Which part of the GI system does Crohn's affect?

Crohn's involves the entire GI tract and all layers of the bowel wall

Which disease tends to have more serious complications and the medical/surgical treatment is less effective: Crohn's or ulcerative colitis?

Crohn's tends to have more serious complications and the medical/surgical treatment is less effective

T/F a Celiac's patient is allowed to have commercially prepared ice cream and pudding in their diet

FALSE

T/F breastfeeding is possible with a cleft palate

FALSE

Clinical manifestations occur in 3 stages: Stage one: SLAPPED FACE appearance (erythema on face/cheeks) Stage two: maculopapular red spot on UE and LE one day after rash appears Stage three: rash subsides but comes back whenever skin is irritated

Fifth disease (erythema infectiosum)

You are a nurse preparing to do a barium enema in a patient suspected of having intussusception. What is it important to do before giving the enema?

Get an abdominal x-ray to check for any intraperitoneal air indicating a bowel perforation

Clinical manifestations include a high fever for 3-4 days that goes away and is replace by rash with rose-pink macules starting on trunk, then on trunk, then on face

HSV 6/7

Clinical manifestations include fever, fatigue, pharyngitis, SPLEEN ENLARGEMET

HSV type 4

***The most common clinical manifestation of this disease in a child is chronic constipation with ribbon-like, foul smelling stools and abdominal distention

Hirschsprung disease

This disease is a congenital anomaly resulting in mechanical obstruction from inadequate motility of part of the intestine

Hirschsprung disease (ACUTE or CHRONIC)

How does necrotizing enterocolitis develop?

Ischemia causes damaged/dead cells. Mucosal enzymes can now further break down the intestinal wall. Bacteria invade the damaged area and peristalsis stops causing abdominal distention

Type of staph that is resistant to certain antibiotics

MRSA

What is the diagnostic tool used to diagnose CDH?

Meckel scan

Why would we need to reassure parents to place GERD infants in prone position when sleeping?

Most are aware of the recommondation to position infants in the supine position to prevent SIDS so we will have to reassure them of the importance of placing their baby in the prone position in order to prevent GERD

This is an acute inflammatory disease of the bowel in preterm/high-risk infants

Necrotizing enterocolitis (NEC)

Raised, skin color lesion

Papule

T/F CDH can be diagnosed and treated in utero

TRUE

T/F HSV symptoms are often precipitated by overexposure to sunlight, febrile illness, stress

TRUE

T/F Hirschsprung disease is usually associated with other anomalies like Down's

TRUE

T/F MRSA lives on the skin and is easily transmitted

TRUE

T/F part of nursing management for VUR could include screening for sibling

TRUE

T/F the stomach lies horizontally until age 2

TRUE

T/F there is a relationship between formula feeding and the development of necrotizing enterocolitis

TRUE

T/F a patient with HSV 4 should not play contact sports

TRUE - risk for enlarged spleen

Why would edema be a clinical manifestation of AGN?

The blockage of the kidneys causes the edema

A 6-month old, previously healthy child comes in and won't stop screaming and keeps pulling his knees up to his chest. What clinical manifestations would indicate to the nurse that the child has intussusception?

There is a sausage-shaped mass in the right upper quadrant and the child is vomiting and has jelly-like stool

What will a patient with Celiac's disease supplement for gluten in order to maintain a gluten-free diet?

They can substitute corn, rice, and millet as grain sources

Which age group does Crohn's tend to affect?

Younger populations

A postinfectious kidney disease

acute glomerulonephritis (AGN)

How can you thicken an infant's feed?

add 1tsp - 1tbsp of rice cereal per ounce of formula

What is pneumoperitoneum?

air in the abdomen (indicting the bowel has perforated or torn and air has leaked out)

What lab would help us determine level of malnutrition in a patient with GI dysfunction?

albumin and prealbumin

What is a fistula?

an abnormal connection between things

What is an atrasia?

an abnormal opening

What would a lab done on a child with Crohn's or ulcerative colitis show us?

anemia and inflammation from increased erythrocyte sedimentation rate

What is used for pain management with hypospadias/epispadia?

anticholinergics (like dotripan) to relieve bladder spasms

How should the nurse respond to a fever day 5 after a GI surgery?

be concerned because there shouldn't be a fever

The AAP guidelines for evaluating febrile infants and children from 2 to 24 months recommends obtaining a urine specimen for culture and urinalysis before what?

before an antimicrobial agent is administered

Why wouldn't a nurse report bloody diarrhea and hypotension in a patient with ulcerative colitis?

bloody diarrhea and hypotension are expected findings

Your patient has a fever, abdominal distention, vomiting, abdominal tenderness, dyspnea, and cyanosis. What should be your primary concern?

bowel perforation

In children under 2 y.o. with a possible UTI, what is the preferred method of collecting a urine specimen?

catheterization or suprapubic aspiration

What effect can congenital diaphragmatic hernia have on the lungs?

causes compression of lungs by abdominal organs (they develop pulmonary hypoplasia)

Clinical manifestations include swollen, red, warm skin occasionally with streaking

cellulitis

Localized infection secondary to break in skin barrier, usually staph, strep, of H flu, penetrate dermis and sub Q tissue

cellulitis

Clinical manifestaions include "dew drop on a rose petal" rash, fever, fatigue, decreased appetite

chickenpox HSV 3

Downward curvature of the penis is known as

chordee

This facial deformity includes the external nose, nasal septum and dental anomalies

cleft lip

This occurs from incomplete fusion of the embryonic structures surrounding the primitive oral cavity

cleft lip

This facial deformity includes the nostril/complete absence of the nasal septum

cleft palate

This occurs when the primary and secondary palatine plates fail to fuse during embryonic development

cleft palate (CP)

Failure of diaphragm to form completely in utero is known as:

congenital diaphragmatic hernia (CDH)

A disorder characterized by undescended testis

cryptorchidism -also retractile testis (cremasteric reflex)

What is the first thing done with an infant born with untreated CDH?

emergency endotracheal intubation

If there is a failure of the esophagus to develop as a continuous passage it is called:

esophageal atresia (EA)

How often should BP measurements be taken in a patient on diuretics for AGN?

every 4-6 hours

Why would an infant with GI dysfunction be hypokalemic?

excessive vomiting could cause decreased potassium levels

What is the final phase of feeding with an SBS patient?

exclusive enteral feedings

When is surgical repair usually done for a cleft lip?

first few months of life

If an infant has a cleft lip and cleft palate, which would be repaired first?

first the cleft lip repair then the cleft palate repair

This occurs when the bowel herniates through a defect in the abdominal wall to the right of the umbilical cord and through the rectus muscle

gastroschisis

HSV 2 is known as

genital herpes

Clinical manifestations include low grade fever, headache, malaise, sore throat, cough, rash starting on face and spreading downward that disappears on the third day

german measles (rubella)

AGN is an infection by which organism?

group A hemolytic streptococcus

***This condition causes PROJECTILE VOMITING which leads to dehydration, METABOLIC ALKALOSIS and FTT

hypertrophic pyloric stenosis (HPS)

When should the parents of a discharged patient with SBS be concerned?

if their child starts to develop a fever (indicating infection)

Absence of a normal anal opening is known as

imperforate anus

Infection when staphylococcus aureus and streptococcus invade the dermis

impetigo

What is the first sign that a patient with AGN is recovering?

increased urine output and decreased body weight

What is the second phase of feeding with an SBS patient?

introduction of enteral feeding

What does a UGI (upper GI x-ray) tell us?

it tells us about the mucosal intactness

small, irregular red spots with bluish white center on buccal mucosa

koplik spots (seen with measles)

What are normal creatinine levels in an infant?

less than 0.4 mg/dL

What are normal creatinine levels in a child?

less than 00.7 mg/dL

What are normal creatinine levels in an adolescent?

less than 1 mg/dL

What are normal BUN levels in a newborn?

less than 12 mg/dL

What are normal BUN levels in an older patient?

less than 18 mg/dL

Cystitis/urethritis is UTI in which part of the urinary tract?

lower urinary tract

Small, flat skin lesion less than 1cm

macule

Raised skin lesion with a color change

maculopapule

Which type of nephrotic syndrome is most common in preschool children?

minimal-change nephrotic syndrome

How is strep throat treated?

oral antibiotics: penicillin

Management of lice includes treatment using

pediculocide (be aware it is neurotoxic)

What is the most significant sign of necrotizing enterocolitis?

pneumatosis intestinalis (gas in the intestinal wall)

What is the most common sign of pyloric stenosis?

projectile vomiting

How should you care for a gastroschisis pre-op?

protect the viscera with moist dressings or silo

Elevated skin lesion containing fuid (pus, bacteria related)

pustule

HSV 3 is AKA

shingles

Clinical manifestations include vesicular eruption along affected nerve/dermatome, stinging, burning, and tingling clustered group of vesicles

shingles HSV 3

Clinical manifestations include sore throat, fever, sandpaper-like rash

strep throat

Why would the antistreptolysin (ASO) titer be increased in a patient with AGN?

the presence of the streptococcus

What is a persistent cloaca?

the rectum, vagina, and urethra all drain into a common channel opening into the perineum

Which trimester is the period of the most extensive and rapid growth?

the third trimester

How are a newborn's glomeruli different from an adult's?

they are enlarged after birth

Clinical manifestations include an annular lesion that is flaky in center and also there is hair breakdown (more common in dark people)

tinea capitis (superficial, on scalp)

Clinical manifestations include an annular, well-defined red border with central clearing (superficial: upper epidermis)

tinea corporis

Why would a patient have an NG tube following GI surgery?

to help pull out excessive secretions from the GI tract (not for nutrition)

Why should oral stimulation be encouraged in an infant following a GI surgery?

to preserve the suck/swallow reflex

If there is a failure of the trachea and esophagus to separate into distinct structures it is called:

tracheoesophageal fistula (TEF)

How should the nurse respond to a fever the day after GI surgery?

treat appropriately but it is anticipated

Continuous, symmetric distribution of lesions: Crohn's or ulcerative colitis?

ulcerative colitis

Cured with a colectomy: Crohn's or ulcerative colitis?

ulcerative colitis

Superficial, extensive ulceration: Crohn's or ulcerative colitis?

ulcerative colitis

pyelonephritis is a UTI in which part of the urinary tract?

upper urinary tract

A child with GERD was prescribed Prilosec, a proton pump inhibitor that decreases GERD by reducing gastric acid secretion. What should the nurse be aware of as possible side effects to Prilosec?

-nausea/vomiting -diarrhea/constipation -abdominal pain -headache/dizziness

What is normal infant urine output?

1 cc/kg/hr

What is normal neonate urine output?

1-2 cc/kg/hr

What is an important nursing intervention for a pre-op patient with hirschsprung disease?

1. Measure the abdominal curve

What are two therapeutic managements of VUR?

1. continuous antibiotic prophylaxis (CAP) 2. surgery

What are the two most serious complications with intussusception?

1. perforation 2. peritonitis

What two diagnostic tests are used to test for hypertrophic pyloric stenosis?

1. x-ray - will show a dilated stomach 2. ultrasound - will show the pyloric mass

Which TEF-EA is classified as TYPE B+D: 1. a blind pouch with no communication to the trachea 2. upper segment of esophagus opens directly into trachea (risk of aspiration) 3. proximal esophageal segment ends in a blind pouch and distal end is connected to trachea 4. trachea and esophagus are connected by a fistula

2. upper segment of esophagus opens directly into trachea (risk of aspiration)

An infant is diagnosed as having pyloric stenosis. When palpating this infant's abdomen, the nurse would expect to find: 1. An impacted and distended colon 2. Marked tenderness around the umbilicus 3. An olive-sized mass in the right upper quadrant 4. Rhythmic peristaltic waves in the lower abdomen

3. an olive-sized mass in the right upper quadrant

Which TEF-EA is classified as TYPE C: 1. a blind pouch with no communication to the trachea 2. upper segment of esophagus opens directly into trachea (risk of aspiration) 3. proximal esophageal segment ends in a blind pouch and distal end is connected to trachea 4. trachea and esophagus are connected by a fistula

3. proximal esophageal segment ends in a blind pouch and distal end is connected to trachea -stomach distends with air -gastric contents regurgitate through fistula into trachea

What can parents use to help their GERD infant sleep in the prone position?

Commercially made harnesses or an improvised harness made with a baby blanket

***Most frequently affected site is the terminal ileum: Crohn's or ulcerative colitis?

Crohn's

Deep ulcerations: Crohn's or ulcerative colitis?

Crohn's

Strep throat

Group A beta-hemolytic streptococci

This disease is the inversion of one part of the intestine within another

Intussusception (occurs in healthy children 3-12 months)

What is initial phase of feeding with an SBS patient?

TPN

T/F breastfeeding is possible with a cleft lip

TRUE

T/F parents should avoid vigorous play following feedings and avoid feeding just before bedtime with children with GERD

TRUE

What positions can decrease GERD in an infant?

The upright or prone position can decrease GERD

What is important to remember about proton pump inhibitors?

They have increased side effects like nausea, vomiting, diarrhea, and constipation Ex. prilosec

What is the median age of onset for AGN?

between 6 and 8 years

What is teatorrhea?

impaired fat absorption

How is a newborn's loop of Henle different from an adult's?

newborns have a short loop of Henle

When will gastroschisis be surgically repaired?

within 24 hours of birth