Week 3 - GI
When assessing an infant/child/adolescent with acute diarrhea, the nurse should be sure to ask about what?
-# and frequency of stools -duration of symptoms -stool volume: how much are you pooping each time? -any abd pain, cramping, N/V, fever? -any blood (potentially bacterial diarrhea) or mucus-like things in stool?
When conducting a physical exam on a child with Celiac disease, the nurse can expect to see what findings?
-A distended abdomen -Wasted buttocks -Thin upper and lower extremities
When performing post-op dressing changes on infants/children/adolescents (or anyone really), the nurse knows it is IMPORTANT to...
-ADMINSTER ORDERED PAIN MEDS PRIOR TO DOING THE DRESSING CHANGE -Employ appropriate distraction techniques based on the pt's age and/or personal preference (have TV on, have parent/fam member sing or read a book) -Contact child life if you really need help w/ this
The nurse knows that foods that should be avoided by people with Celiac disease include...
-ANYTHING with wheat, rye, or barley (especially breads) -Pasta -Pizza -Processed and canned foods
Hospital mgmt of severe dehydration
-Admission to hospital needed if rehydration through PO rehydration is not working. IV rehydration is now needed -Frequent assessment of BP, HR, perfusion (cap refill), skin turgor, status of mucus membranes, and degree of how sunken the fontanelles are -Daily wts -Is & Os -Monitoring of lab values: expect to see low HCO3 and high H&H
Expected lunchtime meals for a child with Celiac disease
-Almond banana sandwich on gluten free bread -Tuna with basmati rice and veggies
Mgmt of functional constipation
-Assess and address stressors child may be facing -Encourage at least 2 L fluid a day, teach parents and child about fiber rich foods -Bowel regimen: expect to see docusate (Colace - stool softener) and polyethylene glycol (Miralax) to help move and "cleanse" bowels -Disimpaction by doc if it's that bad -ENCOURAGE BOWEL TRAINING: after meals, encourage child to sit on toilet and move bowels. Don't rush! -Encourage breastfeeding (if mom isn't contraindicated): breastfeeding produces softer infant stools
The nurse can anticipate for what kind of dx studies to be ordered for an infant/child suspected of Hirschspurng disease?
-Barium enema -Rectal suction biopsy (definitive dx test for Hirschsprung)
The nurse recognizes which of the following as potential causes of cleft lip and/or palate?
-Chromosomal anomalies (Pierre Robin syndrome) -Congenital heart defects, ear malformations, skeletal deformities, and/or genital abnormalities -MATERNAL SMOKING -Prenatal infection -Advanced maternal age -Use of certain meds (e.g. anticonvulsants, corticosteroids) during pregnancy -Being of Asian, Native American, or Hispanic descent
CMs of cleft lip and palate
-Cleft lip: observable when looking at child. May involve small part of lip or extend all the way up to the nostril -Cleft palate: noticeable upon examination (inspection & palpation) of the mouth
Because wheat, barley, rye, and potentially even oats need to be avoided in patients with Celiac disease, the nurse is correct in teaching the patient about which of the following gluten-free grains and starches?
-Corn -Quinoa -Millet -Rice, wild rice -Buckwheat -Flax -Lentils -Potatoes -Soy -Yucca -Tapioca
The nurse knows that appropriate snacks for a child with Celiac disease include...
-Cottage cheese with fruits -Hummus with cucumber and pretzels
For breakfast, the nurse can anticipate for the dietician to suggest what kinds of foods for a child with Celiac disease?
-Eggs -GLUTEN FREE oatmeal -Smoothies (with fruits like blueberries, mangos, and strawberries)
Teaching fora cute diarrhea
-Ensure careful cleaning and preparation of food is being done at home -Handwashing: should be 15-20 seconds with soap and water on all surfaces of hands + fingernails. Are all siblings, family members, and anyone else around the infant/child/adolescent doing this? -If infant or preschooler attends daycare and develops diarrhea, TELL THE DAYCARe -Ensure that clean water supply is available for the infant/child/adolescent to drink out of
The nurse knows that goods that are NATURALLY gluten-free include...
-Fruits -Vegetables -Beef -Poultry -Fish -Nuts -Eggs -Dairy products: all milk and milk products (except those made w/ gluten additives), aged cheese)
Which of the following are expected CMs of acute appendicitis?
-General appearance: anorexic and very ill. Unable to walk/climb up onto the examination table w/o assistance. -PAIN (abdominal): initially starts off as very vague but eventually localizes to RLQ @ McBurney's point within a few hours -N/V that usually develops after the onset of pain -Frequent small-volume and soft stools that are often confused w/ diarrhea -Irritability, reports of discomfort, apprehensive/ anxious appearance
In addition to avoiding gluten containing foods, the nurse knows that generally, a gluten free diet is one that is...
-HIGH in calories and proteins -LOW in fat
The nurse knows that which of the following correctly describes the pain that is characteristic of acute appendicitis?
-INITIALLY, the pain may start as vague abdominal pain -Over the course of a few hrs: the abd pain may localize in the RLQ, specifically at a location in the RLQ known as McBurney's point. When palpating the abdomen of a patient with acute appendicitis, they will report the most pain and tenderness here.
The nurse knows that PO rehydration is beneficial because...
-It's safer, less painful, AND less costly than IV rehydration -The PO rehydration solns used (-lytes: usually pedialyte but also infalyte and ricelyte) enhance and promote reabsorption of H2O and Na -Reduces vomiting, diarrhea, and duration of illness
CMs of intussusception
-Jelly-like stools -Abd pain that stops and starts -Mucus and blood in stool -Sausage-shaped mass in the upper mid abdominal area
The nurse knows that the intracellular fluid (inside cells) contains...
-K -Protein (esp. albumin) -Phosphate -Sulfate
Anticipated surgical tx of acute appendicitis
-Laparoscopic (minimally invasive) appendectomy for an unperforated appendix -OPEN appendectomy needed for a perforated appendix
The nurse knows that the extracellular fluid (outside of cells) contains...
-MOSTLY Na -Cl -HCO3-
-Expected DINNER meals for a child w/ Celiac
-Orange chicken bowl -Vegetarian tacos w/ sweet potatoes
Post-op care for a patient who has just undergone surgery for acute appendicitis intervention includes...
-PAIN assessment and mgmt so that pt is comfy enough to ambulate early, use incentive spirometer (during commercial breaks on TV), and cough and deep breathe q2h -Checking dressing and surgical site for excess bleeding and s/s infection -Continuing abx for 7-14 days (needed for pts who had a perforated appendix) -Teaching parents of pts w/ perforated appendix that they can expect to continue the abx at home when discharged. The abx course should be completed in full and should never be stopped, even when the pt feels/looks better -Potential for NG tube post-op: parent might be wondering why there's a tube in their child's nose when they see them in PACU/back on the floor
A parent asks the nurse why PEDIALYTE is preferred over gatorade for oral rehydration. The nurse knows that pedialyte is preferred because...
-Pedialyte has LESS SUGAR than gatorade -Pedialyte ALSO has higher Na content than gatorade, which helps w/ the restoration of lost Na
The nurse recognizes that compliance w/ a gluten free diet for adolescents with Celiac disease is a challenge because...
-Peers might make fun of them, may not even accept them for who they are -will make it hard to eat out with friends
The nurse is caring for an infant who is S/P surgical repair of a cleft lip. Knowing this, the nurse knows to include which of the following when planning care for this infant?
-Positioning the pt supine or side-lying (but not on the operated side) to prevent the infant from rubbing the facial suture line -If the infant has a Logan bow, anticipated teaching the infant's parents/fam members that this in place so that there will be no stress placed on the sutures (prevents the sutures from getting ruptured/re-opened so that healing is maximized) -As a LAST RESORT: arm wraps might be placed on the infant. Important to note that arm wraps on both arms is considered a restraint.
The nurse recognizes which of the following as CMs of hypertrophic pyloric stenosis?
-Projectile vomiting but infant exhibits hunger cues soon after vomiting -Dehydration (d/t profuse vomiting), metabolic alkalosis (d/t loss of stomach acid w/ projectile vomiting) -Poor wt gain d/t loss of everything they eat -Palpable olive mass
For a infant/child/adolescent w/ acute diarrhea, the nurse can anticipate for what kinds of lab tests to be ordered by the pediatrician?
-STOOL SAMPLE for stool cx -BMP to assess fluid & elec balance out of concerns for dehydration caused by diarrhea
The nurse recognizes which of the following as bacteria that can cause acute bacterial diarrhea?
-Salmonella -E. coli -Shigella -Campylobacter
Prior to sending a patient w/ an appendectomy down for surgery, the nurse should be sure that...
-Surgeon came and spoke to fam, explained (+)/(-), answered Qs about procedure, obtained consent from parent, marked correct surgical site -Anesthesia assessed pt -Baseline labs were drawn and electrolyte repletions were done if needed -Pain is managed at an acceptable level -Type and screen was collected -IVs were placed -The necessary ordered abx were administered (typically ordered to decrease R/F post-op infection) -Teaching to the parents and patient regarding what they can expect AFTER the procedure (PACU then up to floor for recovery) has been done
The nurse knows that a gluten free diet might be hard to maintain for children with Celiac disease because...
-This may require clearing out almost all of the food they currently have in their kitchen/pantry -Some cultures might have foods with gluten in it as staples in their diet -Parents might not always understand what foods have gluten and what foods don't -There are different levels of severity of Celiac. Sometimes even contamination with gluten-containing products can trigger Celiac disease -Family members may not be willing to adapt to the gluten free diet together with the child/patient
Tx of intussusception
-USUALLY non-operative: ultrasound guided saline enema or air enema that essentially "reinflate" the intestine back into its normal position. 80% of cases resolve with non-operative intervention -Surgery is possible as well
Interventions for infants w/ GER:
-Usually resolves on its own -Could give H2 blocker like ranitidine (Zantac) or PPI like pantoprazole (Protonix) -Small, frequent feeds + keeping infant upright after feeding
The nurse recognizes which of the following as CMs of GER in infants?
-Vomiting -Poor feeding -Irritable infant -URI/wheezing
The nurse recognizes which of the following as CMs of SEVERE dehydration?
-WEIGHT LOSS GREATER THAN OR EQUAL TO 10% OF BASELINE WEIGHT -Marked hypoTN w/ reflex tachy along w/ s/s of hypovolemic shock -Change in behavior from hyperirritable to lethargic -Moderate to intense thirst -Dry or even parched mucous membranes -Absent tears (but this is normal for infants until at least 3 mo) and SUNKEN EYES -Sunken fontanelles -Cap refill > 3 sec w/ cool, mottled skin
The nurse recognizes which of the following as CMs of dehydration?
-Wt. loss -HypoTN w/ severe compensatory tachy → leading to decreased systemic circulation AEB cap refill > 3 sec & decreased urinary output -Increased urine specific gravity d/t inability of kidneys to concentrate urine -Skin (over arms, hands, or chest) remains elevated after being pulled up and released → AKA decreased skin turgor w/ tenting -Dry mucous membranes -Absence of tears (but keep in mind that a tearless cry is expected until at least 3 mo. old) -SUNKEN fontanelles in infants -Mental status changes: irritability, restlessness, and lethargy (listlessness)
When assessing for risk factors that could have contributed to the development of acute diarrhea in an infant/child/adolescent, the nurse knows to be sure to assess for:
-likelihood of exposure to infectious agents (for instance if infant/preschool: does the child go to DAYCARE where there could be other kids w/ this bacteria?) -Dietary history: potential salmonella or E. coli exposure -Fam hx of similar s/s -Recent travel -Child's age
ostomy care for a pt s/p hirschsprung disease bowel resection
-wash area w/ warm water and dry well before attaching a new pouch, avoid skin care products that contain alcohol (to avoid drying skin), avoid skin products in general to avoid complications -measure stool output and watch for s/s dehydration
Hypertrophic pyloric stenosis
A GI disorder characterized by hypertrophy of the pylorus that leads to pyloric sphincter constriction w/ gastric outlet obstruction. Develops in infants 2-5 wks old. Dx w/ sonogram
Because rotavirus is the most common cause of acute viral diarrhea, the nurse knows that what is available to reduce the incidence of acute rotavirus diarrhea?
A ROTAVIRUS VACCINE. The only vaccine that can be administered orally. 2 dose and 3 dose series exist. The FIRST DOSE of either types of the rotavirus vaccine should be given before an infant is 15 weeks old.
When assessing for the presence of an inguinal hernia, the nurse knows to look out for...
A bulging mass near the lower abd and groin. It may be possible to visualize the mass... HOWEVER, THE MASS IS USUALLY ONLY SEEN DURING CRYING OR STRAINING (making it hard to catch sometimes)
Inguinal hernia
A hernia that occurs when part of an intestine bulges through the inguinal canal, resulting in a BULGING SPOT AT THE LOWER ABD NEAR THE GROIN
Because gluten is an additive to MANY foods, the nurse knows that is key to teach parents of children with Celiac disease/patients w/ Celiac disease to...
ALWAYS READ FOOD LABELS.
For further evaluation of a patient with suspected acute appendicitis, the nurse can anticipate for the physician to order what kinds of imaging studies for the patient?
Abdominal CT or U/S
Because the basal metabolic rate of infants and children is HIGHER so that it supports growth and development, the nurse knows that this...
Accounts for INCREASED insensible fluid losses and increased need for water for excretory functions Note that BMR will be high even when infant or child is sick. This occurs to support growth and dev.
Acute appendicits
Acute inflammation of the appendix d/t appendiceal obstruction that leads to edema and compression of blood vessels in and around the appendix. Most common cause of emergent abdominal surgery in children
A child is suspected to have Celiac disease. To confirm the diagnosis, what LAB TEST can the nurse expect the pediatrician to order for this patient?
An auto tTg-IgA test. This is a first line test for the diagnosis of Celiac disease. This test is very sensitive to Celiac. If the tTg-IgA test is negative, another test (the antiendomysium IgA test) can be done since it is 100% specific for Celiac.
Celiac disease
An autoimmune disease in which the body damages the small intestine as a result of the digestion of gluten (which is a protein found in wheat, barley, and rye)
Acute diarrhea
An increase in stool frequency OR a decrease in stool consistency towards softer stools. In the "developed world", diarrhea causes a lot of healthcare visits for peds. Diarrhea and the dehydration it causes leads to a lot of deaths in developing countries. Bacteria can calso cause diarrhea.
When assessing for the presence of an umbilical hernia, the nurse knows that it usually appears as what?
As a squishy bulging mass protruding from the belly button that is EASILY retractable when pushed down on
With cleft lip and/or palate, the nurse knows that infants/children w/ this anatomical deformity are at an increased risk of...
Aspiration, esp w/ oral feeding. Therefore before surgery can be done, it is possible for the infant to be fed w/ a special cleft lip nipple. A dentist/OMFS might be able to make a special prosthodontic device that forms a false covering over the palate. This is supposed to prevent breast milk or formula from aspirating
Gastro-esophageal reflux (GER)
BASICALLY heartburn. Transfer (regurgitation) of gastric contents into esophagus. Happens in EVERYONE (even adults). GER is common in infants < 2 mo and premature infants
The nurse knows that unlike viral diarrhea, a child w/ BACTERIAL diarrhea is more likely to have what?
BLOODY diarrhea
For patients that are dehydrated, the nurse knows that what kind of foods should be introduced? How should these foods introduced?
Bland foods (e.g. BRAT diet - bananas, rice, applesauce, toast) should be introduced EARLY and GRADUALLY. Once a child is fully rehydrated, they can resume their regular diet
Because of small intestine injury and steatorrhea, the nurse anticipates a deficiency in what kinds of vitamins for a child with Celiac disease?
Deficiencies in the FAT SOLUBLE vitamins: A, D, E, and K All the fat is leaving the body through stool.
The nurse knows that CHRONIC functional can lead to what?
ENCOPRESIS: soiling of fecal contents into the underwear BEYOND the age of expected toilet training. Occurs btwn 4-5 y/o. d/t chronic constipation and withholding of stool: as stool is withheld in the rectum → rectal muscle stretches over time → causing fecal impactions that can leak out stool through the stretched rectal muscle
The nurse knows that HYPOTONIC dehydration occurs when...
Elec deficit > H2O deficit
When reviewing the lab results of a patient with acute appendicitis, the nurse can expect to see...
Elevated WBC and CRP (note that CRP is a non-specific marker of infection & inflammation)
The nurse knows that children (usually 4-5 y/o) experiencing encopresis are often...
Embarrassed and experience a significant amount of ridicule and shame. Sometimes they hid their underwear from parents to avoid punishment
The nurse knows that E. coli is generally transmitted through...
FOOD
Cleft lip and/or cleft palate
Facial malformation that results in unfused lips and/or palate. Cleft lip and/or palate may appear separately or together. Can be dx while in utero via U/s Note that the lip and/or palate actually remain unfused embryonically BUT usually fuses btwn 5-9 weeks into embryonic development. Cleft lip and/or palate is abnormal when the lip and/or palate stay unfused way past 5-9 wks and present at birth.
The nurse knows that during illness, fluid from which compartment is lost first?
Fluid from the extracellular compartment is lost first. The EC space contains the greatest % of water. This puts infants and children at a greater risk of dehydration and alterations in fluid/elec balance
Extracellular fluid
Fluid outside of cells: -Interstitial fluid: where most ECF is. The fluid surrounding cells -IV fluid: fluid inside the vasculature
The nurse is caring for a child with dehydration secondary to acute bacterial diarrhea. The nurse sees an order for diphenoxylate with atropine (Lomotil). The nurse should question this order and request clarification from the prescriber because...
For cases of diarrhea, you don't want to use an antimotility agent because this will just keep the stool in the patient, which at the same time will also keep the causative agent of the diarrhea in the pt. You basically just want to let it all out while managing the child's dehydration (preferably through PO rehydration w/ pedialyte).
Because BSA tends to be greater in both infants and children, the nurse knows that this makes it more likely for what to occur?
For insensible water loss through skin (e.g. sweating) and lungs (e.g. hyperventilating) to occur
IF an infant's GER progresses to GERD, the nurse knows that what surgery may be done?
Fundoplication: the upper curve of the stomach gets wrapped around the esophagus and sewn. Prevents regurgitation of stomach contents into the esophagus Pre + postop care involves assessment of abd girth, nutrition and hydration, pain mgmt, positioning (don't place on operative side), wound care, and emotional support for the pt and family
Hirschsprung disease (congenital aganglionic megacolon)
GI disorder characterized by mechanical obstruction as a result of the absence of ganglion cells in the bowels anywhere from the rectum to the proximal colon, resulting in decreased intestinal motility in the diseased part of the colon
The nurse knows that HYPERTONIC dehydration occurs when...
H2O deficit > elec deficit (total opposite of hypotonic dehydration)
Umbilical hernia
Hernia that is usually d/t weakness of muscle & incomplete closure of umbilical ring, resulting in intestinal contents herniating through the umbilical ring → visible as a popping of the muscle that points up the belly button. Very common in preterm infants. More common in Afr Am than Caucasians
The nurse is caring for a 15 year old adolescent in the emergency room for suspected appendicitis. The adolescent told the nurse earlier that the abdominal pain was 9/10 in his lower right quadrant of his abdomen. The ER doc ordered IVP morphine for this reason. Once the nurse drew up the morphine and returned to the adolescent, he tells the nurse that his pain is "now between a 1 and 2, maybe even a 0. I feel awesome". Knowing this, what should the nurse do next?
IMMEDIATELY NOTIFY THE DOC. Sudden relief from pain without ANY pain mgmt intervention could indicate potential perforation that requires IMMEDIATE surgical correction
The nurse knows that the primary form of dehydration seen in children is...
ISOTONIC DEHYDRATION, meaning that water and sodium are lost in equal amounts
When assessing a patient with acute appendicitis, the nurse knows that the clinical manifestations of appendicitis appear in what manner?
In a gradual manner. Appendicitis is NOT self limiting - CMs simply don't just come and go. Instead, they remain persistent and intensify as the appendicitis progresses
The nurse knows that the fluid requirements for infants and children are DIFFERENT compared to that of adults because...
Infants and children have a proportionately greater amount of body water than adults. They also require a larger relative fluid intake than adults, excrete a greater amount of fluid, and require a greater amount of water in order to get rid of excess solutes in the blood
The nurse watches a PCT getting ready to insert a suction catheter into an infant who is S/P cleft lip repair. What is an appropriate action by the nurse?
Intervening and stopping the PCT from inserting the catheter. NOTHING should be put in the mouth (suction catheter, spoons, straws, pacifiers, plastic syringes) in order to avoid tearing/disrupting the sutures
The parents of a patient ask what the next steps are for their child suspected of having Celiac disease. In addition to the tTg-IgA test that has been ordered, the nurse knows that
It is possible a biopsy of the small intestines may be done as well.
The nurse knows that an expected TEMPORARY intervention for the mgmt of an inguinal hernia is...
MANUAL reduction of the hernia by a provider by literally pushing it back in. Family members can also be taught how to do this Important to note that manual reduction is a TEMPORARY FIX and surgery is needed to truly correct. Also, an inguinal hernia that fails to get manually reduced has the potential to be trapped in its herniated position (aka incarcerated), leading to a potential for bowel strangulation
The nurse can anticipate for a child with acute diarrhea to be experiencing what kind of acid-base imbalance?
METABOLIC ACIDOSIS. A lot of bicarb leaves with the diarrhea. Together with the metabolic acidosis, the nurse may see hyperK (K > 5.0) on the BMP. The body may or may not be compensating for this through respiratory alkalosis (increasing RR to blow off more CO2 so that pH can rise out of the acidotic range)
The parents of an infant that is severely dehydrated d/t acute diarrhea asks the nurse why abx aren't being given. The nurse is correct in telling the parents that:
Most causes of diarrhea in kids are d/t a virus. Abx only work against bacteria
The nurse knows that tx of umbilical hernias usually involves...
NOTHING since it usually closes and resolves spontaneously by 4 y/o. If that doesn't happen, then it's time for surgery
The nurse knows that with the small intestinal damage that occurs in Celiac disease, a child will experience nutritional deficiencies because...
Nutrients won't be able to be absorbed through the small intestine
The nurse knows that a diffuse peritonitis is more likely in YOUNGER CHILDREN with acute appendicitis compared to older children and adolescents with this condition because...
Older children and adolescents have a more developed omentum (apron-like fold that covers the stomach), which walls off the inflamed or perforated appendix
When a patient with acute appendicitis develops diffuse and widespread abdominal tenderness and distension, the nurse knows that this is likely to be...
PERITONITIS: inflammation and/or infection (in the case of acute appendicits - probably both if the appendix ruptures) of the membrane that lines the abd wall and covers abd organs.
Tx of hypertrophic pyloric stenosis
Pyloromyotomy. Surgical incision of pylorus to relieve hypertrophic obstruction of the gastric outlet
The nurse knows that expected tx of Hirschsprung disease involves what?
Resection of the diseased bowel followed by the placement of a TEMPORARY ostomy that diverts stool through an abdominal stoma. This is removed once the resected bowel heals
Because of the lack of peristalsis and narrowing of the colon as a result of stool accumulation in patients w/ Hirschsprung disease, the nurse knows that stools may appear....
Ribbon-like. Other associated CMs include and distension, vomiting, constipation, and forceful passage of fecal material at the end of a rectal exam as the finger is being withdrawn
The nurse recognizes which of the following as the most common cause of acute VIRAL diarrhea?
Rotavirus
Although a child may be vomiting, the nurse understands that PO rehydration is still possible only if...
SMALL VOLUMES of pedialyte are given
The nurse knows that a significant contributing factor for the development of functional constipation in preschool and school-aged children is...
STRESS: -new school? -little to no privacy in the bathroom while at school? -bullying? -home life: is it safe/welcoming or is it hostile and abusive... -Poor nutrition, lack of breastfeeding could also contribute to constipation. Breastmilk produces soft stools. Lack of fiber and adequate fluids will obv cause constipation -does the child lead a sedentary lifestyle
If not contraindicated, the nurse can expect to initiate what for a infant/child/adolescent experiencing dehydration?
Starting ORAL REHYDRATION THERAPY with CLEAR PEDIALYTE (flavored pedialyte could be confused w/ blood). Small sips should be encouraged
A new nurse is about to give a dehydrated school-aged child tap water for PO dehydration therapy. The nurse should intervene because...
TAP WATER is NOT appropriate for PO rehydration. Milk, undiluted fruit juice, soup, and broth also should NEVER be given for PO rehydration.
The nurse knows that for surgical correction of a cleft lip and palate, which will get corrected first?
The cleft lip will get corrected first (L before P). Usually done at about 2-3 mo. Early repair of the cleft lip restores normal appearance to the child's face, which may help improve parent-infant bonding. Afterwards, the palate is usually corrected btwn 6-9 mo.
Because the kidneys are still relatively immature (esp in infants), the nurse knows that this leads to...
The inability for the kidneys to concentrate urine, resulting in high urine specific gravity. The immature kidneys also put infants and children at R/F dehydration (and sometimes potentially even over-hydration)
The parents of a child newly diagnosed with Celiac disease asks the nurse if they can still continue the regular diet that the child eats daily. The nurse is correct in informing the mother that...
Their child will have to be on a gluten-free diet, which requires avoiding foods that contain wheat products, rye, barley, and possibly oats
An infant or child that is febrile or has some kind of illness (viral infection, bacterial infection, sepsis) is at risk for dehydration as well because...
These are conditions that accelerate the body's basal metabolic rate. Keep in mind that infants and children already have higher basal metabolic rates in order to support growth and dev. These states will only raise BMR even more, contributing to more dehydration
The nurse knows that an important thing to keep in mind about the CMs of Celiac disease is that...
They are VERY BROAD and often confused w/ other GI disorders. Usually, the symptoms are accompanied WITHOUT changes in diet. The child more likely than not was NOT exposed to an illness. The s/s develop very gradually. -Diarrhea, which could lead to failure to thrive and wt loss -Steatorrhea (fatty stools w/ a "frothy" appearance, possibly foul smelling) -Abd distension or bloating -Irritability and listlessness (lethargic) -Dental disorders -Delayed onset of puberty or amenorrhea -Nutritional deficiencies → which could contribute to anemia and poor muscle tone
Unlike E. coli, the nurse knows that salmonella is transmitted how?
Through food AND can be transmitted person-to-person via fecal-oral
Although Hirschsprung disease cannot be picked up in utero, the nurse knows that children dx w/ Hirschsprung disease usually do what?
Usually FAIL to pass meconium within the first 24 hrs of life
The parents of a child newly dx w/ Celiac disease have their doubts about gluten-free diets. They ask the nurse what the benefits are of a gluten free diet. The nurse is correct in telling the parents that...
Usually, children w/ Celiac disease start re-gaining lost weight after starting a gluten free diet. Symptoms (especially diarrhea and abdominal pain) also begin to resolve.
Functional constipation
VERY COMMON IN PRESCHOOL AND SCHOOL AGED CHILDREN. At least 2 of the following s/s for 2 mo: - < 3 BMs weekly -At least one episode of fecal incontinence weekly -Stool withholding behavior (e.g. retentive posturing: child is up against the wall and looks like they're in pain) -Reports of hard or painful BMs -Presence of large fecal rectal mass (as seen by doc) -Stool passage of a volume significant enough to clog a toilet
The nurse knows that for infants s/p cleft lip/palate repair, it is important to prevent the child from vigorously crying/continuously crying for what reason?
Vigorous and sustained crying may cause suture line tension. Thus, it is correct for the nurse to admin ordered pain meds PRN and to encourage cuddling, rocking, and anticipation of the infant's needs
Intussusception
When one part of an intestine slides into another part. Common in male infants 3-9 mo old but can occur in children as old as 5 y/o
Dehydration
Whenever output > intake. What diarrhea can lead to.
Although GER is a common occurrence in infants (and people of every age group), the nurse knows that it is abnormal when...
it recurs frequently and persists. At this point, GER becomes GERD.
The nurse knows that breastfeeding may be ineffective in a child w/ a cleft palate because...
of the pliability of the breast and the fact that soft breast tissue may cover the opening in the palate. Therefore, it's important that families (esp parents) know the cues the infant makes when they're hungry. They should also anticipate BOTTLE FEEDING the infant w/ a special cleft nipple that has a 1 way valve that helps prevent aspiration