UNRS 404 Exam 2 Study Guide from Slides

Asthma Severity Classification in Children Step 5 or 6 severe asthma?

Continual symptoms throughout the day Frequent nighttime symptoms (at least once a week ages 0 to 4 and 7 nights/week ages 5 and up) Pulmonary expiratory flow (PEF) using peak flow meter is <60% Forced expiratory volume in 1 second <75% of predicted value Use of rescue inhaler is usually several times per day

Step 3 or 4 moderate asthma severity classification?

Daily symptoms (exacerbations happen about once per day) Nighttime symptoms: 3-4 times per month (0-4 years old) and at least once per week but not nightly in 5-11 years old PEF is 60-80% of predicted value for 5+ years FEV1: 75% to 80% in 5+ PEF variability is >30% Interference with normal activity: some limitation Use of rescue inhaler about once per day

Step 2 mild asthma severity classification?

Symptoms about >2 times per week but not once a day Nighttime symptoms: 1-2 per month (0-4 years) and 3-4 per month (5-11 years old) PEF or FEV1 ≥80% of predicted value PEF variability: 20-30% Interference with normal activity: minor limitation Use of rescue inhaler: >2 days/wk but not daily

Step 1 intermittent asthma severity classification?

Symptoms ≤2 days/wk Nighttime symptoms none (0-4 years old) and ≤2 nights per month (5-11 years old) PEF or FEV1: ≥80% of predicted value PEF variability: ≤20% No interference with normal activity Use of rescue inhaler: <2 days per week

Creatinine normal level for pediatrics?

0.8-1.4 mg/dL but depends on age

At what age is most common for foreign body aspiration and why??

1-3 years old because thery're getting into everything at that age!! They will be adventurous and try to swallow or eat things they shouldn't

Overall goals of asthma management?

1. Maintain normal activity levels 2. Maintain normal pulmonary function 3. Prevent chronic symptoms and recurrent exacerbations 4. Provide optimum drug therapy with minimum or no adverse effects 5. Assist child in living as normal and happy a life as possible

Cl- normal level for pediatrics?

101-111 mmol/L

Na+ normal level?

136-144 mEq/L

Diagnostic tests that indicate GERD?

H&P, barium swallow or upper GI series, endoscopy with biopsy, ****24-hour intra-esophageal pH monitoring (this is the gold standard!! Why?? b/c if there's a change in pH in the esophagus, we know that it's due to esophageal reflux of gastric acid)

K+ normal level?

3.7-5.2 mEq/L

Anti-reflux meds used for GERD?

H2 receptor antagonists (Ranitidine, Famotidine), PPI's (pantoprazole, omeprazole)

Glucose normal level for pediatrics?

64-128 mg/dL

BUN normal level for pediatrics?

7-20 mg/dL

Diagnostic for biliary atresia?

abdominal ultrasonography allows inspection of liver and biliary system->testing patency of extrahepatic biliary system; *if no evidence of radioactive material excreted into duodenum, BA diagnosis*

When should we be concerned about monitoring pulse in dehydrated patients??

Always!! But we start to see changes in pulse and hemodynamic status in moderately dehydrated patients, and by the time they are severely dehydrated, HR has increased and pulse is not palpable whatsoever!! If you can't find pulse, call code!! This is a medical emergency!!

Which lab value will indicate BA?

Conjugated bilirubin will be elevated!!

Explain GER vs GERD?

GER is transfer of gastric contents into the esophagus (hence the term refluxit's backflow in the wrong direction); while GERD involve the symptoms/tissue damage that occur as a result of GER (this is where the pathological changes occur)

What else should the nurse look for in a patient that has suspected BA?

Dark urine, clay colored stools, and hepatomegaly is an early sign->liver should feel firm upon palpation

When would the nurse start to see sunken fontanels in infant?

In severely dehydrated infants!! This is a life threatening sign!!

When will skin temp start to change in dehydrated patient?

Moderately dehydrated patients will feel cool to touch and by severe dehydration, we will see a cool, mottled, and even cyanotic look!!

What does intussusception look like?

More distant segment of bowel pushes up into the more proximal segment, looks like an inverted folding

When would we start to see shock in dehydration patients?

Most likely in severe isotonic dehydrationWhat would we be watching for?? Pulmonary collapsewatch V/S and stabilize ASAP!!

Explain the supportive medical management for biliary atresia?

Nutrition->infant formulas that have medium-chain triglycerides and essential fatty acids; supplementation with fat-soluble vitamins (A,D, E, and K); aggressive nutritional support->gastrostomy feedings or TPN for moderate to severe growth failure (enteral solution should be low in Na+), phenobarbital may be prescribed after hepatic portoenterostomy to stimulate bile flow, and ursodeoxycholic acid to decrease cholestasis and relieve intense pruritus from jaundice

What should the nurse keep in mind specifically for pylromyotomy for pyloric stenosis?

Preoperatively, infant must be rehydrated and metabolic alkalosis corrected with parenteral fluid and electrolyte administration; replacement fluid therapy usually delays surgery by 24-48 hours; stomach decompressed with NG tub if infant continues with vomiting; in infants with no evidence of fluid and electrolyte imbalance, surgery is performed without delay

When should we be worried about BP in dehydrated patient??

When the severely dehydrated patient is going into hemodynamic shock!! Low BP and significantly high HR will be clear!! Medical emergency!!

Explain hypospadias?

Urethral opening located behind glans penis or anywhere along ventral surface of penile shaft

Why are CF patients at such a high risk for subsequent infections??

Viscous secretions are difficult to expectorate->Stagnant mucus in the lungs provides a favorable environment for bacterial growth

Explain exercise-induced bronchospasm and management?

acute, reversible, usually self-terminating airway obstruction that develops during or after vigorous activity, reaches peak 5-10 min after stopping activity, and usually stops in another 20-30 min; kids still need exercise!! Prophylactic treatment with rescue inhaler before exercise usually allows child to fully participate, just be on top of treatment!!

Diagnostic evaluation for asthma?

age is significant b/c first attack usually occurs before 5 years old!! ; OVERALL DX IS BASED ON CM, H&P, AND LAB TESTS (PFT'S) AND PEFR

Explain pathophysiology of biliary atresia?

aka extrahepatic biliary atresia, progressive inflammatory process that causes both intrahepatic and extrahepatic bile duct fibrosis->*eventual ductal obstruction*; Many infants with BA appear healthy at birth->*nurse must be suspicious of any jaundice that occurs after the infant is older than 2 weeks old*

Prevention of foreign body aspiration?

anticipatory guidance and training for young parents, child-proofing the home and close watch on kids who are 1-3 years old, especially when playing around the house; monitoring during meals, feeding techniques and positioning; • Avoid aspiration risks (oily nose drops, solvents, talcum powder, ESSENTIAL OILS!!) • WHEN IS THE RIGHT TIME TO START INTRODUCING SOLID FOODS TO AN INFANT? 4-6 MONTHS!! INTRODUCE SLOWLY!!

How can the nurse best support the patient and the family with CF?

assessing and teaching coping methods regarding emotional needs of the child and the family, educate the family on the multiple treatments that the child will need per day, educate them on the possibility

Diagnostic criteria for foreign body aspiration?

based on history and physical signs, including CXR always!!

Therapeutic management for hypertrophic pyloric stenosis?

best route is surgical relief-->pylromyotomy (making opening wider by cutting hole in muscle surrounding pylorus)

Explain the etiology of pneumonia?

causative organism varies greatly by age category, most useful classification is etiologic agent->viral pneumonia is most common, BUT IF ATYPICAL->most likely agent is m. pneumoniae (mycoplasmal) especially in immune suppressed children (ie HIV, CF, autoimmune, etc); bacterial pneumonia has an abrupt onset, and the child appears ill; aspiration pneumonia also occurs in children due to choking/aspiration risk in young kids

Etiology of pertussis?

caused by Bordetella pertussis; this occurs most often in children who have not been vaccinated in US (**tDAP vaccine is crucial!!**); highest incidence is summer and spring; highly contagious; **risk to young infants (especially those who have not yet been vaccinated!!)** Why? their immune systems are especially vulnerable at that age (also is mom vaccinated??); effectiveness of booster

Therapeutic management for intussusception?

conservative treatment->pneumoenema (air enema) with or without water-soluble contrast, or ultrasound-guided saline enema (no ionizing radiation needed for the last one) oIV fluids, NG decompression, and antibiotic therapy before hydrostatic reduction is attempted oSurgical intervention if the prior interventions do not work->**manually reducing invagination or resecting nonviable intestine**

What is the biggest key in ensuring a good prognosis for hypertrophic pyloric stenosis?

early diagnosis!!! if not identified, dehydration, metabolic alkalosis, and failure to thrive may occur

Education for parent r/t pertussis?

educate young mom with infants <3 months or so, tell her to stay home as much as possible, especially during flu and cold season, because her baby is at especially high risk since it cannot be vaccinated yet!!

What are some possible complications due to GERD?

esophagitis, esophageal strictures, laryngitis, pneumonia (due to aspiration?)

Prognosis for CF?

estimated life expectancy is 37.4 years, this is a progressive incurable disease, organ transplantation can increase survival rate (lungs and liver/pancreas), maximize health potential (nutrition, prevention and early aggressive treatment of infection, pulmonary hygiene)

Pathophysiology of CF??

exocrine gland dysfunction that produces multisystem involvement (pancreas, lungs, liver)

Postoperative measures and things to keep in mind for patient recovering from pyloromyotomy?

feedings 4-6 hours, begin with small frequent feedings of water or electrolytes; if clear fluids retained, formula can be started 24 hours after surgery in small amounts; amount and interval increased until full feeding schedule is reinstated (usually 48 hours)

Surgical management for GERD?

for severe cases of GER, Nissen fundoplication may be done!!

What constitutes the symptoms as GER?

frequency and persistency may deem it abnormal, usually in infants <2 months, usually resolves on its own by 1 year old (no intervention needed)

CM of GER in infants?

frequent spitting up, forceful vomiting, excessive crying/irritability (remember, they can't tell you what's wrong!! Look for changes in behavior!!), weight loss/failure to thrive; respiratory problems: cough, wheeze, stridor, gagging, apnea (stopping breathing sporadically and randomly)

CM of GER in children?

heartburn and non-cardiac related chest pain (burning of HCl), abdominal pain, chronic cough, recurrent pneumonia, nocturnal asthma

Explain the primary surgical treatment for biliary atresia??

hepatic portoenterostomy (segment of intestine is anastomosed to resected porta hepatis to attempt bile drainage); after surgery, 33% of infants become jaundice free and regain normal liver function, but another third of infants have liver damage, but they may be supported by medical and nutritional support; the other third may require liver transplant

CM in older infants/children for Hirschsprung's disease?

history of chronic constipation or fecal mass, failure to thrive, failure of internal and sphincter to relax, enterocolitis may occur (due to stagnant fecal matter buildup along with bacteria)

What is the most common site for intussusception to occur in a child?

ileocecal valve

Explain CM of hypertrophic pyloric stenosis?

in infants, nonbilious vomiting usually after a feeding; projectile vomiting; infant hungry, avid feeder, eagerly accepts a second feeding after vomiting episode; no evidence of pain or discomfort other than chronic hunger; weight loss; signs of dehydration; distended upper abdomen; readily palpable olive-shaped tumor in the epigastrium just to right of umbilicus; visible gastric peristaltic waves that move from left to right across epigastrium

Which age group is especially at risk for pneumonia complications? How do we prevent complications from occurring?

infants!! early detection and vigorous antibiotics and supportive therapy are the best methods to prevent complications!!

Pathophysiological process of asthma in children?

inflammation contributes to heightened airway reactivity in asthma; it's unlikely that asthma is caused by either single cell or single inflammatory mediatorappears to result from complex interactions among inflammatory cells, mediators, and cells and tissues present in airways; bronchospasm caused by 1. Inflammatory response to stimuli 2. Airway edema and accumulation and secretion of mucus 3. Spasm of smooth muscle of bronchi and bronchiolesdecreases caliber of bronchioles 4. Airway remodelingpermanent cellular changes

What is the most common cause of intestinal obstruction for children 5 months-3 years old?

intussusception

Explain CM in hypotonic/hyponatremic dehydration?

lethargy, confusion, depressed reflexes, seizures (in severe hyponatremia), and coma (in the absolute worst cases!!)

Treatment for hypertonic/hypernatremic dehydration?

lower serum Na+ using hypotonic IV fluid (will draw out excess ions and bring ECF/ICF into equilibrium by adding waterbalance in Na+ will be restored bc we're diluting the concentration)

Earliest postnatal manifestation of CF?

meconium ileus!! obstructed bowel in newborns

Etiology of intussusception?

more common in males than females, and more common in children <2 years old, idiopathic (no specific cause identified)

Explain the influence of the CFTR gene on the development of CF?

mutation of CF transmembrane conductance regulator gene->disrupts the functioning of Na+ and Cl- channels->these channels can no longer regulate the flow of Cl- ions and water across cell membranes->epithelial lining of lungs, pancreas, and other organs produce thick mucus->one of the most serious symptoms: chronic decreased gas exchange in the lungs and mechanical obstruction in the bronchioles and pancreas

Explain the etiology of biliary atresia?

no known cause, although immune or infection-mediated mechanisms may be the cause for the progressive process that results in complete obliteration of the bile ducts; BA is not seen in infants, so it must acquired late in gestation or in perinatal period and manifests weeks after birth; 85% of cases result in complete obliteration of extrahepatic biliary tree at or above porta hepatis

CM in newborns for Hirschsprung's?

no meconium (stools) in the first 24-36 hours, feeding intolerance with bilious vomiting (due to obstruction), abdominal distension, fever

Prognosis for therapeutic management?

nonoperative reduction is successful in about 65-75% of cases, surgery required in cases which saline enema is unsuccessful; early diagnosis and treatment prevent serious complications and death from occurring

Nursing assessment key signs of intussusception?

o Nurse should listen to parent's description of child's physical and behavioral symptoms key indicator: description of child's severe colicky abdominal pain combined with vomiting

What technique is used during pyloromyotomy and explain why it's the best option for resolving pyloric stenosis?

o Often performed by laparoscope with longitudinal incision through circular muscle fibers of pylorus down to submucosasurgery has high success rate!! Laparoscopic surgery means shorter surgical time, more rapid postoperative feeding, and shorter hospital stay

Nursing care management priorities for pyloric stenosis patient in general?

o Primarily observation for clinical features that help establish diagnosis, careful regulation of fluid therapy, and reestablishment of normal feeding patterns; assessment based on observation of eating behaviors and evidence of CM, hydration, and nutritional status o Preoperatively, focus on restoring hydration and electrolyte balance o If stomach is decompressed with NG tube preoperatively, make sure that NG tube is patent and record amount of drainage o Postoperative vomiting common, so IV fluids administered and then restarting feedings gradually

Conservative management for GERD?

o Thickened formula for infant (with enlarged nipple) o Frequent burping and feeding o Avoid strenuous activity/play after eating (this will prevent any upset) o No feeding before bedtime (most likely time when GER symptoms will occur, especially bc in supine position) o Positioned with head elevated after feeding!! o In infant with severe GERD, position prone with HOB elevated, but only if infant is >1 year old b/c of the risk for SIDS!!!!

Explain hypertonic/hypernatremic dehydration?

o Water loss> Na+ loss o Higher concentration of Na+ in ECF causing fluid to pull from ICF in an attempt to balance out NA+ serum concentrationmost dangerous type!! o Cause: hypertonic IV fluids, infants given formula rich in solutes by mouth, children who receive high protein NG tube feeds (high concentration solutes are very likely to cause this b/c will increase concentration in ECF once absorbed)

Clinical signs and symptoms of dehydration in general?

o What is the urine output like? **need to know normal UO=1 mL/kg/hr For example, a 5 kg child will have a 24 hr output of 120 mL for that period o How does the child look like overall? Skin: temperature, dry skin and mucous membranes? Poor turgor, tenting, dough like feel (test the skin!!), pale, ashen, cyanotic nail beds or mucous membranes, delayed cap refill >3 seconds Sunken eyeballs, no tears Sunken fontanels in infants Lethargic or irritable (think CNS or LOC changes) May have neurologic complications (ie seizures), or even coma in very severe cases; Why seizures?? Because hyponatremia can lead to major neuro complications

CM depends on what factors for pneumonia??

oAge oEtiology of pneumonia (how did onset of pneumonia occur, what was it caused by?) oSystemic reaction to infection oExtent of the lesions (CXR will reveal this!!) oDegree of obstruction o***Chest X-ray is gold standard!! Diffuse or patchy infiltration with peribronchial distribution***

Treatment priorities for CF patients??

oDiet!! Increase in calories and protein (high-fat, high protein diet) oAirway clearance of thick mucus->*chest physiotherapy (CPT), aerosol bronchodilators, and mucolytics to break up secretions* oMonitor blood glucose!! b/c of pancreatic dysfunction oAerobic exercise oMeds->aggressive antibiotics for infection (IV therapy and aerosolized antibiotics), water soluble forms of Vitamins A, D, and K, and pancreatic enzymes!!, steroids or nonsteroidal anti-inflammatory drugs (NSAIDs) oTx goals for CF?? prevent or minimize pulmonary complications, adequate nutrition for growth, and help child adapt to living with a chronic illness oManagement of complications that could occur (pneumothorax, hemoptysis, and nasal polyps) o*GI management*->replacement of pancreatic enzymes, high-protein high-calorie diet, treating constipation, reducing rectal prolapse, salt supplements, and treat GERD (place patient in upright position after meals!!)

Complications of pneumonia?

oEMPYEMA: pus-like secretions (usually white or discolored and foul smelling) oPyopneumothorax->especially in infants oPneumothorax: accumulation of air in the pleural spaceincreased intrapleural pressuredifficulty in lung expansiondyspnea, chest pain, back pain, labored respirations, tachycardia, decreased oxygen saturation (SaO2) First sign in infants and infants on mechanical ventilation are oxygen desaturation and hypotension **CXR will be definitive answer for presence of pneumothorax** oPleural effusion: excessive accumulation of fluid in pleural space (CXR will find this!!) Treatment involves evacuation of fluid by needle aspiration followed by chest tube or close drainage set in place

Most common signs of foreign body aspiration that nurse will look for in assessment?

oLaryngotracheal obstructiondyspnea, cough, stridor, hoarseness (decreased air entry) oUp to half of all children that are being assessed may be asymptomatic oCyanosis may occur if obstruction worsens oBronchial obstructionusually cough (paroxysmalsudden recurrence or intensification), wheezing, asymmetric breath sounds, decreased airway entry, dyspnea oWhen an object is lodged in larynx, child is unable to speak or breathe oIf obstruction progresses, child's face may become livid, if obstruction is total, child may become unconscious and die of asphyxiation

Nursing care for family and patient with intussusception?

oNurse should prepare parents for immediate need for hospitalization, nonsurgical technique of hydrostatic reduction, and possibility of surgery oNurse should explain basic defect of intussusception to family oPhysical care for child is same as any other abdominal surgery patient (NPO status, routine lab testing/CBC/urinalysis, signed parental consent, and preanesthetic sedation) oChild will need IV fluids, systemic antibiotics, and bowel decompression before surgery, as well as fluid volume replacement and restoration of electrolytes o**Nurse should monitor all stools before surgery**

Diagnostic evaluation for CF?

oQuantitative sweat chloride test o*CXR (chest X-ray)* o*PFT's->pulmonary function tests* oStool fat (steatorrhea) or enzyme analysis (tests for malabsorption of nutrients, especially fat) oBarium enema

What should a nurse see in a CF patient during assessment?

oWheezing, dry nonproductive cough oGeneralized obstructive emphysema oPatchy atelectasis (collapse or closure of lung field->reduced or absent gas exchange) oCyanosis oClubbing of fingers and toes (due to chronic hypoxia) oRepeated bouts of bronchitis and pneumonia oRectum prolapse oDistal intestinal obstruction syndrome oExcretion of undigested food in stool->stool is bulky, frothy, and foul smelling oWasting of tissues oHypoalbuminemia due to decreased protein in diet or decreased absorption of protein oBabies taste salty when parents kiss them oDelayed puberty in females and sterility in males

Explain pathophysiology of hypertrophic pyloric stenosis?

occurs when the circumferential muscle of the pyloric sphincter becomes thickenedelongation and narrowing of the pyloric channeloutlet obstruction and compensatory dilation, hypertrophy, and hyperperistalsis of the stomach; **usually develops within the first few weeks of life** unknown etiology

Explain hypotonic/hyponatremic dehydration?

overall decrease in Na+ in ECF o Occurs when electrolyte deficit exceeds the water deficit (less Na+ in equivalent to the amount of water in the body system), hence why it's called hypotonic dehydrationsolute concentration is way lower than normal o Causes: excessive water intake or reduced renal water excretion (if you're holding onto fluid, the sheer volume will eventually dilute the existing electrolyte concentration)this can be due to cystic fibrosis, malnutrition, or prolonged low salt diet (not enough electrolyte intake in general) o Fluid shifts from ECS to ICS (because ICS is more concentrated)fluid goes from hypotonic solution to the more hypertonic solution in order to maintain equilibrium, but this means that there is a severe decrease in the ECS volumenot enough blood volumecirculatory collapse (shock)

Other serious CM of CF?

pancreatic fibrosis->pancreatic enzymes do not reach duodenum->malabsorption and risk for malnutrition in CF kids!! these kids look like they're wasting away->malabsorption syndrome; Weight loss despite increased appetite (this is one of the main reasons why CF patients are on high-fat, high protein diet) DM: by age 30, 50% of CF patients have DM oElevation in sweat electrolytes (Na+ and Cl-) oIn infants, intestinal obstruction of newborn due to inspissated meconium oBile ducts->fibrosis->biliary cirrhosis->portal HTN due to liver dysfunction oBronchial obstruction->chronic bronchial pneumonia and generalized obstructive emphysema, COPD associated with infection oThese patients are usually severely immune compromised!! oFailure to thrive!! oPotential for gradual respiratory deterioration

Nursing management for child with pneumonia??

primarily supportive and symptomatic but thorough respiratory assessment and oxygen therapy, fluids, and antibiotics for bacterial pneumonia are critical! o Nursing care for child with chest tube->close attention to respiratory status; monitoring tube and drainage for proper functioning; movement in bed and ambulation with chest tube are encouraged based on what the child can tolerate; pain management as well; HOB positioninglying on affected side if pneumonia is unilateral splints the chest on that side and reduces comfort r/t pleural rubbing o Control fever!! antipyretic drugs and cooling environment o Pain management appropriate analgesic drugs

Diagnostic evaluation for intussusception?

subjective findings usually leading to dx but can also be confirmed by ultrasonography, and *rectal exam will reveal mucus, blood, and occasionally a low intussusception itself*

Nursing care management for biliary atresia?

support of family before, during, and after surgical procedures and education regarding treatment plan o Post-op care!! similar to any other major abdominal surgery care

Explain CM of hypertonic/hypernatremic dehydration?

thirst, alterations in LOC (due to Na+ imbalancesCNS problems), inability to focus attention, lethargy, increased muscle tone, hyperirritability (due to NA+ imbalance)

Pertussis management of disease?

treated mainly at home with supportive measures

Prognosis for biliary atresia?

untreated BA results in progressive cirrhosis and death in most children under 10 years old; Kasai procedure (surgery) improves prognosis but is not a cure

General signs of pneumonia?

usually high fever, unproductive OR productive cough with whitish sputum, crackles or altogether decreased breath sounds, dullness with percussion, chest pain, retractions, nasal flaring in infants, pallor to cyanosis (depending on severity); chest radiography/CXR will reveal diffuse/patchy infiltration with peribronchial distribution; behaviorirritability, restlessness, malaise, lethargy; GIanorexia, vomiting, diarrhea, abdominal pain

What is the normal specific gravity lab value for children? What does it mean if abnormal??

with normal fluid intake->1.016 to 1.022, newborns 1.001 to 1.020 o If high, indicates dehydration, presence of protein or glucose o If low, excessive fluid intake most likely cause, distal tubular dysfunction, insufficient ADH, diuresis

Normal daily fluid maintenance requirements for children and infants (not neonates)?

• 1-10 kg=100 mL/kg • 11-20 kg=1000mL plus 50 mL/kg for each >10kg • >20 kg=1500 mL plus 20 mL/kg for each kg >20kg

Asthma management using medications?

• Adrenergics (Beta 2 agonists)ie: albuterol, xoepenex • Inhaled steroids (ie Flovent, Pulmicort) • Theophylline (when not responsive to rescue meds) • Hydration: IV with severe distress, if severe asthma and airway is severe obstructed due to asthma complications (reducing risk for aspiration due to preexisting airway obstruction rt asthma attack) • Maintain O2 Saturation >90% • Anticholinergics (Atropine and Cogentin)

Explain the overall pathophysiology and disease process for Hirschsprung's disease?

•Congenital aganglionic megacolon •Mechanical obstruction from inadequate motility in the intestines (things aren't moving properly so things start backing up!!) •Incidence: 1 in 5000 live births; males>females and more likely in Downe syndrome •Cause: absence of ganglion cells in affected area of the colon oUsually rectum and some portion of distal colon (80%)

Etiology for CF patients??

• Etiology: most common lethal genetic disease in Caucasian children, autosomal recessive trait, 3% of US Caucasian people are asymptomatic carriers95% of symptomatic cases occur in Caucasians (~1 in 2,00-3000 Caucasians, 1 in 17,000 Af-Am, then Hispanics, then Asians- very rare)

Why is it so bad if hernias are left untreated?

• If both left untreated, incarcerated and strangulated hernias will progress to **necrotic bowel**

What are the different types of hernias?

• Incarcerated hernia: inguinal hernia that cannot be reduced easily • Strangulated inguinal hernia: blood flow to herniated organ is impaired

Complications r/t foreign body aspiration?

• May result in life-threatening airway obstruction->decreased gas air exchange due to obstruction • Aspiration pneumonia->who's most at risk?? Child with feeding difficulties!! Can they swallow effectively on their own??

Normal urine output for a child??

• Normal urine output= 1-2 mL/kg/hour for a child • Oliguria= <0.5 mL/kg/hr • Fluids to be measuredif on IV fluids, all output is to be measured!! • Diaper weighing technique1 g of wet diaper weight=1 mL of urine • Newborns should be about 30-60 mL volume, for children, bladder capacity (oz)=age (years) +2

Explain herniation disease process?

• Protrusion of portion of organ or organs through abnormal opening • Danger of herniation arises when organ protruding through opening is constricted so much that circulation is impaired or when protruding organs encroach on and impair functioning of other structures • Umbilical hernia is most common in infants • Inguinal hernias account for 80% of childhood hernias and boys>girls

What else to assess for in a child postoperatively that could help anticipate potential complications??

•Check bowel sounds!!! Especially in abdominal surgery patients •Observe for signs of shock, abdominal distension, and bleeding •Assess for bladder distension •Observe for signs of dehydration (are we giving them IV fluids??) •Detect presence of infection->take V/S q2-4 hours as ordered, collect/request needed specimens, inspect wound for signs of infectionredness, swelling, heat, pain, and purulent drainage

Explain asthma disease presentation?

•Chronic inflammatory disorder of the airways characterized by recurring symptoms, airway obstruction, bronchial hyper-responsiveness, and underlying inflammatory process •In susceptible children, inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough (especially at night or early morning); airflow limitation is reversible either spontaneously or with treatment; crucial part to treating asthma is recognizing that this is an inflammatory processusing anti-inflammatory agents, especially inhaled steroids

Nursing priorities for child with major abdominal (or HEENT) surgery postoperatively?

•Ensure that preparations are made to receive childbed or crib is ready and IV pumps and poles, suction apparatus, and oxygen flow meter are at bedside •Obtain baseline informationV/S, and record more frequently if any value is fluctuating; inspect operative area!! •Check dressing if presentoutline any bleeding area on dressing or cast with pen; reinforce, but do not remove loose dressing; observe areas below surgical site for blood that may have drained toward bed; assess for bleeding and other symptoms in areas not covered with dressing (ie throat after tonsillectomy) •Assess skin color and characteristics!! •Assess LOC and activity •Notify MD if any changes/irregularity in child's condition •Assess for evidence of pain •Review surgeon's orders after completing initial assessment, and check that preoperative orders have been reordered and can be given by available routes •Monitor V/S as ordered and more often if indicated •Check dressings for bleedings

Nursing guidelines when preparing the family for a procedure??

•Name of procedure •Purpose of procedure •Length of time anticipated to complete procedure •Anticipated effects •Signs of adverse effects •Assess family's level of understanding •Demonstrate and have family return demonstration

Pathophysiology for intussusception?

•Pathophysiology: occurs when proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery (artery supply) with it->mesentery is compressed and angled->lymphatic and venous obstruction (artery and lymph supply is cut off)->edema from obstruction increases->increased pressure in the area oOnce the pressure equals the arterial pressure, arterial blood flow stops->intestinal ischemia!! And pouring of mucus into the intestine oVenous engorgement->leaking of blood and mucus into intestinal lumen->classic currant colored jelly-like stools