307 assessment 4

Dehydration manifestations

-tachycardia (earliest) - dry skin & mucous membranes - sunken fontanels - coolness & mottling of extremities (sign of circulatory failure) - loss of skin elasticity - prolonged cap refill - abnormal respiratory patterns

Constipation hospital management

Infants - increase carbs (sucrose & corn syrup) childhood - diet modifications to include fiber & fluids - promote regular bowel movements

SIADH ("soaked inside")

increased ADH secretion

Meckel Diverticulum manifestations

inflammation, bleeding, or intestinal obstruction

type 2 Dm

insulin resistance

volvulus

intestine is twisted around itself and comprises blood supply to intestines

assess for what if 1st meconium doesn't pass in 48 hours

meconium plug (from reduced h2o content) meconium ileus (initial s/s of CF, obstruction of the distal small intestine) Hirschsprung disease, hypothyroidism

Cushing Syndrome manifestations

moon face excessive hair growth red cheeks stretch marks poor wound healing weight gain bruises pendulous abdomen

@ risk for type 2 DM

native americans hispanic african american children

secondary sex characteristics

nonreproductive sexual characteristics, such as female breasts and hips, male voice quality, and body hair

which is more emergent Omphalocele or Gastroschisis

omphalocele

primary tx for diarrhea

oral rehydration therapy

Hypothyroidism tx

oral thyroid hormone replacement

Cleft lip: What are they at risk for prior to being fully repaired

otis media aspiration

type 1 DM

pancreatic beta cell destruction leads to absolute insulin insufficiency (pancreas doesn't make insulin)

Diabetes Insipidus manifestations

polyuria polydipsia 1st is usually enuresis (pee myself) infants - irritability that is relieved with feedings of water but not milk, dehydration, full diapers

Hirschsprung nursing care

pre-op - low fiber, high cals, high protein (or TPN) - bowel prep w/ saline enemas and antibiotics post-op - assess surgical site - urinary Cath care - stony care if needed Discharge - teach care for ostomy & incision - monitor for dehydration

isotonic dehydration

proportionate loss of fluid and electrolytes

umbilical hernia

protrusion of part of the intestine at the navel

celiac disease treatment

remove gluten from diet (wheat, barley, rye)

Cleft lip: What can be done to help feed the infant

special feeding equipment squeeze breast gently and self express

celiac disease (accumulation of glutamine) manifestation

steatorrhea general malnutrition abdominal distention secondary vitamin deficiencies diarrhea & FTT

Hypopituitarism (GH deficiency) manifestations

stunted somatic growth

intussusception manifestations (prolapses in, looks like its folded)

sudden onset cramps ab pain current jelly stools

Hirschsprung Disease tx

surgery in 2 stages - 1st: temporary ostomy - 2nd: "pull through" procedure

hyperthyroidism (graves disease) S/S

tachycardia widened pulse pressure dyspnea on exertion exopthalamus (big eyes) tremor goiter warm moist skin heat intolerance fine hair

Appendicitis diagnostics

ultrasound

Diabetes Insipidus tx

vasopressin daily hormone replacement DDAVP

hypertrophic pyloric stenosis s/s

vomit after feeding hunger after feeding

hypertonic dehydration

water loss exceeds electrolyte loss

What defines childhood obesity?

weight greater than 95%

Malrotation vs volvulus vs umbilical hernia: which is emergent

1st 2 are

Esophageal Atresia and Transesophageal Fistula (TEF) surgical considerations

1st separate, 2nd let esoph grow post op- NG, gastrostomy tube, PN (causes liver failure)

Crohn Disease vs Ulcerative Colitis

Crohns= skip lesions, primarily ileum, rectal bleeding rare, fistulas, strictures, perineal abcesses, cancer uncommon UC= continuous, primarily rectum and colon, rectal bleeding common, cancer common

Appendicitis manifestations

- N/V - RLQ pain @ mcburneys point - rebound tenderness - refereed pain - colicky - cramps

causes of incomplete precocious puberty

- Premature thelarche - Premature menarche - Premature pubarche or adrenarche

Hyperthyroidism (graves disease) tx

- antithyroid (PTU & methimazole) - subtotal thyroidectomy - ablation with radioiodine

causes of peripheral precocious puberty

- familial male-limited - albright syndrome - gonadal or extragonadal tumors - adrenal (congenital adrenal hyperplasia, adenoma, carcinoma, glucocorticoid resistance) - exogenous sex hormones - primary hypothyroidism

4 goals in dehydration management

- replacement of fluid volume deficit with an isotonic fluid - maintenance fluid replacement with dextrose and potassium - replacement of ongoing fluid loss - reestablishment of oral fluid intake and adequate diet

Hirschsprung Disease manifestations (aganglionic megacolon)

- swollen/big part of colon before rectum - failure of internal anal sphincter to relax - fail to pass stool w/in 24-48 hours after birth - enterocolitis may occur

When can the child have honey and cows milk

12 months

when 1st meconium should be passed

24-36 hours

Esophageal Atresia and Transesophageal Fistula manifestations (failure of esophagus to open as continuous passage)

3 c's: coughing, ,choking, cyanosis excessive drooling

Turner Syndrome

A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted.

Klinefelter syndrome

A chromosomal disorder in which males have an extra X chromosome, making them XXY instead of XY.

Juvenile Hypothyroidism

Congenital -Congenital hypoplastic thyroid gland Acquired -Partial or complete thyroidectomy for cancer or thyrotoxicosis -Following irradiation for Hodgkin disease or other malignant disease Rarely occurs from dietary iodine insufficiency in the United States

SIADH tx

I&O daily weight fluid overload assessment seizure precautions

Appendicitis care for the child following surgery

IV fluids NPO antibiotics low, intermittent gastric decompression until fart

kussmauls respirations

Respirations that are regular but abnormally deep and increased in rate from respiratory acidosis

Meckel Diverticulum

a common congenital outpouching of the wall of the small intestine. volvulus or intussusception are common obstructive mechanisms in these children and their S/S include ab pain, distention, nausea, and vomitting

Precocious Puberty

a condition in which puberty begins before the age of 8 in girls and 9 in boys tx: lupron

Failure to Thrive (FTT)

a disorder of impaired growth in infancy and early childhood characterized by failure to gain weight within normal limits

chrons clinical manifestations

ab pain diarrhea with ab cramping

Malrotation

ab rotation around superior mesenteric artery during embryonic development

Constipation

alteration in the frequency, consistency, or ease of passing stool - 4+ years diagnosed when they have less than 3 stools in a week

PUD tx

antacids sucrafate H2 receptors antibiotics

SIADH complications

hyponatremic encephalopathy - emergent! requires hypertonic sodium chloride

Effects of hypothyroidism on young child's development

can affect brain growth if not promptly treated cardiac

chrons tx

corticosteroids immunimodulators amino salicylates

diabetes insipidus ("dry inside")

hyposecretion of ADH

causes of central precocious puberty

idiopathic - w/ or w/out hypothalamic hamartoma secondary - congenital anomalies - radiotherapy - trauma - neoplasms - post inflammatory: encephalitis, meningitis, abscess, granulomatous after treatment of long-standing pseudo sexual precocity

hypothyroidism manifestations

decelerated growth constipation sleppiness dry skin sparse hair preorbital edema cold intolerance

Risk for young children and infants with diarrhea

deficient fluid volume imbalanced nutrition risk for infection

Diabetes Insipidus complications in infants

dehydration electrolyte imbalance hyperthermia azotemia circulatory collapse

Gynecomastia

development of breast tissue in males

intussusception: Air or Barium enema, what is it used for?

diagnostic & tx - unfolds it give power rest & small feeds

food jags preschoolers

eat only one food constantly

hypotonic dehydration

electrolyte loss exceeds water loss

Hyperthyroidism (graves disease) cardinal signs

emotional lability physical restlessness (@ rest usually) decelerated school performance weight loss fatigue

Cushing Syndrome: most common cause

excessive or prolonged steroid use

Hypopituitarism diagnostics

fam hx radioimmunoassay of plasma GH levels hand X-rays endocrine studies to detect deficiencies

how to know its not PUD

feed and the pain stays

SIADH manifestations

fluid retention hypotonicity anorexia n/v irritability personality changes

Gynecomastia: who it affects

frequently in boys during puberty

Type 1 DM education

glucose goal: 80-120 lifelong insulin therapy test q3hr when sick test ketones when >240