MC Chapter 28 the child with a GI condition & 29 the child with a GU condition
The nurse has provided teaching to the parents of an infant with gastroesophageal reflux disease. Which statement made by the parents would the nurse recognize requires further teaching?
"After a feeding I can sit the baby upright in an infant seat." Sitting upright in an infant seat or swing is not recommended after feeding because it increases intraabdominal pressure. After a feeding the infant can be propped on the left side. Adding rice cereal to the formula increases the caloric density and may be appropriate depending on the age of the infant. The baby should be fed the prescribed amount of formula every 3 to 4 hours.
A child presents to the clinic with suspected functional constipation. Which question would the nurse ask?
"Has your child ever been incontinent of stool?" Incontinence is associated with functional constipation. Encopresis is a symptom in which constipation in conjunction with fecal soiling occurs. Weight loss and vomiting are not associated with functional constipation. Defecation fewer than two times a week is associated with functional constipation.
The nurse has provided teaching for a parent about general feeding guidelines for a 4-month-old infant with gastrointestinal reflux disease. Which statement made by the parent indicates an understanding of the teaching?
"I will not give my baby more than 7 ounces during a feeding." The general guideline for optimal nutritional intake to prevent gastric distention is to feed the infant no more than the age in months plus 3 ounces every 3 to 4 hours. A 4-month-old infant requires 4 ounces plus an additional 3 ounces in one feeding for a total of 7 ounces every 3 to 4 hours.
The nurse has provided teaching for a parent about fluid and nutrition replacement for a child at risk for dehydration. Which statement made by the parent indicates further teaching is required?
"I will offer my child some orange juice." Fluids high in glucose content such as orange juice should not be used for fluid replacement. Half-strength apple juice can be used for oral hydration. Simple proteins and starches such as those found in cereal and yogurt can lessen fluid loss.
The nurse notes an abdominal mass appears in the umbilical area when a child begins to cry. Which statement made by the parent would the nurse associate with the assessment finding?
"My child has always been constipated." An abdominal mass that appears at the umbilical area when a child begins to cry is associated with an umbilical hernia. Chronic constipation can be associated with an umbilical hernia. An increased appetite, vomiting, and mucus in the stool are not associated with an umbilical hernia.
The nurse has provided teaching for a parent whose child is scheduled to have a capsule endoscopy. Which parent statement indicates an understanding of the teaching?
"My child is nervous about wearing a wireless device." A capsule endoscopy requires the child to swallow a capsule that contains a camera and wear a wireless device outside of the body that records pictures of the gastrointestinal tract. Anesthesia is not administered to the child. A tube is not inserted into the child's mouth during the procedure. Preparation for the test includes a clear liquid diet and bowel preparation the day before the procedure.
A parent states that he or she read to not start a 2-month-old infant on cereal. Which response would the nurse provide?
"The baby does not have the ability to properly digest the cereal." Many enzymes that are necessary for digestion of cereal and other foods are deficient until 4 to 6 months of age. It is not advisable to mix cereal into formula or introduce cereal until the infant reaches the age to appropriately digest the food.
The nurse is preparing to teach a parent about the scheduled Schilling test for a child with failure to thrive. Which information would the nurse include?
"This test will assess the absorption capacity of the lower ileum." Malabsorption in a child is a contributing factor for a child that is diagnosed with failure to thrive. The Schilling test is used to assess the absorption capacity of the lower ileum for a child with suspected malabsorption. The test does not assess the absorption capacity for the entire small intestine, the effectiveness of the stomach's digestive enzymes, or the colon's ability to absorb an adequate amount of water.
nursing care dehydration
- safety/fall precautions - daily weight - hourly I&O - expect intake to exceed output initially - monitor for s&s of fluid excess (rising pulse and BP) - monitor blood glucose if diabetic - oral hygiene
Ways child GI tract differs from adult
1. At birth the resistance of the newborns intestinal tract to bacterial and viral infection is incompletely developed 2. As children grow, they have higher nutritional, metabolic & energy needs 3. Children with nausea & vomiting dehydrate more quickly than adults 4. Infants stomach is small & empties rapidly 5. Newborns produce little saliva until 3mo of age 6. Swelling is a reflex for first 3 mo 7. Hepatic efficiency in the newborn is immature, sometimes causing jaundice 8. The infants fat absorption is poor bc of a decreased pool of bile acid
At what point in gestation can the sex of the child be identified?
12 weeks By the end of the 12th week, external genitalia are formed in the fetus. Therefore the sex of the child is identified by the 12th week of pregnancy. Formation of eyes starts at the fourth week of pregnancy. Kidney formation starts at the seventh week of pregnancy. Limb formation starts from the sixth week of gestation.
The nurse is assessing the urine output for an infant weighing 19.8 lb. Which would the nurse anticipate is the average urine output for the infant? __________ mL/hour
18 mL/hr The average urine output for infants is 2mL/kg/hour. An infant weighing 19.8 lb is expected to have an average of 18 mL/hour. 2mL/kg/hr 19.8 lbs ÷ 2.2 = 9 kg 2mL x 9kg = 18 mL/hr
Four types of TEF
1. The upper esophagus & the lower esophagus (leading from the stomach) end in a blind pouch. 2. The upper esophagus ends in a blind pouch; the lower esophagus (leading from the stomach) connects to the trachea. 3. The upper esophagus is attached to the trachea; the lower esophagus (leading from the stomach) is also attached to the trachea 4. The upper esophagus connects to the trachea; the lower esophagus (leading from the stomach) ends in a blind pouch *aspirate
The bladder capacity of a child can be approximated by the following formula: Age in years + ____ = Ounces of bladder volume or capacity
2
Pyloric Stenosis Occurs
2-6 weeks of age Boys > girls
Glomerulonephritis is the most common form of nephritis in children, and it occurs most often in boys ____ to _____ years of age. Both kidneys are usually affected.
3 to 7
There is an unexplained relationship between ______ ears in the newborn and urinary tract anomalies.
low-set
What age does celiac disease manifest?
6 months - 2 years of age
Which is the approximate bladder capacity of a 4-year-old child?
6 oz. The bladder capacity of a child can be approximated by the following formula: Age in years + 2 = oz of bladder volume or capacity. 4 years old + 2 = 6-oz bladder volume or capacity.
What is the maximum volume of one feeding in a 3-month-old infant to prevent gastric distension? Record your answer using a whole number. Answer: ______ oz
6oz Overfeeding may lead to gastric distention in the infant. As per the standard format, the infant should be fed a volume no more than the age in months plus 3. Since the infant's age is 3 months, according to the guideline, the infant should be fed a maximum of (3 months + 3) 6 oz in one feeding.
At which point in gestation do the testes begin to descend along a pathway into the scrotum?
7 Months Toward the end of the seventh month the testes begin to descend along a pathway into the scrotum.
currant jelly stool
A mix of blood/mucous in the stool, consistency of jelly
Aspirin poisoning treatment
Activated Charcoal Sodium BiCarb Vitamin K Hemodialysis
____________ ________, is an allergic reaction (antigen-antibody) to a group A beta-hemolytic streptococcal infection.
Acute glomerulonephritis (AGN), formerly called Bright's disease
An infant appears dehydrated. Laboratory results indicate a serum sodium of 143 mEq/L. Which fluid would the nurse use for IV replacement? A. 0.45% normal saline B. 0.9% normal saline C. 3% normal saline D. D5W with 20 mEq KCL
ANS: B This child has an isotonic dehydration, in which fluids and solutes are lost in balanced proportions, as evidenced by the normal serum sodium level. The child needs an isotonic IV solution, which would be 0.9% normal saline. The 0.45% normal saline ("half normal saline") is hypotonic, as is D5W, with or without potassium. The 3% normal saline is hypertonic.
A child is suspected to have appendicitis. Which finding would concern the nurse the most?
Abdominal Distention Sudden relief of acute pain, rigid guarding of the abdomen, abdominal distention, tachycardia, chills, and irritability are signs of a ruptured appendix with peritonitis. Increased C reactive protein and white blood cell count indicates an infection is present in the body. Vomiting after the onset of abdominal pain is associated with appendicitis.
Which indicates oligohydramnios, as seen in an ultrasound?
Absence of or little amniotic fluid The scarcity or absence of amniotic fluid indicates oligohydramnios, which results in fetal respiratory distress. During the third month of gestation, the fetal kidney starts to secrete urine that contributes to a portion of the amniotic fluid. The presence of urine in the amniotic fluid is a normal finding. Oligohydramnios manifests as little amniotic fluid but is not green in color. Green-colored amniotic fluid may indicate other complications in the fetus, such as respiratory distress. The presence of excessive amounts of amniotic fluid is seen in pregnant patients with polyhydramnios but not oligohydramnios.
Which findings would the nurse expect in a child diagnosed with Hirschsprung's disease?
Anorexia Ribbon-like stools Abdominal distention Hirschsprung's disease is a condition characterized by the absence of ganglionic nerves in the bowel leading to impaired peristalsis. As a result, the child has difficulty passing stools. As a result of improper bowel function, the child's appetite is decreased, leading to anorexia. Ribbon-like stools may be observed as a result of the passing of feces through the narrowed segment of the intestine. The portion of the bowel nearest to the obstruction dilates and leads to abdominal distention. Decreased urination is a symptom of dehydration. Swelling of the extremities indicates overhydration.
Which medication may cause Reye's syndrome in children?
Aspirin Aspirin may cause Reye's syndrome in children. Reye's syndrome causes edema of the liver and brain. Nystatin is an antifungal agent and does not cause Reye's syndrome. Acetaminophen is an analgesic drug and is not related to Reye's syndrome. Docusate sodium is a stool softener.
fistula treatment
Assessment during 1st feeding NPO -IV nutrition Suction -NG in pouch to suction -Gastrostomy to empty stomach Prevent -Choking, aspiration and respiratory distress Surgical repair
The nurse is caring for a child who has Wilms' tumor. Which is the priority nursing intervention in this situation?
Avoid palpating the abdomen. Wilms' tumor is a malignant tumor of the kidneys typically seen in young children. The priority nursing intervention for this condition is to avoid palpation of the abdomen because palpation can cause dissemination of the cancer cells to adjacent sites. Bladder spasm is not a common finding of a child with Wilms' tumor. Regular urinalysis helps determine the status of renal functioning in the child. However, regular urinalysis is not the priority intervention in the case of Wilms' tumor. The nurse would avoid giving bubble baths to patients with urinary tract infections, because the surfactant products that produce bubble foam may irritate the urethra.
The nurse is caring for a child with a fever. Which nursing interventions help obtain accurate results in a urinalysis test?
Avoiding collection of urine sample from diapers The chemicals and gels present in the diaper fabric may alter the urinalysis report of the child. Therefore the nurse avoids the collection of urine specimens from diapers. The nurse stores the samples in a refrigerator to avoid decomposition. Antibiotics may alter the urinalysis results; therefore the nurse collects the urine sample before the administration of antibiotics. The nurse collects the urine sample every hour if ordered by the primary health care provider in cases of severe renal disease. However, this is not necessary in the case of a child with fever.
Why are tap water enemas are never given to children?
Because they can lead to water intoxication and death.
A child is suspected to have intussusception. Which assessment finding would the nurse anticipate?
Bilious emesis Bilious emesis is an assessment finding for a child with intussusception. Mucus and blood that contain no feces are a common finding about 12 hours after the obstruction. Bowel movements diminish and flatulence is decreased, resulting in hypoactive or absent bowel sounds.
An infant who has been vomiting is suspected of having a formula intolerance. Which intervention would the nurse include in the care of the infant?
Burp the infant after feeding. The infant should be burped after feeding to prevent vomiting. The infant should be handled as little as possible after feedings, so treatments should be deferred. The infant should be positioned on the right side to prevent aspiration of vomitus. The infant is not placed in a low Fowler's position.
The parents report to the nurse that the child has mistakenly consumed wintergreen oil. Which complication would the nurse monitor the child for?
Cardiovascular collapse Wintergreen oil contains methyl salicylate and may cause cardiovascular collapse in the child. Benzocaine, camphor, and tetrahydrozoline hydrochloride poisoning cause seizures. Camphor and diphenoxylate poisoning cause CNS depression. Benzocaine poisoning causes methemoglobinemia.
Esophageal Atresia (Tracheosophageal Fistula)
Caused by failure of the tissues of the GI tract to seperate properly from the resp tract early in prenatal life.
A patient with which condition would be advised against consuming wheat and wheat products?
Celiac disease Celiac disease is an autoimmune disorder resulting in gluten intolerance. Wheat and wheat products contain gluten. So consumption of these foods can lead to indigestion and diarrhea. Therefore wheat and wheat products should be avoided in the diet. Pyloric stenosis, Meckel's diverticulum, and Hirschsprung's disease are not associated with gluten tolerance. Therefore the patient is allowed to have gluten-containing foods.
pinworm s/s
Child scratches anal area Weight loss Irritability Poor appetite
Hypospadias may be accompanied by _______, a downward curvature of the penis caused by a fibrotic band of tissue
Chordee
Roundworms S/S
Chronic cough without fever Asymptomatic Complaints of abdominal pain
Hyposadias
Congenital defect in which the urinary meatus is located on the lower portion of the shaft (ventral side) May be accompanied by chordee, a downward curvature of the penis from a fibrous band of tissue
Metabolic acidosis s/s
Drowsiness Confusion Headache Coma ↓BP Dysrhythmias (R/T Hyperkalemia) Warm, flushed skin Nausea/Vomiting/Diarrhea/Abdominal pain Deep, rapid respirations
What causes most UTI's?
E. coli
The nurse is caring for a child with salicylate poisoning. The physician prescribes vitamin K. Which assessment finding would the nurse anticipate if the vitamin K is effective?
Controlled bleeding Salicylate poisoning may cause liver dysfunction that can lead to bleeding. Vitamin K promotes clotting and helps control bleeding. Vitamin K does not impact fever, nausea, or vomiting.
A child who has a habit of biting colored furniture is found to have neuritis and muscular incoordination. Which other symptoms might this child also be exhibiting?
Convulsions & Encephalitis Furniture paint may contain lead. If the child has a habit of biting painted furniture, it may result in lead poisoning. Lead has toxic effects on the synthesis of heme in the blood. Heme is essential for the functioning of the renal tubules and the formation of hemoglobin. Therefore the child may also be exhibiting convulsions and encephalitis. Lead poisoning does not cause fever, tinnitus, or tachycardia. Tinnitus and tachycardia can be caused by salicylate poisoning.
A child is admitted to the emergency department with suspected intussusception. Which significant assessment finding supports this diagnosis?
Currant jelly stools In typical cases of intussusception the onset is sudden. The child feels severe pain in the abdomen. The child vomits. The stomach contents are green or greenish yellow (bilious). Movements of blood and mucus that contain no feces are common about 12 hours after the onset of the obstruction; these are termed currant jelly stools.
Steroids and vaccines
DO not give live virus vaccines when a patient is on steroids.
A patient with acetaminophen poisoning has been prescribed N-acetylcysteine. Which complication is the health care provider attempting to avoid by prescribing this medication?
Destruction of the liver N-acetylcysteine is an antidote to acetaminophen and is used in case of acetaminophen poisoning to prevent hepatic destruction. GI irritation, reduced kidney function, and platelet dysfunction are complications of NSAID overdose, not acetaminophen overdose.
Wilms' tumor, or nephroblastoma: in the hospital a sign is placed on the crib: "___________."
Do not palpate the abdomen
hypotonic dehydration
ELECTROLYTE LOSS exceeds water loss Results: fluid shifts between compartments causing a decrease in plasma volume and the cells to SWELL.
S/S of TEF Earlier sign occurs in prenatal- mother develops polyhydroaminos. When the upper esophagus ends in blind pouch, fetus cannot swallow the amniotic fluid in amniotic sac (polyhydroaminos). At birth infant will vomit & choke when first feeding introduced. Bc upper end of the esophagus ends in a blind pouch, newborn cannot swallow accumulated secretions & used will appear to be drooling. If upper esophagus enters trachea, the first feeding will enter trachea & result in coughing, choking, cyanosis, apnea. If the lower end of esophagus (from the stomach) enters trachea, air will enter the stomach each time infant breathes causing abdominal distention.
Earlier sign occurs in prenatal- mother develops polyhydroaminos. When the upper esophagus ends in blind pouch, fetus cannot swallow the amniotic fluid in amniotic sac (polyhydroaminos). At birth infant will vomit & choke when first feeding introduced. Bc upper end of the esophagus ends in a blind pouch, newborn cannot swallow accumulated secretions & used will appear to be drooling. If upper esophagus enters trachea, the first feeding will enter trachea & result in coughing, choking, cyanosis, apnea. If the lower end of esophagus (from the stomach) enters trachea, air will enter the stomach each time infant breathes causing abdominal distention.
Nursing Care Overhydration
Early detection Accurate daily weights Vital Signs Physical assessment Monitor I&O Monitor labs Administer appropriate fluids
Which organism is the most common cause of urinary tract infections in children?
Escherichia coli Of all infections, 75% to 90% are caused by Escherichia coli followed by Klebsiella and Proteus.
Hydrocele
Excessive amount of fluid Causes scrotum to swell Self corrects by age 1 Chronic hydrocele that persists beyond 1 year is corrected by surgery
Which condition presents as the bladder lying open and exposed on the abdomen?
Extrophy The condition is exstrophy of the bladder, in which the bladder lies open and exposed on the abdomen. This condition occurs because of the absence of the lower portion of the abdominal wall and the anterior portion of the bladder. Cystitis is inflammation of the bladder. Hydronephrosis is the accumulation of fluids in the kidneys resulting in the distention of the renal pelvis. Vesicoureteral reflux (VUR) is the backward flow of the urine into the ureter.
Intussusception S/S
Fever Abdominal pain Bilious emesis No stool / gas passage Treatment Air enema Surgery
Diarrhea: Metabolic Acidosis Response to:
Food Medication Poisoning Allergic response
Constipation
Hard, dry fecal material < 7 bowel movement / 2 weeks
The nurse is caring for a child with nephrotic syndrome who has whole-body edema. Which foods would the nurse exclude from the child's diet?
High-salt foods The nurse would exclude high-salt foods from the child's diet because high salt may increase the concentration of sodium in the blood. As a result, the body would retain more water to dilute excess sodium leading to increased fluid accumulation. Consumption of high-fiber foods reduces the risk of constipation by allowing the easy passage of food through the gut, but this intervention is not helpful for a child suffering from nephrotic syndrome. In this case the child should have low-protein foods to prevent further damage to the kidneys. Fat does not interfere with the functioning of the kidneys; therefore low fat foods can be included in the child's diet.
Which is the condition in which the urinary meatus is located on the underside of the penis?
Hypospadias Hypospadias is the condition in which the meatus is located on the underside of the penis. This condition is corrected with surgery.
vomiting/ metabolic alkalosis Vomiting can occur because of:
Improper feeding technique Illness Increased ICP Structural abnormality At risk for aspiration pneumonia
Plumbism (Lead poisoning)
Ingestion or absorption of substances containing lead
Lead poisoning symptoms
Irritability Weakness Anemia Cognitive delays
Which condition is a result of protein-energy malnutrition?
Kwashiorkor Kwashiorkor is a nutritional deficiency that occurs as a result of protein deficiency. Scurvy occurs as a result of vitamin C deficiency. Rickets occurs as a result of vitamin D deficiency. Celiac disease is an autoimmune genetic illness characterized by gluten intolerance.
Lab procedures to determine GI disorders
Lab work- CBC with differential, will reveal anemia infections & chronic illness Comprehensive chemical panel- reveal electrolyte & chemical imbalances. Xray studies- barium enema, flat plates of abdomen, GI series
Stools in the child with celiac disease are?
Large, bulky, frothy.
Isotonic dehydration s/s
Low BP (Hypotension) High HR (Tachycardia) increased RR weak pulses (rapid, thready) and a decreased urinary output.
Extrophy of the Bladder
Lower portion of abdominal wall and anterior wall of bladder are missing Noticeable by fetal sonogram Bladder lies open and exposed Urine leaks continually -Skin breakdown
celiac disease symptoms
Malabsorption Irritability Failure to thrive Stools --Large, bulky, frothy
Symptoms of hirschusprung disease (congenital aganglionic megacolon)
Meconium ileus Constipation Abdominal distention Ribbon-like stools Anorexia Vomiting Failure to thrive
The nurse finds that a child has lost 5% of her body weight. Skin turgor is normal and the urine output is adequate. The nurse observes that the child's anterior fontanelle is flat. Which degree of dehydration is the child exhibiting?
Mild dehydration Dehydration can be categorized as mild, moderate, or severe depending on the symptoms. A normal urine output and skin turgor, 5% loss of body weight, flat anterior fontanelle, and slight thirst indicate that the child has mild dehydration. Minor dehydration is not a type of dehydration. Moderate thirst, 10% body weight loss, and decreased urine output are the symptoms of moderate dehydration. Intense thirst, 15% loss of body weight, sunken anterior fontanelle, decreased skin turgor, and minimal urine output are the symptoms of severe dehydration.
The nurse is caring for a child with acetaminophen poisoning. Which nursing intervention will be necessary if the patient is exhibiting kidney problems?
Monitoring intake and output Acetaminophen poisoning occurs at an acute overdose. A patient exhibiting kidney problems will need to have their intake and output monitored closely and their IV lines monitored. A patient with respiratory obstruction, hypoventilation, or hypoxia may need CPR. A patient displaying absorption symptoms may need to have activated charcoal administered. A patient with difficulty swallowing will need to be placed on NPO status.
Appendicitis
Most common reason for emergency abdominal surgery Initial pain usually in periumbilical and increases within a 4-hour period When inflammation spreads to peritoneum, pain localizes in RLQ of abdomen Appendix may become gangrenous or rupture Can lead to peritonitis and septicemia
What is the treatment of acetaminophen poisoning?
N-acetylcysteine (Mucomyst)
Aspirin poisoning S&S
Nausea Vomiting Tinnitus Tachypnea
Thrush Treatment
Nystatin
Which signs and symptoms would alert the nurse to the possibility of intussusception?
Onset is sudden Kicking and drawing of legs Bile stained vomit Currant Jelly stools All of these are signs of intussusception except failure to thrive. This diagnosis is an acute condition, and it will be diagnosed before a child has the opportunity to develop a diagnosis of failure to thrive.
Which is the treatment to correct for cryptorchidism?
Orchiopexy Orchiopexy is the surgery performed to correct for cryptorchidism. Nephrostomy is performed to bypass a urinary obstruction. A vesicostomy is performed to bring the bladder to the surface of the abdomen. A suprapubic tube is placed above the symphysis pubis into the bladder to provide urinary drainage.
The nurse observes a 2-week-old infant vomiting fluid containing mucus and undigested milk immediately after a feeding. Which intervention would the nurse perform to assess the cause?
Palpate the abdomen The infant has symptoms of pyloric stenosis, which is an obstruction at the lower end of the stomach caused by an overgrowth of the circular muscles of the pylorus or by spasms of the sphincter. The nurse will perform an abdominal assessment to determine if there is an olive-shaped mass in the upper right quadrant of the abdomen. Burping the infant is done before and after feedings to remove any gas accumulated in the stomach. Refeeding the infant slowly can be done after the physical assessment. Right lateral position is implemented after feedings to facilitate drainage into the intestines.
While collecting the data on a newborn, the nurse finds the presence of a narrowed preputial opening of the foreskin. During a follow-up visit, the parent says, "I forcibly retracted the foreskin of my child's penis to make urination easier." Which risk would the nurse expect in the newborn?
Paraphimosis Phimosis refers to the presence of a narrowed preputial opening of the foreskin in the child. Phimosis prevents the retraction of the foreskin over the penis. Forcible retraction of the foreskin may lead to paraphimosis that manifests as swelling and impaired circulation as a result of constriction. This condition needs immediate medical intervention. Hydrocele is an excess amount of fluid in the scrotum. Wilms' tumor is an embryonal adenosarcoma that manifests as a mass in the abdomen and would not lead to paraphimosis in the child. Undescended testes in the child indicate cryptorchidism.
Which is a narrowing of the preputial opening of the foreskin, which prevents the foreskin from being retracted over the penis?
Phimosis Phimosis is a narrowing of the preputial opening of the foreskin, which prevents the foreskin from being retracted over the penis. This is normal in newborns and usually disappears by 3 years of age.
Which condition is characterized by the eating of nonfood substances?
Pica Eating nonfood items is called pica. Bulimia, anorexia, and emaciation are disorders associated with eating.
The nurse is caring for a patient who has acute cystitis. Which complications would the nurse expect in the patient if the treatment is delayed?
Pyelonephritis Kidney Damage Acute cystitis is a urinary tract infection that affects the bladder. It requires prompt treatment. If treatment is delayed, the infection may spread to the upper parts of the urinary tract, leading to pyelonephritis and kidney damage. Dehydration, cardiac toxicity, and metabolic alkalosis are not associated with acute cystitis. Depressed fontanelle, sunken eyeballs, lack of tears, dark circles around the eyes, and poor skin turgor indicate dehydration. Acute glomerulonephritis may lead to impaired excretion of potassium resulting in hyperkalemia. This may lead to cardiac toxicity in the patient. Metabolic acidosis is common in renal impairment, but not metabolic alkalosis.
Appendicitis S/S
RLQ pain, low grade fever, nausea, rebound tenderness at McBurney's point.
Manifestations Trachesophageal Fistula
Polyhydramnios Excessive oral secretions / drooling First feeding -Choking -Vomiting -Respiratory distress
While collecting the data on a 10-month-old child, the nurse finds that the child's urine output is 14 mL/Kg/hr. Which condition is consistent with this finding?
Polyuria The normal urine output in infants and toddlers is 2 to 3 mL/Kg/hr. The child has a urinary output of 14 mL/Kg/hr, which signifies increased urinary output. Therefore the nurse infers that the child has polyuria. If the documented finding falls below the normal range or less than 2 mL/Kg/hr, it indicates oliguria or decreased urinary output. Bacteriuria is the presence of bacteria in the urine specimen of the child. Encopresis refers to involuntary defecation, especially associated with emotional disturbance or a psychiatric disorder.
Phimosis
Prevents foreskin from being retracted over penis Corrected by circumcision
Which clinical manifestation suggests pyloric stenosis?
Projectile vomiting Vomiting is the outstanding symptom of pyloric stenosis. The force progresses until most of the food is ejected a considerable distance from the mouth. This is termed projectile vomiting. Regurgitation is a symptom of gastroesophageal reflux. Bloody stool is a symptom of gastroenteritis. Steatorrhea is the presence of excess fat in stools caused by malabsorption and is not a clinical manifestation of pyloric stenosis.
Pyloric Stenosis S/S
Projectile vomiting Hunger Dehydration RUQ mass
The nurse is caring for a patient who has acute cystitis. The primary health care provider prescribes urological tests to find the causative organism. Which nursing intervention will be helpful for this patient?
Remind the child to void frequently Acute cystitis is a urinary tract infection that affects a part of the urinary tract. Broad-spectrum antibiotic therapy can prevent the spread of the infection before finding the specific causative organism. The child should be encouraged to void frequently. The child should drink plenty of fluids and be instructed to wipe from front to back. Urine specimens would not be collected from a diaper, as the chemicals and gels in the diaper may alter the test results.
Poisoning Goals of Treatment
Remove the poison Prevent further absorption Call the poison control center Provide supportive care --Seek medical help
While collecting data on a newborn, the nurse finds the presence of low-set ears. Which assessment would the nurse expect to be performed by the registered nurse to ensure safety in the newborn?
Renal Examination Ears and kidneys develop at the same time during fetal life. Therefore any abnormality related to the ears may be a sign of renal abnormality in the newborn as well. Gastric, thyroid, and pancreatic examinations are not associated with low-set ears in the newborn.
Hypotonic Dehydration S/S
Skeletal muscle weakness dry mouth change in mental status headache
Emergency Intussusception
Sudden onset, always an emergency
Pyloric Stenosis Treatment
Surgery to relieve stenosis (pyloromyotomy)
The nurse is caring for a child who has undergone a nephrostomy. The parent of the child states, "My child is experiencing irritation at the site of the stoma." Which is the most important nursing intervention in this situation?
Take precautions to prevent infections. While caring for a child who has undergone nephrostomy, the priority nursing intervention is to take precautionary measures to prevent infection in the child. Irritation at the stoma may be caused by adhesives, blockage of the tube, or infection and needs medical attention. The nurse would not prepare a dose of antibiotics without direction from the health care provider. An increase in fluid intake can improve renal function, but is not the most important intervention in this situation.
cryptorchidism
Testes fail to descend Unilateral Testes are warm in abdomen --Sperm cells begin to deteriorate --Sterility can result Inguinal hernia common No impact on secondary sex characteristics
Scurvy
a disease caused by lack of vitamin C
What will and infant with tracheoesophageal fistful do during the first feeding is given?
The infant with tracheoesophageal fistula will vomit and choke when the first feeding is given.
At which month of development does the fetal kidney begin to secrete urine?
Third At approximately the third month of gestation, the fetal kidney begins to secrete urine. The fetal kidney is already secreting urine by the fifth, sixth, and ninth months of gestation.
Function of GI tract
Transports and metabolizes nutrients necessary for life of cell. Extends from mouth to anus. Nutrients are broken down into absorb able products by enzymes from various digestive organs
The external genitalia of the fetus are recognizably male or female by which week of gestation?
Twelfth By the 12th week the external genitalia of the fetus are recognizably male or female. The external genitalia of the fetus are not recognizably male or female at the 6th, 8th, or 10th weeks of gestation.
Which is the gastrointestinal capacity of a 1-year-old infant?
Up to 360 mL The gastrointestinal capacity of a child increases with age. Understanding the physiology of the pediatric digestive tract helps when introducing new food during the first year. A 1-year-old infant has a gastrointestinal capacity of up to 360 mL. A 1-week-old infant has a gastrointestinal capacity of 30 to 90 mL. A 1-month-old infant has a gastrointestinal capacity of 90-150 mL. A 2-year-old child has a gastrointestinal capacity of up to 500 mL.
Trachesophageal Fistula (TE Fistula) Esophageal Atresia Type A
Upper and lower esophagus end in a blind pouch No tracheal fistula
Trachesophageal Fistula (TE Fistula) Esophageal Atresia Type D
Upper esophagus connects to the trachea Lower esophagus connects to the trachea
Trachesophageal Fistula (TE Fistula) Esophageal Atresia Type E
Upper esophagus connects to the trachea Lower esophagus connects to the trachea
Trachesophageal Fistula (TE Fistula) Esophageal Atresia Type B
Upper esophagus connects to trachea Lower esophagus ends in a blind pouch
Trachesophageal Fistula (TE Fistula) Esophageal Atresia Type C
Upper esophagus ends in a blind pouch Lower esophagus connects to the trachea
epispadias
Urinary meatus is on the upper surface of the penis (dorsal side)
Rickets
Vitamin D Deficiency osteomalacia in children; causes bone deformity
GE Reflux: symptoms
Vomiting Weight loss Failure to thrive Infant fussy / hungry Respiratory problems
hypertonic dehydration
WATER LOSS exceeds electrolyte loss; alteration in the concentration of specific plasma electrolytes Results: fluid moved from the intracellular compartment into the plasma and interstitial fluid spaces causing cellular dehydration and SHRINKAGE
Thrush
White patches on the tongue that --Look like curds of milk --Cannot be wiped away
The earliest sign of Hirschsprung's disease is failure to pass meconium stools within how many hours after birth?
Within 24 to 48 hours after birth.
Failure to thrive
a condition in which infants become malnourished and fail to grow or gain weight for no obvious medical reason
chelation therapy
a procedure in which excess metals, such as iron, are removed from the blood
Wilms' tumor, or nephroblastoma: A mass in the ______ is generally discovered by a parent or by the physician during a routine checkup.
abdomen
Hirschsprung's disease (congenital megacolon)
absence at birth of the autonomic ganglia in a segment of the intestinal smooth muscle wall that normally stimulates peristalsis
Aspirin poisoning
acetylsalicylic acid poisoning
Normal urine is:
acidic Alkaline urine favors pathogens
What does acetaminophen poisoning do?
causes hepatic destruction
Lead Poisoning Treatment
chelation therapy
bacteriuria
condition that occurs when bacteria enter the bladder during catheterization, or when organisms migrate up the catheter lumen or the urethra into the bladder; bacteria in the urine
GE Reflux
digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach. Many people, including pregnant women, suffer from heartburn or acid indigestion caused by GERD.
vesicoureteral reflux (VUR)
disorder caused by the failure of urine to pass through the ureters to the bladder, usually due to impairment of the valve between the ureter and bladder or obstruction in the ureter
glomerulonephritis s/s
elevated blood pressure headache facial edema lethargic low fever weight gain
The characteristic symptom of nephrosis is edema. Which is first noticed around the ______ and _____ and later becomes generalized.
eyes and ankles
Urinary tract infections are more common in ____________.
girls Shorter urethra Urethra is near anus Wearing of close-fitting nylon underwear Bubble baths, Urine retention Vaginitis
nephrotic syndrome (nephrosis)
group of conditions in which excessive amounts of protein are lost through the urine Boys Ages 2-7 Hypoalbuminemia Edema --Eyes
constipation treatment
high fluid, high fiber, exercise Stool softener
infant dehydration
indications of dehydration: -tachycardia -dry skin -mucous membranes -sunken frontanels Nurse care inclues: -Accurate I & O's -Oral rehydration thereapy
diarrhea metabolic acidosis causes
inflammation infection
ureteritis
inflammation of a ureter
cystitis
inflammation of the bladder
Glomerulonephritis
inflammation of the glomeruli of the kidney Recent Strep infection Periorbital edema Bloody urine Low urine
pyelonephritis
inflammation of the renal pelvis and the kidney
Urethristis
inflammation of the urethra
paraphimosis
is an uncommon medical condition in which the foreskin of an uncircumcised penis becomes trapped behind the glans penis, and cannot be reduced (pulled back to its normal flaccid position covering the glans) Act immediately, emergency surgery due to cut off circulation
Wilm's tumor
malignant tumor of the kidney < age 3 years Common malignancies Few or no symptoms Abdominal mass
What diet is recommended for nephrotic syndrome (nephrosis)?
normal protein diet
To assess for a distended bladder, the nurse gently palpates below the umbilicus, moving toward the symphysis pubis. The normal bladder is _____ palpable because it lies behind the symphysis pubis.
not
Glomerulonephritis: From 1 to 3 weeks after a streptococcal infection has occurred, the parent may notice that the child has ____ _____ when awakening in the morning and that the child's urine is smoky brown or bloody.
periorbital edema
What should be restricted in patients with glomerulonephritis?
potassium
What operation to correct pyloric stenosis?
pyloromyotomy
Not BRAT diet
small oral liquid feedings
intussusception
telescoping of a segment of the intestine within itself
Nephrotic syndrome: No ______ or ______ should be administered while the disease is active and during immunosuppressive therapy.
vaccinations or immunizations
Isotonic dehydration
water and dissolved electrolytes are lost in equal proportions
Measuring urine output in infant
weigh diaper in grams convert to mls 1 gram = 1 ml
Interventions to prevent urinary tract infection (UTI) include
•Cleanse perineum with each diaper change •Wipe perineum from front to back •Avoid bubble baths •Have child urinate immediately after a bath •Use white, cotton underwear •Use loose-fitting pants •Offer adequate fluid intake (diuresis increases antibacterial properties of the renal medulla)
