fear of becoming fat, disturbed body image, progressive weight loss and what we see is not what they see
What is restrictive anorexia?
restrict calories; eating healthy
What is binge and purging anorexia?
take in a lot of calories and purge them out
How is bulimia characterized?
binge eat to compensate and purge, excessive exercise, no progressive weight loss, and they look ideal
What are findings related to bulimia?
erosion on teeth, scars on hands suspected anemia, and irregular menstrual cycle
How do people with anorexia look?
wasting away; skeletal
How do people with bulimia look?
What is Marasmus?
depletion of caloric and protein intake characterized by "wasting away" and muscle atrophy
What is Kwashiorkor?
depletion of protein intake and mostly starch intake
What else is evident in Kwashiorkor?
poor immune system, vitamin and mineral deficiency, loss of hair, edema, rashes and diarrhea
Why is a Haberman feeder used with a cleft palate?
seals to where the palate would be and the baby can suck
What should you teach the patients using a Haberman feeder?
What are patient's with a cleft palate at risk for?
aspiration, ear infections, hearing loss
With a cleft palate what is inserted to help with drainage in the ears?
Post-op cleft lip repair what is commonly used? Why?
elbow restraints; keep the baby from pulling out the sutures
What are signs and symptoms of a TEF?
frothy saliva, projectile vomiting, aspiration, drooling, choking and cyanosis
What is the cardinal sign of a TEF?
projectile vomiting after first feeding
After a TEF what will the baby come back with?
A baby with TEF how do you give them the satisfaction of sucking since the mom can't breast feed?
What is pyloric stenosis?
pylors becomes thickened and elongated forming a blockage
What are the signs and symptoms of pyloric stenosis?
white projectile vomiting and they are hungry as soon as they vomit
What are infants with pyloric stenosis at risk for?
failure to thrive and dehydration
What type of palpable mass is felt in pyloric stenosis?
olive-shaped on the right side
What post-op care should you teach the parents with pyloric stenosis?
sit the baby up to feed, and lay elevated on the right side to promote gastric emptying while sleeping
What is intussesception?
intestine telescopes into itself
What does intussusception present like?
What are the signs and symptoms of intussusception?
currant jelly like stools, severe abdominal pain and cramping and draw their legs up to their chest
What type of mass is seen in intussusception?
What is used to treat intussusception?
What is celiac disease?
impaired fat absorption
What do the stools look like in celiac disease?
pail, oily, large, frothy and foul odor
What is given to patient's with celiac disease?
fat soluble vitamins (A, D, E, K)
What are the signs and symptoms of celiac disease?
muscle wasting, anemia, anorexia and abdominal distention
How do you treat celiac disease?
gluten free diet and fat soluble vitamins
What is short bowel syndrome?
part of the bowel has been removed due to abdominal trauma, infection, or necrotizing intercolitis
How do you treat short bowel syndrome?
supplement whatever was taken out
What nutritional needs are associated with short bowel syndrome?
permanent G tube or parenteral nutrition
What are signs and symptoms of lactose intolerance?
upset stomach, diarrhea, gassy and abdominal cramping
How do you treat lactose intolerance?
remove dairy from diet
What are signs of food allergies?
bloating, gassy and abdominal cramping
What is Meckel diverticulum?
inutero a fistula forms between the small intestine and the umbilicus
What are the signs of Meckel diverticulum?
bright red painless stools, abdominal pain, and currant jelly like stool
What is the pain and bleeding related to in Meckel diverticulum?
pain and bleeding from the ulcer
With an increase loss of blood what would you see is Meckel diverticulum and how would you treat it?
anemia; treat it by giving blood
If the patient has a reaction to the blood what do you give them?
What is Hirschsprung disease?
no ganglion cells in the colon allowing no stool to pass
What do you develop with Hirschsprung disease?
megacolon and chronic constipation
What are manifestations of Hirschsprung disease in newborns?
not passing stool within 24-48 hours after birth, vomiting and abdominal distention
What are manifestations of Hirschsprungs disease in infants?
Bilious emesis, abdominal distention, and constipation
What are manifestations of Hirschsprung disease in childhood?
chronic constipation, ribbon and foul smelling diarrhea
What management is used in Hirschsprung disease?
a clean out is first priority using Miralax and antibiotics
What is a pull through procedure?
remove the section with no ganglion cells and pull through the rest of the intestine to meet the colon
What is acute constipation related to?
stress, dietary and potty training
What is ulcerative colitis?
inflammation of the large intestine and the colon (colon and rectum)
What are signs and symptoms of ulcerative colitis?
severe diarrhea, frequent bloody stools, abdominal pain, significant anemia, moderate weight loss, and rectal bleeding
What labs would you look for in ulcerative colitis?
CBC, erythrocyte sedimentation rate, and trace vitamins and minerals
How do you manage ulcerative colitis?
steroids and antibiotics
What should you teach patients on long term steroids?
spot glucose checks
What is Crohn's disease?
inflammation of the entire GI tract
What are signs and symptoms of Crohn's disease?
moderate to severe diarrhea, pain, anorexia, growth retardation, sexual maturation delay, weight loss, anal lesions, fistulas and strictures
How do you manage Crohn's disease?
antibiotics, steroids, and barrier cream
Due to severe diarrhea in Crohn's disease what do you see develop?
skin tags, skin breakdown, fissures, and fistulas
What irritable bowel syndrome?
recurrent abdominal pain
What is irritable bowel syndrome related to?
What are the signs and symptoms of irritable bowel syndrome?
alternating diarrhea and constipation, flatulence, bloating, abdominal distention, lower abdominal pain, feeling or urgency to defecate, and a feeling of incomplete evacuation of the bowel
How do you manage irritable bowel syndrome?
regular bowel habits, relief of symptoms and parent and child support and education
What is GERD?
gastric contents reflux back up into the esophagus making esophageal mucosa vulnerable to injury from gastric acid and resulting in GERD
What are clinical manifestations in infants with GERD?
white projectile vomiting after feed, irritability, excessive crying, blood in stool stiffening, respiratory problems, failure to thrive and apnea
What are clinical manifestations in children with GERD?
heartburn, abdominal pain, difficulty swallowing, chronic cough and chest pain
How do you manager GERD in infants?
Zantac or thicken feeds with rice cereal
What do you teach parents with infants about GERD?
lay baby on right side at angle while sleeping and elevate at a high angle while feeding
Why do older children experience reflux?
eating too much, overweight, or eating spicy foods
How do you diagnose GERD?
24 hr intraesophageal pH study to measure the amount of gastric acid reflux into the esophagus, endoscopy with biopsy to detect strictures, and scintigraphy to identify cause of gastric content aspiration
What surgical intervention is used in GERD?
Nissen fundoplication- fundus of the stomach is wrapped around the distal esophagus to decrease reflux
How is colic described?
abdominal pain or cramping that is manifested by loud crying and drawing the legs up to the abdomen.
What are additional characteristics of colic?
duration of cry greater than 3 hours a day, occurring more than 3 days per week, and for more than 3 weeks and parental dissatisfaction with the child's behaviors
What are the causes of colic?
too rapid feeding, overeating, swallowing excessive air, improper feeding technique, and emotional stress or tension between parent and child
What is the mother at risk for with colic?
post partum depression
What can help calm the infant with colic?
Why are TPN feeds given?
provides nutritional needs for those who cannot consume an adequate amount of nutrients
What are complications with TPN feeds?
central line infection or migration, decreased fat absorption and liver function over time, thrombosis and necrosis of veins
What is biliary atresia?
progressive inflammatory process that causes both intrahepatic and extrahepatic bile duct fibrosis, resulting in eventual obstruction
What is the cause of biliary atresia?
immune mechanisms or viral injury may be responsible and result in complete obliteration of the bile ducts
What are the signs and symptoms of biliary atresia?
jaundice, dark urine, and grey colored stools (acholic)
What laboratory tests may be done with biliary atresia?
complete blood counts, serum billirubin levels, and liver function studies
What is the Kasai procedure?
dissection of the porta hepatis to expose an area through which bile may drain
What are the different pediatric endocrine differences?
least developed system at birth, 12-18 months lack of hormone control, normal hormone levels are related to age and stage of puberty, developmental assessment can be associated with endocrine disorders
What are red flags in tanner staging?
too soon (pubic hair and breast buds at age 7), or too late (full stage tanner and no period)
What are cardinal signs of an endocrine assessment?
changes in growth, activity pattern, appetite and thirst, sleep patterns, elimination patterns, visual disturbance, fatigue, increased or decreased sweating, nausea, vomiting, mood changes, and decreased libido,
What is growth hormone?
naturally occurring in the body from the anterior pituitary and is needed or normal growth, development and cellular metabolism
What can a deficiency in growth hormone be due to?
structural factors, hereditary disorders, and congenital issue
How do you administer supplemental growth hormone?
Sub Q injection before bed
What are physical findings of growth hormone deficiency?
short stature but proportional height and weight, delayed epiphyseal closure, increased insulin sensitivity, delayed dentition, underdeveloped jaw, and delayed sexual development
What is hypopituitarism?
deficient secretion of pituitary hormones primarily GH
What is anchrondroplasia?
not growth hormone deficiency, autosomal dominant genetic defect, non-poroportional dwarfism characterized by long torso and short limbs and large head with prominent forehead; it cannot be treated with growth hormone
What is your assessment with growth hormone deficiency?
family growth patterns, child's history of nutritional information, height more affected than weight, permanent teeth can be delayed or crowded, evaluation of growth curve, skeletal maturity, psychosocial issues: self esteem and body image and fasting IGF
How do you treat growth hormone deficiency?
growth hormone replacement, continued monitoring of growth, and education and psychosocial support
What is diabetes insipidus?
disorder of the posterior pituitary hypo-function; missing ADH
What are the causes of diabetes insipidus?
head trauma or cranial injury, genetic defect or infection
What are the cardinal signs of diabetes insipidus?
polyuria (increased urine output) and polydipsia (extreme thirst)
What happens to the urine specific gravity in diabetes insipidus?
stays the same
What labs are used in diabetes insipidus?
UA, osmolality, CT, MRI, BNP, endocrine and kidney function test
What is the most objective data with diabetes insipidus?
What nursing considerations are need in diabetes insipidus?
strict I&O's and fluid replacement
What is type I diabetes mellitus?
irreversible; pancreatic beta cell destruction
What are micro vascular complications?
nephropathy, retinopathy, and neuropathy
What should be given first if hypoglycemia is suspected?
milk, orange juice or life savers (quick acting)
What should be given second if hypoglycemia is suspected?
peanut butter (source of protein-long acting)
What is the pathophysiology of type I diabetes?
loss of beta cell mass, insufficient endogenous insulin and absolute insulin deficiency
What are the causes of hypoglycemia?
too little food, too much insulin or diabetes medicine or extra exercise
What is the sign of hypoglycemia?
blood sugar below 70 mg/dL, shaking, sweating, anxious, dizziness, hunger, fast heartbeat, impaired vision, weakness, fatigue, headache and irritability
How do you treat hypoglycemia?
check blood sugar, treat with 15 grams of quick acting carbohydrates, recheck in 15 minutes and retreat if necessary
What is the cause of hyperglycemia?
too much food, too little insulin, illness or stress
fractures in various stages of healing, head injuries, bruises and welts shaped as hands or objects, human bites, rope burns, burns to buttocks, genitals, soles of feet or palm of hands related to immersion
What are subtle signs of child abuse?
school dysfunction, withdrawal or acting out, phobias, eating disorders, suicide attempts, cutting, drug abuse, inappropriate response to pain, little eye contact with adult, child may protect abuser for fear of punishment, and withdrawal from physical contact from adult
What is the family stress theory?
when a family can no longer cope with cumulative stress
What is the family systems theory?
family is viewed as a system that continually interacts with its members and environment, family is viewed as a whole that is different from the sum of the parts, and is viewed as highly adaptable
What are examples of non-organic failure to thrive?
inadequate caloric intake, incorrect formula prep, neglect, fads, juice, poverty, and behavioral problems affecting eating or CNS problems
What are characteristics of organic failure to thrive?
inadequate absorption, increased metabolism and defective utilization
What is Tinea Capitis?
ringworm of the scalp; scaly circumscribed lesions with alopecia on the scalp
What are clinical manifestations of Tinea Capitis?
lesions in the scalp but may extend to hairline or neck; severe deep inflammatory reaction may occur that manifest as boggy encrusted lesions
How do you manage Tinea Capitis?
oral griseofulvin or oral ketoconazole or topical antifungal agents
What is tinea corporis?
ringworm of body
What are clinical manifestations of tinea corporis?
round or oval erythematous scaling patch that spreads peripherally and clears centerally
How do you treat tinea corporis?
oral griseofulvin and local application of anti-fungal
What is tinea pedis?
athlete's foot; maceration and fissuring between toes and patches with pinhead-sized vesicles on plantar surface
How do you manage tinea pedis?
oral griseofulvin and local application of anti-fungal; use clean white socks and ventilated shoes
What is scabies?
endemic infestation, lesions are created as the scabies mite burrows into the stratum corneum of the epidermis
What are clinical manifestations of scabies?
inflammatory response causes intense pruritus that leads to punctuate discrete excoriation secondary to itching
How do you manage scabies?
permethrin 5% cream (Elimite); treat entire family, wash everything in hot water, and vacuum carpets and furniture
How do you manage lice?
shampoo hair with 1% permethrin, remove nits with nit comb, wash clothing and bed sheets in hot water, place stuffed animals in dark bag, vacuum furniture and carpet
What are clinical manifestations of impetigo contagiosa?
reddish macule, becomes vesicle, ruptures easily, tends to spread peripherally, exudate dries to form heavy honey-colored crusts, pruritus common and minimal or asymptomatic
What are clinical manifestations of pinworms?
intense rectal bleeding
How do you diagnose pinworms?
How are pinworms treated?
Mebendazole (child > 2yrs), albendazole (Albenza), and pyrantel pamoate (Pin-X)
What do you use to treat Giardiasis?
How do you develop Giardiasis?
What immunizations are given at 2, 4, and 6 months?
dTap, polio (IPV), prednar (PCV13), rotavirus and HIB
What is the only newborn immunization that is given?
What immunizations are given at 1 year?
MMR and Varicella (measles, mumps, and rubella)
What immunizations are given to teens?
MCV4 (menactra-meningitis), HPV-Guardasil and Tdap
Clinical manifestations of chicken pox?
slight fever, malaise and anorexia for first 24 hours, rash highly pruritic, stages-papule, vesicle, and crust