Appendicitis
Intussusception & Pyloric Stenosis
TEF
HD/Malrotation/
Volvulus
Sauce Drawer
100

Hallmark sign of appendicitis 

RLQ pain (McBurney's point)

May also have nausea/periumbilical pain

later signs are vomiting/fever

100

Non-bilious PROJECTILE vomiting and olive-shaped mass in the upper abdomen with gastric peristalsis visualization

Pyloric stenosis hallmark signs 

100

a newborn has frothy saliva coming from the mouth and nose, is drooling, choking, and coughing, unexplained episodes of apnea, cyanosis, and desats what are the classic signs of?

TEF

100

this is caused by abnormal rotation of the intestine around the superior mesenteric artery during embryonic development

Malrotation

100
What do we teach parents pre-post op Cleft lip/cleft palate specifically about feeding?

they need to be taught alternative feeding systems like syringes, speciality bottles  

200

Why may this child have right hip pain?

related to inflammation in the psoas muscles! this is why they may say they can not walk

200

Currant jelly-like stools and palpable sausage-shaped mass in upper right quadrant

Hallmarks of intussecpition 

200

When an infant is suspected to have TEF what is the first thing to do immediately?

MAKE PATIENT NPO 

they have been or will aspirate, so make NPO, start IVF

200

the complete twisting of the intestine around itself

Volvulus 

200

True or False 

Cleft palate is apparent at birth whereas cleft lip is less obvious and may not be seen immediately 

false 

CLEFT LIP IS APPARENT AT BIRTH and cleft palate is less obvious and is normally found with more thorough assessment 

300
How is it diagnosed? What lab values may be important to know?

Typically with US (95% accurate) but sometimes they may need CT

-CRP (may be elevated, inflammatory marker >10mg/ml)

-WBC (may be elevated)

-older females want to r/o pregnancy 

-r/o UTI

300

What indicates that the intussusception has reduced itself?

passage of normal brown stool

300

3 nursing interventions pre-op for TEF babies 

1. respiratory assessment 

2.airway management with suctioning or artificial airway

3. supine positioning with HOB 30 degrees

3.blind pouch to suction 

4.if gtube in place don't feed through it, use for emptying to gravity 

3. thermoregulation

4. fluid and electrolyte management

5. parental nutrition support

300
Treatment/Management of malrotation/volvulus 

surgery is indicated to remove the affected area, and dependent on the severity they may have short bowel syndrome as a result of surgery 

300

Gtubes can be used for multiple things! 

List 2

feedings

administering medications

decompression

400

Typical treatment plan

-surgical removal (appendectomy)

-ABX preop and post if ruptured/gangrene

-IVF and electrolyte replacement/management if dehydrated 

400

True or False

Due to the electrolyte imbalances pyloric stenosis can cause, surgery may have to be delayed 24-48 hours to ensure they are corrected. 

True, often the have decreased potassium/chloride/sodium levels related to the emesis and dehydration and due to the potential cardiac effects that low K could cause this has to be corrected prior to going to ER 

400

2 teaching topics for a parent discharging home with a TEF baby who is repaired

1. small feedings

2 .semi upright 

3. observe for choking, cyanosis or troubles swallowing 

4. stridor/wheezing 

5. cut food into small pieces

400

Mechanical obstruction related to inadequate motility of part of the intestine that requires surgical intervention

HD or congenital aganglionic megacolon

400

3 nursing interventions/orders to be placed that are expected with kiddos with Gastroschisis and Omphalocele

NPO

do not swaddle

overhead warmer

temperature regulation

covering with NS soaked gauze

NG with LIWS 

500

How does treatment/management of a ruptured appendix differ from that of a non ruptured?

ruptured will have longer hospital stay 

prolonged ABX

NG tube possibly

NPO

JP drains and removal after 2-3 months 

open abdomen 

500

Why is intussusception an emergency??

Because of the bowel telescoping in and out, the distal bowel can remain distended and necrosis and perforation are possible

500

There are 5 types of EA/TEF you do not need to know them all but define what EA/TEF means?

Rare malformations that represent the failure of the esophagus to develop a continual passage and a failure of the trachea and esophagus to separate into distinct structures

500

99% of term newborns do this within the first 48 hours of life, but with HD few do

pass meconium

500

how to diagnose celiac 

biopsy of the small intestine

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