Intussusception & Pyloric Stenosis
Non-bilious PROJECTILE vomiting and olive-shaped mass in the upper abdomen with gastric peristalsis visualization
Hallmark signs of pyloric stenosis
Hallmark sign of appendicitis
-McBurney's point
-Colicky/cramping/Periumbilical pain (referred pain) followed by nausea, RLQ pain, and later vomiting with fever
Abnormal rotation of the intestine around the superior mesenteric artery during embryonic development
Malrotation
A newborn has frothy saliva coming from the mouth and nose, drooling, choking, and coughing, and unexplained episodes of apnea, cyanosis, and desaturations what are the classic or hallmark signs of?
TEF
What do we teach parents pre and post op of a child with Cleft lip/cleft palate specifically about feeding?
they need to be taught alternative feeding systems like syringes, specialty bottles
-CL interferes with ability to achieve adequate anterior lip seal
-Isolated CL would not interfere with breastfeeding, the tissue confirms to the cleft
-CL use a wide base nipple
-CP needs modification of positioning(upright)/bottles/feeder support techniques
Currant jelly-like stools and palpable sausage-shaped mass in upper right quadrant
Hallmark signs of intussusception
A child with appendicitis has right hip pain, why would that be?
-it is related to inflammation in the appendix putting pressure on the psoas muscles and this is why they may say they have right hip pain and may report not being able to walk
Mechanical obstruction related to inadequate motility of part of the intestine that requires surgical intervention
HD or congenital aganglionic megacolon
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 and anticipate the physician starting IVF or some type of parental nutrition
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 a more thorough assessment
What indicates that the intussusception has resolved/ reduced itself?
-passage of normal brown stool
How is it diagnosed?
DOUBLE JEOPARDY
What lab values may be important to know?
-typically diagnosed with US (95% accurate) but sometimes they may need CT to see more clearly
-CRP (may be elevated, inflammatory marker >10mg/ml)
-WBC (may be elevated)
-older females want to r/o pregnancy
-r/o UTI
The complete twisting of the intestine around itself
Volvulus
3 nursing interventions pre-operatively for TEF babies
-respiratory assessment
-airway management with suctioning or artificial airway
-supine positioning with HOB 30 degrees
-blind pouch to suction
-if gtube in place don't feed through it, use for emptying to gravity
-thermoregulation
-fluid and electrolyte management
-parental nutrition support
Gastrostomy tubes can be used in pediatric patients to.... list 2
feedings
administering medications
decompression
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 these infants may have decreased potassium/chloride/sodium levels related to the ongoing projectile emesis that causes dehydration and due to the potential cardiac effects that low potassium could cause this has to be corrected prior to going to operating room
Typical treatment plan/goals for a child with appendicitis?
-surgical removal (appendectomy) laparoscopic vs open
-IVF and electrolyte replacement/management if dehydrated
-ABX
-Pain management
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
2 teaching topics for a parent of a repaired TEF infant who is preparing to be discharged home?
-small feedings
-semi-upright positioning
-observe for choking, cyanosis or trouble swallowing
-stridor/wheezing
-cut food into small pieces
List 3 nursing interventions/expected orders that are expected to be seen in infants with Gastroschisis and Omphalocele
NPO
do not swaddle
overhead warmer
temperature regulation
covering with NS soaked gauze-Omphalocele
Silo-gastroschisis
NG with LIWS
True or False
Intussusception an emergency?
Why or why not?
True
-Because of the bowel telescoping in and out, the distal bowel can remain distended and necrosis and perforation are possible
How does the treatment/management of a ruptured appendix differ from that of a non-ruptured appendix?
-ruptured will have longer hospital stay
-prolonged ABX
-NG tube possibly
-NPO
-JP drains and removal after 2-3 months
-open abdomen
99% of term newborns do this within the first 48 hours of life, but with HD few do
pass meconium
There are 5 types of EA/TEF you do not need to know them all but define EA/TEF
-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
What is the definitive way to diagnose celiac disease?
DOUBLE JEOPARDY
What are some of the symptoms/classic presentation of celiac disease?
biopsy of the small intestine
-Intestinal symptoms, FTT, chronic diarrhea, abdominal distention, pain, muscle wasting, fatigue
-Villious atrophy in the small intestine in response to the protein gluten
-Symptoms appear when solid foods/beans/pastas are introduced age 1-5ish
-Usually several months between the introduction and presentation of symptoms