Appendicitis
Hallmark sign of appendicitis
RLQ pain (McBurney's point)
May also have nausea/periumbilical pain
later signs are vomiting/fever
Non-bilious PROJECTILE vomiting and olive-shaped mass in the upper abdomen with gastric peristalsis visualization
Pyloric stenosis hallmark signs
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
this is caused by abnormal rotation of the intestine around the superior mesenteric artery during embryonic development
Malrotation
they need to be taught alternative feeding systems like syringes, speciality bottles
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
Currant jelly-like stools and palpable sausage-shaped mass in upper right quadrant
Hallmarks of intussecpition
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
the complete twisting of the intestine around itself
Volvulus
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
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
What indicates that the intussusception has reduced itself?
passage of normal brown stool
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
surgery is indicated to remove the affected area, and dependent on the severity they may have short bowel syndrome as a result of surgery
Gtubes can be used for multiple things!
List 2
feedings
administering medications
decompression
Typical treatment plan
-surgical removal (appendectomy)
-ABX preop and post if ruptured/gangrene
-IVF and electrolyte replacement/management if dehydrated
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
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
Mechanical obstruction related to inadequate motility of part of the intestine that requires surgical intervention
HD or congenital aganglionic megacolon
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
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
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
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
99% of term newborns do this within the first 48 hours of life, but with HD few do
pass meconium
how to diagnose celiac
biopsy of the small intestine