Method used to calculate MIVF
4, 2, 1 method
If a child is > or equal to 20kg, add how much fluid to body wt for MIVF?
40ml
Most common form of dehydration; 5% fluid loss, or < 50ml/kg
Mild
Dehydration classified by a 10% wt loss, or 50-90ml/kg
Moderate
Dehydration classified by a 15% wt loss from pre-illness weight, or > 100ml/kg
Severe
Inside the vessel; Na can change based on fluid volume
Intravascular space
Interstitial fluid is located here; can see third spacing, periorbital swelling, edema, crackles
Extravascular space
When the serum Na+ increases, water does what?
Pulls into vessel to dilute Na+
Increased frequency and decreased consistency of stool
Diarrhea
Virus that frequently causes diarrhea
Rotavirus
Big complication of diarrhea
Metabolic acidosis
What is the #1 cause of vomiting?
Overfeeding
Thickening of abdominal muscle around circular pyloris muscle causing obstruction of the gastric outlet
* More common in males than females
Pyloric stenosis
Main clinical manifestations of pyloric stenosis (3)
Projectile vomiting
Presents between 1-6 months of life
"Olive-like" mass in abdomen
Frequent emesis r/t pyloric stenosis can cause what?
Metabolic alkalosis
Main surgical intervention for pyloric stenosis is called what?
Pyloromyotomy
What should be corrected prior to sx intervention for pyloric stenosis?
Electrolyte imbalances
Passage of abdominal contents to the esophagus from incompetent or poorly developed lower esophageal sphincter
GERD
Congenital defect with hereditary component:
Incomplete midline fusion of the bones and tissues of the upper jaw/palate
- Partial or incomplete
- Unilateral or bilateral
Cleft lip and/or palate
Age/weight pt needs to be before cleft lip/palate repair
10 wks, 10 lbs
Occurs when the proximal end of the esophagus ends in a blind pouch; food can't enter stomach
Esophageal atresia
Occurs when there is a connection between esophagus and trachea
Tracheoesophageal fistula (TEF)
Inflammation and obstruction of the blind sac at the end of the cecum
Appendicitis
Major s/s of appendicitis (2)
RLQ pain (McBurney's point)
Rebound tenderness
S/s ruptured appendix (2)
Instant relief of pain
Fever
Postop intervention to avoid in appendicitis pts
NO hot packs
Insensitivity to gluten found in wheat; second leading cause of malabsorption in kids; diagnosed between 6-18mo
Celiac disease
S/s celiac disease (4)
Fatty stools
Abd. distention
FTT
Muscle wasting
How is celiac disease diagnosed?
Small bowel biopsy
Teaching regarding celiac disease (3)
Gluten is in thickener (pudding, ice cream)
Read all labels
Avoid high fiber foods at time of inflamed bowel
Interventions for celiac disease (3)
Eliminate wheat, rye, barley, and oats
Substitute with corn, rice, millet
Multivitamins, folic acid
Congenital disorder of decreased GI motility and results in mechanical obstruction of intestines; absence of ganglionic cells in distal bowel
Hirschsprungs
S/s Hirschsprungs in neonates (2)
Failure to pass meconium in first 2 days of life
Feeding intolerance with bilious vomiting
S/s Hirschsprungs in older children (2)
Constipation
Abdominal distention
How Hirschsprungs is diagnosed
Rectal biopsy
Treatment of Hirschsprungs (2)
Enema to relieve obstruction
Surgical repair (resection, temporary ostomy)
Most frequent cause of intestinal obstruction kids 3 mo - 3 yr; occurs when one portion of the intestine telescopes into another leading to:
- Ischemia
- Mucous backflow into intestine
- Leaking of blood into intestine
Intussusception
Classic s/s intussusception (4)
Currant jelly stools
Sudden onset of abd pain
Inconsolable cry
Bilious vomiting
Diagnostic interventions for intussusception (3)
Abd XR
US
Barium enema to show obstruction
75-85% of intussusception cases are fixed by what?
Air enema
Bilirubin that is created when RBCs hemolyze
Unconjugated (indirect) bilirubin
Congenital anomaly; obstruction/obliteration/absence of extra hepatic biliary structures
Biliary atresia
Assessment findings with biliary atresia (7)
Pruritis
Dark urine
Pale stools
Hepatomegaly
Ascites
Splenomegaly
FTT
Inc. LFTs
Interventions for biliary atresia (2)
Surgery (Kasai procedure)
ADEK (fat-soluble vitamins)
How is Hep A transmitted?
Fecal-oral route
Preventative measures for Hep A (2)
Handwashing
Keep food preparations separate
Which NGT placement measure is not evidence-based?
Air bolus