Gastric Motility Disorder:
OBSTRUCTIVE DISORDERS
A. PYLORIC STENOSIS – hypertrophy of muscles of pylorus causing narrowing &
obstruction. 1.) outstanding Sx- projectile vomiting
- vomiting is an initial sx of upper GI obstruction
- vomitus of upper GI can be blood tinged not bile streaked. (with blood) - vomitus of lower GI is bilous ( with pupu)
- projectile vomiting – increase ICP or GI obstruction - abd distension – major sx of lower GIT obst
2.) met alk
3.) failure to gain wt
4.) olive shaped mass – on palpation
5.)serum electrolyte – increase Na & K, decrease chloride 6.) ultrasound
7.) x ray of upper abd with barium swallow reveal “string sign” Mgt:
1. Pyleromyotomy
2. Fredet Ramstedt procedure
INSTUSSUSCEPTION- invagination or telescoping of position of bowel to another
Common site – ilio-secal junction Prone pt: person who eats fat
Complication – peritonitis – emergency Sx:
1.) persistent paroxysmal abd pain 2.) vomiting
3.) currant jelly stool- dye bleeding & inflammation - palpate sausage shaped mass
Mgt:
1.) Hydrostatic reduction with barium enema 2.) Anastomosis & pull thru procedura
Inborn Errors of Metabolism- deficient liver enzymes
PHENYLKETONURIA (PKU) – deficiency of liver enzymes (PHT)
Phenylalaninehydroxylase Transferase – liver enzyme that converts CHON to amino acid 9 amino acids:
valine isolensine tryptophase lysine phenylalanine
1.) fair complexion 2.) blond hair 3.) blue eyes
Thyroxine – decrease basal metabolism - accumulation of Phenyl Pyruvic acid 4.) Atopic dermatitis
5.) musty / mousy odor urine 6.) seizure – mental retardation
Test – GUTHRIE TEST – specimen – blood - preparation increase CHON intake - test if CHON will convert to amino acid specimen and urine
mixed with pheric chloride, presence of green spots at diaper a sign of PKU
DIET:
Low phenylalanine diet- food contraindicated- meats, chicken, milk, legumes, cheese, peanuts
Give Lofenalac- milk with synthetic protein
Galactosemia – deficiency of liver enzyme
- GUPT – Galactose Urovil Phosphatetranferase - Converts galactose to phosphate tranferace glucose
Galactose – will destroy brain cells if untreated – death within 3 days Dx:
Beutler test – get blood -done after 1st feeding presence of glucose in blood – sign of galactosemia galactose free diet lifetime
neutramigen – milk formula
CELIAC DISEASE – gluten enteropathy
Common gluten food: Intolerance to food with brow B- barley
R- rye O- oat W- wheat
Early Sx:
1. diarrhea – failure to gain wt ff diarrheal episodes 2. constipation
3. vomiting Late Sx:
1. abd pain – protruberant abd even if with muscle wasting 2. steatorrhea
Celiac Crisis- exaggerated vomiting with bowel inflammation Dx:
1. lab studies – stool analysis
2. serum antiglyadin – confirmatory of disease gluten free diet – lifetime
all BROW – not allowed ok – rice & corn
Mgt:
1. vitamin supplements 2. mineral supplements 3. steroids
POISONING- common in toddlers. (falls- common to infant)
1. determine substance taken, assess LOC
Gluten – glutamine ( normal absorption)
Gliadin ( toxic to epithelial cells of villi of intestines, effects is malabsorption syndrome)
Malabsorption
Fats CHON & CHO
peripheral edema & malnutrition
Vit D calcium Vit K Iron folic acid
Inadequate blood
coagulation
Steatorrhea Osteomalasia Bleedin
gg
2. unless poison is corrosive, caustic (strong alkali such as lye) or a hydrocarbon, vomiting is the most effective way to remove poison.
- Give syrup 1 pecac to induce vomiting 3. 1 pecac – oral emetic
- 15 ml – adolescent, school age & pre school - 10 ml to infant
4. UNIVERSAL ANTIDOTE- charcoal, milk of magnesia & burned toast 5. Never adm charcoal before 1 pecac
6. antidote for acetaminophen poisoning – acetylsysterine ( mucomyst)
7. caustic poisoning ( muriatic acid ) neutralize acid by giving vinegar . Don’t vomit prepare tracheostomy set
8. Gas- mineral oil will coat intestine
Lead poisoning
Lead = Destroy RBC functioning = Hypochornic Microcytic Anemia = Destroy kidney functioning
Accumulation of anemia = Encepalopathy Sx:
1. beginning sx of lethargy
2. impulsiveness, learning difficulties
3. as lead increases, severe encepalopathy with seizure and permanent mental retardation Dx: 1. Blood smear 2. abd x ray 3. long bones Mgt:
1. remove child from source
2. if > 20 ug/dL – need chelation therapy = binds with led & excreted by kidney =nephrotoxic
Amogenital
Female:
Pseudomenstration slight bleeding on vagina related to hormonal changes Tearing of fourchette with blood – rape/ child abuse
Rape- Report within 48 h
Shape pubic hair in inverted triangle ( female) Male:
Undescended testes – cyrptorchidism -common to preterm surgery – orchidopexy
baby – pee within 24 h -check for arch of urination
Epispadias- urinary meatus located dorsal or above glans penis Hypospadias- urinary meauts loc ventral or below glans penis
Hypospadias with chordee- fibrous band causing penis to curb downward Mgt:
Surgery
Phimosis- tight foreskin
Balanitis-infection of glands penis – due smegma Mgt:
Circusicion
Hydroseal – fld filled scrotum
Tst of Dx:
Transillumination with use of flashlight - glowing sign
Varicoseal – enlarged vein of epididimis ( girls- vulvular varicosities)
Renal Disorder Cause Sx Tx NSG CARE
NEPHROTIC SYNDROME
infectious 1. Anasarca- gen edema 2. massive protenuria 3. microscopic or no hematuria 4. serum CHON decreased 5. serum lipid increased 6. fatigue 7. normal or decreased BP Prednisone Diuretic Focus of care: monitor edema - weigh daily Diet: Increase CHON Increase K- OJ, beef broth, banana Decrease Na AGN ( acute Glomerulo Nephritis) 3A’s; AGN, autoimmune, Autoimmune Grp A beta hemolytic streptococcus 1. (PPP) primary peripheral periobital edema 2. moderate protenuria 3. gross hematuria 1. anti HPN drug - hydralazine or apresoline 2. iron 1. weigh daily 2. monitor BP & neurologiuc status 3. Diet: decrease K, decrease Na
4. serum K increased 5. fatigue 6. increase BP Complication : 1. hypersensive encephalopathy 2. anemia
BACK- check for flatness & symmetry
Open Neural Tube Defect- decreased Folic Acid intake
SPINA BIFIDA OCCULTA- failure of post laminae of vertebrae to fuse Sx: dimpling of back , Abnormal tufts of hair
SPINA BIFIDA CYSTICA- failure of post laminae of vertebrae to fuse with a sac
Types:
1. Meningocele – protrusion of CSF & Meninges
2. Myelomeningocele – protrusion of CSF & Meninges & spinal cord ( most dangerous)
3. Encephalocele ( CNS complication – hydrocephalus) – cranial meningocele or myelomeningocele
Most common problem - rupture of sac - prone pos
- sterile wet dressing
Most common complication - infection
Myelomeningocele – genitourinary complication- urinary & fecal incontinence Nsg care: always check diaper
Orthopedic complication – paralysis of lower extremities Surgery to prevent infection
Post op – prone position
SCOLIOSIS- lateral curvature of the spine
2 types:
1. structural – rye neck
2. postural – improper posture Dx:
1. uneven hemline
2. bend forward- 1 hip higher
1 shoulder blade more prominent Nsg care:
1. conservative – avoid obesity, exercise
3. corrective surgery – insert Harrington rod post op- how to move
log rolling- move client as 1 unit
EXTREMITIES:
check # of digits = 20
1. syndactyly – webbing of digits 2. polydactyly – extra digits 3. olidactyly – lack of digits
4. Amelia – total absence of digits
5. pocoamelia- absence of distal part of extremities
ErQ duchennes – paralysis- brachial plexus injury or brachial palsy
- birth injury caused by lateral & excessive traction during a breech injury Sx:
1. unable to abduct arms from shoulders, rotate arm externally or supinate forearm 2. absence or asymetrical moro reflex
Mgt:
1. abduct arm from shoulders with elbow flex.
CONGENITAL HIP DISLOCATION – head of femur is outside acetabulum Types;
1. subluxated – most common type 2. dislocated
Sx:
1. shortening of affected leg 2. asymmetrical gluteal fold 3. limited movement – earliest sx
4. (+) ortolanis sign – abnormal clicking sound
5. when able to walk – child limps – late sx- trendelenburg sign Goal of Mgt:
Facilitate abduction Mgt.
1. triple diaper 2. carry baby astride 3. Frejka splint 4. Pavlik harness 5. Hip Spica Cast
TALIPES – “clubfoot”
a.) Equinos – plantar flexion – horsefoot
b.) Calcaneous – dorsiflexion – heal lower that foot anterior posterior of foot flexed towards anterior leg
Equino varus- most common Assessment:
1. Straighten legs & flexing them at midline pos Mgt:
1. Corrective shoe- Dennis brown shoe, spica cast Fx: of cast –
- to immobilize - bone alignment - prevent muscle spasm
lead pencil – mark area to be amputated cold H20 – hasten setting process
hot H20- slow setting process
After cast application – how to move pt:
- use open palm not fingers- fingers will cause indention - dry cast – natural air not blower
- priority check : neurovascular check C- circulation
M- motion S- sensation Cast – with bleeding
- mask with ball pen edge of blood to know if bleeding is on going sign cast is dry = resonant sound, cast cold to touch
-do petaline – making rough surface of cast smooth
CRUTCHES
Fx: To maintain balance - To support weakened leg
Principles in crutches
- wt of body on palm!
- Brachial pulsing – if wt of body in axila - Do palm exercise- squeeze ball
Different crutch Gaits:
1. Swing Through 2. Swing to
- no weight bearing are allowed into lower ext 3. Three point Gait
- wt bearing is allowed in 1 ext 4. Four point gait
5. Two point Gait