fina

• Intussusception


  • One of the most common cause of intestinal obstruction in children (3 months to 3 years)
  • Boys > girls; (+) cystic fibrosis
• Cause of intussusception


  Unknown - Idiopathic: hypertrophy of intestinal lymphoid tissue 2˚ viral infection
• Pathophysiology of intussusception


  1. One segment of the bowel telescopes into another segment pulling the mesentery

  2. Mesentery is compressed and angled resulting in lymphatic and venous obstruction

  3. Venous engorgement leads to leaking of blood and mucus into intestinal lumen forming the classic "currant jelly-like stools

  
• Hirschsprung disease


  • Congenital Aganglionic Megacolon
  • A congenital angangliosis of the megacolon resulting to intestinal obstruction
  • Aganglion in distal portion GIT; rectosigmoid (75%)
• Appendicitis


  • Inflammation of vermiform appendix (fluid sac at the end of cecum)
  • Progresses to perforation to peritonitis if missed
  • Etiology: Poorly understood - Causes of obstruction : fecalith, foreign body, microorganism, parasite
• Hypertrophic Pyloric Stenosis (HPS)

  • Occurs when circumferential muscle of pyloric sphincter thickened resulting in elongation & narrowing of pyloric channel
  • Projectile vomiting (nonbilious), DHN, metabolic alkalosis, and growth failure
  • Pathologic disturbance – hypertrophy of the pyloric muscle
• Fluids


  • GI system plays a major role in maintaining fluid, electrolyte, and acid–base balance
  • Body water accounts for approximately 75-80% of total body weight in infants, and 65-70% in children
  • Infants at greatest risk of f & e imbalances caused by the immaturity of kidney functioning
• Dehydration


  • Excessive loss of water from the body tissues
  • Common disturbance in infants and children whenever total fluid output exceeds total fluid intake
• Degree of dehydration


  • Mild - Infants: <5%, Older children: <3%
  • Moderate - Infants: 5-10%, Older children: 3-6%
  • Severe - Infants: >10%, Older children: >6%
• Gastroenteritis


  • Rotavirus - leading cause in children <5 years of age
  • Bacterial causes includes: Escherichia coli (E. Coli) - an cause severe stomach cramps, bloody diarrhea and vomiting, Salmonella - stomach cramps and diarrhea that lasts four to seven days, Shigella - cause watery or bloody diarrhea
• Nephrotic Syndrome


  • Massive proteinuria (>3.5g in 24 hrs)
  • Hypoalbuminemia (<3 g/dl)
  • Edema
  • Lipiduria
  • Hyperlipidemia – should provide low fat diet
  • Increased coagulation
  • Renal insufficiency
  • Dark and foamy urine
• Type 1 Diabetes Mellitus (Insulin Dependent)


  • Characterized by destruction of pancreatic islet beta cells, which fail to secrete insulin
  • Onset in childhood and adolescence, but it can occur at any age
  • Juvenile onset DM
• Type 2 Diabetes Mellitus

  • Arises because of insulin resistance in which the body fails to use insulin properly combined with relative insulin deficiency
  • Onset usually after age of 45
  • Adult-onset DM
• Glucose cannot enter to the cell

  hyperglycemia
• Hyperglycemia


  Attract fluid, polyuria, Intracellular thirst, polydipsia, Viscose blood, Poor wound healing, Poor circulation, Intracellular hunger, polyphagia, Impaired nerve function
• Diagnostic tests for Diabetes Mellitus

  • Random Blood Sugar (RBS) - >200mg/dL + symptoms is suggestive of DM
  • Fasting blood sugar (FBS) - No DM (70-110mg/dL, DM (>110 but <126mg/dL)
  • Postprandial Blood sugar - No DM (70-110mg/dL), DM (>140 but <200mg/dL)
  • Highly elevated glycosylated hemoglobin (Hb) test results – indicative of poor sugar control for the last 3 months
  • Oral Glucose Tolerance Test (OGTT) - No DM (glucose returns to normal in 2-3 hours & urine is negative for glucose), DM (blood glucose returns to normal slowly; urine is positive for glucoe
• Hypoglycemia


  Blood glucose level is less than 80mg/dL
• Hyperglycemia


  Blood glucose level is more than 200mg/dL
• Types of Seizure


  • Partial seizures - Simple Partial Seizure with Motor signs, Simple Partial Seizure with Sensory signs, Complex Partial Seizure (Psychomotor seizures)
  • Generalized seizures - Tonic-Clonic seizures, Absence seizure (Petit Mal or Lapses)
• Stress is a common trigger for seizures
• Sensory phenomena (aura)


  Precursor to a seizure
• Types of Seizure


  • Generalized seizures
  • Tonic-Clonic seizures
• Generalized seizures


  • Involves both hemispheres of the brain and are without local onset
• Tonic-Clonic seizures


  • Most common and most dramatic of all seizure manifestations
  • Protect the child from hitting the arms against the bed
  • Occur without warning
  • Tonic phase lasts approximately 10-20 seconds
• Absence seizure (Petit Mal or Lapses)


  • May go unrecognized due to little change in behavior
  • Abrupt onset; suddenly develops 20 or more attacks daily
  • Event often mistaken for inattentiveness or daydreaming
  • Blank expression during seizure attack
• Routine assessment of seizures

  1. Duration of seizure

  2. Progression and type of movements

  3. Changes in pupil size
• Equipment to prepare at the bedside

  • Suction equipment
  • Airway
  • Do not put padded tongue blade
• Priority during seizure episode

  Clear the area of any hazard
• Position of the patient

  Side lying to prevent aspiration of secretions
• Stress importance of adherence to medication regimen even if child has no evidence of seizure activity
• Teach patient and family to identify and avoid situations that are known to precipitate a seizure (e.g. blinking lights, sleep deprivation, excess activity or exercise, physical factor)
• Initiate seizure precautions in the hospital: pad side rails of bed, crib, or wheelchair, keep bed relatively free of objects
• Educate family to initiate seizure precautions at home
• Discharge Plan


  1. Help the child to lie down if having an attack

  2. Remove glasses or other harmful objects in the area

  3. Do not try to put anything in the child's mouth. In doing so, you may injure the child or yourself.

  4. After the seizure ends, place the child on one side and stay with the child until fully awake. Observe the child for breathing

  5. If the child has a fever, acetaminophen (such as tylenol) may be given rectally

  6. Do not try to give food, liquid, or medications by mouth to a child who has just had a seizure
• Hydrocephalus


  • A condition caused by an imbalance in the production and absorption of CSF in the ventricular system
  • When production exceeds absorption, CSF accumulates, usually under pressure, producing dilation of the ventricles
  • CSF volume: child = 60-100 ml
• Lumbar puncture


  Side lying with knees bend towards the chin
• Surgical Intervention


  • VP shunt – remove CSF from ventricles to peritoneal cavity
• Acetazolamide


  Drug of choice for hydrocephalus
• Postoperative care


  1. Watch for changes in behavior and eating patterns

  2. Assess for signs of increased ICP and check for the ff: head circumference (daily), Anterior fontanelle for size and fullness, and behavior

  3. Provide shunt care

  4. Monitor for shunt infection – signs - vomiting

  5. and malfunction – sign – bulging fontanelle

  
• Prevent infection