finals

• Packed RBC


  Increase hemoglobin, hematocrit, and neutrophil levels
• Fresh frozen plasma


  Provide clotting factors and volume expansion
• Platelets


  Used with dengue fever, no crossmatching required
• Nursing Responsibilities


  • Use 0.9% PNSS - compatible with packed RBCs
  • Give antihistamine & antipyretic drugs before blood transfusion
  • Dipenhydramine hydrochloride for allergic reactions
  • Aeknil to reduce fever
  • Stop transfusion if transfusion reaction occurs
• NGT


  Used for those who have problems with GIT problems
• Types of feeding tubes

  • Ryle's tube - attached to a drainage bag
  • Levin's tube - single lumen
  • Miller-abbott tube - long double-lumen used to drain and decompress the small intestine
  • Sengstaken-blakemore tube - 3-lumen tube
  • Cantor tube - single lumen long tube with a small inflatable bag at the distal end
• Enteral Feeding Methods


  • Intermittent Fasting - 300-500mL/day for 30mins each feeding
  • Continuous Feeding - used with infusion pump for 24 hrs
  • Cyclic Feeding - <24hrs at night
• Purposes of feeding tubes

  • Provide feeding
  • Administer meds
  • Decompression
  • Irrigation
  • Obtain specimen for lab analysis
• Feeding tube sizes


  • Neonates - 6fr
  • Infants to 5yrs - 8fr
  • Above 5yrs - 8-10fr, 10-14fr
• Feeding tube position


  Adult: high fowler

  Infants: supine with head slightly hyperflexed
• Feeding tube placement confirmation

  • X-ray
  • pH (5.5 low pH)
  • Stethoscope
• Feeding tube complications


  • Aspiration
  • Hyperglycemia
  • Abdominal distention
  • Diarrhea
  • Fecal impaction
• Magnesium Sulfate


  Mechanism of action: Physiological calcium channel blocker

  Used in pregnant women with pre-eclampsia to prevent seizure and convulsion
• Magnesium Sulfate side effects

  • Flushing - report to doc
  • Sweating
  • Low BP
  • Hypothermia
  • Stupor
  • Respiratory depression (RR <11/min)
  • Decreased urine output (<30mL/hr)
• Magnesium Sulfate administration


  IM - dorsogluteal; Z-track method

  IV - not exceed 1.5mL/min
• Antidote for Magnesium Sulfate

  Calcium gluconate
• Phototherapy


  Helps liver process bilirubin and prevents kernicterus
• Phototherapy parameters


  • Distance: 35-50cm
  • Intensity: 10-12uW/cm2
• Physiologic jaundice


  Occurs after 24 hrs, 2-3 days after birth
• Pathologic jaundice


  Occurs within 24hrs
• Indications for phototherapy


  • Treatment for hyperbilirubinemia
  • Helps liver process bilirubin
  • Prevents kernicterus
• Newborn screening


  Detects if infant has heritable congenital metabolic disorder
• Ideal time for newborn screening

  48-72hrs after birth
• Hydrocephalus


  Imbalance in production of CSF in ventricular system
• Hydrocephalus treatment


  Ventriculoperitoneal shunt (VP shunt) - remove CSF from ventricles to peritoneal cavity

  Medication: Acetazolamide
• Intussusception


  Most common cause of intestinal obstruction in 3mos-3yr olds
• Intussusception symptoms


  • <12mos: Emesis, irritability, blood stools

  >12mos: Abdominal pain, high abdominal distention, vomit contains bile, currant jelly-like stools (after 12hrs)
• Intussusception treatment


  Barium enema - helps confirm diagnosis and may fix intussusception
• Hirschsprung's disease


  Affects large intestine (colon) and causes problems with passing stool
• Hirschsprung's disease risk factors

  • Male

  Sibling with Hirschsprung's disease

  Have other inherited conditions
• Hirschsprung's disease complications


  Prone to serious intestinal infection - Enterocolitis
• Hirschsprung's disease treatment


  • Temporary ostomy (proximal to aganglionic segment)

  Complete corrective "pull-through" surgery (when child weighs 9kg)
• Pyloric stenosis


  Blocks food from entering small intestine, leading to forceful vomiting, dehydration, and weight loss
• Pyloric stenosis treatment


  Pyloromyotomy (Fredet-Ramstedt procedure)
• Pyloric stenosis in infants


  Greatest risk of fluids and electrolyte imbalance due to immaturity of kidney functioning
• Type 1 Diabetes Mellitus

  Insulin Dependent, early onset (4yrs), common age 11-13yrs, 90% caused by immune system destroying beta cells
• Type 2 Diabetes Mellitus

  Fails to use insulin properly combined with relative insulin deficiency, onset after age 45, common cause is obesity
• Diabetes Mellitus management


  • Diet with decreased calories and low-fat foods

  Oral medications (metformin) to improve insulin sensitivity
• Diabetes Mellitus diagnostic tests

  • Random blood sugar (RBS)

  Fasting blood sugar (FBS)

  Postprandial blood sugar
• Hypoglycemia


  Blood sugar <80mg/dL