ExamI2:INSGI434/INSG434I(LatestI2024/I
2025IUpdate)INursingICareIofItheI
ChildbearingIFamilyICompleteIGuide|IQsI
&IAs|I100%ICorrect|IGradeIAI(VerifiedI
Answers)-IGCU
Q:IHirschsprungIdisease
Answer:
-
LackIofIinnervationIoftenIinIlowerIportionIofIbowel,InoIperistalticIwavesIcausingIchronicIcons
tipationIaboveIthisIarea,Imegacolon
-RectalIsphincterIfailsItoIrelax:Iribbon-likeIstoolIfromIpassingIthroughItheInarrowIsegment
-Etiology:IbothIgeneticIandIenvironmentalIfactors,IbutItheIexactIetiologyIisIunknown
-MostIcommonlyIobservedIinIneonatesI-I4xImoreIcommonIinImales
-AbsenceIofIganglionIcellsIinItheIrectumIorIinItheIcolon
-AbnormalIorIabsentIperistalsis
-TotalIabsenceIofIspontaneousIbowelIevacuation
ClinicalIManifestations:
-Neonate:IfailureItoIpassImeconiumIwithinI24-48IhoursIofIbirth,IbiliousIvomiting
-InfancyI&Ichildhood:Iconstipation,IrecurrentIdiarrhea,Iribbon-like,Iflat,Ifoul-
smellingIstool,IfailureItoIthrive
-RectalIbiopsyItoIdetectIabsenceIofIganglionIcellsIisIdefinitiveIdiagnosis
Treatment:
-One-stageIsurgicalItreatment:ItransanalIpull-through
-ColostomyI(temporary)IandIthenIremovalIofIaganlionicIsection
-
IfItheIproximalIbowelIisInotIextremelyIdistendedI(possibleIwithIearlyIdiagnosis),IwhenItheIinf
antIisIbetweenI6ItoI12ImonthsI(orI8ItoI10Ikg)ItheIsurgeonIwillIperformIaIrectalIpull-
thruIprocedureIinIwhichIallItheIaganglionicIbowelIisIremovedIandItheInormalIbowelIisIreconn
ectedItoItheIanus.I
,-IfIaItransanalIpull-
thruIisInotIpossible,IthenItheIsurgeonIwillIperformIaIremovalIofItheIdefectiveIbowelIandIcolost
omyItoIdecompressItheIbowelIandIdivertItheIfecalIcontents.I
-
TheIcolostomyIallowsItheIdilatedIandIhypertrophiedIportionIofItheIbowelItoIregainInormalIton
eIandIsizeI(takesIapproximatelyI3ItoI4Imonths)
-Post‐
op:IassessIsite,INPOIuntilIbowelIsoundsIreturn,IIVIfluids,ImayIrequireIdailyIanalIdilations
Q:IgastroesophagealIreflux
Answer:
-
TheIpresenceIofIabnormalIamountsIofIgastricIcontentsIinItheIesophagus,IupperIairways,IandItr
acheobronchialIarea.
-TheIrefluxIofIgastricIcontentsIcanIleadItoIinflammationIandIstrictureIofItheIesophagus
-ResultingIeffects:
•AspirationIofIgastricIcontents
•RecurrentIpneumonia
•PulmonaryIdisease
•Esophagitis
•EsophagealIstricture
-ResolutionIofIGERIisIoftenIaImaturationalIprocess
-PeakIincidenceIisI4ImonthsIofIage.I85%IofIinfantsIoutgrowIbyI12Imonths
-TheIchildImayIrequireIsurgeryIifItheyIdoInotIrespondItoImedicalImanagement
-Predisposed:IpretermIinfantsIandIbronchopulmonaryIdysplasia
-Diagnostic:Iweight,Ilength,IOFC,IchestIx-
rayIforIrespiratoryIsymptoms,IpHIprobe,IsometimesIendoscopy
-Ranitidine,Izantac,Iprevised,IPrilosecIgivenItoIkids
ConservativeITreatment:
-FeedingIthickenedIformula
-FeedingIsmall,IfrequentImeals
-
Positioning:IelevatingIheadIofItheIbed,IholdIinfantIinIanIuprightIpositionIforI30IminutesIfollo
wingIaIfeeding
-AcidIsuppressionIandIneutralizationImedications:
•DecreasesIstomachIacidIsoIitIwillInotIbeIasIirritatingIifItheIchildIspitsIup
,•AdministerIPPIsI30IminutesIbeforeIbreakfastIandIifIaIsecondIdoseIisIprescribed,I30IminutesIb
eforeItheIeveningImeal.
•RemindIparentsIthatItheyImayInotIseeIresultsIrightIawayIasIitItakesIseveralIdaysIforIaIsteadyI
stateIofIacidIsuppression.
•RanitidineI-Izantac,IlansoprazoleI-Iprevacid,IomeprazoleI-Iprilosec
SurgicalITreatment:
-NissanIfundoplication
•UpperIendIofIstomachI(fundus)IisIwrappedIaroundItheIlowerIportionI(inferior)IofItheIesophag
usIcreatingIaIlowerIesophagealIsphincterIorIcardiacIsphincter
•LowerI2-3IcmIofIesophagus
•Laparoscopic
•ThisIsurgeryIisIirreversible
Q:Iappendicitis
Answer:
EarlyISymptoms:
-DevelopIslowly,IoverIaI12IhourIperiod
-Anorexia
-ChildIdoesn'tIseemI"normal"
-N&V,IlowIgradeIfever
-KneesIbent
-PainIisIdiffuseIatIfirstIthenIgraduallyIlocalizesItoIRLQI(reboundItenderness)
-
McBurney'sIpoint:IaIpointImidwayIbetweenItheIanteriorIsuperiorIiliacIcrestIandItheIumbilicus;I
doesn'tIhurtIwhenIyouIpressIthere,IhurtsIwhenIyouIletIgo
-IfIpainIisIsuddenlyIrelievedIwithoutIintervention,IsuspectIperforation
DiagnosticITesting:
-CBC
-UA
-CT
Pre-Op:
-NPO,IIVItherapyI(antibiotics,Ifluids,IandIelectrolytes)
-PositionIofIcomfort
-PrepareIforIsurgeryI(laparoscopicIifInon-perforated)
Post-Op:
, -MonitorIVS
-MaintainIIVIandIthenIadvanceIdietIasItolerated
-AssessIforIpain
-EncourageIambulation
-MonitorIincisionalIsite(s)
-DischargeIteaching
RupturedIAppendix:
-Peritonitis:
•IVIantibiotics
•NPO,INGItubeItoIlowIcontinuousIsuctioning
•MayIhaveIaIdrainIplacedIinIsurgery
•PainImanagement
•LongerIhospitalIstay
•RequiresI7-14IdaysIofIantibiotics
Q:IinflammatoryIbowelIdisease
Answer:
-TwoIgastrointestinalIconditions:
•UlcerativeIcolitis
•Crohn'sIDisease
-Autoimmune
-EtiologiesIareIunknown
-PrognosisIisIdependentIon:
•AgeIofIonsetIandIrapidityIofIonset
•ResponseItoImedicalItreatment
•ExtentIofIinvolvement
SimilarIInitialISigns:
-Diarrhea
-RectalIbleeding
-AbdominalIpain
-Fever
-Malaise
-AnorexiaIandIweightIloss
-Anemia
-MayIincludeIvagueIsymptoms:
•GrowthIfailure
•JointIpainsI(dueItoIinflammation)
