NURS 629 Exam 4 QUESTIONS AND ANSWERS
What is physiological jaundice? - CORRECT ANSWER -occurs when baby accumulates bilirubin
-secondary
... [Show More] to immature liver in newborns
-Risk factor is prematurity
What level is conjugated hyperbilirubinemia? - CORRECT ANSWER serum conjugated bilirubin concentration greater than 1 mg/dL if the total bilirubin is less than 5.0 mg/dL or more than 20% of the total bilirubin if the the total bilirubin is greater than 5 mg/dL (p. 862 AAP book)
What is breastfeeding jaundice? - CORRECT ANSWER -due to poor intake that causes lack of stools and urine output
-common in first week and resolves once milk comes in and infant is feeding well-more stools and urinary output
-peaks around 2-3 weeks
How do you diagnose jaundice? - CORRECT ANSWER -dx with a bili level of 5 mg/dL
-12 mg/dL threshold for all newborns having jaundiced appearance
-direct/indirect bili levels
-CBC
-reticulocyte count
-use of bilitool.org
How do you treat jaundice? - CORRECT ANSWER increased intake, longer feeding
indirect sunlight
phototherapy
IV fluids
Bili lights
Biliblanket
What are other causes of jaundice? - CORRECT ANSWER abnormal blood cell shapes (like sickle cell)
Rh incompatibility
cephalohematoma
polycythemia (increased RBCs, SGA infants, twins)
infection
specific enzyme disorders
What is biliary atresia? - CORRECT ANSWER -life-threatening condition causing a blockage of bile ducts inside or outside of liver
-leads to build-up of toxins (like bilirubin)
-malabsorption of fat-soluble vitamins A,D,E,K
-scaring of the liver, loss of tissue, cirrhosis
-not inherited
What are the two types of biliary atresia? - CORRECT ANSWER fetal- noted in womb (other defects like heart, spleed, intestines)
perinatal- appears 2-4 weeks after birth
What causes biliary atresia? - CORRECT ANSWER -infection after birth (cytomegalovirus or rotavirus)
-autoimmune disorder
-developmental issue in womb
-exposure to toxic substances
What are symptoms of biliary atresia? - CORRECT ANSWER jaundice
dark urine
light to white stools
poor wt gain and growth
How do you diagnose biliary atresia? - CORRECT ANSWER any infant with jaundice present 2-3 weeks after birth
-direct and indirect serum bilirubin
-LFTs
-abdominal x-ray
-abdominal US
-liver bx
How do you treat biliary atresia? - CORRECT ANSWER -surgery (Kasai procedure), small intestine is attached directly to the liver to allow bile to flow into the small intestine bypassing the cystic, hepatic, and common bile duct.
-liver transplant
What are risk factors for dehydration? - CORRECT ANSWER GI virus
NVD
What are s/sx of dehydration? - CORRECT ANSWER -sunken fontanels
-tachycardia and decrease cap refill >2-3 seconds
-decrease urine output is sensitive but nonspecific
-increase in urine specific gravity
-decrease BP- late finding=more than 10% fluid loss
How do you treat dehydration? - CORRECT ANSWER -if minimal, mild, moderate- oral rehydration
-if severe (drowsy, cold extremities, lethargic, sunken/dry eyes, very depressed anterior fontanel, no tears, dry mouth/tongue, very decreased skin turgor, rapid/sometimes impalpable pulse, decreased/unrecordable pulse, deep/rapid respiratory rate, markedly reduced urine output) - IV fluids
What is emesis? - CORRECT ANSWER vomiting=symptom
must distinguish from regurgitation in infants
integrated response to noxious stimuli-coordinated by CNS
What is acute emesis? - CORRECT ANSWER short-term
abrupt onset
episodic
What is recurrent emesis? - CORRECT ANSWER -at least 3 episodes over 3 months
-chronic
-relatively mild but occurs frequently
What is cyclic emesis? - CORRECT ANSWER -recurrent, intense episodes
-periods of being asymptomatic
How do you treat emesis? - CORRECT ANSWER NPO for 1-2 hrs
**rehydrate with small/frequent amounts of clear liquids
avoid dairy and solids for 4-6 hrs and then add bland foods slowly
What are causes of diarrhea? - CORRECT ANSWER -primarily viral (most common) or bacterial
-bacterial pathogens are usually C. difficile, salmonella, Giardia, Campylobacter
**always serious in infancy due to small ECF reserve, and can dehydrate quickly
Patho of diarrhea - CORRECT ANSWER 1. retention of water w/in the intestine (malabsorptive syndrome, lactose intolerance)
2. excessive secretion of water and electrolytes into the intestinal lumen (cholera, e. coli, chrohn's, laxatives)
3. release of protein and fluid into the intestinal mucosa (ulcerative colitis, Crohn's. infections)
4. altered intestinal motility resulting in rapid transport through the colon (IBS, scleroderma)
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