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PEDS FINAL STUDY GUIDE NOTES
REVIEW
Covers all modules, 100 questions on exam Morbidity/mortality statistics Infant Mortality = deaths per 1,000 live births during the 1st year of life ● 0-12 months Neonatal period: Day 1-28 Days — living past the 28 days decreases the death rate ● Have the highest mortality rate — congenital anomalies & LBW dt congenital Postnatal period - Day 28- 1 year of life ● Highest cause of postnatal death- SIDS ○ Educate parents about back to sleep campaign ● Unintentional injury- MVA, falls ● Congenital anomalies ○ If you live first 28 days without death from anomaly, the risk is decreased Low Birth Weight = less than 2500g Risk Factors = African American, Low birth weight, short term or post term babies, maternal age, maternal education Over 1 year/childhood mortality - unintentional accidents occur ● Motor vehicle accidents ○ Make sure child is safely secured ● Drowning ○ One of the leading causes of death ○ Make sure child is not left unattended even in shallow water ● Burns ○ Keep matches and candles away ○ Keep away from stove tops ● Firearms ● Poisoning Most common acute illness- an illness that limits activity- requires medical attention ● Respiratory- 50% of all acute illnesses ● Other: infections and parasitic disease ● Risk factors: homelessness, poverty, LBW, chronic illness, foreign- born, nutrition Most common chronic illness = asthma Principle of family centered care ● Family-centered care recognizes the family as the constant in the child’s life ● Involve family and patient in plan of care, decision making; work together ● Let the family room- in Family centered care: Discipline ● Consistency: each family member is approaching the discipline the same way ● Timing: initiate discipline as soon as the child misbehaves ● Commitment: Follow through with the details of the discipline such as timing of the timeout ○ Avoid distractions that may interfere with the plan (telephone calls) ● Unity: make certain that all caregivers agree to the plan and are familiar with the details to prevent confusion ● Flexibility: choose disciplinary strategies that are appropriate to the child’s age, temperament, and severity of behavior
● Planning: plan disciplinary strategies in advance and prepare the child if feasible ○ Explain the use of timeout for unexpected misbehavior and try to discipline when you are calm
○ Herd immunity: if most of the population gets vaccine, the ones who can’t will be protected because there is less exposure ● Birth- hep B ● 2 months- rotavirus, dtap, Hib, PCV13, IPV, Hep b ● 4 months- rotavirus, dtap, Hib, PCV13, IPV ● 6 months- rotavirus, dtap, Hib, PCV13, IPV, Hep b ● 12 months- Hib, PCV13, IPV, Hep b, Hep A, MMR ● ** no live vaccines < 12 months or to immunocompromised ● AVOID dorsogluteal site!!! How to determine communication style with a pediatric patient Assess developmental level and use appropriate communication that matches (question on exam
Allow kids to play with equipment to establish trust, be honest, and follow home routines if the child will be in care for longer-term ● Ask the child how they are feeling, if they understand the plan of care, make sure you use terms that a young child will understand ● Let parents be the experts on their children's health ○ They are not our children!! ○ Respect the family ● Nurse should perform comprehensive family assessment to identify strengths and weaknesses Infant (birth - 1 year or 1 month - 1 year) ● Infants age 0-6 months are easiest to examine because they are very receptive and trusting of provider ● Infants 6-12 months start having stranger anxiety ○ Distract with toys ○ Examine on parent’s lap ● Do non-invasive to more invasive ○ Ex- count respirations before taking BP ○ Examine abdomen before examining inner ear ○ Direct teaching at the parents Toddler (1-3 years) ● Most difficult to examine, most uncooperative and fearful ● Good at assimilating but not accommodating- have good memory ○ May remember that the last person wearing blue scrubs drew blood, so if you have them on they will be scared of you ○ Let them handle equipment ○ Rectal temp may be easier than oral ○ Can do simple education with toddlers, use picture books ○ Fully explain the rationale for drug therapy and type of administration to parents, use simple term for toddlers Preschooler (3-6): ● Fear mutilation- if they think of something, they think it may happen ● Magical thinking- band-aids can cure everything ○ May think beeping IV is a monster ● Answer all questions truthfully ● Allow child to pretend to be nurse while educating ● Will deny pain- if the last time they said they had pain they had to go to the doctor/have a procedure, they may deny pain because they want to avoid the doctor/procedure again School-aged: ● Concerned with body disability/death
○ May associate hospital visits with older people and death (grandparents death) ● Want to know the reasons- explain reasoning behind interventions; this will help them feel better and more compliant ○ Answer questions as simple and honest as possible ● Can understand cause and effect ○ May relate health education to science classes when teaching ● Can describe pain ● Give them as much choice as possible ● Be sensitive to their modesty! Adolescent: ● Appearance is most important ● Want to be “cool” ○ May hesitate to admit fear, pain and ask questions ○ Say things like “often people your age will wonder…..” when educating ● Can describe pain clearly ● Treat like an adult ○ Use full explanations and rationale for drug therapy ○ Examine alone ● Confidentiality is of great importance when interviewing adolescents. Explain to parents and teenagers the limits of confidentiality, reports will not be shared unless they indicate a need for intervention, like suicidal behavior. Types of heat loss ● Evaporation: the loss of heat through moisture. The newborn should be quickly dried after birth to avoid hypothermia ● Radiation: loss of heath to a cooler solid object. The cold air from either the window or the air conditioner will cool the walls of the incubator and subsequently the body of the newborn ● Conduction: loss of heat from the body because of direct contact of the skin with a cooler object ● Convection: similar to conduction, but it is the loss of heat aided by air currents Risk factors for respiratory distress in a newborn ● Preterm infants- most often ● Multi-fetal delivery ● Infants of diabetic mothers ● C-section ● Cold stress ● Asphyxia ● Family Hx of RDS Nursing interventions for pain reduction ● Infants → sucrose, swaddle, hold ○ FLACC (Faces, Legs, Activity, Cry, and Consolability; used up to age 7, good for children who are older but have communication disorders) ○ Wong-baker FACES pain scale (children 3-4) ○ NIPS (behavioral pain, increased HR, RR, BP, etc.) ○ OUCHER scale (self-report of pain intensity for children 3 to 12 years old. It has a numerical scale from 0 to 10 for older children and a six-picture photographic scale for younger children. This method would require the child to verbalize and correlate the pictures) ● Toddlers → play, sensory (hugging, holding) ● Preschool → home items, stickers ● School age → hot/cold, massage, ask what they like
● Meet emotional needs ● Educate family — decrease life expectancy and home care needs Treatment: ● Aimed at preventing and treating pulmonary infections ● Antibiotics ● Mobilization of secretions ● Exercise ● Maintaining optimal nutritional status ○ Pancreatic enzyme with every meal and snack ○ Dosage is adjusted according to stool formation ○ Extra salt and increase calorie and protein ● Chest Pt- vibrating vest ● Eat meal upright; stay upright after eating too ● High risk for diabetes ● Antibiotics prophylactic for bacteria ● Huffing - mobilize the secretions Patient education for using peak flow meter ● Parents need to know how to understand how to administer meds correctly and understand peak flow meter ● Green some = good, stay on daily meds ● Yellow- increase what they are going their child ● Red- Need medical attention and to change medications + albuterol ● How to use: ○ Exhale as fast/ hard as you can into the device ○ How severe the asthma is ○ BEFORE — make sure arrow at the bottom ○ Stand up straight ○ blow out as hard and as quickly ○ Look for the marker ○ repeat 3x — then record the HIGHEST!!, wait 30 seconds between trail ○ Green = good 100-75, yellow - some med changes 75-100 , Red - bad less than 50 ■ Indicator of how well is the asthma controlled Signs and symptoms/nursing interventions related to respiratory infections Rhinitis + Common Cold ● Younger children: Toddler and infants; fever, irritable, restless, not taking their bottle, sneezing, nasal secretions, diarrhea ● Older Children: dry throat, change in voice, nasal discharge, sneezing, cough ○ * there are many different causes no quick treatment ○ *Main problem — they can lead to pneumonia ● Treatment = supportive care ○ Antipyretics- decrease the workload, requires less o2, fever increases RR and O2 demand- rectal if vomiting ○ Rest is recommended ○ Encourage cool mist humidifiers ○ Encourage fluids — They thin secretions ■ A child may have to go back to using a bottle during the time of illness ○ Keep child relaxed and comfortable
Sinusitis ○ Decongestants and cough suppressants are NOT recommended because they thicken secretions ○ Do not overheat child with blankets and clothing ○ *** NO Pseudoephedrine because they cause arrhythmias ● Older children: Sinus headaches ● Younger Children: persistent tacky cough, gum pain, thick yellow discharge (Rhinorrhea), vertigo ● Treatment: ○ 1st line treatment = amoxicillin or penicillin ○ Normal saline— ocean drops, nevi pot ○ Corticosteroids — nasal sprays to help with inflammation Pharyngitis / Tonsillitis ● ** always assessing for what could obstruct the airway ● Viral Pharyngitis/ Tonsillitis ○ Symptoms: gradual onset, sore throat, erythema of pharynx and tonsils, ulcers on the tonsils, fever, hoarseness, Rhinitis, conjunctivitis, malaise, anorexia ○ Cervical lymph nodes may be engaged, or tender ● Bacterial Pharyngitis ○ Symptoms: ABRUPT onset, sore throat, inflammation of tonsils and pharynx, fever, abdominal pain, headache, vomiting ○ Cervical lymph nodes may be enlarged ○ Nursing Interventions ■ **MUST SWAB the throat to detainee if its bacterial or viral ○ Treatment: 1st line = Amoxicillin ■ Ice collar ■ Explain to parents if viral there is nothing to do besides supportive treatment Croup— Laryngotracheobronchitis ● Viral ● Inflammation around the vocal cords ● Symptoms = Hoarseness, barking cough, inspiratory stridor ○ Slowly progressive ○ Often proceeds the Flu or RSV ○ Signs of Respiratory distress— accessory muscles, substernal retractions, pallor, cyanosis ● Treatment/ Nursing Interventions ○ Cool mist humidifiers ○ Keep child calm ○ fluids Antipyretics ● Hospitalized: racemic epinephrine (Dilates airways), corticosteroids (decrease inflammation) ○ No Antibiotics ○ IM Decahedron or PO Pronisalone ○ Problem!! ○ ***if left untreated can lead to Pneumonia ● Education: no cough suppressants Epiglottis : ● MEDICAL EMERGENCY ● Bacterial disease ○ Haemophilus influenzae + strep = risk factor ○ Cherry red Epiglottitis
○ Contact precautions ● Prevention- hand washing, separate room from other clients, contact precautions Pneumonia ● Inflammation of the lung parenchyma ● Neonates are at risk for pneumonia from GBS positive parents ● High risk = premature infants ○ Can get it from the Flu or RSV ● Symptoms: Low to high fever cough, headache, malaise, infiltrates on chest x-ray, High WBC count, Fine crackles on decreased breath sounds or rales, may complain of chest pain ○ Irritable, restless, tired ● Treatment: Antibiotics if bacterial ○ Increase fluids + antipyretics + cool mist humidifiers ○ Avoid exposure to smoke ○ Decrease anxiety and rest ○ Supportive care Pertussis— whooping cough ● -Highly contagious ● get immunized — children under 4 ● Long protracting cough followed by a gasp for air ● Symptoms— severe cough, repetitive series of cough during single expiration, followed by a whooping sound ● Treatment: Antibiotics ○ Macrolide ○ Erythromycin ○ Increase fluids + Tylenol Parent education related to tonsillectomy Indications for surgery: airway obstruction, recurrent infections or sleep apnea, tonsils resulting in febrile seizures ● 6 infections a year, bad breath and mouth, cancerous ● Avoid suctioning and obstruction ● NOTHING red color ● Discouraged from coughing or blowing nose ● No straws ● no scratchy foods ● BIGGEST risk for hemorrhage — up to 14 days after surgery — ○ Watch for signs of bleeding — excessive swallowing ○ Frequent Swallowing = bad sign, need to assess for bleeding ○ ** RISK FOR HEMORRHAGE, ineffective airway clearance ■ SS of hemorrhage: tachycardia, pallor, frequent clearing of throat, frequent swallowing ■ Late sign is restlessness ● Teach parents to give regular pain medications ● Popsicles but not red- may miss blood, thinning it’s popsicle-related Complications of strep infection
● Rheumatic fever ● Bacterial endocarditis ● Scarlet fever ● Acute kidney infection ● Impetigo and pyoderma Skins lesions - macule, papule, vesicle ● Macule: small, flat, non-palpable lesion, <1 cm (freckle) ● Papule: Small, elevated, palpable lesion, <1 cm (wart) ● Vesicle : Small, elevated, clear fluid-filling lesion, <1 cm (blister, chicken pox Patient/family education for scabies/pediculosis capitis/cellulitis/impetigo Impetigo: ● Most common bacterial skin infection + very contagious ● Ask how the rash presented.. was there honey discharge? Scab appearance? ● Very contagious— teach parents to wash their child’s face, then this face cloth needs to be put in HOT water when washed ● Can be secondary to an insect bite or anytime there is pyretic component there is an increased risk for a secondary infection due to impetigo due to scratching from the bacteria under the nails ○ Can follow an upper respiratory infection in which frequent wiping of the nose allows impetigo to grow ○ Avoid picking or scratching lesions as scarring can occur ○ Usual locations = mouth + nose ○ Children’s nails should be kept short and wash hands frequently ○ Discourage family members from sharing towels, combs, or eating utensils + sharing athletic equipment ● Treatment Teaching ○ Lesions should be gently washed 3-4 x a day ○ Crusts are soaked and gently removed BEFORE topical antibiotics are placed on lesions ○ Mild cases = 7-10 days of treatment ○ Severe cases around mouth or other body parts = oral antibiotics ○ Good hand hygiene and washing to prevent spread ○ The child SHOULD NOT attend school until after 48 hours after treatment has started Cellulitis: ● Bacterial infection of the subcutaneous tissue and the dermis ● Cellulitis of head and neck can follow a URI, sinusitis, otitis media, or tooth accesses ● Often follow a splinter or invasive trauma ● Swelling around the eye can lead to blindness ● Reduction in cases due to the Haemophilus influenzae vaccine ● The child usually exhibits a fever, malaise and headache, tenderness and heat at site or may cause immobility ● Treatment Teaching: ○ Ceftriaxone then 10 day course of antibiotics such as penicillin ○ Extremity should be elevated and immobilized ○ Warm moist soaks applied Q4 hours ○ Frequent hand washing is essential to prevent spread ○ Mark the area and watch to see if the redness expands outside the marked area — indicates treatment success — have the parent watch to see if the area is expanding or receding
Scabies ● Mite infestation + Very contagious ● Mites cannot survive for more than 3 days away from human skin = bag up bedding, pillows, stuffed animals and things that cannot be washed in hot water ○ Intense pruritus = major complication of impetigo ○ Infants might show signs of rubbing their hands and feet together when they sleep ○ 1st they look like burrows then they tube into papule, vesicles and nodules are common on the wrists , in the finger webs, elbows, umbilicus, axillae, groin + butt ox ● Treatment Teaching: ○ Elimite or Lindane cream ○ Lindane should NOT be used in children under 2 years old ○ Medications should be kept on 8-14 hours to be effective — apply at bedtime ○ Pruritus may last several days to weeks even after treatment has ended — this does NOT mean mites are still on the skin ○ ALL family members even if asymptomatic should be treated and day care contacts ○ Wash child’s bedding and clothing in HOT water Pediculosis Captious ● Lice infestation on the scalp or body ● Social embarrassment ● Lice cannot jump ● Clean hair is NOT deterrent to head lice ● Girls are affected twice as much as boys ● Body lice can live on clothing ● Risk for impetigo ● Pubic lice is spread through sexual contact ● Lice can live only 48 hours off the human host ● When looking for nits, start with the light off with a flatlight off at ears and base of the neck, lice run from light ● Treatment Teaching: ● Three Tiered approach
- Killing the active lice with RIDx, Kwell (can be neurotoxic) — follow directions on bottle carefully — should only be applied to air and rinsed off well for 30min
- Remove the nits
- Prevent spread to reoccurrence by managing the environment ○ Need to treat and wash anything that the child’s environment comes in contact with ○ Retreat 1-2 in 1-2 weeks because nits hatch at 10 days ○ Treat other families that are in close contact Nursing assessment/interventions for treating burn patient and preventing complications ● Assess ABC’s ● At the scene: ○ Stop the burning process, ABCs, begin resuscitation if child is not breathing ○ Remove burned clothing and jewelry ○ Cover wound with clean cloth ○ Keep child warm ○ NPO ○ Provide reassurance and reduce anxiety ● At ED: 1st PRIORITY IS AIRWAY MAINTENANCE
○ If inhalation injury is suspected, admin 100% O2, determine ABGs ○ If child exhibits sensorium, air hunger, nasal flaring, grunting, or respiratory distress then ET tube to maintain airway 2nd priority: fluid replacement ○ Insert large bore IV catheter, preferable through unburned skin to deliver fluids for resuscitation ○ Initiate treatment for burn shock in children with > 10-20% TBSA burn ○ LR are most commonly used ○ Children should have hourly urine output (UO) of 30 mL/hr; older kids- 0.5-1 mL/kg ○ Cap refill, alteration in sensorium, and UO are the most reliable indicators of fluid resuscitation in children ● Other interventions: ○ Evaluate burn wound depth and extent ○ Obtain admission weight ○ Insert NG tube to maintain gastric decompression ■ 2-3 days post burn, hypometabolic state → CO and metabolic rate decreases ■ After this, there is a hypermetabolic state ■ Use enteral feeding or if able, encourage high protein/high calorie diet after resolution of paralytic ileus and respiratory complication is ruled out ○ Provide IV meds to manage pain- morphine, fentanyl, midazolam ○ Obtain baseline values ○ Administer tetanus prophylaxis ■ ABX prophylactic is NOT recommended ● Complications: ○ Immediate threat: airways compromise and shock ○ Later/during healing: infection and sepsis ○ Pulmonary: inhalation injury, risk for bacterial pneumonia ■ Watch for burned lips, face, signed nasal hairs, wheezing, increased secretions, hoarseness, wet rales ○ Wound sepsis: exudate/ dead tissue are breeding groups for microorganisms ■ Watch for: disorientation (1st sign of overwhelming sepsis), spiked fever, diminished bowel sounds over 48-72 hours (paralytic ileus), and then temp falls ■ Other factors: hyperglycemia, thrombocytopenia, ABD distention, diarrhea ■ Wound deteriorates, WBC drop, then septic shock ○ GI: enteral nutrition is very important bc mucosal changes can cause feeding intolerance and ulcers ■ Early feelings are important to prevent issues ■ Watch for Abd distention and pain ○ CNS: burn encephalopathy Nursing interventions when caring for CHF patient ● Improve cardiac function ○ Digoxin, ACE inhibitors ○ Dig: dangerous drug – lethal doses can occur ■ Give at regular intervals ■ Parents need to be precise in measurements ■ Give water after admin to prevent tooth decay ■ Don’t mix with foods or liquids ■ If miss a dose, don’t give double ■ Don’t give another dose if child vomits
● Children are more at risk ● Newborns have a total body make up of 75% water —— Compared to adolescents that have a total body water of 45% and it decreases as you get older ○ Increase in ECF + increase in insensible losses ○ Increase in peristalsis ○ Decreased ability to concentrate urine ○ Decreased ability to communicate thirst ● Dehydration ○ Children are at an increased risk for dehydration because of their ECF and total body water make up ○ Stages of dehydration are based on total body weight lost ○ Mild ■ 4-5% loss of body weight ■ Alert, fussy, thirsty, irritable ■ Vitals WNL ■ Mucous membrane “tacky” or sticky ■ Fontanels flat, eye “dull” ● If still have open fontanelle ■ Capillary refill, skin turgor WNL ■ Decreased urine output ● Changing baby less frequently ○ Moderate ■ 6-10% loss of body weight ■ Fussy, thirsty, lethargic ■ Increased heart rate to pump decreased volume, decreased BP ■ Mucous membranes dry ■ Fontanels & eyes sunken ● Can feel depressions ■ Increased capillary refill, decreased skin turgor ■ Decreased urine output, increased specific gravity ● Spec. grav 1. ○ Severe ■ > 10% loss of body weight ■ Drowsy, limp, unarousable ● Carried into emergency room ■ Weak thready pulse, low BP ■ Mucous membranes parched ● Increased lines on top of child's palette from decreased moisture ■ Marked sunken fontanels & eyes ■ Marked increased cap refill, decreased skin turgor ■ Minimal / no urine output ● Specific gravity 1. Nursing interventions when caring for infant with a cleft palate ● Immediate issues: feeding the baby and dealing with the parents’ reaction to the defect ● Cleft palate ○ Make sure nipple is enough bc child will have difficulty latching ○ Burn frequently ○ Will be noisy feeders- educate parents ○ Small frequent feedings ○ Feed them upright so the fluid doesn’t flow into the nasal cavity→ can cause infections ● Encourage expression of parental grief and fears, which can promote attachment Identifying assessments and treatments for children with Hirschsprung disease, intussusception, gastroesophageal reflux and pyloric stenosis Pyloric Stenosis
● Commonly seen in newborns — most common surgical disorder of early infancy ● Some hereditary components and links to erythromycin use ● The pyloric sphincter tightens and is overgrown and hypertrophied — decreases the amount of what is allowed out of the stomach = does not allow stomach contents to flow into the duodenum ○ More common in males ● Dx: is often made by physical presentation and history of vomiting after feeding ● Barium Swallow + Ultrasound ○ Given through bottle or ET tube ○ the stomach is lit up with the barium — you can see that the sphincter is overgrown and does not allow any of the barium into the duodenum ● Assessment of Symptoms ○ Vomiting is progressive and projectile and NON BILIOUS ■ Color is of breast milk or formula but No bile ■ 1st week appear they are spitting up with every feed and then increase in consistency and larger volumes as feeding continues ○ Does the pt. appear hungry and irritable ○ Assess for “Olive in RUQ ○ Assess for failure to gain weight , weight loss, dehydration ○ Assess of peristalsis waves moving right to left ● Treatment: ○ NPO — decrease risk for aspiration — no value in eating when nutrients are not being absorbed ○ NG tube to decompress the stomach ○ IV placed 24-48 hours before surgery to replace fluids and hydrate the infant and F/E replacement ○ Pt. Needs surgery = parental support — Prognosis = great that they will recover completely and they can go home in 24-48 hours ○ Surgery = Pyloromyotomy — very little complications associated with this surgery ○ Post Op vomiting is common in most infants EVEN if the surgery was successful — due to inflammation around the pylorus ○ Feedings are started as soon as vomiting stop ○ Decrease the pressure on the stomach = burp frequently — DO NOT MOVE infant after eating ○ After feeding position them on RIGHT side — to help facilitate emptying Intussusception ● Bowel prolapses and telescopes into distal section causing obstruction — most common intestinal obstruction in children ○ Most common 3 months - 3 years and more common in males than females ○ More common in children with CF due to thickened mucus increases their risk ● Assessment ○ Assess and ask parents about their child’s stool = is it Jelly-like? ○ Assess signs and symptoms = n/v. pain, listlessness, hyper/hypoactive bowel sounds, blood currant jelly stools ○ CLASSIC TRIO = abdominal pain (cramping, colicky), Vomiting + bloody stools ○ NURSE MUST ASK parents about stool ● Treatment ○ Barium Enema = Dx + Tx ■ Enema sometimes allows for the reduction to occur ■ Helps pull the bowel away and does not allow it to telescope anymore ■ Helps to reduce Intussusception 80% of time + prevent surgery
○ ALL = feed in Upright position — keep babies head above stomach ■ Keep babies up in a baby seat or chair for 30 min - 1hours to the fluid can get into the duodenum ○ Mild — formula change, small frequent feeds, thickened feeds (rice cereal), positioning ■ smaller meals = decrease is over distention ■ Burp the child frequently and slow the pace of feedings ■ rice cereal = hypoallergenic ○ Moderate: same as mild + pharmacological agents ■ Decrease acidity = Zantac or Prilosec (decrease amount of acid produced) ■ Increase gastric emptying = Raglan — not used in children much ○ Severe = surgery ■ Reserved for children with: recurrent pneumonia, recurrent apnea, severe esophagitis, failure to thrive ■ All other measures must have been tried first ■ Nissen Fundoplication ● Nursing Care Goal = maintains normal weight gain + parents are comfortable with care ○ Identify children with problem — pt. not meant growth standards ○ Assess for failure to thrive + respiratory problems ○ parental teaching = how to feed properly ■ how much volume e ■ position before and after feeding ■ Safety = CPR due to apnea ○ Post op care if surgery is needed ■ Education to the parents to identify complications such as break down of the wrap or small bowel obstruction = need to report any signs of complications immediately Identifying assessments and treatments for acute appendicitis Appendicitis = inflammation of the appendix ● Most common at age 10 -15 years ● Can be caused by a viral infection or impaction due to fecal material ● Need to prevent necrosis + ischemia = rupture = fecal and bacteria are allowed to escape into the peritoneal area ● Assessments ● Signs and symptoms = decreased appetite, N/V/D/C, abdominal pain + tenderness at McBurney’s point ○ 1st complaint of periumbilical pain — then will become more intense and localized over McBurney's point ○ Increase pain with movement- allow child to find a comfortable position to decrease pain ○ Have child march in place — very time the child lifts the right leg pain increase ○ Child is choosing to stay motionless and do not want to get up because of increasing pain ○ Assess for low grade fever ○ Tell tale sign = increased activity = increased pain ○ Assess for sudden relief of pain = perforation — which is then followed by increase in symptoms ○ CBC ○ Gold standard = CT scan but often times uses ultrasound ● Treatment— surgical removal ASAP ● Nursing Care:
○ frequent and careful pain assessment
