NSG 6435 Quiz 2 Latest 2022 Graded A

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NSG 6435 Quiz 2 Latest 2022 Graded A Encopresis ✔✔constipation with fecal soiling, partial stool incontinence Constipation etiologies ✔✔NB: iron in formula overzealous toilet training fear of using bathroom 2nd to lack of privacy or cleanliness personality/emotion diet Constipation 2nd to disorders of GI tract ✔✔Structural (Hirschsprung's) Systemic (hypothyroidism) 2nd to meds (narcs, antihistamines) neurogenic (spinal cord lesions) Constipation tx ✔✔NB: water with prune juice, glycerin suppository Older: stool softeners, miralax, lactulose Encopresis criteria ✔✔must occur once a month for at least 3 months chronological or developmental age of child must be at least 4 years fecal incontinence must not be due to physiologic effects of meds or medical condition Encopresis male vs female ✔✔occurs more commonly in MALES than females primary encopresis ✔✔child who has never achieved fecal continence by 4 years of age 2ndary encopresis ✔✔fecal incontinence occurring in a child over 4 years following a period of established fecal continence most common cause of encopresis ✔✔CONSTIPATION encopresis tx ✔✔aggressive bowel cleansing daily stool softeners bathroom times/star chart hirschsprung's disease ✔✔congenital aganglionic megacolon congenital anomaly resulting in mechanical obstruction from inadequate motility in 1 part of the intestine incidence 1:1000 live births 4x more common in MALES associated with downs hirsch s/sx ✔✔NB: failure to pass meconium stool within 24-48 hours after birth poor feeding, vomiting, abd distention infancy: sx as above as well as poor weight gain, constipation ominous signs: fever, lethargy, bloody diarrhea childhood: chronic constipation hirsch. typical stool ✔✔FOUL SMELLING RIBBON LIKE STOOLS hirsch diagnosis ✔✔gastro graphin enema- shows transition zone bt megacolon and aganglionic distal segment dx confirmation= RECTAL BIOPSY daily maintenance fluid requirements ✔✔100ml/kg for first 10kg 50 ml/kg for second 10mg 20ml/kg for remaining body wt isotonic ✔✔equal amounts of h2o and na are lost hypotonic ✔✔electrolyte loss is >fluid loss hypertonic ✔✔water loss > electrolyte loss dehydration levels ✔✔mild- weight loss 5% moderate: wt loss 10% infants, 6-8% children severe: 15% infants 10% children toddler's diarrhea (chronic non-specific diarrhea) ✔✔diarrhea >2 weeks common in infants/children 6-54 months stools are loose with undigested food children are healthy and normal growth juice, dietary fat restriction, carb map-absorption tx: limit all orbitol/fructose foods/liquids, increase fiber/fat GERD ✔✔peaks at 4 months, sharply declines at 6 months appendicitis peak ✔✔preschool to young adult- peaks at 10 years most common cause of emergency abdominal surgery in childhood ✔✔appendicitis diagnostic test of choice for appy ✔✔ct hypertrophic pyloric stenosis ✔✔most common in WHITE FIRST BORN MALES hypertrophic pyloric stenosis ✔✔non bilious vomiting becoming more forceful- projectile 4-12 weeks olive shaped abd mall with visible peristalsis in ULQ Intussusception ✔✔collapse of telescoping of a section of the intestine into a distal portion of intestine more common in males, rare after 4 CURRANT JELLY STOOL (bowel obstruction) sausage shaped mass in URQ intussusception dx and tx ✔✔and us to r/o perf (no barium enema) tx of choice: hydrostatic reduction via water soluble contrast and air pressure (75% success rate)

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