PNR 311 PEDS FINAL EXAM REVIEW

INFANT

Posterior fontanelle closes at 6-8 weeks

Anterior fontanelle closes at 12-18 months

Birth weight doubles by 6 months ( eg. Baby is born at 7.5 lbs in 6 months baby weighs 7.2x
2=14.4lbs

Average HR 110-118, Average RR 40/min

Rolls over by 6 months, Begins to reach for objects by 3 months

Sits with support by5 months, Sits alone by 8 months

Turns completely over by 6 months, pulls self up by 10 months

Teeth eruption begins at 6-7 months begins to crawl 7 months, creeps by 9 months

Should be walking by 12-16 months Head lag no longer evident by 6 months

Feeding: breast/ formula milk until 6mos, then no homo milk until 1 yr

Solid foods introduced at6 months, start with rice, 1 new food every 4 days to a week

Erikson stage: Trust vs Mistrust

Sleep 8-9 hr/night, naps same amt

Object permanence developing

Speech 2 months( making vowel sounds) 3 months ( adding consonants n,k,g,b,l) 6 months
(imitating sounds) 9-10 months ( obey simple command, understand no) 1 yr ( may say up 3-5
words with meaning and understanding 100 words)

Safety: Car seat If less than a 1 yr and less then 22lbs must be rear facing middle, if 20-40 lbs
can be front facing

Immunizations: DPTP, HiB @ 2, 4, 6 mos, MMR @ 12-15 months

Play: solitary play, appropriate toys (

TODDLER

Triples weight by 1 yr, then quadruples weight by 2 1/2

HR 70-110 RR 25/min

Bladder/bowel control begins18-24 months, full control at 2 ½ to 3

Sign of readiness waking up dry and staying dry for2 hr

Language 18 mos 10 words, and simple commands, 24 mos 300 words, and can speak in 2 word
sentences

Egocentric, ritualistic, compulsive, favorite word: No

Erikson Autonomy vs self doubt

Play: still solitary but also parallel play

Milk: 3/ day homo milk until 3yr , feeding themselves. Serving: 1 table spoon /yr

Sleep 12/hr may still nap

Car seat 9-18 front faceing

Separation anxiety, regression if hospitalized common

PRESCHOOLER

First year weight doubles

Primary teeth present, hand preference, speech 2100 words

Fear Harm, dark ( leave a light on) pain

Erikson Initiative vs guilt

Play assitive play

Needs discipline, time out rules1 min/yr

Imitate adults, may be jealous, need prep for new changes

Sleep 12 , infrequent naps

Safety: Booster seat until 8yr or 18-36 kg

Immunization – DPT @ 4-6 yrs

SCHOOL AGE

Slower growth, double weight over the 6 yr period, rapid growth before puberty

Begin to lose primary teeth

Erikson: Industry Vs inferiority

No longer egocentric

Friends of same sex important

Sleep 12 hr

Fears bullys, fauiler

Safety – accidents: bike

ADOLESCENT

Puberty10-12 boy are longer may take up to 18 yr

Secondary sex characteristics: Boys: voice deepened, facial hair, acne, increased in size

Girls: hips widen, breast begin to erupted,

Menarche: 12 – 13 years, may be as early as 10 yrs or as late as 15 yrs

Erikson: Identity vs role confusion

Prefer friends over family, rebellious, invincible, popularity important

Safety – accidents, sex education

Immunizations:

 12 yrs - Grade 7

◦ Hepatitis B

◦ 2 dose series, 4-6 months apart

 ◦ Given in school, funded

 14-16 yrs

◦ DPT booster

◦ Given in Dr.’s office

HPV Vaccine:

o Recommended to all girls ages 9 – 26 yrs

o Gardisil

o Protects against 4 strains of HPV that are known to cause cervical cancer

o Given in Grade 8, preferably before sexually active

RESPIRATORY CONDITIONS

Croup – LTB ( braking cough)

• May be viral, post infection
• Symptoms: hoarseness, inspiratory stridor, barky cough
• Treat: bronchodilators, croupette

RSV – Bronchiolitis
• Caused by: RSV
• Bronchioles obstructed
• Classis signs: Deep congestive cough, crackles, wheezes
• Treat: bronchodilators, Contact isolation

Otitis Media
• Why occur: Children have shorter, wider, straighter & more horizontal
eustachian tubes

• Bacterial, therefore treatment Antibiotics, PE tubes

• Signs: Pulling, poking ear, miserable, increased temp

Asthma
 • 3 processes: Bronchial spasm , Inflammation & edema of mucosa ,Production of thick
mucus – increased airway resistance, hyperinflation, impaired gas exchange

• Wheezing, Productive cough

• Treatment: Bronchi dilatators, oxygen

Pneumonia
• Caused by Bacteria, viruses, and aspiration
• Treat with _Antibiotics
• Cough, fever, dyspnea, increased temp

Cystic Fibrosis
• Disorder of endocrine glands
• Secretions become thick viscous
• Airways become obstructed with thick sercetions
• Can’t cough up secretions d/t decreased action of cilla
• Resp Complications_Infections (pseudomonas*, staph aureus, H. influenza) – *
most difficult to treat – bronchiolitis, pneumonia, Emphysema, Pneumothorax,
Respiratory distress

• GI effects – secretions block release of Pancreatic enzymes

• GI effects Meconium ileus in newborn – blockage of small intestine by thick,
sticky meconium stool, Biliary cirrhosis from blockage of biliary duct , Pancreatic
fibrosis → diabetes and glucose tolerace problems, Bowel disorders – rectal prolapse
(poor muscle in rectal area), Diabetes becoming more common in CF patients

• High NaCl in sweat, leads to Fluid and electrolyte disorders

• Stools become bulky, frothy if untreated
• Treatment
o Lungs – need to mobilize secretions, meds bronco dilatators
• GI – will need Pancreatic enzymes for Life
NEURO

Increased ICP

• Bulging fontanelle, High pitch shrill cry

• Change in pupils, headache, projectile vomiting
• Lethargy  coma, seizures
Treat: cause of ↑ ICP, HOB elevated, osmotic diuretic, corticosteroids
• No activities to ↑ ICP, decrease stimuli

Seizures –
• What to do if pt seizures: Safe position – turn to side if vomiting – recovery
position after, Check airway and breathing, Do not try to put something in
mouth during seizure, NPO until fully alert, Febrile seizure caused by Rapid
increased temp

Hydrocephalus – increase in CSF

• Behaviours – see ICP, delayed head lag after 6months
• Treat – VP shunt

Meningitis
• Caused by virus or bacteria
• Diagnosed by lumbar puncture
• Symptoms – signs of increased ICP, nuchal rigidity, projectile vomiting, fever….
• Treat: Antibiotics, Resp isolation for 24 hrs minimum

Cerebral Palsy
• Causes: by dysfunction of motor centre in brain, Disabilities caused by brain
injury before or during birth, or in early infancy

• Behaviours – delayedgross motor development, poor head control, delayed

milestones (sitting, walking), seizures common types: Spastic Most common, damage to
cortex of brain (r/t cerebral asphyxia),Hypertonicity, spasms. Athetoid : Damage to
basal nuclei ganglion (assoc with hyperbilirubenemia),Abnormal involuntary
movements. Ataxic: Lesion in cerebellum, Loss of coordination,Unsteady gait –
ataxia. Rigid/Mixed: Combination of spastic and athetoid ,Constant muscle
tension

• Treat – maximize potential, prevent injury

Spina Bifida
• Neural tube defect
 • Caused by 3-4th week of gestation – folic acid deficiency .
• Occulta Hidden
• Meningocele external saclike protrusion containing meninges (membranes) & CSF
• Myelomeningocele external sac contains meninges, CSF and spinal nerves (cord)
• Treat – surgery
• Protect sac pre op: monitor VS, neuro status, place in incubator for warmth, do not
allow sac to dry, prone position, protect myelomeningocele sac – moist, sterile dressing, skin
care – cleanse skin, fleece pad

GI Conditions

Pyloric Stenosis
• Obstruction of pyloric sphincter by hypertrophy of muscle
• Classic signs - Projectile vomiting, occurs after eating, Emesis will consist of
mucous and ingested milk, Colicky pain, Weight loss,Hunger

• Treatment : surgery, post op care: Maintain fluid & electrolyte balance, Intake /
Output, weight, IV therapy, Maintain nutrition, Small, frequent feeds as ordered, burp
before & after feeds, May be NPO, NG tube, Fowler’s position or on rt side pc, Provide
comfort, Pacifier, cuddling, analgesics, Alleviate parental anxiety

Gastroenteritis

• Causes: non infectious: usually caused by food intolerance, overfeeding,

improper formula prep, ingesting large amounts of sorbitol ( in sugar free
items), Infectious causes can be from rotavirus E. coli, Salmonella, May also be from
medication or poisoning

• Behaviours: Diarrhea – mild to severe. May be expelled with force, yellow –

green, Vomiting Listless, refuses to eat, Weight loss, Elevated temp. Dehydration –
sunken eyes, sunken fontanelle, dry skin, tongue & mucous membranes (sticky),
Decreased urine output

• Treatment – IV fluids, oral rehydrating solutions

Celiac Disease
• Intolerance to gluten
 • Symptoms – failure to thrive, Large, bulky, frothy stools – food not digested,
Irritability, Abdominal distention, Buttock atrophystools.

• Treat - Will need to eliminate all gluten in diet for life (no wheat, barley, oats,
rye) rice and corn ok.

Diabetes
• Chronic disorder of metabolism
• Body unable to use insulin properly, impaired glucose transport results
• Body not able to store & use fats properly, decrease in protein synthesis
TYPE 1 DIABETES
 IDDM - Juvenile Onset Diabetes Mellitus
 Beta cells in pancreas destroyed
 Autoimmune condition, child has genetic predisposition
 Beta cells may be destroyed by drugs, chemicals, radiation
 Can occur at any age, but most new cases seen at 5-7 yrs & at 11-13 yrs
 Not inherited but hereditary is a prominent factor being observed more
 May be linked to stress or exposure to infectious disease which triggers onset
 Puberty, rapid growth, increased emotional stress & insulin antagonism of sex
hormones may be contributing factors
Type 2 Diabetes
 NIDDM, adult onset diabetes mellitus
 Involves insulin resistance
 Associated with sedentary lifestyle, obesity
Symptoms
• usually recognized more in children than in adults
• Diabetes is a great imitator – may be mistaken for flu, gastroenteritis, appendicitis
• Lethargy, weakness, weight loss common complaints
• Abdominal discomfort common complaint
• Polydipsia (common complaint!), polyuria, polyphagia
• Previously toilet trained child may begin soiling themselves
 • Recurrent infections, vaginal yeast infection in adolescent girls
• Symptoms may go unnoticed until infection or coma results
• Hyperglycemia, glucosuria
• Review /recall lab tests
• Diagnosis made, child stabilized with insulin, condition appears to improve
• Child feels well, insulin demands/requirements decrease
• “Honeymoon” phase – feels like remission, may deny accepting diagnosis of DM
• A temporary feeling – need to stress importance of proper glucose control
• American ranges - ÷17

Treatment
 Focus of treatment of child with diabetes:
 Ensure normal growth and development
 Ensure child able to cope with this chronic illness while having a “normal”
childhood
 Prevent complications
Child & parents need education
 Must consider child’s age, financial & educational status, culture, religion
 Consider children’s growth spurts, hydration status
 Children eat irregularly, have irregular activity
 Puberty will affect insulin requirements
 Adolescents may rebel against treatment, body image issues
 Child needs to learn to assume own responsibility for diabetes
 Test own blood glucose level
 If in hospital, will usually bring own testing machines
 Test urine for ketones if suspect ketonuria
Management includes well balanced diet, insulin, regular exercise
Nutrition
• No specific diet, no special foods – well balanced nutrition is key
• Will have same nutritional needs as non diabetic children
• Need sufficient calories to balance energy expenditure and to satisfy requirements for
G&D
• Must correlate food with insulin administration (onset, peak, action…)
• Dietician assists with nutritional intake/diet plan
• Diet should consist of 55% carbohydrates, 30% fats, and 15% protein
• Exchange system and carbohydrate counting used to determine intake & insulin
requirements
• Carbs should mostly be complex carbs - these are absorbed slowly so blood glucose does
not fluctuate greatly
 • Fats from animal sources limited
• Need to look at glycemic index of foods – foods with low glycemic index will take longer
to increase blood glucose levels
• Need to allow excesses occasionally to prevent rebellion, ie birthdays
• Need to respect cultural patterns & personal preferences
Insulin
o Short
o Rapid
Insulin Pumps
 Administers continuous subcutaneous insulin through battery powered pump
 Delivers fixed amounts of regular or lispro insulin continuously so it imitates the
function of the pancreas
 Tubing changed q48 hrs, using sterile technique, device worn on belt or shoulder
holster
 If needs to be removed – not for more than 1-2 hrs, water proof models available
 Watch for malfunctioning – low battery, occlusion
Exercise
• Body uses glucose, exercise lowers blood sugar
• If planning vigorous activity, should carry extra sugar or blood sugar will drop
• Diabetic child can participate in all activities but must plan properly
• Increased activity better after meals because blood glucose is _________, quieter activity
best _________meals when blood glucose is lower
• Carry money for snacks, cell phone
Home Management
• Proper hygiene, especially foot care
• Assess injection sites for lipodystrophy
• Maintain immunizations up to date
• Stress, emotional upsets will affect appetite, insulin requirements
• Wear medical bracelet, alert teachers, coaches, etc….
• If travelling, bring proper equipment, extra supplies – put in carry on luggage
• Time changes may affect child
• Will need very close monitoring when ill
Carb Counting
• Carbs considered equivalent but portions are looked at
• Insulin given in relationship to amount of carbs eaten
• Used to determine insulin to scale
• Match insulin doses to amount eaten ie 1 unit insulin for each 15gms carbs eaten
• Insulin usually given after child eats
Example
  John wears an insulin pump. He checks his blood sugar and notes that it is 11.0. He plans
on eating 90 gm of carbs for his lunch.
 His “insulin/carb ratio” is 1:15
• How much insulin should he bolus?
15/ 90= 6 so jonh will get 6 units of insulin
Cancer
 Most common cancers in children are bone marrow cancers, such as leukemia. Other
types include brain tumors, lymphomas. Childhood cancers grow faster because body
tissues are normally in a state of rapid growth and high metabolic rate. Treatment for
cancers includes surgery (for solid tumors), chemotherapy and radiation.
 Leukemia
o Bone marrow disorder in which there is proliferation of abnormal,
immature WBCs

o Immature WBC’s referred to as “blasts” or stem cells

o Leukemia is most common form of childhood cancer
o Immature WBC’s are overproduced which leads to disruption in bone marrow
function
Types of Leukemia
Classified by which cells are affected
 Acute lymphocytic leukemia (ALL) – most common (1/3rd of all childhood cancers) –
produces blast cells which destroy normal marrow
 Acute nonlymphocytic leukemia (ANLL)
 Acute myelogenous leukemia (AML) – affects granulocytes

Main Consequences of Leukemia

• These WBC’s cannot do their proper function – ie to fight infection, therefore increased
susceptibility to ___________________
• WBC’s infiltrate where RBC’s should be forming – therefore ↓RBC’s & RBC destruction
– results in ______________
• If WBC’s infiltrate where platelets should be forming - ↓ platelets & destruction – results
in __________________________________
• Overgrowth in bone marrow  pain
• Bone marrow invasion leads to weakened bones – results in fractures
• Infiltration of lymph system  enlarged liver and spleen
• Leukemic cells can invade liver, spleen, lymph nodes – leads to poor functioning of these
organs
• Cancer cells may also invade CNS and other organs (testes, ovaries, kidneys, lungs, GI
tract)
• Invasion of CNS - headaches, convulsions, vision disturbances
Signs and symptoms
 Initial – may develop slowly or suddenly
 Low grade fever,
 Pale skin
 Bruise easily
 Leg & joint pain
 Fatigue
 Abdominal pain
 Enlarged lymph nodes
 As disease progresses
 Liver & spleen enlargement
 Skin – lemon yellow colour
 Petechiae, purpura
 Anorexia, vomiting, weight loss
 Dyspnea
 Bacterial invasion (WBC’s not functioning)
 Ulcers and bleeding to mucous membranes around mouth and anus
 Anemia even with transfusions

Diagnosis: by bone marrow aspiration – will look at type & # of cells present
• WBC’s & RBC’s formed in bone marrow
• Insertion of needle into iliac crest to withdraw sample
• Child is positioned prone on hard surface
• Local anesthetic, e.g. EMLA, is used
• May also obtain sample from sternum
Nursing Care
• Explanation of procedure – pain from local anesthetic use (if with needle) and feeling of
pressure as needle is inserted
• Pressure after procedure to prevent bleeding – monitor closely q 15 min x 1hr
• Keep child quiet for 1 hr post procedure
• Monitor temp for 24 hours
• May also do xrays to determine if bones affected
• May do lumbar puncture to see if CNS involved
• Blood tests include liver & kidney function
Treatment Stages
Induction of remission ****
• Achieve remission
 • Chemotherapy for 4-6 weeks
• Effective for about 95% children with ALL
• Uses prednisone, vincristine, L-asparaginase, doxorubicin
 ** side effects include: nausea, vomiting, diarrhea, alopecia, weight loss, anemia**
CNS prophylaxis (sanctuary)
• Prevent leukemic cells from invading CNS
• Because chemotherapy drugs do not cross blood-brain barrier well
• Intrathecal (into spinal column by lumbar puncture) methotrexate, hydrocortisone
Maintenance
• Begun after successful induction to preserve remission
• Continues for 2-3 years
• Combination of drugs
• Regular testing to detect relapse

Reinduction following relapse

• Leukemic cells seen in bone marrow, CNS…
• Using similar regimen as initial induction
• Consider bone marrow transplant

Bone marrow transplant

• Not done initially as chemotherapy usually produces excellent results
• Autologous (own) or allogeneic (compatible donor)
• High-dose radiation or chemotherapy to destroy bone marrow
• IV infusion of new bone marrow – migrates to bone marrow by 3 weeks
• Anti-rejections drugs given
• Reverse/Protective isolation


Nursing Care of the Child with Cancer

Risk for infection r/t nonfunctioning WBC & chemotherapy effects
• Monitor for signs of infection – Temp, urine, piercings, skin breakdown,
• Private room – avoid contact with possible infections, reverse isolation
• Good hygiene practices
• Nutritionally complete diet
• Avoid administration of vaccines – body cannot manufacture antigens

Risk for injury (hemorrhage) r/t decreased platelet formation

 • Safe environment – pad bedrails, pressure-reducing mattresses & sheepskins, avoid rough
handling, minimize injurious treatments (injections)
• Assess for bleeding
• Avoid aspirin products
• Provide quiet activities, soft toys
• Pressure & ice following injections, venipuncture
• May need blood transfusion (platelets or RBC’s) – see pg 622 – watch for transfusion
reaction
Pain r/t cancer effects and treatments
• Analgesics on regular schedule
• Use alternative pain management techniques
• Gentle handling
• Monitor pain levels and effectiveness of medication
Altered nutrition: less than body requirements r/t anorexia, nausea and vomiting from
chemotherapy
• Administer anti-emetics prior to chemotherapy
• Frequent small feedings of favorite foods.
• Supplements can be given (Pediasure), TPN
• High protein, high calorie diet
• Create a pleasant environment for eating
• I&O
Impaired mucous membranes (oral & rectal) r/t chemotherapy effects
• Frequent, gentle oral care. No toothbrush – use soft sponge brush.
• Lip balm to lips
• Avoid acid-containing drinks.
• Bland diet
• Local oral anesthetic if ordered, e.g. Oragel to gums
• Hygiene to genital and rectal areas, sitz baths
• Prevent constipation
Activity intolerance r/t cancer & chemotherapy effects
• Plan care to provide adequate rest
• Quiet diversionary activites
• School tutoring
Altered family processes r/t diagnosis of cancer & effects of long-term illness
• Arrange support services – home care, pastoral care, palliative care, counseling, Ronald
McDonald house, etc.
• Help parents to identify and mobilize their own support systems
• Be accepting of parent's anger and anxiety
• Recognize parents' stage of acceptance of diagnosis
• Complete and careful explanations of procedures, treatments, disease pathology, etc.
 • Involve siblings in family care – explanations of what is going on, recognition of their
needs and fears
• Develop a coordinated system – "everyone on the same page" – family/health care team
conferences
Care of the Dying Child
 Infant & toddler – no comprehension of death

Preschooler – think death is reversible – terms like "sleep" are understood literally (may become
afraid to go to bed)
 -feel their thoughts are powerful – may feel they have caused the death
 -repeated questions about death

School age – begin to understand permanence of death

 -curious about physical details
 -accept parents' religious beliefs re: life after death
 -need tangible ways to show grief
o Adolescent – understand death, but tend to feel it won't happen to them, -fear of pain and
process of dying

Anticipatory grieving r/t child's impending death

• Demonstrate respect for child's and family's wishes
• Spend time with family to listen, provide answers and information
• Encourage expression of feelings of loss (Note: this is a Western culture expectation –
may increase distress for some other cultures)
• Be aware of family's religious, cultural beliefs and practices related to dying. Arrange for
appropriate spiritual care.
• Offer non-verbal support
• Arrange palliative care services, grief counseling
• At death, allow family time with child as desired – hold, rock child, etc.

BONE CANCER
Malignant tumour of long bone –more common in males, average 10 - 15 years of age
but even up to 19 yrs
 Peaks during periods of rapid growth
 Most occur in femur (>50%), but can involve humerus, tibia, pelvis, jaw or
phalanges - occurs in the metaphyses of long bones
 May cause pathological fractures
 If had radiation for other cancers – may have increased incidence of osteosarcoma
May metastasize to lungs, brain
Assessment

 Taller than average child – accelerated growth of osseous tissue

 Pain, swelling at tumour site
 Diagnosed by biopsy, ct scan, bone scan – “sunburst” appearance with needle-like
projections
 alkaline phosphatase

Management

 Resection of bone or amputation (3” above tumour) or limb salvage procedure -

(resection and prosthetic replacement of bone)
 Anti-neoplastic drugs – before &/or after surgery
 50% five years survival
Nursing Care

• pain (phantom limb pain) r/t amputation

• assess for pain, signs of infection
• speak with others who had amputation
• stump care
• prosthesis fitted in 6-8 weeks
• discuss hair loss  wear wig, baseball cap
• encourage visits from friends

Tonsillectomy – 5 questions
o Palantine tonsils removed for tonsillectomy (sides of pharynx, seen through
mouth)
o Child may have 1 or both procedures
o Tonsils made up of lymph tissue, part of body’s defense mechanism
o Most commonly age 4-12 yr., not recommended in children < 3 yrs

When should tonsillectomy be removed

 Indications:
 recurrent tonsillitis, adenoiditis, difficulty eating
 recurrent otitis media
 airway obstruction, difficulty breathing, sleep apnea
• Contraindicated for children with bleeding disorders, acute resp. infection, cleft palate
 • Preop screening (Hg, PT, PTT) is done – assess child pre-op for signs of URI – runny
nose, fever, sore throat. Note loose teeth( loose teeth could fall out and cause aspiration if
hit during surgey) . No surgery if has current infection
Signs & symptoms
• Enlarged, reddened tonsils
• Sore throat, dysphagia
• Increased temp
• Mouth breathers
• If abscessed – grey discharge on tonsils
Post-Op
• Cool, non-acidic fluids, clear fluids – popsicles, , apple juice, ice chips
• No red or red brown fluids
• Frequent small amount –unrealistic to expect child to drink 4-8 oz at one time
• Encourage parents to give drinks frequently while at bedside
• Milk & milk products coat throat so child will want to clear throat – BAD!
NO STRAWS!!!!
Monitor for complications
• Watch for HR, freq. swallowing, restlessness, trickle of bright blood at back of
throat
• Child often vomits old blood – watch for bright emesis
• Gentle suctioning if necessary
 when recoving
 Position on side, partly on abdomen with upper leg flexed to promote drainage
 Rest, keep quiet, settled
DISCHARGE TEACHING
• Pain management - analgesics (acetaminophen), ice collar, vapourizer
• Allow to chew gum – increases saliva production which is antibacterial & ↓ odour
• No nose blowing, throat clearing, gargling or vigorous brushing of teeth
• Needs rest, no strenuous exercise
• Can usually resume school in a week or so
• Watch for bleeding days 7 – 14 post op prone to re hem
• Tylenol for pain, no Aspirin
• Gravol for vomiting
• May have dark brown blood in vomit
Call Doctor if:
• Large amounts of fresh bleeding
• Fever > 38
• Pain not relieved by analgesic
Appendectomy – 3 questions
o Most common reason for emergency surgery

o Frequently seen in children, average age is 10 yrs

o Appendix can rupture or perforate within 36 hours of onset of pain
o Rupture leads to peritonitis, paralytic ileus
o Lumen of appendix becomes obstructed with feces, lymph tissue, parasites
Sign & Symoptams

o PAIN – initially periumbilical

o Pain then moves to RLQ - as peritoneum becomes inflamed
o Pain at McBurney’s point – midway between umbilicus & anterior superior iliac
crest
o Elevated WBC
o Vomiting
o May have diarrhea or constipation
o Fever – but may have other causes
o Guarding, rebound tenderness (press RLQ, release  causes severe pain)
o Ultrasound  thickened appendix, soft tissue mass
Nursing diagnosis
 Pre Op:

• Risk for infection

• PC Peritonitis
• Deficient Fluid Volume
• Pain
Post Op:
• Risk for Infection
• Acute Pain
Treatment
• Prepare for surgery
• Bed rest pre-op – to ensure that minimul pressure is being placed on the appendix.
• Are enemas and laxatives required pre op????
NO, because it will force pressure through the bowels and then end at the appendix,
which will be increase the chance of a rupture.
• IV antibiotics if ruptured appendix
• Usual post op care – NPO, IV, dressing, no heat assess……