Nursing 209

N209: Reproductive Health Study Guide • Signs and symptoms: Failure to pass meconium in the first 24 hours (in 40% of cases); abdominal distention with constipation progressing to vomiting (can alternate with diarrhea) • “Blast sign”: Occurs in older infants; no stool palpated in rectum on exam but explosive passing of stool after finger is removed (stool is usually high up in the colon) • Diagnosis usually initiated with barium enema (with no prep) • Definitive diagnosis is done via full thickness rectal or colon biopsy • Treatment: Laparoscopic surgical repair with removal of affected portion • Complication: Hirschsprung Enterocolitis o Life-threatening; enlarged colon with sepsis and shock o Death occurs in 10% of cases o Most common prior to surgery, but can occur post-op Pyloric Stenosis • Thickening of the pylorus muscles between the stomach and small intestine • Most common cause of intestinal obstruction in infancy • Occurs more often in males than females • Also occurs with family history and antibiotic use later in pregnancy, or in the first few weeks after birth (for pertussis) • Signs and symptoms: o Projectile vomiting, usually within 30 minutes after a feed o Persistent hunger and weight loss o Dehydration (no tears and decreased wet diapers) o Constipation (because food cannot reach the intestines) • Diagnosis: Confirmed on an ultrasound; may feel a lump on the abdomen over pyloric muscle with palpation due to enlargement • Treatment: Surgery o Pyloromyotomy: Done laparoscopically; usually successful with few complications Phenylketonuria • Inborn error of metabolism; in 98-99% of cases there is a genetic mutation • There is an absence or deficiency in phenylalanine hydroxylase (responsible for the conversion of excess dietary phenylalanine) • Causes intellectual disability along with behavioral and cognitive difficulties (the main organ affected is the brain) • Incidence: 1:10,000 births among mostly white populations • Signs and symptoms: Normal at birth with development of symptoms over months as the phenylalanine accumulates

©2018

Achieve

Page 86

of 109

Made with FlippingBook Learn more on our blog