MVU NURS 629 Exam 4
What is physiological jaundice? ans: -occurs when baby accumulates bilirubin
-secondary to immature liver in newborns
-common first 2-4 days of life and resolves by 2 weeks
What level is conjugated hyperbilirubinemia? ans: 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? ans: -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? ans: -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
How do you treat jaundice? ans: increased intake
indirect sunlight
phototherapy
IV fluids
What are other causes of jaundice? ans: abnormal blood cell shapes (like sickle cell)
Rh incompatibility
cephalohematoma
polycythemia (increased RBCs, SGA infants, twins)
infection
specific enzyme disorders
What is biliary atresia? ans: -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 causes biliary atresia? ans: -infection after birth (cytomegalovirus or rotavirus)
-autoimmune disorder
-developmental issue in womb
-exposure to toxic substances
What are symptoms of biliary atresia? ans: jaundice
dark urine
, light to white stools
poor wt gain and growth
How do you diagnose biliary atresia? ans: 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? ans: surgery (Kasai procedure)
liver transplant
What are risk factors for dehydration? ans: GI virus
vomiting/diarrhea
What are s/sx of dehydration? ans: sunken anterior fontanel
tachycardia and decrease cap refill
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? ans: 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? ans: vomiting=symptom
must distinguish from regurgitation in infants
integrated response to noxious stimuli-coordinated by CNS
What is acute emesis? ans: short-term
abrupt onset
What is recurrent emesis? ans: at least 3 episodes over 3 months
chronic, relatively mild that occurs frequently
What is cyclic emesis? ans: recurrent, intense episodes separated by asymptomatic periods
How do you treat emesis? ans: 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? ans: -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
What is physiological jaundice? ans: -occurs when baby accumulates bilirubin
-secondary to immature liver in newborns
-common first 2-4 days of life and resolves by 2 weeks
What level is conjugated hyperbilirubinemia? ans: 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? ans: -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? ans: -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
How do you treat jaundice? ans: increased intake
indirect sunlight
phototherapy
IV fluids
What are other causes of jaundice? ans: abnormal blood cell shapes (like sickle cell)
Rh incompatibility
cephalohematoma
polycythemia (increased RBCs, SGA infants, twins)
infection
specific enzyme disorders
What is biliary atresia? ans: -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 causes biliary atresia? ans: -infection after birth (cytomegalovirus or rotavirus)
-autoimmune disorder
-developmental issue in womb
-exposure to toxic substances
What are symptoms of biliary atresia? ans: jaundice
dark urine
, light to white stools
poor wt gain and growth
How do you diagnose biliary atresia? ans: 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? ans: surgery (Kasai procedure)
liver transplant
What are risk factors for dehydration? ans: GI virus
vomiting/diarrhea
What are s/sx of dehydration? ans: sunken anterior fontanel
tachycardia and decrease cap refill
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? ans: 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? ans: vomiting=symptom
must distinguish from regurgitation in infants
integrated response to noxious stimuli-coordinated by CNS
What is acute emesis? ans: short-term
abrupt onset
What is recurrent emesis? ans: at least 3 episodes over 3 months
chronic, relatively mild that occurs frequently
What is cyclic emesis? ans: recurrent, intense episodes separated by asymptomatic periods
How do you treat emesis? ans: 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? ans: -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
