PEDIATRICS EXAM 1 STUDY GUIDE

NORMAL VALUES
Temperature: 97 to 99 F
Heart Rate
o Newborn
Awake: 100-180
Asleep: 80-160
o Infants
Awake: 100-160
Asleep: 75-160
o Toddler
Awake: 80-110
Asleep: 60-90
o Preschool
Awake: 70-110
Asleep: 60-90
o School-age
Awake: 65-110
Asleep: 60-90
o Adolescent
Awake: 60-90
Asleep: 50-90
Respiratory Rate
o Newborn/infant: 30-60
o Toddler: 24-40
o Preschool: 22-34
o School-age: 18-30
o Adolescent: 12-16
Blood Pressure
o Neonate
Systolic: 60-90
Diastolic: 20-60
o Infant
Systolic: 86-105
Diastolic: 53-66
o Toddler
Systolic: 95-105
Diastolic: 53-66
o School-age
Systolic: 97-112
Diastolic: 57-71
 o Adolescent
Systolic: 112-128
Diastolic: 66-80

Reflexes
Sucking
o Suck on anything in mouth
Rooting
o Turn head to the side when cheek is stroked
Moro
o Startle reflex or feel like theyre falling they will extend arms and legs
 Palmar grasp
o Grasp anything that is put in palm
Plantar
o Stroking up the middle foot to the big toe and they flex their toes
Tonic Neck/Fencing
o When the babys head is turned their arms will go into the fencing position
Stepping
o If you hold baby in the air they will do the stepping motion
Babinski up the foot
o When the bottom foot is stroked on the outer sole the toes fan out
FLUID REQUIREMENTS
Daily
o 1-10 kg = 100 ml/kg
o 11-20 kg = 1000 ml + 50 ml/kg
o >20 kg = 1500 ml + 20 ml/kg
Hourly
o 1-10 kg = 4 ml/kg/hr
o 11-20 kg = 40 ml/hr + 2 ml/kg/hr
o 21-30 kg = 60 ml/hr + 1 ml/kg/hr
DEHYDRATION
Normal Lab Values
o Sodium
139-146 mEq/L for an infant
138-145 mEq/L for a child
o Potassium
3.5-5 mEq/L
o Calcium
8.8-10.8 mg/dL
o Specific Gravity
Urine 1.002-1.030
Assessment findings
o Cap refill >2 seconds
o Skin turgor
o Abnormal respiratory patterns
o Dry lips
Mild dehydration
o Weight loss: 3-5%
o Pulse: normal
o RR: normal
o BP: normal
o Behavior: normal
o MM: normal
o Thirst: slight
 o Tears: present
o Anterior fontanel: normal
o External jugular: visible when supine
o Skin: cap refill <2 sec
o Urine SG: >1.020
Moderate dehydration
o Weight loss: 6-9%
o Pulse: slightly increased
o RR: slight tachypnea
o BP: normal to orthostatic (>10% mmHg change)
o Behavior: irritable, more thirsty
o MM: dry/tacky
o Thirst: moderate
o Tears: decreased
o Anterior fontanel: normal to sunken
o External jugular: not visible except with supraclavicular pressure
o Skin: cap refill 2-4 sec
o Urine SG: >1.020, oliguria
Severe dehydration
o Weight loss: > or = 10%
o Pulse: very increased
o RR: hypernea (deep and rapid)
o BP: orthostatic to shock
o Behavior: hyperirritable to lethargic
o MM: parched
o Thirst: intense
o Tears: absent
o Anterior fontanel: sunken
o External jugular: not visible with supraclavicular pressure
o Skin: cap refill >2 sec
o Urine SG: oliguria or anuria

TYPES OF DEHYDRATION
Isotonic
o Occurs in conditions in which electrolyte and water deficits are present in
approximately balanced proportions
o Aka isomotic or isonatremic
o Most common in children
o Plasma sodium remains in the 130-150 mEq/L (WNL)
o Significantly reduces the plasma volume circulating in body - which can
lead to shock
o Manifestations
Skin gray, cold, poor turgor, dry
 MM dry
Tearing/salivation absent
Eyeball & fontanel sunken
Behavior irritable to lethargic
Body temp subnormal or elevated
Pulse rapid
Respirations rapid
Hypotonic
o Occurs when the electrolyte deficit is greater than the water deficit
o Aka hyposmotic or Hyponatremia
o Plasma sodium is typically less than 130 mEq/L
o Is more severe with smaller volumes of loss shock is frequent but less
apparent
o Manifestations
Skin gray, cold, very poor turgor, clammy
MM slightly moist
Tearing/salivation absent
Eyeball & fontanel sunken
Behavior lethargy to comatose; convulsions
Body temp subnormal or elevated
Pulse very rapid
Respirations rapid
Hypertonic
o Occurs from water loss in excess of electrolyte loss
o Aka hyperosmotic or hypernatremia
o Plasma sodium is >150 mEq/L
o Most dangerous for children
o More likely to have cerebral changes including:
Disturbances in consciousness
Poor ability to focus attention
Lethargy
Increased muscle tone with hyperreflexia
Hyperirritability to stimuli
o Manifestations
Skin gray, cold or hot, fair turgor, thick skin
MM parched
Tearing/salivation absent
Eyeball & fontanel sunken
Behavior marked lethargy w/ extreme hyperirritability on
stimulation
Body temp subnormal or elevated
Pulse moderately rapid
Respirations rapid
Manifestation Isotonic Hypotonic Hypertonic

Skin Gray, Cold, poor Gray, Cold, Very poor Gray, Cold or hot, Fair
turgor, dry turgor, Clammy turgor, Thick skin
Mucous Membranes Dry Sl Moist Parched

Tearing/salivation Absent Absent Absent

Eyeball & Fontanel Sunken Sunken Sunken

Behavior Irritable to lethargic Lethargy to comatose; Marked lethargy w/

convulsions extreme hyperirritability on
stimulation
Body temperature Subnormal or elevated Subnormal or elevated Subnormal or elevated

Pulse Rapid Very rapid Moderately rapid

Respirations Rapid Rapid Rapid

Rehydration
o Determine degree & type of dehydration
o Oral
If mild 50 ml/kg
If moderate 100 ml/kg
o Parental
Isotonic solutions 0.9% NaCl or Lactated ringers (first choice)
Bolus 20 ml/kg over 20-60 mins
o Can use electrolyte solutions like Pedialyte or Gatorade
Electrolyte
o Serum Potassium (K+)
ICF move to ECF
K+ follows fluid from ICF to ECF causing total body K+ depletion
Renal function decreased causing increased serum K+
During rehydration - ECF K+ moves back to ICF risking
hypokalemic unless replaced
o Serum Calcium (Ca+)
Usually reduced, especially with K+ loss
Risk of tetany (neuromuscular irritation) with hypocalcemia
Acid Base Imbalances
o Hydrogen ions imbalances reflect CNS involvement
 o Acidosis vs Alkalosis
Acidosis lethargy, stupor, coma
Alkalosis overexcitability, nervousness, tingling sensations,
tetany progressing to seizures
o Respiratory vs Metabolic
ROME respiratory opposite, metabolic equal
Pallor
Decrease UOP

PRIMARY DISTURBANCE COMPENSATIONS

pH PCO2 HCO3 pH PCO2 HCO3

Metabolic acidosis N -N

Metabolic alkalosis N -N

Respiratory acidosis N -N

Respiratory alkalosis N -N

HCO3, Bicarbonate; N, normal; -N, increase toward normal; -N, decrease toward
normal; PCO2, carbon dioxide partial pressure; pH, measure of the acidity or alkalinity of a
solution.
TYPES OF SHOCK
Compensated shock
o Childs ability to compensate is effective
o Cardiac output and systemic BP normal or increased
o Blood flow is generally uneven or not distributed evenly
o Early clinical signs
Apprehension
Irritability
Normal BP
 Narrowing pulse pressure
Thirst
Pallor
Decreased UOP
Uncompensated shock
o Manifestations
Tachypnea
Moderate metabolic acidosis
Oliguria
Cool, pale extremities
Decreased skin turgor
Poor cap refill
o If it progresses beyond bodys limits of compensation results in hypoxia,
metabolic acidosis and organ failure
Shock
o Ventilation
o Fluids
Isotonic crystalloid solution (NS or LR)
IV boluses of 10 to 20 ml/kg over 10 to 15 mins and repeated as
necessary
Colloids such as albumin
o Improvement of the pumping heart dopamine & Epi
o IF septic antimicrobial therapy
Sepsis/Septic Shock
o Systemic Inflammatory response syndrome (SIRS)
Widespread activation and systemic release of inflammatory
mediators caused by noninfectious and infectious
o Stages
Early compensated chills, fever, vasodilation with increased
cardiac output, normal urine output, and BP
Cool stage hyperdynamic decompensated cool skin, normal
pulse and BP, diminished urine output, mental changes and mental
depression
Cold stage hypocompensated hypothermia, cold extremities,
weak pulses, hypotension, oliguria, anuria, severe lethargy, coma,
multi organ failure

RESPIRATORY
Infants are obligatory nose breathers
Respiratory distress
o Signs & Symptoms
Abdominal breathing (when old enough to be chest breathers)
 Nasal flare
Retractions skin pulls in above, in between, or below ribs
Supraclavicular, suprasternal, intercostal, substernal,
subcostal
Increased respiratory effort, gasping, apnea, absent/decreased
aeration, adventitious breath sounds
Cardio: tachycardia, bradycardia, mottles color
Physiologic: hemoglobin desaturation, hypoxemia, hypercarbia
(CO2 retention), and acidosis
Cyanosis, decreased LOC, agitation, unable to speak
Upper Airway & Disorders
o The crucial issue in upper airway is PATENCY
Being open, expanded, and unobstructed
o Upper Airway Obstruction (UAO)
Acute onset common causes in children are infections, foreign
body aspiration, angioedema, and trauma
Chronic UAO many etiologies, including congenital
malformations affecting airway, cartilaginous weakness, vocal
word paralysis, and subglottic stenosis
o Acute Streptococcal Pharyngitis
Viral and GABHS most common, Scarlett fever
Manifestations
Abrupt onset, fever, sore throat, HA, abd pain, rash , LAD
Diagnostic: rapid strep, culture
Treatment: if viral - supportive care; if GABHS antibiotics
penicillin/erythromycin
Nursing management: antibiotics (penicillin), compress, fluids
If you dont treat GABHS post strep acute nephritis & rheumatic
heart fever can happen (very severe)
o Peritonsillar or Retropharyngeal abscess
Location pharyngeal (up behind nose), tubal (up behind top
teeth), palatine (visible in back of throat), lingual (very back of
tongue)
Peritonsillar: this is usually a complication of acute tonsillitis
usually caused by GABHS unilateral
Retropharyngeal: 6 yr; gradual, 2-5 days; may follow oral trauma
May be caused by - S. aureus/MRSA; streptococcus
pyogenes; anaerobes; GABHS, (similar to epiglottitis)
Manifestations
Fever, sore throat, dysphagia, trismus, pooling of saliva,
muffled voice
Diagnostic: throat culture or rapid strep identification test should
be performed to rule out GABHS (similar to ASP above)
Treatment: abscess drained and antibiotics
 Nursing management: management of airway, fluids
o Post-Op Tonsillectomy
Airway: positioning on one side when lying down or sleeping &
sitting up when awake
Bleeding
Observation frequent swallowing?
Prevention of recurrent bleeding
Avoid suctioning
Maintain quiet environment
Minimize agitation/crying
Comfort ice collar if child wants it; analgesic; antiemetic if
nauseous after surgery
Diet soft foods, no milk products, no red or brown drinks, no
citrus drinks or foods; cool water, crushed ice chips, and popsicles
are good
o Upper Respiratory Infection (URI)
Children have an average of 6-8 URIs per year
Complications
Otitis media, conjunctivitis, lower respiratory tract
infections, sinusitis
Manifestations
Watery nasal discharge, mild sore throat, may have a fever,
but not ill appearing
s/s last 7-10 days
Viral etiology
Treatment: supportive, Zinc, Vitamin C, increase fluids, cold
medicines
Nursing management: supportive, cool mist humidifier, bulb
suction and saline, rest, hand washing
o Influenza
Acute viral disease of the respiratory tract
3 antigenic types A and B mostly seen
Spread by direct contact, droplet contamination, and fomites
Occurs in winter, lasting 4-8 weeks
Children shed virus longer than adults; viral shedding usually
ceases 7 days after the onset, but in children can last > 10 days
Incubation period is 1-3 days
Manifestation
High fever (102-106 F)
HA
Chills
Stuffy, runny nose (coryza)
Vertigo
 Sore throat
Pain in back & extremities malaise/myalgia
Dry hacking cough (most frequent sign)
Vomiting, diarrhea, and croup occur in young children
Diagnostic: nasopharyngeal secretions (cotton swab in nose)
Treatment: supportive care;; antiviral drugs (Tamiflu) treat within
first 2 days to lessen severity and give for 2-5 days; it is not
recommended for young children by most pediatricians due to SE
such as hallucinations
Nursing management: Prevention is key! Flu immunizations, no
antibiotics, supportive care is best
Flu vaccine now recommended for children over 6
months; should not get vaccinated if you have an egg
allergy
o Otitis Media
A result of malfunctioning eustachian tubes; mechanical or
functional obstruction of the eustachian tubes causes accumulation
of secretions in the middle ear
Eustachian tube functions: protection of middle ear from
nasopharyngeal secretions; drainage of secretions produced
in the middle ear into nasopharynx; ventilation of middle
ear to equalize pressure within middle ear and atmospheric
pressure in external ear canal
Usually caused by Strep pneumoniae, H influenza, and Moraxella
catarrhalis
Many cases of OM are preceded by RSV or influenza
One of the most prevalent early childhood diseases & most
common in the first 24 months of life and highest incidence in the
winter months
Risk factors include URIs, allergies, down syndrome, cleft palate,
day care attendance, exposure to secondhand smoke, and bottle
propping during feeding
Breast-fed infants have less OM than bottle-fed d/t
immunoglobulin A & position during feeding
Diagnostic: assessment with otoscope and of s/s
Treatment: if over 6 m.o. watching waiting up to 72 hrs for
spontaneous resolution; antibiotics (amoxicillin first line); topical
relief (hot/cold or benzocaine drops); surgical if necessary
Otitis Externa swimmers ear; infection of external ear
o Aspiration
Foreign object anywhere in airway
Manifestation
Severity? Depends on location, type and size of object
Apnea, stridor, increase wob, decreased aeration
 Diagnostic: x-ray, assessment, look
Treatment: removal of object
Management: ABC; pulse ox monitoring; supportive care
Croup Syndromes
o Characterized by hoarseness, barking cough, inspiratory stridor (no
retractions), and varying degrees of respiratory distress
o Affects larynx, trachea, and bronchi
o Described by anatomic area primarily affected
Epiglottis, laryngitis, laryngotracheobronchitis (LTB), and
tracheitis
o Acute laryngotracheobronchitis
Croup (most common croup syndrome)
Most common in children 6 months to 3 years; M>F; fall and
winter; usually gradual
Caused by Viral agents (Parainfluenza 1 & 3, influenza A, RSV)
Definition: clinical syndromes characterized by laryngeal
obstruction caused by subglottic edema
Manifestation
Harsh cough; stridor; low-grade fever; nasal discharge;
conjunctivitis
Nursing Management: airway management, maintain hydration by
PO or IV, high humidity with cool mist, nebulizer treatments
(epinephrine or steroids)
Continuous, vigilant observation and accurate assessment
of respiratory status; pulse ox monitoring
o Epiglottitis
Abrupt and acute (medical emergency)
Typically occurs in 2-5 y.o.
A serious obstructive inflammatory process that causes
inflammation of the supraglottic structures
Usually caused by Haemophilus influenza type B (Hib) and Group
A streptococci
Vaccine for Hib given to infants
Manifestations
Severe sore throat, high fever, toxic appearance, muffled
voice, may drool, sits erect and quietly, hot potato voice
(aphonia), stridor, perioral cyanosis, respiratory failure
Nursing management: airway, position for comfort, NO tongue
blade, suction at bedside, prepare for emerge
Obstructive sleep apnea
o Prolonged, partial, or intermittent complete
o Defined as a disorder of breathing during sleep with prolonged partial
upper airway obstruction or complete obstruction that disrupts normal
respiration during sleep and normal sleep patterns
 o Affects children 2-8 years old
o Causes: multifactorial, adenotonsillar hypertrophy, obesity
o Manifestations
Snoring, increase wob, restlessness, diaphoresis during sleep, large
tonsils, mouth breathers
Disorders of the Lower airways
o Lower airway disease is one of the leading causes of morbidity in the first year of
life and continues to be an important component of other illnesses
o Surfactant is a lipid-protein mix, critical for maintaining alveolar expansion
o Lines alveoli and reduces surface tension, preventing collapse
o Deficiency is often seen in preemies and causes RDS
o Produced by 20-24 weeks and is secreted into fetal airways by 30 weeks
o Neonatal RDS
o Prematurity increases risk (W>B, M>F, C/S)
o Patho: decreased surfactant, pulmonary insufficiency, reduced lung
function, alveolar stability and effective pulmonary blood flow, and right
to left shunts (PDA contributes)
o Manifestations
Onset near time of birth
Retractions, tachypnea, grunting, rales, hypoxia, hypothermia,
irregular rate, possible atelectasis
o RDS babies develop bronchopulmonary dysplasia
A form of arrested lung development with fewer and larger alveoli
that have less functional surface area, less elasticity, and
ventilation
Manifestations of BPD
Increased O2 needs, hypoxemia, increase wob, difficulty
feedings, wheezing, mucous plugging, pulmonary HTN,
`require prolonged ventilation
Treatment: prevention, wean ventilator, adequate
growth/diet/calories
Nursing management: illness prevention, vaccination, airway
management, growth/developmental delays, hydration, education
of parents
o Bronchiolitis
o Inflammation of the bronchioles resulting in small airway obstruction,
most common lower respiratory tract infection in infants
o Cause: RSV is the most common etiologic agent, also adenovirus,
rhinovirus, influenza, paraflu
o Generally younger than 24 m.o. but ranges 3 months to 3 years
o Direct contact transmission; occurs late winter, early spring; virus shed for
long as long as 3-4 weeks; incubation 3-5 days
o Manifestation
Rhinitis, cough, stuffy nose 1-2 days, may have low grade fever
 Abrupt onset of wheezing and dyspnea (lots of wheezing and lots
of mucus with these patients)
Feeding/sleeping difficulties, possible dehydration
Wheezing, retractions, tachypnea, breath sounds should be equal
bilaterally
o Diagnostic: by auscultation, nasopharyngeal secretions viral cultures
o Nursing management: prevention; Palivizumab (vaccine) for preemies or
high risk infants; contact/droplet precautions; O2 and suction
o Treatment: symptomatically; supplemental O2 if needed; routine CPT not
recommended; IV fluids if needed; corticosteroids
o Pneumonia
o Inflammation of the pulmonary parenchyma
o Causes: usual organisms vary by age
Newborn: Group B strep
Infants (2-19 wks): Chlamydia
>5 yrs: Mycoplasma
All ages: viral or bacterial
Strep Pneumo most common of Bacterial Pneumonia in every age
beyond neonate
o Classification by agent viral, bacterial, mycoplasmal; classification by
site lobular, bronchial, interstitial
o Manifestations
Chlamydia in first 2 wks
Staccato cough, rales, no wheezes, conjunctivitis common,
x-ray shows infiltrates and hyperinflation
Viral (gradual onset)
Rhinorrhea, low grade fever, cough, wheeze, rales,
progressive increase in respiratory rate & retractions, x-ray
shows transient lobar infiltrates
Mycoplasma (gradual onset)
Persistent non-productive cough, fever, malaise, HA, x-ray
will show interstitial infiltrates
Bacterial
Fever (>102), productive cough, pleural pain, rales,
diminished breath sounds, tachypnea, grunting, retractions,
toxic appearing, nonspecific findings in infants, abd pain,
WBC > 15,000, x-ray shows lobar consolidation
o Diagnostic: chest x-ray, CBC (WBC <5000 or >15000), sputum cultures
difficult to obtain, cold agglutinins to diagnose Mycoplasma, blood &
urine cultures per fever protocol, give PPD if TB is suspected
o Treatment: depends on if viral or bacterial, O2
o Nursing management: supportive and symptomatic; thorough respiratory
assessments are important; and administration of supplemental oxygen,
fluids, and antibiotics
o Pertussis
o Aka whooping cough
o Caused by Bordetella pertussis
o Severe, debilitating cough illness lasting weeks to months (100 day
cough)
o It is highly contagious and threatening in young infants
o Characterized by paroxysms (a sudden attack) of cough; vomiting;
inspiratory whoop (not present in <6 m.o. and older children)
o Apnea is a common manifestation in infants (which can lead to death)
o It can result in encephalopathy, seizures, and pneumonia
o Diagnostics: culture is the gold standard, but obtaining adequate specimen
requires a special swab
o Vaccination 2, 4, 6, 15 mo; 4-6 yrs; 11 yrs; then q 7-10 yrs
o Treatment: hospitalize young infants and children with respiratory
distress; erythromycin; make sure to treat close contacts (home, daycare)
Supportive at home, encourage adequate hydration,
administering antipyretics
o Asthma
o Chronic inflammatory disorder of the airways which causes bronchial
hyper-responsiveness to stimuli and recurrent episodes of respiratory s/s
which are associated with reversible airflow obstruction
(bronchoconstriction, edema, mucous)
o Inflammatory response from cells and cellular elements
o Acute bronchoconstriction results from airway hyper-responsiveness after
exposure to stimuli allergens, drugs, weather changes, viruses, irritants,
emotions, exercise, stress
o Risk factors
Age, atrophy, heredity, gender, mother <20 yrs, smoking, ethinicity
(AA at greatest risk)
o Increased Microvascular permeability and leakage are the cause of airway
walls with edema and mucosal thickening (chronic mucus plug forming &
airway wall remodeling)
o Factors contributing to severity: inhaled allergens, occupational exposures,
irritants, GER, sensitivity to drugs, URI, FH, atrophy
o Types
Recurrent wheezing usually precipitated by a viral respiratory tract
infection
Chronic asthma associated with allergy persisting into later
child/adulthood
Associated with girls who develop obesity & early-onset puberty
Cough-variant asthma
o Categories
Intermittent, mild persistent, moderate persistent, and severe
persistent
 o Manifestations
Wheeze, cough, retractions, increased wob, usually develop s/s by
5 yrs old
o Diagnostic: peak flow, assessment, S/S
o Treatment: bronchodilator (short & long acting), steroids, inhaled
corticosteroids, avoidance of triggers
Most meds are inhaled USE SPACER
Nebulizer tx
Oral and IV not very effective treatment
o Nursing management: education, exercise, CPT, hypo-sensitization,
prognosis, asthma action plan (they should be able to do everything a
healthy kid can do if it is controlled)
o Cystic Fibrosis
o Characterized by several clinical features: increased viscosity of mucous
gland secretions, a striking elevation of swear electrolytes, an increase in
several organic and enzymatic constituents of saliva, and abnormalities in
autonomic nervous system function
o Autosomal recessive inheritance (both parents must carry gene)
o Median life expectancy 30 40 years
o Manifestations
Early postnatal-meconium ileus (intestines not passing stool)
FTT failure to thrive
Increased weight loss with increased appetite
Gradual deterioration of respiratory system progressive COPD
Wheezing, dry non-productive cough
Atelectasis, repeat infections
Cyanosis, clubbing of fingers
Hyponatremia (esp. during exercise or hot weather)
o Effects on the respiratory system
Stagnation of mucus and bacterial colonization result in destruction
of lung tissue
Tenacious secretions are difficult to expectorate obstruct
bronchi/bronchioles
Decreased O2/CO2 exchange
Results in hypoxia, hypercapnia, and acidosis
Compression of the pulmonary blood vessels and progressive lung
dysfunction lead to pulmonary hypertension, cor pulmonale,
respiratory failure, and death
o Respiratory progression of s/s
Gradual progression follows chronic infection
Bronchial epithelium is destroyed
Infection spreads to peribronchial tissues, weakening bronchial
walls
Peribronchial fibrosis
 Decreased O2/CO2 exchange
o Effects on the GI system
Mechanical obstruction caused by increased viscosity of mucous
gland secretions in the lung and GI tract including the pancreas
Vitamin and nutrient malabsorption
Growth failure
Pancreatic fibrosis can cause diabetes
Prevents pancreatic enzymes from reaching duodenum need to
take pancreatic enzymes right before eating or with first bite of
food to replace enzyme r/t duct blockage
Impaired digestion/absorption of fat steatorrhea
Impaired digestion/absorption of protein azotorrhea
o Diagnostic: newborn screening as part of metabolic screening panel;
quantitative sweat chloride higher concentration of NaCL in saliva and
sweat (2-5x greater than control); after onset of symptoms CXR,
pulmonary function tests, stool fat, enzyme analysis, barium enema
o Treatment: prevent respiratory infection, promote clearing of secretions
(CPT), promote aeration w/ exercise, aggressive treatment of pulmonary
infections w/ IV antibiotics & aerosolized antibiotics
o Nursing management: replace pancreatic enzymes, high-protein, high-
calories diet; salt supplementation, adequate hydration; close monitoring
of blood glucose (d/t insulin resistance & deficiency); diet & exercise