Chapter 43: The Child with a Gastrointestinal Alteration Flashcards
Endoscopies are performed under _____________ sedation.
conscious
The ________ is responsible for sodium and water retention; removal can result in _________________.
ileum, fluid and electrolyte imbalance
Nutritional support for biliary atresia includes ___________ vitamins and restricted __________ intake
fat-soluble, protein
During the (single, two) step correction of Hirschsprung disease, the diseased portion is removed, and a temporary colostomy is formed.
two
In treating ulcers, ________________ are found to be as effective as medications
dietary changes
acceptable substitutes for gluten in diet
corn, rice
constipation is defined as a delay of passing stools for _______________
2 or more weeks
Children with chronic GERD may be at increased risk of upper ___________. ________________ is used to evacuate these, and radiologic procedures may be used to ____________ vessels.
GI bleeds, Stomach lavaging, coagulate
Ulcerative colitis affects the _____________, while Chron’s disease can affect _____________________ and involves _________ of the mucosa.
colon only, anywhere in the GI tract, all layers
avoidance of ____________ and ________________ can help reduce symptoms of irritable bowel syndrome (IBS)
caffeine, carbonated drinks
Medication management for ulcers is usually a combination of these four medications
antibiotics, proton pump inhibitors, H2 receptor blockers, mucosa protectants
most common surgical procedure for children
to treat appendicitis (appendectomy)
first line of treatment for gastroesophageal reflux disease (GERD) in infants
small, more frequent feedings with frequent burping
incomplete development or absence of anus in its normal position in perineum
imperforate anus
In treating ulcers, surgery is reserved for these three complications
hemorrhage, obstruction, perforation
Preoperative nursing management for Hirschsprung disease includes _________________ enemas until the return is clear, keeping child _____, maintaining the ____, and administering rectal and IV ____________.
isotonic saline, NPO, IV, antibiotics
area within GI tract that has lost part of the mucosa due to exposure to acids
ulcer
During the (single, two) step correction of Hirschsprung disease, the diseased portion is removed and the healthy bowel is reconnected to the rectum.
single
incidence of pyloric stenosis is most common in this ethnic group
white male (especially first born)
manifestations include diarrhea, constipation, combination, diffuse abdominal pain unrelated to meals, undigested food/mucus in stools
irritable bowel syndrome (IBS)
Diagnosis of lactose intolerance is presumed when ________________ resolves symptoms.
lactose removal
final, definitive diagnostic test for biliary atresia
liver biopsy
__________ restraints can be used so that child does not touch or pick at suture lines so they can be kept clean and intact (cleft lip/palate)
Elbow
lack of enzyme lactase
lactose intolerance
embryonal weakness in abdominal wall causes herniation of intestines on one side of umbilical cord during early development, most commonly on right side
gastroschisis
congenital, inherited disease that results in inability to digest gluten
celiac disease
manifestations include failure to pass a suction catheter 10-11 cm beyond gum line, excessive oral secretions, vomiting, abdominal distention
esophageal atresia (EA) and tracheoesophageal fistula (TEF)
treatment is symptomatic and aimed at education and identification of triggers
irritable bowel syndrome (IBS)
ultimate treatment required for biliary atresia
liver transplant
four medications used to treat gastroesophageal reflux disease (GERD)
antacids
proton pump inhibitors
H2 receptor blockers
prokinetic agents
malformation in which the esophagus does not reach the stomach
esophageal atresia (EA)
medical emergency in which a section of intestines telescopes inside of itself
intussusception
manifestations include failure to pass meconium stool, absence of anorectal canal, presence of anal membrane, external fistula to perineum
imperforate anus
Manifestations may include bowel obstruction, chronic constipation, abdominal pain, distention, vomiting, failure to thrive
Hirschsprung disease
a child has involuntary defecation over 4 years of age and has a normal anatomy
encopresis
at risk for esophageal motility dysfunction, GERD, strictures, bronchitis, pneumonia with aging and growth
esophageal atresia (EA) and tracheoesophageal fistula (TEF)
_______________ lactose intolerance occurs in early to late childhood
Developmental
viscera are inside the abdominal cavity and under the skin
umbilical hernia
type of surgery that can be done to treat gastroesophageal reflux disease (GERD)
fundoplication surgery
Nursing care for biliary atresia is balanced in six areas
nutrition, skin, developmental, education, assessment, emotional support
umbilical hernia is usually _____ cm and easily reduced
1-5
_____________ anastomosis is used to repair esophageal atresia
end to side
In treating child with an ulcer, parents should call the physician immediately with these five manifestations
“coffee ground” emesis, tarry stools, increased pain, diarrhea, unexplained weight loss
An exploratory laparotomy for biliary atresia attempts to identify the ________ and to _________ it. If not identified, a ________ procedure is performed.
lesion, drain, Kasai
Manifestations include diarrhea, abdominal distention, vomiting, anorexia, irritability, muscle wasting, growth failure
celiac disease
Supportive care for child with bleeding ulcer includes these four things
IV fluids, blood, oxygen, vasoactive drugs
_______________ oil has been found to be beneficial at relieving symptoms of irritable bowel syndrome (IBS)
Peppermint
In treating ulcers, _______________ intake should be reduced because it increases the amount of acid produced in the GI tract
caffeine
________________ changes are the most useful when treating ulcerative colitis
Dietary
two tests that can be used to diagnose lactose intolerance: the _______________ test measures sugar absorption, and the ____________ test reviews absorbed levels of sugar in serum glucose.
clinitest stool, lactose tolerance
parents may notice that milk comes out of the nose when feeding with this deformity
cleft palate
While feeding an infant with cleft lip/palate, keep in __________ position to decrease chance of choking, and ________ frequently
upright, burp
________________ are done to check for GI bleeding
Fecal occult blood tests
regurgitation of gastric contacts back into esophagus
gastroesophageal reflux disease (GERD)
______________ lactose intolerance involves complete absence in lactase at birth.
Congenital
Children with Hirschsprung disease should not have a ____________ temperature.
rectal
most common in low-birth-weight and black infants
umbilical hernia
__________________ are used to visualize the upper GI tract and take biopsies of the mucosa to diagnose ulcers
Endoscopies
congenital condition in which ganglion cells do not form in colon or rectum, creating lower bowel obstructions due to dilation with feces and gas
Hirschsprung disease
________________ may be possible for infant with small cleft lip
Breastfeeding
occurs as a result of congenital malformation or surgical resection of GI tract
short bowel syndrome
While there is not a set liver function test specifically for hepatitis, reviewing these five lab results give a good view of the extent of liver damage.
AST, ALT, bilirubin, alkaline phosphatase, sedimentation rate
tub baths can be used to clean gastrostomy tube after ________
1-2 weeks
Postoperative patients with Hirschsprung disease are kept NPO until ____________ is released or ________________ return, which is when the child is started on a __________________ diet.
flatulence, bowel sounds, clear liquid
cleft palate is repaired by __________ of age with recommended repair by __________
6-24 months, 1 year
____________ is common with biliary atresia due to deposits of bilirubin under skin
Pruritus
gently rotate or turn new gastrostomy tube in each direction ______
daily
first choice in treatment of intussusception is a ______________, which uses a(n) ___________ or ________ enema and is visualized under ____________.
hydrostatic reduction, isotonic, air, fluoroscope
three medications prescribed to maintain regular stools after constipation
mineral oil, lactulose, polyethylene glycol
Treatment for infectious gastroenteritis is __________________ and prioritizes ____________________ replacement.
symptomatic, fluid volume
in caring for imperforate anus, report any ___________ or presence of stool in _______ or ________
skin dimples, urine, vagina
Use _____________ technique when dealing with gastroschisis or omphalocele defect
sterile
condition is diagnosed during newborn examination with radiography, ultrasound, or CT scan used to determine level of lesion and associated anomalies
imperforate anus
occurs with a higher incidence in children with Down syndrome
Hirschsprung disease
Manifestations include frothy (not fatty) diarrhea, abdominal distention, increased flatulence, cramping, abdominal pain
lactose intolerance
A ___________ screen should be conducted to rule out inborn errors in patients with manifestations of biliary atresia.
metabolic
diagnosis of celiac disease is confirmed with anti-_____ and ___________ diet.
tTga, gluten-free
Hepatitis B and C spread is prevented with
standard precautions (PPE, gloves, mask, eye/face shield; safe injections)
most common cause of end-stage liver disease and top indicator of liver transplant in children
biliary atresia
imperforate anus is treated with repeated dilations in __________________ or _________ in all other defects
anal stenosis, surgery
short bowel syndrome results in impaired ________________ through GI tract due to reduced amount of surface area
nutrient absorption
Altered feeding techniques for cleft lip/palate involve a special bottle with _____________ to reduce the amount of milk from exiting through nares and gently squeezing sides of bottle to reduce stimulation of _________ and _________ energy required for feeding
longer nipple, gag reflex, decrease
In intussusception, __________________ pain at first then increases in frequency until ________________. Bloody mucus-like stools are described as ___________________ stools. A ____________-shaped mass occurs in the abdomen.
intermittent, constant, red currant jelly, sausage
result of hypertrophy of the muscle surrounding the pyloric sphincter, resulting in obstruction of gastric emptying
pyloric stenosis
manifestations include jaundice, acholic stools (absence in color), bile-stained urine, hepatomegaly
biliary atresia
imperfect closure of umbilical ring allows intestines to push outward at umbilicus during straining and crying
umbilical hernia
placing infants in _________ position while awake has been effective in reducing reflux
prone
With intussusception, complications such as ________ and ____________ related to bowel necrosis can occur within ___________ of symptom onset.
shock, sepsis, 12-24 hours
type of surgery for pyloric stenosis
pyloromyotomy
It is difficult to state the true occurrence of ulcers in children because they often _______ before the diagnosis is confirmed.
heal
appears as notched vermilion border, variable sizes that might involve alveolar ridge, and possible dental abnormalities
cleft lip
Aspiration precautions before surgery to repair esophageal atresia (EA) and tracheoesophageal fistula (TEF) include elevating the head while lying ____ (using a(n) _______ board), a(n) _________________ placed in proximal pouch, and possible _________________ for prophylactic pneumonia
flat/supine, chalasia, suction catheter, IV antibiotics
new gastrostomy tubes should be cleaned daily with _____________
soap and water
rebound tenderness at _____________________ is a clinical key for appendicitis
McBurney’s point
cardinal sign of Hirschsprung disease
delayed or absence of meconium
When the gastrostomy tube is well healed, it can be ____________ as directed
secured
diagnosis of esophageal atresia (EA) and tracheoesophageal fistula (TEF) is confirmed when radiologist instills <__ mL of a medium into an NG tube and documents movement
1
children with this condition are at an increased risk of intussusception
cystic fibrosis
obstruction or absence of extrahepatic bile ducts
biliary atresia
In Chron’s disease, _______________ is a problem, and it is best to intervene before structural damage occurs.
malnutrition
Diet (is, is not) a contributing factor to ulcers.
is not
high defects may require a colostomy and bowel pull-through procedure
imperforate anus
two manifestations of celiac crisis
profuse watery diarrhea, vomiting
In treating celiac disease, relief of symptoms usually occurs within _________ of removing gluten.
1 week
During acute flareups of inflammatory bowel disease, _____ may be necessary for nutrition.
TPN
viscera are outside abdominal cavity and are not covered with the sac
gastroschisis
Manifestations include diarrhea, vomiting, abdominal pain, fever
infectious gastroenteritis
large herniation of intestines into umbilical cord
omphalocele
While site is healing, make sure new gastrostomy tube is ___________
stabilized
most common congenital facial deformity
cleft lip/palate
For esophageal atresia (EA) and tracheoesophageal fistula (TEF), G-tube care includes _____ and ______ care and using a _____________ to help infant practice suckling motion
skin, site, pacifier
____________ may be used to thicken feeds to help treat gastroesophageal reflux disease (GERD) before giving ______________
rice cereal, medications
Children with cleft lip/palate may have long term problems with __________, recurrent ___________, _________ dysfunction, _________ issues, and high risk for developing ________________
dentition, otitis media, speech, emotional, hearing loss
________________ or _______________ can be prescribed for more severe forms of irritable bowel syndrome (IBS)
antispasmodics, antidepressants
most common cause of short bowel syndrome in infants
necrotizing enterocolitis (NEC)
_____________ testing may be necessary to determine the specific type of hepatitis
viral antigen
for treating gastroesophageal reflux disease (GERD) in an infant, __________ can be changed and commonly known triggers such as ______ and ________ can be removed from mother’s diet (breastfeeding)
formula, eggs, cows’ milk
viscera are outside the abdominal cavity but inside translucent sac, covered with peritoneum and amniotic membrane
omphalocele
Keep new gastrostomy tube (open, closed) during initial postoperative period
open
Use skin __________ around stoma to prevent skin breakdown (gastrostomy tube)
barriers
Manifestations include burning, cramping when stomach is empty, awakening during the night with abdominal pain, and vomiting in children under 6 years
ulcers
three types of medications used to treat inflammatory bowel disease
antiinflammatory
antibiotics
immunosuppressive
infants have a shorter _________________ and have more reflux episodes than older children
lower esophageal sphincter (LES)
if repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) cannot be completed in a primary surgery, a _______________ is placed to provide nutrition
gastrostomy tube (G-tube)
Infants with pyloric stenosis present with _______________________ beginning at __________ of age
projectile vomiting, 3 weeks
most common site of intussusception
along terminal ileum
most influential factor of formation of cleft lip/palate
maternal smoking
diagnosis for Hirschsprung disease is confirmed by performing ___________ and scanning for __________ cells
biopsy, ganglion
Recurrent or chronic constipation can result in ______________ and ______________. This creates _____________ and pain when passing bowels and results in a cycle of ________________.
fecal impaction, enlarged rectum, fissures, retaining stools
severe GERD can cause ___________, frequent back ___________, _____________, and failure to _________.
irritability, arching, esophagitis, thrive
When diagnosing ulcers, _____________ are used to rule out gallstones, tumors, and obstructions
ultrasounds
Treatment for uncomplicated viral hepatitis is _______________ with a diet low in _____ to support liver function.
symptomatic, fat
Type of medication that should be avoided in children (when treating for infectious gastroenteritis)
antidiarrheals
___________________________ can be used to decrease moisture after cleaning gastrostomy tube in a tub bath
Stomahesive Protective Powder
includes nasal distortion, is midline or bilateral with variable extension, exposed nasal cavities
cleft palate
____________ are used for surgical and procedure prep when caring for inflammatory bowel disease
Enemas
cleft lip is repaired by ___________ of age
3-6 months
congenital diaphragmatic hernia (CDH) usually occurs around ____________ gestation and results in abdominal organs pushing through ___________ and into ___________ cavity
6-10 weeks, diaphragm, thoracic
presence of ____________ during pregnancy is significant clue to esophageal atresia (EA) and tracheoesophageal fistula (TEF) malformation
polyhydramnios
Two most frequent modes of transmission of infectious gastroenteritis
consuming contaminated food or water
person-to-person contact
three Cs of tracheoesophageal fistula (TEF)
coughing, choking with feedings, cyanosis
more prevalent in infants born to young mothers
gastroschisis
Manifestations may include a moveable, olive size mass in upper right quadrant and deep peristaltic wave from left to right prior to vomiting
pyloric stenosis
most common cause of viral gastroenteritis
rotavirus
use ________________ to clean new gastrostomy tubes if crusty drainage appears
half-strength hydrogen peroxide
four complications of biliary atresia
portal hypertension, skin infections, cirrhosis, GI bleeds
Hepatitis A is spread through ___________ route and can be prevented with
fecal-oral; hand hygiene, PPE, gloves, identification of infected food handlers
two respiratory conditions associated with gastroesophageal reflux disease (GERD)
respiratory illness, asthma
During the first month of life, the infant with Hirschsprung disease may have hard _________-like stools or more commonly, foul-smelling _________-like stools
pebble, ribbon
If the gastrostomy tube becomes clogged, contact your _________________ for recommendations such as _____________ and _____________ to break them up
enterostomal therapist, pancreatic enzymes, bicarbonate
Synthetic material called __________ is used to cover intestines exposed in gastroschisis or ruptured omphalocele
Silastic
malformation in which a fistula is formed between the esophagus and trachea
tracheoesophageal fistula (TEF)
surgery for congenital diaphragmatic hernia (CDH) is ideally performed _________ but if not, should be performed within ______________
in utero, first 18 hours after birth
prior to surgery, infants with pyloric stenosis should be treated for these three things
dehydration, malnutrition, metabolic alkalosis
In caring for gastroschisis, ____ and ____ tubes are placed immediately. _____ is provided for nutrition.
IV, NG, TPN
abnormality that occurs when part of an organ or tissue protrudes through structures that normally contain it
hernia
Assess gastrostomy tube site every day and report any _____________, __________ of formula, _________, or _______ to your physician
drainage, leakage, redness, pain
manifestations include emesis after a meal, hiccupping, recurrent otitis media
gastroesophageal reflux disease (GERD)
the two-step correction of Hirschsprung disease is reserved for ____________ under _____ kg
infants, 8-10
if not reduced, most umbilical hernias disappear spontaneously by _______
1 year
Postoperatively, the child with intussusception should be kept _____ until normal bowel function returns without evidence of reoccurrence.
NPO
two diagnostic lab tests for biliary atresia
liver function
clotting (PT, PTT, INR)
disimpaction is done by administering a ___________ enema or by giving a ____________ or ____________ as the initial step to treat constipation
fleets, stool softener, laxative
