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Pediatric Nursing Care > Chapter 43: The Child with a Gastrointestinal Alteration > Flashcards

Chapter 43: The Child with a Gastrointestinal Alteration Flashcards

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1
Q

Endoscopies are performed under _____________ sedation.

A

conscious

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2
Q

The ________ is responsible for sodium and water retention; removal can result in _________________.

A

ileum, fluid and electrolyte imbalance

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3
Q

Nutritional support for biliary atresia includes ___________ vitamins and restricted __________ intake

A

fat-soluble, protein

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4
Q

During the (single, two) step correction of Hirschsprung disease, the diseased portion is removed, and a temporary colostomy is formed.

A

two

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5
Q

In treating ulcers, ________________ are found to be as effective as medications

A

dietary changes

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6
Q

acceptable substitutes for gluten in diet

A

corn, rice

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7
Q

constipation is defined as a delay of passing stools for _______________

A

2 or more weeks

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8
Q

Children with chronic GERD may be at increased risk of upper ___________. ________________ is used to evacuate these, and radiologic procedures may be used to ____________ vessels.

A

GI bleeds, Stomach lavaging, coagulate

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9
Q

Ulcerative colitis affects the _____________, while Chron’s disease can affect _____________________ and involves _________ of the mucosa.

A

colon only, anywhere in the GI tract, all layers

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10
Q

avoidance of ____________ and ________________ can help reduce symptoms of irritable bowel syndrome (IBS)

A

caffeine, carbonated drinks

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11
Q

Medication management for ulcers is usually a combination of these four medications

A

antibiotics, proton pump inhibitors, H2 receptor blockers, mucosa protectants

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12
Q

most common surgical procedure for children

A

to treat appendicitis (appendectomy)

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13
Q

first line of treatment for gastroesophageal reflux disease (GERD) in infants

A

small, more frequent feedings with frequent burping

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14
Q

incomplete development or absence of anus in its normal position in perineum

A

imperforate anus

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15
Q

In treating ulcers, surgery is reserved for these three complications

A

hemorrhage, obstruction, perforation

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16
Q

Preoperative nursing management for Hirschsprung disease includes _________________ enemas until the return is clear, keeping child _____, maintaining the ____, and administering rectal and IV ____________.

A

isotonic saline, NPO, IV, antibiotics

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17
Q

area within GI tract that has lost part of the mucosa due to exposure to acids

A

ulcer

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18
Q

During the (single, two) step correction of Hirschsprung disease, the diseased portion is removed and the healthy bowel is reconnected to the rectum.

A

single

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19
Q

incidence of pyloric stenosis is most common in this ethnic group

A

white male (especially first born)

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20
Q

manifestations include diarrhea, constipation, combination, diffuse abdominal pain unrelated to meals, undigested food/mucus in stools

A

irritable bowel syndrome (IBS)

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21
Q

Diagnosis of lactose intolerance is presumed when ________________ resolves symptoms.

A

lactose removal

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22
Q

final, definitive diagnostic test for biliary atresia

A

liver biopsy

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23
Q

__________ 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)

A

Elbow

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24
Q

lack of enzyme lactase

A

lactose intolerance

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25
Q

embryonal weakness in abdominal wall causes herniation of intestines on one side of umbilical cord during early development, most commonly on right side

A

gastroschisis

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26
Q

congenital, inherited disease that results in inability to digest gluten

A

celiac disease

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27
Q

manifestations include failure to pass a suction catheter 10-11 cm beyond gum line, excessive oral secretions, vomiting, abdominal distention

A

esophageal atresia (EA) and tracheoesophageal fistula (TEF)

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28
Q

treatment is symptomatic and aimed at education and identification of triggers

A

irritable bowel syndrome (IBS)

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29
Q

ultimate treatment required for biliary atresia

A

liver transplant

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30
Q

four medications used to treat gastroesophageal reflux disease (GERD)

A

antacids
proton pump inhibitors
H2 receptor blockers
prokinetic agents

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31
Q

malformation in which the esophagus does not reach the stomach

A

esophageal atresia (EA)

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32
Q

medical emergency in which a section of intestines telescopes inside of itself

A

intussusception

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33
Q

manifestations include failure to pass meconium stool, absence of anorectal canal, presence of anal membrane, external fistula to perineum

A

imperforate anus

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34
Q

Manifestations may include bowel obstruction, chronic constipation, abdominal pain, distention, vomiting, failure to thrive

A

Hirschsprung disease

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35
Q

a child has involuntary defecation over 4 years of age and has a normal anatomy

A

encopresis

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36
Q

at risk for esophageal motility dysfunction, GERD, strictures, bronchitis, pneumonia with aging and growth

A

esophageal atresia (EA) and tracheoesophageal fistula (TEF)

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37
Q

_______________ lactose intolerance occurs in early to late childhood

A

Developmental

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38
Q

viscera are inside the abdominal cavity and under the skin

A

umbilical hernia

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39
Q

type of surgery that can be done to treat gastroesophageal reflux disease (GERD)

A

fundoplication surgery

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40
Q

Nursing care for biliary atresia is balanced in six areas

A

nutrition, skin, developmental, education, assessment, emotional support

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41
Q

umbilical hernia is usually _____ cm and easily reduced

A

1-5

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42
Q

_____________ anastomosis is used to repair esophageal atresia

A

end to side

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43
Q

In treating child with an ulcer, parents should call the physician immediately with these five manifestations

A

“coffee ground” emesis, tarry stools, increased pain, diarrhea, unexplained weight loss

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44
Q

An exploratory laparotomy for biliary atresia attempts to identify the ________ and to _________ it. If not identified, a ________ procedure is performed.

A

lesion, drain, Kasai

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45
Q

Manifestations include diarrhea, abdominal distention, vomiting, anorexia, irritability, muscle wasting, growth failure

A

celiac disease

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46
Q

Supportive care for child with bleeding ulcer includes these four things

A

IV fluids, blood, oxygen, vasoactive drugs

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47
Q

_______________ oil has been found to be beneficial at relieving symptoms of irritable bowel syndrome (IBS)

A

Peppermint

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48
Q

In treating ulcers, _______________ intake should be reduced because it increases the amount of acid produced in the GI tract

A

caffeine

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49
Q

________________ changes are the most useful when treating ulcerative colitis

A

Dietary

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50
Q

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.

A

clinitest stool, lactose tolerance

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51
Q

parents may notice that milk comes out of the nose when feeding with this deformity

A

cleft palate

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52
Q

While feeding an infant with cleft lip/palate, keep in __________ position to decrease chance of choking, and ________ frequently

A

upright, burp

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53
Q

________________ are done to check for GI bleeding

A

Fecal occult blood tests

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54
Q

regurgitation of gastric contacts back into esophagus

A

gastroesophageal reflux disease (GERD)

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55
Q

______________ lactose intolerance involves complete absence in lactase at birth.

A

Congenital

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56
Q

Children with Hirschsprung disease should not have a ____________ temperature.

A

rectal

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57
Q

most common in low-birth-weight and black infants

A

umbilical hernia

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58
Q

__________________ are used to visualize the upper GI tract and take biopsies of the mucosa to diagnose ulcers

A

Endoscopies

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59
Q

congenital condition in which ganglion cells do not form in colon or rectum, creating lower bowel obstructions due to dilation with feces and gas

A

Hirschsprung disease

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60
Q

________________ may be possible for infant with small cleft lip

A

Breastfeeding

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61
Q

occurs as a result of congenital malformation or surgical resection of GI tract

A

short bowel syndrome

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62
Q

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.

A

AST, ALT, bilirubin, alkaline phosphatase, sedimentation rate

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63
Q

tub baths can be used to clean gastrostomy tube after ________

A

1-2 weeks

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64
Q

Postoperative patients with Hirschsprung disease are kept NPO until ____________ is released or ________________ return, which is when the child is started on a __________________ diet.

A

flatulence, bowel sounds, clear liquid

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65
Q

cleft palate is repaired by __________ of age with recommended repair by __________

A

6-24 months, 1 year

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66
Q

____________ is common with biliary atresia due to deposits of bilirubin under skin

A

Pruritus

67
Q

gently rotate or turn new gastrostomy tube in each direction ______

A

daily

68
Q

first choice in treatment of intussusception is a ______________, which uses a(n) ___________ or ________ enema and is visualized under ____________.

A

hydrostatic reduction, isotonic, air, fluoroscope

69
Q

three medications prescribed to maintain regular stools after constipation

A

mineral oil, lactulose, polyethylene glycol

70
Q

Treatment for infectious gastroenteritis is __________________ and prioritizes ____________________ replacement.

A

symptomatic, fluid volume

71
Q

in caring for imperforate anus, report any ___________ or presence of stool in _______ or ________

A

skin dimples, urine, vagina

72
Q

Use _____________ technique when dealing with gastroschisis or omphalocele defect

A

sterile

73
Q

condition is diagnosed during newborn examination with radiography, ultrasound, or CT scan used to determine level of lesion and associated anomalies

A

imperforate anus

74
Q

occurs with a higher incidence in children with Down syndrome

A

Hirschsprung disease

75
Q

Manifestations include frothy (not fatty) diarrhea, abdominal distention, increased flatulence, cramping, abdominal pain

A

lactose intolerance

76
Q

A ___________ screen should be conducted to rule out inborn errors in patients with manifestations of biliary atresia.

A

metabolic

77
Q

diagnosis of celiac disease is confirmed with anti-_____ and ___________ diet.

A

tTga, gluten-free

78
Q

Hepatitis B and C spread is prevented with

A

standard precautions (PPE, gloves, mask, eye/face shield; safe injections)

79
Q

most common cause of end-stage liver disease and top indicator of liver transplant in children

A

biliary atresia

80
Q

imperforate anus is treated with repeated dilations in __________________ or _________ in all other defects

A

anal stenosis, surgery

81
Q

short bowel syndrome results in impaired ________________ through GI tract due to reduced amount of surface area

A

nutrient absorption

82
Q

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

A

longer nipple, gag reflex, decrease

83
Q

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.

A

intermittent, constant, red currant jelly, sausage

84
Q

result of hypertrophy of the muscle surrounding the pyloric sphincter, resulting in obstruction of gastric emptying

A

pyloric stenosis

85
Q

manifestations include jaundice, acholic stools (absence in color), bile-stained urine, hepatomegaly

A

biliary atresia

86
Q

imperfect closure of umbilical ring allows intestines to push outward at umbilicus during straining and crying

A

umbilical hernia

87
Q

placing infants in _________ position while awake has been effective in reducing reflux

A

prone

88
Q

With intussusception, complications such as ________ and ____________ related to bowel necrosis can occur within ___________ of symptom onset.

A

shock, sepsis, 12-24 hours

89
Q

type of surgery for pyloric stenosis

A

pyloromyotomy

90
Q

It is difficult to state the true occurrence of ulcers in children because they often _______ before the diagnosis is confirmed.

A

heal

91
Q

appears as notched vermilion border, variable sizes that might involve alveolar ridge, and possible dental abnormalities

A

cleft lip

92
Q

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

A

flat/supine, chalasia, suction catheter, IV antibiotics

93
Q

new gastrostomy tubes should be cleaned daily with _____________

A

soap and water

94
Q

rebound tenderness at _____________________ is a clinical key for appendicitis

A

McBurney’s point

95
Q

cardinal sign of Hirschsprung disease

A

delayed or absence of meconium

96
Q

When the gastrostomy tube is well healed, it can be ____________ as directed

A

secured

97
Q

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

A

1

98
Q

children with this condition are at an increased risk of intussusception

A

cystic fibrosis

99
Q

obstruction or absence of extrahepatic bile ducts

A

biliary atresia

100
Q

In Chron’s disease, _______________ is a problem, and it is best to intervene before structural damage occurs.

A

malnutrition

101
Q

Diet (is, is not) a contributing factor to ulcers.

A

is not

102
Q

high defects may require a colostomy and bowel pull-through procedure

A

imperforate anus

103
Q

two manifestations of celiac crisis

A

profuse watery diarrhea, vomiting

104
Q

In treating celiac disease, relief of symptoms usually occurs within _________ of removing gluten.

A

1 week

105
Q

During acute flareups of inflammatory bowel disease, _____ may be necessary for nutrition.

A

TPN

106
Q

viscera are outside abdominal cavity and are not covered with the sac

A

gastroschisis

107
Q

Manifestations include diarrhea, vomiting, abdominal pain, fever

A

infectious gastroenteritis

108
Q

large herniation of intestines into umbilical cord

A

omphalocele

109
Q

While site is healing, make sure new gastrostomy tube is ___________

A

stabilized

110
Q

most common congenital facial deformity

A

cleft lip/palate

111
Q

For esophageal atresia (EA) and tracheoesophageal fistula (TEF), G-tube care includes _____ and ______ care and using a _____________ to help infant practice suckling motion

A

skin, site, pacifier

112
Q

____________ may be used to thicken feeds to help treat gastroesophageal reflux disease (GERD) before giving ______________

A

rice cereal, medications

113
Q

Children with cleft lip/palate may have long term problems with __________, recurrent ___________, _________ dysfunction, _________ issues, and high risk for developing ________________

A

dentition, otitis media, speech, emotional, hearing loss

114
Q

________________ or _______________ can be prescribed for more severe forms of irritable bowel syndrome (IBS)

A

antispasmodics, antidepressants

115
Q

most common cause of short bowel syndrome in infants

A

necrotizing enterocolitis (NEC)

116
Q

_____________ testing may be necessary to determine the specific type of hepatitis

A

viral antigen

117
Q

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)

A

formula, eggs, cows’ milk

118
Q

viscera are outside the abdominal cavity but inside translucent sac, covered with peritoneum and amniotic membrane

A

omphalocele

119
Q

Keep new gastrostomy tube (open, closed) during initial postoperative period

A

open

120
Q

Use skin __________ around stoma to prevent skin breakdown (gastrostomy tube)

A

barriers

121
Q

Manifestations include burning, cramping when stomach is empty, awakening during the night with abdominal pain, and vomiting in children under 6 years

A

ulcers

122
Q

three types of medications used to treat inflammatory bowel disease

A

antiinflammatory
antibiotics
immunosuppressive

123
Q

infants have a shorter _________________ and have more reflux episodes than older children

A

lower esophageal sphincter (LES)

124
Q

if repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) cannot be completed in a primary surgery, a _______________ is placed to provide nutrition

A

gastrostomy tube (G-tube)

125
Q

Infants with pyloric stenosis present with _______________________ beginning at __________ of age

A

projectile vomiting, 3 weeks

126
Q

most common site of intussusception

A

along terminal ileum

127
Q

most influential factor of formation of cleft lip/palate

A

maternal smoking

128
Q

diagnosis for Hirschsprung disease is confirmed by performing ___________ and scanning for __________ cells

A

biopsy, ganglion

129
Q

Recurrent or chronic constipation can result in ______________ and ______________. This creates _____________ and pain when passing bowels and results in a cycle of ________________.

A

fecal impaction, enlarged rectum, fissures, retaining stools

130
Q

severe GERD can cause ___________, frequent back ___________, _____________, and failure to _________.

A

irritability, arching, esophagitis, thrive

131
Q

When diagnosing ulcers, _____________ are used to rule out gallstones, tumors, and obstructions

A

ultrasounds

132
Q

Treatment for uncomplicated viral hepatitis is _______________ with a diet low in _____ to support liver function.

A

symptomatic, fat

133
Q

Type of medication that should be avoided in children (when treating for infectious gastroenteritis)

A

antidiarrheals

134
Q

___________________________ can be used to decrease moisture after cleaning gastrostomy tube in a tub bath

A

Stomahesive Protective Powder

135
Q

includes nasal distortion, is midline or bilateral with variable extension, exposed nasal cavities

A

cleft palate

136
Q

____________ are used for surgical and procedure prep when caring for inflammatory bowel disease

A

Enemas

137
Q

cleft lip is repaired by ___________ of age

A

3-6 months

138
Q

congenital diaphragmatic hernia (CDH) usually occurs around ____________ gestation and results in abdominal organs pushing through ___________ and into ___________ cavity

A

6-10 weeks, diaphragm, thoracic

139
Q

presence of ____________ during pregnancy is significant clue to esophageal atresia (EA) and tracheoesophageal fistula (TEF) malformation

A

polyhydramnios

140
Q

Two most frequent modes of transmission of infectious gastroenteritis

A

consuming contaminated food or water
person-to-person contact

141
Q

three Cs of tracheoesophageal fistula (TEF)

A

coughing, choking with feedings, cyanosis

142
Q

more prevalent in infants born to young mothers

A

gastroschisis

143
Q

Manifestations may include a moveable, olive size mass in upper right quadrant and deep peristaltic wave from left to right prior to vomiting

A

pyloric stenosis

144
Q

most common cause of viral gastroenteritis

A

rotavirus

145
Q

use ________________ to clean new gastrostomy tubes if crusty drainage appears

A

half-strength hydrogen peroxide

146
Q

four complications of biliary atresia

A

portal hypertension, skin infections, cirrhosis, GI bleeds

147
Q

Hepatitis A is spread through ___________ route and can be prevented with

A

fecal-oral; hand hygiene, PPE, gloves, identification of infected food handlers

148
Q

two respiratory conditions associated with gastroesophageal reflux disease (GERD)

A

respiratory illness, asthma

149
Q

During the first month of life, the infant with Hirschsprung disease may have hard _________-like stools or more commonly, foul-smelling _________-like stools

A

pebble, ribbon

150
Q

If the gastrostomy tube becomes clogged, contact your _________________ for recommendations such as _____________ and _____________ to break them up

A

enterostomal therapist, pancreatic enzymes, bicarbonate

151
Q

Synthetic material called __________ is used to cover intestines exposed in gastroschisis or ruptured omphalocele

A

Silastic

152
Q

malformation in which a fistula is formed between the esophagus and trachea

A

tracheoesophageal fistula (TEF)

153
Q

surgery for congenital diaphragmatic hernia (CDH) is ideally performed _________ but if not, should be performed within ______________

A

in utero, first 18 hours after birth

154
Q

prior to surgery, infants with pyloric stenosis should be treated for these three things

A

dehydration, malnutrition, metabolic alkalosis

155
Q

In caring for gastroschisis, ____ and ____ tubes are placed immediately. _____ is provided for nutrition.

A

IV, NG, TPN

156
Q

abnormality that occurs when part of an organ or tissue protrudes through structures that normally contain it

A

hernia

157
Q

Assess gastrostomy tube site every day and report any _____________, __________ of formula, _________, or _______ to your physician

A

drainage, leakage, redness, pain

158
Q

manifestations include emesis after a meal, hiccupping, recurrent otitis media

A

gastroesophageal reflux disease (GERD)

159
Q

the two-step correction of Hirschsprung disease is reserved for ____________ under _____ kg

A

infants, 8-10

160
Q

if not reduced, most umbilical hernias disappear spontaneously by _______

A

1 year

161
Q

Postoperatively, the child with intussusception should be kept _____ until normal bowel function returns without evidence of reoccurrence.

A

NPO

162
Q

two diagnostic lab tests for biliary atresia

A

liver function
clotting (PT, PTT, INR)

163
Q

disimpaction is done by administering a ___________ enema or by giving a ____________ or ____________ as the initial step to treat constipation

A

fleets, stool softener, laxative

Pediatric Nursing Care (17 decks)

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