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OB/Peds > Exam 3 Peds GI > Flashcards

Exam 3 Peds GI Flashcards

1
Q

When is an infant’s GI tract mature?

A

Age 2

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2
Q

Why is the mouth an optimal point of infection entrance?

A

?

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3
Q

What prevents regurgitation of stomach contents into the esophagus?

A

Lower esophageal sphincter (LES)

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4
Q

When is the LES developed?

A

1 month

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5
Q

What is the stomach capacity for newborns?

A

10-20 mL

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6
Q

What is the stomach capacity for infants?

A

200 mL

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7
Q

What is the stomach capacity for a 16 year old?

A

1,500 mL

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8
Q

When do pancreatic enzymes reach adult levels?

A

2 years

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9
Q

Liver at birth

A

Large, easily palpated

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10
Q

If infants have small bowel loss what happens?

A

Chronic problems with absorption and diarrhea

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11
Q

Small intestines at birth

A

Not fully functionally mature, rapid growth spurts

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12
Q

Physical exam order

A

Inspect and observe
Auscultation
Percussion
Palpation

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13
Q

2 categories of food sensitivity

A

Allergy/hypersensitivity

Intolerance

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14
Q

Systemic effects of food sensitivity

A

Anaphylactic, growth failure

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15
Q

GI effects of food sensitivity

A

Abdominal pain, vomiting, cramping, diarrhea

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16
Q

Respiratory effects of food sensitivity

A

Cough, wheezing, rhinitis, infiltrates

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17
Q

Cutaneous effects of food sensitivity

A

Urticaria, rash, atopic dermatitis

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18
Q

What can help prevent food sensitivity?

A 
Breastfeeding
No solids for first 6 mo
No whole milk until 12 mo
No eggs until 24 mo
No peanuts, nuts, fish, seafood for 36 mo
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19
Q

How do you identify possible reactions to food?

A

Add one new food at 5 day intervals

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20
Q

Cow’s Milk Allergy

A

Adverse systemic and local GI reaction to cow’s milk protein

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21
Q

When can cow’s milk allergy be seen?

A

Within the first 4 months of life

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22
Q

What are GI symptoms of cow’s milk allergy?

A

Diarrhea, committing, colic, abd pain

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23
Q

What are respiratory symptoms of cow’s milk allergy?

A

Rhinitis, wheezing, sneezing, eczema, excessive crying, pallor

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24
Q

How do you diagnose cow’s milk allergy?

A

Occult blood
Serum IgE levels
Allergy testing
Milk restriction followed by challenge test

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25
Q

Treatment of cow’s milk allergy

A

Elimination of cow’s milk based formula

Continue until one year old, then small amounts are reintroduced

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26
Q

Nursing care management for cow’s milk allergy

A

Prevent and reduce exposure of infants to cow’s milk protein (through exclusive breastfeeding for the first 4-6 months)
Help parents identify signs and symptoms
Teach parents when introduce solid foods to be aware of those that contain milk
Educate on re-introduction of milk products after one year

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27
Q

Happens much more quickly in infants and children than adults due to differences in A&P

A

Dehydration

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28
Q

Why must dehydration be recognized quickly?

A

To prevent hypovolemic shock

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29
Q

Occurs whenever the total output of fluid exceeds the total intake

A

Dehydration

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30
Q

Causes of dehydration

A 
Vomiting/Diarrhea
Decreased oral intake
High fever
DKA
Burns, insensible losses
Increased renal excretion
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31
Q

Fluid balance and losses compared with older children and adults

A

Infants have a greater need for water and have more alterations in fluid and electrolyte balance

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32
Q

Expanded extracellular compartment lasts how long?

A

Age 2

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33
Q

Expanded extracellular compartment

A

Constitutes more than half of their total body water, causes greater and more rapid water loss

34
Q

Fluid losses are divided into what 3 types?

A
  1. Insensible
  2. Urinary
  3. Fecal
35
Q

Insensible fluid losses

A

Fever increases fluid loss
Increased Body Surface Area (BSA) in infants and children increase fluid loss
Basal metabolic rate is higher than adults
Kidneys are immature and cannot concentrate urine

36
Q

Nursing assessment for fluid loss

A

Mental status
Fontanel
Eyes
Oral mucosa
Skin turgor
Heart rate
Blood pressure
Extremities – capillary refill
Urine output – specific gravity
Table 41-1 – mild vs. moderate vs. severe
*Must accurately measure intake and output
Intake – anything that goes in the mouth/IV/tube feedings
Output – anything that comes out – urine, stool, emesis, sweat, drainage

37
Q

Nursing care management for insensible fluid loss

A

Must restore fluid volume
Replace ongoing losses 1:1
Offer at frequent intervals and small amount
Do NOT manage by encouraging intake of clear liquids other than ORS or BRATT diet
IV fluids – used for severe dehydration or shock
Observe for s/s of dehydration
Need at least 1 cc/kg/hr of urine output
Probiotics may decrease the extent of diarrhea
Lactobacillus (Culturelle)

38
Q

Constipation

A

Alteration in the frequency, consistency, or ease of passing stool
Passing hard, dry stools, often painful
Liquid stools around hard stools

Bowel habits vary between children
Meconium stools

Assessment signs and symptoms
What are normal bowel habits??
Abdominal distention
Inspect for any anal fissures
Bowel sounds

KUB and stool studies

39
Q

Nursing care management for constipation

A

Change dietary habits
Increase high-fiber foods and fluids
Eliminate constipating foods

Behavior modification
Positive reinforcement
Scheduled times to sit on toilet

40
Q

Hirschprung’s Dz

A

Absence of ganglion cells in the bowel
Also called congenital aganglionic megacolon
Causes inadequate peristalsis in part of the intestine

Males affected 4x more than females

Associated with Down syndrome

41
Q

Therapeutic management for Hirschsprung’s Dz

A

Surgical resection of aganglionic bowel to relieve obstruction and restore normal bowel motility
1st surgery to create ostomy
2nd surgery to “pull-through” the healed intestines to rectum and close ostomy

42
Q

Nursing care management for Hirschsprung’s Dz

A

Provide Postoperative Care
Observe for complications of enterocolitis

Provide Ostomy Care
Ensure proper function of stoma
Daily ostomy care
Skin care
Diet: avoid foods that produce excess gas and constipation

Patient and Family education
Explain surgical procedure
Educate on stoma care
Medications

43
Q

GERD

A

Passage of gastric contents into the esophagus
Occurs during episodes of transient relaxation of LES
Common during first year of life

44
Q

Nursing assessment for GERD

A

Assess for signs and symptoms and risk factors
Ask parents what they observed

Physical exam
May appear malnourished
Assess for aspiration and breathing patterns

Diagnosis
Upper GI/EGD
pH probe – gold standard
Hemoccult stool

45
Q

Therapeutic management for GERD

A 
Modify feeding habits
Appropriate positioning 
Elevate HOB during feeding and for 30 min - 1 hour after
Smaller more frequent feeds
Thicken feeds with rice cereal
Avoid foods known to cause reflux
Medications
Histamine-2 blockers (Zantac, Pepcid)
Proton Pump Inhibitors (Nexium)
Prokinetics (Reglan)

Surgical intervention
Nissen fundoplication

46
Q

Nursing care management for GERD

A

Promote safe feeding techniques
Monitor vomiting
Weight daily

Maintain patent airway
Risk for aspiration and ALTE

Post-operative care

Parent education
Feeding 
Positioning
Medications
NG care/Apnea monitor
47
Q

Hypertrophic Pyloric Stenosis

A

The circular muscle of the pylorus becomes hypertrophied creating a gastric outlet obstruction
Compensatory dilation, hypertrophy, and hyperperistalsis of stomach

Infant usually presents at 2-5 weeks old with a history of projectile nonbilious vomiting

Other symptoms include:
Hard, moveable “olive” mass is the RUQ, no pain
Hunger soon after vomiting
Wt loss, dehydration, and electrolyte disturbancesCircular muscle thickens  severe narrowing of the pyloric canal (olive shaped mass) 
obstruction  vomiting  dehydrated, lethargic, malnourished

48
Q

Nursing care management for Hypertrophic Pyloric Stenosis

A

Requires surgical intervention (pyloromyotomy)
Preop care:
Assess laboratory values/physical exam for dehydration
Restore hydration and electrolyte balance
Monitor VS - dehydration
Strict intake and output - NPOPostop care:
May have vomiting, pain
feedings begun 4-6 hours post op (clears then formula)
Monitor tolerance of feedings
Incision site care
Strict intake and output
Provide emotional support for anxious family

49
Q

Intussusception

A

Occurs when a proximal segment of bowel “telescopes” into a more distal segment
Pulls the mesentery with it
Most common at ileocecal valve

Can result in lymphatic and venous congestion and bowel wall edema
Leads to obstruction, infarction, and perforation

Venous engorgement leads to leaking of blood and mucous into intestinal lumen
Forms the classic “currant jelly” stools

50
Q

Nursing assessment for intussusception

A 
Look for common signs and symptoms
Sudden onset of intermittent abd pain
Child screaming and drawing knees to abdomen but comfortable in between episodes
Distended, tender abdomen
Vomiting/Diarrhea
Currant-jelly stools or bloody

Palpate the abdomen for sausage-shaped mass in the upper-mid abdomen

Ultrasound, Pneumo/Saline/Barium enema

Surgical reduction

51
Q

Nursing care management for intussusception

A

IV fluids/NPO
Monitor for adequate hydration and nutrition
May need abx and NG tube before intervention

Monitor for return of normal bowel function after enema or surgery
Passage of a normal brown stool usually indicates that the intussusception has reduced itself
Can d/c home once tolerating feedings
Reoccurs in 1 out of 10 patients

52
Q

Cleft lip and cleft palate

A

Facial malformations that occur during embryonic development
Frequently occurs with other anomalies

Can occur individually or together and can be unilateral or bilaterally

Causes include
Maternal smoking and alcohol consumption
Prenatal infection
Medications used during pregnancy- anticonvulsants
Advanced maternal age

Involves the care of a multidisciplinary team

53
Q

Cleft lip

A

Can involve only the lip or extend into the nostril

Can be diagnosed by prenatal ultrasound or at birth by classic appearance
Significant emotional reaction in parents

Repaired surgically at 2-3 months old
Z-plasty or Millard technique

54
Q

Cleft palate

A

Can involve both the hard and soft palate

Not as obvious as cleft lip
Can be seen when mouth examined

Management directed at:
closure of cleft
prevention of complications
normal growth and development

Repaired surgically at 6- 12 months

55
Q

Nursing care management for cleft lip/palate

A

Immediate problems related to feeding and parent reaction

Encourage infant-parent bonding, provide emotional support

Feeding can be difficult, must educate parents
Infants have a reduced ability to suck
Must feed in upright position
Need to start feeding as soon as possible after birth
Special cleft lip/palate nipple used
Burp frequently
Breastfeeding usually most effective
Risk for aspiration
Risk for failure to grow
56
Q

Preop care for cleft lip/palate

A

Preoperative
Educate parents on what to expect
Place elbow restraints on infant

57
Q

Cleft palate postop care

A

Allowed to lie on abdomen after surgery

May resume feeds after surgery
Usually through syringe or soft sipee cup
Sent home on soft diet

Avoid the use of tongue depressors, thermometers, pacifiers, spoons, or straws

Packing in place – will remove after 2 to 3 days

Watch for respiratory complications, risk for aspiration
Suction with extreme caution!

Elbow restraints in place to prevent injury to mouth and continued for 7-10 days

Pain medication as needed – want to avoid crying

58
Q

Complications/Prognosis of cleft lip and palate

A

Feeding difficulties
Upper respiratory infections
Altered dentition
Delayed speech development, will need speech therapy
Chronic otitis media, possible hearing loss
Long-term social adjustment

59
Q

Ingestion of injurious agents

A 
Very common in pediatrics
Cosmetics and personal care products
Cleaning products
Plants
Foreign bodies, toys
Medications

Often occur in the home or relatives house

Infants and toddlers explore their environment through oral experimentation
Very curious
Imitation

60
Q

Emergency tx for ingestion of injurious agents

A

Call Poison Control Center
Will develop a plan of care

Treat the child first, not the poison
Immediate concern is life support
Vital signs, respiratory, circulation

Gastric Decontamination

Specific antidotes for certain poisons

Would like to originally prevent
Parents need education on how to prevent recurrence

61
Q

Heavy metal poisoning

A

Ingestion of a variety of substances
Lead
Iron
Mercury

Treatment involves chelation therapy

62
Q

Tracheoesophageal Fistula (TEF)

A

Failure of the trachea and the esophagus to separate
Proximal- ends in a blind pouch
Distal- connected to the trachea or bronchus
Commonly associated with VATER or VACTERL

63
Q

Biliary Atresia

A

Inflammatory Process that causes intrahepatic and extrahepatic bile duct fibrosis with eventual obstruction

64
Q

Biliary Atresia tx

A

Hepatic portoenterostomy
Intestine anastomosed to help bile drainage
Liver transplant later
Nutrition support

65
Q

Omphalocele

A

Protrusion of intra-abdominal viscera- out pouching from umbilical cord- contents covered in peritoneum without skin
Surgical Repair

66
Q

Nursing care for omphalocele

A 
Protect sac from drying or trauma
Keep soaked with saline soaked dressings
Maintain temperature
Prophylactic antibiotics
After surgery- bowel decompression, pain management
67
Q

Gatroschisis

A

Protrusion of intra-abdominal contents- no peritoneal sac covering the exposed bowel
Surgical repair
Sometimes requires gradual reduction of contents into the abdomen

68
Q

Nursing care for Gatroschisis

A

Same as Omphalocele EXCEPT:
NG decompression
Observe exposed bowel for necrosis or color change
Post op-
Monitor lower extremities- pulses and perfusion
Siloh Pouch

69
Q

Total Parenteral Nutrition

A 
Why do we need TPN?
Side effects/Adverse events
Know the patho behind patient’s illness to know what is in the TPN
Evaluate patients response
Weight gain
Bloating
Electrolyte imbalance
Central access unless less than 12.5% dextrose
Sometimes they will add meds
Liver testing
Other metabolic labs
70
Q

What is the treatment of choice for mild dehydration?

A

Oral rehydration treatment

71
Q

After initial rehydration what may be used as maintenance fluid therapy?

A

ORS and alternate with formula/breastmilk or regular diet

72
Q

Meds for fluid loss

A

If bacteria or parasitic causes may need antibiotics or antiparasitics
Metronidazole, Vancomycin
*Antidiarrheals not recommended
Educate parents- Rotavirus oral vaccine (3 doses at 2, 4, and 6 months)

73
Q

Meds for constipation

A

Medications and enemas
Stool Softeners (colace)
Laxatives (Miralax, Milk of Magnesia, Lactulose)
Pediatric Fleets Enema, Milk and Molasses enema

74
Q

Health history for Hirschsprung’s Dz

A

Newborn stool patterns

75
Q

Physical exam for Hirschsprung’s Dz

A

Inspect and palpate abdomen for distention

76
Q

Lab and diagnostic tests for Hirschsprung’s Dz

A

Barium enema
Rectal biopsy to evaluate for absence of ganglion cells Absence of ganglion cells causes contraction which leads to obstruction
Stool collects = distention, leading to ischemia and enterocolitis

77
Q

GERD clinical manifestations in infants

A

Spitting up, forceful vomiting
Excessive crying, arching of back
Wt loss, growth failure
Respiratory problems, ALTE

78
Q

GERD clinical manifestations in children

A

Heartburn, abdominal pain, non cardiac chest pain

Chronic cough, dysphagia, recurrent PNA

79
Q

Postoperative CL Repair

A

Must protect the operative site!!
Place elbow restraints
Prevent infant from rolling onto abdomen
Will be supine immediately after surgery then can go into infant seat
Adequate pain relief – want to avoid crying
Clear liquids once recovered from anesthesia

80
Q

Clinical manifestations of TEF

A 
Excessive salivation
Coughing 
Choking
Cyanosis
Apnea/ respiratory distress
Abdominal distention Immediately NPO
Prone position to aid in the drainage of secretions
Low intermittent suction in the blind pouch via a catheter
One surgery or several staged surgeries
81
Q

Clinical manifestations of Biliary Atresia

A 
Jaundice
Dark urine
Light color (tan) stool
Hepatomegaly
Poor weight gain
Growth retardation
Pruritus
Irritability

OB/Peds (11 decks)

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