[Exam 4] Chapter 42 – Alteration in Bowel Elimination/Gastrointestinal Disorder Flashcards
Stomach: Capacity in newborn vs adult?
10-20 in newborn
2000-3000 in adult
Insensible Fluid Losses: Fever increases fluid loss to a rate of what?
7 mL / kg / 24 - hour period.
Common Medical Txs: Protuberant (bulging outward) abdomen suggests what?
Presence of ascites, fluid retention, gaseous distention, or even a tumor
Common Medical Txs: Right upper quadrant tenderness could indicate what
liver enlargement.
Common Medical Txs: Right lower quadrant pain can be a warning sign of what?
appendicitis
Cleft Lip and Palate: Most common anomalies associated with this?
heart defects, ear malformations, skeletal deformities, and GU abnormality
Cleft Lip and Palate: Complications of this?
Feeding difficulties, altered detention, delayed speech and otitis media.
Cleft Lip and Palate: What may occur in babies with cleft palate when feeding?
Gagging, choking, and nasal regurgitation.
Cleft Lip and Palate: Opening in cleft palate contributes to the build-up of fluid where?
Middle ear (otitis media ) which can lead to an acute infection. Can lead to permanent hearing loss.
Cleft Lip and Palate - Patho: When does this normally form?
Lip - by 5-6 weeks
Palate - by 7-9 weeks.
Cleft Lip and Palate - Therapeutic Mx: What does their team consist of?
Plastic surgeon, oral surgeon, dentist, psychologist, social worker and speech pathologist.
Cleft Lip and Palate - Therapeutic Mx: When are cleft lip and palates repaired?
Lip - 2-3 months
Palate: 6-9 months.
Cleft Lip and Palate - Therapeutic Mx: Risk factos for this?
Maternal smoking
Prenatal infection
Advanced maternal age
Cleft Lip and Palate - Labs: This may be diagnosed how?
By prenatal ultrasound.
Cleft Lip and Palate - Nursing Mx, Preventing Injury to Suture Line: How to best do this?
Do not allow infant to rub the facial suture line. Place them in supine or side-lying position. Restraints may be used.
Cleft Lip and Palate - Nursing Mx, Preventing Injury to Suture Line: What options can be used to clean this?
Petroleum jelly or devices like Logan Bow (curved thin metal apparatus) or butterfly adhesive.
Cleft Lip and Palate - Nursing Mx, Preventing Injury to Suture Line: Should things be placed in the mouth?
No. No suction catheters, spoons, or straws.
Cleft Lip and Palate - Nursing Mx, Preventing Injury to Suture Line: What to do with crying?
Prevent it. Give medications for pain or cuddle and distract the child
Cleft Lip and Palate - Nursing Mx, Promoting Adequate Nutrition: Infant with unrepaired cleft palate is at risk for what
aspiration. Prosthodontic device may prevent breast milk from being aspirated.
Inguinal Hernia: What is this?
When the abdominal or pelvic viscera travel through the internal inguinal ring into canal.
Inguinal Hernia: Who is more likely to have this?
Boys, especially those who are premature
Inguinal Hernia: WHich is surgical correction performed?
When the infant is several weeks old and has been thriving
Inguinal Hernia - Assessment: How will they appear?
THere will be a bulging mass in th elower abdomen or groin area. Often seen only during crying, strainiing.
Inguinal Hernia - Nurse Mx: What can nurse do if mass felt?
Reduce hernia by pushing it back through the external inguinal ring.
Inguinal Hernia - Nurse Mx: What should happen if reduction not possible?
Hernia could be incarcerated. Can evantualaly lead to bowel strangulation
Inguinal Hernia - Nurse Mx: What is the only way to fix this?
Surgically. Can be manually reduced until surgery.
Inguinal Hernia - Nurse Mx: When should parents call physical or NP?
If inguinal hernia becomes hard, discolored, or painful
Umbilical Hernia: What causes this?
Caused by incomplete closure of the umbilical ring, allowing intestinal contents to herniate through opening.
Umbilical Hernia: How is this fixed?
Will have spontaneous closure of umbilical hernia by 4 years of age.
Umbilical Hernia: When is surgical herniation necessary?
For largest umbilical hernias that have failed to close by time child is 4.
Umbilical Hernia, Nursing Mx: Main part of nrusing management?
Teach the child and family how to reduce the hernia. Can have some self-esteem issues.
Dehydration: Why is the risk increased here?
Because they have more ECF percentage and a relative increase in body water compared to adults.
Dehydration: What contributes to increased risk for this?
Increased basal metabolic rate, increased BSA, immature renal function, and increased insensible fluid losses.
Dehydration: If untreated, can lead to what
hypovolemic shock.
Dehydration, Health Hx: Risk factors for this?
Diarrhea, Vomiting, Decreased oral intake, and sustained high fever or burns.
Dehydration, Health Hx: How will fontanels appear?
Will be sunken
Dehydration, Health Hx: How will heart rate change?
Will be increasd, and then progressing to bradycardia.
Dehydration, Health Hx: Once initial fluid volume restored, more IV fluids may be ordered with maintenance fluid. What is this?
Refers to the amount needed under normal conditions of normal hydration.
Dehydration, Health Hx: Formula for fluid requirement?
100 ml/kg per first 10 kg
50 mL/kg for next 10 kg
20 mL/kg for remaining kg
Vomiting: Occurs as a reflex with what three different phases?
PRodromal Period (Nausea and signs of stimulation)
Retching
Vomiting
Vomiting, Health Hx: Assessment of vomiting should include what
Contents/Character of emesis
Effort force of vomiting
Timing
Vomiting, Health Hx: Bilious vomiting suggests what
obsturction, whereas bloody emesis can signify esophageal or gi bleeding
Vomiting, Health Hx: Vomiting that occurs several hours past meals could signify what?
delayed gastric emptying
Vomiting, Health Hx: Pain in epigastric area could signify what
peptic ulcer disease, pancreatitis, or cholecystitis
Vomiting, Health Hx: What can be used to role out causes?
Abdominal Ultrasound
Upper GI series
Plain abdominal x-rays
Vomiting, Nursing Mx: What should be done for child with mild-to-moderate rehydration?
Withold oral feedings for 1-2 hours. Then give infant 0.5 to 2 oz of oral rehydration every 15 minutes.