Gastrointestinal 1

Question 1

Pediatric Differences

Answer 1

> small stomach capacity
incr peristalsis
small, freq feedings
freq + liquidy stools

Question 2

30% of kids w cleft will have…

Answer 2

other congenital anomaly

Question 3

___ intake may help prevention of cleft

Answer 3

folate

Question 4

cleft lip + palate

etiology

Answer 4

45% cleft lip + palate
35% cleft palate
20% cleft lip

Question 5

cleft occurs when…

Answer 5

maxillary process fails to fuse properly

Question 6

cleft lip repair should occur…

Answer 6

2-3 months

Question 7

cleft palate repair should occur… because…

Answer 7

6-12 months
>protects formation of tooth buds
>allows more norm speech pattern developt

Question 8

Cleft Repair

post op

Answer 8

• soft elbow restraints to protect incision
• may affect feeding
• may need longer nipples w enlarged holes

Question 9

Esophageal Atresia + Tracheoesophageal Fistula

Answer 9

foregut fails to lengthen, separate, + fuse into 2 parallel tubes
»4-5 wks gestation

Question 10

Esophageal Atresia + Tracheoesophageal Fistula

manifestations

Answer 10

3 classic signs:
>cyanosis
>choking
>coughing
fluid returns thru nose + mouth during feeding

Question 11

Pyloric Stenosis

Answer 11

hypertrophy of circular pylorus muscle

>stenosis is between stomach + duodenum

Question 12

Pyloric Stenosis

manifestations

Answer 12

> projectile vomiting
hungry
peristaltic waves
olive-sized mass in RUQ

Question 13

Pyloric Stenosis

diagnosis

Answer 13

> blood test to assess dehydration, alkalosis, hypo-Cl, hypo-K
U/S

Question 14

Pyloric Stenosis

treatment + prognosis

Answer 14

laparoscopic pyloromyotomy
>good prognosis
>discharge win 24 hr after advancing diet

Question 15

children are at risk for GERD…

Answer 15

• short narrow esophagus
• large vol feedings
• liquid diet
• frequent horizontal position

Question 16

at risk population for GERD

Answer 16

hx of repaired esophageal atresia

Question 17

symptoms of GER

Answer 17

• regurg, spit up, vomit

- freq hungry + irritable

Question 18

symptoms of GERD

Answer 18

GER +
>more severe irritability
>refusal of feedings
>poor wt gain
>resp symptoms (cough, choke, wheeze, arching back during feedings)
**in children, heartburn**

Question 19

treatment for mild GER

Answer 19

> feed modificatn, smaller, + more frequent
thickened feeds
positioning
diet change

Question 20

medication for GER

Answer 20

H2 antagonist: ranitidine + famotidine

Question 21

if medication failed, treatment for ger

Answer 21

fundoplication

-may need G tube to vent or feed

Question 22

Omphalocele

Answer 22

intestines fail to return to ab cavity

*membranes covering organs

Question 23

Gastroschisis

Answer 23

bowel protrudes thru defect into side of umbilicus

**no membrane to cover organs ***

Question 24

Omphalocele + Gastroschisis

nursing action

Answer 24

protect organs
prevent hypothermia or infection

*use bowel bag (covers body) or silo (covers just umbilicus + guts)

Question 25

Intussusception

Answer 25

one part of intestines prolapses + invaginates (telescopes) into another

Question 26

most common site of Intussusception

Answer 26

ileocecal valve

Question 27

Intussusception can lead to.

Answer 27

> edema
necrosis
perforation
sepsis

Question 28

Intussusception

manifestations

Answer 28

• abrupt onset
• bilious vomiting
• intermittent periods of comfort
• stools are red + resemble currant jelly bc mix of blood + mucus

Question 29

Intussusception

diagnosis

Answer 29

• U/S

- contrast edema using air or barium (therapeutic + diagnostic)

Question 30

which is the safer contrast enema? air or barium

Answer 30

air enema

Question 31

Intussusception may require ___ for gastric decompression

Answer 31

NG tube

Question 32

Volvulus

Answer 32

twisting of intestines

>can disrupt blood flow

Question 33

Volvulus

manifestations

Answer 33

• bilious vomiting
• firm + distended abdomen
• bloody stools
• dehydration

Question 34

Volvulus

treatment

Answer 34

emergency surgery required to prevent necrosis