Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics Test II > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

major problems assoc with GI dysfunction

A
  • fluid/electrolytes and acid-base imbalance
  • failure to thrive - inc metabolic needs and problems with absorption
  • vomiting and aspiration
  • infection
  • pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GI diagnostics

A
  • radiologic
  • endoscopic
  • U/S and scan
  • analysis of stools and secretions
    • if having a test that requires NPO, teach when and how to do that
    • use developmentally appropriate language
    • if getting dye, ask if they’ve had any rxns to this dye in their hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

alternative means of nutrition and elimination

A
  • Nasogastric tube:
    • feeding
    • decompression
    • lavage
  • Nasoduodenal tube and nasojejunal
    • feeding
  • parents are taught to replace G button but if can’t then need to go to a hospital to get it put back in
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

common problems with a gastrostomy tube

A
  • leakage around the tube
  • blocked tube
  • erythema around the stomal site
  • vomiting/diarrhea
  • bleeding around the tube or stoma
  • build up of granulation tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

mushroom device

A
  • can be placed as primary button during open gastrostomy procedure
  • low profile
  • not easily pulled out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

balloon device

A
  • patient and family friendly
  • locking feature w/ universal extension tubes
  • balloon ruptures
  • top heavy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the proper solution to use for an enema in a child?

A
  • use isotonic soln - 0.9% NaCl or mix 1 tbsp of table salt in 500 mLs (1 pint) of tap water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

enemas

A
  • don’t get in habit of giving child enema if constipated b/c invasive and can cause dependence
    • try diet changes first or Miralax
    • inc fluid intake
  • smaller the pt is the, the smaller amount of instillation fluid that is given to them and the smaller the amount of tube that goes into them
  • if they feel pain, lower the instillation bag
  • instilled fluid should be room temp so as not to cause cramping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

preop nursing care for child with cleft lip/palate

A
  • timing
  • prevention of aspiration
  • providing nutrition
  • prevention of infection
  • prevent delay in speech - surgery for cleft palate usually done b/w 9-15 mos
    • surgery for cleft lip typically done when child weighs 10 lbs (4.5 kgs) and is 10 weeks old
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

post op nursing care for a child with cleft lip/palate

A
  • immediately assess for hemorrhage, shock, and respiratory status (priority!)
  • prevent:
    • trauma to the suture line: by keeping child supine and elevate to HOB
    • F/E imbalances
    • pain: can use tylenol (not ibuprofen until after 6 mos)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ongoing care after a child has surgery for cleft lip/palate

A
  • promote:
    • healing - gently wash with soap and water and apply thin layer of abx ointment
    • parent-infant attachment
  • prevent:
    • trauma
    • crying
  • provide nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

special interventions for repair of cleft palate

A
  • do not use forks, spoons, or straws post op!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

clinical manifestations of esophageal atresia and tracheoesophageal fistula

A
  • maternal polyhydramnios
  • excessive mucus
  • continuous or sporadic resp distress
  • repeated regurgitations of feedings
  • acute gaseous abdominal distention
  • passage of abnormal amounts of flatus
  • three C’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the 3 C’s of Tracheoesophageal fistula??

A
  • coughing
  • choking
  • cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

preop teaching for TE fistula

A
  • place child NPO immediately - b/c don’t want child to aspirate and cause aspiration pneumonia
  • oral suctioning to keep airway clear
  • parenteral IV fluid therapy - need peripheral line
  • abx: if have aspiration pneumonia
  • humidified oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

postop teaching for TE fistula

A
  • maintain:
    • airway
    • nutrition: G button
  • prevent:
    • fluid and electrolyte imbalance
    • infection at operative site
    • pneumonia
  • promote comfort w/ pain meds
  • educate parents about home care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what to do if pt has a G button/NG tube and they pull it out after abdominal surgery?

A
  • need to call provider b/c can’t just stick it back in since may go thru surgical site
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

clinical manifestations of Hirschsprung Dz

A
  • AKA aganglionic colon
  • onset w/ in 24-48 hrs of life
    • most children dx w/in first few weeks of life
  • assess neonates for passage of meconium or bile stained vomitus and abdominal distention
    • older infants may present with constipation or overflow diarrhea
  • rectal biopsy to confirm dx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

tx of Hirschsprung Dz

A
  • surgery will be performed to create a temporary colostomy
    • will have for about 3 mos to get swelling of colon back to normal proportions
  • then will have pull through surgery - pull thru innervated tissue to surface so child can defecate
20
Q

preop care for Hirschsprung’s

A
  • placement and maintenance at an NG tube - for decompression
  • administration of abx (prophylaxis) and vit K (clotting)
  • NPO prior to surgery
21
Q

imperforate anus clinical manifestations

A
  • may be discovered on a neonate when taking rectal temp b/c there is no rectum
  • meconium is not passed
  • definitive dx made by xray
22
Q

imperforate anus preop care

A
  • maintain IV
  • keep NPO
  • clean fistulas well after stool passed
  • educate parents on colostomy and its care
23
Q

clinical manifestations of pyloric stenosis

A
  • may appear normal in first 2 weeks of life and then nonprojectile vomiting or regurgitation will occur
  • projectile vomiting is hallmark sign and will begin about 2 weeks after initial symptoms begin
    • vomiting may occur right after feeding or may be delayed an hour or more
  • after infant vomits, they will be hungry
  • vomitus NOT bile stained b/c don’t make it to small intestine
  • F/E imbalances may occur - metabolic alkalosis
  • weight loss and FTT
  • olive shaped mass on palpation where hypertrophy of pyloric muscle occurs
24
Q

biggest concern with pyloric stenosis

A
  • fluid volume deficit and electrolyte imbalances
25
Q

preop care for pyloric stenosis

A
  • establish and maintain IV line
  • correct F/E imbalances before surgery - usually hyponatremic and hypokalemic
  • educate about postop care
26
Q

postop care for pyloric stenosis

A
  • pain mgmt with tylenol
  • prevention of injury to surgical site - supine
  • resumption of feedings - stomach has shrunk so have to start with 1 oz feedings and see how they do, b/c if too big will vomit and inc risk of aspiration
27
Q

degree of dehydration

A
  • pre illness weight - illness weight/pre illness weight
  • mild: <5 %
  • moderate: 6-9%
  • severe: >10%
28
Q

gastroesophageal reflux dz (GER-GERD)

A
  • GER becomes GERD when have FTT, bleeding, or dysphagia
  • clinical manifestations:
    • usually start in 1st week of life
    • chronic vomiting or regurg
    • FTT
    • cardiorespiratory symptoms b/c airway doesn’t like acid
    • hematemesis
29
Q

diagnostic assessment of GER-GERD

A
  • barium esophagram
  • esophageal pH monitoring
  • scintigraphic studies - radioactive nucleotide added to infant’s formula to see if child has problem with gastric emptying
30
Q

non-pharm mgmt of GER-GERD

A
  • formula thickened w/ rice cereal–usually 1 tbsp of TC w/ 1 oz of formula
  • small volume feedings
    • give feedings slowly
  • frequent burping during feeding
  • upright prone or side lying position for 1 hr after feeding
    • some docs want them prone but have to have order
  • HOB elevated - use reflux harness
31
Q

pharm mgmt of GER-GERD

A
  • start these if non pharm meds not working!
  • antacids or H2 receptor antagonists:
    • ranitidine, cimetidine, pepcid
  • PPI
    • omeprazole
  • prokinetic meds:
    • metoclopramide, bethenechol
32
Q

surgical tx of GERD

A
  • Nissen fundoplication
    • bring fundus of stomach up around esophagus and tighten
    • child can’t burp or vomit, so if get air in stomach, then have to decompress
33
Q

intussusception of GI tract

A
  • invagination or telescoping of one portion of the intestine into another portion of intestine
    • narrowing of tract occurs and peristalsis has stopped!
34
Q

intussusception clinical manifestations

A
  • sudden abdominal pain
  • vomiting - usually bile stained
  • passage of currant jelly like stool
    • just blood and mucus is passing, no stool
    • if child passes a normal stool, then they have self corrected and no longer need tests/care
  • abdominal distention
35
Q

dx and tx of intussusception

A
  • hx
  • water soluble contrast or air enema
    • non surgical hydrostatic reduction
    • cannot be done by a nurse! have to be done by a trained person! - b/c perforation can occur if too much pressure is used
    • used to do barium enemas - but concerned about perforation which would cause barium to go into GI
  • tx:
    • enema
    • surgery if they don’t self correct
36
Q

acute appendicitis

A
  • inflammation of the appendix
  • cause not understood - but often there is obstruction of the lumen by stool
  • have to try to prevent perforation!
37
Q

clinical manifestations of appendicitis

A
  • initially periumbilical and then RUQ abdominal pain (McBurney’s point)
  • fever
  • rigid abdomen
  • dec or absent bowel sounds
  • vomiting
  • constipation or diarrhea
  • anorexia
  • tachycardia and rapid, shallow respirations
  • lethargy
  • pallor
  • irritability
  • stooped posture bc painful to stand upright
38
Q

diagnostics of appendicitis

A
  • H&P
  • elevated WBC - usually no higher than 20,000 w/ elevated bands indicating infection
  • abdominal U/S or CAT scan
39
Q

mgmt of appendicitis if not ruptured

A
  • before perforation: surgical removal - can do laparoscopically
    • preop: prophylactic abx, IV fluids, chem panel and CBC w/ diff
    • postop: care of child having abdominal surgery
40
Q

mgmt of appendicits if ruptured

A
  • preop:
    • IV administration of fluid, abx, and electrolytes
    • placement of NG tube for decompression
  • postop:
    • maintenance of IV fluids
    • triple abx
    • NG to wall suction
    • wound may or may not be sutured closed by surgeon
41
Q

NG drainage replacement

A
  • when a child is on suction through an NG tube, then we are removing fluids and electrolytes!
    • we have to replace this
    • this replacement of F/E is in addition to their maintenance fluids
  • have to look at order and see how doc wants you to replace NG drainage
    • may say replace mL/mL lost or 1/2 mL/mL lost
    • ie. replace NG drainage mL/mL lost with NS over 4 hours
      • if NG drainage is 100 mL, then set pump to deliver 100 mL over 4 hours, so 25 mL/hour
42
Q

short bowel syndrome (SBS)

A
  • malabsorption syndrome that occurs as a result of dec mucosal surface, usually due to extensive resection of the smll intestine
  • most common causes:
    • congenital anomalies: jejunal/ileal atresia or gastroschiesis (so intestines outside body when born - can’t just push back in, so put in sterile silo and slowly reinsert)
    • ischemia from necrotizing enterocolitis
    • trauma or vascular injury - ie seatbelts
43
Q

goals of therapy for SBS

A
  • preserve as much length of bowel as possible - the more bowel you lose, the less absorption you have, so may need parenteral nutrition
  • maintain optimal nutrition status, growth and development while intestinal adaptation occurs
  • stimulate intestinal adaptation w/ enteral feedings
    • if restarting PO feeds, then must be extremely slowly (1 mL/hour) b/c want to prevent gut from reacting
  • minimize complications related to the dz process and tx
44
Q

nutritional support of SBS

A
  • TPN:
    • highest % of dextrose in peripheral line that you can give is 10%! - if give too much, then can cause major infiltration
    • if higher than 10%, then need central line - must get CXR to confirm placement, use sterile procedure to care for
    • complications of TPN: line infection, perforation
  • enteral feedings: continuous vs. bolus feedings - know how much can tolerate
  • oral feedings: very, very important to continue stimulating suck reflex during TPN and enteral feedings!
    • so if get to take things PO, will at least still have strength and reflex present
45
Q

Port a Cath

A
  • when not getting tx, then nothing there on the skin
  • have to use Huber needle - need pain meds to access b/c it is painful to the child
  • use sterile procedure to care for

Pediatrics Test II (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions