Gastrointestinal disorders Flashcards
1
Q
▪ Protrusion of intraabdominal contents through defect in abdominal wall lateral to umbilical ring which is
never with a peritoneal sac
▪ M. membranes covers the exposed
A
GASTROSCHISIS
2
Q
Incomplete fusion of the palate which results in
communication between the mouth and the nose
A
Cleft Palate
3
Q
when will cleft palate precede cleft lip
A
6 – 12 weeks
4
Q
AE/TEF: A2
A
Simple esophageal atresia with no fistula (Isolated EA)
5
Q
signs of Esophageal motility disorders
A
dysphagia, GER (50%)
6
Q
- non union of the tissue and bone of the upper lip and hard/soft palate during embryonic development
- Distinct facial defects that occurs singly or in combination
- Malformation of the face that may occur individually or together
- Both occur during embryonic development
A
CLEFT LIP (HARELIP)/CLEFT PALATE
7
Q
Type of cleft palate: occurs in midline and may involve soft
and hard palate
A
CP alone
8
Q
what is ESSR
A
▪ Enlarge the nipple (long, soft)
▪ Stimulate the suck reflex
▪ Swallow fluid appropriately
▪ Rest =to allow child to finish what has been placed in the mouth
9
Q
(-) air in the GIT in EA/TEF meaning
A
EA without TEF
10
Q
Type of EA/TEF: Both upper and lower ends of esophagus open into the
trachea by a fistula
A
EA with double TEF
11
Q
Rule of 10
A
10gms Hgb?10lbs?10wks
12
Q
Restraints for cleft palate
A
▪ Elbow restraint until palate healed (4-
6 weeks)
13
Q
How to prevent infection in Cleft lip/palate
A
- Assess v/s
- Cleanse suture line with normal saline/sterile water if ordered
- Cleanse cleft areas by giving 5-15 cc of water after feeding
- loosen crust
aiding in removal - Antibiotic cream as prescribed
- Careful hand washing and sterile technique
14
Q
Assessment for Transesophageal Atresia (TEF)
A
a) 3 Cs - choking, coughing, cyanosis
b) Aspiration pneumonia
c) Distended abdomen
15
Q
Preop preparation of the infant for surgery in omphalocele
A
NPO, IVF, NGT for decompression
16
Q
Major Etiology/Causes of Cleft lip/palate
A
genetics and environmental
17
Q
Speech impairment in CL/CP
A
o Insufficient functioning of the muscle of the soft palate and nasopharynx
o Improper tooth alignment-orthodontics
o Hearing loss
18
Q
CLINICAL MANIFESTATIONS of EA/TEF
A
- 3 C’s of TEF = choking, coughing, cyanosis (intermittent)→due to aspiration from overflow of secretions from the blind pouch
- copious, fine white frothy bubbles of mucus in the mouth and nose=EA
- increased respiratory distress after feeding
- Distended abdomen-air from trachea passes through the fistula into the stomach
19
Q
Structural Defects
A
- Cleft lip/ cleft palate
- Esophageal Atresia with Transesophageal Fistula
- Omphalocele
20
Q
Protrusion of intraabdominal contents into the base of umbilicus which is covered by a translucent sac
(peritoneum without skin)→rupture→****
A
evisceration
21
Q
position for maintaining patent airway in Cleft lip
A
upright/infant seat position
22
Q
How to maintain Airway patency in CP/CL
A
gentle aspiration (NO SUCTIONING=trauma to the site) of mouth and nasopharyngeal
secretions to prevent aspiration and respiratory complications
23
Q
Gastrointestinal System of the Newborn
A
- The infant does not have voluntary control over swallowing until 6 weeks old.
- Stomach capacity is small and intestinal motility is greater than in older children.
- Relaxed cardiac sphincter.
- Deficiency of several enzymes until 4 to 6 months.
- Liver junctions are immature until the first year of life.
24
Q
How to optimize nutrition in Cleft lip
A
Rubber tipped syringe on the side of the mouth
25
incidence of cleft palate
1:2000 live births
26
week of Fusion of palatal processes
7 – 12th wk AOG
27
stomach capacity of 2-3 weeks
75-100 ml
28
postop preparation of the infant for surgery in omphalocele
measures to control pain, prevent infection, fluid and electrolyte balance,
adequate nutritional intake
29
Gastrostomy tube feedings are elevated and secured to a point above the level of the stomach in how many inches to prevent reflux to the healing esophagus; allows gastric secretions to pass duodenum and swallowed air to escape through open tube
4"
30
Type of cleft lip: small notch; maybe a little
more than a notching of the vermillion border of the lip and may extend to the nostril
Incomplete
31
management of EA/TEF
1. Prevention of aspiration pneumonia through drug therapy
* →inevitable and appear early
* Broad spectrum antibiotic
2. Surgery
▪ to repair anomaly→ emergency; closing the fistula and anastomosing esophageal
segments (NGT for feeding until esophagus heals; chest tube)
32
diagnosis of cleft lip
apparent at birth – detected by Sonogram (while in Utero)
33
How to protect sac from trauma and infection in omphalocele
▪ Monitor sac and make sure that it is covered with sterile gauze soaked in NSS to prevent drying of abdominal contents
▪ Place dried sterile gauze over sterile moist gauze and cover with plastic wrap to provide additional protection from heat and moisture loss
▪ Monitor vital signs especially temperature because the infant easily loses heat through sac
▪ Monitor for s/s of infection
34
Pediatric Nursing Gastrointestinal Disorders
A. Structural Defects
B. Disorders of Motility
C. Obstructive Disorders
D. Malabsorption Syndrome
35
development of larynx, trachea, beginning lung tissue, esophageal
lumen
4th – 8th week
36
corrective surgeries for EA/TEF
▪ End-to-end anastomosis
▪ Colon transplants for defects
37
why infant with cleft palate have difficulty feeding
infant is unable to generate a negative pressure and create suction in the oral cavity
38
incidence of cleft lip
1:800 live births
39
how to provide adequate nutrition in CL/CP
a. ESSR
b. Upright position when feeding to facilitate swallowing and discourage aspiration
c. Burp frequently because more air is swallowed which can cause regurgitation/vomiting
d. NGT feeding as ordered
40
▪ Protrusion of intraabdominal contents into the base of umbilicus which is covered by a translucent sac
(peritoneum without skin)→rupture→evisceration
▪ Herniated organs
OMPHALOCELE
41
Type of cleft lip: extends into the base of the nose and even the gums in which upper teeth are set may also be deformed
Complete
42
Characteristics of cleft lip
Associated with deformed dental structures
43
NURSING DIAGNOSIS
Preoperative of CL/CP
* High risk for aspiration (breastmilk, formula or mucus) related to anatomic defect
* High risk for aspiration (breastmilk, formula or mucus) related to anatomic defect
44
stomach capacity of 3 months
150-200 ml
45
intestines which include stomach and liver covered by psa
Herniated organs
46
NURSING CARE of omphalocele
1. Protect sac from trauma and infection
2. Prepare the infant for surgery
47
stomach capacity of 2 years
500 ml
48
Type of EA/TEF: most common
EA with distal TEF
49
stomach capacity of 1 month
90-150 ml
50
Pre-op nursing care for EA/TEF
1. Maintain open airway
2. NPO
3. Administer IVF as ordered
4. Oxygen to relieve respiratory distress
51
Other defects associated with cleft lip/palate
omphalocele, TEF
52
3Cs of TEF
choking, coughing, cyanosis
53
purposes of cheiloplasty
* early repair avoids oral deprivation, prevents trauma and difficulty for the parents
* its difficult to bond with an infant with deformed face
* Help infant experience the pleasure in sucking
54
Palliative surgery for EA/TEF:
* Provision of constant drainage of the esophageal
pouch=tube in the mouth to upper pouch
o Esophageal replacement
Esophagostomy
55
Types of cleft palate
* CP alone
* With CL
56
Palliative surgery for EA/TEF:
* Several stages – indicated for premature, multiple
anomalies/in poor condition LIGATION OF TEF + PALLIATIVE
MEASURES
* for gastric decompression (placement of a feeding tube,
left open to drain by gravity to keep stomach empty of
secretion and prevent reflux into lung) and jejunostomy
feeding
Gastrostomy
57
how to observe for bleeding in CL/CP
check for frequent swallowing, increased PR and restlessness
58
ethnicity where cleft lip/palate is most common
Asians
59
gender at risk for cleft palate
Females
60
Palliative surgeries for EA/TEF
▪ Gastrostomy
▪ Esophagostomy
61
Management of cleft palate
URANOPLASTY
62
chest tube care (thoracotomy) in EA/TEF
* Check clots
* Keep lower than chest
* Check amount, color, drainage
* Vaselinized gauze at bedside
* Don’t clamp unless ordered
d. Semi-Fowler’s position or right side to prevent gastric juice from flowing to the fistula
63
Type of cleft lip: generally below the center of one nostril
Unilateral
64
In CL/CP, why cleanse cleft areas by giving 5-15 cc of water after feeding
to prevent accumulation of carbohydrates
which encourage bacterial growth
65
How to help parent cope with the impact of the defect in CL/CP
o Encourage them to hold and cuddle the infant
o Explain surgical procedure and expected outcome
o Show pictures before and after surgery
66
Types of EA/TEF
- Simple esophageal atresia with no fistula (Isolated EA)
- EA with proximal TEF
- EA with distal TEF
- EA with double TEF
- Isolated TEF
67
postop nursing care for EA/TE
1. Promote respiratory function
2. Provide optimum nutrition
68
an alternative to gastrostomy if the 2nd step surgery will be much later
Cervical esophagostomy
69
risk for EA/TEF
* low birth weight
* prematurity
* occurs with other congenital disorders (VACTERL)
70
Type of EA/TEF: Upper end of esophagus is blind, lower end
connects into the trachea
EA with distal TEF
71
when can cheiloplasty be done
on or before 2nd month
72
nursing responsibilities in oral feeding of postop EA/TEF
* Carefully observe to make sure that infant is able to swallow without choking
* Start with sterile water, followed by small feedings of formula
* May be supplemented with gastrostomy/parenteral nutrition if unable to take sufficient amount by mouth
* Discharged if able to take oral fluids well and gastrostomy tube removed but for palliative surgery,
discharged with gastrostomy tube (EDUCATION)
73
stomach capacity of NB
10-20ml
74
cause of EA/TEF
unknown
75
failure of the maxillary and median
nasal processes to fuse (incomplete
fusion of the lip)
Cleft Lip
76
AE/TEF: B4
EA with proximal TEF
77
management of speech impairment
speech therapy
78
Characteristics of cleft palate
❖ Although these are also through with CL, it is
more with CP
* Difficulty feeding
* Prone to recurrent otitis
media
79
evidence that cleft lip/palate is inherited
increased incidence in relatives
80
diagnosis of Cleft lip/palate
physical assessment
81
what covers omphalocele
peritoneal sac
82
sex incidence of EA/TEF
equal
83
How to optimize nutrition in Cleft palate
Paper cup/large hole nipple
84
How to promote respiratory function in EA/TEF
a. Assessment of respiratory difficulties
b. Suction PRN
c. Provide chest tube care (thoracotomy)
d. Semi-Fowler’s position or right side to prevent gastric juice from flowing to the fistula
e. Gastrostomy returned to gravity drainage
85
Care for patients in restraint
→ Check site for s/s of irritation
→ Release one at a time at frequent intervals to provide opportunity to exercise arms and for cuddling
86
position for maintaining patent airway in Cleft palate
lie on abdomen
87
abnormal connection between the esophagus and the trachea
Tracheoesophageal fistula (TEF)
88
Nursing Care for Cleft lip/palate
1. Help parent cope with the impact of the defect
2. Provide adequate nutrition
3. Prepare for surgery
4. Postoperative care
89
Type of cleft lip: beneath
both nostril
Bilateral
90
Obstructive Disorders
1. Intususception
2. Pyloric Stenosis
91
* failure of the esophagus to develop a continuous passage
* esophagus ends in a blind pouch with no entry to the stomach
Esophageal atresia (EA)
92
associated with other congenital anomalies of omphalocele
heart, genitourinary, TEF and imperforate anus
93
ethnicity where cleft lip/palate is least common
Blacks
94
congenital disorders associated with EA/TEF
(VACTERL)=vertebral,
anorectal, cardiovascular, tracheoesophageal, renal, limb
abnormalities
95
Malabsorption Syndrome
Celiac Disease
96
DIAGNOSTIC TESTS for EA/TEF: (to confirm placement , aspirate stomach contents)
Inability to pass NGT
97
MANAGEMENT of omphalocele
immediate surgical repair to replace abdominal contents and close abdominal wall
98
how to loosen crust in CL/CP surgery
use cotton swab to apply a half-strength peroxide solution
99
Avoid trauma to the operative site in CL/CP
▪ Logan’s bow/butterfly adhesive after surgery to hold in close approximation the suture line
▪ Restraints (elbow pinned to the infant’s clothing) to avoid rubbing the incision with hands
▪ Minimize crying – anticipate needs (produces tension on the suture line)
▪ No to sucking – no pacifiers
▪ No tongue depressor, thermometer, spoons, straws, toothbrushing, hard food items
100
AE/TEF: E3
Isolated TEF
101
Type of cleft palate: midline of the soft palate and one orboth sides of the hard palate
With CL
102
repair for cleft lip (cheiloplasty) is until what age
age 2
103
Pacifier and NPO purpose is to
prevent food aversion
104
signs of stricture due to tension
dilatation
105
DIAGNOSTIC TESTS for EA/TEF
1. History (polyhydramnios=EA) and clinical manifestations
2. Inability to pass NGT
3. Radiography
106
Management of cleft lip
CHEILOPLASTY
107
gender at risk for cleft lip
Males
108
diagnosis of cleft palate
may not be detected without thorough assessment of the mouth (palpate with the finger)
109
results of otitis media
→fluid can get in the middle ear
→tympanic membrane scarring
→hearing loss
110
NURSING DIAGNOSIS
Postoperative of CL/CP
* Ineffective breathing pattern related to anesthetic and increased secretions
* Impaired tissue integrity related to surgical correction of cleft
* Knowledge deficit (parent) related to diagnosis, treatment, prognosis and home care needs
* Altered nutrition: less than body requirements related to surgery and feeding difficulties
111
diagnostic sign of EA without TEF
(-) air in the GIT
112
Etiology/Causes of Cleft lip/palate
o Genetics
o Environmental
o Family History
o Exposure to certain drugs during pregnancy
o Nutritional deficiencies
o Certain Medical Conditions
113
Cause of omphalocele
Abdominal contents fail to return when abdominal wall closes by 10th week.
114
How to Provide optimum nutrition in EA/TEF
a. Gastrostomy tube feedings
b. Oral feeding when anastomosis site healed
c. Maintain IVF
d. Pacifier
e. NPO or no oral stimulation
115
when can uranoplasty be done
12 – 18 months
116
COMPLICATIONS OF SURGERY in EA/TEF
* Anastomostic leak
* Stricture due to tension
* Esophageal motility disorders
117
Assessment for Esophageal Atresia (EA)
a) History of polyhydramnios in mother
b) Inability to pass NG tube
c) Increased drooling & salivation
d) Immediate regurgitation of undigested formula/milk when fed
e) copious, fine white frothy bubbles of mucus in the mouth and nose
118
signs of anastomostic leak
purulent chest tube drainage, temperature instability and increased WBC
119
* to take advantage of palatal changes that take place with normal growth and before child develops faulty speech in anticipation of speech development, it is done before the child develops faulty speech habits
URANOPLASTY
120
on what day will you give gastrostomy tube feedings in postop care for EA/TEF
5th-7th day-post-op feedings
121
Restraints for cleft lip
▪ Elbow restraint
▪ Jacket restraint for older children to prevent rubbing of site
122
Type of EA/TEF: Upper end of the esophagus ends into the trachea
EA with proximal TEF
123
Type of EA/TEF: Upper and lower ends of esophagus are blind, no connection to the trachea
Simple esophageal atresia with no
fistula (Isolated EA)
124
stomach capacity of 1 week
30-90 ml
125
Alternative to nipple feeding
rubber tipped medicine dropper or aseptosyringe,
Breck feeder
(large syringe with soft rubber tubing) deposited at the back of the mouth
126
Cleft lip/palate has higher incidence in
Caucasians
127
Type of EA/TEF: No Esophageal atresia but with fistula between
normal esophagus and trachea
Isolated TEF
128
what covers gastroschisis
mucus membranes
129
Types of cleft lip
1. Complete
2. Incomplete
3. Unilateral
4. Bilateral
130
How to maintain patent airway in EA/TEAF
* Continuous/low intermittent suction to remove secretions from blind pouch
* TEF=supine with HOB elevated on an inclined plane for at least 30 degrees→minimizes reflux of gastric secretions up the distal esophagus into the trachea and bronchi
131
Disorders of Motility
1. Gastrointestinal Reflux Disease
2. Hirschprung's Disease
3. Colic
132
on what day will you give oral feeding in postop care for EA/TEF
when anastomosis site healed (10th day-2nd week)
133
Postoperative care for cleft lip/palate
a. Maintain Airway patency
b. Observe for Bleeding
c. Avoid trauma to the operative site
d. Minimize pain
e. Optimize nutrition
f. Prevent infection
134
week of Fusion of maxillary and premaxillary processes
7 – 8th wk AOG
135
AE/TEF: C1
EA with distal TEF
136
o may appear alone with cleft lip
o midline of hard & soft palate
o midline of soft palate & one or both
side of hard palate
Cleft Palate
137
AE/TEF: D4
EA with distal TEF
