GI Flashcards
2201 exam #1 GI
1
Q
Malabsorption d/t decreased mucosal area?
A
SBS
2
Q
Initial management after delivery of infant with omphalocele?
A
Inspection If bowel covering is intact, a nonadherent dressing is placed over the defect. If exposed, the contents are covered with a bowel bag or moist dressings and plastic drape to prevent excessive fluid loss, drying, and temp instability. IVF and ABX gastric bowel decompression - with silastic double-lumen cath (NG-OG)
3
Q
Most common cause of intestinal obstruction in children b/w ages 3 months and 3 years?
A
Intussusception
4
Q
The DX of HPS is PRIMARILY based on?
A
H&P - PRIMARY -projectile vomiting, olive shaped mass U/S - 2nd choice Upper GI radiography - 3rd choice
4
Q
Most common manifestation of GER during infancy?
A
Passive regurgitation or emesis
5
Q
Occurs when the abd contents herniate through the umbilical ring, usually with an intact sac?
A
Omphalocele
5
Q
Most common site of intussusception?
A
Ileocecal valve (ileocolic)
5
Q
When does GER most frequently occur?
A
After meals and at night
6
Q
Clinical manifestations of Intussusception?
A
Sudden acute abd pain child screaming and drawing knees to chest child appearing normal & comfortable b/w episodes vomiting lethargy passage of red, currant jelly-like stools Tender distended abd palpable sausage shaped mass in RUQ Empty RLQ eventual s/s of peritonitis (fever, prostration, etc)
6
Q
SBS prognosis?
A
Improved with advances in PN and enteral nutrition. Intact Ileocecal valve improves prognosis
6
Q
An infant with SBS will be discharged home on TPN and gastrostomy feedings. Nursing care should include which of the following?
A. Prepare family for impending death.
B. Teach family how to calculate caloric needs.
C. Ensure that family can identify signs of central venous catheter infections.
D. Secure TPN and gastrostomy tubing under diaper to lessen risk of dislodgment.
A
C. RATIONALE: During TPN therapy care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis for patients with SBS depends in part on the length of residual small intestine. It has improved with advances in TPN. Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. The tubes should not be placed under the diapers because of the risk of infection. p. 1328
6
Q
An infant who was born yesterday is scheduled for surgery tomorrow. Which of the following interventions in the pre-op period will be the most helpful in assessing post-op pain in this neonate? A. Assess neonate’s behavior. B. Interview mother about neonate’s behavior. C. Ask mother what measures comfort neonate. D. Assess neonate’s response after inducing pain.
A
A. A pre-op assessment of the infant’s behavior is essential. This provides a baseline against which to measure post-op behavior. Changes may indicate pain or unstable condition. The mother will not have had an opportunity to learn the infant’s response to pain and comfort measures.
7
Q
Why is Necrotizing Enterocolitis so serious?
A
Because it occurs in infants, who cannot describe their pain level – so it can be missed or overlooked
8
Q
Pre-op care for infant with HPS undergoing a pyloromyotomy?
A
Decompression with NG Hydration and Lyte balance NPO IVF of glucose and Lytes
8
Q
DX of Hirschspung Disease?
A
Neonate: Clinical signs or failure to pass meconium Infants & children: H&P Rectal BX confirms DX Barium enema
8
Q
Mr. and Mrs. Wilson have a newborn with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. The nurse’s intervention should include which of the following? A. Explain the disorder so they can explain it to others. B. Help parents understand that this is a minor problem. C. Encourage parents not to worry while the tests are being done. D. Suggest that parents avoid family and friends until the gender is assigned.
A
A. Although ambiguous genitalia may appear as one entity, there are many causes. It is essential that the parents understand the complex issues that are involved in gender assignment as they work with the multidisciplinary team. Depending on the etiology, this can be a life-long problem. Gender assignment should be a slow, deliberative process. Telling the parents not to worry negates their concern about their child. Suggesting that parents avoid family and friends until the gender is assigned is not realistic.
10
Q
Biliary Atresia Management?
A
Nutritional support Kasai procedure liver transplant
11
Q
HPS has GREATEST risk of recurrence in which individual?
A
First-born boy of a mother who was affected.
12
Q
The nurse is caring for a neonate born with an omphalocele. Initial mgmt after delivery includes: A. Beginning breast-feeding B. Supine positioning with nasogastric feedings C. Covering the omphalocele with saline-soaked gauze and plastic drape D. Using radiant warmer to dry sac and maintain neutral thermal environment
A
C. The sac is covered to prevent drying and excessive fluid loss from the neonate. The child will not be fed. With the abdominal contents outside of the infant, the stomach is decompressed and the infant is maintained with parenteral nutrition.
13
Q
Biliary atresia is not seen in the _________ or _______ or _________ infant.
A
fetus stillborn newborn
14
Q
Primary source of nutrition in children with SBS?
A
PN
14
Q
Which of the following is an important nursing consideration in the care of a child with celiac dz? A. Refer to a nutritionist for detailed dietary instructions and education. B. Help child and family understand that diet restrictions are usually only temporary. C. Teach proper hand washing and Standard Precautions to prevent disease transmission. D. Suggest ways to cope more effectively with stress to minimize symptoms.
A
A: RATIONALE: The main consideration is helping the child adhere to dietary management. Considerable time is spent in explaining to the child and parents the disease process, the specific role of gluten in aggravating the condition, and those foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible. Celiac disease is not stress related. pp. 1326, 1327
15
Q
Nursing Care for SBS?
A
NUTRITIONAL THERAPY Prevent complications r/t central venous device
15
Q
Which of the following is the earliest clinical manifestation of biliary atresia? A. Jaundice B. Vomiting C. Hepatomegaly D. Absence of stooling
A
A. Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until ages 2-3 wks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.
16
True or False: HPS is a congenital disorder.
FALSE It is NOT a cong disorder
16
Passage of red, currant jelly-like stools occurs with?
Intussusception
16
Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies, which are now being successfully treated with antihistamines. In this situation, the constipation is most likely caused by which of the following? A. Diet B. Puberty C. Allergies D. Antihistamines
D. Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known change in her habits, the addition of antihistamines is the most likely cause of the constipation. A: With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. B: With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. C: With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. p. 1303
17
Which of the following reflexes appear at about 7 to 9 months of age? A. Moro B. Parachute C. Neck righting D. Labyrinth righting
B: The parachute reflex appears at 7 to 9 months of age and persists indefinitely. The Moro reflex is one of the primitive reflexes present at birth. Neck righting appears at 3 months of age and persists until 24 to 36 months. Labyrinth righting appears at 2 months and is strongest at 10 months.
18
Dx of Intussusception?
Frequently made on subjective data alone. Definitive DX-Barium enema (MUST do abd XR 1st) Rectal exam - reveals mucus
18
Clinical manifestations of Hirschspung Disease during childhood?
Constipation Ribbonlike, foul-smelling stools Abd distention visible peristalsis easily palpable fecal mass Undernourished, anemic in appearance
19
The RN should assess a child DX with HPS for which of the following?? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis
C. Metabolic alkalosis
20
Pica refers to which of the following? A. Overeating of nonnutritive food substances B. Refusal to eat proper amts of food despite its availability C. Obsessive ingestion of unusual foods that persists over time D. Compulsive and excessive ingestion of both food and nonfood substances
D. Pica is the compulsive and excessive ingestion of both food and nonfood substances. Food picas include the excessive eating of ordinary foods or unprepared food substances, such as coffee grounds or uncooked cereals. Nonfood picas include the ingestion of substances such as clay, soil, stones, laundry starch, paint chips, ice, hair, paper, rubber, and feces. A: Pica also includes the eating of nonfood substances. B: Eating, not refusing to ingest, is the issue in pica. C: Nonfood substances are also involved. p. 1298
21
Transfer of gastric contents into the esophagus?
Gastroesophageal reflux (GER)
22
Acute inflammatory disease of the bowel with increased incidence in preterm and other high-risk infants.
Necrotizing Enterocolitis (NEC)
24
Pica refers to which of the following?
A. Overeating of nonnutritive food substances
B. Refusal to eat proper amounts of food despite its availability
C. Obsessive ingestion of unusual foods that persists over time
D. Compulsive and excessive ingestion of both food and nonfood substances
Biliary atresia
24
DX of biliary atresia is confirmed by?
Exploratory lap & intraoperative cholangiogram
24
Manifestations of Malrotation?
Bilious vomiting Abd pain Abd distention GI bleeding
24
Cong anomaly resulting in mechanical obstruction from inadequate motility of part of the intestine?
Hirschspung Disease (Cong Aganglionic Megacolon)
24
The nurse is assessing a 6-month-old infant who has head lag. The nurse should recognize which of the following? A. This is normal. B. Child is probably cognitively impaired. C. Developmental-neurologic evaluation is needed. D. Parent needs to work with infant to stop head lag.
C: Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months head control is well established. Developmental-neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. A 6-month-old infant with head lag is a sign of delay. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified.
25
Which of the following is an important consideration in understanding the reactions of parents when their infant is born with physical defects? A. Grief lasts until the defects are repaired. B. Denial is a common maladaptive reaction. C. The psychologic reaction is similar to that with the death of an infant. D. Reactions of health professionals to the birth of an infant do not affect parents’ reactions.
C. Parents need to grieve for the loss of the expected child. They also must adapt to the needs of a child with physical defects and the additional demands this will place on the family. The grief usually consists of several stages, including shock, frustration, and anger. The grief response may last for years. Denial and disbelief during the shock phase are not maladaptive. They can serve to protect the parents as they begin to deal with the impact of the initial stress. Parents are sensitive and responsive to the behaviors of others. Health professionals' interactions w/the infant and parents provide cues to the parents that can greatly influence their reaction to the infant.
26
According to Erikson, infancy is concerned with acquiring a sense of which of the following? A. Trust B. Industry C. Initiative D. Autonomy
A: During the first year of life, the infant focuses on the task of developing a sense of trust of self, of others, and of the world. This presents challenges for infants who are separated from parents or consistent caregivers. Industry is the focus of school-age children. Preschoolers are engaged in acquiring initiative. Autonomy is a developmental task during the toddler years.
28
NEC PATHO?
Damage to mucosal cells lining the bowel wall Diminished blood supply to mucosal cells causes their death Unable to secrete protective, lubricating mucus Thin, unprotected bowel wall is attacked by proteolytic enzymes Gas-forming bacteria produce intestinal pneumatosis (presence of air in submucosal/subserosal surfaces of bowel)
29
Which of the following vaccines is recommended for administration at birth? A. MMR B. Hepatitis B C. Hepatitis A D. Haemophilus influenzae type b
B: Hep B immunization is recommended early. Hep B virus infections that occur during childhood can lead to fatal consequences from cirrhosis or liver cancer during adulthood. MMR is recommended for children ages 12 to 15 months. The hep A series should begin between 12 and 23 months. Hib is administered beginning at age 2 months.
30
Abdominal pain, abdominal mass, and bloody stools are the classic triad of ________ symptoms?
Intussusception
31
Nursing Interventions for GER?
· Position with head elevated 30-45 º · Small, frequent feedings with adequate burping · Provide client teaching and discharge planning · Teach parents how to position and feed infant · Administration of medications
33
HPS may be associated with other disorders such as?
Intestinal malrotation Esophageal and duodenal atresia Anorectal anomalies
34
A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be which of the following? A. Encourage her to express her feelings. B. Suggest holding baby but without eye contact. C. Restate what the physician has told her about plastic surgery. D. Recognize that attachment usually does not occur until after initial surgery.
A. For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must emphasize not only the infant's physical needs but also the parents' emotional needs. The mother needs to be able to express her feelings before she can accept her child. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The child's normalcy is emphasized, and the mother is assisted in recognizing the child's uniqueness. Although this will be addressed, it is not part of the initial therapeutic approach. Maternal-infant attachment usually is not negatively affected at this stage.
36
Labs associated with HPS?
Metabolic alterations d/t dehydration. Decreased Cl Increased pH & HCO3 (Metabolic alkalosis) Increased BUN
37
Most serious type of intestinal obstruction? Why?
Malrotation! Because, if the intestine undergoes complete volvulus (twisting around itself), it will lead to intestinal necrosis, peritonitis, perforation, and death.
37
The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. Which of the following should the nurse suggest to help them deal with this problem? A. Let her cry herself back to sleep. B. Put her in parents’ bed to cuddle. C. Start putting her to bed while still awake while the parent is present. D. Give her a bottle of formula instead of breast-feeding her so often at night.
C: Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Cobedding could be unsafe at this age. The type of feeding will not affect the child's sleep pattern.
38
DX of GER?
H&P Upper GI 24 hr intraesophageal pH - GOLD STANDARD!!! Scintigraphy-detects radioactive sub feeding comp.
39
The nurse is caring for a boy with probable intussusception. He had diarrhea before admission, but while waiting for a barium enema, he passes a normal brown stool. The most appropriate nursing action is which of the following? A. Notify physician. B. Measure abdominal girth. C. Auscultate for bowel sounds. D. Take vital signs, including blood pressure.
A. RATIONALE: Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic and therapeutic care plan. The first action would be to report the normal stool to the practitioner. p. 1325
40
Pyloric stenosis can best be described as which of the following? A. Dilation of pylorus B. Hypertrophy of pyloric muscle C. Hypotonicity of pyloric muscle D. Reduction of tone in the pyloric muscle
B. RATIONALE: Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of pylorus, hypotonicity of pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis. p. 1322
41
Leads to cirrhosis, liver failure, and eventually death if untreated?
Biliary atresia
42
This condition usually develops in the first few weeks of life, causing projectile vomiting, dehydration, metabolic alkalosis, and failure to thrive (FTT)??
Hypertrophic pyloric stenosis (HPS)
43
When assessing an infant, the nurse notes the infant to be hungry and irritable. The mother states the her child has been vomiting a lot which explains why the infant is dehydrated and has lost weight. The nurse should suspect?
HPS
44
Occurs when the intestine herniates lateral to the umbilical ring, usually to the right of the umbilicus and without a sac?
Gastroschisis
45
Biliary atresia manifestations?
Healthy @ birth JAUNDICE (after two wks needs testing!!) CLAY colored stool d/t no bile pigment Dark urine Liver is firm on palpation Enlarged liver early in the DZ
46
occurs in approx. 1 in 10,000 - 15,000 live births?
Biliary atresia
47
Clinical manifestations of Hirschspung Disease during the newborn period?
Failure to pass meconium w/in 24-48 hr after birth Refusal to feed Bilious vomiting Abd distention
49
Manifestations associated with HPS in infants?
Vomiting begins at 3 wk (may start @ 1 wk to 5 wk) PROJECTILE VOMITING Visual peristalsis METABOLIC ALKALOSIS Nonbilious vomiting (early stages) Projectile and progressive Brown in later stages if gastritis develops
50
What is the primary TX for biliary atresia?
Kasai portoenterostomy
51
Projectile vomiting is associated with?
HPS
53
Nursing care for Intussusception?
NPO Pain mgmt. Check for jelly like stool If stool is normal, Intussusception has resolved
55
The biggest single reason why children need a liver transplant is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Biliary Atresia
56
GER symptoms in infants?
Spitting up, regurgitation, vomiting Excessive crying, irritability, arching of back Wt. loss, FTT Resp (cough, wheeze, stridor, gagging, choking) Hematemesis Apnea or apparent life-threatening event
57
The nurse assesses the neonate immediately after birth. EA or TEF is suspected if which of the following is present? A. Jaundice B. Absence of sucking C. Hyperactive bowel sounds D. Excessive amount of frothy saliva in the mouth
D. Frothy saliva in the mouth and nose, drooling, choking, and coughing in a newborn are associated with esophageal atresia and TEFs. Jaundice in a neonate is indicative of a hematologic problem. Absence of sucking and hyperactive bowel sounds are not signs of esophageal atresia or TEF.
58
abnormal rotation of intestine during embryonic development?
Malrotation
59
What is the Kasai procedure?
surgery that involves dissecting the porta hepatis to promote bile drainage. A Roux-en-Y jejunal limb is then anastomosed to the porta hepatis. Highly successful if done before 8 wk of age.
61
Olive-like mass in the upper abdomen is associated with?
HPS
61
Therapeutic management of most children with Hirschsprung dz is primarily which of the following? A. Daily enemas B. Low-fiber diet C. Permanent colostomy D. Removal of affected piece of bowel
D. Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. A: Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. B: Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. C: The colostomy that is created in Hirschsprung disease is usually temporary. p. 1306
62
The parent of a 10-week-old infant tells the nurse, "She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed." The most appropriate nursing intervention is which of the following? A. Reassure parent that nothing is wrong. B. Explain how to better interpret infant cues. C. Evaluate for failure of parent to bond with infant. D. Reassure parent that periods of “unexplained fussiness” are normal.
D: A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent's concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.
64
Associated with trisomies 13, 18m and 221 (down syndrome), and with advanced maternal age (\>30 years)?
Omphalocele
66
Clinical manifestations of Intussusception?
Sudden acute abd pain child screaming and drawing knees to chest child appearing normal & comfortable b/w episodes vomiting lethargy passage of red, currant jelly-like stools Tender distended abd palpable sausage shaped mass in RUQ Empty RLQ eventual s/s of peritonitis (fever, prostration, etc)
68
Initial Management of Gastroschisis involves?
Covering exposed bowel with transparent bowel bag or loose, moist dressings. IVF and ABX LARGE amt of IVFs SURGICAL REPAIR!!
69
A PPI is ordered for an infant with GER. The nurse should include in the drug teaching that: A. drug should be given 30 min before bedtime. B. three times a day dosing has maximum effect. C. drug can be stopped once sxs have resolved. D. several days may pass before full effect
D. RATIONALE: PPIs require several days to achieve the max effect. A: Optimum admin time is 30 min before breakfast. This allows for peak plasma levels at mealtime. B: Once daily dosing is usually recommended. C: Continued admin is necessary to maintain effect. p. 1309
70
Management of Intussusception?
Radiologist guided air enema with or w/o water soluble contrast or U/S-guided hydrostatic (saline) enema. IVF, NG decompression, & ABX before hydrostatic reduction. Surgery if procedures are not successful Recurrence is RARE
71
Complications after Kasai procedure?
ascending cholangitis cirrhosis portal HTN GI bleeding
73
3 MAJOR signs of entercolitis that MUST be reported STAT?
Explosive watery diarrhea Fever Severe Lethargy
74
NEC is most common in?
Premies
76
Occurs when the proximal segment of the bowel telescopes into a more distal segment?
Intussusception
78
Main cause of death in children with SBS?
INFECTION
79
In terms of fine motor development, what should the infant of 7 months be able to do? A. Transfer objects from one hand to the other B. Use thumb and index finger in crude pincer grasp C. Hold crayon and make a mark on paper D. Release cubes into a cup
A: The ability to transfer objects from one hand to another occurs about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.
81
DX evaluation of biliary atresia is based on?
HX physical findings Labs
82
GER symptoms in Children
Heartburn abd pain noncardiac chest pain chronic cough dysphagia nocturnal asthma recurrent pneumonia
84
Management of Intussusception?
Radiologist guided air enema with or w/o water soluble contrast or U/S-guided hydrostatic (saline) enema. IVF, NG decompression, & ABX before hydrostatic reduction. Surgery if procedures are not successful Recurrence is RARE
86
Two common forms of cong abd wall defects?
Gastroschisis and omphalocele
87
When are feedings begun and how are they initiated for an infant after a pyloromyotomy (surgery for HPS)?
4 to 6 hrs post-op - start w/small, frequent feedings of glucose, water, or Lyte soln. If clear liquids are retained - formula is started 24 hrs after surgery.
88
Clinical manifestations of Hirschspung Disease during the Infancy period?
FTT Constipation Abd distention Episodes of diarrhea and vomiting Signs of entercolitis
89
Sara, age 4 months, was born at 35 weeks of gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was full term. The nurse should explain that: A. infants tend to become more difficult over time. B. Infants become less difficult if they are kept on scheduled feedings and structured routines. C. Sara's behavior is suggestive of failure to completely bond with her parents. D. Sara's difficult temperament is the result of painful experiences in the neonatal period.
B: Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.
90
Incidence of HPS?
First born children Boys 5 times \> girls More Caucasians than African American's Full-term infants more than premies Siblings and offspring of affected persons.
91
Passage of red, currant jelly-like stools occurs with?
Intussusception
92
3 MAJOR signs of entercolitis that MUST be reported STAT?
Explosive watery diarrhea Fever Severe Lethargy
93
Malformations associated with biliary atresia?
Polysplenia Intestinal atresia Malrotation of the intestine
94
Which of the following is a major long-term problem for a child with cleft lip and palate? A. Faulty dentition B. Nutritional deficits C. Aspiration pneumonia D. Abnormally small maxilla
A. A comprehensive team approach is used for children with cleft lip and palate. Extensive orthodontics and prosthodontics are usually required to correct the malposition of the teeth and other bony structures. The child can be adequately nourished before and after surgical repair takes place. Aspiration is a possibility before repair of the cleft palate, but it is not a long-term problem. The nonunion of the maxilla usually requires surgery and possible bone grafts to close.
95
The clinic is loaning a federally approved car seat to a 10-pound (4.5 kg) infant's family. The nurse should explain that the safest place to put the car seat is in the: A. back seat facing forward. B. Middle of the back seat facing rearward. C. front seat with airbags on passenger side. D. front seat if there is no air bag on the passenger side.
B: The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. The middle of the back seat is the safest position for the child. The infant must be rear facing to protect the head and neck in the event of an accident. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.
96
The nurse is guiding parents in selecting a daycare facility for their child. Which of the following is especially important to consider when making the selection? A. Health practices of facility B. Structured learning environment C. Socioeconomic status of children D. Cultural similarities of children
A: Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not consistently used. A structured learning environment is not the highest priority for this age child. Socioeconomic status of the children should have little effect on the choice of facility. Cultural similarities may be important to some families, but the facility's health care practices are more important.
97
What information should the nurse give a mother regarding the introduction of solid foods during infancy? A. Fruits and vegetables should be introduced into the diet first. B. Foods should be introduced one at a time, at intervals of 5 to 7 days. C. Solid foods can be mixed in a bottle to make the transition easier for the infant. D. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear.
B: One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant's diet. 3. Mixing solid foods in a bottle has no effect on the transition to solid food. 4. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months.
98
Pre-op care for infant with HPS undergoing a pyloromyotomy?
Decompression with NG NPO IVF of glucose and Lytes (NaCl & K) Strict I&Os and urine spec gravity VS, Daily Wt., assess skin & mucous membranes
99
The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse should expect the infant to now weigh approximately how many kilograms? A. 5.2 B. 6.3 C. 8.7 D. 9.6
B: Birth wt doubles at about ages 5-6 mo. At 6 mo, a child who weighed 3.2 kg at birth would weigh approx 6.3 kg. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 5.2 kg is too little. The infant would have tripled the birth wt by 6 mo; 8.7 kg to 9.6 kg is too much. The infant would have tripled the birth weight by 6 mo; 8.7 - 9.6 kg is too much.
101
Which of the following behaviors indicates that an infant has developed object permanence? A. Secures objects by pulling on a string B. Actively searches for a hidden object C. Recognizes familiar face, such as mother D. Recognizes familiar object, such as bottle
B: During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. The ability to understand cause and effect is part of secondary schema development, which is a later developmental task. B/w ages 8-12 weeks, infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence.
102
Labs associated with HPS?
Metabolic alterations d/t dehydration. Decreased Cl Increased pH & HCO3 (Metabollic alkalosis) Increased BUN
103
A mother tells the nurse that she is discontinuing breast-feeding her 5-month-old infant. The nurse should recommend that the infant be given: A. skim milk. B. whole cow's milk. C. commercial formula without iron. D. Commercial iron-fortified formula.
D: For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breast-feeding has been discontinued, then iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.
104
Distended abdomen, Gastric residuals, Blood in stools are highly indicative of?
NEC
105
Nutritional management for infants with biliary atresia?
Medium chain triglycerides and essential fatty acids. Vitamins - A, D, E, K multivitamin Minerals - iron, zinc, selenium Continuous gastrostomy feedings or TPN
106
Prognosis of HPS?
Excellent mortality rate is LOW 15% will have GER
107
Primary source of nutrition in children with SBS?
PN
108
Incidence of intussusception?
More common in: males children with cystic fibrosis
109
Complication after surgery for malrotation?
Short bowel syndrome (SBS)
110
Diarrhea Incidence
111
Abd pain or cramping manifested by loud cryinng and drawing legs up to the abd?
COLIC
112
Colic etiology?
• Rapid feeding • Overeating • Swallowing excessive air • Improper feeding technique (esp in positioning and burping) • Emotional stress or tension b/w parent & child
113
Other potential causes of colic?
Smoking strained parent-infant interaction lactase deficiency difficult infant temperament CNS immaturity
114
How much crying is considered colic in healthy baby?
\>3 hours/day \>3 days/week
115
When does colic usually onset, how long might it persist?
Onset after 2-4 weeks 30% might persist until 4 months
116
What is the MOST LIKELY cause of colic?
GI related etiology:
Lactose intolerance
Intolerance to proteins in mom's diet (eg cow's milk)
117
If colic approaching 4 months, what disease might be considered?
GERD
118
What are 5 management strategies for parents of infant with colic?
1) Parent reassurance - self-limting, no long term sequelae, nobody's fault
2) Keep a diary
3) Relief and support
4) Regular schedule and routine
5) \*\*DIET change in MOM (avoid diary, green veggies)
119
What are 3 nonpharm measures for colic?
1) Rocking, music, patting, car, burping
2) Check bottle nipple; feed baby more upright
3) If formula fed, switch formulas
120
What is a pharmacological measure for colic that is SAFE?
Simethicone (Ovol)
0.25-0.5ml drops with meals
but no proven efficacy
121
What pharm measure for colic might be effective but has safety concerns?
Antispasmodics
dicyclomine (Bentyl)
122
What are 2 safety concerns with antispasmodics, therefore should not be recommended?
Seizures
apnea
123
What is the recommendation for probiotics for treatment of colic?
Insufficient evidence to recommend for or against
## Footnote
124
What is the problem with gripe water?
Has alcohol, Effect is likely to sedate infant
125
Most common infections in the world?
Intestinal parasitic diseases
126
Two most common parasitic infections amoung children in the U.S.?
giardiasis & pinworms
127
MOST important nursing intervention for the cjild with a parasitic infection?
HYGIENE & HEALTH EDUCATION for the child and family
128
Most important precautionary method to teach a child with a parasitic infection as well as the family?
Thorough hand washing before eating or handling food and after using the toilet!!
129
The single most common intestinal parasitic pathogen in the U.S.?
Giardiasis
130
Cheif modes of giardiasis transmission?
Person to person
Food
Animals (esp puppies)
131
Clinical Manifestations of GIARDIASIS in infants and young children?
Diarrhea
Vomiting
Anorexia
Growth failure (FTT) - If chronic
132
How is giardiasis diagnosed?
Microscopic exam of stool specimens or duodenal fluid, Or ID of G. lamblia antigens in these specimens by EIA
Aspiration, BX, string test
Repeated microscopic exams of stool specimens may be req to id trophjozoites or cysts
133
What is the "String Test" and what is it used to diagnose?
Used to DX giardiasis
Child swallows gel cap with a nylon string attached, then several hours later it is withdrawn to analyse the contents
134
DRUGS used for Giardiasis?
metronidazole (**Flagyl**)
tinidazole (**Tindamax**)
nitazoxanide (**Alinia**)
135
Which 2 drugs used for giardiasis that have a metallic taste and GI side effects?
metronidazole (Flagyl)
Tinidazole
136
Most common helminthic infection in the U.S.?
Enterobiasis (PINWORMS)
137
\_\_\_\_\_\_\_\_\_\_\_\_\_ persist in the indoor environment for 2 to 3 weeks, contaminating anything they contact, such as toilet seats, doorknobs, bed linen, underwear, and food.
Pinworm eggs
138
The typical hand-to-mouth activity of infants and children makes them especially prone to reinfection with?
Pinworms
139
How long do pinworm eggs persist indoors?
2-3 weeks
140
How long do the giardiasis cysts survive?
MONTHS
141
Clinical Manifestations of pinworms?
Perianal ITCHING!!!
irritability
restlessness
bed-wetting
distractibility
142
How is the DX of pinworms made?
TAPE TEST
143
Details about the tape test?
Used to DX PINWORMS -
A loop of transparent tape, sticky side out, is placed around a tougue depressor and pressed against perianal area.
Specimens are Collected in the morning asap and before child has BM or bathed
May need to repeat 3 or more consecutive days
144
Drug of choice for pinworms?
Vermox
145
When is Vermox is not recommended in the TX of pinworms?
AGE \< 2 years
146
Drug regimen for children with pinworms?
DRUGS:(Vermox, pyrantel pamoate (Pin-Rid, Antiminth), or albendazole
REGIMEN: 1 dose initially, and a 2nd dose during the 2nd week
147
Details about Ascariasis (Roundworm)
Transferred to mouth by way of food, fingers, toys
Largest of intestinal helminths
Affects young children 1-4 y/o
Warm climates
148
C/M of Roundworms
LIGHT INFECTIONS - asymptomatic
HEAVY - anorexia, irritability, nervousness, enlarged abd, wt loss, fever, intestinal colic
SEVERE - intestinal obs., appendicitis, perforation w/peritonitis, obs. jaundice, lung involvement (pneumonitis)
149
Most cases of poisoning occur in children of what age group?
\< 6 years of age
150
What is the FIRST action parents should initiate when their child is poisoned?
Call the poison control center (PCC)!!!
151
Harmful substances commonly ingested?
Analgesics (acetaminophen!)
Plants (poison ivy, apple, apricot, etc.)
Cosmetics
Cough syrup
Hydrocarbons (gas, kerosene, lamp oil, lighter fluid, paint thinner/remover)
152
Where do MOST (90%) of harmful ingestions occur?
HOME
153
What decreased children poisoning drastically and when?
Poison prevention packaging act of 1970
154
C/M of acetaminophen poisoning?
Occurs in 4 stages:
1. INITIAL (2-4 hr) - N/V, sweating, pallor
2. LATENT (24-36)- patient improves
3. HEPATIC involvement (may last up to 7 days) - RUQ pain, jaundice, confusion, stupor, coagulation abnormalities
4. Patients who do not die in hepatic stage gradually recover
155
Most common accidental drug poisoning in children?
Acetaminophen
156
What is the toxic dose of acetaminophen in children?
150 mg/kg or more
157
Therapeutic management of acetaminophen poisoning?
Antidote - Mucomyst
Give orally but dilute in fruit juice or soda (offensive odor)
Given as one loading dose and 14 maintenance doses
158
C/M of Acute aspirin poisoning versus chronic aspirin poisoning?
ACUTE: nausea, disorientation, vomiting, dehydration, diaphoresis, hyperpnea, oliguria, tinnitus, coma, convulsions, hyperpyrexia
CHRONIC: Same as above but subtle onset. Dehydration, coma, seizures may be more severe, bleeding tendencies.
159
ASA Toxicity TX?
Hospitalization if severe
Emesis, lavage, activated charcoal, or cathartic may be used
Lavage will not remove concretions of ASA
Activated charcoal is important early in ASA tox
Sodium bicarb transfusions are used to correct metabolic acidosis
Monitor for any fluid overload
External cooling
anticonvulsants
O2 & ventilation for resp depression
Vit K for bleeding
HD (NOT PD) in severe cases
160
C/M of hydrocarbon ingestion?
Gagging, choking, coughing
N/V, lethargy
Tachypnea, cyanosis, retractions, grunting
IMMEDIATE DANGER is ASPIRATION
161
TX of hydrocarbon ingestion?
Inducing Emesis is contraindicated
If gastric lavage must be performed, a cuffed ETT MUST be in place before lavage
Symptomatic TX of chemical pneumonia includes: HIGH humidity, O2, hydration, & ABX
162
What are some examples of corrosives?
Drain, toilet, and oven cleaners
Liquid dishwasher detergent
Mildew remover
Batteries
Clinitest tablets
Denture cleaners
Bleach
163
TX of corrosive ingestion?
Dilute with water or mild usually no more than 120 mL
**DO NOT NEUTRALIZE!!!**
Airway mgmt
Analgesics
Keep NPO
164
ANTIDOTE for Benzodiazepines (diazepam [Valium], midazolam [Versed])?
flumazenil (Romazicon)
165
ANTIDOTE for cyanide?
amyl nitrate
166
ANTIDOTE for certain poisonous bites?
antivenin
167
MOST cases of acute childhood lead poisoning are from?
Paint in older home
lead contaminated bare soil in the yard
168
Acute signs of lead poisoning include?
N/V
Constipation
Anorexia
Abd pain
169
What is the level of concern for an elevated blood lead level (BLL)?
10 mcg/dl
170
Lead poisoning is a high concern in individuals that repaint and renovate homes built before?
1978
171
Term used for removing lead from circulating blood and, theoretically, some lead from organs and tissues?
Chelation
172
The MAJOR principles of TX for poisoning include?
Assessment, ABCs
Minimization of poison absorption
Prevention of complications
Family support
Prevention of recurrence
173
Chealating agents for lead poisoning include?
Calcium disodium edetate (EDTA)
succimer (DMSA)
British antilewisite (BAL)
D-penicillamine
174
NURSING CARE for children who undergo chelation therapy?
Prep for injections
REDUCE injection pain (the injections are admin deep into large muscle)
Inject procaine with the drug
ROTATE SITES
I&Os & U/A results!!! Lead and chelation are TOXIC to kidneys!!
175
What are the classic FIRST symptoms of appendicitis?
Periumbilical pain, followed by nausea, RLQ pain, and then later vomiting with fever
176
The 4 general mechanisms of diarrhea are?
Secratory
Cytoxic
Osmotic
Dysenteric
177
PRIMARY TX of acute diarrhea?
Oral rehydration and provision of adequate diet
178
LEADING cause of illness in children \< 5 years of age?
ACUTE DIARRHEA
179
Chronic diarrhea is an increase in stoll frequency and increased water content with a duration of more than?
14 days
180
Treat infants and children with acute diarrhea and dehydration FIRST with?
Oral rehydration therapy (ORT).
181
What are the major goals in the management of acute diarrhea?
(1) assessment of fluid and electrolyte imbalance
(2) rehydration
(3) maintenance fluid therapy
(4) reintroduction of an adequate diet.
182
What is intractable diarrhea?
**_Diarrhea that:_**
Occurs in the first few months of life
Persists for longer than 2 weeks with no recognized pathogens
AND is refractory to TX
