GI Flashcards
2201 exam #1 GI
Malabsorption d/t decreased mucosal area?
SBS
Initial management after delivery of infant with omphalocele?
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)
Most common cause of intestinal obstruction in children b/w ages 3 months and 3 years?
Intussusception
The DX of HPS is PRIMARILY based on?
H&P - PRIMARY -projectile vomiting, olive shaped mass U/S - 2nd choice Upper GI radiography - 3rd choice
Most common manifestation of GER during infancy?
Passive regurgitation or emesis
Occurs when the abd contents herniate through the umbilical ring, usually with an intact sac?
Omphalocele
Most common site of intussusception?
Ileocecal valve (ileocolic)
When does GER most frequently occur?
After meals and at night
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)
SBS prognosis?
Improved with advances in PN and enteral nutrition. Intact Ileocecal valve improves prognosis
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.
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
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 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.
Why is Necrotizing Enterocolitis so serious?
Because it occurs in infants, who cannot describe their pain level – so it can be missed or overlooked
Pre-op care for infant with HPS undergoing a pyloromyotomy?
Decompression with NG Hydration and Lyte balance NPO IVF of glucose and Lytes
DX of Hirschspung Disease?
Neonate: Clinical signs or failure to pass meconium Infants & children: H&P Rectal BX confirms DX Barium enema
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. 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.
Biliary Atresia Management?
Nutritional support Kasai procedure liver transplant
HPS has GREATEST risk of recurrence in which individual?
First-born boy of a mother who was affected.
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
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.
Biliary atresia is not seen in the _________ or _______ or _________ infant.
fetus stillborn newborn
Primary source of nutrition in children with SBS?
PN
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: 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
Nursing Care for SBS?
NUTRITIONAL THERAPY Prevent complications r/t central venous device
Which of the following is the earliest clinical manifestation of biliary atresia? A. Jaundice B. Vomiting C. Hepatomegaly D. Absence of stooling
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.
True or False: HPS is a congenital disorder.
FALSE It is NOT a cong disorder
Passage of red, currant jelly-like stools occurs with?
Intussusception
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
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.
Dx of Intussusception?
Frequently made on subjective data alone. Definitive DX-Barium enema (MUST do abd XR 1st) Rectal exam - reveals mucus
Clinical manifestations of Hirschspung Disease during childhood?
Constipation Ribbonlike, foul-smelling stools Abd distention visible peristalsis easily palpable fecal mass Undernourished, anemic in appearance
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
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
Transfer of gastric contents into the esophagus?
Gastroesophageal reflux (GER)
Acute inflammatory disease of the bowel with increased incidence in preterm and other high-risk infants.
Necrotizing Enterocolitis (NEC)
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
DX of biliary atresia is confirmed by?
Exploratory lap & intraoperative cholangiogram
Manifestations of Malrotation?
Bilious vomiting Abd pain Abd distention GI bleeding
Cong anomaly resulting in mechanical obstruction from inadequate motility of part of the intestine?
Hirschspung Disease (Cong Aganglionic Megacolon)
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.
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.
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.
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)
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.
Abdominal pain, abdominal mass, and bloody stools are the classic triad of ________ symptoms?
Intussusception
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
HPS may be associated with other disorders such as?
Intestinal malrotation Esophageal and duodenal atresia Anorectal anomalies
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.
Labs associated with HPS?
Metabolic alterations d/t dehydration. Decreased Cl Increased pH & HCO3 (Metabolic alkalosis) Increased BUN
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.
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.
DX of GER?
H&P Upper GI 24 hr intraesophageal pH - GOLD STANDARD!!! Scintigraphy-detects radioactive sub feeding comp.
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
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
Leads to cirrhosis, liver failure, and eventually death if untreated?
Biliary atresia
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)
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
Occurs when the intestine herniates lateral to the umbilical ring, usually to the right of the umbilicus and without a sac?
Gastroschisis
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
occurs in approx. 1 in 10,000 - 15,000 live births?
Biliary atresia
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
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
What is the primary TX for biliary atresia?
Kasai portoenterostomy
Projectile vomiting is associated with?
HPS
Nursing care for Intussusception?
NPO Pain mgmt. Check for jelly like stool If stool is normal, Intussusception has resolved
The biggest single reason why children need a liver transplant is _________________
Biliary Atresia
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
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.
abnormal rotation of intestine during embryonic development?
Malrotation
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.
Olive-like mass in the upper abdomen is associated with?
HPS
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
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.
