GI Flashcards
3 types of mouth hole clefts
incomplete fusion of lip, palate, or both
2 ways to improve feeding with clefties?
◦ special bottles that can cover palate area
◦ maneuvers: squeeze cheeks for cleft lip
when does surgery happen for cleft lip vs cleft palate?
3 months for lip
18 month for palate
diet for cleft palate after surgery?
Clear liquid diet for 24 hours
Liquid diet for 2 weeks
Soft diet for 6 weeks
post op considerations for clefties?
• Avoid trauma to the site by avoiding placing things in the mouth (ex. thermometer, toys)
◦ elbow restraints to keep them from putting hands/objects in mouth
• Avoid client rubbing the site
• Pain relief - pharm/nonpharm
Most reliable indicator of fluid loss for infants and young children=
body weight
when total output of fluid exceeds intake of fluid =
dehydration
s/s of dehydration
• Weight loss, irritability, increased pulse, decrease b/p, increase urine specific gravity
urine specific gravity normal vs dehydration
1.010 to 1.025= normal range
> 1.025 = dehydration
first line intervention with signs of dehydration
oral rehydration therapy
what do we do after rehydration is achieved?
alternate oral rehydration therapy with low-sodium solution (water, breast milk, lactose free formula)
urine output for infant vs child
- Child= > 1ml/kg/hr
* Infant= >2ml/kg/hr
s/s of adequate fluid volume
- Moist mucus membranes
- Cap refill of 2 seconds or less
- Brisk skin turgor
- Balanced fluid intake and output
- Electrolytes in expected range
mild/mod/severe dehydration:
◦ weight loss 3-5% infant ◦ weight loss 3-4% children
mild
mild/mod/severe dehydration:
◦ weight loss 6-9% infant ◦ weight loss 6-8% children
moderate
mild/mod/severe dehydration:
◦ weight loss >10% in infants ◦ weight loss >10% in children
severe
how does BP change from mild/mod/severe dehydration
mild = normal mod = orthostatic severe= orthostatic --> shock
cap refill mod/mild/severe dehydration
mod = >2
mild - 2-4
severe = >4
breathing mild/mod/severe dehydration
mild: normal
mod: slgiht tachypnea
severe: hyperpnea
s/s of severe dehydration
cap refill >4 seconds, tachycardia, orthostatic BP can progress to shock, extreme thirst, very dry mucous membrane, tented skin, hyperpnea, no tearing, sunken eyeballs, sunken anterior fontanel, oliguria to anuria
1 cup = ____ ounces
8
1 ounce = ____ mL
30
3 types of dhydration
isotonic, hypotonic, hypertonic
GERD vs GER?
• Gastric contents come back up into esophagus causing injury
*becomes disease when tissue damage is done
infant vs children s/s of GERD
Signs/Symptoms Infants::
-Vomiting, irritability, arching of back, weight loss, failure to thrive, wheezing, respiratory problems
Signs/Symptoms Children::
-Heartburn, difficulty swallowing, chronic cough (different than adults –> like asthma in kids)
interventions for GERD
- small frequent meals
- thicken infant formula with 1 tsp to 1 tbsp rice cereal/ 1 oz milk
- elevate head after meals for 1 hour
- avoid irritating foods
what is Nissen Fundoplication? when do we use it?
wraps fundus of stomach around distal esophagus to decrease reflux (for severe GERD)
Narrowing/thickening of the pyloric sphincter causing an obstruction =
pyloric stenosis
what happens as a result of pyloric stenosis?- aka whats the big deal?
The narrowing doesn’t allow for emptying of the stomach contents
s/s of pyloric stenosis
- Vomiting after feedings – projectile vomiting
- Projective vomiting followed by hunger
- Olive shaped mass in RUQ;
- possible peristaltic wave from left to right
- dehydration
intervention for pyloric stenosis
pylorotomy / pyloromyotomy
complications from pyloric stenosis
recurrent pneumonia, weight loss, failure to thrive
Proximal segment of bowel telescopes into distal section of bowel =
Intussusception
what happens as a result of Intussusception to the intestines?
Edema from lymphatic and venous obstruction
• Ischemia and increased mucus into intestine
s/s of intussesception
- Palpable mass in RUQ of abdomen
- Stools mixed with blood and mucus (red currant jelly stools)
- Vomiting; Lethargy
- Drawing knees to the chest in severe pain then normal behavior
- Eventual fever and signs of peritonitis
treatment for intussesception?
air enema
Mechanical obstruction from inadequate motility of part of intestine due te lack of ganglionic cells in segments of colon =
Hirschsprung Disease
Section of large intestine without nerve innervation =
Aganglionic megacolon
interventions for Aganglionic megacolon
Surgery to obtain normal bowel function
First surgery – create temporary ostomy –> Relieves obstructed area
s/s of appendicitis
• Pain, fever, rigid abdomen • Anticipate need for appendectomy • Avoid enemas and laxatives • Rovsing’s sign – appendicitis ◦ Tenderness in RLQ with palpation of any quadrant
appendix PERFORATION s/s
- Sudden decrease in abdominal pain (short time before peritonitis)
- Peritonitis
- Distended abdomen
- Fever – high
RBC/WBC/Neutrophils/Lymphocytes ofr appendicitis
RBC 4-5.5 million/mm3
WBC 5,000- 10,000/mm3
Neutrophils 3,000-5,800/mm3
Lymphocytes 1,000-4,000/mm3
s/s of celiac disease
◦ Growth problems, chronic diarrhea/constipation, recurring abdominal pain and bloating, fatigue, irritability
avoid all ____ with celiac
gluten
–> barley, rye,wheat
