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Peds Exam 2 > GI > Flashcards

GI Flashcards

1
Q

Why are infants at higher risk than adults for dehydration?

A

-Higher % of H2O in Extracellular fluid (ECF)
-Immature renal function
-Decreased ability to concentrate urine
-Decreased GFR
-Higher metabolic rates = Higher H2O consumption
-Unable to communicate thirst
-Thirst receptors underdeveloped
-Proportionally greater BSA
-Proportionally longer GI tract
-Increased BMR due to constant state of growth

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2
Q

What are the signs and symptoms of dehydration in infants?

A

-Fewer wet diapers than usual
-No tears when crying; inside of mouth dry and sticky
-Irritability, high-pitched cry
-Difficulty in awakening, change LOC
-Increased respiratory rate or difficulty breathing
-Sunken fontanel, sunken eyes with dark circles
-Abnormal skin color, temperature, or dryness
-Prolonged cap refill time
-Tachycardia
-Hypotension

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3
Q

What is the intervention for mild/moderate dehydration?

A

-Managed at home with ORT
-Replace fluids over 4-6 hour
-Maintain current fluid requirements
-Start with 50 mL/kg of ORT, increase 100mL/kg for moderate cases

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4
Q

What is the intervention for severe dehydration?

A

-Need IVF boluses: 20mL/kg over 5 – 20 min minutes
-Usually using isotonic IVF for replacement: NS or LR

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5
Q

What viral pathogen is the most common cause of dehydration in infants in the US?

A

Rota Virus

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6
Q

What is the advice for parents on feeding a child with GERD?

A

-Avoid foods that exacerbate acid reflux
-Feeding maneuvers
-Positioning
-Pharmacologic therapies – histamine receptor agonist – ranitidine (Zantac)
-In severe cases – surgical management (Nissen fundoplication)

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7
Q

What is the nursing care following surgery for Hirschprung disease?

A

-Help parents understand defect
-Foster bonding
-Prepare for medical-surgical
interventions
-Assist with colostomy care
post procedure

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8
Q

What is Hirschprung disease?

A

Congenital Aganglionic Megacolon

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9
Q

What are the clinical manifestations for Hirschprung disease?

A

-Distended abdomen
-Feeding intolerance
-Bilious vomiting
-Delay in the passage of meconium
-Enterocolitis is most common complication
-More common in Down syndrome

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10
Q

What is the therapeutic management of Hirschsprung disease?

A

-Surgery – remove Aganglionic portion of bowel
-Relieves obstruction and restores normal bowel motility
-2 step procedure: ostomy to relieve distension, pull through procedure later

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11
Q

How should you position a child with pain due to appendicitis?

A

let the child pick which position they want that is comfortable

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12
Q

What is appendicitis?

A

-The inflammation of the vermiform appendix, a blind sac at the distal end of the cecum
-Most common cause of surgical emergency in children

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13
Q

when does appendicitis go to peritonitis?

A

Perforation or rupture can happen within 48 hours of initial symptoms

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14
Q

What is the average age of appendicitis diagnosis?

A

10 year old

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15
Q

How do you diagnosis appendicitis?

A

-CBC
-Urinalysis (r/o UTI)
-Serum pregnancy test (r/o ectopic pregnancy in adolescent girls)
-WBC, CRP
-CT scan

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16
Q

What are signs and symptoms of appendicitis?

A

-Diffuse abdominal pain that then
-Localizes to RIGHT LOWER QUAD at McBurney’s Point
-Rebound tenderness at RLQ
-N/V, anorexia
-Low grade fever
-Elevated WBC
-Decreased bowel sounds
-Abdominal distention, rigidity and guarding

17
Q

What are signs and symptoms of peritonitis?

A

-Fever
-Progressive abdominal distention and rigidity
-Sudden relief of pain followed by diffuse pain
-Decreased bowel sounds
-N/V
-Elevated WBC
-Tachycardia
-Rapid shallow breathing
-Pallor, chills, irritability

18
Q

What is post op care for a patient whose appendix ruptured?

A

-IVF
-NPO with NGT to low/intermittent suction
-Monitor for evidence of GI motility /Peristalsis
-Skin care of surgical site
-Possible care of Penrose drain
-Pain management
-Days of IV antibiotics

19
Q

What measures can be taken to care for a child post-surgery for cleft lip?

A

-Gavage feeds may be needed
-Breastfeeding moms need support and encouragement
-May need to pump milk and use an assisted delivery bottle for feeding
-Assess abdominal distention from swallowing air
-Need frequent burping
-Monitor for signs of aspiration and respiratory distress
-Assess feeding ability
-Suck and swallow reflexes are present
-ESSR feeding technique
-Enlarge nipple, Stimulate suck reflex, Swallow fluid appropriately, Rest when infant signals with facial expression
-Assisted delivery bottle: Haberman bottle
-Position infant upright when feeding
-Keep feeds less than 30 minutes
-Feed small amount of water after eating to prevent pooling of formula

20
Q

how do you diagnosis a cleft lip or palate?

A

-Prenatal Ultrasound
-Visual assessment at birth
-Important to assess palate in newborn

21
Q

A nurse is providing care for an infant following a surgical repair of a cleft lip. Which of the following actions should the nurse take to minimize the infant’s crying?

a) Gently rock the infant with a favorite blanket

b) Offer the infant a pacifier

c) Place the infant in an infant seat at the nurse’s station

d) Position the infant on the abdomen

A

a) Gently rock the infant with a favorite blanket

22
Q

A nurse is caring for a child in the ED with acute abdominal pain and possible appendicitis. Which is appropriate to relieve the abdominal discomfort?

A. Place in Trendelenburg position
B. Allow the child to assume a position of comfort
C. Apply a heating pad to the abdomen
D. Administer a saline enema to cleanse the bowel

A

B. Allow the child to assume a position of comfort

23
Q

A histamine-receptor antagonist such as ranitidine (Zantac) is ordered for an infant with Gastroesophageal reflux (GER). The purpose of this is to:

a) Prevent reflux

b) Prevent hematemesis

c) Reduce gastric acid production

d) Increase gastric acid production

A

c) Reduce gastric acid production

24
Q

What is the nursing care for a child with trachea-esophageal fistula?

A

-Key to diagnose prior to first feeding
-Monitor for 3 C’s: Coughing, Choking, Cyanosis
-Excessive salivation and drooling
-Monitor for abdominal distention
-Maintain patent airway
-Supine position, elevated 30 degrees
-Frequent or continuous suctioning of oral cavity
-Surgical emergency
-NPO immediately
-Gastric tube placement

25
Q

A nurse is providing care for an infant following a surgical repair of a cleft lip. Which of the following actions should the nurse take to minimize the infant’s crying?

a) Gently rock the infant with a favorite blanket

b) Offer the infant a pacifier

c) Place the infant in an infant seat at the nurse’s station

d) Position the infant on the abdomen

A

a) Gently rock the infant with a favorite blanket

26
Q

What is the nursing care for a child with oomphalocele?

A

-Maintain infant NPO
-IV therapy
-Monitor infant temperature closely
radiant warmer
-Omphalocele – Keep sac moist and protected from trauma
-Gastroschisis - Keep viscera moist and protected from trauma
-Low intermittent gastric suction via NGT
-Repair may be staged depending on size of defect
-Silo used to support defect if reduced over time
-May take 7-10 days for full reduction and abdominal closure

27
Q

What are the symptoms of pyloric stenosis?

A

-Projectile non-bilious vomiting
-Dehydration
-FTT with hunger cues
-Lethargy
-Fluid/electrolyte disturbances
-Upper abdomen distention with visible peristaltic waves
-Palpable olive like mass in the upper quadrant

28
Q

What is the treatment for intussusception?

A

-Radiologist guided pneumoenema
-Ultrasound guided hydrostatic (saline) enema
-If not successful surgical intervention may be needed
-Nonoperative reductions are successful in 80% of cases
-Recurrence of condition post treatment occurs in 1 out of 10 patients

29
Q

What is intussusception?

A

-Portion of the bowel invaginates into a more distant portion of the bowel (telescoping)
-Leads to possible infarction, obstruction, or perforation
-Most common cause of acute intestinal obstruction in children <5 years old
-More common in males and pediatric patients with cystic fibrosis

30
Q

A patient is to receive TPN and lipids. Which of the following is the priority when caring for this patient?

A. monitor the patient’s blood glucose per protocol
B. Infuse the solution in a large peripheral vein
C. Change the infusion set every 72 hours
D. Monitor urine specific gravity q shift

A

A. monitor the patient’s blood glucose per protocol
D. Monitor urine specific gravity q shift

31
Q

What is the risk of TPN (total parenteral nutrition)?

A

Long term use = liver failure

32
Q

What medications are used for severe inflammatory bowel disease?

A

-Aminosalicylates
-Corticosteroids
-Immunomodulators
-Antibiotics
-Biologics

Peds Exam 2 (6 decks)

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