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Peds > GI > Flashcards

GI Flashcards

1
Q

the stomach is round until about what age

A

2

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2
Q

emptying time of the stomach is slower or faster in infants

A

faster

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3
Q

stomach acid is not fully produced until when

A

6M

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4
Q

what is failure to thrive

A

inadequate growth resulting from inability to obtain or use calories required for growth

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5
Q

what deficiency is most common in children 12-36M

A

iron

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6
Q

what are the two characteristics of failure to thrive

A

weight/height less than 5th percentile
persistent deviation from an established growth chart

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7
Q

what are the 3 classifications of failure to thrive

A

organic, non-organic, idiopathic

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8
Q

what is organic failure to thrive

A

failure to thrive with a physical cause like an underlying medical condition

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9
Q

what is non-organic failure to thrive

A

potentially a psychosocial cause but not 1–% sure

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10
Q

what is idiopathic failure to thrive

A

we have no idea why this has happened

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11
Q

what are the clinical manifestations of non-organic failure to thrive

A

developmental delays (social, motor, language), inadequate feeding, no stranger anxiety, no eye contact, apathy

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12
Q

what are some of the factors that may contribute to failure to thrive

A

caregiver (hard time understanding infants needs), poverty, health beliefs, inadequate nutritional knowledge, family stress/crisis, feeding resistance, insufficient breast milk

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13
Q

what are the primary goals with failure to thrive

A

catch up their growth and correct nutritional deficiencies

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14
Q

what is cleft palate

A

involves abnormal openings in the lip or palate

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15
Q

is cleft palate unilateral or bilateral

A

can be either

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16
Q

what are some of the potential teratogens that can cause a cleft palate

A

anticonvulsants, accutane, alcohol, rubella, radiation, early maternal smoking

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17
Q

when a child has a cleft palate they will mouth breathe more exclusively, what does this result in

A

more swallowed air which will distend the abdomen and cause pressure on the diaphragm
dry, cracked mucous membranes
increased risk of infection due to aspiration pneumonia

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18
Q

if a child needs a surgical correction of the lip due to cleft palate when can it be expected to be done

A

within the first weeks of life

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19
Q

if a child has a true cleft palate when can this expect to be fixed and why

A

between 12-18 months, so they have time to grow and develop teeth as well as letting the natural shifts of the palate, but needs to be fixed before speech

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20
Q

why should babies with cleft palate be burped frequently

A

because they are swallowing more air when they feed

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21
Q

how can you promote bonding of a parent and a baby with a cleft palate

A

Encourage expression of grief and fears
Emphasize the positive
Express optimism regarding surgical correction while acknowledging concerns
Handle the infant like a precious human

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22
Q

infants with cleft palate should be fed no longer than how long at a time

A

20-30 minutes

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23
Q

how should a baby with a cleft LIP be positioned post-operatively **

A

on their back

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24
Q

how should a baby with a cleft palate be positioned post operatively **

A

on their belly

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25
Q

what is a good tool to use for infants after they have a cleft palate correction surgery to avoid having them pick at their sutures

A

elbow restraints

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26
Q

what are 3 specific long term consequences of cleft palate

A

altered speech, altered dentation, and potential hearing problems

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27
Q

how would you educate the parents of a child with a cleft palate (after correction) to promote speech development

A

promote development of the oral muscles by blowing bubbles, chewing, swallowing, using a party horn, blowing on pinwheels

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28
Q

what is a tracheoesophageal fistula

A

failure of the esophagus to develop as a continuous passage (esophageal atresia) and/or failure of the trachea and esophagus to separate

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29
Q

what are clinical manifestations of esophageal atresia and tracheoesophageal fistula

A

frothy saliva in the mouth / nose, choking and coughing, feedings return through the nose and mouth, may becomes cyanotic
*remember the 3 c’s : choking, coughing, cyanosis

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30
Q

what are the nursing considerations with a patient who has esophageal atresia and/or tracheoesophageal fistula

A

Do not feed if this is suspected
Maintenance of airway #1 priority
Prevention of pneumonia
Prepare for surgical correction

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31
Q

postoperatively, what is to be expected on the nurse for a patient that had esophageal atresia and/or tracheoesophageal fistula

A

provide careful suctioning
high humidity
maintain adequate nutrition
positioning upright
preventing pneumonia
care of chest tubes
provide comfort and physical contact
NG to LWS - irrigated frequently

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32
Q

what are the 2 preoperative nursing interventions for an anorectal malformation

A

GI decompression, IV fluids

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33
Q

what are the postoperative nursing considerations for an anorectal malformation

A

perineal care
positioning - either side lying with hips elevated or supine with legs suspended to take pressure off the sutures
colostomy care
adequate nutrition

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34
Q

what is an omphalocele

A

herniation of the abdominal contents through the umbilicus ring - there is an intact peritoneal sac

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35
Q

what is a gastoschisis

A

herniation of the abdominal contents right of the umbilical ring - there is NO peritoneal sac

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36
Q

what do you do as the nurse if you walk in and see an omphalocele or gastroschisis of an infant

A

loosely cover with saline soaked pads and a plastic drape and call HCP

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37
Q

after an infant has a surgical correction for an omphalocele or gastroschisis what does the nurse need to do to care for the patient

A

careful handling and sterile technique around sutures
monitor for ileus
promote bonding between baby and parents
be involved with discharge planning and educating about home care

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38
Q

what is most likely the culprit of gastroenteritis

A

a virus (usually rotavirus or norovirus)

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39
Q

what are the symptoms of gastroenteritis

A

low grade fever, nausea, vomiting, abdominal cramps, watery diarrhea

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40
Q

when someone has gastroenteritis, how long do they stay contagious

A

for weeks because there is continual viral shedding

41
Q

what is the usual transmission of bacterial diarrhea

A

fecal - oral transmission (eating contaminated food)

42
Q

what are the symptoms of bacterial diarrhea

A

abdominal cramps (severe), malaise, and bloody diarrhea

43
Q

what is the usual treatment for someone with gastroenteritis

A

oral rehydration plus a normal diet for mild - moderate dehydration
IV fluids - moderate - severe dehydration

44
Q

a child with gastroenteritis is on your floor and is asking for a coca-cola while he plays video games, what is your response and why

A

nope, sodas/sports drinks/fruit juices have caffeine and will make you have to pee more and we need you to hold fluid and not get rid of it

45
Q

how do you determine how much fiber a child should have

A

age + 5 for children older than 3

46
Q

when giving a child fiber for constipation what is a key thing not to forget

A

fluids, fluids, fluids

47
Q

when assessing a child’s level of constipation we look at quality and quantity, which is more important

A

quality

48
Q

what is enopresis

A

chronic constipation with soiling

49
Q

what are the potential causes of enopresis

A

psychological trauma, voluntary withholding, chronic constipation

50
Q

what are the 3 key management interventions to help with enopresis

A

purge the bowel - some sort of bowel prep solution to clear it out
stool softeners
bowel retraining (potty same time every day 10-15 minutes)

51
Q

what is Hirschsprung disease

A

enlargement of the bowel proximal to defect in autonomic parasympathetic ganglion cells in the color - this results in mechanical obstruction

52
Q

what is the most dangerous complication of Hirschsprung disease

A

enterocolitis

53
Q

what is enterocolitis and what are the symptoms

A

inflammation of the small intestines and colon
bloating, bloody stools, fever, vomiting, can lead to necrotizing enterocolitis

54
Q

what are the clinical manifestations of Hirschsprung disease in newborns

A

failure to pass meconium within 48-hours, food refusal, bilious vomiting, abdominal distention

55
Q

what are the clinical manifestations of Hirschsprung disease in infants

A

poor weight gain, constipation, abdominal distention, episodes of vomiting and diarrhea

56
Q

what are the clinical manifestations of Hirschsprung disease is children

A

constipation, ribbon like foul smelling stools, palpable fecal mass, abdominal distention, poor appetite and growth

57
Q

what are the 5 pre-op nursing considerations for a child with Hirschsprung disease

A

Note first BM for all babies
Measure abdominal girth daily
Bowel prep enemas and antibiotics
Monitor hydration, fluid, and electrolyte status
Teach enema techniques to parents

58
Q

what are the 6 post-op nursing considerations for a child with Hirschsprung disease

A

NG to LWS
NPO
I & O to include NG losses and ostomy drainage
Hydration and electrolyte balance
Abdominal assessment
Ostomy care

59
Q

what is gastroesophageal reflux disease (GERD)

A

the passive transfer of gastric content into the esophagus, transient and inappropriate relaxations of the lower esophageal sphincter

60
Q

what are some factors that can increase a child’s risk of GERD

A

Prematurity
Bronchopulmonary dysplasia
Esophageal scar tissue
Neurological disorders
Scoliosis
Asthma
CF
Some medications

61
Q

what are s/s in infants of GERD

A

Spitting up a lot (can be forceful and painful)
Intermittent vomiting
Blood in throw up or stool
Irritability
Classic back arching
ALTE or apnea
Persistent aspiration pneumonia

62
Q

what are s/s in children of GERD

A

Heartburn
Anemia
Persistent aspiration pneumonia
Chronic cough
Difficulty swallowing
Abdominal pain

63
Q

what are types of medications a child with GERD would be prescribed

A

Antacids or histamine receptor antagonists
Proton pump blocker
Prokinetic medications

64
Q

what is the surgical treatment for GERD

A

Nissen fundoplication - takes the top of the stomach and wraps it around the LES to strengthen the closure

65
Q

what HOB elevation should a child with GERD be placed in after eating

A

30 degrees

66
Q

why is it not beneficial to have an infant sit in a stroller after eating if they have GERD

A

Because they will scrunch up because they don’t have the abdominal muscles to support themselves and that increases the pressure on their abdomen

67
Q

what foods should be avoided with children who have GERD

A

fatty foods, chocolate, tomato products, carbonated liquids

68
Q

how do feedings look different for an infant with GERD

A

smaller, frequent feedings with a thickened formula

69
Q

what is hypertrophic pyloric stenosis

A

when the circular muscle of the pylorus becomes thickened causing obstruction of the gastric outlet and contents are not able to pass from the stomach to the intestines

70
Q

do males or females have a higher likelihood of developing hypertrophic pyloric stenosis

A

males

71
Q

what are the clinical manifestations of hypertrophic pyloric stenosis

A

Projectile vomiting without bile
Hunger and irritability progressing to lethargy
Dehydration and weight loss
Visible gastric peristalsis
Olive shaped mass upon palpation of abdomen, right above umbilicus

72
Q

what are the pre-op nursing considerations for a child with hypertrophic pyloric stenosis

A

NPO, strict I&O, monitor IV fluids, monitor electrolytes, NG tube

73
Q

what are the nursing considerations post-op for a patient with hypertrophic pyloric stenosis

A

pain control and titrating PO feedings

74
Q

what is the highest priority of a patient with hypertrophic pyloric stenosis

A

hydration level

75
Q

what is intussusception

A

invagination of telescoping of one portion of the intestine into another

76
Q

is intussusception more likely to happen in males or females

A

males

77
Q

what are the potential complications from intussusception

A

obstruction
inflammation
edema
ischemia
perforation
shock

78
Q

what are the clinical manifestations of intussusception

A

Severe paroxysmal abdominal pain
Screaming and drawing knees up to chest
Vomiting, bile or fecal stained
Palpable sausage - shaped mass upper right quadrant
Current jelly like stools

79
Q

what is the purpose of an enema for a patient with intussusception

A

it will confirm diagnosis and has a high chance of fixing it

80
Q

what is celiac disease

A

a chronic inflammation of the small intestinal mucosa, which may result in varying degrees of atrophy to intestinal villi, malabsorption, and a variety of CM triggered by the inability to digest gluten

81
Q

where is gluten found

A

wheat, oat, barely, rye

82
Q

someone with celiac disease will not show symptoms until what age

A

roughly 6M

83
Q

when do the major symptoms of celiac disease present in children

A

1-5Y

84
Q

what are the clinical manifestations of celiac disease

A

progressive malnutrition
secondary deficiencies (anemia, rickets)
watery, pale, foul smelling stools
vomiting, consitpation

85
Q

what diet is recommended for children with celiac disease

A

eliminate triggers, eat diets high in calories and protein and low in fat, supplemental vitamins and iron

86
Q

what is short bowel syndrome

A

malabsorptive disorder that occurs as a result of decreased mucosal surface area

87
Q

what are the problems associated with short gut syndome

A

less absorption of fluid, electrolytes, and nutrients

88
Q

for a patient with short gut syndrome how can you stimulate intestinal adaptation

A

slow, steady stimulation with TPN

89
Q

what is acute appendicitis

A

inflammation of the vermiform appendix

90
Q

what are the potential causes of acute appenditis

A

Obstruction of the lumen of the appendix, hardened fecal material, foreign bodies, microorganism parasites (not pin worms)

91
Q

what are the clinical manifestations of acute apendicitis

A

colicky abdominal pain and tenderness in the lower right quadrant
guarding of the abdomen
rebound tenderness
nausea, vomiting, anorexia
low grade fever

92
Q

in the case of acute appendicitis, a fever > 102 indicates what

A

perforation

93
Q

what are the signs of peritonitis

A

Sudden relief of pain (usually means rupture), tachycardia, rapid shallow breathing, chills, restlessness, pallor

94
Q

how is the therapeutic management of peritonitis after appendicitis differ from the regular care of an appendectomy

A

NG tube and delayed closure to prevent abscess

95
Q

what two things must you specifically avoid if a patient has an acute appendicitis

A

enemas and heating pads - these can speed up rupturing

96
Q

how long does it take for a child to return to sports after having an appendectomy

A

4-6 weeks plus a surgeon release

97
Q

what is meckel diverticulum

A

a fibrous band connecting the small intestines to the umbilicus

98
Q

what are the potential complications from meckel diverticulum

A

bleeding from peptic ulceration or perforation, obstruction, inflammation

99
Q

what are the clinical manifestations of meckel diverticulum

A

painless rectal bleeding
abdominal pain
obstruction
currant, jelly like stools (hematochezia)

Peds (12 decks)

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