GI Flashcards
1
Q
the stomach is round until about what age
A
2
2
Q
emptying time of the stomach is slower or faster in infants
A
faster
3
Q
stomach acid is not fully produced until when
A
6M
4
Q
what is failure to thrive
A
inadequate growth resulting from inability to obtain or use calories required for growth
5
Q
what deficiency is most common in children 12-36M
A
iron
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
7
Q
what are the 3 classifications of failure to thrive
A
organic, non-organic, idiopathic
8
Q
what is organic failure to thrive
A
failure to thrive with a physical cause like an underlying medical condition
9
Q
what is non-organic failure to thrive
A
potentially a psychosocial cause but not 1–% sure
10
Q
what is idiopathic failure to thrive
A
we have no idea why this has happened
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
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
13
Q
what are the primary goals with failure to thrive
A
catch up their growth and correct nutritional deficiencies
14
Q
what is cleft palate
A
involves abnormal openings in the lip or palate
15
Q
is cleft palate unilateral or bilateral
A
can be either
16
Q
what are some of the potential teratogens that can cause a cleft palate
A
anticonvulsants, accutane, alcohol, rubella, radiation, early maternal smoking
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
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
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
20
Q
why should babies with cleft palate be burped frequently
A
because they are swallowing more air when they feed
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
22
Q
infants with cleft palate should be fed no longer than how long at a time
A
20-30 minutes
23
Q
how should a baby with a cleft LIP be positioned post-operatively **
A
on their back
24
Q
how should a baby with a cleft palate be positioned post operatively **
A
on their belly
25
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
elbow restraints
26
what are 3 specific long term consequences of cleft palate
altered speech, altered dentation, and potential hearing problems
27
how would you educate the parents of a child with a cleft palate (after correction) to promote speech development
promote development of the oral muscles by blowing bubbles, chewing, swallowing, using a party horn, blowing on pinwheels
28
what is a tracheoesophageal fistula
failure of the esophagus to develop as a continuous passage (esophageal atresia) and/or failure of the trachea and esophagus to separate
29
what are clinical manifestations of esophageal atresia and tracheoesophageal fistula
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
30
what are the nursing considerations with a patient who has esophageal atresia and/or tracheoesophageal fistula
Do not feed if this is suspected
Maintenance of airway *#1 priority*
Prevention of pneumonia
Prepare for surgical correction
31
postoperatively, what is to be expected on the nurse for a patient that had esophageal atresia and/or tracheoesophageal fistula
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
32
what are the 2 preoperative nursing interventions for an anorectal malformation
GI decompression, IV fluids
33
what are the postoperative nursing considerations for an anorectal malformation
perineal care
positioning - either side lying with hips elevated or supine with legs suspended to take pressure off the sutures
colostomy care
adequate nutrition
34
what is an omphalocele
herniation of the abdominal contents through the umbilicus ring - there is an intact peritoneal sac
35
what is a gastoschisis
herniation of the abdominal contents right of the umbilical ring - there is NO peritoneal sac
36
what do you do as the nurse if you walk in and see an omphalocele or gastroschisis of an infant
loosely cover with saline soaked pads and a plastic drape and call HCP
37
after an infant has a surgical correction for an omphalocele or gastroschisis what does the nurse need to do to care for the patient
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
38
what is most likely the culprit of gastroenteritis
a virus (usually rotavirus or norovirus)
39
what are the symptoms of gastroenteritis
low grade fever, nausea, vomiting, abdominal cramps, watery diarrhea
40
when someone has gastroenteritis, how long do they stay contagious
for weeks because there is continual viral shedding
41
what is the usual transmission of bacterial diarrhea
fecal - oral transmission (eating contaminated food)
42
what are the symptoms of bacterial diarrhea
abdominal cramps (severe), malaise, and bloody diarrhea
43
what is the usual treatment for someone with gastroenteritis
oral rehydration plus a normal diet for mild - moderate dehydration
IV fluids - moderate - severe dehydration
44
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
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
how do you determine how much fiber a child should have
age + 5 for children older than 3
46
when giving a child fiber for constipation what is a key thing not to forget
fluids, fluids, fluids
47
when assessing a child's level of constipation we look at quality and quantity, which is more important
quality
48
what is enopresis
chronic constipation with soiling
49
what are the potential causes of enopresis
psychological trauma, voluntary withholding, chronic constipation
50
what are the 3 key management interventions to help with enopresis
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
what is Hirschsprung disease
enlargement of the bowel proximal to defect in autonomic parasympathetic ganglion cells in the color - this results in mechanical obstruction
52
what is the most dangerous complication of Hirschsprung disease
enterocolitis
53
what is enterocolitis and what are the symptoms
inflammation of the small intestines and colon
bloating, bloody stools, fever, vomiting, can lead to necrotizing enterocolitis
54
what are the clinical manifestations of Hirschsprung disease in newborns
failure to pass meconium within 48-hours, food refusal, bilious vomiting, abdominal distention
55
what are the clinical manifestations of Hirschsprung disease in infants
poor weight gain, constipation, abdominal distention, episodes of vomiting and diarrhea
56
what are the clinical manifestations of Hirschsprung disease is children
constipation, ribbon like foul smelling stools, palpable fecal mass, abdominal distention, poor appetite and growth
57
what are the 5 pre-op nursing considerations for a child with Hirschsprung disease
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
what are the 6 post-op nursing considerations for a child with Hirschsprung disease
NG to LWS
NPO
I & O to include NG losses and ostomy drainage
Hydration and electrolyte balance
Abdominal assessment
Ostomy care
59
what is gastroesophageal reflux disease (GERD)
the passive transfer of gastric content into the esophagus, transient and inappropriate relaxations of the lower esophageal sphincter
60
what are some factors that can increase a child's risk of GERD
Prematurity
Bronchopulmonary dysplasia
Esophageal scar tissue
Neurological disorders
Scoliosis
Asthma
CF
Some medications
61
what are s/s in infants of GERD
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
what are s/s in children of GERD
Heartburn
Anemia
Persistent aspiration pneumonia
Chronic cough
Difficulty swallowing
Abdominal pain
63
what are types of medications a child with GERD would be prescribed
Antacids or histamine receptor antagonists
Proton pump blocker
Prokinetic medications
64
what is the surgical treatment for GERD
Nissen fundoplication - takes the top of the stomach and wraps it around the LES to strengthen the closure
65
what HOB elevation should a child with GERD be placed in after eating
30 degrees
66
why is it not beneficial to have an infant sit in a stroller after eating if they have GERD
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
what foods should be avoided with children who have GERD
fatty foods, chocolate, tomato products, carbonated liquids
68
how do feedings look different for an infant with GERD
smaller, frequent feedings with a thickened formula
69
what is hypertrophic pyloric stenosis
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
do males or females have a higher likelihood of developing hypertrophic pyloric stenosis
males
71
what are the clinical manifestations of hypertrophic pyloric stenosis
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
what are the pre-op nursing considerations for a child with hypertrophic pyloric stenosis
NPO, strict I&O, monitor IV fluids, monitor electrolytes, NG tube
73
what are the nursing considerations post-op for a patient with hypertrophic pyloric stenosis
pain control and titrating PO feedings
74
what is the highest priority of a patient with hypertrophic pyloric stenosis
hydration level
75
what is intussusception
invagination of telescoping of one portion of the intestine into another
76
is intussusception more likely to happen in males or females
males
77
what are the potential complications from intussusception
obstruction
inflammation
edema
ischemia
perforation
shock
78
what are the clinical manifestations of intussusception
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
what is the purpose of an enema for a patient with intussusception
it will confirm diagnosis and has a high chance of fixing it
80
what is celiac disease
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
where is gluten found
wheat, oat, barely, rye
82
someone with celiac disease will not show symptoms until what age
roughly 6M
83
when do the major symptoms of celiac disease present in children
1-5Y
84
what are the clinical manifestations of celiac disease
progressive malnutrition
secondary deficiencies (anemia, rickets)
watery, pale, foul smelling stools
vomiting, consitpation
85
what diet is recommended for children with celiac disease
eliminate triggers, eat diets high in calories and protein and low in fat, supplemental vitamins and iron
86
what is short bowel syndrome
malabsorptive disorder that occurs as a result of decreased mucosal surface area
87
what are the problems associated with short gut syndome
less absorption of fluid, electrolytes, and nutrients
88
for a patient with short gut syndrome how can you stimulate intestinal adaptation
slow, steady stimulation with TPN
89
what is acute appendicitis
inflammation of the vermiform appendix
90
what are the potential causes of acute appenditis
Obstruction of the lumen of the appendix, hardened fecal material, foreign bodies, microorganism parasites (not pin worms)
91
what are the clinical manifestations of acute apendicitis
colicky abdominal pain and tenderness in the lower right quadrant
guarding of the abdomen
rebound tenderness
nausea, vomiting, anorexia
low grade fever
92
in the case of acute appendicitis, a fever > 102 indicates what
perforation
93
what are the signs of peritonitis
Sudden relief of pain (usually means rupture), tachycardia, rapid shallow breathing, chills, restlessness, pallor
94
how is the therapeutic management of peritonitis after appendicitis differ from the regular care of an appendectomy
NG tube and delayed closure to prevent abscess
95
what two things must you specifically avoid if a patient has an acute appendicitis
enemas and heating pads - these can speed up rupturing
96
how long does it take for a child to return to sports after having an appendectomy
4-6 weeks plus a surgeon release
97
what is meckel diverticulum
a fibrous band connecting the small intestines to the umbilicus
98
what are the potential complications from meckel diverticulum
bleeding from peptic ulceration or perforation, obstruction, inflammation
99
what are the clinical manifestations of meckel diverticulum
painless rectal bleeding
abdominal pain
obstruction
currant, jelly like stools (hematochezia)
