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Peds Exam 1 > GI > Flashcards

GI Flashcards

1
Q

Functions of GI System

A
  • ingestion, digestion, and absorption of fluids and nutrients
  • metabolism of needed nutrients
  • excretion of waste products
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2
Q

Any alteration in GI system…

A

decreases body’s ability to obtain nutrients, thus impairing growth

(difference in peds)

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3
Q

Pediatric Differences: GI

A
  • GI system immature at birth
  • sucking is a primitive reflex
  • infant stomach is small
  • peristalsis is increased
  • digestive enzymes deficient
  • liver function immature
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4
Q

Nursing Care Priorities: GI

A
  • assessment
  • establish feeding
  • prevent infection
  • monitor for serious infection
  • protect airway
  • protect suture line
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5
Q

Cleft Lip/Cleft Palate

A

(CL/CP)

  • occur during 3rd and 12th week of gestation
  • occur singly or in combination, must more together
  • maxillary and nasal processes fail to fuse
  • 10-50% cases have other defects (Trisomy 13)
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6
Q

Cause of Cl/CP

A
  • multifactoral
  • environment: maternal smoking and alcohol, phenytoin, genetics
  • folate: added to breads and cereals in 1998, deceased incidence of clefts
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7
Q

Diagnosis: Cleft Palate

A

-cleft palate without cleft lip may not be detected at birth

slide a gloved finger directly across the newborn palate

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8
Q

Diagnosis: Cleft Lip

A
  • detected at birth or fetal U/S by 13-26 weeks
  • size varies a small notch to a complete cleft
  • may be unilateral or bilateral
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9
Q

Problems with cleft lip and palate

A
  • recurring OM, Tempanic Membrane scarring, hearing loss
  • speech impairment/delay
  • improper tooth alignment
  • long term problems, social adjustment, threat to self image
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10
Q

EBP: CL/CP and risk for dental caries

A
  • children with CL/CP had higher risk of dental caries
  • higher risk factors: poor oral hygiene and higher levels of salivary lactobacilli
  • higher risk children had more caries
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11
Q

Therapeutic Management of CL/CP

A
  • collaboration of specialists: plastic surgery, ENT, speech therapist, and dentist
  • closure of clefts, prevention of complications, facilitation of normal growth and development of the child
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12
Q

Surgical Correction: Cleft Lip

A
  • cheiloplasty, surgery
  • usually repaired by 3-6 months
  • lip sutured together
  • protect suture line from tension/trauma
  • elbow restraints
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13
Q

Surgical Correction: Cleft Palate

A
  • platoplasty, surgery
  • CP repaired by 18 months but usually done earlier (6-12 months)
  • protect tooth buds
  • allows for development of normal speech (first words)
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14
Q

Nursing Management: Emotional Support

A
  • big deal
  • may generate negative responses in both nurses and parent
  • have a positive aspect of infant’s physical appearance
  • be positive regarding surgical correction
  • before positive aspect of infant’s physical appearance
  • before and after photographs of possible cosmetic improvements
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15
Q

Nursing Management of CL/CP: Pre-op feeding

A
  • cleft lip/palate reduces ability to suck
  • some CL babies may breastfeed
  • mother’s breast soft, fill gap caused by cleft
  • CP makes it difficult to create suction
  • food enters nasal cavity through cleft (OM, fluid accumulation)
  • bottle feed with expressed breast milk
  • hold head in upright position
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16
Q

Special feeders

A

long nipples with enlarged holes, gravity nipples with squeezable bottle

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17
Q

Nursing Management: Cleft Lip Post-op Care

A
  • clear liquids - dropper or syringe
  • formula/breast feeding resumed when tolerated
  • aspirate oral/nasal prn (soft suction tip catheter)
  • maintain suture line
  • elbows in soft restraints
  • no prone position
  • minimize crying pain med prn
  • incision care, antibiotic cream
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18
Q

Nursing Management: Cleft Palate Post-op Care

A
  • start with clear fluids from syringe or dropper
  • advance to formula/breast milk by cup
  • protect sutures, no pacifier
  • no chewing, pureed diet, no hard foods
  • soft tip suction prn
  • pain management
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19
Q

Esophageal Artesia and Tracheoesophageal Fistula

A
  • rare congenital malformations, occur by the 4th week of gestation
  • cause unknown
  • the foregut fails to lengthen, separate and fuse into two parallel tubes
  • esophagus may end up in a blind pouch or develop as a pouch connected to the trachea by a fistula
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20
Q

Clinical Manifestations of Esophageal Atresia and Tracheoesophageal Fistula

A
  • excessive salivation and drooling
  • the three C’s of TEF: Coughing, Choking, Cyanosis
  • feeding: fluid comes out nose and mouth
  • apnea, grasping with frothy sputum
  • risk of aspiration and penurmonia
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21
Q

Diagnosis of Esophageal Atresia and Tracheoesophageal Fistula

A
  • established clinically: difficulty feeding, excessive drooling, choking, apnea, coughing, cyanosis
  • confirmed by attempting to pass a NGT
  • x-ray stomach, air pilled pouch
  • other tests done R/O associated defects: abdominal ultrasound and echo
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22
Q

Treatment of Esophageal Atresia and Tracheoesophageal Fistula

A
  • tube inserted to suction the upper pouch
  • IVF, IV antibiotics
  • surgery: accomplished in stages
  • stage 1: ligation of fistula, G tube placement
  • stage 2: 2 ends of esophagus reconnected if possible
  • may need repeated surgeries
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23
Q

Nursing Management: Pre-op Care of Esophageal Atresia and Tracheoesophageal Fistula

A
  • NPO/IVF (offer pacifier)
  • maintain patent airway, suction, HOB elevated
  • continuous or LIS for blind pouch
  • constant monitoring of vital signs and condition: surgical emergency
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24
Q

Nursing Management: Post-op Care of Esophageal Atresia and Tracheoesophageal Fistula

A
  • gastric decompression - GT to drain
  • GT care teaching
  • administer IVF/antibiotics/watch electrolytes
  • TPN until G tube feeds or oral feeding tolerated
  • parental support: encourage to hold infant, express emotions
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25
Q

Pyloric Stenosis

A
  • hypertrophic obstruction of the circular muscle of the pyloric canal
  • occurs in 1-3 per 1000 live births, may be familial
  • male to female ratio 6:1
  • seen more frequently in firstborn white males
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26
Q

Pathophysiology for Pyloric stenosis

A
  • pylorus sphincter narrows due to progressive hypertrophy of the circular pylorus muscle
  • results in outlet obstruction
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27
Q

Clinical Manifestations of Pyloric Stenosis

A
  • 2-6 weeks after birth
  • initially infant appears well or regurgitates after feeding
  • vomiting progresses to projectile
  • vomiting is non-bilious (no bile in vomit), may be blood tinged
  • infant: hungry, irritable, fail to gain weight, fewer and smaller stools
  • if goes on too long: dehydration, metabolic alkalosis and increased bilirubin
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28
Q

Clinical therapy: Diagnosis of Pyloric Stenosis

A
  • physical exam: visible peristaltic wave across the abdomen moving from left or right
  • olive-size mass in left upper quadrant
  • pyloric ultrasound
  • upper GI series
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29
Q

Clinical therapy: Treatment of Pyloric Stenosis

A
  • surgery: pyloromyotomy
  • release of muscle fibers allows the passage of food and fluid
  • high success rate
30
Q

Nursing Management: Pre-op of Pyloromyotomy

A
  • NPO
  • IVF
  • Monitor electrolytes
  • NGT for decompressing
31
Q

Nursing Management: Post-op Pyloromyotomy

A
  • pain management
  • vital signs monitoring
  • establish feeding
  • involve parents
  • discharge teaching
32
Q

GASTROESPHAGEAL Reflux (GER)

A
  • return of gastric contents into the esophagus due to relaxation of the lower esophageal or cardiac sphincter
  • 50% of FT infants have GER
  • higher in premature infants
  • males affected 3x more than females
  • children with neuro impairment (CP) have increased GER
  • peak age is 1-4 months of age, often resolves spontaneously by age 12 months
33
Q

GERD

A
  • more serious than GER
  • spit up any time, even between feedings
  • cries and arches back during and after feeds
  • eat often but still lose weight
  • respiratory problems: cough, wheeze, choking, color changes during feeding (ALTE?)
  • may aspirate: pneumonia, apnea
  • generalized irritability, poor weight gain, weight loss or delayed growth
34
Q

Diagnosis of GERD

A
  • hx of feeding, vomiting episodes, pain with feeding
  • upper GI series: UGI: check for anatomic abnormalities
  • pH probe monitoring: valid and reliable measure of reflux, determines number of reflux episodes
35
Q

Treatment of GERD

A
  • depends on severity
  • mild: “happy spitter”
  • modification of feeding habits: small frequent feeds, frequent burping
  • thicken formula with rice cereal (1 tsp RC/ 1 oz formula) make nipple hole bigger
  • position: hold child upright after feeds for 20-30 min
  • supine position while sleeping due to risk of SIDS (AAP)
36
Q

Pharmacological Tx for GERD

A
  • moderate to severe
  • poor weight gain, irritable, no improvement with modification of feeding habits and position
  • H2 Receptor Antagonists
  • Proton Pump Inhibitors
37
Q

H2 Receptor Antagonists

A

Action: decrease gastric acid production

“silent reflux” reflux without vomiting

Ranitidine (Zantac)

Fomatidine (Pepcid)

38
Q

Proton Pump Inhibitors

A

Action: blocks acid production by inhibiting proton pumps, increases LES tone, more effective than H2 receptor agonists

  • works better than H2
  • risks of aspiration patients
  • insurance issues (ranitidine first)

Lansoprazole (Prevacid)

Omeprazole (Prilosec)

39
Q

Severe GERD

A
  • failure to thrive, aspiration
  • surgical management: Nissen Fundoplication
  • Gastrostomy tube is inserted during surgery and left in place for 6 weeks or longer
40
Q

Nissen Fundoplcation

A

involves a 360 degree wrap of the fundus of the stomach around the distal esophagus

-acts like a sphincter

41
Q

In children with GERD

A
  • observe for respiratory distress, monitor VS
  • provide adequate nutrition, small frequent feeds
  • position, increase HOB, prone position with caution while awake only
42
Q

Post-op Fundoplication

A
  • GT: maintain integrity, secure tube, provide pacifier

- educate parent about home care: feeding, position, medication, suctioning

43
Q

Hirschsprung Disease

A
  • congenital aganglionic megacolon
  • decreased motility causes obstruction of the intestines
  • incidence: 1:5000, males more than females
  • familial tendency
  • can occur with Down syndrome, congenital heart disease, other syndromes
44
Q

Pathophysiology of Hirschsprung

A
  • absence of ganglion cells in one segment of the colon causes lack on innervation in that segment
  • usually rectosigmoid colon
  • prevents peristalsis: leads to blockage, and stool builds up behind blockage
  • results in constipation, abdominal distension, poor weight gain, poor growth
45
Q

Clinical Manifestations of Hirschsprung Disease in Newborn

A
  • lack of meconium stool
  • bilious vomiting
  • S/S enterocolitis
46
Q

Clinical Manifestations of Hirschsprung Disease in Older Child

A

chronic constipation alternating with diarrhea, ribbon-like stools, abdominal distension, poor weight gain, decreased growth

47
Q

Diagnosis of Hirschsprung Disease

A
  • barium enema, abdominal xray, dilated bowel
  • rectal examination: rectum small, no stool
  • anal manometry
  • (gold standard) rectal biopsy: absence of ganglionic cells CONFIRMS DIAGNOSIS
48
Q

Treatment child with milder defect (Hirschsprung)

A
  • dietary modification: high fiber diet
  • stool softeners
  • enemas to prevent impaction in children not toilet trained
49
Q

Treatment of infant with Hirschsprung

A
  • surgical removal of the aganglionic bowel and pull through procedure
  • temp colostomy: closure 2-6 months later
  • normal bowel function depends on the amount of bowel involved
50
Q

Enterocolitis

A

inflammation of small intestine and colon

  • results in ischemia and ulceration of the bowel wall
  • may occur before or after surgery
  • greatest cause of morbidity and mortality in Hirschsprungs
51
Q

Enterocolitis presents with…

A

-abdominal pain, fever, foul smelling and/or bloody stools

52
Q

When should enterocolitis be suspected in neonate…

A
  • distended abdomen
  • feeding intolerance with bilious vomiting
  • delay of meconium
53
Q

If enterocolitis is not recognized…

A
  • progress to sepsis
  • perforation

Tx: IVF, antibiotics, NGT, monitor electrolytes and VS

54
Q

Nursing Management Pre-op of Enterocolitis

A
  • dependent on condition
  • assess: skin turgor, fontanels, urinary output, MMs
  • monitor fluid and electrolyte balance
  • maintain nutrition, TPN if NPO
  • ensure patent NG tube if NPO
  • monitor abdominal circumference
  • encourage parent to hold and cuddle infant
55
Q

Nursing Management Post-op of Enterocolities

A

-PO clear or breast milk in several hours

  • Observe for signs of enterocolitis
  • Monitor I/O
  • Avoid pressure on incision – diapering
  • Provide comfort, pain relief
  • Encourage parents to partake in infant’s care
  • Discharged when tolerating full feeds
56
Q

Intussusception

A
  • occurs when one portion of the intestine invaginates or telescopes into another
  • one of the most frequent causes of intestinal obstruction in children
  • more common in males
  • peak age: 3-9 months, up to 3 yrs
57
Q

cause of intussusception

A

unknown, viral infections, intestinal polyps, medications, Rotashield vaccine

58
Q

Pathophysiology of Intussusception

A
  • most common site is the ileocecal valve
  • telescoping of the intestines obstructs the passage of stools
  • intestinal walls rub together causing inflammation, edema, and decreased blood flow
  • leads to necrosis, perforation, hemorrhage, peritonitis
59
Q

Clinical Manifestations of Intussusception

A
  • sudden onset of abdominal pain, draw legs to chest
  • may vomit
  • periods of calm between episodes of pain
  • abdominal pain and distension
  • palpable “sausage-shaped mass” in upper right quadrant
  • passage of “currant-jelly stools” (blood and mucus stool)
60
Q

Diagnosis of intussusception

A
  • made on subjective findings, history
  • abdominal xray
  • abdominal US CONFIRMS DIAGNOSIS
61
Q

Treatment of Intussusception

A
  • may spontaneously reduce without treatment
  • hydrostatic reduction by air, saline, or barium enema
  • rare: surgery to reduce or to remove necrotic bowel
  • NG tube for gastric decompression
62
Q

Nursing Management Pre-op: Intussusception

A
  • maintain IVF
  • fluid and electrolye balance
  • NGT decompression
  • antibiotic therapy
63
Q

Nursing Management Post-op: Intussusception

A
  • monitor for infection
  • pain management
  • NGT patency
  • assess VS
  • check for abdominal distension
  • bowel sounds
64
Q

When to discharge from Intussusception surgery

A
  • when tolerating feeds

- D/C teaching: can reoccur after enema or surgery, must return for fever, pain, bloody stools

65
Q

If infant is NPO…

A

offer pacifier to continue sucking reflex

-can lead to difficulty eating and develop food aversions

66
Q

Newborn BMs

A

1-10 BMs a day

67
Q

NB NB vomit

A

non-bilious and non-bloody vomit

68
Q

bilious vomiting

A

-if due to obstruction it is a lower obstruction and more serious

69
Q

Projectile vomiting hallmark sign of…

A

pyloric stenosis

70
Q

Priority in the care of an infant with GERD

A

risk for aspiration

71
Q

hallmark sign of intussception

A

currant jelly stools and tension of abdomen

Peds Exam 1 (6 decks)

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