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Peds Exam 2 > GI > Flashcards

GI Flashcards

1
Q

Pediatric differences in GI system

A

Duodenum- digestion takes place

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2
Q

Enzymes that aid in digestion

A

Amylase- saliva; digests carbs
Lipase- enhances fat absorption
Trypsin- breaks down protein into polypeptides & some amino acids

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3
Q

Signs/ symptoms of GI disorders in infants/ children

A

GI sx immature at birth
Liver function immature at birth & next few weeks
GI structures in 2nd year of life more mature

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4
Q

Review of GI system

A

Stomach- secretes HCl & digestive enzymes to break down fats (gastric lipase) & proteins (pepsin)- little absorption
Small intestine- digestion is completed here by pancreatic enzymes, bile & small intestine enzymes
Large intestine- major fxn is water absorption
Liver- bile production, detoxification, vitamin storage
Gallbladder- stores bile

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5
Q

GI assessment

A

Subjective- lifestyle/ family factors (including family hx)
Diet- gaining weight; through h/o feeding pattern, any problems w/ breastfeeding
Allergies- lactose intolerance, celiac
Elimination patterns- I’s/O’s, encopresis, constipation
Mental status- ask parents/ caregiver
Auscultation
Percussion/ palpation- rebound tenderness

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6
Q

Physiologic differences

A

Minimal saliva
Decreased stomach capacity; newborn- 10-20ml, 1 yo- 210-260ml, adolescent- 1500ml
Reverse peristalsis- leads to reflux
Increased gastric emptying time
Lg. intestine relatively short, less reabsorption of water, stools softer w/ greater water loss during diarrhea- high risk of dehydration

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7
Q

nursing implications

A

dehydration- assess I & O, fluid replacement
malnutrition/ poor growth- assess growth, feeding methods, nutritional intake, quality of stools, other s/s
inflammation/ infection- monitor for fever, pain; assess abdomen/ bowel sounds, stool

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8
Q

cleft lip/ palate

A 
congenital malformation (failure of maxillary processes to fuse)- during 6-12 wks gestation
may appear by itself/ together/ varying severity
most common craniofacial deformities in US
multifactorial causes
key is to do surgery before speech begins
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9
Q

cleft lip/ palate

A

abnormal opening in lip, palate, nasal cavity
multifactorial inheritance pattern (teratogenic, viral, seizure meds during wks 9-12)
failure of foregut to close during fetal development
1st sign may be formula coming from the nose
surgical correction- done early to stimulate pleasure when sucking
lip repair- usually by 12 wks
palate- palatoplasty; usually btwn 6-24 mos to maximize speech
complications- cosmetic, speech/ hearing, feeding, orthodontic, otolaryngology

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10
Q

cleft lip

A

opening btwn nose & lip
apparent @ birth
should be documented during newborn assessment
assess child’s ability to suck & swallow
cleft lip repair is performed during 1st month of life
special feeding techniques if surgery is delayed

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11
Q

cleft lip/ palate pre-op nursing care

A

feeding- upright position to prevent aspiration; breastfeeding if possible; Haberman nipple- longer/ crosscut nipple w/ compressible bottle; frequent burping
facilitate bonding
growth & monitoring
logan bar- protects surgical repair

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12
Q

cleft lip

A

surgery- usually done early (1st few days to 1st month of life)- improve parental bonding/ feeding
closure of lip defect precedes correction of palate
z-plasty to minimize retraction of scar
protect suture line w/ Logan bow/ other methods
plastic surgery- staggered suture line (often in shape of letter Z to minimize scarring
Logan bar used post-op

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13
Q

cleft palate

A

repaired surgically btwn 12-18 months prior to talking
parents will care for child @ home until surgical repair
altered dentition/ speech dysfunction may occur
frequent episodes of otitis media before being fixed

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14
Q

cleft lip/ palate post-op nursing

A

restraint- no-no for at least 6-8 days (longer w/ palate repair); remove 1 at a time q 2 hrs for 15 min; swaddling for babies
feeding- no straws, pacifiers, spoons, fingers by mouth for 7-10 days; use shorter nipple; can feed w/ side of spoon for older children; advance diet as tolerated
suture care- lip protective device (logan bar) to prevent tension on suture site; no brushing teeth for 1-2 wks (clean suture line w/ water after each feed); don’t place on stomach; no oral temps/ tongue depressors
referrals- hearing, speech, orthodontic

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15
Q

nursing management

A

prevent injury to suture line
promote adequate nutrition
encouraging infant-parent bonding
providing emotional support

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16
Q

esophageal atresia/ tracheoesophageal fistula (TEF)

A

congenital malformations in which esophagus terminates before it reaches stomach &/ or a fistula is present that forms an unnatural connection w/ trachea
foregut fails to lengthen, separate, fuse into 2 parallel tubes (@ 4-5 wks gestation)
assoc. w/ maternal polyhydramnios (fetus can’t swallow/ absorb amniotic fluid in utero)
over half have other abnormalities
*medical emergencies

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17
Q

EA/ TEF

A

manifestations- 3 C’s- coughing, choking, cyanosis
excessive oral secretions, choking, resp. distress
NG tube can’t be passed into stomach
child needs NG tube bc unable to tolerate own oral secretions which will land in blind pouch
diagnostic eval- prenatal
treatment- emergency actions to prevent pneumonia
teaching- gastrostomy tube feedings, skin/ stoma care, nutritive sucking; oral hypersensitivity/ food aversion

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18
Q

nursing management of TEF

A 
pre/ post-surgical interventions:
initiate NPO
elevate HOB
monitor hydration
assess/ maintain orogastric tube/ prevent aspiration
O2/ suction equipment available
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19
Q

pyloric stenosis

A

hypertrophy of circular muscle that surrounds pylorus causing obstruction of gastric emptying

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20
Q

hypertropic pyloric stenosis

A

unknown cause
manifestations- projectile vomiting 30-60 min after feeding @ about 2 wks of age; movable, palpable, olive-shaped mass; dehydration w/ metabolic alkalosis
treatment- pyloromyotomy- incision of pyloric muscle to release obstruction around pyloric sphincter

21
Q

pyloric stenosis

A

pre-op nursing interventions- assess for dehydration/ acid-base imbalance; examine abdomen/ listen for bowel sounds; I’s & O’s, NG tube drainage; oral care; treat dehydration/ electrolyte imbalance prior to surgery
post-op nursing interventions- feeding according to surgeon protocol; usually pedialyte after 4-6 hrs, advance to full strength breast milk/ formula
teach parents signs of problems- abdominal distention, excessive vomiting, redness/ purulent drainage @ surgical site

22
Q

abdominal wall defects- gastroschisis/ omphalocele

A

congenital defect of ventral abdominal wall- herniation of abdominal viscera outside abdominal wall
gastroschisis- occurs to side (usually right) of umbilicus
omphalocele- through umbilical cord
week 11 of gestation
multifactorial causes

23
Q

omphalocele

A

protrusion of abdominal contents through abdominal wall @ junction of umbilical cord
may include intestines, stomach, & liver
organs covered by thin transparent layer/ membrane of amnion
size of sack depends on extent of protrusion of abdominal contents through umbilical cord

24
Q

gastroschesis

A

similar to omphalocele- except defect is far from umbilicus (not on it)/ organs not contained by membrane

25
Q

management of omphalocele & gastroschesis

A

bowel returned to abdomen
if defect is large- staged repair done w/ silastic pouch/ “silo”
TPN dependent
potential for infection

26
Q

omphalocele & gastroschesis (newborn)

A

both are congenital anomalies of anterior abdominal wall
omphalocele- membranous sac covers exposed organs
gastroschesis- organs not covered by membrane
nursing management- minimize fluid loss, protect exposed abdominal contents from trauma/ infection, postop care, surgical repair of both defects occur after birth/ are done in stages

27
Q

intussusception

A

telescoping/ invagination of 1 portion of intestine into another- causes obstruction
decreases blood flow to that area- causes ischemia/ pain, WBC may form pus/ bleeding
occasionally d/t intestinal lesions, but often cause is unknown
severe pain
lethargy
“currant-jelly” stools, gross blood
sudden onset of intermittent crampy abdominal pain
most common cause of intestinal obstruction in children <2
manifestations- sudden onset of pain, draw up legs, vomit; blood in stool; sausage-shaped abd. mass may be palpated; extreme paroxysmal pain (subsides then recurs); assess for shock
treatment- US-guided saline, barium, air enema to reduce
if no response- surgical emergency to avoid bowel necrosis
laparoscopy- post-op treatment; gradually increase feeding after NG removal
high risk of recurrence- have to be hospitalized for 24 hrs after

28
Q

malrotation & volvulus

A 
twisting of intestine
obstruction of feces
occurs d/t intestinal malrotation
manifestations- pain, vomiting, signs of obstruction
surgical emergency
nursing care similar to intussusception
29
Q

Hirschsprung’s disease

A

absence of ganglion cells in rectum & upward to colon- inadequate motility in part of intestine
absence of ganglionic innervation leading to no persistalsis waves
mechanical obstruction from inadequate motility of intestine
incidence- 1 in 5000; more common in males & DS
delayed passage of meconium- signs of obstruction
ribbon-like stool (passing through small narrow segments)
diagnosis- by rectal biopsy
treatment- medical- stool softeners
surgical removal of aganglionic segment w/ or w/out colostomy
assess for enterocolitis (acute illness); completel bowel cleansing (enema/ GoLytely); bowel sterilization, IV abx
pain management, I&O, VS, colostomy care, enterostomal therapy
temporary ostomy/ “pull-through” procedure

30
Q

anorectal malformations

A

imperforated anus identified in newborn period
level of defect–> outcome of care
staged repair for corrective surgery w/ ostomy
major challenge- finding adequate nerve & muscle structures for normal evacuation
associated anomalies
absence/ stenosis of rectal cancal
stool in urine d/t fistula to perineum
stool in vagina d/t fistula
DX- digital rectal exam, ultrasound, abd x-rays, CT scans
treatment- low lesions w/ anal membrane- serial rectal digital dilations are effective
higher lesions- 2-stage surgical repair

31
Q

anal stenosis

A

thickened/ constricted anal wall

characteristic ribbon-like stool

32
Q

anal atresia (imperforate anus)

A

PE reveals absent anal opening

failure to pass meconium during 1st 24 hrs also diagnostic

33
Q

meckel’s diverticulum

A

pouch on wall of lower part of intestine (congenital)
diverticulum may contain tissue that’s identical to tissue of stomach/ pancreas
digested food can cause diverticulitis
remant of fetal duct (fiberous band connected from sm. intestine to umbilicus)
*most common congenital malformation of GI tract
surgery to remove diverticulum to prevent complications- ulceration, bleeding, intussuception, intestinal obstruction

34
Q

umbilical hernia

A

hernia- protrusion/ projection of organ/ part of organ through muscle wall of cavity that normally contains it
imperfect closure of umbilical muscle ring
danger of incarceration/ strangulation
protrusion of intestines through umbilicus
shouldn’t be hard, should be reducable
should hear bowel sounds
most spontaneously resolve by 3-4 yrs as muscular ring closes
surgery if s/x of strangulation, increased protrusion >2 yrs of age/ no improvement in large defect after 4 yrs

35
Q

appendicitis

A

inflammation of appendix caused by obstruction

dull steady umbilical pain that localizes to RLQ at mcburney’s pt

36
Q

nursing considerations for constipation

A 
administer enema
hx of bowel patterns, medications, diet
educate parents/ child
dietary modifications
*common in school-aged children
37
Q

constipation/ encopresis

A

constipation- failure to achieve complete evacuation of lower colon
encopresis- soiling of fecal contents into underwear beyond age of expected toilet training (4-5 yrs)
may be 2ndary to other disorders- Hirschsprung, toilet refusal, bathroom accessibility, SCI, med side effects
chronic constipation- envt/ psychosocial factors (stress)
clean out w/ enema/ laxative, ensure hydration/ regular bowel regimen

38
Q

vomiting

A 
common in childhood
prevention of complications from loss of fluid
antiemetic meds
observe &amp; record
*metabolic alkalosis
39
Q

diarrhea

A

leading cause of illness in children <5
acute infectious diarrhea- variety of causative organisms
20% of deaths in developing countries r/t diarrhea/ dehydration
types- acute, acute infectious gastroenteritis, chronic, intractable diarrhea of infancy, chronic nonspecific diarrhea
metabolic acidosis
etiology- rotavirus, salmonella, shigella, campylobacter organisms, giardia, cryptosporidium, clostridium difficile, abx therapy

40
Q

dehydration

A

health hx- diarrhea, vomiting, decreased oral intake, sustained high fever
diagnostic evaluation- wt. is most important determinant of percent of total body fluid loss in infants/ children
VS, skin turgor, fontanels, mucous membranes, eyes, mental status, urinary output
oral rehydration therapy
nursing considerations- weight, I&O

41
Q

oral rehydration

A

rehydration solution of 75-90 mEq of Na+/ L
give 40-50ml/ kg over 1st 4 hrs
maintain hydration w/ solution of 40-60 mEq Na+/ L
daily volume of maintenance hydration <150 ml/ kg/ day

42
Q

formula for fluid maintenance

A

100 ml/kg for 1st 10 kg
50 ml/kg for next 10 kg
20 ml/kg for remaining kg
add together for total ml needed per 24 hr period
divide by 24 for ml/ hr fluid requirement

43
Q

oral candidiasis (thrush)

A

fungal infection of oral mucosa
children @ risk- immune disorders (corticosteroid inhaler use, chemotherapy, abx use), transmitted btwn infant & breastfeeding mother
therapeutic management w/ nystatin/ fluconazole

44
Q

appendicitis

A

obstruction of fecal matter, swollen lymphoid tissue, or parasite
periumbilical pain w/ nausea, RLQ pain, & vomiting w/ fever
ruptured appendix
N/V, diarrhea, constipation
WBC- 15-20, anorexia, fever, chills
appendectomy
IVF/ IV antibiotics
pain management
*watch for s/s of perforation- fecal material spills into abdomen causing peritonitis

45
Q

GER/ GERD

A

vomiting vs “spitting up”
overflowing (regurgitation) vs projectile
esophagus is shorter distance to stomach, stomach contents come back up much easier
GER- backward flow of stomach contents up into esophagus/ mouth; happens to everyone; in babies- small amount is normal & almost always goes away by the time child is 18 mos old
GERD- when complications from GER arise- failure to gain wt, bleeding, resp. problems, cough, esophagitis
*eg. after feeding, baby sticks back out
immaturity of cardiac sphincter (LES) causes reflux of stomach contents into esophagus
manifestations- regurgitation, fussiness 30-60 min after meal, poor growth
45-50% of healthy infants
<2 mos have GERD, peaks @ 4 mos, then decreases when LES matures; resolves by 1 yo

46
Q

GERD treatment

A

nursing considerations- identify children, educate parents in home care, feeding, positioning, meds
non-pharmacologic tx- smaller feedings, thicken formula, keep baby upright before/ after feeding, burping, if bottle feeding- find nipple that makes good seal to prevent air into mouth
prokinetics- increase motility, usually w/ meds that inhibit acid
antacids may be tried 1st in school-aged children
2 major therapies- H2 blockers (-ine)/ PPIs (-zole)
1st line is H2, then PPI

47
Q

lactose intolerance

A

malabsorptive disorder
absence/ deficiency of lactase–> inability to digest lactose
more common in Asians, Native Americans, African Americans
frothy diarrhea w/ presence of reducing substances, abd. pain, & distention
treatment is avoidance of milk-based products, soy formula, elimination of milk-based products for breastfeeding mothers, use of Lact-Aid
calcium/ vit. D supplementation

48
Q

short bowel syndrome (SBS)

A

malabsorptive disorder
decreased mucosal surface area, usually d/t small bowel resection
prognosis has advanced w/ TPN & nutrition
administer/ monitor nutritional therapy

49
Q

celiac disease

A

AKA gluten-induced enteropathy & celiac sprue
immunologic disorder in which gluten causes damage to small intestine
4 characteristics:
steatorrhea
general malnutrition
abd. distention
secondary vitamin deficiencies

Peds Exam 2 (3 decks)

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