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Pediatrics > GI disorders > Flashcards

GI disorders Flashcards

1
Q

Organic Failure to Thrive

A

physical cause

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2
Q

Non Organic Failure to Thrive

A

no physical cause

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3
Q

FTT related factors

A 
poverty
beliefs
knowledge
family stress
feeding resistance 
insufficient breast milk
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4
Q

s/s FTT

A 
< 3-5% birth weight
development
muscle mass 
abdominal distention
behavior
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5
Q

FTT Assessment

A

psychosocial history
infant parent interactions
caregiver response to child’s cues
parents confidence

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6
Q

FTT feeding approaches

A 
consistent staff
quiet atmosphere
give directions about eating
face to face posture
feeding routine
high calorie formula 24 kcal/oz (norm 20 kcal)
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7
Q

cleft lip and palate

A

structures altered during 1st trimester

  • unilateral or bilateral
  • cleft palate less obvious
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8
Q

cleft lip diagnosis

A

in utero w/ ultrasound

at birth in newborn exam

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9
Q

cleft lip Tx

A
  • lip repair at 3-6 mos
  • palate repair at 6-24 mos
  • early repair= better feeding
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10
Q

Cleft Lip RN Management

A
  • allow parents to express feelings
  • emotional support
  • mom can still BF
  • follow feedings w/ H20
  • teach cleaning and to position upright after feeding
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11
Q

Cleft Lip Post-Op Management

A
  • medical asepsis, keep suture line clean
  • resume feeding per MD orders
  • keep away straws, pacifiers, fingers, spoons/utensils
  • use elbow “nono’s”
  • don’t brush teeth x1-2 weeks
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12
Q

Gastroenteritis

A
  • Acute inflammation on stomach and intestines
  • vomiting and diarrhea
  • children >5, avg 2-3 episodes/yr
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13
Q

Gastroenteritis s/s

A
  • mild-severe diarrhea
  • irritability
  • anorexia, N/V
  • ELECTROLYTE IMBALANCE
  • DEHYDRATION
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14
Q

Gastroenteritis Dx testing

A
  • neutrophils & RBC on stool specimin, very indicative of bacterial gastroenteritis
  • Rotovirus is most likely cause of V/D
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15
Q

Questions to ask about infant vomiting

A
  • Parents should keep written record
    • Can you wipe the vomit off with a rag?
    • Was it eaten or curdled?
    • What color was it? How much?
    • Was it projectile?
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16
Q

Gastroenteritis RN assessment and management

A

> fluids with fever
observe for dehydration
acute diarrhea may be caused by abx
no antidiarrheals for acute diarrhea

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17
Q

Gastroenteritis Rehydration

A 
oral rehydration therapy
avoid plain water
IV: LR or 0.9% NaCl
KCL only after adequate urine output
Food as soon as rehydrated and tolerating PO
BRAT or ABC diet
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18
Q

Gastroenteritis diet

A

start when rehydrated & vomiting stopped
no diarrhea x3 days
ABCs diet: applesauce, bananas, strained carrots
BRAT diet: bananas, rice, applesauce, toast

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19
Q

Lactose Intolerance

A

inability to digest lactose

congenital (rare) or developmental

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20
Q

Lactose Intolerance s/s

A

diarrhea
pain, cramping
abdominal distention
excessive flatus

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21
Q

Lactose intolerance Dx

A

1+ or > of clinitest stool
breath hydrogen testing
improvement of sxs of lactose-free diet

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22
Q

Lactose Intolerance Management

A

Examine labels for milk/milk products
soy based, lactose free formulas, soy milk
BF mothers- limit dairy intake
Ca & Vit D suppplements
yogurt, hard cheeses etc. addded to diet after sxs disappear

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23
Q

High Calcium Diet

A 
egg yolks
green leafy vegetables
dried beans
cauliflower
molasses
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24
Q

Hirshsprung Disease

A

Absence of ganglion cells in segment of colon
stool accumulates proximal to defect
obstruction results

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25
Q

Hirshsprung Disease Dx

A

barium enema
rectal biopsy
history & PE

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26
Q

Hirshsprung Disease s/s

A

Meconium stool, constipation in 1st month
pellet like or ribbon, foul smelling stools
visible peristalsis
abdominal pain, refusal to feed
bile stained vomit

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27
Q

Hirshsprung Disease Preop Tx

A 
Observation for s/s meconium passage
obtain hx, weight gain/loss, bowel habits
daily enemas
low-fiber, high-cal, high protein diet
monitor fluid & lytes
if severe NPO & TPN
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28
Q

Hirshsprung Disease OR and post op

A 
bowel resection or temp colostomy
NPO until NG to LIS
no rectal temps
fluid/ lytes monitoring
pt edu for colostomy care
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29
Q

Hypertrophic Pyloric Stenosis (HPS)

A

Pyloric muscle hypertrophies= narrowing of the pyloric canal
obstructs gastric emptying
develops in 1st few weeks of life

30
Q

HPS Dx

A 
H & P (Familial disposition)
flat panel of abdomen
ultrasound
barium swallow
labs: metabolic alkalosis
31
Q

HPS s/s

A 
projectile vomiting
palpable mass in RUQ
deep paristaltic waves in stomach
FTT
constipation/ dehydration= metabolic alkalosis
32
Q

HPS Tx

A 
Pyloromyotomy
Preop: 	restore hydration & lytes
postop: 	may vomit 24-48 hrs post op
		may have NG to LIS
		advance to 1/2 strength formula or BF
33
Q

Intussusception

A
  • Proximal bowel segment telescopes into more distal segment
  • vasculature compressed resulting in lymphatic & venous obstruction
  • eventually arterial supply stops, results in ischemia
34
Q

Intussusception s/s

A
  • sudden actute abd pain, may be colicky
  • stool:
  • palpable sausage-shaped mass in RUQ
  • vomiting (bile-stained)
  • bowel sounds:
  • peritonitis if not treated
35
Q

Intussusception Tx

A 
Hydrostatic reduction
	-barium or air enema
	*monitor for bowel function return
surgery
	-manual reduction
	-resection of nonviable areas of bowel
36
Q

Intussusception RN management

A

focused to restore fluid & lyte balance

37
Q

Intussusception post-op care

A 
monitor for early s/s infection
manage pain
assess vitals
assess abd distention and bowel sounds
may have NG to LIS (keep patent)
38
Q

GER

A

Gastroesophageal reflux

The transfer of gastric contents into the esophagus

39
Q

GERD

A

sxs or tissue damage from GER

40
Q

GER etiology

A
  • return of gastric contents into esophagus due to relaxation of lower esophageal spincter (LES)
  • may occur at any time
  • not always related to having a full stomach
41
Q

GER causes

A
  • LES dysfunction from transient relaxation of the sphincter
  • delay in gastric emptying
  • poor clearance of esophageal acid
  • esophageal mucosa susceptibility to acid injury
42
Q

GER Dx

A 
Hx & PE
Esophageal pH monitoring (Tuttle test)
Scintigraphy
endoscopy
UGI
43
Q

physiologic GER

A 
painless vomiting after meals
parents may think it's normal
rarely occurs during sleep
no FTT
pharmacologic and medical management
44
Q

Pathologic GERD

A 
FTT
aspiration, pneumonia, asthma
apnea, coughing and choking
frequent vomiting
may require surgery and pharm tx
45
Q

Infant sxs GER

A 
spitting up/ vomiting
crying, irritable, arching back, stiffening
weight changes
cough, wheeze, gag, choking
hematemisis
apnea
46
Q

GER sxs in children

A 
heartburn
abd pain
noncardiac chest pain
dsyphagia
nocturnal asthma, recurrent pneumonia
47
Q

Infant feedings w/ GER

A

thickened formula (w/ rice cereal) caloric intake
small freq feedings, burp often
trial of hypoallergenic formula
HOB- supine position, no car/ infant seat after feedings

48
Q

Toddler diet GER

A

feed solid foods 1st
follow w/ liquids
same restrictions as older child diet

49
Q

Older child diet GER

A 
restrictions can < GER
Avoid: 	-fatty foods
		-caffeine
		-spicy
		-carbonated drinks & fruit juice
obesity> abd pressure> GER
50
Q

GER management children > 1

A

sleep on R side

elevate HOB

51
Q

GER medications

A 
antacids: sx relief
H2 Antagonists: < acid, < espohagitis
mucosal protectants: barrier protection
prokinetic agents: > gastric emptying
PPIs: block acid production
52
Q

uncontrolled GER complications

A

esophageal strictures due to esophagitis
laryngitis
recurrent pneumonia
anemia

53
Q

GER surgical tx criteria

A 
recurren pneumonia
apnea
esophagitis
FTT
failed medical tx
54
Q

GER surgical complications

A 
Breakdown of the wrap
gas-bloat syndrome
infection
retching
dumping syndrome
55
Q

GER prognosis (infants)

A

Improve by 12-18 mos w/o surgical tx

56
Q

Traecheoesophageal Fistula & Esophageal Atresia

TEF & EA

A 
Can occur together or seperatley
failure of the esophagus to develop as a continual tube
4th-5th wks gestation
cause unknown
common in preemies and low birth weight
57
Q

EA & TEF Dx

A 
confirmed by NG placement
x-ray
ultrasound
bronchoscopy/ endoscopy
hx of maternal polyhydramnios
58
Q

EA & TEF s/s

A 
excessive saliva and drooling
3 C's: coughing, choking, cyanosis
apnea
> resp distress after feedings
abdominal distention
vomiting
59
Q

EA & TEF RN Management

A 
Positioning: HOB @ 30 degrees, lay supine
NPO
suction to PRN (protect airway)
NG to LIS
monitor hydration
60
Q

EA & TEF surgery and pos-op care

A

surgery: -fistula ligation
- atresia anastomosis

post op care: -resp assessment

		- tubes: G-tube, NG tube, chest tubes
		- non-nutritive sucking--> pacifier
61
Q

Meckel Diverticulum

A

Most common GI anomoly
a fiberous band connecting small int to umbilicus
most symptomatic in childhood < 10 yr
surgical pts usually < 10 yr
pouch in the ileum is formed which secretes acid

62
Q

Meckel Diverticulum s/s

A

usually occurs before age 2
painless rectal bleeding
abdominal pain
intestinal obstruction signs

63
Q

Meckel Divertculum Dx/Tx

A

Meckel scan
blood studies: anemia

surgical intervention

- clip diverticulum
- bowel resection if severe
64
Q

Meckel Diverticulum RN management

A

post op care related to abdominal surgery
watch for s/s infection
monitor I&O
stool for OB (occult blood)

65
Q

Causes of Apendicitis

A

hardened fecalith
swollen lymphoid tissue
parasite

66
Q

McBurney’s Point & Revsing’s Sign

A

McBurney: midway between anterior iliac crest & the umbilicus in RLQ
-classic area for localized tenderness during late stages of Apendicitis
Revsings: pushing on the L side causes R side to hurt (pushing abd contents to R side)

67
Q

Appendicitis s/s

A 
RLQ pain 		>pulse
fever			>shallow resp
rigid abd			pallor
V/D, constipation	lethargy, irritable
anorexia			stooped posture
68
Q

Assessing Apendicitis

A

sxs develop slow over 12 hr period
if pain precedes vomiting suspect Apendicitis, if vomiting before pain-> gastroenteritis
Knee-chest position
initial generalized pain, then focused to RLQ

69
Q

Appendicitis Dx

A

CT scan- most often used
ultrasound
> WBC
CRP: c-reative protien (> in 12 hrs of inf)

70
Q

Appendicitis Assessment

A

Allow pt to be in position of comfort
classic abd sxs, OPQRSTm vitals
sudden spike in fever and relief of pain = indicates preforation

71
Q

Appendectomy pre/post op

A

Pre: -no laxatives/ enemas
-no heat to abd

post: -Abx: - non pref: cefepime -pref: meropenem

72
Q

Appey post-op abcess

A

> pain
restlessness
irritability
< ambulation

Pediatrics (8 decks)

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