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NSG 434 - Peds > GI Dysfunction > Flashcards

GI Dysfunction Flashcards

1
Q

dehydration

A

A common body disturbance in infants and children, total output of fluid exceeds total intake

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2
Q

mild dehydration percentage loss in infant and children

A

loss of less than 5% in infants and 3% in children

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3
Q

moderate dehydration percentage loss in infant and children

A

loss of 5%-10% in infants and 3%-6% in children

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4
Q

severe dehydration percentage loss in infant and children

A

loss of more than 10% in infants and 6% in older children

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5
Q

predictors of fluid loss

A

oChange in level of consciousness
oAltered response to stimuli
oDecreased skin elasticity and turgor
oProlonged cap refill
oIncreased heart rate
oSunken eyes and fontanels

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6
Q

what is usually the earliest sign of dehydration

A

tachycardia

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7
Q

therapeutic management for mild-moderate dehydration

A

*Oral rehydration over 4 to 6 hours

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8
Q

therapeutic management for sever dehydration

A

*IV fluids to expand fluid volume and replace deficits

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9
Q

acute diarrhea

A

sudden increase in frequency and a change in consistency of stools, often caused by an infectious agent in the GI tract

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10
Q

chronic diarrhea

A

increase in stool frequency and increased water content with a duration of more than 14 days

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11
Q

most pathogens that cause diarrhea are spread by…

A

the fecal-oral route from person to person
Close contact (day care centers)

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12
Q

What is the most important cause of serious gastroenteritis among children

A

rotavirus

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13
Q

management for diarrhea

A

oOral rehydration therapy
oEarly reintroduction to a normal diet is recommended
oEducation regarding s/s of dehydration
oSkin care to prevent excoriation
oEducation regarding prevention measures

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14
Q

constipation

A

*An alteration in the frequency, consistency, or ease of passing stool

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15
Q

constipation is often associated with

A

oBlood-streaked or retained stool
oAbdominal pain
oLack of appetite
oStool incontinence

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16
Q

Encopresis

A

oRepeated and involuntary defecation in a child older than 4, may be the result of constipation

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17
Q

management of constipation and encopresis

A

high fiber diet, exercise, regular toileting habits after meals, stool softeners, emotional support - helping child to feel in control

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18
Q

Hirschsprung Disease

A

Lack of innervation often in lower portion of bowel, no peristaltic waves causing chronic constipation above this area, megacolon
*Rectal sphincter fails to relax - Ribbon-like stool from passing through the narrow segment

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19
Q

treatment of Hirschsprung Disease

A

1) One-stage surgical treatment - transanal pull-through OR
(2)Colostomy (temporary) and then removal of aganglionic section

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20
Q

Hirschsprung Disease is most commonly seen in

A

neonate, 4x more common in males

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21
Q

clinical manifestations of Hirschsprung Disease in neonates

A

Failure to pass meconium within 24-48 hours of birth, bilious vomiting

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22
Q

clinical manifestations of Hirschsprung Disease in infancy & children

A

constipation, recurrent diarrhea, ribbon-like, foul-smelling stool, failure to thrive

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23
Q

diagnosis for Hirschsprung Disease

A

Rectal biopsy to detect absence of ganglion cells is definitive diagnosis

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24
Q

post of for surgery of Hirschsprung Disease

A

assess site, NPO until bowel sounds return, IV fluids, may require daily anal dilations

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25
Q

Gastroesophageal Reflux

A

*The presence of abnormal amounts of gastric contents in the esophagus, upper airways, and tracheobronchial area.

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26
Q

resulting effects of Gastroesophageal Reflux

A

oAspiration of gastric contents
oRecurrent pneumonia
oPulmonary disease
oEsophagitis
oEsophageal stricture

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27
Q

conservative treatment for GERD

A

oFeeding thickened formula
oFeeding small, frequent meals
oPositioning - elevating head of the bed
oAcid suppression and neutralization medications (Zantac, Prevacid, Prilosec)

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28
Q

surgical treatment for GERD

A

Nissan fundoplication (Upper end of stomach (fundus) is wrapped around the lower portion (inferior) of the esophagus creating a lower esophageal sphincter or cardiac sphincter)

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29
Q

how long should an infant be held upright after a feeding for GERD

A

30 minutes following a feeding

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30
Q

when should a PPI be administered

A

30 minutes before breakfast and if a second dose is prescribed - 30 minutes before the evening meal.

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31
Q

teaching for PPIs

A

Remind parents that they may not see results right away as it takes several days for a steady state of acid suppression.

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32
Q

early symptoms of appendicitis

A

oAnorexia,
oChild doesn’t seem “normal”,
oN&V, fever
oPain is diffuse at first then gradually localizes to RLQ (rebound tenderness)
*MCBURNEYS POINT
oIf pain is suddenly relieved without intervention, suspect perforation

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33
Q

McBurney’s point

A

a point midway between the anterior superior iliac crest and the umbilicus, pain indicating appendicitis

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34
Q

how long does antibiotics last for peritonitis

A

7-14 days of abx

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35
Q

pre op for appendicitis

A

oNPO, IV therapy
oPosition of comfort
oPrepare for surgery

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36
Q

post op for appendicitis

A

oMonitor VS
oMaintain IV and then advance diet as tolerated
oAssess for pain
oEncourage ambulation
oMonitor incisional site(s)
oDischarge teaching

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37
Q

management for Ruptured Appendix (Peritonitis)

A

*IV antibiotics
*NPO, NG tube to low continuous suctioning
*May have a drain placed in surgery
*Pain management
*Longer hospital stay

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38
Q

Crohn’s Disease

A

*An inflammatory and ulcerative disease affecting any part of the alimentary tract from the mouth to the anus.
*Affects the full-thickness of the intestine
*Inflammation “skips” - disease free areas are common

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39
Q

manifestions of chrons

A

*Diarrhea, occult blood (if colon involved)
*Cramping abdominal pain aggravated by eating
*Growth retardation
*Weight loss and fatigue
*Intestinal blockage

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40
Q

treatment for Crohn’s Disease

A

oCorticosteroid therapy to induce remission
oAntibiotics to eradicate inflammatory bacterial agents
oInfliximab therapy (tumor necrosis factor blocker)
oImmunosuppressives
oNo known cure
oMay require an ileostomy or colostomy

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41
Q

Infliximab therapy

A

tumor necrosis factor blocker used to treat crohns

42
Q

Ulcerative Colitis

A

*A recurrent inflammatory and ulcerative disease
*Affecting primarily the large intestine
*Continuous distribution; superficial inflammation

43
Q

manifestations of ulcerative colitis

A

*Frequent, bloody stools 10-20/day
*Abdominal pain
*Anorexia, pallor, and fatigue
*Electrolyte imbalance
*Ten- to 20-pound weight loss over 2 months

44
Q

treatment of ulcerative colitis

A

*Antidiarrheal
*Corticosteroids therapy to induce remission
*Antibiotics may be used
*Immunosuppressives
*Analgesics and narcotics for pain
oNutritional support
oSurgical intervention is eventually needed in 25% of cases and provides a cure

45
Q

Biliary Atresia

A

*A progressive inflammatory process that causes bile duct fibrosis
*Results in an obstruction of the bile flow

46
Q

what does biliary atresias cause

A

*Causes cholestasis resulting in jaundice
*Eventually progressive fibrosis with end-stage cirrhosis of the liver

47
Q

clinical manifestations of biliary atresia

A

oStools will be chalky and white d/t lack of bile pigment
oJaundice of skin and sclera
oEnlarged liver and abdominal distention
-poor weight gain

48
Q

treatment for biliary atresia

A

Kasai procedure, liver transplant

49
Q

Kasai procedure

A

Procedure done for treatment of biliary atresia in which the bowel lumen is connected to the bile duct

50
Q

the kasai procedure is most successful if performed …

A

before 10 weeks of age

51
Q

if biliary atresia is not identified early enough or Kasai is not successful…

A

*liver transplant by age of 2

52
Q

vitamin and calorie support for biliary atresia

A

Special formula containing medium-chain triglycerides

53
Q

cleft lip and palate are results from…

A

*embryonic failure of the soft tissue and/or bony structure to fuse during embryonic development

54
Q

when does cleft lip/palate defect occur

A

occurs at approximately 6‐8 weeks gestation

55
Q

Cleft lip

A

*a separation of the two sides of the lip

56
Q

Cleft palate

A

a midline opening of the palate

57
Q

Etio Multifactoral

A

a combination of environmental and genetic factors

58
Q

clinical manifestations of cleft lip/palate

A

oVisible unilateral or bilateral cleft lip
oPalpable and/or visible cleft palate
oCleft of the alveolus (gum line)
oNasal distortion
oFeeding difficulties

59
Q

complications of cleft lip/palate

A

oSpeech difficulties
oMalocclusion
oExcessive dental decay
oChronic otitis media
oAltered self-esteem and body image

60
Q

Malocclusion

A

abnormal tooth eruption pattern; abnormal development of the way the mandible and maxilla meet

61
Q

cleft lip is repaired at

A

2 to 3 months of age
(May need modifications at 4 to 5 years of age)

62
Q

cleft palate is repaired before

A

12 months of age

63
Q

goal of cleft lip surgery

A

to achieve lip competence and to create the most natural-appearing lip

64
Q

goal of cleft palate surgery

A

reconstruction of the palatal musculature to allow normal speech development

65
Q

preoperative care for cleft lip/palate

A

oFacilitate parents’ positive adjustment to infant
oRefer to cleft palate team
oProvide information and resources to parents
oMaintain adequate nutritional intake
oMonitor respiratory status

66
Q

adequate nutritional intake for cleft lip/palate

A

*Use special feeding equipment
*Sit upright
*Learn baby’s feeding cues

67
Q

postoperative care for cleft lip/palate

A

oDo not allow the child to use anything that creates suction in the mouth (straws, pacifiers)
oNothing hard in the mouth (candy, crackers or a spoon)
oClean suture line with normal saline
oPosition to allow secretions to drain
oProvide pain medication regularly to prevent crying which can place stress on the suture line

68
Q

postitioning after cleft lip/ palate surgery

A

-usually on back to prevent rubbing the face on the bedding
-Back to Sleep

69
Q

Haberman bottle

A

a squeeze bottle and a soft nipple with a valve, prevents the baby from ingesting excess air during the feeding, used for infants with cleft lip/palate

70
Q

feeding for infant with cleft lip/palate

A

-Place infant in an upright (almost sitting) position
-Place nipple in the mouth - position where there is more palate tissue
-Use chin support with your pinky finger to improve the oral seal
-The nipple should have a X cut in it (soft nipple) - may have to adjust the size of the X
-If using a Haberman - compress bottle in time with the infant’s chewing motions
-Allow for rest periods

71
Q

what helps keep infants hands away from incision after cleft lip/palate surgery

A

Elbow immobilizers - keep hands away from mouth for 7-10 days

72
Q

palate/lip care after feeding

A

*Rinse mouth after feeding palate repair, clean lip repair site with a wet sterile cotton swab after feeding

73
Q

Esophageal atresia and tracheoesophageal fistula (TEF)

A

*failure of the esophagus to develop as a continuous passage and a failure of the trachea and esophagus to separate into distinct structures.

74
Q

clinical manifestations of esophageal atresia (TEF)

A

oExcessive salivation and drooling
oThree C’s of tracheoesophageal fistula:
*Coughing
*Choking
*Cyanosis
oApnea
oIncreased respiratory distress during feeding
oAbdominal distension

75
Q

Three C’s of tracheoesophageal fistula:

A

*Coughing
*Choking
*Cyanosis

76
Q

treatment of Esophageal Atresia/TEF

A

oMaintain patent airway
*Intermittent or continuous suctioning
oPrevention of pneumonia

77
Q

surgery for Esophageal Atresia/TEF

A

*Thoracotomy with division
*Ligation of the TEF and an end-to-end or end-to-side anastomosis of the esophagus
*G-tube may be required

78
Q

Pyloric Stenosis

A

*Stomach contents unable to empty (usually diagnosed at 4‐6 wks) infant vomits in a projectile way right after eating and then is hungry

79
Q

an infant with pyloric stenosis is at risk for

A

metabolic alkalosis

80
Q

treatment for pyloric stenosis

A

oSurgical correction (Pyloromyotomy)
oLaparoscopy
oIncision is high risk for infection due to location in diaper area‐fold diaper down to avoid contamination

81
Q

post op for pyloric stenosis

A

oBegin small feedings 4 to 24 hours post-op

82
Q

clinical manifestation of pyloric stenosis

A

Palpable hard, moveable, “olive” pyloric mass in the right upper quadrant felt many times but not always

83
Q

Celiac Disease

A

*A genetic disorder in which gluten causes damage to the small intestine
*Villi of the small intestine absorb nutrients into the bloodstream - now damaged causing malnutrition

84
Q

treatment for celiac disease

A

*strict gluten-free diet

85
Q

clinical manifestations of celiac disease

A

oSteatorrhea (fatty stools)
oDiarrhea and/or constipation
oVomiting
oFailure to thrive or weight loss
oNutritional deficiencies (low vitamin D)
oAnemia

86
Q

Celiac crisis

A

extreme vomiting and diarrhea. Requires IV therapy and electrolyte replacement

87
Q

*Diagnostic Studies for celiac disease

A

oCBC
oAnti-tissue transglutamase antibodies
oTotal immunoglobulin A (IgA)
oIgA antiendomysial antibodies
oVitamin B 12 level, ferritin, total iron-binding capacity, folate
oStool for occult blood, fat
oEndoscopy and tissue biopsy for definitive diagnosis

88
Q

when doing a biopsy for celiac disease…

A

Do not start gluten free diet before endoscopy

89
Q

Intussusception

A

*Proximal segment of bowel telescopes into a more distal segment

90
Q

intussusception usually occurs before the age of

A

2 years

91
Q

clinical manifestations of intussesception

A

oSudden onset of crampy abdominal pain (Typically flares and then regresses every 15 to 20 minutes)
oSevere pain where child draws up knees and screams
oSausage-shaped abdominal mass
oCURRANT JELLY STOOL

92
Q

Intussusception needs to be treated immediately or

A

necrosis of bowel can occur

93
Q

what is used fro diagnosis of intussesception

A

Barium enema - use for diagnosis but may be successful in correcting the problem otherwise requires surgery

94
Q

volvulus

A

A portion of the intestine twists around itself

95
Q

clinical manifestations of volvulus

A

*Intense crying and pain
*Pulling up legs
*Abdominal distension
*Vomiting, usually bilious
*Tachycardia and tachypnea

96
Q

intervention for volvulus

A

*Surgical emergency

97
Q

clinical manifestations Necrotizing Enterocolitis

A

oTense, distended abdomen
oIncrease in abdominal circumference
oLarge residuals greater than 2 mL
oStool positive for occult blood
oIncreased periods of apnea, decreased BP, temperature instability

98
Q

treatment of Necrotizing Enterocolitis

A

oRest the bowel à TPN/Lipids
oAntibiotics
oSurgery

99
Q

Omphalocele

A

*A defect of the umbilical ring that allows evisceration of the abdominal contents into an external peritoneal sac.
*Defect varies in size
*Usually detected on prenatal ultrasound

100
Q

Gastroschisis

A

*A herniation of the abdominal contents through an abdominal wall defect
*No peritoneal sac protecting the herniated organs
*Exposure to amniotic fluid causes organs to thicken, become edematous, and inflamed

101
Q

nursing management for Omphalocele and Gastroschisis

A

oPrevention of hypothermia
oKeep baby in a radiant warmer to maintain temperature
oMaintaining perfusion to the eviscerated abdominal contents by minimizing fluid loss
oCovered with a non-adherent sterile dressing
oMay require 2-3 times maintenance fluids to maintain perfusion
oProtecting the abdominal contents from trauma and infection
oUtilize strict sterile technique to prevent contamination

NSG 434 - Peds (17 decks)

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