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Sophomore 1 Test 6 > GI/GU > Flashcards

GI/GU Flashcards

1
Q

Cleft Lip and Cleft Palate In Utero

A
  1. 5-6 weeks gestation: tissue that forms lip fuses

2. 7-9 weeks gestation: palate closes

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2
Q

Risk Factors for Cleft Lip or Palate

A
  1. Maternal smoking
  2. Prenatal infection
  3. Advanced maternal age
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3
Q

Cleft Lip and Cleft Palate are usually associated with what other disorders?

A
  1. Heart defects
  2. Ear malformations
  3. Skeletal deformities
  4. Genitourinary abnormalities
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4
Q

Cleft Lip and Palate Specialized Healthcare Team

A
  1. Craniofacial specialist
  2. Nurse
  3. Social worker
  4. Audiologist
  5. SLP (speech language pathologist)
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5
Q

Criteria for Cleft Lip/Palate Surgical Repair

A

Must be infection-free and stable to have the surgery

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6
Q

When is a cleft lip surgically repaired?

A

2-3 months old

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7
Q

When is a cleft palate surgically repaired?

A

9-18 months old

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8
Q

Complications of Cleft Lip/Palate

A
  1. Feeding difficulties (weight loss, failure to thrive)
  2. Altered dentition
  3. Delayed or altered speech
  4. Otitis media
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9
Q

Cleft Lip/Palate Nursing Management

A
  1. Protect suture line
  2. Adequate nutrition
  3. Bonding and support
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10
Q

How do you protect the suture line of a patient with cleft lip/palate?

A
  1. Apply ointment as ordered
  2. Apply mitts to hands
  3. Avoid spoon, straw, catheters in mouth
  4. Prevent vigorous crying
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11
Q

How do you provide adequate nutrition to a patient with a cleft lip/palate?

A
  1. They benefit from breastfeeding
  2. Burp well
  3. High risk for aspiration with cleft palate
  4. They can tire very easily
  5. Listen intently to sound of feeding for aspiration
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12
Q

How do you encourage bonding and support for the parents of a patient with a cleft lip/palate?

A
  1. Encourage parents to hold infant
  2. Support in helping parents feed
  3. Cleft Palate Foundation
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13
Q

Inguinal Hernia

A

Bulging mass in the lower abdomen or groin area

  • More visible during crying or straining
  • Boys more susceptible than girls
  • Surgical correction when infant is several weeks old and thriving (gaining weight)
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14
Q

Umbilical Hernia

A

Bulging mass herniating through umbilical ring

  • More visible during crying or straining
  • Will usually self-correct by age 5
  • Surgery after age 5
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15
Q

What babies are most susceptible to hernias?

A

Preemies

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16
Q

Reducing Hernias

A

Reduction: pushing the hernia back into the inguinal ring or umbilical ring

  • Temporary management of hernias
  • Teach family how to do it
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17
Q

What problems with hernias should you contact your HCP about?

A

Contact the surgeon immediately if the hernia becomes irreducible, hard, or discolored
- If not reducible it can lead to an incarcerated hernia which could lead to bowel strangulation

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18
Q

Appendicitis

A

The lumen of the appendix is obstructed which leads to edema, pressure, bacterial overgrowth, and eventually perforation

  • It is a surgical emergency due to risk of perforation
  • Appendix is removed through minimally invasive laparoscopic technique
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19
Q

Pathophysiology of a perforated appendix

A

Inflammatory fluid and bacterial contents leak into abdominal cavity = peritonitis
- Open emergency surgery required to lavage abdominal cavity

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20
Q

Diagnostic Tests for Appendicitis

A
  1. CT
  2. CBC
  3. C-reactive protein (will be elevated)
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21
Q

Appendicitis S/Sx

A
  1. Pain - gradual and persistent, will intensify
  2. Vague abdominal pain (localized RLQ)
  3. Rebound tenderness
  4. N/V
  5. Small volume, frequent soft stools
  6. Low grade fever
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22
Q

S/Sx of perforated appendix

A
  1. Sudden pain relief
  2. Diffuse tenderness
  3. Distention
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23
Q

Nonruptured, Nongangrenous Appendix Nursing Management

A
  1. No antibiotics

2. Routine surgical care

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24
Q

Gangrenous, Nonruptured Appendix Nursing Management

A
  1. 48-72 hours of antibiotics

2. Routine surgical care

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25
Q

Perforated Appendix Nursing Management

A
  1. 7-14 days of IV antibiotics

2. Routine surgical care

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26
Q

Gastrointestinal Reflux (GER)

A
  • Passing of gastric contents into the esophagus during relaxation of the lower esophageal sphincter (LES)
  • Considered normal in healthy infants, usually outgrown by 12 months old
27
Q

When does GER progress to GERD in infants?

A

If they have feeding problems, are losing weight, or reflux continues past 12 months

28
Q

Complications of GERD

A
  1. Esophagitis
  2. Esophageal stricture
  3. Chronic esophageal erosion
  4. Laryngitis
  5. Recurrent pneumonia
  6. Asthma
29
Q

GERD Diagnostics

A
  1. Upper GI

2. Esophageal scope

30
Q

S/Sx of Reflux

A
  1. Recurrent vomiting or regurgitation
    • Can have “silent” GERD with no vomiting
  2. Weight loss, poor weight gain
  3. Irritability in infants
  4. Hoarseness/sore throat
  5. Halitosis
  6. Dysphagia or feeding refusal
  7. Poor dentition (from acid erosion)
31
Q

GERD Treatments (Noninvasive)

A
  1. Elevating HOB, keeping infant upright for 30 minutes after feeding
  2. Smaller, more frequent feedings
  3. Burp frequently
  4. Thicken formula with rice cereal
32
Q

GERD Treatments (Medications)

A
  1. H2 Blockers (ranitidine, famotidine)
  2. Prokinetics (metoclopramide)
  3. Proton Pump Inhibitors (omeprazole, pantoprazole)
33
Q

Reflux Nursing Management (Maintain Airway)

A
  1. GERD often involves the airway
  2. Apnea can lead to quick respiratory decline
  3. Teach parents CPR
  4. Have suction nearby
34
Q

GERD Treatment (Surgery)

A

Nissen Fundoplication

35
Q

Gastrostomy Tube (Care)

A
  1. Clean skin around G-tube once a day
  2. Rotate button a quarter turn a day to prevent skin breakdown
  3. For infants, still provide pacifier during feedings
  4. Maintain normalcy of “active” feeding times
  5. Elevate HOB 30 degrees for nighttime feedings
  6. Allow a normal routine
    • Walking, crawling, whatever is normal for their developmental level
36
Q

Hirschprung Disease

A
  • Common cause of neonatal intestinal obstruction

- Lack of ganglion cells in bowel leads to lack of peristalsis

37
Q

S/Sx of Hirschprung Disease

A
  1. Constipation
  2. No meconium in 24-48 hours
  3. Required rectal stimulation to pass meconium
  4. Poor feeding and failure to thrive
38
Q

Hirschprung Disease Diagnostics

A
  1. KUB

2. Barium enema

39
Q

Hirschprung Disease Treatment

A

Surgical resection of the aganglionic bowel and reanastomosis of remaining intestine
- Commonly requires a temporary ostomy while the bowel heals

40
Q

Hirschprung Disease Potential Complication

A

Enterocolitis

41
Q

Hirschprung Disease Nursing Management

A
  1. Ostomy care

2. Monitor for s/sx of enterocolitis

42
Q

S/Sx of Enterocolitis

A
  1. Fever
  2. Abdominal distention
  3. Explosive stools
  4. Bloody stools
43
Q

Gastroschesis

A
  • Exposed, herniated organs
  • Thick, edematous, inflamed
  • Silo bag or surgical correction
  • Significant mortality and morbidity rates due to feeding intolerance, failure to thrive, prolonged hospital stays
44
Q

Omphalocele

A
  • Umbilical ring defect allows contents into external peritoneal sac
  • Associated with genetic syndrome 50% of the time
  • Surgical correction
45
Q

Nursing Management specific to Omphalocele

A
  1. Using strict sterile technique, wrap moist gauze soaked in warm sterile saline around contents
  2. Handle gently to prevent trauma
46
Q

Nursing Management of both Gastroschesis and Omphalocele

A
  1. Inspect contents closely (color, twisting of organs, presence of liver)
  2. Prevent hypothermia!!!
  3. Place OG tube to low intermittent suction
  4. IV fluids and IV antibiotics
  5. Closely monitor bowels (color and temperature)
47
Q

Hypertrophic Pyloric Stenosis

A

Pylorus becomes hypertrophied -> thickness in the luminal side of the pyloric canal -> gastric outlet obstruction -> nonbilious projectile vomiting

48
Q

When does Hypertrophic Pyloric Stenosis Typically Present?

A

Between 2-4 weeks of life

49
Q

Hypertrophic Pyloric Stenosis Treatment

A

Surgery = Pyloromyotomy

50
Q

S/Sx of Hypertrophic Pyloric Stenosis

A
  1. Nonbilious, forceful vomiting
  2. Weight loss
  3. Hunger after vomiting
  4. Dehydration
  5. Irritable
51
Q

Hypertrophic Pyloric Stenosis Diagnostics

A
  1. Palpable “olive” in RUQ

2. Ultrasound

52
Q

Hypertrophic Pyloric Stenosis Nursing Management

A
  1. Fluid management and electrolyte correction
    • Check fontanels for hydration status
  2. Address high family anxiety and provide emotional support
  3. Usually resume oral feedings after 1-2 days after surgery
53
Q

S/Sx of Nephrotic Syndrome

A
  1. Edema
  2. Weight gain
  3. Ascites
  4. Weakness
  5. Irritability
  6. Usually normal BP
54
Q

Nephrotic Syndrome Diagnostics

A
  1. Protein in urine
  2. Low serum protein and albumin
  3. high serum cholesterol and triglyceride
  4. Creatinine and BUN increase if there is renal failure
55
Q

Nephrotic Syndrome Treatment

A
  1. Corticosteroids
  2. IV albumin
  3. Possibly diuretics
  4. Immunosuppressive therapy for steroid-resistance
56
Q

Potential Complications of Nephrotic Syndrome

A
  1. Anemia
  2. Infection
  3. Poor growth
  4. Peritonitis
  5. Thrombosis
  6. Renal failure
57
Q

Nephrotic Syndrome Nursing Management

A
  1. Taper or wean steroids
  2. Monitor potassium (furosemide)
    - Diet high in potassium
  3. Monitor temperature for infection
  4. Possible fluid restriction
  5. Possibly Na restriction
  6. Encourage protein in diet
  7. Emotional support
58
Q

Hypospadias and Epispadias

A

Urethral defect at birth, but can still urinate pre-op

  • Hypo = below
  • Epi = above
59
Q

Future S/Sx of Hypospadias and Epispadias

A
  1. Difficulty with urinary stream
  2. Infertility
  3. Self-esteem issues
60
Q

When is surgery done on an baby born with hypospadias or epispadias?

A

Surgical repair at 1 year of age

61
Q

What other disorders are usually associated with hypospadias or epispadias?

A
  1. Undescended testes
  2. Hydrocele
  3. Inguinal hernia
62
Q

Double Diapering

A

Double diapering is a method used to protect the urethra and stent or catheter after surgery; it also helps keep the area clean and free from infection. The inner diaper contains stool and the outer diaper contains urine, allowing separation between the bowel and bladder output.

63
Q

Double Diapering Method

A

Double Diapering:
Cut a hole or a cross-shaped slit in the front of the smaller diaper.
Unfold both diapers and place the smaller diaper (with the hole) inside the larger one.
Place both diapers under the child.
Carefully bring the penis (if applicable) and catheter/stent through the hole in the smaller diaper and close the diaper.
Close the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.

Sophomore 1 Test 6 (4 decks)

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