- stool that is blood/mucus-streaked (currant jelly) - sauage shaped abdominal mass - vomiting (non-projectile) - guarding, crying, DRAWING KNEES TO CHEST

GI/GU/Endocrine Flashcards by Nicole F

what are major issues with children with cleft lip and palate?

Feeding and bonding w parents/family (trust vs. mistrust)

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Child w cleft lip and palate have problems later in school age w

speech

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Every newborn with cleft lip/palate need ________ in the oral cavity for sucking

negative pressure

babies with cleft palates need a special bottle with a one way valve

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It is hard for babies with cleft l/p to ______ so the mom can pump milk and feed baby w a bottle

breast feed

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babies w cleft palate need a special bottle with a _____ way valve

one

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When feeding, a baby with cleft palpate the child should sit

sit up-right, burp frequently and small frequent feeds (not too much at once)– aspiration risk

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Cleft lip is repaired at ______

repaired within the first 6 months of life

ATI: 10 pounds and 10 weeks

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Cleft palate surgical repair is done at ________

18 months of age

- consider how child’s speech is affective

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baby cleft LIP surgical repairs post-op care

the no-no touch restraints for infants (PRN)
Avoid prone positions (cleft palate is okay but not lip)
Maintain the airway
light suction only if needed

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post-op cleft palate repair

Prone postion is ok
clear liquid 4 hours and then formula 3-4 days
NOOO pacifiers, NOOO straws (nothing going into the mouth other then liquid)
Child MUST use a cup for feeds (no bottle)

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long term effects of cleft palate

speech impairment

- otitis media (ear infection)– due to positioning of tubes in-ear connecting to the mouth

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Hypertrophic Pyloric stenosis (HPS) is

a condition of the lower stomach in newborns, where the lower sphincter of the stomach becomes enlarged preventing food from entering the small intensities resulting in vomiting –> leading to dehydration

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pyloric stenosis s/s

Projectile vomiting after feedings = pyloric stenosis (PS)
constant hunger
abdominal distension
palpable gastric olive shaped mass in the right umbilicus
poor weight fain and dehydration
–compare the current weight to birth weight

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palpable gastric olive-shaped mass in the right umbilicus with vomiting is a sign of

hypertrophic pyloric stensis

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HPS vomiting occurs

after feedings

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infants stomachs can hold

30mL

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How do you diagnose AND fix hypertrophic pyloric stenosis

Ultrasound

Laparoscopic surgery

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Before a baby goes for surgery for HPS the nurse should

start IVF bolus NSS

NPO and NG tube to decompress the stomach before operation

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Intussusception compare in what age group?

9 month-toddlers

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Intussusception is when

one part of the intestines intestines into another part of the intestines

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Intussusception s/s

stool that is blood/mucus-streaked (currant jelly)
sauage shaped abdominal mass
vomiting (non-projectile)
guarding, crying, DRAWING KNEES TO CHEST

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S/S Intussusception is now peritonitis

fever
abdominal RIDIDITY
rebound tenderness

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Treatment for Intussusception

Air enema !!! most effective
enema is given under imaging to reduce the defect
surgery is only needed if enema is not affective

—the goal is the passage of normal brown stool —> surgery won’t be needed

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the child has currant jelly stool!!!!!!!! and the cycle of intermittent legs pulled up and the child is screaming!!! then they are relaxed and fine.. then get worst and loses LOC
what is happening?

Intussusception —> bowel ruptured (perforated) –> can lead to sepsis

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Appendicitis s/s

``` cramping around the umbilicus pain at the McBurney's point (right lower quadrant) rebound tenderness!!!!! fever vomiting guarding rigidity ```

the appendix is located in the

right lower quadrant (McBurney's point)

tx of appendicitis

-----SURGERY before it ruptures, antibodies, fluid replacement, and pain control NEVER use heating pads NO laxatives and NO enema

s/s of peritonitis

``` increased HR rebound tenderness feel better and get worst fever vomiting rigid board-like abdomen ```

reflux is expected and common during

infancy

If an infant is spitting up that's normal buttttt if they are _____ it is considered GER/GERD

failure to gain weight or lose weight

adverse drug reaction for omeprazole _____ and it is in the drug class ____

bone lose | proton pump inhibitors (inhibited bone growth)

Feedings interventions to prevent reflex

small feedings

constipation is common with kids and is treated with

disimpaction, enemas, and laxatives

encopresis is common in

adolescence boys

encopresis also know as ______

fetal incontinence

how do you treat encopresis

- fetal incontinence - tx: STOOL CLEAN OUT---Miralax laxative and still softeners fluid and fiber schedule regular toilet visits after meals---sit on the toilet with an ipad keep a diary for toiler sessions parent should reward for EFFORT and do NOT reward for each BM

encorpresis is caued by

voluntary or involuntary passage of stool | ---pt loses feeling in the rectum

Hirschsprung's disease

is a chronic constipation disease where the stool is backed up - large intense is not about to move stool properly

s/s of Hirschsprung's disease and what does the stool looks

- failure to pass meconium within 48 hours - distended abdomen - consipation - ribbon-like because the stool is being contracted!

What causes hirschsprung's diease?

missing nerve cells in the colon | no movement in the intestines

worst-case scenario if Hirschsprung's disease is untreated

Enterocolitis --inflammation of the colon

Hirschsprung disease is tx by

``` surgical correction: pull through (surgery) ``` or if the colon is too inflamed they will just do a colostomy and wait for surgery

celiac diease is

auotimmune reation to gluten

s/s of celiac disease

``` present with forth, foul smelling and greasy stool abdominal distenion signs of malnurtion muscle wasting hypotonia ```

Diagnose Celiac disease

tTG-IgA test | small intentional biopsy = villous atrophy on biopsy

a child is about to get tested for celiac disease the parent should be educated that the child

should continue to eat gluten before the test

________ is at risk for celiac diease

Type 1 DM

What can a pt with celiac NOT eat?

- wheat - barley - oats - rye

everytime a patient (with celiacs) eats gluten is causes

microscope damage

Growth hormone-deficient also known as

hypopituiarisum

A parent comes in asking for growth hormones bc their child is short what does the nurse do first

check the human growth hormones to check the pituitary | - if there is a problem insurance covers if not it costs soooo much

In diabetes insipidus urine output is ________ Na is ________ specific gravity _________

high high (stays in body) down

In SIADH (too much ADH) urine output is ________ Na is ________ specific gravity _________

low low (too much fluid compared to Na) high

s/s of type 1 DM

``` weight loss polydipsia fatigue blurred vision mood change NOT hunger (change in content) ```

Honeymoon phase for DM type 1

the pancreas is still producing insulin on its own (causing hypoglycemia) Honey moon think HO---hypoglycemia

DM type 1 labs we look at

Hg-A1C | want this level higher then adults 7-7.5% for kids

when are urine tests done for ketones (DM)

when a sick is sick (check Q3 hours) | their glucose is over 250

giving rapid insulin want

breakfast tray ready

giving short insulin want

meal tray in 30 mintutes

giving long insulin want to know it has

NO PEAK

suspected UTI the nurse should do a

urine sample for culture and sensitivity

If a patient had pyelonephritis

start an antibiotic

UTI medication for symptomatic management

pyelonephritis

Kid comes in with a fever with no other symptoms get a ___

urine culture -- check for UTI

To be considered a UTI the sample must have

50,000 units per mL of the SAMEEEE colony forming | e.coli is most common

If a child has a 2nd UTI

must get voiding cystourethrogram VCUG

______ retrograde flow of the urine from the bladder back up to the kidneys may occur in both ureters

Vesicoureteral reflux

Vesicoureteral reflux is corrected by

antibiotics or surgery | surgery only if high grade 4-5

______ bed wetting past the age of toilet training

Enuresis

How to treat enuresis

``` fluid restriction before bed bladder exercises timed voiding enuresis alarms antidiuretic hormones - tricyclic anitdepress ```

Enuresis is most common in children

chronically constipated | deep sleepers

_________ is when one or both testes fail to descend through inguinal canal into the scrotum

Cryptorchidism

Cryptorchidism should be tx w surgery within 4 months to prevent

infertility and increase risk for cancer

Cryptorchidism assessment and surgery should be done in a ____ area

warm

__________ is an Emergency condition where the testicle rotates and twists the spermatic cord cutting off blood supply to the scrotum

Testicular Torsion

What is testicular torsion?

when the testicles rotates and causes sudden onset of severe pain and swelling

how do you treat testicular torsion?

Prompt surgical intervention and detersion with orchiopexy

Hypospadias and epispadias is surgical corrected between ages

6- 12 months

Hypospadias and epispadias the child will have a stent and be doubled binder to

keep the urine and bacteria away from the surgical site

Post-opt Hypospadias and epispadias should never have ____

a tub bath | circumcision (they can after surgical repair just not before)

Nephrosis is caused by

HIGHER PROTEIN LOSS

what sign due you report if you have nephrotic syndrome

``` Report key signs: • Headache & Mental Status Changes • Nausea & Vomiting • Oliguria - NO or low urine output • New, Sudden, Rapid Weight Gain ```

- Nasty protein loss in the urine

- Nephrotic Syndrome

How do you treat Nephrotic syndrome?

prednisone - steroids to stop the immune sys. from attacking the kidneys

Nephrotic syndrome goal of tx is to

reduce edema, decrease proteinuria, manage symptoms, improve nutrition and prevent infection

How do you calculate units need bc of blood sugar

(blood glucose- target blood sugar) / (sensitivity)

How do you calculate how many units a pt needs of insulin bc of carbs

Carbohydrates/ carb ratio #