GI/GU/Endocrine Flashcards

1
Q

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

A

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

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2
Q

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

A

speech

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3
Q

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

A

negative pressure

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

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4
Q

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

A

breast feed

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5
Q

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

A

one

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6
Q

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

A

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

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7
Q

Cleft lip is repaired at ______

A

repaired within the first 6 months of life

ATI: 10 pounds and 10 weeks

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8
Q

Cleft palate surgical repair is done at ________

A

18 months of age

- consider how child’s speech is affective

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9
Q

baby cleft LIP surgical repairs post-op care

A
  • 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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10
Q

post-op cleft palate repair

A

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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11
Q

long term effects of cleft palate

A
  • speech impairment

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

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12
Q

Hypertrophic Pyloric stenosis (HPS) is

A

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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13
Q

pyloric stenosis s/s

A

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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14
Q

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

A

hypertrophic pyloric stensis

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15
Q

HPS vomiting occurs

A

after feedings

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16
Q

infants stomachs can hold

A

30mL

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17
Q

How do you diagnose AND fix hypertrophic pyloric stenosis

A

Ultrasound

Laparoscopic surgery

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18
Q

Before a baby goes for surgery for HPS the nurse should

A

start IVF bolus NSS

NPO and NG tube to decompress the stomach before operation

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19
Q

Intussusception compare in what age group?

A

9 month-toddlers

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20
Q

Intussusception is when

A

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

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21
Q

Intussusception s/s

A
  • 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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22
Q

S/S Intussusception is now peritonitis

A

fever
abdominal RIDIDITY
rebound tenderness

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23
Q

Treatment for Intussusception

A

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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24
Q

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?

A

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

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25
Appendicitis s/s
``` cramping around the umbilicus pain at the McBurney's point (right lower quadrant) rebound tenderness!!!!! fever vomiting guarding rigidity ```
26
the appendix is located in the
right lower quadrant (McBurney's point)
27
tx of appendicitis
-----SURGERY before it ruptures, antibodies, fluid replacement, and pain control NEVER use heating pads NO laxatives and NO enema
28
s/s of peritonitis
``` increased HR rebound tenderness feel better and get worst fever vomiting rigid board-like abdomen ```
29
reflux is expected and common during
infancy
30
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
31
adverse drug reaction for omeprazole _____ and it is in the drug class ____
bone lose | proton pump inhibitors (inhibited bone growth)
32
Feedings interventions to prevent reflex
small feedings
33
constipation is common with kids and is treated with
disimpaction, enemas, and laxatives
34
encopresis is common in
adolescence boys
35
encopresis also know as ______
fetal incontinence
36
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
37
encorpresis is caued by
voluntary or involuntary passage of stool | ---pt loses feeling in the rectum
38
Hirschsprung's disease
is a chronic constipation disease where the stool is backed up - large intense is not about to move stool properly
39
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!
40
What causes hirschsprung's diease?
missing nerve cells in the colon | no movement in the intestines
41
worst-case scenario if Hirschsprung's disease is untreated
Enterocolitis --inflammation of the colon
42
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
43
celiac diease is
auotimmune reation to gluten
44
s/s of celiac disease
``` present with forth, foul smelling and greasy stool abdominal distenion signs of malnurtion muscle wasting hypotonia ```
45
Diagnose Celiac disease
tTG-IgA test | small intentional biopsy = villous atrophy on biopsy
46
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
47
________ is at risk for celiac diease
Type 1 DM
48
What can a pt with celiac NOT eat?
- wheat - barley - oats - rye
49
everytime a patient (with celiacs) eats gluten is causes
microscope damage
50
Growth hormone-deficient also known as
hypopituiarisum
51
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
52
In diabetes insipidus urine output is ________ Na is ________ specific gravity _________
high high (stays in body) down
53
In SIADH (too much ADH) urine output is ________ Na is ________ specific gravity _________
low low (too much fluid compared to Na) high
54
s/s of type 1 DM
``` weight loss polydipsia fatigue blurred vision mood change NOT hunger (change in content) ```
55
Honeymoon phase for DM type 1
the pancreas is still producing insulin on its own (causing hypoglycemia) Honey moon think HO---hypoglycemia
56
DM type 1 labs we look at
Hg-A1C | want this level higher then adults 7-7.5% for kids
57
when are urine tests done for ketones (DM)
when a sick is sick (check Q3 hours) | their glucose is over 250
58
giving rapid insulin want
breakfast tray ready
59
giving short insulin want
meal tray in 30 mintutes
60
giving long insulin want to know it has
NO PEAK
61
suspected UTI the nurse should do a
urine sample for culture and sensitivity
62
If a patient had pyelonephritis
start an antibiotic
63
UTI medication for symptomatic management
pyelonephritis
64
Kid comes in with a fever with no other symptoms get a ___
urine culture -- check for UTI
65
To be considered a UTI the sample must have
50,000 units per mL of the SAMEEEE colony forming | e.coli is most common
66
If a child has a 2nd UTI
must get voiding cystourethrogram VCUG
67
______ retrograde flow of the urine from the bladder back up to the kidneys may occur in both ureters
Vesicoureteral reflux
68
Vesicoureteral reflux is corrected by
antibiotics or surgery | surgery only if high grade 4-5
69
______ bed wetting past the age of toilet training
Enuresis
70
How to treat enuresis
``` fluid restriction before bed bladder exercises timed voiding enuresis alarms antidiuretic hormones - tricyclic anitdepress ```
71
Enuresis is most common in children
chronically constipated | deep sleepers
72
_________ is when one or both testes fail to descend through inguinal canal into the scrotum
Cryptorchidism
73
Cryptorchidism should be tx w surgery within 4 months to prevent
infertility and increase risk for cancer
74
Cryptorchidism assessment and surgery should be done in a ____ area
warm
75
__________ is an Emergency condition where the testicle rotates and twists the spermatic cord cutting off blood supply to the scrotum
Testicular Torsion
76
What is testicular torsion?
when the testicles rotates and causes sudden onset of severe pain and swelling
77
how do you treat testicular torsion?
Prompt surgical intervention and detersion with orchiopexy
78
Hypospadias and epispadias is surgical corrected between ages
6- 12 months
79
Hypospadias and epispadias the child will have a stent and be doubled binder to
keep the urine and bacteria away from the surgical site
80
Post-opt Hypospadias and epispadias should never have ____
a tub bath | circumcision (they can after surgical repair just not before)
81
Nephrosis is caused by
HIGHER PROTEIN LOSS
82
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 ```
83
- Nasty protein loss in the urine
- Nephrotic Syndrome
84
How do you treat Nephrotic syndrome?
prednisone - steroids to stop the immune sys. from attacking the kidneys
85
Nephrotic syndrome goal of tx is to
reduce edema, decrease proteinuria, manage symptoms, improve nutrition and prevent infection
86
How do you calculate units need bc of blood sugar
(blood glucose- target blood sugar) / (sensitivity)
87
How do you calculate how many units a pt needs of insulin bc of carbs
Carbohydrates/ carb ratio #