GI/GU/Endocrine Flashcards
what are major issues with children with cleft lip and palate?
Feeding and bonding w parents/family (trust vs. mistrust)
Child w cleft lip and palate have problems later in school age w
speech
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
It is hard for babies with cleft l/p to ______ so the mom can pump milk and feed baby w a bottle
breast feed
babies w cleft palate need a special bottle with a _____ way valve
one
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
Cleft lip is repaired at ______
repaired within the first 6 months of life
ATI: 10 pounds and 10 weeks
Cleft palate surgical repair is done at ________
18 months of age
- consider how child’s speech is affective
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
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)
long term effects of cleft palate
- speech impairment
- otitis media (ear infection)– due to positioning of tubes in-ear connecting to the mouth
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
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
palpable gastric olive-shaped mass in the right umbilicus with vomiting is a sign of
hypertrophic pyloric stensis
HPS vomiting occurs
after feedings
infants stomachs can hold
30mL
How do you diagnose AND fix hypertrophic pyloric stenosis
Ultrasound
Laparoscopic surgery
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
Intussusception compare in what age group?
9 month-toddlers
Intussusception is when
one part of the intestines intestines into another part of the intestines
Intussusception s/s
- stool that is blood/mucus-streaked (currant jelly)
- sauage shaped abdominal mass
- vomiting (non-projectile)
- guarding, crying, DRAWING KNEES TO CHEST
S/S Intussusception is now peritonitis
fever
abdominal RIDIDITY
rebound tenderness
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
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
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 #
