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Pediatrics > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

1
Q

Therapeutic management of ab wall defects

A
  • loosely cover with saline soaked pads and pastic drape
  • IV fluids
  • antibiotics
  • surgical correction—stages, silo pouch
  • NC—sterile, monitor for ileus, family support, D/C planning, home care
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2
Q

Cloacal exstrophy

A

Bowel and bladder is on the outside of the body

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3
Q

Cloacal exstrophy

A

Bowel and bladder is on the outside of the body

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4
Q

Therapeutic management for anorectal malformations

A
  • Anal stenosis—manual dilation, widen the anus gradually
  • Perianal fistula—opening btwn bowel and vagina so need surgery (anoplasty—move the opening)
  • imperforate anus—surgery in stages
  • extensive defects; colostomy
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5
Q

What to check in the anus at birth?

A

Check for patency and meconium, check for the external opening

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6
Q

Anorectal malformation NC

A
  • identify problem
  • look for meconium in first 24h
  • look for poorly developed gluteal folds and anal opening
  • pre-op—IVF and GI decompression
  • post-op—anorectoplasty; need good peri care, expect diarrhea, colostomy care, nutrition ASAP after bowel sounds return, side lying with elevated legs or supine
  • fam support and edu
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7
Q

Omphalocele

A

Herniation of the ab contents thru the umbilical ring; intact peritoneal sac but grows outside of the body

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8
Q

Gastroschisis

A

Intestines are not contained and grown outside the body through the umbilical ring; intestines swell bc not compressed

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9
Q

Abdominal wall defects NC

A
  • can be diagnosed prenatally and best to be born with C-section
  • if born with it, need IVF and antibiotics
  • intestines covered with sterile pad
  • surgical correction—put intestines in silo to contain, squeeze them down with silo
  • may not be able to get all intestines in which can cause small bowel/short bowel syndrome
  • careful handling, monitor for ileus, family support, home care maybe
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10
Q

Gastroenteritis

A
  • most common cause of morb/mort worldwide in kids
  • causes diarrhea—3+ loos or watery stools per day
  • alteration in normal BM with inc freq and Dec consistency
  • less than 14 days duration
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11
Q

Viral diarrhea

A

Most common—rotavirus or norovirus often
- low grade fever, N/V/D, belly hurt
- virus can shed for weeks after sx resolve (still contagious)

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12
Q

Bacterial diarrhea

A
  • all age groups
  • fecal-oral transmission (contaminated food) often
  • sx: bloody diarrhea, severe cramp, malaise
  • antibiotic tx not always needed
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13
Q

Diarrhea tx

A
  • HYDRATION—oral rehydration solution—pedialyte, naturalyte, rehydralyte
  • avoid fruit juice, colas, sports drinks, etc bc lots sugar
  • normal diet with ORS for mild-moderate dehydration
  • IVF for moderate-severe dehydration
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14
Q

Nursing management for diarrhea

A
  • Gloves
  • prevent skin b/d
  • good nutrition
  • Dec fear/anxiety by explain/reassure
  • infection control
  • provide health education for prevention and home management
  • restore F&E balance by ORS and IVF
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15
Q

Constipation

A
  • quality, not quantity
  • structural disorders, hypothyroidism, hypercalcemia, lead poisoning, drugs, spinal cord lesions
  • most is functional—kids not taking the time to slow and go
  • dietary, stool softeners
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16
Q

Constipation tx

A
  • emphasize good exercise, water, nutrition, fiber is age+5
  • give half juice half water
  • give prunes
  • give K rose sugar to the bottle
  • Miralax—works in 3 days
    takes about 6M after constipation for colon to un-stretch back to normal
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17
Q

Encopresis

A

Chronic constipation with soiling (fecal impaction) from psychological trauma and voluntary withholding

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18
Q

Encopresis management

A
  • purge the bowel
  • stool softeners
  • bowel retraining
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19
Q

Encopresis NC

A
  • teaching
  • support compliance with long-term therapy
  • empower the child
  • positive reinforcement
  • use toilet that is appropriate size so kid can chill
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20
Q

Hirschsprung disease (congenital aganglionic megacolon)

A

Absence of autonomic parasympathetic ganglion cells in 1+ segment of the colon causing enlargement and inability for peristalsis to occur—mechanical obstruction
- most dangerous complication is enterocolitis (caused by ischemia)—bloody diarrheal, fever, lethargy

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21
Q

CM of Hirschsprung disease

A
  • newborn—failure to pass meconium w/i 48h, food refusal, bilious vomiting, ab dissension
  • infancy—poor wt gain, constipation, ab distinction, D/V
  • childhood—chronic constipation, ribbon like foul stool, poor appetite and growth, palpable fecal mass, ab distension
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22
Q

Hirschsprung tx

A
  • Dx—Barium enema, rectal biopsy, anorectal manometry (use Cath and balloon to study)
  • tx for mild-mod disease can be repeated enemas to keep cleaned out or surgical removal (temporary ostomy) and Soave endorectal pull-thru (attach colon to rectum)
  • prognosis is good—may have anal stricture and incontinence post-op
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23
Q

Pre-op NC for Hirschsprung

A
  • note first BM on all babies
  • measure ab girth daily
  • bowel prep—enemas and antibiotics
  • monitor hydration, fluid, electrolyte status
  • teach enema technique—1 tsp salt and 1 pint water is best (avoid tap water)
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24
Q

Post-op Hirschsprung NC

A
  • N/G to suction
  • NPO
  • I&O to include N/G losses and ostomy drainage
  • ostomy care
  • hydration and electrolyte balance
  • ab assessment
25
Q

Gastroesophageal reflux disease (GERD)

A

Passive transfer of gastric contents into the esophagus—transient and inappropriate relaxations of the lower esophageal sphincter (LES) like CNS prob OR dev exaggerated enteric reflex OR ab pressure

26
Q

Factors inc risk of GERD

A
  • born premature
  • bronchopulmonary dysplasia
  • esophageal scar tissue
  • scoliosis
  • neuro dx
  • asthma
  • CF
  • some meds
27
Q

Infant s/s GERD

A
  • spit up lots
  • intermittent vomit
  • hematemesis and melena
  • irritability
  • back arch
  • ALTE or apnea
  • persistent aspiration pneumonia
28
Q

Childhood s/s of GERD

A
  • heartburn (older kids)
  • anemia from blood loss
  • persistent aspiration pneumonia
  • chronic cough
  • difficulty swallowing
  • ab pain
29
Q

Therapeutic management of GERD

A
  • Dx—UGI, 24h pH probe, endoscopy, labs
  • Meds—antacids or histamine receptor antagonists, proton-pump blocker—omeprazole (Prilosec), prokinetic meds like raglan, bethanechol, cisapride
30
Q

Nissen fundoplication

A

Take top of stomach and wrap it around the esophageal sphincter to tighten it—keep stomach contents in the stomach

31
Q

NC for GERD

A
  • position baby with elevated HOB 30 degree and wedge under mattress, harness after eating
  • small frequent feedings with thickened formula
  • avoids fatty foods, chocolate, tomato products, carbonated liquids
  • educate parents
  • burp often
32
Q

Hypertrophic pyloric stenosis

A

Circular muscle of the pylorus becomes thickened causing obstruction of the gastric outlet
- some genetic component
- develops in first few weeks of life causing edema and inflammation inc with obstruction
- much more common in males

33
Q

CM of HPS

A
  • projectile from w/o bile
  • hunger and irritable progress to lethargy
  • dehydration and weight loss
  • visible gastric peristalsis
  • olive-shaped mass
34
Q

HPS therapeutic management

A

Diagnose with H&P, ultrasound, ab x-ray, labs show metabolic alkalosis, hyponatremia, hypokalemia
- surgical removal
- pyloromyotomy—correct dehydration and acid/base balance prior to surgery

35
Q

HPS NC

A
  • observe for clinical features
  • regulate fluid therapy
  • pre-op—NPO, strict I&O, monitor IVF, monitor for F&E balance, may need NG tube
  • post-op—pain control, titrate PO feedings—may be very slow process, begin with pedialyte and gradually get to formula
36
Q

Intussusception

A

Invagination or telescoping of one portion of the intestine into another
- common in kids with CF
- can be viral infection

37
Q

Intussusception complications

A

Obstruction, inflam, edema, ischemia, perforation, peritonitis, shock

38
Q

Clinical manifestations of Intussusception

A
  • severe paroxysmal ab pain
  • scream and draw knees to chest
  • vomit—bile or fecal stained
  • palpable sausage-shaped mass URQ
  • currant jelly-like stool
  • ab is tender and distended
39
Q

Intussusception therapeutic management

A
  • diagnosed with H&P, flat plate for free air followed by barium enema—caused telescoping of the bowel to straighten out when air goes in
  • non-surgical hydrostatic reduction
  • surgical reduction and resection
40
Q

NC for Intussusception

A
  • recognize sx and refer for tx
  • NG for decompression
  • monitor for signs of shock
  • administer antibiotics safely
  • hydration and nutrition
  • routine post-op care—observe for signs of ab distention
  • family support
41
Q

Celiac disease

A

Chronic inflammation of the small intestinal mucosa which may result in varying degrees of atrophy to intestinal villi, malabsorption, and a variety of CM
- triggered by inability to digest gluten
- results in accum of a toxic substance that damages the mucosal surface and interferes with the absorption of nutrients
- gluten includes wheat, rye, barley, oats

42
Q

Celiac disease CM

A
  • no sx for first 6M
  • major sx appear between 1-5Y
  • progressive malnutrition—anorexia, muscle wasting, ab pain, distention
  • secondary deficiencies—anemia, rickets
  • watery, pale, foul smell stool
  • vom, constipation
  • celiac crisis
43
Q

Therapeutic management (Celiac disease)

A
  • Diagnosis—jujunal biopsy, abnormally elevated levels of endomysial and anti-tissue transglutaminase antibodies
  • Eliminate wheat, rye, barley, oats
  • diet high in calories and protein, low fat
  • supplemental vitamins and iron
  • inc risk of malignant lymphoma of small intestine
44
Q

Celiac disease NC

A
  • promote compliance with dietary restrictions
  • teach parents to read labels, what they can and can’t have
  • stress long-term complications of this
45
Q

Short bowel syndrome

A
  • malabsorptive disorder that occurs as a result of dec mucosal surface area
  • etiologies are congenital anomalies (jujunal and ileal atresia, gastroschisis), ischemia, trauma, long segment resection
46
Q

probs with SBS

A
  • dec intestinal surface area for absorption of nutrients and fluids
  • inc and disorganized transit time for intestinal contents
47
Q

SBS therapeutic management

A
  • keep as much bowel as possible
  • maintain optimum nutrition
  • stimulate intestinal adaptation with feedings that use the bowel
  • dec complications
  • prob need TPN but as last resort
48
Q

Can you feed immediately after surgery?

A

No, need to let bowel rest then use TPN to allow the gut to still work

49
Q

Complications of SBS and TPN admin

A
  • central venous cath infection and technical probs
  • metabolic probs–electrolyte disturbances, hyper/hypo glycemia, HLD, cholestasis, liver dysfxn
  • bacterial overgrowth
  • gastric acid hypersecretion
50
Q

SBS NC

A
  • TPN–sterile set up and consistent rate
  • CVAD–infection, occlusions, dislodgement
  • enteral feedings–non-nutritive sucking, check placement, daily stools for occult blood
  • teach home care
  • skin care
  • chronic diarrhea
  • promote development
51
Q

Acute appendicitis

A

Inflam of the veriform appendix (blind sac at end of cecum)
- uncommon before age 2; assoc with inc probs
- rapidly progresses to perforation and peritonitis
- obstructs lumen of the appendix, hardened fecal material, foreign bodies, microorgs, parasites (not pin worms)

52
Q

Acute appendicitis CM

A
  • colicky ab pain and renderness (McBurney point) to LRQ
  • guarding ab
  • rebound tenderness–hurts more when you let go
  • N/V
  • anorexia
  • low fever; over 102 means perforation
  • signs of peritonitis
53
Q

What does it mean when appendicitis pain gets better suddenly?

A

Rupture–pallor, etc

54
Q

Acute appendicitis therapeutic management

A
  • diagnose with H&P, CBC, ab ultrasound
  • apppendectomy–pre-op fluids and antibiotics–remove appendix (may need to do later to not cause more damage)
  • peritonitis–fluids, antibiotics, NG tube, delayed closure to prevent abscess formation
55
Q

Appendicitis NC

A
  • assess
  • avoid enema and heating pad
  • prep for surgery–psych and phys
  • post-op care–not big deal if not ruptured
  • if ruptured, probs eating, fever, may need peritoneal washed out multiple times
56
Q

Meckel Diverticulum

A

fibrous band connecting small intestine to umbilicus
- most common congenital malformation of the GI tract
- complications–bleeding from peptic ulcer or perforation, obstruction, inflammation

57
Q

Meckel diverticulum CM

A
  • painless rectal bleeding
  • ab pain
  • s/s obstruction
  • currant jelly stool (hematochezia)
  • intussusception
58
Q

Meckel diverticulum therapeutic management

A
  • diagnose H&P, radionuclide imaging
  • surgical removal–correct shock and/or infection first
  • prognosis–full recovery if treated early; 2.5-15% mortality rate if untreated
59
Q

NC for meckel diverticulum

A
  • psych support
  • bleed–monitor for shock, bed rest, record blood loss in stool
  • post-op–IVF, NG to suction

Pediatrics (26 decks)

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