Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds Exam 3 > GU/GI disorders - exam 3 > Flashcards

GU/GI disorders - exam 3 Flashcards

1
Q

What is meconium

A

the dark green substance forming the first feces of a newborn infant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is Hirschsprung disease?

A
  • congenital aganglionic (lack of ganglionic nerve cells) in part of the colon (leads to megacolon/mechanical obstruction d/t lack of peristalsis)
  • usually involves rectum and distal colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the signs and Sx of Hirschsprung disease?

A
  • no meconium 24-48 hours after birth
  • refusal to fee (FTT)
  • vomiting, distention and constipation
  • complications: enterocolitis (severe diarrhea, potentially fatal) and ribbon like stools, leads to dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you Dx hirschsprung disease?

A
  • x-ray after a barium enema

- rectal biopsy (can confirm 100%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to treat hirschsprung disease?

A
  • “pull through” surgery
  • temporary ostomy
  • if total paralysis hirschsprung is present, ileostomy is needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is intussusception

A
  • Telescoping (invagination) of 1 portion of intestine into another
  • cause is usu unknown, may be d/t intestinal lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In what demographic is intussusception most common?

A
  • in male infants (3-9 months)

- may happen up to 5 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs and Sx of intussusception?

A
  • Colicky abdominal pain (intermittent in beginning, constant in later ischemic stage)
  • bringing knees to belly
  • acute pain
  • edema, mucous, irritation, leaking of blood
  • vomiting
  • *RED CURRANT JELLY STOOLS (d/t mix of mucus and blood)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is intussusception diagnosed?

A

by ultrasound guided saline enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is intussusception Treated?

A
  • by air enemas (80% cases are able to be reduced by this non-operative route)
  • if not, surgery is needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is pyloric stenosis?

A
  • Hypertrophy of pylorus causing constriction of pyloric sphincter w obstruction of gastric outlet
  • runs in families
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When does pyloric stenosis usu develop?

A

-in first 2-5 weeks of life (more common in males)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the signs and Sx of pyloric stenosis?

A
  • *PROJECTILE VOMITING
  • child is hungry immediately after feedings
  • poor weight gain or weight loss
  • can result in signs of dehydration
  • palpable olive shaped mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is pyloric stenosis diagnosed?

A

with sonogram (shows thickening of pylorus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is pyloric stenosis treated?

A
  • treat dehydration

- surgical correction w fundoplacation (required!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Post op considerations with pyloric stenosis surgery?

A

rapid recover feeding 4-5 hours post op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is GERD

A
  • Transfer of gastric contents into esophagus

- occurs in everyone but frequency and persistency is what makes is abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In what pediatric demographic is GERD very common?

A

infants less than 2 months old (often resolves spontaneously)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the signs and Sx of GERD?

A
  • regurgitation, vomiting, poor feeding, irritable, URI/wheezing
  • Sandifer syndrome (arching of the back)
  • heartburn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment for GERD in peds?

A
  • thicken formula w ith ceral
  • feed small amts more often
  • medications: H2 receptor antagonist (Zantac) or PPI (Nexium, Prevacid)
  • surgical fundoplication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is celiac disease?

A
  • An autoimmune disease caused by sensitivity to the protein gluten
  • if gluten is consumed (wheat, barley, rye) an immune response is triggered and damage is caused to lining of sm intestine
  • once lining of sm intestines is damaged, nutrients cant be absorbed causing nutrient deficiencies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the signs and Sx of celiac disease?

A
  • diarrhea, abdominal pain, ab distention, weight loss, fatigue
  • frothy, foul-smelling stools
  • malnutrition
  • steatorrhea
  • anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is celiac disease treated?

A

with a gluten-free diet for LIFE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some grains/starches that are naturally gluten-free?

A

corn, quinoa, millet, rice, buckwheat, flax, lentils, potato, wild rice, soy, yucca, tapioca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Etiology of diarrhea in children?

A

can be viral (most likely ROTAVIRUS!!) or bacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the most common viral cause of diarrhea in the US?

A

rotavirus (new vaccine is helping to reduce cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the leading cause of illness in kids aged 5 or less?

A

acute diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the most common bacterial causes of bacterial acute diarrhea?

A

salmonella, e. coli, shigella, campylobacter

  • salmonella (feed borne and person-to-person transmission
  • e. coli: food borne
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why are children more susceptible to diarrhea and DEHYDRATION?

A

kids have:

  • GREATER body surface area (more at risk for insensible water loss thru skin and lungs)
  • FASTER basal metabolic rate (w fever, BMR increases)/higher metabolism
  • kidney function is immature
  • GREATER fluid requirements than adults
  • MORE extracellular fluid volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

types of dehydration (3 types)

A
  • isotonic (most common) [water and salt are lost in equal amts)
  • hypotonic: electrolyte deficit exceeds water deficit
  • hypertonic: water loss exceeds electrolyte deficit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

As we age, we (INCREASE/DECREASE) intracellular fluid and (INCREASE/DECREASE) extracellular fluid

A

As we age, we INCREASE intracellular fluid and DECREASE extracellular fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Why do we tend to decrease our amt of extracellular fluid as we age?

A

Bc when we get sick, we lose first the extracellular fluid (this is why kids loose a bigger proportional percentage and are at a higher risk of dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the clinical manifestations of dehydration?

A
  • weight loss (d/t fluid loss)
  • rapid pulse
  • decr BP
  • Decr peripheral circulation
  • decr urinary output
  • incr specific gravity (seen w dipstick)
  • decr skin turgor
  • dry mucous membranes
  • absence of tears
  • sunken fontanel in infants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Biggest complication we worry about with diarrhea is…

A

dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

nursing management/recommendations for dehydration

A
  • oral rehydration therapy: pedialyte
  • small amounts, often
  • observe I and O’s
  • NO ANTIMOTILITY AGENTS
  • NO ANTIBIOTICS (if it’s d/t a virus)
  • early and gradual reintroduction of bland foods (avoid junk food, fried foods and milk. Promote mashed potatoes, baked chicken, chicken noodle soup)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does oral rehydration therapy (ORT) work?

A
  • enhances and promotes reabsorption of H2O and Na
  • reduces vomiting, diarrhea, and duration of illness
  • usually not given in cases of severe diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

ORT contains

A

75 mEq Na per liter

-also contains glucose, K, and Cl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the recommended dose of ORT

A

50-100ml/kg every 3-4 hours (small volumes, frequently)

39
Q

Signs of progression to SEVERE dehydration

A
  • weight loss of > or = 10%
  • very increased HR
  • hyperpnea (deep and rapid breaths)
  • orthostatic hypotension
  • behavior: hyperirritable or lethargic
  • thirst: moderate to intense
  • mucus membranes: dry to parched
  • absent tears, sunken eyes
  • sunken fontanel
  • very delayed cap refill (>4 seconds)
40
Q

Hospital management of dehydration

A
  • hospitalization for IV rehydration (if ORT isn’t sufficient)
  • nursing assessment (skin turgor, MMs. fontanels)
  • I and Os (1gm wet = 1 ml urine)
  • daily weight
  • vital signs
  • lab values (low bicarb, high H/H)
41
Q

What is acute appendicitis

A

inflammation of vermiform appendix (leads to eventual obstruction)

42
Q

Signs and Sx of acute appendicitis?

A
  • right lower quad pain
  • McBurney’s point (invisible line from belly button to RLQ is where pain is felt)
  • sometimes periumbilical pain)
  • fever
  • vomiting
  • tachycardia
  • pallor
  • hypoactive bowel sounds (or absent)
  • anorexia
  • colicky, cramping, ab pain around umbilicus
  • irritable, uncomfortable, apprehensive
43
Q

With acute appendicitis, what does it mean to when there’s a sudden relief from pain?

A

perforation! (much greater risk for infection and death once it perforates)

44
Q

What is the treatment for acute appendicitis?

A
  • surgical removal (laparoscopy vs laparotomy)
  • per and post op surgical care (antibiotic therapy, possible NG tue)
  • pain mngment (allow child to assume his/her position of comfort
  • never give a laxative or an enema if appendicitis is suspected!! (risks perforation)
45
Q

What is a cleft lip/cleft palate?

A
  • facial malformations that occur during early (5-9 weeks) embryonic development)
  • lip and/or palate do not fuse together
46
Q

What is the cause of cleft lip/cleft palate?

A

associated with chromosomal anomalies (pierre robin syndrome),

  • Also, heart defects, ear malformations, skeletal deformities, genitourinary abnormality
  • also associated with maternal smoking, prenatal infection, advanced maternal age, medications during early pregnancy (anticonvulsants, steroids)
47
Q

When can we usually see/diagnose cleft lips and cleft palates?

A

in early embryonic development (5-9 weeks)

48
Q

What are the biggest complications concerns with cleft lip/cleft palate?

A
  • FEEDING ISSUES!! (need to use bottles with specialized nipples, children unable to breastfeed)
  • **aspiration/aspiration pneumonia (we worry about aspiration most during 1st month of life)
  • ear infections
  • FTT (bc they aren’t eating)
49
Q

Treatment of cleft lip/cleft palate

A
  • surgical closure of lip defect precedes correction of the palate (typically happens ~12-18 months)
  • ongoing mngment w plastic surgery, craniofacial specialists, oral surgery, dental and orthodontist, audiology, speech therapy, psychology
50
Q

Post surgical care for cleft lip/cleft palate

A
  • PREVENT INJURY TO SUTURE LINE!!
  • place infant supine or side lying (always lie on opposite side of where surgical site was)
  • avoid putting ANYTHING in mouth (suction catheters, spoon, straws, pacifiers, plastic syringe, hands)
  • may need to restrain hands
  • prevent child from crying (can disrupt sutures)
  • administer pain meds (prophylactically), cuddle, rock
51
Q

what is the most common facial malformation in children?

A

cleft lip and/or cleft palate

52
Q

Cleft lip and palate may involve problems in what areas for a child?

A

nutritional, dental, ear (otitis media) and speech problems

53
Q

Non-reducible (unable to press hernia inward) umbilical hernias may indicate:

A

incarceration and are considered a medical emergency requiring surgical correction (intestine may be trapped)

54
Q

Common inflammatory disorders of GU tract include: (3)

A
  • UTI
  • nephrotic syndrome
  • acute glomerulonephritis (AGN)
55
Q

In a nutshell, management of a UTI is directed at:

A
  • eliminating infection
  • detecting and correcting functional or anatomic abnormalities
  • preventing recurrences
  • preserving renal function (prevent renal scarring!)
56
Q

What is nephrotic syndrome

A
  • Characterized by increased glomerular permeability to protein causing massive urinary loss of protein resulting in HYPOPROTEINEMIA and edema (PUFFY FACE ESP EARLY AM)
  • it’s the most common presentation of glomerular injury in children
57
Q

What is the cause of nephrotic syndrome

A

idiopathic!

-can sometimes be congenital and/or can be seen secondary to lupus

58
Q

Managment of nephrotic syndrome? (most common med and diet recommendations)

A
  • corticosteroids (reduces protein loss by decreasing inflammation)
  • dietary restrictions: low Na diet, fluid restrictions (in severe cases)
  • advise recovered child to avoid other sick children (can reduce risk for recurrent infection)
59
Q

What are the common signs and Sx of acute glomerulonephritis (AGN)?

A
  • decreased urinary output
  • edema
  • HTN
  • *hematuria
  • proteinuria
60
Q

What is the most common cause of AGN?

A
  • strep (by far, most common)

- can also be caused by post infectious pneumococcal or viral

61
Q

How do you treat AGN?

A
  • antibiotics
  • diuretics
  • antihypertensive meds
  • dietary restrictions: Na and fluid
62
Q

How to Dx AGN?

A

-rapid strep and throat culture

63
Q

what is the most common malignant neoplasm of the kidney in infants and children?

A

Wilm’s tumor

64
Q

Is it okay to palpate the stomach of a child with suspected Wilm’s tumor?

A

Never ever palpate!! Could cause tumor cells to spread to nearby organs

65
Q

What is the most common genitourinary tract disorder?

A

UTI

66
Q

What’s the patho of a UTI?

A

-infection usu involves LOWER urinary tract (urethra and bladder) but can also affect UPPER urinary tract (ureters, renal pelvis, calyces, and renal parenchyma

67
Q

An upper UTI is also called…

A

acute pyelonephritis

68
Q

Acute pyelonephritis is dangerous because it can lead to

A
  • renal scarring (non reversible!), HTN and end-stage renal disease.
  • enough renal scarring can cause AKI
69
Q

What is the most common bacterial cause of a UTI?

A

E. coli

70
Q

Etiology of UTIs?

A
  • URINARY STASIS (single most important contributing factor, esp in KIDS)
  • structure of lower urinary tract (shorter urethra) (leads to higher incidence in females)
  • Reflux (usu resulting from a congenital condition, bladder urine goes up into ureters)
  • Anatomic abnormalities
  • dysfunction of the voiding mechanism
  • bladder compression
71
Q

What are some reasons that make kids more susceptible to UTIs?

A
  • urinary stasis
  • concentrated urine
  • feces (with e. coli) and urine is sitting in diaper for long periods
72
Q

What are the signs and Sx of a UTI in an INFANT

A
  • poor feeding
  • vomiting
  • FTT
  • frequent urination
  • foul-smelling urine
  • pallor
  • fever (any infant
73
Q

What are the signs and Sx of a UTI in CHILDHOOD

A
  • lower ab pain (suprapubic) and/or back pain
  • frequency and urgency on urination, dysuria, hematuria
  • poor appetite
  • vomiting
  • growth failure
  • excessive thirst
  • enuresis/incontinence
  • facial swelling
  • pallor
  • fatigue
74
Q

Signs and Sx of acute pyelonephritis

A

fever > 38.3 (101F), chills, back pain, appearing “quite ill”

75
Q

How to diagnose a UTI?

A
  • Urine culture (sterile)
    • –sterile catheterization, suprapubic aspiration, clean catch
  • urinalysis
    • –presence of leukocytes and nitrates (indicative of a UTI)
  • blood work
  • may need renal US and/or VCUG (Voiding Cystourethrogram) (to check for congenital reflux)
76
Q

Therapeutic management of a UTI

A
  • PO antibiotics (after culture is drawn, try to treat E. coli first, if uneffective, treat with “antibiotic cocktail”)
  • If less than 2 months, will likely need hospital admission and IV antibiotics (we worry abt urosepsis and bacteremia)
  • If vesicoureteral reflux (VUR), may require surgery
  • teach kids to DOUBLE VOID
  • if bladder spasms present, apply warm, moist heat (if it doesn’t raise fever)
77
Q

Common signs and Sx of nephrotic syndrome?

A
  • **proteinuria
  • frothy and foamy urine
  • HYPOalbuminemia
  • HYPERlipidemia
  • facial edema (esp in AM)
  • weight gain (usu pitting edema)
  • ab swelling and diarrhea (d/t edema in intestinal mucosa)
  • anorexia
  • easily fatigued
  • decreased urine volume
78
Q

How do you diagnose nephrotic syndrome?

A
  • urinalysis (3+ protein)
  • 24-hr urine protein (if >50mg/kg/day indicates nephrotic syndrome)
  • serum albumin (low)
  • serum protein (low)
  • renal biopsy required
79
Q

How do you treat nephrotic syndrome?

A
  • Goal is to reduce excretion of urinary protein and reduce fluid retention
  • dietary restrictions: low Na diet
  • fluid restrictions (sometimes diuretics in severe cases)
  • CORITCOSTEROIDS (monitor for SE of long term steroid therapy)
    • –2mg/kg/day for 6 weeks followed by 1.5mg/kg/day for 4 weeks
80
Q

What are some of the effects/signs of long term steroid therapy?

A
  • rounding of face (moonface)
  • weight gain
  • increased appetite
  • growth retardation
  • HTN
  • hyperglycemia
  • infection
81
Q

How can we educate the parents of a child with nephrotic syndrome?

A
  • 2/3 of children will relapse
  • early detection minimizes damage to kidneys
  • teach the signs and Sx of nephrotic syndrome
  • can use urine dipsticks at home
82
Q

what is the nursing mngment of nephrotic syndrome?

A
  • monitor fluid retention or excretion
  • strict I and O’s
  • urine exam for protein (UA dipstick)
  • daily weight and measurement of ab girth
  • vital signs (d/t increased risk of infection)
83
Q

How does acute post streptococcal glomerulonephritis (APSGN) usually come about?

A

-occurs 10-21 days after strep infection in certain strains of strep that cause immune-complexes to deposit in the glomerular basement membrane causing the glomeruli to become edematous occluding the capillary lumen

84
Q

what is the peak age for post strep AGN?

A

6-7 years (uncommon in kids less than 2 yo)

-more common in winter and spring (when we see strep the most)

85
Q

Clinical manifestations of AGN

A
  • edema (esp periorbital)
  • HTN
  • **hematuria (3+, bleeding in upper urinary tract, smoky/tea-colored urine)
  • proteinuria
  • generalized edema (caused by glomerular filtration)
86
Q

How do you treat AGN?

A
  • this is FULLY TREATABLE and curable! (we treat it like we treat strep)
  • dietary modifications: moderate Na, fluid restrictions
  • regular measurements (V/S, body weight, i’s and o’s)
  • specific immunity is conferred
  • subsequent recurrences are UNCOMMON
  • some children have been reported to develop chronic disease (rare)
87
Q

What is a Wilm’s tumor?

A
  • also known as nephroblastoma
  • malignant renal and intra-abdominal tumor of childhood
  • associated with GU anomalies and syndromes
88
Q

what is the peak age for getting Wilm’s tumor?

A

3 years old (more frequent in males)

89
Q

Clinical manifestations of Wilm’s tumor

A
  • increased abdominal girth (ab swelling/mass firm and non-tender to one side)
  • hematuria
  • HTN
  • fatigue
  • weight loss
90
Q

is there usually pain with a Wilm’s tumor?

A

nope

91
Q

What is the therapeutic management of a Wilm’s tumor?

A
  • surgical removal

- chemotherapy (and possibly radiation)

92
Q

Some nursing considerations for a Wilm’s tumor?

A
  • NO AB PALPATION!!!
  • pre-op and post-op mngment (monitor BP closely d/t risk of HTN)
  • child and family teaching/support (surgery is performed 24-48 hrs after diagnosis. Chemo started immediately after surgery)
93
Q

Where is a Wilm’s tumor typically located?

A

it is a firm mass located on one side left or right of midline in the abdomen

Peds Exam 3 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions