Lecture 7

Question 1

pediatric GI history

Answer 1

• what is typical day of food like?
• how often are bowel movements?
• what does stool look like?

Question 2

when to do stool test

Answer 2

loose stool >2 weeks
febrile
bloody stools

Question 3

esophageal atresia and tracheoesophageal fistula

Answer 3

• esophagus does not develop connected to stomach
• esophagus connects to trachea, causes aspiration of milk
• esophagus does not connect to stomach but trachea does, causes aspiration of stomach acid

Question 4

clinical symptoms of esophageal atresia and tracheoesophageal fistula

Answer 4

frothy mucus in mouth and nose
abdominal distention
increased respiratory distress w feeding
3 Cs: coughing, choking, cyanosis

Question 5

hypertrophic pyloric stenosis

Answer 5

• constriction of pyloric sphincter due to hypertrophy of tissue
• obstruction of gastric outlet

Question 6

manifestations of pyloric stenosis

Answer 6

• projectile vomiting
• visible peristalsis
• FTT
• dehydration
• metabolic acidosis
• olive lump in RUQ

Question 7

risk factors for pyloric stenosis

Answer 7

• smoking exposure
• more common in twins
• male sex
• macrolide antibiotics

Question 8

omphalocele

Answer 8

• bowel outside of the abdomen, covered with peritoneal sac
• can be small loop of bowel or entire GI and liver

Question 9

Gastroschisis

Answer 9

• bowel herniates through abdominal wall to side of umbilical cord

Question 10

Gastroschisis risk factors

Answer 10

• young maternal age
• smoking tobacco or marijuana while pregnant
• maternal illness and infection

Question 11

treating abdominal wall defects

Answer 11

cover with sterile moist dressing
thermal regulation
fluid balance
preop postop care

Question 12

umbilical hernia

Answer 12

• belly button pokes out
• usually resolves on its own during first year

Question 13

inguinal hernia

Answer 13

• contents of abdomen bulge through lower abdominal wall
• require surgical repair

Question 14

why is norovirus more common cause of diarrhea in children in US?

Answer 14

rotavirus vaccine is routine, rotavirus has become less common

Question 15

definition of diarrhea

Answer 15

3 or more loose stools in one day

Question 16

how serious is diarrhea?

Answer 16

Second leading cause of death in children under 5yrs old worldwide

Question 17

chronic diarrhea

Answer 17

lasts > 14 days

Question 18

first line fluid replacement

Answer 18

oral rehydration fluid
NOT contraindicated for vomiting

Question 19

nursing care for diarrhea

Answer 19

replace stool losses 1:1 with ORS
frequent small amounts of ORS
continue using breast milk

Question 20

BRAT diet

Answer 20

contraindicated because it has little nutritional value or electrolytes

Question 21

patho of appendicitis

Answer 21

obstruction of the appendix lumen
colic and inflammation
appendix dilates and thickens

Question 22

clinical manifestations of appendicitis

Answer 22

referred pain
mcburney’s point
fever, N/V, diarrhea
sudden relief of pain = appendix burst

Question 23

malrotation

Answer 23

• abnormal rotation of intestine around mesenteric artery

Question 24

volvulus

Answer 24

intestine is twisted around itself, compromises blood supply to intestines

Question 25

signature sign of malrotation and volvulus

Answer 25

bilious emesis - green or bright yellow

Question 26

how many infants have GER

Answer 26

50%, usually resolve spontaneously by 1 year

Question 27

how common is constipation?

Answer 27

30% of children

Question 28

when should first meconium be passed?

Answer 28

first 24 - 36 hours

Question 29

encopresis

Answer 29

inappropriate passage of feces, soiling

Question 30

hirschsprung disease

Answer 30

- aganglionic megacolon - inadequate motility = obstruction - more common in males and down syndrome

Question 31

nursing education for megacolon

Answer 31

- surgery education - stoma care education - pain management - s/sx of infection

Question 32

celiac disease

Answer 32

- steatorrhea - malnutrition, FTT - abdominal distention - vitamin deficiencies - fatigue

Question 33

pathophysiology of celiac disease

Answer 33

villi atrophy after gluten ingestion, become flattened

Question 34

celiac diagnosis

Answer 34

TTG and IgA biopsy of small intestine if labs positive