MCN Final GI tract

Question 1

-AKA aganglionic megacolon, is an absence of ganglionic innervation to the muscle of a section of the bowel.
-The absence of nerve cells means there are no peristaltic waves.
-It is caused by an abnormal gene on chromosome 10.

Answer 1

Hirschsprung’s disease

Question 2

Hirschsprung’s disease
Signs and symptoms:

Answer 2

-Symptoms generally do not become apparent until 6 to 12 months of age.
-Chronic constipation
-Ribbonlike stools or watery stool (stools passing through such a small, narrow segment look like ribbons).
-Distended abdomen

Question 3

Hirschsprung’s disease
Diagnostic:
__________ _________ a technique that tests the strength or innervation of the internal rectal sphincter by inserting a balloon catheter into the rectum and measuring the pressure exerted against it.

Answer 3

Anorectal manometry

Question 4

Hirschsprung’s disease
Therapeutic Management
_______-_______ ________: Dissection and removal of the affected section, with anastomosis of the intestine.
Ø First, a temporary _________ is established, followed by bowel repair at 12 to 18 months of age.

Answer 4

Pull-through operation

colostomy

Question 5

Nursing Intervention(Colostomy care)

Answer 5

-Promote skin integrity
-Comfort and rest
-Maintain fluid balance

Question 6

-Invagination of one portion of the intestine into another
-(90% of cases occurring by 2 years of age
-Point of invagination is generally at the juncture of the distal ileum and proximal colon

Answer 6

Intussusception

Question 7

Intussusception assessments:

Answer 7

-Frank or occult blood in the stool (Red currant jelly)
-distended abdomen
-Sudden drawing up of legs and cry(pain)
-If necrosis occurs in the
invaginated bowel
Ø Elevated temperature,
peritoneal irritation
(guarding behavior) an
increased WBC, and often
a rapid pulse.

Question 8

Intussusception
Diagnostics:
History taking:

Answer 8

Episodes of crying are for a short time but repeat every 15 to 20 minutes; the stomach feels “full” and vomitus and diarrhea with blood may occur.

Question 9

Intussusception
Diagnostics
Confirmatory test.

Answer 9

Abdominal X-ray, or ultrasound

Question 10

AKA Malabsorption syndrome, gluten induced enteropathy, celiac sprue

Answer 10

Celiac disease

Question 11

An immune-mediated abnormal response to gluten, the protein in wheat, and related proteins in rye, barley and possibly oats, in a
genetically susceptible individual.

Answer 11

Celiac disease

Question 12

Celiac disease
Manifestations:

Answer 12

• Steatorrhea (bulky, foul-smelling, fatty stools)
• Failure to thrive
• Malnutrition

Question 13

Intussusception
Therapeutic Management:
For Vomiting and PostSurgical reduction

Answer 13

-Vomiting: IV fluid therapy may be started to reestablish
their electrolyte balance and to supply adequate fluid
to hydrate them.
-NPO status before surgery or nonsurgical reduction.
-Post surgical reduction
NPO for a few hours after and then introduced gradually to regular feedings (once bowel sounds are
present).

Question 14

Intussusception
Therapeutic Management:
Reduction surgery to reduce the
invagination before necrosis of the affected portion of the bowel occurs

Answer 14

Open/ Laparoscopic surgery

Question 15

Intussusception
Therapeutic Management:
Reduction of the intussusception

Answer 15

Instillation of a watersoluble solution, barium enema, or air
(pneumatic insufflation) into the
bowel

Question 16

A stricture or the
absence of the anus.

Answer 16

Imperforate Anus

Question 17

Imperforate Anus
Incidence:
-Approximately 1 in _______ live births
-More commonly in _________

Answer 17

5000
boys than in girls.

Question 18

Imperforate Anus
There may be an accompanying fistula to the bladder in boys (____________)
And to the vagina in
girls (___________), further
complicating a surgical repair.

Answer 18

rectovesical fistula
rectovaginal fistula

Question 19

Imperforate Anus
Diagnostic:

Answer 19

-Prenatal sonogram
-It is discovered at birth when inspection of a newborn’s anal region reveals no anus
Ø A membrane filled with black meconium protrudes
from the anus
Ø If it is impossible to insert a rubber catheter into
the rectum.

Question 20

Imperforate Anus
Diagnostic:
A “_____” reflex (touching the skin
near the rectum should make the
anus contract) cannot be elicited if sensory nerve endings in the rectum are not intact.

Answer 20

Wink

Question 21

Imperforate Anus
Diagnostic:
Some instances of the stricture will not detected at birth because the anus appears as usual, and the stricture exists so far inside that it can’t be seen. By ___ hours, no stool will be passed and abdominal distention will become
evident.

Answer 21

24

Question 22

Imperforate Anus
Diagnostic:
__________ __ ________: Slightly head-down position to
allow swallowed air to rise to the end of the blind pouch
of the bowel.
Ø This method is also helpful to estimate the distance the
intestine is separated from the perineum or the extent of
the correction that will be necessary.
__________ : Presence of meconium to help determine
whether the infant has a rectal-bladder fistula.

Answer 22

An X-ray or sonogram

Urinalysis

Question 23

Imperforate Anus
Therapeutic Management:
________ surgery, may be given a temporary colostomy, and
the final repair performed when the infant is somewhat older
(____ __ ____months).

Answer 23

Extensive
6 to 12 months

Question 24

(PSARP)?
a type of pull-through procedure that is used to repair anorectal malformations in some children. This technique surgically creates the child’s anus within the sphincter muscle.

Answer 24

Posterior sagittal anorectoplasty

Question 25

Stoma Assessment

Answer 25

-Should be pink to red and moist. -Pallor, cyanosis or dusky color indicates poor blood circulation. -Black indicates necrosis.
- Initially there’s some edema

Question 26

Imperforate Anus
Ostomy complications of stoma

Answer 26

•prolapse
•necrosis
•skin irritation
•retraction

Question 27

-A protrusion of a section of the bowel into the inguinal ring.
üUsually occurs in boys (9:1)
-As the testes descend from the abdominal cavity into the scrotum late in fetal life, a fold of parietal peritoneum also descends, forming a tube from the abdomen to the scrotum.

Answer 27

Inguinal hernia

Question 28

Inguinal hernia
Manifestations:

Answer 28

ü Lump in the left or right groin.
ü In some instances, the hernia is apparent only on crying.
ü Inguinal hernias are painless. Pain at the site implies that the bowel has become incarcerated in the sac (Emergency)

Question 29

Inguinal hernia
Therapeutic Management:
Ø The bowel is returned to the abdominal cavity and retained there by sealing the inguinal ring.

Answer 29

Laparoscopic surgery

Question 30

Inguinal hernia
***To prevent the complication of bowelstrangulation, a surgical emergency, infants with inguinal hernia may have surgery before __ year of age.

Answer 30

1 year

Question 31

The maxillary and median nasal
processes normally fuse between
weeks weeks __ and __ of intrauterine life.

Answer 31

5 and 8

Question 32

-Most common orofacial cleft.
-Incidence is highest in the Asian
population at 1 out of every 500
people.
-Small notch in the upper lip to total separation of the lip and facial structures up into the floor of the nose, with even the upper teeth and gingiva absent.
-May be unilateral or bilateral.

Answer 32

Cleft lip

Question 33

Nose generally appears flattened
because the incomplete fusion of
the upper lip has allowed it to expand in a horizontal dimension.

Answer 33

Cleft lip

Question 34

Cleft lip
Factors:

Answer 34

-Transmission of multiple genes aided by teratogenic factors
present during weeks 5 to 8 of intrauterine life, such as a viral
infection, certain seizure medicines such as phenytoin,
maternal smoking or binge drinking, hyperthermia, stress, and maternal obesity.
-Folic acid deficiency may be associated with incomplete
anterior midline closures.
-Genetic influence

Question 35

-Opening of the palate and occurs when the palatal process does not close as usual at approximately weeks 9 to 12 of intrauterine life.

Answer 35

Cleft palate

Question 36

-Usually on the midline and may
involve the anterior hard palate, the posterior soft

Answer 36

Cleft palate

Question 37

Orofacial clefts
-Tends to occur more frequently in girls than boys.
-Appears to be the result of polygenic inheritance or environmental influences.

Answer 37

Cleft palate

Question 38

Orofacial clefts:
Therapeutic Management:
___________: Cleft lip can be
repaired surgically shortly
thereafter, often at the time
of the initial hospital stay or
between 2 and 12 weeks of age
- Early repair also helps infants
experience the pleasure of
sucking as soon as possible.

Answer 38

Cheiloplasty

Question 39

Orofacial clefts: Cleft lip and Palate
Therapeutic Management:
üFacial contours change as a child grows, a revision of the original repair or a nasal rhinoplasty to
straighten a deviated nasal septum may be necessary when the child reaches __ to __ years of
age.
***If the surgical repair for a cleft lip will be done immediately, the mother will be able to breastfeed as early as 7 to 10 days after surgery

Answer 39

4 to 6

Question 40

Orofacial clefts: Cleft lip and Palate
Therapeutic Management:
***If the surgical repair for a cleft lip will be done immediately, the mother will be able to breastfeed as early as __ __ ___ days after surgery

Answer 40

7 to 10

Question 41

Orofacial clefts: Cleft lip and Palate
__________ : Two-stage palate repair, with soft palate repair at 3 to 6 months of age and hard palate repair at 6 to 18 months of age, called the ______ protocol.
ü Early repair increases speech development

Answer 41

Palatoplasty
Malek

Question 42

After surgical repair, about ___% of children affected by cleft palate progress to develop normal speech, yet referral to speech therapy early in infancy should always occur to ensure successful speech development

Answer 42

80

Question 43

Nursing Considerations:
Cleft lip:

Answer 43

• support in an upright position and feed the infant gently using a soft bottle and a commercial cleft lip nipple or a spoon.
  -If there is difficulty with latching, a nipple shield can be suggested to help form a tighter seal at the breast.
  -Review with the mother how to pump or manually express
  breast milk to maintain a milk supply prior to surgical correction and after, if needed.
• Children need follow-up to detect if hearing or speech
  difficulty occurs; because the angle of the eustachian tube
  may be changed in surgery, a child may develop more ear
  infections than usual, possibly leading to some hearing impairment.

Question 44

Nursing Considerations:
Cleft palate: Surgery

Answer 44

• If surgery will be delayed beyond 6 months of age or the time when solid food would usually be
  introduced, teach parents to be
  certain any food they offer is soft (liquid) because particles of coarse food could invade the nasopharynx and be a cause of aspiration.
• Post-operative
  ØInfant is kept on NPO for 4 hours and then introduced to liquids such as plain water.
  ØNo tension is placed on a lip suture line because this helps keep the sutures from pulling apart and leaving a large scar.
  ØAfter palate surgery, only liquids are generally given the first 3 or
  4 days, and then a soft diet is followed until healing is complete.
• When children begin to eat soft food: Don’t use a spoon because
  spoons can invariably be pushed against the roof of their mouth
  and possibly disrupt sutures.
  Be certain milk is not included in the first fluids offered because milk curds tend to adhere to the suture line and so are difficult to remove.
• Clean suture line with sterile saline with sterile cotton-tipped applicators after every feeding or whenever the normal serum that forms on suture lines
  -After a feeding, always offer the sip of clear water to rinse the suture line
  -Prudent twice-daily gum and teeth brushing with an as are biyearly dental visits for monitoring
  -Position patient in side lying position to allow secretions
  to drain.
  -Nothing hard or sharp must come in contact with a recent cleft suture line (toys, straw, toothbrush, etc.)

Question 45

-A paroxysmal abdominal pain that generally occurs in infants under 3 months of age and is difficult to console.
-It is a common condition and is estimated to affect up to 1 in 5 infants during their first few
months.

Answer 45

Colic

Question 46

Colic
Marked by:

Answer 46

ü Loud, intense crying.
ü Infants pull their legs up against their abdomen
ü Face become red and flushed
ü Fists clench
ü Abdomens become tense
ü If offered a bottle, an infant will suck vigorously for a few minutes as if starved and then stop as another wave of intestinal pain occurs.

Question 47

Infantile Colic: _________ _______ (Rule of 3’s)

Answer 47

Wessel criteria

Question 48

Colic
Nursing considerations:

Answer 48

ü Thorough history: An intestinal obstruction or infection can mimic an attack of colic.
ü If the infant is bottle fed, ask about the type of formula used, how it is prepared, and if parents
hold the baby upright and burp the infant adequately after feeding.
ü For a breastfed baby, ask about the mother’s diet (Is she avoiding “gassy” food such as cabbage?).
üBoth breastfed and formula-fed infants may feel more comfortable with small, frequent
feedings to prevent distention and discomfort.
üOffering a pacifier can be comforting.
üPromoting comfort: Ex. Playing a music box that simulates the sound of a heartbeat are often reported as being helpful.
ü Caution parents to check with their primary care provider before using herbs or home remedies such as star anise to be certain what they have heard to be effective is safe for infants.
ü An infant cries and the parents may become tense and unsure of themselves. An infant then senses the tension and develops more colic.

Question 49

A sudden unexplained death in infancy younger than 1 year of
age. The peak age of incidence is 2 to 4 months of age.

Answer 49

Sudden infant death syndrome (SIDS)

Question 50

Sudden infant death syndrome (SIDS)
üTypically, affected infants are well nourished.
üAfter being put to bed at night or for a nap, the infant is then found dead a few hours later.
Infants who die this way do not appear to make any sound as they die, which indicates
they die with _____________.

Answer 50

laryngospasm

Question 51

Sudden infant death syndrome (SIDS)
Tends to occur at a higher than usual rate in (factors):

Answer 51

üInfants of adolescent mothers
üInfants of closely spaced pregnancies
üUnderweight and preterm infants
üEconomically disadvantaged
üNarcotic-dependent mothers

Question 52

Sudden infant death syndrome (SIDS)
üCause of SIDS is unknown
üIn addition to prolonged but
unexplained apnea, other
possible contributing factors
include:

Answer 52

• Sleeping prone rather than supine
• Viral respiratory or botulism infection
• Exposure to secondary smoke
• Pulmonary edema
• Brainstem abnormalities
• Heart rate abnormalities
• Decreased arousal responses
• Possible lack of surfactant in alveoli
• Sleeping in a room without moving air currents (the infant rebreathes expired carbon dioxide)

Question 53

Sudden infant death syndrome (SIDS)
Recommendations:

Answer 53

üPut newborns to sleep on their back: the incidence of SIDS has
declined almost 50% to 60%.
üUse of a firm sleep surface. Caution parents not to place pillows in an infant’s crib.
üBreastfeeding
üRoom sharing without bed sharing
üRoutine immunizations
üMany infants enjoy sucking on a pacifier to help them fall asleep.
üAvoidance of soft bedding, overheating, and exposure to tobacco smoke , alcohol, and illicit drugs.

Question 54

After SIDS Nursing Considerations:

Answer 54

üParents have a difficult time accepting the death of any
child. Parents should be counseled by someone who is
trained in counseling at the time of the infant’s death.
üAutopsy reports should be given to parents as soon as
they are available.
üReassure parents the death was not their fault. They
need this assurance if they are to plan for other children

Question 55

As amniotic fluid passes through the fetal digestive tract, the water part of the amniotic fluid is absorbed. A sticky, thick, dark green substance called meconium is made up of cells, protein, fats, and intestinal secretions.
Meconium is present in the fetal bowel as early as 10
weeks of gestation.

Answer 55

Meconium aspiration syndrome

Question 56

An infant may aspirate meconium
either in utero or with the first
breath at birth. Meconium can
cause severe respiratory distress
(________, _________ and _________).

Answer 56

tachypnea, retractions, and grunting

Question 57

Meconium aspiration syndrome
Pulmonary effects:

Answer 57

ü Airway obstruction
ü Surfactant dysfunction
ü Chemical pneumonitis: Irritation of the airway manifested by cough and shortness of breath.
ü Pulmonary hypertension

Question 58

Meconium aspiration syndrome
Incidence:
ü Approximately __% to __% of all births; in 2% to 4% of these births, infants will aspirate enough meconium to cause meconium aspiration syndrome (MAS)

Answer 58

10% to 20%

Question 59

Meconium aspiration does not tend to occur in ____________ infants because the substance has not passed far enough in the bowel for it to be at the rectum in these infants.

Answer 59

ELBW

Question 60

Meconium aspiration syndrome
Assessment:
-Fluid at birth is _______ to ________ ______ from the staining.
-Difficulty establishing respirations at birth.
-The Apgar score is apt to be
low.

Answer 60

green to
greenish black

Question 61

Meconium aspiration syndrome
Assessment:
üAir trapping may also cause enlargement of the anteroposterior diameter of the
chest (______ _____).
üABG: Poor gas exchange evidenced by a decreased PO2 and an increased PCO2.
üX-ray: Bilateral coarse infiltrates in the lungs.
üThe diaphragm will be pushed
downward by the overexpanded lungs.

Answer 61

barrel chest

Question 62

Meconium aspiration syndrome
Therapeutic Management:
ü___________: To dilute the amount of meconium in the amniotic fluid.
üIf deeply stained amniotic fluid is identified during labor, the infant
may be scheduled for a _______ ______. After birth, infants may needto be treated with oxygen administration and assisted ventilation.
ü_______ therapy may be prescribed to forestall the development of pneumonia as a secondary problem.
üMaintain a ________-________ environment to prevent the infant from having to increase metabolic oxygen demands.

Answer 62

Amnioinfusion
cesarean birth
Antibiotic
temperature-neutral

Question 63

Meconium aspiration syndrome
Therapeutic Management cont…
üIf lung compliance is poor, _________ may be administered. If lung noncompliance continues, this may necessitate high inspiratory pressure.

Answer 63

surfactant

Question 64

High inspiratory pressure can cause a __________ or
pneumomediastinum (air in the chest cavity). Observe the
infant closely, therefore, for signs of trapping air in the alveoli because the alveoli can expand only so far and then will rupture, sending air into the pleural space
(____________).

Answer 64

pneumothorax

Question 65

Meconium aspiration syndrome
Therapeutic Management:
•A _______ ___________ with percussion and vibration may be helpful to encourage the removal
of remnants of meconium from the lungs.
•Some infants may need to be administered nitric oxide or maintained on _________ _______ ________ (ECMO) to ensure adequate oxygenation.

Answer 65

chest physiotherapy

extracorporeal membrane oxygenation

Question 66

Meconium aspiration syndrome
Nursing Consideration:

Answer 66

ü Establish normal core temperature
ü Reduce the risk of infection
ü Establish a balanced fluid volume (Ax. I/O)
ü Provide the family with emotional support and guidance.