Nutritional and GI dysfunction Flashcards

1
Q

Meconium

A

thick, sticky, tarry green-black stool shortly after birth

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2
Q

Digestional differences in kids

A
  • immature digestion at birth
  • swallow is automatic relex until 6W but can control swallow around 6M
  • small stomach
  • emptying time of stomach is faster in infants
  • less saliva until 2Y
  • stomach acid not present until 6M
  • more relaxed esophageal sphincter
  • stomach pain can be from anxiety/other causes (psychosomatic)
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3
Q

Failure to thrive

A

inadequate growth from inability to obtain and/or use calories required for growth
- no universal definition but wt/ht is below 5th percentile or wt/ht does not follow growth curve as expected

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4
Q

Common vitamin/mineral deficiencies

A

Iron (12-36M), Vit A, C, Bs

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5
Q

Organic failure to thrive

A

From underlying medical condition like cardiac prob, CF

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6
Q

Non-organic failure to thrive

A

Can’t find anything attributing to them not growing, often psychosocial factors like parents can’t provide

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7
Q

idiopathic failure to thrive

A

unknown

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8
Q

Clinical features of failure to thrive

A
  • ht/wt below 5th percentile for age
  • persistent deviation from an est growth pattern
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9
Q

Clinical features of non-organic FTT

A
  • developmental delays like social, motor, adaptive, lang
  • apathy
  • inadequate hygiene
  • feeding or eating dx
  • no stranger anxiety
  • avoidance of eye contact
  • stiff and unyielding, flaccid and unresponsive
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10
Q

Factors contribute to NFTT

A
  • caregiver frustration and anger at infant poor response to feeding or prob assessing infant’s needs
  • poverty
  • health beliefs
  • inadequate nutritional knowledge
  • family stress or crisis
  • feeding resistance
  • insufficient breast milk
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11
Q

Therapeutic management (NFTT)

A
  • catch up growth
  • multidisciplinary team approach to therapy
  • correct nutritional deficiencies
  • treat underlying cause
  • educate parents or caregivers
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12
Q

Nursing interventions for FTT

A
  • feeding is a priority
  • give consistent staff
  • quiet, calm atmosphere
  • calm, even temperament
  • talk to child and instruct about eating
  • be persistent
  • face-to-face posture
  • introduce new foods slowly
  • follow child’s rhythm of feeding
  • follow structured routine
  • accurate I&O
  • daily weight
  • support parents and build confidence
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13
Q

Cleft lip/palate

A

Abnormal opening in the lip and/or palate that occurs during embyonic development caused by teratogens, maternal smoking, genetics and environmental

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14
Q

Palate examination

A

Done to all infants at birth

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15
Q

Clinical findings with CL/CP

A
  • difficulty feeding
  • mouth breathing causing more air to be swallowed with distended abdomen and pressure on diaphragm, dry mucus membrane, inc risk of infx esp aspiration pneumonia
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16
Q

Therapeutic management with CL/CP

A
  • surgical correction of lip in first weeks of life; Z-plasty–minimize notching and lengthen lip
  • cleft palate surgery - close between 12-18M, obturators, try to fix before child can speak
  • multidisciplinary care
17
Q

Preop NC for CL/CP

A
  • promote bonding btwn child and parent–show pics of the finished procedure
  • reassure parents it is fixable
  • love and hold
18
Q

CL/CP NC for feeding probs

A
  • breast feeding usually not feasible
  • upright position
  • special nipples–CL/CP feeder, Haberman feeder, pigeon feeder
  • stimulate suck reflex
  • swallows fluid appropriately
  • rest
  • burp frequently
19
Q

Postop NC (CL/CP)

A
  • protect airway (positioning on belly right after birth for cleft palate)
  • position on back for cleft lip
  • hypothermia–give warm blanket
  • prevent infection
  • protect suture line and clean well, antibiotic ointment
  • pain management
  • elbow restraints “no-nos” so can’t pick at face
20
Q

Postop NC (CL/CP)

A
  • long term consequences like altered speech, dentition, and hearing prob
  • discharge teaching like good oral care, watch ears, promote speech dev
21
Q

Esophageal atresia (EA) and Tracheoesophageal fistula (TEF)

A
  • failure of esophagus to dev as a continuous passage and/or failure of the trachea and esophagus to separate
22
Q

EA and TEF diagnosis

A

Passage of radioplaque catheter until obstruction is encountered
- DON’T feed if suspected

23
Q

EA and TEF CM

A

frothy saliva in mouth and nose, choking and coughing, feedings return thru nose and mouth, may become cyanotic and apnic (3 Cs of TEF are choking, coughing, cyanosis)

24
Q

EA and TEF NC

A

Preoperatively–early detection, maintenance of airway, prevention of pneumonia, gastric or blind pouch decompression, antibiotics, prepare for surgical correction, use G tube to keep using the gut

25
Q

Postop NC (EA/TEF)

A
  • careful suctioning
  • positioning
  • provide for non-nutritive sucking
  • N/G to low suction (irrigate frequently)
  • high humidity environment
  • prevent pneumonia
  • care for chest tubes
  • maintain nutrition
  • provide comfort and physical contact
  • D/C teach–s/s of resp distress, tracheomalacia, GERD, constriction of the esophagus