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Peds Exam 2 > Nutritional and GI dysfunctions > Flashcards

Nutritional and GI dysfunctions Flashcards

1
Q

meconium

A

thick black tarry stools, sticks to babies skin

will turn to a yellow paste after 3 days

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2
Q

swallowing becomes an automatic reflex action until

A

6 weeks of age

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3
Q

at birth mechanical functions of digestion are

A

immature

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4
Q

stomach acid is not fully present until what age?

A

6m of age

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5
Q

most common vitamin deficiencies in childhood?

A

A,C, B2, B6, B12

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6
Q

iron deficiency occurs most frequently in children aged

A

12-36 months

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7
Q

Failure to thrive

A

inadequate growth resulting from the inability to obtain and/or use calories required for growth

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8
Q

criteria to be diagnosed with FTT

A

weight/height below 5th percentile or persistent deviation from an established growth curve

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9
Q

organic FTT

A

has a physical cause such as CF

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10
Q

non-organic FTT

A 
no underlying medical issue
psychosocial factor (parents on drugs, don't recognize hunger cues, depression, neglect)
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11
Q

idiopathic FTT

A

unknown cause

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12
Q

factors that contribute to NFTT (non-organic)

A 
caregiver has difficulty perceiving and assessing the infants needs, they become frustrated and angered at infants dissatisfied response
poverty
health beliefs
inadequate nutritional knowledge
family crisis
feeding resistance
insufficient breast milk
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13
Q

therapeutic management of NFTT

A 
catch up growth
multidisciplinary team approach (peds forensics, PT/OT, dietician, case management)
correct nutritional deficits
treat underlying cause
educate parents/ primary care givers
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14
Q

feeding guidelines for NFTT

A 
staff consistency 
quiet non stimulating environment
be persistent (don't force, create a positive environment)
fact to face posture
introduce new foods slowly
follow a structured routine
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15
Q

cleft lip/palate

A

abnormal openings in the lip and/or palate

unilateral or bilateral

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16
Q

what is cleft lip/ palate caused by

A

multi-factorial inheritance, factors and teratogens

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17
Q

clinical findings with CL/CP

A 
difficulty feeding
mouth breathing ( more swallowed air with distended abdomen and pressure on diaphragm, dry cracked mucous membranes, increased risk of infection and aspiration pneumonia)
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18
Q

what do you wait for before a CL/CP repair?

A

for teeth to form, but fix palate before speech starts

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19
Q

when do you perform CL repair?

A

within the first weeks of life

z-plasty minimizes notching and lengthen the lip

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20
Q

when do you perform CP repair?

A

12-18 months with obturators

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21
Q

preop nursing considerations for CL/CP- parents

A

promote bonding
allow parents to express grief and fears
emphasize the positive
express optimism

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22
Q

preop nursing considerations for CL/CP- infants

A 
feeding difficulties ( breast is recommended, so mom will pump them bottle feed)
upright position
special nipples (Haberman, pigeon)
stimulate suck reflex
swallows fluid appropriately
rest
burp frequently
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23
Q

post op considerations for CL/CP infants

A

protect airway- position on belly right after OR
prevent hypothermia
prevent infection
protect suture line
pain mgmt
avoid objects in mouth and suction with caution

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24
Q

how do you protect the suture line of CL

A

avoid laying on stomach
elbow restraints “no no’s”
remove restraints and check skin q2 hours

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25
Q

what are long term consequence of CL/CP

A

altered speech
altered dentation
hearing problems

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26
Q

discharge teaching for CL/CP

A

good oral care
watch ears
promote speech development

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27
Q

esophageal atresia (EA) and tracheoesophageal fistula (TEF)

A

failure of esophagus to develop as a continuous passage and/or failure of the trachea and esophagus to separate

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28
Q

clinical manifestations of esophageal atresia and tracheoesophageal fistula

A

frothy saliva in mouth and nose
chocking and coughing
feedings return through nose and mouth, may become cyanotic and apneic

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29
Q

what are the three C’s of TEF?

A

chocking
coughing
cyanosis

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30
Q

how do you diagnose EA and TEF?

A

passage of radiopaque catheter until obstruction is encountered

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31
Q

preoperative nursing considerations of EA and TEF

A 
early detection
maintenance of airway
prevention of pneumonia
gastric or blind pouch decompression
antibiotics
antibiotics
prepare for surgical correction
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32
Q

anorectal malformations

A

imperforate anus- surgery done in stages
anal stenosis- manual dilations
perineal fistulas- anoplasty during newborn period
extensive defects- colostomy

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33
Q

preoperative nursing considerations of anorectal malformations

A

GI decompression

IV fluids

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34
Q

post operative nursing considerations of anorectal malformations

A

meticulous perineal care
positioning (side lying or supine with legs suspended, hips elevated)
colostomy care
nutrition ( NG, IV, Lipids) when bowel sounds return you can start oral feeds as tolerated
bowel training

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35
Q

abdominal wall defets

A

omphalocele

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36
Q

omphalocele

A

herniation of the abdominal contents through the umbilical ring. intact peritoneal sac
contained in a sac

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37
Q

gastroschisis

A

herniation of abdominal contents, right of the umbilical ring
no peritoneal sac
not contained

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38
Q

why is it difficult to reduce the intestines of gastroschisis

A

because intestines expand and have to be decompressed before putting back in

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39
Q

how do you are for expose intestines?

A

loosely cover with saline soaked pads and plastic drape
IV fluid
antibiotics
surgical correction done in stages, silo pouch
done in a sterile fashion

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40
Q

what is the goal of gastroschisis repair

A

to get as much bowel as possible back into the body
you can hear bowel sounds through a silo
ensure that an ileus is not forming
a large amount of lost gut can result in short gut syndrome

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41
Q

disorders of motility

A 
diarrhea
constipation
encopresis
hischprung disease
GERD
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42
Q

gastroenteritis

A 
2nd leading cause of death world wide
diarrhea ( stool exceeds 200grams/day)
viral cause 70-80% of time
bacterial cause 10-20% of time
protozoan: less than 10%
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43
Q

viral gastroenteritis

A

most likely the cause of infectious diarrhea

rotavirus and norovirus most common

44
Q

symptoms of gastroenteritis

A 
low grade fever
nausea
vomiting
abdominal cramps
watery diarrhea
viral shedding for weeks after symptoms resolve
45
Q

bacterial diarrhea

A

affects all age groups

fecal-oral transmission (contaminated food)

46
Q

symptoms of bacterial diarrhea

A

bloody diarrhea, severe cramping, and malaise

ABX not always necessary

47
Q

treatment of diarrhea

A

oral rehydration-ORS ( infalyte, pedialyte, naturalyte, or rehydralyte)
normal diet with ORS or mild-mod dehydration
IV fluids for mod to severe dehydration

48
Q

what do you avoid with ORS for diarrhea

A

fruit juices
colas
sports drinks

49
Q

causes of constipation

A 
structural disorders
hypothyroidism
hypercalcemia
lead poisoning
drugs
spinal cord lesions
50
Q

management of constipation

A

dietary

stool softeners

51
Q

encopresis

A

chronic constipation with soiling

52
Q

causes of encorpesis

A

psychological trauma

voluntary withholding

53
Q

management of encorpesis

A

purge the bowel
stool softeners
bowel retraining

54
Q

Hirschsprung disease (megacolon)

A

congenital anomaly
absence of autonomic parasympathetic ganglion cells
causes enlargement of the bowel proximal to defect, results in mechanical obstruction from inadequate motility

55
Q

what is the most dangerous complication of Hirschsprung disease?

A

enterocolitis (caused by ischemia) bloody diarrhea, fever, lethargy

56
Q

newborn clinical manifestations of Hirschsprung disease

A

failure to pass meconium within 48 hours food refusal, bilious vomiting, abdominal distention

57
Q

infancy clinical manifestations of Hirschsprung disease

A

poor weight gain, constipation, abdominal distention, episodes of diarrhea and vomiting

58
Q

childhood clinical manifestations of Hirschsprung disease

A

constipation

ribbon-like, foul-smelling stools, palpable fecal mass, abdominal distention, poor appetite, growth

59
Q

how do you diagnose Hirschsprung disease

A

barium enema
rectal biopsy
anorectal manometry

60
Q

treatment of mild to mod Hirschsprung disease

A

based on relieving the chronic constipation
surgery in 2 stages 1. temporary ostomy 2. soave endorectal pull through
prognosis: good, may have anal stricture and incontinence post op

61
Q

pre-op nursing considerations for Hirschsprung disease

A 
note first BM on all babies
measure abdominal girth
bowel prep- enemas and antibiotics
monitor hydration, fluid, and electrolyte status
teach enema techniques
62
Q

post op care for Hirschsprung disease

A 
NG suction
NPO
I and O to include NG losses and ostomy drainage
hydration and electrolyte balance
abdominal assessment
ostomy care
63
Q

GERD

A

the passive transfer of gastric contents into the esophagus

transient and inappropriate relaxations of the LES

64
Q

factors increasing risk of GERD

A 
prematurity
bronchopulmonary dysplasia
esophageal scar tissue
scoliosis
asthma
CF
65
Q

signs and symptoms of GERD in infants

A 
spitting up alot, may be forceful
hematemesis and melena
irritability
classic back arching
ALTE or apnea
persistent aspiration pneumonia
66
Q

signs and symptoms of GERD in children

A 
heartburn
anemia
persistent aspiration pneumonia
chronic cough
difficulty swallowing
abdominal pain
67
Q

diagnosis of GERD

A

UGI
24 hour pH probe
Endoscopy
Labs

68
Q

medications for GERD

A

antacids or histamine receptor antagonists
PPI - omeprazole
prokinetic medications (reglan, bethanechol, cisapride)

69
Q

surgical treatment of GERD

A

nissen fundoplication

take part of stomach and wrap upper portion of stomach around the LES

70
Q

nursing considerations for GERD

A

positioning HOB 30 degrees
wedge under mattress
harness
small frequent feedings with thickened formula
avoid fatty foods, chocolate, tomato products, and carbonated liquids
burp frequently

71
Q

obstructive GI disorders

A

hypertrophic pyloric stenosis (HPS)

intussusception

72
Q

hypertrophic pyloric stenosis (HPS)

A

circular muscle of pylorus becomes thickened causing obstruction of gastric outlet
unknown cause; maybe genetic component
males 5x more likely to get
develops first few weeks of life, edema, and inflammation increases the obstruction

73
Q

clinical manifestations of HPS

A 
projectile vomiting without bile
hunger and irritability progressing to lethargy
dehydration and weight loss
visible gastric peristalsis
OLIVE SHAPED MASS
74
Q

therapeutic management of HPS

A

H&P, abdominal xray, US
labs show metabolic alkalosis
hyponatremia
hypokalemia

75
Q

pyloromyotomy

A

surgical correction of HPS

corrects dehydration and acid/base balance prior to surgery

76
Q

nursing considerations HPS

A

regulation of fluid therapy
pre-op: NPO, strict I and O, monitor IV fluids, monitor for F & E balance, NG tube
post op: pain control, titrate PO feedings

77
Q

intussusecption

A

invagination or telescoping of one portion of the intestine into another
most common in 1st year, males 2x greater than females

78
Q

complications of intussusception

A 
obstruction
inflammation
edema
ischemia
perforation
peritonitis
shock
79
Q

clinical manifestations of intussusception

A 
severe paroxysmal abdominal pain
screaming and drawing knees to chest
vomiting bile or fecal stained emesis
palpable SAUSAGE shaped mass URQ
Current Jelly stools
abdomen becomes tender and distended
80
Q

therapeutic management of intussusecption

A

flat plate for free air followed by barium enema (air enema)
non surgical hydrostatic reduction
surgical reduction and resection

81
Q

nursing considerations for intussesecption

A 
NG for decompression
monitor for signs of shock
administer antibiotics 
hydration and nutrition 
routine post op care
family support
82
Q

malabsorption syndromes

A

celiac disease

short bowel syndrome

83
Q

celiac disease (gluten sensitive enteropathy)

A

chronic inflammation of small intestine mucosa, results in varying degrees of atrophy to intestinal villi, malabsorption, and a variety of clinical manifestations
inability to digest gluten
results in accumulation of toxic substance that damages mucosal surface and interferes with the absorption of nutrients

84
Q

gluten is in

A

wheat, rye, barley, oats

85
Q

clinical manifestations of celiac disease

A 
no symptoms for at least 6 months
major symptoms appear between 1-5 years
progressive malnutrition; anorexia, muscle wasting, abdominal pain and distention
watery, pale, foul smelling stool
vomiting, constipatoin
celiac crisis
86
Q

what is a secondary deficiency of celiac disease

A

anemia and rickets

87
Q

diagnosis of celiac disease

A

jujunal biopsy

abnormally elevated levels of endomysial and anti-tissue transglutaminase antibodies

88
Q

what do celiac patient eliminate from their diets?

A

wheat, rye, barley, oats

89
Q

what type of diet do celiac patients have

A

high in calories and protein, low in fat

supplemental vitamins and iron

90
Q

celiac patients are at an increased risk of

A

malignant lymphoma of small intestine

91
Q

nursing considerations of celiac disease

A

promote compliance with dietary restrictions
teach pt’s to read labels; cereals, baked goods, grains are often added to processed foods, hydrolyzed vegetable protein
stress long range complications

92
Q

short bowel syndrome

A

malabsorptive disorder that occurs as a result of decreased mucosal surface area
part of bowel has been removed causing elimination problems. (diarrhea, malabsorption)

93
Q

causes of short bowel syndrome

A

congenital anomalies (jejunal and ileal atresia, gastroschisis) ischemia, trauma, long-segment resection.

94
Q

problems with SBS

A

decreased intestinal surface area for absorption of fluid, electrolytes, nutrients
increased and disorganized transit time of intestinal contents

95
Q

therapeutic management of SBS

A

preserve as much bowel as possible
maintain optimum nutrition
stimulate intestinal adaptation
minimize complications

96
Q

complications of SBS and TPN

A

CVA, risk of infection
metabolic complications- electrolyte disturbances, hyperglycemia, hypoglycemia, hyperlipidemia, cholestasis, and liver dysfunction
bacterial overgrowth
gastric acid hypersecretion

97
Q

acute appendicitis

A

inflammation of the veriform appendix (blind sac at the end of the cecum) can be full of stool
uncommon before age 2; associated with increased complications and morality
rapidly progress to perforation and peritonitis

98
Q

causes of acute appendicitis

A 
obstruction of the lumen of the appendix
hardened fecal material
foreign bodies 
microorganisms
parasites (not pin worms)
99
Q

clinical manifestations of acute appendicitis

A 
colicky abdominal pain and tenderness at McBurneys point
guarding abdominal pain
rebounding tenderness 
n/v/anorexia
low grade fever >102 mean perforation
look for signs of peritonitis
100
Q

diagnosis of appendicitis

A

CBC, abdominal ultrasound

101
Q

pre-op appendectomy

A

IV fluids and antibiotics

102
Q

Management of peritonitis

A

fluids, antibiotics, NG tube, delayed closure to prevent abscess formation

103
Q

nursing considerations for acute appendicitis

A

avoid enemas and heating pads

prep for surgery

104
Q

how long does it take for the colon to return to normal size and tone after constipation (large stool burden?)

A

6 months- 1 year

105
Q

how long does it take for miralax to work?

A

3 days

106
Q

McBurneys point

A

pain around umbilicus and radiating down the right side

a sign of acute appendicitis

Peds Exam 2 (13 decks)

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