Nutritional Problems in Children Flashcards
Most Common Food Allergies
milk eggs wheat peanuts shellfish seafood soy
Mast-Cell Activation and Granule Release to the System leads to:
- GI: increased peristalsis (v/d)
- Airway: increase in inflammation, increase mucus buildup (rhinorrhea, congestion, sneezing)
- Blood vessels: increased permeability > inflammation > swelling (usually facial)
Food Allergies: Clinical Manifestations
- rashes
- local inflammation
- swelling of lips
- hives
neuro s/sx: irritability, excessive crying, excessive sweating, hyperactivity, lethargy
anaphylaxis: wheeze, hives, swelling
Food Allergies: Dx
- skin prick testing
- eliminate suspected allergen trial
- hypoallergenic diet (for 2 weeks then add food back in one at a time)
Hypoallergenic Foods
rice rice products pears peaches lamb carrots gelatin desserts lettuce
Food Allergies: Primary Prevention
infant: slow introduction of solid foods
do not delay introducing allergenic foods unless strong family history of food allergies
breast milk, then formulas
Food Allergies: Tx
- elimination/avoidance
- allergy shots
- peanut allergen immunotherapy trials: given orally (OIT), sublingually (SLIT) or epicutaneous (EPIT)
Celiac Disease
intolerance to gluten causing damage to villi in the small intestine
Gluten Product
wheat
rye
barley
oats
Celiac Disease: Etiology
autoimmune
genetic susceptibility unknown
Celiac Disease: Pathophysiology
chronic inflammation leading to destruction of the villi
Celiac Disease: Early Sx
- steatorrhea
- weight loss or poor weight gain
- failure to grow
- abdominal distention
- FTT
- anorexia
Celiac Disease: Late Sx
- severe growth retardation
- osteoporosis
- osteomalacia
- easy bruising
- anemia
- muscle wasting
Celiac Disease: Dx
- fecal fat
- biopsy
- serological testing
- trial of gluten free diet
Celiac Disease: Management
- eliminate gluten from diet
- TPM
- Supplements
Celiac Disease: Nursing Dx
- knowledge deficit
- altered nutrition
- fluid volume deficit
- altered electrolytes
- altered comfort
Lactose Intolerance
XXX
Lactose Intolerance: Dx
breath hydrogen test
Lactose Intolerance: Tx
- supplement lactase
- eliminate lactose from diet
Lactose Intolerance Nursing Considerations
- skin care w/ increased stools (increased acid and enzyme content in stools)
- teaching
Lactose Intolerance Nursing Considerations
- skin care w/ increased stools (increased acid and enzyme content in stools)
- teaching
Crohn’s Disease
an inflammatory bowel disease
- chronic intestinal inflammation of unclear etiology
- no known cure
Ulcerative Colitis
an inflammatory bowel disease
- inflammation w/ ulcer formation in the lining of the colon
- cause is unknown
- end of the colon (rectum) is generally involved
Crohn’s Disease: Top S/Sx
- abdominal pain
- rectal bleeding
- diarrhea
- anorexia
- weight loss
Crohn’s Disease: Extraintestinal Manifestations
- arthritis
- osteoporosis
- primary scleorsing cholangitis (inflammation of bile ducts)
- renal calculi
- anemia
- oral aphthous stomatitis
- erythema nodosum (inflammation of fat cells under skin - causes tissue necrosis > ulcers and chronic wounds usually of the legs)
- pyoderma gangrenosum
IBD: Dx
lab testing:
- CBC
- inflammatory markers: ESR, CRP
- nutritional: protein, albumin, iron, zinc, magnesium, B12, fat-soluble vitamins
- stool studies
Serology tests:
-IBD diagnostic panel
Radiology:
- abdominal x-rays
- abdominal CT scan
- MRE
- Small bowel follow through
Endoscopy:
- upper endoscopy (EGD)
- colonoscopy
- video capsule endoscopy
IBD: Tx
Acute phase:
- NPO
- fluid/electrolytes or TPN
- monitor bowel sounds and abdomen
- monitor stool output
- diet: clear to low-residue diet to high-protein, high calorie diet
- vitamin supplementation: multivitamin, iron, folic acid
Meds:
- antibiotics
- Aminosalicylates (5-ASAs): used to tx inflammation of the gut and prevent flair ups
- Corticosteroids
- Immunomodulators
- Biologics
Surgery (last resort):
- UC: severe bleeding, toxic megacolon
- CD: abscess drainage, fistula, obstruction, stricture, perforation
IBD: Priorities
- dehydration
- blood loss
- hemodynamics
- infection
IBD: Evaluation
- pain assessments
- improved stool output
- weight gain
IBD: Goal of Tx
- decrease flare-ups
- improve pt quality of life
Enterobiasis (Pinworms): Source and Mode of Transmission
- infected humans (common in daycare and schools)
- contaminated hands, food, and air
- incubation period (2-6wk)
Pinworms: Clinical Manifestations
- intense itching
- irritability
- n/v
- weightloss
Pinworms: Dx
- place cellophane tape on the anus which will pick up eggs or worms
- stool for O&P
Pinworms: Tx
- anthelmintic (mebendazole):: 1 dose now and 1 dose in 2 wks
- all family members are treated
- wash clothes, towels, linens w/ hot water
- vacuum
- damp mop
- good hygiene
Gastroenteritis: Cause
Dietary: overfeeding, new foods, milk too soon after diarrhea, too much fruit juice
Meds: antibiotics, laxatives
Toxic agents: heavy metals, organic phosphates
Viral (about 60%): -rotavirus -norwalk virus adenovirus -parvovirus
Bacterial:
- Salmonella
- shingella
- campylobacter
- e.coli
- staph aureus
Parastic:
- giardia
- cryptosporidium
Other:
- post-op
- chemo
Gastroenteritis: Tx
- PO trial
- BRAT diet
- if dehydrated, NPO and IVF
- NS bolus (20 mL/kg of crystalloid NS or LR)
- antibiotics if bacterial etiology
Colic
XXX
Phenylketonuria (PKU)
birth defect that causes the amino acid phenylalanine to build up in the body
-untreated can lead to brain damage, intellectual disabilities, behavior symptoms, seizures
PKU: Tx
strict diet w/ limited protein
PKU: Dx
tested a minimum of 24 hours after beginning milk (breast or formula)
retested 7-10 days later to catch false negatives
PKU: Foods to Avoid
- meat
- dairy products
- dry beans
- nuts
- eggs
GERD: Sx
- chronic vomiting
- FTT
- Fussiness
- esophagitis
- aspiration
GERD: Dx
- history
- x-ray
- upper GI
- EGD
- Ph probe (GOLD STANDARD)
GERD: Management
- conservative tx
- meds
surgical: nissen fundoplication
Failure to Thrive (FTT): Organic FTT Cause
growth failure d/t acute or chronic disorder that interferes w/ nutrient intake, absorption, metabolism, or excretion or that increases energy requirements
FTT: Non-Organic Cause
- 80% w/ FTT do not have apparent organic disorder
- failure occurs b/c of environmental neglect (e.g. lack of food), stimulus deprivation, or both
