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Med-Surg > Pediatric Nutrition, Digestion, & Elimination > Flashcards

Pediatric Nutrition, Digestion, & Elimination Flashcards

1
Q

What is cleft lip or cleft palate ?

A

facial malformations that occur during embryonic development
- may appear separately or together
- most common fetal abnormality

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2
Q

What are the causes of cleft lip or palate ?

A
  • no 100% proven risk factors
  • defect in cell migration that results in a failure or the maxillary or premaxillary process to come together
  • between 4th and 10th week of embryo development
  • can sometimes be seen in high definition 20 week ultrasounds
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3
Q

What are some associated problems of cleft lip and palate ?

A
  • inability to form anterior seal when feeding (lip)
  • decreased ability to suck (palate)
  • improper drainage of middle ear which causes an increased risk of ear infections
  • speech, hearing, dental, secretions
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4
Q

How do we feed an infant with cleft lip or palate ?

A
  • hold infant in upright position during feedings (prevents back up into ears)
  • pigeon bottle
  • special needs feeder
  • Mead-Johnson Cleft Palate Nurser
  • breastfeeding
  • obturator
  • burping
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5
Q

What are some Post-Op care for a Cheiloplasty (cleft lip repair) ?

A

surgery at 2-3 months
- cleansing of suture line (gentle patting)
- keep moist (petroleum jelly) to prevent cracks or bleeding
- elbow immobilizers to prevent infant from reaching the suture
- pain control
- resume feedings as tolerated
- avoid hard objects or suction in oral cavity
- home within 24 hours

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6
Q

What is some Post-Op care for a Palatoschisis (cleft palate repair) ?

A

surgery at 6-12 months (best outcome with speech development before 12 months)
- watch for respiratory difficulties
- elbow immobilizers
- no hard or sharp objects in mouth
- monitor suture line
- feeding modifications: syringe feeding

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7
Q

What is Celiac Disease ?

A

intolerance to the dietary protein gluten
- intestinal intolerance that produces mucosal lesions
- chronic disease with severity varying greatly among children

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8
Q

What is the pathophysiology of Celiac Disease ?

A

villus atrophy in the small bowel in response to the protein gluten
- specifically the gliadin component of gluten
- leads to malabsorption

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9
Q

What causes Celiac Disease ?

A

genetic predisposition
- CD4+ T-cells play a critical role in the immune response characteristic of celiac disease

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10
Q

When is Celiac disease typically first noticed ?

A

noticed several months after induction of gluten in diet
- around 1-5 yrs of age

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11
Q

What are some clinical manifestations of Celiac disease ?

A
  • ulcer and tooth enamel erosion
  • diarrhea, bloating (abdominal distention), constipation
  • stomach pain and nausea
  • brittle nails, acne, or eczema
  • impaired fat absorption (diarrhea/steatorrhea)
  • general malnutrition: muscle wasting, anemia, anorexia
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12
Q

How is Celiac disease diagnosed ?

A
  • biopsy of small intestine
  • genetic and serologic testing
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13
Q

How is Celiac disease managed ?

A

primarily through diet
- gluten free diet
- corn and rice become substitute grain foods
- possible lactose restrictions

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14
Q

What foods are allowed for someone with Celiac’s ?

A
  • fruit and vegetables
  • beans, peas, lentils
  • rice
  • corn
  • soy
  • potato
  • eggs
  • millet
  • buckwheat
  • nut flours
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15
Q

What foods not allowed for someone with Celiac’s ?

A

many processed foods contain gluten as a thickener or filler (read labels for all foods)
- oats
- wheat
- barley
- rye
- certain dairy products like yogurt or ice cream that contain thickeners or fillers
- most bread, pasta, cereals and baked goods

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16
Q

What is Celiac Crisis ?

A

when Celiac’s disease is left untreated it can cause:
- lactose intolerance
- vitamin deficiencies
- impaired growth
- osteomalacia (disease that weakens bones)
- Non Hodgekin’s Lymphoma (cancer in lymphatic system)

17
Q

What disease fall under Inflammatory Bowel Disease (IBD) ?

A
  • ulcerative colitis
  • Crohn’s disease
18
Q

What can both diseases in inflammatory bowel disease (IBD) cause ?

A
  • GI symptoms: frequent stools, crampy abdominal pain
  • extraintestinal and systemic inflammatory responses
  • exacerbation and remission without complete resolution
  • growth failure
19
Q

What is the pathophysiology of Ulcerative Colitis ?

A
  • humoral response mediated by T-helper 2 cells
  • inflammation typically limited to colon and rectum
  • mucosa and submucosa continuously along the bowel (varying degrees of ulceration, bleeding, and edema)
20
Q

What is the pathophysiology of Crohn’s disease ?

A
  • T Helper 1 cytokine profile
  • any part of GI tract from mouth to anus (most often affects distal ileum)
  • all layers of bowl in discontinuous fashion (ulceration, fibrosis, adhesions, stiffening of bowel wall, stricture formation, and fistulas)
21
Q

What are some assessments findings or S&S of Ulcerative Colitis ?

A
  • Abdominal pain/cramping (LLQ)
  • rectal bleeding
  • anorexia/weight loss
  • fever
  • diarrhea (15-20 per day) where stool may contain blood, mucous or pus
  • abdominal distension with firmness and/or tenderness upon palpation
  • high pitched bowel sounds
22
Q

What are some assessment findings or S&S of Crohn’s disease ?

A
  • abdominal pain/cramping in RLQ
  • ulcers in the mouth
  • anorexia/weight loss
  • diarrhea (about 5 per day) with mucus or pus
  • abdominal distention with firmness and/or tenderness upon palpation
  • high pitched bowel sounds
  • steatorrhea (fatty stools)
23
Q

What are some ways to diagnose Ulcerative Colitis ?

A
  • history and physical exam
  • labs (CBC, ESR CRP, stool samples & serologic panel to differentiate from CD)
    • the serological panel is a blood test for
      immune cells (helper T and T cytokine)
  • sigmoidoscopy or colonoscopy with biopsy
    • has ulcerations and/or polyps
  • barium enema
  • MRI and/or CT
24
Q

What are some ways to diagnose Crohn’s disease ?

A
  • history and physical exam
  • Labs (CBC, ESR, CRP, stool samples, total protein, albumin, vitamin levels & serological panel)
  • upper GI series with small bowel follow through
  • upper endoscopy and colonoscopy with biopsy
    • thickened bowel wall with fissures
  • barium enema
  • MRI, CTI, and/or US
25
Q

What is a fissure ?

A

a small but deeper ulcer

26
Q

Which type of bowel disease is most likely to cause severe malnourishment?

A

Crohn’s
- most nutrient absorption occurs in the small intestine

27
Q

Does medications for IBD cure the disease ?

A

it’s not curative
- used to maintain remission or to treat complications

28
Q

What is the purpose of Aminiosalicyclic Acids (Sulfasalazine) ?

A

reduces inflammation in the intestinal mucosa
- maintenance of remission in mild-moderate ulcerative colitis
- 1st line therapy for Crohn’s when colon is involved
- Sulfasalazine less preferred due to side effects

29
Q

What is the purpose of corticosteroids (prednisone) ?

A

reduces inflammation and pain
- used for moderate-severe ulcerative colitis
- to achieve remission in Crohn’s

30
Q

What are some side effects of Prednisone ?

A
  • growth suppression
  • weight gain
  • decreased bone density
  • hyperglycemia
  • use with NSAIDS can increase GI bleeds
31
Q

What is the purpose of immunosuppressants (Methotrexate) ?

A

used for children who are steroid resistant or steroid dependent
- increased risk of infection
- decreased platelets, RBC and WBC
- liver damage (jaundice)
- removed by hemodialysis
- folic acid can be given in cases of toxicity

32
Q

What is the purpose of immunomodulators (Infliximab/Remicade & Adalimumab/Humira) ?

A

to regulate inflammatory and anti-inflammatory cytokines (suppresses immune system)
- Drug class: biologic response modifier
- closely monitor for infusion reaction or allergic reaction

33
Q

What are some surgical treatments for Ulcerative Colitis ?

A

when meds and nutrition therapy fails to prevent complications:
- total proctocolectomy is curative (take all of colon out)
1. with ileal pouch/anal anatomosis
or
2. with permanent ileostomy

34
Q

What are some surgical treatments for Crohn’s disease ?

A

not curative
- removal of diseased segments with resection and re-anastomosis of remaining intestine
- repeated resections can lead to Short Bowel Syndrome

35
Q

What is an Ileal pouch/J-pouch ?

A

a pouch made out of the ileum (last part of small intestine) that holds the feces like the rectum used to do
- stapled to the anus so they still use the restroom normally out of anus

36
Q

What are some possible complications of IBD ?

A
  • Toxic Megacolon: more common with ulcerative colitis
  • Fissures, strictures, abscesses, and fistulas: more common with Crohn’s
  • malnutrition, growth failure: more common with crohn;s
  • rectal bleeding/hemorrhage: more common with ulcerative colitis
  • colorectal cancer: more common with ulcerative colitis (anything that changes the lining of the GI tract has the potential for cancer)

Med-Surg (16 decks)

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