Peds Exam 2 - GI Flashcards
two types of failure to thrive
1) because something is wrong with the child organic
2) idiopathic non organic
what is the guidelines to dx FTT
-not growing
-under 5th %ile, drop off the curve
not concerned about height
therapeutic mgt of FTT
-catch up growth
-correct nutritional deficiencies
-treat underlying cause
-educate parents or primary care givers
-multidis team (SLP,OT,ND)
what happens when a pt gets admitted for FTT
observation
feed the child and watch parent interaction then give pointers (if they are not burping or positioning)
what to monitor for FTT
-I&Os
-daily wts
-routine being followed
-parents well being (support and be positive to)
cleft lip / palate
involves abnormal openings in the lip and/or palate (unilateral or bilateral)
cleft L/P etiology
multi-factorial inheritance, factors & teratogens, maternal smoking
cleft L/P clinical findings
-difficulty feeding (cant form suck, very noisy)
-mouth breathing -> distended abdomen & pressure, dry mucous membranes, increased infection risk
cleft lip therapeutic mgt
surgical correction of lip in first weeks of life
- Z plasty: minimize notching & lengthen the lip
cleft palate therapeutic mgt
obturators, closure between 12-18 months
lip first then palate
what is the nurses biggest priority for closures of cleft L/P
bonding w/ parent & positivity & getting the baby to eat and grow
how to feed a child w/ cleft L/P before surgery
-upright position
-special bottles elongated nipple & squeezable
-lots of burping
-stop after 30-45mins of feeding
-stimulate suck reflex
if palate repair, what position should baby be in after surgery
on belly
if lip repair, what position should baby be in after surgery
back or side, need to facilitate drainage
post op care for cleft L/P
-restrains so they do not pick at sutures, to protect surgical site
-protect airway & prevent infection
-pain mgt
-fluids
-careful suctioning
long term consequences of cleft lip/palate
-altered speech
-altered dentition
-hearing problems & ear infections
teach @dc good oral care, watch the ears & promotion of speech
esophageal atresia (EA) & tracheoesophageal fistula definition (TEF)
failure of the esophagus to develop as a continuous passage and/or failure of the trachea & esophagus to separate
esophagus is not connected to lungs and stomach as it should be
clinical manifestations of EA & TEF
frothy saliva in mouth & nose, choking & coughing, feeding return through nose & mouth, may become cyanotic & apnic
choking, coughing & cyanosis
what is most important EA & TEF
early detection -> sit them upright, suction prn and get imaging
what is the diet order for EA & TEF
NPO to avoid aspiration
can drop an NG depending what is connected or TPN + fluids
imperforate anus
when the anal opening is not as it should be, can be stenotic or not exist at all
important things to monitor in a new born assessment
-anus is as it should be
-that the baby stools within the first 24-48hrs
therapeutic mgt of anorectal malformations
-if narrow, manual dilations
-perineal fistulas then anoplasty
-extensive defects then colonstomy
abdominal wall defect: omphalocele
herniation of the abdominal contents through the umbilical ring -> caught prenatal & can be repaired prenatal
intact peritoneal sec
abdominal wall defect: gastroschisis
herniation of the abdominal contents, right of the umbilical ring
no peritoneal sac
kids do ok if they can keep all of their intestines
therapeutic mgt of gastroschisis
-baby born via c section
-loosely cover organs w/ saline soaked pads & plastic drape
-give fluids & antibiotics
-bring to nicu
-multiple surgical corrections , place in silo in between
nursing considerations for gastroschisis
-sterile technique
-careful handling
-monitor for ileus
-family support
-d/c planning
-home care
gastroenteritis (diarrhea)
second leading cause of death world wide
-stool wt in excess of 200gm/d
-3 or more loose water stools per day
-alternation in normal bowel movement (inc freq, dec consis)
-less than 14 days duration
when are we concerned about diarrhea
-when there is blood in it
-presists
what is gastroenteritis mostly caused by
a virus (roto or noro)
gastroenteritis symptoms
low grade fever, nausea, vomiting, abdominal cramps, watery diarrhea
treatment of gastroenteritis
symptomatically
-hydration
-avoid high sugar drinks
-normal diet if mild or moderate
-IV fluids for moderation to severe
-hand hygiene
-watch skin breakdown
if a child is constipated and stretches out the colon, how long does it take for the colon to go back to normal size
6 months so have to keep them cleaned out for 6 months
how much fiber should a child have
5g of fiber + their age (ex: if 5yr then 10g)
might need fluids
mgt of constipation
1) water
2) add in fruits juice to pull water into colon if water isn’t enough
3) then miralax
do this for 6mo
encopresis
chronic constipation with soiling seepage of loose stool around the constipation
Hirschsprung disease
lack of nerve intervation to the end of the colon -> does not have the nerves to evacuate the stool causing a back up
treat by shortening the bowel
pre op nursing considerations for Hirschsprung disease
-measure abdominal girth daily
-bowel prep w/ enema & antibiotic
-monitor hydration, fluid, & lyte status
post op nursing considerations for Hirschsprung disease
-NG to suction
-NPO then clear liquids
-I&Os
-abdominal assessment
-ostomy care
GERD
infant spitting up a lot bc of sphincter is not very tight at the top of the stomach
if happy spitters don’t do anything, super fussy then fix or meds
hypertrophic pyloric stenosis
circular muscle of the pylorus becomes thickened causing obstruction of the gastric outlet leading to failure to thrive and baby to projectile vomit w/o bile
will feel olive shaped mass that, surgery needed
post op for hypertrophic pyloric stenosis
move from NPO to IV fluids to feedings ok if they throw up, give them time to recover and then feed again. slowly increase feeds
intussusception
invagination or telescoping of one portion of the intestine into another causing an obstruction and making it so food cannot pass through
clinical manifestations of intussusception
-pain
-drawing knees to chest
-vomiting
-palpable sausage shaped mass URQ
-jelly like stools
-tender and distended abdomen
therapeutic mgt of intussusception
dx:H&P, flat plate for free air followed by barium enema (straightens it out)
-non surgical hydrostatic reduction
-surgical reduction & resection
what age group do we see appendicitis in
older school agers and young adolescents
appendicitis
inflammation of the vermiform appendix that rapidly progresses to perforation and peritonitis
etiology of appendicitis
obstruction of the lumen of the appendix, hardened fecal material, foreign bodies, microorganisms, parasites (not pin worms)
symptoms of appendicitis
-tenderness around umbilical area to the RLQ
-N/V
-low grade fever
-rebound tenderness & guarding
-pain w/ movement
dx of appendicitis
H&P, CBC & ultrasound
if confirmed, remove appendix
peritonitis
from rupture appendix -> need fluids, antibiotic, NG tube, and has delayed closure to prevent abscess formation
nursing considerations for appendicitis
-assessments
-avoid enemas & heating pads
-prep for surgery
-post op care (pain meds)
