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ABSN > Peds Exam 2 - GI > Flashcards

Peds Exam 2 - GI Flashcards

1
Q

two types of failure to thrive

A

1) because something is wrong with the child organic
2) idiopathic non organic

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2
Q

what is the guidelines to dx FTT

A

-not growing
-under 5th %ile, drop off the curve
not concerned about height

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3
Q

therapeutic mgt of FTT

A

-catch up growth
-correct nutritional deficiencies
-treat underlying cause
-educate parents or primary care givers
-multidis team (SLP,OT,ND)

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4
Q

what happens when a pt gets admitted for FTT

A

observation
feed the child and watch parent interaction then give pointers (if they are not burping or positioning)

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5
Q

what to monitor for FTT

A

-I&Os
-daily wts
-routine being followed
-parents well being (support and be positive to)

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6
Q

cleft lip / palate

A

involves abnormal openings in the lip and/or palate (unilateral or bilateral)

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7
Q

cleft L/P etiology

A

multi-factorial inheritance, factors & teratogens, maternal smoking

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8
Q

cleft L/P clinical findings

A

-difficulty feeding (cant form suck, very noisy)
-mouth breathing -> distended abdomen & pressure, dry mucous membranes, increased infection risk

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9
Q

cleft lip therapeutic mgt

A

surgical correction of lip in first weeks of life
- Z plasty: minimize notching & lengthen the lip

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10
Q

cleft palate therapeutic mgt

A

obturators, closure between 12-18 months
lip first then palate

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11
Q

what is the nurses biggest priority for closures of cleft L/P

A

bonding w/ parent & positivity & getting the baby to eat and grow

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12
Q

how to feed a child w/ cleft L/P before surgery

A

-upright position
-special bottles elongated nipple & squeezable
-lots of burping
-stop after 30-45mins of feeding
-stimulate suck reflex

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13
Q

if palate repair, what position should baby be in after surgery

A

on belly

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14
Q

if lip repair, what position should baby be in after surgery

A

back or side, need to facilitate drainage

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15
Q

post op care for cleft L/P

A

-restrains so they do not pick at sutures, to protect surgical site
-protect airway & prevent infection
-pain mgt
-fluids
-careful suctioning

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16
Q

long term consequences of cleft lip/palate

A

-altered speech
-altered dentition
-hearing problems & ear infections
teach @dc good oral care, watch the ears & promotion of speech

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17
Q

esophageal atresia (EA) & tracheoesophageal fistula definition (TEF)

A

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

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18
Q

clinical manifestations of EA & TEF

A

frothy saliva in mouth & nose, choking & coughing, feeding return through nose & mouth, may become cyanotic & apnic
choking, coughing & cyanosis

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19
Q

what is most important EA & TEF

A

early detection -> sit them upright, suction prn and get imaging

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20
Q

what is the diet order for EA & TEF

A

NPO to avoid aspiration
can drop an NG depending what is connected or TPN + fluids

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21
Q

imperforate anus

A

when the anal opening is not as it should be, can be stenotic or not exist at all

22
Q

important things to monitor in a new born assessment

A

-anus is as it should be
-that the baby stools within the first 24-48hrs

23
Q

therapeutic mgt of anorectal malformations

A

-if narrow, manual dilations
-perineal fistulas then anoplasty
-extensive defects then colonstomy

24
Q

abdominal wall defect: omphalocele

A

herniation of the abdominal contents through the umbilical ring -> caught prenatal & can be repaired prenatal
intact peritoneal sec

25
Q

abdominal wall defect: gastroschisis

A

herniation of the abdominal contents, right of the umbilical ring
no peritoneal sac
kids do ok if they can keep all of their intestines

26
Q

therapeutic mgt of gastroschisis

A

-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

27
Q

nursing considerations for gastroschisis

A

-sterile technique
-careful handling
-monitor for ileus
-family support
-d/c planning
-home care

28
Q

gastroenteritis (diarrhea)

A

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

29
Q

when are we concerned about diarrhea

A

-when there is blood in it
-presists

30
Q

what is gastroenteritis mostly caused by

A

a virus (roto or noro)

31
Q

gastroenteritis symptoms

A

low grade fever, nausea, vomiting, abdominal cramps, watery diarrhea

32
Q

treatment of gastroenteritis

A

symptomatically
-hydration
-avoid high sugar drinks
-normal diet if mild or moderate
-IV fluids for moderation to severe
-hand hygiene
-watch skin breakdown

33
Q

if a child is constipated and stretches out the colon, how long does it take for the colon to go back to normal size

A

6 months so have to keep them cleaned out for 6 months

34
Q

how much fiber should a child have

A

5g of fiber + their age (ex: if 5yr then 10g)
might need fluids

35
Q

mgt of constipation

A

1) water
2) add in fruits juice to pull water into colon if water isn’t enough
3) then miralax
do this for 6mo

36
Q

encopresis

A

chronic constipation with soiling seepage of loose stool around the constipation

37
Q

Hirschsprung disease

A

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

38
Q

pre op nursing considerations for Hirschsprung disease

A

-measure abdominal girth daily
-bowel prep w/ enema & antibiotic
-monitor hydration, fluid, & lyte status

39
Q

post op nursing considerations for Hirschsprung disease

A

-NG to suction
-NPO then clear liquids
-I&Os
-abdominal assessment
-ostomy care

40
Q

GERD

A

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

41
Q

hypertrophic pyloric stenosis

A

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

42
Q

post op for hypertrophic pyloric stenosis

A

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

43
Q

intussusception

A

invagination or telescoping of one portion of the intestine into another causing an obstruction and making it so food cannot pass through

44
Q

clinical manifestations of intussusception

A

-pain
-drawing knees to chest
-vomiting
-palpable sausage shaped mass URQ
-jelly like stools
-tender and distended abdomen

45
Q

therapeutic mgt of intussusception

A

dx:H&P, flat plate for free air followed by barium enema (straightens it out)
-non surgical hydrostatic reduction
-surgical reduction & resection

46
Q

what age group do we see appendicitis in

A

older school agers and young adolescents

47
Q

appendicitis

A

inflammation of the vermiform appendix that rapidly progresses to perforation and peritonitis

48
Q

etiology of appendicitis

A

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

49
Q

symptoms of appendicitis

A

-tenderness around umbilical area to the RLQ
-N/V
-low grade fever
-rebound tenderness & guarding
-pain w/ movement

50
Q

dx of appendicitis

A

H&P, CBC & ultrasound
if confirmed, remove appendix

51
Q

peritonitis

A

from rupture appendix -> need fluids, antibiotic, NG tube, and has delayed closure to prevent abscess formation

52
Q

nursing considerations for appendicitis

A

-assessments
-avoid enemas & heating pads
-prep for surgery
-post op care (pain meds)

ABSN (118 decks)

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