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Peds Exam 2 > Peds GI > Flashcards

Peds GI Flashcards

1
Q

Role and functions of GI

A

Digestion, Absorption & Metabolism

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2
Q

2 basic activities of GI

A

Mechanical (neuromuscular actions mouth to anus) & Chemical (enzymes, hydrochloric acids, hormones, mucous, water and electrolytes).

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3
Q

Infant vs. Children’s Gastrointestinal System

A

Liver function immature at birth
Enzymes deficient until 4 to 6 months old
Abdominal distention from gas common with infants
Stomach capacity smaller

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4
Q

Cleft Lip and Palate info

A

Failure of the maxillary processes to fuse between 5 to 12 weeks gestation
Failure of the tongue to move down at the correct time prevents the palatine processes from fusing
Can have unilateral and bilateral

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5
Q

Nursing management for cleft lip/palate

A 
Facilitate Feeding
Psychosocial support
Pre / Post operative teaching
(Surgeries start around 10 weeks; stabilizing bar used to keep suture line approximated;  have to keep them from touching mouths may even restrain arms. Mouths are also very infectious and need to keep clean.  SO, keep area clean after feeding, protect suture lines.  Can extend surgeries up to 18 months). 
Coordination of Care
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6
Q

Esophageal atresia and tracheoesophageal fistula

A

Foregut fails to lengthen, separate, and fuse into two parallel tubes (esophagus and trachea) at 4 to 5 weeks gestation

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7
Q

what is a prominent risk factor for Esophageal atresia and tracheoesophageal fistula

A

Associated with maternal polyhydramnios

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8
Q

what does the nursing management entail for Esophageal atresia and tracheoesophageal fistula?

A

Identification
-Identifying signs and symptoms of these infants
Perioperative teaching
-Suction is important preoperatively
-Care of the gastrostomy tube postoperatively
Psychosocial Support
think about finding family support and work on bonding.

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9
Q

Gastroschisis and omphalocele: where and when does it usually occur?

A

Gastroschisis usually occurs to the right of the umbilicus and omphalocele occurs through the umbilical cord
Occurs in week 11 of gestation when abdominal contents fail to return to the abdomen

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10
Q

Anorectal malformations: what are they are how do they form?

A

Anal stenosis and anal atresia
Failure of growth of urorectal septum, lateral mesoderm structures, and ectodermal structures
Associated anomalies up to 70% of the time

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11
Q

important parts of a GI assessment

A

Height and weight failure to increase (nursing measurements), hx of what you are eating (breastfeeding, formula, etc.); stool – output, burping, farting. What stool looks like. Abdominal girths, urine tests. All good things to assess for GI d.o.

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12
Q

what is malabsorption a concern?

A

Malabsorption leads to malnutrition and poor growth.

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13
Q

causes of cleft lip/palate

A 
Multifactorial causes (recommend folic acid)
Advanced maternal age
Lack of prenatal care 
Meds/drugs
Genetics
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14
Q

What are the concerns with cleft lip/palate?

A

Becomes a feeding issue; surgical repair long term; speech, increase risk for aspiration; maternal bonding, hearing issues and recurrent ear infxs

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15
Q

what are the manifestations (and timing) of Esophageal atresia (narrowing) and tracheoesophageal fistula

A

Manifestation soon after birth: 3 C’s: choking, coughing, cyanosis (NG, OG tube soon after birth for cont. suctioning.

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16
Q

Nursing considerations for gastroschisis and omphalocele

A

Protection of the sac upon delivery; want to prevent loss of fluid as best you can so body temp reg is difficult and hypovolemia
Use moist sterile gauze to protect
Create a silo with a prosthetic sac that covers over he contents and at the top is a cinch string and gets cinched as muscle and skin grows to allow for closure (for the gastroschisis – the omphalocele is a little easier d/t having it already contained).
Family bonding want to watch for.

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17
Q

anal stenosis/atresia nursing mgt

A

Anal stenosis (decreased movement and looks a little more ribbon like). Picked up at birth in newborn assessment. Watch strict I and O’s.
Want to make sure poop is going through
Temp colostomy may be utilized.
Care and education is a factor for family.

18
Q

what happens with an umbilical hernia?

A

Around week 11 gestation the obliterated umbilical vessels occupy the space in the umbilical ring BUT the hernia usually closes as the muscles strengthen in later infancy and childhood

19
Q

what is Meckel’s diverticulum and what are the s/s?

A

Omphalomesenteric duct fails to atrophy
Outpouching of the ileum remains and contains gastric contents causing ulceration
Bowel obstruction, perforation, or peritonitis can occur
Requires excision and removal surgically
s/s can include Rectal bleeding, inflammation, intestinal obstruction

20
Q

what is Hirschsprung disease?

A

Congenital absence of ganglion cells in the rectum and colon

Genetically acquired and occurs when there is failure of the migration of neural crest cells in utero

21
Q

what are the issues with hirschsprung disease?

A

Colon becomes a “megacolon” d/t the backup of the stool.

22
Q

nursing mgt for Hirschsprung disease?

A

Want to make sure we know meconium has passed; over time may see complaints of decreased BM’s (one a week); abdominal distention; emesis and bile stained emesis is a good indicator. May see development delays
Chronic care overtime; diet, food, lifestyle changes, meds forever.
Want to prevent dehydration and this is critical. Rectal stim to poop every day

23
Q

what are the causes of Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)

A

Faulty regulation of the immune response of the intestinal mucosa
Usually genetically triggered
Crohn’s disease can cause inflammation and ulcers anywhere throughout the GI tract
Ulcerative colitis effects large intestine and rectal mucosa

24
Q

Nursing management if IBS

A

Electrolytes, hemoglobin (anemia is common); home mgt: surgery, steroids, dietary modification

25
Q

what are the Acquired GI disorders

A
  • Pyloric stenosis
  • Intussusception
  • Gastroesophageal reflux
  • Gastroenteritis
  • Appendicitis
  • Colic
26
Q

What is pyloric stenosis

A

Hypertrophy of the circular pylorus muscle where stomach empties.
Stenosis occurs between stomach and duodenum

27
Q

what are the s/s of pyloric stenosis

A

Will lead to backup of food via mouth since cannot go down.

Child will present with severe projectile vomit 6-8 ft. It’s the full amount of what they just took in.

28
Q

assessment findings for pyloric stenosis

A

May feel like an olive but more likely to see on U/S. At severe r/o dehydration and electrolyte balance bc of loss of fluids and inability to digest any.

29
Q

nursing care for pyloric stenosis

A

Nursing care (Pre- and postoperative care)
Peristaltic waves in abdomen
Hyperactive bowel
Olive shape mass
Reports of vomit
Think about pain/fluid/electrolyte mgt post op.

30
Q

Intussusception - causes/dx/presentation

A

Intestine invaginates into another
Mesentary becomes inflamed and obstruction can occur
*Multifactorial causes
*Bad luck viral event typically
*Sometimes a kid on meds that affect motility can lead to this
*Body own inflammatory mediators can lead to this
*Life threatening if untreated b/c its strangles gut and can lead to necrotic gut/abdominal perforation.
*Dx with saline enema under fluoroscopy which may also work to correct the prolapse so its both dx and tx.
*Presents with bloody, mucous/jelly stool.

31
Q

Gastroesophageal reflux: what three mechanisms allow reflux to occur?

A

Lower esophageal relaxations
Incompetent lower esophageal sphincter
Anatomic disruption of esophagogastric junction

32
Q

GERD: education points for families

A 
Upright after feeds
Smaller meals
Dietary restriction
Thicken feeds is one mod that can be made
Sometimes meds
33
Q

Gastroenteritis: nursing considerations

A

Pedialyte: electrolytes and fluids
Can also create an oral solution at home if pedialyte is too expensive
BRAT diet
Clear fluids: anything you can see through.
Want to make sure they go slow to prevent vomiting otherwise you lose ground.
Urine output is the key to determine whether there is pending dehydration.

34
Q

Gastroenteritis: what is it and what causes it

A

Acute vs. chronic diarrhea caused by viruses, bacterial or parasites

35
Q

appendicitis causes

A

Caused by an obstruction of the appendiceal lumen, causing edema
As edema continues, vascular supply is compromised and bacteria invade, which can lead to a ruptured appendix
Common b/w 5 and 14 y.o.
Acute abdomen, several days of increasing abdominal pain

36
Q

appendicitis “classic” presentation

A

Classic presentation: Mr. McBurney’s Point: point of maximal tenderness RLQ. Rebound tenderness (pain on release); heel strike or bump into bed to get sign of rebound tenderness (want movement).
Concern with rupture: resolved after days of pain and then it goes away but then feel really sick. Good sign of perf. Danger is the r/o infx.

37
Q

Colic: what is it?

A

Paroxysmal abdominal pain of intestinal origin and severe crying
Occurs between 2 weeks old and 3 months old
Etiology unknown

38
Q

Colic: what does it look like?

A

Phenomena of severe crying
Don’t find a lot of resolve/help for it
Its very stressful for parents and psychosocial impacts on family we have to support.

39
Q

what is jaundice?

A

Jaundice (sign of hepatic d.o).
Unconjugated bili circulating in system
Can become toxic if not corrected
Determined by progressive yellowing of skin that moves upwards
If gets up to chest that determines admission
Phototherapy helps body reabsorb bili quicker.

40
Q

Clues to Gastrointestinal Disorders in Children

A

Vomiting or abdominal pain
Failure to thrive
Stool changes
EXAM, TEST, HISTORY TAKING

Peds Exam 2 (1 decks)

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