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Nursing 132 Exam # 2 > Peds Test # 2 GI > Flashcards

Peds Test # 2 GI Flashcards

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1
Q

Why do infants often regurgitate their food?

A

Their cardiac sphincter is relaxed and not yet mature allowing food to back flow from the stomach.

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2
Q

Infants have deficiencies in what particular enzymes?

A

1) Amylase (breaks down carbs)
2) Lipase (fat absorption)
3) Trypsin (catabolizes protein)

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3
Q

What are the 6 Related Factors of Failure to Thrive (FTT)?

A

1) Poverty
2) Beliefs
3) Knowledge
4) Feeding Resistance
5) Insufficient Breast Milk
6) Family Stress

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4
Q

What is the difference between Organic FTT and Inorganic FTT?

A

1) Organic FTT - Physical cause (physiogical)

2) Inorganic FTT - No physical cause (not physiological)

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5
Q

What are the 5 SxS of FTT?

A

1) Weight below 5th percentile
2) Development delay
3) Muscle Hypotonia
4) Abd distention
5) Behavior problems

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6
Q

What are the 6 things that should be assessed for children with FTT?

A

1) Psychosocial History
2) Infant-parent interactions
3) Caregiver response to child’s cues
4) Enhanced positive parenting
5) Role mode
6) Parenting confidence

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7
Q

What are the 10 things to consider when approaching the task of feeding a child with FTT?

A

1) Have a consistent staff
2) Quiet atmosphere
3) Approach to infant
4) Give directions about eating
5) Be persistent
6) Face to face (infants)
7) New foods
8) Follow child’s usual rhythm of feeding
9) Use vitamin & mineral supplements
10) Use high calorie formula

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8
Q

Explain “Normal” calorie formula Vs. “High” calorie formula

A

1) Normal - 20 kcal/oz

2) High - 24 kcal/oz with medium chain triglycerides added to formula.

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9
Q

Explain what a cleft palate is using anatomical terms

A

Failure of the maxillary process to fuse with elevations on the frontal prominence during the 6th week of gestation and the tongue to move downward at the correct time causing the palatine process from fusing.

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10
Q

Name 3 congenital defects associated with cleft lip and cleft palate.

A

1) Trisomy 21
2) Traecheoesophageal Fistula
3) Skeletal Deformities

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11
Q

At what ages are cleft lips and cleft palates surgically repaired?

A

1) Cleft Lip - 3 to 6 months

2) Cleft Palate - 6 to 24 months

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12
Q

What is the connection between cleft lip/palate and loss of hearing function?

A

Cleft lip/palate is associated with ⬆ otitis media due to inefficient fx of eustachian. This can affect hearing ability

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13
Q

What are the 3 psychosocial considerations of Cleft lip/palate?

A

1) Physical deformities may be devastating
2) Parents should be allowed to express their feelings
3) Disorder may affect parent-infant attachment

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14
Q

What are the 6 nursing implications when caring for mother/baby with a cleft lip/palate?

A

1) Provide emotional support
2) Provide for satisfaction of sucking needs, use a compressible bottle with a longer nipple if needed. (Mom can still BF though)
3) Follow feeding with water
4) Position child upright during and after feeding
5) Ensure adequate burping “bubbling” during and after feeding.
6) Educate parent on meticulous cleaning of area after feeding.

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15
Q

Why do we follow feedings with water for infants with cleft lip/palate?

A

It helps prevent ear infections from food remaining

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16
Q

List the 9 nursing considerations to implement when caring for a child who is post-op cleft lip/palate?

A

1) Monitor carefully to prevent aspiration
2) Clean suture line frequently using strict medical asepsis
3) Use syringe with rubber tip for feeding
4) Burp the infant during and after feeding
5) Rinse mouth with water after feedings
6) If on solids, give baby food dilute with water
7) Use elbow restraints (for 6-8 wks) and keep pacifier, fingers and spoons away from mouth.
8) Use back or baby seat for sleeping position
9) Don’t brush teeth for 1-2 wks

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17
Q

Define Gastroenteritis

A

An acute inflammation of the stomach and intestines accompanied by vomiting and diarrhea.

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18
Q

What are the SxS of Gastroenteritis?

A

1) Diarrhea (may be mild, moderate or severe)
2) Irritability
3) Anorexia
4) Nausea and vomiting (could lead to electrolyte imbalance)

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19
Q

What is the most indicative sign of bacterial Gastroenteritis?

A

Neutrophils and RBCs on stool specimen

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20
Q

What is the most likely cause of the of the vomiting and diarrhea associated Gastroenteritis?

A

The Rotovirus

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21
Q

What are the 4 nursing considerations to implement when caring for a child with Gastroenteritis?

A

1) ⬆ fluid requirements w/fever
2) Observe for SxS of dehydration
3) Assess for acute diarrhea which may be caused by antibiotic therapy but DO NOT give antidiarrheals for acute diarrhea
4) Do not give potassium if you do not know whether or not the patient can pee.

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22
Q

Explain the 5 aspects of Rehydration for a patient with Gastroenteritis.

A

1) Use ORT (Oral Rehydration Therapy)
2) Avoid plain water (Use LR or 0.9% NaCl
3) After improved status: Use D5 at twice the hourly maintenance rate
4) Use KCl only after adequate urine output has been established
5) Give food as soon as PT is rehydrated and can tolerate it PO

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23
Q

When can you resume the diet of a patient with Gastroenteritis and what kind of diet is acceptable?

A

1) Resume diet when PT is rehydrated, has stopped vomiting, and has had no diarrhea for 3 days.
2) Diets allowed - ABC diet (applesauce, bananas, strained carrots) and BRAT diet (bananas, rice, applesauce and toast).

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24
Q

Define lactose Intolerance. Is it congenital or acquired?

A

Lactose Intolerance is the inability to digest lactose, a sugar found in milk and other dairy products. It can be congenital or acquired (usually after age 3 if acquired).

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25
Q

What are the SxS of Lactose Intolerance

A

1) Pain and cramping
2) Abdominal distention
3) Diarrhea
4) Flatus

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26
Q

What 3 ways can Lactose Intolerance be diagnosed?

A

1) 1+ or > clinitest of stool
2) Hydrogen Breath Test
3) Improvement in symptoms on a lactose-free diet

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27
Q

List the 5 foods that were discussed that are good sources of calcium for Lactose Intolerant patients.

A

1) Egg Yolks
2) Green Leafy Vegetables
3) Dried Beans
4) Cauliflower
5) Molasses

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28
Q

Define Hirschsprung Disease. Where is it usually located and who is most affected?

A 
Hirschsprung Disease (aka Congenital Aganglionic Megacolon) is the absence of ganglion cells in a segment of the colon (Usually the recto sigmoid area). 
- It is more common in boys
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29
Q

What happens as result of Hirschsprung Disease?

A

1) Stool accumulates proximal to the defect
2) Obstruction results
3) Enterocolitis may result

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30
Q

What 3 methods are used to diagnose Hirschsprung Disease?

A

1) History and PE
2) Barium Enema
3) Rectal Biopsy

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31
Q

What are the 7 SxS of Hirschsprung Disease?

A

1) Delayed passage or absence of meconium stool
2) Constipation in 1st month
3) Pellet-like or ribbon foul-smelling stools
4) FTT
5) Abd distention
6) Palpable fecal mass
7) Visible peristalsis

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32
Q

What are the 4 SxS of Bowel Obstruction caused by Hirschsprung Disease?

A

1) Abd pain and distention
2) Refusal to feed or suck
3) Bile stained vomitus
4) Enterocolitis

33
Q

What are the 2 SxS of Enterocolitis which may result from Hirschsprung Disease?

A

1) Explosive, watery diarrhea

2) Toxic fever

34
Q

What 7 nursing considerations should be implemented preop for Hirschsprung Disease?

A

1) Observe for meconium passage
2) Obtain Hx of weight gain/loss, I&O, and bowel habits.
3) Use daily enemas
4 use low-fiber, high-calorie, high-protein diet
5) Measure Abd
6) Monitor fluids and electrolytes
7) If severe: make NPO and give TPN

35
Q

How is Hirschsprung Disease treated?

A

Bowel resection or temporary colostomy

36
Q

What nursing considerations should be implemented postop for patients with Hirschsprung Disease?

A

1) Make PT NPO until bowel sounds are heard or flatus is passed
2) NG tube to LIS
3) DO NOT take rectal temps
4) Monitor fluids & electrolytes

37
Q

Explain what happens with Hypertrophic Pyloric Stenosis.

A

Hypertrophic Pyloric Stenosis is when the pyloric sphincter muscle hypertrophies resulting in narrowing the pyloric canal (blocated btw the stomach and duodenum).

38
Q

What is the result of Hypertrophic Pyloric Stenosis?

A

Gastric emptying is obstructed

39
Q

What are the 5 methods used to diagnose Hypertrophic Pyloric Stenosis?

A

1) H&P (History and Physical)
2) Flat plate of Abd
3) Ultrasound
4) Barium Swallow
5) Labs: Metabolic Alkalosis from vomiting

40
Q

What are 6 the SxS of Hypertrophic Pyloric Stenosis?

A

1) Projectile Vomiting shortly after eating. Vomit is non-billions and contains blood if the esophagus is irritated.
2) Palpable olive-like mass in RUQ
3) Deep peristaltic waves in stomach
4) FTT
5) Constipation
6) Severe dehydration because of vomiting which leads to metabolic alkalosis.

41
Q

What is the Tx for Hypertrophic Pyloric Stenosis?

A

Pyloromyotomy - An incision of the pyloric muscle to release the obstruction.

42
Q

Define Intussusception.

A

Intussusception - An invagination of a section of the intestine into the distal bowel that causes bowel obstruction.

43
Q

What is the result of Intussusception?

A

Intussusception results in compressed vasculature which leads to lymphatic and venous obstruction. Eventually arterial supply stops, resulting in ischemia.

44
Q

What are the 6 SxS of Intussusception?

A

1) sudden acute Abd pain
2) red currant jelly-like stool
3) Palpable sausage-shaped mass in RUQ
4) Tender and Distended Abd
5) Bile-stained vomit
6) Peritonitis if left untreated

45
Q

What is the Tx used for Intussusception?

A

1) Hydrostatic Reduction - Barium or air enema

2) Surgery - Either manual reduction or resection of non-viable areas of bowel.

46
Q

What is the difference between GER and GERD?

A

1) GER - Transfer of gastric contents into esophagus

2) GERD - Symptoms of tissue damage from GER

47
Q

Define Gastroesophageal Reflux (GER)?

A

Gastroesophageal Reflux - Return of gastric contents into the esophagus due to relaxation of the lower esophageal sphincter.

48
Q

What are the 4 different causes of GER?

A

1) LES dysfunction (Lower Esophageal Reflux) from transient relaxation of the sphincter (TRLES)
2) Delay in gastric emptying
3) Poor clearance of esophageal acid
4) Esophageal mucosa susceptibility to acid injury

49
Q

List 8 types of patients who are more prone to GER.

A

1) Premature
2) BPD (Bronchopulmonary Dysplasia)
3) TEF or EA repair
4) Neurological Disorder
5) Scoliosis
6) Asthma
7) CF
8) CP

50
Q

What are the 5 ways GER can be diagnosed?

A

1) Hx & PE
2) Esophageal pH monitoring (Turtle Test)
3) Scintigraph (use of radioactive isotopes to view area)
4) Endoscopy
5) UGI (Upper GI series test using contrast material like barium)

51
Q

What are the two types of GER? Describe the characteristics of each.

A

1) Physiologic GER - a) Painless emesis after meals
b) Parents may think it’s normal
c) Rarely occurs during sleep
d) No FTT
e) Pharmacologic & medical management

2) Pathologic (GERD) - a) FTT
b) Aspiration pneumonia, asthma
c) Apnea, coughing and choking
d) Frequent emesis (amount varies)
e) May require surgery and meds

52
Q

What are the 5 SxS of GER in infants?

A

1) Spitting up/Forceful vomiting
2) Crying, irritable, arching back, stiffening
3) Weight changes
4) Respiratory: Coughing, apnea, wheezing, stridor, gagging, choking, pneumonia.
5) Hematemesis

53
Q

What are the 7 SxS of GER in a child?

A

1) Heartburn
2) Abd pain
3) Noncardiac chest pain
4) Chronic cough
5) Dysphagia
6) Nocturnal asthma
7) Recurrent pneumonia

54
Q

What are the 9 types of foods that older children with GER should avoid?

A

1) Fatty foods
2) Caffeine
3) Spicy Foods
4) Carbonated beverages
5) Fruit juices
6) Tomato products
7) Chocolate
8) Citrus products
9) ETOH

55
Q

What is the connection between obesity and GER?

A

Obesity = greater Abd pressure, which can lead to GER.

56
Q

For children older than 1yr, what PT teaching can nurses implement to ⬇ GER?

A

1) Elevate HOB

2) Sleep in right sided position

57
Q

What are the 4 classes of meds used to treat GER?

A

1) H2 Antagonists
2) Mucosal Protectants
3) Prokinetic Agents
4) Proton Pump Inhibitors

58
Q

What are the 4 complications that can result from GER?

A

1) Esophageal strictures due to esophagitis
2) Laryngitis
3) Recurrent pneumonia
4) Anemia

59
Q

What are the 5 criteria required for surgical Tx of GERD and what is the surgery called?

A

1) Criteria - Recurrent pneumonia, apnea, esophagitis, FTT, failed medical treatment.
2) Nissen Fundoplication Surgery - Gastric fundus encircles the distal esophagus.

60
Q

What are the 5 possible complications of the Nissen Fundoplication surgery for GERD?

A

1) Breakdown of the wrap
2) Gas-bloat syndrome
3) Infection
4) Retching
5) Dumping syndrome

61
Q

Describe what an Esophageal Atresia and a Tracheoesophageal Fistula are.

A

1) Esophageal Atresia - Esophagus terminates before it reaches the stomach.
2) Tracheoesophageal Fistula - An unnatural connection between the esophagus and the trachea.
- Both are congenital malformations resulting from failure of the esophagus to develop during the 4th and 5th weeks of gestation.

62
Q

What are the 6 methods of diagnosing EA and TEF?

A

1) NG tube placement
2) X-ray
3) Ultrasound
4) Bronchoscopy
5) Endoscopy
6) Hx of maternal Polyhydraminos

63
Q

What are the 5 SxS of EA and TEF?

A

1) Excess saliva and drooling
2) Coughing, chokin and cyanosis
3) Apnea
4) ⬆ respiratory distress after feedings
5) Abd distention

64
Q

What nursing considerations should be implemented for an infant with EA or TEF?

A

1) Supine position and HOB elevated 30 degrees.
2) NPO
3) Suction PRN
4) NG to LIS
5) Monitor hydration

65
Q

Name the 2 types of surgical Tx for EA and TEF.

A

1) Fistula ligation

2) Atresia anastomosis

66
Q

What is Meckel Diverticulum?

A

Meckel Diverticulum - A fibrous band connecting the small intestine to the umbilicus.

67
Q

What are the 4 SxS of Meckel Diverticulum?

A

1) Painless rectal bleeding
2) Abd pain
3) Intestinal obstruction
4) Usually occurs before 2yrs old

68
Q

How is Meckel Diverticulum diagnosed?

A

1) Via a Meckel Scan using Scintigraphy - Will show gastric mucosa.
2) Via blood studies - Shows anemia

69
Q

What 2 surgical procedures are used to treat Meckel Diverticulum?

A

1) Clipping the Diverticulum

2) Bowel resection if severe

70
Q

What are the 3 possible causes of Appendicitis?

A

1) Hardened fecalith
2) Swollen lymphoid tissue
3) Parasite

71
Q

What is McBurney’s Point?

A

McBurney’s Point is located midway between the anterior iliac crest and the umbilicus in the RLQ. This is the classic area for localized tenderness during later stages of appendicitis.

72
Q

Name the 12 SxS of Appendicitis?

A

1) RLQ pain
2) Fever
3) Rigid Abd
4) ⬇ or absent bowel sounds
5) Vomiting
6) Constipation or Diarrhea
7) Anorexia
8) Shallow respiration
9) Pallor
10) Lethargy
11) Irritability
12) Stooped posture

73
Q

How do you differentiate appendicitis from gastroenteritis when it comes to the symptoms of pain and vomiting?

A

If pain precedes vomiting, suspect appendicitis

If vomiting precedes pain, gastroenteritis is more likely

74
Q

What is Rosving’s Sign?

A

Pain in the RLQ when pushing on the LLQ. Associated with appendicitis.

75
Q

What are the 4 methods used to diagnose Appendicitis?

A

1) CT scan - most used
2) Ultrasound
3) ⬆ WBCs
4) CRP : C-reactive protein (> in 12 hrs of infection)

76
Q

During Appendicitis, what is the significance of a sudden spike in fever and relief of pain?

A

This may indicate perforation

77
Q

What antibiotics are used for a nonperforated and perforated appendix?

A

1) Nonperforated - Cefepime

2) Perforated - Meropenem

78
Q

What are the 4 SxS of a postop abscess in an appendicitis patient?

A

1) ⬆ pain
2) Restlessness
3) Irritability
4) ⬇ ambulation

Nursing 132 Exam # 2 (5 decks)

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