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NURS 406 > Quiz 2: Gastrointestinal > Flashcards

Quiz 2: Gastrointestinal Flashcards

1
Q

Cleft Lip and Cleft Palate

A
  • You can have one or both together.
  • All of them look different.
  • More common in males
  • May be unilateral or bilateral
  • Multifactorial
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2
Q

What can cause cleft lip and cleft palate?

A
  1. Congenital anomalies (failure of soft tissue or bony structure to fuse during embryonic development)
  2. Hereditary
  3. Environmental factors: exposure to radiation or rubella virus, chromosomal abnormalities or teratogenic factors.
  4. Maternal deficiency: Folic acid deficiency
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3
Q

Birdie Uvula

A
  • Smallest form of velar cleft.

- Not associated with speech or feeding problems.

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4
Q

What are clinical manifestations of cleft lip?**

A
  • Slight notch or complete separation from the floor of the nose.
  • Notched vermillion border.
  • Variably sized clefts involving alveolar ridge
  • Dental anomalies
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5
Q

What are clinical manifestations of cleft palates?**

A
  • Nasal distortion
  • Exposed nasal cavities
  • Midline/Bilateral cleft with variable extension from uvula and soft/hard palates
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6
Q

How is a cleft lip/palate evaluated?

A
  • Palpation of hard and soft palate.
  • Cleft lip evaluated by looking
  • Fetal ultrasound (reliable after 14 weeks gestation)
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7
Q

Cleft Lip/Palate Management include**

A
  • Collaborative team management: surgeon; ears, nose and throat doctor; speech pathologist; dentist/orthodontist; neurologist
  • Severity impacts who is involved.
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8
Q

Cleft Lip Closure

A

Done first at 2-3 months of age

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9
Q

Cleft palate closure

A
  • Done at about 12 months of age
  • Need to wait for normal palate changes with growth
  • Closure is done before beginning speech
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10
Q

What are potential cleft lip/palate problems? **

A
  1. Recurrent middle ear infection
  2. Extensive orthodontic problems (d/t the palate and how the teeth will grow)
  3. Inadequate nasal airway (small nasal passages from surgery)
  4. Speech problems
    Other problems include:
  5. Emotional issues
  6. Cosmetic concerns
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11
Q

Potential problems of cleft lip/palate: Recurrent middle ear infection

A
  • Caused by improper drainage
  • Recurrent otitis media
  • Can lead to hearing impairment (Conductive hearing loss)
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12
Q

Children with cleft lip/cleft palate: Differences in feedings**

A

Severity of condition effects feeding

  • Higher-calorie formula (takes a lot of energy for these babies to eat, need more calories)
  • Unable to acquire suction to feed so they need special nipples or other feeding devices.
  • Burp frequently: they swallow more air
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13
Q

Children with cleft lip/palate: Feeding Instructions

A
  • Hold infant in upright position and direct formula to the side and back of the mouth to prevent aspiration.
  • Gradually feed small amounts and burp frequently.
  • Provide short periods of rest for swallowing (children usually develop a feeding pattern of sucking/swallowing/resting)
  • Do not remove nipple during feeds due to noises
  • Limit feeding to 30 minutes and have baby sit upright for 30 minutes after feeding.
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14
Q

Hirschsprung Disease

A

Aka Congenital Aganglionic Megacolon

Congenital anomaly

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15
Q

What causes hirschsprung disease?

A
  • Absence of ganglion cells in the affected area
  • Once the stool gets to this part of the colon, peristalsis will stop and the stool will stop in that area causing the colon to enlarge.
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16
Q

Hirschsprung Disease results in

A
  • Resulting in a loss of the rectoshincteric reflex
  • Lack of peristalsis
  • Results in a mechanical obstruction
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17
Q

What are clinical manifestations of Hirschsprung disease in newborns?

A
  • Failure to pass meconium stool
  • Refusal to suck
  • Abdominal distention
  • Bile stained vomitus
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18
Q

What are clinical manifestations of Hirschsprung disease in children?

A
  • Failure to gain weight/thrive
  • Delayed growth
  • Abdominal distention
  • Vomiting
  • Constipation
  • Visible peristalsis
  • Ribbon/pellet-like, foul smelling stools***
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19
Q

How is Hirschsprung disease diagnosed?

A
  • Barium Enema

- Rectal biopsy (confirms diagnosis)

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20
Q

Hirschsprung Disease Management

A

-Surgical removal of aganglionic portion of bowel

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21
Q

Complications of Hirschsprung Disease

A
  • Anal strictures
  • Incontinence
  • Diaper Rash
  • Constipation
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22
Q

Gastroesophogeal Reflux

A

Transfer of gastric contents into the esophagus.

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23
Q

Gastroesophageal Reflux most frequently occurs when?

A
  • After meals

- At night

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24
Q

Children with Gastroesophageal Reflux are prone to develop what problems?

A
  • Premature infants
  • BPD
  • Neurological disorders
  • Tracheoesophageal repairs
  • Scoliosis
  • Asthma
    -Cystic Fibrosis
  • Cerebral Palsy
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25
Q

What are clinical manifestations of gastroesophageal reflux? **

A
  • Emesis
  • Chronic cough**
  • Hematemesis
  • Anemia from blood loss
  • Poor weight gain
  • Irritability
  • Heartburn in older children
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26
Q

Gastroesophageal reflux is the cause of apparent life threatening events including

A
  • Chronic cough
  • Recurrent stridor
  • Reactive airway disease
  • Recurrent pneumonia
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27
Q

How is gastroesophageal reflux evaluated?

A
  • History and assessment

- Gold Standard: 24 hour pH monitoring

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28
Q

Management of Gastroesophageal Reflux: If no respiratory complications

A
  • No treatment needed
  • Small, frequent feedings
  • Upright position after feeds
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29
Q

Management of Gastroesophageal Reflux

A
  • Avoidance of acid exacerbating foods
  • Lifestyle modifications
  • Family teaching
  • Surgical management
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30
Q

Gastroesophageal reflux management in infants

A
  • Thickening of feedings
  • Breast feeding may continue: more frequent feeding times or express milk for thickening with rice cereal.
  • Burp frequently when feeding and handle them minimally after feedings.
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31
Q

Surgical Treatment for Gastroesophageal Reflux

A

Nissan fundoplication

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32
Q

What should you teach parents about managing gastroesophageal reflux in children? **

A
  • Avoid fatty foods (i.e chocolate, tomato products, fruit juice, citric products, spicy foods)
  • Avoid vigorous play after feeding
  • Avoid feeding before bedtime
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33
Q

What medications are used to treat gastroesophageal reflux?

A
  • PPI’s
  • H2 Receptor Antagonists: i.e Ranitidine (can take regardless of meals)
  • Antacids for symptom relief
  • *MUST BE TAKEN CORRECTLY FOR THEM TO WORK (should be taken on empty stomach)
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34
Q

What are complications of gastroesophageal reflux?**

A
  • Esophagitis
  • Esophageal strictures
  • Aspiration of gastric contents
  • Aspiration pneumonia
  • Bleeding
35
Q

Appendicitis

A
  • Inflammation of vermiform appendix caused by obstruction usually by hardened fecal material.
  • Is the most common cause of emergency abdominal surgery in children
36
Q

What are clinical manifestations of appendicitis?

A
  • Pain that is exacerbated with movement; pain at McBurney Point
  • Fever
  • Increased WBC and C-reactive protein
  • Vomiting
  • Change in behavior
  • Tachycardia
  • Perforation may occur
37
Q

How is appendicitis evaluated?

A
  • Lab studies: WBC, CRP
  • US
  • CT scan (most reliable and most commonly used; quick and easy)
38
Q

Management of Appendicitis**

A

Surgical removal of appendix: Laparoscopic appendectomy

39
Q

Management of Appendicitis if ruptured

A
  • NG Tube - with replacements (low intermittent suction; prevents vomiting; turn off to listen to bowel sounds)
  • NPO
  • Foley
  • Ambulation: most important b/c it gets the bowels moving, decreases pain and helps to pass flatus. (Lot of gas is left over air from surgery)
  • IV ABT
40
Q

The difference of what will be done to manage appendicitis depends on whether the child is vomiting prior to the procedure or not: If the child is not vomiting

A
  • Child will be NPO prior to surgery and then for 6-8 hours post surgery
  • At this time range is when you want to start advancing their diet slowly (only if their bowel sounds are present do you let the child eat)
41
Q

The difference of what will be done to manage appendicitis depends on whether the child is vomiting prior to the procedure or not: If ruptured and/or vomiting

A
  • Sent to surgery and an NG tube is placed to suck out all of the contents and fluids in the stomach and essentially decompressing the stomach.
  • After surgery -> just wait. Make walk around to manage pain and wait for the bowels to wake up.
  • Once the bowel sounds are present, NG tube removed.
42
Q

Appendectomy: Pre-op Administration

A
  • IV F&E: prevents dehydration and corrects electrolyte imbalances
  • ABT
  • Comfort measures: Ice pack to abdomen for 20-30 min qh if prescribed; position in right side lying or low semi-Fowler’s; promotes comfort
43
Q

Appendectomy: Pre-op Monitoring

A
  • Bowel sounds
  • Changes in level of pain
  • Ruptured appendix and peritonitis
44
Q

Appendectomy Pre-op: Need to avoid

A
  • Use of pain meds (in an uncomplicated appendicitis): Don’t want to mask changes associated with perforation.
  • Application of heat to abdomen: Increases chance of perforation d/t vasodilation
  • Laxatives or enemas
45
Q

Appendectomy Post-op: Monitor

A
  • VS, especially temperature

- Drainage in peprose drain; may be inserted if perforation

46
Q

Appendectomy Post-op: Maintain

A
  • NPO till bowel function and sounds return

- NG tube suction and latency of tube if present

47
Q

Pyloric Stenosis

A
  • Occurs when the pyloric sphincter is thickened.

- This results in elongation and narrowing of the pyloric canal.

48
Q

Pyloric Stenosis: Increased incidence

A
  • Full-term infants
  • First born children
  • Boys
49
Q

What happens in a baby with pyloric stenosis?

A

the baby eats, the contents go into the stomach and will just hang out in the stomach bc the stomach is essentially a big bowl but it kind of gets stuck there since the sphincter is thickened and won’t let the contents pass through → so as stomach tries to push down the baby ends up → projectile vomiting

50
Q

What are clinical manifestations of pyloric stenosis? **

A
  • Projectile vomiting
  • Hunger after vomiting
  • Failure to thrive (b/c they aren’t able to absorb anything if the contents aren’t going to the intestines)
  • Dehydration
  • Metabolic alkalosis
  • Palpable olive-like mass in right upper abdomen
  • Visible peristaltic waves
  • Distended upper abdomen
51
Q

How is pyloric stenosis diagnosed?

A
  • History and assessment

- Ultrasound of upper GI

52
Q

Management of Pyloric Stenosis

A

-Pyloromyotomy: gold standard; opening up the sphincter

53
Q

Pyloromyotomy Post Op Feeding

A
  • Begins 4-6 hours after surgery
  • Start with pedialyte
  • Gradually increase amount
  • Advance to regular formula/breast milk
  • Give slowly, burp frequently and handle minimally after feedings.
54
Q

Pyloromyotomy Post Op Feeding: If they vomit, what should you do?

A

Stop, wait 2-3 hours and go back one (i.e if they vomited after breastfeeding, go back to pedialyte)

55
Q

When can a child with pyloric stenosis go home?

A

When they can eat without projectile vomiting.

56
Q

Intussusception

A

Proximal segment of bowel telescopes into a more distal segment -> basically the intestines go into and onto each other.

57
Q

What are clinical manifestations of intussusception? **

A
  • Sudden onset of cramps abdominal pain
  • Red, currant, jelly-like stools: bloody
  • Palpable sausage-shaped mass in upper right quadrant
  • Inconsolable crying
  • Drawing up of knees to chest
  • Vomiting -> bilious
  • Lethargic
58
Q

How is intussusception treated?**

A
  • Enema (will cause bowels to go to their normal positions)
  • Surgery if indicated: Manually reduces the invagination and resecting any nonviable intestine.
  • If nothing is done, the bowels will end up becoming necrotic.

*Recurrence after treatment is rare.

59
Q

Celiac Disease

A
  • Villous atrophy of the small intestine d/t gluten protein (which is toxic to intestinal mucosal cells).
  • This leads to inadequate absorption.
60
Q

Gluten substances include

A
  • Wheat
  • Barley
  • Rye
  • Oat grains
61
Q

What are clinical manifestations of celiac disease? **

A
  • Steatorrhea: excessively large, pale, oily, frothy stools
  • Foul smelling stools
  • Abdominal distention (all the time!)
  • Irritability
  • Profuse watery diarrhea and vomiting
  • Anorexia (usually really thin because they aren’t absorbing what they need)
  • Anemia
  • Muscle wasting
62
Q

Managment of Celiac Disease

A
  • Dietary management: avoidance of gluten
  • Administration of mineral and vitamin supplements: Fe, Folic acid, Fat soluble vitamins (ADEK)
  • Read all labels b/c most of children’s favorite foods contain gluten (i.e bread, cake/cookies, spaghetti, hot dogs, pizza and ice cream)
63
Q

Celiac Disease Prognosis

A
  • Chronic disease
  • If strict compliance, no complication or symptoms if diet is maintained.
  • If non-compliant, increased risk of colon cancer.
64
Q

Celiac Crisis is precipitated by:

A
  • Fasting
  • Infection
  • Ingestion of gluten
65
Q

Celiac Crisis causes

A

Profuse watery diarrhea and vomiting

66
Q

Celiac Crisis leads to

A
  • Rapid dehydration
  • Electrolyte imbalance
  • Severe acidosis
67
Q

Biliary Atresia

A
  • Progressive inflammatory process resulting in bile duct obstruction.
  • Cause is unknown
  • Not seen in fetus; manifestations shown a few weeks after birth.
68
Q

If biliary atresia is left untreated:

A
  • Leads to cirrhosis
  • Liver failure
  • Death by 2 y/o
69
Q

What are clinical manifestations of biliary atresia?**

A
  • Jaundice after 2 weeks
  • Dark urine, grey stools (absence of bile pigment)
  • Hepatomegaly
  • As disease progresses: child appears thin, FTT, marked jaundice, evidence of rickets and major pruritus.
70
Q

How is biliary atresia evaluated?

A
  • Lab tests
  • Abdominal US
  • Liver biopsy
  • Outcome is better if surgically treated before 2 mo old
71
Q

Biliary Atresia Prognosis

A
  • If untreated, death by 2 y/o

- Even if treated, many still develop liver failure and require transplant

72
Q

Management of Biliary Atresia

A
  • Kauai Portoenterostomy: allows bile to drain into the intestine
  • Fat soluble vitamin supplementation
  • Phenobarbital: stimulates bile flow
  • Prophylactic ABT
  • Management of portal HTN: control bleeding, restricting salt intake, using diuretics.
73
Q

Foreign Bodies: Signs and Symptoms

A
  • Acute coughing episode
  • Abdominal pain
  • Constipation
  • Unilateral findings: lungs, nose
74
Q

Foreign Body Complications

A
  • Obstruction

- Ulceration

75
Q

Foreign Body Evaluations

A
  • History and assessment

- XRay

76
Q

Foreign Body Treatment

A
  • Urgent removal for sharp objects, magnetic or disc batteries, compromised GI tract
  • Flexible endoscopy: allows for direct visualization
  • Feed usual diet when gag reflex returns.
77
Q

Constipation

A

A delay or difficulty in defecation that has lasted for 2 weeks or more

78
Q

Encopresis

A

Repeated and involuntary defecation in a child older than 4 years who has normal colon and rectal anatomy.

79
Q

What are causes of constipation?

A
  • Changes in diet
  • Dehydration
  • Lack of exercise
  • Emotional stress
  • Pain from anal fissures
  • Excessive milk intake
80
Q

Encopresis results from

A

-Recurrent fecal impaction and enlarged rectum caused by chronic constipation

81
Q

What are clinical manifestations of constipation?

A
  • Absence of stool
  • Abdominal pain
  • Cramping without distention
82
Q

What are clinical manifestations of encopresis?

A
  • Soiled clothing
  • Fecal odor without awareness
  • Anal irritation
  • Social withdrawal
83
Q

How is constipation and encopresis evaluated?

A
  • History
  • Abdominal radiographs
  • Rectal examination: not usually performed on children.
84
Q

How is constipation and encopresis managed?

A
  • Disimpaction
  • Education: diet, fluids, activity
  • Maintenance
  • Changing habits

NURS 406 (18 decks)

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