Quiz GI & Cardio Flashcards
What is Kwashiokor?
Malnutrition due to lack of protein
What is Marasmus?
A condition of chronic undernourishment occurring especially in children and usually caused by a diet deficient in calories and proteins.
Dehydration that causes an imbalance of electrolytes is called _____ if there is a lack of electrolytes, and _____ if there is an excess of electrolytes.
Hypotonic. Hypertonic
How do we check for dehydration?
Check turgor on chest or forehead and look at the tongue. (scrotal/geographic tongue)
How much fluid does a child require per 24 hrs?
100 mL/kg for the 1st kg. 50 mL/kg for the second 10 and 20 mL/kg for any above 20 kg
What are gastroenteritis, enteritis, colitis, and entercolitis?
Gastroenteritis = inflammation/irritation of the stomach (gastro) and small intestines (entero). Enteritis = small intestines only. Colitis = colon only. Entercolitis = colon and small intestines involved
How is most diarrhea spread?
The fecal/oral route
Why is listeria so bad?
It can survive in cold temperatures
How is listeria cured? Prevented?
Antibiotics. Clean, clean, clean, keep fridge at 40 deg and below
What are many cases of listeria related to? What else shouldn’t you eat while pregnant?
Eating soft or raw cheese, like caso fresco from Mexico. Brie or veined cheese, pates, or other soft meats
What fish should be avoided while pregnant? Why?
Shark, Swordfish, Tilefish, King Mackerel. Methyl mercury accumulates in larger, predatory fish
How is toxoplasmosis spread, and why avoid it when pregnant?
It is a parasite often found in cat feces, so don’t change the litter box when pregnant! It can cause fetal problems
How else can toxoplasmosis be avoided?
Change litter daily, wear gloves when changing litter, stay out of the pig pen!
What diet is recommended for diarrhea?
BRAT = Bananas, rice, apples, toast/tea
How is diarrhea avoided in a breast feeding baby?
Wash hands (not breasts)
What causes idiopathic constipation? Chronic?
It’s idiopathic b/c the cause is not known. Chronic may be caused by environmental factors (food) or psychological factors
What is Hirschsprung disease? What can be done for it?
Congenital aganglionic megacolon. No nerves in the sigmoid colon and rectum, so they fill with stool. Biopsy to dx, diet may control milder cases, but removal in 2 stages (temporary colostomy) is the option for worse cases
What is the leading cause of death in kids with Hirschprungs? Is it genetic?
Entercolitis. Yes. More common in males and kids with Down’s Syndrome
When should a newborn pass meconium?
Within the first 24-48 hrs
What is a common physical side effect of Hirschprungs?
Alternating bouts of constipation/diarrhea and anemia
What is the difference between GER and GERD?
GERD is a disease because it causes issues
What is GER/GERD?
Stomach contents are transferred into the esophagus
What makes GER abnormal (GERD)?
Frequency and persistency
What surgical procedure can help/cure GERD?
Nissen fundoplication. Fundus of the stomach is wrapped around the esophagus to lift it off the diagram
What can GERD result in?
Barrett’s esophagus, which is scarring from the constant exposure to stomach acid and may lead to cancer
What parasites are mentioned in the PowerPoint?
Giardiasis and pinworm
What are some later signs of appendicitis?
Pain at McBurney’s point, rigid/board like abdomen
What is an earlier sign of appendicitis?
Stooped posture
What does it mean if the pain disappears?
The appendix has ruptured and is an emergency
What are some other signs of appendicitis?
WBC’s 10,000-18,000. Anorexia, rigid abdomen, absent bowel sounds, N/V, fever, leukocytosis, no eosinophils
What did Carley teach us about appendicitis?
If you can’t isolate pain at McBurney’s point, have the child jump up and down, if no pain it’s not appendicitis
How can appendicitis & pinworm incidences be reduced?
Increase fiber in the diet
What is the most common congenital malformation of the GI tract?
Meckel’s diverticulum, which is a bulge in the wall of the colon
Who is usually affected by Meckel’s diverticulum?
Children < 2 years old
What is a common complication of Meckel’s?
Intesussecption
What is a common sign of Meckel’s diverticulum?
Bloody, jellylike diarrhea
What is done in most cases of Meckel’s?
Usually nothing, as it is asymptomatic, or it mimics peptic ulcer/Crohn’s/appendicitis s/s. Surgical repair if severe
What 2 problems compromise IBD (inflammatory bowel disease)?
Crohn’s disease and ulcerative colitis
What can cause IBD?
Diet, infection, environmental factors
What is the difference between Crohn’s and ulcerative colitis?
Crohn’s can affect the entire GI tract, from mouth to anus, while ulcerative colitis only affects the colon
Is there a cure for IBD?
Pancolectomy (removal of the colon) will cure colitis, although meds are tried 1st. Crohn’s is managed with meds only
What are the s/s of ulcerative colitis?
Bloody diarrhea, abdominal pain, anemia, N/V, lesions remain
Which form of IBD is slow/fast?
Crohn’s is slow and has skip lesions. UV is fast, with bad lesions that stay (bloody diarrhea)
Where does Crohn’s usually start?
Terminal ileum (where small bowel & colon meet)
How does Crohn’s affect the body?
Arthritis, liver disease, renal calculi, long term debilitating, FTT in children
Which form of IBD increases cancer risk within 15 years?
UC
What meds are used to treat IBD?
Steroids, 6MP immune modulators, sulfasalazine (Azulfidine), TPN
What foods are not allowed on the IBD diet?
Everything, so you might as well quit eating
What can cause hepatitis to become acute?
Chemical reaction, drug reaction, other disease processes
What forms of hepatitis are passed via the fecal/oral route?
A and E. (The A&E channel is pretty crappy)
What forms of Hepatitis are caused by blood and sex?
Basically all that aren’t fecal/oral: B, C, D & G
Which forms of hepatitis have vaccines available?
A & B
What are the 2 phases of hepatitis?
Anicteric (absence of jaundice) and icteric (jaundice)
What are some s/s of phase 1 hepatitis?
Malaise, fatigue, RUQ pain, N/V
What are some s/s of phase 2 hepatitis?
Dark urine, clay colored stools, jaundice of skin and sclera
How long does each phase of hepatitis last?
Anicteric = 5-7 days; Icteric = 4 wks
What does Hirshprung’s disease cause?
A mechanical blockage of the colon
In what demographic groups is Hirshprung’s more prevelent?
Males and those with Down’s syndrome
Which is closed first, the cleft lip or palate?
The cleft lip is always repaired first (at 3 mo), then the palate is repaired at 12-18 months
Is cleft lip/palate more common in males or females?
Cleft lip & palate are more common in males while just cleft palate is more common in females. Cleft lip/palate is more common in Asian & white populations and less prevalent in black populations
How is breast feeding different for a baby with a cleft palate/lip?
Baby must be stimulated first (rub nipple on lip) and milk flow must be started first (warm washcloth)
How do you reduce the chance of choking while feeding a baby with cleft lip/palate?
Keep slow steady pressure on the bottle or breast
What acronym applies to feeding a baby with cleft lip/palate?
ESSR. Enlarge (nipple - unless, of course, you are breast feeding), Stimulate, Swallow, Rest
Should you burp a baby more or less often if it has a cleft lip/palate?
Burp often
What is a tracheoesophageal fistula and why do we need to know what it is?
It is an abnormal connection between the esophagus and trachea and is an emergency. 50% have more complex defects like cupped ears
What is the most important nursing intervention for an tracheoesophageal fistula?
NPO! Prognosis is poor
What is another name for gluten-induced enteropathy and what are its 4 main characteristics?
Celiac’s disease. Steatorrhea, malnutrition, abdominal distention, secondary vitamin deficiencies
How is a hiatal hernia repaired?
Nissen fundoplication
What are the s/s of pyloric stenosis?
Projectile vomiting, non-bilious vomiting
What is hypertrophic pyloric stenosis?
An enlarged muscle of the pyloric sphincter occludes the passageway to the small intestine
What is an intussusception and what is done for it?
The bowel folds in on itself. A barium or air enema
What is a “tet spell” and what are the s/s?
Bluish fingers/toes/mouth during feeding/crying. Other symptoms include cyanosis, clubbing, SOB, fainting, poor weight gain, irritability, prolonged crying, murmur
If you attempt to put a rectal thermometer in an infant and it won’t go in, that baby has an _____ _____.
Imperforate anus
What are some s/s of Celiac’s disease/gluten intolerance?
Steatorrhea, chronic diarrhea, weight loss/malnutrition, pale/foul smelling stool/floaters, low RBC/anemia, bone pain, gas, behavioral changes/irritable, numbness in legs, discolored teeth
At what point are cardiac problems visible?
With normal hemoglobin, when O2 sat is at 85%
What is done for a tet spell?
Hold in the knee/chest position
What is the best way to examine heart abnormalities?
Electrocardiogram, echocardiogram, heart cath, O2 challenge test
What are the early s/s of CHF in infants?
Tachycardia at rest, fatigue during feeding, sweating scalp and forehead, dyspnea, sudden weight gain
What meds are used to treat HF?
Digoxin (improves cardiac fxn), Ace inhibitors (lisinopril made me cough!)(decrease vascular resistance, BP, afterload), diuretics
What heart defects increase pulmonary blood flow?
Abnormal connection between two sides of the heart. Either the septum or the great vessels
What heart defects decrease pulmonary blood flow?
Tetrology of FAllot and tricuspid artresia
Most cardiac defects are _____ (from birth) and affect the structure of the heart.
Congenital
What are some nursing considerations for Digoxin?
Assess HR, RR, BP q2-4hrs. Accurate I&O (1-2 mL/kg/hr)
What is Heart failure?
Not enough cardiac output to maintain METABOLIC NEEDS
How is HF compensated for?
Impaired myocardial fxn (vasoconstriction [cold/blue hands and feet], < BP/urine), Pulmonary congestion (tachypnea, dyspnea, cyanosis), Systemic congestion (peripheral and periorbital edema, wt gain, ascites, hepatomegaly, neck vein distention)
What are some s/s of dig toxicity?
N/V, anorexia, bradycardia, dysrhythmias
What are some nursing measures for HF?
HOB at 45 degrees, maintain nutrition status to fight infection
What is a s/s of hypoxemia?
Clubbing
What is bacterial endocarditis?
An infection in the valves and inner lining of the heart
How is bacterial endocarditis treated?
Long term antibiotics lasting for 7-8 wks
What does endocarditis lead to?
HF. Will take antibiotic before any dental work
What causes Rheumatic fever?
Beta-hemolytic strep
What tissues does RF involve?
Collagen of the joints, heart, CNS (brain), skin, subQ system
When is RF more likely to occur?
In the winter and spring of kids age 5-15
What is RHD?
An autoimmune disease that is the result of untreated strep
How is RF diagnosed?
Must have 1 major and 2 minor symptoms, and a hx of strep infection
How is it treated?
Antibiotics for 5 years. If cardiac involvement even longer. Education/follow-up is essential. Prophylactic antibiotic before dental work/procedures
What are the major criteria of RF?
Carditis, polyarthritis, erythema marginatum (rash), chorea (not to be confused with Korea), subcutaneous nodes
What are the minor criteria for RF?
Fever, arthralgia
What is Kawasaki disease?
Acute systemic vasculitis of unknown cause. Leads to HF
What can Kawasaki’s lead to?
Aneurysm due to weakening of vessel walls
How can Kawasaki’s be treated?
Oil change! Dig, angiotensin enzyme inhibitors, K+ supplements
How is Kawasaki’s diagnosed?
Clinical s/s, no lab studies. S/S = fever >102 deg F >5 days + 4/5 clinical criteria which are edema/erythema of extremities (desquamination), conjunctival infection without exudate, changes in oral mucosa (red), polymorphous rash, cervical lymphadenopathy (1 >1.5 cm)
What are some s/s of hypertension in kids?
Teens - HA, dizziness, visual changes; Kids - irritability, head banging/rubbing, wake up screaming at night
What meds are given for Kawasaki’s?
High dose aspirin (antiplatelet) and IV immunoglobulin
At what Hgb level is blood shunted to the core?
<8 g/dL
What is the treatment for anemia?
IV fluids, O2, bedrest
What is sickle cell anemia and what is its cause?
A genetic defect causes “s” shaped Hgb cells
What are some consequences of sickle cell anemia?
Growth retardation, chronic anemia, delayed sexual maturity, sepsis, vaso-occlusive crisis, sequestration crisis
What are the s/s of a vaso-occlusive crisis?
Pain, ischemia
What are the s/s of a sequestration crisis?
Pooling of blood, hepatomegaly, splenomegaly, circulatory collapse
How is sickle cell anemia diagnosed?
Neonatal metabolic screening, cycledex test (result in 3 min) if +, then Hgb electrophoresis
What is the treatment for sickle cell anemia?
IV fluids/electrolytes, O2, analgesics, blood replacement, antibiotic therapy (bacterial infection is the leading cause of death in these kids)
What is hemophilia “A”?
Lack of clotting factor VIII. 80% of cases. X-linked recessive. Only males affected/females are carriers
What can precipitate a sickle cell crisis?
Stress, dehydration, accident
How is hemophilia treated?
Transfusion, DDAVP increases factor VIII activity
What is hypoplastic left heart syndrome?
Critical underdevelopment of the left side of the heart
What are some s/s of hypoplastic left heart syndrome?
Tachypnea, cyanosis, poor feeding, cold hand/feet, drowsy/inactive
What is a grave complication of hypoplastic left heart syndrome?
If the hole btwn the foramen ovale and the ductus arteriosis is allowed to close, the child may die
What kids are at greater risk for ALL?
Kids with trisomy 21 have 20x greater risk for ALL
What are “neutropenic” precautions?
Child wears a mask, no flowers or fresh fruit
What organs does ALL affect?
Liver and spleen
What is the difference between Hodgkin’s and non-Hodgkin’s lymphoma?
Both are lymphomas (neoplastic disease), Hodgkins is more prevalent in the 15-19 year old range, while non-Hodgkin’s is more prevalent in kids <14
What genetic defect increases risk for ALL?
Down’s syndrome
What are the 2 classifications of Hodgkin’s? Describe them.
A=asymptomatic. B=temp >38 deg C for 3 days, night sweats, unexplained weight loss of 10% or more over previous 6 months
What is done for hypotrophic left heart syndrome?
Mechanical vent, inotropic support, prostaglandin E, surgery
