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Med Surg II > Updated GI Disorders > Flashcards

Updated GI Disorders Flashcards

1
Q

What are indicators of fluid status?

A

Urinary output, mucous membranes, capillary refill, decreased skin elasticity and turgor, decreased blood pressure, increased HR, sunken eyes and fontanels

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2
Q

T or F. Compared to older children and adults, infants and young children have a greater need for water and are more vulnerable to alterations in fluid and electrolyte balance?

A

TRUE

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3
Q

Fluid losses can be divided into 3 categories, what are they?

A

Insensible losses (occur through the skin), Urinary, and Fecal

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4
Q

Heat and humidity, body temperature, and respiratory rate influence what type of fluid loss?

A

Insensible losses

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5
Q

Name 4 sources of fluid loss

A

Diarrhea, NG tube drain, polyuria, third spacing. If fluid intake and output are not matched, fluid imbalance can occur rapidly.

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6
Q

Sarah weighed 19lbs and 8 ounces at her MD visit last week. Today she weighs 8.1 kg, what is her weight loss (percent of dehydration)?

A

8.6 percent

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7
Q

Insufficient use of nutrition to meet the demands for growth

A

Failure to thrive (FTT)

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8
Q

Premature birth, GERD, short bowel syndrome, malabsorption, and cleft lip are all examples of what?

A

Organic causes of FTT

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9
Q

State of cachexia caused by environmental factors describe what?

A

Inorganic causes of FTT. This includes abuse, inadequate preparation of formula by caregiver.

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10
Q

Abnormal signs and symptoms of MILD dehydration (3-5 percent)?

A

Tachy or slightly dry buccal mucosa, normal or mildly reduced UO, increased thirst.

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11
Q

Abnormal signs and symptoms of MODERATE dehydration (6- 9 percent)?

A

Rapid pulse, normal to low SBP, deep and increased RR, dry buccal mucosa, sunken anterior fontanels, sunken eyes, cool skin, reduced skin turgor, markedly reduced UO, listlessness and irritability.

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12
Q

Abnormal signs and symptoms of SEVERE dehydration (more than 10 percent)?

A

Rapid and weak or absent pulse; low SBP, deep; tachypnea or decreased to absent RR; parched buccal mucosa; markedly sunken anterior fontanels; markedly sunken eyes; tenting skin turgor; cool, mottled, acrococyanosis skin; anuria; grunting, lethargy, coma

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13
Q

What are 6 common causes of Infantile Colic?

A

Allergic reactions, GERD/ acid reflex, overstimulation, gas producing foods, air intake (from feeding or crying), immature digestion and nervous system

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14
Q

You’re caring for a child you suspect has Infantile Colic. What are 6 common symptoms you expect to see?

A

Trapped stomach and intestinal gas, abdominal bloating, acute gastric and intestinal pains, intense and prolonged crying, sleeplessness/ exhaustion, stressed out parents

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15
Q

T or F. In the US, almost 200,000 under 5 are hospitalized for gastroenteritis and approx 200 children under 5 die of diarrhea and dehydration each year?

A

TRUE

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16
Q

T or F. Acute gastroenteritis is caused by a variety of viral and bacterial pathogens only?

A

False. It is caused by a variety of viral, bacterial, and parasitic pathogens, such as rotavirus, e.coli, salmonella, and staphylococcus organisms.

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17
Q

BUN, SG, Lytes, Stool culture and stool WBC, O and P, and UA are common diagnostic test used to identify what condition?

A

Gastroenteritis

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18
Q

Baby Amy is admitted for acute gastroenteritis. How will you treat her?

A

Assess state of hydration, correct fluid and electrolyte imbalance, and give PO ASAP (very mild, like pedialyte)

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19
Q

In regards to treatment for gastroenteritis/ acute diarrhea, what are the 4 major goals the management of this condition?

A
  1. Assessment of fluid and electrolyte imbalance 2. Rehydration 3. Maintenance fluid therapy 4. Reintroduction of an adequate diet.
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20
Q

T or F. Infants and children with acute diarrhea and dehydration should be treated with fluid replacements, such as juice or plain water?

A

False. Infants and children should be first treated with oral rehydration therapy (ORT) and avoid juice, soda, and plain water

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21
Q

How is FTT managed?

A

Identify the cause (prenatal hx, patient’s hx, current home practices), treat underlying cause to catch up weight gain by nutritional intervention and behavior modification, provide family support

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22
Q

In patients with gastroesophageal reflex, the lower esophageal __________ is open allowing reflex.

A

Sphincter

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23
Q

The MD on your floor has just reviewed Baby Johnny’s diagnostic tests and has diagnosed him with gastroesophageal reflex (GERD). What tests did the MD evaluate to reach this diagnosis?

A

Upper GI series and PH probe

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24
Q

T or F. GERD becomes a disease when complications such as FTT, bleeding, and dysphagia develop/.

A

TRUE

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25
Q

How is GERD managed?

A

By providing small, frequent feedings and implementing reflex precautions

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26
Q

What is included in reflex precautions?

A

thickening feedings with one tablespoon of rice cereal per ounce of formula and elevating the HOB 30 degrees after feeds.

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27
Q

Tagamet and Prevacid are examples of medications used to treat what condition?

A

GERD. Tagamet is a H2 Receptor antagonist and Prevacid is a PPI

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28
Q

Before a Nissen Fundoplication (surgery to tx GERD) can take place, what must first be observed and documented?

A

FTT, Esophagitis, and Recurrent aspiration pneumonia

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29
Q

This disease is described as the congenital absence of autonomic parasympathetic ganglion cells in a distal portion of the colon and rectum.

A

Hirschsprung Disease (HD). It is a mechanical obstruction caused by inadequate motility. Because there is no nerve stimulation, substances collect there and stretch the colon

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30
Q

What is the first sign of HD in infants?

A

Failure to pass meconium within 24 to 48 hrs after birth

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31
Q

In addition to failure to pass meconium, what are other common symptoms of HD?

A

Abdominal distention, vomiting, poor feeding, constipation, diarrhea and vomiting.

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32
Q

Ribbon like stools is a common symptom of _____ in older children

A

HD. Younger children are usually constipated

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33
Q

T or F. For patients with HD, it is best to assess their temperature orally?

A

False, you should take their axillary temp (hesi hint)

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34
Q

What is another name for HD?

A

Congenital Aganglionic Megacolon

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35
Q

T or F. Any section of the colon can be affected in HD?

A

True, however the lower the defect, the better.

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36
Q

What is the primary nursing diagnosis for patients with pyloric stenosis?

A

Alteration in nutrition, less than bodily requirements related to frequent vomiting

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37
Q

T or F. The younger the child, the more vulnerable they are to fluid and electrolyte imbalances and the greater is the need for caloric intake required for growth?

A

True. Nutritional needs and fluid and electrolyte balance are key problems for children with GI disorders.

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38
Q

T or F. Fecal contents accumulate BELOW the aganglionic area of the bowel?

A

False, ABOVE

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39
Q

Baby Mike is diagnosed with HD and his parents want to know how the MD plans to correct it, what would you say?

A

Correction usually involves a series of surgical procedures (2). A temporary colostomy and later, a reanastomosis and closure of the colostomy.

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40
Q

When managing HD, what are 3 important interventions to keep in mind?

A

Keep patient NPO, initiate fluids to fluids to correct FE imbalance, and IV antibiotics if sepsis and enterocolitis is suspected.

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41
Q

How is HD diagnosed?

A

Biopsy to confirm intestinal involvement.

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42
Q

Baby Mike is scheduled for surgery to correct his HD the following day. What pre-op tasks are most important to complete?

A

Give him an ENEMA, fluid and electrolyte correction, early central lines and nutritional support, IV antibiotics administration

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43
Q

Post-op care for Baby Mike (HD) should include?

A

ostomy care, parental education and support for second surgery (pull through procedure with ostomy takedown) later on

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44
Q

Name 5 conditions that are considered surgical emergencies.

A

Malrotation, pyloric stenosis, intussusception, appendicitis, and incarcerated inguinal hernia

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45
Q

When is an incarcerated ingunial hernia considered an emergency situation?

A

When there is a color change. Assess for hernia discoloration.

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46
Q

T or F. An incarcerated hernia is very common in preemie girls?

A

False. It is more common in preemie boys

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47
Q

Baby Timmy is admitted to the ER and you suspect that he has an incarcerated hernia. What symptoms helped you reached this conclusion?

A

Edematous inguinal hernia with erythema.

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48
Q

When is surgery for an incarcerated hernia usually performed?

A

When manual reduction (applying pressure and analgesia) is not successful or the hernia has been incarcerated for more than 12 hours.

49
Q

This surgical emergency is described as hypertrophy of the pyloric sphincter and narrowing of the pyloric canal

A

Pyloric stenosis

50
Q

T or F. Pyloric stenosis usually occurs in first born females?

A

False, first born males. 4 to 1 (boys to girls)

51
Q

When is pyloric stenosis most often first recognized as an issue?

A

When babies are 2 to 4 weeks old or during the first few months of life.

52
Q

T or F. For patients with pyloric stenosis, vomiting usually begins after 14 days of life and becomes projectile?

A

True.

53
Q

What are the most common signs and symptoms of pyloric stenosis?

A

Projectile vomiting, hungry, fretful infants, weight loss, dehydration, olive shaped mass in RUQ that is palpable, visible peristaltic/ gastric waves

54
Q

T or F. In regards to pyloric stenosis, the prognosis following surgery is excellent?

A

True.

55
Q

Small intestine fails to UNTWIST itself during gestational period

A

Malrotation. Midgut does not rotate correctly and twist occurs (volvulus)

56
Q

T or F. Malrotation by itself is not considered an emergency?

A

True. When volvus is included however, it becomes an emergency.

57
Q

A common sign of Malrotation with Volvulus is bilious vomiting related to obstruction. What color is this emesis?

A

Green

58
Q

T or F. Malrotation with Volvulus is compatible with life?

A

False. This condition is not compatible with life. Emergency surgery is needed to avoid bowel necrosis and or death.

59
Q

Intussusception

A

Telescoping of one part of the intestine into another part of the intestine, usually the ileum into the colon.

60
Q

T or F. In regards to intussuseption, blood vessels become trapped in the telescoping bowel, causing necrosis.

A

True. Blood flow is cut off distally from telescoping and a partial or complete bowel obstruction occurs.

61
Q

In what age would you expect children to be diagnosed with Intussuseption?

A

6 to 18 months

62
Q

T or F. Intussuseption is more common in boys than girls?

A

True. 3 to 1 (boys to girls)

63
Q

What are common sign and symptoms of intussuseption?

A

Colicky abdominal pain, episodes of screaming with legs/ knees drawn UP to abdomen every 15 mins, vomiting, currant jelly stools, sausage shaped mass in RUQ.

64
Q

What are currant jelly stools?

A

Stools mixed with blood and mucus. This is a LATE symptom of intussuseption that indicates sloughing of intestines.

65
Q

How is intussuseption usually managed?

A

Fluids resuscitated if indicated, abdominal US, iodinated contrast or air enema to reduce it, image guided reduction (for recurrent cases), and laparotomy.

66
Q

Abdominal pain that starts in the periumbilical area and migrates to RLQ. This condition results from the inflammation of the VERIFORM appendix.

A

Appendicitis

67
Q

What are the classic first symptoms of appendicitis?

A

Periumbilical pain, followed by nausea, RLQ pain, and later vomiting with fever.

68
Q

What 2 assessments can help determine if a patient has appendicitis?

A

Low grade temp and the hop off the table test.

69
Q

T or F. Perforation of the appendix can occur approx 48 hrs of the initial complaint of pain?

A

True. If perforation occurs, you will notice decreased bowel sounds, distention, and abdominal pain in the patient

70
Q

Why should you be worried about the risk of perforation of the appendix?

A

Perforation is an emergency situation due to risk of peritonitis. It causes fecal and bacterial to spread in the abdomen resulting in infection.

71
Q

What does post op care for a ruptured appendix include?

A

A focused assessment and focused interventions to relieve pain, infection, and fluid and electrolyte imbalance

72
Q

T or F. Colic is self limiting?

A

True, patients will outgrow it

73
Q

Bacterial, viral, and fungal invasion of lower and or upper urinary tract

A

UTI. However, UTIs are most commonly caused by e.coli (80 percent).

74
Q

Identify 5 risk factors for UTIs

A

Vesicoureteral reflex, female anatomy, uncircumcised males, neurogenic bladder, constipation, infrequent voiding, poor hygiene, and sexual activity.

75
Q

T or F. 20 percent of bacterial UTIs are asymptomatic?

A

False, 40 percent are asymptomatic

76
Q

What are the most common symptoms of cystitis (bladder infection)?

A

pyrexia, pyuria, hematuria, dysuria, urinary frequency and foul smelling urine

77
Q

What are the most SERIOUS symptoms of pyelonephritis (kidney infection)?

A

ALL of the symptoms of cystitis, plus back or flank pain, abdominal pressure or pain, chills, high fever, extreme fatigue, and emesis.

78
Q

What is a common issue that results from recurrent UTIs?

A

More scarring on the kidneys occurs with recurrent infections. Scarring can eventually lead to the need for dialysis

79
Q

The most common diagnostic tests for a UTI are an UA and Culture, how is this performed?

A

By collecting a clean catch of urine, catheterization, or from a suprapubic tap

80
Q

T or F. When collecting urine for a UA, it is best to use the first void of the day?

A

TRUE

81
Q

When is a renal ultrasound and VCUG used as a diagnostic test?

A

For patients with recurrent UTIs

82
Q

Why is pyelonephritis more serious than cystitis?

A

The kidneys are above the bladder, therefore it becomes more serious the higher the infection is. Requiring more aggressive treatment

83
Q

T or F. Tx for UTIs usually require antibiotics for 7 to 10 days?

A

True. It can be given IV (Ceftriaxone) or PO (Bactrim, Keflex).

84
Q

In regards to UTI management, what else should be considered besides follow up urine cultures every 1 to 2 years?

A

Education for prevention and the importance of increasing fluid intake.

85
Q

VCUG

A

Voiding cystourethrogram

86
Q

Nephrotic Syndrome

A

A kidney disorder characterized by 3 clinical signs, proteinuria, edema (facial and lower extremity), and hypoalbuminemia and hyperlipidemia

87
Q

Baby Jess is admitted for Nephrotic Syndrome. What symptoms would you expect to see?

A

Weight gain, stretched skin, periorbital edema that progresses to general edema, respiratory difficulty, dark, frothy urine but with decreased output

88
Q

Corticosteroids, IV albumin, diuretics, and a no salt diet is a common treatment plan for which condition?

A

Nephrotic Syndrome. For resp distress, apply O2.

89
Q

This disorder is characterized by increased glomerular permeability to plasma protein, which results in massive urinary protein loss.

A

Nephrotic Syndrome.

90
Q

A disease of the kidney in which there is severe inflammation of the glomerular capillaries as a reaction to group A streptococcal infection.

A

Acute glomerulonephritis. The onset of the dz is preceded by post strep infections, such as a viral URI

91
Q

Common S/S of Acute Glomerulonephritis include?

A

High fever, sudden onset of hematuria, hypertension and circular congestion, edema and proteinuria.

92
Q

What does an elevated positive ASO titer indicate?

A

That the immune system is working overtime

93
Q

Common dx tests used for Acute Glomerulonephritis include?

A

Blood tests (ASO titer, BUN, Cr), US, CT scan and biopsy

94
Q

Proteinuria, azotomia, and hematuria are all indicators of what?

A

Acute glomerulonephritis (AG).

95
Q

T or F. To prevent AG, you should treat the underlying cause first?

A

TRUE

96
Q

Besides prevention, management of AG includes?

A

Fluid restriction, diuretics, penicillin to eradicate strep, corticosteroid to suppress the immune system, and monitoring of BP and UO.

97
Q

What is the best treatment for mild and moderate dehydration?

A

ORS. They enhance and promote the reabsorption of sodium and water.

98
Q

These solutions greatly reduce vomiting, volume loss from diarrhea, and the duration of the illness

A

ORS.

99
Q

T or F. ORS is also given to replace ongoing loss of STOOL in both the MILD and MODERATE dehydration phases?

A

True.

100
Q

Baby Alex comes into the ED and is Dx with MILD dehydration. What is the most important nursing intervention to perform at this time?

A

ORS 50 ml per kg over 4hrs and q2h reassessment of Alex’s hydration status and ongoing losses.

101
Q

Baby Meredith comes into the ED and is Dx with MODERATE dehydration. What is the most important nursing intervention to perform at this time?

A

ORS 100 ml per kg over 4hrs, q1h reassessment of Meredith’s hydration status and ongoing losses.

102
Q

T or F. Unlike treatment for MILD dehydration, treatment for MODERATE dehydration MUST be done in a medically supervised setting?

A

True.

103
Q

T or F. In regards to ORS, you should add the ongoing losses to the next hour of ORS?

A

True.

104
Q

How will you know that a patient has SEVERE dehydration?

A

Based on your percentage of dehydration calculation (10 percent or more) and other findings, such as symptoms.

105
Q

T or F. SEVERE dehydration is a medical emergency that requires emergent ORS administration?

A

False. It is an medical emergency that requires emergent IV therapy with rapid infusion of 20 ml per kg of ISOTONIC saline.

106
Q

A rare, uncommon acute renal dz that affects children under the age of 10 that is thought to be precipitated by E Coli from contaminated food and water

A

Hemolytic Uremic Syndrome (HUS)

107
Q

T or F. in HUS, platelet aggregation that results from damage to the glomerular endothelium produce thrombocytopenia?

A

True. Platelet aggregation leads to destruction of RBCs, thus causing obstruction to the tiny vessels in the kidneys. The end result is Acute renal failure

108
Q

Common S/s of HUS include?

A

Vomiting, irritability, lethargy, marked pallor, oliguria or anuria, CNS symptoms such as seizures, coma, or stupor; bruising, petechiae, jaundice, and bloody diarrhea; Acute heart failure (sometimes).

109
Q

How is HUS managed?

A

PREVENTION, fresh frozen plasma, plasmapheresis, dialysis for oliguria for more than 24hrs.

110
Q

Hypospadias

A

Characterized by the urethral opening on ventral surface of the penis. The urinary meatus is located on the ventral surface or anywhere along the penile shaft.

111
Q

T or F. Repair of Hypospadias should be done before age 5?

A

False. Before potty training.

112
Q

T or F. Circumcision on a male with Hypospadias is ok before correction?

A

False.

113
Q

Twisting of the testicle on its spermatic cord that occurs in infants and children between the age of 10 and 14.

A

Testicular Torsion

114
Q

Testicular Torsion is a SURGICAL EMERGENCY. What are the common s/s of the condition?

A

Sudden onset of unilateral pain; N/V; edematous, red, taut, scrotal skin; firm, fixed swollen testicle

115
Q

Enuresis

A

Involuntary voiding after established control

116
Q

What is the difference between primary and secondary enuresis?

A

Primary- no history of dryness; Secondary- occurs in kids who have been bladder trained for 6 months or more, and is also inherited.

117
Q

What are 3 causes of Enuresis?

A

Emotional stress, possible organic factors, and inappropriate toilet training.

118
Q

T or F. Scientific evidence demonstrates potential medical benefits of newborn male circumcision?

A

True, however these data are not sufficient to recommend routine neonatal circumcision.

Med Surg II (12 decks)

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