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ADN005 Pediatrics > Week 3 Chapter 42 > Flashcards

Week 3 Chapter 42 Flashcards

1
Q

What are the primary functions of the GI?

A

GI includes mouth to anus.

Digestion and absorption of nutrients, water, and elimination of waste products, and secretion of substances for digestion.

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2
Q

When is the GI system fully developed and mature at what age?

A

2 years old

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3
Q

Highly vascular and makes it common entry point for infection.

A

Mouth

  • Commonly bring objects to the mouth.
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4
Q

LES is not fully developed until the age of

A

1 years of age.

Causing regurgitation and reflex.

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5
Q

What is the newborn stomach capacity?

A

10-42 mL

Increases to 200mL by several months of age

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6
Q

Is the small intestine not functionally mature at birth.

A

True

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7
Q

Cm of small intestine in infants?

A

250cm

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8
Q

Cm of small intestine in adults?

A

600cm

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9
Q

Small bowel loss equates to what type of problems?

A

Problems with absorption and diarrhea

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10
Q

When do pancreatic enzymes adult age level?

A

Age 2.

Liver is large at birth.

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11
Q

Who is at the greatest risk for fluid balance losses?

A

Infants and children.

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12
Q

Infants and children have the least amount of body water than adults which places them at increased risk of fluid loss due to fever or GI upset.

A

False

Fluid balance and losses

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13
Q

Prematurity
Family Hx
Genetic Syndromes
Chronic Illness
Prenatal Factors
Exposure to Infectious Agents
Foreign Travel
Immune Deficiency/ Chronic Steroid Use
Unvaccinated Children- Hep B vaccine reduces the lifetime risk

A

Risk Factors for GI Disorders

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14
Q

Data Collected in the Physical Assessment

A

Inspection and Observation:
Child’s color, hydration status, abdominal size and shape, mental status

Auscultation:
Hyperactive or hypoactive bowel sounds.

Percussion:
Dullness, flatness, tympany

Palpation:
Reserve for last sequence: palpable kidneys may indicate tumor or hydronephrosis: RLQ pain may warn appendicitis

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15
Q

Soft, muffled thud- like tone over fluid or solid organs (Liver or Spleen)

A

Dullness

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16
Q

Soft, short tone over solid tissue like muscle and bone.

A

Flatness

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17
Q

High Pitched, drum-like over gastric bubble (gas)

A

Tympany

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18
Q

What is the most common result of GI illness is?

A

Dehydration requiring fluid therapy at home or in most serious cases in the hospital.

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19
Q

Common Medical Treatments in GI

A

-Hydration: oral (preferred) enteral, and IV
-Providing adequate nutrition ( oral, enteral, and IV)
- Enemas and Bowel Preparations
- Ostomies- Surgical Opening into a digestive organ
- Probiotics: Support/ intestinal microbial flora.

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20
Q

Common Laboratory and Diagnostic Tests

A

Abdominal Ultrasonography
Barium swallow, small bowel series
Blood work: amylase, electrolytes, lipase, LFTs
Esophageal Manometry/ Esophageal pH probe
Endoscopy ( Gastroscopy, colonoscopy)
Hemoccult, stool sample/ culture, stool O&P
HIDA Scan- hepatobillary
Liver biopsy
Lactose tolerance Test, Urea breath test

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21
Q

Use a tongue blade to scrape a specimen into the collection container

A

Diaper Collection Technique

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22
Q

How would obtain a stool collection on a runny stool?

A

-A piece of plastic wrap in the diaper may catch the specimen.
- Very liquid stool may require application of a urine bag to the anal area.

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23
Q

Stool collection technique for older ambulatory child

A

First urinate in the toilet

Retrieve specimen a clean collection container fitting under the seat at the back of the toilet.

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24
Q

Stool Collection for Bedridden child

A

Collect the specimen from a clean bedpan

Do not allow urine to contaminate the stool specimen

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25
Q

Histamine -2 Blockers, PPIs
Prokinetics
Antibacterial/ Antibiotics
Corticosteroids/ Immunosuppressants
Stimulants/ Laxatives
Antidiarrheals and antiemetics
Anticholinergics
Anti-Inflammatories

A

Medications for Management for GI Disorders

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26
Q

Stool diversions can be temporary or permanent

Portion of the intestine is brought to the level of the skin to allow passage of stool

A

True

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27
Q

Nursing Steps for Performing Ostomy Care

A

1.Set up the Equipment
- Warm wet washcloths or paper towels
-Clean pouch and clamp
-Skin Barrier powder, paste, and/ or sealant
-Pencil or Pen
-Scissors
-Pattern to measure the stoma size
2. Take off the pouch ( may need to use adhesive remover or wet washcloth to ease pouch removal)
3. Observe the stoma and surrounding skin. Clean the stoma and skin as needed, allowing it to dry.
4. Measure the stoma, mark the new pouch backing, and cut the new backing to size.
5. Apply the new pouch.

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28
Q

Cleft Lip and Palate
Meckel Diverticulum
Hernias (inguinal and umbilical)

A

Structural Anomalies of the GI Tract

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29
Q

Most common congenital craniofacial anomaly occurring 1:700 births worldwide

A

Cleft Lip and Palate

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30
Q

Risk Factors for Cleft Lip and Palate

A

Maternal Smoking, prenatal infection , AMA, use of anticonvulsants, steroids, and other medications during early pregnancy.

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30
Q

This is associated with heart defects, ear malformations, skeletal deformities, and GU abnormalities.

A

Cleft Lip and Palate

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31
Q

Development of cleft occurs in?

A

Pregnancy

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32
Q

Tissue that forms the lip fuses by how many weeks of gestation

A

5-6 weeks

Palate closes between 7 and 9 weeks

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33
Q

How many % of infants born with cleft lip also have cleft palate?

A

50%

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34
Q

Feeding Difficulties
Altered Dentition
Delayed or altered speech development
Otitis Media
Aspiration

A

Complications of Cleft Lip and Palate

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35
Q

When is cleft lip repaired at what months?Palate?

A

2-3 months

6-9 months

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36
Q

Result of an incomplete fusion of the omphalomesenteric duct during embryonic development

A

Meckel Diverticulum

Fibrous band to connect the small intestine to the umbilicus

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37
Q

S/S of MD

A

Blood or mucous in stools
Severe, colicky abdominal pain

Complications Include
- Bleeding
- Anemia- May require blood transfusion
- Intestinal Obstruction

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38
Q

What is necessary for children with MD?

A

Surgical Correction

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39
Q

Occurs when the processes vaginalis falls to close completely during the embryonal development

A

Inguinal Hernia
- Abdominal or pelvic viscera to travel through internal inguinal ring to inguinal canal

40
Q

If mass is felt, what may the MD do for Inguinal Hernia ?

A

Reduce it.

Temporary

If reduction is not possible, hernia could be incarcerated

  • Bowel Strangulation
41
Q

When is surgical correction needed for infant with inguinal hernia?

A

Several Weeks old and has been thriving.

42
Q

Occurs commonly in preterm infants

A

Umbilical Hernia

43
Q

This is caused by incomplete closure of the umbilical ring allowing intestinal contents to herniate through the opening

A

Umbilical Hernia

44
Q

When do we notify the surgeon for umbilical hernia?

A

Notify the surgeon

Incarceration is rare

45
Q

S/S of Umbilical Hernia

A

Abdominal Pain, tenderness or redness at the umbilicus

46
Q

Spontaneous closure of umbilical hernia occurs at ?

A

4 years of age

  • Surgical Correction if large or fail to close
47
Q

Dehydration, vomiting, diarrhea

Oral Candidiasis and Oral Lesions
Hypertrophic Pyloric Stenosis
Intussusception, malrotation, volvulus
Appendicitis

A

Acute GI Disorders

48
Q

Risk Factors for Dehydration

A

Diarrhea
Vomiting
Decreased Oral Intake
Sustained high fever
DKA
Extensive Burns

  • Important to document characteristics of the products related to vomiting or diarrhea ( volume, color, frequency)
49
Q

Oral Rehydration Solution should contain

A

75mmol/ L sodium chloride
13.5 g/L glucose
Standard ORS solutions include: Pedialyte, Infalyte, and Ricelyte

49
Q

What is not appropriate for oral rehydration?

A

Tap water
Milk
Undiluted fruit juice
Soup
Broth

50
Q

Mild to Moderate dehydration requires what?

A

50-100 ml/ kg over 4 hours

51
Q

IV FLUID BOLUS rate is

A

20ml/ kg of NS over 20-30 min (max of 1L per bolus)
- Reassess the Hydration status

52
Q

MD may order IV fluids maintenance rate or 1.5 times maintenance

A

True

100ml/ kg 1st 10kg
50ml/ kg Next 10 kg
20ml/ kg for remaining kg

Add for total 24 hr. and divide by 24 for hourly rate

53
Q

Should one hang potassium when the patient has NOT voided?

A

No hold the K+ until the patient voids

54
Q

S/S of Diarrhea and Dehydration

A

Sunken eyes and fontanels
Dry mucous membranes
Weight loss= Water Loss
Fatigue, Lethargy
Decreased Tearing
Decreased Skin Turgor

55
Q

Viral Infection is most common for diarrhea and dehydration?

A

True

Leads to severe fluid and electrolyte depletion

56
Q

Bacteria and parasites typically come from?

A

Undercooked food causing salmonella and poor sanitation or lack of clean drinking water.

Diarrhea and Dehydration

57
Q

Medications causing Diarrhea and Dehydration are?

A

Antibiotic and Laxatives

Lactose Intolerance can cause diarrhea and dehydration

58
Q

Interventions for Diarrhea and Dehydration

A

ORS- oral Rehydration Solutions

IV Fluids: 20ml/kg- IV Normal Saline bolus (0.9 Sodium Chloride) or LR (Lactated Ringers )

59
Q

S/S of Diarrhea and Dehydration

A

Sunken Eyes and fontanels
Dry Mucous Membranes
Weight loss= Water Loss
Fatigue, Lethargy
Decreased Tearing
Decreased skin turgor

60
Q

Condition in newborns, where the lower sphincter of the stomach becomes enlarged, preventing food from entering the small intestine

A

Pyloric Stenosis

61
Q

More common in males and occurs between 3 and 6 weeks of life

A

Pyloric Stenosis

62
Q

Forceful, projectile, non- bilious vomiting
Hunger soon after vomiting episode
Weight loss due to vomiting
Hard, moveable “ olive” mass in RUQ
Progressive Dehydration with subsequent lethargy
Family History

Requires Surgical Intervention

A

Pyloric Stenosis

63
Q

Occurs when 1 part of the intestine slides inside another part of the intestines, like a telescope

Creates an obstruction that blocks normal flow of bowels, leading to increased pressure, swelling, and decreased blood flow within the bowels causing ischemia ( lack of oxygen to the bowel tissues leading to tissue death)

A

Intussusception

64
Q

Most cases occur in toddlers in 1-2 years old

Medical Emergency can lead to perforation and peritonitis where the bowels explode and infection settles into the peritoneal cavity Patients can go into sepsis and die quickly

A

Intussusception

65
Q

Symptoms flare and then regress

Symptoms include
Intermittent, crampy abdominal pain
Severe Pain
Vomiting ( non projectile) and diarrhea
Current Jelly like stool
Sausage Shaped Abdominal Mass
Lethargy

Bilious vomiting- Obstruction
Requires air or barium enema; surgery

A

Intussusception

66
Q

Results from disruption in embryonic development

When malrotation occurs, the intestine is abnormally attached and the mesentery narrows, twisting on itself (volvulus)

A

Malrotation and Volvulus

67
Q

Most case will present in the first few weeks of life

Symptoms include
Bilious vomiting
Abdominal Pain
Shock Symptoms
Abdominal Distention
Tachycardia
Bloody Stools

Requires Surgery- Ladd Procedure

A

Malrotation and Volvulus

68
Q

Due to closed loop obstruction it is thought that the obstruction is due to fecal matter impacted into the narrow ….

A

Appendix

Appendicitis

69
Q

_____________ causes inflammatory fluid and bacterial contents leak into the abdominal cavity resulting in peritonitis

A

Perforation

70
Q

Most common cause of emergent abdominal surgery in children

Peeks in prevalence in the second decade of life

Symptoms include: Vague Abdominal pain initially, localizing to the RLQ over a few hours

Nausea and Vomiting

Small Volume, frequent soft stools

Fever

A

Appendicitis

71
Q

If pain is suddenly relieved without intervention …

A

Suspect Perforation and notify MD

Requires Surgical Perforation

72
Q

Gastroesophageal Reflux, Peptic Ulcer Disease
Constipation, Encopresis
Hirschsprung Disease
Short Bowel Syndrome
Inflammatory Bowel Disease
Celiac Disease- Gluten Free Diet
Recurrent Abdominal Pain- Functional, non-ulcer dyspepsia, and IBS
Failure to Thrive and Chronic Feeding Syndrome

A

Chronic Gastrointestinal Disorders

73
Q

Most common cause of neonatal intestinal obstruction

A

Hirschsprung Disease

Characterized by constipation

74
Q

Feeding adjustments are an essential part of _____________ management

A

Reflux

75
Q

Give infants __________ and ________ frequent feedings

A

Smaller and more

Use a nipple that controls flow well

Frequently burp the infant to control reflux

76
Q

_____________ of formula with products such as ______- and ________ cereal can help keep the formula and gastric contents down

A

Thickening ,Rice; oatmeal

77
Q

Keep infants upright for? after feeding by holding them and/ or elevating the head of the crib 30 degrees

A

30-45 minutes

78
Q

Infrequent bowel movements or difficult passage of stools that persists for several weeks or longer

A

True

Causes stress, low fluid, and fiber

79
Q

Causes of constipation of newborn/ infant

A

Meconium Plug
Hirschsprung Disease
Cystic Fibrosis
Hypothyroidism
DI
Dietary Changes
Withholding

80
Q

Toddler and Ages 2-4 Years old causes of constipation

A

Anal Fissures
Withholding
Toilet Refusal
Short Segment
Hirschsprung Disease
Spinal Cord
Neurologic Disorders

81
Q

School Age causes of constipation

A

Toilet or bathroom access limited

Tethered Cord
Withholding

82
Q

Adolescent causes of constipation

A

Spinal Cord Injury
Dieting
Anorexia
Pregnancy
Laxative Abuse
IBS

83
Q

Any Ages causes of constipation

A

Medication Side Effect
Previous Anorectal Surgery
Hypothyroidism

84
Q

Affects the large intestine and causes problems with passing stool

Results due to missing nerve cells in the colon, which leads to bowel obstruction as the anal sphincter is unable to relax and coupled with no peristalsis

A

Hirschsprung’s Disease

85
Q

S/S of Hirschsprung’s Disease

A

No passage of stool (meconium)or thin ribbon like stool

Distended Abdomen

Refusing to feed and vomiting green bile

86
Q

Complications of Hirschsprung’s Disease

A

Fever and episodes of foul smelling Diarrhea

Report to HCP immediately

Surgery is often required to bypass the affected part of the colon or remove it entirely

87
Q

Rome Committee 12 Week Criteria for IBS

A

Abdominal Pain relieved by defecation
Onset of pain or discomfort associated with a change in frequency of stool

Onset of pain or discomfort associated with a change in form of stool.

No structural or metabolic explanation for this abdominal pain

Types can be designated as constipation , diarrheal, or mixed

Use FODMAP diet, avoid dietary triggers

88
Q

Common causes of ___________ include abdominal trauma, drugs and alcohol, multisystem disease, infections, congenital anomalies, obstruction or metabolic disorders.

A

Pancreatitis

89
Q

Usually associated with hyperlipidemia, obesity, pregnancy, birth control pill use, or cystic fibrosis.

A

Cholelithiasis

90
Q

Pancreatitis
Gallbladder Disease
Jaundice
Biliary Atresia
Hepatitis
Cirrhosis and Portal HTN
Liver Transplantation

A

Hepatobiliary Disease

Cholelithiasis is presence of stones in the gallbladder

91
Q

Child and Family education dependent on GI disorder . Key focus is to prevent illness from progressing

A

True

Teaching Plan

92
Q

For a child with dehydration, what are the goals?

A

Restore fluid Volume and prevent progression to hypovolemia.

Child with vomiting- Promote fluid and electrolyte balance

93
Q

Nurses should teach parents that to facilitate daily bowel evacuation, what should the child do?

A

Sit on the toilet twice daily after breakfast and dinner for 5 to 15 minutes

94
Q

Psychosocial Impact GI

A

Constipation can be stressful process

Sensitive and embarrassing topic

Behavior modification is necessary

95
Q

Children with short bowel syndrome are considered medically___________ for a lengthy period, causing much anxiety related to the initial bowel resection that resulted in short bowel

A

Fragile

96
Q

Sometimes long term hospitalization is required for GI disorders. Causes parents to miss work and cutting down on the time they have to spend with other children. Creates further stress and even more anxiety about finances and relationships.

A

True

ADN005 Pediatrics (21 decks)

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