Week 3 - GI and Nutrition Flashcards
What GERD stand for?
Gastroesophageal Reflux Disease
describe GERD
when the Lower esophageal sphincter is too relaxed or open
what is another name for the lower esophageal sphincter?
cardiac sphincter
GERD is super common to some degree in what age group?
3 months - 1 year
most common in infancy
GERD occurs with more severe case and results in what?
- failure to thrive
- bleeding
- vomiting
- weight loss
what are the treatments for GERD?
- positional feeding c head up
- small feedings
- medications
in regards to treating GERD what do you need to also teach parents around small feeds?
use smaller nipple if bottle feeding
in regards to treating GERD what medication is normally used?
PPI (ranitidine)
how does GERD often present in most babies?
- seen as spitting up
- can be in various amounts
- will have some kid of reflux
describe pyloric stenosis
narrowing of the lower stomach sphincter
what is another name for the lower stomach sphincter?
pylorius sphincter
pyloric stenosis occurs in what age range?
2-5 weeks old
who is more likely to get pyloric stenosis?
- first borns
- males
- caucasians
- full term babies
what are the symptoms for pyloric stenosis?
- similar to GERD but more pronounced vomiting
- directly after feeding/ all intake comes up
what is the treatment for pyloric stenosis?
surgery > have to open up where the swelling is
for babies who have pyloric stenosis why do they projectile vomit right after a feed?
feed fast b/c they are hungry/ have nothing in their stomach
- food can’t pass through sphincter fast enough so baby projectile vomits
what is intussusception?
slipping of one part of the intestine into another part just below it
intusussception occurs most often in who? at what age?
- boys
-2 months to 2 years
what are symptoms of intussusception?
- sudden onset
- high pitch cry (pain)
- kicking legs
- indrawing legs to chest
- yellow/ green vomit
- decreased BM
- palpable mass
is intussusception common?
no, barely see this happen
what is the treatment for intussusception?
- emergent care
- spontaneous reduction
- air enema with or without saline
- surgery
in regards to the types of treatments provided for intussusception, why do we have to provide emergent care?
oxygen can be cut off from bowels and can cause necrotic bowels
in regards to the types of treatments provided for intussusception, how do air or saline enemas work?
provides enough pressure to flip intestine back over/ out
in regards to the types of treatments provided for intussusception, when would we do surgery?
- severe case
- necrotic bowels
why can intussusception be hard to diagnose in children?
- children at this age can’t speak
- normally only diagnosed do the severe pain seen
what is the key finding you need to know about intussusception for the exam?
there will be some kind of mass felt when palpating
what is the most common emergency abdominal surgery in children?
appendicitis
describe appendicits
inflammation of the appendix
often resulting in rupture
how is appendicitis diagnosed?
- ultrasounds
- WBC
what are symptoms for appendicitis?
- localized RLQ pain
- fever
- bloating
- rebound tenderness
- guarding
- vomiting
- diarrhea
what are some complications of appendicitis? list them in order of what you would see first down to last
- rupture of the appendix
- abscess
- peritonitis
- sepsis/septic shock
what is the treatments available for appendicitis?
- rest/ abx
- likely to come back - non ruptured
- surgery - ruptured
- surgery plus 7-10 days abx and/ or NG suction
1 in how many births will have congenital abnormalities?
1 in 600
cleft lip and palate are more common in who?
- boys
- people of colour
describe a cleft lip and palate
fissure/ opening in lip and/ or hard palate
what are some complications of cleft lips and palates?
- malnutrition
- ear infections
- respiratory infections
- oral infections
what is the treatment for cleft lips and palates?
surgery
for cleft lips and palates what do we need to watch for/ be careful of post-surgery?
- prevention of crying
- bleeding
- pain management
- re-feeding
- speech therapy
what do most kids who have had a cleft lip or palate end up with?
lisp
how will you know your infant is ready for solid foods?
- sits up alone
- uses neck muscles to hold head up straight
- opens mouth when they see something coming
- keeps tongue flat/ low when spoon enters mouth
- closes lips over spoon
- keeps food in mouth
what will your infant do if they are not ready for solid foods?
- turn head away if they don’t want it
- mouth stays open after spoon enters
why should you set the infant up for dinner time around 3-4 months?
they can start to see/ become familiar with meal times/ foods
how long should children be breast fed exclusively for?
6 months
what is extrusion? (on exam)
- tongue thrusting movement
- goes away around 4 months
- if they still have this not ready to eat solid foods
when you start feeding your child solid foods, what should you start with?
warm iron fortified baby rice/ barley mixed with formula or breast milk
what consistence should solid foods be in when you first try them with infants?
- thin to thick
- leave in lumps
why don’t you want to start children with cows milk?
- don’t have the enzyme for this yet
- develop it closer to 12 months
why is it recommended to introduce foods one at a time to infants?
so you know/ learn what they are allergic to
for 6-9 month olds, what are normal milestones for feeding?
- spoon feeding
- finger feeding
- cup drinking
- cuddling and breast or bottle feeding
what are some suggested foods for 6-9 month olds?
- soft/ well cooked
- mashed/ milled
- vegetables/ fruits
- mashed potatoes
- sticky rice
why do we want to give 6-9 month olds larger pieces of food?
- so they can have a better grasp on it
- smaller pieces can be choking hazard
for 9-12 month olds, what are normal milestones for feeding?
- finger feeding soft table foods
- drinking by self from covered cup
- cuddling and breast/ bottle feeding away from meal time
what are suggested foods for a 9-12 month old?
chopped/ cooked
- vegetables
- fruits
- cheese
- strips of bread
- toast
- tortillas
- crackers
- cereal
- tender chopped meats
at 9-12 months old where do most children get their nutrients from?
from food, they get topped up with breast milk between meals
what is considered a high allergy food?
- peanut butter
- eggs
- milk
- fish/ shellfish
will you see an allergic reaction from milk right away?
yes
what are foods that should be avoided for kids 9-12 months old?
- honey
- juices
- dairy
- anything unpasteurized
- hotdogs
- hard cheeses
- raw vegetables
- sugar
at what age is it okay to introduce honey? Why do you want to wait this long?
- 2 years old
- due to botulism/ unpasteurized
when you start to give cow milk to a 12 month old what type do you always want to start with?
pasteurized whole milk due to fat content
if a child has an allergy to milk products why do you need to be careful of the alternatives? What should you recommend instead?
- they are made from nuts > don’t have high fat content
- recommend pea based milk product > closest thing for fat content
why do you want to ensure to creased ambiance for meal times for kids? What would this look like?
- informs kids time to eat
- all sitting at table
- music playing
- no electronics/ TV
- provide lots of colour
what do portion sizes look like for toddlers?
- smaller meals at first then add on food if they are still hungry
- large amounts can over whelm them
what minerals do you want to ensure toddlers get?
- iron
- fluoride
failure to thrive refers to what?
children whose current weight or rate of weight gain is significantly lower than that of other children of similar age/ gender
what percentile would failure to thrive children fall in?
5th or lower
what can failure to thrive be a result of?
- medical problems
- factors in the environment
- abuse/ neglect
- physical problems
can the cause of failure to thrive normally be determined?
no
what are some medical/ organic causes for failure to thrive?
- chromosome problems
- hormone deficiency
- damage to brain/ CNS
- heart/ lung problems
- blood disorders
- GI problems
- long term gastroenteritis/ GERD
- cerebral palsy
- chronic infections
- metabolic disorders
- complications oof pregnancy
- low birth weight
- cleft pallet
- previous choking problem
- prolonged ventilation
- premature baby
- having parental feeding for long period
what are some non-organic causes for failure to thrive?
- emotional deprivation as a result of parental withdrawal, rejection
- poverty
- problems with child-caregiver relationship
- parents don’t understand appropriate diet needs
- exposure to infections, parasites, toxins
- poor eating habits
what are some clinical manifestations for failure to thrive?
- lethargic
- small/ skinny looking
- weight, length, size much smaller
- avoiding eye contact
- lack of appropriate weight gain
- irritability
- excessive sleepiness
- lack of age-appropriate social response
- don’t make vocal sounds
- delayed motor development
- constipation
what may be recommended for failure to thrive?
- increase number of calories/ amount of fluid
- correct any vitamin/ mineral deficiencies
- identify/ treat any other medical conditions
for a child who doesn’t thrive for a long time what might be affected?
- normal growth and development
what are some complications of failure to thrive?
permanent mental, emotional, or physical delays can occur
depending on the severity of failure to thrive what might this affect for treatment?
what they choose to use, if very severe will start with IV then move to NG then move to bottle
is obesity a medical condition?
yes
what is a sign of childhood obesity?
weight well above the average for a child’s height/ age
what is considered overweight?
85th - <95th percentile
what is considered obese ?
anything above the 95th percentile
what are some things that can be recommended to reduce incidence of obesity ?
- 5 fruits or vegetables/ day
- < 2hours of screen time/ day outside of work/ homework
- minimum 1 hour/ day activity
- 0 sugar sweetened beverages/ day
what puts someone at risk for obesity?
- eating food/ drinks high in sugar and fat on regular basis
- have limited physical activity
- environment doesn’t encourage healthy eating/ physical activity
- eat to deal with stress/ problem
- low-income family
- genetic disease
what are complications of obesity?
- type 2 diabetes
- increased depression
- low self-esteem
- digestive problems
- higher risk of asthma
- higher risk of sleep apnea
what does obesity put you at a greater risk for in adulthood?
- increased cardiac concerns
- increased chronic medical conditions
what is type 2 diabetes caused by?
resistance to insulin as well as the ability of the pancreas to keep up with the increase demand of insulin
what percent of children are obese when diagnosed with type 2 diabetes?
85%
what is the age of onset for type 2 diabetes in children?
- middle to late puberty
- around 13 years
what populations has a higher rate of type 2 diabetes?
minority populations
for people who have type 2 diabetes is there normally a strong family history of it?
yes
when assessing an obese child what do you expect to find?
- BMI > 30
- apple shape
- acanthosis nigricans
- hypertension
- family history of type 2DM
- ethnicity
what is acanthosis nigricans ?
- hyper- pigmentation/ thickening of the skin into velvety irregular folds in the neck/ flex areas
- reflex hyperinsulinemia
obesity falls in what percentile?
equal to or greater than the 95th percentile
in regards to the management of type 2 diabetes what is included in the nursing assessment?
- health history
- physical exam
in regards to the management of type 2 diabetes what is included in the therapeutic management?
- glucose monitoring
- insulin replacement therapy
- oral hypoglycaemic medications
- other therapies
in regards to the management of type 2 diabetes what is included in the nursing management?
- regulating glucose control
- monitoring for complications
- educating family
DM type 1 is what?
- autoimmune disorder
- occurs in genetically susceptible individuals
what is type 1 DM characterized by?
- autoimmune destruction of pancreatic beta cells that produce insulin
- results in insulin deficiency
what does insulin support in DM type 1?
metabolism of
- carbohydrates
- fats
- proteins
what is insulin glucose metabolism essential for?
- growth
- activity
- wound healing
- brain function
when is type 2 DM most often diagnosed?
- winter months
what will be noted during the assessment at diagnosis for DM type 1?
- weight loss (as much as 30%)
- polyuria
- thirst
- ketones in urine
- decreased pH
what are presenting symptoms of DM type 1?
- hyperglycemia
- glucosuria
- polyuria
- electrolyte imbalance
- polydipsia
- polyphagia
what does glucosuria mean?
sugar in urine
what does hyperglycaemia mean?
glucose in blood stream
what does polydipsia mean?
attempt to relieve dehydration
what are diagnostic tests used to diagnose DM type 1?
- elevated blood sugars
- urine sample
- glucose tolerance test
what would show up in a glucose tolerance test for someone who has DM type 1?
low insulin levels and high glucose levels
what are short term goals for the management of DM type 1?
prevent:
- ketosis
- electrolyte abnormalities/ volume depletion secondary to osmotic diuresis
- impairment of leukocyte function
- impairment of wound healing
what are some hospital interventions that can be done for the management of DM type 1?
- administration of insulin
- blood glucose levels
- dietary management
- glycosylated hemoglobin
what are some long term goals for the management of DM type 1?
- prevention of microcirculatory/ neuropathic changes
- management of blood glucose
what is the target blood glucose for children under 6 years?
6-12 mmol/ L
what is the target blood glucose for children 6-12 years?
4-10 mmol/L
what is the target blood glucose for children 13-18 years?
4-7 mmol/L
what are some home internventions that can be done for the management of type 1 DM?
- blood glucose levels
- carb counting
- exercise
- illness prevention
- sick days protocol
what are presenting symptoms of DKA?
- polyuria
- polydipsia
- weight loss
- altered LOC
- dehydration
- nausea/ vomiting
- fruity smelling breath
- electrolyte disturbances
- dysrhythmias
- shock
- complete vascular collapse
what are the 3 phases of management for DKA?
- resuscitation
- airways/ fluids - corrections
- acid-base and electrolyte abnormalities
- insulin/ blood glucose levels - transition to daily routine
what is included in the management of DKA in the hospital?
- BGM Q30-60 min
- lab work
- VS & neuro hourly until stable
- ketone urine dips
- strict I&O
- teaching
why do we want to give more sugar when we provide insulin to a patient who has DKA?
so their sugars don’t drop even if they are hight to start with
what are long term things people can do to manage their diabetes?
- management by paediatrician/ endocrinologist
- insulin
- blood sugar monitoring
- diet
- exercise
- screen for retinopathy
what are included in goals of nutritional therapy for diabetics?
- maintain blood glucose in normal range
- balance food intake with insulin and activity
- appropriate calories for normal growth/ development
- preventing/ treating acute long term complications
what is carb counting?
meal planning tool that helps control blood sugar
what are different types healthy carbs?
- whole grains
- legumes
- fruits
- vegetables
hat do healthy carbs provide?
- energy
- nutrients
- vitamins
- minerals
- fiber
describe unhealthy carbs
- food and drinks with added sugar
- provide energy
- have no nutritional value
why is carb counting important?
- help keep blood glucose levels stable
- way to figure out ISF
keeping your blood glucose levels as close to normal as possible can help prevent or delay what?
- prevent kidney disease
- blindness
- nerve damage/ amputations
- heart attacks/ strokes
why do we need to teach kids to eat before they give themselves insulin?
- b/c they are picky eaters and may not eat enough
- want to correct what ever they need/ couldn’t get from what they ate
