Week 6 Gi part 2 Flashcards
why do newborns regurgitate?
because the esophogeal spincter is not fully developed until 1 mo
what are the 5 most common causes of pediatric gastroenteritis?
rotavirus, norovirus, e coli, salmonella, C diff
what is considered ‘moderate’ dehydration in peds/infants?
5-10% of body weight lost
if a child weighing 20 kg has lost <5% of their body weight in fluid, how do we rehydrate them?
give them 50ml/kg of body weight of an oral rehydrations solution (pedialyte) over 4 hours. in this case, 1000 mls total, or 250 mls/hr.
most common cause of emergency abdominal surgery in kids
appendicitis
what age range of kids is most likely to have appendicitis?
10-18
how do we assess for appendicitis in kids?
require them to do an activity which irritates the peritoneal area (jumping, climbing), or have child’s hand over mine to palpate
what are 3 interventions for a ruptured appendix?
rehydrate, antibiotics, prep for surgery
what are six interventions for appendicitis post-op?
-manage pain
- IV fluids and antibiotics
- NG to suction
-wound care
- mobilize pt
-psychological support
what are two ways i can protect the site after a cleft lip and palate surgery?
apply petroleum jelly, and elbow immobilizers
is the following a description of acute or chronic cholecystitis?
- a result of gallstones obstucting the cystic duct.
-a complication of cholelithiasis
acute
is the following a description of acute or chronic cholecystitis?
-gallbladder becomes fibrotic and atrophies
what is blumberg’s sign?
rebound tenderness d/t cholecystitis
what are two non-surgical stone managment options for cholecystitis
- extra-corporeal shock wave lithotripsy (ESWL)
- percutaneous transhepatic biliary catheter
Describe the care plan for a post-laparoscopic cholecystectomy patient (6 things)
-Pain management
-DB and C
-Prevent DVT through ambulation
-MOnitor/treat N&V (dance party)
-IV fluids until eating
-Dishcarge same day
what are the differences in post-op care for laparascopic vs. open cholecystectomy?
for open d/c is in 1-2 days post op, we give antibiotics, access the surgical site, and they’ll have a jackson pratt drain
what are the two extremes of pancreatitis
edema (mild) to necrotizing (severe)
is ascites found in acute or chronic pancreatitis?
chronic
are grey-blue flanks and absent bowel sounds found in acute or chronic pancreatitis?
acute
what are the complications of pacreatitis? name 6
jaundice
intermittent hyperglyc
++organ failure
coag defects
shock
paralytic ileus
three non-drug interventions for acute pancreatitis (two monitoring, one positioning)
fetal position, monitor for hypocalcemia, monitor respiratory status
drugs for acute pancreatitis
opioids for pain, ranitidine and PPI, antibiotics if its necrotizing
nutritional interventions for acute pancreatitis
NPO but provide oral care, NG tube w/ suction, jejunal tube feed after NPO and gradually resume food
what is the particular different drug given for chronic pancreatitis as opposed to acute?
pancreatic enzymes
when would we give TPN for pancreatitis?
in chronic (exacerbation)
what should epople with chronic pancreatitis avoid?
high fat food, alcohol
besides excessive ETOH intake, what causes liver cirrhosis?
hepatitis, NAFLD, drugs like acetaminophin, chronic biliary obstuction
what interventino could be appropriate if ascites was affecting ability to breathe?
paracentesis
people with liver cirrhosis should be screened for _________ ________
esophogeal varices
three endoscopic therapies that treat bleeding in liver cirrhosis
ligation of bleeding veins, sclerotherapy (injected into varices), and balloon tamponade or stents
how is sertraline used to treat symtpms of liver cirrhosis?
its an SSRI which tricks brain into not being itchy
two goals of care for viral hepatits
prevent weight loss from compications of disease, and reduce fatigue d/t infection and decreased metabilic energy productino
which drugs should be avoided in GERD and hiatal hernia?
oral contraceptive, anticholinergics, sedatives, NSAIDS, nitrates, Ca channel blockers as they all lower LES prsesure
what will be in situ after a nissen fundoplication?
an NG tube to drain
first sign of esophogeal tumor
dysphagia
what is a non-surgical treatment for esophageal tumor that has a risk of perforation?
dilation
highest priority post-op after removal of esophageal tumor
respiratory care
how is nutrition delivered after esophogeal surgury/
initially through jejunostomy
what is a VERY IMPORTANT thing to consider about the GI system of children/infants.
dehydration
what three reasons are infants at higher risk for dehydration?
they can’t tell us about thirst
they have a high metabolic rate
they have a higher body surface area per body volume
how many wet diapers a day do we want?
6
what is a common nutritional deficiency in children?
vit D
what is Hirschsprung disease?
part of the bowel is not innervated = no peristalsis
what is congenital esophageal atresia?
when the esophagus does not connect to the stomach
what are the early signs of dehydration in a baby?
decreased UO, ++ thirst, slightly dry MM
what four types of issues can a cleft lip/palate cause?
feeding (fluid can go into sinuses)
dentition
speech
cosmetic
what is barret’s esophagus?
when cells are pre-cancerous d/t gerd
if a pt with GERD had wheezing, why would I be concerned?
because they may have aspirated stomaach acid
what would keep me most busy managing a pt with acute pancreatitis?
what could be done to alleviate this?
pain management
patient controlled analgesic
