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N362: Practice of Nursing III > Week 8 Part 2: PEDS GI > Flashcards

Week 8 Part 2: PEDS GI Flashcards

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1
Q

What things are more frequent and faster in pediatric GI systems

A

frequent feedings

frequent bowel movements

faster intestinal motility (peristalsis)

faster rate of dehydration

all due to a higher basal metabolic rate

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2
Q

Since children dehydrate fast, it is important to assess…

A

assess skin turgor

assess fontanels

lack of tearing

dry mucus membrane assessment

thirst level

skin temp

activity level

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3
Q

What is different regarding breast fed and formula fed infants

A

the breast milk is easier to digest so more frequent stools and easier stools occur

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4
Q

S/S of a GI disorder in infants/children

A

vomiting and regurgitation

irritability and fussiness

abdominal pain and distention

FTT

weight loss

stool changes

abdominal pain

fussy with feedings

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5
Q

What are some subjective things to assess regarding Pediatric GI

A
  1. Lifestyle and family factors including family hx
  2. Diet - are they gaining or losing, hx of feeding pattern, allergies, do they spit up
  3. Elimination patterns - I?Os, encorpresis/constipation, stool patterns
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6
Q

What are some objective things to assess regarding pediatric GI

A

observe for abdominal distention, symmetry, bumps, bulges, massess, and the umbilicus

Auscultate hyper and hypo active bowel sounds

percussion - tympany v dullness

palpation - light v deep, rebound tenderness, McBurneys point

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7
Q

Always listen ___ before you feel for GI assessments

A

before

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8
Q

McBurneys Point

A

area third of the distance laterally of a line drawn from the umbilicus to the anterior superior iliac spine

this corresponds to the base of the appendix

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9
Q

Types of Disorders of the GI System

A

Structural Defect

Disorders of Motility

Inflammatory Disorders

Disorders of Malabsorption

Hepatic Disorders

Injuries to the GI System

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10
Q

What are some important structural defects to know for peds GI

A

cleft lip and cleft palate

esophageal atresia and tracheoesophageal fistulas

pyloric stenosis

intussusception

abdominal wall defects

anorectal malformations

umbilical hernia

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11
Q

What is the start of the GI system

A

the oral cavity

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12
Q

Cleft Lip and Cleft Palate

A

Structural congenital anamoly that occurs as a result of failure of soft tissue or bony structures to fuse during weeks 6-12 of gestation

multifactorial causes

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13
Q

Do cleft lip and cleft palate always occur together?

A

they each can appear by themselves or be seen together

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14
Q

Cleft lip can occur ____ or ____

A

unilaterally or bilaterally

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15
Q

What is the msot common craniofacial deformities overall in the US

A

cleft lip and cleft palate

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16
Q

Complications caused by cleft lip and cleft palate

A

Feeding Problems (ability to suck, swallow, breath w/out distress to be checked)

Speech development

Otologic

Dental and orthodontic

Developmental

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17
Q

Why do otologic issues occur with cleft lip and cleft palate

A

because there is more drainage into the ear leading to more frequent ear infections

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18
Q

What needs to be done in the time between being born but before having surgery to correct a cleft lip or palate

A

special feeding techniques that will take more time such as the Haberman feeder or ESSR method

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19
Q

Haberman Feeder

A

special device used for feeding cleft lip and palate babies

It involves holding the infant upright and it stimulates sucking by rupping the nipple to allow the child to get food into the back of the throat withou strong sucking

can even give breast milk instead of formula by first pumping the milk and then putting it inside

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20
Q

ESSR Method

A

method for feeding cleft lip and palate babies

it stands for:
Enlarge nipple (hole)
Stimulate sucking
Swallow
Rest

This allows the baby to not put too much strain and take plenty of time to eat

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21
Q

When feeding the cleft palate or lip baby it is important to allow…

A

for small and frequent feedings that allow time to swallow and burp frequently

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22
Q

When is cleft lip repair surgery usually done

A

usually 1-3 months post birth

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23
Q

Cleft Lip Repair

A

suture line staggered “Z shape” occurs to close the cleft

A logan bar is then put over the child’s mouth along with elbow restraints

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24
Q

Logan Bar

A

a bar that goes over a post op cleft lip babies mouth to reduce tension on the suture line

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25
Q

What is the purpose of elbow restraints following a cleft lip repair

A

it prevents the baby from bending the elbow to pick or pull at the incision

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26
Q

Incision care following a cleft lip repair involves…

A

cleaning sutures with sterile cotton swab and half strength H2O2 followed by saline to prevent crusting

Antibiotic ointment is then applied to suture line

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27
Q

Elbow restraints should be released…

A

every 2 hours`

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28
Q

What is the feeding technique following a cleft lip repair

A

Breck Feeder Technique

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29
Q

Breck Feeder

A

A droplet device that allows for feeding a post-op cleft lip repair infant

Baby must be on their back or side lying to feed

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30
Q

When is a cleft palate usually repaired

A

it is usually repaired IN STAGES between 6 months to 2 years old

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31
Q

What does a cleft palate repair protect against

A

altered dentitions and speech dysfunction

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32
Q

What is a common problem for cleft palate babies

A

frequent otitis media due to an open nasopharynx

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33
Q

For a cleft palate infant to undergo repair, they must be able to…

A

drink from a cup

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34
Q

Cleft Palate Repair Post Op Considerations

A

Post Op: Maintain Airway and O2 Sat MOnitor

No bottles, straws, pacifiers, spoons for 7-10 days

Elbow restraints and mittens

Clear to soft diet

all feedings followed by rinsing the mouth with water to clean the suture line

no brushing teeth 1-2x weeks

pain medication

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35
Q

What things should be avoided following a cleft palate repair to prevent injury

A

bottles
straws
pacifiers
spoons

for at least 7-10 days

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36
Q

What must be done after every post op cleft palate repair feeding

A

rinse mouth with water to clean suture line

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37
Q

Why is red dye avoided following a cleft palate repair

A

because you cannot tell it apart from blood

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38
Q

Esophageal Atresia (EA)

A

structural defect

congenital disruption of the upper and lower portions of the esophagus

basically the esophagus ends in a sac not connected to the stomach

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39
Q

Tracheoesophageal Fistula (TEF)

A

structural defect

abnormal communication b/t the trachea and the esophagus

a fistula or abnormal connection occurs - so like the esophagus could lead into the trachea which then leads abck to stomach or the two are connected lower down or the esophagus just drains into the trachea

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40
Q

Do EA and TEF occur together?

A

Usually they occur together but they can occur alone

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41
Q

EA and TEF are associated with

A

Maternal Polyhydramnios

(Too much fluid)

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42
Q

S/S of EA and TEF

A

In the immediate newborn period:

Respiratory Distress

Difficulty Feeding

Excessive Drooling

Choking, Coughing

Cyanosis

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43
Q

How is EA and TEF diagnosed

A

it is initially notices when the NG tube cannot pass through

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44
Q

Esophageal Atresia (EA) is…

A

a surgical emergency!

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45
Q

What is the treatment for EA and TEF

A

surgical correction

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46
Q

Pre Operative Nursing Care for EA and TEF Surgery

A

Maintain airway

NG Tube to suction - dont want to aspirate

Prevent aspiration by raising HOB and keeping them NPO

IV fluids and TPN

Sometimes a G tube may be placed to drain stomach contents and allow air to escape

May need tracheostomy and care for it

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47
Q

What is the surgical intensity like for EA and TEf surgery

A

it depends - it can be a single repair or staged surgery depending on age, size, length of gap

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48
Q

Post Operative Nursing Care for EA and TEF Surgery

A

Initially NPO

TPN

G Tube Feeding

Feeds start with clear diet (pedialyte) then advance over several days

Family teaching

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49
Q

What are some complications that can occur from EA and TEF surgery

A

tears

strictures

gastric reflux

infection

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50
Q

Pyloric Stenosis

A

structural defect

narrowing of the pyloric part of the stomach

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51
Q

Etiology of Pyloric Stenosis?

A

Unknown - but it is present at birth and often affects FIRST BORN MALES 2-5x more than females

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52
Q

How is pyloric stenosis diagnosed

A

by ultrasound

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53
Q

Where is pyloric stenosis occurring

A

between the stomach and the duodenum

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54
Q

What is causing the pyloric stenosis in physiologic terms

A

hypertrophy of the circular muscles of the pylorus that causes narrowing of the pyloric canal between the stomach and the duodenum

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55
Q

S/S of Pyloric Stenosis

A

Eating/Food leading to irritation, progressive edema, further narrowing, FTT, NV, and poor feeding

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56
Q

What is the hallmark symptom of pyloric stenosis

A

projectile vomitting (forceful, shortly after meals, 2-4 feet)

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57
Q

Things seen on clinical assessment for pyloric stenosis

A

vomiting progresses from mild regurgitation to projectile vomiting

The vomiting is forceful, occurs after meals

constant funger, fussiness, and crying

Decreases in size and number of stools

failure to gain weight or loses weight

dehydration results / lyte imbalance

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58
Q

What is sometimes palpable on abdominal exam of an infant of pyloric stenosis

A

olive shaped mass

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59
Q

What is the treatment for Pyloric Stenosis

A

Pyloromyotomy - surgery

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60
Q

Preop consideration for pyloromyotomy

A

NPO

IV fluids for fluids and electrolyte management

NG tube

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61
Q

Post op considerations for pyloromyotomy

A

maintain IVF, analgesics, d/c NG tube

start feeds - pedialyte, 1.2 strength formula, then full str formula

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62
Q

Gastroschisis and Omphalocele

A

congenital defect of the ventral abdominal wall

it is characterized by herniation of abdominal viscera outside the abdominal wall

intestines outside the belly

63
Q

What is the difference between Gastroschisis and Omphalocele

A

Gastroschisis occurs to the side of the umbilicus and does not have a protective sac covering contents

Omphalocele occurs through the umbilical cord and does have a protective sac covering around its contents

64
Q

What is the cause of Gastroschisis and Omphalocele

A

Multifactoral causes

65
Q

Nursing Management for Gastroschisis and Omphalocele

A
  1. Prevent infection - cover the sac with sterile gauze soaked in NS then sterile plas

Monitor VS closely - temperature!!

NPO, Maintain IVF’s, TPN

Parental Support

66
Q

What is the key to Gastroschisis and Omphalocele nursing treatment

A

PREVENT INFECTION

67
Q

Anal Stenosis

A

Anorectal Malformations

A thickened and constricted anal wall

68
Q

Anal Atresia

A

Imperorate Anus

Failure of an infant to pass meconium and examination reveals absent anal opening

69
Q

What is the key sign of anal stenosis

A

production of ribbon like stools

70
Q

What is the key sign of anal atresia

A

lack of an anal opening and failure to pass meconium

71
Q

What can help test patency of the infant anus

A

taking a rectal temperature

72
Q

Where can stool appear when an infant has anal stenosis or atresia

A

stool in the urine due to a fistula to the perineum

or

stool in the vagina from a fistula

73
Q

Treatment for Low Anorectal Defects (Anal Stenosis and Anal Atresia)

A

Anoplasty and serial digital dilations are effective

74
Q

Treatment for HIgh Anorectal Defects (Anal Stenosis and Anal Atresia)

A

2 Step Procedure:

  1. Temporary Colostomy
  2. Pull through method
75
Q

What is the pull through method for high anorectal defects

A

its pulling the intestines through as the child ages

76
Q

Umbilical Hernia

A

Hernia protrusion of an organ or part of an organ through the muscle wall of the cavity that normally contains it

77
Q

What does an umbilical hernia result from

A

imperfect closure of the umbilical muscle ring

78
Q

What is the etiology of umbilical hernias

A

while it results from imperfect closure of the umbilical muscle ring - the etiology of that is unknown

However, it is often associated with separation of the abdominal muscles

79
Q

Why is umbilical hernia more seen in premies

A

because the muscle walls are weakened

80
Q

Clinical Manifestations of Umbilical Hernia

A

Herniated umbilicus protrudes with coughing, crying, and or straining - increased pressure occurs with these activities

81
Q

How may an umbilical hernia reduce?

A

Hernia can be reduced by pushing contents back into fibrous ring

if it can be pushed back in than its not an emergency

82
Q

Most umbilical hernias…

A

spontaneously resolve by 3-4 years old as the muscular ring closes

83
Q

When is umbilical hernia surgery indicated

A

in cases of strangulation

increased protrusion after 2 years of age

no improvement in large defect after 4 years

84
Q

What are some GI Disorders of Motility

A

Vomiting and Diarrhea

Gastroesophageal Reflux

Constipation and Encopresis

Hirschsprung Disease

Parasitic Disorders

Gastroenteritis

85
Q

What motility disorders are common causes for hospitalizations in infants

A

NV and Gastroenteritis

86
Q

Encopresis

A

abnormal elimination pattern - recurrent soiling or passage of stool at inappropriate times

87
Q

How is diagnosis of encopresis made

A

made on history and physical examination

may need a barium enema to rule out organic causes

88
Q

Treatment of Encopresis involves…

A

behavior modification

dietary changes

clearing out impacted stool

bowel program

89
Q

Nursing Considerations for Encopresis

A

Education for child and parents

reassurance and emotional support

school nurses keeping spare undergarments around and assisting

investigating potential sexual abuse when other causes ruled out

90
Q

Hirschspung’s Disease

A

Absence of ganglion cells in the distal bowel resulting in mechanical obstruction d/t inadequate motility

91
Q

Causes for Hirschspung’s Disease

A

Strong genetic predisposition

Increased incidence in downs syndrome and anomalies of urinary tract

92
Q

What signs in neonates signal potential Hirspung’s Disease

A

no stool in 24 hours

poor feeding

abdominal distention

chronic constipation

93
Q

Diagnostics for Hirschspung’s Disease

A

X Ray

Barium Enema

Rectal Biopsy

94
Q

Treatment for Hirschspung’s Disease

A

constipation –> surgical repair

A temp colostomy followed by anastomose - connecting the intestines as they grow

95
Q

Gastroenteritis

A

inflammation of the stomach and small and large intestines

it is an infection caused by viruses, bacteria, or parasites

96
Q

Gastroenteritis commonly manifests as ___

A

diarrhea

97
Q

Gastroenteritis usually occurs in children under ___ years old, and they get ___ cases/year on average

A

5 yo / 2 cases/year

98
Q

Why do kids get gastroenteritis so commonly

A

because they are bad at washing hands and not putting them in their mouth -ew

99
Q

Gastroenteritis caused by viruses lasts how long? What if it is caused by bacterial causes?

A

viral - 1-2 days

bacteria - a week or more

100
Q

70-80% of diarrhea of acute diarrahea in NA is caused by what

A

viral gastroenteritis

101
Q

Complications of Gastroenteritis

A

diarrhea

dehydration

lyte and acid base disturbance

bacteremia and sepsis

malnutrition

102
Q

Diarrhea

A

watery stool

increased frequency

(Or Both)

caused by dirty hands in kids a lot

103
Q

What is Acute Diarrhea

A

lasting less than 2 weeks

usually r/t bacterial or viral infections

104
Q

Most common childhood reason for Diarrhea

A

Rotavirus (Causes acute diarrhea)

105
Q

What is Chronic Diarrhea

A

lasting longer than 2 weeks

r/t functional disorders like IBS, or diseases like UC or chorhns disease

106
Q

Meds for Diarrhea

A

Flagyl (anaerobic bacteria, parasites, H Pylori)

Immodium (anti diarrheal)

107
Q

It is important to monitor for what with diarrhea

A

electrolyte imbalances

108
Q

What is a very common cause of being absent or for reasons for visits to the school nurse

A

recurrent abdominal pain - challenging

109
Q

Recurrent abdominal pain is a frequent problem among what groups of children

A

young children and adolescents, especially school aged girls

110
Q

Recurrent Abdominal Pain pain is generally where

A

in the periumbilical area

111
Q

Causes of Recurrent Abdominal Pain

A

Examine / check pressures and stressors in life - bullying, trouble with class or teachers

Organic causes - uncommon but must rule out

Abuse or Pregnancy

112
Q

Nursing Treatment for Recurrent Abdominal Pain

A

Supportive and non judgmental care

113
Q

Inflammatory GI Disorders

A

Appendicitis

Meckel’s Diverticulum

114
Q

Appendicitis

A

inflammation of the appendix

115
Q

Appendicitis is most common in what group

A

adolescent males 10-19 years of age

116
Q

What can lead to appendicitis rupture

A

edema continuing to grow, causing vascular supply to be compromised –> bacteria follow by an immune response –> leads to a rupture

117
Q

What is indicative of an appendix rupture

A

decreased pain while still feeling sick - emergency!

118
Q

S/S of Appendicitis

A

pain

loss of appetitie

fever

n/v

abdominal rebound tenderness & rectal tenderness

119
Q

What are positive signs of appendicitis

A

abdominal rebound tenderness

digital rectal exam elicits tenderness

120
Q

What confirms a dx of appendicitis

A

CT or ultrasound

121
Q

Labs to give and their changes with Appendicitis

A

elevated WBC - infection

pregnancy test to rule out ectopic pregnancy - would have raised HcG if pregnant

122
Q

Pre/Post Op Care of Appendicitis

A

NPO, IV Fluids

Correction of fluid/lyte deficits

Surgical Incision

Antibiotics

123
Q

Nursing Dx for Appendicitis

A

Pain

risk for infection

124
Q

Appendices are removed ___

A

laproscopically

125
Q

Meckel’s Diverticulum

A

inflammatory disorders

occurs when the connetion between the intestine and the umbilical cord doesn’t completely close off during fetal development

this results in a small outpouching of the small intestine - a diverticula sticking out in the intestine that is liek a pouch

126
Q

What is one of the most common congenital abnormalities

A

Meckels Diverticulum

127
Q

What can occur to the diverticula of Meckel’s Divericulum

A

they can become infected - diverticulitis - causes obstruction of the intestine or causes bleeding from the intestine

128
Q

Most common symptom of Meckel’s Diverticulitis

A

Painless bleeding from the rectum!!

Stools may contain fresh blood or may look black and tarry

129
Q

Meckel’s Diverticulum is an outpouching of the ___ which remains and contains gastric contents leading to what things

A

ileum; ulceration, bowel obstruction, perforation, peritonitis

130
Q

What is the Rule of 2’s

A

It is for Meckel’s Diverticulum

Under 2 yeras old usually, 2% of the population, occurs within 2 feet of the ileocecal valve, 2 inches in length, and affects 2 types of mucosa

131
Q

What is the most common complication of Meckel’s Diverticulum

A

Bowel Obstruction

132
Q

What is the diagnostic needed for Meckel’s Diverticulum

A

Made on Hx, observed rectal bleeding

133
Q

Tx for Meckel’s Diverticulum

A

Surgical incision resetting the diverticulum

134
Q

Nursing Care for Meckel’s Diverticulum

A

Pre and Postop care similar to other abdominal surgery

135
Q

When does malabsorption occur in children

A

when a child is unable to digest or absorb nutrients in the diet leading to concerns of poor growth and FTT

136
Q

Disorders of Malabsorption include…

A

Short Bowel Disease

Celiac Disease

Lactose Intolerance

Cystic Fibrosis *

137
Q

Pediatric Hepatic Disorders

A

Hyperbilirubinemia of the newborn

Biliary Atresia

Viral hepatitis

Cirrhosis

138
Q

Biliary Atresia

A

Hepatic Disorder

Pathologic closure or absence of hepatic or common bile ducts

139
Q

Biliary Atresia leads to what things

A

Cholestasis, Fibrosis, and Cirrhosis

140
Q

The most common pediatric liver disease is…

A

biliary atresia

141
Q

Biliary Atresia often necessitates what

A

transplantation of the liver

142
Q

Biliary Atresia is the most common cause of infant ___

A

jaundice

143
Q

What gender is more affected by biliary atresia

A

girls > boys

144
Q

Cholestasis

A

gall stones

145
Q

Etiology of BIliary Atresia

A

unknown but blockage of bile flow from the liver the duodenum causes inflammation and fibrotic changes

146
Q

Since there is a lack of bile in biliary atresia what occurs

A

lack of bile acids interferes with FAT SOLUBLE VITAMIN DIGESTION (ADEK) - leading to steatorrhea and nutritional deficits

147
Q

Without treatment for biliary atresia ….

A

it is fatal - FTT will occur, they dont grow well as you cannot get fat soluble vitamins (ADEK)

148
Q

What is a clinical apperance of a child with biliary atresia

A

abdominal distention in biliary atresia

distended vessels

thin arms

overall sickly appearance

149
Q

Clinical Manifestations of Biliary Atresia

A

newborn is initially asymptomatic

Jaundice around 2-3 weeks

abdominal distention

increase in bilirubin levels

splenomegaly

easy bruising, prolonged bleeding time and intense itching

odd colored urine and stools

FTT/Malnutrition

150
Q

What color is the urine and stool in biliary atresia

A

urine - tea colored

stool - clay colored

this is due to impaired bile excretion

151
Q

Why is there easy bruising, prolonged bleeding time, and intense itching in biliary atresia

A

clotting factor manufacturing in the liver is impaired

152
Q

How to dx biliary atresia

A

History, physical examination, and labs

153
Q

Treatment for Biliary Atresia

A

Surgery to correct obstruction

*Liver transplantation

154
Q

Nursing Care for Biliary Atresia Pre and Post Op

A

Teach the family

prep for organ transplant

teach about how it is a chronic problem and the need for lifelong organ anti rejection drugs

N362: Practice of Nursing III (15 decks)

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