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Nursing, LPN, Year 2 > X GI: Pediatric (Ms Si, Foundations) > Flashcards

X GI: Pediatric (Ms Si, Foundations) Flashcards

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1
Q

Cleft Lip/Palette

A
  • Birth defect, in early fetal development (by 7wks gestation, lips/palette already formed)
  • facial/mouth deformity (tissue doesn’t form properly)
  • 1/1,000 births
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2
Q

Types of Clefts

A
  • c lip w/out c palate (BOYS)
  • c palate w/out cleft lip (GIRLS)
  • c lip + c palate together
  • unilateral or bilateral clefting (one, both sides)
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3
Q

Cleft Lip

A
  • Split/Separation of 2 sides of upper lip

- involves base of nose, upper jaw and/or upper gum

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4
Q

Cleft Palate

A
  • split/opening at roof of mouth

- involves hard (front roof) and/or soft (back roof) palate

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5
Q

Cleft Lip/Palate: Risk factors

A
  • Genetics play a role
  • Envt Factors: meds (anti seiz), maternal (smoking,etoh), infection, deficiency of folic acid
  • if normal parents have child w cleft, risk of 2nd child having cleft is 3-5%
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6
Q

Cleft Lip/Palate: Dx

A
  • prenatal US

- physical exam after birth

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7
Q

Cleft Lip/Palate: Complications

A
  • feeding difficulties (sucking, gaging, choking –> aspiration)
  • frequent otitis media (ear infec) + hearing loss (r/t improper drainage of middle ear. Eustacian Tube drains to pharynx)
  • Speech impairment (speech delay/articulation)
  • Dental problems
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8
Q

Parents of Cleft Children

A
  • need emotional support
  • promote bonding + attachment (emphasize positives about the child, appearance and behavior)
  • can be surgically repaired w reconstructive Sx. Show parents b4 and after shots
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9
Q

Cleft: Surgical Mgmt

A

-Cleft Lip: 1-3 months
weight gain, no infection, child needs to be healthy weigh with no infections before Sx.

-Cleft Palate: 12-18mos
wait longer because child is stronger and speech is beginning to start.

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10
Q

Cleft: Feeding Goals

A
  • to get adequate nutrition
  • prevent aspiration
  • Cleft Lip: Bottle and Breast susscessfully
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11
Q

Cleft Palate: Feeding

A
  • difficult to suck
  • problems: gas, choke, milk out nose
  • equipment: special nipples/obturator
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12
Q

Obturator

A

special took use to seal off cleft (like a retainer) to allow eating/drinking

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13
Q

Cleft: Feeding

A
  • feed almost sitting. never lying down
  • direct flow to side or back of mouth
  • Burp frequently (ever 15-30ml)
  • Cleaning mouth after feeds w water/towel
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14
Q

Cleft Palate: Post Op

A
  • position on abdomen
  • NO straws, utensils, paci d/t injury. Use cup
  • advance diet. Liquid –> puree w/in 48 hours
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15
Q

DEHYDRATION

A

-Deficiency in total fluid intake

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16
Q

Dehydration S/S

A
  • Skin: cold, dry, grey, loss turgor
  • Mucous Mem: dry
  • Eyes: sunken
  • Fontanelle: sunken
  • Behavior: Lethargic
  • Pulse: rapid, weak
  • B/P: low
  • Resp: rapid
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17
Q

Dehydration: MM

A
  • oral rehydration over 4-6hrs after ONSET of diarrhea to replace lost fluid
  • Fluid: Pedialyte/Infalyte
  • Older child: clear liquids
  • LO # and content of stools
  • hydrate until on advanced diet.
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18
Q

Dehydration: MM cont’d

A
  • solid foods: non irritating to bowel
  • revised BRAT diet. banana, rice, applesauce, cereal, vege juice, crackers, pretzel, toast
  • given when diarrhea subsiding
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19
Q

Severe Diarrhea

A
  • may need hospitalization
  • IV rehydration
  • K+, lose w/diarrhea (can affect heart)
  • Rx, underlying cause
20
Q

Dehydration - NI

A
  • I+O
  • Monitor PO, parenteral, wound, or NGT drainage, urine, stools
  • in pedes, weigh wet diapers (ml = g, 75g = 75ml)
21
Q

Wet Diapers weight

A

Weigh DRY, Weigh WET, subtract DRY from WET, ml=weight in grams

22
Q

Diarrhea & Gastroenteritis (Stomach Flu)

A

Disturbance of intestinal motility. Gastroenteritis is when D caused by inflammatory process like infection.

  • UP frequency, fluid content, volume
  • Types: Acute/Chronic
  • Infectious/Non Infectious
23
Q

Gastroenteritis

A
  • Inflammation of mucous membrane lining of stomach and intestine
  • CAUSE: Virus/bacteria
  • Diarrhea –> Dehydration
24
Q

Gastroenteritis: MM

A
  • oral rehydration (immed after onset of loose stool)
  • test stool: culture, c diff., O+P
  • liquid (first 24) –> reg diet –> modified BRAT when # and content of stool DECREASES
  • monitor I+O
25
Q

Gastroespophageal Reflux (GERD)

A
  • effortless regurgitation of gastric contents into esophagus
  • begins 1wk after birth. Most common cause of vomiting in infants. Seen immediately after feeding or if baby lays down.
26
Q

Gastroespophageal Reflux (GERD): Cause

A
  • incompetent LES

- gastric contents flow backwards into esophagus

27
Q

Gastroespophageal Reflux (GERD): S/S

A
  • V or spitting up
  • Aspiration –> respiratory signs
  • cough, wheeze, recurrent PNA (older children)
  • growth, weight gain abnormalities
28
Q

GERD:MM

A
  • small freq feedings
  • thickened w infant cereal
  • breast milk manually expelled and thickened w infant cereal. (Don’t breasfeed directly)
29
Q

GERD:MM more

A
  • Prone position. Head up 30*. (prevent aspiration)
  • MEDS: H2 Antagonist (pepsid, zantac, tagamat, LO acid in stomach)
  • MEDS: Reglan, Anti Emetic, N. Speeds up gastric emptying.
  • Sx: Nissen Fundoplication
30
Q

Nissen Fundoplication

A
  • Fundus of stomach wrapped around back of esophagus

- create 1-way valve in esophagus allowing food to pass into stomach. (squeezing it tight, not really a valve)

31
Q

Hypertrophic Pyloric Stenosis

A
  • Gastric outlet obstruction. (blockage in stomach)
  • Cause: congenital hypertrophied pyloric muscle
  • 1/250 births
  • more males
32
Q

Hypertrophic Pyloric Stenosis: Dx test

A
  • US
  • Upper GI Series
  • 2 tests w reveal thick pyloris. so thick nothing can leave tummy
33
Q

Hypertrophic Pyloric Stenosis: S/S

A
  • Regurgitation –> projectile vomit
  • Hunger
  • Dehydration
  • weight loss
  • Palpable Olive shape mass, RT of umbilicus
  • visible gastric peristaltic waves
34
Q

Hypertrophic Pyloric Stenosis: Sx

A
  • Fredt-Ramstedt Procedure: cut pyloric sphincter then re-suture
  • creates larger lumen
  • aka Pyloromyotomy
35
Q

Pyloromyotomy: Pre Op

A
  • NPO
  • IV Fluid
  • I/O
  • Emotional support
36
Q

Pyloromyotomy: Post Op

A

-I/O
-Start oral feeds: 4-6hrs post op
?-full feed start after 24hrs (1st feed, Glucose H2O –> after 24hr advanced diet (formula/mik)?
-emotional support

37
Q

Intussusception

A
  • telescoping intestines
  • cause: unknown
  • more common males (3mos - 6yrs)
  • common cause of intestinal obstruction in pedes
38
Q

Intussusception S/S

A
  • severe acute abd pain
  • fetal position
  • **currant jelly stools (mucous/blood) (from irritation rubbing intestine mucous membrane)
  • vomit/lethargy
39
Q

Intussusception: Dx

A
  • Clinical presentation
  • Barium Enema (diagnose/treat)
  • Abd Xray
  • DRE, digital rectal exam
  • US
  • CT Scan
40
Q

Intussusception: Rx

A
  • IV
  • NGT (let intestines relax)
  • *Barium/Air Enema (forces reverse obstruction)
  • Sx: manual reduction and/or resection
41
Q

Hirschsprung’s Disease (Megacolon)

A
  • congenital defect (born w it)
  • Cause: Absence of parasympathetic nerve in portion of colon
  • Intestinal obstruction
  • Affects LI
  • peristalsis stops at spots w missing nerve cells. blockage forms
42
Q

Hirschsprung’s Disease (Megacolon): S/S

A
  • fail to pass meconium in 1st 48hrs
  • abd distension
  • V/O/Constipation
  • Poor feeding b/c not feeling well
43
Q

Hirschsprung’s Disease (Megacolon): Dx tests

A
  • Abd xray
  • Barium Enema
  • Colon Biopsy
44
Q

Hirschsprung’s Disease (Megacolon): MM

A
  • pull through surgery (2 steps)
    1) perform colostomy (stoma)
    2) remove affected colon segment
    3) normal intestine then pulled down to anus.
45
Q

Hirschsprung’s Disease (Megacolon): Nursing Int

A

-emotional support
-nutrition
-enemas
-abd girth
-colostomy education
baby undergoing this surgery is only days old.

Nursing, LPN, Year 2 (27 decks)

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