X GI: Pediatric (Ms Si, Foundations) Flashcards
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
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)
3
Q
Cleft Lip
A
- Split/Separation of 2 sides of upper lip
- involves base of nose, upper jaw and/or upper gum
4
Q
Cleft Palate
A
- split/opening at roof of mouth
- involves hard (front roof) and/or soft (back roof) palate
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%
6
Q
Cleft Lip/Palate: Dx
A
- prenatal US
- physical exam after birth
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
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
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.
10
Q
Cleft: Feeding Goals
A
- to get adequate nutrition
- prevent aspiration
- Cleft Lip: Bottle and Breast susscessfully
11
Q
Cleft Palate: Feeding
A
- difficult to suck
- problems: gas, choke, milk out nose
- equipment: special nipples/obturator
12
Q
Obturator
A
special took use to seal off cleft (like a retainer) to allow eating/drinking
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
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
15
Q
DEHYDRATION
A
-Deficiency in total fluid intake
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
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.
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
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
Gastroespophageal Reflux (GERD)
- 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
Gastroespophageal Reflux (GERD): Cause
- incompetent LES
| - gastric contents flow backwards into esophagus
27
Gastroespophageal Reflux (GERD): S/S
- V or spitting up
- Aspiration --> respiratory signs
- cough, wheeze, recurrent PNA (older children)
- growth, weight gain abnormalities
28
GERD:MM
- small freq feedings
- thickened w infant cereal
- breast milk manually expelled and thickened w infant cereal. (Don't breasfeed directly)
29
GERD:MM more
- 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
Nissen Fundoplication
- 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
Hypertrophic Pyloric Stenosis
- Gastric outlet obstruction. (blockage in stomach)
- Cause: congenital hypertrophied pyloric muscle
- 1/250 births
- more males
32
Hypertrophic Pyloric Stenosis: Dx test
- US
- Upper GI Series
- 2 tests w reveal thick pyloris. so thick nothing can leave tummy
33
Hypertrophic Pyloric Stenosis: S/S
- Regurgitation --> projectile vomit
- Hunger
- Dehydration
- weight loss
- Palpable Olive shape mass, RT of umbilicus
- visible gastric peristaltic waves
34
Hypertrophic Pyloric Stenosis: Sx
- Fredt-Ramstedt Procedure: cut pyloric sphincter then re-suture
- creates larger lumen
- aka Pyloromyotomy
35
Pyloromyotomy: Pre Op
- NPO
- IV Fluid
- I/O
- Emotional support
36
Pyloromyotomy: Post Op
-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
Intussusception
- telescoping intestines
- cause: unknown
- more common males (3mos - 6yrs)
- common cause of intestinal obstruction in pedes
38
Intussusception S/S
- severe acute abd pain
- fetal position
* **currant jelly stools (mucous/blood) (from irritation rubbing intestine mucous membrane)
- vomit/lethargy
39
Intussusception: Dx
- Clinical presentation
- Barium Enema (diagnose/treat)
- Abd Xray
- DRE, digital rectal exam
- US
- CT Scan
40
Intussusception: Rx
- IV
- NGT (let intestines relax)
* *Barium/Air Enema (forces reverse obstruction)
- Sx: manual reduction and/or resection
41
Hirschsprung's Disease (Megacolon)
- 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
Hirschsprung's Disease (Megacolon): S/S
- fail to pass meconium in 1st 48hrs
- abd distension
- V/O/Constipation
- Poor feeding b/c not feeling well
43
Hirschsprung's Disease (Megacolon): Dx tests
- Abd xray
- Barium Enema
- Colon Biopsy
44
Hirschsprung's Disease (Megacolon): MM
- pull through surgery (2 steps)
1) perform colostomy (stoma)
2) remove affected colon segment
3) normal intestine then pulled down to anus.
45
Hirschsprung's Disease (Megacolon): Nursing Int
-emotional support
-nutrition
-enemas
-abd girth
-colostomy education
baby undergoing this surgery is only days old.
