X GI: Pediatric (Ms Si, Foundations) Flashcards
Cleft Lip/Palette
- 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
Types of Clefts
- 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)
Cleft Lip
- Split/Separation of 2 sides of upper lip
- involves base of nose, upper jaw and/or upper gum
Cleft Palate
- split/opening at roof of mouth
- involves hard (front roof) and/or soft (back roof) palate
Cleft Lip/Palate: Risk factors
- 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%
Cleft Lip/Palate: Dx
- prenatal US
- physical exam after birth
Cleft Lip/Palate: Complications
- 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
Parents of Cleft Children
- 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
Cleft: Surgical Mgmt
-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.
Cleft: Feeding Goals
- to get adequate nutrition
- prevent aspiration
- Cleft Lip: Bottle and Breast susscessfully
Cleft Palate: Feeding
- difficult to suck
- problems: gas, choke, milk out nose
- equipment: special nipples/obturator
Obturator
special took use to seal off cleft (like a retainer) to allow eating/drinking
Cleft: Feeding
- 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
Cleft Palate: Post Op
- position on abdomen
- NO straws, utensils, paci d/t injury. Use cup
- advance diet. Liquid –> puree w/in 48 hours
DEHYDRATION
-Deficiency in total fluid intake
Dehydration S/S
- Skin: cold, dry, grey, loss turgor
- Mucous Mem: dry
- Eyes: sunken
- Fontanelle: sunken
- Behavior: Lethargic
- Pulse: rapid, weak
- B/P: low
- Resp: rapid
Dehydration: MM
- 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.
Dehydration: MM cont’d
- solid foods: non irritating to bowel
- revised BRAT diet. banana, rice, applesauce, cereal, vege juice, crackers, pretzel, toast
- given when diarrhea subsiding
Severe Diarrhea
- may need hospitalization
- IV rehydration
- K+, lose w/diarrhea (can affect heart)
- Rx, underlying cause
Dehydration - NI
- I+O
- Monitor PO, parenteral, wound, or NGT drainage, urine, stools
- in pedes, weigh wet diapers (ml = g, 75g = 75ml)
Wet Diapers weight
Weigh DRY, Weigh WET, subtract DRY from WET, ml=weight in grams
Diarrhea & Gastroenteritis (Stomach Flu)
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
Gastroenteritis
- Inflammation of mucous membrane lining of stomach and intestine
- CAUSE: Virus/bacteria
- Diarrhea –> Dehydration
Gastroenteritis: MM
- 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
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.
Gastroespophageal Reflux (GERD): Cause
- incompetent LES
- gastric contents flow backwards into esophagus
Gastroespophageal Reflux (GERD): S/S
- V or spitting up
- Aspiration –> respiratory signs
- cough, wheeze, recurrent PNA (older children)
- growth, weight gain abnormalities
GERD:MM
- small freq feedings
- thickened w infant cereal
- breast milk manually expelled and thickened w infant cereal. (Don’t breasfeed directly)
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
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)
Hypertrophic Pyloric Stenosis
- Gastric outlet obstruction. (blockage in stomach)
- Cause: congenital hypertrophied pyloric muscle
- 1/250 births
- more males
Hypertrophic Pyloric Stenosis: Dx test
- US
- Upper GI Series
- 2 tests w reveal thick pyloris. so thick nothing can leave tummy
Hypertrophic Pyloric Stenosis: S/S
- Regurgitation –> projectile vomit
- Hunger
- Dehydration
- weight loss
- Palpable Olive shape mass, RT of umbilicus
- visible gastric peristaltic waves
Hypertrophic Pyloric Stenosis: Sx
- Fredt-Ramstedt Procedure: cut pyloric sphincter then re-suture
- creates larger lumen
- aka Pyloromyotomy
Pyloromyotomy: Pre Op
- NPO
- IV Fluid
- I/O
- Emotional support
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
Intussusception
- telescoping intestines
- cause: unknown
- more common males (3mos - 6yrs)
- common cause of intestinal obstruction in pedes
Intussusception S/S
- severe acute abd pain
- fetal position
- **currant jelly stools (mucous/blood) (from irritation rubbing intestine mucous membrane)
- vomit/lethargy
Intussusception: Dx
- Clinical presentation
- Barium Enema (diagnose/treat)
- Abd Xray
- DRE, digital rectal exam
- US
- CT Scan
Intussusception: Rx
- IV
- NGT (let intestines relax)
- *Barium/Air Enema (forces reverse obstruction)
- Sx: manual reduction and/or resection
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
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
Hirschsprung’s Disease (Megacolon): Dx tests
- Abd xray
- Barium Enema
- Colon Biopsy
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.
Hirschsprung’s Disease (Megacolon): Nursing Int
-emotional support
-nutrition
-enemas
-abd girth
-colostomy education
baby undergoing this surgery is only days old.
