Pediatric Gastrointestinal Disorders
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| Unique Characteristics of Digestive System of Children | show 🗑
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| show | Short Bowel Syndrome is a Malabsorptive Disorder, Common causes- NEC Necrotizing enterocolitis (occurs in premies), intestinal obstructions, & Crohn disease
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| Therapeutic mgt of sort bowel syndrome | show 🗑
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| show | short bowel syndrome
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| show | liver failure 6 mo, expensive, may not take bottle when done (use pacifier), intenstine cells atrophy and die; central line
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| ____ is when an infant is born without anus, some more ovious than others, put a ____few cm up rectum to make sure ok. | show 🗑
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| VATER syndrome is associated with imperforated anus, what does VATER stand for? sometimes they add a C. What does the C stand for? | show 🗑
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| show | invertogram (inject dye into anal opening to see level of obstruction), ultrasound (need air so wait 24hrs after birth), cardiac evaluation, spinal films
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| show | Imperforate anus therapeutic mgmnt includes an IV, Possibly a NG tube, pt will be NPO for the anoplasty
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| position pt in post operative imperforate anus | show 🗑
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| show | colostomy
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| show | biliary atresia Inflammation or injury to bile ducts>fibrosis>obstruction occurs>impaired digestion fats> accumulation bile in ducts & gallbladder> progressess intrahepatic ducts> leads to Cirrhosis of the liver
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| In biliary atresia the ducts are ____ which causes impaired digestion of fats and accumulation of bile in ducts and gallbladder | show 🗑
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| show | liver
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| show | False, it is congenital, tetratogenic factors include radiation, drugs, ischemia, and viruses; 15% have associated defects-GI narrowing in the valve of congential heart disease
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| show | biliary atresia
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| With biliary atresia the appearance of skin is greenish bronze as ____ increases | show 🗑
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| stolls became ____ colored and urine ____ within a few weeks after birth of an infant with biliary atresia | show 🗑
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| show | 2-3 months
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| show | Kasai procedure; 10 wks IF not done within the first 10 weeks they will need a hepatic transplant
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| pt with biliary atresia; monitor VS carefully especially ____, look for bleeding tendencies due to liver failure; before surgery you have an active role in diagnosis & treatment | show 🗑
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| show | one and a half more calories
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| show | cleft lip and cleft palate, highest in japanese and lowest in african americans
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| cleft lip and cleft palate are ____ and ___ ? | show 🗑
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| show | cleft lip & cleft palate
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| show | midline
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| show | True
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| show | False it is done early to promote bonding. CL closure at 6 weeks to 4 months of age
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| show | before child develops faulty speech habits and the palate has more tissue after 12 months.
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| Major nursing intervention for parents with a child born with cleft lip and cleft palate is ____ support | show 🗑
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| show | Enlarge nipple, Stimulate such reflex, Swallow fluid appropriately, Rest facial expressions. Mom can possibly breast feed
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| post op care of cleft lip feeding include using what type of instuments to feed | show 🗑
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| post op care of cleft lip positioning / restraints include | show 🗑
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| post op care of cleft lip wound care include | show 🗑
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| show | prone to prevent secretions collecting, observe for respiratory distress (supine for cleft lip) elbow restraints for 4-6 wks. paking is in for 2-3 days (IV fluids given as well)
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| show | tracheoesophageal fistula
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| therapeutic management of T-E fistula includes gastric or blind ____ decompression | show 🗑
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| over ____% of T-E fistula pt get GERD after the pulled smaller esophagus after surgery | show 🗑
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| ____ is a state of inadequate growth from inability to obtain and or use calories required for growth, it is a symptom - not a diagnosis | show 🗑
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| below ___ percentile for age on growth chart is a characterisitc of ____ | show 🗑
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| ____ is a catagory of failure to thrive where there is a problem with a body system that increases the need for calories. What test will you need to do to rule out things? | show 🗑
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| ____ is a catagory of failure to thrive that includes neglect or lack of knowledge | show 🗑
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| nursing intervention for failure to thrive include | show 🗑
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| guidelines to promote a positive feeding interaction for pt with failure to thrive | show 🗑
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| Hypertrophic pyloric stenosis (HPS)develops when | show 🗑
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| show | hypertropic pyloric stenosis (HPS)
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| show | obstruction
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| show | hypertrophic pyloric stenosis (HPS)
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| hypertrophic pyloric stenosis causes gastric ____, constipation, dehydration and metabolic ____ | show 🗑
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| show | barium study
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| show | Na, K, and Cl down and bicarbonate up - due to loss of gastric secretions and dehydration; Increased pH
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| show | fluid and electrolytes
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| show | pyloromyotomy
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| show | 6 hrs, then every 2 hrs, start with clear then 1/2 strength and so on. If vomit go back to previous step prior to vomiting.
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| show | celiac disease
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| Patients with celiac disease must avoid the gluten protein what 4 natural items contain gluten? | show 🗑
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| show | damage or destroy
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| T/F celiac disease is inherited | show 🗑
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| show | stools - frothy & foul odor, growth failure, muscle wasting, distended abdomen, and anemia
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| Late manifestations of celiac disease | show 🗑
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| Diagnosis of celiac disease includes a ____ biopsy | show 🗑
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| Tx for celiac disease | show 🗑
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| T/F manifestations of celiac disease is always present during infancy | show 🗑
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| nursing intervention of celiac disease includes stressing ___ compliactions | show 🗑
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| show | intussusception
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| show | intussusception
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| show | Meckel's Diverticulum
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| show | acute colickly abdominal pain, sausage shaped mass in URQ and normal stool
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| Later assessment of intussesception includes classic ____ stool, abdomen tender and ____ | show 🗑
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| If intussusception is not treated may develope ____ and signs of ____ | show 🗑
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| diagnostic studies of intussusception include: abdominal radiograph and or ____ will show mass, X-ray looking for ____ escaping perforation and ____ enema | show 🗑
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| show | True - 10% do
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| upon examining stools of an intussusception pt, they are narrow and ____ like with ____ mucus | show 🗑
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| show | obstruction
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| ____ congenital abnormality - absence of parasympathetic ganglion cells | show 🗑
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| Hirschsprung's disease affects mostly the ____ colon, stool goes to that area and stops and that area expands | show 🗑
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| show | Infant
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| show | meconium
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| An older child with Hirschsprung's disease will have progressive constipation ___ stools and presence of palpable fecal mass | show 🗑
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| show | rectal biopsy and or anorectal manometer
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| Management of Hirschsprung's includes stabalization then tempoary ____. | show 🗑
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| ___ is a normal problem due to immature sphincter | show 🗑
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| GER is an inappropriate ____ of the lower esophageal spincter | show 🗑
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| show | low & increases with age 90% 18 mo old = correction GERD
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| show | emesis, FTT, anemia, irritability, gagging during feeding, apnea and recurrent pneumonia
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| show | emesis, blood in emesis and stool, heartburn, dysphagia, abdominal and chest pain and chronic nocturnal asthma
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| show | barium swallow, esophageal manometry, esophagoscopy and pH monitoring
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| show | Zantec - don't give an antiacid b/c affects absortion
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| A child with GERD has a three step pharmacological managment starting with Maalox or Mylanta then what | show 🗑
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| ____ is usually not given to children under a year unless they have severe GERD with N/V/D | show 🗑
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| Dietary measures for an infant with GERD | show 🗑
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| An infant who has had surgery to correct GERD doesn't ____ or vomit | show 🗑
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| show | The tube goes through a surgical site and only the physican can put the tube through a surgical site - this is the only time a nurse does not put the NG tube back
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| show | Encopresis
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| show | regression
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| show | 6 months
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| show | contract
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| show | stretch - the larger stool is harder to get out
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| Etiology and risk factors of ___ include toilet training techniques, toileting behaviors, stool patterns, stress, trauma, disturbed parent-child relationship, sexual and physical abuse and temperment | show 🗑
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| show | encopresis minimal distention and Hirshprungs large distention
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| With encopresis the movable fecal masses are palpable due to ____ | show 🗑
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| show | encopresis
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| First therapeutic management of encopresis is | show 🗑
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| Bowel management of encopresis includes ____ enema and giving the child ____ oil 3tsp TID or QID | show 🗑
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| show | increase water soluble vitamins, high roughage diet with increased fluids
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| If both parents are obese then ___% chance child will be obese too. If both parents are normal there is a ____% chance the child will be obese - why | show 🗑
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| show | maintain weight while they grow taller
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| show | are not as effective as for adults
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| Last resort for therapeutic management for obese children | show 🗑
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| show | BMI over 95% - at risk between 85-95%
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| show | (lbs / inches squared) X 703
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| At some point during a child's course of the disorder, intussusception, a stool is described as | show 🗑
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| The nurse notes on assessment that a one-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive associated with what disorder? | show 🗑
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| The nurse is teaching parents of a 5-week-old about a pyloromyotomy (dividing the muscle of the pylorus to open up the gastric outlet), she informs the parents that | show 🗑
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| show | Advance diet from clear liquid to regular formula as tolerated.
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| show | Teach the parents how to do infant cardiopulmonary resuscitation (CPR).
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| show | Apply K-pad to abdomen prn for pain. Need to keep pt NPO, obtain CBC, start IV of D5/.45 normal saline at 60ml/hr
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| Which of the following orders should the nurse question when caring for a child following surgery for Hirschsprung's disease? | show 🗑
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| show | Large amounts fresh formula projected - no blood
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| Which of the following nursing diagnoses has highest priority for the child with irritable bowel syndrome? | show 🗑
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| In NEC Nectorizing Entercolitis why do the intestines become inflamed? | show 🗑
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| show | It has to be removed
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| A risk factor for Short Bowel syndrome: ______ there is a problem in theintestines, intestines that is left there is a decrease for absorption? | show 🗑
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| When preserving the bowel you need at least ___cm of bowel to function? | show 🗑
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| TPN within ___ months can damage liver quickly? U also have ___ problems too. | show 🗑
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| A nursing intervention for short bowel syndrome is administration & monitoring of nutritional therapy. What does this entail? | show 🗑
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| show | TPN is expensive, Children willfeelisolated, & it puts stress on the family
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| show | Don't have extra energy for play, makesure they suck on a pacifier for oral stimulation, if they have not had anything by mouth for 6 months it will be hard for them to have that sucking refles. their cognitive development may be intact
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| In short bowel syndrome if you have less than ___ cm of bowel left, then you need a transplant. You can loose ___ % w/o problem with ___ % you have severe malabsorption? | show 🗑
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| T/F Imperforate Anus Is never a thin membrane over anus or very extensive where whole rectum is occulated. | show 🗑
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| show | It is where there is a thin tissue covering the opening of the anus
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| What is a intermediate imperforate anus? | show 🗑
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| What is a high imperforate anus? | show 🗑
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| T/F In Imperforate Anus there is a slight increase in incidence in males | show 🗑
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| Names some other abnormalities Imperforate Anus is associated with? | show 🗑
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| If a child is born with GI defect look at the ___ & the opposite is true? | show 🗑
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| T/F in imperforate Anus a fistula maybe present from the return to the urethra? | show 🗑
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| show | W/in the first 24hrs
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| show | Yes as a nurse during his initial physical exam you look to see if he has a visible anus possiblymake sure there is an opening with the use of a cath
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| What are the post-op nursing interventions for a low lesion imperforate anus? | show 🗑
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| show | opening has a tendency to close up, teach parent to insert a metal rod in rectum to keep anus open. Done for 4-6 weeks
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| show | 1. IV fluids 2. NG & NPO until peristalsis returns (may take 2-3 days) 3. Colostomy care 4. Family support 5. Final repair/follow up 6. Measure NG tube drainage
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| show | flat bottom
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| show | biliary atresia - see sx after 1 wk old
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| show | False Males & occurs 1 in 1000 births
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| A pt with biliary Atresia will be ____ at birth, have jaudice beyond ___ week and can have ___ hyptertension? | show 🗑
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| In a Kasai procedure for Biliary Atresia can leakage develope? | show 🗑
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| show | Biliary Atresia
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| In Biliary Atresia a nursing intervention is efficient collection of multiple blood samples. What do you need to know as a nurse? | show 🗑
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| show | they need 1.5x the calories. They will have ascities and that will affect their appitite. They are abdominal breathers,they are placed on a formula that is easy for them to absorb.
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| How do you treat pruritus of a biliary atresia pt? | show 🗑
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| What are the positions that a cleft lip can be in? | show 🗑
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| show | Tracheoesophageal (T-E) Fistula
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| show | Drooling, frequent cough, cyanosis, when fed formula returns through mouth & nose
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| What is the classic manifestation of Tracheoesphageal Fistula? | show 🗑
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| show | Diagnosed by passing catheter through esophagus-suspected if you get a catheter more than 10 cm. an ex-ray will be done with the catheter in
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| With a Tracheoesphageal (T-E) Fistula a child may be allowed only ____; the abdomen is often times ___? | show 🗑
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| Gastricor blind pounch depression (to remove excess air in abdomen; Intermittent/continous suctioning; NPO; IV fluids; Transfer to NICU; Surgical repair (thoracotomy) w/ 24hrs of birth unless they have pneumonia; & ELEVATE THE HOB thearaputic mgmnt for__? | show 🗑
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| show | Assist with diagnosis 2. Maintain airway 3. monitor IV fluids 4. manage decompression tube 5. provide support care 6 family support-Child will have problems with GERD later on
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| show | Idiopathic failure to thrive; Observe parents feeding the baby and feed the baby also.
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| Therapeutic management of FTT-treatment is directed at ___ malnutrition and is a multidisciplinary team approach-OT, & ___ are involved | show 🗑
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| What do you need to assess in FTT? | show 🗑
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| T/F leagally you can put a hold on a baby for 24 hrs if you think it is danger. | show 🗑
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| If the pt has FTT how much do they need to eat if they are less than 6 months old and how much if they are more than 6 months old? | show 🗑
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| Having a firm calm schedule that is consistent and non stimulating in environement as well as staying with the clild having consistent care givers and dont force the baby to eat are all guidlines for promoting ____? | show 🗑
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| What are some strategies for promoting a positive parenting? | show 🗑
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| If a child is not thriving what do you whant to check for? | show 🗑
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| show | False it dosent
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| show | Celiac disease
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| ___ IS USED IN INTUSSUSCEPTION-air with or without water-soluble contrast or barium- 75% success | show 🗑
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| T/F In intussusception surgical intervention is needed if reduction is unsuccessful or for perforation? | show 🗑
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| Assist with establishing diagnosis; Monitor for signs of complete obstruction & perforation; & examine stools are nursing interventions for ____? | show 🗑
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| How often should a baby have BMs? | show 🗑
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| show | every 20 mins and chart what they ate due to Juices decrease pH and formula increases pH
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| show | GERD
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| What does ALTE stand for? | show 🗑
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