peds GI M/B 1

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mthompson17
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195784
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peds GI M/B 1
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2013-01-29 09:06:47
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nursing pediatrics GI pathophysiology
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nursing - pediatric GI alterations pathophysiology
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  1. How is the stomach lining protected from stomach acid?

    What happens if this is disturbed?
    stomach lining has a mucous layer that contains bicarbonate that neutralizes acid

    ulcers (erosion)
  2. 9 known factos that can alter mucous-bicarbonate barrierin the stomach and duodenum of children?
    • 1. excessive acid secretion
    • 2. bile salts break down mucous structure of gastric duodenal lining
    • 3. deficiendies in mucosal prostaglandins that augment mucous lining and bicarbonate secretion
    • 4. genetic factors - duodenal ulcers run in families, O type has more ulcerws
    • 5. H. pylori weakening the gastric mucosal barrier
    • 6. physilogic stress/ serious illness
    • 7. meds - NSAIDS, aspirin, indomethacin, alcohol, and tobacco
    • 8. cola, tea, and chocolate may contribute but diet usually doesn't affect it
    • 9. psych is not a factor but can exacerbate condition once it develops
  3. Main cause of duodenal ulcers in children?
    h. pylori
  4. Causes of secondary ulcers in children?
    NSAIDS, physiologic stress critical/acute illness
  5. Manifestation of ulcer disease in children?
    • 1. burning, cramping pain when stomach is empty
    • 2. awakening hs or early am with abd discomfort
    • 3. vomiting (< 6 years old)
    • 4. hematemesis and melena (black face) in infants and young children
  6. How are ulcers diagnosed?
    fiberoptic upper endoscopy, ultrasound to rule out other conditions, occult blood test
  7. What is endoscopy used for?
    visualize the esophagus, stomach, and duodenum and obtain tissue for biopsy
  8. Diet for ulcers?
    regular diet low in caffeine and high in fiber and polyunsaturated oils
  9. Caffeine affect on ulcers?
    stimulant of acid secretion
  10. _____ is the first line of treatment for ulcers.
    medications
  11. Treatment for H. pylori?
    4 to 6 week med combo of proton pump inhibitor, antibiotic, and bismuth salts
  12. _____ is indicated for managemtn of ulcer complications such as hemorrhage, perforation, or obstruction.
    surgery
  13. Why may an NG tube be inserted if a child has an ulcer?
    for active bleeding to remove blood, decompress stomach, and estimate blood loss
  14. Interventions that may be used for bleeding ulcer?
    IV fluids, oxygen, blood replacement, and vasoactive drugs (vasopressin)

    balloon tamponade with a sengstaken - blakemaore tube
  15. How are blood or clots removed with bleeding ulcer?
    room-temp gastric lavage
  16. What is included in the nursing history of a child with an ulcer?
    family history of ulcers, pst episodes of abd pain, recent stress
  17. What is included in assessment of ulcer pain?
    description and nature of pain, location, relationship to meals, defecation, or voiding, nocturnal pain, meds that relieve pain,
  18. If a child has an ulcer bowel sounds should be ausculatated for ____ minutes.
    5
  19. The major focus of nursing interventions in ulcers is ____.
    teaching
  20. What are nursing responsibilities with a child having a fiberoptic endoscopy
    preparing the child for conscious sedation, NPO for at least 6 h prior, maintaining an IV line, monitoring VS during procedure
  21. Why is education important with ulcers?
    most of the care is done at home
  22. Meds that should not be given with an ulcer?
    aspirin and NSAIDS
  23. Foods to avoid with ulcer?
    acidic foods, caffeine, and carbonated beverages
  24. When should the parent contact MD if child has ulcer/
    coffee-ground vomitus, tarry stools, increased pain, diarrhea, vomiting, or unexplained weight loss
  25. Cause of infectious gastroenteritis?
    bacteria, viruses, and parasites
  26. 2 ways to get infectious gastroenteritis?
    ingesting contaminated food & person to person contact
  27. 2 common causes of infectious gastroenteritis?
    giardia & rotavirus
  28. When should infants be vaccinated against rotavirus?
    2, 4, & 6 months
  29. Antacids should not be used withing ____ hour(s) of other antiulcer meds.
    1
  30. Manifestations of gastroenteritis?

    Which are the most common 3?
    most common - diarrhea, vomiting, and abd pain

    tenesmus, fever, dehydration
  31. Who is most at risk for dehydration with gastroenteritis?
    children < 2 years
  32. Pathophysiology of infectious gastroenteritis?
    pathogen adheres to mucosal lining -> inflammatory response activated -> pathogen releases toxins -> excess secretions due to toxins + decreased absorption due to inflammation = excess fluid in the intestine = diarrhea
  33. Diagnostic evaluation of gastroenteritis?
    stool culture (for pathogen), WBC, unprepared sigmoidoscopy (for determining extent of mucosal involvement)
  34. Priority intervention for gastroenteritis?
    replace fluids and maintain pH and electrolytes
  35. What 3 substances are lost in diarrhea?
    K, Na, and bicarbonate
  36. tenesmus
    feeling of constantly needing to pass stools
  37. Nursing history of gastroenteritis?
    length of symjptoms, frquency and consistency of stools, presence of blood or mucus in stools, symptoms in family members, travel, formula and food prep
  38. 4 symptoms of neurotoxins?
    HA, nucal rigidity, irritability, and seizures
  39. What gastric bacteria releases neurotoxins?
    shigella
  40. Indications of dehydration during assessment?
    low urine output, high specific gravity, mucous membranes, skin turgor, no tears, sunken fontanel
  41. Why is metabolic acidosis a major concern with diarrhea?

    Assessment factors?
    lose bicarbonate in diarrhea

    increased RR and effort compensating for acidosis by blowing off CO2
  42. 6 nursing diagnoses for infant or child with gastroenteritis?
    • 1. dehydration
    • 2. risk for infection
    • 3. acute pain
    • 4. deficient knowledge
    • 5. imbalanced nutrition due to malabsorption
    • 6. risk for impaired skin integrity
  43. Priority nursing intervention with gastroenteritis?
    oral/parenteral rehydration with I&O and weights
  44. How does the nurse evaluate the effectiveness of rehydration interventions?
    skin turgor, urine output, and serum electrolyte
  45. Precautions to take with infectious gastroenteritis?
    contact isolation, hygiene, determining if contaminated food is indicated
  46. ORT
    oral rehydration therapy
  47. What foods should be avoided when a child is experiencing vomiting and diarrhea?
    foods high in sugar and fat
  48. ______ assists in reducing diarrhea by restoring normal bowel flora.
    lactobacillus
  49. When may a child with gastroenteritis resume regular diet?
    when fluid imbalance is corrected / after IV fluids are given
  50. When to call MD with gastroenteritis?
    • 1. child is < 6 months old
    • 2. fever
    • 3. diarrhea worsens
    • 4. diarrhea has blood
    • 5. vomiting increases or cannot keep fluid down
    • 6. severe abd pain
    • 7. dehydration
  51. Most common cause of emergency surgery in children and adolescents?
    appendicitis
  52. 4 causes of appendicitis?
    lymphoid swelling r/t viral infection, impacted fecal material, foreign bodies, and parasites
  53. McBurney point?
    midway b/t right anterior superior iliac crest and the umbilicus where appendix is
  54. Manifestations of appendicitis?

    if it perforates?
    abd pain progressing in intensity and localizing to the right lower quadrant, N/V, anorexia, diarrhea or constipation, fever & chills

    pain relieved initially then gets worse along with worsening of other symptoms, rigid abd, and shock symptoms
  55. Diagnosis of appendicitis?
    abd pain localizing at McBurney point, guarding, rebound tenderness, N/V, and fever, WBC, ultrasound or CT,
  56. Pathology of appendicitis?
    obstruction of appendix -> secretions accumulate-> distention occludes caps and engorges walls of appendix -> can have abscesses and fistulas -> perforation due to tissue b/d and swelling -> bowel contents contaminate mesenteric bed and peritoneum -> peritonitis and sepsis
  57. Preop treatment of appendicitis?
    fluid therapy, immobilizatrion, pain control, NPO status, antibiotics, and antipyretics
  58. What postition may a child with appendicitis have?
    supine postition with right leg flexed to decrease tension on abd wall
  59. 2 important indicators of appendicitis in infants and toddlers?
    behavioral changes and refusal to eat
  60. 4 nursing diagnoses for appendicitis?
    • 1. acute pain
    • 2. risk for infection
    • 3. deficient fluid volume
    • 4. anxiety
  61. Considerations for diagnosing appendicitis in young children?
    if pain, anorexia, or N&V, and fever occur together should consider appendicitis

    • if pain comes before N = appendicitis
    • if N before pain = gastroenteritis

    child will not want to play and cannot get comfortable or may flex right leg
  62. Why should heat not be used with appendicitis?
    causes vasodilation and can = perforation
  63. Pre and post op considerations for appendectomy?
    pre op - pain meds, IV fluids, NPO, VS & monitoring for sepsis, comfort measures

    post - op- NPO until bowel functions returns
  64. If a child has a ruptured appendix what should be done?
    NG tube for decompression pre op and draining gastric contents post op, IV antibiotics, may have postop incisional drains, wound may be left open and treated with steril we-to-dry or wet - to -moist dressings & wound irrigation with antibacterial solutions
  65. How is the presence of wound infection, abscess, or fistula evaluated in post op appendectomy?
    assessment of abd pain
  66. After appendectomy monitor VS q ____ h.
    2 - 4
  67. What position should post op appendectomy pt be in?  Why?
    elevate HOB or have child lie on operative side

    facilitates drainage and minimizes spread of infection into the upper abd
  68. Teach parents of appendectomy pt to watch for ___, ____, and ____ as signs of bowel obstruction or peritoneal infection.
    vomiting, abd pain, or distention
  69. Inflammatory bowel disease?
    chronic inflammatory condition of the small or large intestine
  70. 2 distinct conditions that are included in IBD?
    ulcerative colitis and Crohn disease
  71. IBD
    inflammatory bowel disease
  72. Ulcerative colitis affects only the _____ involving the ____ & _____ layers of the intestine.  Chron disease occurs where?
    • colon
    • mucosal and submucosal

    anywhere in the GI tract mouth to anus and involves all layers of the intestine
  73. Cause of IBD?
    unknown
  74. Factors that affect IBD?
    infection, food allergies, vasculitis, increased intestinal permeability, immunologic dysfunction, stress effects on immune response
  75. Appearance of affected areas with Crohn's disease & ulcerative colitis?
    Crohn's - cobblestone appearnace

    ulcerative colitis - mucosa is gone
  76. Does Crohn's disease or ulcerative colitis cause fistulas?
    Crohn's disease
  77. In IBD caused by ____ ______ remissions are uncommon, but IBD caused by _____ ______ will have remissions and exacerbations.
    ulcerative colitis

    crohn's disease
  78. 4 tests used for diagnostic evaluation of Crohn's and ulcerative colitis?
    colonoscopy, rectoscopy, barium enema, biopsy
  79. In colonoscopy of Crohn's diseae and ulcerative colitis what will be seen?
    Crohn's - "skip" lesions with deep fissures and granulomas (collection of macrophages)

    ulcerative colitis - inflammation and superficial ulceration demarcation b/t areas of inflamed and normal colon
  80. Biopsy showing nonspecific chronic inflammation may indicate _____ _____ IBD?
    Crohn's disease
  81. Differences between the manifestations of Crohn's and ulcerative colitis?
    • 1. Crohn's = abd pain
    • 2. diarrhea in ulcerative colitis may have blood
    • 3. Cronhn's has fever
    • 4. Crohn's has abd masses
    • 5. Chron's has anorexia and more weight loss than ass. with ulcerative colitis
    • 6. more growth impairment in Chron's
    • 7. perianal and anal lesions usually not present in UC
    • 8. fistualas and obstructions rare in UC
    • 9. Crohn's has extraintestinal symptoms (arthralgia, arthritis) and UC has risk of toxic megacolon
    • 10. surgery does not cure Crohn's
  82. Meds used to treat IBD?
    antiinflammatory, antibiotic, immunosuppresants, steroids
  83. TPN?
    total parenteral nutrition
  84. _____ ____ ____ my be necessary during flare-ups of Crohn's
    TPN
  85. _____ or ____ promotes healing of the mucosa and can control Crohn's disease in some children as effectively as prednisone.
    NG tube nutrition and gastrostomy
  86. Diet for UC?
    no milk, hypoallergenic, low-fiber, lowfat, low-residue- high-protein diet
  87. Surgery for UC?
    total or partial colectomy with colostomy or ileostomy
  88. Primary finding in history of child with IBD?
    diarrhea
  89. Symptoms of IBD?
    weight loss, dehydration, anorexia, growth failure, vitamin deficiencies, and anemia
  90. How does IBD affect CH growth rate?
    malabsorption and steroid use
  91. Which form of IBD has remissions & exacerbations?
    ulcerative colitis
  92. Which form of IBD has intermittent cramping exacerbated by eaTing?
    Crohn's disease
  93. 2 skin issues with Crohn's disease?
    oral lesions & perianal skin b/d
  94. Psych issues with IBD?
    depression, anxiety, fears about social interactions, and low self-esteem
  95. Nursing diagnoses with IBD? (4)
    • 1. malnutrition/malabsorption
    • 2. low self-esteem
    • 3. disturbed body image
    • 4. anxiety
  96. Focus of nursing interventions for IBD? (3)
    drug interventions, nutrition, and emotional support
  97. Steroids should be given with ____ or ____ to prevent GI distress.
    food or antacids
  98. Supplements for IBD?
    vitamin, Fe, folate,
  99. What must be continually assessed in CH with IBD?

    How are they assessed?
    G&D & nutritional status

    # of stools, nutritional status, weight, developmental milestones, pain
  100. Camp for kids with IBD?
    Camp Oasis
  101. Important education for home care of a child with IBD?
    steroid use, side effects, and not stopping abruptly
  102. When to seek med help with IBD?
    sudden exacerbations of symptoms, weight loss, blood loss, and severe abd pain
  103. Hypertrophic pyloric stenosis?

    When is it common in CH?
    circular area of muscle surrounding the pylorus hypertrophies and obstructs gastric emptying

    infancy
  104. HPS?
    hypertrophic pyloric stenosis
  105. Cause of HPS?
    unknown
  106. Main factor that affects incidence of HPS?
    genetics - parent who has it
  107. Highest risk for HPS?
    white, full term, male infant
  108. Major manifestation of HPS?

    Others?
    projectile, nonbilious vomiting in a previously healthy infant that may be blood -tinged if esophageal irritation occurs

    firm, olive-shaped mass in RUQ, visible peristalsis before vomiting, irritable/hungry right after feeding, dehydration, met. alkalosis
  109. 3 factors for diagnosis of HPS?
    history of vomiting, visible peristalsis, and palpable pyloric mass
  110. If HPS is suspected but mass cannot be felt what is done?
    ultrasound / radiography
  111. Possible lab findings for HPS?
    metabolic alkalossis, decreased serum K & Na, increased bicarbonate, decreased CL, elevated bilirubin level
  112. Patho of HPS?
    pyloric spasms = milk curds propelled against a narrowed pyloric channel -> irritation of mucosal lining -> edema of pyloric mucosa -> reduces size of pyloric canal & creates resistance to flow of milk -> to promote gastric emptying & compensate for resistance pylorus contracts with more force & gradually enlarges -> begins to constrict pyloric channel (when mucosal edema subsides the muscle is still causing resistance) -> cycle is created -> obstruction of pyloric canal
  113. Pyloromyotomy?
    incision of the pyloric muscle to release the obstruction
  114. What is included in nursing history of child with HPS?
    feeding schedule & relation to vomiting,
  115. Assessment exam data for HPS?
    dehydration, K / Na,/ CL depletion, abd distention / tenderness, bowel sounds, presence of pyloric mass, and peristalsis
  116. Nursing diagnoses r/t HPS?
    • 1. dehydration
    • 2. imbalanced nutrition
    • 3. impaired skin integrity r/t surgical incision
    • 4. deficient knowledge
    • 5. acute pain r/t surgery
    • 6. anxiety of parents
  117. Preop interventions with HPS?
    NPO, IV fluids, VS, daily weight, monitoring labs, I&O, oral care (dehydration = increased risk for mucosal b/d), elevated HOB with towels or blankets rolled up to keep position, resp assessment, explain procedure to parents
  118. When will NG tube be removed and feedings be resumed after a pyloromyotomy?
    NG may be removed immediately with feeding starting 4 - 6 h post op if bowel sounds present or may leave NG for 24 hours
  119. How is feeding resumed post op pyloromyotomy?
    start with oral electrolye solution -> 1/2 strength formula that is progressed to full strength in 48 hours - breast milk does not need diluting

    progress to next strength when previous can be taken without vomiting
  120. Postop assessment HPS?
    same as preop except must assess surgical incision
  121. What to report to MD with HPS?
    vomiting, abd tenderness, fever and incisional redness and drainage
  122. _____ is a pediatric emergency in which enfolding of a section of the intestine into the distal bowel causes bowel obstruction.
    intussusception
  123. How does intussusception usually occur in children?
    section of the terminal ileum telescopes in to the ascending colon through the ileocecal valve
  124. Most common cause of intestinal obstruction in children b/t ages 3 months and 6 years?
    intussesception
  125. Cause of intussusception?
    unknown
  126. Contributing factors to intussusception?
    preexisting upper resp tract infection or other viral infection
  127. Most likely cause of intussusception in children > 6 years?
    pathologic condition within the colon - mass or anatomic defect
  128. Who is usually affected by intussusception?
    infants and young children <2 years old
  129. Children with _____ ______ are more at risk for intussusception.
    cystic fibrosis
  130. What is the pain like with intussusception?

    Is there vomiting?
    comes and goes then becomes more constant and severe

    yes
  131. Classic symptoms of intussusception?
    • 1. bloody mucus stool & diarrhea - may not appear until post op period
    • 2. sausage-shaped abd mass
  132. When will symptoms of shock and sepsis be present in intussusception?
    obstruction present longer than 12 to 24 h
  133. When assessing GI pain what aspects are important?
    location, frequency, relationship to meals, nocturnal pain, what releves the pain
  134. In intussusception what may abd radiographs show?

    What is ultrasound used for?
    abnormal gas patterns r/t bowel obstruction of a soft tissue mass

    ID location of intususception and amnt of edema in area
  135. How can a definitive diagnosis & treatment be provided at the same time with intussusception?
    barium enema or air enema exam
  136. How is intussusception treated with if no sepsis/shock?

    If this fails?
    hydrostatic reduction with barium, air, saline enema

    immediate surgery
  137. Typical njursing history of child with intussusception?
    previously healthy infant who suddenly began crying and flexing the legs in severe pain
  138. What should a CH presenting with symptoms of intussusception be asessed for?
    bowel obstruction
  139. S/S of bowel obstruction?
    N/V, abd distention, & hypoactive or hyperactive bowel sounds
  140. What S/S with intussusception are emergency?

    Why?
    fever, increased heart rate, changes in LOC or BP, & resp. distress

    may be sepsis or peritonitis
  141. 3 assessments essential before pt has hydrostatic reduction with intussusception?

    What should be documented?
    hydration, sepsis, shock

    mental status, cap perfusion, urine output
  142. Post hydrostatic reduction care?
    observe stools, S/S bowel obstruction, intermittent NG suction, IV, pain meds, maintenance of resp function, frequent assessment, meet dev needs
  143. Volvulus?
    bowel obstruction that is caused by a malrotation or twisting of the bowel
  144. Cause of Volvulus?
    congenital defect where mid-gut that normally rotates 270 degrees around superior mesenteric artery, fails to rotate and fixes itself to the abd wall
  145. Manifestations of volvulus?
    pain, bilious vomiting, S/S of bowel obstruction
  146. Tx for volvulus?  Why?
    surgery to prevent ischemia
  147. Hirschsprung Disease?
    results from absence of ganglion cells in rectum and to varying degrees upward in the colon

    AKA congenital aganglionosis or megacolon
  148. Major cause of lower bowel obstruction in newborns?
    Hirschsprung
  149. Males: female ration for Hirschsprung?
    4:1
  150. 2 risk factors for Hirschsprugn?
    • 1. hereditary
    • 2. down syndrome present
  151. Cardinal sign of Hirschsprung disease?
    delayed/absence of meconium
  152. Any child who does no pass meconium in first 24 hours or is prone to constipation in first month after birth is suspected of having _____.
    Hirschsprung
  153. Stool of child in first moth of Hirschsprung?
    pellet-like or ribbon-like & foul smelling
  154. Definitive diagnosis of Hirschsprung is made by ___ ____ ____.

    What will the results be?
    suction rectal biopsy

    ganglionic cells will be absent
  155. ARM?
    anal rectal manometry
  156. ARM procedure and pupose?

    Results in Hirschsprug/
    catheter with a balloon is inserted into the rectum to test nerves and sphincter peressure of the anus

    diagnose ultrashort-segment Hirschsprung AKA anal achalasia

    nonrelaxing internal anal sphincter
  157. What area of the colon is affected by Hirschsprung?
    any and all
  158. Tx of Hirschsprung?
    removing aganglionic portion of colon
  159. Medical interventions for Hirschsprung?
    botox injections to decrease internal anal sphincter pressure

    rectal irrigations to remove air and stool
  160. Life-threatening complication of Hirschsprung?

    When should it be suspected?
    enterocolitis

    if a child suspected of having Hirschsprung presents severely ill
  161. Route of temp in Hirschsprung or suspected Hirschsprung?
    not rectal
  162. Pre-op Hirschsprung?
    monitor bowel elimination, isotonic saline enemas or GoLYTELY in NG tube in CH > 5 or NA phosphate, NPO, IV fluids, I&O
  163. NG tube post op Hirschsprung?
    intermittent suction until bowel sounds return
  164. 3 things to tell parents about post op Hirschsprung?
    S/S of obstruction, distention, and infection
  165. What is lactose?
    sugar in dairy products
  166. Lactose intolerance?
    can't digest lactose b/c of absence of lactase
  167. Lactase?
    enzyme secreted by sm intestines that is required for the digestion of lactose
  168. 2 types of lactose intolerance?

    Difference?
    congenital - from birth have no lactase

    developmental - in early - late CH have a deficiency of lactase
  169. What conditions exacerbate lactose intolerance?
    illnesses that affect GI mucosa

    GE, food poisoning, etc
  170. Ethnicities at risk for lactose intolerance?
    asian, American indian, arab, AA, jews, southern europeans
  171. Manifestations of lactose intolerance?
    frothy/not fatty diarrhea, abd distention, cramping abd pain, excessive flatus
  172. When do lactose intolerance symptoms usually appear?
    after age 3 or when other GI probs occur
  173. Clinitest stool test positive for lactose intolerance?
    1+ shows intestinal malabsorption of sugar
  174. Lactose intolerance testing?

    AKA?
    give oral lactose load then measure blood glucose levels and the amount of hydrogen in breath samples

    low = positive

    AKA breath hydrogen test
  175. Tx of lactose intolerance?
    • remove lactose form diet
    • lactase supplements
  176. Pathophysiology of lactose intolerance?
    absence of deficiency of lactase -> can't digest lactose -> accumulation of lactose in lumen of sm intestines -> water is drawn into the colon and GI bacteria b/d lactose and release hydrogen -> hydrogen release =gas & water in colon = diarrhea containing undigested lactose
  177. Assessment findings of child with lactose intolerance?
    healthy, with episodes of abd pain & diarrhea w/out any other probs or nutritional deficiencies
  178. Who is lactose intolerance serious for?
    congenital - infants have more severe symptoms = diarrhea
  179. Principle nursing intervention for child with lactose intolerance?

    How should diet be adjusted?
    teaching

    lactose free for a time then gradually increase to see what is tolerated
  180. Celiac Disease?  (CD)
    lifelong deficiency resulting from inability to digest gluten
  181. What is gluten?
    storage proteins found in wheat, barley, and rye
  182. Cause of CD?
    autoimmune disease that occurs in genetically susceptible pt due to combo of env and genetic factors
  183. 2 genes ass with CD?
    • HLA - DQ2
    • HLA-DQ8
  184. Who is at highest risk for Celiac disease?
    siblings and children of ppl who have it
  185. Manifestations of CD?
    diarrhea, growth failure, abd distention, vomiting, anemia, irritability, anorexia, muscle wasting, edema, folate deficiency
  186. When are symptoms of Celiac diseae usually seen?
    9 - 12 months/3-6 mo after grains are first introduced
  187. Tests for Celiac disease?
    immunoglobulin A (IgA) antitissue transglutaminase antibody tes, IgA antiendomysial antibody test, jejuno biopsy, removing gluten from diet, breath hydrogen test (for carb malabsorption )
  188. Mainstay of celiac treatment?
    diet
  189. What substitues may be used for wheat, rye, barley, and ots with Celiac?
    corn, rice, millet
  190. What vitamins may be needed to correct deficiencies caused by Celiac diet
    folate and fat soluble vitamins
  191. Who is most ar risk for nutritional deficiency with Celiac disease?
    adolescents
  192. manifestations of Celiac crisis?
    profuse, watery diarrhea, & vomiting leading to dehydration, and metabolic acidosis, poor perfusion, edema, changes in VS due to shock or met acidosis
  193. What usually causes Celiac crisis?
    hidden source of gluten or infection
  194. Tx for Celiac?
    IV fluids, albumin for shock, and corticosteroids to decrease severe mucosal inflammation
  195. Assessment results of infant with Celiac?

    Abd assessment?
    irribable, malnourished infant with failure to thrive by 9 - 12 months

    abd distention & ascites with increasing girth
  196. When should Celiac be suspected?
    diarrhea (esp foul smelling), fatty stools, significant growth delays
  197. Priority nursing intervention for child with Celiac?
    teaching about diet
  198. SBS?
    Short bowel syndrome
  199. Short bowel syndrome?
    congenital malfomrations of the GI tract of surgical resection that decreases the length of the sm intestines
  200. Effects of SBS with 50% loss?
    malabsorption/nutrient deficiencies
  201. 3 causes of SBS in newborns?
    • 1. congenital SBS
    • 2. mult GI tract atresias (areas that aren't tubular/open)
    • 3. gastroschisis (abd contents protrude from abd)
  202. Non-congenital causes of SBS?
    surgery to remove part of the sm int for other GI probs
  203. Most common cause of SBS in preterm infants is _____.
    NES - necrotizing enterocolitis
  204. Patho of SBS?
    bowel is short -> decreased mucosal surface area -> inadequate absorption (deficiencies may depend on section of bowel missing b/c diff areas absorb diff things)
  205. Manifestations of SBS?
    watery diarrhea, steatorrhea, bloating, gas, foul smelling stool, poor appetite, vomiting, weight loss or inability to gain weight, fatigue
  206. Complication of SBS?
    protein - caloric malnutrition, dehydration, electrolyte imbalances, gallstones, kidney stones, and high levels of bacteria in the intestines, vitamin & mineral deficiencies
  207. Mainstay o therapy for post op SBS?
    nutrition
  208. Primary source for all nutrients post op SBS?
    TPN qd for 10 - 12 h or longer using a central line
  209. Nursing implications for TPN & enteral feedings postop SBS?
    infection from central catheter, proper NG tube placement, assess/document ability to tolerate enteral feedings, dehydrtion, electrolyte imbalance, and nutritional defecits
  210. Nursing implication for infants receiving TPN or enteral feedings?
    need oral stimulation
  211. Viral hepatits?
    acute or chronic inflammation of the liver caused by several diff viruses, toxins, and disease states
  212. Most common causes of hepatitis?
    hepatitis A, B, C, D, and E viruses
  213. Causes of hepatitis that occur in children?
    rubella, cytomegalovirus (CMV), herpes simplex virus, and Epstein-Barr virus
  214. Hepatitis ___ virus is highly contagious in CH and daycare centers.
    A
  215. Infections with hepatitis ___ can be spread perinatally.
    B
  216. Ways hepatitis may be spread?
    body fluids, contact with objects up to 1 week after its contact with body fluids
  217. Which hepatits viruses are vaccinated against in US?
    A & B
  218. Why is spread of hepatitis common if hand hygiene is not used?
    can be excreted for 2-3 weeks before appearance of symptoms and 2 - 3 weeks after they go away
  219. Manifestations of HAV in infants and preschool children?

    What can this cause?
    asymptomatic or nonspecific symptoms:  anorexia, malaise, and fatigue

    spread of infection before it is identified
  220. Symptoms of HBV?
    asymptomatic to fulminanty hepatitis (can be fatal)
  221. 2 stages of symptomatic acute hepatits?
    • anicteric - no jaundice
    • icteric - jaundiced
  222. Manifestations of the anicteric phase of HBV infection?
    anorexia, N/V, RUQ or epigastric pain, fever, malaise, fatigue, depression , & irritability
  223. How long does the anicteric phase of HBV last?
    5 to 7 days
  224. Manifestations of the icteric phase of HBV?
    jaundice, urticaria, dark urine & light-colored stools, feels better as jaundice appears,
  225. Manifestations of acute fulminating hepatitis?
    bleeding abnormalities, encephalopathy, ascites, adn acute hepatic failure
  226. 2 primary causative organisms in fulminating hepatits?
    HBV & HCV
  227. When should symptoms of hep virus go away?

    What is present if they don't?
    3 MONTHS

    chronic state
  228. Which 3 types of hep can result in chronic hep and cirrhosis?

    Which type can cause hepatic carcinoma?
    HBV, HCV, HDV

    HBV
  229. What factors should cause suspicion of hep infection?
    • 1. exposure to jaundiced ind
    • 2. confirmed outbreaks
    • 3. exposure to body fluids
  230. Blood tests to diagnose hep?
    ID of antigens & genetic material
  231. ___ ___ may be needed for hep infection to evaluate chronic forms and to det. extent of liver damage.
    liver biopsy
  232. _____ ______ increases with the duration of HCV infection.
    liver fibrosis
  233. Tx for uncomplicated viral hepatitis?
    maintaining comfort b/c self-limiting
  234. Tx for fulminant hepatitis?
    intensive care
  235. Important consideration for HAV?
    hygiene to prevent the spread of infection
  236. What should be done if person is exposed to HAV?
    give immunoglobulin (Ig) ASAP
  237. When should immunization for hep be given?
    age 1 year
  238. Most effective means of preventing HBV infection?
    immunization
  239. Ppl who need HBV vaccine?
    IV drug users, health care ppl, ppl in contact with HBV carriers, inmates, travelers
  240. What can prevent HBV infection if given within 2 weeks after exposure?
    hep B immune globulin (HBIG)
  241. How can HDV be prevented?
    preventing HBV with vaccine
  242. Where is jaudice best assessed?
    sclera, nail beds and mucous membranes
  243. _____ _____ is crucial b/c most care of children with hep is done at home.
    parental education
  244. When may a child with HAV return to school?
    1 week after onset of jaundice b/c no longer contagious
  245. Signs of worsening hep infection to teach parents?
    change in LOC, bleeding, and fluid retention
  246. How is HAV spread?
    fecal
  247. How is HBV spread?
    parenteral
  248. Diet for hep infection?
    low-fat
  249. Biliary atreasia?
    obstruction or absence of the extra-hepatic bile ducts
  250. End results of biliary atresia?
    cellular damage liver failure and death
  251. Cause of  biliary atresia?

    When does it develop?
    unknown

    prenatal
  252. Number 1 indication for liver transplants in kids?
    biliary atresia
  253. Manifestations of biliary atresia?
    appears health at birth then develops acholic stools (light color b/c of absence of bile pigment), bile-stained urine, and hepatomagaly (swelling of liver)
  254. Diagnostic testing for biliary atresia?
    liver function tests, PT & PTT, metabolic screening to rule out met probs, hep test, urine and stool samples, urobilinogen levels to det degree of obstruction
  255. What can provide definitive diagnosis of biliary atresia?
    percutaneous liver biopsy that shows bile plugs, edema, and fibrosis in hepatic structure
  256. Tx for biliary atresia?
    drain bile to buy time for liver transplant

    treatment of portal hypertension & ascites and variceal bleeding
  257. Nutritional management in biliary atresia?
    need extra calories, possible TPN, need vitamins
  258. How is portal hypertension treated?
    control bleeding, restrict salt, & use diuretics
  259. 6 majors areas of nursing intervetions for biliary atresia?
    nutrition, skin care, developmental stimulation, continued assessment, education, and emotional support
  260. Nutrition goals and assessments in biliary atresia.
    providing adequate calories, aiding in vitamin supply and absorption, and preventing hepatic encephalopathy

    calorie counting, daily weights, and abd girths
  261. Vitamins needed for biliary atresia?
    A, D, E, K, Ca, phosphate, and zinc
  262. What should be restricted in diet of biliary atresia pt?
    protein
  263. Why is skin b/d a concern in biliary atresia?
    pruritis and scratching
  264. Bile acid binders function in biliary atresia?
    help excrete bile salts and decrease pruritus and development of xanthomas (fat build up under the skin)
  265. 3 things to teach parents to watch for with biliary atresia?
    GI bleeding, severe edema, & ascites b/c = portal hypertension
  266. Tx for portal vein hypertension
    Na restriction, diuretics, IV albumin
  267. When do liver transplants in biliary atresia usually occur?
    before age 2
  268. Cirrhosis?
    chronic, degenerative condition of the liver that results in the development of bands of fiberous tissue, firm nodules, and connections b/t central and portal areas of the liver
  269. Patho of Cirrhosis?
    stasis of bile -> inflammation and hepatomegaly -> liver destruction & attempts to heal itself -> fibrous tissue -> altered hepatic blood flow and decreased liver cell function -> scarring/collapse of hepatic vasculature, incresed vascular resistance, and portal hypertension -> liver cells die more and can't produce proteins or bile -> malabsortion and malnutrition -> more liver cells die and cycle is repeated
  270. Most common causes of cirrhosis?

    Other causes?
    HBV infection, chronic hepatits, or biliary atresia

    sickle cell, metablic errors, copper metabolism dysfunction, cystic fibrosis, and Wilson disease
  271. Manifestations of cirrhosis result from ___ or ____.
    liver cell failure or portal hypertension
  272. Manifestations of cirrhosis?
    jaundice, intense pruritus, steatorrhea, abd distention, edema, anemia, bleeding tendencies, anorexia, frequent infections, poor growth, splenomegaly, esophageal varices, GI bleeding
  273. Tx to halt progression of cirrhosis?
    none
  274. Tx for cirrhosis/
    management S/S & have transplant
  275. Earliest findings of cirrhosis?
    anorexia, N, indigestion, fatigue, and RUQ pain/fullness
  276. What is reveled by palpation with cirrhosis?
    splenomegaly, RUQ tenderness, & hepatomegaly
  277. _____ can revel the extent of bile obstruction and malabsorption in cirrhosis.
    stool specimen
  278. The most critical cirrhosis assessment needs to be centered on detecting signs of 3 major complictions, ____, _____, & _____.
    ascites, varices, and encephalopathy
  279. Emergency symptoms in cirrhosis/
    changes in LOC, increased abd girth, edema, bloody emesis,
  280. 4 areas of care for cirrhosis?
    nutrition, skin care, prevention of complications, support
  281. Diet of child with cirrhosis?
    high carb and calories, normal protein, low fat

    limit protein if encephalopathy develops

    restrict Na

    ADEK supplements
  282. Cause of skin probs in cirrhosis?
    scratching r/t pruritis
  283. Tx for edematous child with cirrhosis?
    diuretics and albumin
  284. 3 ways to prevent bleeding with cirrhosis/
    • 1. injections avoided
    • 2. child protected from injury
    • 3. vitamin K given
  285. Encephalopathy?
    brain damage
  286. Why does liver damage cause encephalopathy?

    3 ways to prevent it?
    excess ammonia in the blood due to incomplete b/d of protein by the liver

    • 1. limit protein
    • 2. lactulose to decrease GI bacteria that produce ammonia
    • 3. admin antibiotics
  287. Why should some drugs be avoided if liver function is impaired?

    What are they?
    affects metabolism of the drugs

    sedatives, opioids, acetaminophen, alcohol
  288. Upper GI system contains ___, ____, and ____ and primary function is ____.
    mouth, esophagus, stomach

    take in food and start digestion
  289. UES?

    Function?
    upper esophageal sphincter

    prevents food/etc from going into the airway
  290. LES?  AKA?

    Function?
    lower esophageal sphincter

    cardiac sphincter

    keeps stomach contents from entering lower esophagus
  291. Lower GI system organs?
    liver, gallbladder, sm & lg intestine, appendix, rectum, and anus
  292. Primary functions of the lower GI tract?
    digest and absorb nutrients, detoxify, and excrete unwated waste, and aid fluid/electrolyte balance
  293. 2 functions of the pancreas?
    • 1. secretes enzymes to digest food
    • 2. secretes glucagon and insulin to control motility and absorption
  294. Where is the liver?
    RUQ
  295.  sources of blood for the liver?
    • 1. hepatic artery -O2 blood
    • 2. hepatic portal vein - de-O2 blood from with absorbed nutrients from the GI tract
  296. 5 functions of the liver?
    • 1. phagocytosis
    • 2. bile production
    • 3. detox
    • 4. glycogen storage and b/d
    • 5. vitamin storage
  297. What is bile used for?
    absorption of fat and excretion of end products of blood cell b/d
  298. Primary function of the gallbladder?
    store bile for secretion into the duodenum when stim by presence of fat
  299. Where does absorption of all nutrients and vitamins occur?
    in the jejunum and ileum of the sm int
  300. Major functions of the large intestine?
    • 1. water reabsorption
    • 2. synth of vit B & K
    • 3. b/d of bile
    • 4. mucus secretion & peristalsis
  301. 6 categories of GI conditions?
    • 1. developmental
    • 2. probs affecting motility
    • 3. inlammatory or infectious
    • 4. obstructive disorders
    • 5. malabsorption conditions
    • 6. hepatic disorders
  302. 3 Gi disorders of prenatal development?
    cleft palate, esophageal atresia with tracheoesophageal fistula, upper GI hernias
  303. Cause of cleft palate?
    environmental and genetic factors:  smoking of mother, family risk
  304. First intervention for cleft lip and palate?
    modifying feeding to allow adequate growth
  305. What may be the first sign of cleft palate?
    milk coming from the nose
  306. When is cleft lip repair usually done?
    by age 3 to 6 months
  307. When is cleft palate repair don?
    based on degree of deformity and size of the child - usually completed between 6 & 24 MONTHS
  308. Concern of cleft palate if not repaired before age 1?
    speech development
  309. Children with cleft palate at risk for developing ___ ____ ___ which can lead to ____.
    chronic ottitis media

    long-term hearing loss
  310. EA & TEF?
    Esophagel atresia and tracheoesophageal fistula

    congenital malformations in which the esophagus terminates before it reaches the stomach and/or a fistula is present that forms an an unnatural connection b/t esophagus and trachea
  311. Nearly half of all infants born with EA have other ass. anomalies of the ____, ____, & ____ systems.
    cardia, GI, and CNS
  312. Manifestations of EA with TEF?
    failure to pass suction catheter, NG tube at birth, excessive oral secretions, coughing, choking, vomiting, abd distention,
  313. manifestation of EA without TEF?
    airless, scaphoid abd
  314. History of maternal ____ can be risk for EA & TEF.
    polyhydramnios
  315. Testing for EA & TEF?
    try to put in NG tube, radiography will show defects, endoscopy/bronchoscopy to assess fistula, testing for ass. congenital anomalies
  316. What type of restraints should be used for babies with cleft repair?

    How long?

    When should they be removed?
    elbow

    6 to 8 days

    q 2 h for 10 to 15 minutes
  317. What position should child with cleft repair be in?
    supine or infant seat
  318. How to clean cleft repair site after feeding?
    rinse with water
  319. Position of infant with EA/TEF?
    supine with HOB elevated
  320. How is the proximal pouch kept clear of secretions with EA/TEF?
    NG tube in place and aspirated q 5 to 10 minutes
  321. Tx for EA/TEF?
    surgery - repair fistula first then anastomosis of atresia to decrease severity of stricture formation
  322. Patho of EA & TEF?
    TEF occurs b/c embryo fails to differentiate foregut into trachea and esophagus & they are fused -> oral intake enters lungs/air enters stomach -> coughing, choking, severe abd distention -> aspiration pneumonia and severe resp distress -> death

    EA -> resp distress due to aspiration of saliva and oral fluids
  323. Priority diagnosis for infant with TEF?
    risk for aspiration
  324. Assessment of infant with TEF/EA?
    excesive secretions, choking, cyanosis, dysphagia, regurgitation, vomiting,
  325. How is resp distress relieved immediately after the birth of a child with EA or TEF?

    Other interventions?
    placed in radiant warmer and admin humidified O2

    IV fluids, NPO, monitoring VS
  326. Any child exhibiting ____ should be suspected of having a TEF.
    three C's - coughing, choking, and cyanosis
  327. Interventions to minimize aspiration risk in EA and TEF?
    • 1. chalasia board = 30 degree angle
    • 2. suction catheter in proximal pouch and mouth
    • 3. constant assessment of resp
  328. Priority interventions if cervical esophagostomy is performed for EA/TEF?
    cover incision with gauze to absorb saliva and keep clean

    is wet and will easily b/d
  329. In immediate postop for anastomosis why is G-tube left open?
    to dran gastric contents and air for comfort and decreases pressure at the anastomosis
  330. How are ostomies cleaned?
    half strength peroxide
  331. Upper GI hernias?
    abnormal protrusion of part of an organ or tissue through the structures that normally contain it
  332. 2 types of hernias
    congenital or aquired
  333. Medical emergency associated with hernias?
    strangulated and blood supply is cut off
  334. Hiatal hernia?
    protrusion of portion of the stomach through the esophageal hiatus of the diaphragm
  335. Congenital Diaphragmatic hernia?
    opening in the diaphragm thru which abd contents herniate into the thoracic cavity during prenatal development
  336. Symptoms of upper GI hernias?
    resp problems, coughing, wheezing, apnea, failure to thrive, vomiting, scaphoid abd, bowel sounds over chest
  337. GER?
    Gastroesophageal reflux - regurgitation of gastric contents ack into the esophagus

    normal phenomenon
  338. Causes of GER?
    • 1. neurologic - affects signal to LES
    • 2. delayed gastric emptying of liquid meal
    • 3. partial or incomplete swallowing dysfunction
    • 4. drugs -theophyllline or caffeiene trigger LES relaxation
  339. When will reflux from developmental causes likely resolve?
    1 to 2 years
  340. Manifesations of GERD in babies?
    vomiting/spitting up after a meal, hiccupping, recurrent otitis media r/t pooled secretions, weight loss, failure to thrive, irritability, discomfort, abd pain, hematemesis, melena, anemia, resp symptoms - coughing, choking, asthma, wheezing, pneumonia, apnea, or bradycardia
  341. What is frequently ass. with GERD?
    resp illness and asthma
  342. 4 Tx for GERD?
    diet, positional changes, meds, and surgery
  343. Early treatment of GERD may prevent or leson complcations such as ___, ____, and _____.
    failure to thrive, esophagitis, and strictures
  344. GERD diet?
    breastfed w/d from milk protein and eggs, thickened feedings with rice cereal,
  345. Foods that lower LES pressure?
    cffeine, carbonation, acidic, spicy, and fatty foods
  346. Position of infants with GERD?
    prone reduces reflux

    to sleep should be supine to prevent SIDS
  347. Posistion of older children with GERD?
    elevate HOB
  348. ___is a complication of long-standing GERD and esophagitis?
    bleeding
  349. How are blood and blood clots eliminated from upper GI with GI bleeds?
    stomach lavage with an NG tube
  350. Patho of gastroesophagel reflux?

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