Gastrointestinal defects peds

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Gastrointestinal defects peds
2010-11-05 09:55:22
Gastrointestinal defects peds

Gastrointestinal defects peds
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  1. What is the GI system defect in peds?
    Immature GI system
  2. What is the Stomach defect in peds?
    Small stomach capcity
  3. What is the intestinal defect in peds?
    Increased peristalsis
  4. What is the digestive enzyme in peds?
    Deficient digenstive enzymes
  5. Most common congenital gastrointestinal defect in peds
    Cleft lip/palate
  6. Hard and soft palate develop by what week?
  7. Can clients have both cleft lip and palate at the same time or one instead of the other?
  8. Combination of enviromnment and gentics are multifactoral causes of
    cleft lip/palate
  9. tobacco is one of the multifactoral causes of
    Cleft lip/palate
  10. Parental age is one of the multifactoral causes of
    cleft lip/palate
  11. Anticonvulsants are are one of the multifactoral causes of
    Cleft lip/palate
  12. Steriods are one of the multifactoral causes of
    Cleft lip/palate
  13. Infections are one of the multifactoral causes of
    Cleft lip/palate
  14. When is the cleft lip/palate detected by the ultra sound?
    12-16 weeks
  15. Primary management before surgery of cleft lip/palate
    Airway management
  16. What airway managment is important prior to surgery for cleft lip/palate
  17. What is the greatest challange in management of a client with cleft lip/palate?
  18. Can a client with cleft lip/palate breast feed?
    Yes, the breast fills the deficit
  19. ESSR feeding technique...what is it, and when is it used?
    • E- Enlarged nipple
    • S- Stimulate succk reflex
    • S- Swallow appropriately
    • R- Rest periods
  20. What position should cleft lip/palate clients feed?
  21. What frequent problems do cleft lip/palate clients suffer from during eating?
    • Excess air
    • GI distress
  22. When feeding a cleft lip/palate children, what helps in feeding?
    • Upright position
    • Frequent burping
    • Special nipples/bottles
  23. What parenting issues are there with cleft lip/palate
    Altered parenting - may need emotional support and bonding
  24. Altered speech development common in what congenital gastrointestinal defect?
    Cleft lip/palate
  25. Otologic issues with cleft lip/palate
    inatequate draining > OM> tx ear infection > audiology screening
  26. Dental problems with cleft palate/lip
    • Frequent carries
    • Misplaced/missing teeth
  27. Developmental problems often seen with cleft lip/palate
    Screeen for learning disabilities
  28. Cheiloplasty
    Repair of cleft lip
  29. Alternatives to manage pain after cheiloplasty
    • Provide distractions
    • TLC
  30. When should you feed after cheiloplasty
  31. How to protect the site after cheiloplasty
    • Logan bar
    • Elbow restraints
    • Suture Line
  32. Cleaning suture line after cheiloplasty
    With normal saline
  33. What position to keep a client in after cheloplasty
    Side, supine or upright
  34. Palatoplasty is what?
    Repair of cleft palate
  35. Age for palatoplasty
    6-8 months
  36. #1 nursing intervention for palatoplasty
  37. Avoid what in the mouth after palatoplasty
    Hard objects
  38. What is really important after palatoplasty
  39. May need several surgeries for what?
  40. Small lower jaw is called
  41. Micrograthia seen in
    Pierre Robin Sequence
  42. Receding chin seen in
    Pierre Robin Sequence
  43. Glossoptosis is seen in
    Pierre Robin Sequence
  44. Respiratory distress seen in
    Pierre Robin Sequence
  45. Surgery in Pierre Robin sequence repairs what?
    Cleft palate
  46. Distraction osteogenesis/Mandible distraction is used to do what, in what sequence?
    Pierre Robin sequence, enlarges jaw
  47. During an osteotomy for Pierre Robin Sequence, during an osteotomy, what is done?
    Distraction devvice placed under skin and across osteotomy
  48. 2 ends of the bones are gradually pulled causing bone to form...performed in
    Surgery for pierre robin sequence
  49. How long for osteotomy to heal?
    6-8 wks
  50. Device for pierre robin sequence surgery removed when?
    After osteotomy healed 6-8 weeks
  51. Esophageal Atresia and Tracheoesophageal Fistula usually occur when?
    Same time
  52. Incompentent formation of esophagus terminates before reaching stomach
    Esophageal Atresia
  53. Ends in blind pouch connected to trachea by a fistula
    Tracheoesophageal Fistula
  54. May be associated with plyhydramnios
    Esophageal atresia and Tracheoesophageal Fistula
  55. Chocking is a sign of
    Esophageal Atresia & Tracheoesophageal Fistula
  56. Cyanosis is a sign of
    Esophageal Atresia & Tracheoesophageal Fistula
  57. Coughing is a sign off
    Esophageal Atresia & Tracheoesophageal Fistula
  58. Frothhy sputum is a sign of
    Esophageal Atresia & Tracheoesophageal Fistula
  59. Drooling is a sign of
    Esophageal Atresia & Tracheoesophageal Fistula
  60. Classic signs of Esophageal Atresia & Tracheoesophageal Fistula
    • chocking
    • cyanosis
    • Coughing
    • Forthy sputum
    • Drooling
  61. How to dx Esophageal Atresia & Tracheoesophageal Fistula
    N/G tube willnot descend. Confirmed with xray and echo
  62. Associated anamolies of Esophageal Atresia & Tracheoesophageal Fistula
  63. V of VACTERL of Esophageal Atresia & Tracheoesophageal Fistula
    V- Vertebral Defect
  64. A of VACTERL of Esophageal Atresia & Tracheoesophageal Fistula
    A- Anorectal malformation
  65. C of VACTERL of Esophageal Atresia & Tracheoesophageal Fistula
    C - Cardiac defets (heart murmor)
  66. T of VACTERL of Esophageal Atresia & Tracheoesophageal Fistula
    T - Tracheoesophageal fistule
  67. E of VACTERL of Esophageal Atresia & Tracheoesophageal Fistula
    E -Esophageal atresia
  68. R of VACTERL of Esophageal Atresia & Tracheoesophageal Fistula
    R- Renal anomalies
  69. L of VACTERL of Esophageal Atresia & Tracheoesophageal Fistula
    L - Limb defects
  70. Primary goal in the treatment of Esophageal Atresia and Tracheosophageal Fistula
    Prevent aspiration
  71. When should surgery be performed for treatment of Esophageal Atresia and Tracheoesophageal Fistula?
    Within a few days
  72. Treatment of Tracheoesophageal fistula - surgery
    1 stage reapir recommended. Connect both ends of esophagus and close fistula
  73. How to hyrate during Atresia and Tracheoesophageal Fistula?
    Umbilical vein
  74. How to feed during Atresia and Tracheoesophageal Fistula?
    TPN via umb artery
  75. Position during Atresia and Tracheoesophageal Fistula?
    Elevate HOB
  76. Gastrostomy drainage is an intervention during?
    Atresia and Tracheoesophageal Fistula
  77. Antibiotics used as an intervention for?
    Atresia and Tracheoesophageal Fistula
  78. Increased eosinophils infiltrate esophagus
    Eosinophilic esophagitis
  79. Stomach pain, "Food sticks on the way down"
    Eosinophilic esophagitis
  80. Vomiting is a sign of
    Eosinophilic esophagitis
  81. How to confirm Eosinophilic esophagitis
    Esophageal biopsy
  82. Eliminate the 6 most common food alltergies durin Eosinophilic esophagitis. What are they?
    • Milk
    • Soy
    • Wheat
    • Eggs
    • Peanuts
    • Seafood
  83. Medication in Eosinophilic esophagitis
  84. Surgery in stages for tx of Esophagealo Atressia and Tracheosophageal Fistula
    Closing of fistula and inserting of G tube for feeding, then later, anastomosis of 2 ends of esophagus
  85. Oral feeding can begin how long after surgery for Esophageal Atresia & Tracheophageal Fistula
    8-10 days post op
  86. What is pyloric Stenosis
    Hypertrophy of pyloric sphincter
  87. Projectile, non bilious vomiting seen in
    Pyloric stenosis
  88. Visible peristalsis is seen in what disorder?
    Pyloric stenosis
  89. Olive sized mass is common in upper right quadrant
    pyloric stenosis
  90. Small stools common in
    pyloric stensosis
  91. infant hungry and unable to gain weight
    pyloric stenosis
  92. How ling before the projectile, non bilious vomiting starts with pyloric stenosis?
    3-5 weeks after birth.
  93. How to diagnose a pyloric stenosis
    • U/S; UGI
    • Watch for dehydration and anemia
  94. Tx for pyloric stenosis
  95. Discharge after pyloromyotomy (tx for pyloric stenosis)
    After 2 feedings w/o emesis
  96. Home care instructions with pyloric stenosis tx (after pyloromyotomy)
    • Small frequent meals
    • Frequent burping
    • Monitor for projectile vomiting
  97. A frequent cause of bowel obstruction
  98. An abrupt onselt of bowel obstruction in a previoulsy healty child
  99. Pain associated with bowel obstruction, seen in what disorder?
  100. Jelly stools
  101. Proximal end of bowel telescopes into distal end.
  102. A long cylinder mass found in upper R or mid abdomen
  103. Intussusception is a long cylinder mass seen where?
    Upper R quadrant and mid abdomen
  104. If a client with intussuseption now has passage of normal stool, what shoud you do?
    Contact surgeon, as they may cancel surgery
  105. Insufflation is what, and used to treat what?
    • Inflation of a body cavity
    • Tx of intussusception
  106. Treatments of intussusception
    • Surgery
    • Insufflation
    • N/G tube
  107. Passage of normal brown stool indicates what in intussusception?
    Self correction!
  108. Gastrochisis is what?
    An abdominal wall defect in which the umbilical cord is intact, and small intestines and ascending colon are found outside the abdomen. There is no membrane. It is rare, and is found with other anomalies.
  109. Omphalocele is what?
    Abdominal contect connects through umbilical cord, and abdominal organs, with a membrane covering. Other anomalies are seen with THIS abdominal wall defect, with POSSIBLE mental retardation.
  110. How do you protec tthe sac and exposed contents of gastrochisis or omphalocele?
    With sterile warm saline soaked dressings.
  111. Thermoregulation is a treatment of
    Abdominal wall defects (Gastrochisis/Omphalocele)
  112. Replace fluids is important int treating what?
    Abdominal wall defects (Gastrochisis/Omphalocele)
  113. Blood cultures/antibiotics treatments for
    Abdominal wall defects (Gastrochisis/Omphalocele)
  114. O/G or N/G to prevent distention used in what disorder?
    Abdominal wall defects (Gastrochisis/Omphalocele)
  115. Prosthetic silo, then surgical closure is treatment for what condition?
    Abdominal wall defects (Gastrochisis/Omphalocele)
  116. Gor gradual return of contects in abdominal wall defects (Gastrochisis/Omphalocele), how long?
    5-10 days then surgery to close.
  117. How long for normal bowel function to return after tx for abdominal wall defects (Gastrochisis/Omphalocele)?
    Several weeks
  118. Parenteral nutrition in important in abdominal wall defects (Gastrochisis/Omphalocele). Must watch specifically for what?
    Strict I/O's
  119. Ribbon-like stools
    Anal stenosis-constricted anal wall
  120. 70% of the time it has associated anamolies
    Anal stenosis-constricted anal wall.
  121. Constricted anal wall seen in what anorectal malformation?
    Anal Atresia
  122. Absent anal opening and failure to pass meconium
    Anal Atresia
  123. Stool in urine is caused by?
    Fistula between colon and urinay tract, seen in anal atresia
  124. No baby sent home if...
    No voiding or stool
  125. A "Low" defect-rectal pouch descends below...
    sphincter muscle defect
  126. Which is easier to correct, a low or high defect-rectal pouch?
  127. Low defect-rectal pouch may appear as
  128. Translucent membrane to a deep dimple and strong muscular contractions when pricked with a pin
    "Low" defect-rectal pouch
  129. Flat perineum, no anal dimple, o muscle contraction when pricked ith a pin
    High defect
  130. Low defect surgery
    creates an opneing then dilation to prevent stenosis
  131. High defect surgery
    • 2 stages
    • 1.) Temporary colostomy
    • 2.) Closure of colostomy and pull through procedure - blind pouch of rectum anastamosed to anus
  132. What is a cloacal malformation?
    Rectum, vagina and urethra into a common channel
  133. Opens onto perineum or GU system via usual urethra site
    Cloacal malformation
  134. Tx for Cloacal malformation
  135. Umbilical hernia
    Improper closure of umbilical muscle ring- usually closes as muscle streathens
  136. Congenital diaphramatic hernia
    Herniation of abdominal contents through defect in diaphragm into chest chest cavity usually on left side.
  137. Life threatenting!
    Congenital diaphramatic hernia
  138. Can cause severe respiratory distress
    Congenital diaphramatic hernia
  139. May hear bowel sounds over chest
    Congenital diaphramatic hernia
  140. Barrel chest, sunken abdomen
    Congenital diaphramatic hernia
  141. High mortality rate
    Congenital diaphramatic hernia
  142. Surgery for congenital diphramatic hernia
    Repositioning abdominal contents
  143. Heart sounds are shifted to the right side
    Congenital diaphramatic hernia
  144. Poor weight gain
  145. FTT
  146. Neurobehavioral changes
  147. Respiratory symptoms
  148. Cyanotic episodes
  149. Hematemesis
  150. Esophagitis
  151. Apnea
  152. Complications of aspiration and pneumonia
  153. How to DX DERD
    • Hx of feeding pattern
    • UGI
    • PH Probe monitoring
  154. Feeding treatment of GERD
    Thickened formula, frequent burps, small frequent feedings, upright may change to hypoallergic formula
  155. Meds to TX GERD
    • Histamine H2 receptor blocker
    • Znatac,
    • Pepcid
    • Proton pump inhibitor
    • Prevacid
    • Prilosec
    • Gaviscon
  156. Constipation can be caused by
    • Due to diet
    • Underlying disease
    • Meds
    • Psych issues
  157. Treatment of constipation
    • Cleansing bowel - enemas, suppositories,and meds
    • Establishing a routine
    • Diet modifications: Fiber, water, aplle/pear juice
  158. What to avoid to prevent constipation
    Rice, cheese, banana
  159. Encopresis
    -Stool retention or constipation which leeds to loose stools that expel around hard stool
  160. Abnormal bowel elimination by child who should have already acheived bowel continence
  161. Voluntary or unvoluntary stool
  162. BMs irregular and painful
  163. Stress can cause
  164. Tx for encopresis
    • Behavioral mods, diet, psychotherpay, laxatives, stool softenener.
    • R/O underlying disease
  165. What is Hirschsprung/Aganglionic Megacolon?
    Congenital absenese of parasympathetic ganglion cells in rectum and colon > prevents peristalsis > obstruction > trapped stool "megacolon" > abdonimal distention
  166. Untx Hirschsprung/AnganglionicMegacolon
    Complete obstruction > respiratory distress > shock!
  167. TX of Hirschsprung/AganglionicMegacolon
    Surgical removal of aganglionic portion and end to end anastamosis of anal canal.
  168. Prior to surgery for Hirschsprung/
    Decrease fiber, increase calories, increase protein
  169. Gastroenteritis
    Inflammation of stomach and intestines; decreased absorptive capacity of bowel
  170. Vomiting and diarrhea is a simptom of
  171. Tx of gastroenteritis
    • Tx organism and cause (colon disease)
    • Prevent dehydration/rehydrate
    • Maintain F&E balance; I & O
    • ASAP - Breastmilk, regular diet
  172. Don't use the BRAD diet with
  173. With acute diarrhea and dehydration, treat first with
    Oral rehydration therapy (ORT)
  174. What is the order for oral rehydration therapy?
    75-90 MEQ NA+/liter
  175. After rehydration, you may alternate
    with water, breast milk, lactose-free formula or 1/2 st. lactose formula, po, n/g
  176. Oral rehydration therapy for older children
    With regular diet.
  177. GI disorder, make sure you assess for!???!
  178. Sigs and symptoms of dehydration:
    • Tachyccardia
    • Dy mucous membranes
    • Sunken fontenanls
    • Irritability/lethargy
    • weight loss
    • Poor skin turgor
  179. Nomal heartrate
  180. Causes of parasitic disorders
    • Water
    • Food - unproperly prepared
    • Sanitation PO
    • Pets and Wildlife
    • Child care centers
  181. TX of parasitic disorders
    ID organism; antihelmintic teach good hand washing and cover sand boxes
  182. Enteroblasis
    Pinworms, most common
  183. Anal itching
  184. Treatment of pinworms
    • Mebendazole, pyrantel pamoate, and piperazine citrate; tx evereyone in home
    • repeat in 2 weeks.
    • Tape
  185. Pyrantel pamoate can...
    cause red vomit/stain clothes
  186. What is a peptic ulcer
    Erision of mucosa of lower esophagus, stomach or duodenum
  187. Other causes of peptic ulcers
    • Steroids
    • NSAIDS
  188. Usual cause of peptic ulcers
    Helicobacter pylori
  189. Tx for peptic ulcers
    Antimicrobials, antacids, histamine antagonists, proton inhibitors -> Prevacid, prilosec > blocks acid production
  190. Inflammation of vermiform
  191. Most common cause of emergency abdominal surgery
  192. Periumbilical pain
  193. RLQ pain is found during what?
  194. McBurney's point
    Pin in RLQ of appendicitis
  195. Anorexia and N&V are a sign of
  196. Possible diarrhea or constipation
  197. Rigid abdomen
  198. Guards site, side lying with knees flexed
  199. more common in men
  200. Failure to x most frequent cause of malpractice suits
  201. Do not administer laxative/enema or apply heat
    with abdoinal pain...stimulates bowel and increases risk of performation.
  202. May or may not have fever or increased WBC
  203. C/T with contrast is the dx tool of choice for
  204. CRP elevated in
  205. Pain control for appendicitis
    • IVFs, I & O
    • Antibiotics
    • NPO
    • N/G Tube - prevent distention/maintain decompression
    • - Penrose drin (PRN count as output on strict I&O
  206. Sudden relief of pain during appendicitis
    Report STAT
  207. Fever during appendicitis
    Ruptured appendix
  208. Abdominal distention with apendicitis
    Ruptured appendix
  209. Irritability, restlessness with ruptured appendix
    Ruptured appendix
  210. Rapid, shallow respirations seen with apendicitis
    Ruptured appendix
  211. Pallor, chills during apendicitis
    Ruptured appendix
  212. Rapid shallow respirations during appendicitis
    Ruptured appendix
  213. Signs of shock during apendicitis
    Ruptured appendix
  214. Most common GI anomaly and most common cause of GI bleeding in children
    Mecke's Diverticulum
  215. Blind pouch/sac protruding from ileium
    Mecke's diverticulum
  216. Pouch contains gastric or pnacreatic tissue which secretes acids > irritation and ulceration
    Mecke's diverticulum
  217. Presents by 2 years old
    Mecke's diverticulum
  218. Rectal bleeding
    Mecke's diverticulum
  219. Most common complication of Mecke's diverticulum
  220. Surgery for Mecke's diverticulum
    Remove pouch to prevent hypovolemic shock
  221. Inability to absorb nutrients
    Malabsorption disorder
  222. Caused from rescection or gengenital defect, trauma or vascular injurly (volvulus)
    Malabsporption disorders
  223. Intolerance to gluten
    Celiac disease
  224. Vascular injury
  225. TX for short bowel syndrome
    • TPN per central line
    • Entereral feedings ASAP
    • Vitamins and minerals
    • H2 blockers, proton pump inhibitors
    • Antibiotics PRN
    • Surgery as indicated
  226. Intollerance to pritein, wheat, barley rye, oats
    Celiac Disease
  227. Symptoms of celiac disease
    • Steatorrhea
    • Malnutrition
    • Abdominal dist
    • Secondary Vitamin def
  228. DX of Celiac disease
    Fecal fat content
  229. Treatment of celiac disease
    Lifetime treatment
  230. Hiddens sources of gluten
    • Chocolate candy
    • Luncheon meats, hotdogs, hamburgers
    • Malts, Ice cream
    • Canned soup, mayo, ketchup
    • Vinegar (except apple cider vinegar)
  231. Sign and symptoms of malabsorption
    Abdominal pain, flatus, diarrhea
  232. TX of lactose intolerance in children
    use soy formula
  233. Lactaid added to foods and supplimental vitamin D and Calcium are treatmetns for
    Lactose intolerance
  234. Paroxysmal abdominal pain and distension & crying dyring first 3 mo of life
  235. Usually crying the same time of day for several hours and may stop after flatus, stool or exhaustion
  236. When colic, R/O what?
  237. Nursing responsibiity for colic child
    assess feedings, diet, burping
  238. Suggestions that can help with colic
    • Rhythmic movement
    • Position
    • Decrease environmental stim
    • tactile stim
    • decrease amount of food, frequently burping
    • upright for 30 minutes after feeding
  239. Risk for abuse
  240. Blockage/absence of extrahepatic ducts
    Biliary Atresia
  241. Blocks bile flow from liver to deudenum leading to inflammation and fibrotic liver changes
    Biliary Atresia
  242. How long does Jaundice last?
    2-3 weeks after birth
  243. Tea colored urin, white clay clored stools, bruising, prolonged bleeding, FTT, decreased Vit K
    Hepatomeglay which leads to spleenomegaly
  244. Is there a cure for hepatomegaly?
  245. Hepatoportoenterostomy
    Treatment for biliary Atresia
  246. Kasai procedure
    Another name for hepatoportoenterostomy, part of the intestine anastomosed to porta hepatis to promote bile drainage and liver function, which improves prognosis, but complication of damage to liver
  247. Child eventually needs liver transplant
    tx of biliary Atresia
  248. Vit K & D
    Tx of biliary atresia
  249. Control itching
    Biliary atresia
  250. Antibiotics, nutrition and family support important in tx of
    Biliary atresia
  251. Hepatitis most seen in children
  252. Vaccine for Hep A when?
    2-18 years; IG if exposed
  253. Serum hepatitis
    Hep B
  254. When Hep B given
    2 mo, then 1 mo after than 6 mo...HBIG if exposed
  255. Careful with meds in hepatitis...why?
    Liver can't detox meds
  256. Diet for heptatits
    • Increased protin and carbs
    • Decreased fat diet, in small frequent meals
  257. When poisoned do not gastric lavage when?
    alkaline corrosive ingestion
  258. Activated charcoal for what kind of poison?
    acid ingestion po/gastric
  259. May mix charcoal with what?
    Jice/soda;use a cup with over
  260. What is REALLY important for the nurse after indigestion of poison
  261. Should you use IPECAC ever
  262. State law requires testing for what?
    PKY phenylketonuria
  263. PKU Phenylketonuria
    Rare, inherited metabolic disease
  264. What is PKU Phenylketonuria?
    absense of enzyme which normally converts PKY to tyrosine
  265. Build up off PKY is toxic to what?
  266. What must be removed from diet if have PKU?
    Protein, and no aspartane
  267. May cause mental retardation
  268. can cause convulsions
  269. Can cause behaivior problems
  270. May cause skin rash
  271. May cause musty body odor
  272. Babies are tested both boob and formula milk at a miniumum of 24 hours beginning milk
  273. Retust in 7 days to catch earlier false negatives
  274. C
    • Chocking
    • Logan bar
    • Evaluate airway
    • Feed slowly
    • Teaching
    • Lamb's nipple
    • Incidence increased in males
    • Prevent crust formation and prevent aspiration