Exam 3 Peds GI Flashcards

Question

Treatment of cow's milk allergy

Answer 1

Elimination of cow’s milk based formula | Continue until one year old, then small amounts are reintroduced

Answer 2

Prevent and reduce exposure of infants to cow’s milk protein (through exclusive breastfeeding for the first 4-6 months) Help parents identify signs and symptoms Teach parents when introduce solid foods to be aware of those that contain milk Educate on re-introduction of milk products after one year

Answer 3

Dehydration

Answer 4

To prevent hypovolemic shock

Answer 5

Dehydration

Answer 6

``` Vomiting/Diarrhea Decreased oral intake High fever DKA Burns, insensible losses Increased renal excretion ```

Answer 7

Infants have a greater need for water and have more alterations in fluid and electrolyte balance

Answer 8

Constitutes more than half of their total body water, causes greater and more rapid water loss

Answer 9

1. Insensible 2. Urinary 3. Fecal

Answer 10

Fever increases fluid loss Increased Body Surface Area (BSA) in infants and children increase fluid loss Basal metabolic rate is higher than adults Kidneys are immature and cannot concentrate urine

Answer 11

Mental status Fontanel Eyes Oral mucosa Skin turgor Heart rate Blood pressure Extremities – capillary refill Urine output – specific gravity Table 41-1 – mild vs. moderate vs. severe *Must accurately measure intake and output Intake – anything that goes in the mouth/IV/tube feedings Output – anything that comes out – urine, stool, emesis, sweat, drainage

Answer 12

Must restore fluid volume Replace ongoing losses 1:1 Offer at frequent intervals and small amount Do NOT manage by encouraging intake of clear liquids other than ORS or BRATT diet IV fluids – used for severe dehydration or shock Observe for s/s of dehydration Need at least 1 cc/kg/hr of urine output Probiotics may decrease the extent of diarrhea Lactobacillus (Culturelle)

Answer 13

Alteration in the frequency, consistency, or ease of passing stool Passing hard, dry stools, often painful Liquid stools around hard stools Bowel habits vary between children Meconium stools ``` Assessment signs and symptoms What are normal bowel habits?? Abdominal distention Inspect for any anal fissures Bowel sounds ``` KUB and stool studies

Answer 14

Change dietary habits Increase high-fiber foods and fluids Eliminate constipating foods Behavior modification Positive reinforcement Scheduled times to sit on toilet

Answer 15

Absence of ganglion cells in the bowel Also called congenital aganglionic megacolon Causes inadequate peristalsis in part of the intestine Males affected 4x more than females Associated with Down syndrome

Answer 16

Surgical resection of aganglionic bowel to relieve obstruction and restore normal bowel motility 1st surgery to create ostomy 2nd surgery to “pull-through” the healed intestines to rectum and close ostomy

Answer 17

Provide Postoperative Care Observe for complications of enterocolitis ``` Provide Ostomy Care Ensure proper function of stoma Daily ostomy care Skin care Diet: avoid foods that produce excess gas and constipation ``` Patient and Family education Explain surgical procedure Educate on stoma care Medications

Answer 18

Passage of gastric contents into the esophagus Occurs during episodes of transient relaxation of LES Common during first year of life

Answer 19

Assess for signs and symptoms and risk factors Ask parents what they observed Physical exam May appear malnourished Assess for aspiration and breathing patterns Diagnosis Upper GI/EGD pH probe – gold standard Hemoccult stool

Answer 20

``` Modify feeding habits Appropriate positioning Elevate HOB during feeding and for 30 min - 1 hour after Smaller more frequent feeds Thicken feeds with rice cereal Avoid foods known to cause reflux Medications Histamine-2 blockers (Zantac, Pepcid) Proton Pump Inhibitors (Nexium) Prokinetics (Reglan) ``` Surgical intervention Nissen fundoplication

Answer 21

Promote safe feeding techniques Monitor vomiting Weight daily Maintain patent airway Risk for aspiration and ALTE Post-operative care ``` Parent education Feeding Positioning Medications NG care/Apnea monitor ```

Answer 22

The circular muscle of the pylorus becomes hypertrophied creating a gastric outlet obstruction Compensatory dilation, hypertrophy, and hyperperistalsis of stomach Infant usually presents at 2-5 weeks old with a history of projectile nonbilious vomiting Other symptoms include: Hard, moveable “olive” mass is the RUQ, no pain Hunger soon after vomiting Wt loss, dehydration, and electrolyte disturbancesCircular muscle thickens  severe narrowing of the pyloric canal (olive shaped mass)  obstruction  vomiting  dehydrated, lethargic, malnourished

Answer 23

Requires surgical intervention (pyloromyotomy) Preop care: Assess laboratory values/physical exam for dehydration Restore hydration and electrolyte balance Monitor VS - dehydration Strict intake and output - NPOPostop care: May have vomiting, pain feedings begun 4-6 hours post op (clears then formula) Monitor tolerance of feedings Incision site care Strict intake and output Provide emotional support for anxious family

Answer 24

Occurs when a proximal segment of bowel “telescopes” into a more distal segment Pulls the mesentery with it Most common at ileocecal valve Can result in lymphatic and venous congestion and bowel wall edema Leads to obstruction, infarction, and perforation Venous engorgement leads to leaking of blood and mucous into intestinal lumen Forms the classic “currant jelly” stools

Answer 25

``` Look for common signs and symptoms Sudden onset of intermittent abd pain Child screaming and drawing knees to abdomen but comfortable in between episodes Distended, tender abdomen Vomiting/Diarrhea Currant-jelly stools or bloody ``` Palpate the abdomen for sausage-shaped mass in the upper-mid abdomen Ultrasound, Pneumo/Saline/Barium enema Surgical reduction

Answer 26

IV fluids/NPO Monitor for adequate hydration and nutrition May need abx and NG tube before intervention Monitor for return of normal bowel function after enema or surgery Passage of a normal brown stool usually indicates that the intussusception has reduced itself Can d/c home once tolerating feedings Reoccurs in 1 out of 10 patients

Answer 27

Facial malformations that occur during embryonic development Frequently occurs with other anomalies Can occur individually or together and can be unilateral or bilaterally ``` Causes include Maternal smoking and alcohol consumption Prenatal infection Medications used during pregnancy- anticonvulsants Advanced maternal age ``` Involves the care of a multidisciplinary team

Answer 28

Can involve only the lip or extend into the nostril Can be diagnosed by prenatal ultrasound or at birth by classic appearance Significant emotional reaction in parents Repaired surgically at 2-3 months old Z-plasty or Millard technique

Answer 29

Can involve both the hard and soft palate Not as obvious as cleft lip Can be seen when mouth examined Management directed at: closure of cleft prevention of complications normal growth and development Repaired surgically at 6- 12 months

Answer 30

Immediate problems related to feeding and parent reaction Encourage infant-parent bonding, provide emotional support ``` Feeding can be difficult, must educate parents Infants have a reduced ability to suck Must feed in upright position Need to start feeding as soon as possible after birth Special cleft lip/palate nipple used Burp frequently Breastfeeding usually most effective Risk for aspiration Risk for failure to grow ```

Answer 31

Preoperative Educate parents on what to expect Place elbow restraints on infant

Answer 32

Allowed to lie on abdomen after surgery May resume feeds after surgery Usually through syringe or soft sipee cup Sent home on soft diet Avoid the use of tongue depressors, thermometers, pacifiers, spoons, or straws Packing in place – will remove after 2 to 3 days Watch for respiratory complications, risk for aspiration Suction with extreme caution! Elbow restraints in place to prevent injury to mouth and continued for 7-10 days Pain medication as needed – want to avoid crying

Answer 33

Feeding difficulties Upper respiratory infections Altered dentition Delayed speech development, will need speech therapy Chronic otitis media, possible hearing loss Long-term social adjustment

Answer 34

``` Very common in pediatrics Cosmetics and personal care products Cleaning products Plants Foreign bodies, toys Medications ``` Often occur in the home or relatives house Infants and toddlers explore their environment through oral experimentation Very curious Imitation

Answer 35

Call Poison Control Center Will develop a plan of care Treat the child first, not the poison Immediate concern is life support Vital signs, respiratory, circulation Gastric Decontamination Specific antidotes for certain poisons Would like to originally prevent Parents need education on how to prevent recurrence

Answer 36

Ingestion of a variety of substances Lead Iron Mercury Treatment involves chelation therapy

Answer 37

Failure of the trachea and the esophagus to separate Proximal- ends in a blind pouch Distal- connected to the trachea or bronchus Commonly associated with VATER or VACTERL

Answer 38

Inflammatory Process that causes intrahepatic and extrahepatic bile duct fibrosis with eventual obstruction

Answer 39

Hepatic portoenterostomy Intestine anastomosed to help bile drainage Liver transplant later Nutrition support

Answer 40

Protrusion of intra-abdominal viscera- out pouching from umbilical cord- contents covered in peritoneum without skin Surgical Repair

Answer 41

``` Protect sac from drying or trauma Keep soaked with saline soaked dressings Maintain temperature Prophylactic antibiotics After surgery- bowel decompression, pain management ```

Answer 42

Protrusion of intra-abdominal contents- no peritoneal sac covering the exposed bowel Surgical repair Sometimes requires gradual reduction of contents into the abdomen

Answer 43

Same as Omphalocele EXCEPT: NG decompression Observe exposed bowel for necrosis or color change Post op- Monitor lower extremities- pulses and perfusion Siloh Pouch

Answer 44

``` Why do we need TPN? Side effects/Adverse events Know the patho behind patient’s illness to know what is in the TPN Evaluate patients response Weight gain Bloating Electrolyte imbalance Central access unless less than 12.5% dextrose Sometimes they will add meds Liver testing Other metabolic labs ```

Answer 45

Oral rehydration treatment

Answer 46

ORS and alternate with formula/breastmilk or regular diet

Answer 47

If bacteria or parasitic causes may need antibiotics or antiparasitics Metronidazole, Vancomycin *Antidiarrheals not recommended Educate parents- Rotavirus oral vaccine (3 doses at 2, 4, and 6 months)

Answer 48

Medications and enemas Stool Softeners (colace) Laxatives (Miralax, Milk of Magnesia, Lactulose) Pediatric Fleets Enema, Milk and Molasses enema

Answer 49

Newborn stool patterns

Answer 50

Inspect and palpate abdomen for distention

Answer 51

Barium enema Rectal biopsy to evaluate for absence of ganglion cells Absence of ganglion cells causes contraction which leads to obstruction Stool collects = distention, leading to ischemia and enterocolitis

Answer 52

Spitting up, forceful vomiting Excessive crying, arching of back Wt loss, growth failure Respiratory problems, ALTE

Answer 53

Heartburn, abdominal pain, non cardiac chest pain | Chronic cough, dysphagia, recurrent PNA

Answer 54

Must protect the operative site!! Place elbow restraints Prevent infant from rolling onto abdomen Will be supine immediately after surgery then can go into infant seat Adequate pain relief – want to avoid crying Clear liquids once recovered from anesthesia

Answer 55

``` Excessive salivation Coughing Choking Cyanosis Apnea/ respiratory distress Abdominal distention Immediately NPO Prone position to aid in the drainage of secretions Low intermittent suction in the blind pouch via a catheter One surgery or several staged surgeries ```

Answer 56

``` Jaundice Dark urine Light color (tan) stool Hepatomegaly Poor weight gain Growth retardation Pruritus Irritability ```

Exam 3 Peds GI Flashcards

(81 cards)