GastroIntestinal

Question 1

What is the priority concern for a child that is vomiting?

Answer 1

Risk of aspiration.

Maintain a patent airway.

Question 2

What should be done if a child vomits right after giving a medication?

Answer 2

Do NOT give another dose of medication if a child vomits.

Question 3

What can the child blow on after surgery to prevent respiratory complications?

Answer 3

A pinwheel! It’s fun :)

Question 4

What type of room should a child with diarrhea be placed in?

Answer 4

A private room on enteric precautions.

Use gown and gloves; and wash hands with soap and water.

Question 5

What is the priority concern with both vomiting and diarrhea?

Answer 5

Dehydration.

Question 6

What are the characteristic signs and symptoms of dehydration in a child?

Answer 6

• sunken fontanels (in an infant)
• poor skin turgor
• decreased urinary output
• dry mucous membranes
• decreased tear production
• lethargy

Question 7

What is given to a child with mild to moderate dehydration to rehydrate?

Answer 7

Rehydrate with Pedialyte or another rehydration therapy that contains electrolytes.

Question 8

What are the interventions for a child with severe dehydration?

Answer 8

• keep NPO
• give IV fluids
• daily weights
• monitor intake and output

Question 9

Describe:

Cleft lip and cleft palate

Answer 9

Congenital condition where the upper palate or lip doesn’t fuse completely together.

Question 10

How should an infant with a cleft lip or palate be fed?

Answer 10

Hold the infant upright and direct the formula to the side and back of the mouth to prevent aspiration.

Baby may still be able to breastfeed.

Question 11

How is an infant positioned after a cleft lip or palate repair?

Answer 11

Lay infant on side or back to prevent them from rubbing face on bed and causing trauma.

Question 12

What type of restraints does an infant wear after a cleft repair?

Answer 12

Elbow restraints.

Question 13

What should NOT be placed in the mouth of an infant after a cleft repair?

Answer 13

Do NOT place a tongue depressor, thermometer, straws, spoons, forks or pacifiers in the mouth due to risk of trauma.

Question 14

Describe:

Esophageal atresia and tracheoesophageal fistula

(Immediate complication)

Answer 14

When the esophagus forms an unnatural connection with the trachea causing food to enter the airway.

There is a high risk of aspiration.

Question 15

What are the characteristic signs and symptoms of esophageal atresia and tracheoesophageal fistula?

Answer 15

• “The 3 C’s”:
  
  • coughing
  • choking during feeding
  • cyanosis
• excessive drooling

Question 16

Treatment:

Esophageal atresia and tracheoesophageal fistula

Answer 16

• Surgery to repair the trachea and esophagus.
• TPN

Question 17

What tube may an infant have after an esophageal and trachea repair surgery?

Answer 17

Gastrostomy tube for nutrition while the esophagus heals.

Question 18

What is the teaching to parents after an esophagus and trachea repair surgery?

Answer 18

• poor feeding
• dysphagia
• drooling
• coughing during feedings
• vomiting undigested food

Report these symptoms to the HCP.

Question 19

Describe:

Hypertrophic pyloric stenosis

Answer 19

Projectile vomiting due to a restricted pylorus caused by an enlarged muscular area.

Question 20

What are the characteristic signs and symptoms of hypertrophic pyloric stenosis?

Answer 20

• projectile vomiting
• peristaltic waves that occur over the abdomen from left to right after a feeding
• an olive-shaped mass in the epigastrium just right of the umbilicus

Question 21

Treatment:

Hypertrophic pyloric stenosis

Answer 21

Pyloromyotomy or pyloroplasty to make the opening of the pylorus bigger.

Question 22

Describe:

Lactose intolerance

Answer 22

A lack of or deficiency of the enzyme lactase.

This enzyme is needed to digest foods with lactose such as milk.

Question 23

What are the characteristic signs and symptoms of lactose intolerance?

Answer 23

Occur after dairy products are consumed:

• abdominal distention and cramps
• diarrhea and excessive flatus

Question 24

Interventions:

Lactose intolerance

Answer 24

1. limit dairy products
2. take supplemental enzyme tablets that digest lactose
3. encourage foods such as hard cheese, cottage cheese, and yogurt - has the inactivated form of lactose

Question 25

What is the child with **lactose intolerance** at **risk** for?

Answer 25

**Vitamin D and calcium deficiencies.** ## Footnote Teach parents to provide these supplements.

Question 26

# Describe: Celiac disease

Answer 26

An **intolerance to gluten**, a component of protein. ## Footnote Don't eat foods with gluten: "BROW": * Barley * Rye * Oats * Wheat

Question 27

What is the **characteristic symptom** of celiac disease?

Answer 27

**Watery diarrhea** which can lead to fluid and electrolyte imbalances.

Question 28

# Describe: Hirschsprung's disease

Answer 28

A birth defect in which **nerves are missing from parts of the intestine**. ## Footnote If not treated, the child can have a bowel obstruction, enterocolitis, and perforation.

Question 29

# Interventions: Hirschsprung's disease

Answer 29

Focus on **preventing constipation and obstruction**: * healthy diet * stool softeners * rectal irrigation ## Footnote The goal is to have at least 2 soft bowel movements a day.

Question 30

What is the last resort **treatment** for Hirschsprung's disease?

Answer 30

**Surgery** to remove the part of the colon that does not have nerves.

Question 31

What **tube** will a child have after surgery for Hirschsprung's disease?

Answer 31

**NG tube** to decompress the stomach while the bowels heal.

Question 32

# Describe: Intussusception

Answer 32

When **part of the intestine folds into the section immediately ahead** of it causing a blockage. ## Footnote It typically involves the small bowel.

Question 33

What is the **characteristic symptom** of intussusception?

Answer 33

**Currant jelly-like stools** containing blood and mucus.

Question 34

# Interventions: Intussusception

Answer 34

Focus on **assessing for perforation and monitoring bowel movements**: * **hydrostatic reduction:** this is the use of air or fluids to move the folded intestine back to the normal area * monitor for soft brown stools

Question 35

# Describe: Imperforate anus

Answer 35

A birth defect in which the **opening to the anus is missing or blocked**.

Question 36

# Treatment: Imperforate anus

Answer 36

Surgery **to make an anal opening**. ## Footnote Child may have a temporary colostomy.

Question 37

What **position** is an infant placed in after surgery to correct imperforate anus?

Answer 37

Focuses on **preventing tension on the perineum**: * side-lying supine with hips elevated or * 90-degree angle with legs in air

Question 38

If a child is suspected of ingesting a poison, what is the **first** response by the parents?

Answer 38

Call the **Poison Control Center.**

Question 39

At what **age** is lead poisoning screened for?

Answer 39

At **1 - 2 years old**. ## Footnote If it is a low-risk area for lead poisoning, screening may not be done.

Question 40

What is the **treatment** for severe lead poisoning?

Answer 40

**Chelation therapy:** medications are administered to remove lead from the blood.

Question 41

What are some **sources** of lead poisoning?

Answer 41

Lead paint from old houses, contaminated dust, soil, and water. ## Footnote Children may chew on window sills with old lead paint.

Question 42

What is the **treatment** for acetaminophen overdose? | (Immediate complication)

Answer 42

* give acetylcysteine * use activated charcoal with gastric lavage

Question 43

What is the **treatment** for aspirin (acetylsalicylic acid) overdose? | (Immediate complication)

Answer 43

Give activated charcoal.

Question 44

What is the **treatment** for corrosive poisoning in a child, such as household cleaners, bleach, paint or batteries? | (Immediate complication)

Answer 44

* give water or milk * don't induce vomiting as it can cause damage to the esophagus

Question 45

# Describe: Intestinal parasites

Answer 45

Pinworms that come out of the anus. ## Footnote Anal itching is common.

Question 46

How are pinworms **diagnosed**?

Answer 46

By a **piece of tape that is placed firmly against the anus and then removed in the morning**. ## Footnote Place in a jar or plastic bag and take it to a lab for analysis.

Question 47

# Treatment: Pinworms

Answer 47

* medications are given to kill the parasites * the whole family is treated ## Footnote These meds are not given to children less than 2 years old due to toxicity.