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NUR 440 Exam 2 > Gastrointestinal Dysfunctions > Flashcards

Gastrointestinal Dysfunctions Flashcards

1
Q

Disrupts Fluid Balance

A 
Fever
Vomiting, diarrhea
High output kidney failure
DM, DKA
Burns, shock
Tachypnea
Radiant warmer, photo therapy
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2
Q

Greatest Risk for Fluid Imbalance

A

Less than 2 years old
Larger extracelluar fluid percentage
High body surface
High metabolic rate + Less interstitial Fluid Reserve = Increased Risk for Imbalance

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3
Q

High Oral Needs 1st Year of Life

A 
Poor swallowing control until 6 weeks
Swallowing is reflexive for 3 months
Wet burps
No feeling of fullness 
Formula feedings every 3- 4 hours
Breastfeedings every 2-3 hours
Increased peristaisis
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4
Q

Daily Fluid Requirements

A

Up to 10kg * 100ml/kg/day
11 - 20kg * 50ml/kg/day
> 21kg * 20ml/kg/day

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5
Q

Diagnostic Tool: X-ray

A

Plain film looks at detect foreign body, looks at bowel gas pattern, detect perforation or obstruction

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6
Q

Diagnostic Tool: Upper or Lower GI Series

A

Barium to look at the function, reflux and other problems

Drink lots of water!! Can cause impaction

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7
Q

Stool Sample

A

To look for blood for infection
Teach to save diapers, fresh is best
GLOVES!

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8
Q

Abdominal Ultrasound

A

Look for tumors, size and placement of abdominal contents
May require sedation — NPO
Explain the gel

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9
Q

CT/ MRI

A

View density of organs, detects blood and masses
CT is a shorter test, MRI is longer
MRI- IV, PO, contrast, no radiation, worry about magnets
Not painful

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10
Q

pH Probe

A

Placement like NG tube, measure pH over 24 hours
Determines frequency and duration of GER
Teach parents about a diary: feedings, irritability
No antacids, proton pump inhibitors or H2 blockers

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11
Q

Metabolic Acidosis

A

< 7.35 pH
Normal PCO2
< 22 HCO3
Loss of bicarbonate - diarrhea

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12
Q

Metabolic Alkalosis

A

> 7.45 pH
Normal PCO2
26 HCO3
Loss of acid – vomiting

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13
Q

Hypotoinc Dehydration

A

Loss of salt > water
Prolonged vomiting and diarrhea, burns and renal disease
Fluid shifts from extracellular to intracellular
Shock

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14
Q

Hypertonic Dehydration

A

Loss of water > salt
Diabetes Insipidus
Na+ > 150
*Neuro changes and seizures

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15
Q

Isotoinc Dehydration

A

Water loss = salt loss
Most commonly from vomiting and diarrhea
Great risk for shock

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16
Q

Dehydration Treatment

A

Look at electrolyte panel!
Treat fluid imbalance
Treat underlying cause
Oral re-hydration works well
If not thirsty - administer small volumes frequently
For severe dehydration - IVF bolus then oral feedings

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17
Q

Cleft Lip and Palate

A 
Early in embryonic development - 6 weeks
At birth - nurse feels for intact palate at birth
Genetic or environmental factors 
Facilitate bonding - can breastfeed!
Haberman bottle if not breastfeeding
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18
Q

Closure of Lip Defect

A

Correction of the palate is done as early as 2 to 3 months to allow for better seal for feeding ans speech

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19
Q

Closure of Lip Defect POSTOP

A 
Supine or side lying
Incision care - clean with normal saline, keep moist
Medicating for discomfort
Observe for signs of bleeding
Teach home care
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20
Q

Closure of Palate

A

Closure happens anytime between 9 and 15 months to maximize speech production and growth of the midface

21
Q

Closure of Palate POSTOP

A

Lie prone or side lying
No metal utensils or straws
Elbow restraints to keep hands away from their mouth
Clear diet – Soft diet
Rinse mouth after eating with water
Pain management
Increase risk of otitis media - can cause hearing issues

22
Q

Tracheoesophageal Fistula with Esophageal Artesia

A 
Diagnosed by X-ray
Polydraminous
Respiratory distress, cyanosis
Frothy Saliva
Coughing, drooling
Aspiration
23
Q

TEF with AE PreOP

A

Reduce respiratory distress and potential for aspiration
NPO, HOB elevated, suctioned as needed
If strictures present then the child will need serial dilations

24
Q

TEF with AE PostOP

A 
NG tube for suction
Parental nutrition
Chest Tube
Pain management!
High risk for developing a feeding aversion
High incidence of GER
25
Q

Anorectal Malformation/ Anal Atresia

A

No anal opening
Meconium exits via a fistula into bladder in boys and vagina in girls
NPO, IV hydration, gastric de-compensation with NG tube
Often requires a colostomy
Toilet training will be delayed, bowel training with stool softeners, diet modification, bowel irrigations

26
Q

Umbilical Hernia

A

Protrusion through the umbilical ring
Assess for incarceration- should be soft is not present
Incarcerated – immediate surgery
Small defects will close on its own- if not be age 5 surgery
Do not tape hernia

27
Q

Inguinal Hernia

A

Boys > Girls
Result from failure of the proximal portion of the processus vaginalis to atrophy and close
Fluid or abdominal structures may move in
Diagnosed with transillumination
Fix around 9 months - once they start to stand and walk the bowels and slip into the hernia

28
Q

PICA

A

Eating non- food items
May be triggered by nutritional deficiency
Impaction or obstruction possible
Nutritional Deficiency b/c the non- food items fill them up

29
Q

Constipation

A

A symptom not a disease
Alternation in the frequency, consistency or ease of passing stool
May result from toilet training, environmental changes, stress, low fiber diet, not wanting to go at school
Treat with diet change, increase fluids, MiraLax.
Chronic- can take up to 6-12 months

30
Q

Hirschsprung Disease - Congenital Aganglionic Megacolon

A

Absence of ganglion cells which affects the itnernal sphincter that impairs motility
Inability to push stool out
Diagnosed by exam and rectal biopsy
Treatment - temporary colostomy, removal of affected bowel and pull through

31
Q

Hirschsprung Disease Symptoms

A

Newborn- no meconium within 48 hours, refusal to feed, bilious vomiting, abdominal distension

Infancy- FTT, constipation, abdominal distension, episodes of diarrhea and vomiting, explosive watery diarrhea, fever

Childhood - constipation, ribbon like foul smelling stool, abdominal distension, palpable fecal mass, undernourished

32
Q

Gastroesophageal Reflux

A

Gastric contents into the esophagus

Upper GI and pH probe aids in the diagnosis

33
Q

GER Symptoms

A 
Spitting up, vomiting
Excessive crying and irritability
Weight loss and FTT
Heartburn
Abdominal pain, chest pain
Chronic cough
34
Q

GER Management

A

Aspiration precautions - teach thicken feeds, upright position for after feedings
Proton pump inhibitor, h2 receptors
Surgery indicated for all other methods
Overfeeding is an issue!!

35
Q

Appendicitis

A

Abdominal pain, RLQ
Side lying
Fever, rigid abdomen, decreased or absent bowel sounds
Vomiting, constipation, anorexia
Tachycardiac, pallor, lethargic, irritability
Diagnosed by CT, also a pregnancy test!

36
Q

Appendicitis Treatment

A

Ruptured – put drain in, wait for abscess to wall off, NPO, IVF, antibiotics, IV PCA for pain, NG tube, dressing changes

Not ruptured – Surgery, laparoscopic

37
Q

Pyloric Stenosis

A

Projectile like vomiting – shortly after feedings
Olive like abdominal mass
Ultrasound for diagnosis
HYPERTROPHY of the muscle – restricts stomach emptying leading to the projectile vomiting

38
Q

Pyloric Stenosis PREOP

A

NPO
Treat dehydration
Correct metabolic alkalosis with IVF
NG tube to decompress the stomach

39
Q

Pyloric Stenosis POSTOP

A

Feeding per surgeon order
EBP = early feeding
Monitor VS, I/O’s, weight, pain, diet tolerance
Emesis should not be more than 1/2 of feeding

40
Q

Intussusception Symptoms

A 
Abdominal pain
Draws knees to chest
Sausage like mass in abdomen
Jelly like stools with blood
Green colored emesis-- billious 
Lethargic
41
Q

Intussusception

A

Telescoping of the bowel on itself

Hydrostatic reduction with air enema or water soluble contrast

42
Q

Celiac Disease

A

Large, pale, oily, frothy, foul smelling stools
Irritability, anorexia, weight loss
DIET CHANGE! NO wheat, rye, barley, or certain oats
Untreated - atrophy in small bowel and vitamin deficiencies of ADEK
Diagnosed through biopsy

43
Q

Colic Symptoms

A

Loud, continuous crying
Distended, tense abdomen
Crying stops when exhausted or passes stool or gas

44
Q

Colic Etiology

A 
Cause is unknown
Cow's milk allergy higher incidence 
Rule out organic cause or intussusception
Subsides by 3 or 4 months
Greater risk for shaken baby
45
Q

Failure to Thrive

A

Inadequate calorie intake, inadequate absorption, increased metabolism or defective utilization
Disturbed parent child interactions
Assessment of diet, growth, activity, home environment
Careful documentation

46
Q

Mild Dehydration

A 
3-5% weight loss
Normal activity
Dry skin
Normal mucus membranes
Cap refill >2 seconds
47
Q

Moderate Dehydration

A 
6-9% weight loss
Irritable
Clammy skin
Dry mucus membrane
Cap Refill 2-4 seconds
48
Q

Severe Dehydration

A

> 10% weight loss
Lethargic
Parched mucus membranes
Cap refill >4 seconds

NUR 440 Exam 2 (4 decks)

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