GI

Question 1

3 types of mouth hole clefts

Answer 1

incomplete fusion of lip, palate, or both

Question 2

2 ways to improve feeding with clefties?

Answer 2

◦ special bottles that can cover palate area

◦ maneuvers: squeeze cheeks for cleft lip

Question 3

when does surgery happen for cleft lip vs cleft palate?

Answer 3

3 months for lip

18 month for palate

Question 4

diet for cleft palate after surgery?

Answer 4

Clear liquid diet for 24 hours
Liquid diet for 2 weeks
Soft diet for 6 weeks

Question 5

post op considerations for clefties?

Answer 5

• Avoid trauma to the site by avoiding placing things in the mouth (ex. thermometer, toys)
◦ elbow restraints to keep them from putting hands/objects in mouth
• Avoid client rubbing the site
• Pain relief - pharm/nonpharm

Question 6

Most reliable indicator of fluid loss for infants and young children=

Answer 6

body weight

Question 7

when total output of fluid exceeds intake of fluid =

Answer 7

dehydration

Question 8

s/s of dehydration

Answer 8

• Weight loss, irritability, increased pulse, decrease b/p, increase urine specific gravity

Question 9

urine specific gravity normal vs dehydration

Answer 9

1.010 to 1.025= normal range

> 1.025 = dehydration

Question 10

first line intervention with signs of dehydration

Answer 10

oral rehydration therapy

Question 11

what do we do after rehydration is achieved?

Answer 11

alternate oral rehydration therapy with low-sodium solution (water, breast milk, lactose free formula)

Question 12

urine output for infant vs child

Answer 12

• Child= > 1ml/kg/hr

* Infant= >2ml/kg/hr

Question 13

s/s of adequate fluid volume

Answer 13

• Moist mucus membranes
• Cap refill of 2 seconds or less
• Brisk skin turgor
• Balanced fluid intake and output
• Electrolytes in expected range

Question 14

mild/mod/severe dehydration:

◦ weight loss 3-5% infant
◦ weight loss 3-4% children

Answer 14

mild

Question 15

mild/mod/severe dehydration:

◦ weight loss 6-9% infant
◦ weight loss 6-8% children

Answer 15

moderate

Question 16

mild/mod/severe dehydration:

◦ weight loss >10% in infants 
◦ weight loss >10% in children

Answer 16

severe

Question 17

how does BP change from mild/mod/severe dehydration

Answer 17

mild = normal
mod = orthostatic 
severe= orthostatic --> shock

Question 18

cap refill mod/mild/severe dehydration

Answer 18

mod = >2
mild - 2-4
severe = >4

Question 19

breathing mild/mod/severe dehydration

Answer 19

mild: normal
mod: slgiht tachypnea
severe: hyperpnea

Question 20

s/s of severe dehydration

Answer 20

cap refill >4 seconds, tachycardia, orthostatic BP can progress to shock, extreme thirst, very dry mucous membrane, tented skin, hyperpnea, no tearing, sunken eyeballs, sunken anterior fontanel, oliguria to anuria

Question 21

1 cup = ____ ounces

Answer 21

8

Question 22

1 ounce = ____ mL

Answer 22

30

Question 23

3 types of dhydration

Answer 23

isotonic, hypotonic, hypertonic

Question 24

GERD vs GER?

Answer 24

• Gastric contents come back up into esophagus causing injury
*becomes disease when tissue damage is done

Question 25

infant vs children s/s of GERD

Answer 25

Signs/Symptoms Infants:: -Vomiting, irritability, arching of back, weight loss, failure to thrive, wheezing, respiratory problems Signs/Symptoms Children:: -Heartburn, difficulty swallowing, chronic cough (different than adults --> like asthma in kids)

Question 26

interventions for GERD

Answer 26

* small frequent meals * thicken infant formula with 1 tsp to 1 tbsp rice cereal/ 1 oz milk * elevate head after meals for 1 hour * avoid irritating foods

Question 27

what is Nissen Fundoplication? when do we use it?

Answer 27

wraps fundus of stomach around distal esophagus to decrease reflux (for severe GERD)

Question 28

Narrowing/thickening of the pyloric sphincter causing an obstruction =

Answer 28

pyloric stenosis

Question 29

what happens as a result of pyloric stenosis?- aka whats the big deal?

Answer 29

The narrowing doesn’t allow for emptying of the stomach contents

Question 30

s/s of pyloric stenosis

Answer 30

* Vomiting after feedings – projectile vomiting * Projective vomiting followed by hunger * Olive shaped mass in RUQ; * possible peristaltic wave from left to right * dehydration

Question 31

intervention for pyloric stenosis

Answer 31

pylorotomy / pyloromyotomy

Question 32

complications from pyloric stenosis

Answer 32

recurrent pneumonia, weight loss, failure to thrive

Question 33

Proximal segment of bowel telescopes into distal section of bowel =

Answer 33

Intussusception

Question 34

what happens as a result of Intussusception to the intestines?

Answer 34

Edema from lymphatic and venous obstruction | • Ischemia and increased mucus into intestine

Question 35

s/s of intussesception

Answer 35

* Palpable mass in RUQ of abdomen * Stools mixed with blood and mucus (red currant jelly stools) * Vomiting; Lethargy * Drawing knees to the chest in severe pain then normal behavior * Eventual fever and signs of peritonitis

Question 36

treatment for intussesception?

Answer 36

air enema

Question 37

Mechanical obstruction from inadequate motility of part of intestine due te lack of ganglionic cells in segments of colon =

Answer 37

Hirschsprung Disease

Question 38

Section of large intestine without nerve innervation =

Answer 38

Aganglionic megacolon

Question 39

interventions for Aganglionic megacolon

Answer 39

Surgery to obtain normal bowel function | First surgery – create temporary ostomy --> Relieves obstructed area

Question 40

s/s of appendicitis

Answer 40

``` • Pain, fever, rigid abdomen • Anticipate need for appendectomy • Avoid enemas and laxatives • Rovsing’s sign – appendicitis ◦ Tenderness in RLQ with palpation of any quadrant ```

Question 41

appendix PERFORATION s/s

Answer 41

* Sudden decrease in abdominal pain (short time before peritonitis) * Peritonitis * Distended abdomen * Fever – high

Question 42

RBC/WBC/Neutrophils/Lymphocytes ofr appendicitis

Answer 42

RBC 4-5.5 million/mm3 WBC 5,000- 10,000/mm3 Neutrophils 3,000-5,800/mm3 Lymphocytes 1,000-4,000/mm3

Question 43

s/s of celiac disease

Answer 43

◦ Growth problems, chronic diarrhea/constipation, recurring abdominal pain and bloating, fatigue, irritability

Question 44

avoid all ____ with celiac

Answer 44

gluten | --> barley, rye,wheat