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Fall - Pediatrics > GI > Flashcards

GI Flashcards

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1
Q

What is the most common viral cause of belly aches in kids?

A

Gastroenteritis

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2
Q

What is the most common surgical cause for belly aches in children?

A

Appendicitis

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3
Q

What is colic pain characterized by? When does it peak? How long does it last? Is there long lasting effects?

A

Excessive crying for 3 or more hours a day most days of the week

Peaks at 4-8 weeks of age and can last as long as 12 weeks

No impact on development or cognitive abilities

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4
Q

When does function abdominal pain most common? Why? How can this be treated?

A

Peak in preschool (especially boys)

Potty training is developing and there can often be a dysfunction in the patten of holding the BM –> pain –> large hard stool –> more pain

Fiber, fruit, bowel retraining habits, water, miralax, veggies

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5
Q

What is chronic pain categorized by?

A

3 pain episodes that have been present over 3 months

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6
Q

Where is the most common area for pain? Why should you be concerned about that area?

A

Periumbilicus

Appendicitis begins in that area and localizes

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7
Q

What history should you be getting from parents and child about the pain?

A
  1. Pain assessment (PQRST - location, quality, triggers, relieving, onset and duration)
  2. Associated symptoms like change in appetite, vomit, diarrhea, fever, rash, joint aches/pains, weight loss
  3. Treatment tried
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8
Q

Should you give you child anti motility drugs for diarrhea?

A

NO it can mask s/s and prolong the illness

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9
Q

When should you worry about abdominal pain?

A
  1. Severe, localized pain
  2. Blood in emesis or stool
  3. Fever (infection/autoimmune)
  4. Appears ill/lethargic
  5. Losing weight
  6. Nocturnal pain
  7. Periumbilical pain
  8. If pain proceeds vomiting/diarrhea
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10
Q

What is a concern if the patient has pain and they are also lethargic?

A

Shock/sepsis concern

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11
Q

When visually inspecting the abdomen, what should you look for? What could these mean?

A

Distention: obstruction
Abdominal contours: abdominal mass
Discoloration like bruising: bowel incarcerations or perfusion is altered
Rebound and guarding

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12
Q

What does an increase/decrease in bowel sounds mean? What would they sound like for an obstruction

A

Increase: excessive peristalsis, gastroeneritis OR before level of obstruction

Decrease: decrease peristalsis, peritonitis/apendicitis OR after level of obstruction

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13
Q

What spot should you palpate/percuss last?

A

The spot that is painful

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14
Q

What are diagnostics tests that should be run for abdominal pain?

A

CBC, CMP, UA
Inflammatory markers: ESR, CRP
Pregnancy test
Stool cultures
Ultrasound/CT
Barium enema and x ray
Endoscopy
Colonoscpy

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15
Q

Would you use an ultrasound or CT in peds?

A

Ultrasound because their bellies are thin so you can see better

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16
Q

What are 6 important nursing diagnosis r/t GI?

A
  1. FTT or impaired weight gain
  2. Fluid volume deficit
  3. Pain
  4. Delayed G&D
  5. Risk for aspiration
  6. Risk for altered perfusion
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17
Q

What on the Bristol stool chart considered normal?

A

Type 3 and Type 4

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18
Q

How do you evaluate interventions?

A

Weight Gian
Pain relief
Appetite
BMs
UOP

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19
Q

What are nursing interventions that can be done for GI issues?

A
  1. IVF
  2. I&Os
  3. PEWS/VS
  4. Focused GI/respiratory
  5. Surgical care
  6. G-tube care
  7. Bowel regimen
  8. Pain management
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20
Q

Interventions to increase weight Gian/nutrition

A

Dietician, enteral feedings and supplemental nutrition

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21
Q

How do you decrease the risk of aspiration?

A

Clear airway
Positioning
Small feeds

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22
Q

What is gastroesophageal reflux? When does It peak? What is the treatment?

A

Normal baby spit up, happy spitters, asymptomatic

Peaks in 4-6 months

Resolves spontaneously, at 6 months normal foods so it will decrease and by 18 months will be completely gone

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23
Q

Why does gastroesophageal reflux peak at 4-6 months?

A

Generally happens with increase pressure on the abdomen

Sitting and rolling

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24
Q

When does GERD occur?

A

Preemies and complex diseases

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25
How does GERD present in children?
Pain FTT and poor weight gain Cry during feeds Arch away from feeding Look like it is hurting to swallow
26
What does GERD increase the risk of in babies? Why?
Aspiration and apnea Vomitting so frequently even in sleep
27
What is the medical management of GERD?
Position the baby upright for feeds and 20 minutes after feeds Allow them to be prone while supervised b/c decreased pain Feed small frequent meals and burp after every 1-2 ounces Education parents on CPR d/t increased risk for aspiration and apnea Medications: PPI and famotidine Surgery required if extreme
28
What is the cause of gastroesophageal reflux and GERD?
Caused by a weakness in lower esophageal sphincter that allows for the contents of gastro to reflux up Usually 1-2 ounces
29
What is considered delayed meconium? What are you worried about with delayed meconium?
24-36 hours of life w/o meconium Concerned about CF, thrones, congenital hypothyroidism
30
When would you consider using cereal to thicken milk?
If child is not gaining weight
31
What are the obstructive disorders?
Pyloric stenosis Intussiception Hieschsprung disease
32
What are the interventions for obstructive disorders?
Prepare for surgery IVF NPO Pain management
33
What are the s/s of pyloric stenosis?
Look ill and hangry - fussy Vomiting will be impressive Presents much sooner than GERD Dehydrated Weight loss Palpate olives sized mass in epigastric region
34
What is the cause of pyloric stenosis? What is the treatment?
Muscle in the pyloric opening is hypertrophied and closes/obstructs the passage of good Treatment is surgery
35
When does pyloric stenosis peak?
2-4 weeks of age
36
What is intussusception? What could it cause?
Telescoping of the intestine which leads to an obstruction Decrease perfusion, inflammation, septic shock/death, gangrene, infection
37
When does intussusception peak? What is the diagnostic?
Peaks in toddlers (6 months - 3 years) Barium enema
38
How do you treat intussusception?
Barium enema - force area of intestine to be straightened out but tends to return within 24 hours so need to stay overnight and be rechecked Surgery (this is a surgical emergency if barium enema doesn't work)
39
What are the s/s of intussusception?
Healthy No appetite Start by squatting in pain and then perk up, overtime pain is more persistent and severe Child crying all the time doesn't want to eat, sleep, play Fever Gaurding abdomen Currant jelly like stools Possible mass palpated
40
What is Hirschensprung disease?
total absence of autonomic nerve cells in a portion of the colon therefore peristalsis cannot happen in that area which created a congenital aganglionic megacolon and can lead to enterocolitis and evolve into peritonitis
41
What does the assessment of a child with Hirschensprung disease look like?
FTT Fever Distended abdomen BS are hyperactive before obstruction and hypoactive after obstruction Guarding abdomen LLQ palate mass Percuss sounds dull over the solid BM
42
When does Hirschensprung disease turn into a surgical emergency?
Fever and explosive/forceful diarrhea
43
What is the difference between Hirschensprung disease in a newborns and older infant/preschool/toddler
Newborn: full - delayed meconium Older infant/preschool/toddler: partial - FTT, ribbon like stools, constipation, fecal masses
44
What do you diagnose Hirschensprung disease?
Rectal biopsy
45
How do you manage Hirschensprung disease?
Rectal irrigations Surgery: remove section of bowel and pull through to the rectum OR temporary stony and pull through Lifelong bowel stimulation and regulation (miralax, enema, digital manipulation)
46
What are the types of structural disorders?
Midline Cleft lip and palate Tracheoesophageal fistula or atresia Abdominal wall defects
47
What are the risks associated with structural disorders?
Infection Necrotizing enterocolitis Sepsis Chronic abdominal indues (feeding tubes) FTT Aspiration
48
What occurs in Tracheoesophageal fistula or atresia?
Trachea and esophagus are undifferentiated, become tangled or malformed
49
What are the s/s of Tracheoesophageal fistula or atresia? When are these seen? What type of emergency is this?
Threee C's Coughing, choking, cyanosis Seen with feeds - need to stop and treat RESPIRATORY emergency
50
How do you diagnose Tracheoesophageal fistula or atresia? Treatment?
Contrast abdominal x ray Prenatal diagnosis Treat surgically - no feeds until then
51
What us the first thing to do with a cleft lip/palate?
Establish a normal feeding and strong suck - may need to modify feeding techniques to allow for adequate growth Establish a bond with parents - bond at risk
52
When are cleft lip/palates fixed?
6-24 months
53
What are the s/s of appendicitis?
Pain starts in the periumbilical/vague region --> localizes to RLQ (mcburnies point) Pain proceeds diarrhea Guarding Fever Acute pain starts within 24 hours
54
What are some lab values that may be different with appendicitis?
High WBC count Increase inflammation markers
55
What is the peak age for appendicitis?
school age to adolescent
56
What is a complication of appendicitis? What are the s/s of this?
Perforation of the appendix if diagnosis is missed --> sepsis S/s: severe pain that significantly improves and then clinical deterioration occurs
57
What is the difference between inflammatory bowel disease and appendicitis?
Ultrasound will show an inflamed appendix
58
What are the s/s of inflammatory bowel disease?
Chronic pain (3 or more months) Pain is episodic Joint pain Rash Delayed puberty Poor growth Bloody diarrhea Feeling of BM but nothing comes
59
What is the treatment of inflammatory bowel disease?
Immune modulators Immune suppression Surgical management for pain Nutritional support
60
How do malabsorption disorder present?
Chronic FTT Chronic abdominal pain Foul, greasy stools with undigested food particles
61
What is the patho behind celiac disease?
Immune dysregulation to the digestion of gluten Protein touches the vili in small intestine --> inflammation and destroys vili and loose surface area in the gut that absorbs nutrients
62
What type of stool is associated with celiac disease?
Loose/explosive stools
63
How do you diagnose celiac? How do you treat it?
Biopsy to confirm diagnosis - FTT prior to Treat by avoiding gluten which is found in wheat, rye, barely, and oats
64
What is occurs in cystic fibrosis?
Pancreatic insufficiency --> malabsorption because body isn't excreting the enzymes needed to digest food Bowel obstructions DM
65
What should diet and hydration look like for a patient with CF?
high fat, high protein, high calorie diet (might not be able to consume all calories needed orally so supplement with G-tube may be needed) 2-3 L of hydration/day
66
What type of supplement do patients with CF need to take?
Vitamin A, D, E, and K Pancreatic enzyme supplement every time eat
67
What type of stool does a patient with CF have?
Steatoea - fatty stools

Fall - Pediatrics (15 decks)

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