GI Flashcards

Question

management of omphalocele & gastroschesis

Answer 1

bowel returned to abdomen if defect is large- staged repair done w/ silastic pouch/ "silo" TPN dependent potential for infection

Answer 2

both are congenital anomalies of anterior abdominal wall omphalocele- membranous sac covers exposed organs gastroschesis- organs not covered by membrane nursing management- minimize fluid loss, protect exposed abdominal contents from trauma/ infection, postop care, surgical repair of both defects occur after birth/ are done in stages

Answer 3

telescoping/ invagination of 1 portion of intestine into another- causes obstruction decreases blood flow to that area- causes ischemia/ pain, WBC may form pus/ bleeding occasionally d/t intestinal lesions, but often cause is unknown severe pain lethargy "currant-jelly" stools, gross blood sudden onset of intermittent crampy abdominal pain most common cause of intestinal obstruction in children <2 manifestations- sudden onset of pain, draw up legs, vomit; blood in stool; sausage-shaped abd. mass may be palpated; extreme paroxysmal pain (subsides then recurs); assess for shock treatment- US-guided saline, barium, air enema to reduce if no response- surgical emergency to avoid bowel necrosis laparoscopy- post-op treatment; gradually increase feeding after NG removal high risk of recurrence- have to be hospitalized for 24 hrs after

Answer 4

``` twisting of intestine obstruction of feces occurs d/t intestinal malrotation manifestations- pain, vomiting, signs of obstruction surgical emergency nursing care similar to intussusception ```

Answer 5

absence of ganglion cells in rectum & upward to colon- inadequate motility in part of intestine absence of ganglionic innervation leading to no persistalsis waves mechanical obstruction from inadequate motility of intestine incidence- 1 in 5000; more common in males & DS delayed passage of meconium- signs of obstruction ribbon-like stool (passing through small narrow segments) diagnosis- by rectal biopsy treatment- medical- stool softeners surgical removal of aganglionic segment w/ or w/out colostomy assess for enterocolitis (acute illness); completel bowel cleansing (enema/ GoLytely); bowel sterilization, IV abx pain management, I&O, VS, colostomy care, enterostomal therapy temporary ostomy/ "pull-through" procedure

Answer 6

imperforated anus identified in newborn period level of defect--> outcome of care staged repair for corrective surgery w/ ostomy major challenge- finding adequate nerve & muscle structures for normal evacuation associated anomalies absence/ stenosis of rectal cancal stool in urine d/t fistula to perineum stool in vagina d/t fistula DX- digital rectal exam, ultrasound, abd x-rays, CT scans treatment- low lesions w/ anal membrane- serial rectal digital dilations are effective higher lesions- 2-stage surgical repair

Answer 7

thickened/ constricted anal wall | characteristic ribbon-like stool

Answer 8

PE reveals absent anal opening | failure to pass meconium during 1st 24 hrs also diagnostic

Answer 9

pouch on wall of lower part of intestine (congenital) diverticulum may contain tissue that's identical to tissue of stomach/ pancreas digested food can cause diverticulitis remant of fetal duct (fiberous band connected from sm. intestine to umbilicus) *most common congenital malformation of GI tract surgery to remove diverticulum to prevent complications- ulceration, bleeding, intussuception, intestinal obstruction

Answer 10

hernia- protrusion/ projection of organ/ part of organ through muscle wall of cavity that normally contains it imperfect closure of umbilical muscle ring danger of incarceration/ strangulation protrusion of intestines through umbilicus shouldn't be hard, should be reducable should hear bowel sounds most spontaneously resolve by 3-4 yrs as muscular ring closes surgery if s/x of strangulation, increased protrusion >2 yrs of age/ no improvement in large defect after 4 yrs

Answer 11

inflammation of appendix caused by obstruction | dull steady umbilical pain that localizes to RLQ at mcburney's pt

Answer 12

``` administer enema hx of bowel patterns, medications, diet educate parents/ child dietary modifications *common in school-aged children ```

Answer 13

constipation- failure to achieve complete evacuation of lower colon encopresis- soiling of fecal contents into underwear beyond age of expected toilet training (4-5 yrs) may be 2ndary to other disorders- Hirschsprung, toilet refusal, bathroom accessibility, SCI, med side effects chronic constipation- envt/ psychosocial factors (stress) clean out w/ enema/ laxative, ensure hydration/ regular bowel regimen

Answer 14

``` common in childhood prevention of complications from loss of fluid antiemetic meds observe & record *metabolic alkalosis ```

Answer 15

leading cause of illness in children <5 acute infectious diarrhea- variety of causative organisms 20% of deaths in developing countries r/t diarrhea/ dehydration types- acute, acute infectious gastroenteritis, chronic, intractable diarrhea of infancy, chronic nonspecific diarrhea metabolic acidosis etiology- rotavirus, salmonella, shigella, campylobacter organisms, giardia, cryptosporidium, clostridium difficile, abx therapy

Answer 16

health hx- diarrhea, vomiting, decreased oral intake, sustained high fever diagnostic evaluation- wt. is most important determinant of percent of total body fluid loss in infants/ children VS, skin turgor, fontanels, mucous membranes, eyes, mental status, urinary output oral rehydration therapy nursing considerations- weight, I&O

Answer 17

rehydration solution of 75-90 mEq of Na+/ L give 40-50ml/ kg over 1st 4 hrs maintain hydration w/ solution of 40-60 mEq Na+/ L daily volume of maintenance hydration <150 ml/ kg/ day

Answer 18

100 ml/kg for 1st 10 kg 50 ml/kg for next 10 kg 20 ml/kg for remaining kg add together for total ml needed per 24 hr period divide by 24 for ml/ hr fluid requirement

Answer 19

fungal infection of oral mucosa children @ risk- immune disorders (corticosteroid inhaler use, chemotherapy, abx use), transmitted btwn infant & breastfeeding mother therapeutic management w/ nystatin/ fluconazole

Answer 20

obstruction of fecal matter, swollen lymphoid tissue, or parasite periumbilical pain w/ nausea, RLQ pain, & vomiting w/ fever ruptured appendix N/V, diarrhea, constipation WBC- 15-20, anorexia, fever, chills appendectomy IVF/ IV antibiotics pain management *watch for s/s of perforation- fecal material spills into abdomen causing peritonitis

Answer 21

vomiting vs "spitting up" overflowing (regurgitation) vs projectile esophagus is shorter distance to stomach, stomach contents come back up much easier GER- backward flow of stomach contents up into esophagus/ mouth; happens to everyone; in babies- small amount is normal & almost always goes away by the time child is 18 mos old GERD- when complications from GER arise- failure to gain wt, bleeding, resp. problems, cough, esophagitis *eg. after feeding, baby sticks back out immaturity of cardiac sphincter (LES) causes reflux of stomach contents into esophagus manifestations- regurgitation, fussiness 30-60 min after meal, poor growth 45-50% of healthy infants <2 mos have GERD, peaks @ 4 mos, then decreases when LES matures; resolves by 1 yo

Answer 22

nursing considerations- identify children, educate parents in home care, feeding, positioning, meds non-pharmacologic tx- smaller feedings, thicken formula, keep baby upright before/ after feeding, burping, if bottle feeding- find nipple that makes good seal to prevent air into mouth prokinetics- increase motility, usually w/ meds that inhibit acid antacids may be tried 1st in school-aged children 2 major therapies- H2 blockers (-ine)/ PPIs (-zole) 1st line is H2, then PPI

Answer 23

malabsorptive disorder absence/ deficiency of lactase--> inability to digest lactose more common in Asians, Native Americans, African Americans frothy diarrhea w/ presence of reducing substances, abd. pain, & distention treatment is avoidance of milk-based products, soy formula, elimination of milk-based products for breastfeeding mothers, use of Lact-Aid calcium/ vit. D supplementation

Answer 24

malabsorptive disorder decreased mucosal surface area, usually d/t small bowel resection prognosis has advanced w/ TPN & nutrition administer/ monitor nutritional therapy

Answer 25

AKA gluten-induced enteropathy & celiac sprue immunologic disorder in which gluten causes damage to small intestine 4 characteristics: steatorrhea general malnutrition abd. distention secondary vitamin deficiencies

GI Flashcards

(49 cards)