GI Disorders Flashcards
(108 cards)
1
Q
Deciduous teeth appear….
A
6 - 24 months
2
Q
Tonsils aren’t seen in infants but become visible by age 2
When do they begin to atrophy….
A
6yrs
3
Q
Regurgitation is common in less than 1 yrs due to a weak ….
A
Lower esophageal sphincter
4
Q
Stomach capacity by age.
New born…
2 months…
16 yrs….
Adult….
A
New born 10 - 20ml
2 months 200
16 yrs 1500
Adult 2000 - 3000
5
Q
At which age does hydrochloric acid reach adult level of production….
A
6 months
6
Q
Small intestines not functionally mature at birth.
What problems arise from this…
A
Absorption & Diarrhea
7
Q
The liver is relatively ( large / small ) at birth.
A
Large
Making it easy to palpation
8
Q
What does a potbellied stance in infants suggest…
A
Nothing. It’s normal
9
Q
Ausculate for ____ before identifying hypoactive / absent bowel sounds.
A
5 min
10
Q
During abdominal examination have child in this position…
A
Knee to knee
11
Q
Change ostomy pouching system every _____ days
A
3 - 5
12
Q
Ostomy
Measure Ostomy and cut skin barrier to this size…
A
1/8” larger than ostomy
13
Q
NG Tube
- Main purpose…
- Salem Sump NG double lumen tube used/ connected to suction. What level of suction…
- Irrigation of tube with 5 - 15ml (child) every ____ hours…
- Type of feeding that can be adminstered…
A
- Decompression/ Drain stomach of contents.
- 30 - 40 standard
- 4 -8
- None- bad practice
14
Q
Type of patients that have a ng tube ordered on intermittent suction…
A
Bowel obstruction
Postop illeus - purposeful suppression of peristalsis
15
Q
Umbilical hernias happen in infants why….
A
When fusion of the umbilical ring is incomplete at the point where the umbilical vessel exits the abdominal wall
16
Q
Umbilical hernia assessment.
Push hernia back into body to assess….
A
True
If can’t push back inside it is considered Incarcerated/ Strangulation
EMERGENCY
17
Q
SS of hernia Incarceration/ strangulation….
A
Hard
Discolored
Painful
Can’t be manually pushed back inside body
18
Q
Which age do umbilical hernia correct themselves…
A
By 4
19
Q
Inguinal hernias define…
happen how…
A
Abdominal/ viscera moves into inguinal canal
Defect occurs during embryonic development
REQUIRES SURGERY
20
Q
Bulging mass in lower abdomen/ groin area is found in…
Treatment…
A
Inguinal hernias
Surgery
21
Q
Inguinal hernia
Attempt to push hernia back through the Inguinal ring…
T or F
A
T
If doesn’t reduce. Medical emergency HCP
22
Q
Cleft lip / palate
Feeding difficulty
Alter teeth formations
Speech
Otitis media
Surgical intervention (AGE)
Lip….
Palate…
A
Lip 2-3 month
Palate 6-9 months
23
Q
Cleft lip / palate
Preop
- Feed up right & maintain upright for 30 minutes after…. Why?
- Burp how frequently…
A
- Aspiration risk
- Every 15 - 30mL
24
Q
Cleft lip / palate
Postop
Use ____ to stop infant from touching sutures….
Considerations for this intervention….
A
Elbow restraints
Remove & replace q2h
STAY WITH CHILD DURING REPLACEMENT/ NO MATTER WHT
25
Besides for analgesia purposes why ensure Postop Cleft lip and palate has pain medications on schedule...
Stop from vigorously crying
Which can break the suture lines
26
Constipation can be diagnosed in a >4 yrs if less than ____ per week.
3 stoola
27
Constipation causes:
Organic disorders (3)
Systemic disorders (3)
Organic: Hirschprung, strictures, anorectal malformation
Systemic disorders: hypothyroidism, chronic lead poison, Hypercalcemia
28
Hirschsprung disease
Origin...
SS
Newborns:
Failure to pass meconium within 24-48 hours after birth
Abdominal distension
Bilious vomiting
Refusal to feed
Infants & Older Children:
Chronic constipation since birth
Ribbon-like, foul-smelling stools
Poor weight gain and failure to thrive
Enterocolitis (severe complication) – Fever, explosive diarrhea, toxic appearance
TREATMENT.....
Congenital: ganglion lacking in colon & no peristalsis
Treatment
Surgical removal (pull-through procedure) of the aganglionic segment.
Temporary colostomy may be needed in severe cases.
29
Constipation can happen due to transient illness & Withholding/ Avoidance due to painful/ negative stooling experiences.
T or F
T
30
Bisacodyl & senna
Are used for...
Stimulant Laxatives
31
Enemas
Don't use in infants
Saline & mineral oil
32
To help constipation in <1 yrs old....
2 - 4 oz pear or prune juice
33
Posistion for enemas
Infant / toddler
Child / adolescente
Infant / toddler
On abdomen with knees bent
Child / adolescente
Left side with right leg flexed towards chest
Or
Head down on knees
34
How long to hold enema...
5 - 10
35
Is a specific volume of fluid needed in ememas...
Yes in peds
36
Gastroenteritis causes Diarrhea or Vomiting and is usually not serious
When is it worrisome...
<2 months
Dehydration from diarrhea >8
37
Cause of gastroenteritis....
Virus, bacteria, parasite
38
Mild to moderate dehydration
Severe dehydration
Interventions...
Mild oral rehydration
Severe iv bolus, fluid, oral
39
Foods generally not held longer than....
For diarrea/ vomiting
1 / 2 days
40
Obstruction of the gi tract can cause vomiting. It will require this type of intervention...
Gastric decompression
41
Why posistion a vomiting child upright...
Prevent aspiration
42
Why rinse mouth / brush after vomiting...
Hydrochloric acid contained in stomach juices damage teeth
43
Diarrhea is considered chronic....
Malabsoption , ibd, immunodeficiency
Acute...
Viruses (Mostly)
Bacterial/ parasitic
Antibiotics
Time frame....
Chronic 2 - 4 weeks
Acute >3 loose stools daily
44
After fluids & electrolyte are stable with diarrhea.
Encourage this type of diet...
Avoid these foods...
Regular
High in Glucose (Juice, Gelatina, Soad)
45
Oral candida albicans grows in theee types of areas...
Chronically moist
46
Trush (Oral Candida) is treated with...
Oral nystatin
47
Oral nystatin administration.
Infant/ neonates...
Older children...
Infant Paint Nystatin around the mouth
Older children: adminster 1/2 dose in each side of the mouth and swish for several minutes before swallowing
48
Projectile vomiting (non bilirubin maybe blood tinged)
Hungry: accepts 2nd Breastfeeding after vomiting
No pain / discomfort Except Hunger
Dehydration
Distended upper abdomen
Palpable olive shapped mass in epigastrum - Right to the umbilical
Visible gastric peristalsis waves that move from left to right
Hypertrophic pyloric stenosis
(I'm guessing in babies )
49
Hypertrophic pyloric stenosis
Projectile vomiting (non bilirubin maybe blood tinged)
Hungry: accepts 2nd Breastfeeding after vomiting
No pain / discomfort Except Hunger
Dehydration
Distended upper abdomen
Palpable olive shapped mass in epigastrum - Right to the umbilical
Visible gastric peristalsis waves that move from left to right
What is the Therapeutic Management.....
What is the nursing Management...
Pre (3)
Post OP
Vomiting....
Site covering...
Feeding...
Therapeutic: laparoscopic pyloromytomy ( cutting muscle of the pylorus)
Nursing:
Pre: Electrolyte balance, NPO, I&O
Post: Post op vomiting is common 24 - 48 hrs post surgery
Pain management
IV fluids
Dermabond to cover site
Feeding started shortly after
Differentiating between Vomit / Spit up
Pt can be released after eating goal amount
50
Intussusception happens when the proximal segment of the bowels telescopes into the distal end.
(Xan cause ischemia)
1. Most common....
SS
Acute abdominal pain
2. Posistion .....
3. Appearance between episodes..
Vomiting / lethargy.
4. Stool appearance...
Tender distension of ab
5. Palpable sausage shapped mass in ....
6. Eventually Fever, exhaustion, firm / hard abdomen (Sign of...)
1. <2 yrs
2. Knees to chest
3. Fine between episode
4. Red, current jelly
5. Upper right quadrant
6. Peritonitis
51
_____ is successful in reducing a large amount of cases of Intussusception.
Barium enema
52
If barium enema is unsuccessful at reducing Intussusception.
What is the next action...
Surgery
53
If bowel necrosis occurred due to Intussusception what is the solution...
Bowel resection
54
Befire giving a barium enema Intussusception use these nursing interventions...
Non-surgical post enema....
IV
NGT for decompression
Antibiotics
Observe for passage of water-solvable contrast material and stool patters
55
McBurneys Point - define location and significance...
Right lower quadrant
one-third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus.
Appendicitis
56
Appendicitis or Ruptured Apendix
Colicky
Cramping
Ab Pain - near umbilicus
NV / Anorexia / Diarrhea
Low fever
Appendicitis or Ruptured Apendix
Sudden relief of pain
Fever
Subsequent increased pain / guarding of abdomen
Abdominal distension
Tachycardia, pallor, chills, Restlessness, rapid shallow breathing
SS Appendicitis
Colicky
Cramping
Ab Pain - near umbilicus
NV / Anorexia / Diarrhea
Low fever
SS Ruptured Apendix - (Signs of peritonitis)
Sudden relief of pain
Fever
Subsequent increased pain / guarding of abdomen
Abdominal distension
Tachycardia, pallor, chills, Restlessness, rapid shallow breathing
57
Appendicitis is treated laparoscopic but may have to be an open surgery.
Which antibiotics are given pre-op...
Cetriaxone & metronidazole Q2H
58
A protozoan infection caused by person - person, animal, foods.
Contaminated water / diaper in the swimming pool
Causes this problem...
Therapeutic Management...
Giardias
Metronidazole (Flagyl)
Tinidazole
Nitazoxanide
59
SS of Giardiasis (protozoan infection) - treated with Metronidazole.
Asymptomatic
Or
Ab cramps, bloating, diarrhea
60
Enterobiasis...
(Pin/ Round worms)
61
Enterobiasis - Pin/Round worms
Caused by nematode
1. Transmission is favored in these types of environments...
Eggs ingested/inhaled (float in air)
Hatch in upper intestin3s and mature and migrate through system.
2. Female exits anus & does what...
3. SS...
4. Diagnosis...
1. Crowded
2. Lays eggs near anus
3. Anal itching
4. Tape test 3 rounds
62
How long after starting antiparasitario medication are they all dead...
2 weeks
63
GERD peaks when in infants and resolves without treatment when....
4 months - 1 yr
64
SS of GERD. Which are for children which are for infants.
Heartburn
Ab pain
Chronic cough
Dsyphagia
Asthma
Recurrent vomiting
Children or infants
Spitting up, regurgitation, Recurrent Vomiting
Excessive crying
Arching of back / Stiffness
Resp problems (Cough, wheeze, stridor, gag, choking)
Poor weight gain
Refuse to eat
Kids
Heartburn
Ab pain
Chronic cough
Dsyphagia
Asthma
Recurrent vomiting
infants
Spitting up, regurgitation, Recurrent Vomiting
Excessive crying
Arching of back / Stiffness
Resp problems (Cough, wheeze, stridor, gag, choking)
Poor weight gain
Refuse to eat
65
GERD
Infant feeding to help...
Mix 1 tbs rice ceral / 1 oz formal
66
Should the mother excluded irritating foods from her diet if breastfeeding baby with gerd
Yes
67
How long to keep baby up right after feeding if thy have GERD...
30 min
68
2 types of meds for GERD...
Histamine 2 Antagonist (famotidine)
PPI (pantoprazole)
69
Sever GERD can lead to aspiration pneumonia, failure to thrive, apnea
What is the management....
Also used if medication doesn't work.
Nissen fundoplication
Fundus is wrapped around the lower esophagus
70
Congenital agaglionic megacolon aka Hirschsprung.
Describe..
Congenital anomalie that results in mechanical obstruction of intestine from lack of peristalsis.
Due to lack of nerve ganglion in the intestines
71
New borns
Failure to pass meconium 48 hrs after birth
Refuse to feed
Bilous vomiting
Ab distension
Infants
Failure to thrive
Constipation
Distension
Diarrhea/ Vomiting
Enterocolitis: watery Diarrhea, fever, looks ill
Childhood
Ribbon like smelly stool
Visible peristalsis
Easily palpable fecal mass
Anemic appearance
Describes...
Hirschsprung
Congenital agaglionic megacolon
72
Diagnosis
Abnormal barium enema
Confirmed with rectal biopsy (absent ganglion cells)
Hirschsprung
73
Hirschsprung disease
Treatment...
Surgery (3 operations & a potential Temp ostomy)
74
Post op Hirschsprung treatment
1. What is done with post op vitals....
Post op ostomy care
Stool output & fluid status
2. Observe for Enterocolitis SS Including.....
3. Parent education on dilation of...
May require rectal irrigation
1. Abdominal circumference- increased distension is call HCP
2. Fever, ab distension, chronic/ explosive diarrhea, rectal bleeding/ straining
3. Parents dilate anus
75
Short bowel syndrome
Malabsorptive disorder that follows small intestine loss / resection
Primary consequence is diarrhea
SBS includes 2 important findings...
1. Decreased intestinal surface area for absorption
2. Need for parental nutrition
76
Monitor this level closer in a patient who is on TPN...
When to pay close attention to these levels...
Blood glucose
Starting, rate change, stopping
77
TPN is given when...
Longterm NPO
Swallowing difficulty
Short bowel syndrome
Necrotizing Enterocolitis
78
Best gluten free grains...
Rice
Oats
Quioma
Miles
Arrormath
Buck wheat
79
Why can't people with celiac disease eat gluten...
Unable to diges5 the protein
Leads to toxic build up that damages mucosal cells of small intestine.
Thus, Unable to absorb nutrients (iron, fat soluble vitamin, folic aicd)
80
SS
Rash
Osteoporosis
Short stature
Failure to thrive
Iron deficiency
Fatty stools
Vomiting
Ab pain
Diarrhea/ constipation
Ab distension/ wasted extremities
Celiac disease
81
___ antibody testing
Small intestine biopsy
For celiac disease
IgA
82
Should a pt continue to eat gluten if suspected celiac until all testing has been completed...
Yes, according to teacher
83
For poisoning
Call poison control center even in the hospital.
Why put child in side-lying or sitting posistion...
Prevent aspiration
84
Acetycysteine is used for...
Antidote for Acetaminophen OD
85
Growth failure
Organic / inorganic
Clinical Manifestions:
Weight is below the ___ percentage and weight-for-length is < ____ % for ideal weight
Weight is below the 5th percentage and weight-for-length is < 80 % for ideal weight
86
Correct determination of length of NG tube is decided by...
NEMU
Nose, Ear, midway to umbilicus
87
_____ is the gold standard NG placement determinant. But is not often done....(Why)
Radiography X-ray
Radiation exposure
88
NG Tube feeding (I guess it is ok)
Visual inspection of aspirate
Gastric....
Respiratory...
Intestineal....
Gastric: clear / off white or tan / brown tinged
Respiratory: same as gastric
Intestineal: bile stained, light / dark yellow, greenish brown
89
pH determination of correct NG tube placement....
Auscultation method....
pH <5 maybe <5.5
Auscultation NOT accurate
90
Drooling ___ during Infancy and ___ during toddlerhood
Increase/ decrease
91
How to best assess if the belly is distensted in an infant...
Ask parents how it normally looks
92
GI Assessment
Start with which technique...
And describe the process.
Inspection
Auscultation
Percussion
Palpation
93
Ostomy care products
Duoderm
Adapt cream
Cavilon
Duoderm: patching leaks for stomas
Adapt cream: fills cracks and bumps; like caulk
Cavilon: preps skin barrier
94
Type of patients who need gastric decompression...(6)
Postoperative patients: Especially after abdominal surgery, where bowel motility is temporarily impaired.
Gastrointestinal obstruction: This includes mechanical obstructions such as tumors, adhesions, or hernias.
Severe ileus: A condition where the intestines stop functioning, leading to the accumulation of stomach contents.
Gastric distension: This may occur due to a blockage or inability to expel stomach contents.
Trauma patients: Particularly those with injuries to the abdomen or who are at risk of aspiration.
Patients with swallowing difficulties: Such as those with neurological disorders that affect the ability to swallow properly (e.g., stroke or dementia).
Gastric decompression is often achieved through a nasogastric (NG) tube or an orogastric tube to remove stomach contents and relieve pressure.
95
Types of patients who recieve gastric decompression
Postoperative patients: Especially after abdominal surgery, where bowel motility is temporarily impaired.
Gastrointestinal obstruction: This includes mechanical obstructions such as tumors, adhesions, or hernias.
Severe ileus: A condition where the intestines stop functioning, leading to the accumulation of stomach contents.
Gastric distension: This may occur due to a blockage or inability to expel stomach contents.
Trauma patients: Particularly those with injuries to the abdomen or who are at risk of aspiration.
Patients with swallowing difficulties: Such as those with neurological disorders that affect the ability to swallow properly (e.g., stroke or dementia).
Gastric decompression is often achieved through a nasogastric (NG) tube or an orogastric tube to remove stomach contents
96
What is special about the haberman nipple & pigeon bottle....
They are used to feed infants with cleft lips / pallete
97
Post op for a cleft lip / pallete
Goal: have no episodes of gagging or aspiration.
(5) Interventions....
Asess vs
_____ at bedside
Upright posistion for feeding
Hold up right ______ after eating
Burp frequent ____ mL
Asess vs
Suction equipment and bulb syringe at bedside
Upright posistion for feeding
Hold up right 30 minutes after eating
Burp frequent 15 - 30 mL
98
Cleft lip repair surgery will require this intervention to the nose postop.
Nasal irrigation through the nasal stenosis
1 mL Q2-4H
99
Diarrhea will cause
This acid base balance...
This K balance...
Metabolic acidosis
Hypokalemia
100
Breastfeed babies color of stool...
Yellow / Seedy
101
Pain starts in mid-epiastric region and moves to McBurneys point...
Appendicitis
102
What is the cause of appendicitis...
Possible previous viral infection
103
Appendicitis
Best way to return mobility to the gi tract.
Ambulation
104
Most common parasitic infection...
Giardiasis
105
Enterobiasis (Pin/Round worms)
SS - Anal itching
Interventions...(2)
Keep finger nails short & clean
Dress in onesie to stop from itching
106
What is a big defining factor to treat GERD..
Failure to thrive
107
What is Enterocolitis...
Enterocolitis is an inflammation of both the small intestine (enteritis) and colon (colitis). It can be caused by infections, inflammatory conditions, or ischemia
108
TPN & Gtube feeding is hard on this organ....
Increasing mortality rate
Liver
