GI/GU Flashcards
(117 cards)
1
Q
Stomach capacity of infant
A
30 to 300 mL
2
Q
T or F: Gastric reflux doesn’t hurt the infant.
A
TRUE
normal reflex ok
not as acidic
3
Q
T or F: Food remains in the infant stomach for longer periods of time
A
FALSE
shorter
eat more often
4
Q
Dehydration definition
A
total output of fluid exceeds the total intake
5
Q
Low urine output = < __ ml/kg/hour
A
< 1 ml/kg/hr
6
Q
Minimum # of voids we want to see in the first 6 days of life
A
1 void a day, per day up to 6 days of life
7
Q
Minimum # of diapers we want to see a day
A
6 diapers a day
8
Q
We get concerned when child hasn’t voided in __ hours
A
8 hours
9
Q
Dehydration symptoms (many)
A
decreased urine output
darker colour
LOC changes
dry mucous membranes
sunken eyes
sunken fontanelles
tachycardia
tachypnea
headache
thirst
low BP
10
Q
What is a later, concerning sign of dehydration?
A
low BP
11
Q
Best fluid type to give:
a) oral fluids
b) IV fluids
A
a) oral fluids
give IV fluids if severely dehydrated or can’t keep fluids down
12
Q
Medication commonly given with fluids
A
anti-emetic
Ondansetron
to keep fluids down
13
Q
Fluid amount to give dehydrated child
A
start with 10 mL every 10 minutes
14
Q
Bolus amount to give
A
10-20 mL/kg
normal saline
20 mL/kg if SEVERE
15
Q
Nursing care
A
encourage hydration
ins and outs
assessing symptoms
parent education
16
Q
Symptoms of GI dysfunction (many)
A
underweight, weight loss
N/V
diarrhea
jaundice
abnormal bowel sounds
blood in vomit or stools
abdominal pain*
abdominal distention
dysphagia - not as common in children
17
Q
Failure to thrive
A
weight less than 2nd percentile for age and sex
decreased velocity of weight gain disproportionate to growth in length
18
Q
Reasons for failure to thrive (5)
A
1) inadequate caloric
2) inadequate absorption
3) increased metabolism
4) defective utilization
5) increased urinary or intestinal losses
19
Q
Reasons for inadequate calories (many)
A
finances
appetite
inadequate breast milk
inadequate formula prep
eating disorders
ARFID
drinking too much cow’s milk
20
Q
Reasons for inadequate absoprtion
A
Crohn’s
Celiac
obstruction
21
Q
Reasons for increased metabolism
A
cardiac issues
hyperthyroidism
22
Q
Reasons for ineffective utilization
A
Trisomies
23
Q
Reasons for increased urinary or intestinal losses
A
diarrhea
vomitting
24
Q
Evaluation of failure to thrive
A
history**
age of onset, pattern over time
family history
diet & feeding
psychosocial issues, ACES
examination (-weight, length, ratio
head circumference in infants)
development and behaviour - milestones
25
T or F: There is no definitive diagnostic test for failure to thrive
TRUE
lab tests - immune?
-CBC
-ESR
urinalysis and culture - UTI? protein? carbs?
26
Mainstay of failure to thrive management
nutritional therapy!
gives calories and nutrition
if they gain weight, then we know its social
27
Disorders of Motility (5)
1) diarrhea
2) constipation
3) Hirshprung disease
4) vomitting
5) Gastroesophageal reflux
28
Most significant complication of diarrhea
dehydration!
29
Common causative organisms of diarrhea in children (3)
1) COVID
2) norovirus
3) salmonella
-reptiles, turtles
30
Acute diarrhea
SUDDEN increase in frequency & change in consistency of stools
>3 loose or watery stools in 24h; OR several watery stools that exceeds the child’s usual number by 2 or more
may be associated with URI or UTI, antibiotic therapy or laxative use
31
T or F: Acute diarrhea is usually self-limiting.
TRUE
<14 days
32
Nursing considerations for acute diarrhea management
emotional support
child may not want to talk about it
rest and comfort
adequate nutrition
handwashing
teach about symptoms of dehydration
33
T or F: You should not offer the child with acute diarrhea liquids if they already have an IV in place.
FALSE
offer liquids throughout
34
Diarrhea prevention
teach personal hygiene
clean water supply
careful food prep
handwashing
35
Idiopathic (functional) constipation
no known cause
36
Chronic constipation
may be due to environmental or psychosocial factors
37
The first meconium should be passed with the first ___ to ___ hours of ife
24 to 36 hours
38
Causes of constipation in the newborn period
1) imperforated anus
2) Hirschsprung disease
3) hypothyroidism
4) meconium plug
5) meconium ileus (CF)
39
T or F: Constipation is rare in the breastfed infant.
TRUE
more common in formula fed infants due to iron
40
Constipation in infancy
diet related (formula)
transitioning to solids
41
Interventions for constipation infancy
making sure they’re mixing formula correctly (not too thick/concentrated)
rule out organic causes - e.g. Hirschprung
42
Constipation in childhood
often due to environmental changes or control over body functions
painful defecation
toilet training and pressure on child
stress
encopresis
43
Encopresis
involuntary passage of stool in underwear after acquisition of toilet training
liquid stool passing around rock hard stool
requires intervention
44
Encopresis types (2)
1) retentive
-most common*
2) non-retentive
-psychosocial link
45
Constipation management
hydration
mobility
heating pad for comfort
diet - prunes
glycerin suppositories
decrease in stress
46
Approach for encopresis
from TOP and BOTTOM
TOP: strong laxative like PEG 3350
BOTTOM: enema
47
Hirschsprung Disease
aka congenital aganglionic megacolon
mechanical obstruction from inadequate motility of intestine
absence of ganglion cells in colon
lack of innervation = no peristalsis
48
Part of the colon affected by Hirschsprung Disease
rectosigmoid area
49
Major/serious side effect of Hirschsprung Disease
enterocolitis
50
enterocolitis
inflammation of small bowel & colon
leading cause of death
can lead to toxic megacolon
51
Diagnosis of Hirschsprung Disease
rectal biopsy
52
Treatment of Hirschsprung Disease
surgery
53
T or F: Gastroesophageal Reflux (GER) is a cause for concern.
FALSE
typically resolves in 1st year of life
gastric contents not as acidic
underdeveloped sphincter in stomach
54
Management of GER
no intervention for child that is growing
avoid tobacco smoke
feeding positions
medications – dependent on severity, most can be treated with meds
surgery – Nissen Fundoplication
55
When would surgery be considered for GER?
in severe cases
causing aspiration, pneumonia, affecting respirations
56
Nursing considerations for GER
dehydration
keeping upright
emotional support
57
Gastroesophageal Reflux Disease (GERD)
serious manifestation of GER
lower esophageal sphincter relaxes
poor weight gain
esophagitis
persistent resp symptoms
requires treatment!
58
Treatment for GERD
PPI
omeprazole
59
Immediate goal of vomiting management
recognize SERIOUS conditions for which immediate intervention is required
60
Concerning signs of vomiting in neonates
vomiting > 12 h
green/yellow vomiting (bile)
61
Concerning sign of vomiting in children under 2
vomiting > 24 h
62
Concerning sign of vomiting in older children
vomiting > 48 h
63
Other concerning signs
dehydration symptoms
altered LOC
symptoms of appendicitis, infection, head injury, meningitis etc.
64
Treatment of vomiting
aimed towards cause
Ondansetron
65
Why is Ondansetron preferred over Gravol?
Gravol makes you drowsy
66
Nursing considerations - vomiting
ins and outs
rehydration
characteristics of emesis
mental health - binge/purge
67
T or F: The BRAT diet is recommended for gastro.
FALSE
lacks protein and calories
whatever they want that is easily digestible for the next 48 hours
68
Inflammatory disorders (2)
1) appendicitis
2) IBD
69
Acute appendicitis
obstruction of the lumen of the appendix, usually by a fecalith
most common cause of emergency abdominal surgery in children
peak: 10 to 16 years, rare < 5
70
Symptoms of acute appendicitis
pain - RLQ
vomiting, nausea
fever
increased WBC
increased signs of infection
abdominal distention
71
Complication of acute appendicitis
ruptured appendix
72
Symptoms of a ruptured appendix
more septic looking, more symptoms, full body
pain STOPS!********** (swelling is relieved when it bursts - then comes back but more generalized)
73
Diagnosis of acute appendicitis
history and physical
blood work - WBC
younger kids: ultrasound
older kids: CT
74
Treatment of acute appendicitis
rehydration
antibiotics - typically not
surgical intervention
75
Treatment of ruptured appendix
appendectomy (laparoscopic)
may give antibiotics
76
Post-op appendectomy - perforated
IV antibiotics
bowel rest (probably going to have paralytic ileus)
NG - decompression
NPO
drains
77
Important considerations for NG
replace NG losses to avoid dehydration and hypokalemia
normal saline and potassium
78
"Sham clear fluid"
letting child drink, but suctioning it so it doesn't count towards intake
comfort measure
79
Discharge post-appendectomy
need to be at least passing gas
stable, pain controlled
regular diet as tolerated
no lifting over 10 pounds for 6 weeks
shower: wait 48 hours
swim/bath: wait 2 weeks
80
Forms of IBD (2)
1) ulcerative colitis
-limited to colon and rectum
2) Crohn's
-any part of GI, most often terminal ileum
81
Symptoms of IBD
diarrhea
anorexia
bloody stools
weight loss
joint pain
82
Diagnosis of IBD
H&P
lab Tests – CBC, ESR, CRP
endoscopy & colonoscopy – biopsies
CT & Ultrasound
83
Goal of IBD management
control inflammatory process to reduce or eliminate symptoms
84
IBD management
surgery - moreso for UC
meds - 5-ASAs, corticosteroids, immunomodulators, antibiotics, biologics
nutritional support
-partially broken down formulas
mental health, stress, emotional support
85
Structural defects (2)
1) cleft lip or palate
2) hernias
86
Cleft lip or palate
embryonic development
lip and/or palate
linked to teratogens
more common in boys
cleft LIP - ultrasound
cleft palate - feel with gloved hand
87
Biggest nursing consideration for cleft lip or palate
assistance with feeding!
upright position
special nipples
-CL/CP nurser
-Haberman Nipple
head cradled in hand
88
Long-term consideration for cleft lip or palate
speech therapy
89
What to avoid in cleft lip or palalate
suction
tongue depressors
spoons
straws
90
When is repair for cleft LIP typically done?
4 months
91
When is repair for cleft PALATE typically done?
9 to 12 months
92
Hernias
protrusion of a portion of an organ or organs through an abnormal opening
93
Hernias types (4)
1) umbilical hernia
2) inguinal hernia
3) omphalocele
4) gastroschisis
94
Omphalocele
congenital defect caused by abdominal wall that doesn’t close properly
internal organs - stomach, intestines, liver - outside of body through hole
95
Omphalocele care considerations
deliver as close to term as possible
may need to do C-section
NICU
keep covered and moist****
96
Gastroschisis
hernia through the bowel
put in silo and moves down through gravity
97
Gastroschisis care considerations
long-term: constipation
good recovery
body image - umbilicus isn't in normal spot
98
Obstructive disorders (2)
1) pyloric stenosis
2) intussusception
99
Pyloric stenosis
hypertrophic obstruction/enlargement of the pyloric sphincter at bottom of stomach
food can't empty from stomach --> duodenum
symptoms begin around 3-5 weeks of age
100
Symptoms of pyloric stenosis
non-bilious emesis***
projectile emesis***
emesis - food they've just eaten
right after eating
hungry, irritable
abdominal pain
101
Nursing considerations for pyloric stenosis
fluids and electrolytes
minimize weight loss
surgery needed*
promote rest and comfort
prevent infection
provide supportive care
102
T or F: Vomiting after pyloric stenosis surgery is a cause for concern.
FALSE
may vomit, caused by swelling
but won't be projectile
reassure parents
103
Intessuption
proximal segment of bowel telescopes into more distal segment, pulling mesentry with it
104
Symptoms of intussusception
red jelly stool*
colocy pain that comes and goals
vomiting
105
Treatment for intussusception
pneumatic or hydrostatic reduction
surgery if more severe
106
How to know if intussusception has resolved?
passage of brown stool
107
T or F: Recurrence of UTIs is normal.
FALSE
recurrence isn't normal
needs investigation
108
Factors contributing to development of UTI (many)
hygiene
short urethra
urinary stasis
alteration in urine and bladder chemistry
hydronephrosis
VUR
109
Most common cause of UTIs
E. coli
110
UTI symptoms
incontinence in a toilet-trained child
pain
strong or foul-smelling urine
frequency or urgency
111
UTI diagnosis
urine culture and sensitivity
112
UTI treatment
antibiotics
penicillin, sulfonamide, cephalosporins, nitrofurantoin
113
Sign that UTI is causing kidney infection
back pain
more sick
114
Wilm's tumour
aka nephroblastoma
malignant renal and intraabdominal tumor of childhood
115
Wilm's tumour symptoms
abdominal mass
hematuria
decreased urine output
hypertension
116
What do you need to be careful about when assessing for Wilm's tumour
be careful during palpation
don't want tumour to rupture
117
Wilm's tumour treatment
surgery
chemo
