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NRSR 22 > NRSR 22 Unit 3: Pedi GI Disorders > Flashcards

NRSR 22 Unit 3: Pedi GI Disorders Flashcards

1
Q

How can you tell before regurgitation and vomiting?

A

Regurgitation shortly occurs right after consumption. Less digested. Peristaltic waves also may reverse.

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2
Q

When tube feeding, why is rate a concern?

A

Dumping syndrome. May not be able to digest the nutrients, because the peristalsis is fast. Diarrhea will occur.

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3
Q

How long should an infant go without feeding?

A

No more than 4 hours. Especially for an ill child. Sleeping for 5 hours can be a problem for a child if it goes without feeding.

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4
Q

Which enzymes are missing before 4 months?

A

Amylase, lipase, and trypsin. Children usually begin on solids until 4-6 months. Digestion development does not begin until that age.

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5
Q

Why check for respirations on an infant?

A

Aids in detecting anatomical defects.

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6
Q

Why is urine specific gravity important?

A

Fluid levels and ???

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7
Q

What is indicative of aspiration?

A

Episodes of apnea and respiratory distress.

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8
Q

Why is hydration status important for a child?

A

Most of the child consumed is liquid and the infant’s body has a higher percentage of water.

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9
Q

When does cleft lip and palate develop?

A

They occur at the 12th week of gestation. Development occurs between the 7th and 12th week. from the lateral and then toward the center. If by 12th week closure does not occur completely, cleft develops. Most common is cleft and palate unilateral.

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10
Q

Why would a physician insert a finger in the infant’s mouth?

A

To check a sucking reflex and palate.

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11
Q

Who is part of the collaborative team for lip and palate cleft?

A

need notes

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12
Q

Why is repairing the lip cleft performed first?

A

Bonding between child and parent, reactions from other adults. Also for sucking.

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13
Q

Cleft Peroperative Care Consideration

A
  1. Continuously assess respiratory status during feeding.
  2. Feed infants in upright position.
  3. Feed infant slowly, burp frequently.
  4. Use alternative feeding devices (elongated nipple and breast shield.
  5. Assess degree of cleft and ability to suck.
  6. Encourage parents to verbalize fears, concerns and negative emotions.
  7. Refer to community resources and parent support groups.
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14
Q

Why is not GT tubing common?

A

There is a small window when infants need to learn how to suck. If not learned after birth, learning to suck later is very difficult.

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15
Q

Cleft Lip and Palate Postoperative Care Part 1

A
  1. No oral temp assessment
  2. No utensils, fingers or pacifiers around mouth for 7 to 10 days.
  3. Cleft lip: resume preoperative feeding technique. Still may allow to suck.
  4. Cleft palate: Liquids taken from cup but no straws. Soft food can be taken side of the spoon. Child is not allowed to feed self.
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16
Q

Cleft Lip and Palate Postoperative Care Continued

A
  1. Clean lip from culture line. Avoid hard scabs b/c it will cause scares.
  2. Apply antibacterial ointment
  3. Use elbow restraints
  4. No tooth brushing for 1 to 2 weeks.
  5. Place infant in supine or side lying position to avoid excessive contact with linen.
  6. Analgesics and sedatives (not common) as ordered. Children may not want to eat due to discomfort in the mouth.
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17
Q

What are concerns for postoperative palate repair?

A

Palate repair may swell and be edematous. Mist may help to reduce the inflammation.

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18
Q

What is pyloric stenosis?

A

Hypertrophy in the pylorus sphincter which causes an obstruction to the duodenum. As the child vomits, the hypertrophy/edema swells and further obstructs the lumen.

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19
Q

Who is affected more by pyloric stenosis?

A

Most often with firstborn child and males. Occur within 2 to 4 weeks after birth.

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20
Q

What are clinical manifestations of pyloric stenosis?

A
  • Projectile vomiting
  • Failure to gain weight
  • Hungry - wants to eat after vomiting
  • Palpable mass to right of the umbilicus.
  • Visible peristaltic waves.
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21
Q

Nursing considerations for Pyloric stenosis.

A
  • Depends on underlying cause
  • Prevention of dehydration /hydration maintenance
  • Rehydrate if needed to replenish K+ sotres and correct alkalosis.
  • NPO if blockage or obstruction is suspected.
  • Family teaching: Family is not aware of the importance to dehydrate.
22
Q

Post OP Care

A
  • Procedure: Pyloromyotomy - Surgically incise the muscle around the pyloric sphincter. Longitudinal incision.
  • Feedings begun 4-6 hours postop (must wave for bowel sounds)
  • Nursing priority is to document how the infant tolerates the feedings (breast milk or formula). I&O are extremely important.
23
Q

What is first assessment after Post Op?

A

Bowel sounds, respiratory system. Find out able to eat and not vomit.

24
Q

What is Tracheoesophageal Fistula (opening) or Atresia (Dead End, blind pouch)?

A
  • Malformation that results from failure of esophagus to develops a continuous tube during the 4th to 5th weeks of gestions.
  • Caused by defective separation, incomplete fusion or altered cellular growth.
25
Q

What is type A Tracheosophageal complication

A

Separation of the esophagus with an atresia at the top and a fistula to the trachea at the bottom. Very common (85%?) and complicated.

26
Q

What are the three C’s?

A

Chocking, coughing and cyanosis

27
Q

Clinical manifestations of tracheosophageal complication

A
  • Excessive salivation
  • Drooling with coughing, choking and sneezing (infants do not sneeze unless build up salivation).
  • Cyanosis secondary to laryngospasm.
  • Increasing respiratory distress
28
Q

First steps before surgical repair before connecting the esophagus.

A
  1. Remove the fistula from esophagus to trachea.
  2. Place NG tube
    The esophagus is not repaired yet because there may be enough tissue to make the connection. Usually surgeries are not performed until infant weights over 10lb (3 months old).
29
Q

What are Collaborative treatment goals of tracheoesophageal fistula and/or atresia?

A
  1. Prevent respiratory distress
    - First priority
    - Remove secretions
    - NPO
    - Positioning
  2. Provide nutrition
    - GT feedings
    - After repair, there may not be normal esophageal peristalsis.
    - May need therapy to learn how to eat after NPO for months.
30
Q

Collaborative Treatment Goals Continued

A
  1. Prevent complications pre- and post-op.
    - Aspiration pneumonia
    - Post-op injury to surgical repair site
    - Stricture at anastomosis site
    - Leaking at anastomosis site (increased saliva, secretion, increased WBC and unstable temp)
  2. Support the infant and family
    - Provide non-nutritive sucking (pacifier). Ostomy is created in the neck in order to saliva to drain).
    - Teach care to family
    - Provide resources (emotional, financial)
31
Q

What questions to ask when receiving this type of patient?

A
  1. Eating
  2. breathing
  3. what type of surgical treatment
  4. Family education
32
Q

What causes acute diarrhea?

A

-Viral infection
-bacterial infection
-parasitic infection
Often called gastroenteritis

33
Q

What causes chronic diarrhea?

A

need notes

34
Q

What is included in diagnostic evaluation?

A
  1. Stool (most common): cultures, pH, RBC, leukocytes, glucose, blood
  2. Breath hydrogen test (Ruling all possibility for diarrhea eq. H. Pilori)
  3. Blood tests (most common): complete cell count, electrolytes, BUN, glucose blood cultures
  4. Radiographs
35
Q

Nursing considerations for patient with diarrhea

A

-Provide emotional support
-Promote rest and comfort
-Good hand washing
-Good skin care
-Ensure adequate nutrition: oral hydration therapy, CRAM diet (complex carb, rice and milk)
Oral hydration (Pedi-lite, rice-lite)
-Family and child eduction for home care.

36
Q

Why are children are at increased risk for dehydration?

A

need notes

37
Q

What are conditions that can cause dehydration?

A

need notes

38
Q

Stages of dehydration

A 
Mild = up to 5% of body wight lost. 40 to 50ml/kg
Moderate = 6% to 10% weight lost 50 to90 mL/kg
Severe = >10% or more body weight. 100+ mL/kg
39
Q

Clinical Assessment of Mild Dehydration

A
  • watery diarrhea
  • decreased urine output
  • increased thirst
  • slightly dry mucous membranes
40
Q

Clinical assessment of moderate dehydration

A
  • abnormal skin turgor
  • sunken eyes
  • very dry mucous membranes
  • depressed anterior fontanel
41
Q

Clinical assessment of severe dehydration

A
  • Signs of moderate dehydration +
  • rapid weak pulse/hyptension
  • cold extremities
  • oliganuria, coma
42
Q

Nursing assessment of dehydrated child

A

need notes

43
Q

What are management of dehydration?

A
  1. Restoration of circular by rapid expansion of extracellular fluid.
  2. Accurate identification of the degree of dehydration in addition to physical signs and symptoms.
44
Q

What are management of dehydration Continued

A
  1. Administration of fluid containing sodium by oral or IV.
  2. Replacement of loss over 24hr period + maintenance fluid
  3. Potassium is replaced only after urine output is adequate.
  4. Sodium bicarbonate if metabolic acidosis is present.
45
Q

What are the factors associated with Colic

A
  1. intermittent vigorous crying
  2. Self-limiting
  3. Other causes of crying/discomfort must be ruled out - Allergy, intolerance to formula
  4. Failure to gain weight and slow development can indicate underlying disease.
46
Q

Clinical Manifestations of Colic

A
  • intermittent loud cries often for several hours
  • infant’s face may become flushed
  • Distended and tense abdomen
  • Drawn up legs and clenched hands
  • Episodes often occur at the same time each day (late afternoon or early evening)
  • Crying may stop only after infant is exhausted or has passed flatus or stool
47
Q

Colic - nursing considerations

A
  1. Provide for emotional support
  2. Foster attachment
  3. Prevent or reduce episodes of colic
    - -Carry infant closely
    - -Change position frequently
    - -Massage to burp
    - -Don’t overfeed; change formula
    - -Distraction
    - -Caregiver should get help, adequate rest/relaxation
48
Q

What is Intusseception?

A

Telescoping or invagination of the ileum to the ascending colon.

49
Q

How to diagnose intusseception?

A

Barry enema. It could be used for treatment. It can push back the telescope. Also only bloody colon secretion will pass. Also look at age group: toddlers. 80% cases happen under 2yrs old.

50
Q

What is anastomosis site?

A

An anastomosis site is a surgical connection between two structures. It usually means a connection that is created between tubular structures.

NRSR 22 (12 decks)

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