Nutritional and GI dysfunctions Flashcards
(106 cards)
1
Q
meconium
A
thick black tarry stools, sticks to babies skin
will turn to a yellow paste after 3 days
2
Q
swallowing becomes an automatic reflex action until
A
6 weeks of age
3
Q
at birth mechanical functions of digestion are
A
immature
4
Q
stomach acid is not fully present until what age?
A
6m of age
5
Q
most common vitamin deficiencies in childhood?
A
A,C, B2, B6, B12
6
Q
iron deficiency occurs most frequently in children aged
A
12-36 months
7
Q
Failure to thrive
A
inadequate growth resulting from the inability to obtain and/or use calories required for growth
8
Q
criteria to be diagnosed with FTT
A
weight/height below 5th percentile or persistent deviation from an established growth curve
9
Q
organic FTT
A
has a physical cause such as CF
10
Q
non-organic FTT
A
no underlying medical issue psychosocial factor (parents on drugs, don't recognize hunger cues, depression, neglect)
11
Q
idiopathic FTT
A
unknown cause
12
Q
factors that contribute to NFTT (non-organic)
A
caregiver has difficulty perceiving and assessing the infants needs, they become frustrated and angered at infants dissatisfied response poverty health beliefs inadequate nutritional knowledge family crisis feeding resistance insufficient breast milk
13
Q
therapeutic management of NFTT
A
catch up growth multidisciplinary team approach (peds forensics, PT/OT, dietician, case management) correct nutritional deficits treat underlying cause educate parents/ primary care givers
14
Q
feeding guidelines for NFTT
A
staff consistency quiet non stimulating environment be persistent (don't force, create a positive environment) fact to face posture introduce new foods slowly follow a structured routine
15
Q
cleft lip/palate
A
abnormal openings in the lip and/or palate
unilateral or bilateral
16
Q
what is cleft lip/ palate caused by
A
multi-factorial inheritance, factors and teratogens
17
Q
clinical findings with CL/CP
A
difficulty feeding mouth breathing ( more swallowed air with distended abdomen and pressure on diaphragm, dry cracked mucous membranes, increased risk of infection and aspiration pneumonia)
18
Q
what do you wait for before a CL/CP repair?
A
for teeth to form, but fix palate before speech starts
19
Q
when do you perform CL repair?
A
within the first weeks of life
z-plasty minimizes notching and lengthen the lip
20
Q
when do you perform CP repair?
A
12-18 months with obturators
21
Q
preop nursing considerations for CL/CP- parents
A
promote bonding
allow parents to express grief and fears
emphasize the positive
express optimism
22
Q
preop nursing considerations for CL/CP- infants
A
feeding difficulties ( breast is recommended, so mom will pump them bottle feed) upright position special nipples (Haberman, pigeon) stimulate suck reflex swallows fluid appropriately rest burp frequently
23
Q
post op considerations for CL/CP infants
A
protect airway- position on belly right after OR
prevent hypothermia
prevent infection
protect suture line
pain mgmt
avoid objects in mouth and suction with caution
24
Q
how do you protect the suture line of CL
A
avoid laying on stomach
elbow restraints “no no’s”
remove restraints and check skin q2 hours
25
what are long term consequence of CL/CP
altered speech
altered dentation
hearing problems
26
discharge teaching for CL/CP
good oral care
watch ears
promote speech development
27
esophageal atresia (EA) and tracheoesophageal fistula (TEF)
failure of esophagus to develop as a continuous passage and/or failure of the trachea and esophagus to separate
28
clinical manifestations of esophageal atresia and tracheoesophageal fistula
frothy saliva in mouth and nose
chocking and coughing
feedings return through nose and mouth, may become cyanotic and apneic
29
what are the three C's of TEF?
chocking
coughing
cyanosis
30
how do you diagnose EA and TEF?
passage of radiopaque catheter until obstruction is encountered
31
preoperative nursing considerations of EA and TEF
```
early detection
maintenance of airway
prevention of pneumonia
gastric or blind pouch decompression
antibiotics
antibiotics
prepare for surgical correction
```
32
anorectal malformations
imperforate anus- surgery done in stages
anal stenosis- manual dilations
perineal fistulas- anoplasty during newborn period
extensive defects- colostomy
33
preoperative nursing considerations of anorectal malformations
GI decompression
| IV fluids
34
post operative nursing considerations of anorectal malformations
meticulous perineal care
positioning (side lying or supine with legs suspended, hips elevated)
colostomy care
nutrition ( NG, IV, Lipids) when bowel sounds return you can start oral feeds as tolerated
bowel training
35
abdominal wall defets
omphalocele
36
omphalocele
herniation of the abdominal contents through the umbilical ring. intact peritoneal sac
contained in a sac
37
gastroschisis
herniation of abdominal contents, right of the umbilical ring
no peritoneal sac
not contained
38
why is it difficult to reduce the intestines of gastroschisis
because intestines expand and have to be decompressed before putting back in
39
how do you are for expose intestines?
loosely cover with saline soaked pads and plastic drape
IV fluid
antibiotics
surgical correction done in stages, silo pouch
done in a sterile fashion
40
what is the goal of gastroschisis repair
to get as much bowel as possible back into the body
you can hear bowel sounds through a silo
ensure that an ileus is not forming
a large amount of lost gut can result in short gut syndrome
41
disorders of motility
```
diarrhea
constipation
encopresis
hischprung disease
GERD
```
42
gastroenteritis
```
2nd leading cause of death world wide
diarrhea ( stool exceeds 200grams/day)
viral cause 70-80% of time
bacterial cause 10-20% of time
protozoan: less than 10%
```
43
viral gastroenteritis
most likely the cause of infectious diarrhea
| rotavirus and norovirus most common
44
symptoms of gastroenteritis
```
low grade fever
nausea
vomiting
abdominal cramps
watery diarrhea
viral shedding for weeks after symptoms resolve
```
45
bacterial diarrhea
affects all age groups
| fecal-oral transmission (contaminated food)
46
symptoms of bacterial diarrhea
bloody diarrhea, severe cramping, and malaise
| ABX not always necessary
47
treatment of diarrhea
oral rehydration-ORS ( infalyte, pedialyte, naturalyte, or rehydralyte)
normal diet with ORS or mild-mod dehydration
IV fluids for mod to severe dehydration
48
what do you avoid with ORS for diarrhea
fruit juices
colas
sports drinks
49
causes of constipation
```
structural disorders
hypothyroidism
hypercalcemia
lead poisoning
drugs
spinal cord lesions
```
50
management of constipation
dietary
| stool softeners
51
encopresis
chronic constipation with soiling
52
causes of encorpesis
psychological trauma
| voluntary withholding
53
management of encorpesis
purge the bowel
stool softeners
bowel retraining
54
Hirschsprung disease (megacolon)
congenital anomaly
absence of autonomic parasympathetic ganglion cells
causes enlargement of the bowel proximal to defect, results in mechanical obstruction from inadequate motility
55
what is the most dangerous complication of Hirschsprung disease?
enterocolitis (caused by ischemia) bloody diarrhea, fever, lethargy
56
newborn clinical manifestations of Hirschsprung disease
failure to pass meconium within 48 hours food refusal, bilious vomiting, abdominal distention
57
infancy clinical manifestations of Hirschsprung disease
poor weight gain, constipation, abdominal distention, episodes of diarrhea and vomiting
58
childhood clinical manifestations of Hirschsprung disease
constipation
| ribbon-like, foul-smelling stools, palpable fecal mass, abdominal distention, poor appetite, growth
59
how do you diagnose Hirschsprung disease
barium enema
rectal biopsy
anorectal manometry
60
treatment of mild to mod Hirschsprung disease
based on relieving the chronic constipation
surgery in 2 stages 1. temporary ostomy 2. soave endorectal pull through
prognosis: good, may have anal stricture and incontinence post op
61
pre-op nursing considerations for Hirschsprung disease
```
note first BM on all babies
measure abdominal girth
bowel prep- enemas and antibiotics
monitor hydration, fluid, and electrolyte status
teach enema techniques
```
62
post op care for Hirschsprung disease
```
NG suction
NPO
I and O to include NG losses and ostomy drainage
hydration and electrolyte balance
abdominal assessment
ostomy care
```
63
GERD
the passive transfer of gastric contents into the esophagus
| transient and inappropriate relaxations of the LES
64
factors increasing risk of GERD
```
prematurity
bronchopulmonary dysplasia
esophageal scar tissue
scoliosis
asthma
CF
```
65
signs and symptoms of GERD in infants
```
spitting up alot, may be forceful
hematemesis and melena
irritability
classic back arching
ALTE or apnea
persistent aspiration pneumonia
```
66
signs and symptoms of GERD in children
```
heartburn
anemia
persistent aspiration pneumonia
chronic cough
difficulty swallowing
abdominal pain
```
67
diagnosis of GERD
UGI
24 hour pH probe
Endoscopy
Labs
68
medications for GERD
antacids or histamine receptor antagonists
PPI - omeprazole
prokinetic medications (reglan, bethanechol, cisapride)
69
surgical treatment of GERD
nissen fundoplication
| take part of stomach and wrap upper portion of stomach around the LES
70
nursing considerations for GERD
positioning HOB 30 degrees
wedge under mattress
harness
small frequent feedings with thickened formula
avoid fatty foods, chocolate, tomato products, and carbonated liquids
burp frequently
71
obstructive GI disorders
hypertrophic pyloric stenosis (HPS)
| intussusception
72
hypertrophic pyloric stenosis (HPS)
circular muscle of pylorus becomes thickened causing obstruction of gastric outlet
unknown cause; maybe genetic component
males 5x more likely to get
develops first few weeks of life, edema, and inflammation increases the obstruction
73
clinical manifestations of HPS
```
projectile vomiting without bile
hunger and irritability progressing to lethargy
dehydration and weight loss
visible gastric peristalsis
OLIVE SHAPED MASS
```
74
therapeutic management of HPS
H&P, abdominal xray, US
labs show metabolic alkalosis
hyponatremia
hypokalemia
75
pyloromyotomy
surgical correction of HPS
| corrects dehydration and acid/base balance prior to surgery
76
nursing considerations HPS
regulation of fluid therapy
pre-op: NPO, strict I and O, monitor IV fluids, monitor for F & E balance, NG tube
post op: pain control, titrate PO feedings
77
intussusecption
invagination or telescoping of one portion of the intestine into another
most common in 1st year, males 2x greater than females
78
complications of intussusception
```
obstruction
inflammation
edema
ischemia
perforation
peritonitis
shock
```
79
clinical manifestations of intussusception
```
severe paroxysmal abdominal pain
screaming and drawing knees to chest
vomiting bile or fecal stained emesis
palpable SAUSAGE shaped mass URQ
Current Jelly stools
abdomen becomes tender and distended
```
80
therapeutic management of intussusecption
flat plate for free air followed by barium enema (air enema)
non surgical hydrostatic reduction
surgical reduction and resection
81
nursing considerations for intussesecption
```
NG for decompression
monitor for signs of shock
administer antibiotics
hydration and nutrition
routine post op care
family support
```
82
malabsorption syndromes
celiac disease
| short bowel syndrome
83
celiac disease (gluten sensitive enteropathy)
chronic inflammation of small intestine mucosa, results in varying degrees of atrophy to intestinal villi, malabsorption, and a variety of clinical manifestations
inability to digest gluten
results in accumulation of toxic substance that damages mucosal surface and interferes with the absorption of nutrients
84
gluten is in
wheat, rye, barley, oats
85
clinical manifestations of celiac disease
```
no symptoms for at least 6 months
major symptoms appear between 1-5 years
progressive malnutrition; anorexia, muscle wasting, abdominal pain and distention
watery, pale, foul smelling stool
vomiting, constipatoin
celiac crisis
```
86
what is a secondary deficiency of celiac disease
anemia and rickets
87
diagnosis of celiac disease
jujunal biopsy
| abnormally elevated levels of endomysial and anti-tissue transglutaminase antibodies
88
what do celiac patient eliminate from their diets?
wheat, rye, barley, oats
89
what type of diet do celiac patients have
high in calories and protein, low in fat
| supplemental vitamins and iron
90
celiac patients are at an increased risk of
malignant lymphoma of small intestine
91
nursing considerations of celiac disease
promote compliance with dietary restrictions
teach pt's to read labels; cereals, baked goods, grains are often added to processed foods, hydrolyzed vegetable protein
stress long range complications
92
short bowel syndrome
malabsorptive disorder that occurs as a result of decreased mucosal surface area
part of bowel has been removed causing elimination problems. (diarrhea, malabsorption)
93
causes of short bowel syndrome
congenital anomalies (jejunal and ileal atresia, gastroschisis) ischemia, trauma, long-segment resection.
94
problems with SBS
decreased intestinal surface area for absorption of fluid, electrolytes, nutrients
increased and disorganized transit time of intestinal contents
95
therapeutic management of SBS
preserve as much bowel as possible
maintain optimum nutrition
stimulate intestinal adaptation
minimize complications
96
complications of SBS and TPN
CVA, risk of infection
metabolic complications- electrolyte disturbances, hyperglycemia, hypoglycemia, hyperlipidemia, cholestasis, and liver dysfunction
bacterial overgrowth
gastric acid hypersecretion
97
acute appendicitis
inflammation of the veriform appendix (blind sac at the end of the cecum) can be full of stool
uncommon before age 2; associated with increased complications and morality
rapidly progress to perforation and peritonitis
98
causes of acute appendicitis
```
obstruction of the lumen of the appendix
hardened fecal material
foreign bodies
microorganisms
parasites (not pin worms)
```
99
clinical manifestations of acute appendicitis
```
colicky abdominal pain and tenderness at McBurneys point
guarding abdominal pain
rebounding tenderness
n/v/anorexia
low grade fever >102 mean perforation
look for signs of peritonitis
```
100
diagnosis of appendicitis
CBC, abdominal ultrasound
101
pre-op appendectomy
IV fluids and antibiotics
102
Management of peritonitis
fluids, antibiotics, NG tube, delayed closure to prevent abscess formation
103
nursing considerations for acute appendicitis
avoid enemas and heating pads
| prep for surgery
104
how long does it take for the colon to return to normal size and tone after constipation (large stool burden?)
6 months- 1 year
105
how long does it take for miralax to work?
3 days
106
McBurneys point
pain around umbilicus and radiating down the right side
| a sign of acute appendicitis
