Pediatrics Test 2: GI Disorders

Question 0

What is dehydration

Answer 0

Output of fluids exceeds the intake of fluid

Enequal fluid balance

Question 1

What Is the primary symptom of pyloric stenosis

Answer 1

Projectile vomiting

Question 2

What are some causes of dehydration

Answer 2

Diane that causes insensible loss through skin and respiratory tract
Increased renal excretion: high output kidney failure
Increase loss in GI tract: vomit and diarrhea
Diabetic ketoacidosis
Extensive burns
Shock
Tachycardia
Radiant Warmers
Phototherapy
Diabetes insipidus

Question 3

How much fluid do we need to stay healthy

Answer 3

Important for baseline data

Weight 1-10 kg there is 100mL/kg

Question 4

Why are infants at greater risk

Answer 4

Longer GI tract relative to body size
Greater body surface
Higher metabolic rate
Less able to concentrate urine

Question 5

What are some clinical manifestations to dehydration

Answer 5

Weight loss
Poor skin turgor 
Dry mucous membrane
Absent tearing and salivation
Sunken fontanel
Tachycardia
Rapid respirations
Irritable to lethargic

Question 6

Extent of dehydration

Answer 6

Look at the slide

Question 7

Fluid volume deficiet outcomes

Answer 7

Moist mucous membranes
Sodium and potassium elevated
Capillary refill of 2 seconds or less
Skin turgor brisk
Fluid I & O balanced 
Voiding >1 mL/kg/hr

Question 8

Oral hydration management

Answer 8

Mild dehydration: 50ml/kg over 4-6 hours
Moderate dehydration: 100ml/kg over 4-6 hours
Solution addresses electrolyte needs
Don’t want too much glucose because it will push fluid loss
Introduce fluid loss in 24 hours

Question 9

Predisposing factors to diarrhea

Answer 9

Virus is big in daycare
Hand washing and sanitation: in fields and food packing area
Recent travel and hiking
Recent antibiotic use

Question 10

What are the diarrhea bacterial agents

Answer 10

E. Coli
Salmonella
Shigella
Campylobacter jejuni
Clostridium difficile

Question 11

E. Coli reasons

Answer 11

Food borne
Watery
Abdominal cramps
Common in summer

Question 12

Salmonella

Answer 12

Person to person or food borne
With children often transmitted from pet
Common in summer
Loose, slime, green, seldom bloody, rotten egg smell

Question 13

Shigella

Answer 13

Most common less than 9 years
Appears very sick
Watery yellow green stool, blood with mucous

Question 14

Campylobacter jejuni

Answer 14

Contaminated food and pets
Peak in less than 1 year
Watery and foul smelling, profuse diarrhea

Question 15

Clostridium difficile

Answer 15

Alterations in normal flora
1-3 day incubation
Most mild watery diarrhea and can progress to extreme illness with high fever and prolonged diarrhea

Question 16

Diarrhea parasitic agents

Answer 16

Entamoeba histolytica

Giardia lambs: most common intestinal parasite
- bloating and flatulence with loose greasy stool

Question 17

Constipation causes

Answer 17

Passage of infrequent hard stools due to defects

Functional (inorganic): no underlying cause, can be gene
Organic: strictures, Hirschsprungs
Drugs: antacids, diruetics, opioids, iron, antihistamines
Metabolic: hypothyroidism, hypercalcemia, lead poisoning
Neuromuscular: spinal cord lesions
Psychiatric: stool holding, anorexia

Question 18

Nursing measures for constipation

Answer 18

Increase fluids
Give smaller goals to accomplish
Increase fiber intake

Question 19

Hirschsprungs disease

Answer 19

No peristolsis in bowel

Continuous smooth muscle spasm

Question 20

Clinical manifestations of Hirschsprungs disease

Answer 20

Neonatal: failure to pass meconium, bilious vomiting, poor feeding
Later: chronic constipation, ribbon like foul smelling stool

Question 21

Physical findings of Hirschsprungs

Answer 21

Enlarged distended abdomen
Palate fecal matter
Empty rectal ampulla
Visible peristalsis

Question 22

Treatment for Hirschsprungs

Answer 22

Resection of aganglionic segment
May have temporary colostomy before pull, through reanastomosis at rectum
Let family know it is temporary

Question 23

Nursing measures for Hirschsprungs

Answer 23

Help patient adjust to congenital defects
Foster parent-infant bonding
Prepare them for medical and surgical interventions
Assists with colostomy care

Question 24

What is gastroesophageal reflux

Answer 24

Flow of gastric content in esophagus as result of neuromuscular failure of lower esophageal sphincter Becomes GERD is there symptoms or tissue damage from reflux-failure to thrive, bleeding, pneumonia Apnea second to GERD

Question 25

Clinical manifestations of GERD

Answer 25

``` Regurgitation - spitting up Excessive crying Weight loss Esophagitis - heartburn, dysphasia Anemia Irritability Pulmonary symptoms: cough, choke, wheeze Nocturnal asthma Cry after eating ```

Question 26

Treatment of GERD

Answer 26

``` Avoid foods that exacerbate acid reflux Weight control Small, more frequent meals Thickened feeding Upright positioning Prone after feeding Medication Head elevated 30 minutes Surgery for infants ```

Question 27

Acute appendicitis

Answer 27

``` Inflammation of vermiform appendix caused by obstruction of lumen of appendix usually hardened by fecal matter RLQ Anorexia Vomiting Diarrhea or constipation Low grade fever ```

Question 28

Physical finding of acute appendicitis

Answer 28

Pain at McGruneys point, right iliac fossa Bowel sound depressed or hyperactive Rectal exam may show tenderness

Question 29

Diagnosis and treatment for GERD

Answer 29

CAT scan Laparoscopic Current treatment philosophy - see if body walls off abscess and if it does make a drain and have body naturally clear it out

Question 30

Cleft lip and palate

Answer 30

Most common congenital deformity Facial malformation that occurs during embryonic period Failure of the maxillary and median nasal processes to fuse Midline fissure of the palate that results fro. Failure of two slides to fuse May occur separate or together

Question 31

Nursing measures of cleft lip

Answer 31

``` Feeding issues Parental emotional needs Post operative Occur with other syndromes Drug associated is diluadid Surgical repair is two steps - lip 6 months, concerned about maintaining lip line - palate 12-18 months, mouth grows and want more room. Preserve speech ```

Question 32

What I'd pyloric stenosis

Answer 32

Congenital hypertrophy of circular muscle of pyloric sphincter More common in males Increased family incidence Milk can't get into small intestines

Question 33

Clinical manifestations of pyloric stenosis

Answer 33

Vomiting after feelings: progressive Usually start 2-4 weeks post-birth Surgically treated by opening the muscle

Question 34

Intussusception

Answer 34

Imagination of one segment of bowels usually the terminal ilium, into the cecum Telescopes in upon itself

Question 35

Clinical manifestations of intusseption

Answer 35

``` Intense pain Knees upto chest Pain lasts several minutes and child is quiet Early non-bilious vomiting Current (red) jelly diarrhea stools ```

Question 36

Physical finding of intussuception

Answer 36

``` Sausage shaped mass palpable in RUQ abdominal distention in tenderness Fever Bloody mucous on rectal exam Shock like state Cramping ```

Question 37

Treatment of Intussuception

Answer 37

Hydrostatic enema