Peds Exam 2 - GI

Question 1

two types of failure to thrive

Answer 1

1) because something is wrong with the child organic
2) idiopathic non organic

Question 2

what is the guidelines to dx FTT

Answer 2

-not growing
-under 5th %ile, drop off the curve
not concerned about height

Question 3

therapeutic mgt of FTT

Answer 3

-catch up growth
-correct nutritional deficiencies
-treat underlying cause
-educate parents or primary care givers
-multidis team (SLP,OT,ND)

Question 4

what happens when a pt gets admitted for FTT

Answer 4

observation
feed the child and watch parent interaction then give pointers (if they are not burping or positioning)

Question 5

what to monitor for FTT

Answer 5

-I&Os
-daily wts
-routine being followed
-parents well being (support and be positive to)

Question 6

cleft lip / palate

Answer 6

involves abnormal openings in the lip and/or palate (unilateral or bilateral)

Question 7

cleft L/P etiology

Answer 7

multi-factorial inheritance, factors & teratogens, maternal smoking

Question 8

cleft L/P clinical findings

Answer 8

-difficulty feeding (cant form suck, very noisy)
-mouth breathing -> distended abdomen & pressure, dry mucous membranes, increased infection risk

Question 9

cleft lip therapeutic mgt

Answer 9

surgical correction of lip in first weeks of life
- Z plasty: minimize notching & lengthen the lip

Question 10

cleft palate therapeutic mgt

Answer 10

obturators, closure between 12-18 months
lip first then palate

Question 11

what is the nurses biggest priority for closures of cleft L/P

Answer 11

bonding w/ parent & positivity & getting the baby to eat and grow

Question 12

how to feed a child w/ cleft L/P before surgery

Answer 12

-upright position
-special bottles elongated nipple & squeezable
-lots of burping
-stop after 30-45mins of feeding
-stimulate suck reflex

Question 13

if palate repair, what position should baby be in after surgery

Answer 13

on belly

Question 14

if lip repair, what position should baby be in after surgery

Answer 14

back or side, need to facilitate drainage

Question 15

post op care for cleft L/P

Answer 15

-restrains so they do not pick at sutures, to protect surgical site
-protect airway & prevent infection
-pain mgt
-fluids
-careful suctioning

Question 16

long term consequences of cleft lip/palate

Answer 16

-altered speech
-altered dentition
-hearing problems & ear infections
teach @dc good oral care, watch the ears & promotion of speech

Question 17

esophageal atresia (EA) & tracheoesophageal fistula definition (TEF)

Answer 17

failure of the esophagus to develop as a continuous passage and/or failure of the trachea & esophagus to separate
esophagus is not connected to lungs and stomach as it should be

Question 18

clinical manifestations of EA & TEF

Answer 18

frothy saliva in mouth & nose, choking & coughing, feeding return through nose & mouth, may become cyanotic & apnic
choking, coughing & cyanosis

Question 19

what is most important EA & TEF

Answer 19

early detection -> sit them upright, suction prn and get imaging

Question 20

what is the diet order for EA & TEF

Answer 20

NPO to avoid aspiration
can drop an NG depending what is connected or TPN + fluids

Question 21

imperforate anus

Answer 21

when the anal opening is not as it should be, can be stenotic or not exist at all

Question 22

important things to monitor in a new born assessment

Answer 22

-anus is as it should be
-that the baby stools within the first 24-48hrs

Question 23

therapeutic mgt of anorectal malformations

Answer 23

-if narrow, manual dilations
-perineal fistulas then anoplasty
-extensive defects then colonstomy

Question 24

abdominal wall defect: omphalocele

Answer 24

herniation of the abdominal contents through the umbilical ring -> caught prenatal & can be repaired prenatal
intact peritoneal sec

Question 25

abdominal wall defect: gastroschisis

Answer 25

herniation of the abdominal contents, right of the umbilical ring **no peritoneal sac** **kids do ok if they can keep all of their intestines**

Question 26

therapeutic mgt of gastroschisis

Answer 26

-baby born via c section -loosely cover organs w/ saline soaked pads & plastic drape -give fluids & antibiotics -bring to nicu -multiple surgical corrections , place in silo in between

Question 27

nursing considerations for gastroschisis

Answer 27

-sterile technique -careful handling -monitor for ileus -family support -d/c planning -home care

Question 28

gastroenteritis (diarrhea)

Answer 28

**second leading cause of death world wide** -stool wt in excess of 200gm/d -3 or more loose water stools per day -alternation in normal bowel movement (inc freq, dec consis) -less than 14 days duration

Question 29

when are we concerned about diarrhea

Answer 29

-when there is blood in it -presists

Question 30

what is gastroenteritis mostly caused by

Answer 30

a virus (roto or noro)

Question 31

gastroenteritis symptoms

Answer 31

low grade fever, nausea, vomiting, abdominal cramps, watery diarrhea

Question 32

treatment of gastroenteritis

Answer 32

**symptomatically** -hydration -avoid high sugar drinks -normal diet if mild or moderate -IV fluids for moderation to severe -hand hygiene -watch skin breakdown

Question 33

if a child is constipated and stretches out the colon, how long does it take for the colon to go back to normal size

Answer 33

6 months so have to keep them cleaned out for 6 months

Question 34

how much fiber should a child have

Answer 34

5g of fiber + their age (ex: if 5yr then 10g) **might need fluids**

Question 35

mgt of constipation

Answer 35

1) water 2) add in fruits juice to pull water into colon if water isn't enough 3) then miralax **do this for 6mo**

Question 36

encopresis

Answer 36

chronic constipation with soiling **seepage of loose stool around the constipation**

Question 37

Hirschsprung disease

Answer 37

lack of nerve intervation to the end of the colon -> does not have the nerves to evacuate the stool causing a back up **treat by shortening the bowel**

Question 38

pre op nursing considerations for Hirschsprung disease

Answer 38

-measure abdominal girth daily -bowel prep w/ enema & antibiotic -monitor hydration, fluid, & lyte status

Question 39

post op nursing considerations for Hirschsprung disease

Answer 39

-NG to suction -NPO then clear liquids -I&Os -abdominal assessment -ostomy care

Question 40

GERD

Answer 40

infant spitting up a lot bc of sphincter is not very tight at the top of the stomach **if happy spitters don't do anything, super fussy then fix or meds**

Question 41

hypertrophic pyloric stenosis

Answer 41

circular muscle of the pylorus becomes thickened causing obstruction of the gastric outlet leading to failure to thrive and baby to projectile vomit w/o bile **will feel olive shaped mass that, surgery needed**

Question 42

post op for hypertrophic pyloric stenosis

Answer 42

move from NPO to IV fluids to feedings **ok if they throw up, give them time to recover and then feed again. slowly increase feeds**

Question 43

intussusception

Answer 43

invagination or telescoping of one portion of the intestine into another causing an obstruction and making it so food cannot pass through

Question 44

clinical manifestations of intussusception

Answer 44

-pain -**drawing knees to chest** -vomiting -palpable sausage shaped mass URQ -jelly like stools -tender and distended abdomen

Question 45

therapeutic mgt of intussusception

Answer 45

dx:H&P, flat plate for free air followed by barium enema (straightens it out) -non surgical hydrostatic reduction -surgical reduction & resection

Question 46

what age group do we see appendicitis in

Answer 46

older school agers and young adolescents

Question 47

appendicitis

Answer 47

inflammation of the vermiform appendix that rapidly progresses to perforation and peritonitis

Question 48

etiology of appendicitis

Answer 48

obstruction of the lumen of the appendix, hardened fecal material, foreign bodies, microorganisms, parasites (**not pin worms**)

Question 49

symptoms of appendicitis

Answer 49

-tenderness around umbilical area to the RLQ -N/V -low grade fever -rebound tenderness & guarding -pain w/ movement

Question 50

dx of appendicitis

Answer 50

H&P, CBC & ultrasound **if confirmed, remove appendix**

Question 51

peritonitis

Answer 51

from rupture appendix -> need fluids, antibiotic, NG tube, and has delayed closure to prevent abscess formation

Question 52

nursing considerations for appendicitis

Answer 52

-assessments -avoid enemas & heating pads -prep for surgery -post op care (pain meds)