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NRSG 329 > Week 3 - GI and Nutrition > Flashcards

Week 3 - GI and Nutrition Flashcards

1
Q

What GERD stand for?

A

Gastroesophageal Reflux Disease

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2
Q

describe GERD

A

when the Lower esophageal sphincter is too relaxed or open

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3
Q

what is another name for the lower esophageal sphincter?

A

cardiac sphincter

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4
Q

GERD is super common to some degree in what age group?

A

3 months - 1 year
most common in infancy

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5
Q

GERD occurs with more severe case and results in what?

A
  • failure to thrive
  • bleeding
  • vomiting
  • weight loss
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6
Q

what are the treatments for GERD?

A
  • positional feeding c head up
  • small feedings
  • medications
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7
Q

in regards to treating GERD what do you need to also teach parents around small feeds?

A

use smaller nipple if bottle feeding

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8
Q

in regards to treating GERD what medication is normally used?

A

PPI (ranitidine)

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9
Q

how does GERD often present in most babies?

A
  • seen as spitting up
  • can be in various amounts
  • will have some kid of reflux
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10
Q

describe pyloric stenosis

A

narrowing of the lower stomach sphincter

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11
Q

what is another name for the lower stomach sphincter?

A

pylorius sphincter

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12
Q

pyloric stenosis occurs in what age range?

A

2-5 weeks old

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13
Q

who is more likely to get pyloric stenosis?

A
  • first borns
  • males
  • caucasians
  • full term babies
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14
Q

what are the symptoms for pyloric stenosis?

A
  • similar to GERD but more pronounced vomiting
  • directly after feeding/ all intake comes up
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15
Q

what is the treatment for pyloric stenosis?

A

surgery > have to open up where the swelling is

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16
Q

for babies who have pyloric stenosis why do they projectile vomit right after a feed?

A

feed fast b/c they are hungry/ have nothing in their stomach
- food can’t pass through sphincter fast enough so baby projectile vomits

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17
Q

what is intussusception?

A

slipping of one part of the intestine into another part just below it

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18
Q

intusussception occurs most often in who? at what age?

A
  • boys
    -2 months to 2 years
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19
Q

what are symptoms of intussusception?

A
  • sudden onset
  • high pitch cry (pain)
  • kicking legs
  • indrawing legs to chest
  • yellow/ green vomit
  • decreased BM
  • palpable mass
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20
Q

is intussusception common?

A

no, barely see this happen

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21
Q

what is the treatment for intussusception?

A
  • emergent care
  • spontaneous reduction
  • air enema with or without saline
  • surgery
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22
Q

in regards to the types of treatments provided for intussusception, why do we have to provide emergent care?

A

oxygen can be cut off from bowels and can cause necrotic bowels

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23
Q

in regards to the types of treatments provided for intussusception, how do air or saline enemas work?

A

provides enough pressure to flip intestine back over/ out

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24
Q

in regards to the types of treatments provided for intussusception, when would we do surgery?

A
  • severe case
  • necrotic bowels
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25
Q

why can intussusception be hard to diagnose in children?

A
  • children at this age can’t speak
  • normally only diagnosed do the severe pain seen
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26
Q

what is the key finding you need to know about intussusception for the exam?

A

there will be some kind of mass felt when palpating

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27
Q

what is the most common emergency abdominal surgery in children?

A

appendicitis

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28
Q

describe appendicits

A

inflammation of the appendix
often resulting in rupture

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29
Q

how is appendicitis diagnosed?

A
  • ultrasounds
  • WBC
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30
Q

what are symptoms for appendicitis?

A
  • localized RLQ pain
  • fever
  • bloating
  • rebound tenderness
  • guarding
  • vomiting
  • diarrhea
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31
Q

what are some complications of appendicitis? list them in order of what you would see first down to last

A
  • rupture of the appendix
  • abscess
  • peritonitis
  • sepsis/septic shock
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32
Q

what is the treatments available for appendicitis?

A
  1. rest/ abx
    - likely to come back
  2. non ruptured
    - surgery
  3. ruptured
    - surgery plus 7-10 days abx and/ or NG suction
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33
Q

1 in how many births will have congenital abnormalities?

A

1 in 600

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34
Q

cleft lip and palate are more common in who?

A
  • boys
  • people of colour
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35
Q

describe a cleft lip and palate

A

fissure/ opening in lip and/ or hard palate

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36
Q

what are some complications of cleft lips and palates?

A
  • malnutrition
  • ear infections
  • respiratory infections
  • oral infections
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37
Q

what is the treatment for cleft lips and palates?

A

surgery

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38
Q

for cleft lips and palates what do we need to watch for/ be careful of post-surgery?

A
  • prevention of crying
  • bleeding
  • pain management
  • re-feeding
  • speech therapy
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39
Q

what do most kids who have had a cleft lip or palate end up with?

A

lisp

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40
Q

how will you know your infant is ready for solid foods?

A
  • sits up alone
  • uses neck muscles to hold head up straight
  • opens mouth when they see something coming
  • keeps tongue flat/ low when spoon enters mouth
  • closes lips over spoon
  • keeps food in mouth
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41
Q

what will your infant do if they are not ready for solid foods?

A
  • turn head away if they don’t want it
  • mouth stays open after spoon enters
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42
Q

why should you set the infant up for dinner time around 3-4 months?

A

they can start to see/ become familiar with meal times/ foods

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43
Q

how long should children be breast fed exclusively for?

A

6 months

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44
Q

what is extrusion? (on exam)

A
  • tongue thrusting movement
  • goes away around 4 months
  • if they still have this not ready to eat solid foods
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45
Q

when you start feeding your child solid foods, what should you start with?

A

warm iron fortified baby rice/ barley mixed with formula or breast milk

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46
Q

what consistence should solid foods be in when you first try them with infants?

A
  • thin to thick
  • leave in lumps
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47
Q

why don’t you want to start children with cows milk?

A
  • don’t have the enzyme for this yet
  • develop it closer to 12 months
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48
Q

why is it recommended to introduce foods one at a time to infants?

A

so you know/ learn what they are allergic to

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49
Q

for 6-9 month olds, what are normal milestones for feeding?

A
  • spoon feeding
  • finger feeding
  • cup drinking
  • cuddling and breast or bottle feeding
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50
Q

what are some suggested foods for 6-9 month olds?

A
  • soft/ well cooked
  • mashed/ milled
  • vegetables/ fruits
  • mashed potatoes
  • sticky rice
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51
Q

why do we want to give 6-9 month olds larger pieces of food?

A
  • so they can have a better grasp on it
  • smaller pieces can be choking hazard
52
Q

for 9-12 month olds, what are normal milestones for feeding?

A
  • finger feeding soft table foods
  • drinking by self from covered cup
  • cuddling and breast/ bottle feeding away from meal time
53
Q

what are suggested foods for a 9-12 month old?

A

chopped/ cooked
- vegetables
- fruits
- cheese
- strips of bread
- toast
- tortillas
- crackers
- cereal
- tender chopped meats

54
Q

at 9-12 months old where do most children get their nutrients from?

A

from food, they get topped up with breast milk between meals

55
Q

what is considered a high allergy food?

A
  • peanut butter
  • eggs
  • milk
  • fish/ shellfish
56
Q

will you see an allergic reaction from milk right away?

A

yes

57
Q

what are foods that should be avoided for kids 9-12 months old?

A
  • honey
  • juices
  • dairy
  • anything unpasteurized
  • hotdogs
  • hard cheeses
  • raw vegetables
  • sugar
58
Q

at what age is it okay to introduce honey? Why do you want to wait this long?

A
  • 2 years old
  • due to botulism/ unpasteurized
59
Q

when you start to give cow milk to a 12 month old what type do you always want to start with?

A

pasteurized whole milk due to fat content

60
Q

if a child has an allergy to milk products why do you need to be careful of the alternatives? What should you recommend instead?

A
  • they are made from nuts > don’t have high fat content
  • recommend pea based milk product > closest thing for fat content
61
Q

why do you want to ensure to creased ambiance for meal times for kids? What would this look like?

A
  • informs kids time to eat
  • all sitting at table
  • music playing
  • no electronics/ TV
  • provide lots of colour
62
Q

what do portion sizes look like for toddlers?

A
  • smaller meals at first then add on food if they are still hungry
  • large amounts can over whelm them
63
Q

what minerals do you want to ensure toddlers get?

A
  • iron
  • fluoride
64
Q

failure to thrive refers to what?

A

children whose current weight or rate of weight gain is significantly lower than that of other children of similar age/ gender

65
Q

what percentile would failure to thrive children fall in?

A

5th or lower

66
Q

what can failure to thrive be a result of?

A
  • medical problems
  • factors in the environment
  • abuse/ neglect
  • physical problems
67
Q

can the cause of failure to thrive normally be determined?

A

no

68
Q

what are some medical/ organic causes for failure to thrive?

A
  • chromosome problems
  • hormone deficiency
  • damage to brain/ CNS
  • heart/ lung problems
  • blood disorders
  • GI problems
  • long term gastroenteritis/ GERD
  • cerebral palsy
  • chronic infections
  • metabolic disorders
  • complications oof pregnancy
  • low birth weight
  • cleft pallet
  • previous choking problem
  • prolonged ventilation
  • premature baby
  • having parental feeding for long period
69
Q

what are some non-organic causes for failure to thrive?

A
  • emotional deprivation as a result of parental withdrawal, rejection
  • poverty
  • problems with child-caregiver relationship
  • parents don’t understand appropriate diet needs
  • exposure to infections, parasites, toxins
  • poor eating habits
70
Q

what are some clinical manifestations for failure to thrive?

A
  • lethargic
  • small/ skinny looking
  • weight, length, size much smaller
  • avoiding eye contact
  • lack of appropriate weight gain
  • irritability
  • excessive sleepiness
  • lack of age-appropriate social response
  • don’t make vocal sounds
  • delayed motor development
  • constipation
71
Q

what may be recommended for failure to thrive?

A
  • increase number of calories/ amount of fluid
  • correct any vitamin/ mineral deficiencies
  • identify/ treat any other medical conditions
72
Q

for a child who doesn’t thrive for a long time what might be affected?

A
  • normal growth and development
73
Q

what are some complications of failure to thrive?

A

permanent mental, emotional, or physical delays can occur

74
Q

depending on the severity of failure to thrive what might this affect for treatment?

A

what they choose to use, if very severe will start with IV then move to NG then move to bottle

75
Q

is obesity a medical condition?

A

yes

76
Q

what is a sign of childhood obesity?

A

weight well above the average for a child’s height/ age

77
Q

what is considered overweight?

A

85th - <95th percentile

78
Q

what is considered obese ?

A

anything above the 95th percentile

79
Q

what are some things that can be recommended to reduce incidence of obesity ?

A
  • 5 fruits or vegetables/ day
  • < 2hours of screen time/ day outside of work/ homework
  • minimum 1 hour/ day activity
  • 0 sugar sweetened beverages/ day
80
Q

what puts someone at risk for obesity?

A
  • eating food/ drinks high in sugar and fat on regular basis
  • have limited physical activity
  • environment doesn’t encourage healthy eating/ physical activity
  • eat to deal with stress/ problem
  • low-income family
  • genetic disease
81
Q

what are complications of obesity?

A
  • type 2 diabetes
  • increased depression
  • low self-esteem
  • digestive problems
  • higher risk of asthma
  • higher risk of sleep apnea
82
Q

what does obesity put you at a greater risk for in adulthood?

A
  • increased cardiac concerns
  • increased chronic medical conditions
83
Q

what is type 2 diabetes caused by?

A

resistance to insulin as well as the ability of the pancreas to keep up with the increase demand of insulin

84
Q

what percent of children are obese when diagnosed with type 2 diabetes?

A

85%

85
Q

what is the age of onset for type 2 diabetes in children?

A
  • middle to late puberty
  • around 13 years
86
Q

what populations has a higher rate of type 2 diabetes?

A

minority populations

87
Q

for people who have type 2 diabetes is there normally a strong family history of it?

A

yes

88
Q

when assessing an obese child what do you expect to find?

A
  • BMI > 30
  • apple shape
  • acanthosis nigricans
  • hypertension
    • family history of type 2DM
  • ethnicity
89
Q

what is acanthosis nigricans ?

A
  • hyper- pigmentation/ thickening of the skin into velvety irregular folds in the neck/ flex areas
  • reflex hyperinsulinemia
90
Q

obesity falls in what percentile?

A

equal to or greater than the 95th percentile

91
Q

in regards to the management of type 2 diabetes what is included in the nursing assessment?

A
  • health history
  • physical exam
92
Q

in regards to the management of type 2 diabetes what is included in the therapeutic management?

A
  • glucose monitoring
  • insulin replacement therapy
  • oral hypoglycaemic medications
  • other therapies
93
Q

in regards to the management of type 2 diabetes what is included in the nursing management?

A
  • regulating glucose control
  • monitoring for complications
  • educating family
94
Q

DM type 1 is what?

A
  • autoimmune disorder
  • occurs in genetically susceptible individuals
95
Q

what is type 1 DM characterized by?

A
  • autoimmune destruction of pancreatic beta cells that produce insulin
  • results in insulin deficiency
96
Q

what does insulin support in DM type 1?

A

metabolism of
- carbohydrates
- fats
- proteins

97
Q

what is insulin glucose metabolism essential for?

A
  • growth
  • activity
  • wound healing
  • brain function
98
Q

when is type 2 DM most often diagnosed?

A
  • winter months
99
Q

what will be noted during the assessment at diagnosis for DM type 1?

A
  • weight loss (as much as 30%)
  • polyuria
  • thirst
  • ketones in urine
  • decreased pH
100
Q

what are presenting symptoms of DM type 1?

A
  • hyperglycemia
  • glucosuria
  • polyuria
  • electrolyte imbalance
  • polydipsia
  • polyphagia
101
Q

what does glucosuria mean?

A

sugar in urine

102
Q

what does hyperglycaemia mean?

A

glucose in blood stream

103
Q

what does polydipsia mean?

A

attempt to relieve dehydration

104
Q

what are diagnostic tests used to diagnose DM type 1?

A
  • elevated blood sugars
  • urine sample
  • glucose tolerance test
105
Q

what would show up in a glucose tolerance test for someone who has DM type 1?

A

low insulin levels and high glucose levels

106
Q

what are short term goals for the management of DM type 1?

A

prevent:
- ketosis
- electrolyte abnormalities/ volume depletion secondary to osmotic diuresis
- impairment of leukocyte function
- impairment of wound healing

107
Q

what are some hospital interventions that can be done for the management of DM type 1?

A
  • administration of insulin
  • blood glucose levels
  • dietary management
  • glycosylated hemoglobin
108
Q

what are some long term goals for the management of DM type 1?

A
  • prevention of microcirculatory/ neuropathic changes
  • management of blood glucose
109
Q

what is the target blood glucose for children under 6 years?

A

6-12 mmol/ L

110
Q

what is the target blood glucose for children 6-12 years?

A

4-10 mmol/L

111
Q

what is the target blood glucose for children 13-18 years?

A

4-7 mmol/L

112
Q

what are some home internventions that can be done for the management of type 1 DM?

A
  • blood glucose levels
  • carb counting
  • exercise
  • illness prevention
  • sick days protocol
113
Q

what are presenting symptoms of DKA?

A
  • polyuria
  • polydipsia
  • weight loss
  • altered LOC
  • dehydration
  • nausea/ vomiting
  • fruity smelling breath
  • electrolyte disturbances
  • dysrhythmias
  • shock
  • complete vascular collapse
114
Q

what are the 3 phases of management for DKA?

A
  1. resuscitation
    - airways/ fluids
  2. corrections
    - acid-base and electrolyte abnormalities
    - insulin/ blood glucose levels
  3. transition to daily routine
115
Q

what is included in the management of DKA in the hospital?

A
  • BGM Q30-60 min
  • lab work
  • VS & neuro hourly until stable
  • ketone urine dips
  • strict I&O
  • teaching
116
Q

why do we want to give more sugar when we provide insulin to a patient who has DKA?

A

so their sugars don’t drop even if they are hight to start with

117
Q

what are long term things people can do to manage their diabetes?

A
  • management by paediatrician/ endocrinologist
  • insulin
  • blood sugar monitoring
  • diet
  • exercise
  • screen for retinopathy
118
Q

what are included in goals of nutritional therapy for diabetics?

A
  • maintain blood glucose in normal range
  • balance food intake with insulin and activity
  • appropriate calories for normal growth/ development
  • preventing/ treating acute long term complications
119
Q

what is carb counting?

A

meal planning tool that helps control blood sugar

120
Q

what are different types healthy carbs?

A
  • whole grains
  • legumes
  • fruits
  • vegetables
121
Q

hat do healthy carbs provide?

A
  • energy
  • nutrients
  • vitamins
  • minerals
  • fiber
122
Q

describe unhealthy carbs

A
  • food and drinks with added sugar
  • provide energy
  • have no nutritional value
123
Q

why is carb counting important?

A
  • help keep blood glucose levels stable
  • way to figure out ISF
124
Q

keeping your blood glucose levels as close to normal as possible can help prevent or delay what?

A
  • prevent kidney disease
  • blindness
  • nerve damage/ amputations
  • heart attacks/ strokes
125
Q

why do we need to teach kids to eat before they give themselves insulin?

A
  • b/c they are picky eaters and may not eat enough
  • want to correct what ever they need/ couldn’t get from what they ate

NRSG 329 (5 decks)

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