Week 3 - GI and Nutrition Flashcards
(125 cards)
1
Q
What GERD stand for?
A
Gastroesophageal Reflux Disease
2
Q
describe GERD
A
when the Lower esophageal sphincter is too relaxed or open
3
Q
what is another name for the lower esophageal sphincter?
A
cardiac sphincter
4
Q
GERD is super common to some degree in what age group?
A
3 months - 1 year
most common in infancy
5
Q
GERD occurs with more severe case and results in what?
A
- failure to thrive
- bleeding
- vomiting
- weight loss
6
Q
what are the treatments for GERD?
A
- positional feeding c head up
- small feedings
- medications
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
8
Q
in regards to treating GERD what medication is normally used?
A
PPI (ranitidine)
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
10
Q
describe pyloric stenosis
A
narrowing of the lower stomach sphincter
11
Q
what is another name for the lower stomach sphincter?
A
pylorius sphincter
12
Q
pyloric stenosis occurs in what age range?
A
2-5 weeks old
13
Q
who is more likely to get pyloric stenosis?
A
- first borns
- males
- caucasians
- full term babies
14
Q
what are the symptoms for pyloric stenosis?
A
- similar to GERD but more pronounced vomiting
- directly after feeding/ all intake comes up
15
Q
what is the treatment for pyloric stenosis?
A
surgery > have to open up where the swelling is
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
17
Q
what is intussusception?
A
slipping of one part of the intestine into another part just below it
18
Q
intusussception occurs most often in who? at what age?
A
- boys
-2 months to 2 years
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
20
Q
is intussusception common?
A
no, barely see this happen
21
Q
what is the treatment for intussusception?
A
- emergent care
- spontaneous reduction
- air enema with or without saline
- surgery
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
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
24
Q
in regards to the types of treatments provided for intussusception, when would we do surgery?
A
- severe case
- necrotic bowels
25
why can intussusception be hard to diagnose in children?
- children at this age can't speak
- normally only diagnosed do the severe pain seen
26
what is the key finding you need to know about intussusception for the exam?
there will be some kind of mass felt when palpating
27
what is the most common emergency abdominal surgery in children?
appendicitis
28
describe appendicits
inflammation of the appendix
often resulting in rupture
29
how is appendicitis diagnosed?
- ultrasounds
- WBC
30
what are symptoms for appendicitis?
- localized RLQ pain
- fever
- bloating
- rebound tenderness
- guarding
- vomiting
- diarrhea
31
what are some complications of appendicitis? list them in order of what you would see first down to last
- rupture of the appendix
- abscess
- peritonitis
- sepsis/septic shock
32
what is the treatments available for appendicitis?
1. rest/ abx
- likely to come back
2. non ruptured
- surgery
3. ruptured
- surgery plus 7-10 days abx and/ or NG suction
33
1 in how many births will have congenital abnormalities?
1 in 600
34
cleft lip and palate are more common in who?
- boys
- people of colour
35
describe a cleft lip and palate
fissure/ opening in lip and/ or hard palate
36
what are some complications of cleft lips and palates?
- malnutrition
- ear infections
- respiratory infections
- oral infections
37
what is the treatment for cleft lips and palates?
surgery
38
for cleft lips and palates what do we need to watch for/ be careful of post-surgery?
- prevention of crying
- bleeding
- pain management
- re-feeding
- speech therapy
39
what do most kids who have had a cleft lip or palate end up with?
lisp
40
how will you know your infant is ready for solid foods?
- 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
41
what will your infant do if they are not ready for solid foods?
- turn head away if they don't want it
- mouth stays open after spoon enters
42
why should you set the infant up for dinner time around 3-4 months?
they can start to see/ become familiar with meal times/ foods
43
how long should children be breast fed exclusively for?
6 months
44
what is extrusion? (on exam)
- tongue thrusting movement
- goes away around 4 months
- if they still have this not ready to eat solid foods
45
when you start feeding your child solid foods, what should you start with?
warm iron fortified baby rice/ barley mixed with formula or breast milk
46
what consistence should solid foods be in when you first try them with infants?
- thin to thick
- leave in lumps
47
why don't you want to start children with cows milk?
- don't have the enzyme for this yet
- develop it closer to 12 months
48
why is it recommended to introduce foods one at a time to infants?
so you know/ learn what they are allergic to
49
for 6-9 month olds, what are normal milestones for feeding?
- spoon feeding
- finger feeding
- cup drinking
- cuddling and breast or bottle feeding
50
what are some suggested foods for 6-9 month olds?
- soft/ well cooked
- mashed/ milled
- vegetables/ fruits
- mashed potatoes
- sticky rice
51
why do we want to give 6-9 month olds larger pieces of food?
- so they can have a better grasp on it
- smaller pieces can be choking hazard
52
for 9-12 month olds, what are normal milestones for feeding?
- finger feeding soft table foods
- drinking by self from covered cup
- cuddling and breast/ bottle feeding away from meal time
53
what are suggested foods for a 9-12 month old?
chopped/ cooked
- vegetables
- fruits
- cheese
- strips of bread
- toast
- tortillas
- crackers
- cereal
- tender chopped meats
54
at 9-12 months old where do most children get their nutrients from?
from food, they get topped up with breast milk between meals
55
what is considered a high allergy food?
- peanut butter
- eggs
- milk
- fish/ shellfish
56
will you see an allergic reaction from milk right away?
yes
57
what are foods that should be avoided for kids 9-12 months old?
- honey
- juices
- dairy
- anything unpasteurized
- hotdogs
- hard cheeses
- raw vegetables
- sugar
58
at what age is it okay to introduce honey? Why do you want to wait this long?
- 2 years old
- due to botulism/ unpasteurized
59
when you start to give cow milk to a 12 month old what type do you always want to start with?
pasteurized whole milk due to fat content
60
if a child has an allergy to milk products why do you need to be careful of the alternatives? What should you recommend instead?
- they are made from nuts > don't have high fat content
- recommend pea based milk product > closest thing for fat content
61
why do you want to ensure to creased ambiance for meal times for kids? What would this look like?
- informs kids time to eat
- all sitting at table
- music playing
- no electronics/ TV
- provide lots of colour
62
what do portion sizes look like for toddlers?
- smaller meals at first then add on food if they are still hungry
- large amounts can over whelm them
63
what minerals do you want to ensure toddlers get?
- iron
- fluoride
64
failure to thrive refers to what?
children whose current weight or rate of weight gain is significantly lower than that of other children of similar age/ gender
65
what percentile would failure to thrive children fall in?
5th or lower
66
what can failure to thrive be a result of?
- medical problems
- factors in the environment
- abuse/ neglect
- physical problems
67
can the cause of failure to thrive normally be determined?
no
68
what are some medical/ organic causes for failure to thrive?
- 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
what are some non-organic causes for failure to thrive?
- 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
what are some clinical manifestations for failure to thrive?
- 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
what may be recommended for failure to thrive?
- increase number of calories/ amount of fluid
- correct any vitamin/ mineral deficiencies
- identify/ treat any other medical conditions
72
for a child who doesn't thrive for a long time what might be affected?
- normal growth and development
73
what are some complications of failure to thrive?
permanent mental, emotional, or physical delays can occur
74
depending on the severity of failure to thrive what might this affect for treatment?
what they choose to use, if very severe will start with IV then move to NG then move to bottle
75
is obesity a medical condition?
yes
76
what is a sign of childhood obesity?
weight well above the average for a child's height/ age
77
what is considered overweight?
85th - <95th percentile
78
what is considered obese ?
anything above the 95th percentile
79
what are some things that can be recommended to reduce incidence of obesity ?
- 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
what puts someone at risk for obesity?
- 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
what are complications of obesity?
- type 2 diabetes
- increased depression
- low self-esteem
- digestive problems
- higher risk of asthma
- higher risk of sleep apnea
82
what does obesity put you at a greater risk for in adulthood?
- increased cardiac concerns
- increased chronic medical conditions
83
what is type 2 diabetes caused by?
resistance to insulin as well as the ability of the pancreas to keep up with the increase demand of insulin
84
what percent of children are obese when diagnosed with type 2 diabetes?
85%
85
what is the age of onset for type 2 diabetes in children?
- middle to late puberty
- around 13 years
86
what populations has a higher rate of type 2 diabetes?
minority populations
87
for people who have type 2 diabetes is there normally a strong family history of it?
yes
88
when assessing an obese child what do you expect to find?
- BMI > 30
- apple shape
- acanthosis nigricans
- hypertension
- + family history of type 2DM
- ethnicity
89
what is acanthosis nigricans ?
- hyper- pigmentation/ thickening of the skin into velvety irregular folds in the neck/ flex areas
- reflex hyperinsulinemia
90
obesity falls in what percentile?
equal to or greater than the 95th percentile
91
in regards to the management of type 2 diabetes what is included in the nursing assessment?
- health history
- physical exam
92
in regards to the management of type 2 diabetes what is included in the therapeutic management?
- glucose monitoring
- insulin replacement therapy
- oral hypoglycaemic medications
- other therapies
93
in regards to the management of type 2 diabetes what is included in the nursing management?
- regulating glucose control
- monitoring for complications
- educating family
94
DM type 1 is what?
- autoimmune disorder
- occurs in genetically susceptible individuals
95
what is type 1 DM characterized by?
- autoimmune destruction of pancreatic beta cells that produce insulin
- results in insulin deficiency
96
what does insulin support in DM type 1?
metabolism of
- carbohydrates
- fats
- proteins
97
what is insulin glucose metabolism essential for?
- growth
- activity
- wound healing
- brain function
98
when is type 2 DM most often diagnosed?
- winter months
99
what will be noted during the assessment at diagnosis for DM type 1?
- weight loss (as much as 30%)
- polyuria
- thirst
- ketones in urine
- decreased pH
100
what are presenting symptoms of DM type 1?
- hyperglycemia
- glucosuria
- polyuria
- electrolyte imbalance
- polydipsia
- polyphagia
101
what does glucosuria mean?
sugar in urine
102
what does hyperglycaemia mean?
glucose in blood stream
103
what does polydipsia mean?
attempt to relieve dehydration
104
what are diagnostic tests used to diagnose DM type 1?
- elevated blood sugars
- urine sample
- glucose tolerance test
105
what would show up in a glucose tolerance test for someone who has DM type 1?
low insulin levels and high glucose levels
106
what are short term goals for the management of DM type 1?
prevent:
- ketosis
- electrolyte abnormalities/ volume depletion secondary to osmotic diuresis
- impairment of leukocyte function
- impairment of wound healing
107
what are some hospital interventions that can be done for the management of DM type 1?
- administration of insulin
- blood glucose levels
- dietary management
- glycosylated hemoglobin
108
what are some long term goals for the management of DM type 1?
- prevention of microcirculatory/ neuropathic changes
- management of blood glucose
109
what is the target blood glucose for children under 6 years?
6-12 mmol/ L
110
what is the target blood glucose for children 6-12 years?
4-10 mmol/L
111
what is the target blood glucose for children 13-18 years?
4-7 mmol/L
112
what are some home internventions that can be done for the management of type 1 DM?
- blood glucose levels
- carb counting
- exercise
- illness prevention
- sick days protocol
113
what are presenting symptoms of DKA?
- polyuria
- polydipsia
- weight loss
- altered LOC
- dehydration
- nausea/ vomiting
- fruity smelling breath
- electrolyte disturbances
- dysrhythmias
- shock
- complete vascular collapse
114
what are the 3 phases of management for DKA?
1. resuscitation
- airways/ fluids
2. corrections
- acid-base and electrolyte abnormalities
- insulin/ blood glucose levels
3. transition to daily routine
115
what is included in the management of DKA in the hospital?
- BGM Q30-60 min
- lab work
- VS & neuro hourly until stable
- ketone urine dips
- strict I&O
- teaching
116
why do we want to give more sugar when we provide insulin to a patient who has DKA?
so their sugars don't drop even if they are hight to start with
117
what are long term things people can do to manage their diabetes?
- management by paediatrician/ endocrinologist
- insulin
- blood sugar monitoring
- diet
- exercise
- screen for retinopathy
118
what are included in goals of nutritional therapy for diabetics?
- 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
what is carb counting?
meal planning tool that helps control blood sugar
120
what are different types healthy carbs?
- whole grains
- legumes
- fruits
- vegetables
121
hat do healthy carbs provide?
- energy
- nutrients
- vitamins
- minerals
- fiber
122
describe unhealthy carbs
- food and drinks with added sugar
- provide energy
- have no nutritional value
123
why is carb counting important?
- help keep blood glucose levels stable
- way to figure out ISF
124
keeping your blood glucose levels as close to normal as possible can help prevent or delay what?
- prevent kidney disease
- blindness
- nerve damage/ amputations
- heart attacks/ strokes
125
why do we need to teach kids to eat before they give themselves insulin?
- 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
