Week 6 Gi part 2

Question 1

why do newborns regurgitate?

Answer 1

because the esophogeal spincter is not fully developed until 1 mo

Question 2

what are the 5 most common causes of pediatric gastroenteritis?

Answer 2

rotavirus, norovirus, e coli, salmonella, C diff

Question 3

what is considered ‘moderate’ dehydration in peds/infants?

Answer 3

5-10% of body weight lost

Question 4

if a child weighing 20 kg has lost <5% of their body weight in fluid, how do we rehydrate them?

Answer 4

give them 50ml/kg of body weight of an oral rehydrations solution (pedialyte) over 4 hours. in this case, 1000 mls total, or 250 mls/hr.

Question 5

most common cause of emergency abdominal surgery in kids

Answer 5

appendicitis

Question 6

what age range of kids is most likely to have appendicitis?

Answer 6

10-18

Question 7

how do we assess for appendicitis in kids?

Answer 7

require them to do an activity which irritates the peritoneal area (jumping, climbing), or have child’s hand over mine to palpate

Question 8

what are 3 interventions for a ruptured appendix?

Answer 8

rehydrate, antibiotics, prep for surgery

Question 9

what are six interventions for appendicitis post-op?

Answer 9

-manage pain
- IV fluids and antibiotics
- NG to suction
-wound care
- mobilize pt
-psychological support

Question 10

what are two ways i can protect the site after a cleft lip and palate surgery?

Answer 10

apply petroleum jelly, and elbow immobilizers

Question 11

is the following a description of acute or chronic cholecystitis?
- a result of gallstones obstucting the cystic duct.
-a complication of cholelithiasis

Answer 11

acute

Question 12

is the following a description of acute or chronic cholecystitis?
-gallbladder becomes fibrotic and atrophies

Question 13

what is blumberg’s sign?

Answer 13

rebound tenderness d/t cholecystitis

Question 14

what are two non-surgical stone managment options for cholecystitis

Answer 14

• extra-corporeal shock wave lithotripsy (ESWL)
• percutaneous transhepatic biliary catheter

Question 15

Describe the care plan for a post-laparoscopic cholecystectomy patient (6 things)

Answer 15

-Pain management
-DB and C
-Prevent DVT through ambulation
-MOnitor/treat N&V (dance party)
-IV fluids until eating
-Dishcarge same day

Question 16

what are the differences in post-op care for laparascopic vs. open cholecystectomy?

Answer 16

for open d/c is in 1-2 days post op, we give antibiotics, access the surgical site, and they’ll have a jackson pratt drain

Question 17

what are the two extremes of pancreatitis

Answer 17

edema (mild) to necrotizing (severe)

Question 18

is ascites found in acute or chronic pancreatitis?

Answer 18

chronic

Question 19

are grey-blue flanks and absent bowel sounds found in acute or chronic pancreatitis?

Answer 19

acute

Question 20

what are the complications of pacreatitis? name 6

Answer 20

jaundice
intermittent hyperglyc
++organ failure
coag defects
shock
paralytic ileus

Question 21

three non-drug interventions for acute pancreatitis (two monitoring, one positioning)

Answer 21

fetal position, monitor for hypocalcemia, monitor respiratory status

Question 22

drugs for acute pancreatitis

Answer 22

opioids for pain, ranitidine and PPI, antibiotics if its necrotizing

Question 23

nutritional interventions for acute pancreatitis

Answer 23

NPO but provide oral care, NG tube w/ suction, jejunal tube feed after NPO and gradually resume food

Question 24

what is the particular different drug given for chronic pancreatitis as opposed to acute?

Answer 24

pancreatic enzymes

Question 25

when would we give TPN for pancreatitis?

Answer 25

in chronic (exacerbation)

Question 26

what should epople with chronic pancreatitis avoid?

Answer 26

high fat food, alcohol

Question 27

besides excessive ETOH intake, what causes liver cirrhosis?

Answer 27

hepatitis, NAFLD, drugs like acetaminophin, chronic biliary obstuction

Question 28

what interventino could be appropriate if ascites was affecting ability to breathe?

Answer 28

paracentesis

Question 29

people with liver cirrhosis should be screened for _________ ________

Answer 29

esophogeal varices

Question 30

three endoscopic therapies that treat bleeding in liver cirrhosis

Answer 30

ligation of bleeding veins, sclerotherapy (injected into varices), and balloon tamponade or stents

Question 31

how is sertraline used to treat symtpms of liver cirrhosis?

Answer 31

its an SSRI which tricks brain into not being itchy

Question 32

two goals of care for viral hepatits

Answer 32

prevent weight loss from compications of disease, and reduce fatigue d/t infection and decreased metabilic energy productino

Question 33

which drugs should be avoided in GERD and hiatal hernia?

Answer 33

oral contraceptive, anticholinergics, sedatives, NSAIDS, nitrates, Ca channel blockers as they all lower LES prsesure

Question 34

what will be in situ after a nissen fundoplication?

Answer 34

an NG tube to drain

Question 35

first sign of esophogeal tumor

Answer 35

dysphagia

Question 36

what is a non-surgical treatment for esophageal tumor that has a risk of perforation?

Answer 36

dilation

Question 37

highest priority post-op after removal of esophageal tumor

Answer 37

respiratory care

Question 38

how is nutrition delivered after esophogeal surgury/

Answer 38

initially through jejunostomy

Question 39

what is a VERY IMPORTANT thing to consider about the GI system of children/infants.

Answer 39

dehydration

Question 40

what three reasons are infants at higher risk for dehydration?

Answer 40

they can't tell us about thirst they have a high metabolic rate they have a higher body surface area per body volume

Question 41

how many wet diapers a day do we want?

Answer 41

6

Question 42

what is a common nutritional deficiency in children?

Answer 42

vit D

Question 43

what is Hirschsprung disease?

Answer 43

part of the bowel is not innervated = no peristalsis

Question 44

what is congenital esophageal atresia?

Answer 44

when the esophagus does not connect to the stomach

Question 45

what are the early signs of dehydration in a baby?

Answer 45

decreased UO, ++ thirst, slightly dry MM

Question 46

what four types of issues can a cleft lip/palate cause?

Answer 46

feeding (fluid can go into sinuses) dentition speech cosmetic

Question 47

what is barret's esophagus?

Answer 47

when cells are pre-cancerous d/t gerd

Question 48

if a pt with GERD had wheezing, why would I be concerned?

Answer 48

because they may have aspirated stomaach acid

Question 49

what would keep me most busy managing a pt with acute pancreatitis? what could be done to alleviate this?

Answer 49

pain management patient controlled analgesic