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100 Cards in this Set
- Front
- Back
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Cleft Lip and Palate is detectable at birth
-if they have either problem, they can have what kind of problems? -tell me about bonding? |
they can have sucking problems
Possible impaired parent –infant bonding |
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Cleft Lip and Palate
because the lip and the palate form at the same time, they usually have both cleft lip and palate (true or false) |
true
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Cleft lip and Cleft palate
-etiology? |
they are congenital anomalies that occur as a result of failure of soft tissue or bone structure to fuse during embryonic development
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Cleft lip and Cleft palate
-plan to use specialized feeding techniques such as: -what do you make sure to keep at the bedside? |
You need special devices for feeding because they can’t suck: Haberman feeder, Breck feeder, Asepto syringe (these are all nipples that are longer with a bigger opening at the end of it so you can pour the formula or breast milk down)
keep suction equipment and bulb syringe at the bedside |
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Cleft lip and Cleft palate
-tell me about feeding |
Feeding can be a problem because they have a sucking problem
–Complete within 30 minutes –Our goal is for them to follows normal G&D |
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Cleft lip & palate
-how do you feed them the formula? |
You are pouring formula down the child’s throat between breaths – pour when breathing out. You don’t want to pour it in when they are breathing in because their epiglottis is open and they can aspirate
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Cleft lip & palate
-how do you hold the infant when feeding? |
–hold the infant in an upright position and direct the formula to the side and back of the mouth to prevent aspiration
–feed small amounts gradually and burp frequently |
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Cleft lip & palate
Feedings: the baby is at risk for what 3 things? |
Risk for aspiration – so feed baby when the are sitting up,
there is also a risk for ear infections (Eustachian tube is not very long and the formula can get into the tube which can cause ear infections and hearing problems) they are also at risk for dental problems because the milk can sit in their mouth |
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Cleft lip & palate
-OR/surgery as soon as possible: when can cleft lip be done? when can the palate be done? |
cleft lip 6 – 12 weeks after birth
palate 12-18 months after birth. They can many times do both surgeries at the same time. |
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Cleft Palate - Repair
-Done in stages At what age is this done? Instruct them to keep everything out for the mouth for how long? |
• Age 12-18 months
•Keep everything out of mouth for 10 day |
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Cleft Palate - Repair
-tell me about the diet following this surgery -what should they use to feed? |
Clear liquids for 72 hours then go to soft with no spoon
Use Lambs nipple, wide bowl spoon or plastic cup – don’t want sucking |
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Cleft Palate - Repair & restraints used
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Elbow restraints to prevent hand from going in mouth
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Cleft Palate - Repair
-make sure you burp them frequently -what care do you perform with the sutures? how do you position them? |
-cleanse suture line after feeding with NS or sterile water
-avoid rubbing suture line – so put in supine or side lying positions |
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Cleft Lip - Repair
•Repaired in one stage – surgery done first Care: |
No pressure on cheeks – never on abdomen, elbow restraints, lessen crying
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Cleft Lip - Repair
Keep incision clean Risk for infection: what do you instruct them to do? |
rinse mouth with sterile water
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Cleft lip & palate
-what other therapy may be necessary? why? |
Speech therapy may be necessary for both slept palate and lip, it is used for speech development and maybe for the feeding aspect to get them to suck
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Risk Factors from cleft lip and palate
- heredity - teratogens such as: (3) |
maternal intake of Dilantin
maternal smoking, family tendency |
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Postoperative notes for cleft lip
position the child how? |
upright in car seat position, on back, or on side
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Postoperative notes for cleft lip
-how can you prevent respiratory complications? |
- gently aspirate secretions of mouth and nasopharynx
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Postoperative notes for cleft palate
-position? |
change positions frequently to facilitate breathing
- infant may be placed on abdomen in immediate post operative period |
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Postoperative for cleft lip and palate
- keep infant as free from pain as possible to decrease stress and crying on repair -when assessing sites, look for: |
crusting and infection
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Pyloric Stenosis
-what happens to the pyloric sphincter? -when palpating, what do you find? |
-the pyloric sphincter is narrowed
-the child will have a football shaped hard spot in the upper part of their abdomen. -Their pyloric muscle is hypertrophied. |
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Pyloric Stenosis
--when does this occur? |
Occurs 2 – 3 week after birth
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Pyloric Stenosis
-tell me about the big CM? |
Projectile vomiting several hours after eating b/c the breast milk builds up in the stomach and causes it to distend
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Pyloric Stenosis
Complication: |
pt can die from dehydration
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Surgery for pyloric stenosis: surgeon goes in and cuts the muscle
-what do you teach about the diapers? -what do you teach about bathing the child? |
Fold diapers over so don’t contaminate; sponge baths only till incision healed
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Surgery for pyloric stenosis: surgeon goes in and cuts the muscle
–May vomit after feedings – this is normal (true or false) |
true
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Surgery for pyloric stenosis: surgeon goes in and cuts the muscle
–Bottle fed baby: how often do you have to burp them? |
burp after every 1 – 2 oz b/c we don’t want the stomach to become distended and put stress on the suture line
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Surgery for pyloric stenosis: surgeon goes in and cuts the muscle
–Breastfeed baby: how often do you have to burp them? |
burp every 5-10 minutes
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Pyloric stenosis surgery
–In order to promote dumping of the formula, what should you teach them to do after the feeding? -how should they position their child? -what do you intruct them not to do after feeding? |
after feeding hold upright 30 minutes or position on right side with head elevated
–Don’t play or rock for 30 minutes after feeding |
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Pyloric stenosis
-Lab? -What will their appetite be like? |
- Increased BUN due to dehydration
- Constant hunger |
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Pyloric stenosis
-watch for signs of dehydration such as: |
dry skin, pale cool lips, dry mucous membranes, decreased skin turgor, diminished UO, concentrated urine, thirst, rapid pulse, sunken eyes, decreased BP
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Pyloric stenosis
-Diagnosis (1) |
ultrasound of abdomen will reveal an elongated, sausage
shaped mass and an elongated pyloric area |
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Diverticula is what
Diverticulosis: |
– out pouching in colon
multiple diverticula, or an out pouching or herniation of the intestinal mucosa |
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Diverticulitis – inflammation of diverticula that occurs from what?
-what can it result in (2) |
penetration of fecal matter through the thin-walled diverticula
-it can result in local abscess formation and perforation (leading to peritonitis) |
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-Diverticulitis is an inflammation of the diverticula (hernia in intestinal wall) that occurs in the colon. Comes from an increase in what?
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an increase in intercolinc pressure because by then the majority of the fluid has been absorbed from the colon
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Diverticulitis
-what quadrant is the pain felt in? -what is unique about their pain? |
-LLQ pain because it most commonly affects the sigmoid colon
-This pain increases with coughing, straining, and lifting |
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Diverticulitis
-3 other CM |
-Palpable tender mass may be present
-Blood in stools -fever |
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Treatment for Diverticulitis
-bed rest and maintain NPO status or clear liquids during the acute phase -what about their diet? |
-Low roughage, high-fiber diet = for mild cases/typical diet for diverticulosis
-when someone has diverticulitis, they will decrease the fiber and roughage because you want to rest the bowel -they will increase the fiber in the diet when inflammation is gone because these foods irritate the mucosa -high fiber foods are whole grains |
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Diverticulitis
-What type of medication is used? |
Bulk forming agents (metamucil) is good for diverticulosis because it increases stool mass
- (start someone out slow so the patient doesn’t become bloated and tell them to drink a lot of water) |
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Diverticulitis
-what is used to help reduce bowel spasms? |
Anticholinergics to help reduce bowel spasms
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Diverticulitis
-Avoid increasing intracolonic pressure (how?) |
(this is why the stool softeners, bulk forming agents are important)
-don’t do lifting, coughing, straining, or bending to avoid increased intra-abdominal pressure -Using the abdominal muscles increases intracolonic pressure) |
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Diverticulitis
-what do you do for an exacerbation? |
NPO to rest the colon, antibiotics, IVF, NG to rest the colon, resection to remove diseased portion
– temporary colostomy placed to rest area of inflammation in the colon. |
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Diverticulitis
-what is a complication? |
Perforation of colon that can cause peritonitis
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Who is at greatest risk for developing diverticulosis:
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truck drivers, secretaries – they sit all day and can’t always evacuate the colon when they need to
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Types of Obstructions
-what is a neurogenic obstruction? -when is it common? |
Also called a paralytic ileus
after abdominal surgery. (means that peristalsis is decrease or absent resulting in slowing of the movement or back up of intestinal contents) |
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Obstructions
-bowel sounds after surgery -when do we expect BS to return? -if a pt had a colon resection, how long may it take for BS to return? |
-if BS haven’t returned within 3 days, we start to be concerned
-if colon resection, BS may take up to 5 days to return |
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Obstructions
-Adhesions can occur as a result of abdominal surgery. What is it? How can it result? |
-scar tissue. They pull everything out during surgery and they shove the intestines back in and between the drying out of the GI tract and adhesions form (it is when something sticks together)
-easy to fix: cut it apart |
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Obstruction
Intussusception –AKA: |
telescoping. The bowel falls back on itself. Usually seen in children but it can occur in adults as a result of abdominal surgery. Can cause an obstruction.
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Volvulus means what
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–twisting of the bowel
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CM of obstructions:
-Small intestine Onset? |
rapid onset
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CM of obstructions:
-Small intestine Vomiting? |
common!
-may look like brown stuff because they may be vomiting fecal material |
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CM of obstructions:
-Small intestine What type of pain will they experience? |
colicky, cramplike pain
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CM of obstructions:
-Small intestine Tell me about their bowel movements? |
they will have BMs for a short time
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CM of obstructions:
-Small intestine Abdominal distension? |
slight distension
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CM of obstructions:
-Sm or Lg intestine? S/S are more significant |
small
-vomiting is the big CM |
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CM of obstructions:
-Large intestine Onset? |
gradual onset
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CM of obstructions:
-Large intestine Vomiting? |
rare
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CM of obstructions:
-Large intestine What type of pain will they experience? |
low grade cramping and abdominal pain
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CM of obstructions:
-Large intestine Tell me about their bowel movements |
constipation is seen
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CM of obstructions:
-Large intestine Abdominal distension? |
large amounts of distention
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GI Surgery
•Hemicolectomy is what? |
remove half of colon (could be a tumor, cancer, disease)
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GI Surgery
•Resection: what is this? |
remove only the diseased part of the colon (may be a couple of inches)
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GI Surgery
-Total colectomy results in an ostomies (true or false) |
true
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Ostomy
-ileostomy is located where? -colostomy is located where? -colon refers to what? |
-ileostomy, which is in the small intestine
-colostomy which is in the large intestine -colon refers to the large intestine |
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•NG (nasal gastric)
How do you measure this? How do you measure this in infants? |
–Tip of nose to ear to xyphoid process
-Infants must be flat to measure |
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-If a pt has an NG tube in with significant gastric output. The MD may order gastric replacement, which is what?
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This is where you replace what has come out of the NG tube. If on day shift , 250 mL comes out of the day shift. On PMs you replace the 250mL. This is given back to them IV over an entire shift of over 4 hours.
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Gastric replacement
-If the MD's order says replace 200 out and the output is 250, how much do you replace? |
you replace 50mL
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-if the pt has a lot of NG output, the physician may order albumin, why?
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(albumin is a plasma protein) which will pull the fluid back into the vascular space to decrease their NG tube output
-albumin is sticky and thick, straw yellow, hangs separately like a blood product |
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Post-op Care for someone who has GI surgery
•NPO •Possible NG -Catheter will be placed, why? |
(we want accurate I/O, we do not want the bladder filling up and putting pressure on the surgical site)
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Post-op Care for someone who has GI surgery
•Respiratory & vascular care: |
get them ambulating and cough and deep breathing
•Pain management is important otherwise they won’t deep breath and cough or go for a walk |
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Complications of surgery
-What is dehiscence? |
when the surgical site opens.
-It is a partial or complete separation of the outer wound layers, sometimes described as “splitting open of the wound” |
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Complications of surgery
-What is evisceration? |
when organs come out.
-This is the total separation of all wound layers and protrusion of internal organs through the open wound |
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Complications of surgery
-How do you treat dehiscence and evisceration? -How do you position them? -Tell them not to do what? |
cover it with a moist saline dressing
-position them laying down with head up a little bit to take pressure off the abdominal surgical site, -tell them not to cough, laugh, sneeze, cough |
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Complications of surgery
- dehiscence and evisceration is common in patient's with what? (3) |
in obese patients, DM, malnutrition
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Complications of surgery
- dehiscence and evisceration What can be used to help prevent these? |
abdominal binders
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Complications of surgery
- dehiscence and evisceration When does this usually occur? -what may the patient describe when this happens? |
-between the 5-10 day after surgery or may follow forceful coughing, vomiting, or straining and when not splinting the surgical site during movement.
-the pt may say “something gave way or I feel as if I just split open” |
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Hirschsprung Disease is what?
Obstruction results because of what? |
-congenital anomaly
-mechanical obstruction results because of inadequate motility in an intestinal segment |
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Hirschsprung Disease occurs as a result of an absence of what?
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absence of ganglion cells in the rectum and other areas of the affected intestine
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Hirschsprung Disease
-most often affects what colon? |
-distended sigmoid colon
-the area of the colon is not innervated, so fecal material gest stuck there |
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Hirschsprung Disease
-most serious complication is what? |
entercolitis (fever, severe protrusion, gastrointestinal bleeding and water explosive diarrhea)
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Hirschsprung Disease
-what type of bowel movements patterns will the child have? |
-realize that a child will have alternating constipation and diarrhea (constipation because the aganglionic colon causes nothing to pass) but the liquid part of the fecal content passes by) this is why people think they have diarrhea but it isn’t.
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Hirschsprung Disease
-what is our concern with kids? -what kind of pain is felt? |
-growth and development problems because they are not eating right
-crampy, intermittent pain |
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Hirschsprung Disease
CM - Newborn: (5) |
-Failure to pass meconium 24-48 hours after birth
-Reluctance to ingest fluids -Bile-stained vomitus -Abdominal distention -Refusal to suck |
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Hirschsprung Disease
CM - Infancy (5) |
•Failure to thrive
•Constipation •Abdominal distention •Episodes of diarrhea and vomiting •Enterocolititis: explosive watery diarrhea, fever, severe prostration |
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Hirschsprung Disease
tell me about the characteristics of their stool |
•Constipation
•Ribbonlike foul smelling stools because of the aganglionic cool. The stool sits in the colon and rots. |
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Hirschsprung Disease
CM - Childhood -what do they fail to gain? -what will their abdominal look like? -what can you palpate? -are they anemic? |
-Failure to gain weight and delayed growth
•Abdominal distention with visible peristalsis •Fecal masses easily palpable •Poorly nourished and anemic •Symptoms are more chronic |
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Hirschsprung Disease
-Treatment is based on what |
relieving the chronic constipation
-Enemas as needed to prevent the constipation from occurring. |
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Hirschsprung Disease
-what is the treatment if there is an inflammatory process taking place? |
-IV antibiotics & NPO if there is an inflammatory process
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Hirschsprung Disease / Surgery
-what is done? |
temporary colostomy during the initial neonatal period to relieve obstruction and allow the normally innervated dilated bowel to return to its normal size
-when the bowel returns to its normal size (3-6 months) a complete surgical repair is performed via a pull through procedure to excise portions of the bowel, at this time, the colostomy is closed |
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Hirschsprung Disease
-Concern for nutrition Encourage a diet that consists of what? |
-Concern for nutrition (encourage a low fiber, high calorie, high protein diet)
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Intussusception is what?
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telescoping of one portion of the bowel into another portion
-the colon folds back on itself (can occur anywhere in the GI tract) |
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Intussusception
-this condition results in what? |
obstruction to the passage of intestinal contents
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Intussusception
-onset? |
-comes on suddenly
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Intussusception is a deadly condition that can result in what?
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-can cause perforation and shock
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Intussusception CM:
-what does their stool look like |
-passage of bloody mucous “currant jelly” stool*
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Intussusception CM:
-what can you palpate? what is the pain described as? |
-sausage shaped and mass-
-Crampy abdominal pain -Colickly abdominal pain that causes the child to scream and draw the knees to the abdomen similar to the fetal position |
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-Intussusception the child is inconsolable
-monitor for signs of perforation & shock such as: |
fever, tachycardia, changes in LOC or BP, respiratory distress
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Intussusception
what indicates that the intussusception has reduced itself? |
-monitor for passage of normal, brown stool
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Intussusception
-Diagnosis & Treatment |
-take them for a cat scan & then surgery is the current treatment
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