Pediatric Gi Alterations + Family

Front 1

The normal age for menarche is usually___ to ______, with the average age being ___years and _____months

Back 1

10.5 to 15
12 to 9.5

Front 2

Girls may be considered to have pubertal delay if breast development has not occurred by age_____ or if menarche has not occurred by age_____

Back 2

13,13

Front 3

The first pubescent change in boys is

Back 3

testicular enlargement with thinning, reddening, and increased loosness of the scrotum

Front 4

What type of thinking occurs between the ages of 11 to 14 years?

Back 4

formal operational thinking: thought processes includes thinking in abstract terms, possibilities and hypotheses

Front 5

What is the best way to influence adolescents health promotion?

Back 5

peer pressure of positive health behaviours. Not telling them of rules, punitive consequences, or health dangers.

Front 6

According to Erickson, a key to identity achievement in adolescence is best described as

Back 6

related to the adolescent's interactions with others, serving as a mirror and reflecting information back to the adolescent

Front 7

Of the following male reproductive problems, the one most likely to be identified in an adolescent male is: hypospadias;cryptorchidism;testicular tumor;urethritis

Back 7

urethritis

Front 8

an absence of menses by age 16 when there are normal secondary sex characteristics

Back 8

primary amenorrhea

Front 9

an abscence of menses for 3-6 months in a previously menstruating female when pregnancy has been excluded

Back 9

secondary amenorrhea

Front 10

What are 3 guiding principles to offer to parents of adolescents to help them better communicate with their adolescent child?

Back 10

Show respect for the adolescent's privacy
show honest and sincere interest in their beliefs and feelings
listen without interrupting the adolescent

Front 11

WHat is the multidisciplinary treatment for anorexia and bulimia?

Back 11

Behaviour modification programs
continuity of caregivers
clear communication among team
support of patient

Front 12

what are the characteristics typically seen with adolescent suicide?

Back 12

disturbed family situation
economic stresses
family disintigration
medical problems
psychiatric illness
abandonment
alcoholism

Front 13

Extremely long intervals between defecation

Back 13

obstipation

Front 14

What is the first line treatment for diarrhea and dehydration?

Back 14

oral rehydration solution

Front 15

constipation with fecal soiling

Back 15

encopresis

Front 16

fluid compartment, 40% of which is lost when a child is dehydrated

Back 16

intracellular fluid

Front 17

eleminates any food of animal origin, including milk and eggs

Back 17

pure vegetarianism, or vegan.

Front 18

Most restrictive of all types of vegetarianism, using brown rice as the mainstay of the diet

Back 18

Zen macrobiotics

Front 19

excludes meat but allows milk

Back 19

lactovegetarianism

Front 20

What are the major nutritional deficiencies that are most likely to occur in the diet of a family that follows a strict vegetarian diet

Back 20

decreased protein
decreased calories
poor digestion
deficiency of B vit's, D, iron,calcium,zinc, b12

Front 21

Kwashiorkor results in populations in which the diet consists mainly of what?

Back 21

starch grains

Front 22

Nutritional marasmus usually results in populations in which;

Back 22

the adults eat first, leaving insufficient food for the children

Front 23

What is the most definitive diagnostic strategy for identifying a milk allergy?

Back 23

a challenge of milk after elimination

Front 24

Treatment of cow's milk allergy in infants involves changing the formula to

Back 24

casein/whey hydrolysate milk

Front 25

dehydration that occurs when electrolyte and water deficits are present in balanced proportion

Back 25

isotonic

Front 26

dehydration that occurs when the electrolyte deficit exceeds the water deficit

Back 26

hypotonic

Front 27

In hypotonic dehydration Na+ concentration is usually less than what?

Back 27

130mEq/L

Front 28

dehydration resulting from water loss in excess of electrolyte loss

Back 28

hypertonic

Front 29

hypertonic dehydration is caused by what?

Back 29

water loss in excess of electrolyte loss and/or a large intake of electrolytes.

Front 30

in hypertonic dehydration, plasma Na+ is greater than

Back 30

150mEq/L

Front 31

What is the test for Hirschsprung disease?

Back 31

rectal biopsy

Front 32

What are the clinical manifestations of Hirschsprung disease?

Back 32

constipation, visible peristalsis, and palpable fecal mass

Front 33

What is the positioning recommended for reflux?

Back 33

after feeding and burping, position the infant prone with the head and chest elevated 30 degrees.

Front 34

What are the s+s of giardiasis?

Back 34

abdominal cramps with intermittent loose stools

Front 35

What are the s+s of possible peritonitis from a ruptured appendix in a child suspected of having appendicitis?

Back 35

temp of 103f, absent bowel sounds, and sudden relief from abdominal pain

Front 36

What are the most common clinical manifestations expected with Meckel diverticulum?

Back 36

Painless rectal bleeding, abdominal pain, or intestinal obstruction

Front 37

What is the COMMON feature of inflammatory bowel disease?

Back 37

growth abnormalities

Front 38

what is the single most effective strategy to prevent and control hepatitis?

Back 38

handwashing

Front 39

biliary atresia

Back 39

progressive inflammatory process causing bile duct fibrosis

Front 40

What are the options used when feeding the infant with cleft of the lip or palate?

Back 40

Use of "cleft palate" nipple or large, soft nipple with large hole, or breastfeeding. ALso "gravity flow" nipple attached to a squeezable plastic bottle or rubber-tipped Asepto syringe or Breck feeder

Front 41

intussusception

Back 41

an invagination of one portion of the intestine into another

Front 42

What are the clinical manifestations of intussusception?

Back 42

crying with abdominal examination, vomiting, and currant-jelly-appearing stools

Front 43

A 5-month old infant's intussusception is treated with hydrostatic reduction. The nurse should expect care after the reduction to included?

Back 43

observation of stool

Front 44

what are the clinical manifestations of esophageal atresia?

Back 44

frothy saliva in the mouth and nose of the neonate and frequent drooling. When fed, the infant swallows normally, but suddenly the fluid returns through the nose and mouth of the infant.

Front 45

pyloric stenosis is associated with what symptom?

Back 45

projectile vomiting

Front 46

What is the most important therapeutic management for the child with celiac disease?

Back 46

eliminating wheat, rye, barley, and oats from the diet

Front 47

What do you teach the parents of a child with GERD?

Back 47

position infant prone with head elevated at 30 degrees for 24 hours a day, maintain position with a body harness or leave flat/prone, and do not put in supine position

Front 48

Ulcerative colitis

Back 48

large intestine mucosa becomes hyperemic and edematous with patchy granulation that bleeds easily and leads to superficial ulceration

Front 49

crohn's disease

Back 49

affects terminal ileium and all layers of bowel wall. Edema and inflammation progress to deep ulceration with fissure and obstruction

Front 50

what are the 2 symptoms of UC?

Back 50

rectal BLEEDING and diarrhea

Front 51

what are the 3 symptoms of CD?

Back 51

PAIN, weight loss, growth retardation

Front 52

What are the major concerns with vomiting?

Back 52

dehydration, loss of fluid and electrolytes, metabolic ALKALOSIS, aspiration.

Front 53

What is the weight loss percentage categories indicating levels of dehydration?

Back 53

Mild=5% in infants, 3%-4% in children
Moderate=10% in infants, 6-8% in children
Severe = 15% in infants
10%in children

Front 54

What are the manifestations of mild dehydration?

Back 54

Behaviour, mucous membranes, anterior fontanel, pulse, and BP all WNL.
Cap refill greater than 2 sec.
Slight thirst
Urine-specific gravity is greater than 1.020

Front 55

What are the manifestations of moderate dehydration?

Back 55

Cap refill between 2 and 4 sec.
Thirst and irritability
Pulse slightly increased
Mucous membranes dry and tears and skin turgor decresed
Urine specific gravity is greater than 1.020(oliguria)

Front 56

What are the manifestations of severe dehydration?

Back 56

Cap refill greater than 4 sec.
Tachycardia present and orthostatic BP may progress to shock.
Extreme thirst present
mucous membranes very dry and skin is tented
anterior fontanel is sunken
oliguria or anuria is present

Front 57

Provide fluid replacement RAPIDLY for __________ and _________dehydration.

Back 57

isotonic and hypotonic. (serum sodium 150mEq/L or less)

Front 58

Provide fluid replacement over 24 to 48 hours SLOWLY for _____________dehydration to prevent _________

Back 58

hypertonic(NA+ >150mEq/L), cerebral edema.

Front 59

GERD is more likely to occur in _________________, intussusception with ___________

Back 59

GERD-premies and congenital defects, INTUSSUSCEPTION-cystic fibrosis.

Front 60

AN elevated BUN indicates what?

Back 60

dehydration

Front 61

What are the lab tests that indicate appendicitis?

Back 61

increased WBC's with increased band (immature neutrophil) count

Front 62

What can diarrhea cause?

Back 62

metabolic ACIDOSIS

Front 63

What is the treatment for mild to moderate dehydration?

Back 63

Pedialyte, avoid carbonated beverages because they are gas-producing and fluids that contain high amounts of sugar such as apple juice.

Front 64

What is the treatment for severe dehydration?

Back 64

NPO
IV fluids as prescribed.
**if K+ given, ensure that the child has voided and has adequate renal function.

Front 65

A child with cleft palate is at risk of what?

Back 65

frequent otitis media resulting in hearing loss

Front 66

What are the interventions for feeding an infant with cleft lip or palate?

Back 66

plan to use special nipples and feeders, and techniques.
hold infant upright and direct formula to the side and back of mouth.
small amount gradually and burp frequently
Teach parents the ESSR method of feeding.

Front 67

What is the ESSR method of feeding?

Back 67

for cleft palate: Enlarge the nipple, Stimulate the sucking reflex, Swallow, Rest

Front 68

Keep what at the bedside of the infant with cleft palate?

Back 68

bulb syringe and suction

Front 69

Milk coming out of the nose in an infant with cleft palate is_______

Back 69

normal. It is okay because the cleft palate opens directly into the nasal cavity. (ATI)

Front 70

What is the positioning for post-op cleft lip repair?

Back 70

avoid positioning the infant on the side of the repair or in the prone position. POsition on the back, upright. Use elbow restraints.

Front 71

Post-op care for cleft palate is what?

Back 71

oral packing removed in 2 to 3 days. no teeth brushing. soft foods only.

Front 72

esophageal atresia and tracheoesophageal fistula

Back 72

When the esophagus terminates before it reaches the stomach, sometimes forms a fistula opening into the trachea.

Front 73

What are the assessment findings of esophageal atresia?

Back 73

Frothy saliva in the mouth and nose and excessive drooling. The "3 C's" , Coughing, Choking, and Cyanosis. vomiting, abdominal distention, resp distress with feeding.

Front 74

Monitor what post-op esophageal atresia?

Back 74

monitor for anastomotic leaks as evidenced by purulent drainage from the chest tube, increased temp, and increased WBC count.

Front 75

what is the parental teaching after esophageal atresia surgery?

Back 75

techniques of suctioning, tube care, feedings, skin care, signs of resp distress and constricted esophagus (poor feeding, dysphagia, drooling, coughing, regurgitated undigested food.)

Front 76

what is the treatment for GERD?

Back 76

Diet, positioning, medications, surgery.

Front 77

Hypertrophic pyloric stenosis

Back 77

hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. The stenosis usually devolops in the first few weeks of life , causing projectile vomiting , dehydration, metabolic alkalosis and FTT.

Front 78

Celiac disease

Back 78

AKA gluten enteropathy or celiac sprue. Intolerance to gluten, the protein component of wheat, barley, rye, and oats, which results in the accumulation of glutamine, which is toxic to intestinal mucosal cells. Intestinal villous atrophy occurs, which affects absorption.

Front 79

What are the interventions for lactose intolerance?

Back 79

eliminate dairy or administer enzyme lactase. Substitute soy-milk, limit milk to one glass at a time and/or consume with other foods. Encourage hard cheese, cottage cheese and yogurt which because they contain lactase. Identify hidden sources.

Front 80

Appendicitis

Back 80

inflammation of the appendix. Perforation may occur within a matter of hours, leading to peritonitis, sepsis, septic shock, and potentially death. Treatment is surgical removal.

Front 81

Hirschsprung's disease

Back 81

A congenital anomaly AKA congenital aganglionosis or aganglionic MEGACOLON

Front 82

intussception

Back 82

telescoping of one prtion of the bowel into another portion resulting in obstruction

Front 83

Omphalocele

Back 83

the herniation of the abdominal contents through the umbilical ring, usually with an intact peritoneal sac.

Front 84

Gastroschisis

Back 84

occurs when the herniation of the intestine is lateral to the umbilical ring. No membrane covers the exposed bowel.

Front 85

Umbilical hernia

Back 85

A protrusion of the bowel through an abnormal opening in the abdominal wall, most often occuring at the umbilicus and through the inguinal canal.

Front 86

hydrocele

Back 86

the presence of abdominal fluid in the scrotal sac.

Front 87

incarcerated hernia

Back 87

when the descended portion of the bowel becomes tightly caught in the hernial sac, compromising blood supply.

Front 88

encopresis

Back 88

constipation with fecal incontinence

Front 89

IBS

Back 89

results from increased motility, which can lead to spasm and pain. Alternating constipation and diarrhea with the presence of undigested food and mucus in the stool. Stress and emotional factors may contribute to it's occurrence.

Front 90

imperforate anus

Back 90

incomplete development or absence of the anus in it's normal position in the perineum

Front 91

hepatitis B immunoglobulin

Back 91

provides passive immunity and is given to newborns whose mothers are positive for Hep B surface antigen.

Front 92

In the event of a poisoning, the nurse treats what first?

Back 92

THE CHILD, not the poison. ABC's and vital signs, CPR first. Then exposure to the poison is terminated next, such as emptying the mouth of pills or flushing skin. Then identify the poison. Then administer antidote or activated charcoal.

Front 93

What is the Erythrocyte protoporphyrin test?

Back 93

an indicator of anemia. Normal value for a child is 35 mcg/100 mL of whole blood or lower.

Front 94

What treats lead poisoning?

Back 94

Chelation therapy. Medications:
calcium disodium edetate
succimer (Chemet)
British anti-Lewisite (BAL, dimercaprol)

Front 95

BAL

Back 95

British anti-Lewisite...IV or IM. Contraindicated in children with an allergy to peanuts because the med is prepared in a peanut oil solution or with G6PD deficiency. Do not give with iron. Monitor renal hepatic, heme closely. Ensure adequate urinary output and urinary PH prior and during. Provide adequate hydration.

Front 96

What are the interventions for pinworm?

Back 96

perform a visual inspection of the anus with a flashlight 2-3 hours after going to sleep. Tape test. Medications. Teach about importance of handwashing and wash all clothes and linens in hot water.

Front 97

What is the tape test?

Back 97

a loop of transparent tape is placed firmly against the childs perianal area before bed. It is removed in the am and placed in a glass jar or plastic bag for pinworm testing.

Front 98

What are the meds for pinworm?

Back 98

mebendazole (Vermox)
pyrantel pamoate (Pin-Rid, Antiminth)
albendazole (albenza)

Front 99

What are the positing interventions for GERD?

Back 99

supine to sleep unless GERD is really severe, then prone to sleep. MD rx. Prone when awake.

Front 100

What is the diet for GERD?

Back 100

small, frequent feedings. Thickened formula or breastmilk in bottle with cross-cut nipple. Burp frequently, handle infant minimally after feeding. For toddlers, solids first, then liquids. Avoid fatty foods, chocolate, tomato, carbonation, fruit juice, spicy foods. Avoid vigorous play after feeding and before bed.

Front 101

What are the meds for GERD?

Back 101

antacids, PPI's, H2rA's, prokinetics (Reglan)

Front 102

What is the surgery for GERD?

Back 102

Fundoplucation to restore the competance of LES.

Front 103

What is the assessment findings for pyloric stenosis?

Back 103

projectile vomiting after a feeding with no bile.
Perastaltic waves visible from L to R after a feeding.
on olive-shaped mass in the epigastrum just r of the umbilicus

Front 104

What is pyloromyotomy?

Back 104

For pyloric stenosis. An incision through the muscle fibers of the pyloris

Front 105

What are the signs and symptoms of celiac disease?

Back 105

diarrhea, steatorrhea, anorexia, abdominal pain and distention, MUSCLE WASTING PARTICULARLY IN THE BUTTOCKS AND EXTREMITIES, vomiting, anemia, irritability

Front 106

What is an indication of a perforated appendix?

Back 106

the sudden relief of pain and then a subsequent increase in pain accompanied by right guarding of the abdomen.

Front 107

In a child pre-op for appendectomy, avoid the use of what?

Back 107

pain meds so as not to mask pain changes associated with perforation. Apply ice packs to abdomen for 20-30 min if rx. Avoid heat, laxatives or enemas.

Front 108

Why does Hirschsprung's disease occur?

Back 108

the result of an absence of ganglion cells in the rectum and other areas of the affected intestine

Front 109

what are the s+s of enterocolitis due to Hirschsprung's ?

Back 109

fever, severe prostration, gastrointestinal bleeding, and explosive watery diarrhea.

Front 110

What is the treatment for mild to moderate Hirschsprungs?

Back 110

relieve chronic constipation with stool softeners and rectal irrigations. Severe requires surgery., temp colostomy, then removal of the part of the bowel.

Front 111

What are the s+s of Hirschsprungs in newborns?

Back 111

failure to pass meconium stool
refusal to suck
abdominal distention
BILE-STAINED VOMITUS

Front 112

What are the s+s for Hirschsprungs disease in children?

Back 112

failure to gain weight
abdominal distention
vomiting
constipation alternating with diarrhea
ribbon-like and foul smelling stools.

Front 113

What are the interventions for Hirschsprung's disease?

Back 113

LOW-FIBER
high calorie
high protein diet
TPN
stool softeners
daily rectal irrigations with NS

Front 114

What is an assessment used often in Hirschsprungs?

Back 114

Measure abdominal girth often.

Front 115

What are the s+s of intussusception?

Back 115

colicky abdominal pain that causes the child to scream and draw the knees to the abdomen, similar to the fetal position.
vomiting
bile-stained fecal emesis
CURRANT JELLY STOOLS
hypo or hyperactive bowel sounds
tender distended abdomen, possibly with a mass in URQ.

Front 116

Monitor for what with intussusception?

Back 116

the passage of normal, brown stool, which indicates the intussusception has reduced itself.

Front 117

WHat is the surgery for intussusception?

Back 117

hydrostatic reduction, air or fluid (or barium) is used to exert pressure on area to lesson, diminish, or rid the intestine of prolapse.

Front 118

What is the diet for encopresis?

Back 118

decrease sugar and milk intake
high in fiber and fluids

Front 119

What is the post-op positioning for imperforate anus surgery?

Back 119

side-lying prone with hips elevated to reduce pressure on the surgical site.

Front 120

What is the parental teaching for post-op imperforate anus surgery?

Back 120

perform anal dilation if RX. use only the dilators supplied. Use a water-soluble lubricant and insert no more than 1-2 cm to prevent damage.

Front 121

What is the order for female changes in puberty?

Back 121

Big Girl PAM.
B=Breast
G=Growthspurt
P=pubic hair
A=axillary hair
M=menses

Front 122

The presence of what in diarrhea stools indicate bacterial gastroenteritis?

Back 122

neutrophils and RBC's

Front 123

What is present in diarrhea stools that indicate protein intolerance?

Back 123

eosinophils

Front 124

What is a presenting sign of Meckel's diverticulum?

Back 124

Blood in stools

Front 125

With trachealesophageal fistula it is important to do what often?

Back 125

Suction, to prevent laryngospasm caused by overflow of saliva into the larynx.