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36 Cards in this Set
- Front
- Back
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Failure to Thrive (FTT)
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Refers to “inadequate growth in infants and children” (Ricci & Kyle, 2009).
Generally if child is below 5th percentile or falls two percentiles Weight, height, and head circumference Adequate nutrition needed for brain growth |
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Types of Failure to Thrive
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Organic
Medical cause – developmental delay, poor suck or swallow, malabsorption, v/d Inorganic Unrelated to medical cause – not eating enough, poverty, neglect/abuse, poor technique, parental mental illness Idiopathic Inability to determine cause |
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Cleft Lip/Palate
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Incidence – most common, 1 in 500/550 births
Pathophysiology – usually by 5th or 6th week of gestation Complications – poor suck, hearing problems, speech issues, poor dentition, frequent ear infections, increased risk for aspiration Management – usually surgery, palate usually at 15 months, lip at 2 months |
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Cleft Lip/Palate
post op |
Positioning – post op don’t want them prone, want them supine or on the side
Restraints – arm board restraints (“no no’s) Mouth Care – hydrogen peroxide, no pacifiers, hard food, toys in the mouth post op Calming Techniques – includes pain management, sustained crying increase bp, can pop sutures Feeding – no hard foods 4-6 weeks after surgery Medications Want to send the child to a speech therapist afterwards |
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Esophageal Atresia (EA)
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EA: Failure of the esophagus to develop a continuous passage from the mouth to the stomach
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Tracheoesophageal Fistula (TEF)
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TEF: Fistula between the esophagus and trachea
3 signs (coughing, choking and cyanosis), aspiration is a problem, NG tube, TEF is a surgical emergency |
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Hypertrophic Pyloric Stenosis
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Pylorus becomes hypertrophied
Stenosis of the pyloric sphincter Inflammation and edema increases obstruction |
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Pyloric Stenosis
Clinical Manifestations |
Nonbilious, projectile vomiting, presents 2-4 weeks of age, more common in boys
30-60 minutes after feed Hungry after vomiting Physical Exam – for diagnosis, palpation |
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Pyloric Stenosis
Management Pre-op |
Fluids – dehydration and metabolic alkalosis (high CO2)
Correcting Electrolytes – most be done before surgery, NA, K and CL are usually low, PH is high NG to LIS – to make sure stomach is empty |
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Pyloric Stenosis
Post-op |
Pyloromyotomy – cut pyloris muscle to open it up
Strict feeding Schedule – start with clear liquids, feed every 3 hours, 15 cc’s to start with at a time of Pedialite, then 30 cc’s, then start adding formula with 45 cc’s, 75 cc’s, 90 cc’s, if they vomit they start over |
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Gastroesophageal Reflux (GER)
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Passage of gastric contents into the esophagus
Normal in healthy infants and children, lower esophageal sphincter hasn’t developed, more common in premature infants, usually corrects itself Complications = GERD, delayed gastric emptying, hernia, acidic stomach contents, neurologic disease “Laundry problem” or GERD |
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Reflux
Case Study: Corinne Clinical Manifestations |
FTT/ weight loss
Respiratory Issues – due to aspiration Hungry/ irritability “Wet burps” or vomiting after feeds Pain with feeding ALTE – acute life threatening event – after eating, babies choke after eating when they nap, cyanosis |
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GERD diagnostics
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Thorough history including feeding patterns and weight changes
Upper GI pH probe EGD CBC, hemoccult because of milk intolerance that can cause GI bleeding |
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GERD - Treatments
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“Reflux precautions” – elevate head of bed, frequent burping, frequent small feedings, thicken the feeds as a last resort,
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Medications to treat GERD
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Reflux Medications
Antacids Neutralize stomach acid (calcium carbonate, magnesium hydroxide) Histamine-2 blockers Reduces gastric acid secretion (ranitidine, famotidine, nizatidine) Reflux Medications Proton Pump Inhibitors Blocks acid production (omeprazole, lansoprazole, pantoprazole) Prokinetics Stimulates GI motility to empty stomach (metocloprimide) |
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Malabsorption Syndromes
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Chronic diarrhea causing malabsorption of nutrients
Digestive Defects: enzyme deficiency Cystic Fibrosis Absorption Defects: transport deficiency Celiac Disease, UC Anatomic Defects: transit time Short bowel syndrome, bowel resection |
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Celiac Disease
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Immunologic disorder
Inability to digest gluten --Found in wheat, barley, rye, oats Damages villi in small intestine Malabsorption leading to malnutrition |
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Celiac Disease - Clinical manifestations
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Early
Fat absorption affected Steatorrhea, greasy, frothy stools Diarrhea FTT Abdominal distention Later Mucosal lining damage Impaired absorption Protein deficiency – muscle wasting, abdominal distention |
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Therapy for Celiac Disease
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Strict gluten-free diet for life
(Teaching guidelines pg. 1368 Ricci & Kyle) Vitamins if malnourished Close monitoring of growth – should have normal height and weight 1 year after treatment begins |
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Constipation and Encopresis
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Constipation: failure to completely evacuate lower colon, usually due to the rectal sphincter not relaxing enough to evacuate the stools, could be because of trauma from a one time experience with constipation so they hold their stools
Encopresis: soiling of underwear after toilet training age Treatment: Dietary, behavior mod, laxatives, disimpaction Diagnostics – look for blood in the stool, x-rays, barium enema, rectal suction biopsy to rule out hersh?? |
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Hernias
Inguinal or Umbilical |
Hernia: protrusion of an organ/ organs through the abdominal opening, more common in boys, most common reason for pediatric abdominal surgery, umbilical usually seen in premies,
Can constrict organ, loss of blood supply, loss of function |
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Abdominal Wall Defects
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Herniation of abdominal contents outside the body 2000 incidence
Omphalocele: Contained in an external peritoneal sac, can be caused by maternal illness, infections, drug use or smoking or may be a genetic abnormality, often effects Gastroschisis: Organs not covered by a peritoneal sac |
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Omphalocele
Gastroschisis Immediate Treatment |
Prevention of Hypothermia and Fluid Loss
Blood cultures and Antibiotics NG/OG to prevent abdominal distention Protect exposed abdominal contents Bowel Bag |
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Hirschsprung Disease
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Congenital aganglionic megacolon- most common cause of neonatal obstruction, more common in males, often associated with Down’s Syndrome
Lack of ganglion cells causes inadequate motility, keeps stools from passing as easily, usually in sigmoid colon Mostly rectosigmoid colon but can total colon Cannot pass stool—stretches colon “megacolon” |
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Hirschsprung Disease
manifestations in infants |
Constipation
Distention Refusal to eat Does not pass meconium stool (red flag) Bilious emesis – due to obstruction |
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Hirschsprung Disease
later manifestations |
Constipation/ watery diarrhea
Visible peristalsis Distention Poor growth Vomiting Stools may look normal or ribbon shaped |
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Hirschsprung
Diagnosis/ Treatment Diagnosis |
Barium enema
Rectal suction biopsy – most common Treatment Infants: resection/ reanastamosis Temporary ostomy to rest connection Older: Prevent constipation (stool softeners/ enemas) |
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Intussusception
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Proximal segment of bowel telescopes into a more distal segment, usually under age 2, peak is 5-9 months, 3 times more likely in males, CF, Celiac disease and Chrone’s increases risk, a high incidence with no true cause
Creates a partial or total obstruction |
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Intussusception - manifestations
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Motility decreased
Impaired blood circulation Peristalsis causes the telescoping Walls rub together → edema Stool cannot pass Sudden, severe, intermittent pain Bilious vomiting Currant-jelly stool, gross blood Lethargy |
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Intussusception
Diagnosis |
Air enema
↑ WBCs Dehydration signs Guiac stool to check for blood Currant-jelly Stool |
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IIntussusception
Treatment |
Air enema to reduce it
Surgery, sometimes needing a resection Resolves on its own sometimes |
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Malrotation and Volvulus
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Malrotation
Twisting of the intestine around the superior mesenteric artery during development Volvulus Twisting of the intestine around itself Diagnosis: KUB, UpperGI** Treatment: Surgical procedure: LADD Symptoms include billius vomiting to distinguish between pyloric stenosis and GERD, distention, tachycardia, bloody stool |
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Short Bowel Syndrome
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Malabsorption of nutrients
Excessive fluid and electrolyte loss Small intestine loss or resection |
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Short Bowel Syndrome
Contributing factors |
Necrotizing enterocolitis, SI atresia, gastroschisis, malrotation, volvulus, trauma
Older children—intussusception Can lose up to 70% of bowels without problems if they still have duodenum, terminal ileum, illeocecal valve Jejunum absorbs fats, proteins and carbs If they don’t have illume they are B12 deficient and have trouble absorbing bile salts |
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Short Bowel Syndrome
Common Treatments |
Vitamins
Antidiarrheals Total Parenteral Nutrition (TPN)/ Lipids Enteral Feeding Antibiotics for frequent infections Long term use of TPN- intestinal and liver transplants, given through central line, increased risk of infection in either the line or the bowels themselves Often causes developmental delays due to prolonged hospitalizations |
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Biliary Atresia
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Absence of some or all of the major bile ducts—obstruction of bile flow
Causes: infectious, autoimmune, ischemic ?? Symptoms: chalky, white stools, jaundice is usually the first symptom Diagnosis: Labs, ultrasound, liver biopsy Treatment: Surgery (kasai if under 8 weeks which is a hepatocortoenterostomy – opens up bile ducts), after 8 weeks will generally need liver transplant Nursing care is supportive care – vitamins, special formula |
