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62 Cards in this Set
- Front
- Back
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What causes defects in physical development?
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Genetic factors
Environmental factors |
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How is fetal growth accomplished?
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Hyperplasia: increase in cell number
Hypertrophy: increase in cell size |
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When does organogenesis occur?
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First 8 to 12 weeks of gestation
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In a disorder of the GI tract, what (anatomically) may be involved?
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Anything from the mouth to anus.
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If a child has a disorder of the GI tract, what is usually the cause?
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Crucial stage of embryonic development was affected
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Define cleft lip/palate:
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Facial malformations that occur during embryonic development.
May appear separately or together. Etiology and pathophysiology-OCCURS IN FAMILIES. 5-12 weeks of gestation |
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What reduces incidences of clefts?
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Folate
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How does a nurse evaluate the child with possible cleft?
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Check sucking reflex. Feel hard and soft palate. Visually see a cleft.
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Children with clefts need multidisciplinary medical teams. Give examples:
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Dentists
Hearing Speech therapy Surgeons Psychologist |
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When is a cleft lip surgically corrected?
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2-3 months
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What is used to minimize retraction of scar in cleft lip?
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Z-plasty
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What is a Logan Bow?
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heavy stainless steel wire bent in an arc and taped to both cheeks to protect a freshly repaired cleft lip.
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Post-op: What position should the child not be in?
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NOT prone for cleft lip
NOT supine for cleft palate |
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What should be avoided post-op for clefts?
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No STRAWS, NO CHIPS, NO HARD THINGS IN MOUTH
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What issues will child face post-op for cleft?
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Elbow restrains
Special feeding equipment Breastfeeding issues |
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When is a cleft palate surgically corrected?
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12-18 months
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What is the CLEFT LIP mneumonic?
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C-choking
L-lie on back E-evaluate airway F-Feed slowly T-Teach parents-patience (for feeding baby slowly) L-large hole in nipple I-Increased incidence in males P-prevent crust from forming on lip after feeds |
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Post-op care of baby with cleft palate?
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No pacifiers.
Feed with dropper or asepto syringe in corner of mouth. Clean suture line after each feed to minimize risk of infection if ordered. Clean Cleft palate with 10-15cc sterile water after feeds. Antibiotic ointment if ordered for lip. |
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What is esophageal atresia?
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Failure of esophagus to develop as a continuous passage
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90% of babies with esophageal atresia have....
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Tracheoesophageal Fistula (TEF)
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At how many weeks gestation does esophageal atresia occur?
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4-5 weeks
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What are diagnostic tests done to diagnose esophageal atresia?
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Useing 5-8fr ng tube (see if it meets resistance)
X-ray, US |
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TEF has classic 3 C’s:
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choking, cyanosis, coughing
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Managment of TEF:
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Surgical interventions
Prognosis Associated tracheomalacia Nursing considerations |
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Failure to Thrive (Ftt):
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Failure to thrive refers to children whose current weight or rate of weight gain is significantly lower than that of other children of similar age and gender.
It can be organic or nonorganic. |
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Organic Ftt
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CHD
Chronic illness CF AIDS |
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Nonorganic Ftt
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Parents have depression, are substance abusers, psychotic, or have disorder that prevents them from bonding and providing adequate nutrition to their infant.
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What are S/S of Nonorganic ftt?
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no wt gain or weight loss in child under 6yo
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What is the nurse's responsibility in treating nonorganic (NO) ftt?
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TX-hospitalize to feed, watch weight, run diagnostic tests to R/O organic etiology.
Nurses feed child. Plot wt, ht, intake and output. Get thorough hx from parents Observe parent-child interactions and document |
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What are the parents doing in NO ftt?
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They are not responsive to infant’s cues.
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What do you teach parents when their child is diagnosed NO ftt?
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Once dg of NO-FTT is made parents are taught to respond to child’s cues. This
Teach parents how to hold, rock, play, establish eye contact, and interact with child. Discharge-referrals made to agencies to watch home situation. |
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What is the goal for a child with NO ftt?
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Child will gain 4-5 oz/week
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What is Munchausen?
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Child abuse by proxy. Parent has some medical training ( most are nurses!).
Child has unusual S/S. Unable to get diagnosis. D/T conflicting information. |
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What is the nursing interventions for a parent with Munchausen?
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Observe parent, get video surveillance of the patient’s room. Confront parent with behavioral plan and social services involves. Get counselling for parent.
Parent is getting attention of the medical staff and nurses. |
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What are some Anorectal Malformations?
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Imperforate anus
Persistent cloaca Cloacal exstrophy Genitalia may be indefinite |
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What is Biliary Atresia?
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Also called extrahepatic biliary atresia. Biliary atresia is a blockage in the tubes (ducts) that carry a liquid called bile from the liver to the gallbladder. The condition is congenital, which means it is present from birth. Can lead to liver damage and cirrhosis of the liver, which is deadly if not treated.
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What are some abdominal wall defects?
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Omphalocele and Gastroschisis
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What is Gastroschisis?
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herniation is lateral to the umbilical ring, and peritoneal sac not present
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What is Omphalocele?
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herniation of abdominal contents through umbilical ring, usually with an intact peritoneal sac. Infants with omphalocele often have additional congenital anomalies.
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What is a hernia?
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a protrusion of a portion of an organ through an abnormal opening.
Danger of incarceration or strangulation |
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What types of hernia's are most common in infants?
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Umbilical
Diaphragmatic Inguinal Femoral |
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What is Congenital Diaphragmatic Hernia (CDH)?
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Diaphragm is not completely formed; herniation of abdominal contents into thoracic cavity.
Fetal lungs are compressed; fetal lung development is altered. Incidence is 0.3 in 3300 live births. |
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How is CDH treated?
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Fetal surgery. Tracheal obstruction to expand lung tissue development and push abdominal contents back into abdomen results in larger, functional lungs.
Ex utero intrapartum treatment procedure. Mortality remains high. |
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When should the first meconium be passed?
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Within 24-36 hours.
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If first meconium has not been passed in 24-36 hours what should you assess for?
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Hirschsprung disease, hypothyroidism, meconium plug, meconium ileus (CF)
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What is Hypertrophic Pyloric Stenosis (HPS)?
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Constriction of the pyloric sphincter with obstruction of the gastric outlet. Obstruction of the passage between stomach and duodenum. The pyloric sphinctor is normal at birth and hypertrophies with growth.
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When is diagnostic evaluation of HPS done?
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2-8 weeks
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What are manifestations of HPS?
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Vomiting, nonbilious (why?), coffee grounds possible, projectile (70%), hungry after vomits, peristalsis waves are visible.
Olive sized mass in RUQ, US of abdomen |
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What are the 3 P's in pyloric stenosis?
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Palpable mass
Peristalsis seen Projectile vomiting |
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Therapeutic management of HPS?
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Treat dehydration.
Treat metabolic alkalosis. Surgery to open stenotic area. Fluid and electrolyte imbalances (strict I&O). Fears of parents. |
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Nursing Interventions of HPS?
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Daily weights
D/C 24 hours post-op May have pacifier Diapering by sliding diaper under buttocks instead of lifting legs-decreases strain on abd muscles. Pain Infection Post-op vomiting may occur-teach parents. Teach parents to watch for I&O and stool pattern. Hold upright PC for 30 minutes, no rough play. |
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Peptic Ulcer Disease (PUD):
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Erosion of the lower mucosa of espohagus or in the duodenum.
Primary-in healthy child. Secondary-stress ulcer from illness, injury and taking medication that erodes the mucosa( steroids, salicylates, NSAIDS). H. Pylori (gram negative rod) causes ulcers: Oral-oral or oral-fecal route. |
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S/S of PUD:
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Burning assoc with empty stomach
Anemia, occult + stools |
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How is PUD diagnosed?
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Urea on urine and breath
H. Pylori + via gastroscopy |
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How is H. pylori treated?
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Antibiotics
Check water supply for contamination Check other family members for S/S Antibody titers measured over 6 months to make sure H. Pylori is gone. |
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What medications are used in PUD?
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Antacids ( maalox, mylanta)
Histamine antagonists (ranitidine,cimetidine). |
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What is the nursing care involved in PUD?
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Diet, nutrition, prevent re-occurences.
Identify medications that irritate mucosa and consult with MD to see if there are alternatives. Reduce stressors-identify psychological stressors and help child problem solve, role play, etc. |
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What is Gastroesophageal Reflux (GER)?
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Defined as transfer of gastric contents into the esophagus.
Occurs in everyone (most resolve by 1yo). Frequency and persistency may make it abnormal. Relaxation of lower esophageal sphinctor. May occur without GERD (more serious). GERD may occur without regurgitation. |
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Diagnostics for GER?
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Monitoring 18-24 hours plus S/S
Ck for cow milk allergey |
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Therapeutic management-lifestyle changes for GER?
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Rice cereal
Small freq feeds Positioning PC Medications to decrease acid, and promote faster gastric emptying. |
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Surgical Management-Fundoplication?
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Wrap stomach around lower esophagus
Gastrostomy tube or PEG Left open to air after surgery (why?) |
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Post-op teaching for Fundoplication (GER)?
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Parents need to know how to care for PEG or G-tube.
Cleaning If comes out, loose etc. After surgery and feeding, hold upright 30 minutes. No infant seats PC-increases intrabdominal pressure. No rough play |
