Peds Gi Quiz

Front 1

What causes defects in physical development?

Back 1

Genetic factors
Environmental factors

Front 2

How is fetal growth accomplished?

Back 2

Hyperplasia: increase in cell number
Hypertrophy: increase in cell size

Front 3

When does organogenesis occur?

Back 3

First 8 to 12 weeks of gestation

Front 4

In a disorder of the GI tract, what (anatomically) may be involved?

Back 4

Anything from the mouth to anus.

Front 5

If a child has a disorder of the GI tract, what is usually the cause?

Back 5

Crucial stage of embryonic development was affected

Front 6

Define cleft lip/palate:

Back 6

Facial malformations that occur during embryonic development.
May appear separately or together.
Etiology and pathophysiology-OCCURS IN FAMILIES.
Exposure
5-12 weeks of gestation

Front 7

What reduces incidences of clefts?

Back 7

Folate

Front 8

When can clefts been seen during gestation via US?

Back 8

13-16 weeks

Front 9

How does a nurse evaluate the child with possible cleft?

Back 9

Check sucking reflex. Feel hard and soft palate. Visually see a cleft.

Front 10

Children with clefts need multidisciplinary medical teams. Give examples:

Back 10

Dentists
Hearing
Speech therapy
Surgeons
Psychologist

Front 11

When is a cleft lip surgically corrected?

Back 11

2-3 months

Front 12

What is the new procedure for cleft palate?

Back 12

Nasoalveolar molding (NAM) is a new treatment that is a nonsurgical method of reshaping the gums, lip and nostrils before the surgical correction of the cleft palate.

Front 13

What is used to minimize retraction of scar in cleft lip?

Back 13

Z-plasty

Front 14

What is a Logan Bow?

Back 14

heavy stainless steel wire bent in an arc and taped to both cheeks to protect a freshly repaired cleft lip.

Front 15

Post-op: What position should the child not be in?

Back 15

NOT prone for cleft lip
NOT supine for cleft palate

Front 16

What should be avoided post-op for clefts?

Back 16

No STRAWS, NO CHIPS, NO HARD THINGS IN MOUTH

Front 17

What issues will child face post-op for cleft?

Back 17

Elbow restrains - remove q2h
Special feeding equipment - Restrict feeding time to 30-45 minutes for these children. Burp q ½ oz.
Breastfeeding issues-Refer to Le Leche League

Front 18

When is a cleft palate surgically corrected?

Back 18

12-18 months

Front 19

Surgical Correction of Cleft Palate nursing considerations:

Back 19

Effect on speech development-try to minimize
Check family reaction to “deformed” baby
Help parents learn to feed baby-Patience!
Prognosis
Nursing considerations –Preop and postop care
Positioning, feeding, restraints, prevention of scar tissue, airway management

Front 20

Postop and home care for cleft lip/palate

Back 20

No pacifiers, no crying with cleft lip
Feed with dropper or asepto syringe in corner of mouth
Clean suture line after each feed to minimize risk of infection if-----------------?
Clean Cleft palate with 10-15cc sterile water after feeds
Antibiotic ointment if ordered for lip
Soft elbow restraints

Front 21

What is the CLEFT LIP mneumonic?

Back 21

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

Front 22

Post-op care of baby with cleft palate?

Back 22

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.

Front 23

What is esophageal atresia?

Back 23

Failure of esophagus to develop as a continuous passage

Front 24

90% of babies with esophageal atresia have....

Back 24

Tracheoesophageal Fistula (TEF)

Front 25

At how many weeks gestation does esophageal atresia occur?

Back 25

4-5 weeks

Front 26

What are diagnostic tests done to diagnose esophageal atresia?

Back 26

Useing 5-8fr ng tube (see if it meets resistance)
X-ray, US

Front 27

TEF has classic 3 C’s:

Back 27

choking, cyanosis, coughing

Front 28

Children with TEF mothers' will probably have a history of what?

Back 28

Many of these infants will have a mother with a prenatal history of polyhydramnios-unable to swallow amniotic fluid, so there is too much

Front 29

Surgical interventions for TEF

Back 29

-Ligate the TEF
Gastrostomy for decompression and feedings
Esophageal esophagostomy to drain oral secretions (meticulous skin care)

Front 30

Prognosis of TEF:

Back 30

Prognosis-excellent for FT babies
Associated tracheomalacia

Front 31

First TEF surgery:

Back 31

TEF surgery initally created esophagostomy and inserts Peg or G tube. Growth, stabilize.
Feed small bits of glucose water to let them suck/swallow. Drains out esophagostomy and suction tube

Front 32

2nd TEF surgery:

Back 32

connects the esophagus to stomach...may have to use a length of bowel to bridge the gap.

Front 33

Post-op issues TEF

Back 33

Parenteral nutrition initially, then G tube feeds. Leave G tube open to air (elevated) so pressure is let out.
G-tube feed-give pacifier so baby relates suck with satiation.
1st oral________________

May have anatomical leak if pt has resp distress. Stop feeding, suction, give oxygen, call surgeon.
Care for chest tube site, G-tube site and surgical site.
Most infants are OK to feed. Feedings progress slowly until tolerating well. G-tube removal and parents are taught about tracheomalacia, S/S of problems and complications.

Front 34

Failure to Thrive (Ftt):

Back 34

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.

Front 35

Organic Ftt

Back 35

CHD
Chronic illness
CF
AIDS

Front 36

Nonorganic Ftt

Back 36

Parents have depression, are substance abusers, psychotic, or have disorder that prevents them from bonding and providing adequate nutrition to their infant.

Front 37

What are S/S of Nonorganic ftt?

Back 37

no wt gain or weight loss in child under 6yo

Front 38

What is the nurse's responsibility in treating nonorganic (NO) ftt?

Back 38

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

Front 39

What are the parents doing in NO ftt?

Back 39

They are not responsive to infant’s cues.

Front 40

What do you teach parents when their child is diagnosed NO ftt?

Back 40

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.

Front 41

What is the goal for a child with NO ftt?

Back 41

Child will gain 4-5 oz/week

Front 42

What is Munchausen?

Back 42

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.

Front 43

What is the nursing interventions for a parent with Munchausen?

Back 43

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.

Front 44

What are some Anorectal Malformations?

Back 44

Imperforate anus
Persistent cloaca
Cloacal exstrophy
Genitalia may be indefinite

Front 45

What is Biliary Atresia?

Back 45

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.

Front 46

What are some abdominal wall defects?

Back 46

Omphalocele and Gastroschisis

Front 47

What is Gastroschisis?

Back 47

herniation is lateral to the umbilical ring, and peritoneal sac not present

Front 48

What is Omphalocele?

Back 48

herniation of abdominal contents through umbilical ring, usually with an intact peritoneal sac. Infants with omphalocele often have additional congenital anomalies.

Front 49

What is a hernia?

Back 49

a protrusion of a portion of an organ through an abnormal opening.
Danger of incarceration or strangulation

Front 50

What types of hernia's are most common in infants?

Back 50

Umbilical
Diaphragmatic
Inguinal
Femoral

Front 51

What is Congenital Diaphragmatic Hernia (CDH)?

Back 51

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.

Front 52

How is CDH treated?

Back 52

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.

Front 53

When should the first meconium be passed?

Back 53

Within 24-36 hours.

Front 54

If first meconium has not been passed in 24-36 hours what should you assess for?

Back 54

Hirschsprung disease, hypothyroidism, meconium plug, meconium ileus (CF)

Front 55

What is Hypertrophic Pyloric Stenosis (HPS)?

Back 55

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.

Front 56

When is diagnostic evaluation of HPS done?

Back 56

2-8 weeks

Front 57

What are manifestations of HPS?

Back 57

Vomiting, nonbilious (why?), coffee grounds possible, projectile (70%), hungry after vomits, peristalsis waves are visible.
Olive sized mass in RUQ, US of abdomen

Front 58

What are the 3 P's in pyloric stenosis?

Back 58

Palpable mass
Peristalsis seen
Projectile vomiting

Front 59

Therapeutic management of HPS?

Back 59

Treat dehydration.
Treat metabolic alkalosis.
Surgery to open stenotic area.
Fluid and electrolyte imbalances (strict I&O).
Fears of parents.

Front 60

Nursing Interventions of HPS?

Back 60

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.

Front 61

Peptic Ulcer Disease (PUD):

Back 61

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.

Front 62

S/S of PUD:

Back 62

Burning assoc with empty stomach
Anemia, occult + stools

Front 63

How is PUD diagnosed?

Back 63

Urea on urine and breath
H. Pylori + via gastroscopy

Front 64

How is H. pylori treated?

Back 64

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.

Front 65

What medications are used in PUD?

Back 65

Antacids ( maalox, mylanta)
Histamine antagonists (ranitidine,cimetidine).

Front 66

What is the nursing care involved in PUD?

Back 66

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.

Front 67

What is Gastroesophageal Reflux (GER)?

Back 67

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.

Front 68

Diagnostics for GER?

Back 68

Monitoring 18-24 hours plus S/S
Ck for cow milk allergey

Front 69

Therapeutic management-lifestyle changes for GER?

Back 69

Rice cereal
Small freq feeds
Positioning PC
Medications to decrease acid, and promote faster gastric emptying.

Front 70

Surgical Management-Fundoplication?

Back 70

Wrap stomach around lower esophagus
Gastrostomy tube or PEG
Left open to air after surgery (why?)

Front 71

Post-op teaching for Fundoplication (GER)?

Back 71

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

Front 72

Nursing Care of the Surgical Neonate
Preoperative care:

Back 72

Fluids and electrolytes-more water/Kg in younger child-Must get Fluid and Lytes corrected pre-op.

Front 73

Nursing Care of the Surgical Neonate
Preoperative care: Psychosocial

Back 73

Psychological concerns-mask and injections were MOST scary for child
Use play therapy-masks, hair covers, etc pre-op
Parents can stay for induction in some places. Research shows it reduced long term behavior effects of surgery on child (Secrist, 2005)

Front 74

Nursing Care of the Surgical Neonate
Immediate Post-operative care:

Back 74

Child remembers being in PACU, pain.
Monitor O2 Sats, VS, Fluid and electrolytes.
Watch for malignant hyperthermia-reaction to halothane or succhinylocholine-myopathy. Hypermetabolism, muscle rigidity and fever.
TREATMENT: Stop cause, hyperventilate with 100% O2, IV dantroline, Cool IV, cold pack to groin and axillae.

Front 75

Malignant hyperthermia defined by NIH

Back 75

Malignant hyperthermia is disease passed down through families that causes a fast rise in body temperature (fever) and severe muscle contractions when the affected person gets general anesthesia.
Bleeding
Dark brown urine
Muscle ache without an obvious cause, such as exercise or injury
Muscle rigidity and stiffness
Quick rise in body temperature to 105 degrees F or higher
The person may have a fast and often irregular heart rate.
During an episode of malignant hyperthermia, wrapping the patient in a cooling blanket can help reduce fever and the risk of serious complications. Drugs such as dantrolene, lidocaine, or a beta-blocker drug can help with heart rhythm problems.
To preserve kidney function during an episode, you must get fluids through a vein and by mouth, as well as certain medications.

Front 76

Nursing Care of the Surgical Neonate
Post-operative care:

Back 76

Treat pain with medications. Use pedi pain scale according to age
Splint with teddy bear to cough
Use games
Change position every 2 hrs.
Assess surgical site-blood – draw