Monday's Class

Front 1

Esophageal Atresia def.

Back 1

failure of esophagus to develop as a continuous passage

Front 2

What is 1 type of esophageal atresia?

Back 2

Tracheoesophageal Fistula (TEF)

Front 3

Tracheoesophageal Fistula (TEF) def.

Back 3

proximal segment of esophagus terminates in blind pouch and distal segment of esophagus connects to traceha or bronchus by a short fistula

Front 4

What is a tell-tale diagnostic indicator of tracheoesophageal fistual (TEF?)

Back 4

polyhydramnios

Front 5

3 clinical manifestations of tracheoesophageal fistula (TEF)

Back 5

excessive salivation

acute gastric distention

3 C's (choking, coughing, cyanosis)

Front 6

What type of preoperative nutrition will a child receiving surgery for a TEF be on?

Back 6

hyperal given parenterally

Front 7

How should the suction be set up on preoperatively for a child undergoing TEF surgery?

Back 7

low-intermittent suction through an NG tube

Front 8

What type of tube will be inserted preoperatively for gastric decompression sin a child undergoing TEF surgery?

Back 8

g-tube

Front 9

What sign will be above the bed for a patient receiving TEF surgery?

Back 9

**DO NOT MANIPULATE NG TUBE**

Front 10

Describe the post-operative process for TEF recovery.

Back 10

do nothing for 1 week to allow healing

then barium swallow

if OK, then feed orally

if tolerated, everything's good

Front 11

complications of TEF

Back 11

leak

tracheomalacia (softening of tracheal cartilages)

strictures at suture lines

reflux

Front 12

hernia def.

Back 12

protrusion of portion of an organ though an abdominal opening

Front 13

What is the most common type of hernia?

Back 13

inguinal

Front 14

What are the 3 dangers of hernias if not treated?

Back 14

incarceration

strangulation

Front 15

incarceration of a hernia def.

Back 15

hernia does not reduce easily (can result in strangulation)

Front 16

strangulation of a hernia def.

Back 16

result of an incarcerated hernia

blood supply is cut off

Front 17

If strangulation of a hernia goes untreated, what type of infection results?

Back 17

gangrene

Front 18

3 pediatric hernias

Back 18

diaphragmatic

hiatal

umbilical/abdominal wall defects

Front 19

diaphgragmatic hernia def.

Back 19

hernia protrudes through diaphragm unilaterally or bilaterally

Front 20

What are 2 complications of a diaphragmatic hernia?

Back 20

pulmonary hypoplasia and pulmonary hypertension

Front 21

hiatal hernia defined

Back 21

part of the stomach sticks upward into the chest, through an opening in the diaphragm

Front 22

what are 2 types of umbilical/abdominal wall defects that result in hernias?

Back 22

omphalocele

gastroschisis

Front 23

omphalocele def.

Back 23

herniation of abdominal contents through umbilical ring covered by a peritoneal sac

Front 24

gastroschisis def.

Back 24

herniation of abdominal contents lateral to umbilical ring NOT covered by a peritoneal sac

Front 25

How do children with a diaphragmatic hernia breathe and how long do they have to be this way postop?

Back 25

through an intubation tube for several weeks postop (in NICU)

Front 26

What is the treatment for an umbilical/abdominal wall defect (omphalocele or gastroschisis)?

Back 26

surgery!

Front 27

How should the nurse manage the exposed abdomincal contents in an gastroschisis or omphalocele?

Back 27

cover the exposed abdominal contents with warm gauze soaked in Normal Saline

Front 28

Which 2 types of nutrition will a child with gastroschisis or omphalocele possibly be on?

Back 28

hyperal or lipids

Front 29

What type of tube will be used for decompression in a child with gastroschisis or omphalocele?

Back 29

NG tube

Front 30

hypertrophic pyloric stenosis (HPS) def.

Back 30

hypertrophy of pylorus causes constriction of pylorus and obstruction of gastric outlet

Front 31

What are the tell-tale symptoms of hypertrophic pyloric stenosis (HPS) in infants?

Back 31

irritable, fussy baby with projectile vomitting

Front 32

What would you see and palpate in the abdomen of an infant with hypertrophic pyloric stenosis (HPS)?

Back 32

see: visible peristaltic waves

palpate: olive-like mass in upper abdomen

Front 33

What does hypertrophic pyloric stenosis (HPS) lead to?

Back 33

dehydration

FTT

Front 34

What is the treatment for hypertrophic pyloric stenosis (HPS)?

Back 34

pylorotomy (surgery that takes 20 minutes)

Front 35

intussusception def.

Back 35

telescoping or invagination of one portion of intenstines into another

Front 36

What causes intussusception?

Back 36

unknown but occassionally due to intestinal lesions

Front 37

What does intussusception cause?

Back 37

edema

inflammation

low blood flow

Front 38

What type of pain is felt in intussusception?

Back 38

colicky pain

Front 39

What is the stool described as in intussusception?

Back 39

currant jelly stool (red, slimy stool)

Front 40

What are 2 therapeutic managements of intussusception?

Back 40

hydrostatic reduction or it fixes itself

Front 41

What is malrotation of the intestines due to?

Back 41

abnormal rotation around the supoerior messenteric artery during embryonic development

Front 42

volvulus def.

Back 42

when intestines twist around themselves and compromises blood supply

Front 43

What can malrotation and volvulus lead to? (4)

Back 43

intestinal perforation

peritonitis

necrosis

death

Front 44

What does the vomit look like in an infant with malrotation and volvulus & when does it occur?

Back 44

green, yellow vomit

within first week of life

Front 45

describe the surgery to correct malrotation and volvulus

Back 45

untwist gray (dead) bowel & watch for repinking

if no repinking, section out gray bowel

leave patient open for 24 hours to make sure bowel stays pink

Front 46

imperforate anus definition & treatment

Back 46

def: no anal opening

tx: create opening and pull intestine through

Front 47

presistent cloaca definition

Back 47

def: uretrha, vagina and anus all come through 1 perineal opening

Front 48

cloacal definition

Back 48

bowel and bladder protrude through the abdominal wall

Front 49

3 types of malabsorption syndromes

Back 49

digestive defects (CF)

absorptive defects (Celiac)

anatomic defects (short bowel syndrome)

Front 50

What are the #1 and #2 causes of malabsorption syndromes?

Back 50

#1: cystic fibrosis

#2: Celiac disease

Front 51

Celiac disease def.

Back 51

an absorptive disease:

A gluten intolerance that results in damages of the mucosa and atrophy of the villi in the small intestines. (Nutrients are no longer absorbed b/c villi are destroyed)

Front 52

How is Celiac disease treated?

Back 52

with diet (no wheat, rye or barley)

can have corn, rice and millet

Front 53

What type of cancer does Celiac disease put a person at risk for?

Back 53

lymphoma

Front 54

short bowel syndrome (SBS) def.

Back 54

decreased mucosal surface area usually a result of a small bowel resection

or it can happen for no reason

Front 55

Describe the nutrition management for a person with short bowel syndrome (SBS)?

Back 55

TPN or hyperal initially

Then, wean with intermittent enteral feeds

Lastly, enteral feeds only

Front 56

Why are TPNs given through a central line?

Back 56

Because of the high amount of dextrose in TPNs

Front 57

What are the 2 risks of TPN as a primary source of nutrition?

Back 57

infection

liver dysfunction

Front 58

What is required for those dependent on TPNs?

Back 58

intestinal transplant