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GI Exam 2 Pediatrics
Terms in this set (54)
at what age does a child have suck and swallow coordination
do infants have more peristalsis or decreased
how much does the following age hold in their stomach?
NB : 10-20 mL
1 year: 210-360 mL
2 year: 500 mL
Teen: 3 Liters
because of an infant increased peristalsis what might you expect to see?
stomach empties faster
feed more quickly
why is reflux more common in children and infants
increased reflux and spit up
a patient comes in and is 4 months old and wants to know why she can't give her infant solid foods. What is your response?
that they do not have enzymes for digestion yet such as
Amylase = carbs
lipase = fats
trypsin = protein
You have a mother who comes in and is 6 months pregnant she is a smoker, admitted to drinking occasionally, has a history of seizures and upon asking about folic acid she had no idea what we were asking her about. What do these things increase the infant to be at risk for?
Cleft Lip and Cleft Palate
How soon do you want to fix the lip and palate?
lip is at 10-12 weeks
Palate prior to one year
A mother is holding her infant that was just born with a unilateral cleft lip and palate you notice that she is crying and asking herself why what is an appropriate response as the nurse?
point out other beautiful qualities
say she has your eyes etc.
the deformity may lead to bonding issues
you see an order for a child that has a cleft lip to use a Haberman feeder and have an increased caloried diet you know to explain this to the student because?
the Haberman feeder is because its a special nipple and the increased calorie is because the infant has to work hard to eat and is burning more calories you don't want to feed more than 30 minutes and you want to increase burping
how might post op care difference for a patient with a cleft palate vs a cleft lip?
lip will have to lay supine
and if its just a palate they can lay prone
they will both have immobilizers and will be all liquid and then to soft foods
no pacifier and want to keep baby calm at all times
whats the most common GI defect
A patients parent is asking you if her infants GERD will have to be treated for their entire life what can you explain to her?
that normally it will resolve at about 2 years when their body increases in development and they start having solid foods that can't be refluxed as easily
whats the main difference between GERD and normal spit up of an infant and how might a parent be able to tell?
GERD will be projectile vomiting
Explain the process of the pH in an infant that is diagnosed with GERD
the normal pH in the esophagus is 7
the normal pH in the stomach is 1-2
when you have a weak LES these two will often mix creating a pH of 4
what are two things you might want to rule out in an infant with GERD?
allergy to cows milk
H Pylori - can be checked with endoscopy
A mom calls the office completely frustrated about the management shes been trying with her infant that struggles with GERD what are some nursing managment things you could recommend to her?
upright at a 30 degree angle after feeds and during
no rough play after eating
avoid fats, spices, citrus
List two types of pharmacological medications that can be used for GERD and an example of each
Histamine Receptor Antagonists : Zantac
Proton Pump Inhibitor : Omeprazole (Prilosec) give on an empty stomach
A patient is in the PACU and you see the diagnosis as GERD they have a temp G tube. what surgery do you think they might have performed
a Nissen Fundoplication
take the upper portion of the stomach and wrap around to create a stronger LES
A mom comes in to the ER freaking out that her Childs abdomen is hard they have a fever and the last diaper that she changed it looked like the infant had jelly in their diaper. Upon assessment you notice a distention in the RLQ, they have an increased HR and decreased BP. What are you thinking?
caused by Hib DO NOT give this vaccine if they have this
may need surgery make patient NPO and don't start liquids until bowel sounds have returned
you read a patients chart and notice that they are projectile vomiting about 30 minutes after eating and they are missing what the doctor terms ganglionic cells and the stomach is showing hypertrophy. You also notice a bump the size of an olive in the RUQ. what are you thinking? What do you need to do to confirm this?
the pyloric sphincter is blocked and not allowing the food to go into the intestine
you confirm this by doing an ultrasound to measure thickness of pylorus
What disorder might you see metabolic alkalosis in?
You see a friend in the waiting room and she states that her daughter is having a pyloromyotomy but shes nervous about what to expect after the procedure what do you inform her of?
She's having surgery for pyloric stenosis
they are splitting it to allow passage of food and fluid to go through the umbilical area
they will do Q2H turns
decrease agitation to abdomen cluster care
good hand hygiene
begin feeds 5 hours after OR
fold diaper to decrease irritation
sponge baths till it heals
This disease can also be referred to as "Mega Colon" and there is no peristalsis there is an increased risk of perforation peritonitis and ischemia. This is often hereditary and there is a problem with nerve cells. May be associated with Downs Syndrome. What are you thinking?
A patient comes to the office with ribbon-like stool, FTT, the mom states that they have been vomiting bile, showing signs of abdominal pain. Upon assessment you see a distended abdomen. You know a complication of this can be Enterocolitis. What are you thinking?
A student nurse comes up to you and states that her patient is having surgery for their current problems with Hirschsprung's Disease she states the method being used is Pull-through how do you describe this for her?
that they pull through the damaged bowel and cut it and reattach the healthy bowel back. if that doesn't work they can do a colostomy temporary or permanent
when is it appropriate to change a colostomy or empty it?
when its 2/3 full
what if the stoma appears white?
could be a decrease in circulation or anemia
what is the leading cause of illness in children less than 5?
what can cause acute diarrhea?
A parent calls into the office and states that her child has diarrhea and is sweating excessively she says that she went to the store to get an anti-diarrheal but want to call to make sure it was ok to give it first. What do you respond with?
NO do not give it want to rid the body of whatever organism is in the body
if it continues may want to explore celiac disease
do a stool culture
what are fluid requirements for a child that is dehydrated?
100ml/kg (first 10kg)
50ml/kg (second 10kg)
dived by 24 (ml/hr)
how much fluid is needed for a patient that weighs 15 kg?
1,250 for the day
Your patient has a normal HR and BP, Urine output is decreased, and mucous membranes are slightly dry and tears are present. What degree of dehydration?
Mild < 5%
Slightly increased HR, normal to orthostatic BP, moderately decreased UO, Very dry mucous membranes, fontanels may be normal or sunken, decreased tears upon crying. What degree of dehydration?
Moderate Dehydration 5-10%
Patient has a weak rapid pulse, hypotension, anuria, they are parched and super thirsty, their anterior fontanel is sunken and tears are absent. what degree of dehydration is this?
Severe Dehydration >10%
You have a 12 year old patient come into the ER they are having stomach pain in the RLQ have diarrhea. Complained that they couldn't walk in and when you assessed them and put their right leg up to their chest they cried in pain. YOu want to make sure you rule out a possible bowel obstruction but what are you thinking?
A nurse is carting for a child who has suspected appendicitis. Which of the following provider prescriptions should the nurse question?
A. maintain NPO status
B. Monitor Oral Temp Q4H
C. medicate the client for pain Q4H as needed
D. Administer sodium biphosphate/sodium phosphate (Fleet Enema) today. q
D never give an enema may cause the appendix to rupture
What do you never want to do if you suspect appendicitis?
give an enema
give a laxative
and if the pain suddenly stops then it may have ruptured
I involved mucosal and submucosal wall
i have superficial ulcers
upon assessment i have lesions that are continuous and i am mostly in the colon and rectum
I involve the entire bowel wall
my ulcers run deep and increase the risk of rupture and peritonitis
my lesions are often "cobblestones" and segmental
and my area of involvement is the ascending colon
Which inflammatory bowel disease may have fistulas
A 12 year old patient comes in with an inflammatory bowel disease they have arthritis of large joints, skin lesions. What disorder are you thinking?
You have a 20 year old patient that is presenting with fistulas, adhesions, some arthritis of the knees and erythema nodosum along with inflammation of the eye what disorder are you thinking?
describe what erythema nodosum is?
inflammation of the fatty area
knot that will be there for about 3-6 weeks on extremities
can biopsy them
will rule out strep
and chest x-ray for active TB
if you didn't know that your patient had Crohns what other disorders might you think of if they present with erythema nodosum
will treat with NSAID's and prednisone
a patient comes in complaint of bloody stool, and stools of about 10-20 stools a day. Their pain tends to subside after a bowel movement and their pain is normally in the LLQ.
This inflammatory bowel disease patient has mild bleeding, abdominal pain, and is often faced with weight loss growth retardation and anorexia
5-ASA's will be used to treat? How does it help? What is something you need to watch for?
It will treat bowel inflammatory diseases like UC and Crohns
It blocks prostaglandins that cause diarrhea
and it can alter the absorption of folic acid and may cause neutropenia
Name two other medications that may be given to treat inflammatory bowel diseases like UC and Crohns.
Corticosteroids - taper, take with food, watch for steroid issues
Immunosuppressant - increased risk of infection this is only used if they dont' respond to other medications
Infliximab and Humira are used to treat?
Crohns, they are biologics, Anti-TNF which is tumor necrosis factor that is present with inflammation.
use up to 8 weeks to notice improvement
What type of diet might a patient with UC or Crohns be on?
increased protein to promote healing
increased Vit D and Calcium supplement because they are at a risk for osteoporosis
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