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Pediatrics Gastrointestinal

Terms in this set (84)

How does a child get cleft lip?
In utero, failure of maxillary processes to fuse. Can travel through family hx (genetics + environment).
When should cleft lip be fixed and why?
Within 6 months; otherwise there will be speech impediment.
What is the main focus in nursing care of cleft lip/palate?
Avoid aspiration!
What 4 things should parent of child with cleft lip/palate be taught about feeding?
1) Feed slowly in upright to prevent aspiration.
2) Use wide based nipple.
3) Baby can still breastfeed, just need help latching on.
4) Burp frequently
With cleft lip/palate, what are no-no's?
Used to keep child from touching face after surgery.
A child with cleft lip or palate is more prone to what type of infxn?
Ear infections due to the relationship btwn ear and mouth....so check for ear infxn's
The 3 classic signs of tracheal esophageal fistula (TEF) are...
1) Cyanosis
2) Choking
3) Coughing
CCC
What is the first tell tale sign of TEF?
NG tube meets resistance
When should surgery be performed on baby with TEF?
ASAP-- considered a surgical emergency. Remember there is excessive salivation, drooling, sneezing, and resp distress....along with the 3 classic signs.
TEF is usually fixed in one surgery. True/False
False. Usually fixed in several stages.
What type of feeding may be necessary after surgery of TEF?
G Tube usually placed.
A mother lays her child flat after TEF surgery so he can get some rest. Should the nurse intervene?
Yes! Head of bed must be kept up.
Following TEF repair, the nurse should administer....
IV fluids and antibx.
Also, monitor for G tube drainage.
What is important for nurses to do pre-operatively for pt with TEF?
Suction
What is important for nurse to do post-op TEF surgery?
Care of the G tube. (Just as a little side note, if the G tube gets clogged, a little bit of soda or coke will clear the line.
What type of is kid more likely to have pyloric stenosis?
First born, White, male baby with family hx of the disease.
Why will a child with pyloric stenosis have vomting?
Where else do you want the acid to go if the pyloric sphincter is narrowed.
What is a hallmark S/S of pyloric stenosis?
Projectile vomiting with NO BILE (meaning it's not green)
A child with pyloric stenosis may be fussy. True/False
True
Olive size mass in upper right quadrant may indicate...
Pyloric stenosis
Visible peristaltic waves may indicate...
Pyloric stenosis
What is the surgical repair for pyloric stenosis?
Cut pyloric muscle and make it open
A child who is not gaining weight and is vomiting vomit that is NOT green may have...
Pyloric stenosis
What is the nursing care pre-op for pt with pyloric stenosis?
1) Assess for dehydration
2) Daily weights
3) Monitor I & O's
What is the nursing care post-op for pt with pyloric stenosis?
1) Offer very small oral feedings with pedialyte for first 4-6 hours.
2) Burp frequently
3) Weigh daily
4) I & O's
Why does this make sense? Small feedings with pedi(kid)lyte(little bit) so they dont throw up. Burp frequently so they dont throw up or aspirate. Weight daily in case they are gaining weight, considering fluid can't pass. I&O's, there is a blockage so are they kicking out what they're putting in?
What is the tx for GER
H2 antagonist (i.e. Zantac, pepcid)
PPI (i.e. prevacid, prilosec)
What are the S/S of GERD, which is more serious than GER?
Poor weight gain
Vomiting, irritable, refusal to eat
Arching of neck
Apnea, cough, pneumonia
How should child w/ GERD be positioned for feeding?
Urpright
What may need to be done to food for child with GERD?
Thicken the feeding- perhaps adding rice cereal. Also, burp frequently.
What test may be done for GERD?
Esophageal pH test
What is intussusception?
Telescoping of one part of intestine into another part. Cause by intestinal obstruction
What is the presentation of intussusception?
Abrupt severe abd pain. Lining of intestines inflames, rub together --> inflammation, edema, and decreased blood flow
What are currant jelly stools and what do they indicate?
Mixture of blood and mucus in stool. LATE SIGN that bowel is dying in intussusception. By the time you have currant jelly stools you have missed the boat.
Would a child with intussusception have green vomit?
Yes. The vomit is bilious.
What is the tx for intussusception?
Air enema and/or barium enema
Air enema and/or barium enema is the tx for what?
intusussception
What is a volvulus?
Twisitng of the intestine
What is the most dangerous of GI issues?
Volvulus-- Surgical Emergency
When does volvulus usually occur?
Volvulus occurs in the 7th-12th week of gestation
The rotation of bowel leads to...
interrupted blood flow and necrosis
What color is vomiting with a volvulus?
Green- due to bile in vomit
What color is stool with volvulus?
Spinach green; it may be bloody. Also, there may be abdominal distention.
A pt with volvulus is scheduled for surgery tomorrow. Should the nurse intervene?
Yes, surgical emergency. Call surgeon
Should pt with volvulus be allowed to drink clear fluids?
NO, should be NPO
Nurse should hydrate pt with water if he comes in with volvulus. True/false
False. Should be given IV fluids
A mother of a child with a volvulus is worried that her son will have a bag hanging out of him and never be normal. Should she be worried about this?
Yes, an ostomy is a possibility. But it's not an absolute
What is Hirschsprung Disease?
Congenital absence of ganglion cells in the rectum and colon. This leads to lack of peristalsis
What are the S/S of Hirschsprung Disease?
Lack of peristalsis and maybe MEGACOLON. There will be no BM in first 24-48 hours.
Huge distention
No meconium within 24 hrs
Ribbon like stools
A nurse notices no meconium in first 24 hours. What should the nurse be suspicious of?
Hirschsprung Disease
A 3 year old comes into ER with ribbon like stools. What should the nurse suspect?
Hirschsprung Disease
A child comes into ER with abdominal distention along with chronic constipation ALTERNATING with diarrhea. What should the nurse suspect?
C-diff!! Haha just kidding

Hirschsprung Disease is what should be suspected lol
What should the nurse measure pre-operatively for a pt with Hirschsprung Disease?
Abdominal girth
The nurse assistant is about to take the oral temperature for a pt with hirschsprung.Should the nurse intervene? If so, why?
Yes, axillary temperature only for Hirschsprung Disease pt-- I guess vomiting, idk why else she would state that
The father of a child asks you to explain the surgery for Hirschsprung Disease, because the doctor used too many big words. How should the nurse describe it?
They biopsy different parts of the intestine, looking for presence or absence of ganglion cells. If absent, the remove it and connect the sections of bowel that have ganglion cells.
Rules of Stools Trivia:
Stools with blood and/or mucus indicate what
Intussusception
Rules of Stools Trivia:
No stools or anal leakage indicates
Hirschprung's
Rules of Stools Trivia:
Floating stools indicate
Malabsorption (Celiac)
What is the site called where kids feel pain for appendicitis? It is the right lower quadrant, but what is the specific name of spot?
McBurney's Point- between umbilicus and right iliac crest
What causes appendicitis?
Obstruction in appendiceal lumen--> edema--> decreased vascular supply and bacteria invade--> rupture
A mother and child smile in joy because the child with appendicitis says the pain has suddenly stopped. How should the nurse feel?
Freaking out! That means appendix has perforated or burst; notify the doctor IMMEDIATELY
What is the tx for perforated appendix?
IV Antibx 7-28 days
What age group has appendicitis most often?
Ages 10-19 and children less than 3 (80-100%)
Is fever a S/S of appendicitis?
Yes
Is abdominal distention a S/S of appendicitis?
Yes
Is rapid shallow breathing one of the S/S of appendicitis?
Yes
Might a pt with appendicitis have rapid shallow breathing
Yes
Might a pt with appendicitis have chills?
Yes
Might a pt with appendicitis have swollen throat?
No
What type of pain may pt have with appendicitis?
Rebound pain
A pt with appendicitis could have either diarrhea or constipation. True/false
True. Both are possible.
How does a child usually lie who has appendicitis?
Motionless on his side with knees flexed.
If removal of appendix is uncomplicated, when can child go home?
Next day
If appendix has ruptured, and surgery is done, what is nursing care?
Some surgeons will close wound, others leave it open.
If left open, pack with sterile saline soaked gauze.
What is purpose of NG tube in pt with appendectomy?
Decompress abdomen
How do you know bowel is functioning after appendectomy?
Gas or stool
How should pt be positioned post-op appendectomy?
Semi fowlers (meaning supine, 30 degrees up); or right side lying
Postop, how soon can child walk and why?
As soon as possible. You want them to get up and walk 2-3 times per day to prevent pulmonary complications. Notice, it is not DVT like adults. Well maybe they are at risk, but according to book concern is pulmonary.
When is child with uncomplicated appendicits discharged and hwat should parents be taught?
Following surgery, once bowel function has returned. Parents should increase nutritious diet slowly and as tolerated. Also, teach S/S of infxn
A child with appendectomy should avoid contact sports for 5 years post op. True/false
False. Child cannot participate immediately after surgery, but parents should check with doc to see when child can.
What foods should a pt with celiac disease avoid?
Barley
Rye
Oats
Wheat
Can a pt with celiac disease eat gluten products when S/S get better?
No; lifelong diet change--discontinuing will mess upp growth and may lead to GI cancers
Where is there hidden gluten in foods?
Chocolate candy, prepared meats, ice cream, soups, condiments, and food starch
What may help cost of diet for parents with celiac kid?
Dietary prescription; reduces cost of ingredients because they are a medical necessity
What are complications of cleft lip?
1) Feeding problems
2) Otitis media--> hearing loss
3) Abnormal tooth growth
4) Speech problems
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