PEDS - GI/NUTRITION

TX Hirschsprung Disease

- surgical removal - possible colostomy - bowel irrigation - hydration

Recommended supplements for infants (at 6mon)

- vitamin D - iron - fluoride

NIV for patient with pyloric stenosis/projectile vomiting?

- IVs - NPO - surgery

S&S of intussusception

- abrupt onset - acute abd pain - vomiting - red jelly stool - palpable RUQ mass

S&S of diaphragmatic hernia

- barrel chest - sunken abdomen

foods you should avoid in the 1st 2-3 yrs b/c of common allergies

- eggs - strawberries - wheat - corn - fish - nuts

TX of intussusception

- enema - OR - pain control - assess BS Q4 hours - asses for distension - reduce infection

S&S Hirschsprung Disease

- failure to pass meconium w/in 48 hours of birth - abd distension - emesis - pencil thin stools

TX of gastroenteritis

- oral rehydration therapy - IV

NIV of gastroenteritis

- skin care - strict I&Os - ATB therapy - limit carbs, spicy

TX of diaphragmatic hernia

- support cardiac/respiratory complications - decrease stimulation (pressure) - raise HOB - intubate/high frequency vent - ECMO

when should an infant wean from a bottle to a cup

12 months

obesity isn't calculated in children until ____ yrs., because they need fat intake for myelinization of nerves

2

at what age should you introduce baby cereal?fruits/vegetables to a child? meat?

6 months, 6-8, 8-10

when does the sucking reflex become voluntary

6 wks

for a toddler limit juice to __oz a day and preschool __oz

6,10

The mother of an 18-month-old child with a cleft palate asks the nurse why the pediatrician has recommended that closure of the palate be performed before the child is 2 years old. How would the nurse respond? a. "As the child gets older, the palate gets wider and more difficult to repair" b. "Eruption of the 2-year molars often complicates the surgical procedure." c. "You need to have the surgery performed before your child starts to use faulty speech patterns." d. "After a child is 2 years old, surgery is frightening, so you need to avoid it."

C

pathologic condition of GER - S&S: poor wt. gain, esophagitis (Sandifer's Syndrome - resp. symptoms), FTT, aspiration, sleep disturbances

GERD

Serious inflammatory condition of the intestines lack of O2 to gut causes rapid multiplication of anaerobic bacteria --> air as byproduct air trapped in bowel or perforates bowel -pre-term, LBW, bottle-fed

NEC

Which teaching would the nurse provide the parents of a 6-week-old infant recently diagnosed with gastroesophageal reflux? a. feeding cereal with a spoon b. providing formula thickened with cereal c. placing the infant supine after feedings d. explaining changes in care after surgical repair of defect

b

there is a Ca+ deficiency especially in

adolescence

TX pyloric stenosis:

-NG to decompress stomach -tx alkalosis, dehydration, electrolyte imbalances -low Cl-/Na+/K+, high pH -NPO -OR -analgesics -incision care -**vomiting common 24-48 hrs. after surgery

NIV for EA and TEF:

-NPO -G-tube -suction at bedside -prepare for OR

NIV for NEC

-NPO -IV -ATB -surgery -Salem Sump - Anderson drain - Penrose drain - Ostomy

S&S of EA and TEF:

-excessive drooling -salivation -cyanosis -choking -coughing -sneezing -intability to pass NG to stomach with EA (tube curls and comes back out mouth) -TEF abdominal distension (trapped air)

S&S NEC

-feeding intolerance -bloody stools -sepsis -free peritoneal gas -dilated bowel loops -pneumotaosis

S&S of FTT

-growth failure -refuse food -abnormal sleep wake cycles - irritable -DD

NIV feeding for child with cleft lip/palate:

-hold upright -place nipple in check facing back of tongue -special bottles/nipples -feed slowly - burp regularly -NG feeds -hold upright for 30 min after feeding -elevate HOB -suction at bedside -no pacifier, metal utensils -medicate to avoid crying -elbow immobilizers -ATB -supine

S&S of pyloric stenosis:

-hungry -vomiting -projectile vomit -non-bilious -irritable -lack of wt. gain/loss -dehydration -met. alkalosis -visible peristaltic waves in abdomen -not nauseous

S&S appendicitis

-periumbilical cramping -abd tenderness -fever -RLQ (McBurney's Point) -abd distension

TX of omphalecle/gastroschosis

-prevent heat loss -sterile plastic -saline soaked gauze -NPO -pain control -incision case -I&Os

TX of GER/GERD

-small, thickened/frequent feedings -positioned upright after feeds for 30min. - don't rock or swing after eating - antacids -histamine antagonists -proton pump inhibitors - prokinetic agents (emptying of stomach stimulation)

for serving sizes of a toddler, ___tbsp/age = 1 serving

1

when should a kid be potty trained due to the development of excretory control

2-3 yrs

% of total body water in - NB - infant - child/adolescent (has more ICF than ECF)

75, 65, 50

Which statement is true about the signs and symptoms of projectile vomiting? A. This condition may cause dehydration. B. These signs and symptoms may be the result of maternal exposure to a stomach virus during fetal development. C. Firstborn children and males are more frequently at risk for projectile vomiting than females. D. The client may present with exhibit signs and symptoms of failure to thrive.

A

Which complications would the nurse expect in relation to lead toxicity? select all that apply a. anemia b. proteinuria & glycosuria c. heart failure d. encephalopathy e. GI bleeding

a, b, c

Which food would the nurse instruct the parents of a 7-month-old to wait until 1 year of age to introduce into the child's diet? Select all that apply. a. eggs b. soda c. honey d. shellfish e. cow's milk

a, b, c, d, e

Which intervention would the nurse perform while caring for a preschooler with lead poisoning? (select all that apply) a. administering chelation therapy b. educating parents to use hot water for cooking c. preventing further lead exposure d. identifying the sources of lead in the environment e. implementing a low-calcium diet

a, c, d

A nurse is caring for a 6-year-old child who has undergone laparoscopic appendectomy. What interventions should the nurse document on the child's clinical record? Select all that apply. a. intake and output b. measurement of pain c. tolerance of low-residue diet d. frequency of dressing changes e. presence or absence of bowel sounds

a,b,e

folic acid deficiency is common in adolescents who

are pregnant

Why should a bottle never be propped on the child during feeding

aspiration can occur

absence or closure of a normal body orifice

atresia

A newborn with a diaphragmatic hernia has impaired gas exchange. Which would the nurse identify as the cause of the infant's decreased gas exchange? a. incarcerated hernia b. decreased oxygen intake c. increased basal metabolic rate d. excessive respiratory secretions

b

The nurse knows that additional discharge instructions are needed for parents whose infant has just undergone corrective surgery for cleft palate when the parent makes which statement? a. "We need to schedule regular hearing tests, even at this young age." b. "Lying on the abdomen is prohibited, so we'll keep him in an infant seat." c. "We know that some difficulty breathing is expected, so we'll position him upright. " d. "We'll use the elbow restraints you provided to keep him from putting his hands in his mouth."

b

What is the recommended position for the infant while awaiting surgery for pyloric stenosis? a. place infant on his stomach with his head turned to the side b. flat and supine with head of crib slightly elevated c. upright in a car seat at approximately a 90 degree angle d. position the infant's head lower than the level of his heart with his feet elevated

b

Which condition would the nurse suspect in a 6-year-old child who was admitted with abdominal pain and guarding, nausea, anorexia, and pain with palpation of the right lower quadrant? a. viral infection b. inflamed appendix c. irritable bowel d. parasitic infestation

b

Which nutrition-related problem would the nurse address when teaching childhood nutrition to a group of parents whose children have Down syndrome? a. rickets b. obesity c. anemia d. rumination

b

Which parent teaching would the nurse provide to minimize regurgitation in an infant with a cleft lip? a. offer a thickened formula b. burp frequently during a feeding c. place the child in an infant seat during feedings d. position the child on the side with the bottle propped

b

What characteristics does a nurse expect infants and young children with failure to thrive to exhibit? (Select all that apply.) a. hyperactivity b. language deficit c. being overweight d. tendency to illness e. responsiveness to stimuli

b, d

allows visualization of colon with x-ray/fluoroscopy - will have clay colored stools after ingesting (notify parents)

barium enema

what's in honey that makes you avoid it within 1st year of feeding?

botulism

are breastfed or bottle milk babies' stools often soft, yellow, and seefy

breastfed

Which nursing intervention would the nurse provide a 3-week-old infant immediately after surgery for esophageal atresia? a. restarting oral feedings slowly b. reporting vomiting to the HCP c. checking the patency of the nasogastric tube d. monitoring for signs of infection at incision sight

c

Which positioning would the nurse use for a newborn with a diagnosis of tracheoesophageal fistula? a. prone, to reduce risk of aspiration b. trendelenburg, to drain stomach contents c. semi-fowler, to reduce the risk of chemical pneumonia d. supine, to reduce the risk of sudden infant death syndrome

c

a procedure in which excess metals, such as iron, are removed from the blood

chelation therapy

hard, pebble-like stool for 2 weeks

constipation

________ is BOTH diagnostic and therapeutic for intussusception

constrast enema

For which complication would the nurse assess an infant with gastroesophageal reflux? a. bowel obstruction b. abdominal distention c. increased hematocrit d. respiratory problems

d

The mother of a 2-year-old child tells the nurse that her child is frequently constipated. the nurse asks the mother how she handles the child's toileting. Which response indicates to the nurse that the mother requires further education? a. "My child drinks a lot of fluids." b. "I give my child high-fiber foods." c. "My child has one bowel movement a day." d. "I schedule my child's toileting before each meal."

d

Which nursing assessment would the nurse recognize as indicative of improved respiratory status in an infant who had corrective surgery for a diaphragmatic hernia? a. cessation of crying b. retention of 1oz (30ml) formula c. reduction of arterial blood pH to 7.31 d. auscultation of breath sounds bilaterally

d

What is the purpose of a NG tube for a child who had surgery for esophageal atresia?

decompress the stomach and limit tension on suture line

what is the most severe type of hernia that inhibits the growth of the left lung

diaphragmatic

potassium levels are often dropped with

diarrhea

what is bottle mouth

don't put bottle in bed with baby with milk, juice, etc

failure of esophagus to develop as a continuous tube

esophageal atresia

T/F: a child with pyloric stenosis is usually nauseous

false

t/f: gastroschisis is more common than omphalocele

false

when would you need to screen for otitis media in a child with a cleft lip/palate

fluid may pool in eustachian tubes

inflammation of stomach/intestines - diarrhea, N/V - rotavirus #1 cause - chronic - severe dehydration complication

gastroenteritis

return of gastric contents into the esophagus

gastroesophageal reflux (GER)

extrusion of abdominal contents through abdominal folds; not covered by peritoneum -risk for heat loss - risk for infection

gastroschisis

should an infant with a cleft lip be held or positioned in an infant seat during feedings

held

congenital megacolon caused by absence of ganglion cells in distal colon males>females

hirschprung disease

- telescoping of the bowel/narrows the passage and limits passage of stool intestinal walls rub together --> edema/decreased blood flow --> necrosis, perforation, hemorrhage

intussusception

what determines a school-agers food preferences

media, peers

prolonged emesis --> prolonged diarrhea -->

metabolic alkalosis, metabolic acidosis

a surgical technique used to suture the fundus of the stomach around the esophagus to prevent reflux (GERD); in severe cases - pts are unable to vomit

nissen fundoplication

why should you avoid carrots, beets, squash, and spinach in first 6 months?

nitrate

does a hernia always need to be surgically repaired?

no, depends on severity

herniation at the umbilicus (a part of the intestine protrudes through the abdominal wall at birth) -risk for heat loss - risk for infection

omphalocele

what provides nutrients/waste removal in utero

placenta

narrowing of the opening of the stomach to the duodenum edema-->stenosis-->obstruction

pyloric stenosis

regurgitation & spitting up (due to weak cardiac sphincter) - frequent burping - more frequent feeds/smaller

reflux

thickened formula is given to infants with _____ problems

reflux

When do kids start losing teeth?

school-age

decreased ability to absorb nutrients due to shortened intestine

short bowel syndrome

what do you want to limit intake of with gastroenteritis b/c it pulls fluid into the bowel and can worsen diarrhea (and spicy foods)

simple carbs

_____ levels are often dropped with GI drainage (t-tube, NG suction)

sodium

fistula connects the esophagus and trachea

tracheoesophageal fistula

T/F: a hernia should be soft/reducible/not painful

true

T/F: the GI tract is complete but immature at birth

true

T/F: toddlers have a lower growth rate and appetite than infants

true