Exam 2 GI
Daily requirements Fluid maintenance
Calculate childs weight in Kg Allow 100 mL for first 10kg of body weight Allow 50 mL for second 10 kg of body weight Allow 20 mL for the remaining body weight
After several episodes of abdominal pain and vomiting, a 5-month-old infant is admitted with a tentative diagnosis of intussusception. What assessment should the nurse document that will aid confirmation of the diagnosis?
Characteristics of stools
What is the most accurate method of monitoring the infant's hydration status?
Daily weighing provides an objective measurement because a weight loss indicates a loss of fluid;
Appendicitis dx?
H/p periumbilical pain which descends to RLQ, rebound tenderness, fever, vomiting, increased WBC, CT
An infant with diarrhea requires contact precautions. What is the most effective nursing action to control the spread of this infant's pathogens?
Hand washing
A 16-month-old toddler has had large, frothy, foul-smelling stools since the introduction of table foods and is irritable and apathetic. The child is diagnosed with celiac disease and a gluten-free diet is prescribed. What response does the nurse anticipate in the child after 2 days on the diet?
Improved behavior
Cleft lip/ palate restrained child care
Remove one arm at a time and dor ROM
A newborn has just been admitted to the pediatric surgical unit from the birth hospital with a diagnosis of tracheoesophageal fistula. In what position should this child be maintained?
Semi-Fowler, to reduce the risk of chemical pneumonia
How to improve GER
Small frequent feedings and put child prone after meals (ONLY WHEN CHILD IS AWAKE)
IBD and diet
Stay away from Fiber it is too rough on intestines
A nurse in the pediatric clinic is reviewing the health history of a 6-year-old child with celiac disease who has been on the dietary regimen for 6 months. What evaluation criterion does the nurse use to assess the child's adherence to the diet?
Formed Bowel movements
What liquid should a nurse recommend that a mother offer her 8-month-old infant who has diarrhea?
Formula
GER can occur with
GER can occur w/o GERD or w/o regergitation
What do parents experience with cleft lip or palate
Grief, anger, guilt, disappointment, sense of loss
Hypotonic dehydration
Na less than 130 give d5/.9
Intussuception s/s
Abdominal pain, drawing knees to chest, vomiting, current jelly like stools, sausage shaped mass in URQ, child under 1 screaming
An infant who has undergone surgery for hypertrophic pyloric stenosis (HPS) is being bottle fed by the mother. What should the nurse teach the mother about feedings to decrease the chance of the infant vomiting?
Start with small, frequent feedings.
Hirchsprung Disease s/s
Suspected if infant doesn't pass meconium stool, distended abdomen, chronic constipation, nutritional deficiency, ribon like stools, enterocolitis (emergency)
GER management
Small/frequent feedings; thickened feedings Current positioning recommendation is flat prone of HOB elevated 30°, prone after meals ONLY WHEN AWAKE OR IF GERD COMPLICATIONS OUTWEIGH SIDS RISK Decreased risk of esophagitis with H₂ blockers (Zantac, Tagamet, or Pepcid) Proton pump inhibitors (Prilosec or Nexium) are more effective Prokinetic medications (Reglan, Urecholine) minimize respiratory symptoms Antacids generally not recommended
How to diagnosis Hirchsprung disease
X-ray, barium enema, anorectal manometric exam, Rectal Biopsy gives the definitive diagnosis
Cleft lip position
On side upright in infant seat not prone
S/s of GER
Passive regergitation or emesis, heartburn gaging, apnea, bleeding, poor weight gain, failure to thrive
S/s of chrons disease
Abdominal pain, diarrhea, decrease in appetite, fever, growth delay, delayed sexual development
An infant is to be discharged after surgery for pyloric stenosis. What instructions should the nurse give the parents?
"Hold the baby while continuing to feed a regular formula slowly and burp frequently."
The nurse is teaching health promotion tips to the mother of a 2-year-old child. During the follow-up visit, the nurse observes that the child has diarrhea and dental caries. Which action made by the parent is responsible for this condition?
"I give my child 8 ounces of fruit juice daily."
Tracheosophageal Fistula s/s
Coughing, choking and cynosis Excessive salvation, drooling Feedings may comeout of the nose Aspiration pneumonia This is an emergency situation
A 3-week-old infant who has been vomiting for 3 days is admitted to the pediatric unit with a diagnosis of hypertrophic pyloric stenosis. What essential information should the nurse identify during the admission procedure?
Respiratory status, amount and appearance of last voiding
A nurse is feeding an infant who recently underwent surgical repair of a cleft lip. What does the nurse plan to do for the infant just after each feeding?
Rinse the suture line
A nurse is caring for an infant after a cleft lip repair. Which item should the nurse use to feed the infant for several days after the surgery?
Rubber-tipped syringe
Brat diet
Banannas, rice, applesauce and toast
What makes GER abnormal
frequency and persistancy
Celiac disease managment
give Fe and folic acid and fat soluble vitamins (A,D,E,K)
Regular formula calorie
20 kcal/oz
What is Hirchsprung Disease
Congenital aganlionic megacolon Mechanical obstruction of the intestine caused by lack of peristalsis in that area
Side effect of antibiotics
Diarrhea
Failure to thrive
Investigate weight/ height loss less than 5% for age of weight >3 standard devitions
Diagnosis of IBD
Labs, vitamin levels, stool specimens
Positioning and vomiting
Side lying, Hob elevated
Vomiting
Treat cause Prevent dehydration and malnutrition Give meds Position, oral care (brush teeth exc)
How is salmenella spread?
through uncooked meats
Gstroesophageal reflux?
transfer of gastric contents into the esophagus, occurs in everyone generally improved by age 1
Managment of diarrhea
treat underlying cause oral replacement of fluid discourage clear fluids?BRAT diet I/o IVFs blood work Wash hands, clean water supply
Idiopatic FTT
unrelated to either organic/environmental etiologies
Acute appendicitis
usually 10 years of age, boys more than girls
Hirchsprung post op
vitals AXILLARY temps only, Iv fluids, monitor I/os begin toilet training after 2 years of age
Wipes with alcohol
will hurt the child if they have a raw bottom
FTT formula
24 or 27 kcal/oz
GER foods to avoid
Avoid fatty foods and carbonated liquids; reduce juices and citrus foods
FTT interventions
optimize nutrition give calories treat co-existing problem, Establish a positive feeding environment
A newborn with a severe bilateral cleft lip and palate is shown to the father first. The father says, "How could this happen to us? What's my wife going to do? It would've been better if she'd never gotten pregnant." How should the nurse respond?
"This must be very hard on you. I can go with you when your wife sees the baby."
After her baby boy undergoes corrective surgery for hypertrophic pyloric stenosis, the mother is asked to offer him his first feeding. He sucks it eagerly and vomits immediately. What is the nurse's explanation to the mother?
"This often occurs after the first feeding."
First meconium should pass?
24-46 hours after birth
Discharge planning for a toddler with newly diagnosed celiac disease includes instructions regarding dietary restrictions. What foods should the nurse recommend? Select all that apply.
Oat meal Ice cream Rice cakes corn crisps
A month-old-infant is admitted to the pediatric unit after 3 days of vomiting. Hypertrophic pyloric stenosis (HPS) is diagnosed. The nurse performs a physical assessment and obtains a health history from the mother. What continual assessments are necessary to determine the infant's immediate needs? Select all that apply.
Amount and color of last voiding Skin turgor and respiratory status
A toddler is admitted to the pediatric unit with diarrhea and severe dehydration. After several days of treatment the child is evaluated. What clinical findings indicate that the child is rehydrated? Select all that apply.
Decreased hematocrit Increase in daily weight Decrease in BUN
Rebound tenderness and appendicitis
Not reliable in kids (when you depress area and when you let go the person feels pain)
The parents of an infant with uncorrected Hirschsprung disease tell the nurse which foods they plan to give their child. What choice indicates that the parents need further teaching about the diet?
Apples (low-residual diet)
Cleft lip and palate repair avoid
Avoid the use of suction; no tongue depressors, thermometers, pacifiers, spoons, or straws
Hirchsprung Pre op?
Bowel cleansing as needed, rectal tube, teach s/s of perferation, teaching regarding ostomy
A newborn with a cleft lip is fed with a special nipple. What instructions should the nurse give the parents to reduce the incidence of regurgitation of the feedings?
Burp frequently during feedings.
How can we increase calories in formula?
Butter in milk
History of Diarrhea
Diet, travel, medications, How long have you had it, what color is it, how consistent, when does it occur
A 4-week-old infant is found to have hypertrophic pyloric stenosis (HPS) and is scheduled for surgery. Oral feedings are usually initiated a few hours after surgery. What does the nurse expect the practitioner to prescribe initially?
Electrolyte solution
Dietary consideration with celiac disease
Eliminate wheat, rye, bailey and oats Substitute with rice, corn and millet Decrease high fiber foods until inflammation disapears
A nurse is caring for an infant with a cleft lip and palate. What information should the nurse include when teaching the parents about this diagnosis?
Expectation that these children will have no other defect and otherwise will be healthy
A nurse is caring for an infant with hypertrophic pyloric stenosis. A pyloromyotomy is scheduled. Which pathophysiological modification must be addressed before this surgery can be performed safely?
Fluid and electrolyte imbalances must be corrected.
A 1-year-old infant with a distended abdomen is admitted to the pediatric unit with the diagnosis of Hirschsprung disease. In which position should the nurse place the infant?
Lateral
A nurse is caring for an infant who just underwent surgery for a cleft lip. In which position should the nurse place the infant?
Low Fowler
A nurse teaches the mother of a 2-year-old child who has celiac disease which foods to avoid. Which foods identified by the mother indicate that she understands the teaching?
Macaroni and cheese
An infant with a cleft lip and palate is admitted to the hospital for surgical repair. Place the nurse's postoperative interventions in order of priority.
Maintaining a patent airway Prevent Vomiting Monitoring parenteral fluid infusions Teaching the parents alternate feeding methods Assessing the infant's hearing status
Diagnose GER
May have barium swallow, UGI, esophageal pH probe testing, endoscopy
Severe dehydration causes??
Metabolic acidosis
Metabolic acidosis
Metabolic acidosis occurs with loss of alkaline fluid through diarrhea and is manifested by lethargy and Kussmaul breathing; all of the assessments indicate severe dehydration.
What is the priority of preoperative nursing care for an infant with a cleft lip?
Modifying feeding
A nurse is teaching the parents of an infant with a cleft lip and palate how to prevent infection. What information should the nurse include about why the infant is predisposed to infection?
Mouth breathing dries the oropharyngeal mucous membranes.
Isotonic dehydration
Na WNL give d5/.45
Hypertonic dehydration
Na greater than 150. Give D5/.2
GER surgury
Nissen fundoplication - gastic fundus is wrapped around lower esophagus
Cleft Palate/ Lip repair
Patient airway remove secretions with bulb syringe or yanker Protect the surgical site by elbow restraints and minimizing crying Logan bow to lip if applied Perform care for restrained child Clean suture site with sterile water after feeding Clear soft diet nothing harder than mashed potatoes
A mother reports feeding her infant immediately before arriving in the emergency department. After completing the assessment, the nurse reports which finding immediately to the health care provider because it likely indicates pyloric stenosis?
Peristaltic waves that traverse the epigastrium
Cleft Palate repair position
Place on side or abdomen
After tolerating an oral rehydration solution (Pedialyte) being given because of dehydration resulting from diarrhea, a 20-month-old toddler's condition improves and a regular diet is started. What foods should the nurse suggest that the parents offer their child? Select all that apply.
Poached eggs Strained carrots Animal crackers
Feeding with pyloric stenosis
Projectile vomiting small oral feedings 4-6 hours after surgery beginning with clear liquids. Advance as tolerated. Place the child on the right side in semi-fowlers position after eating
Appendicitis treatmnet?
Re-hydrate, antibiotics, surgery, NG,-> Lis (low intermitent suction), possible drain, pain management, IV, NPO, bowel sounds passing flatus, SCDs
Definitive diagnosis of Hirchsprung disease?
Rectal Biopsy gives the definitive diagnosis
The parents of an infant with pyloric stenosis ask a nurse many questions about the problem. What information should the nurse communicate when answering these questions?
This is a condition with an excellent prognosis.
A 25-day-old infant is admitted to the hospital after 3 days of vomiting, and pyloric stenosis is diagnosed. What are the most important nursing assessments at the time of admission? Select all that apply.
Tissue turgor Neurologic status Amount of last voiding
Hirchsprung treatment
Two stages of surgery: stage 1 temporary ostomy, stage 2 pull through procedure
Med to prevent nausea
Zofran
Intussuception treatment
air or saline enema if this doesn't work surgery
Nonorganic FTT
cause unrelated to organic diseases; often psychosocial in origin
Most accurate way to monitor hydration status
daily weights
Purpose of H2 receptor antagionists
decrease risk of esophagitis
S/s of perferation
distended abdomen, vomiting, irritability, Hard board like abdomen, dyspenea
Organic FTT
due to physical causes (cardiac, neurologic, CF, AIDS, or other chronic conditions)
Appendicitis
incentive spirometer, pain meds upon getting up
Signs of rehydration
increased urine output and a dilution of the urine, which results in a decrease in specific gravity.
Ulcertive colitis
inflammation of the colon or rectum
Celiac disease is at increased risk for
lymphoma
GER
most infants improve by age 1
NG tube
prevents abdominal distention
