Peds GI

You are going to feed baby with cleft lip/pallate, what 3 considerations will you take into account?

-position upright -support lip seal/suction -burp frequently

Gold standard dx evaluation of Ger/Gerd?

24-hour intraesophageal pH monitoring study looking at es

A nurse is assessing an infant who has hypertrophic pyloric stenosis. Which of the following findings should the nurse expect? (3) Dry mucus membranes Sausage-shaped abdominal mass. constant hunger projectile vomiting Currant jelly stools.

Dry mucus membranes constant hunger projectile vomiting

Parents come in bc their baby is having bilious vomiting. You go through your assessment and guess they may have Hirschsprung Disease. What other assessment findings besides bilious vomiting leads you to Hirschsprung?

FTT mass @ abdomen BM: -constipation -ribbon like, foul smelling stool

Baby came in with mom for intermittent vomiting. Baby has passive regurgitation, is hungry, and irritable. Does baby have GER or GERD?

GER

Baby came in with mom bc baby is vomiting blood (hematemesis), is refusing feedings, and poop has changed to a very dark color (melena). You do your assessment and see baby looks like it is FTT and has some respiratory symptoms. Does baby have GER or GERD?

GERD

This disease is characterized by an absence of ganglion cells.

Hirschsprung dz

Mom brings baby in for projectile vomiting shortly after feeding and wants to feed again right after, super hungry. You do assessment and you see visible peristalsis on babys abd and an olive shaped mass. Also, baby has dry mucous membranes. What does baby have?

Hypertrophic Pyloric Stenosis (HPS)

Babys with cleft lip/pallate have problems maintaining suction for adequate intake. How should a baby with a cleft lip be fed? Cleft palate?

baby with cleft lip can make suction with breast or nipples that are like breasts (Nuk nipple) cleft palate -provide bottles that dont need suctioning like bottle nipple that utilizes compression to let milk out -longer & thinner nipples that go into back of mouth, mom squeezes out milk -(haberman or mead-johnson)

Baby has suspected Hirschsprung Disease, what diagnostics tests are you going to look out for to validate this?

barium enema w/ xray rectal biopsy to check for absence of ganglion cells

Mom of baby with GER/GERD asks what she can do to prevent DO, you respond

diet: -avoid offending foods -thicken foods -small, frequent feedings -keep baby upright -avoid car seat (pressure on tummy) meds: H2-receptor antagonists Proton-pump inhibitors

Long term mgmt of cleft lip/palate includes interventions that address common comorbidities of this problem which include

ear infections missing teeth speech problems

1. Baby is post op from surgery to correct Short Bowel Syndrome, they are initially put on TPN and the second phase of feeding includes _______. 2. Oral feedings should be attempted if enteral feedings are tolerated. Why is this important and what can happen if either is delayed for too long following surgery?

enteral feedings oral aversion- baby doesnt want to eat orally

Taking _____ decreases chance of getting cleft lip/pallet

folic acid

Infants stomach lies _____ which is why they have a small stomach capacity, need frequent feedings, and should be sat upright during and after feedings.

horizontally

Child with Meckel Diverticulum will be undergoing surgery, but first, if needed, you need to correct

hypovolemic shock r/t hemorrhage

Baby who has Intussusception is ordered to have surgery, what event would make the surgery unecessary?

if baby has normal BM, bc this can resolve on own

Mom of baby recently dx with GER asks what may have predisposed baby to this, you respond

immature GI tract: -esophagus is short/narrow -tummy tiny -lower esophageal sphincter immature feeding: -large volume feedings -liquid diet positioning: horizontal positioning

In infant, peristalsis is (increased/decreased)?

increased; thus babies have more BM

This disorder is characterized by a *sudden onset of crampy abdominal pain.

intussesception

Besides surgery for cleft lip/palate, what are your nursing priorities?

maintain airway adequate nutrition

Infants have enzymes in their tummy to help break down food but they depend on a specific pH to work properly which is

more alkaline, less acidic

This disease is a typical cause of Short Bowel Syndrome (SBS).

necrotizing enterocolitis (The wall of the intestine is invaded by bacteria, which cause local infection and inflammation that can ultimately destroy the wall of the bowel)

What is an important piece of education to give babys parents about feeding after surgery?

nothing should go into mouth, so no bottle, spoons feed with open cup

You are going to check baby's hard and soft palates to see if it is cleft or not. How do you proceed?

palpate it w/ gloved hand

Most common parasitic infection in U.S. Eggs are _______ or ingested

pinworm inhaled (eggs float in air!)

Hypertrophic Pyloric Stenosis is the narrowing of

pyloric sphincter

This is a characteristic of Hirschsprung's Disease.

ribbon like stools

McBurney's point tenderness is described as and is correlated with what problem?

right lower quadrant pain appendicitis

*Most common cause of serious diarrhea in children <5 years and diarrhea-associated hospitalization

rotavirus

Why are children with SBS prone to nutritional deficiencies and diarrhea once parenteral nutrition is discontinued?

shortened bowel = 1. not as much surface area 2. food moves through bowels too quickly

Baby has been dx with Hirschsprung Disease. How will this DO be fixed?

surgery to remove aganglionic portion of bowel

Baby has cleft lip and palate, how will this problem be resolved?

surgical closure

In Hirschsprung Disease BM is altered because

there is a lack of ganglionic cells that make rectum and anus narrow, thus fecal matter is backed up in colon, making it distended

CP repair usually occurs between 6-12 months. Why is timing important for the fix, not too early & not too late?

too early may restrict growth of the skull too late, after baby has began talking, may impair their speech fine line with/in 6-12 mos.

A nurse is caring for an infant who is postoperative following cleft lip and palate repair. Which of the following actions should the nurse take? Place the infant in an upright position. Assess the mouth with a tongue blade. Offer a pacifier with sucrose. Remove the packing in the mouth.

upright positon It is important that the infant be placed in an upright position in order to maintain patency of the airway and prevent aspiration, especially during feedings.

Management of Hypertrophic Pyloric Stenosis (HPS) is a Pyloromyotomy (loosen narrowed pylorus), what post op education will be given to parents about introduction of feedings? (study guide)

will be put on IVF then gradual intro to feedings

intervention for mild & moderate dehydration? Severe?

any kind of oral liquid, pedialyte or breast milk IVF

This problem is characterized as one portion of the bowel slides into the next, much like the pieces of a telescope.

Intussusception

A baby comes in with bilious vomiting, currant jelly-like stools, crampy abd pain, and a *sausage shaped and mass. These are manifestations of

Intussusception *sausage shaped and mass *crampy pain

Intusspetion is occasionally r/t what other GI problem that manifests lesions?

Meckel diverticulum

Parent brings in child c/o colicky, cramping pain around umbilicus that just started today. You look into it more b/c this is an early sign of

appendicitis

What education can you give to babys parents who is going into surgery for Hirschsprung Disease about what to expect post op?

baby may have temporary colostomy if surgery will be done in 2 stages if only 1 stage, no colostomy bag

A nurse is teaching a parent of an infant about gastrointestinal reflux disease. Which of the following should the nurse include in the teaching? Position baby upright after feedings. Use a wide-based nipple for feedings. Use a bottle with a one-way valve. Thicken formula with rice cereal. Offer frequent feedings.

Position baby upright after feedings. Thicken formula with rice cereal. Offer frequent feedings

A nurse is caring for a child who has Hirschsprung's Disease. Which of the following actions should the nurse take? Initiate bed rest. Place an NG tube for decompression. Encourage a high-fiber, low-protein, low-calorie diet. Prepare the family for surgery.

Prepare the family for surgery. Surgery is required to remove the defective segment of intestine.

This is the primary method of nutrition for SBS following surgery.

TPN

Meconium is usually passed between 24-36 hours after birth. Does lack of meconium confirm that the GI tract is not patent? this could indicate what possible problems?

Yes hirschprungs hypothyroidism cystic fibrosis

A nurse is caring for a child who has Meckel diverticulum. Which of the following manifestations should the nurse expect? (3) Rapid, shallow, breathing. Abdominal pain. Vomiting. Currant jelly-like stools Fever

abd pain vomiting Currant jelly-like stools

Baby has Intussusception, what interventions are you planning to carry out?

air or saline enema