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Pedes GI Disorders
Pedes Final
63
Nursing
Undergraduate 4
04/03/2016

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Term
Malformations of the face and oral cavity that seem to be multifactorial in hereditary origin
Definition
Cleft lip or palate
Term
Characteristics of cleft lip or palate
Definition
a. cleft lip is realily apparent
b.cleft palate may not be identified until the infant has difficulty with feeding
c. initial closure of cleft lip is performed when infant weighs approximately 10 pounds and has an Hgb of 10 g/dL
d. closure of palate defect is usually performed at 1 year of age to minimizes speech impairment
Term
Variations of cleft lip and palate at birth:
Definition
A. notch in vermillion border
B. Unilateral cleft lip and cleft palate
C. Bilateral cleft lip and cleft palate
D. Cleft palate
Term
Nursing Assessments for Cleft Lip or Palate
Definition
a. failure of fusion of the lip, palate or both
b. difficulty sucking and swallowing
c. parent reaction to facial defect
Term
Nursing Diagnoses for Cleft Lip or Palate
Definition
a. Imbalanced nutrition less than body requirements related to...
b. Risk for impaired attachment related to...
Term
For cleft lip or palate, inform family that
Definition
successful corrective surgery is available
Term
For cleft lip or palate, in the newborn period, assist with feeding in the following ways:
Definition
a. feed in upright position
b. feed slowly, with frequent bubbling
c. Use soft, large nipples; lambs nipples; prosthetic palate; or rubber tipped Asepto syringe
d. support mother's breast feeding if possible.
e. Consider the ESSR method for feeding: Enlarge nipple opening, stimulate the child to Suck, Swallow normally, and Rest
Term
In cleft lip or palate postoperatively maintain patent
Definition
airway and proper positioning
Term
The proper placement postoperatively of a child with a cleft lip is
Definition
place client on side or upright in infant seat (not prone)
Term
The proper placement postoperatively of a child with a cleft palate is
Definition
Place client on side or abdomen
Term
In cleft lip or palate, postoperatively, remove oral secretions carefully with
Definition
bulb syringe or Yankauer suction set
Term
For cleft lip or palate, protect the surgical site by
Definition
a. apply elbow restraints
b. minimize crying to prevent strain on lip suture lines
c. maintain Logan bow to lip if applied
Term
In cleft lip or palate, provide care for restrained child by
Definition
a. remove one restraint at a time and perform ROM exercises
b. provide age appropriate stimulation
Term
Postoperatively for the cleft lip or palate resume feeding as prescribe and cleanse
Definition
suture site with sterile water after feeding; formula remaining on suture line may impede healing and lead to infection
Term
for cleft lip or palate, encourage family participation in care and feeding and teach
Definition
a. fluids are taken by a cup or an asepto syringe with a rubber tip (gravity feeder)
b. the diet progresses from a clear to a full liquid diet
c. the child may go home on a soft diet (nothing harder than mashed potatoes.)
Term
Usually for cleft palate: Coordinate long=term care with other team members including:
Definition
Plastic surgeon, ENT specialist, nutritionist, speech therapist, orthodontist, pediatrician,nurse
Term
What are the typical parent and family reactions to a child with an obvious malformation such as cleft lip or palate are
Definition
guilt, disappointment, grief, sense of loss, anger
Term
Congenital anomaly in which the esophagus does not fully develop.
Definition
Esophageal Atresia with Tracheoesophageal Fistula (TEF)
Term
With Esophageal Atresia with Tracheoesophageal Fistula (TEF) the most common is
Definition
Upper esophagus ends in a blind pouch, and the lower part of the esophagus is connected to the trachea --- this condition is clinical and a surgical emergency
Term
The 3 C's of Esophageal Atresia with Tracheoesophageal Fistula (TEF) in the newborn
Definition
Choking
Coughing
Cyaosis
Term
Other nursing assessments for Esophageal Atresia with Tracheoesophageal Fistula (TEF)
Definition
Excessive salivation
Respiratory distress
Aspiration pneumonia
Term
Nursing Diagnoses for Esophageal Atresia with Tracheoesophageal Fistula (TEF)
Definition
a. Risk for aspiration related to...
b. Imbalanced nutrition: less than body requirements related to...
Term
Provide preoperative care for Esophageal Atresia with Tracheoesophageal Fistula (TEF) by
Definition
a. monitor respiratory status
b. remove excess secretions (suction is usually continuous to blind pouch)
c. elevate infant into antireflux position of 30 degrees
d. provide oxygen as prescribed
e. maintain NPO
f. administer IV fluids as prescribed
Term
Provide postoperative care for Esophageal Atresia with Tracheoesophageal Fistula (TEF) by
Definition
a. Maintain NPO
b. Administer IV fluids
c. Monitor I&O
d. provide gastrostomy tube care and feedings as prescribed
e. provide pacifier to meet developmental needs
f. monitor child for postoperative stricture of the esophagus
Term
Signs of Postoperative stricture of the esophagus in Esophageal Atresia with Tracheoesophageal Fistula (TEF)
Definition
a. poor feeding
b. dysphagia
c. drooling
d. regurgitating undigested food
Term
Narrowing of the pyloric canal; the sphincter (circular muscle of the pylorus hypertrophies to twice the normal size
Definition
pyloric stenosis
Term
Pyloric Stenosis usually occurs in
Definition
first-born males
Term
In pyloric stenosis, vomiting (free of bile) usually begins after
Definition
14 days of birth and becomes projectile
Term
Other signs of pyloric stenosis
Definition
a. hungry, fretful infant
b. weight loss, failure to gain weight
c.
Term
Pyloric Stenosis usually occurs in
Definition
first-born males
Term
In pyloric stenosis, vomiting (free of bile) usually begins after
Definition
14 days of life and becomes projectile
Term
Other signs of pyloric stenosis
Definition
a. hungry, fretful infant
b. weight loss, failure to gain weight
c. dehydration with decreased sodium and potassium
d. metabolic alkalosis (decreased serum chloride, increased pH and bicarbonate or CO2 content)
e. palpable olive-shaped mass in upper right quadrant of the abdomen
f. visible peristaltic waves
Term
Nursing diagnoses for pyloric stenosis
Definition
a. Imbalanced nutrition: less than body requirements related to...
b. Deficient fluid volume related to...
Term
Children with cleft lip or palate and those with pyloric stenosis both have a nursing diagnosis of "Alteration of nutrition: less than body requirements" This is because
Definition
In the cleft lip or palate it is related to decreased ability to suck.
In pyloric stenosis it is related to frequent vomiting
Term
Nursing Plans and Interventions for Preoperative care for pyloric stenosis
Definition
a. assess for dehydration
b. administer IV fluids and electrolytes as prescribed
c. weigh daily; monitor I&O
d. provide small frequent feedings if prescribed
Term
In pyloric stenosis, prepare family for surgery by teaching that
Definition
a. hypertrophied muscle will be split
b. prognosis is excellent
Term
Postoperative care for pyloric stenosis includes:
Definition
a. Continue IV fluids as prescribed
b. provide small oral feedings with electrolyte solutions or glucose (usually 4 to 6 hours postoperative)
c. position on right side in semi-Fowler position after feeding
d. Burp frequently to avoid stomach becoming distended and putting pressure on surgical site
e. weigh daily, monitor I&O
Term
Telescoping of one part of the intestine into another part of the intestine, usually the ileum into the colon (called ileocolic)
Definition
Intussusception
Term
In Intussusception there is
Definition
a. partial to complete bowel obstruction
b. blood vessels become trapped in the telescoping bowel, causing necrosis
Term
Nursing Assessments/signs, symptoms for Intussusception
Definition
a. child under 1 year of age
b. acute, intermittent abdominal pain
c. screaming, with legs drawn up to abdomen
d. vomiting
e. "currant jelly" stools (mixed with blood and mucus
f. Sausage-shaped mass in upper right quadrant while lower right quadrant is empty
Term
Nursing Diagnoses for Intussusception
Definition
a. Ineffective tissue perfusion (bowel) related to...
b. Risk for deficient fluid volume related to...
Term
Nursing Plans and Interventions for Intussusception
Definition
a. monitor carefully for shock and bowel perforation
b. administer IV fluids as prescribed
c. monitor I&O
d. Prepare family for emergency intervention
e. prepare child for barium enema (which provides hydrostatic reduction ) Two of three cases respond to this treatment, if not, surgery is necessary
f. provide postoperative care for infants who require abdominal surgery
Term
Nutritional needs and fluid and electrolyte balance are key problems for children with GI disorders.
Definition
The younger the children, the more vulnerable they are on fluid and electrolyte imbalances and the greater is the need for the caloric intake required for growth.
Term
Congenital absence of autonomic parasympathetic ganglion cells in a distol portion of the colon and rectum
Definition
Congenital Aganglionic Megacolon (Hirschsprung Disease)
Term
Characteristics of Congenital Aganglionic Megacolon (Hirschsprung Disease)
Definition
a. There is a lack of peristalsis in the area of the colon where the ganglion cells are absent.
b. fecal contents accumulate above the aganglionic area of the bowel.
Term
Correction of Congenital Aganglionic Megacolon (Hirschsprung Disease)usually involves a series of surgical procedures
Definition
a. a temporary colostomy
b. Later, a reanastomosis and closure of the colostomy
Term
Signs/symptoms of Congenital Aganglionic Megacolon (Hirschsprung Disease)
Definition
a. suspicion in newborn who fails to pass meconium within 24 hours
b.distended abdomen, chronic constipation alternating with diarrhea
c. nutritionally deficient child
d. enterocolitis that occurs as an emergency event
e. ribbon like stools in older child
Term
Nursing diagnoses for Congenital Aganglionic Megacolon (Hirschsprung Disease)
Definition
Constipation related to...
Diarrhea related to...
Imbalanced nutrition: less than body requirements related to...
Term
Provide for preoperative care for Congenital Aganglionic Megacolon (Hirschsprung Disease) by
Definition
a. begin preparation for abdominal surgery
b. provide bowel cleansing programs as prescribed
c. insert rectal tube if prescribed
d. observe for symptoms of bowel perforation
e. initiate preoperative teaching regarding colostomy
Term
Signs / symptoms of bowel perforation in Congenital Aganglionic Megacolon (Hirschsprung Disease)
Definition
a. abdominal distention (measure abdominal girth)
b. vomiting
c. increased abdominal tenderness
d. irritability
e. dyspnea and cyanosis
Term
For a child with congenital megacolon, take an
Definition
axillary temperature
Term
Provide the following postoperative care for Congenital Aganglionic Megacolon (Hirschsprung Disease)
Definition
a. check vital signs, axillary temperature
b. administer IV fluids as prescribed
c. monitor I&O
d. care for nasogastric tube with connection to intermittent suction
e. check abdominal and perineal dressings
f. Assess bowel sounds
Term
Prepare the family for home care
Definition
a. teach care of temporary colonostomy
b. teach skin care
c. refer family to enterostomal therapist and social services
d. prepare child and family for closure of temporary colostomy
e. after closure, encourage family to be patient with child when toileting
f. teach family to begin toilet training after age 2
Term
Congenital malformation of the anorectal section of the GI tract (imperforate anus)
Definition
Anorectal Malformation
Term
Anorectal Malformation characteristics
Definition
a. often associated with a fistula
b. may be associated with urinary tract anomalies
c. type and level of rectal anomaly determine surgical procedure and degree of bowel control possible
Term
Signs / symptoms of Anorectal Malformation
Definition
a. an unusual appearing anal dimple
b. newborn who does not pass meconium stool within 24 hours
c. meconium appearing from perineal fistula or in urine
Term
Nursing Diagnoses for anorectal malformation
Definition
Bowel incontinence related to...
Deficient knowledge (bowel or colostomy home program) related to...
Term
For anorectal malformation, determine newborn's first temperature;
Definition
axillary or tympanic temperature is used to determine first reading unless hospital policy indicates otherwise
Term
For anorectal malformation assess newborn for passage of meconium and assist
Definition
family's ability to cope with diagnosis
Term
For anorectal malformation, provide preoperative care to infant
Definition
a. assess vital signs
b. administer IV fluids (NPO)
c. monitor I&O
Term
For anorectal malformation, provide postoperative care for anal reconstruction
Definition
a. keep perineal site clean
b. position infant in side-lying prone position with hips elevated (decreases pressure on perineal sutures)
c. Provide colostomy care if needed
Term
For anorectal malformation teach home care
Definition
a. teach home care of colostomy if necessary
b. teach that with high level defects, long-term follow-up is required
c. teach that toilet training is delayed and full continence may not be achieved
Term
Explain why a barium enema is used to treat intussusception.
Definition
A barium enema reduces the telescoping of the intestine through hydrostatic pressure without surgical intervention.
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