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peds unti 7
GI unit
217
Nursing
Undergraduate 1
04/27/2011

Additional Nursing Flashcards

 


 

Cards

Term
the GI system is __________ at birth
Definition
immature
Term
lack voluntray swallowing< age ?
Definition
6 weeks
Term
stomach capacity is _________ and GI motility is______________.
Definition

small, and increased

lots of diapers

Term
what enzymes do infants lack?
Definition
amalase, lipase, and trypsin
Term
what conjunctive GI organ is also immature?
Definition
LIVER
Term
liver begins to conjugate bilirubin and excrete bile after how many weeks?
Definition
2-3 weeks
Term
because the liver is immature, what process involving glycogen is also immature?
Definition

gluconeogenesis

the formation of glycogen

Term
by what age are the digestive processes complete?
Definition
by age 2
Term
when myelination of the spinal cord is complete:
Definition
voluntary control over excretion begins
Term
mouth principal site for:
Definition
initial preparation of food
Term
digestion is:
Definition
muscular activity which produces peristalsis
Term
what are the three TYPES of muscles involved in digestion:
Definition

circular

longitudinal

sphincter

Term
circular muscles:
Definition
churn and mix food particles
Term
longitudinal muscles:
Definition
propel food bolus
Term
spincter muscles:
Definition
control passage of feces
Term
food absorption occurs primarily in:
Definition
small intestines
Term

digestion

large intestine:

Definition

completes process

absorbs water and sodium

Term

mechanisms of absorption:

(four types)

Definition

passive diffusion

carrier mediated diffusion

active absorption

energy-driven transport and engulfment

Term

history

ask about:

Definition

recent changes in appetite

changes in fluid intake/thirst

food intolerances

belching

vomiting

heartburn

flatulence

feeding or eating routine/ritual

SPITTING UP OR REGURGITATION WITH MEALS

Term
SERUM CHEMISTRY STUDIES:
Definition
liver and lipid profiles, ESR, C-reactive protein, thyroid studies
Term
stool examination:
Definition
detects presence of ova, parasites, blood, and WBC's
Term
stool PH and culture:
Definition
determines the presence of bacteria
Term
diagnostic tests:
Definition
upper GI series, barium enema, rectosigmoidoscopy, colonoscopy, abdominal and pelvic ultrasound
Term

cleft lip and palate

can occur:

 

Definition
alone or together
Term
cleft lip and palate:
Definition
failure of the maxillary process to fuse
Term

cleft lip and palate

union of upper lip is complete by:

Definition
the 7th week
Term
cleft lip is more common in?
Definition
BOYS!
Term

cleft lip and palate

treatment:

Definition
surgical repair
Term

cleft lip and palate

#1 goal during treatment:

Definition
maintain patent airway
Term

cleft lip and palate

children prone to:

Definition

recurrent otitis

hearing loss

or speech delay

 

observe bonding patterns

Term

colic

 

Definition

feeding disorder

abdominal pain outbursts

Term

colic

may be related to:

Definition
immature digestive system
Term

colic

patho:

Definition
relaxed spincters allow mixing of gastric acids with esophagus and intestines
Term

colic

enzyme quantity:

Definition
insufficient
Term

colic

usually worse:

Definition
in the evening
Term

colic

s/s

Definition

infant cries loudly and constantly for several hours

abdomen distended, tense

draws legs up toward abdomen

clenched fists

 

Term

colic

begins at what age?

Definition
6 weeks
Term

colic

lasts for how long?

Definition
3 months
Term

failure to thrive

 

Definition
describes a child whose weight falls below 5th percentile - on standard growth charts
Term

failure to thrive

two types:

Definition
organic and nonorganic
Term

failure to thrive

organic:

Definition

physical causes:

cystic fibrosis

celiac disease

system failures

 

Term

failure to thrive

nonorganic:

Definition

psychosocial factors

bonding attachment disorders

NEGLECT!

Term

failure to thrive

diet:

Definition
high protein high calorie diet
Term

failure to thrive

children need:

Definition
consistency in nursing care
Term

failure to thrive

indicators:

Definition

cachexia

and generalized weakness

avoidance of eye contact

sleep disturbances

Term

failure to thrive

diagnosis:

Definition

physical and medical work up to r/o organic causes

bowel and muscle biopsies

Term

failure to thrive

intussusception:

Definition
intestine "telescopes" into itself
Term
most common cause of obstruction (5months-1year)
Definition
intussusception
Term

intussusception

s/s

Definition

sudden, acute pain, "currant jelly" stools

sausage shaped mass RUQ

Term

intussusception

most common site:

Definition

ileocecal valve

RUQ

Term

intussusception

diagnosis:

Definition

barium enema (may correct problem)

 

Term

intussusception

treatment:

Definition
usually self limiting- may go to OR
Term

intussusception

4- 10% will have what outcome within 36 hours?

Definition
recurrence!!!
Term

pyloric stenosis

 

Definition
circular muscle surrounding pylorus is hypertrophied and blocks gastric emptying
Term

pyloric stenosis

more common in:

Definition

males 5x more common than girls

full term infants rather than preterm infants

Term

pyloric stenosis

can start with:

Definition
just regurgitation then progress to projectile vomiting
Term

pyloric stenosis

s/s

Definition

progressive, projectile, non-bilious vomiting

moveable, palpable, olive shaped mass in RUQ

visible deep peristalic waves

irritability

HUNGER

crying

sunken fontanels

dehydration

Term

pyloric stenosis

diagnostics:

Definition

abdominal ultrasound

upper GI

labs

Term

pyloric stenosis

treatment:

Definition

NG tube

surgery

IV fluids

Term

pyloric stenosis

management:

Definition

maintain NG patency

small frequent feedings

IV hydration

VS

incisional site care

Term

Omphalocele

defintion:

Definition

intra-abdominal contents herniate through

umbilical cord

Term

Omphalocele

patho:

Definition
failure of abdominal contents to return to abdomen when the abdominal wall begins to close by 10th week gestaion
Term
gastroschisis
Definition
viscera outside abdominal cavity not covered with peritoneal sac
Term

gastroschisis

assessment:

Definition
protuberance of abd. contents outside of body at birth
Term

true of false

gastroschisis may be noted on prenatal ultrasound

Definition
ture
Term

gastroschisis

immediately:

Definition
cover with warm, moist sterile gauze, plastic wrap to conserve heat and prevent infection
Term

gastroschisis

monitor for:

Definition

circulatory compromise

NG compression

observe for possible ileus

Term
congenital diaphramatic hernia
Definition
abdominal contents protrude into thoracic cavity through diaphram
Term

congenital diaphramatic hernia

is a failure of what type of tissues?

Definition

pleuroperitoneal tissues

failure to properly develop and form diaphram

Term

congenital diaphramatic hernia

what is the effect on the lungs?

Definition

lung growth may cease

decreased breathing by pulmonary hypoplasia and compression of the lungs, airways and vessels

Term

congenital diaphramatic hernia

assessment:

Definition

depends on severity of lesion

dimisnished/absent breath sounds

bowel sounds heard in chest

cardiac sounds on RIGHT side of chest

 

Term

congenital diaphramatic hernia

s/s

Definition

dyspnea

cyanosis

nasal flaring

tachypnea

retractions

sunken abdomen

Term

congenital diaphramatic hernia

Pre-op:

Definition

elevate HOB on affected side

maintain: NG patency, monitor IV fluids, mechanical ventilation

Term

congenital diaphramatic hernia

Post-op:

Definition

wound care- prevent infection

monitor for respiratory distress, position in semi-fowlers on affected side

promote nutrition when feedings resume

 

Term

Biliary Atresia

 

Definition
pathologic closure or absence of bile ducts
Term

Biliary Atresia

progressive inflammatory process:

Definition
causes both intra and extrahepatic bile duct fibrosis
Term

Biliary Atresia

obstruction of normal flow of the bile duct out of the liver causes:

Definition
accumulation in the liver
Term

Biliary Atresia

caused by:

Definition

teratinogen

originates PRENATAL period

may be viruses, toxins, or chemicals

 

Term

Biliary Atresia

s/s:

Definition

inflammation

edema

permanent injury

 

Term

Biliary Atresia

liver becomes:

Definition
fibrotic
Term

Biliary Atresia

if not treated:

Definition
it is fatal
Term

Biliary Atresia

at birth the infant appears:

Definition
healthy
Term

Biliary Atresia

the bilirubin levels:

Definition
increase
Term

Biliary Atresia

jaundice begins:

Definition
2 weeks- 2 months
Term

Biliary Atresia

s/s:

Definition

acholic stools: putty like, clay colored

hepatomegaly

abdominal distention

FTT

malnutrition

intense itching

tea colored urine

 

Term

Biliary Atresia

diagnostic:

Definition
ultrasound
Term

Biliary Atresia

ultrasound reveals:

Definition
shrunken galbladder with missing or blocked hepatic duct
Term

Biliary Atresia

non surgical treatment:

Definition

TPN or lipids

monitor weight

vitamins

monitor stool

pattern

tepid baths

nutrional support

emotional supprt

 

Term

Biliary Atresia

Education:

Definition

meticulous skin care

home medication regimen

s/s of liver failure

available support groups

MEDICATIONS TO PREVENT REJECTION

Term

Esophageal Atresia

malformation from:

Definition

failure of esophagus to develop as a continuous tube

foregut fails to seperate into 2 distinct tubes

Term

Esophageal Atresia

the esophagus:

Definition
ends in a blind spot r/t the tubes not seperated distinctly
Term

Esophageal Atresia

tracheoesophageal fistula:

Definition

esophageal pouch connected to trachea bya fistula

* aspiration risks*

Term

Esophageal Atresia

associated with:

Definition

GI anomalies(imperforate anus)

Malformation of:

cardiac

urinary

musculoskeleton

Term

Esophageal Atresia

s/s:

Definition

excessive salivation

drooling

cyanosis

coughing and choking with feeding

fluid return via nose

aspiration

 

Term

Esophageal Atresia

diagnostic:

Definition

inability to pass NG tube into stomach

x-ray shows blind pouch

Term

Esophageal Atresia

Rx:

Definition

surgical emergency!

 

Term

Esophageal Atresia

surgical repair prognosis:

Definition
good
Term

Esophageal Atresia

surgical repair may involve:

Definition
permanent placement of gastrostomy tube for feedings
Term

biliary atresia

surgical treatment:

Definition
transplant
Term

Hirschsprung's Disease

(congenital Aganglionic megacolon)

 

 

Definition
results from absence of ganglionic cells iin colon
Term

Hirschsprung's Disease

two types:

Definition

acute

chronic

Term

Hirschsprung's Disease is a congenital __________

_____________ disease

Definition
Aganglionic Megacolon
Term

Hirschsprung's Disease

mechanism:

Definition

lack of innervation to colon

preventing peristalis and results in mechanical obstruction

Term

Hirschsprung's Disease

more common in:

Definition
males 4x more than females
Term

Hirschsprung's Disease

s/s of newborn:

Definition

failure to pass mechonium stools

abdominal distention

bile stained emesis

reluctant to take fluids

 

Term

Hirschsprung's Disease

s/s for infants:

Definition

FTT

constipation

vomiting

episodic diarrhea

 

Term

Hirschsprung's Disease

s/s for toddlers:

Definition

chronic constipation

foul smelling stools

visible peristalsis

palpable fecal mass

anemia

hypoproteinemia

abdominal distention

Term

Hirschsprung's Disease

diagnosis:

Definition

rectal exam

rectal biopsy

barium studies

 

Term

Hirschsprung's Disease

Rx:

Definition
surgical
Term

Hirschsprung's Disease

surgical Rx:

 

Definition

removal of aganglionic bowel segment and

temporary colostomy

 

later surgery- colostomy take down

reanastomosis the bowel and colostomy closed

Term

Hirschsprung's Disease

pre-op:

Definition

antibiotics

colostomy education to family

Term

Hirschsprung's Disease

post-op:

Definition

assess stoma for: color, bleeding, breakdown of surrounding skin

NPO

pain management

fluid management I&O's

Term

Hirschsprung's Disease

post-op keep child NPO until:

Definition
bowel sounds return
Term

Gastroesophageal Reflux

(GERD)

 

Definition

regurgitation of gastric contents into esophagus

 

Term

Gastroesophageal Reflux

(GERD)

cause:

Definition

incompetence of lower esophageal sphincter

reflux(backward flow) damages esophagus

Term

Gastroesophageal Reflux

(GERD)

typically is self limiting by age:

Definition
1 year
Term

Gastroesophageal Reflux

(GERD)

rate increases with:

Definition
CP, down's syndrome and prematurity
Term
what is the most common esophageal problem in infancy?
Definition

Gastroesophageal Reflux

(GERD)

Term

Gastroesophageal Reflux

(GERD)

complications occur most in who:

Definition

males 3x more than females

 

*complications pathological

Term

Gastroesophageal Reflux

(GERD)

when complications occur they are:

Definition
pathologic in origin
Term

Gastroesophageal Reflux

(GERD)

treatment depends on:

Definition
severity
Term

Gastroesophageal Reflux

(GERD)

Rx for MILD refulx:

Definition
change feeding habits, child upright 30 degrees after feedings, thicken feedings with rice cereal.
Term

Gastroesophageal Reflux

(GERD)

Rx for severe reflux:

Definition

surgical treatment (nissen fundoplication)

small frequent feedings, medications

Term

Gastroesophageal Reflux

(GERD)

medications:

Definition

antacids

histamine blockers (ranitidine, cimetidine)

prilosec

encourage the use of tylenol (not advil or motrin)

 

Term

Appendicitis

 

Definition
inflammation and infection of veriform appendix (lymph tissue)
Term

Appendicitis

causes:

Definition

maybe caused by fecalith (hardend feces)

obstructing the lumen of cecum

parasites

stenosis

Term
what is the most common reason for abdominal surgery?
Definition
Appendicitis
Term

Appendicitis

more common in:

Definition
males age 10-19
Term
dont ususally see Appendicitis before what age?
Definition
age 2
Term

Appendicitis

assessment:

Definition

generalized abdominal pain

progressively worsening in RLQ at Mcburney's point

 

 

Term

Appendicitis

s/s:

Definition

nausea

vomiting

fever

chills

guarding

rigidity

rebound tenderness

diarrhea

constipation

Term

Appendicitis

WBC count:

Definition

elevated

(15-20,000 cells/mm3)

Term

Appendicitis

diagnostic:

Definition

x-ray or abdominal ultrasound

 

*reveals enlarged appendix*

Term

Appendicitis

Rx:

Definition

surgery

*appendectomy*

Term

Appendicitis

Pre-op:

Definition

NPO

IV

assess bowel sounds

do NOT stimulate peristalsis (rupture)

 

Term

Appendicitis

palpating the abdomen:

Definition

may cause rupture

NEVER palpate their abdomens

Term

Appendicitis

post-op:

Definition

IV- electrolytes, antibiotics

 

Term

Appendicitis

rupture:

Definition

slows recovery!

*infection present*

Term

Irritable Bowel Syndrome:

key points

Definition

diarrhea and constipation

food intolerances common

Term

Ulcerative Colitis:

key points

Definition

limited to colon and rectum

bloody diarrhea

abdominal pain

Term

Chron's disease:

key points

Definition

involves any part of the GI system

INFLAMMATION

ulceration -bleeding -edema

narrowed bowel

inflexible scar tissue

Term

Necrotizing eterocolitis:

key points

Definition

primarily premature infants

usually first 2 weeks of life

Term
what are the four Inflammatory GI diseases:
Definition

Irritable bowel syndrome

Ulcerative colitis

Chron's disease

Necrotizing enterocolitis

Term

 

Ulcerative colitis AND Chron's

origin:

Definition
Genetic component to BOTH diseases
Term

Ulcerative colitis AND Chron's

develops at age:

Definition

15-25

 

Term

Ulcerative colitis AND Chron's

Cause:

Definition
faulty regualtion of immune system to intestinal mucosa
Term

Ulcerative colitis AND Chron's

marked by:

Definition
periods of remission and exacerbation
Term

Ulcerative colitis AND Chron's

medications:

Definition

corticosteriods

immunosuppressantsw

antidiarrheals

sulfasazine

folic acid supplements

metronidazole (flagyl)

antispasmotic agents

cyclosporin

Term

Ulcerative colitis AND Chron's

encourage:

Definition
adequate nutrition
Term

Ulcerative colitis AND Chron's

nutrition:

Definition

involve child in meal planning

INCREASED:

calories

carbs

protein

DECREASE fiber

 

 

*frequent small feedings*

 

NG feedings, TPN/lipids

Term

Ulcerative colitis AND Chron's

NG feedings:

Definition
TPN/lipids
Term

Ulcerative colitis AND Chron's

surgery:

Definition
colecotomy with ileostomy; colostomy
Term
Celiac disease:
Definition

gluten insensitive eropathy

*Chronic malabsorption*

chronic inability to tolerate gluten

Term

Celiac disease:

nutrition:

Definition

LIFELONG management of gluten free diet

 

Term

Celiac disease

more common:

Definition

within families

*it IS your mothers fault*

Term

Hepatitis

type of disease:

Definition
INFECTIOUS
Term

Hepatitis

definition:

Definition

inflammation of liver, viral infection

*wide range of severity*

Term

Hepatitis

types:

Definition
Hepatitis A, B, C, D, E
Term
Hepatitis A:
Definition

Oral/fecal route

*contagious*

Term
Hepatitis B:
Definition

blood borne

parenteral route

*sexual Activity*

Term
Hepatitis C:
Definition

body fluids

IV drug use

frequent transfusions

*most common CHRONIC Hepatitis*

Term
Hepatitis D
Definition

percutaneous route in people infected with Hep B

*must be already infected with type B*

Term
Hepatitis E
Definition

transmitted enterically

 

*contaminated water*

Term

Hepatitis

Two types:

Definition
symptomatic & asymptomatic
Term

Hepatitis

children < 5 are usually:

Definition

asymptomatic with Hep A

*highly contagious*

Term

Hepatitis

Anicteric:

Definition

(absence of jaundice)

lasts 5 days

Term

Hepatitis

symptomatic:

Definition

ancinteric (absence of jaundice) 5-7 days

anorexia

RUQ pain

fever

malaise

hepatosplenomegaly

Icteric: (jaundice) lasting up to 4 weeks

uticaria

darking urine

light colored stools

*child feels temporarily better as jaundice appears*

Term

Hepatitis

child temporarily feels better as:

Definition
jaundice appears
Term
dormant Hep C can be:
Definition
asymptomatic for years
Term

Acute Fulminating Hepatitis

 

Definition

total destruction of hepatic paraenchyma

*bleeding problems*

hepatic encephalopathy

Term

Acute Fulminating Hepatitis

associated:

Definition

Acites

acute liver failure

Term

Acute Fulminating Hepatitis

can lead to death within:

Definition
2 weeks of onset
Term

Acute Fulminating Hepatitis

positive history of:

Definition
exposure
Term

Acute Fulminating Hepatitis

percutaneous exposure to:

Definition
blood or body fluids
Term

Acute Fulminating Hepatitis

at risk for:

Definition
bleeding problems
Term

Acute Fulminating Hepatitis

diagnositcs:

Definition

elevated liver function tests (SGOT, SGPT)

antigen indentification markers ( IgM anti-HAV)

positive liver biopsy

Term

Hepatitis

nursing interventions

 

Definition

supportive Rx

symptomatic Rx

Provide homeostasis, nutrition, and hydration support

Term
Hepatitis A and B focus on:
Definition
prevention
Term

Hepatitis

fulminating cases treatment:

Definition
ICU
Term

Hepatitis A & B

education:

Definition

disinfection of dirty diaper changing area

hand washing

universal precautions

vaccinations for hep A & B

Term

Dehydration

deficit from which fluid volume:

Definition
extra-cellular fluid volume
Term

Dehydration

loss of fluid containing what?

Definition
sodium
Term

Dehydration

main cause:

Definition
vomiting and diarrhea
Term

Dehydration

accompanies:

Definition
many childhood illnesses
Term

Dehydration

types:

Definition

acute/chronic

inflammatory/non inflammatory

Term

Dehydration

major concerns:

Definition

electrolyte imbalance

hypovolemic shock

& death

 

*esp. in ped pt's*

 

Term

Dehydration

assessment:

Definition
determine reason for vomiting
Term

Dehydration

Green bilious vomiting indicates:

Definition
may be a bowel obstruction
Term

vomiting

curdled content, mucous indicates:

Definition
may be poor gastric emptying
Term

vomiting

Coffee grounds colored may indicate:

Definition
bleeding in GI system
Term

vomiting

accomanying fever may indicate:

Definition
infection or severe dehydration
Term
how much of the body fluids is made up by the extra-cellular fluid?
Definition
1/3
Term

how much of the bodies fluid is made up of

intracellular fluid?

Definition
2/3
Term

Exchange of fluid across the membranes:

 

younger children have more fluid:

Definition
Outside of the cell
Term
extracellular sodium causes:
Definition
amount of body fluid- cells shrink or swell
Term

intracellular K:

r/t

 

Definition

muscle function

 

Term

Intracellular K

decreased levels cause:

Definition

flaccid skeletal muscles

GI cramping

Cardiac arrythmias

Term

Diarrhea

common in:

Definition
dehydrated infant and child
Term
Diarrhea
Definition

increased motility and rapid emptying

*decreased electrolytes*

 

Term

Diarrhea

what two electrolytes are affected the most?

Definition
sodium and potassium
Term

Diarrhea

causes:

Definition

colon disease

infection

stress

food intolerance

medications

surgery

Term

Diarrhea

which types of infectious agents:

Definition

viral

bacterial

parasitic

 

Term

 

Acid/Base Balance determines:

Definition
proper cell function
Term

Acid/Base Balance

balance maintained through:

Definition
kidneys and lungs
Term

Acid/Base Balance

Acidosis determined by:

Definition

# of H ions in fluid

 

*increase=acidosis*

Term

Acid/Base Balance

lungs compensate with:

Definition

increased rate and depth of respirations

 

<CO2

Term

Acid/Base Balance

kidney's compensate with:

Definition
increased excretion of H ions
Term

Acid/Base Balance

Alkalosis is a shift of:

Definition
K from extracellular fluid into cells
Term

Acid/Base Balance

body :

Definition
reverses compensatory measures
Term

Acid/Base Balance

highest priority for assesment in pediatrics:

Definition
hydration status
Term

Acid/Base Balance

assess:

Definition

amount

color

consistency

timing of stools and emesis

history

Term

Acid/Base Balance

monitor:

Definition

daily weights

I&O's

abdominal cramping

Term

diarrhea

nursing interventions

Definition

s/s of dehydration

oral or IV rehydration

reduce fever

maintain skin integrity- manage diaper rash

universal precautions

 

 

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