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N114 Gastrointestina
N114 - Gastrointestinal dysfunction
| Question | Answer |
|---|---|
| What is an esophageal atresia & tracheoesophageal fistula? | Malformations that represent failure of the esophagus to develop as a continuous passage. Each can occur separately, but usually occur together. |
| When does an esophageal atresia & TEF occur in the developing fetus? | During the 4th & 5th weeks of development. |
| What are the symptoms of esophageal atresia & TEF? | Excessive salivation & drooling, fine frothy bubble of mucus in mouth & nose. Three C's of TEF - coughing, choking & cyanosis. |
| How is esophageal atresia & TEF diagnosed? | Exact anomaly is determined with x-rays. Nasogastric or feeding tube is advanced until it encounters and obstruction. |
| What is the primary treatment for esophageal atresia & TEF before repair? | Treatment is aimed at preventing aspiration pneumonia until surgical repair can be done. |
| What is a stage one repair for esophageal atresia & TEF? | Connecting both ends of the esophagus and closing the fistula is preferred in all infants with TEF. |
| What can prevent a stage one repair from being performed? | Preterm, low birth weight or pneumonia. |
| What is a two stage repair for esophageal atresia & TEF? | Stage one will involve closing the fistula and inserting a gastrostomy tube for feeding. Stage two involves anastomosis of the two ends of the esophagus. |
| What are the pre-op nursing considerations associated with esophageal atresia & TEF repair? | Prevention of aspiration, NPO, IV fluids as ordered, head elevated to minimize reflux of secretions into trachea & bronchi, intermittent or continuous suctioning of esophageal segment. |
| When does feeding begin after surgical repair of esophageal atresia & TEF? | Usually 5th to 7th day post op. A pacifier is offered to meet sucking needs. |
| What factors can increase the risk of a cleft lip or palate? | Paternal age, maternal intake of excessive alcohol, maternal exposure to Dilantin or valium, dietary deficiencies of folic acid & vitamins, maternal smoking. |
| At what stage of fetal development does cleft lip occur? | Cleft lip is caused by a failure of the nasal & maxillary processes to fuse between the 5th & 8th week of gestation. |
| At what stage of fetal development does cleft palate occur? | Cleft palate is caused by failure of the palatine plates to fuse between the 7th & 12th week of gestation. |
| How can cleft lip/palate affect the parents? | Can cause severe emotional reactions in parents. |
| When can a cleft lip/palate be diagnosed? | Both can be diagnosed in utero by ultrasound. If not diagnosed at birth, cleft palate may be diagnosed by formula coming from the nose during 1st feeding. |
| When is a cleft lip repaired? | Rule of tens - weight >10 pounds, age >10 weeks, hemoglobin >10 mg/dl. Done early to decrease scaring & increase chance of normal development. |
| When is a cleft palate repaired? | Usually occurs between 6 & 18 months. |
| What type of feeding is best for cleft lip/palate? | Breast feeding appears to work best, breast conforms better to abnormalities. Bottle fed may require special nipple or cross cut nipple. |
| What are major concerns after surgical repair of a cleft lip/palate? | Protection of the operative area. Butterfly adhesives or Logan bow may be placed over upper lip & taped to infants cheeks. Arm or elbow restraints are used. Adequate pain medication needed to minimize crying and stress on suture line. |
| What is avoided after surgical repair of a cleft lip/palate? | Avoid the use of suction or anything in the mouth, tongue depressors, thermometers, spoons or straws. |
| What other problems can be associated with cleft lip/palate? | Improper tooth alignment, varying degrees of hearing loss, recurrent otitis media. |
| When does hypertrophic pyloric stenosis develop? | Babies are born normal, it develops after birth. Develops during the 3rd or 4th week after birth. |
| What is hypertrophic pyloric stenosis? | It is the hypertrophy of the muscle of the pyloric sphincter. It increased to 4x the normal size creating a very small exit from the stomach to the duodenum. |
| What are the symptoms associated with HPS? | Vomiting is the initial symptoms. Vomiting eventually becomes projectile - up to 3 feet. There is no bile present in emesis since the obstruction occurs before the bile duct. |
| What other symptoms are associated with HPS? | Peristaltic wave - left to right visible after eating. Child may become dehydrated and progress to metabolic alkalosis. May exhibit signs of failure to thrive. |
| How is HPS diagnosed? | A olive shaped mass is usually palpated in the epigastrum. Diagnosis is confirmed with an ultrasound. |
| What is the treatment for HPS? | Initially restore hydration & electrolyte balance. Pyloromotomy is standard procedure. Circular muscle fibers are released opening passage from stomach to duodenum. |
| What can be expected after HPS surgery? | IV fluids continue until infant is taking and retaining fluids. Feedings are begun slowly and in small amounts (2ml of glucose increasing by 2ml every 1/2 hour). Some vomiting can occur in first 24-36 hours. |
| What is intussusception? | It is when one segment of the bowel telescopes into the lumen of another segment. |
| What can occur with intussusception? | Walls of the bowel press against each other causing inflammation, edema, bleeding & eventually necrosis. |
| What are the symptoms of intussusception? | Child appears normal between episodes of pain. Other signs include vomiting, currant jelly stools, sausage shaped mass may be palpable. |
| What are currant jelly stools? | Stools that contain primarily blood and mucus. |
| How is intussusception diagnosed? | A barium enema which clearly demonstrates the obstruction to the flow of barium. Ultrasound is also being used and is noninvasive. |
| How is intussusception treated? | Non-surgical hydrostatic reduction using barium, a water soluble contrast or air. Force exerted by any of the methods is usually sufficient to push the portion of bowel back into position. |
| Who is at risk for repeat intussusception? | Children with cystic fibrosis. |
| What is Hirshsprung's disease? | Also called congenital aganglionic megacolon is a congenital abnormality in which inadequate motility in the colon causes a mechanical obstruction. |
| What is the cause of Hirshsprung's disease? | The absence of parasympathetic ganglion cells in one or more segments of the colon. Affected section is unable to transmit peristaltic waves to pass fecal contents. |
| Which section is the actual megacolon? | One section does not produce peristaltic waves, section preceding it becomes filled with feces, this is the megacolon. |
| What are the symptoms of Hirshsprung's disease in a newborn? | Failure to pass meconium within 24-48 hours, abdominal distention, bile stained emesis, refusal to feed, intestinal obstruction. |
| What are the symptoms of Hirshsprung's disease in an older child/infant? | Initial symptom is chronic constipation. Other signs include abdominal distention, episodes of explosive passage of stools, poor weight gain, ribbon-like or pellet shaped foul smelling stools, vomiting, palpable fecal mass. |
| What is a complication of Hirshsprung's? | Enterocolitis - inflammation of small intestine & colon. Illness rapidly progresses with perforation of the bowel and sepsis. Major cause of death with Hirshsprung's. |
| How is Hirshsprung's diagnosed? | Suspected in neonate who doesn't pass meconium & has abdominal distension. Rectal biopsy is needed for definitive diagnosis - confirms absence of ganglionic cells. |
| How is the two stage surgical repair for Hirshsprung's performed? | 1st stage-temporary colostomy in healthy bowel. Provides a way for defecation, allows bowel to rest and infant to gain weight. Second stage involves removal of the aganglionic segment and anastomosis of normal segment. Temporary colostomy is closed. |
| What virus causes the majority of gastroenteritis? | Either the Rotavirus or the Norwalk virus. By age 2 most children are immune to severe rotaviral diarrhea. Norwalk affect primarily older children. |
| What bacteria can cause gastroenteritis? | Shigella is spread person to person or ingestion of contaminated food. Salmonella is transmitted via contact with infected animals or from contaminated food. |
| What parasites can cause gastroenteritis? | Giardia is transmitted through ingestion of cysts from contact with infected individual or from food or water contaminated with infected feces. Cryptosporidium also causes diarrhea. |
| What is isotonic dehydration? | Loss of electrolytes and water in approximately the same proportion. Primary form of dehydration in children. |
| What is hypotonic dehydration? | Loss of electrolytes exceeds that of water. |
| What is hypertonic dehydration? | Loss of water exceeds that of electrolytes. |
| What are the symptoms of mild dehydration? | Pale skin, decreased turgor, dry mucous membranes, decreased urinary output, normal BP, normal pulse, capillary refill normal. |
| What are the symptoms of moderate dehydration? | Gray skin color, poor turgor, very dry mucous membranes oliguria, normal or low BP, increased pulse, capillary refill 2-3 seconds. |
| What are the symptoms of severe dehydration? | Mottled skin color, very poor turgor, parched, sticky mucous membranes, marked oliguria, low BP, rapid thready pulse, capillary refill greater than 3 seconds. |
| How is dehydration treated? | Mild to moderate can be treated at home using oral rehydration therapy. Severe requires hospitalization & IV rehydration. |
| What things are not recommended with diarrhea? | Anti-diarrhea meds - prevent body of eliminating the infecting organism. Fruit juices, soft drinks and gelatin are discouraged because of high carb content. Sugar increased diarrhea. |
| When do you need to call a doctor concerning dehydration? | Child is confused or disoriented, vomiting for >12 hours, blood appears in diarrhea or >10 watery stools in 1 day, continuous abdominal pain, temp >100, lack of urination, no tears, sunken anterior fontanel. |
| How are pinworms contracted? | Caused by nematode Enterobius vermicularis. Transmitted by fecal-oral route, eggs are ingested or inhaled. |
| How are pinworms spread? | Movement of worms on skin and mucous membranes causes itching. Eggs are deposited on hands and underneath nails causing reinfection. |
| What is the lifespan of pinworms? | Eggs can live for 2-3 weeks on fomites. |
| What is the main symptom of a pinworm infection? | Perianal itching |
| How is pinworms treated? | One dose of mebedazole (Vermox) upon diagnosis, and second dose in two weeks. All family members must be treated. Vermox will stain stools & emesis bright red. |
| What is appendicitis? | The lumen of the appendix becomes obstructed with fecalith (stone-like fecal matter), calculi, tumors, parasites or foreign body. May be caused by bacteria, virus or trauma. |
| What symptoms are associated with appendicitis? | Pain localized to periumbilical area, McBurney's point, anorexia & nausea w/wo vomiting, constipation or diarrhea, rigid abdomen (with rupture), tachycardia, rapid shallow breathing |
| How is appendicitis diagnosed? | Abdominal tenderness, muscle rigidity over tender area may be felt, intense pain at McBurney's point, slightly elevated WBC with elevated bands. CT scan with contrast |
| What are elevated bands? | Elevated bands are immature neutrophils - sign of a very bad or long standing infection, not a good sign |
| What complications are associated with appendicitis? | Most common complication is wound infection and intrabdominal abscess. |
| What is celiac disease? | Also know as gluten-sensitive enteropathy. A permanent intolerance to gluten, the protein component of wheat, barley, rye and oats. |
| How does celiac disease progress? | Begins as subtle anorexia, irritability and weight loss. Progresses to abdominal distention and chronic diarrhea. May progress to loss of subcutaneous fat, muscle wasting and anemia. Late signs- growth retardation, osteoporosis & delayed puberty. |
| How is celiac disease diagnosed? | Definitive test is a small bowel biopsy. May measure fecal fat content or remove gluten products to see if s/s improve. |
| How is celiac disease managed? | Lifelong adherence to a gluten free diet. All wheat, barley, rye and oats are eliminated and substituted with rice, corn & millet. |
| What are the symptoms of anorexia nervosa? | Extreme weight loss and refusal to maintain weight. Intense & irrational fear of gaining weight, distorted body image. |
| What are the signs of anorexia nervosa? | Primary or secondary amenorrhea, hypothermia, muscle wasting, growth of lanugo, dry skin, brittle nails, cardiac dysrhythmias, osteoporosis. |
| What are the symptoms of bulimia nervosa? | Binge behavior consists of secretive, frenzied consumption of large amounts of food in a short period of time. |
| What other symptoms occur with bulimia? | Purging behaviors, self induced vomiting, diuretic & laxative abuse and rigorous exercise. |
| What physical problems are associated with bulimia? | Fluid & electrolyte imbalances, abdominal distention, esophagitis, erosion of tooth enamel, increased dental caries, tooth discoloration |
| How are anorexia & bulimia treated? | Both involve treatment of underlying conditions, malnutrition, potassium depletion. Therapy is required to work on real issues, poor self-esteem, control issues. Antidepressants (SSRI's) have been effective in treatment. |
| What is Steatorrhea? | It is large, pale, oily, frothy, foul-smelling stools that float. |
Created by:
jrb265
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