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child nutrition
level 3 test 4
| Question | Answer |
|---|---|
| Main function of the GI system? | To supply nutrients to body cells. |
| 3 functions of the GI system that allows it to complete its main function? | ingestion, digestion and absorption |
| mechaninical component of ingestion | Deglution (swallowing) |
| An important barrier that normally prevents refulux of acidic gastric contents into the esophagus | Lower esophageal sphincter |
| The function of this is to store food, mix food with gastric secretions and empty contents in small boluses into the small intestine | Stomach |
| Two primary functions of the small intestine? | digestion and absorption |
| What is digested in the stomach? | Proteins |
| Most absorption occurs in the? | Small intestine |
| Most important function of the large intestine? | Absorption of water and electrolytes |
| Function in bile sythesis, fat metabolism, protein metabolism and detoxification? | Liver |
| Exocrine function of the liver? | digestion through the production and release of enzymes |
| HCL secretion increases? | Intrinsic factor, this is lessen in the elderly |
| in older age glucose tolerance is? | Decreased |
| explore in detail any weight loss or gain in the last? | 6-12 months |
| ectomy means? | removal of |
| can be used to analyze the adequacy of the diet | 24 hour food recall |
| peptic ulcer disease may be aggravated by? | stress |
| How to assess abdomen in order? | Inspect, auscultate, percuss and palpate |
| Listen for bowel sounds for at least? | 2 minutes |
| Loud gurgles indicate hyperperistalis and are called? | borborygmi |
| Directly visualizes entire colon up to illeocecal valve with flexible fiberoptic scope | Colonoscopy |
| The purpose of this is to observe by means of fluroscopy the colon filling with contrast medium and to observe by x ray the filled colon. Identifies polyps, tumors and other lesions in the colon | Barium enema (lower GI) |
| Direct visualization of a body structure through a lighted fiberoptic instrument | Endoscopy |
| During a liver biopsy it is important to ask the patient to? | Hold ones breath |
| What child is most at risk for vitamin d defficiency rickets? | exclusivly breastfed after 6 months, so supplement vitamin D after 6 months |
| When give iron? | If baby being exclusivly breast fed after 4 months untill iron fortified ceral can be given. |
| Malnutrition is a major health problem in the world, most specifically in kids under? | 5 years of age |
| A major factor in malnutrion in both developing and uncerdeveloped nations? | diarhea (gastroenteritis) |
| Bottle feeding in poor sanitary conditions can lead to? | malnutrition |
| poverty is the underlying cause of? | malnutrition |
| The most extreme form of malnurtrion is termned? | protein-energy malnutrition |
| edmetaous malnutrion? | Kwashiorkor |
| Nonedematous malnutrion? | Marasmus |
| A defict, excess or imbalance of essential nutrients | Malnutrition |
| occurs when nutritional needs are not met. a state in ehich there is chronic starvation without inflammation | Primary protein calorie- energy malnutrion or stavation related malnutrition |
| Associated w/ conditions that impose sustained mild to moderate inflamation. Occurs when tissue needs not met even though dietary intake would be satisfactory under normal conditions, examples = c word, rheumatoid arthritis, obesity/ metabolic syndrome | Secondary protein-energy malnutrition or chronic disease-related malnutrition |
| major infections, burns, and trauma can result in? | Acute disease related malnutrition |
| Prolonged illness, major surgery, sepsis, draining wounds, fractures, immobilization, abdominal cramping, N/V, diarrhea | Can cause malnutrition |
| impaired absorption of nutrients from the GI tract. | Malabsorption sydrome |
| fever can lead to? | malnutrition |
| People who have had surgery on the GI tract are at risk for? | Vitamin deficiencys |
| Quick patho of starvation | First carbs used, then when those out use protein for 5-9 days, then to conserve protein it breaks down fat, when that runs out in 4 weeks then switches back to using protein. The client is in a negative nitrogen balance |
| inflamation results in increased? | protein and muscle breakdown |
| Includes, chewing and swallowng ability, changes in appetite or taste, food and nutrient intake and avalibility of food | Diet history |
| Underweight BMI? | less than 18.5 |
| Normal BMI? | 18.5-24.9 |
| Overweight bmi? | 25-29.9 |
| Obese BMI? | 30 or more |
| Cystic fibrosis, renal dialysis c word and GI malabosrtption can result in? | Protein-energy malnutrition |
| main reason for malnutrion in developing coutnries? | inadequate food |
| rice beverage diet suspect? | Kwashiorkor |
| rice drink has | Less protein than formula |
| Seen in developed coutnries who were fed nonstandard infant diers such as flour water, sorn porridge, mollasess and nondairy creamer | Kwashiorhor |
| This has been reported in the united states when infants have been fed inapopriate food as a result of caregiver nutritional ingornace, a perceived formula intollerance, family social chaos or cows milk intolerance. | Kwashiorkor |
| If you see clinical manifestations of protein-energy malnutrition due what? | Obtain a dietary history |
| Primarily a deficency of PROTEIN with adequate supply of calories | Kwashiorkor |
| A diet consiting mainly of starch grains or tubers provide adequate calories in the form of carbohydrates but an inadequate amount of high quality proteins | Kwashiorkor |
| may result from interplay of nutrient deprivation and infectious or enviormental sresses, which produces an imbalanced result | Kwashiorkor |
| Oxidative stress occurs resulting in free radical damage which may precipitate cellular changes, resulting in edema and muscle wastign | Kwashiorkor |
| The sickeness the older child gets when the next baby is born as the first baby is weaned from the breast | Kwashiorkor |
| Child has thin, wasted extremities and prominent abdomen from edema (ascities) | Kwashiorkor |
| The edema/asictes in this often masks severe muscle atrophy, making the child appear less deibiltated than he is. | Kwashiorkor |
| The skin is scaly, dry and dipegmented, dermatoses (from vitamin deficency) deficiecy in calcium/ zinc, permentant blindness from low vitA, acute zinc deficency = skin rashes, loss of hair, supressed immunity, defective wound healing and impaired growth | Kwashiorkor |
| Kwashiorkor has what affect on appetie? | it depresses it |
| Diarrhea commonly occurs from a lowered resistnce to infection and further complicates the electrolyte imbalance | Kwashiorkor |
| protein cells incolved in the primary response to infection? | Cytokines, so it is low in Kwashiorkor |
| Protein deficiecy ( seen in Kwashiorkor) increases the childs suspectibility to? | infection |
| Fatal deterioration of kwashiorkor may be caused by? | diarrhea or infection or circulatory failure |
| Results from general malnutrition of both calories and protein. | Marasmus |
| It is common in underdeveloped countries during times of drought especially in cultures where adults eat first, the remaining food is often insufficent in quality and quanitiy for the children | Marasmus` |
| Usually a syndrome of physical and emotional deprivation and is not confined to geogrphic areas where food supplies are inadequate. It can be seen in kids where there is no nutritional problem only emotional | Marasmus |
| The child has edema, severe wasting and stunted growth, inadequate intake and superimposed infection, fluid and electolyte disturbances and hypothermia | Marasmus |
| Characterized by gradual wasting and atrophy of body tissues, especially subcuntaneous fat. The child appears very old, with loose and wrinkled skin, | Marasmus |
| appears more rounded from the edema | Kwashiorkor |
| Fat metabolism is greatly effected | Kwashiorkor |
| Deficiency of fat soulible vitimanis is usually ABSENT | Marasmus |
| Deficiency of fat souluble vitiamins is usually COMMON | Kwashiorkor |
| s/s sodium retention | Kwashiorkor |
| edema from hyoalbuminea | Kwashiorkor |
| Severely emaciated apperence | Marasmus |
| Dermatoes caused by vitamin deficency | Kwashiorkor |
| Little or no depigmenttion of hair or skin | Marasmus |
| Normal fat metabolism and lipid absorption | Marasmus |
| Smaller head size | Marasmus |
| slower recovery and treatment | Marasmus |
| the clid is fretful, apathetic, withdrawn and so lethargic that prostration occutd intecurrent infection with debiliating disease is common | Marasmus |
| often occurs subsequent to an infectious outbreak of measles and dysentry | Kwashiorkor |
| Treatment of protein energy malnutrition? | Providing a diet with high quality proteins, carbohydrats, vitamins and minerals. |
| What to do if protein-energy malnutrition occurs as a result of persistant diarhea, do what? | Rehydration with ORS, Administer antibiotics to prevent intercurrent infection, and Provision of adequate energy intake nutrition |
| involves the intiaton of treatment for oral rehydration, diarhea and intestinal parasites, prevention of hyoglycemia and hypothermia and subseqent dietary managemetn | Acute or intial phase of treatemetn of PEM |
| Focuses on increasing dietary intake and weight gain in PEM | Recovery or rehabilitation of PEM |
| Focuses on care after discharge in an outpatient setting to precent relapse and promote weight gain, provide developmental stimulatio and evaluate cognitive and motor deficts | Follow up phase of treatment of PEM |
| Care is taken to prevent fluid overloasd, the child is observed closely for signs of food or fluid intolerance | Acute phase of treatment of PEM |
| May occur if intake progresses too rapidly, cardiac failute may cause sudden death in a child who has been malnourished and refed too rapidly | The refeeding syndrome |
| Vitamins reccomended for treatment of PEM? | Vitamin A, zinc and copper NOT iton untill they can tolerate a food source |
| associated with freqeunt infections, and delayed introduction of complementary foods | PEM |
| Increase in body weight resulting from an excessive accumulation of body fat relative to lean body mass | Obesity |
| Refers to the state of weighing more than average for height and body build | Overweight |
| Most accurate mehtod for screening children with obesity? | BMI |
| What ethnicitys are at higher risk for obesity? | Hispanics and aftican- americans |
| Parenteral obesity increases the risk of overweight by? | 2-3 fold |
| increases the risk of adult obesity by 70-80% | Adolescat overweightness |
| caloric intake that consistencly exceeds caloric requirements and expenditure and may involve a variety of interealated influences including metabolic, hypothalmic, heridterary, social, cultural and psychologic fActors | Patho of obesity |
| critrical factor in regulating body weight | A balance between energy intake and energy expenditure |
| Birth weight in regards to obesity | Does not effect future |
| Hypothyroidsims, adrenal hypercorticoidism, hyperinsulinism ad dysfunction or damage to the CNS as a result of tumor, injury, infection or vascular accident | Diseases that can be attributed to obesisty. but only 5% of cases are this |
| Where is expression of appetite coded? | Hypothalmus |
| Produce signals that promote eating behaviors | Orexigenic substances |
| There is little evidence to suggest a relationship between obesity and? | low metabolism |
| dominant feature of obesity in children? | Overeating |
| Dominant feature of obesity in adults? | Reduced physical activity |
| Social class with the higher incidence of obeisty? | lower social class |
| An example of an instutitanl factor that places the kids at risk for obesity? | kids leave school for lunch, vending machines and hight fat snacks |
| how ling should parents limit media viewing? | less than 2 hours per day |
| early in infancy children experience relief from discomfort through feeding and learn to asscoiate eating with a sens of | well, beening, security and comforting prescence of mom |
| memory and circuitory in relation to eating | Can be modified over time |
| daytime sleepiness and joint pain may be a sign of? | obesity |
| most accurate measurement of lean body weight | Hydrostatic or underwater weighing |
| in adults BMI is a fixed measurement without regard for? | sex or age |
| The intial assemsne for obese children include screenng to evaluate for? | co-morbities |
| acanthosis nigricans? | Stretch marks |
| Porgnosis of treatment of obesity? | very hard, usually regain the weight in a year or two |
| essential part of weight reduction programs | Diet modification |
| Directed towrds imporcing the nutritional quality of the diet rather than toward dietary restriction | Dietary counselign |
| What is the reccomended diet consistent with my plate? | no trans fat, low-saturated fat, moderate total fat ( less than 30%) and half a plate of fruits and vegetables daily. |
| Promoting high-fiber foods and avoiding highly refined starches and sugars | decrease caloric intake |
| The goal is to encourage the individual to make healthy food choices in food selection and discourage eating food by habit or to appease boredom | A food diary |
| Used in those with severe obesity, a hypocaloric, ketogenic diet that is designed to provide enough protein to minimize loss of lean body mass during weight loss | Protein-sparing modified fast |
| The intake of carbs is low enough to produce ketosis benifits are rapid weight loss and anorexia produced by ketosis | Protein-sparing modifed fast |
| a lipase inhibiro rhar has been approved for adolescants 12-18 years of age. Used for the treatment of obesity. side effects are fatty oily stools and possible malabsorption of fat soluble vitamins | Orilstat |
| Drugs for obese children under 12 | There are none! |
| may be the only practical alternative for increasing numbers of severly overweight adolescants who have failed organized attemps to lose or matain weight loss through convential nonoperative appraches and who have serious lige threatning conditions | Bariatric surgery |
| Play a key role in the adherance and maintance phases of many overweight reduction programs | Nurses |
| the bmi focuses on weight and? | height |
| if BMI greater than 95th perentile do what? | in depth medical assesment |
| BMI in the 85th and 95th percentile do what? | evaluate for seconday coplications such as diabetes, hypertension and hyperlipidemia and family history |
| a pyshcosocial hisory is helpful in? | understanding the impact of obesitiy of the childs life |
| By subsituting low-calori, ow fat foods for high calorie foods (especially snacks you can alter the? | quality of the food |
| Eating what kind of meals helps with weight loss? | Eating regular meals and snacks particulary breakfast. |
| The most succesfull diets are thos that | Use ordinary foods in controlled portions rather than diets that require the avoidance of specific foods |
| The most successdul diets are those that use ordinary foods in | Controlled portions rather than avoidance of specfic foods |
| Dieting teens should eat what the rest of the family eats but | less of it |
| It is important to encourage consumption of high nutrient foods like? | Fruits, vegetables, whole grains and low-fat dairy protein products |
| Altering eating behavior and eliminating innapropriate eating habits are essential to weight reduction, especially in maintaing long-term weight control | Behavior therapy |
| Reccomended daily activity for kids and adolescents? | 60 minutes of moderate-vigourous exercise |
| best choice for exercise? | enjoyable and likely to be sustained, but aerobic helps oxidize fats |
| Bedore initating treatment is important to be certain that the family is? | ready for change |
| how calculate bmi? | dividing a persons weight by the square of the height in meters |
| What is android obesity? | Apple shaped body (Fat mostly in abdomen) |
| Those with fat distribution in the upper legs have a pear shaped body called? | gynoid obesity |
| Heart disease is seen more commonly in what body shape? | Android (apple) |
| Excess calorie intake over energy expenditure fro the body's metabolic demands is termned? | primary obesitiy |
| obesity that can result from various congential anomalies, chromosomak anomlalues, metabolic problems or or central nervous system lessions and disorders | Secondary obesity |
| Leptin does whay? | Supress appetite, increae physical activty and increase fat metabolism |
| An increased releae of cytokines from fat cells may distrupt immune facots, thus predisposing the person to certain? (in obesity) | C words |
| adipkoines produced in fat cells seen in obesity contribute to? | the development of insulin resistance and atherosclerois |
| Hyperinsulimea and insulin resistance is found in obesity escpecially when | Viseral fat is increased |
| Gerd and gallstones are more prevelant with people with? | obesity |
| osteoarthritis is often a complication of? | Obesity |
| Hyperurica and gout is seeen in those with? | obesity |
| The first step in the treatment of obesty? | determine whether any physical conditions are present that may be causing or contributing to obesity |
| average weight loss for weight reduction program? | 10% |
| a dietary reduction of how many calories is neccesary for for weight loss | between 500-1000 cals |
| What is a serving of vegetables or fruit? | Size of a baseball or womans fist |
| What it the serving size of meat? | Persons palm or deck of cards. |
| What is a serving of cheesing? | Size of thumb or six dice |
| 2/3 of a persons diet should be? | plant based |
| Reccomended portion size of animal protein? | 3 ounces |
| Standard zie for chopped veggies? | 1/2 cup |
| an eating disorder charecterized by a refusal to maintain a minimally normal body weight and by severe weight loss in the abscence of obvious physical causes | Anorexia nervosa |
| average age of onset for anorexia nervosa? | 13 years |
| Perfectionists, academically high achievers, conforming and conscitious high energy level evenw ith marked emaciation | Anorexia nervosa. |
| Weight of person with bulmia? | Average or slightgly above average weigt |
| Charecterized by binge eating followed by inapporpriate compensettory behaviors such as self inducing vommiting, misusu of laxative, diuretics or other medications fastign or execssive exercise | Bulimia nervosa |
| binge-purge cylce followed by depression | Bulima nervosa |
| two important prolblems with bulimia thatr seperatie it from other eating disorders | Impulse control and satiety regulation |
| anorexia and bulimia are intiated with? | dieting |
| Relasness pursuit of thiness and a fear of fatness, usually oreddeced by a period of mood disturbances and behavior changes | Anorexia nervosa |
| many of the clinical findings in eating disorders are directly related to the state of starvation and imporve with? | weight gain |
| may diet in an attempt to control their wieght but without the extreme compesantory or vommiting | Binge eating disorder |
| diagnosis of bulimia? | at least two binge eating episodes per week for the preceeding 3 months |
| osteponia is common in? | anorexia |
| most imporatn for diagnosing eating disorders? | medical history |
| may benifit from antidepressants? | bulima nervosa |
| most important goal for eatign disorders? | to treat any life threatning malnutrition and to restore dietary stability and weight gain. |
| In life threatning malnutrition this may be required? | tube feedings or IV fluids introduce foods in a stepwise approach |
| when restoring nutition drs. must avoid this it consists of cardiovacular, neurologic, and hematologic complications that occur when nutritional replacement is given too rapidly | Refeeding syndrome |
| A reasonable goal for severe malnutrition is to EVENTUALLY reach intake of how many calories per day> | 2000-3000 |
| an important component in the tratment of eating disorders is to? | establisha contract |
| urinary problems are common and ketones and protein may be detected in the urine as a result of breakdown of fat and protein | Anorexia nervosa |
| team members must provide what in treatment of anorexia nervosa? | unified front |
| an agreement that the adolsecent makes with others to change a maladaptive behavior? | behanvioral contract |
| acute care of bulmina? | monitor for fluid and electrolyte imbalance and observe for signs of cardiac complications |
| j tube is inserted into the? | small intestine |
| gastronomy and j tubes are usually for? | long term eneteral nutrition |
| short term parenteral nutrition is usually done in? | Peripheral Parenteral nutrition |
| Anticipated long term need of parenteral nutrition | Central parenteral nutrition is used |
| The protein and calorie intake required in the malnourished patinet (not right at begining) is | High calorie and high protein |
| if the undernourished patient is unable to to consume enough nutirion with a high protein high calorie diet then? | oral liquid nutiitonal supplements may be added |
| nutririon provided through the GI tract via a tube catherrer or stoma that delivers nutrients distal to the oral cavity | Enteral nutrrion/tube feeding |
| irritractable vommiting and diarrhea. use what nutritional support? | parenteral nutrition |
| administration of nutrients by a route other than the GI tract (blood stream) | parenteral nutrition |
| binging and vommiting | bulima |
| inludes adequate amounts of fruits and vegetables, provide enough bulk to prevent consipation and meets daily vitamin A and Vitamin C requirements., Lean meat, fish, and eggs provide sufficient protein and B-complex vitamins | A reccomened diet |
| facial malformations that occur during embyronic development and are the most common congetital deformites in this nation | Clefts of the lip and palate |
| Results from failure of the maxillary and median nasal process to fuse. | Cleft lip |
| A midline fissure of the palate that results from failure o f the two palatal processes to fuse. | cleft palate |
| consists of the medial portion of the upper lip and the portion of the alveolar ridge that contains the central and lateral inscisors | Primary palate |
| Consists of the remaining portion of the hard palate and all of the soft palate | The secondary palate |
| deformed dental structures are assoiated with? | Cleft lip |
| isolated cleft palate occurs in? | the midline of the secondary plate |
| Bifda uvula | Mildest from of cleft palate |
| cleft lip usually occurs with? | cleft palate |
| Cleft lip/palate and cleft palate are distinct from? | isolated cleft palate |
| clefts of what is more likely to be associated with sydromes? | clefts of the secondary plate alone aka isolated cleft palate |
| What puts a baby at risk for being born with a cleft? | Teratogens such as alachol, ciggerette smoking, anticonvulsants, steroids and retinoids, also folate deficiency |
| clefts represents a defect in cell migration that results in a failure of the maxillary and premaxillary processes to come together | between the fourth and tenth week |
| explain patho of cleft palate briefly | in the process of the palate fusing the togunge seperates the palates, if the tongue does not descend soon enough the palate never fuses |
| merging of the palates usually occurs? | between the 7 and tenth week |
| How is cleft palate identified? | Visual exam of the oral cavity or when the examiner places a gloved finger directly on the plate |
| Clefts of the hard and soft palate form a contious opening between the ? | mouth and nasal cavity |
| When can clefts be picked up on an ultrasound (more likely to pick up cleft lips) | 13-14 weeks |
| cleft lips can be unilateral or? | bilateral |
| Cleft palate alone occurs? | Midline and can involve the soft and hard palate |
| pyhical and emotional stress and smoking in the first trimester can lead to? | clefts |
| The severity of cleft palate has an impact on? | feeding as infant is unable to creat suction |
| when might you visualize a cleft palate? | during crying |
| Cleft lip is? | obvious to see |
| Management of cleft/clefts? | closure of the cleft, prevention of complications and facilitation of normal growth and development in the child |
| When does cleft lip repair usually occu? | between 2-3 months of age |
| rule of ten for surgical repair of cleft lip? | 10 weeks old, weigh 10 punds and have a hemoglobin of 10 |
| Due to improved surgical techniques healing of cleft lip usually results in? | no scars |
| When does surgical correction of cleft palate occur? | between 6 and 12 months, before the first word. |
| many children with CP and CL/P have some degree of? | Speech impairment |
| Why do those with clefts have speech problems? | velopharngual dysfunction, improper tooth alginment and varying degrees of hearing loss |
| Cleft palate and ears? | Eustachian tube does not drain properly so ear infection is common |
| growth failure with in infants with clefts is attributed to? | pre surgery, it is usually not a problem after |
| isolated cleft lip? | only in the lip |
| cleft lip may interfere with the infants ability to acheive an adequate? | anterior lip seal |
| isolated cleft lips have no difficulty? | breast feeding |
| if bottle fed an infant with an isolated cleft lip may have greater success using bottles with? | a wide based of the nipple and squezzing cheeks toghether to decrease width of cleft |
| cleft palate reduces the ability for the infant to? | suck |
| In what position would you feed a baby with cleft palate? | Positioning in an upright position with the head supported. so gravity helps |
| Several types of bottles that work well with infants who are unable to generate an adequate suck as in cleft palate? | Special needs feeder, pigion bottle and the cleft palate nurser |
| reccurebt ear infection in cleft palate can lead to? | hearing loss |
| ESSR rules for feeding a kid with clefts | Enlarge nipple. stimulate suck reflex, swallow fluid apporpriatly, and rest when infant signals so. |
| large soft niples, with large holses | nursettes used for cleft palate |
| because air is is frequently swallowed in babys eating with clefts it is important to? | stop and burp the infant while feeding |
| when should the mom feed to infant? | before discharge |
| Breast feeding and cleft palate | NOT usually going to work! |
| in cleft palate liquid escapes through the ? | nose |
| Major efforts in post operative care after cleft lip or pallet repair? | Protecting the operative site |
| For cleft lip the patient may be advised to apply? | petrolleum jelly to the operative sire for several days after surgery. |
| How to prevent infants from touching the operative site? after CL/P repair | Elbow immobilizer used for 7-10 days |
| how feed baby for first 7-10 days after cleft repair? | with a syringe |
| Feeding is resumed when tolerared and in what position in the immediate post-operative period? | Upright or infant seat |
| Avoid use of what postoperativly in CL/CP surgical repair? | The use of suction or other objects in the mouth such as tongue depressors, thermometers , pacifiers, spoons and straws |
| The older child with CL/P repair may be dishcarged on a? | soft diet |
| Toasts, hard cookies and pottaoe chips can? | damage the palate and are not reccomended postopertivly after cleft palate repair |
| Immediate care of Cleft lip/Palate is? | directed towards nutrition and modification of feeding methods |
| Diet after cleft lip surgery? | Clear liquids then progress |
| How to take care of cleft lip postopertabily | Cleanse with q tip in normal saline, apply antibiotic ointment |
| a baby just undergoing cleft palate is allowed to? | lie on abdomen |
| Shortly after surgery of cleft palate resume? | Bottle, breast or cup |
| Failure of the esophgus tp develop as a contonous passage and a failre to the trachea and esophagus to seperate into distince structures | Esophageal atreasia and tracheoesophageal fistula |
| Maternal polyhyrdamios think? | EA with TEF |
| Most common form of EA/TEF? | The proximal esophageal segment terminates in a blinf pouch and the distal segment is connected to the trachea or primary bronchus by a short fistula at or near the bifurcation |
| Excessive frothy mucus from nose and mouth expect? | Tracheoesophgeal fistula |
| 3 c's and one A of tracheoesophageal fistula? | Coughing, choking, cyanosis and apnea |
| Increased resp distress during feed and abdominal distention, unexplained episodes of cyanosis, difficulty with secretions think? | Tracheopespohageal fistula |
| Besides S/S how is the exact type of EA/TEF diagnosed? | Radipague catheter inserted untill resistance is met. |
| The prescence of fas or small bowel is indicative of? | TEF |
| What do if EA or TEF is suspected? | NPO, IV fluids, position to decrease apsiration/facilitate drainage of secrerions |
| Suction in suspected EA or TEF? | Sucntion secretions in mouth and have intermittent or contonous low suction. |
| How prevent aspiration pneumonia? | Give antibitoics, position with head up |
| Suregery fo TEF? | Thoractomy and reanstomosis |
| May occur as a result of weakness in the tracheal wall that exists when a dilated proximal pouch compresses the trachea early in fetal life | Trahceopmalacia |
| Barking cough, stridor, wheezing, reccurent respiratory infections, cyanoisis and sometimes apnea | S/S of tracheomalacia a complication of TEF |
| stictures are a major complication following | Surgical repair of EA or TEF may need dilation for lifer |
| Is O2 given in EA/TEF? | yes if resp distress is seen |
| position if suspected of EA/TEF? | head 30 degrees |
| Food intake after EA/TEF repair? | usually with a gasrtomoy untill can adequatly digest. then a little bit to assess oral intake, usually not discharged untill they can take oral intake well |
| why insert a percutaneous gastromoty and leave it open till after corection of EA/TEF? | To allow any air to escape to prevent aspiration of gastric contents |
| Besides pneumonia what else are you at risk for after EA/TEF? | Ateclasis, pneumothorax and larygeal edema |
| What shows anastomotic leasks after EA/TEF surgeru? | Purlulent chest tube drainage, increased WBC count and temp instabilit |
| Poor feeding, dyspahgia, drooling and regurgitation of undigested foods is efived of | Esophageal constriction |
| This may occur when feedings are resumed in surgical repair of EA/TEF? | GER |
| Occurs when the muscle of the pyloric sphincter becomes thickened , resulting in elongation and narrowing of the pyloric channels. | Hypertrophic pyloric stenosis |
| This produces an obstruction and compenstory dilation, hypertropy and hyperperistalis of the stomach | Hypertrophic plyoric stenosis |
| When does hypertrohic pyloric stenosis usually occur? | in the first 2-5 weeks of life |
| This causes projectile nonbillous vommiting, dehydration, metabolic alkalosis and growth failure | Hypertrophic pyloric stenosis |
| The circular muscle of the pylorus thickens as a result of hypertrohy and hyperplasia (increae in mass), this produces severe narrowing of the pyloric canal between the stomach and the duodenum causing what kind of obstruction? | Partial |
| Over time the pylorus is subjected to ______________ which futther reduces the size of the opening resulting in complete obstruction | inflamation and edema |
| The hypertorphied pylorus may be palabale where? | As an olive like mass in the upper abdomen |
| When can you palapate the olive like mass? | Stomach empty, infant quiet and abdominal muscles relaxed |
| Vomminting usually occurs 30-60 minutes after feeding and becomes projectile as the obstruction progress, emesis consists of stale milk | Hypertrohic pyloric stenosis |
| metabilic alkalosis and growth failure is often seen in? | Hypertrophic pyloric stenosis |
| What will ultrasound see in hypertrophic pyloric stenosis? | An elognated sauasage shaped madd with an elongated pyloric channel |
| infant is chronically hungry susupec? | hypertrophic pyloric stenosis |
| Surgical relief of the pyloric obstruction by ? | pyloromotoy with Right upper quandrant incision done laprascopically |
| very young infants who appear alert but fail to gain weight and have a history of vommiting after feeding | Hypertrophic pyloric stenosis |
| Preopetavily what is main focus for HPS? | Restoring hydration and electrolyte imbalance (fix metabolic alkalosis) |
| because replacement therapy is usually delayed do to the need of rehydration do what? | Decompress stomach |
| Feedings after surgery for HPS? | done 4-6 hours after surgery then clear liquids then breast milk/ formula |
| A permenant intestinal intolerance to dietary wheat giladin and related proteins that produces mucosal lesions in gentically suspetible individiual | Celiac disease (gluten-sensitive enteropahy/ celiac spruce) |
| Celliac disease is more common in? | Bristish |
| Altough exact cause is unkwon, it is an immunology mediated small intestine enteropathy. The mucosal lesions contain features that sugesst immunologic overstimulation | Celiac disease |
| What charecterizes celiac disease? | Villous atrophy in the small bowel in reponse to protein gluten. |
| What is gluten found in? | What, barley, rye and oat grains |
| In celiacs, what leads to malabsorption caused by reeduced absoprtive surface area? | Villous atrophy |
| When are classic symptoms of celiac disease noted? | Several months after intoduction of gluten in the diet usually 6 months-2 years |
| Impaired growth, chronic diarhea, abdominal distenstion, muscle wasting with hypotonia, poor apetite and lack of energy | S/S of celiacs |
| The manifistations of celiacs is? | Insidious |
| Abdominal distension, explosive water diahrea and dehydrtation with electolyte imbalace, leading to hypotensive shock and lethargy | Celiac crises |
| inflamatory disease of small intestine? | Celiac disease |
| imared fat absorption and thus steatorhea is seen in? | Celiacs disease |
| Child eats well but has malnutrition | Celiacs |
| Dermatitis herpetiformis is seen in? | adults with celiacs |
| iron deficiancy anemia may be seen in? | celiacs |
| How diagnoses celiac? | Biopsy of small intestine demostration villous atrophy with hyperplacia of the ctyps and abdnormal surface area and FULL remision after gluten is withdrawn or serologic testing |
| Within how many days of starting on a gluten free diet does the kid feel bettwer? | 1-2 days |
| weight gain, improved appetite, resolution of diarrhea and statorrhea is seen ? | with a gluten free diet in those with celiacs |
| in a gluten free diet what can be subsituted grain foods? | Corn and rice |
| Lactose intolerance | goes away after starting a gluten free diet when the mucosa can heal |
| Most serious complication of celiacs? | Developing a lymphoma of the small intestine |
| instant soups? | have gluten avoid! |
| Luncheon meats ? | have gluten avoid! |
| Diet management of celiacs? | A diet high in cals and proteins, simple carbs such as fruits and veg but low in fat/ |
| Because the bowel is inflamed in celiacs as a reult of the pathologic process of absorption, the child must? | avoid high-fiber foods such as nuts raisins, raw vegetables and raw fruits with skin untill inflamation subsides |
| Corn or rice? | GOOD for celiac |
| In celiacs treat nutritional deficinceies with supplements including? | vitamins, iron and calories |
| chronic disorder of metbaolism charecterized by a partial or complete deiciency of the hormone insulin | Diabetes mellitus |
| characterized by a destruction of the pancreatic b cells which produce insulin, absolutle insulin deficency | Typer one diabters |
| usually arises because of insulin resitance in which the body fails to use insulin properly combined with relative (rather than absolute) insulin deiciency | Type two diabetes |
| needed for the entry of glucose into muscle and fat cells, prevention of mobilization of fats from fat cells and stroage of glucose as glycogen in cells of liver and muscles | Insulin |
| Not needed for the entry of glucose into nerve cells or vascular structure | Insulin |
| With a deficeincy of insulin, glucose is unable to enter the cells and its concenetraion in the bloodstream increase | Hyperglycemia |
| When the glucose concentration in the glomeular filtrate exceeds the renal threshold what happens? | Glucose spills in the urine (glycosuria) |
| A cardial sign of diabetes caused by an osmotic diversion of water (following glucose) | Poluiria |
| The urinary flude losses cause excessive? | thirs (polydypsia) |
| When glucose can not get into cells cuz no insulin what happens? | Protein is broken down and converted to glucose thus adding more glucose to the problem |
| When glucose is not avalible to the body. the body breaks down this instead? | Fat resulting in ketones |
| When ketones are present the resp system attemps to eliminate the excess carbon diaoxide (ketones put in acidodic state) by increased depth and respirations. | Kussmal breathing |
| With cellular death seen in ketoacidosis what happens to potassium? | it decreases |
| long term microvascular complications of diabetes? | Nephropathy, retinopathy and neuropathy |
| major causes or mortality in patients with Diabters? | Hypertension and atherosclerosis |
| Reccurent UTI and yeast infections suspect? | Type 2 diabetes |
| history of weight loss or failure to gain depite a big appetite, polyuria, glycosuria and metabolic acisodis | suspect diabetes |
| 8 hour fasting glucose diagnostic for diabets? | 126 or more and one signs |
| Random blood glucose level evident of diabetes? | 200 or more and one common sign |
| A state of relative insulin insufficinecy and may include the prescency of hyperglycemia, ketonnemia, acidosis, glycosuria and ketonuria | DKA |
| Most common endocrine disorder of childhood? | Diabetes |
| formation of structurally abdnormal insulin that has decreased biological activity | Maturity onset diabetes |
| The goal of insulin therapy? | Maintaining near-normal blood glucose values while avoiding too frequent episodes of hypoglycemia |
| Goal of insulin therapy is to have an a1c of? | 7 or less |
| when admister regular insulin? | 30 minutes before meals |
| rapid acting insulin has onset of? | 15 minutes |
| Short acting (regular insulin has onset og? | 30 minutes |
| Long acting insulin has onset of? | 6-14 hours |
| normal glucose level? | 80-120 |
| The glyoslated hemoglobin (A1C) reflects the average blood glucose over the past? | 2-3 months |
| When is it reccomended to test urine? | every 3 hours when sick or if over 240 |
| what special food or supplemnts are needed for children with diabetes? | NONE they need enough cal for daily life and growth |
| calories and proportions of nutrients must be? | consitient from day to day |
| What should be the guide for amount of calories neeedd for kid diabetic? | there appetiete |
| when does hypoglycemia usually occur? | before meals or when insulin is peaking |
| The symptoms of hypoglycemia is caused by? | Adrenergic activity and impaired brain function |
| If doubtful as to if they are hyperglycemic or hypoglycemic do what? | give a simple carb |
| what to do if hypoglycemic? | 10-15 grams of a simple carb like a tbsp of sugar, then give a complex carb like peanut butter or bread |
| Saftey in regards to glycogen? | they usually vomit so put them on there side, when they come through give them food cuz u just used all there stores |
| Somogy effect? | elvated at bedtime then drops at 2 AM with a rebound rise |
| Goals during illness in diabetes? | Restore euglycemia, treat urinary ketones, and maintain hydration. |
| How often check blood sugar when sick? | every 3 hours |
| when call doctor? | if glucose is above 240 |
| Why encourage fluids when sick/hyperglycemic? | to fluch ketones out |
| A complete state of insulin deficiency is a life threatning situation, | DKA |
| managment of DKA? | give insulin cuz glucose levels so high!, fluids cuz dehyrdated, and electolyte replacement (especially potasium) |
| all patients with DKA expetience this? | dehydration, accompanied by electrolyte loss |
| blood pressure in dka? | hypotension |
| when newly diagnosed do what with regrads to protion? | weigh and measure foods for first 3 months |
| opened insulin bottles can be sored in room temp or refigerated for how long? | 28-20 days |
| insulin is injected at what angle? | 90 degrees |
| how many injections should be given in one area? | 4-6 |
| how often measure glucose if using a pump? | at least 4 times a day. |
| How often should the pump be changed? | every 48-72 hours |
| the slowest site for isulin absorption? | butt |
| sterioids due what to blood glucose? | raise it |
| caused by illness, growth, emotional upset | Hyperglycemia |
| sweating and trembling? | hypoglycemia |
| How often should vision be checked? | once a year |
| when postoposne exercise i | if ketones present or more than 240 |
| pubertal patients have | a harder time getting glycemic control |
| hyperglycemia delays? | wound healing |
| in hypoglycemia give? | honey, bread with peanut butter |
| in illness some hyperglycemia and ketonuria is? | expected |
| don't give postatium untill? | you know levels and they voided |
| fruity breath, dehydration, electrolyte imbalnce? | DKA |
Created by:
rebo14