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BRAT diet is begun after vomiting and diarrhea have stopped. What is the BRAT diet made up of? BRATBRATBRAT
How long would you have a patient on the BRAT diet? 24-36 hours
Conditions requiring a high fiber diet? Constipation, irritable bowel
foods to avoid in a gluten free diet? wheat, oats, barley, rye
proteins in cow milk that causes allergy- *casein (found in the curd) *whey (found in liquid part)
TX for cow milk allergy? *remove all dairy *add casein hydrolysate milk formula, pregestimil (lactose free), Nutramigen (hypoallergenic formula to manage colic) *After 2 years, regular milk can be added back in small quantities to assess for continued allergy
CRAM diet adds this from the BRAT diet but excludes this.... Milk added, toast is not
Intolerance to gluten celiac disease
S/S of ???? *Steatorrhea *foul smelling stool *greasy/bulky stool *FTT *muscle wasting *irritable Celiac disease
Mgmt of celiac disease? *Gluten-free diet *high cal/simple carb, high protein *add foods back as the acute phase of disease resolves. *Avoid high roughage food til bowel is rested
S/S of lactase deficiency? *abd pain *bloating *flatulence *diarrhea
DX for lactase deficiency? breath hydrogen test
Collaborative mgmt of lactase deficiency *Infant- soy based formula *small amounts of dairy if consumed *enzyme tabs; lactaid, dairy ease *Monitor need for Ca and Vit D products
Nursing interventions for lactase deficiency? *Ht/wt, growth chart *assess stool consistency *diet management *additives to milk for deficiency *dietary consult *vitamins, proteins, minerals
Which Hep? *an RNA virus, spread by fecal-oral route, ingestion of contaminated food or water or through direct contact Hep A (HAV)
Which Hep? *originally known as serum hepatitis, perinatal transmission, in other children and adolescents- risky behavior Hep B (HBV)
Hep? rare in children, when discovered has usually been present for 1-20 years. HEP C (HCV)
This virus can lead to hepatitis? CMV- cytomegalovirus
S/S of what disorder? *jaundiced by 3-8 weeks of age *pale stools *dark urine *enlarged abd (liver/spleen) *ascites *malnutrition/growth failure *pruritis *irritable Biliary atresia
What med would be given for pruritis cholestasis in Biliary atresia? Rifampin will see orange urine
DX of atresia? *liver scan *CBC *electrolytes *liver enzymes *liver biopsy *PT, PTT, bleeding times
First line operative intervention for Biliary atresia? Kasia procedure
Kasai post procedure entails? *antibiotics to prevent infection of the bile ducts *fat soluble (ADEK) *ursodeoxycholic acid (improves flow of bile, may protect liver cells *nutritional special formulas (predigested) *sometimes steroids
Explain the kansai procedure Hepatic portoenterostomy; conduit is made to bypass the fibrotic extrahepatic biliary tree and re-establish bile drainage.
post-op care for Kansai procedure? *Fluid mgmt *IV antibio *adb decompression via NG tube *
Etiology of cleft lip/palate? *genetics *smoking in first trimester *folate deficiency
Failure of the maxillary and median nasal processes to fuse Cleft lip
midline fissure of the palate that results in failure of the two sides to fuse Cleft palate
When would a cheiloplasty be performed for the child born with cleft lip? 6-12 weeks
When would a palatoplasty be performed? Between 12-18 months, after normal growth and developmental palatal changes have occurred
Post op care for palatoplasty *packing may be in place for 2-3 days *assess for respiratory difficulty *restraints *analgesia *sedation *diet
esophagus malformed, ends in a pouch Esophageal atresia will see constant frothy saliva
Fistula between the esophagus and trachea tracheoesophageal fistula *will see coughing, cyanosis, choking
Conditions that may cause GERD in children *hx of TEF/atresia *prematurity *CF *cerebral palsy *scoliosis *neuro conditions *hiatal hernia
Diarrhea that lasts less than 14 days *Acute* Chronic is longer than 14
6 things considered to be infectious diarrhea 1. Rotavirus 2. Salmonella 3. E. Coli 4. Shigella 5. Clostridium difficile 6. helmintics
Definition of constipation more than 3 days without stool
Very long intervals between bowel movements obstipation
voluntary or involuntary passage of stools in child who has been toilet trained, typically older than 4. encopresis
Causes of constipation in the newborn? *hirschsprungs *ileus *meconium plugs *cystic fibrosis *diet
Constipation causes in the infant? *diet *stricture *hirschsprungs
Constipation causes in the child? *Holding behaviors *stress *pain *diet
congenital aganglionic megacolon Hirschsprungs
S/S of Hirschsprung *abd distention *failure to pass meconium *symptoms of bowel obstruction *impaction *poorly nourished
Dx of hirschsprung *anorectal manometry (measures contractility in the anus/rectum *barium enema *rectal biopsy *x-ray
management of acute hirschsprung *surgery, affected part of bowel removed, temporary ostomy performed. *nutritional support may be provided (TPN)
Common complication of acute hirschsprung? Enterocolitis; antibiotics and lactose free diet may be ordered. Irregular bowel patterns may present even without enterocolitis
care for Chronic hirschsprung May not require surgery, dietary modifications, stool softeners, isotonic irrigations to prevent impaction
Collaborative mgmt of hirschsprungs *1st surgery, colostomy formed above area; affected part of Lg intest removed. *2nd surgery colostomy closed, healthy bowel reattached.
*protozoal, transmitted through close contact as in day cares *S/S; infant: NVD, anorexia, FTT <5 cramps, intermittent loose stools, constipation Giardiasis
RX for giardiasis *Quinicrine (atabrine) *flagyl *furazolidone (furoxone)
*Most common worm infection: ____________ S/S itching/digging, which spreads infection Pinworms
How does someone contract pinworm infestation? The eggs are ingested or inhaled
Tx for pinworms? One dose of vermox
Type of parasite that comes from the soil, eggs or larvae get into the body when a child gets them on hands and puts hands in mouth Roundworm
Primary source of infection of toxoplasmosis to humans are from cats. however, it can also be from........... raw meat, esp pork.
Drug of choice to prevent toxoplasmosis Trimethoprim/sulfamethoxaxole prevention, not treatment
Collaborative mgmt of toxoplasmosis? *Pyrimethatmine (antimalarial) *sulfadiazine (antibiotic) often used in combo *clindamycin, spiramycin, aindamycin
Transmitted through infected water, areas of poor sanitation, public water supplies. Drinking unpasteurized cider, swimming in contaminated pool/lake Cryptosporidiosis; resistant to chlorine
TX for cryptosporidiosis Nitazoxanide, fluids, antidiarrheal meds.
At what age would a umbilical hernia need treatment. If it continues past the age of 3-4.
Sudden acute abd pain, vomiting, lethargic, jelly stools, palpable abd mass, tender,distended abd, signs of peritonitis possible Intussusception
TX for Intussusception *Barium or air enema can correct the telescoping intestine. If this works no further tx needed. *Surgery if the intestine is damaged or enema unsuccessful
cecum in place other than where it belongs. Malrotation/Volvulus
Tx for malrotation/volvulus *NG to suction *assess for bowel obstruction *Ladd's procedure to put bowel in correct position
Leftover tissue from structures in the unborn baby's digestive tract not fully reabsorbed at birth Meckel diverticulum
S/S of Meckel diverticulum Abd discomfort,pain ranging from mild-severe, blood in stool
RX for meckel diverticulum Surgery to remove diverticulum if bleed develops
Ulcerative colitis occurs in rectum/colon
Crohns disease occurs in..... any area of GI tract
S/S of Ulcerative colitis or crohns? *Crampy, bloody diarrhea, L sided lower pain Ulcerative
S/S of Ulcerative colitis or crohns? *watery diarrhea, R sided abd pain Crohns
Created by: purpleapple87