GI

what is a common upper GI issues associated with infants?

reflux

at a newborn check up, the mother states that she is worried because her infants abdomen is often distended - what should you say in response to her?

this is common with infants

an infants increased metabolic rate affects what?

infants ability to concentrate urine

diarrhea that last less than 14 days is considered -

acute

diarrhea that lasts longer than 14 days is considered -

chronic diarrhea

what is the most common cause of acute diarrhea?

infection and acute gastroenteritis (bacterial, viral, or parasitic)

what are common causes of chronic diarrhea?

chronic conditions - malabsorption syndrome, IBD, food allergies

a child presents with acute onset of diarrhea in the absence of abdominal pain, fever, nausea, or vomiting - what do you suspect?

acute gastroenteritis

the most common cause of acute gastroenteritis is -

viral

what should you ask the parents of an child who you believe has acute gastroenteritis?

how long their child has had diarrhea and the consistency of the stool

what would a parent tell you that would indicate a higher risk of acute gastroenteritis?

recently starting daycare, poor sanitation, recent travel, or contact with ill family members

how do you calculate % of dehydration?

(pre-illness weight - illness weight/pre-illness weight) x 100

what would indicate labs in a child with acute gastroenteritis?

blood or mucus in stool

what is the most important NANDA for a child with acute gastroenteritis?

risk for dehydration and fluid/electrolyte imbalance

what is a hallmark sign of a moderately dehydrated infant?

sunken fontanel

mild dehydration is defined as how much weight loss?

less than 5% of body weight

moderate dehydration is defined by how much body weight loss?

7-9%

severe dehydration is defined as how much body weight loss?

10%

when would you give antibiotics to a child with acute gastroenteritis?

if they’re less than 3 months old, if they’re immunosuppressed, or if they have severe disease

what do you treat parasitic acute gastroenteritis with?

metronidazole

a mother wants to give her child with acute gastroenteritis Imodium or Pepto to help with the symptoms - what do you say?

this is not recommended for children

what education should you provide to a parent with a child with acute gastroenteritis?

increase carbs and protein in the diet; encourage fluids

what is the recommend way to replace fluids in a mildly to moderately dehydrated child?

orally (5-10 mL every 5-10 minutes, gradually increasing the rate as tolerated for four hours)

what is the recommend fluid replacement for a mild to moderately dehydrated child?

Pedialyte or breastmilk

what is the appropriate way to replace fluids in a severely dehydrated child?

IV fluids

a moderately dehydrated child throws up when you begin hydration therapy - what should you do?

weight 1 hour and try again

a parent asks when they can start giving their dehydrated child normal foods - what do you recommend?

once they are tolerating fluid

a parent asks if it would be okay to give their dehydrated child some Gatorade to help hydrate them faster - what is an appropriate response?

you should not give this to your child - the high amounts of sugar can dehydrate your child further

should you give antidiarrheals to children?

no

what can parents give to their children to help shorten the length of diarrhea?

probiotics

what transition often causes constipation in infants?

dietary changesw

what transition common causes constipation in toddlerhood?

potty training

what transition commonly causes constipation in childhood?

use of the toilets away from home

what accounts for about 95% of all constipation in childhood?

functional constipation (no physiologic cause)

what happens to the rectum during functional constipation when the child is voluntarily holding stool?

the rectal wall stretches

leaking of stool around a large mass of compacted stool is called what? what is it associated with?

encopresis; functional constipation

what is a common complication associated with function constipation?

bowel obstruction

what should you go over with the parents of an infant with constipation?

proper formula preparation

what is a way to treat constipation specifically in infants?

rectal stimulation

what type of suppository is safe for use in children and infants?

glycerin

what should you educate a parent to increase in their child’s diet if they are struggling with constipation?

juices (prune, pear, apply); increase fiber and water intake

what do you suspect when a child is having difficulty passing bowel movements due to missing nerves within the bowel?

Hirschsprung Disease

what effect does the missing segment of nerves have in Hirschsprung Disease?

prevents peristalsis

what increases a child’s risk for Hirschsprung Disease?

males, chromosome abnormalities

a newborn has failed to pass their meconium, is refusing to feed, and has bile-stained vomitus - what do you suspect?

Hirschsprung Disease

an older child comes into the clinic complaining of chronic constipation, and states that when he does pass stool its very explosive, smells terrible, and is ribbon like. the child has had poor weight gain and is smaller than normal. what do you suspect?

Hirschsprung Disease

what is done to diagnosis children with Hirschsprung Disease?

rectal biopsy

what is the treatment of Hirschsprung Disease?

surgery (colostomy then anastomoses - colon is healed than then reattached)

when does gastroesophageal reflux peak with an infant?

four months

a mother complains that her infant her infant often spit and vomits after feeds, but the vomiting is not projectile. this infant has no complications due to this. what do you suspect?

gastroesophageal reflux

a mother states that her infant frequently throws up following feeds, and has begun refusing feedings, is extremely irritable, and has developed a weird wheezing sound when they breath. what do you suspect?

GERD

an infant with GERD arches their back when you go to feed them - what is this called?

Sandifer syndrome

an older child will commonly complain of what when they are suffering from GERD?

regurgitation into the mouth, heartburn, and dysphagia

what would you educate a mother with an infant with GERD to do during feedings to help decrease symptoms?

provide small frequent meals, burp frequently, lay the infant on their left side with the HOB up

what medications would you expect a child to be given following a GERD diagnosis?

H2 agonists (pepcid) and PPIs (omeprazole and lansoprazole)

when can children begin taking PPIs?

one year of age

what is important to remember when assessing for appendicitis in children?

the presentation may be atypical

what is a common cause of appendicitis in children?

fecalith (harden stones of feces)

a child’s appendix has ruptured - what do you suspect is their treatment plan?

drain is placed, antibiotics are given, and surgery will be done when they are stable

an infant presents to the clinic with recent pain when stooling and small amount of blood present with stool is passed. otherwise, this infant is normally behaved. what do you suspect?

Meckel diverticulum

what scan is used to diagnosis Meckel diverticulum?

Meckel scan

what do you see in a child with Meckel diverticulum?

a small pouch in the digestive tract that should’ve disappeared following fetal development

what is a common cause of cleft lip and palate?

teratogen exposure during embryonic development

failure of the nasal and maxillary processes to fuse causes -

cleft lip

failure of the palatine plates to fuse causes -

cleft palate

what is education you should provide to the parents of an infant with cleft lip or palate?

use special nipple for bottle, provide small and frequent meals, body needs to upright during feedings to prevent aspiration

how long does it take to replace cleft lip?

2-3 months

how long does it take to fix cleft palate?

9-12 months

what method should be used to help a baby with cleft lip/palate eat?

ESSR (enlarged nipple, stimulate sucking reflex, swallow, rest - limit feedings to 20-30 minutes)

how is a child fed preoperatively for cleft lip/palate surgery?

breck feeder (large syringe with soft rubber tubing)

what should children not do before cleft lip/palate surgery?

suck

what is the number one priority following cleft lip/palate surgery?

airway

what should you have a baby avoid in the days following cleft lip/palate repair?

straws, pacifiers, spoons, or anything else they might stick in their mouth and suck on

what is a logan bar used for?

to protect sutures from trauma or tension

what is it referred to as when the esophagus ends in a blind pouch?

esophageal atresia

what is it referred to as when the tracheal and esophagus have a connection?

tracheoesophageal fistula

an infant presents with excessive oral secretions, coughing and choking during feeding, and abdominal distention. what do you suspect?

esophageal atresia and tracheoesophageal fistula

if you suspect a child has esophageal atresia or tracheoesophageal fistula what should you immediately do?

stop feedings

what is it referred to as when abdominal contents extend into the chest cavity through a hole in the diaphragm?

diaphragmatic hernia

what is the hallmark sign of diaphragmatic hernias?

respiratory distress

what is a complication of the GI tract that can occur due to diaphragmatic hernias?

tissue death due to constriction

what is a respiratory complication that can occur due to a diaphragmatic hernia?

lungs are unable to expand and mature

how can diaphragmatic hernias be treated?

surgery in utero or immediate following birth if the hernia is small enough

what procedure is done in utero to treat diaphragmatic hernia?

fetoscopic tracheal occlusion (FETO)

what is the main difference between gastroschisis and omphalocele?

gastroschisis is not in a sac and omphalocele is

what are your main concerns in a child with gastroschisis or omphalocele?

prevent hypothermia, maintain sterility, maintain tissue perfusion

how does the bowel remain sterile in a patient with gastroschisis or omphalocele before surgery?

they are placed in a bag filled with saline

what is important education to provide a parent about surgical correction of gastroschisis and omphalocele?

it is usually repaired in segments

a weak or imperfectly closed umbilical ring is referred to as -

umbilical hernia

a parent asks about their child’s umbilical hernia, how do you describe it to them?

parts of their child’s omentum or intestine are sticking through the weak muscles of their abdomen

what is an important assessment to make on a child with an umbilical hernia?

if the hernia is retractable

what is the treatment for an umbilical hernia?

most should resolve by 3-4 years old; if not surgical repair is done

should a child’s hernia be bound?

no - it is ineffective and can be harmful

how is at increased risk for developing pyloric stenosis?

1st born Caucasian boys with a family history

what are high priority NANDAs for a child with pyloric stenosis?

dehydration, metabolic alkalosis, and failure to thrive

what labs should be monitored on a patient with pyloric stenosis?

BUN

an infant present to the ER with forceful, projectile vomiting. the parent states that their child has has persistent hunger and is extremely irritable. they also state their child has loss weight the past few weeks. what do you suspect?

pyloric stenosis

upon assessment, what would indicate a child may have pyloric stenosis?

olive sized mass in the RUQ that is palpable

what should you makes sure is done before a child with pyloric stenosis goes for surgical repair?

treat dehydration and fluid/electrolyte imbalances

what is done during surgery to treat pyloric stenosis?

the muscle is cut to open up the stenosed area