Download GI Disorders: Anorectal Malformations, Pyloric Stenosis, and More and more Exams Nursing in PDF only on Docsity!
Galen NURS 3600 GI disorders (Exam 3)
Anorectal Malformations - correct answer Interruption in the rectum preventing proper bowel movements. Includes Anal atresia, Rectal stenosis, Imperforate anus, and rectal fistula. One of the most common congenital defects Rectal Stenosis - correct answer Narrowing of rectum S/S of Rectal Stenosis (4) - correct answer Ribbonlike/narrow stools (may not be apparent at birth) Difficulty pooping Vomiting Distended abdomen Imperforate Anus - correct answer Absence of anus that may include rectal fistula Rectal Fistula - correct answer Stool from vagina or urethra Anal atresia - correct answer Anus is present but rectum is incomplete/closed S/S of Anal Atresia or Imperforate Anus (1) - correct answer No stools Diagnostics for Anorectal Malformations (5) - correct answer Physical Exam MRI X-Ray Ultrasound IV Pyelogram/voiding cystogram for malformations including the urinary tract Treatment of Anorectal Malformations - correct answer ALL require surgery New anus: 1st surgery to form colostomy and resect intestine 2nd to remove colostomy and anastomosis May include manual dilation Pre-op Interventions for Anorectal Malformations (2) - correct answer NPO IV maintenance with fluids that include sugar Post-op Interventions for Anorectal Malformations (8) - correct answer VS I&O
pain management infection control skin care monitor stools NG decompression PO feedings after bowel sounds become present Education for Anorectal Malformations (7) - correct answer Colostomy care Manual anal dilation instructions Dietary fiber Maintain fluids Infection prevention Stool softeners May need to delay toileting Hypertrophic pyloric stenosis - correct answer Constriction of the pyloric sphincter with obstruction of the gastric outlet Cause of pyloric stenosis - correct answer Unknown, may be ganglion immaturity Risk factors of pyloric stenosis - correct answer 1st born white males Family hx S/S of pyloric stenosis (6) - correct answer Normal feedings then sudden, projectile, non-bilious vomiting (often occurs within 16 min of feeding) Olive shaped mass Dehydration Weight loss Visible reversal peristalsis in LUQ Constipation Diagnostics for pyloric stenosis (4) - correct answer Palpable olive shaped mass Abdominal x-ray Abdominal ultrasound
Interventions for CL/CP (5) - correct answer Nutrition Sit upright when feeding Provide emotional support for parents Lengthen nipple and provide rest Breastfeeding possible with break for surgical repair Education for CL/CP (5) - correct answer Explain tx, feeding, and care Nothing in mouth until healed No-no's/ Logan bow to prevent pulling of nasal packing Breastfeeding: nipple shield, pump 1st so baby doesn't have to such so much ESSR Mead Johnson Cleft Palate Nurser - correct answer Large plastic squeeze bottle with cross cut nipple Haberman Feeder - correct answer Most common feeder for CL/CP, or any infant with feeding problems. Lengthened nipple Valve to adjust milk flow Pigeon bottle - correct answer Plastic bottle with bulbous Y nipple, one way valve to minimize air swallowed Intussesception - correct answer One part of the intestine (usually SI) telescoped into another part (usually LI) Usually before the age of 2 S/S of intessusception (8) - correct answer infants pulling legs up Colicky Acute abdominal pains d/t bowel spasms Currant jelly stool d/t pressure Fever Dehydration Vomiting
Grunting in pain Diagnosis for Intessusception (5) - correct answer History Physical exam Sausage-like mass in RUQ (dance's sign) Barium/air enema Abdominal ultrasound Treatment of intessusception (4) - correct answer 1. Air enema
- Saline enema
- Barium enema (Enemas may decrease 65-90%)
- Surgery Interventions for intussusception (9) - correct answer Monitor for s/s of perforation, shock, or sepsis VS Monitor for normal, brown stools which mean it fixed itself (call doc if ā surgery) Pre-op: NG tube NPO IV fluids Post op: Dehydration Pain Infection Education for intussusception (5) - correct answer Wound care Infection prevention Feeding Dehydration
Education for FTT (2) - correct answer feeding education community resources Munchausen Syndrome by Proxy/Factitious disorder - correct answer Mental illness where caretaker makes up/causes illnesses/injuries in vulnerable person form of abuse S/S of MSBP (3) - correct answer S/S of FTT S/S of abuse/neglect Suspicious pt. hx: has seen multiple doctors/facilities, hx doesn't add up Diagnostics for MSBP (6) - correct answer pt. hx physical assessment feeding hx developmental assessment nurses assessment (abuse? knowledge deficit?) CBC, CMP, iron panel Treatment for MSBP - correct answer Nurses feed formula with increases calories, vitamins, and mineral Prevention of MSBP (3) - correct answer sufficient pre/postnatal care nutrition education community resources (WIC) Interventions for MSBP (3) - correct answer nutrition emotional support abuse protocol Education for MSBP (3) - correct answer how to feed community resources therapy/emotional support Appendicitis - correct answer inflammation of the appendix d/t obstruction of fecal matter = distention and potential ischemia/necrosis most common abdominal surgery in children ages 6- 10
S/S of appendicitis - correct answer periumbilical pain that radiates to RLQ rebound pain to McBurney's point vomiting anorexia constipation small amount of mucus-like stools inability to stand straight fever with perf decreased pain with perf Diagnostics for appendicitis - correct answer progression of S/S heel-drop test ultrasound CT X-ray: may show fecal matter Increased WBC Treatment for appendicitis - correct answer Surgery to remove appendix with perf: increased antibiotics, flushing of abdomen Pre-op interventions for appendicitis - correct answer NPO IV fluids VS pain (call doc if stops=perf) Post-op interventions for appendicitis - correct answer pain I&O wound care infection prevention NPO for 24 hrs or until bowel sounds Education for appendicitis - correct answer wound care
Treatment for acute diarrhea (3) - correct answer hydration nutrition medications Prevention of acute diarrhea (3) - correct answer hand washing food handling diapering Interventions for diarrhea (4) - correct answer I&O sugarless PO fluids skin care: perineum nutrition as indicated Education for diarrhea (5) - correct answer preventative measures hydration hand hygiene nutrition proper cleaning of soiled diapers and clothing Chronic diarrhea - correct answer 3+stools/day for 14+days associated with chronic illnesses Causes of chronic diarrhea - correct answer chronic illnesses such as IBD, lactose intolerance, overfeeding, malabsorption, and food allergies Diagnostics for chronic diarrhea (6) - correct answer C&S ova & parasites fecal pH occult blood fat stain clinitest Treatment of chronic diarrhea - correct answer Treat underling cause Vomiting - correct answer forceful expulsion of gastric contents through the mouth
Causes of non-bilious vomit (4) - correct answer infection metabolic issue neurologic issue psychological issue Cause of bilious vomit - correct answer obstruction Cause of bloody vomit - correct answer active bleeding in the GI tract S/S of vomiting (6) - correct answer nausea abdominal distention hyper/hypoactive bowel sounds dehydration malnutrition visible peristalsis Diagnostics for vomiting (13) - correct answer pt. hx physical exam ultrasound x-ray urinalysis C&S CBC electrolytes blood culture liver fxns toxicology screen strep throat culture pregnancy test Treatment of vomiting (2) - correct answer Treat cause fluids
Education for GERD (6) - correct answer dietary modifications positioning medications burping (q15 minutes) avoid dietary irritants avoid vigorous play after feeding Hirschsprung disease - correct answer absence of ganglion cells results in lack of motility in the affected portion of the bowel S/S of Hirschsprung Disease (7) - correct answer no meconium in 48 hrs FTT poor feeding chronic constipation chronic vomiting abdominal distention enterocolitis Diagnostics for Hirschsprung Disease (3) - correct answer x-ray barium enema biopsy in affected bowel (diagnosis in first few days/months Treatment of Hirschsprung disease - correct answer removal of affected bowel Interventions for Hirschsprung Disease - correct answer pre-op: NPO, sugary IV fluids post-op: NPO, NG tube to remove gas Education for Hirschsprung Disease - correct answer colostomy care and complications Celiac Disease - correct answer Small bowel mucosa is damaged when exposed to gluten. Leads to permanent gluten intolerance. Presents when gluten is introduced (age 6mo.-2yrs) Risk Factors of Celiac Disease (6) - correct answer 1% of US affected women 3x more likely Northern European
Type 1 diabetics Trisomy 21 Turner's S/S of Celiac disease (7) - correct answer Early: anorexia listlessness irritability weight loss Later: bloating steatorrhea constipation Diagnostics for Celiac Disease (4) - correct answer S/S serological markers bowel biopsy lab studies show evidence of malabsorption and nutritional deficiencies Treatment for Celiac Disease - correct answer change in diet to decrease S/S Interventions for Celiac Disease (3) - correct answer gluten free diet assess growth and development supplement calories, vitamins, and minerals Education for Celiac Disease (5) - correct answer gluten free, increased calories, protein, and simple carbs temporary lactose restriction periodic measure of TTG assess growth S/S of when ingested Dehydration - correct answer when fluid output is > fluid input
treat cause Interventions for dehydration (5) - correct answer I&O VS fluids meds education Fluid excess - correct answer input > output Causes of fluid excess (3) - correct answer kidney disease CHF too much IV fluid S/S of fluid excess (6) - correct answer pulmonary edema (crackles) weight gain lethargy decreased LOC slow, bounding pulse decreased hematocrit Interventions for fluid excess (4) - correct answer I&Os daily weights assess fluid status educate Lead Poisoning - correct answer ingestion of lead disrupts biochemical processes, neurotransmission, blood brain barrier, and synaptic regulation Risk factors of lead poisoning (6) - correct answer 500,000 kids btwn 1-5 exceed reference level (5ug/dL) living in a dated home (before 1970s) imported spices imported pottery tracking in dirt/dust with lead
artists paint workplaces with lead S/S of lead poisoning with different concentrations - correct answer >80ug/dL: convulsions, loss of muscle control, death
40ug/dL: abdominal pain, vomiting, anorexia, constipation, colic <10ug/dL: increase in behavioral effects, decreased hearing, cognition, and growth <5ug/dL: increase in behavioral effects, decreased cognition and kidney fin, delayed puberty Diagnostics of lead poisoning (2) - correct answer lab values environmental hx Treatment of lead poisoning - correct answer chelation therpy Prevention of lead poisoning (3) - correct answer reducing potential exposure diet high in Ca, Fe, and vitamin C regular developmental screenings
