Nutritional and GI dysfunction

Question 1

Meconium

Answer 1

thick, sticky, tarry green-black stool shortly after birth

Question 2

Digestional differences in kids

Answer 2

• immature digestion at birth
• swallow is automatic relex until 6W but can control swallow around 6M
• small stomach
• emptying time of stomach is faster in infants
• less saliva until 2Y
• stomach acid not present until 6M
• more relaxed esophageal sphincter
• stomach pain can be from anxiety/other causes (psychosomatic)

Question 3

Failure to thrive

Answer 3

inadequate growth from inability to obtain and/or use calories required for growth
- no universal definition but wt/ht is below 5th percentile or wt/ht does not follow growth curve as expected

Question 4

Common vitamin/mineral deficiencies

Answer 4

Iron (12-36M), Vit A, C, Bs

Question 5

Organic failure to thrive

Answer 5

From underlying medical condition like cardiac prob, CF

Question 6

Non-organic failure to thrive

Answer 6

Can’t find anything attributing to them not growing, often psychosocial factors like parents can’t provide

Question 7

idiopathic failure to thrive

Answer 7

unknown

Question 8

Clinical features of failure to thrive

Answer 8

• ht/wt below 5th percentile for age
• persistent deviation from an est growth pattern

Question 9

Clinical features of non-organic FTT

Answer 9

• developmental delays like social, motor, adaptive, lang
• apathy
• inadequate hygiene
• feeding or eating dx
• no stranger anxiety
• avoidance of eye contact
• stiff and unyielding, flaccid and unresponsive

Question 10

Factors contribute to NFTT

Answer 10

• caregiver frustration and anger at infant poor response to feeding or prob assessing infant’s needs
• poverty
• health beliefs
• inadequate nutritional knowledge
• family stress or crisis
• feeding resistance
• insufficient breast milk

Question 11

Therapeutic management (NFTT)

Answer 11

• catch up growth
• multidisciplinary team approach to therapy
• correct nutritional deficiencies
• treat underlying cause
• educate parents or caregivers

Question 12

Nursing interventions for FTT

Answer 12

• feeding is a priority
• give consistent staff
• quiet, calm atmosphere
• calm, even temperament
• talk to child and instruct about eating
• be persistent
• face-to-face posture
• introduce new foods slowly
• follow child’s rhythm of feeding
• follow structured routine
• accurate I&O
• daily weight
• support parents and build confidence

Question 13

Cleft lip/palate

Answer 13

Abnormal opening in the lip and/or palate that occurs during embyonic development caused by teratogens, maternal smoking, genetics and environmental

Question 14

Palate examination

Answer 14

Done to all infants at birth

Question 15

Clinical findings with CL/CP

Answer 15

• difficulty feeding
• mouth breathing causing more air to be swallowed with distended abdomen and pressure on diaphragm, dry mucus membrane, inc risk of infx esp aspiration pneumonia

Question 16

Therapeutic management with CL/CP

Answer 16

• surgical correction of lip in first weeks of life; Z-plasty–minimize notching and lengthen lip
• cleft palate surgery - close between 12-18M, obturators, try to fix before child can speak
• multidisciplinary care

Question 17

Preop NC for CL/CP

Answer 17

• promote bonding btwn child and parent–show pics of the finished procedure
• reassure parents it is fixable
• love and hold

Question 18

CL/CP NC for feeding probs

Answer 18

• breast feeding usually not feasible
• upright position
• special nipples–CL/CP feeder, Haberman feeder, pigeon feeder
• stimulate suck reflex
• swallows fluid appropriately
• rest
• burp frequently

Question 19

Postop NC (CL/CP)

Answer 19

• protect airway (positioning on belly right after birth for cleft palate)
• position on back for cleft lip
• hypothermia–give warm blanket
• prevent infection
• protect suture line and clean well, antibiotic ointment
• pain management
• elbow restraints “no-nos” so can’t pick at face

Question 20

Postop NC (CL/CP)

Answer 20

• long term consequences like altered speech, dentition, and hearing prob
• discharge teaching like good oral care, watch ears, promote speech dev

Question 21

Esophageal atresia (EA) and Tracheoesophageal fistula (TEF)

Answer 21

• failure of esophagus to dev as a continuous passage and/or failure of the trachea and esophagus to separate

Question 22

EA and TEF diagnosis

Answer 22

Passage of radioplaque catheter until obstruction is encountered
- DON’T feed if suspected

Question 23

EA and TEF CM

Answer 23

frothy saliva in mouth and nose, choking and coughing, feedings return thru nose and mouth, may become cyanotic and apnic (3 Cs of TEF are choking, coughing, cyanosis)

Question 24

EA and TEF NC

Answer 24

Preoperatively–early detection, maintenance of airway, prevention of pneumonia, gastric or blind pouch decompression, antibiotics, prepare for surgical correction, use G tube to keep using the gut

Question 25

Postop NC (EA/TEF)

Answer 25

- careful suctioning - positioning - provide for non-nutritive sucking - N/G to low suction (irrigate frequently) - high humidity environment - prevent pneumonia - care for chest tubes - maintain nutrition - provide comfort and physical contact - D/C teach--s/s of resp distress, tracheomalacia, GERD, constriction of the esophagus