NSG 3600
EXAM 3 STUDY GUIDE
Nursing Practice – Children’s Health
Galen College of Nursing
, Peds Exam #3 Review
UNIT 5: Gastrointestinal (GI)
Acute diarrhea
o Excessive loss of fluid and electrolytes in the stool, with the disruption occurring
in the intestinal tract.
o Stool is considered excessive if it is more than 10g/kg in children less than 2.
Stooling is 4 or more times in 24 hours in children older than 2
o Multiple causes- infections, diet, medications, or toxic materials
o Osmotic diarrhea occurs when water is pulled into the bowel due to conditions
such as lactose intolerance and overfeeding.
o Secretory diarrhea occurs when there is an increase in the active of fluid or
electrolytes into the stool.
o S/S
Increased frequency and fluid content of stools with or without associated
symptoms.
o Diagnosis:
History- family, day care, medications, food allergies, recent travel,
dietary consumption of poorly cooked food
Physical examination-focus on abdomen and perineum, hydration, level of
alertness, #of stools, illness contacts
Culture and sensitivity, serum electrolytes, CBC with diff
Evidence of blood in the stool: assess stool for C&S
o Prevention: proper hand washing, food handling, diapering, avoid over feeding
the child and the use of excess juice.
o Medical: mostly supportive, hydration, dietary needs, medications for infections.
o Nursing care:
Monitor fluid intake and output, IV fluids
Observe for signs of dehydration.
Offer PO fluids- no fruit juices, soda, or sports drinks.
Skin care- perineum and buttock areas
Diet as indicated-start with bland, soft foods.
o Education/discharge
Preventative measures
Monitoring hydration status
Instruction on good hand hygiene
Care of soiled clothing and diapers
Cleft lip:
o Birth defect characterized by incomplete formation of the lip (cleft lip) or the roof
of the mouth (cleft palate)
o Risk factors: over the age of 35, seizure medication, methotrexate medication,
not taking folic acid, more common in males.
, o S/S:
Unilateral or bilateral cleft lip
Can occur with or without cleft of the hard and/or soft palate
Both or either of the palates can have a cleft without lip affected
Uvula can also contain cleft
o Nursing care:
Maintaining adequate nutrition
Breastfeeding possible but may be interrupted for period of time based on
the need for surgical repair
Bottle feeding is initiated with special nipple that is longer than a regular
nipple to help prevent aspiration. Has a reservoir to regulate the flow of
the formula (Haberman feeder)
Feed in upright position to decrease the incidence of regurgitation (not in
infant seat)
o Surgical Care of a Cleft Lip
Closure of lip defect precedes correction of the palate.
Performed when patients are 2-3 months of age.
Z-plasty to minimize retraction of scar.
Protect suture line with Logan bow or other methods.
No-No’s (elbow restraints) must keep these on, patients go home
with this.
o Education/Discharge:
Cleft palate- position in upright position. Use bottle with one-way flow
valve.
Cleft lip-use nipple with wide base, squeeze cheeks together during
feeding
Apply petroleum jelly to operative site as directed.
Feeding with a syringe or dropper
Avoid use of pacifiers
Nothing in mouth after surgery
Hirschsprung's:
o Also known as congenital aganglionic megacolon—birth defect with the absence
of ganglion cells results in lack of motility/peristalsis in segments of the colon
resulting in obstruction.
o S/S:
Failure to pass meconium within the first 48 hours of life.
Abdominal distension
Ribbon like stool
Failure to thrive/ poor feeding.
Constipation, vomiting bile
Palpable fecal mass
o Diagnosis:
X-ray evidence of dilated loop of bowel
, Barium enema
Fractal biopsy
Anorectal manometry
o Medical/surgical- removal of aganglionic section with colostomy
o Nursing care
Pre-op- NPO, NG tube with low interment suction
Post-op: physical assessment, NPO, pain management, wound care, and
fluid maintenance- patency of the NG tube is maintained.
NG tube & IV
Monitor for enterocolitis (fever, bloody diarrhea, abdominal pain)
o Education/discharge:
Care for temporary colostomy
Teach about symptoms of complications.
Hypertrophic pyloric stenosis:
o Etiology is unknown. Thickening of the pyloric sphincter, causing an obstruction
of the pyloric canal.
o Suggested causal theories include a deficiency in inhibitory neuronal signals or
molecular causes.
o Ganglionic cell immaturity has also been suggested as a causative factor.
o More common in “healthy” Caucasian population
o Commonly seen in 3–6-week-old babies
o More common in males- especially first born. There may be a family trait.
o S/S:
Pattern of normal feedings and then new onset on non-bilious vomiting.
Begins with regurgitation for the few weeks of life.
Projectile vomiting- may occur right after the feed. Vomit is non-
bilious.
Baby usually wants to eat immediately after.
Other symptoms can be:
o Weight loss
o Dehydration (no tears, tachy)
o Constipation
o Olive shaped mass RUQ
o Visible reverse peristalsis in LUQ
o Diagnosis:
Palpating pyloric mass (olive shaped), moveable, firm, and best palpated
from the left side located above and to the right of the umbilicus in the
mid-epigastrium beneath the liver edge (RUQ).
Ultrasound usually confirms the Pyloric Stenosis
Confirmation by upper GI series demonstrates “string sign” which is
caused by barium passing through narrowed pylorus.
o Surgical care: Pyloromyotomy-laparoscopic procedure with endoscope
EXAM 3 STUDY GUIDE
Nursing Practice – Children’s Health
Galen College of Nursing
, Peds Exam #3 Review
UNIT 5: Gastrointestinal (GI)
Acute diarrhea
o Excessive loss of fluid and electrolytes in the stool, with the disruption occurring
in the intestinal tract.
o Stool is considered excessive if it is more than 10g/kg in children less than 2.
Stooling is 4 or more times in 24 hours in children older than 2
o Multiple causes- infections, diet, medications, or toxic materials
o Osmotic diarrhea occurs when water is pulled into the bowel due to conditions
such as lactose intolerance and overfeeding.
o Secretory diarrhea occurs when there is an increase in the active of fluid or
electrolytes into the stool.
o S/S
Increased frequency and fluid content of stools with or without associated
symptoms.
o Diagnosis:
History- family, day care, medications, food allergies, recent travel,
dietary consumption of poorly cooked food
Physical examination-focus on abdomen and perineum, hydration, level of
alertness, #of stools, illness contacts
Culture and sensitivity, serum electrolytes, CBC with diff
Evidence of blood in the stool: assess stool for C&S
o Prevention: proper hand washing, food handling, diapering, avoid over feeding
the child and the use of excess juice.
o Medical: mostly supportive, hydration, dietary needs, medications for infections.
o Nursing care:
Monitor fluid intake and output, IV fluids
Observe for signs of dehydration.
Offer PO fluids- no fruit juices, soda, or sports drinks.
Skin care- perineum and buttock areas
Diet as indicated-start with bland, soft foods.
o Education/discharge
Preventative measures
Monitoring hydration status
Instruction on good hand hygiene
Care of soiled clothing and diapers
Cleft lip:
o Birth defect characterized by incomplete formation of the lip (cleft lip) or the roof
of the mouth (cleft palate)
o Risk factors: over the age of 35, seizure medication, methotrexate medication,
not taking folic acid, more common in males.
, o S/S:
Unilateral or bilateral cleft lip
Can occur with or without cleft of the hard and/or soft palate
Both or either of the palates can have a cleft without lip affected
Uvula can also contain cleft
o Nursing care:
Maintaining adequate nutrition
Breastfeeding possible but may be interrupted for period of time based on
the need for surgical repair
Bottle feeding is initiated with special nipple that is longer than a regular
nipple to help prevent aspiration. Has a reservoir to regulate the flow of
the formula (Haberman feeder)
Feed in upright position to decrease the incidence of regurgitation (not in
infant seat)
o Surgical Care of a Cleft Lip
Closure of lip defect precedes correction of the palate.
Performed when patients are 2-3 months of age.
Z-plasty to minimize retraction of scar.
Protect suture line with Logan bow or other methods.
No-No’s (elbow restraints) must keep these on, patients go home
with this.
o Education/Discharge:
Cleft palate- position in upright position. Use bottle with one-way flow
valve.
Cleft lip-use nipple with wide base, squeeze cheeks together during
feeding
Apply petroleum jelly to operative site as directed.
Feeding with a syringe or dropper
Avoid use of pacifiers
Nothing in mouth after surgery
Hirschsprung's:
o Also known as congenital aganglionic megacolon—birth defect with the absence
of ganglion cells results in lack of motility/peristalsis in segments of the colon
resulting in obstruction.
o S/S:
Failure to pass meconium within the first 48 hours of life.
Abdominal distension
Ribbon like stool
Failure to thrive/ poor feeding.
Constipation, vomiting bile
Palpable fecal mass
o Diagnosis:
X-ray evidence of dilated loop of bowel
, Barium enema
Fractal biopsy
Anorectal manometry
o Medical/surgical- removal of aganglionic section with colostomy
o Nursing care
Pre-op- NPO, NG tube with low interment suction
Post-op: physical assessment, NPO, pain management, wound care, and
fluid maintenance- patency of the NG tube is maintained.
NG tube & IV
Monitor for enterocolitis (fever, bloody diarrhea, abdominal pain)
o Education/discharge:
Care for temporary colostomy
Teach about symptoms of complications.
Hypertrophic pyloric stenosis:
o Etiology is unknown. Thickening of the pyloric sphincter, causing an obstruction
of the pyloric canal.
o Suggested causal theories include a deficiency in inhibitory neuronal signals or
molecular causes.
o Ganglionic cell immaturity has also been suggested as a causative factor.
o More common in “healthy” Caucasian population
o Commonly seen in 3–6-week-old babies
o More common in males- especially first born. There may be a family trait.
o S/S:
Pattern of normal feedings and then new onset on non-bilious vomiting.
Begins with regurgitation for the few weeks of life.
Projectile vomiting- may occur right after the feed. Vomit is non-
bilious.
Baby usually wants to eat immediately after.
Other symptoms can be:
o Weight loss
o Dehydration (no tears, tachy)
o Constipation
o Olive shaped mass RUQ
o Visible reverse peristalsis in LUQ
o Diagnosis:
Palpating pyloric mass (olive shaped), moveable, firm, and best palpated
from the left side located above and to the right of the umbilicus in the
mid-epigastrium beneath the liver edge (RUQ).
Ultrasound usually confirms the Pyloric Stenosis
Confirmation by upper GI series demonstrates “string sign” which is
caused by barium passing through narrowed pylorus.
o Surgical care: Pyloromyotomy-laparoscopic procedure with endoscope
