NURS 2346: GI Disorders of Pediatric
Patients, NURS 2346 Peds GI, 2345 ACTUAL
QUESTIONS AND CORRECT ANSWERS
Which ethnicity is more prone to lactose intolerance? - CORRECT ANSWERS - high
incidence in african americans According to the national digestive diseases information clearing
house there is a "50-90% incidence in Asians, American indians, Arabs, Jews, African
Americans, and Southern Europeans
What are nutritional concerns for children with lactose intolerance? - CORRECT
ANSWERS Not getting enough calcium so some dairy products people can usually
tolerate are hard cheeses and yogurt (Fresh not frozen) and take Vitamin D and K
-bone density; causes problems with bone growth
What multifactorial causes are related to clefting - CORRECT ANSWERS potential causes
of clefting- maternal smoking, advanced maternal age, fever,diabetes, prenatal infection, AMA,
use of certain drugs - anticonvulsants, steroids, and other medications early in pregnancy
feeding with cleating - CORRECT ANSWERS Infants with cleft palate are generally fitted
with a removable orthopedic device (Latham device) to facilitate closure of palate. This device
serves as a feeding plate. Special bottles with nipples (Habermas feeder, Mead Johnson Cleft
Feeder) are also used to facilitate feedings
. Explain teaching for care of the feeding plate, treatment of thrush, and precautions with
compressible squeeze bottles - CORRECT ANSWERS Put medication on mouth piece for
thrush, can't LATCH well so a Breastfeeding consultant needs to be contacted, and with the
Haberman feeder you need to line the lines up with the nose
order following a cleft repair
,will include- - CORRECT ANSWERS Normal Saline to cleanse the suture line q shift and
PRN
"No-No restraints at all times
Feeding plate
Special nipples/bottles (Haberman Feeder or Mead Johnson Cleft Feeder)
Tylenol 15 mg/kg/dose and Codeine 1 mg/kg/dose q 4 - 6 hours PRN for pain- for central
incisional pain
How long must a child with repair to the mouth have nothing put in their mouth? and what kind
of feeder do we use for these children? - CORRECT ANSWERS -2-4 weeks
- Brek feeders
Therapeutic management of cleft lip/palate involves a multidisciplinary team. Which
professionals are members of this team? - CORRECT ANSWERS -seek care at agency
where they do multidisciplinary care; one place where can look at everything Plastic surgeon,
craniofacial specialist, oral surgeon, dentist and/or orthodontist, prosthodontist, psychologist,
otolarygologist, nurse, social worker, audiologist, and speech-language pathologist
OT, PT, Dietary
Why should crying be prevented and how is this accomplished post-op surgical repair of cleft lip
and palate? - CORRECT ANSWERS -crying pulls on suture line; pulls on sutures and can
cause repair to break open
-Avoid damage to repair and have parents request pain medication before the pain gets
bad,comforting
Cleft Palate Repair - CORRECT ANSWERS Generally done about 1 year of age-because
this is when speech production normally happens.
Done before speech production
Infants generally say "mama and dada" around 1 year of age
,-want to wait a year because they have time to grow and can tolerate anesthesia better and more
tissue for the repair.
Explain the difference between Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF) -
CORRECT ANSWERS EA is a blind pouch of the esophagus and TEF is where there is a
hole between the esophagus and the trachea
cleft lip/palate nursing diagnoses - CORRECT ANSWERS -parenting,risk for impaired
- knowledge, deficient
- imbalanced nutrition less than
- impaired gas exchange
- ineffective airway clearance
- ineffective breathing pattern
-pain(acute- post surgical)
ESOPHAGEAL ATRESIA WITHOUT FISTULA - CORRECT ANSWERS Second most
common defect ( 6-8%)
Blind pouch
No communication to the trachea
ESOPHAGEAL ATRESIA WITHOUT FISTULA repair - CORRECT ANSWERS Two-
Stage Repair
1. Gastrostomy to keep the bowel empty of secretions and cervical esophagostomy to handle the
excessive oral secretion
2. Connect the esophagus-reconnect the esophagus.
, ESOPHAGEAL ASTRESIA WITHOUT FISTULA ;what happens - CORRECT
ANSWERS -excess oral secretions
-regurgitation of feedings; undigested food
-blind pouch with no communication to trachea
-no hole
ASSESSMENT OF
ESOPHAGEAL ATRESIA (EA) - CORRECT ANSWERS Excessive salivation and
drooling from inability of secretions to pass through the esophagus
Regurgitation of undigested formula immediately after feeding
NG tube or SXN catheter cannot be passed
EA post-op - CORRECT ANSWERS Postoperatively
Change gauze dressing to cervical esophagostomy to prevent skin breakdown and prevent
infection
Administer gastrostomy feedings only by gravity- this is to protect the surgical repair- so don't
add extra pressure to the site
ESOPHAGEAL ATRESIA WITH DISTAL TEF - CORRECT ANSWERS Most common
type of defect (85-88%)
Blind Pouch
Fistula from the trachea to the lower esophagus- hole btw trachea and esophagus
Distended Abdomen- end up with air in the stomach
ESOPHAGEAL ATRESIA WITH DISTAL TEF Repair - CORRECT ANSWERS One-
Stage Repair
Ligate the fistula and anastamose the esophagus
Patients, NURS 2346 Peds GI, 2345 ACTUAL
QUESTIONS AND CORRECT ANSWERS
Which ethnicity is more prone to lactose intolerance? - CORRECT ANSWERS - high
incidence in african americans According to the national digestive diseases information clearing
house there is a "50-90% incidence in Asians, American indians, Arabs, Jews, African
Americans, and Southern Europeans
What are nutritional concerns for children with lactose intolerance? - CORRECT
ANSWERS Not getting enough calcium so some dairy products people can usually
tolerate are hard cheeses and yogurt (Fresh not frozen) and take Vitamin D and K
-bone density; causes problems with bone growth
What multifactorial causes are related to clefting - CORRECT ANSWERS potential causes
of clefting- maternal smoking, advanced maternal age, fever,diabetes, prenatal infection, AMA,
use of certain drugs - anticonvulsants, steroids, and other medications early in pregnancy
feeding with cleating - CORRECT ANSWERS Infants with cleft palate are generally fitted
with a removable orthopedic device (Latham device) to facilitate closure of palate. This device
serves as a feeding plate. Special bottles with nipples (Habermas feeder, Mead Johnson Cleft
Feeder) are also used to facilitate feedings
. Explain teaching for care of the feeding plate, treatment of thrush, and precautions with
compressible squeeze bottles - CORRECT ANSWERS Put medication on mouth piece for
thrush, can't LATCH well so a Breastfeeding consultant needs to be contacted, and with the
Haberman feeder you need to line the lines up with the nose
order following a cleft repair
,will include- - CORRECT ANSWERS Normal Saline to cleanse the suture line q shift and
PRN
"No-No restraints at all times
Feeding plate
Special nipples/bottles (Haberman Feeder or Mead Johnson Cleft Feeder)
Tylenol 15 mg/kg/dose and Codeine 1 mg/kg/dose q 4 - 6 hours PRN for pain- for central
incisional pain
How long must a child with repair to the mouth have nothing put in their mouth? and what kind
of feeder do we use for these children? - CORRECT ANSWERS -2-4 weeks
- Brek feeders
Therapeutic management of cleft lip/palate involves a multidisciplinary team. Which
professionals are members of this team? - CORRECT ANSWERS -seek care at agency
where they do multidisciplinary care; one place where can look at everything Plastic surgeon,
craniofacial specialist, oral surgeon, dentist and/or orthodontist, prosthodontist, psychologist,
otolarygologist, nurse, social worker, audiologist, and speech-language pathologist
OT, PT, Dietary
Why should crying be prevented and how is this accomplished post-op surgical repair of cleft lip
and palate? - CORRECT ANSWERS -crying pulls on suture line; pulls on sutures and can
cause repair to break open
-Avoid damage to repair and have parents request pain medication before the pain gets
bad,comforting
Cleft Palate Repair - CORRECT ANSWERS Generally done about 1 year of age-because
this is when speech production normally happens.
Done before speech production
Infants generally say "mama and dada" around 1 year of age
,-want to wait a year because they have time to grow and can tolerate anesthesia better and more
tissue for the repair.
Explain the difference between Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF) -
CORRECT ANSWERS EA is a blind pouch of the esophagus and TEF is where there is a
hole between the esophagus and the trachea
cleft lip/palate nursing diagnoses - CORRECT ANSWERS -parenting,risk for impaired
- knowledge, deficient
- imbalanced nutrition less than
- impaired gas exchange
- ineffective airway clearance
- ineffective breathing pattern
-pain(acute- post surgical)
ESOPHAGEAL ATRESIA WITHOUT FISTULA - CORRECT ANSWERS Second most
common defect ( 6-8%)
Blind pouch
No communication to the trachea
ESOPHAGEAL ATRESIA WITHOUT FISTULA repair - CORRECT ANSWERS Two-
Stage Repair
1. Gastrostomy to keep the bowel empty of secretions and cervical esophagostomy to handle the
excessive oral secretion
2. Connect the esophagus-reconnect the esophagus.
, ESOPHAGEAL ASTRESIA WITHOUT FISTULA ;what happens - CORRECT
ANSWERS -excess oral secretions
-regurgitation of feedings; undigested food
-blind pouch with no communication to trachea
-no hole
ASSESSMENT OF
ESOPHAGEAL ATRESIA (EA) - CORRECT ANSWERS Excessive salivation and
drooling from inability of secretions to pass through the esophagus
Regurgitation of undigested formula immediately after feeding
NG tube or SXN catheter cannot be passed
EA post-op - CORRECT ANSWERS Postoperatively
Change gauze dressing to cervical esophagostomy to prevent skin breakdown and prevent
infection
Administer gastrostomy feedings only by gravity- this is to protect the surgical repair- so don't
add extra pressure to the site
ESOPHAGEAL ATRESIA WITH DISTAL TEF - CORRECT ANSWERS Most common
type of defect (85-88%)
Blind Pouch
Fistula from the trachea to the lower esophagus- hole btw trachea and esophagus
Distended Abdomen- end up with air in the stomach
ESOPHAGEAL ATRESIA WITH DISTAL TEF Repair - CORRECT ANSWERS One-
Stage Repair
Ligate the fistula and anastamose the esophagus
