Failure to Thrive
Cleft Lip/Palate
Hypertrophic Pyloric Stenosis
Gastroesophogeal Reflux
Esophageal Atresia/Tracheosophageal Fistula
100
Clinical Manifestations: physical and behavioral
What is (physical): deceleration in grown curve delay in meeting developmental milestones, weakness and decrease in muscle mass (behavioral): irritability and inability to sleep, avoidance of physical contact, withdrawn behavior, repetitive motion e,i rocking, sucking, avoidance of eye contact, "radar gaze", minimal smiling, no fear of strangers.
100
Nursing Care includes the coordination and collaboration of whom?
What is parents, pediatrician plastic surgeon, social worker, orthodontist, otolaryngologist, speech therapist, and perhaps psychologist.
100
What is Hypertrophic Pyloric Stenosis (HPS)?
What is hypertrophy of the circular muscle surrounding the pylorus, constriction of pyloric sphincter with obstruction of gastric outlet, gastric emptying is restricted or blocked.
100
Define gastroesophageal reflux
What is the transfer of gastric contents into the esophagus
100
Description of EA/TF
What is EA: No tracheal connection, just a blind esophagus pouch TF: the failure of the esophagus to develop into a continuous pathway; a fistula or pathway develops from the esophagus to the trachea
200
Diagnostic testing
What is developmental assessment, documented growth failure, dietary intake log, assessment of home environment, Labs (CBC, sweat test, stool analysis, T4), bone scan, upper/lower GI
200
Etiology of Cleft Lip/Palate
What is this occurs during embryonic development, can be due to inherited and environmental factors. No parts are missing, they just need to be fused together.
200
What is a pyloromyotomy?
What is the surgical release of sphincter muscle.
200
Symptoms
What is vomiting, spitting up or regurgitation in infants; excessive irritability; weight loss; failure to thrive; respiratory problems; can develop esophagitis, strictures, pneumonia due to aspiration
200
Signs and Symptoms
What is excessive salvation or blowing bubbles; 3 C's: Coughing, Choking, Cyanosis; apnea; RD if undetected and infant is fed
300
Plan of Care
What is document childs eating patterns and food log, assess food likes and dislikes, increase intake as tol, monitor I&O, offer frequent small portions, assess parent and child interaction.
300
Main risks for infant with Cleft Lip/Cleft Palate?
What is aspiration and feeding difficulties
300
HPS Diagnostics
What is history and physical; ultrasound; upper GI radiography; Labs
300
Nursing Assessments for a child/infant with GER
What are: when vomiting started; type of formula; type of vomiting (undigested, color); feeding techniques (positioning, frequency); infants eating in general
300
Interventions
Main goal is to prevent aspiration! Initiate parenteral fluids either with a peripheral line or an umbilical line; psychosocial support for parents to prepare for immediate surgery; keep infant NPO to prevent aspiration; naso-gastric tube to suction; elevate head of bed.
400
Family teaching for a child with Failure to Thrive
What is document diet and weights, provide positive feedback to child and family, initiate referrals as needed: home care, social services
400
What are the feeding issues presented in an infant with Cleft Palate?
What is inability to suck, which interferes with breastfeeding and traditional bottle feeding; special feeders and nipples requiring less suction may be required; infant should be fed in upright position.
400
Clinical Manifestations
What is PROJECTILE VOMITING, can project up to 3 feet; olive shaped mass in the RUQ; irritability and hunger, hypoactive bowel sounds, minimal stool; visible gastric peristaltic waves that move from let to right across the epigastrium
400
Diagnostics for GER
What is through H&P or endoscopy
400
Surgical Management
What is surgeon ligates the TE and then performs an end-to-end anastomosis of the esophagus, depending on the type of TE, several successive surgeries may be required for full repair
500
Steps to initiate during feedings
What is provide a primary core of staff to feed child; provide quite, unstimulating atmosphere; maintain a calm, even temperament throughout the meal; talk to child by giving directions about eating; be persistent; maintain face-to-face posture when possible; introduce new foods slowly; follow the child's rhythm of feeding; develop a structured routine
500
Cheiloplasty - what is it and when it's performed
What is closure of the lip, a z-plasty (staggered suture line) done at 6-12 weeks. Following procedure, a Logan's bow is used to protect the suture line.
500
HPS Management
What is to recognize symptoms early; parenteral fluids to manage dehydration; manage alkalosis, assess ABG's; prepare for surgery
500
Possible medications and what their effects are
What are Tagamet, Pepcid, Zantac; may be utilized to decrease stomach acidity and increase tone in the lower esophageal sphincter
500
Post-Op Care
What is: prevent aspiration; elevate HOB; NGT to low intermittent suction; maintain chest tube if thoracotomy is done; pain management; infection prevention; G-tube feedings; gradual introduction of clear fluids.
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