1
any infant with unexplained frothy saliva in the mouth and unexplained episodes of cyanosis
esophageal atresia
what is the difference in GER and GERD
GER =regurgitation of the gastric contents back into the esophagus
GERD = results in tissue damage, becomes a disease when complications occur
describe a celiac crisis
sudden accumulation of glutamine and destruction of mucosa cells
causes severe vomiting and diarrhea to gluten
A newborn is suspected to have esophageal atresia. Which of the following findings would the nurse expect? Select all that apply:
A. Coughing and choking during feeding
B. Polyhydramnios in the mother’s history
C. Abdominal distention
D. Projectile vomiting
E. Excessive oral secretions
Correct Answers: A, B, C, E
Rationale:
A: Coughing and choking occur due to the esophagus ending in a blind pouch.
B: Polyhydramnios is common in pregnancy with EA because the fetus cannot swallow amniotic fluid.
C: If a tracheoesophageal fistula is also present, air may enter the stomach, leading to abdominal distention.
E: Secretions accumulate due to inability to swallow.
D: Projectile vomiting is more characteristic of pyloric stenosis, not EA.
7-12 weeks gestation via ultrasound
what are the cardinal signs of esophageal atresia
chocking, cyanosis, and coughing WITH feeding
what are some signs of GERD
frequent back arching, failure to thrive, recurrent otitis media, hiccuping, aspiration pneumonia or asthma can happen, vomiting or spitting up after a meal
severe = hematemesis or melena and anemia
MAINTAIN PATENT AIRWAY
how do we diagnose celiac disease
immunoglobulin a deficiency
IgG
Jejunal biopsy for ulcers in GI
monitor reactions to gluten-free diet - symptoms should relieve 1 week after new diet
The nurse is caring for a neonate with a confirmed tracheoesophageal fistula. What is the priority nursing intervention?
A. Administer formula via nasogastric tube
B. Position the infant supine
C. Maintain NPO status and initiate suction
D. Encourage frequent breastfeeding
Correct Answer: C. Maintain NPO status and initiate suction
Rationale:
Feeding is contraindicated due to the risk of aspiration. Suctioning is essential to prevent accumulation of secretions and aspiration pneumonia. The infant should be NPO and placed at a 30–45° angle (semi-upright), not supine, to reduce aspiration risk.
if my infant weighed 11kg how much fluid is required?
1050mL
<10kg = 100mL/kg
10-20kg = 1000mL + 50mL/kg for each additional kg
>20kg = 1500mL + 20mL/kg
what is
congenital abnormality from embryonic failure (supposed to develop at 4-6) leads to fluid filling the lungs or air accumulating in the stomach from the fistula
- can lead to aspiration pneumonia or severe aspiration
EA with TEF
what is the gold standard for diagnosing GERD
24 hour intraesophageal pH monitoring study
what causes projectile vomiting, nonbilious begins 3 months after birth, may become blood-tinged
pyloric stenosis
other symptoms: hungry even after being fed, dehydration (monitor daily weights), irritabile, palpable olive like mass in RUQ
A newborn has a cleft lip and is scheduled for surgical repair. Which nursing action is most important in the preoperative period?
A. Use a regular bottle with a slow-flow nipple for feeding
B. Position the infant flat after feeding
C. Monitor weight and nutritional intake
D. Suction the oropharynx frequently after feeding
Correct Answer: C. Monitor weight and nutritional intake
Rationale:
Infants with cleft lip/palate have difficulty feeding, which puts them at risk for poor weight gain and malnutrition. Monitoring intake and weight ensures the baby is in optimal health before surgery. Special bottles/nipples may be used, and feeding upright reduces aspiration risk. Frequent suctioning is not routine unless there's excessive secretion.
what is the minimum urine output by age
infant and toddlers = 2-3mL/kg/h
preschoolers and young school children = 1-2mL/kg/h
school age and adolescents = 0.5-1mL/kg/h
what can EA with TEF lead to in the future
GERD
how should we position someone with GERD
prone helps to reduce reflux BUT
supine for infants younger than 12 months to reduce the risk of SIDs
HOB elevated - but not too elevated
treatment for pyloric stenosis
may need surgery to help with hydration
Pre-Op: NPO, weight, IV fluids, vital signs, elevate HOB, NG tube maintenance, respiratory status
Post-Op: monitor for infection, remove NG within 24 hours, advance diet, home care, incision site, small sips than advance as ordered
Postoperative care for an infant after cleft lip repair includes which of the following nursing interventions?
A. Position the infant prone to protect the incision site
B. Clean the surgical site with hydrogen peroxide
C. Use elbow restraints to prevent injury to the surgical site
D. Feed the infant using a spoon to avoid bottle use
Correct Answer: C. Use elbow restraints to prevent injury to the surgical site
Rationale:
Elbow restraints prevent the infant from touching or disrupting the suture line. The infant should be positioned supine or side-lying, not prone. Hydrogen peroxide can irritate tissue; gentle cleaning with prescribed solutions is preferred. Spoons may cause trauma; specialized bottles or syringes are used.
describe differences in isonatremic dehydration, hyponatremic dehydration, and hypernatremic dehydration
isonatremic = electrolytes are lost and water is lost in equal amounts
sodium is NORMAL 135-145
hyponatremic = dehydration occurs when electrolytes loss is greater than water deficit, may have hypovolemic shock
sodium is <135
hypernatremic = dehydration results from water loss in excess electrolyte loss
sodium is >150, NO RAPID IV FLUID = can cause cerebral edema
nursing considerations for EA with TEF
monitor for dehydration - sunken fontanels
NG with aspiration q 5-10 minutes to empty the stomach
NPO until repair occurs - will need to wait until esophagus has grown enough to reach the stomach
infant needs to be in warmer with humidified air
HOB 30 degrees
medications/treatment for GERD
PPI - omeprazole, pantoprazole
H2 receptor antagonist - famotidine, ranitidine (decrease acid secretion)
erythromycin to improve esophageal peristalsis and gastric emptying
surgery as needed - fundalocation to tighten sphincter and prevent reflux
may need g tube to help with gastric decompression
pacifiers help with crying and encourage swallowing
A 6-week-old infant is brought to the clinic with a history of projectile vomiting after feedings. The nurse notes a palpable olive-shaped mass in the upper abdomen. Which of the following is the priority nursing intervention?
A. Reassure the parents that vomiting is normal in infants
B. Start oral rehydration therapy
C. Prepare the infant for surgery
D. Feed the infant slowly and burp frequently
Correct Answer: C. Prepare the infant for surgery
Rationale:
Projectile vomiting and a palpable olive-shaped mass are hallmark signs of hypertrophic pyloric stenosis. This condition requires surgical correction (pyloromyotomy). Rehydration may be needed pre-op, but surgery is the definitive treatment. Feeding should be stopped until surgical intervention is complete.
Which of the following foods is appropriate for a 6-month-old infant starting solid foods?
A. Honey
B. Whole milk
C. Iron-fortified rice cereal
D. Chopped grapes
Correct Answer: C. Iron-fortified rice cereal
Rationale:
Iron-fortified rice cereal is often the first solid food introduced around 4–6 months. Honey is avoided until after 1 year due to the risk of infant botulism. Whole milk is not recommended until 12 months. Grapes are a choking hazard.
A toddler with vomiting and diarrhea has been diagnosed with moderate dehydration. What is the priority nursing action?
A. Administer an antiemetic
B. Encourage clear fluids like juice and soda
C. Begin oral rehydration therapy with an electrolyte solution
D. Start IV fluids immediately
Correct Answer: C. Begin oral rehydration therapy with an electrolyte solution
Rationale:
For mild to moderate dehydration, oral rehydration therapy (ORT) is the preferred treatment using solutions like Pedialyte. IV fluids are reserved for severe dehydration or if the child cannot tolerate oral fluids. Juice and soda can worsen diarrhea due to high sugar content.