347 Questions
At what age does the peak incidence of GER occur?
4 months
When does GER generally resolve spontaneously in most infants?
After 12 months of age
What is the medication of choice for pinworm treatment?
Mebendazole
What percentage of children in temperate climates can be infected with Enterobius vermicularis?
30%
What is a common method for diagnosing pinworms?
Tape test
What is a key preventive measure for pinworm transmission?
Hand hygiene
What is a notable adverse effect of pyrantel pamoate?
Stains stool and vomitus bright red
What should be emphasized in nursing care for pinworms?
Clear instructions for the tape test
What is a key aspect of preventing giardiasis?
Education on sanitation practices
What is a distinctive feature of nitazoxanide in comparison to metronidazole and tinidazole?
Has no bitter taste
What is a common mode of pinworm transmission?
Hand-to-mouth
What is a recommended practice to prevent pinworm reinfection?
Washing clothes and bed linens in hot water
What should families be informed about regarding pinworm recurrence?
It is common and should be treated in the same manner as the initial infection
What is a notable adverse effect of metronidazole and tinidazole?
Cause metallic taste and GI adverse effects
Which diagnostic evaluation method is NOT mentioned for gastroesophageal reflux?
Esophageal manometry
What is the most common surgical procedure for children with severe complications of gastroesophageal reflux?
Nissen fundoplication
Which feeding maneuver is mentioned as potentially improving mild gastroesophageal reflux symptoms in infants?
Thickened feedings
What is the primary cause of inflammation and reactive airway disease in gastroesophageal reflux?
Inappropriate transient relaxation of the lower esophageal sphincter (LES)
What is a potential complication of gastroesophageal reflux in children?
Esophageal stricture
What is the recommended sleeping position for infants to minimize reflux, considering the risk of sudden infant death syndrome?
Supine position
What is a potential pharmacological therapy for treating infants and children with gastroesophageal reflux disease (GERD)?
H2-receptor antagonists
What is the primary pathophysiology of gastroesophageal reflux?
Inappropriate transient relaxation of the lower esophageal sphincter (LES)
What is a potential lifestyle modification for managing gastroesophageal reflux?
Smoking cessation
What is a potential complication of the Nissen fundoplication surgical procedure?
Dysphagia
What is a potential clinical manifestation of gastroesophageal reflux symptoms in infants?
Excessive crying
What is a potential therapeutic option for managing gastroesophageal reflux depending on its severity?
Lifestyle modifications
What are some simple measures to help parents cope with frequent spitting up in infants with GERD?
Using bibs and prone positioning
What is the most frequent infection in the world in terms of intestinal parasitic diseases?
Giardiasis
What is the potential transmission route for giardiasis?
Contaminated water, food, and person-to-person contact
How can the diagnosis of giardiasis be made?
Microscopic examination of stool specimens or duodenal fluid
Which medication for treatment of giardiasis is said to have an 80 to 100% cure rate after a single dose?
Tinidazole
What is a possible intervention for severe cases of regurgitation and growth restriction in infants with GERD?
NG tube or gastrostomy feedings
What is the cause of giardiasis?
Protozoan Giardia lamblia
What is the incidence trend of intestinal parasitic diseases, especially giardiasis, among young children in day care centers in Canada?
Increased
What is the role of parents in pediatric nursing care for GERD?
Identification of symptoms and parent education on home care
What are the symptoms of giardiasis?
Abdominal cramps and diarrhea
What are the possible interventions for parents to cope with GERD in infants?
Positioning, avoiding feeding spicy foods, and scheduling more frequent feeding times
What are the possible medications for treatment of giardiasis?
Metronidazole, tinidazole, paromomycin, and nitazoxanide
What is the peak age range for children with appendicitis?
10-18 years
What is the most common cause of obstruction in appendicitis?
Fecalith
What is a potential complication of appendiceal perforation?
Partial bowel obstruction
What is the classic first symptom of appendicitis?
Periumbilical pain
Which medication is indicated for induction therapy in children with moderate to severe UC and CD?
Mesalamine
What is the primary goal of any treatment regimen for UC and CD?
Maintain remission over time
Which medication is designed for controlled release in the ileum and is indicated for ileal and right-sided colitis?
Budesonide
Which immunomodulator is used to induce and maintain remission in children with IBD who are steroid resistant or steroid dependent?
Azathioprine
Which medication is used to treat left-sided colitis with suppository and enema preparations?
Mesalamine
Which medication has been shown to be effective in inducing remission in severe steroid-dependent UC?
Cyclosporine
Which medication is indicated for induction and maintenance therapy in left-sided colitis?
Rectal steroid therapy
Which medication blocks the synthesis of purine, thus inhibiting the ability of DNA and RNA to hinder lymphocyte function?
Azathioprine
What is the preferred imaging tool for diagnosing pediatric appendicitis?
Ultrasound
Which diagnostic evaluation method is NOT mentioned for pediatric appendicitis?
Endoscopy
What is the most common surgical procedure for treating pediatric appendicitis?
Laparoscopic surgery
What is a key sign of peritonitis in pediatric patients with appendicitis?
Sudden pain relief after perforation
What is the primary treatment for pediatric appendicitis before perforation?
Rehydration, antibiotics, and appendectomy
What is a common nonoperative treatment for ruptured pediatric appendicitis?
IV antibiotics and oral antibiotics post-discharge
What is the role of antibiotics in the management of pediatric appendicitis?
To lower postoperative complications
What is a key aspect of postoperative care for pediatric appendicitis?
IV fluids and continued antibiotics
What is crucial in the assessment of abdominal pain in nonverbal children with suspected appendicitis?
Abdominal pain assessment
What can the loss of extracellular fluid (ECF) to the peritoneal cavity lead to in pediatric patients with appendicitis?
Electrolyte imbalance and hypovolemic shock
What is the gold standard imaging tool for diagnosing pediatric appendicitis?
CT scanning
What is a notable complication of pediatric appendicitis?
Peritonitis
What is the standard treatment for Meckel diverticulum?
Surgical removal
What is an essential part of routine assessment for postoperative care of nonperforated appendix?
Regular bowel sound checks
What is the primary cause of excoriation around the surgical site?
Frequent dressing changes
What is the recommended approach to prevent complications associated with prolonged bed rest postoperatively?
Early ambulation with adequate pain management
What is the standard diagnosis approach for Meckel diverticulum?
Specialized radiographic study
What is the primary cause of Meckel diverticulum?
Fetal omphalomesenteric duct remnant
What is the standard care for a ruptured appendix and peritonitis?
IV fluids, NPO, and NG tube with low continuous gastric decompression
What is a potential consequence of inadequate skin care postoperatively?
Delayed wound healing
What is the primary preventive measure for complications associated with prolonged bed rest postoperatively?
Early ambulation with adequate pain management
What percentage of the Canadian population is affected by Inflammatory Bowel Disease (IBD)?
0.7%
Which type of IBD primarily affects the colon and rectum?
Ulcerative colitis (UC)
What is the primary characteristic of Crohn disease (CD) in terms of inflammation?
Transmural inflammation
What is the aim of therapeutic management for IBD?
Control the inflammatory process, achieve long-term remission, promote healthy growth, and maintain a balanced lifestyle
What is a significant challenge in pediatric CD?
Growth failure
What has been observed in relation to breastfeeding and the risk of developing CD?
Breastfeeding decreases the risk of developing CD
What type of immune process characterizes Crohn disease (CD)?
Chronic immune process with a T-helper-1 cytokine profile
What is a key characteristic of ulcerative colitis (UC) in terms of immune response?
Response is more humoral and mediated by T-helper-2 cells
What is the course of IBD characterized by?
Unpredictable, with flare-ups severely impairing physical and social functioning
What age group is at the highest risk of IBD diagnosis?
Adolescents and young adults
What is the etiology of IBD considered to be?
Multifactorial, involving genetic predisposition, defective immunoregulation, and environmental factors
What is the primary difference between ulcerative colitis (UC) and Crohn disease (CD)?
Location and nature of inflammation
What is a common cause of growth failure in children with Crohn's Disease (CD)?
Inadequate dietary intake due to anorexia and increased disease activity
What is a potential consequence of inadequate dietary intake in children with IBD?
Delayed sexual maturation and restricted height
What is a factor contributing to malnutrition in children with IBD?
Medication–nutrient interaction leading to excessive nutrient absorption
What is a potential consequence of excessive GI losses in children with IBD?
Excessive nutrient loss leading to malnutrition
Which medication is not effective in infants for peptic ulcer disease (PUD)?
Omeprazole
What is the standard first-line treatment for H. pylori in peptic ulcer disease (PUD)?
Triple-medication therapy
What is a common adverse effect of medications for peptic ulcer disease (PUD)?
Diarrhea
What is the most common form of acute viral hepatitis?
Hepatitis A
How is Hepatitis A primarily spread?
Through the fecal-oral route
What is the likelihood of infants developing jaundice due to HAV infection?
1 in 12
Does HAV infection result in chronic infection or chronic liver disease?
No
What is the standard first-line treatment for HAV infection?
HAV vaccine
What is the long-term prognosis for peptic ulcer disease (PUD)?
Variable, with many ulcers treated successfully but some recurring
What is the role of nursing care for peptic ulcer disease (PUD)?
Promoting healing through medication adherence and considering stress as a factor in ulcer formation
What can cause hepatitis?
Viral infections, metabolic conditions, and immune-mediated diseases
Is proton pump inhibitor (PPI) therapy effective in infants for peptic ulcer disease (PUD)?
No
Which of the following is a significant cause of ulcers, weakening the gastric mucosal barrier and allowing acid to damage the mucosa?
Helicobacter pylori infection
What is the primary cause of gastric ulcers induced by exogenous factors like Aspirin and NSAIDs?
Inhibition of prostaglandin synthesis
Which syndrome may occur in children with multiple, large, or recurrent ulcers?
Zollinger-Ellison syndrome
What is the primary diagnostic method for detecting Helicobacter pylori infection in pediatric peptic ulcer disease?
Upper endoscopy and biopsy
What is the primary focus of therapeutic management for pediatric peptic ulcer disease?
Preventing recurrence
What is the primary medical management for reducing or neutralizing gastric acid secretion in pediatric peptic ulcer disease?
Histamine (H2) receptor antagonists
Which age group is primary ulcers more common in?
Children older than 10 years
What is the primary pathophysiological imbalance involved in the development of peptic ulcers?
Imbalance between destructive and defensive factors in the GI tract
What is the primary cause of secondary ulcers in infants and children with underlying diseases or taking certain medications?
Underlying diseases
What percentage of children in North America are diagnosed with peptic ulcer disease (PUD)?
1.8 to 5%
What are the factors contributing to ulcer formation in pediatric peptic ulcer disease?
Ulcerogenic medications
What is a notable characteristic of primary ulcers in children with pediatric peptic ulcer disease?
More common in children older than 10 years
Which nutritional support is recommended for children with adequate oral intake in Inflammatory Bowel Disease (IBD)?
Parenteral nutrition with high-protein, high-calorie diet
What has been shown to improve nutritional status and induce disease remission in Inflammatory Bowel Disease (IBD) patients?
Oral elemental formulas
What is the long-term complication of Inflammatory Bowel Disease (IBD) that requires surveillance colonoscopies?
Colorectal cancer
What is a questionable dietary choice for active Inflammatory Bowel Disease (IBD)?
Bran or high-fiber diets
What is the less likely outcome of Total Parenteral Nutrition (TPN) in ulcerative colitis (UC) compared to Crohn's disease (CD)?
Inducing remission
What is a surgical option for Ulcerative Colitis (UC)?
Subtotal colectomy with ileostomy
What is a surgical option for Crohn's Disease (CD)?
Segmental intestinal resections
What is a crucial nursing consideration in managing Inflammatory Bowel Disease (IBD)?
Guidance on diet and coping with stress
What is a potential long-term complication of Inflammatory Bowel Disease (IBD) that requires surveillance colonoscopies?
Colorectal cancer
What is a crucial nursing role in managing Inflammatory Bowel Disease (IBD)?
Explaining the purpose and expected outcomes of nutritional therapies
How is Peptic Ulcer Disease (PUD) described in terms of location?
Duodenal and primary
What is a recommended nursing consideration for Peptic Ulcer Disease (PUD)?
Guidance on smoking cessation
What is the incubation period for hepatitis E?
2 to 9 weeks
Which hepatitis infection has an incubation period of 45 to 160 days?
Hepatitis B
What is the primary route of transmission for hepatitis D?
Parenteral transmission
What is the recommended vaccination strategy for hepatitis A for infants less than 6 months?
Immunoglobulin
Which region has high prevalence of hepatitis B?
Africa
What is the average incubation period for hepatitis C?
7 to 9 weeks
Which hepatitis infection is absent in Canada, the United States, and Western Europe?
Hepatitis E
What is the primary risk factor for acquiring HCV?
Injection drug use
What is the primary route of transmission for HBV infection?
Parenteral transmission
Which type of hepatitis infection is more severe than HBV infection?
Hepatitis D
What is the primary preventive measure for HBV infection in newborns at risk?
Universal vaccination
Which population is hepatitis D primarily endemic in?
Africa
What percentage of affected children with cleft lip and palate (CL/P) are male?
70-90%
At what gestational age does fetal ultrasonography become reliable for prenatal diagnosis of cleft lip and palate (CL/P)?
13-14 weeks
When is surgical repair of cleft lip (CL) typically performed?
2-3 months
What maternal factors are linked to cleft lip and palate (CL/P)?
Alcohol, smoking, and obesity
What is the primary cause of cleft deformities?
Genetic defect in cell migration
When is surgical repair of cleft palate (CP) typically performed?
6-9 months
How many newborns in Canada are affected by cleft lip and palate (CL/P) annually?
600
What percentage of cleft deformities occur with a recognized syndrome?
70-80%
When are unilateral clefts more common than bilateral clefts?
In all ethnic groups
At what age does cleft lip (CL) become apparent?
At birth
What portion of the palate consists of the remaining hard and soft palate?
Secondary portion
What is the primary management approach for cleft palate (CP)?
Surgical repair
What is the primary cause of liver failure and liver transplant for Canadian children?
Biliary atresia
How is acute hemorrhage of varices managed in children with liver cirrhosis?
IV fluids, blood products, vasopressin, and gastric lavage
What is the primary treatment for ascites in children with liver cirrhosis?
Sodium restriction and diuretics
What is the suggested cause of the progressive inflammation leading to complete obliteration of the bile ducts in biliary atresia?
Immune mechanisms or viral injury
What has revolutionized the approach to liver cirrhosis in Canadian children?
Liver transplantation
Which type of liver transplantation has been associated with better survival outcomes in children?
Living donor transplantation
What is the primary treatment for hepatic encephalopathy in children with liver cirrhosis?
Limiting ammonia formation and absorption with medications like neomycin and lactulose
What is the primary consequence of portal hypertension in children with liver cirrhosis?
Esophageal and gastric varices
What is crucial for the nutritional support of children with liver cirrhosis and malnutrition?
Fat-soluble vitamins and minerals supplements
What has decreased the wait time for liver transplantation in children?
Reduced-sized grafts
What is the primary nursing emphasis for children with liver cirrhosis?
Prevention of infection
What is the primary goal of liver cirrhosis treatment in children?
Prolonging survival
Which factor is NOT mentioned as a cause of articulation errors in children with cleft lip and palate (CL/P)?
Nasal congestion
What is commonly used to drain the middle ear and prevent hearing impairment in children with CL/P?
Myringotomy tubes
What is a primary focus of nursing care for newborns with CL/P?
Feeding difficulties and emotional support for parents
What is linked to growth failure in infants with CL/P?
Preoperative feeding difficulties
Which feeding method is protective against otitis media in infants with CL/P?
Breastfeeding
What is available to assist with feeding infants with CL/P?
Cleft Lip/Cleft Palate Nurser and Special Needs Feeder
What may infants with CL/P tend to swallow excessive of during feedings?
Air
What may not improve feeding efficiency or growth in infants with CL/P within the first year of life?
Feeding obturators
What can help infants with CP feed efficiently?
Positioning, bottle selection, and supportive techniques
What is a potential consequence of feeding obturators in infants with CL/P?
No improvement in feeding efficiency
What is a potential challenge for children with CL/P?
Social adjustment and self-image
What can lead to recurrent ear infections and scarring of the tympanic membrane in children with CL/P?
Inefficient eustachian tube function
What is the primary treatment for Biliary Atresia (BA)?
Hepatic portoenterostomy (Kasai procedure)
What is the aim of the Kasai procedure for Biliary Atresia (BA)?
To establish bile drainage
What is the survival rate with native liver at 10 years of age if the Kasai procedure is done before 30 days of age for Biliary Atresia (BA)?
Around 49%
What is the primary cause of cleft lip (CL) and cleft palate (CP)?
Failure of fusion of facial structures during embryonic development
What is the association of cleft palate (CP) with deformed dental structures?
CP involves the soft and hard palates
What is the potential long-term outcome of Biliary Atresia (BA) despite the Kasai procedure?
Progressive cirrhosis
What is the role of ursodeoxycholic acid in the medical management of Biliary Atresia (BA)?
To decrease cholestasis and treat hypercholesterolemia
What is the potential consequence of untreated Biliary Atresia (BA) in children?
Progressive cirrhosis and death
What is a common presentation of Biliary Atresia (BA) in infants?
Dark urine
What is a common challenge in children with Biliary Atresia (BA) that requires close nursing attention?
Growth failure
What is a key aspect of nursing care for children with Biliary Atresia (BA) postoperatively?
Supporting the family and educating them about the treatment plan
What is a potential consequence of Kasai failure in Biliary Atresia (BA)?
Progressive cirrhosis
Which of the following is a potential consequence of cirrhosis in children?
Impaired pulmonary function due to pressure against the diaphragm
What is a key goal of managing cirrhosis in children?
Monitoring liver function and managing specific complications
What is a common clinical manifestation of cirrhosis in children?
Jaundice and poor growth
What is an important consideration for therapeutic management of cirrhosis in children?
Assessment of the child’s degree of liver dysfunction for transplantation evaluation
What is a potential cause of cirrhosis in children?
Viral infection
Which manifestation may be present in children with impaired intrahepatic blood flow due to cirrhosis?
Ascites
What is a potential consequence of impaired pulmonary function in children with cirrhosis?
Dyspnea
What is a primary goal of managing cirrhosis in children?
Monitoring liver function
What is the most common esophageal malformation?
Esophageal atresia
Which syndrome is often associated with EA/TEF?
Down syndrome
What is the acronym for syndromes involving a combination of Vertebral, Anorectal, Cardiovascular, TracheoEsophageal, Renal, and Limb abnormalities?
VACTERL
What is the most frequently occurring anomaly with EA/TEF?
Cardiac anomalies
What is the most common form of Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)?
Proximal esophageal segment terminating in a blind pouch, and the distal segment connected to the trachea by a short fistula
What is the diagnostic evaluation for EA and TEF based on?
Radiographic studies and clinical manifestations
What percentage of infants with EA have tracheomalacia?
Up to 75%
What are signs of significant tracheomalacia in infants with EA?
Barking cough and cyanosis
What is the primary therapeutic management for EA and TEF?
Surgical repair of the anomaly
In what percentage of infants with EA is significant tracheomalacia present?
Up to 20%
What is the aim of surgical correction for EA and TEF?
To restore normal tracheoesophageal anatomy and function
What is the preferred procedure for infants who are preterm, have multiple anomalies, or are in poor condition?
Staged procedure involving palliative measures
What is the primary factor determining the prognosis for EA and TEF?
Presence and severity of associated anomalies
What is a possible complication in infants with EA and TEF?
Pneumonia
What is the primary aim of therapeutic management for EA and TEF?
To restore normal tracheoesophageal function
What is the preferred surgical approach for correcting EA and TEF?
Open surgical repair
Which condition is associated with the covered herniation of abdominal organs, often with other defects?
Omphalocele
What is the primary nursing emphasis for children with esophageal atresia/tracheoesophageal fistula (EA/TEF)?
Feeding assistance
What is the primary cause of growth failure in children with gastroschisis?
Malnutrition
What is the most common type of hernia in boys?
Inguinal hernia
What is the primary goal of preoperative nursing care for infants with abdominal wall defects?
Thermoregulation
What is the primary cause of reactive airway disease in children with EA/TEF?
GER
What is the primary focus of therapeutic management for infants with gastroschisis?
Surgical closure
Which condition involves the uncovered herniation of bowel with a lower likelihood of associated anomalies?
Gastroschisis
What is the primary consequence of prolonged NPO status or lack of oral stimulation in infants with esophageal atresia/tracheoesophageal fistula (EA/TEF)?
Feeding difficulties
What is the primary focus of nursing care for infants requiring esophageal replacement?
Feeding assistance
What is the primary consequence of feeding obturators in infants with cleft lip/palate (CL/P)?
Feeding difficulties
What is the primary manifestation of tracheomalacia as a complication of esophageal atresia/tracheoesophageal fistula (EA/TEF)?
Reactive airway disease
What is a common complication of primary repair for esophageal atresia and tracheoesophageal fistula?
Anastomotic leak
What is the most common cause of death in newborns with esophageal atresia and tracheoesophageal fistula?
Extreme prematurity
What is the primary purpose of routine esophageal dilation in the management of esophageal strictures?
Treating strictures resulting from tension or ischemia
What is a key consideration in the discharge education for infants with repaired esophagus?
Feeding techniques in a semi-upright position
What is the most desirable position for a newborn with typical esophageal atresia and tracheoesophageal fistula?
Supine with the head elevated on an inclined plane of at least 30 degrees
What is a potential indication for fundoplication in infants with esophageal atresia and tracheoesophageal fistula?
Feeding difficulties and GER
What is a crucial factor in the prognosis of esophageal atresia and tracheoesophageal fistula?
Birth weight
What is a common consequence of inadequate growth in infants with esophageal atresia and tracheoesophageal fistula?
Feeding difficulties
What is crucial for early detection of esophageal atresia and tracheoesophageal fistula?
Clinical suspicion
What is a common complication in preterm low-birth-weight infants with associated anomalies?
High incidence of complications
What is a primary consideration in the postoperative care of infants with esophageal atresia and tracheoesophageal fistula?
Respiratory assessment and airway management
What is a potential cause of feeding difficulties in infants with esophageal atresia and tracheoesophageal fistula?
Dysphagia
Which condition is characterized by projectile nonbilious vomiting, dehydration, metabolic alkalosis, and growth failure in the first 2 to 5 weeks of life?
Pyloric stenosis
Which congenital obstruction usually appears in the newborn period?
Atresia
What is the primary cause of obstruction in hypertrophic pyloric stenosis?
Thickening of pyloric sphincter muscle
Which group is more commonly affected by hypertrophic pyloric stenosis?
Boys
What is the primary method for diagnosis of hypertrophic pyloric stenosis?
Ultrasound
What is the standard treatment for hypertrophic pyloric stenosis?
Pyloromyotomy
What is a common symptom of hypertrophic pyloric stenosis?
Vomiting
What is a key focus of preoperative care for hypertrophic pyloric stenosis?
Hydration and electrolyte balance
What is a crucial aspect of postoperative care for hypertrophic pyloric stenosis?
Hygienic care and protection from infections
What is the primary role of nursing care in hypertrophic pyloric stenosis?
Observation of vital signs and hydration status
What is a notable risk factor for hypertrophic pyloric stenosis?
Maternal smoking
What is a common outcome for infants with hypertrophic pyloric stenosis if diagnosed early?
Rapid recovery
What is a primary consideration in the surgical management of hypertrophic pyloric stenosis?
Pyloromyotomy
What is a crucial aspect of parental involvement in the care process for hypertrophic pyloric stenosis?
Providing emotional support
What is a key focus of postoperative care for hypertrophic pyloric stenosis?
Hygienic care and protection from infections
What is a common method for managing dehydration in infants with hypertrophic pyloric stenosis?
Oral rehydration therapy
What is the most common cause of intestinal obstruction in children between the ages of 5 months and 3 years?
Intussusception
What is the success rate of nonoperative reduction in cases of intussusception?
80 to 95%
What is the primary diagnostic method for confirming intussusception?
Ultrasound
What is the standard treatment for intussusception if nonoperative reduction is unsuccessful?
Surgery
What is the primary aim of postoperative care for infants after surgery?
Preventing infection
What is the most common cause of death in newborns with esophageal atresia and tracheoesophageal fistula?
Aspiration pneumonia
What is the primary cause of cleft lip and cleft palate?
Maternal smoking
What is the primary focus of nursing care for infants requiring esophageal replacement?
Nutritional support
What is the primary characteristic of Crohn's disease in terms of inflammation?
Continuous inflammation
What is the primary aim of therapeutic management for esophageal atresia and tracheoesophageal fistula?
Preventing aspiration
What is a potential clinical manifestation of gastroesophageal reflux symptoms in infants?
Irritability
What is the primary cause of reactive airway disease in children with esophageal atresia and tracheoesophageal fistula?
Gastroesophageal reflux
What is the definitive diagnostic procedure for malrotation and volvulus?
Upper GI series
What is the primary treatment for malrotation?
Surgery
What are the symptoms that may be present in infants with malrotation?
Bilious vomiting, recurrent abdominal pain, lower GI bleeding
What is the classification basis for anorectal malformations?
Gender and anatomical features
What is the diagnostic evaluation for anorectal malformations primarily focused on?
Inspecting the perineal area for anomalies
What is a potential complication associated with surgery for malrotation?
Short-bowel syndrome
What is the primary nursing intervention for infants with malrotation preoperatively?
NG tube insertion
What is a potential consequence of anorectal malformations?
Urinary incontinence
What is a common presentation of imperforate anus?
Abnormal communications from the rectum
What is the ratio of occurrence of anorectal malformations between male and female infants?
2:1
What is the potential life-threatening complication of malrotation if not promptly diagnosed and treated?
Volvulus
What is the potential consequence of malrotation and volvulus if not promptly diagnosed and surgically treated?
Short-bowel syndrome
What is the primary surgical treatment for perineal fistulas in newborns with anorectal malformations?
Anoplasty
What may indicate the presence of rectourinary fistulas in newborns with anorectal malformations?
Meconium in the urine
What is the primary method to identify anal stenosis in older children with anorectal malformations?
History of difficult defecation and ribbonlike stools
Which procedure may be required if the rectum is unidentifiable by the posterior approach in anorectal malformations surgery?
Laparotomy
What is the primary factor influencing the long-term prognosis of anorectal malformations?
Type of defect, sacral anatomy, and muscle quality
What is the primary method for successful treatment of anal stenosis?
Manual dilations
Which imaging technique is performed to determine the existence of other malformations in newborns with anorectal malformations?
Abdominal ultrasonography
What is the primary nursing role in managing anorectal malformations in newborns?
Providing postoperative care and support for families
What is the primary surgical procedure for correcting anorectal malformations in newborns with perineal fistulas?
Anoplasty
What is the primary preoperative care for newborns with anorectal malformations undergoing posterior sagittal anorectoplasty (PSARP)?
Irrigation of the distal stoma
What is the primary method to manage perineal fistulas in newborns with anorectal malformations?
Anoplasty
What is the primary surgical treatment for anorectal malformations that cannot be corrected by the posterior approach?
Laparotomy
Which of the following is a condition classified as an absorptive defect in malabsorption syndromes?
Cystic fibrosis
What is the primary cause of malabsorption in Hirschsprung's disease?
Accelerated bowel motility
Which anatomical defect affects digestion by decreasing the transit time of substances and compromises the absorptive surface?
Short-bowel syndrome
What is the primary defect in lactase deficiency?
Congenital lactose intolerance
Which medication is often prescribed to improve diarrhea associated with bile salt malabsorption?
Cholestyramine
What is a potential consequence of inadequate growth in infants with esophageal atresia and tracheoesophageal fistula (EA/TEF)?
Bowel atrophy
What is a potential cause of feeding difficulties in infants with esophageal atresia and tracheoesophageal fistula (EA/TEF)?
Bacterial overgrowth
What is the primary preventive measure for catheter sepsis related to central venous access devices (CVAD)?
Proper catheter care
What is the most important component of nursing care during parenteral nutrition therapy?
Administering nutritional therapy
What is a potential long-term complication of Inflammatory Bowel Disease (IBD) that requires surveillance colonoscopies?
Colon cancer
What is the primary cause of mortality in infants and children with Short Bowel Syndrome (SBS)?
Parenteral nutrition cholestasis
What is the aim of surgical interventions such as constructing intestinal valves or tapering enteroplasty in SBS?
To slow intestinal transit
What is a potential consequence of Total Parenteral Nutrition (TPN) in ulcerative colitis (UC) compared to Crohn's disease (CD)?
Less likely outcome of TPN
What is a potential life-threatening complication of malrotation if not promptly diagnosed and treated?
Midgut volvulus
What is a key aspect of postoperative care for pediatric appendicitis?
Antibiotic prophylaxis
What is the primary manifestation of tracheomalacia as a complication of esophageal atresia/tracheoesophageal fistula (EA/TEF)?
Respiratory distress
Which type of deficiency may lead to lactose intolerance?
Lactase deficiency
What can untreated celiac disease in children lead to?
Lactose intolerance
What is a common source of gluten that requires label reading to avoid?
Hydrolyzed vegetable protein
What is a potential consequence of untreated celiac disease?
Severe symptoms
What is the primary cause of lactose intolerance?
Deficiency of lactase enzyme
What is a potential consequence of financial burdens due to celiac disease?
Increased risk of nutritional deficiencies
What is the primary cause of gluten intolerance?
Genetic mutation
What is a common symptom of lactose intolerance?
Bloating and gas
What is a potential cause of secondary lactase deficiency?
Damage to the intestinal lumen
What is the primary treatment for celiac disease-related nutritional deficiencies?
Appropriate supplements
What is a potential consequence of severe mucosal damage in celiac disease?
Temporary lactose intolerance
What is a common symptom of lactose intolerance?
Diarrhea
What is the reported incidence of celiac disease?
1 in 266
What is the primary cause of celiac disease?
Intestinal intolerance to dietary gluten
Where are the genes located that are found in almost 90% of those affected with celiac disease?
Chromosome 6
What is the primary diagnostic method for celiac disease?
Biopsy of the small intestine
What is the primary treatment for chronic celiac disease?
Dietary changes
What is the role of gradual introduction of gluten in the infant’s diet between 4 and 12 months?
It prevents celiac disease
What are the classic symptoms of celiac disease?
Impaired growth, chronic diarrhea, abdominal distension, and malabsorption
What are the commercially available serological tests for celiac disease?
Antigliadin antibodies, antiendomysium IgA, and antitissue transglutaminase IgA and IgG antibodies
What is the primary response of most children with celiac disease after instituting the gluten-free diet?
Favorable response, including weight gain and improved appetite
What is the gender distribution of celiac disease?
Higher occurrence in women than men
What is the characteristic feature of celiac disease in the small bowel?
Villous atrophy
What is the primary cause of impaired growth in children with celiac disease?
Malabsorption of nutrients
What is the primary method used for positive diagnosis of lactose intolerance?
Breath hydrogen test
What may lead to reduced bone mineral density and osteoporosis in children with lactose intolerance?
Avoiding dairy products
What is a viable option for individuals with lactose intolerance?
Lactase-treated dairy products
What is a potential consequence of avoiding dairy products in individuals with lactose intolerance?
Increased risk of osteoporosis
What is a key difference between lactose intolerance and dairy allergy?
Lactose intolerance causes skin rash or hives
What is a potential treatment for lactose intolerance?
Reducing dairy products
What is a possible consequence of inadequate dairy intake in individuals with lactose intolerance?
Increased risk of osteoporosis
What is a potential method to improve lactose intolerance?
Probiotic intake
What is a necessary supplementation due to reduced dairy intake in individuals with lactose intolerance?
Calcium and vitamin D
What is a characteristic of lactose intolerance?
Manifests as an anaphylactic-type reaction
What is a potential consequence of inadequate dairy intake in individuals with lactose intolerance?
Increased risk of bone fractures
What is a viable option for lactose intolerance?
Lactase-treated dairy products
What is the primary diagnostic method for lactose intolerance?
Breath hydrogen test
What may happen if children with lactose intolerance avoid dairy products?
Reduced bone mineral density and osteoporosis
What is a viable option for managing lactose intolerance?
Yogurt
What is a potential consequence of inadequate skin care postoperatively in short-bowel syndrome?
Skin breakdown and infection
What is a potential life-threatening complication of short-bowel syndrome if not promptly diagnosed and treated?
Sepsis
What is necessary due to reduced dairy intake in individuals with lactose intolerance?
Supplementation of calcium and vitamin D
What is the aim of treatment for lactose intolerance?
Eliminating or reducing dairy products
What is a potential effect of probiotics in lactose intolerance?
Improvement in symptoms
What is often mistaken for lactose intolerance but is triggered by various factors in addition to lactose?
Irritable Bowel Syndrome (IBS)
What is the most common symptom of lactose intolerance?
Abdominal pain
What is a potential consequence of lactose intolerance?
Abdominal pain and bloating
What is a malabsorptive disorder resulting from decreased mucosal surface area?
Short-bowel syndrome
Study Notes
Pediatric Nursing Care for Gastroesophageal Reflux Disease (GERD) and Intestinal Parasitic Diseases
- Pediatric nursing care for GERD involves identification of symptoms, parent education on home care, and possible surgical care
- Parents should be reassured that most infants and children outgrow GERD and lifestyle changes are often sufficient
- Simple measures such as using bibs and prone positioning can help parents cope with frequent spitting up in infants
- Parents should be educated about positioning, avoiding feeding spicy foods, and scheduling more frequent feeding times
- Severe cases of regurgitation and growth restriction may require NG tube or gastrostomy feedings, which necessitate special caregiver preparation
- Parents need specific information about the administration and efficacy of medications for GERD, such as PPIs
- Intestinal parasitic diseases, including giardiasis, are the most frequent infections in the world
- In Canada, the incidence of intestinal parasitic diseases, especially giardiasis, has increased among young children in day care centers
- Giardiasis is caused by the protozoan Giardia lamblia, with potential transmission through contaminated water, food, and person-to-person contact
- Symptoms of giardiasis include abdominal cramps and diarrhea, and diagnosis can be made through microscopic examination of stool specimens or duodenal fluid
- Medications for treatment of giardiasis include metronidazole, tinidazole, paromomycin, and nitazoxanide
- Tinidazole is said to have an 80 to 100% cure rate after a single dose and has fewer adverse effects than metronidazole
Inflammatory Bowel Disease: Key Points
- Inflammatory bowel disease (IBD) encompasses ulcerative colitis (UC) and Crohn disease (CD), distinct chronic intestinal inflammations.
- Both UC and CD have similar epidemiological, immunological, and clinical features, but CD is more disabling with less effective treatment than UC.
- IBD affects approximately 0.7% of the Canadian population, with adolescents and young adults at highest risk of diagnosis.
- The etiology of IBD is multifactorial, involving genetic predisposition, defective immunoregulation, and environmental factors.
- Ulcerative colitis primarily affects the colon and rectum, with varying degrees of mucosal inflammation and systemic symptoms.
- Crohn disease involves any part of the GI tract, with transmural inflammation, skip lesions, and extraintestinal manifestations.
- Diagnostic evaluation for UC and CD includes laboratory tests, serological panels, upper GI series, endoscopy, and imaging.
- Therapeutic management aims to control the inflammatory process, achieve long-term remission, promote healthy growth, and maintain a balanced lifestyle.
- Growth failure is a significant challenge in pediatric CD, affecting healthy development.
- Breastfeeding decreases the risk of developing CD, while infantile diarrhea increases the risk.
- CD is characterized by a chronic immune process with a T-helper-1 cytokine profile, while UC's response is more humoral and mediated by T-helper-2 cells.
- The course of IBD is unpredictable, with flare-ups severely impairing physical and social functioning, requiring individualized and managed treatment.
Hepatitis Infections in Children
- Hepatitis A vaccine is recommended over immunoglobulin for people over 6 months of age, while immunoglobulin is recommended for infants less than 6 months and those with contraindications for vaccination.
- Incidence of hepatitis B is declining with universal immunization programs, but varies globally, with high-prevalence areas in Africa and Asia and lower prevalence in Canada.
- HBV infection can be acute or chronic, transmitted parenterally through blood, bodily fluids, and other sources like organ transplantation and mother-to-infant transmission.
- Universal vaccination for all children is recommended in Canada, with newborns at risk if the mother is infected, as infants are more than 90% likely to become chronic carriers.
- Incubation period of HBV infection varies from 45 to 160 days, with high-risk groups including individuals with hemophilia, IV drug users, and those in congregate settings.
- Highest risk factor for acquiring HCV is a history of injection drug use, with transmission through contaminated blood, especially from IV drug use and from pregnant parent to child.
- HCV incubation averages 7 to 9 weeks, with about 85% of individuals infected developing chronic disease.
- Hepatitis D is rare in North America but endemic in other regions, occurring primarily in hemophiliac patients, immigrants from endemic regions, and IV drug users.
- Hepatitis D infection is more severe than HBV infection, requiring testing in children who are hepatitis B carriers with evidence of serum hepatitis B surface antigen positivity and elevated liver enzymes despite an undetectable HBV viral load.
- Hepatitis E is absent in Canada, the United States, and Western Europe but endemic in other regions, enterally transmitted, with an incubation period of 2 to 9 weeks.
- Hepatitis E is uncommon in children, does not cause chronic liver disease, but can be devastating among pregnant persons with an unusually high case-fatality rate.
- Hepatitis infections in children have varying transmission routes, incubation periods, and severity, with different vaccination and testing recommendations based on the specific type of hepatitis.
Biliary Atresia and Cleft Lip/Palate: Diagnosis, Treatment, and Nursing Care
- Biliary atresia (BA) is a liver disease in infants, often presenting with jaundice, pale stool, and dark urine.
- Early diagnosis of BA is crucial for the child's survival, as it may initially present with mild jaundice.
- Diagnostic evaluation for BA involves blood tests, additional laboratory analyses, abdominal ultrasonography, hepatobiliary scintigraphy, and liver biopsy.
- The primary treatment for BA is the hepatic portoenterostomy (Kasai procedure), aiming to establish bile drainage, with a success rate of 80 to 90% in newborns.
- Kasai failure and progressive cirrhosis may still occur, leading to the need for eventual liver transplantation.
- Medical management for BA includes nutritional support, supplementation of vitamins and minerals, and the use of ursodeoxycholic acid to decrease cholestasis and treat hypercholesterolemia.
- Untreated BA leads to progressive cirrhosis and death in most children by 2 years of age, while the Kasai procedure improves long-term survival, with 49% of children surviving with their native liver at 10 years of age if the procedure is done before 30 days of age.
- Nursing care for children with BA involves supporting the family, educating them about the treatment plan, and providing postoperative care similar to major abdominal surgery.
- Growth failure, pruritus, and nutritional challenges are common in children with BA, requiring close nursing attention and support for the family.
- Families of children with BA need education about proper administration of medications and nutritional therapy, while also receiving psychosocial support.
- Cleft lip (CL) and cleft palate (CP) are common congenital malformations of the head and neck, resulting from the failure of fusion of facial structures during embryonic development.
- CL and CP may occur separately or together, with CP involving the soft and hard palates and being associated with deformed dental structures.
Pediatric Surgical Conditions: Tracheomalacia, Esophageal Atresia/Tracheoesophageal Fistula, and Hernias
- Tracheomalacia can be a complication of esophageal atresia/tracheoesophageal fistula (EA/TEF) and parents should be educated on its signs and symptoms.
- Gastroesophageal reflux (GER) may occur after feedings resume in children with EA/TEF, leading to reactive airway disease with wheezing and labored respirations.
- Children with EA/TEF may face difficulties with thriving and gaining weight, especially if born preterm, requiring early intervention and interprofessional referral for developmental milestones.
- For infants requiring esophageal replacement, non-nutritive sucking with a pacifier and oral stimulation are provided to develop mature sucking patterns.
- Prolonged NPO status or lack of oral stimulation can lead to feeding difficulties and oral hypersensitivity, requiring guidance and potential referral to a feeding behavior program.
- Parents of children with EA/TEF need support in adjusting to the condition, particularly during the immediate transfer to critical care and hospitalization, and should be prepared for discharge with necessary home care skills.
- Hernias, including umbilical and inguinal, pose risks when circulation is impaired or when organs encroach on other structures, with inguinal hernias being more common in boys.
- Omphalocele and gastroschisis are rare abdominal wall defects, with omphalocele occurring in 1 in 3,000 to 10,000 live births and gastroschisis in 1 in 6,000 live births, with a gradual increase in prevalence noted in Canada.
- Omphalocele involves the covered herniation of abdominal organs, often with other defects, while gastroschisis is the uncovered herniation of bowel with a lower likelihood of associated anomalies.
- Preoperative nursing care for both defects involves managing thermoregulation, fluid and electrolyte balance, and physiological support, with surgical closure and postoperative management improving prognosis.
- The prognosis for infants born with abdominal wall defects has improved, with over 80% survival for omphalocele and over 90% for gastroschisis, although residual feeding difficulties such as GER are not uncommon.
- Therapeutic management and nursing care for infants with abdominal wall defects include covering exposed viscera, fluid and electrolyte replacement, gastric decompression, and surgical closure after reduction of contents.
Esophageal Atresia and Tracheoesophageal Fistula Nursing Care
- Prognosis is linked to birth weight, associated congenital anomalies, and time of diagnosis.
- Nearly 100% survival rate in full-term newborns without severe respiratory distress or other anomalies.
- Most deaths result from extreme prematurity or other lethal anomalies.
- Preterm low–birth-weight infants with associated anomalies have a high incidence of complications.
- Complications of primary repair include anastomotic leak, strictures, dysphagia, and GER.
- Routine esophageal dilation is often used to treat strictures resulting from tension or ischemia.
- Feeding difficulties are common and growth must be monitored; fundoplication may be required.
- Early detection of the malformation is crucial.
- Newborns with signs of EA must have a patent airway established to prevent respiratory compromise.
- The most desirable position for a newborn with typical EA and TEF is supine with the head elevated on an inclined plane of at least 30 degrees.
- Postoperative care includes respiratory assessment, airway management, thermoregulation, fluid and electrolyte management, and often parenteral nutrition.
- Discharge education should include instructions about feeding techniques in the infant with a repaired esophagus, including a semi-upright feeding position, small feedings, and observation for adequacy of swallowing.
Management of Anorectal Malformations in Newborns
- Meconium on the perineum in newborns may not always indicate anal patency, as a fistula may allow meconium evacuation through the vagina.
- Rectourinary fistulas should be suspected if there is meconium in the urine.
- Anal stenosis may not be identified until the child is older and presents with a history of difficult defecation, abdominal distension, and ribbonlike stools.
- Abdominal ultrasonography is performed to determine the existence of other malformations.
- Successful treatment for anal stenosis is generally accomplished by manual dilations, initiated by a healthcare provider and continued at home by parents.
- Perineal fistulas are treated by anoplasty during the newborn period, with more extensive defects managed with a colostomy and corrective surgical repair later in the first year.
- The type of defect, sacral anatomy, and muscle quality influence the long-term prognosis.
- Surgical treatment of anorectal malformations involves anoplasty, colostomy, posterior sagittal anorectoplasty (PSARP), or other pull-through procedures.
- A laparotomy may be required if the rectum is unidentifiable by the posterior approach.
- Nursing care includes identifying undetected anorectal malformations, preoperative care, postoperative care, and support for families in providing optimum care for the child.
- Preoperative PSARP care often involves irrigation of the distal stoma to prevent fecal contamination of the operative site.
- Nurses play a vital role in helping families of a child with anorectal malformations provide optimum care for successful bowel management and enhanced quality of life.
Lactose Intolerance and Short-Bowel Syndrome: Key Points
- Lactose intolerance symptoms include abdominal pain, bloating, flatulence, and diarrhea after lactose consumption
- Symptoms of lactose intolerance onset within 30 minutes to several hours after lactose ingestion
- Lactose intolerance is often mistaken for a dairy allergy or IBS, but dairy allergies are immediate and may cause skin rash or hives, while IBS is triggered by various factors in addition to lactose
- Diagnosis of lactose intolerance may be based on history and improvement with a lactose-reduced diet
- Breath hydrogen test is used for positive diagnosis, with lactose-deficient individuals showing higher hydrogen levels in breath samples after ingesting lactose
- Treatment involves eliminating or reducing dairy products, with most individuals tolerating a single serving of lactose per day, especially when consumed with food
- Avoiding dairy products in children with lactose intolerance may lead to reduced bone mineral density and osteoporosis
- Probiotics may improve lactose intolerance, but their widespread use in infants requires further study
- Supplementation of calcium and vitamin D is necessary due to reduced dairy intake
- Yogurt, hard cheeses, lactase-treated dairy products, and lactase tablets are viable options for lactose intolerance
- Lactose intolerance does not manifest as an anaphylactic-type reaction
- Short-bowel syndrome is a malabsorptive disorder resulting from decreased mucosal surface area, often due to extensive resection of the small intestine
Test your knowledge of pediatric nursing care for Gastroesophageal Reflux Disease (GERD) and Intestinal Parasitic Diseases with this quiz. Explore symptoms, treatments, and caregiver education for GERD, as well as the causes, symptoms, diagnosis, and medications for intestinal parasitic diseases such as giardiasis.
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