MCN Exam 4
What complications are associated with Cleft Lip and Palate? correct answers 1.
Increased risk for aspiration
2. Feeding difficulties
3. Dentation issues
4. Increased risk for ear infections
5. Speech and language difficulties
When is a cleft lip repaired? correct answers 3-6 months of age;
if patient has a cleft palate also, lip will be repaired first
When is cleft palate repaired? correct answers 6-12 months of age;
if patient has a cleft lip, it will be repaired after the cleft lip
What is the goal for cleft lip/ palate repair? correct answers to treat prior to the child
learning to speak
When is breastfeeding encouraged and contraindicated? (in regards to cleft lip/palates)
correct answers Breast feeding encouraged if the patient has ONLY a cleft lip.
If the patient has a cleft palate, Bottle feeding only
Post-op nursing care: cleft lip
- Arm Restraints correct answers Arm restraints are kept on all the time for the 1st 10
days
a. Used bilaterally
b. Take them off 1 at a time every few hours (maybe during feeding)
c. Keeps the baby from grabbing at the sutures (Logan Bow)
why do you want to keep a post- op (cleft lip/palate) infant calm? correct answers
vigorous and sustained crying can pull on the sutures
Post-Op Nursing Care (Cleft Palate): correct answers Be aware of swelling in the back
of the throat
-1st 3 weeks, goal is to protect the suture line
-Takes approx. 3 weeks for sutures to heal
-Child will be on full liquids for 2-3 weeks (no solids)
-Avoid straws/sippy cups that have a long reach
-No pacifiers (do not want a lot of sucking)
-A little bit of water after they finish feeding
-Arm Restraints may be needed
,What are signs and symptoms of Hypertrophic Pyloric Stenosis? correct answers -Non-
bilious emesis 30-60 minutes after feeding (KEY FINDING): Can be blood tinged
-Hungry and crying despite having been fed
-Progressive weight loss
-Progressive and severe dehydration
-"Olive shaped" mass in upper abdomen that is palpable
-Failure to gain weight
what are signs of dehydration? correct answers -Sunken fontanelle (head)
-Eyes become sunken
-No tears when crying
-Less urination
When is a pyloromyotomy done? correct answers 1-2 months after birth
What are the signs and symptoms of intussusception? correct answers -Sudden onset
intermittent pain
-Bilious emesis (different than pyloric stenosis)
- "Currant jelly" stools
- Lethargy
-Fever
-"Sausage"-shaped mass on palpation
- Tender, distended abdomen
what is used to diagnose intussusception? correct answers Ultrasound
What is the treatment for intussusception? correct answers Barium or air enema
a. If the air enema doesn't help, then surgery would be required
Manage dehydration
At what age does the GI tract mature? correct answers ~ 2 years
How long is a Esophageal PH probe left in for? correct answers 24 hours
How is the Esophageal PH probe placed? and where? correct answers thru the nose
just above the stomach
What should you encourage the patient after a barium study ? correct answers LOTS
OF WATER
What does hypoactive bowel sounds mean ? correct answers there's a obstruction
What does hyperactive bowel sounds mean? correct answers Gastroenteritis or
diarrhea
,When doing percussion what would a dull sound indicate? correct answers there's
organ or bone
If a cleft palate isn't felt, what would be a sign of the cleft? correct answers choking or
gagging during the first feeding
What is an important skill for a parent of a child with cleft lip to learn? and why. correct
answers CPR due to the increased risk of choking and aspiration
what would you want to monitor in a child with cleft lip/palate? correct answers -
Hydration status
-Growth over time/ weight gain
What is thought to cause the obstruction of the appendix that causes appendicitis?
correct answers Fecal matter
What are the signs and symptoms of appendicitis correct answers Right lower quadrant
pain
Nausea and vomiting
Frequent small soft stools
Fever
Rigid abdomen
Anorexia
Tachycardia
Diarrhea or constipation
Decreased or absent bowel sounds
Where is McBurney's point located? correct answers RLQ
What is the purpose of labs for appendicitis? correct answers Assess for infection and/
or bleeding
What is the purpose of CT scan or ultrasound for appendicitis? correct answers
diagnose inflamed or ruptured appendix
Appendicitis:
Perforated (Complicated) correct answers Patient is at risk for peritonitis.
-Emergency Appendectomy
-Drainage and Irrigation of peritoneal cavity
-IV antibiotics 7-14 days
Appendicitis :
Non-Perforated (Uncomplicated) correct answers Appendectomy - pre-op antibiotics,
fluids and electrolytes, pain meds and possible post-op antibiotics
, gastroesophageal reflux disease (GERD) Signs and symptoms correct answers Failure
to thrive/ weight loss
Respiratory problems/ hoarseness
Hungry/ irritability
"Wet burps" or vomiting after feeds
Infant: Pain with feeding
Results in infant posturing (arched back; Sandifer Syndrome)
Older child:
Dental erosion
Heartburn
Abdominal pain
Difficulty swallowing
Chronic cough
Non Cardiac chest pain
If left untreated, GERD can cause what? correct answers Esophagitis
Pneumonia
What is the initial feeding technique include for a child with GERD? correct answers -
Small, frequent feedings
-Upright positioning for 30-45 minutes after feeding
-Thickened formula
-Burp child more frequently
-Give breaks during feeding, allow them to rest
What is the largest concern with GERD? correct answers aspiration post feeding
What medications are used in children with GERD? correct answers -Histamine 2
blockers (Pepcid, Tagamed)
*Decrease gastric acidity
-Proton pump inhibitors
*Reduces gastric acid production
*"-zole" medications
-Prokinetics (Reglan)
*Helps stimulate GI motility so the stomach empties faster
*Has some CNS effects, so H2 and PPIs are the go to
What is a Nissen fundoplication , and what does it do? correct answers wraps the
upper stomach around the esophagus. It makes it more difficult to regurgitate feedings
Hirschsprung Disease is a
Lack of ganglionic cells. what do ganglionic cells do? correct answers assist in
peristalsis in the bowel. lack of cells cause inadequate motility
when is Hirschsprung disease typically diagnosed? correct answers in the first 3 years
What complications are associated with Cleft Lip and Palate? correct answers 1.
Increased risk for aspiration
2. Feeding difficulties
3. Dentation issues
4. Increased risk for ear infections
5. Speech and language difficulties
When is a cleft lip repaired? correct answers 3-6 months of age;
if patient has a cleft palate also, lip will be repaired first
When is cleft palate repaired? correct answers 6-12 months of age;
if patient has a cleft lip, it will be repaired after the cleft lip
What is the goal for cleft lip/ palate repair? correct answers to treat prior to the child
learning to speak
When is breastfeeding encouraged and contraindicated? (in regards to cleft lip/palates)
correct answers Breast feeding encouraged if the patient has ONLY a cleft lip.
If the patient has a cleft palate, Bottle feeding only
Post-op nursing care: cleft lip
- Arm Restraints correct answers Arm restraints are kept on all the time for the 1st 10
days
a. Used bilaterally
b. Take them off 1 at a time every few hours (maybe during feeding)
c. Keeps the baby from grabbing at the sutures (Logan Bow)
why do you want to keep a post- op (cleft lip/palate) infant calm? correct answers
vigorous and sustained crying can pull on the sutures
Post-Op Nursing Care (Cleft Palate): correct answers Be aware of swelling in the back
of the throat
-1st 3 weeks, goal is to protect the suture line
-Takes approx. 3 weeks for sutures to heal
-Child will be on full liquids for 2-3 weeks (no solids)
-Avoid straws/sippy cups that have a long reach
-No pacifiers (do not want a lot of sucking)
-A little bit of water after they finish feeding
-Arm Restraints may be needed
,What are signs and symptoms of Hypertrophic Pyloric Stenosis? correct answers -Non-
bilious emesis 30-60 minutes after feeding (KEY FINDING): Can be blood tinged
-Hungry and crying despite having been fed
-Progressive weight loss
-Progressive and severe dehydration
-"Olive shaped" mass in upper abdomen that is palpable
-Failure to gain weight
what are signs of dehydration? correct answers -Sunken fontanelle (head)
-Eyes become sunken
-No tears when crying
-Less urination
When is a pyloromyotomy done? correct answers 1-2 months after birth
What are the signs and symptoms of intussusception? correct answers -Sudden onset
intermittent pain
-Bilious emesis (different than pyloric stenosis)
- "Currant jelly" stools
- Lethargy
-Fever
-"Sausage"-shaped mass on palpation
- Tender, distended abdomen
what is used to diagnose intussusception? correct answers Ultrasound
What is the treatment for intussusception? correct answers Barium or air enema
a. If the air enema doesn't help, then surgery would be required
Manage dehydration
At what age does the GI tract mature? correct answers ~ 2 years
How long is a Esophageal PH probe left in for? correct answers 24 hours
How is the Esophageal PH probe placed? and where? correct answers thru the nose
just above the stomach
What should you encourage the patient after a barium study ? correct answers LOTS
OF WATER
What does hypoactive bowel sounds mean ? correct answers there's a obstruction
What does hyperactive bowel sounds mean? correct answers Gastroenteritis or
diarrhea
,When doing percussion what would a dull sound indicate? correct answers there's
organ or bone
If a cleft palate isn't felt, what would be a sign of the cleft? correct answers choking or
gagging during the first feeding
What is an important skill for a parent of a child with cleft lip to learn? and why. correct
answers CPR due to the increased risk of choking and aspiration
what would you want to monitor in a child with cleft lip/palate? correct answers -
Hydration status
-Growth over time/ weight gain
What is thought to cause the obstruction of the appendix that causes appendicitis?
correct answers Fecal matter
What are the signs and symptoms of appendicitis correct answers Right lower quadrant
pain
Nausea and vomiting
Frequent small soft stools
Fever
Rigid abdomen
Anorexia
Tachycardia
Diarrhea or constipation
Decreased or absent bowel sounds
Where is McBurney's point located? correct answers RLQ
What is the purpose of labs for appendicitis? correct answers Assess for infection and/
or bleeding
What is the purpose of CT scan or ultrasound for appendicitis? correct answers
diagnose inflamed or ruptured appendix
Appendicitis:
Perforated (Complicated) correct answers Patient is at risk for peritonitis.
-Emergency Appendectomy
-Drainage and Irrigation of peritoneal cavity
-IV antibiotics 7-14 days
Appendicitis :
Non-Perforated (Uncomplicated) correct answers Appendectomy - pre-op antibiotics,
fluids and electrolytes, pain meds and possible post-op antibiotics
, gastroesophageal reflux disease (GERD) Signs and symptoms correct answers Failure
to thrive/ weight loss
Respiratory problems/ hoarseness
Hungry/ irritability
"Wet burps" or vomiting after feeds
Infant: Pain with feeding
Results in infant posturing (arched back; Sandifer Syndrome)
Older child:
Dental erosion
Heartburn
Abdominal pain
Difficulty swallowing
Chronic cough
Non Cardiac chest pain
If left untreated, GERD can cause what? correct answers Esophagitis
Pneumonia
What is the initial feeding technique include for a child with GERD? correct answers -
Small, frequent feedings
-Upright positioning for 30-45 minutes after feeding
-Thickened formula
-Burp child more frequently
-Give breaks during feeding, allow them to rest
What is the largest concern with GERD? correct answers aspiration post feeding
What medications are used in children with GERD? correct answers -Histamine 2
blockers (Pepcid, Tagamed)
*Decrease gastric acidity
-Proton pump inhibitors
*Reduces gastric acid production
*"-zole" medications
-Prokinetics (Reglan)
*Helps stimulate GI motility so the stomach empties faster
*Has some CNS effects, so H2 and PPIs are the go to
What is a Nissen fundoplication , and what does it do? correct answers wraps the
upper stomach around the esophagus. It makes it more difficult to regurgitate feedings
Hirschsprung Disease is a
Lack of ganglionic cells. what do ganglionic cells do? correct answers assist in
peristalsis in the bowel. lack of cells cause inadequate motility
when is Hirschsprung disease typically diagnosed? correct answers in the first 3 years
