1229 Exam 7 Intussusception, Celiac, Hirschsprung, and Volvulus

Question 1

What is celiac disease?

Answer 1

Known also as gluten enteropathy or celiac sprue.

Intolerance to gluten.

Results in the accumulation of the amino acid glutamine, which is toxic to intestinal mucosal cells.

Question 2

What is gluten?

Answer 2

the protein component of wheat, barley, rye, and oats.

Question 3

Assessment for celiac disease?

Answer 3

acute or insidious diarrhea

steatorrhea

anorexia

abdominal pain and distention

muscle wasting particularly in the buttocks and extremities

vomiting

anemia

irriability

Question 4

What is celiac crisis?

Answer 4

precipitated by infection, fasting, or ingestion of gluten.

causes profuse watery diarrhea and vomiting

can lead to electrolyte imbalance, rapid dehydration, and severe acidosis.

Question 5

Interventions for Celiac Disease?

Answer 5

Maintain a glueten free diet.

(Substituting corn, rice, and millet as grain sources.

instruct the parents and child about life long elimination of gluten sources such as wheat, rye, oats, and barley.

administer mineral and vitamin supplements

teach the child and parents about gluten free diet and about reading food labels carefully for hidden sources of gluten.

instruct the parents in measures to prevent celiac crisis.

inform the parents about the celiac spruse association.

Question 6

what sources of food have gluten in them?

Question 7

What are good suplements for gluten foods?

Answer 7

corn

rice

millet

Question 8

What does strict dietary avoidance of gluten minimize the risk for?

Answer 8

developing malignant lymphoma of the small intestine and other gastrointestinal malignancies.

Question 9

How long does it take to develop symptoms of Celiac disease?

Answer 9

It usually takes 3-6 months between the introduction of gluten in the diet and the onset of the symptoms.

Question 10

When is celiac disease usually diagnosed?

Question 11

What is Hirschsprung’s disease?

Question 12

What results from Hirschspring’s disease?

Answer 12

mechanical obstruction results because of the inadequate motility in an intestinal segment.

Question 13

What causes Hirschsprung’s disease?

Answer 13

may be a familial congenital defect or may be associated with other anomalies, such as down syndrome and genitourinary abnormalities.

Question 14

aHow do you diagnose Hirschisprung’s disease?

Question 15

What is the most serious complication of Hirschsprung’s disease?

Question 16

what are the entercolitis sings and symptoms?

Question 17

treatment for mild to moderate disease:

Answer 17

based on relieving the chronic constipation with stool softeners and rectal irrigations.

*many children require surgery.

Question 20

*Treatment for moderate to severe disease:

Question 21

Assessment of newborn infants:

Question 22

Assessment of children:

Answer 22

failure to gain weight and delayed growth

abdominaldistention

vomiting

constipation alternating with diarrhea

ribbon like and foul smelling stools

Question 23

Interventions: medical management:

Question 24

Surgical management: Preoperative interventions:

Question 25

Surgical management: post Op interventions:

Answer 25

monitor vitals, avoiding rectal temp

measure abdominal girth daily and prn.

assess the surgical site for reddness, swelling, and drainage

assess th stoma if present for bleeding or skin breakdown.

(STOMA SHOULD BE RED AND MOIST)

assess the anal area for the presence of stool redness or discharge

maintain NPO status until bowel sounds return or flatus is passed (48-72 hours)

maintain NG tube to allow intermittent suction until peristalsis returns.

maintain iv fluids until the child tolerates appropriate oral intake, advancing the diet from clear liquids to regular as tolerated and as prescribed

assess for dehydration and fluid overload

monitor strict I&O

obtain dialy weight

assess for pain and provide comfort measures as required

provide the parents with instructions regarding colostomy care and skin care

teach the parents about the appropriate diet and the need for adequate fluid intake.

Question 26

what is intussusception?

Answer 26

Telescoping of one portion of the bowel into another portion

The condition results in obstruction to the passage of intestinal contents.

Question 27

What does Intussusception look like?

Answer 27

colicky abdominal pain that causes the child to scream and draw the knees to the abdomen, similar to the fetal position

vomiting of gastric contents

bile stained fecal emesis

currant jelly like stools containing blood and mucus

hypoactive or hyperactive bowel sounds

Question 28

Interventions for intussusception:

Answer 28

monitor for signs of perforation and shock AEB fever, increased heart rate, changes in LOC, or blood pressure, respiratory distress, and report immediately

antibiotics, iv fluids, and decompression via ng tube that may be prescribved

monitor for the passage of normal brown stool which indicates that the intussusception has reduced itself

prepare for hydrostatic reduction as prescribed, if no signs of perforation or shock occur

Question 29

posthydrostatic reduction:

Answer 29

monitor for the return of normal bowel sounds for the passage of barium and the characteristics of stool.

administer clear fluids and advance the diet gradually as prescribed.

Question 30

What is Volvulus?

Answer 30

the intestine twisting around itself

Question 31

What does Volvulus look like?

Answer 31

intermittent bilious vomiting

recurrent abdominal pain

distention

lower GI bleeding

Question 32

What is complete volvulus called and why is it serious?

Answer 32

malrotation. it is most serious because intestine undergoes complete volvulus where the intestine twist completely around itself.

Question 33

How do I diagnose Volvulus?

Answer 33

GI series.

it is important that it is diagnosed promptly and surgical treatment instituted quickly.

Question 34

What is therapeutic management for Volvulus?

Answer 34

surgery is indicated to remove the affected area.

Because of the extensive nature of some lesions, short gut syndrome is a post op complication.

Question 35

Nursing care for Volvulus: pre op.

Answer 35

preop the nursing care is the same as that provided to an infant or child with intestinal obstruction.

Question 36

Nursing care: post op:

Answer 36

the nursing care is similar to that provided tothe infant or child who has undergone abdominal surgery.