1229 Exam 7: Intussusception, Celiac, Hirschsprung, and Volvulus Flashcards
what is gluten?
the protein component of wheat, barley, rye, and oats.
What is celiac disease?
known also as gluten enteropathy or celiac sprue.
intolerance to gluten
results in the accummulation of the amino acid glutamine, which toxic to intestinal mucosal cells.
Assessment for Celiac disease:
Acute or insidious daiarrhea steatorrhea anorexia abdominal paiin and distention muscle wasting particularly in the buttocks and extremities vomiting anemia irriability
What is celiac crisis?
precipitated by infection, fasting, or ingestion of gluten.
causes profuse watery diarrhea and vomiting
can lead to electrolyte imbalance, rapid dehydration, and severe acidosis
interventions for celiac disease:
maintain a gluten 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 barey.
administer mineral and vitamin supplements.
teach the child and parent 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.
what sources of food have gluten in them?
wheat
rye
oats
barley
what are good supplements for gluten foods?
corn
rice
millet
what does strict dietary avoidance of gluten minimize the risk for?
developing malignant lymphoma of the small intestine and other gastrointestinal mllignancies.
How long does it take to develop symptoms of Celiac disease?
it usually takes 3-6 months between the introduction of gluten in the diet and the onset of the symptoms.
when is celiac disease usually diagnosed?
between the ages of 1-5 years.
what is Hirschsprung’s disease?
a congenital anomaly also known as congenital aganglionosis or aganglionic mega colon
occurs as the result of an absence of ganglion cellls in the rectum or other areas of the affected intestine.
what results from Hirschsprung’s disease?
mechanical obstruction results because of the inadequate motility in an intestinal segment.
What causes Hirschsprung’s disease ?
may be a familial congenital defect or maybe associated with other anomalies, such as Down syndrome and genitourinary abnormallities.
how do you diagnose Hirschsprung’s Disease?
a rectal biopsy specimen shows histological evidence of the absence of ganglionic cells
what is the most serious complication of hirschsprung’s disease?
enter colitis
what are the signs and symptoms of enter colitis?
fever
severe prostration
gastrointestinal bleeding
explosive watery diarrhea
treatment for mild to moderate disease:
based on relieving the chronic constipation with stool softeners and recital irrigations
***many children require surgery.
treatment for moderate to severe disease:
treatment for moderate to severe disease involves a two step surgical procedure
- initially,in the neonatal period, a temporary colostomy is created to relieve obstruction and allow the normally innervated dilated bowel to return to its normal size.
- when the bowel returns to its normal size, a complete surgical repair is performed via a pull through procedure to excise portions of the bowel; at this time, the colostomy is closed.
Assessment of the newborn infants:
failure to pass meconium stool
refusal to suck
abdominal distention
bile stained vomitus
Assessment of the children
failure to gain weight and delayed growth abdominal distention vomiting constipation alternating with diarrhea ribbon like and foul smelling stools
interventions: medical management:
maintain low fiber, high calorie, high protein diet.
parenteral nutrition may be necessary in extreme cases
administer stool softeners as prescribed
administer daily rectal irrigations with normal saline to promote adequate eliminations and prevent obstruction as sprescribed.
surgical management Pre op interventions:
assess bowel function
administer bowel preparation as prescribed
maintain NPO status
monitor hydration and fluid and electrolyte status; provide fluids via IV as prescribed for hydration
administer antibiotics or colonic irrigations with an antibiotic solution as prescribed to clear the bowel of bacteria
monitor strict I&O
obtain weight daily.
avoid taking temp rectally
monitor for respiratory distress with abdominal distention
surgical management post op:
monitor vitals, avoiding rectal temp
measure abdominal girth daily and prn
assess the surgical site for redness, swelling, and drainage.
assess the stoma for the presence of 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 daily weight
assess for pain an 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 intake.
what is intussusception?
telescoping of one portion of the bowel into another portion
the condition results in obstruction to the passage of intestinal contents
what does intussusception look llike?
colicky abdominal pain that causes the child to scream and draw the knees near the abdomen. similar to the fetal postion.
vomiting of gastric contents
bile stained fecal emesis
currant jelly like stools containing blood and mucus
hypoactive or hyperactive bowel sounds
tender distended abdomen possibly with a palpable sausage shaped mass in the upper right quadrant.
interventions for intussusception:
monitor for signs of perforation and shock AEB fever, increased HR, changes in LOC, or BP, respiratory distress, and report immediately
antibiotics, IV fluids, and decompression via NG tube that may be prescribed
monitor for the passage of normal brown stool which indicates that the intussusception has redced itself.
prepare for hydrostatic reduction, if no signs of perforation or shock occur
post hydrostatic reduction
if surgery is required post op is similar to the care after any abdominal surgery
post hydrostatic reduction:
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.
what is volvulus?
the intestine twisting around itself.
what does volvulus look like?
intermittent billlous vomiting
recurrent abdominal pain
distention
lower GI bleeding
what is compete volvulus called and why is it serious?
malrotation is most serious because the intestine undergoes complete volvulus where the intestine twist completely around itself.
how do i diagnose volvulus?
GI series.
It is important that it is diagnosed promptly and surgical treatment is instituted quickly.
what is therapeutic management for volvulus?
surgery is indicated to remove the affected area.
because of he extensive nature of some lesions, short gut syndrome is a post op complication
nursing care for volvulus preop:
same as that is provided to an infant or child with intestinal obstruction.
nursing care post op:
similar to that provided to the infant or child who has undergone abdominal surgery
