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3 GI Flashcards

1
Q

Lower esophageal sphincter is what

Fully developed when

A

Lower esophageal sphincter is:
-relaxed at birth allowing mild occasional regurgitation (spitting up)

Fully developed at 1 month old

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2
Q

Fluid differences in children

-greater amount of what than adults
-lose more what
-require what
-what occurs faster

A

Proportionally greater amount of body water than adults:
-lose more water daily than adults do

Require larger fluid intake and excrete more fluids

Dehydration can occur faster because of these things

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3
Q

Fluid differences in children

BSA (body surface area)

A

Greater amount of skin surface (compared to wt)

Affects insensible fluid loss
(Immeasurable loss of water through skin)

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4
Q

Fluid differences in children

Kidneys

A

Kidneys cannot fully concentrate urine until child is 2y/o

Greater daily fluid need

Unable to conserve water and electrolytes or fully assist in acid-base balance

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5
Q

Fluid differences in children

Lungs

Insensible losses

A

Lungs:
-Water is lost thru lungs d/t higher resp rate

Insensible losses:
-Fever
-Increased basal mtabolic rate
-Larger BSA

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6
Q

Threats to fluid balance

A

Insensible losses

Stressors:
-disease/illness (vomiting/diarrhea/fever)
-exercise in hot weather

Medical tx:
-NPO
-IV fluids
-drainage
-diuretic

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7
Q

Metabolic acidosis

Causes

A

Ingestion of something act like acid:
-antifreeze, ASA

Body makes too much acid:
-ketoacidosis (diabetes)
-lactic acidosis (sepsis)

Decrease renal acid excretion

Loss of bicarbonate:
-diarrhea

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8
Q

Metabolic alkalosis

Causes

A

Excessive intake of bicarbonate :
-ingestion of baking soda, antiacids
-large blood transfusions

Excessive loss of acid:
-vomiting
-gastric suction
-diuretic

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9
Q

Peds GI assessment

A

Hx: freq of bowel/bladder emptying
Calorie counts
I/O
DW/growth patterns
Focus assessment

-assessment of other areas (cardia shows dehydration)

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10
Q

Peds GI assessment

Look
Listen
Feel
Measure
GI symptoms

A

Visual inspection: flat/round/distended
-s/s of dehydration

Bowel sounds

Palpate: (soft, firm, rigid, tender, guarding)

Abdominal circumference

Gi s/s: N/V/D

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11
Q

What landmark do we use to measure abd circumference

A

Umbilicus

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12
Q

Acute GI disorders

A

Dehydrations (vomiting/diarrhea)

Pyloric stenosis

Intussusception

Appendicitis

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13
Q

Dehydration

-what is happening (5)

A

Rapid reduction of ECF
Loss of ICF
Electrolyte imbalance
Hypovolemic shock
Death

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14
Q

Types of dehydration

A

Isotonic
Hypotonic
Hypertonic

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15
Q

Isotonic dehydration

A

H2O and Na lost in equal parts
Blood sodium normal limits
Loss of ECF=reduced volume of circulating fluids

Hypovolemix shock can occur

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16
Q

Hypotonic dehydration

A

Electrolye loss > H2O loss
Fluid shifts from ECF to ICF
Blood sodium low

Shock likely

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17
Q

Hypertonic dehydration

A

H2O loss > electrolyte loss
Fluid shifts from ICF to ECF
Blood sodium elevated

Neuro changes:
-change in LOC, irritable, hyperreflexia, SZ

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18
Q

Infectious gastroenteritis

Most commonly what but can be what
What is it
Caused by
Can cause what

A

Mostly diarrhea but can be vomiting also

Alteration of GI tract resulting in increased motility and rapid emptying of intestinal content

Caused by: virus/bacteria/parasites
-Rotavirus, Ecoli, salmonella, C.diff, C.botulinum, shigellosis

Causes:
-loss of nutrients, electrolytes, water

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19
Q

Infectious gasteroenteritis: rotavirus

Most commonly cause of gasteroenteritis

S/s
What is it
What can lead to what
Tx

A

Fever
Vomiting
Watery diarrhea

-highly contagious
-diarrhea can lead to severe dehydration/death

TX: support tx, prevention

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20
Q

Dehydration assessment

A

Monitor early signs

Look at behavior:
-irritable, lethargic, confused

Skin color/oral membranes
Anterior fontanel (sunken)
VS (high HR, low BP)
DW

UOP (weigh wet diapers)
(want 1-2mL/kg/hr)

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21
Q

Dehydration goals
Avoid what

A

Correct fluid/electrolytes

If child is awake and alert try PO fluids (pedialyte)

If unable to take PO or continues to vomit = IV fluids

AVOID fruit juice

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22
Q

Rehydration:

mild or moderate dehydration

Severe

A

Mild/moderate:
-PO 1st if not tolerated give IV

Severe:
-isotonic fluid replacement (NS/LR)
-20mL/kg bolus
-continuous IV fluid after bolus

important to monitor for fluid overload

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23
Q

How to measure fluid maintenance for:

10kg and under

11-20kg

Over 20kg

A

10kg or under:
4mL/kg/hr

11-20kg:
40+ 2mL/kg(over10kg)/hr

20kg over:
60mL + 1mL/kg (over 20kg)/hr
Only up to 100ml

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24
Q

Dehydration:

S/s we see with excessive fluids

Tx

A

Rapid wt gain
Edema
I/O
Crackles

Tx:
Diuretics
Fluid restriction

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25
Pyloric stenosis What is it Presents when Usually who
Overgrowth (hypertrophy) of the pylorus muscle -results in obstruction of the pyloric sphinctor—> -food cant pass (causes vomiting) Presents around 3-6wks old Usually male
26
Pyloric stenosis s/s Intitially then progression Palpation
Intitially: infants regurgitate slightly after feed -parents say baby is a good eater that occasionally vomits Vomiting becomes more frequent—> Then becomes projectile as obstruction progresses Infant is hungry/irritable/fails to gain wt Fewer/smaller stools Palpation (movable, firm, olive shaped mass in RUQ)
27
Pyloric stenosis Diagnostics When can we do sx
Ultrasound (for confirmation) Electrolyte (need to be fixed before sx)
28
Pyloric stenosis Pre-op management
NPO I/O DW Fluid/electrolytes correction
29
Pyloric stenosis Post-op
Vitals I/O, DW Pain Continue IVF Nutrients -small, freq meals of clear liquids (4-6hrs post-op)—> —> advance to 1/2 strength formula—> —>then full strenth Assess incision for signs of infection
30
Intussusception What is it What it causes Common in what age Can occur how (tx)
Proximal segment of intestine telescopes into a more distal segment Causes lymphatic and venous obstruction—> edema Partial/total bowel obstruction Younger than 6y/o Can be episodes where it resolves on its own —if not surgery required
31
Intususception S/s
Hallmark: -severe abdominal pain (episodic) -blood/mucus in stool (currant jelly stools) Normal: -screaming, drawing knees to abdomen -vomiting/diarrhea -bilious emesis (obstruction in biliary)
32
Intussusception Evaluation
Xray and ultrasound of abdomen Barium enema (dye in rectum w/ imaging)
33
Intussusception Nursing considerations
Stabilize prior to procedure -fluids -prophylactic abx (for sx) -pain management -possible NG for gastric decompression -restoration of fluid and electrolyte balance
34
Appendicitis What is it Most common cause of? If left untreated could what? Causing?
Inflammation of appendix Most common cause of emergent abdominal surgery in children If left untreated: could rupture —leading to sepsis/death
35
Appendicitis S/s
RLQ pain Tenderness over mc burneys point N/V Fever If abdominal pain suddenly relieved without intervention, suspect rupture and notify provider immediatly (need sx)
36
Appendicitis Diagnostics
CT Abd US CBC (increase wbc) CRP
37
Appendicitis Surgical removal How its done
Nonruptured: -laparoscopic Ruptured: -open surgical procedure
38
Appendicitis Pre-op and post-op for non ruptured appendix
Pre: IVF NG for decompression (ruptured) Post: Standard post-op (VS, IV fluid until tolerate PO) Pain management Monitor for infection Assess bowel function
39
Appendicitis Pre-op for ruptured appendic
IVF and electrolyte replacement IV abx NG for decompression
40
Appendicitis Post-op for ruptured appendix
-standard post-op care -pain management -monitor surgical site for infection/bleeding -IVF and ABX -maintain NPO status -NG to low continuous suction -drain care -monitor for signs of peritonitis (rigid board like abd,fever)
41
Chronic GI disorders
Constipation GERD Hirschsprung’s disease
42
Constipation Management
Diet: -high fiber (peas, lentils, black beans, bananas, raspberries, sweet potatoes Fluids Meds: stool softeners, laxatives, probiotics
43
Gastroesophageal Reflux What is it Appears when and resolves when Leads to Complications
Reflux of gastric contents into the esophagus —appears in 1st wk of life —self-limtiing and resolves by one year old GERD is tissue damage from the reflux Complications: -recurrent pneumonia, wt loss, FTT
44
Gastroesophageal Reflux Risk Factors
Prematurity CF, asthma CP delayed gastric emptying Over-eating/feeding
45
Gastroesophageal Reflux Infant s/s
Spitting up Irritability (excessive crying, arching back, stiffening) Apnea FTT (not gaining wt)
46
Gastroesophageal Reflux Older children s/s
Heartburn/Non cardiac chest pain/Abdominal pain Chronic cough Difficulty swallowing
47
Gastroesophageal Reflux Nursing management
-Positioning (elevate HOB or keep infant upright at least 30min after feedings -small more frequent feedings -thickening formula with 1tsp=tbsp rice cereal per oz -change diet or formula
48
Gastroesophargeal Reflux Meds Sx interventions
Med: -H2 antagonis: ranitidine (Zantac), famotidine (Pepcid) -PPIs: omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (protonix) -motility- metoclopramide (Reglan) Sx: -nissen fundoplication
49
Hirschsprungs disease What is it
Cogenital aganglions megacolon: Absence of ganglion cells in colon—> —> allows bowel to relax—> —>results in decreased motility and mechanical obstruction
50
Hirschsprungs disease Newborn and infant s/s
Episodes of vomiting bile Episodes of vomiting/diarrhea/constipation Abdomenal distention Failure to pass meconium 24-48 hrs after birth FTT
51
Hirschsprungs disease Older children s/s
Same as infants: -Abdomenal distention -Constipation New: -undernourished appearance -visible peristalsis -palpable fecal mass -foul-smelling, ribbon like stool
52
Hirschsprungs disease Evaluation/diagnosis
Hx Bowel patterns Radiographic contrast studies (barium enema) Rectal biopsy to confirm absence of ganglion cells
53
Hirschsprungs disease -surgery rection may require what
Temporary colostomy
54
Hirschsprungs disease Preop nursing management
IVF, electrolytes Bowel prep with saline enemas (clean it out) Oral abx (prophylactic for sx) Monitor signs of enterocolitis (inflammation in gut)
55
Hirschsprungs disease Post op nursing management
Standard postop care Pain management Assess bowel function Ostomy care if applicable Monitor signs of enterocolitis (inflammation in gut) Once recovered encourage adequate: -oral fluids, high fiber diet, laxatives as prescribed
56
Hirschsprungs disease Monitoring enterocolitis (inflammation of gut) Tx
Monitor vitals and abdominal girth Abdominal distention Fever Signs of sepsis/shock Tx: Bowel rest (nothing in gut) IVFs Abx
57
Hirschsprungs disease Treatment focused on
Resolving inflammation Prevention bowel perforation Maintain hydration (IVFs) Initiating abx therapy Colostomy, ileostomy if extensive bowel involvement
58
Structural defects of GI system
-Cleft lip/palate -Esophageal atresia/TE fistula -Omphalocele -Gastroschisis -Meckels diverticulum -Anorectal malformations -Umbilical hernia
59
Cleft lip vs cleft palate Repaired when for each
Cleft lip: -incomplete fusion of oral cavity -repaired 2-3mo old Cleft palate: -incomplete fusion of the palates -repaired 6-12mo old
60
Cleft lip and palate Risk factors/complications
RF: -family hx -folate deficiency during pregnancy -exposure to alcohol, tobacco, anti convulsants, steroids during pregnancy Complications: -otitis media/hearing loss -altered dentition -speech impairment
61
Cleft lip and palate Initial nursing care
Feeding support Promote parent bond Monitor resp status while feeding (cyanosis)
62
Feeding for cleft lip
Encourage breast feeding Use wide-based nipple for bottle feeding
63
Feeding for cleft palate (or both lip/palate)
Upright position Specialized bottle w/ one way valve and a specially cut nipple (prevents milk from flooding them) Burp frequently Syringe feeding (if unable to take bottle/nipple)
64
Postop care
Standard: VS, airway managed, I/O, DW Pain management Monitor surgical site for infection Position (supine/upright/side lying) Elbow splint (no-no’s): prevent them from touching incision
65
Post op care Cleft lip (cheiloplasty) Resume what How to clean Avoid
-Protect incision -Resume breastfeeding or prior feeding routine -use water or diluted hydrogen peroxide to clean incision (apply abx ointment/petroleum jelly) AVOID pacifier
66
Post op care Cleft palate
-Positioning -IVF (until able to eat/drink—>liquid then soft solid diet NO straws, rigid utensils, hard tipped sippy cups, suction cath (any thing hard in mouth)
67
Esophageal atresia and tracheoesophageal (TE) fistula What is it
EA: esophagus just ends and does not attach to stomach TE fistula: trach and esophagus connect
68
Esophageal atresia and tracheoesophageal (TE) fistula S/s
-Copious, frothy mucous in mouth/nose -Drooling -Abdominal distention (air into stomach) -vomiting (atresia backs up) If feeding may demonstrate 3 C’s (coughing, choking, cyanosis)
69
Esophageal atresia and tracheoesophageal (TE) fistula Diagnosis
Prenatal US Unable to insert NG (coiled on xray) Lots of air in GI tract if fistual present (abd distention)
70
Esophageal atresia and tracheoesophageal (TE) fistula Tx Preop care
Surgery (go to nicu until then) -Maintain airway (o2/suction setup) -Elevate HOB 30-45 degrees -Orogastric tube insertion (low suction continuous to remove secretions from blind pouch) -NPO=IVF
71
Tracheoesophageal (TE) fistula repair Surgery stages
Stage 1: -ligation of fistula w/ g-tube placement -Gtube feeds/nutrition Stage 2: -ends of esophagus are attached to one another (Leave Gtube to make sure sx is successful)
72
Omphalocele What is it
Evisceration of the abdominal contents thru the umbilical cord Covered by a translucent sack
73
Omphalocele Nursing management Tx
Covered content w/ sterile non-adherent dressing to maintain integrity and prevent infection Prevent hypothermia = radiant warmer Maintain perfusion and minimize fluid loss (need fluids) Tx: surgery
74
Gastroschisis What is it
Herniation of abdominal contents thru the abdominal wall No membrane covering (unlike omphalocele) Tx: same as omphalocele (Wrap contents in saran wrap)
75
Meckels diverticulum What is it Complications
Incomplete fusion of the omphalomesenteric duct during embryonic development (connects fetus to yolk sac) -diverticulum located at terminal ileum Can contain gastric/pancreatic tissue casuing production of stomach acid (results in ulcers) Complications: GI hemorrhage, bowel obstruction
76
Meckels diverticulum S/s Labs/diagnostics
Rectal bleeding/bloody stools Abdominal pain Anemia Test: -CBC -occult stool -meckels scan (imaging)
77
Meckels diverticulum Tx Nursing management
Surgical removal -IVF/blood products -IV ABX -monitor bowel function Post sx: NPO, standard (ABCs/VS/pain management)
78
Anorectal malformations What is it
Imperforated anus or atresia -without obvious opening -diagnosis made at birth or newborn assessment
79
Anorectal malformation S/s
Absent anal opening Abdominal distention Absence of meconium (48hrs)
80
Anorectal tx
Sx: NPO—>IVF Orogastric tube (for gastric decompression)
81
Umbilical hernia What is it Failure of what Tx
Protrusion of intestine at the umbilicus -failure of umbilical ring to close completely Tx: 90% close on their own by 4y/o (You can try to see if you can push it back in)

N305 (17 decks)

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