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AN305 > 3 GI > Flashcards

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
Q

Pyloric stenosis

What is it
Presents when
Usually who

A

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

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26
Q

Pyloric stenosis s/s

Intitially then progression
Palpation

A

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)

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27
Q

Pyloric stenosis

Diagnostics
When can we do sx

A

Ultrasound (for confirmation)
Electrolyte (need to be fixed before sx)

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28
Q

Pyloric stenosis

Pre-op management

A

NPO
I/O
DW
Fluid/electrolytes correction

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29
Q

Pyloric stenosis

Post-op

A

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

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30
Q

Intussusception

What is it
What it causes
Common in what age
Can occur how (tx)

A

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

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31
Q

Intususception

S/s

A

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)

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32
Q

Intussusception

Evaluation

A

Xray and ultrasound of abdomen

Barium enema (dye in rectum w/ imaging)

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33
Q

Intussusception

Nursing considerations

A

Stabilize prior to procedure
-fluids
-prophylactic abx (for sx)
-pain management
-possible NG for gastric decompression
-restoration of fluid and electrolyte balance

34
Q

Appendicitis

What is it
Most common cause of?
If left untreated could what? Causing?

A

Inflammation of appendix

Most common cause of emergent abdominal surgery in children

If left untreated: could rupture
—leading to sepsis/death

35
Q

Appendicitis

S/s

A

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
Q

Appendicitis

Diagnostics

A

CT
Abd US
CBC (increase wbc)
CRP

37
Q

Appendicitis

Surgical removal
How its done

A

Nonruptured:
-laparoscopic

Ruptured:
-open surgical procedure

38
Q

Appendicitis

Pre-op and post-op for non ruptured appendix

A

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
Q

Appendicitis

Pre-op for ruptured appendic

A

IVF and electrolyte replacement

IV abx

NG for decompression

40
Q

Appendicitis

Post-op for ruptured appendix

A

-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
Q

Chronic GI disorders

A

Constipation
GERD
Hirschsprung’s disease

42
Q

Constipation

Management

A

Diet:
-high fiber (peas, lentils, black beans, bananas, raspberries, sweet potatoes

Fluids

Meds:
stool softeners, laxatives, probiotics

43
Q

Gastroesophageal Reflux

What is it
Appears when and resolves when
Leads to
Complications

A

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
Q

Gastroesophageal Reflux

Risk Factors

A

Prematurity
CF, asthma
CP
delayed gastric emptying
Over-eating/feeding

45
Q

Gastroesophageal Reflux

Infant s/s

A

Spitting up
Irritability (excessive crying, arching back, stiffening)
Apnea
FTT (not gaining wt)

46
Q

Gastroesophageal Reflux

Older children s/s

A

Heartburn/Non cardiac chest pain/Abdominal pain
Chronic cough
Difficulty swallowing

47
Q

Gastroesophageal Reflux

Nursing management

A

-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
Q

Gastroesophargeal Reflux

Meds
Sx interventions

A

Med:
-H2 antagonis: ranitidine (Zantac), famotidine (Pepcid)

-PPIs: omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (protonix)

-motility- metoclopramide (Reglan)

Sx:
-nissen fundoplication

49
Q

Hirschsprungs disease

What is it

A

Cogenital aganglions megacolon:

Absence of ganglion cells in colon—>
—> allows bowel to relax—>
—>results in decreased motility and mechanical obstruction

50
Q

Hirschsprungs disease

Newborn and infant s/s

A

Episodes of vomiting bile
Episodes of vomiting/diarrhea/constipation
Abdomenal distention
Failure to pass meconium 24-48 hrs after birth
FTT

51
Q

Hirschsprungs disease

Older children s/s

A

Same as infants:
-Abdomenal distention
-Constipation

New:
-undernourished appearance
-visible peristalsis
-palpable fecal mass
-foul-smelling, ribbon like stool

52
Q

Hirschsprungs disease

Evaluation/diagnosis

A

Hx
Bowel patterns
Radiographic contrast studies (barium enema)
Rectal biopsy to confirm absence of ganglion cells

53
Q

Hirschsprungs disease

-surgery rection may require what

A

Temporary colostomy

54
Q

Hirschsprungs disease

Preop nursing management

A

IVF, electrolytes

Bowel prep with saline enemas (clean it out)

Oral abx (prophylactic for sx)

Monitor signs of enterocolitis (inflammation in gut)

55
Q

Hirschsprungs disease

Post op nursing management

A

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
Q

Hirschsprungs disease

Monitoring enterocolitis (inflammation of gut)

Tx

A

Monitor vitals and abdominal girth
Abdominal distention
Fever
Signs of sepsis/shock

Tx:
Bowel rest (nothing in gut)
IVFs
Abx

57
Q

Hirschsprungs disease

Treatment focused on

A

Resolving inflammation
Prevention bowel perforation
Maintain hydration (IVFs)
Initiating abx therapy

Colostomy, ileostomy if extensive bowel involvement

58
Q

Structural defects of GI system

A

-Cleft lip/palate
-Esophageal atresia/TE fistula
-Omphalocele
-Gastroschisis
-Meckels diverticulum
-Anorectal malformations
-Umbilical hernia

59
Q

Cleft lip vs cleft palate

Repaired when for each

A

Cleft lip:
-incomplete fusion of oral cavity
-repaired 2-3mo old

Cleft palate:
-incomplete fusion of the palates
-repaired 6-12mo old

60
Q

Cleft lip and palate
Risk factors/complications

A

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
Q

Cleft lip and palate

Initial nursing care

A

Feeding support
Promote parent bond
Monitor resp status while feeding (cyanosis)

62
Q

Feeding for cleft lip

A

Encourage breast feeding

Use wide-based nipple for bottle feeding

63
Q

Feeding for cleft palate (or both lip/palate)

A

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
Q

Postop care

A

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
Q

Post op care
Cleft lip (cheiloplasty)

Resume what
How to clean
Avoid

A

-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
Q

Post op care

Cleft palate

A

-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
Q

Esophageal atresia and tracheoesophageal (TE) fistula

What is it

A

EA: esophagus just ends and does not attach to stomach

TE fistula: trach and esophagus connect

68
Q

Esophageal atresia and tracheoesophageal (TE) fistula
S/s

A

-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
Q

Esophageal atresia and tracheoesophageal (TE) fistula

Diagnosis

A

Prenatal US

Unable to insert NG (coiled on xray)

Lots of air in GI tract if fistual present
(abd distention)

70
Q

Esophageal atresia and tracheoesophageal (TE) fistula

Tx
Preop care

A

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
Q

Tracheoesophageal (TE) fistula repair

Surgery stages

A

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
Q

Omphalocele

What is it

A

Evisceration of the abdominal contents thru the umbilical cord

Covered by a translucent sack

73
Q

Omphalocele

Nursing management

Tx

A

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
Q

Gastroschisis

What is it

A

Herniation of abdominal contents thru the abdominal wall

No membrane covering (unlike omphalocele)

Tx: same as omphalocele
(Wrap contents in saran wrap)

75
Q

Meckels diverticulum

What is it

Complications

A

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
Q

Meckels diverticulum

S/s
Labs/diagnostics

A

Rectal bleeding/bloody stools
Abdominal pain
Anemia

Test:
-CBC
-occult stool
-meckels scan (imaging)

77
Q

Meckels diverticulum

Tx
Nursing management

A

Surgical removal

-IVF/blood products
-IV ABX
-monitor bowel function

Post sx: NPO, standard (ABCs/VS/pain management)

78
Q

Anorectal malformations

What is it

A

Imperforated anus or atresia
-without obvious opening

-diagnosis made at birth or newborn assessment

79
Q

Anorectal malformation

S/s

A

Absent anal opening
Abdominal distention
Absence of meconium (48hrs)

80
Q

Anorectal tx

A

Sx:

NPO—>IVF
Orogastric tube (for gastric decompression)

81
Q

Umbilical hernia

What is it
Failure of what
Tx

A

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)

AN305 (15 decks)

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