alterations in GI function (1) Flashcards
What are the stomach sizes of a newborn, one month old, and 12 month old
NB: 20 ml (less than an ounce)
1 month: 90 ml
12 month: 360 ml
Why do newborns have increased frequency and liquid consistency of stool
Increased intestinal motility
what do infants have increased regurgitation of feedings?
They have a relaxed cardiac sphincter at the top of the stomach
why not do the enzymes in the duodenum become fully present?
4-6 months
What enzymes are found in the duodenum
Amylase, lipase, trypsin
when can an infants start to conjugate bilirubin and excrete bile
After a few weeks
by what age are the digestive processes mostly complete?
2
By what age is the stomach capacity increased to accommodate a three meal per day schedule, and usually also two snacks
2
What is failure of maxillary processes to close?
Cleft lip
When does cleft lip occur in gestation?
5th and 12th weeks
What can celft lip usually be combined with?
Cleft pallate
When is cleft lip usually diagnosed?
Prenatally, an ultrasound as early as 13 weeks
what is failure of maxillary processes to fuse?
Cleft palate
When does the palate normally close?
5-12 weeks
When is cleft palate normally diagnosed?
Prenatally in an ultrasound, early as 13 weeks
which is more obvious, cleft lip or cleft palette?
Lip
How is cleft palate diagnosed?
Ultrasound and palpation of the palette with a finger
Case scenario:
You are in the delivery room and are aware the mom will be delivering an infant with cleft lip and cleft palate.
How did you know the infant would have cleft lip and palette?
Once the infant was born, how did you confirm the infant had cleft lip and palette?
- The mother had an ultrasound at 13 weeks
- the cleft lip was easily visible
- cleft palate was diagnosed with palpation with a finger of the palate and ultrasound
Which of the following may be causes of cleft lip and pallet?
1. Maternal use of tobacco or alcohol
2. use of anti convulsions, valproic acid, carbamezapine
3. Steroid during pregnancy
4. folic acid intake during pregnancy
5. combination of environmental and genetic factors
6. increased incidents in Native Americans and Asians
7. Increased incidents with family history
1,2,3,5,6,7
when is a cleft lip repaired and why?
3-5, Early repair facilitates speech
when is cleft palate repaired and why?
- 9-12 months, It protects tooth buds and allows development of normal speech pattern
which nursing interventions would be included for cleft lip or palette?
1. Assessments every two hours with vital signs
2. suction and bulb syringe at bedside
3. provide emotional support to family
4. Restrict breastfeeding
5. assess daily weight
6. Position infant on back
7. Burp at the end of a bottle
8. education with family on signs and symptoms of respiratory distress
1,2,3,5,6,8
Which of the following would you include in your education with parents about cleft lip and palette?
1. bulb syringe available
2. mom will be unable to breast feed
3. regular bottle can be used
4. feed sitting upright
5. Hold up right for 30 minutes after feeds
6. burp frequently, after every 15 to 30 milliliters of formula
7. use cleft lip or palette special nurser bottle
1,4,5,6,7
what is important for postoperative care of cleft lip or palette repair?
- Assessments, especially respiratory status
- vital signs
- Maintain suture line
- Pain meds
- Feeding and nutrition
- education with the family
how do you maintain the suture line after cleft lip or palette surgery?
- Position on back only
- soft elbow immobilizers
- antibiotic ointment two suture line if ordered
- keep comfortable and content
- no pacifiers, straws, spoons, or forks
- Cleanse with water or saline after feedings
How should feeding and nutrition be handled after a cleft lip or pallet surgery?
- Dropper, syringe or special nurser bottle, or Sippy Cup
- set up right
- frequent burping
- 5-15 ml of water after feeds
what is taught to the parents after cleft lip and palate surgery to do to protect the surgical site while the infant is sleeping
Swaddling
The American Academy of Pediatrics advises swaddling an infant up to how old only for the prevention of sudden infant death syndrome and sudden unexpected infant death
2 months
What is hypertrophy of the pyloric muscle, which is between the stomach and the duodenum
Pyloric stenosis
What condition can cause metabolic alkalosis from vomiting?
Pyloric stenosis
what obstructs the pyloric canal in pyloric stenosis?
The hypertrophy
In pyloric stenosis, the pyloric area becomes obstructed and inflamed until when?
Until the obstruction becomes complete
what is the clinical therapy of pyloric stenosis?
- Ultrasound confirms the diagnosis
- surgical correction: pyloromyotomy-pyloric muscle is split
what is the peak age people get pyloric stenosis?
3-5 weeks
Select all: which symptoms would you expect for pyloric stenosis?
1. Good eater who vomits occasionally
2. Multiple formula changes
3. projectile vomiting
4. infant hungry after emesis
5. gaining weight well
6. Normal stools
7. dehydration
8. Metabolic alkalosis
9. peristaltic waves across the abdomen
10. olive size mass in the right upper quadrant
1,2,3,4,7,8,9,10
which would be included in the pre operative nursing management for pyloric stenosis?
1. NPO
2. intake and output
3. maintain IV therapy
4. assessments
5. Insert and monitor NG tube
6. Instruct parents they do not need to save diapers
7. correct fluid and electrolyte imbalance
8. emotional support to fussy, irritable baby
9. provide support to family
1,2,3,4,5,7,8,9
how often should assessments and vital signs be done post operatively for pyloric stenosis surgery
q4h, reassess 1-2 hr aafter if abnormal
what should be looked at for a wound assessment for postoperative treatment of pyloric stenosis
Redness, edema, drainage, temperature, approximation of wound edges
describe feedings after surgery for pyloric stenosis?
- Feelings began per surgeon’s order
- Small amounts of clear liquids, then advance volume and strength
- if the infant vomits, the next feed is decreased
Case scenario:
you are getting a six week old infant with rule out pyloric stenosis. This is your first infant with pyloric stenosis since nursing school.
You need to refresh your memory.
What are the symptoms that go with pyloric stenosis? How is it diagnosed and treated?
Symptoms:
* Good eater who vomit occasionally
* Multiple formula changes
* projectile vomiting
* infant hungry after emesis
* Poor weight gain
* abnormal stools
* Dehydration
* Metabolic alkalosis
* peristaltic waves observed across the abdomen
* olive sized mass in the right upper quadrant
Diagnosis:
* ultrasound, treated with pyloromyotomy
Case scenario:
you are getting a six week old infant with rule out pyloric stenosis. This is your first infant with pyloric stenosis since nursing school.
the parents ask you about why their infant is vomiting, what information would you give them?
- The muscle between the stomach and the small intestine is blocking the passage of formula
- the muscle keeps getting bigger and bigger until it completely blocks the formula going into the small intestine
- This blockage costs the vomiting that will call project dial vomiting, due to it projecting so far away from the infant
Case scenario:
you are getting a six week old infant with rule out pyloric stenosis. This is your first infant with pyloric stenosis since nursing school.
the parents ask you how it is fixed and what they will have to do after surgery?
- The surgery is called a pyloromyotomy and the surgeon cuts the pylorus muscle which is the muscle between the stomach and the small intestine
- After surgery, the infant will start slow with clear liquid feedings and as they tolerate the feed, it will be advanced to formula. You would discuss what happens if the infant vomits
- assessments for pain and infection will occur frequently to be sure the infant is healing well
Case scenario:
Sophie is a 2 month old who the health care provider is seeing for the two month well child checkup appointment. Mamma mentions Sophie spits up after every feed. She is a “happy spitter”. She does not get fussy or irritable after spitting up. Sophie’s length and weight are at the 50th percentile today. This is the curve she has been following since birth.
does sophie have GER or GERD? Why does she spit?
GER, relaxation of sphincter
What is relaxation of the lower esophageal sphincter, is one of the most common GI disorders in children, they are not uncomfortable
GER
When does GER usually resolve by?
12 months
How is GER diagnosed?
- Upper GI series and esophageal pH monitoring
What is the treatment of GER?
- Smaller, more frequent feeds
- Thicken feeds as directed
- Burp every one to two ounces or after each side with breast feeding
- Hold upright for 20 to 30 minutes after feeds
- avoid infant seat or car seat after feeds
- monitor weight gain
- monitor growth and development
Case scenario:
carson is a 9 month old who has not been seen by a health care provider for six months. Mom states he spits up after every feed and is very irritable all the time and cries when he eats. She says he always seems to have a runny nose and a congested cough. Occasionally it sounds like he has a wheeze she can hear. Carson’s weight today is at the 5th percentile. At times when he eats, he appears to be arching his back.
The health care provider will want to rule out which of the following: GER or GERD?
GERD
What is the relaxation or incompetence of the esophagal sphincter causing return of stomach contents into the esophagus?
GERD
What are clinical manifestations of GERD?
- Poor weight gain or failure to thrive
- generalized irritability or excessive crying with feedings
- Refusal to eat
- arching of the back with feedings
- respiratory symptoms
How is GERD diagnosed?
UGI and pH probe!!!
what is the non pharmacological treatment of GERD?
Smaller or more frequent feedings, frequent burping, positioning, and thickening of feeds
what medications are used for GERD?
- Histamine H2 receptor antagonists
- Proton pump inhibitors
what are examples of histamine H2 receptor antagonists used for GERD?
ranitidine or famotidine (Pepcid)
what are examples of proton pump inhibitors used for GERD?
Lansoprazole or omeprazole (Prilosec)
Case scenario:
Carson has been monitored for one year since his initial diagnosis of GERD. He was nine months old when he was first diagnosed and he is now 21 months old. He has had aspiration pneumonia four times related to his GERD. Continues to have poor weight gain.
it was determined that the treatment of his GERD was unsuccessful
he was admitted to the hospital for a Nissen Fundoplication
What will be your preoperative and post operative nursing care?
Pre:
* Reinforce education with family
* NPO
* hydration
Post op:
* aassessment and vital signs
* Intake an output
* wound management
* pain management
* activity
* education
What is 1 apportion of the intestine prolapses and telescopes into another and is a frequent cause on intestinal obstruction
Intussusception
What is the exact cause of intussusception
Unknown
What are symptoms of intussusception
intermittent abdominal pain, vomiting, Brown stools changing to red or currant jelly type stools, mass in the right upper quadrant
What is used for diagnosis and treatment of intussusception
Contrast Air of barium enema
Why does intussusception need to be treated quickly?
Bowel will become necrotic
When does intussusception require surgery
If it happens twice
what is a congenital absence of ganglion cells in the wall of the colon or the rectum, peristalsis is prevented and intestinal contents accumulate with abdominal distinction
Hirschsprung disease
Symptoms of hirschsprung disease
No meconium stool in 48 hours, Abdominal distension, bilius vomiting.
In older children: failure to thrive, constipation
Diagnosis of Hirschsprung disease
History and rectal biopsy
Treatment of Hirschsprung disease
Surgical removal of aganglionic bowel; temporary colostomy may be needed for subsequent reanastomosis
How is appendicitis diagnosed
- elevated WBC greater than 10,000
- history of illness, pain in right lower quadrant
- Ultrasound is preferred over CT to limit radiation exposure
what are clinical manifestations of appendicitis
- Periumbilocal cramps or pain in the right lower quadrant
- Abdominal tenderness, nausea, anorexia, fear
- guarding, rigidity, right side-lying position
- Pain most intense at Mcburney’s point, halfway between anterior superior iliac crest or umbilicus
- rebound tenderness
Case scenario:
you are providing nursing care to a 10 year old who has appendicitis. He will be going to surgery in five hours.
As you perform your assessment you obtain the following data: abdominal distension, Guarding of abdomen, respiratory rate of 34, heart rate of 140, pallor, irritability, temperature of 39.5 Celsius, sudden relief of pain
What is your immediate nursing intervention?
- Call the surgical resident
- clinical manifestations: perforated appendix
- medical emergency, needs appendectomy
what is the preoperative nursing management of appendicitis
- assessment and vital signs
- pain assessment
- Intake an output
- NPO and IV fluids
- education
post operative nursing management of appendicitis
- assessment and vitals every four hours
- wound assessment
- Intake an output
- pain management
- Incentives spirometer and cough and deep breath
- assess bowel function
- activity and education
Case scenario:
John is 16 years old and is newly diagnosed with crohn’s disease. John and his parents have many questions
What is Crohn’s disease?
- a chronic inflammatory process
- Can occur through the GI tract
- enteric fistula’s develop
- mucosal ulcers begin small and grow in size
- Etiology is unknown
where is Crohn’s disease most commonly found?
Illium, colon, and rectum
At what age does Crohn’s disease commonly develop?
Adolescents and young adults
Which of the following would you provide education on regarding Crohn’s disease diagnosis?
1. History and physical
2. Upper GI series
3. upper endoscopy and colonoscopy with biopsy
4. CT scan
5. ultrasound of abdomen
1,3
which of the following are symptoms of Crohn’s disease?
1. Abdominal cramping and pain
2. Diarrhea
3. fever
4. anorexia
5. growth failure
6. weight gain
7. malaise
8. Joint pain
1,2,3,4,5,7,8
nursing care for the clinical therapy of Crohn’s disease would include which of the following?
1. Antibiotics
2. corticosteroids
3. immunosuppressant medication
4. Nutritional support
5. education
6. Biologic therapies
All of them!
Case scenario:
Pam is a 10 month old being admitted for diarrhea which started two days ago. She has had 8-10 watery stools per day. She has been vomiting a few times. She was very irritable but has become much the fear. She did not cry when you walked into the room. Mom said it is difficult to tell if she is urinating since her stools are so watery in the diaper. She is febrile at 39. Heart rate is 188. respiratory rate is 38. Blood pressure 94/60. Her mucus membranes are dry. Capillary refill is less than three seconds and skin turgor is brisk. Fontanelle is slightly sunken
What will her admitting diagnosis be? why?
Rule out gastroenteritis and dehydration
* Information of stomach and intestines
* maybe accompanied by vomiting and diarrhea
* viral, bacterial, or parasite
* dehydration can occur quickly
What is the leading cause of gastroenteritis in children worldwide?
Rotavirus
Clinical manifestations of gastroenteritis include which of the following?
1. Fever
2. Diarrhea
3. nausea/vomiting
4. irritability
5. anorexia
6. signs of dehydration
All of them
what is clinical therapy of gastroenteritis
- diagnosis based on history and lab findings, stool cultures, ova and parasite stool samples
- treat cause
- Correct dehydration and electrolyte imbalances
which of the following would be included in nursing management of gastroenteritis?
1. Intake and output and IV therapy
2. weigh diapers and carefully describes stool
3. Daily weight
4. Assessment and vitals q4h
5. Obtain stool samples
6. Hand washing
7. Education
8. No isolation
9. Skin care
10. no oral fluids or food
All of them except 8&10
which of the following has been shown to decrease the incidence of cleft lip and palette?
1. Prenatal care
2. folic acid supplements
3. corticosteroids
4. multivitamins
2
true or false?
Infants with cleft lip and palette will be unable to breastfeed
False
infants with pyloric stenosis may have which of the following symptoms? Choose all that apply
1. Hunger after feedings
2. Irritability
3. Metabolic acidosis
4. poor weight game
1,2,4
a four month old’s weight is at the 50th percentile. She is an eage eater but spits up after every feed. She is a happy infant who smiles and coos at her family. This infant has gastroesophageal reflux or gastroesophageal reflux disease?
Gastroesophageal reflux
which of the following interventions may be used to treat gastroesophageal reflux disease? Choose all that apply
1. thickened feedings
2. ranitidine of lansoprazole
3. pyloromyotomy
4. Nissen fundoplication
1,2,4
what is a high priority nursing intervention when providing post operative care to a child?
1. Ambulation
2. Regular diet
3. contact with friends
4. schoolwork
Ambulation
Infants and children with gastroenteritis are at a high risk for which of the following?
1. Secondary infection in the diaper area
2. dehydration
3. Progression to appendicitis
4. Intussusception
Dehydration
