alterations in GI functions Flashcards
how is the anatomy and physiology of children’s GI tract different than adults?
- immature until about 2 years of age
- deficient in amylase, lipase, and trypsin until 4-6 months of age
- smaller stomach capacity and greater intestinal motility
- liver function is immature
what are possible causes of GI disorders?
- a congenital defect
- acquired disease
- infection
- injury
- structural problems (usually occur in 1st trimester when GI is developing)
- inflammatory disorder
what is necrotizing enterocolitis?
- an inflammatory disorder
- death of tissue in the small or large intestine because of inflammation
- may be caused by intestinal ischemia, bacterial or viral infection, immaturity of GI mucosa
why does necrotizing enterocolitis occur more commonly in premature infants?
- weaker immune systems
- less time to develop
what are the symptoms of necrotizing enterocolitis
- manifests between 3-14 days of life up to 3 months old most commonly
- general signs of being sick
- vomiting and increased gastric residual
- irritability and lethargy
- abdominal distention
- bloody stools
- temperature instability
- rapid progression of shock
what is an ileostomy?
- a surgically-created opening in the abdomen through which the end of the ileum is brought up to the surface of the skin to provide an outlet for feces when a bowel obstruction or non-functioning structure prevents normal elimination
- may also be done to “rest” an area lower down after surgery
- can be temporary or permanent
- when temporary, there are often two holes
what are indications that may result in an ileostomy?
- bowel infections
- bowel injuries
- bowel obstruction
- cancer
- conditions that cause severe bowel inflammation
Central venous catheters are often used for TPN with pediatric patients, what are the 5 types of CVLs?
- short term, percutaneous
- tunneled
- PICC (peripherally inserted central catheters)
- implanted
- hemodialysis
what are complications that may occur with central venous lines?
- infection
- bleeding
- can be pulled out
- can become occluded
- can get an air emboli
- can be damaged
why are CVLs used for TPN on pediatric patients?
- children are often hard to poke
- TPN is hard on veins and easily lost
- TPN requires daily blood work, another reason to have a CVL!
why is total parenteral nutrition used?
- to provide intravenous nutritional support
- fluids usually contain glucose, amino acids, electrolytes, vitamins, proteins, and lipids
- tailored to meet needs of pediatric patient
- can be used as primary therapy, adjunctive or sole source
what is the normal range for WBCs?
4.0-11.0
what is the normal range for Hgb
135-175
what is the normal range for platelets?
100-400
what is the normal range for MCV?
0.40-0.54
what is the normal range for sodium?
135-145
what is the normal range for potassium
3.5-5.1
what are complications associated with a cleft lip and/or palate?
- susceptibility to colds
- hearing loss
- speech defects (this can be helped by early surgery)
- larger than average number of dental cavities, missing/extra/malformed or displaced teeth
- otitis media because eustachian tubes don’t drain fluid properly from middle ear into throat
- feeding dificulties
what is hirschprung?
a congenital aganglionic megacolon
- the absence of autonomic parasympathetic ganglion cells of the colon that prevents peristalsis at that portion of the intestine
- can lead to obstruction
what is a tracheosophageal fistula
an abnormal opening between the trachea and esophagus
what are some complications that can occur in premature infants?
- apnea
- patent ductus arteriosus
- intraventricular hemorrhage
- retinopathy of prematurity
- anemia because RBC life is shorter in infants than other children
- respiratory distress syndrome
how is liver damage detected?
it can be detected by simple blood work that looks for presence of certain liver enzymes in the blood
-under normal circumstances they reside in the cells of the liver, but when liver is injured, they enter the blood
what are the normal ranges for liver enzymes?
AST 5-40 units per litre of serum
ALT 150-500 units per litre of serum
Bilirubin 3-22 units per litre of serum
how is necrotizing enterocolitis diagnosed and treated?
- septic workup
- radiographs
- NPO
- NG for drainage
- maintain fluid balance
- TPN (done if fluid balance can’t be maintained or treatment takes long)
- antibiotics if septic
- possible bowel resection
- ileostomy or colostomy
- isolations
what are some nursing interventions for a bowel obstruction?
- IV maintenance
- NG tube insertion
- monitor abdominal girth
- abdominal x-ray
- antibiotics
- monitor blood tests
- monitor stool
what is involved in medical treatment for a bowel obstruction?
- surgery - temporary or permanent ostomy
- feeding gradually to prevent refeeding problems
- management of infections and hydration
what is refeeding syndrome?
- metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, malnourished, or metabolically stressed
- potentially fatal shifts in fluids and electrolytes
- hypophosphatemia
- abnormal sodium and fluid balance
- changes in metabolism of fat, protein, and glucose
- thiamine deficiency
- hypokalemia
- hypomagnesaemia
what are some long-term complications of NEC?
- malabsorption
- short bowel syndrome
- scarring and narrowing of bowel causing obstruction
- scaring within the abdomen causing later pain and possible female infertility
- problems relating to long-term use of TPN including cholestasis
what is cholestasis?
- a reduction or stoppage in bile flow
- bile flow is a digestive fluid and without it bilirubin escapes into bloodstream and accumulates
- common symptom is jaundice, dark urine, light-colored stools, itchiness
- calcium and vitamin d are poorly absorbed because of lack of bile in intestine
- vitamin K is also then poorly absorbed from intestine and can lead to clotting problems and bleeding
what is short bowel syndrome?
-too little bowel present to absorb all the nutrients needed by the body
what is a cleft palate?
-where the maxillary processes fail to fuse
how is a cleft lip and palate diagnosed?
- cleft lip is apparent at birth and often easy to diagnose
- cleft palate defects can be less obvious, especially when they do not present with a cleft lip
- palate should be palpated to look for defects, however signs may be feeding issues or recurrent infections r/t food entering where it shouldn’t be
how is a cleft lip treated?
surgery, usually done within 2-10 weeks of birth
how is a cleft palate treated?
surgery, usually between 6-18 months of age
what are some potential nursing diagnoses related to cleft lip and/or cleft palate?
- potential for inadequate nutrition
- potential for infection
- potential for inadequate fluid intake
- potential for bleeding or pain post-op
what are some post-operative nursing interventions for nurses for a patient with a cleft palate repair?
- airway management due to post-op edema
- arm restraints to protect incision
- wound management
- cleaning site with sterile water after each feed
- crusting can increase scarring, want to keep incision looking as good as possible
- keep feeds under 60 minutes
what medications may be used post-operatively for cleft lip/palate repairs?
- morphine
- tylenol
- gravol
what is a tracheoesophageal fistula?
an abnormal opening between the trachea and esophagus
what is esophageal atresia?
a congenital defect where upper esophagus fails to connect to lower esophagus and stomach before birth
-can simply dead end, but more commonly coexists with tracheoesophageal fistula
how is a tracheoesophageal fistula and or esophageal atresia diagnosed?
- may include maternal history of hydramnios
- pt history of vomiting
- may be unable to pass an NG tube which is how it is noticed
- barium swallow test is used for official diagnosis of what is going on
how is a tracheoesophageal fistula and/or esophageal atresia treated?
- surgery to close fistula and/or connect esophagus
- oral feeds stopped and intravenous fluids started or TPN depending how long diagnosis and treatment takes
what is an imperforated anus?
an obstruction of the passage of fecal matter by a structural anomaly of the anus and rectum
-may occur with or without a fistula
how does rectal atresia present clinically?
-failure to pass meconium and abdominal distention
how is an imperforate anus diagnosed?
- visual inspection of perineum
- xray
- retrograde urethrocystogram used to diagnose or rule out rectourethral fistual
what is intussusception?
when one portion of bowel slides into the next, can lead to decreased blood flow and necrotic tissue
how is an intussusception treated?
- may try a barium enema to expand area using fluid
- may require surgery
