Care of kids w/ GI disorders Flashcards
Gastroenteritis: What you need to know for dx
- How many days ago did s/s begin?
- Voiding as usual? Or less?
- How many stools in 3 hours?
- Any changes in mental status and energy?
S/S of gastroenteritis
Vomiting, diarrhea, decreased voiding, dehydration, lethargy
Gastroenteritis: Nursing interventions
*Hx of present illness
*Obtain current wt
*Calculate % wt loss
*Treat dehydration: Severe = IV solution, mild-moderate = oral rehydration
In hospital NRSG care for gastroenteritis
*VS monitoring
*Monitor I/O
s/s of overhydrating
Bulging fontanelles in babies, intracellular edema leading to HA, blurred vision, “wet lungs,” and increased vomiting unrelated to the illness
Feeding recommendations: NPO
*No NPO w/ gastroenteritis, but Dr. may hold fluids for 2-3 hrs
*Fluid replacement by mouth is recommended is child is not actively vomiting
BRAT diet
Bananas, Rice, Applesauce, and Toast
*Not recommended for gastroenteritis
*Instead complex carbs are (fruit, yogurt, whole wheat bread)
Gastroenteritis: What
*inflamm of the lining of the stomach
*Usually not serious but can lead to dehydration
s/s of dehydration
N/V/D, abd pain/cramping, fever sometimes, thirst, dry mucous membranes
Gastroenteritis: etiology
*Commonly viral (rotavirus)
Gastroenteritis: Tx
*Testing rarely needed without acute diarrheal illness
*Antidiarrheal drug are not recommended
Common causes of sudden diarrhea
*Food poisoning
*Traveler’s diarrhea
*Stomach flu
Common causes of chronic diahrrea
*Celiac disease
*Food intolerance/allergy
*Milk/soy protein intolerance
*IBS
*Medication
Diarrhea: NRSG assessment
*Character, amount, frequency of diarrhea
*Skin integrity (turgor/tenting)
*I/O
*s/s of dehydration
Red flags of dehydration (7)
*tachycardia
*hypotension
*lethargy
*Bloody stools
*Bilious vomiting (indicates intestinal blockage)
*Extreme abd tenderness and/or distention
*Petechiae and/or pallor
Dehydration tx: mild to moderate
*oral dehydration (pedialyte: 5 mL every 5 min)
*Avoid carbonated and high sugar beverages (soda, apple juice)
Dehydration tx: severe
*Maintain NPO to place bowel at rest
*Provide fluid and electrolytes via IV
*voiding monitored (voiding b4 IV and has adequate renal func.)
*Reintroduce norm diet when rehydrated
Vomiting: key concepts
common and non-specific s/s
Vomiting: cause
*Infection most likely cause of acute
*Intracrainial causes (non-accidental injury considered ie abuse)
A child who has gastroenteritis (vomiting or diarrhea due to
inflammation of the small or large bowel often due to infection)
has experienced episodes of diarrhea, developed fluid and
electrolyte imbalances, and is lethargic. The child suddenly
vomits. Which two of the following actions are most important to
prevent aspiration:
1. Turn the child on the side (or sit the child upright)
2. Ask another health care team member to obtain suctioning
equipment
3. Check respiratory status and lung sounds
4. Check the character and amount of vomitus
5. Document the episode, including assessment findings and characteristics of the vomitus
- Turn the child on the side (or sit the child upright)
- Ask another health care team member to obtain suctioning
equipment
Pyloric stenosis: what
*HPS: hypertrophic pyloric stenosis
*Increased growth of the circular muscle surrounding the pylorus, the valve between the stomach and duodenum
Pyloric stenosis: Cause
Undetermined, maybe genetics
Pyloric stenosis: who
*More common in males
*Less common in breastfed infants (perhaps due to smaller curds than w/ formula)
Pyloric stenosis: s/s
*starts at 4-6 wks of age
*Most commonly projectile vomiting shortly after each feeding
*Vomitus smells sour
*Baby is hungry after vomiting
*Baby doesn’t gain wt
*Stool volume is less
Pyloric stenosis: tx
Ramstedt procedure: splitting the muscle of the pylorus for a larger opening
Skin tenting range
Time to return to normal = estimated wt loss
* < 2 sec = <5%
* 2-3 sec = 5-8%
*3-4 sec = 9-10%
* > 4 sec = >10%
Determining severity of dehydration by % wt loss
- Convert pounds to kg : 22 divided by 2.2 = 10 kg
- Using the weight loss of 1 kg and the child’s original weight of
10 kg, divide 1 by 10 and multiply by 100 to get the percent of
weight loss: - 1 divided by 10 = 0.1
- 0.1 x 100 = 10%
- The child has lost 10% of his weight.
- According to the table, a weight loss of 10% is “Severe”
Lab values associated w/ dehydration
*Elevated Hct (concentrated blood)
*Elevated specific gravity (concentrated urine)
The higher the number, the more concentrated the urine and
the more dehydration
*Increased serum sodium
*decreased potassium
*Metabolic alkalosis: high pH and high bicarb
*Metabolic acidosis: low pH and low bicarb
A nurse is inserting a gavage tube into a preterm baby who is unable
to suck and swallow. Which of the following actions must the nurse
take during the procedure?
1. Measure the distance from the tip of the ear to the nose and
the xiphoid process.
2. Lubricate the tube with an oil-based solution.
3. Insert the tube quickly if the baby becomes cyanotic.
4. Inject a small amount of sterile water to check placement.
- Measure the distance from the tip of the ear to the nose and
the xiphoid process.
Appendicitis: What
Inflamm of appendicts
Appendicitis: cause
*possibly decreased fiber in diet
*fecal material enters pouch attached to cecum and may harden obstruct, and lead to inflamm and edema
Appendicitis: s/s
*sudden pain on R side of abdomen
*n/v
*Loss of appetite
*Fever
*constipation or diarrhea
*Abd bloating
Appendicitis: tx
*Keep NPO
*No oral pain meds: don’t mask pain
*No heat to abd: might increase rupture
*Generally urgent surgery is required
*Dr. may prescribe antibiotics and take a wait and see approach
A nurse is caring for a 5-year-old who has just returned from having an appendectomy. What is the optimal way to manage pain?
1. IV morphine as needed
2. Liquid acetaminophen (Tylenol) with codeine as needed
3. Morphine administered through a PCA pump
4. Intramuscular morphine as needed
- Morphine administered through a PCA pump offers the child control over managing pain. The PCA pump also has the benefit of offering a basal rate as well as an as-needed bolus for optimal pain management
Intussusception: What
*Intussusception is a medical emergency
*Most common abd emergency in kids under 2 yo
*Part of the bowl slides into the next, like a telescope
Intussusception: causes
*The flow of fluids and food through the bowel can get blocked.
*The intestine can swell and bleed. *The blood supply to the affected part of the intestine can get cut off.
*In time, part of the bowel can die.
Intussusception: s/s classic triad
- Sudden abdominal pain
- Abdominal mass (sausage shaped, in upper right quadrant
- Bloody stools like jelly
describes her child as alternately sleepy and fussy. She states
that her infant vomited once this morning and had two episodes
of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. What is the nurse’s best response?
1. “Your infant will need to have some tests in the emergency department to determine whether anything serious is going on.”
2. Try feeding your baby in about 30 minutes; in the event of repeat
vomiting, bring the baby to the emergency department for some
tests and IV rehydration.”
3. “Many babies display these symptoms when they develop an allergy
to the formula they are receiving; try switching to a soy-based formula.”
4. “Do not worry about the blood and mucus in the stool; it is not unusual for babies to have blood in their stools because their intestines are more sensitive.”
- “Your infant will need to have some tests in the emergency department to determine whether anything serious is going on.” These are signs of intussusception. This is an emergency
Intussusception: tx
*barium enama
*Pneumatic insufflation to straighten intestine
*Ultrasound guided hydrostatic saline enema
*Resection of affected intestine
Intussusception: nursing tx
Pre-op teaching to family
Consent
NPO
Routine lab work, etc
Post-op care: monitor stools, weigh diapers, monitor IVs, monitor NG tube, administer antibiotics, pain meds, vital signs, etc.
Hirschprung’s disease aka “Megacolon”
Hirschsprung’s disease is a birth defect in which some nerve cells are missing in the large intestine, so a child’s intestine can’t move stool and becomes blocked.
Hirschprung’s disease: cues for dx NB
No meconium stool in 24 hours
Abdominal distention
Refusal to feed
Billious (bile-colored) vomitus
Hirschprung’s disease: cues for dx, later s/s
Slow growth
Constipation
Abdominal distention
Palpable fecal mass
Explosive, watery diarrhea, or ribbon-like stools
Hirschprung’s disease: tx
*Temporary colostomy
*Soave endo-rectal pull-through procedure at 12-18 mon (10 kg wt)
Gastroesophageal Reflux (GER): what
GER = Transfer of gastric contents into the esophagus. Also known as
Reflux, Heartburn, etc
Most common at 4 months
Generally resolves by 1 year of age
GERD: What
More serious. refers to symptoms or tissue damage
resulting from GER
Failure to thrive
Bleeding Dysphagia
Bronchospasm and laryngospasm
Gastroesophageal Reflux (GER): Tx
A. Histamine receptor antagonists: Zantac, Pepcid, etc
B. Proton Pump Inhibitors (PPI): Nexium, Prilosec, etc.
*Best given 30 minutes before a feeding. If given twice a day, give before first and last feedings of the day.
