Care of kids w/ GI disorders

Question 1

Gastroenteritis: What you need to know for dx

Answer 1

• 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?

Question 2

S/S of gastroenteritis

Answer 2

Vomiting, diarrhea, decreased voiding, dehydration, lethargy

Question 3

Gastroenteritis: Nursing interventions

Answer 3

*Hx of present illness
*Obtain current wt
*Calculate % wt loss
*Treat dehydration: Severe = IV solution, mild-moderate = oral rehydration

Question 4

In hospital NRSG care for gastroenteritis

Answer 4

*VS monitoring
*Monitor I/O

Question 5

s/s of overhydrating

Answer 5

Bulging fontanelles in babies, intracellular edema leading to HA, blurred vision, “wet lungs,” and increased vomiting unrelated to the illness

Question 6

Feeding recommendations: NPO

Answer 6

*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

Question 7

BRAT diet

Answer 7

Bananas, Rice, Applesauce, and Toast
*Not recommended for gastroenteritis
*Instead complex carbs are (fruit, yogurt, whole wheat bread)

Question 8

Gastroenteritis: What

Answer 8

*inflamm of the lining of the stomach
*Usually not serious but can lead to dehydration

Question 9

s/s of dehydration

Answer 9

N/V/D, abd pain/cramping, fever sometimes, thirst, dry mucous membranes

Question 10

Gastroenteritis: etiology

Answer 10

*Commonly viral (rotavirus)

Question 11

Gastroenteritis: Tx

Answer 11

*Testing rarely needed without acute diarrheal illness
*Antidiarrheal drug are not recommended

Question 12

Common causes of sudden diarrhea

Answer 12

*Food poisoning
*Traveler’s diarrhea
*Stomach flu

Question 13

Common causes of chronic diahrrea

Answer 13

*Celiac disease
*Food intolerance/allergy
*Milk/soy protein intolerance
*IBS
*Medication

Question 14

Diarrhea: NRSG assessment

Answer 14

*Character, amount, frequency of diarrhea
*Skin integrity (turgor/tenting)
*I/O
*s/s of dehydration

Question 15

Red flags of dehydration (7)

Answer 15

*tachycardia
*hypotension
*lethargy
*Bloody stools
*Bilious vomiting (indicates intestinal blockage)
*Extreme abd tenderness and/or distention
*Petechiae and/or pallor

Question 16

Dehydration tx: mild to moderate

Answer 16

*oral dehydration (pedialyte: 5 mL every 5 min)
*Avoid carbonated and high sugar beverages (soda, apple juice)

Question 17

Dehydration tx: severe

Answer 17

*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

Question 18

Vomiting: key concepts

Answer 18

common and non-specific s/s

Question 19

Vomiting: cause

Answer 19

*Infection most likely cause of acute
*Intracrainial causes (non-accidental injury considered ie abuse)

Question 20

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

Answer 20

1. Turn the child on the side (or sit the child upright)
2. Ask another health care team member to obtain suctioning
   equipment

Question 21

Pyloric stenosis: what

Answer 21

*HPS: hypertrophic pyloric stenosis
*Increased growth of the circular muscle surrounding the pylorus, the valve between the stomach and duodenum

Question 22

Pyloric stenosis: Cause

Answer 22

Undetermined, maybe genetics

Question 23

Pyloric stenosis: who

Answer 23

*More common in males
*Less common in breastfed infants (perhaps due to smaller curds than w/ formula)

Question 24

Pyloric stenosis: s/s

Answer 24

*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

Question 25

Pyloric stenosis: tx

Answer 25

Ramstedt procedure: splitting the muscle of the pylorus for a larger opening

Question 26

Skin tenting range

Answer 26

Time to return to normal = estimated wt loss
* < 2 sec = <5%
* 2-3 sec = 5-8%
*3-4 sec = 9-10%
* > 4 sec = >10%

Question 27

Determining severity of dehydration by % wt loss

Answer 27

1. Convert pounds to kg : 22 divided by 2.2 = 10 kg
2. 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:
3. 1 divided by 10 = 0.1
4. 0.1 x 100 = 10%
5. The child has lost 10% of his weight.
6. According to the table, a weight loss of 10% is “Severe”

Question 28

Lab values associated w/ dehydration

Answer 28

*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

Question 29

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.

Answer 29

1. Measure the distance from the tip of the ear to the nose and
   the xiphoid process.

Question 30

Appendicitis: What

Answer 30

Inflamm of appendicts

Question 31

Appendicitis: cause

Answer 31

*possibly decreased fiber in diet
*fecal material enters pouch attached to cecum and may harden obstruct, and lead to inflamm and edema

Question 32

Appendicitis: s/s

Answer 32

*sudden pain on R side of abdomen
*n/v
*Loss of appetite
*Fever
*constipation or diarrhea
*Abd bloating

Question 33

Appendicitis: tx

Answer 33

*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

Question 34

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

Answer 34

3. 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

Question 35

Intussusception: What

Answer 35

*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

Question 36

Intussusception: causes

Answer 36

*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.

Question 37

Intussusception: s/s classic triad

Answer 37

1. Sudden abdominal pain
2. Abdominal mass (sausage shaped, in upper right quadrant
3. Bloody stools like jelly

Question 38

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.”

Answer 38

1. “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

Question 39

Intussusception: tx

Answer 39

*barium enama
*Pneumatic insufflation to straighten intestine
*Ultrasound guided hydrostatic saline enema
*Resection of affected intestine

Question 40

Intussusception: nursing tx

Answer 40

 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.

Question 41

Hirschprung’s disease aka “Megacolon”

Answer 41

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.

Question 42

Hirschprung’s disease: cues for dx NB

Answer 42

 No meconium stool in 24 hours
 Abdominal distention
 Refusal to feed
 Billious (bile-colored) vomitus

Question 43

Hirschprung’s disease: cues for dx, later s/s

Answer 43

 Slow growth
 Constipation
 Abdominal distention
 Palpable fecal mass
 Explosive, watery diarrhea, or ribbon-like stools

Question 44

Hirschprung’s disease: tx

Answer 44

*Temporary colostomy
*Soave endo-rectal pull-through procedure at 12-18 mon (10 kg wt)

Question 45

Gastroesophageal Reflux (GER): what

Answer 45

 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

Question 46

GERD: What

Answer 46

More serious. refers to symptoms or tissue damage
resulting from GER
 Failure to thrive
 Bleeding  Dysphagia
 Bronchospasm and laryngospasm

Question 47

Gastroesophageal Reflux (GER): Tx

Answer 47

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.