Ch. 23: Gastrointestinal Structural and Inflammatory Disorders Flashcards
Results from the incomplete fusion of the oral cavity during intrauterine lip
Cleft lip
Results from the incomplete fusion of the palatine plates during intrauterine life
Cleft palate
What are some risk factors for the clefts?
- Family history of cleft lip or palate
- Exposure to alcohol, cig smoke, anticonvulsants, or steroids during pregnancy
- Folate deficiency during pregnancy
- Other syndromes
What does cleft lip look like?
Visible separation from the upper lip toward the nose
What does cleft palate look like?
A visible or palpable opening of the palate connecting the mouth and the nasal cavity
Nursing care: what should we promote? (2)
- Parent-infant bonding
2. Healthy self esteem thoughtout childs development
Who all is apart of the child with CL and CP?
Plastic surgeon Orthodontist ENT specialist Speech and language specialist OT Dietitian Social services worker
CL:
When is repair done?
How old should infant be for surgery? Weigh? Hgb level?
Repair: done between 2-3 months
Infant be 10 weeks old, weigh 10 lbs, and Hgb of 10 g/dL
CP:
When is repair done?
Is second surgery usual or unusual?
Repair: 6-12 months
Majority require a second surgery!
Nursing actions: PRE-OP (both for CL and CP)
- Inspect infants lip and palate using a ______ to palpate the infants palate
- Asses infants ability to ___
- Obtain what?
- Observe what?
- Determine family ___ & ___
- Refer parents to appropriate _____
- Why would we consult with social services?
- What do we instruct parents about?
- Assess ability to ____
- GLOVED FINGER
- Suck
- Baseline weight of infant
- Observe interaction btwn. family and infant
- Determine family COPING AND SUPPORT
- Support groups
- To provide needed services, like financial or insurance for fam and infant
- Proper feeding and care
- Feed
Strategies for successful feeding: For ISOLATED CL (like this is only CL and CP is not an issue)
What type of feeding is encouraged?
What type of bottle is needed if bottle fed?
How do we get the infant to eat…what do we do to them?
- Breast feeding
- Wide-based nipple for bottle feeding
- Squeeze infants cheeks together during feeding to decrease the gap
Strategites for successful feeding: For CP or CL/CP
- What position is used?
- What bottle?
- Do we burp baby?
- What if baby is unsuccessful with other methods of feeding..what do we do?
Position: Infant upright while cradling head
Bottle: Special bottle wit one-way valve and special cut nipple
Burp: Yes, burp frequently
Unsuccessful feeding: Syringe feeding may be necessary
Post-Op: CL and CP repair
- Can they suck on nipple or pacifier?
- Is it okay if they begin bringing hard toys up to their mouth?
- What is monitored daily?
- Observe?
- No
- No
- I&O and weight
- Family interaction with infant
Post Op: CL
- Monitor what?
- Positon?
- How to clean incision site?
- Why do we aspirate secretions of mouth and nasopharynx?
- Integririty of post op protective device to ensure proper positioning
- Position: Infant on back and upright on side during immediate post op—apply elbow restraints to keep infant from injuring repair site
- Clean: Saline on sterile swab; apply antibiotic ointment if prescribed
- To prevent respiratory complications
Post Op: CP
- Why do we change infants position frequently?
- Position?
- Maintain what till infant is able to eat and drink?
- When is packing removed?
- Can we place objects in the mouth (tongue depressor, pacifier)?
- Elbow restrained?
- To facilitate breathing
- Placed on abdomen immediate post op
- IV fluids
- Packing removed 2-3 days, monitor this until then
- No
- Elbow restraints may be needed
CL or CP or both….If an infant is having to use elbow restraints, how long may they be in them?
4-6 weeks possibly
What are some complications of CL and CP? (3)
- Ear infections and hearing loss
- Speech and language impairment
- Dental problems
What GI problem: Occurs when the gastric contents reflux back into the esophagus, making esophageal music vulnerable to injury from gastric acid
Gastrointestinal reflux disease (GERD)
GERD is tissue damage from ____
GER (gastroesophageal reflux)
GER is self-limiting and usually resolves by ____
1 year of age
Risk factor for GER or GERD:
- Premature
- Bronchopulmonary dysplasia
- Neurological impairments
- Asthma
- CF
- Cerebral palsy
- Scoliosis
GER
Risk factors for GER or GERD:
- Neurologic impairments
- Hiatal hernia
- Esophageal atresia
- Morbid obesity
GERD
What does GER/GERD look like in infants?
- Excessive spitting up
- Forceful vomiting
- Irritability and lots of crying
- Blood in stool or vomit
- Arching of back
- Stiffening
- Resp. problems
- FTT
- Apnea
What does GER/GERD look like in children?-
- Heartburn
- Abdominal pain
- Difficulty swallowing
- Chronic cough
- Chest pain
GER nursing care:
- Meals?
- Avoid what foods?
- Assist with?
- Position after meals?
- Small, frequent meals–thicken infants formula with 1 tsp- 1 tbsp rice cereal per 1 oz formula
- Ones that cause acid reflex (caffeine, citrus, peppermint, spicy, fried foods)
- Assist with WEIGHT CONTROL
- Position after meals: Head elevated 30 degrees for 1 hour after meals
GERD nursing care is the same interventions as GER, PLUS administering a ______ or an ______
Proton pump inhibitor (omeprazole) or H2 receptor antagonist (ranitidine)
A type of procedure used for severe cases of GERD: wraps the funds of the stomach around the distal esophagus to decrease reflux
Laparoscopic surgical procedure
What are complications of GERD?
Recurrent pneumonia, weight loss, and FTT
What can repeated reflux of stomach contents lead to ?
Erosion of the esophagus or pneumonia if stomach contents are aspirated
GERD: What can esophageal damage lead to?
Inability to eat
What GI problem: The thickening of the pyloric sphincter, which creates an obstruction
Hypertrophic pyloric stenosis (HPS)
When does HPS occur?
The first 5 weeks of life
S&O data for HPS
Why is vomiting data for assessing HPS? What color may the vomit be?
Because its vomiting that occurs after a feeding…but it lasts up to several hours following the feeding and it becomes projectile as obstruction worsens
The color may be blood-tinged
S&O data for HPS: What kind of mass may there be. Explain.
OLIVE-SHAPED MASS in RUQ of the abdomen
Possible peristaltic wave that moves from left to right when lying supine
What are some other signs of HPS?
- Failure to gain weight
- Signs of dehydration (dry skin, pale/cool lips, dry mucous membranes, etc)
- Decreased urine output
- Concentrated urine
- Thirst
- Rapid pulse
- Sunken eyes
What does diagnostic procedures of HPS show?
Ultrasound reveals an elongated, sausage shaped mass and an elongated pyloric area
What surgery is done for HPS?
Pylorotomy
How is pylorotomy done?
Laparoscope
HPS: Pylorotomy post op
- What do we administer?
- When do we start clear liquids?
- Administer antimetic and analgesics
- Start clear liquid 4-6 hours after surgery–advance to breast milk or formula as tolerated
What GI problem: A structural anomaly of the GI tract that is caused by a lack of ganglionic cells in segments of the colon resulting in decreased motility and mechanical obstruction
Hirschsprung disease
What is another name for Hirschsprung disease?
Congenital aganlionic megacolon
What are the subjective and objective data for Hirschsprung disease of a NEWBORN?
- Failure to pass meconium within 24-48 hours after birth
- Episodes of vomiting bile
- Refusal to eat
- Abdominal distention
What are the subjective and objective data for Hirschsprung disease of an INFANT?
- FTT
- Abdominal distention
- Vomiting
- Episodes of constipation and watery diarrhea
What are the subjective and objective data for Hirschsprung disease of an OLDER CHILD?
- FTT
- Abdominal distention
- Visible peristalsis
- Palpable fecal mass
- Constipation
- Foul smelling, ribbon like stool
Hirschsprung disease: What nutritional status should patient be until surgery?
High protein, high calorie, low fiber diet
*some TPN in some cases
Hirschsprung disease: What is removed in surgery?
Aganglionic section of the bowel
What are some complications of Hirschsprung disease surgery?
- Enterocolitis
- Anal stricture and incontinence
Complication of Hirschsprung disease: Inflammation of the bowel
Enterocolitis
What GI problem: one part of the intestine telescopes into another part, resulting in lymphatic and venous obstruction that results in edema in the area. With progression, ischemia and increased mucus into the intestine will occur
Intussuception
What age is intussusception common in?
Infants and children ages 3 months-3 year
What is a risk factor for intussusception?
CF
Intussusception subjective and objective data:
- Sudden episodic ____
- ____ with drawing of knees to chest during episodes of pain
- What shape abdominal mass?
- What kind of stools?
- Vomiting?
- Fever?
- Constipation?
- Dehydration?
- Abdominal pain
- Screaming
- Sausage sheped
- Stools mixed with blood and mucus that resemble the consistncy of red currant jelly
- Vomiting: YES
- Fever: YES
- Constipation: NO
- Dehydration: YES
What is a therapeutic procedure for intussusception?
Air enema
intussusception: Who does air enema?
Radiologist
Why would surgery be required for intussusception?
Recurring intussusception
What GI problem: Inflammation of the vermiform appendix caused from an obstruction of the lumen of the appendix
Appendicitis
What is average age for appendicitis?
10 years old
If patient has appendicitis showing signs of abdominal pain in RLQ, having a rigid abdomen, decreased/absent bowel signs, etc…is it okay to apply heat to the area to decrease pain? Is it okay to give enemas or laxatives?
NO to both!
What kind of surgery is done to remove enraptured appendix?
Laparoscopic
What kind of surgery is done to remove ruptured appendix?
Laparoscopic
What is a complication of appendicitis?
Peritonitis
Complication of appendicitis: What is peritonitis?
Inflammation of the peritoneal cavity
What GI problem: A complication resulting from failure of the omphalomesenteric duct to fuse during embryonic development
Meckels diverticulum
Some S&O data for Meckels diverticulum?
- Can be asymptomatic!
- Abdominal pain
- Bloody, mucus stools
What is the therapeutic procedure for Mockers diverticulum?
Surgical removal of the diverticulum
What is a complication of Meckels diverticulum?
GI hemorrhage and bowel obstruction
*this is a complication due to UNTREATED Mockers diverticulum
What GI problem:
Olive shaped mass in RUQ
Hypertrophic pyloric stenosis
What GI problem:
Lack of ganglionic cells
Hirschsprung disease
What GI problem:
Sausage shaped mass
Intussusception
What GI problem:
Stools mixed with blood and music that resemble the consistency of red currant jelly
Intussusception
What GI problem:
May be asymptomatic
Meckels Diverticulum
What GI problem:
Infant unable to pass meconium within 24-48 hours after birth
Hirschsprung disease
What GI problem:
Vomiting that often occurs following a feeding, but can occur up to several hours following a feeding and becomes projectile as obstruction worsens
Hypertrophic pyloric stenosis
What GI problem
Administering omeprazole or ranitidine is part of our nursing care
GERD
Omeprazole= proton pump inhibitor
Ranitidine=H2 receptor antagonist
What GI problem:
Complications include ear infections and hearing loss, speech and language impairment, and dental problems
CL, CP
A nurse is assessing an infant. Which of the following are clinical manifestations of hypertrophic pyloric stenosis? (SATA) A. Projectile vomiting B. Dry mucous membranes C. Currant jelly stools D. Sausage shaped abdominal mass E. Constant hunger
A, B, E
A nurse is caring for a child who has Hirschsprung disease. Which of the following is an appropriate action for the nurse to take.
A. Encourage high fiber, low protein, low calorie diet
B. Prepare family for surgery
C. Place an NG for decompression
D. Initiate bedrest
B.
A: Encourage LOW fiber, HIGH protein, HIGH calorie diet
B: CORRECT
C. Nutritionally managed–Dont need NG
D. Meckels diverticulum is placed on bedrest to prevent further bleeding NOT Hirschsprung Disease!
A nurse is caring for an infant who is post op following cleft lip and palate repair. Which of the following is an appropriate action for the nurse to take. A. Remove packing from mouth B. Place infant in upright position C. Offer a pacifier with sucrose D. Assess mouth with a tongue blade
B
A. Packing should stay in place 2-3 days
B. CORRECT
C. Objects in mouth could injure surgical site and should be avoided.
D. “ “
A nurse is teaching a parent of an infant about GERD. Which of the following should be included in the teaching? (SATA)
A. Offer frequent feedings
B. Thicken formula with rice cereal
C. Use a bottle with a one way valve
D. Position baby upright for 1 hour after feeding
E. Use a wide based nipple for feeding
A, B, D
A nurse is caring for a child. Which of the following are clinical manifestations of Meckels Diverticulum? (SATA) A. Abdominal pain B. Fever C. Mucus, bloody stools D. Vomiting E. Rapid, shallow breathing
A, C
A. CORRECT B. Fever= appendicitis C. CORRECT D. Vomitings= appendicits E. Rapid, shallow breathing= appendicitis
