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ch 25 GI dysfunction Flashcards

1
Q

5 types GI secretions

A

-enzymes
-hormones
-hydrochloric acid
-mucus
-water and electrolytes

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2
Q

what is absorbed from the large intestine

A

water
sodium

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3
Q

primary purpose upper GI system (mouth, esophagus, stomach)

A

-take in food and fluids
-begin the digestive
process
-propel food into the
intestine

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4
Q

primary purpose lower GI system (Duodenum, liver, gallbladder,
pancreas, jejunum, ileum, cecum,
appendix, colon, rectum, and
anus)

A

-digest and absorb nutrients
-detoxify and excrete unwanted waste
-aid in fluid and electrolyte balance

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5
Q

most common complications GI dysfunction in children

A

-malabsorption
-fluid and electrolyte disturbances
-malnutrition
-poor growth

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6
Q

4 types diarrhea

A

-acute
-chronic
-intractable
-chronic nonspecific

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7
Q

possible causes acute diarrhea

A

-infectious (bacteria, virus, parasite)
-illness (URI, UTI)
-med (Abx, laxatives)
-diet (excess sugar in formula or juice)
-functional (IBS)
-other enterocolitis (pseudomembranous, hirschprung)

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8
Q

possible causes chronic diarrhea

A

-malabsorption
-allergy
-immunodeficiency
-IBS

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9
Q

Tx diarrhea

A

-oral rehydration therapy (ORT)
-IV hydration
-assess and correct fluid and electrolytes

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10
Q

-Most important cause of serious Gastroenteritis in Children
-Most common cause of diarrhea associated hospitalizations
-spread through fecal oral route

A

rotavirus

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11
Q

S+S mild dehydration (5-6%)

A

-increased thirst
-slightly dry mucous membranes

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12
Q

Tx mild dehydration

A

-oral rehydration: 50 mL/kg over 4 hrs
-replacement of stool losses

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13
Q

S+S moderate dehydration (7-9%)

A

-dry mucous membranes
-sunken fontanels
-sunken eyes
-no tear production
-loss of skin turgor

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14
Q

Tx moderate dehydration

A

-oral rehydration: 100 mL/kg over 4 hrs
-replacement of stool losses

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15
Q

S+S severe dehydration (>9%)

A

signs of moderate dehydration +
-rapid thready pulse
-cyanosis
-rapid breathing
-lethargy
-coma

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16
Q

Tx severe dehydration

A

-IV fluids: bolus NS 20 mL/kg over 20 mins, LR 40 mL/kg/hr until pulse and LOC normal
-switch to oral rehydration as soon as possible

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17
Q

an eating disorder characterized by
compulsive and excessive ingestion of
both food and non-food substances for at
least one month

A

pica

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18
Q

frequently aspirated items

A

most common:
-peanuts
-nuts
-seeds

other:
-hotdogs
-vegetables
-metal/plastic objects
-bones

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19
Q

when should foreign ingested objects be removed

A

-if sharp object, magnet, or battery in esophagus (especially multiple batteries)
-if airway is compromised
-if in esophagus for 24+ hrs

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20
Q

conditions that may cause delayed passage of meconium in newborn

A

-hirschprung disease
-hypothyroidism
-meconium plug
-meconium ileus

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21
Q

inappropriate/involuntary passage of
feces, often with soiling

A

encopresis

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22
Q

Tx childhood constipation/encopresis

A

-miralax
-debulking of stool
-diet
-hydration
-exercise

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23
Q

what age can you give mineral oil

A

after 1 yo

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24
Q

risk of giving mineral oil

A

aspiration

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25
longterm Tx constipation
phase 1 (3-5 days) -oral clean out (mineral oil, polyethylene glycol, magnesium) -enema clean out (milk and molasses, normal saline, microlax, mineral oil, hypertonic phosphate) -NG lavage if hospitalized phase 2 (6-12 months) -oral laxatives (polyethylene glycol, mineral oil, lactulose, magnesium) -high fiber diet -increased fluids phase 3 -gradual tapering laxatives -high fiber diet -increased fluids
26
Mechanical obstruction from inadequate motility of intestine
hirschsprung disease/ congenital aganglionic megacolon
27
Dx hirschprung disease
-xray -barium enema -anorectal manometric exam -rectal biopsy
28
S+S hirschprung disease in newborn
-failure to pass meconium in first 1-2 days -refusal to feed -bilious vomiting -abdominal distention
29
S+S hirschsprung disease in newborn
-failure to pass meconium in first 1-2 days -refusal to feed -bilious vomiting -abdominal distention
30
S+S hirschsprung disease in infancy
-failure to thrive -constipation -abdominal distention -V/D
31
S+S hirschsprung disease in childhood
-constipation -*ribbonlike, foul smelling stools -abdominal distention -easily palpable stool mass -visible persitalsis
32
possible complication hirschsprung disease
enterocolitis -explosive watery diarrhea -fever -ill appearance
33
Tx hirschsprung disease
-surgery
34
Tx GER/GERD
-avoid offending foods -surgery: nissen fundoplication changes for infant: -thicken feedings -upright position -frequent burping during feeds -avoid overfeeding
35
when would a nissen fundoplication be indicated for GER/GERD
-aspiration pneumonia -apnea -severe esophagitis -severe failure to thrive
36
Tx IBS -general -meds -school considerations
-diet (fiber, fluids, identify triggers) -meds (probiotics for diarrhea, PPI - nexium, provasid) -inform school so they can have bathroom privileges -keep change of clothes with them
37
hirschsprung disease periop teaching/care
-teaching colostomy
38
warnings for probiotics (preparation)
-don't open and mix in room if pt has central line -wear gloves
39
when do kids get rotavirus vaccines
2, 4, 6 months
40
when to avoid removal of foreign ingested body
if already in bowel and not sharp/batteries
41
first sign that patient may have CF at birth
delayed passing meconium
42
why could formula cause constipation
contains iron, causes constipation
43
who is hirshsprung disease more common in
males down syndrome
44
when is Tx indicated for GERD (pathologic)
-failure to thrive -resp problems -dysphagia
45
how do you figure out how thick formula needs to be for feeding baby with GERD
radiology study with different thickness of feedings, using different nipples (slow flow)
46
S+S appendicitis
-referred pain -epigastric pain, mcburneys point -rebound tenderness -fever -N/V -increased WBCs
47
Dx appendicitis
-ultrasound - preferred -CT (if high BMI)
48
Tx nonruptured appendicitis
-lap removal -possible watch and wait -Abx preop -IV fluids and electrolytes
49
S+S ruptured appendicitis (peritonitis)
-sudden relief of pain then: -diffuse pain -abdominal distention, rigid -fever -chills -tachycardia -rapid shallow breathing -pallow -irritability
50
Tx ruptured appendicitis
-surgical removal -IV fluid and electrolytes -Abx -NGT suction to reduce abdominal distention
51
postop care appendicitis
-realistic pain goal -walk (premedicate atleast 30 mins before) -heating pads -splint with pillow when getting up -wound care:
52
2 forms inflammatory bowel disease
ulcerative colitis crohns disease
53
S+S ulcerative colitis
-frequent bloody stools -anemia -fever -weight loss
54
Tx ulcerative colitis
-diet: avoid triggers -med: iron supplement, antiinflammatory
55
Tx crohns disease
-pain management
56
Dx IBD
colonoscopy
57
S+S crohns disease
-some diarrhea -pain -anorexia -weight loss -growth retardation -anal/perinanal lesions -fistulas and strictures
58
bacteria that causes peptic ulder disease
helicobacter pylori
59
Tx peptic ulcer disease
-antacids -PPI -Abx -teach stress management -avoid acidic foods (juices), spicy foods, caffeine
60
common side effects PPI/ H2 receptor antagonist
-hypoTN -LOC depression -N/D -rash, sweating, flushing -thrombocytopenia
61
can meds can you not give to kids with PUD
NSAIDs
62
S+S hypertrophic pyloric stenosis (HPS) (seen within first few weeks of life)
-nonbilious projectile vomiting -visible peristalsis/olive shaped mass above umbilicus -failure to thrive -dehydrated -irritable (always hungry) -metabolic alkalosis
63
Tx HPS
-surgery (pyloromyotomy)
64
nursing consideration preop surgery HPS
-check hydration and electrolytes
65
telescoping/invagination of one portion of intestine to another
intussusception
66
risks with intussusception
-sepsis from bowel necrosis and rupture
67
S+S intussusception
-*"currant jelly like stools" -sudden onset abdominal pain -abdominal mass "sausage like" -bloody stool
68
Dx intussusception
-ultrasound -palpation
69
Tx intussusception (conservative/nonsurgical)
-air enema (with or without contrast) -hydrostatic enema (saline) - ultrasound guided
70
Tx intussusception (if conservative measures unsuccessful)
-surgical reduction/fixation -excision of nonviable bowel
71
abnormal rotation around superior mesenteric artery during embryonic development
malrotation
72
when intestine becomes twisted around itself and compromises blood flow to intestines
volvulus
73
S+S malrotation and volvulus
bilious emesis in newborn
74
Tx malrotation and volvulus
emergency surgery
75
S+S malabsorption syndrome
-chronic diarrhea -failure to thrive
76
complications of malrotation and volvulus post-surgery
short bowel syndrome malabsorption *need TPN and lipids
77
S+S celiac disease
-steatorrhea -abdominal distention -secondary vitamin deficiencies -general malnutrition
78
Dx celiac disease
gluten elimination diet endoscopy possible
79
Tx short bowel disease
TPN (through central line) and lipids ostomy
80
nursing consideration with TPN
check ingredients in TPN (can't just scan barcode) compare ingredients in TPN to lab values
81
S+S upper GI bleed
stomach: -coffee grounds emesis -hematemesis -*black tarry stools esophageal -vomiting bright red blood
82
S+S lower GI bleed
-bright red (rectal bleeding) - hematochezia
83
Dx GI bleed
stool cultures CBC
84
Tx GI bleed
-assess blood loss -possible blood transfusion -emergency: IV, O2, suction if severe
85
nursing considerations for transfusing blood
-2 nurses -consent -blood type on record -cross match on record -infuse with NS only -stay with pt first 15 mins
86
time limit for using bag of blood for infusion
4 hours
87
S+S blood transfusion reactions
-fever -tachycardia -LOC change -hypo/HTN -rash/hives
88
S+S hepatitis
-jaundice -anorexia -fatigue -malaise
89
transmission hep A
fecal oral
90
transmission hep B
perinatally acquired
91
transmission hep C
parenteral exposure (blood)
92
transmission hep D
people who already had hep B
93
transmission hep E
contaminated water fecal oral (worse in pregnant women)
94
what types hepatitis have vaccines
A and B
95
S+S biliary atresia
-prolonged jaundice
96
Tx biliary atresia
cosine procedure (stent for biliary duct) possible liver transplant if stent unsuccessful
97
S+S tracheoesophageal fistula
-choking -pneumonia -fever -frothy saliva
98
common cause esophageal atresia and tracheoesophageal fistula
VATAR disease
99
S+S esophageal atresia
-failure to thrive -vomiting right after eating -aspiration pneumonia
100
Tx tracheoesophageal fistula
-maintain airway -suction -thermoregulation -fluid and electrolytes -surgery -postop: upright with feeding
101
protruding bowel covered with peritoneal sac
omphalocele
102
Tx omphalocele and gastroschisis before birth
C-section
103
bowel herniation through abdominal bowel not covered with peritoneal sac
gastroschisis
104
nursing considerations gastroschisis preop
-keep covered -keep moist -watch for color changes in bowel
105
when does an umbilical hernia need emergency surgery
can't be reduced (pushed back in)
106
S+S inguinal hernia
-painless inguinal/scrotal swelling -tender abdominal distention -anorexia -difficulty with bowel movement
107
possible complications inguinal hernia
-herniation -obstruction -strangulation of bowel
108
Tx inguinal hernia
surgery
109
possible complication imperforate anus
sepsis (no passing of meconium) distention perforation of bowel
110
when should H2 receptor antagonists be given if pt is also receiving antacid
H2 receptor antagonist 2 hours before

peds (28 decks)

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