ch 25 GI dysfunction Flashcards
5 types GI secretions
-enzymes
-hormones
-hydrochloric acid
-mucus
-water and electrolytes
what is absorbed from the large intestine
water
sodium
primary purpose upper GI system (mouth, esophagus, stomach)
-take in food and fluids
-begin the digestive
process
-propel food into the
intestine
primary purpose lower GI system (Duodenum, liver, gallbladder,
pancreas, jejunum, ileum, cecum,
appendix, colon, rectum, and
anus)
-digest and absorb nutrients
-detoxify and excrete unwanted waste
-aid in fluid and electrolyte balance
most common complications GI dysfunction in children
-malabsorption
-fluid and electrolyte disturbances
-malnutrition
-poor growth
4 types diarrhea
-acute
-chronic
-intractable
-chronic nonspecific
possible causes acute diarrhea
-infectious (bacteria, virus, parasite)
-illness (URI, UTI)
-med (Abx, laxatives)
-diet (excess sugar in formula or juice)
-functional (IBS)
-other enterocolitis (pseudomembranous, hirschprung)
possible causes chronic diarrhea
-malabsorption
-allergy
-immunodeficiency
-IBS
Tx diarrhea
-oral rehydration therapy (ORT)
-IV hydration
-assess and correct fluid and electrolytes
-Most important cause of serious Gastroenteritis in Children
-Most common cause of diarrhea associated hospitalizations
-spread through fecal oral route
rotavirus
S+S mild dehydration (5-6%)
-increased thirst
-slightly dry mucous membranes
Tx mild dehydration
-oral rehydration: 50 mL/kg over 4 hrs
-replacement of stool losses
S+S moderate dehydration (7-9%)
-dry mucous membranes
-sunken fontanels
-sunken eyes
-no tear production
-loss of skin turgor
Tx moderate dehydration
-oral rehydration: 100 mL/kg over 4 hrs
-replacement of stool losses
S+S severe dehydration (>9%)
signs of moderate dehydration +
-rapid thready pulse
-cyanosis
-rapid breathing
-lethargy
-coma
Tx severe dehydration
-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
an eating disorder characterized by
compulsive and excessive ingestion of
both food and non-food substances for at
least one month
pica
frequently aspirated items
most common:
-peanuts
-nuts
-seeds
other:
-hotdogs
-vegetables
-metal/plastic objects
-bones
when should foreign ingested objects be removed
-if sharp object, magnet, or battery in esophagus (especially multiple batteries)
-if airway is compromised
-if in esophagus for 24+ hrs
conditions that may cause delayed passage of meconium in newborn
-hirschprung disease
-hypothyroidism
-meconium plug
-meconium ileus
inappropriate/involuntary passage of
feces, often with soiling
encopresis
Tx childhood constipation/encopresis
-miralax
-debulking of stool
-diet
-hydration
-exercise
what age can you give mineral oil
after 1 yo
risk of giving mineral oil
aspiration
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
Mechanical obstruction from inadequate motility of intestine
hirschsprung disease/ congenital aganglionic megacolon
Dx hirschprung disease
-xray
-barium enema
-anorectal manometric exam
-rectal biopsy
S+S hirschprung disease in newborn
-failure to pass meconium in first 1-2 days
-refusal to feed
-bilious vomiting
-abdominal distention
S+S hirschsprung disease in newborn
-failure to pass meconium in first 1-2 days
-refusal to feed
-bilious vomiting
-abdominal distention
S+S hirschsprung disease in infancy
-failure to thrive
-constipation
-abdominal distention
-V/D
S+S hirschsprung disease in childhood
-constipation
-*ribbonlike, foul smelling stools
-abdominal distention
-easily palpable stool mass
-visible persitalsis
possible complication hirschsprung disease
enterocolitis
-explosive watery diarrhea
-fever
-ill appearance
Tx hirschsprung disease
-surgery
Tx GER/GERD
-avoid offending foods
-surgery: nissen fundoplication
changes for infant:
-thicken feedings
-upright position
-frequent burping during feeds
-avoid overfeeding
when would a nissen fundoplication be indicated for GER/GERD
-aspiration pneumonia
-apnea
-severe esophagitis
-severe failure to thrive
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
hirschsprung disease periop teaching/care
-teaching colostomy
warnings for probiotics (preparation)
-don’t open and mix in room if pt has central line
-wear gloves
when do kids get rotavirus vaccines
2, 4, 6 months
when to avoid removal of foreign ingested body
if already in bowel and not sharp/batteries
first sign that patient may have CF at birth
delayed passing meconium
why could formula cause constipation
contains iron, causes constipation
who is hirshsprung disease more common in
males
down syndrome
when is Tx indicated for GERD (pathologic)
-failure to thrive
-resp problems
-dysphagia
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)
S+S appendicitis
-referred pain
-epigastric pain, mcburneys point
-rebound tenderness
-fever
-N/V
-increased WBCs
Dx appendicitis
-ultrasound - preferred
-CT (if high BMI)
Tx nonruptured appendicitis
-lap removal
-possible watch and wait
-Abx preop
-IV fluids and electrolytes
S+S ruptured appendicitis (peritonitis)
-sudden relief of pain
then:
-diffuse pain
-abdominal distention, rigid
-fever
-chills
-tachycardia
-rapid shallow breathing
-pallow
-irritability
Tx ruptured appendicitis
-surgical removal
-IV fluid and electrolytes
-Abx
-NGT suction to reduce abdominal distention
postop care appendicitis
-realistic pain goal
-walk (premedicate atleast 30 mins before)
-heating pads
-splint with pillow when getting up
-wound care:
2 forms inflammatory bowel disease
ulcerative colitis
crohns disease
S+S ulcerative colitis
-frequent bloody stools
-anemia
-fever
-weight loss
Tx ulcerative colitis
-diet: avoid triggers
-med: iron supplement, antiinflammatory
Tx crohns disease
-pain management
Dx IBD
colonoscopy
S+S crohns disease
-some diarrhea
-pain
-anorexia
-weight loss
-growth retardation
-anal/perinanal lesions
-fistulas and strictures
bacteria that causes peptic ulder disease
helicobacter pylori
Tx peptic ulcer disease
-antacids
-PPI
-Abx
-teach stress management
-avoid acidic foods (juices), spicy foods, caffeine
common side effects PPI/ H2 receptor antagonist
-hypoTN
-LOC depression
-N/D
-rash, sweating, flushing
-thrombocytopenia
can meds can you not give to kids with PUD
NSAIDs
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
Tx HPS
-surgery (pyloromyotomy)
nursing consideration preop surgery HPS
-check hydration and electrolytes
telescoping/invagination of one portion of intestine to another
intussusception
risks with intussusception
-sepsis from bowel necrosis and rupture
S+S intussusception
-*“currant jelly like stools”
-sudden onset abdominal pain
-abdominal mass “sausage like”
-bloody stool
Dx intussusception
-ultrasound
-palpation
Tx intussusception (conservative/nonsurgical)
-air enema (with or without contrast)
-hydrostatic enema (saline) - ultrasound guided
Tx intussusception (if conservative measures unsuccessful)
-surgical reduction/fixation
-excision of nonviable bowel
abnormal rotation around superior mesenteric artery during embryonic development
malrotation
when intestine becomes twisted around itself and compromises blood flow to intestines
volvulus
S+S malrotation and volvulus
bilious emesis in newborn
Tx malrotation and volvulus
emergency surgery
S+S malabsorption syndrome
-chronic diarrhea
-failure to thrive
complications of malrotation and volvulus post-surgery
short bowel syndrome
malabsorption
*need TPN and lipids
S+S celiac disease
-steatorrhea
-abdominal distention
-secondary vitamin deficiencies
-general malnutrition
Dx celiac disease
gluten elimination diet
endoscopy possible
Tx short bowel disease
TPN (through central line) and lipids
ostomy
nursing consideration with TPN
check ingredients in TPN (can’t just scan barcode)
compare ingredients in TPN to lab values
S+S upper GI bleed
stomach:
-coffee grounds emesis
-hematemesis
-*black tarry stools
esophageal
-vomiting bright red blood
S+S lower GI bleed
-bright red (rectal bleeding) - hematochezia
Dx GI bleed
stool cultures
CBC
Tx GI bleed
-assess blood loss
-possible blood transfusion
-emergency: IV, O2, suction if severe
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
time limit for using bag of blood for infusion
4 hours
S+S blood transfusion reactions
-fever
-tachycardia
-LOC change
-hypo/HTN
-rash/hives
S+S hepatitis
-jaundice
-anorexia
-fatigue
-malaise
transmission hep A
fecal oral
transmission hep B
perinatally acquired
transmission hep C
parenteral exposure (blood)
transmission hep D
people who already had hep B
transmission hep E
contaminated water
fecal oral
(worse in pregnant women)
what types hepatitis have vaccines
A and B
S+S biliary atresia
-prolonged jaundice
Tx biliary atresia
cosine procedure (stent for biliary duct)
possible liver transplant if stent unsuccessful
S+S tracheoesophageal fistula
-choking
-pneumonia
-fever
-frothy saliva
common cause esophageal atresia and tracheoesophageal fistula
VATAR disease
S+S esophageal atresia
-failure to thrive
-vomiting right after eating
-aspiration pneumonia
Tx tracheoesophageal fistula
-maintain airway
-suction
-thermoregulation
-fluid and electrolytes
-surgery
-postop: upright with feeding
protruding bowel covered with peritoneal sac
omphalocele
Tx omphalocele and gastroschisis before birth
C-section
bowel herniation through abdominal bowel not covered with peritoneal sac
gastroschisis
nursing considerations gastroschisis preop
-keep covered
-keep moist
-watch for color changes in bowel
when does an umbilical hernia need emergency surgery
can’t be reduced (pushed back in)
S+S inguinal hernia
-painless inguinal/scrotal swelling
-tender abdominal distention
-anorexia
-difficulty with bowel movement
possible complications inguinal hernia
-herniation
-obstruction
-strangulation of bowel
Tx inguinal hernia
surgery
possible complication imperforate anus
sepsis (no passing of meconium)
distention
perforation of bowel
when should H2 receptor antagonists be given if pt is also receiving antacid
H2 receptor antagonist 2 hours before
