Chapter 15: Gastrointestional Disorder Flashcards
Treatment and post care of pyloric stenosis
Surgery. Post OP: clear liquids, place infant in seat after feeding. may continue to vomit: report if vomiting after 48 hours. I/O daily weights. Home care: regular feeding hold baby, feed slowly, burp frequently
the nurse caring for children in the emergency room teaches the student nurse about the injury statistics related to abdominal trauma, including:
Injuries are the leading cause of death in children and adolescents after the first year, injuries from motor vehicle accidents are the primary cause of accidental death in the United States, injuries to the abdominal and genitourinary area accounts for 10% of serious trauma
Umbilical hernia
intestines protrude through the abdominal muscle through the belly button. Occurs when the fusion of the umbilical ring is incomplete at the point where the umbilical vessels exit the abdominal wall. 90% close by age 5. Failure to close requires surgery
The nurse explains to the student nurse that ____ is characterized by projectile vomiting and a palpable olive-shaped mass in the epigastrium
pyloric stenosis
What is gastroesophageal reflux?
Return of gastric contents into the esophagus from a relaxation of the lower esophagus sphincter
an acute or chronic inflammation of the colon characterized by recurring bloody diarrhea
ulcerative colitis
A pathological condition that occurs as an end stage to many liver and inflammatory conditions
Cirrhosis
Diagnostic testing for malrotation and volvulus?
Upper GI series, CBC with electrolytes, ultrasound, barium enema
A nurse teaches the family of a child with celiac disease the types of foods to avoid in the child’s diet. The nurse tells the parents to eliminate:
Rye and wheat. gluten products
The nurse explains to the parents of an infant diagnosed with a bowel obstruction that one of the most common causes of intestinal obstruction in infancy is from _____
intussusception
the nurse examining a child with hepatitis knows that the disease may be acute or chronic and involves an inflammation of the pancreas: T/F
False
An infant with tracheosophqgeal fistula will present with?
Increasing respiratory distress until suctioned
What is the treatment of malrotation and volvulus?
Surgical emergency, may need resection with significant damage
The nurse is monitoring a child for signs of hepatitis. The nurse documents the following s/s related to the preicteric phase of hepatitis in the child’s charts
Nausea and anorexia
Clinical manifestations of intussusception
Abrupt onset of abdominal pain vomiting, passage of brown stool alternating with period of comfort, fever, jelly-like stool. may have shock and sepsis after 12-24 hours
What does celiac crisis cause?
Severe dehydration and diarrhea
what diagnostic tests for appendicitis?
CBC w differential: shows WBC with left shift, urinalysis, ultrasound, CT scan
The student nurse studying the digestive system knows that most of the work of absorption occurs through a system of villi and folds in the ______
Small intestines
A nurse listens while a mother describes her toddler’s eating habits. The mother states that her daughter “refuses to eat veggies at mealtime” and “wants peanut butter sandwiches for every meal.” The nurse’s best advice to the mother is:
Reassure her that food jags are normal and the tendency will pass
stool incontinence beyond the age of 4
encopresis
Clinical manifestations for irritable bowel syndrome
hyperperistalsis, diarrhea, cramping, bloating, constipation, change in appearance of the stool, urgency to have a bowel movement, more common in woman than men
Diagnostic testing and treatment for inguinal hernia
upright patient will cough or bear down to feel hernia, transillumination of hydrocele to eliminate hernia, report lump seen in groin area. Treatment: surgical repair
The nurse is caring for a child with biliary atresia. The nurse knows that the s/s of this disease include:
pruritus, jaundice, and dark urine
What can gastroesophageal reflux lead to?
esophagitis, failure to thrive, aspiration, pneumonia, respiratory airway disease, apnea
Manifestations of incarceration hernia
Increased in pain, fever, tachycardia, bilious vomiting, NO STOOL, erythema and edema over a tender groin mass
Treatment for ulcerative colitis
Aminosalicylates such as sulfasalazine or mesalamine orally or suppository, corticosteroids, immunosuppressives, cyclosporine A for sever, nutritional supplementation, surgery if medication doesn’t work
A pediatrician diagnoses pathological gastroesophageal reflux in an infant. The nurse is aware that several conditions are associated with this condition, including:
esophagitis, failure to thrive and aspiration pneumonia
clinical manifestation of ulcerative colitis
abdominal pain, bloody diarrhea, urgency to defecate, anemia, fatigue, weight loss, fever
a disorder in which the proximal small bowel mucosa is damaged as a result of dietary exposure to gluten
Celiac disease
A father brings his infant to the community clinic and tells the nurse that his son has been experiencing bouts of diarrhea for the past 2 days. The nurse notes that the infant is diagnosed with malabsorption syndrome and suspects the infant has:
osmotic diarrhea
An inability to digest milk and some dairy products
lactose intolerance
The pediatric nurse examines an infant who has an inguinal hernia. After researching the incidence of hernias, the nurse learns that:
Inguinal hernia is more prevalent in males than females
Diagnostic tests for peptic ulcers
CBC, sedimentation rate, H. pylori antibody blood test antigen in stool, stool for occult blood, WBC, upper GI series, endoscopy with biopsy and H. pylori culture
Treatment for intussusception
NG tube: decrease vomiting, decompress stomach, Hydrostatic reduction: use barium enema to straighten bowel, document passage of barium, surgical reduction
What is a peptic ulcer
loss of the digestive tract mucosa from excessive acid secretions, bile salts, genes, lack of prostiglandins, bacteria-Helibacter pylori, psychological, stress, diet, and meds
What is pyloric stenosis?
A condition in which the opening between the stomach and the small intestines thickens
What is malrotation and volvulus?
Abnormal rotation or twisting of the intestine
Treatment for peptic ulcers
patient should be seen immediately for sudden persistent stomach pain, bloody or black stools, bloody vomit, or coffee ground vomit, IV therapy for sever symptoms, triple therapy (two antibiotics and a photon pump inhibitor, no antacids 1+- antiulcer meds: interferes with absorption, no milk: stimulates acid production, no cola, coffee, ibuprophen, cigarettes
Treatment and interventions for irritable bowel syndrome
change diet: no triggers, more fiber, small meals, laxatives or Imodium for symptoms, can drink milk, pain control for hyperperistalsis, usually normal growth and development, resolves around 20
What is an incarceration hernia?
a portion of the intestine that can’t be returned to the cavity. Leads to obstruction, pain, strangulation, which leads to necrosis and death.
What is intussusception?
Telescoping of the intestine into adjacent portion. Most common cause of obstruction.
what is an inguinal hernia?
Protrusion of the bowel into the groin muscle. Needs prompt management to prevent incarceration hernia. More prevalent in males
What is a trachesophageal fistula? How is it found? How is it treated?
Inability to handle secretions; cyanosis when feeding, resistance with passage of feeding tube. X-ray and contrast dye. Surgical repair
caused by a congenital absence of Meissner and Auerbach plexus in the bowel wall
Hirschsprung disease
What can’t a person with celiacs disease eat?
Wheat barley oats and rye
clinical manifestations of Crohn’s disease
abdominal pain, often lower right quadrant like appendicitis, fever diarrhea, n and v, anorexia, intestinal blockage, exacerbation and remission
Fibrous band that arises from a remnant of the fetal development in the midgut, which normally is obliterated by the seventh to eighth week of gestation but failed to do so. Requires surgery to prevent hypovolemic shock and hemorrhage
Meckel diverticulum
What are the manifestations of an inguinal hernia?
Lump in the groin, commonly the right side, History of intermittent pain and swelling in the groin, feeling of weakness or pressure in groin with burning gurgling lump, patient with a hydrocele (fluid-filled sac around testes) should be checked for inguinal hernia
Clinical manifestations of peptic ulcers
May be asymptomatic with recurrent abdominal pain, vomiting, anorexia. proceeds to cramping epigastric pain and changes in eating habits, proceeds to chronic episodic epigastric pain, vomiting with recurrent nocturnal awakening, anemia with GI bleeding, perforation of the stomach or duodenum
The nurse documents the s/s of appendicitis, including abdominal pain that begins in the ____ area and moves to the right lower quadrant, accompanied by a low grade fever, _____, and occasional vomiting.
periumbilical: nausea
an infection of the umbilical stump
omphalitis
Clinical manifestations of pyloric stenosis
forceful, progressive, nonbilious vomiting after each feeding, poor weight gain, dehydration causes decrease in serum chloride, avid hunger, restless, irritable olive like mass upper right quadrant to the right umbilicus, metabolic acidosis
a nurse on a pediatric unit is caring for a child with short bowel syndrome. When providing nutritional therapy for the child, the nurse checks for feeding intolerance and makes daily assessments of:
weight, input/output, and specific gravity
Diagnostic testing for ulcerative colitis
CBC, electrolytes, liver enzymes, total protein, albumin, serum iron, stool for occult blood and white blood cells, colonoscopy
What are some clinical manifestations of celiac disease?
Abdominal bloating, diarrhea, vomiting, flatulence, foul-smelling stools
The difficult or infrequent passage of hard stool
constipation
What percentage of peptic ulcers in infants is caused by stress?
80%
Diagnostic testing for Crohn’s disease
CBC, electrolytes, liver enzymes, Serum calcium and phosphorus, stool for occult blood and white blood cells, ultrasound, CT scan, ophthalmic exam, colonoscopy with tissue biopsy
Clinical manifestation of malrotation and volvulus
May be asymptomatic, symptoms of bowel obstruction, intense crying and pain, pulling up of the legs, abdominal distention, vomiting, usually bilious, tachycardia and tachypnea
Inflammatory bowel disease
Crohn disease
A mother brings her infant to the pediatrician for a check-up. She tells the pediatric nurse that almost every afternoon her infant fusses and holds his body in a rigid, flexed position for several hours. Based on this description, the nurse suspects that the infant has:
Infantile colic
A patient on a pediatric unit receives a diagnosis of encopresis without constipation. When planning a diet for this patient, the nurse will be sure to include plenty of?
wheat
hiatal hernia
A condition in which part of the stomach pushes up through the diaphragm muscle
Treatment for Crohn’s disease
Pain w bleeding: immediate treatment, IV therapy, corticosteroid therapy for remission, infliximab therapy, azathioprine, methotrexate, nutritional supplementation, surgery if medication not working
During a well-child visit, the pediatric nurse performs a physical assessment on a 2 year old patient. The nurse knows that developmentally at age 2 _______
The salivary glands reach adult size
what are the s/s of appendicitis?
Fever, nausea and vomiting, abdominal pain, right leg flex relieves pain, increased WBC 15-20,000, usually no stool
A nurse is caring for a 10-year old patient on the pediatric unit who has been vomiting upon arising for the past 2 days. The nurse knows that this symptom is often associated with:
neurological involvement
Why don’t you apply a K pad (heat) to appendicitis?
May rupture the appendix and lead to peritonitis
Diagnostic treatment for irritable bowel syndrome
CBC, stool studies for O and P, blood, WBC, culture, endoscopy if any bleeding to rule out IBS
the nurse knows that appendicitis is considered the most common condition that requires abdominal surgery in children: T/F
True
