Chapter 24: Caring for the Child With a Gastrointestinal Condition

Question 1

The Gastrointestinal (GI) System

Answer 1

responsible for ingestion, digestion, absorption, metabolism, and elimination of solid and liquid nutrients

• each organ in the system performs a specific function in this process
• divided into 2 portions: the upper and lower

Question 2

Upper Portion of the GI System

Answer 2

mouth (teeth and gums), esophagus, and the stomach

• responsible for nutrient intake or ingestion: mouth and esophagus
• tongue= senses the taste and texture of food, which initiates salivation; salivation that occurs in the mouth initiates the beginning of the digestive process; saliva releases enzymes amylase and ptyalin; these begin the breakdown of complex starches into disaccharides
• the esophagus transports food to the stomach by peristalsis
• in the stomach, food mixes with gastric fluids and is then propelled into the small intestine

Question 3

The Lower Portion of the GI system

Answer 3

-small intestine, large intestine (colon), rectum, and anus
-handles the remainder of the digestion, absorption, and metabolism processes with the assistance of the liver and pancreas
>small intestine: does most of the work of absorption through a system of villi and folds, which increases the absorptive surface; small intestine further convert disaccharides into monosaccharides (hindrance of this process can lead to diarrhea); small intestine responsible for absorption of carbohydrates, fats, proteins, minerals and vitamins into the systemic circulation; duodenum forms first part (pancreatic and bile ducts empty in the upper portion of the duodenum), followed by the jejunum (where majority of water, protein, carbohydrates, and vitamins absorbed, where fat breakdown through secretion of lipases by pancreas, proteins are converted to amino acids by pancreatic enzyme trypsin); last segment of small intestine ileum (absorbs bile salts, vitamins C, B12, and chloride
>Large intestine: takes care of elimination

Question 4

What are other organs that are a significant part of the GI system?

Answer 4

liver, pancreas, and gallbladder

Question 5

Salivation

Answer 5

occurs in the mouth and initiates the beginning of the digestive process
-saliva releases amylase and ptyalin; these begin the breakdown of complex starches into disaccharides

Question 6

The Small Intestine

Answer 6

responsible for absorption of carbohydrates, fats, proteins, minerals, and vitamins into the systemic circulation
-does most of the work of absorption through a system of villi and folds, which increases the absorptive surface
-further converts disaccharides into monosaccharides
>3 portions:
-Duodenum: forms the first portion, pancreatic and bile ducts empty in the upper portion
-Jejunum: majority of water, protein, carbohydrates, and vitamins are absorbed; fat breakdown occurs through the secretion of lipases by the pancreas; lymphatic system then absorbs fats; proteins converted to amino acids by pancreatic enzyme trypsin and are absorbed via the capillary walls of the villi and into systemic circulation
-ileum: absorbs bile salts, vitamins C and B12, and chloride

Question 7

The Large Intestine

Answer 7

takes care of elimination

• contents of the small intestine enters the cecum through the ileocecal valve, located in the right lower quadrant of the abdomen and forms the beginning of the large intestine
• the appendix (blind tube containing lymphoid tissue) is attached to the cecum
• ascending colon rises along the right anterior portion of the abdomen, followed by transverse colon (lies horizontally across abdomen), and the forms the descending colon along the left lateral abdomen; sigmoid colon follows the descending colon in the pelvic cavity, then connects to the rectum (where stool is stored until it is expelled through the anal canal and through the anus)
• elimination culminates in the removal of solid waste products through defecation

Question 8

Accessory Structure: Liver

Answer 8

responsible for metabolizing carbohydrates, fats, and proteins; breaks down toxic substances such as drugs; stores vitamins and iron; produces antibodies, bile, prothrombin, and fibrinogen for coagulation

• located below the right diaphragm
• largest and heaviest organ in the body
• a vascular organ composed of right an left hepatic lobes

Question 9

Accessory Structure: Gallbladder

Answer 9

stores bile (which is produced by the liver)

• the bile is then secreted into the duodenum through the cystic duct and common bile duct, where is assists in the digestion of fats
• lies within the inferior surface of the liver

Question 10

Accessory Structure: Pancreas

Answer 10

• found between the spleen and stomach in the left upper quadrant of the abdominal cavity
• produces pancreatic enzymes, which are excreted into the duodenum by pancreatic duct
• pancreatic enzymes assist in the metabolism of proteins, fats, and carbohydrates
• insulin and glucagon are produced and secreted directly into blood stream

Question 11

Developmental Aspects of The GI System: The infant

Answer 11

the infant has several physiological mechanisms in place to ensure the adequate intake of nutrients

• has built-in safeguard to prevent choking while swallowing and sucking
• the posterior portion of the tongue that separates the mouth and throat is raised against the soft palate while the infant sucks; allows the infant to suck and breathe at the same time
• infant has a longer posterior soft palate, which assists in swallowing milk
• passage of mouth to pharynx is smaller; which controls the amount of liquid taken in
• nurse= teach that infant’s stomach usually empties in 2.5 to 3 hours (reason for frequent feedings)
• liver and pancreas do not mature until 6 months of age; infants younger than 4 months do not require solid foods
• pancreatic lipase, essential for fat and protein metabolism, are not adequately secreted until age 1, which limits body’s ability to absorb fats (such as those in cow’s milk)

Question 12

When does a infant’s stomach usually empty?

Answer 12

in 2.5 to 3 hours

-reason for frequent feedings

Question 13

When do the liver ad pancreas mature in an infant?

Answer 13

6 months of age

-infants younger than 4 months do not require solid foods

Question 14

When is pancreatic lipase adequately secreted in a child?

Answer 14

at 1 year of age

-limits infant’s ability to absorb fats (such as those i cow’s milk)

Question 15

GI Developmental Aspects: Infants

Answer 15

• breastfed infants tend to have “watery stool”
• formula fed infants stools are soft and sometimes “seedy”
• do not absorb water as rapidly as older children
• when defecating, may appear to be straining b/c of immature muscle coordination
• digestive system is immature but adequate, and growth is rapid
• gain 1.5 lb/ month; double weight by 6 months; triple weight by 12 months (1 year)
• salivary glands reach adult size by 2 years of age
• needs 108 kcal/kg caloric intake

Question 16

GI Developmental Aspects: Toddler

Answer 16

• gains 5 to 6 lb/ year
• stomach capacity increases to about 500 mL
• liver matures to become more efficient in vitamin storage, glycogenesis (formation of glycogen from glucose), and amino acid changes
• growth of digestive system slows during toddler years, requires reduction in caloric needs than that of infant period; needs 102 kcal/kg instead of 108 kcal/kg in infancy
• appetite may be sporadic or finicky b/c of decreased appetite and reduced metabolic rate
• b/c of sporadic behavior, may also go on food fads or “jags”, preferring only one item and refusing other foods that they have preferred in the past

Question 17

GI Developmental Aspects: Pre-school age

Answer 17

• continues to have appetite fluctuations with periods of overeating or refusal to eat
• gains 4 to 5 lb/ year
• by age 4 to 5, the GI system is mature enough for the child to eat a full range of food
• stools becoming more like adults

Question 18

GI Developmental Aspects: School-aged

Answer 18

• gain 4 to 6 lbs/year
• when reaches middle school years, GI tract becomes stable
• digestive system of a middle-school child is adult sized and fully functional
• stools usually passed once per day and are formed

Question 19

GI Developmental Aspects: Adolescent

Answer 19

• digestive system adult sized and fully functional
• stools usually pass once/day and are formed
• liver and spleen enlarge, though no change in function

Question 20

Dealing with Food Fads or “Jags” with Young Children

Answer 20

• reassure the parents that food fads or jags are normal at this age and that the tendencies will pass
• a little patience will keep both parents ad child from further GI upsets
• do not force the child to eat foods he is not interested in but to provide a variety of nutritious foods during meals and for between-meal snacks in the amount appropriate for the child’s age

Question 21

Growth and Development

Answer 21

the child with a gastrointestinal condition (e.g. celiac disease, Crohn’s disease, gastroesophageal reflux, or short bowel syndrome) is highly susceptible to alterations in physical growth and development
-can impair body’s ability to digest and absorb nutrients resulting in failure to thrive; failure to thrive can pose detrimental consequence’s on physical growth and development; failure to thrive impairs the ability to gain weight, grow and fight against infection; also hinders child’s psychosocial, motor maturation and intellectual development
>nursing care= promote a balanced nutrition required for healthy growth and development

Question 22

Failure to Thrive

Answer 22

Conditions affecting the GI tract can impair the body’s ability to digest and absorb nutrients resulting in failure to thrive
-can impose detrimental consequences on a child’s physical growth and development
-impairs child’s ability to gain weight, grow, and fight against infection
-hinders child’s psychosocial, motor maturation and intellectual development
>early identification and treatment is needed

Question 23

Nursing Care for the Child with a GI condition

Answer 23

promote a balanced nutrition required for healthy growth and development

• collaborate with the nutritionist to implement appropriate oral, enteral, or parenteral diet needed to optimize caloric intake
• closely monitor child’s height, weight, BMI, and weight-to-length ratio observing for an upward trajectory on the growth chart
• nutritional support with a dietician may be helpful to provide effective education about lifelong dietary changes needed; educate family about importance of compliance with the dietary changes to prevent complications of the disease process

Question 24

Proper Treatment for Failure to Thrive

Answer 24

• treatment of the underlying illness combined with nutritional treatment that addresses the mechanism of the accompanying failure to thrive
• nurse should collaborate with the nutritionist to implement appropriate oral, enteral, or parenteral diet needed to optimize caloric intake
• nurse should closely monitor child’s height, weight, BMI, and weight-to-length ratio observing for an upward trajectory on the growth chart
• nutritional support with a dietician may be helpful to provide effective education about lifelong dietary changes needed; educate family about importance of compliance with the dietary changes to prevent complications of the disease process