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ELIMINATION: PEDIATRIC GI DYSFUNCTION Flashcards

1
Q

FUNCTIONS OF GI SYSTEM

A
  • ingestion, digestion, and absorption of fluids and nutrients
  • metabolism of needed nutrients
  • excretion of waste products
  • any alteration in GI system deceases body’s ability to obtain nutrients , thus impairing growth
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2
Q

PEDIATRIC DIFERENCES :GI

A
  • GI system immature at birth
  • sucking is a primitive reflex
  • infant stomach is small
  • peristalsis is increased
  • digestive enzymes deficient
  • liver function immature
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3
Q

NURSING CARE PRIORITIES

A
  • assessment
  • establish feeding
  • prevent infection
  • monitor for serious infection
  • protect suture line
  • protect airway
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4
Q

CLEFT LIP/CLEFT PALATE (CL/CP): ETIOLOGY AND PATHOPHYSIOLOGY

A
  • occur during 3rd and 12th week of gestation
  • occur singly or in combination
  • maxillary and nasal processes fail to fuse
  • 10-15% cases have other defects (trisomy 13)

-multifactorial cause suspected
environment- maternal smoking and alcohol , phenytoin, genetics

folate- added to breads and cereals in 1998, decreased incidence of clefts

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5
Q

DIAGNOSIS: CLEFT PALATE

A
  • cleft palate without cleft lip may not be detected at birth
  • slide a gloved finger directly across the newborn palate
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6
Q

DIAGNOSIS : CLEFT LIP

A
  • detected at birth , or fetal U/S by 13-26 weeks
  • size varies a small notch to a complete cleft
  • may be unilateral or bilateral
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7
Q

PROBLEMS WITH CLEFT LIP AND PALATE

A
  • recurring OM,TM scarring , hearing loss
  • speech impairment /delay
  • improper tooth alignment
  • long term problems, social adjustment , threat to slef image
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8
Q

EBP: CL/CP AND RISK FOR DENTAL CARIES

A
  • children with cl/cp had higher risk of dental caries
  • higher risk factors: poor oral hygiene and higher levels of salivary lactobacilli
  • higher risk children had more caries
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9
Q

THERAPEUTIC MANAGMENT

A
  • collaboration of specialists: plastic surgery, ENT, speech therapist, and dentist
  • closure of clefts prevention of complications, facilitation of normal growth and development of the child
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10
Q

SURGICAL CORRECTION : CLEFT LIP

A
  • cheiloplasty -surgery
  • usually repaired by 3-6 months
  • lip sutured together
  • protect suture line from tension/trauma
  • elbow restraints
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11
Q

SURGICAL CORRECTION: CLEFT PALATE

A

palatoplasty: -surgery

  • CP-repaired by 18 months
  • protects tooth buds
  • allows for development of normal speech
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12
Q

NURSING MANAGMENT :EMOTIONAL SUPPORT

A
  • may generate negative responses in both nurses and parent
  • have a positive regarding surgical correction
  • before and after photographs of possible cosmetic improvements
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13
Q

NURSING MANAGMENT: PRE- OP FEEDING

A

-cleft lip/palate reduces ability to suck
-some cl babies may breast feed
mother’s breast soft, fill gap caused by cleft

Cp makes it difficult to create suction

  • food enters nasal cavity through cleft
  • bottle feed with expressed breast milk
  • hold head in upright position

special feeders; long nipples with enlarged holes, gravity flow nipples with squeezable bottle

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14
Q

NURSING MANAGMENT : POST OP CARE

A

CLEFT LIP

  • clear liquids- dropper or syringe
  • formula/breast feeding resumed when tolerated
  • aspirate oral/nasal prn
-maintain suture line 
elbows in soft restraints
no prone position 
minimize crying-pain med prn 
incision care- antibiotic cream

CLEFT PALATE

  • start with clear fluids from syringe or dropper
  • advance to formula/breast milk by cup
  • protect sutures -no pacifier
  • no chewing- pureed diet ,no hard foods
  • soft tip suction prn
  • pain management
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15
Q

ESOPHAGEAL ATRESIA(EA) AND TRACHEOESOPHAGEAL FISTULA (TEF)

A
  • rare congenital malformations- occur by 4th week of gestation cause unknown
  • the foregut fails to lengthen , separate and fuse into two parallel tubes
  • esophagus may end up in a build pouch or develop as a pouch connected to the trachea by a fistula
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16
Q

CLINICAL MANIFESTATIONS

A
  • excessive salivation and drooling
  • the three C’s of TEF- coughing, choking, cyanosis
  • feeding- fluid comes out nose and mouth
  • apnea, gasping with frothy sputum
  • risk of aspiration and pneumonia
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17
Q

DIAGNOSIS

A
  • established clinically : difficulty feeding, excessive drooling, choking , apnea, coughing, cyanosis
  • confirmed by attempting to pass a NGT
  • x-ray stomach - air filled pouch
  • other tests done to R/O associated defects
    abdominal ultrasound
    Echo
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18
Q

TREATMENT

A
  • tube inserted to suction the upper pouch
  • IVF,IV antibiotics
  • surgery- accomplished in stages
  • stage 1- ligation of fistula, g tube
  • stage 2- 2 ends of esophagus reconnected if possible
  • may need repeated surgeries
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19
Q

NURSING MANAGEMENT ; PREOP CARE

A
  • npo/ivf (offer pacifier)
  • maintain patent airway -suction , HOB elevated
  • continuous or LIS for blind pouch
  • constant monitoring of vital signs and condition surgical emergency
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20
Q

NURSING MANAGEMENT - POST OP CARE

A
  • gastric decompression - GT to drain
  • GT care teaching
  • administer IVF/antibiotics/watch electrolytes
  • TPN until G-tube feeds or oral feeding tolerated
  • parental support - encourage to hole infant , express emotions
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21
Q

PYLORIC STENOSIS

A

-hypertrophic obstruction of the circular muscle of the pyloric canal

  • occurs in 1-3 per 1000 live births- may be familial
  • male to female ratio 6:1
  • seen more frequently in first born white males
22
Q

PATHOPHYSIOLOGY

A
  • pylorus sphincter narrows due to progressive hypertrophy of the circular pylorus muscle
  • results in outlet obstruction
23
Q

CLINICAL MANIFESTATIONS

A
  • 2-6 weeks after birth
  • initially infant appears well or regurgitates after feeding
  • vomiting progresses to projectile
  • vomiting is non- bilious, may be blood tinged
  • infant- hungry , irritable, fail to gain weight, fewer and smaller stools
  • dehydration, metabolic alkalosis and increased bilirubin
24
Q

CLINICAL THERAPY -diagnosis

A
  • physical examination- visible peristaltic wave across the abdomen moving from left to right
  • olive size mass in left upper quadrant
  • pyloric ultrasound
  • upper GI series
25
CLINICAL THERAPY TREATMENT
- surgery pyloromyotomy - release of muscle fibers allows the passage of food and fluid - high success rate
26
NURSING MANAGEMENT
PRE OP - npo - ivf - monitor electrolytes - ngt POST OP - -pain management - vital signs monitoring - establish feeding - involve parents - discharge teaching
27
GASTROESPHAGEAL REFLUX (GER)
-return of gastric contents into the esophagus due to relaxation of the lower esophageal or cardiac sphincter - 50% of FT infants have GER - higher in premature infants - males affected 3x more than females - children with neuro impairments (CP) have increased GER -peak age is 1-4 months of age ,ogten resolves spontaneously by age 12 months
28
GERD
- more serious than GER - spit up any time, even between feedings - cries and arches back during and after feeds - eat often but still lose weight - respiratory problems - cough, wheeze, choking , color changes during feeding - may aspirate- pneumonia, apnea - generalized irritability , poor weight gain, weight loss or delayed growth
29
DIAGNOSIS
- history of feeding , vomiting episodes, pain with feeding - upper GI series- UGI - check for anatomic abnormalities - ph probe monitoring valid and reliable measure of reflux determines number of reflux episodes
30
TREATMENT
- depends on severity - mild- happy spitter - modification of feeding habits - small frequent feeds , frequent burping - thicken formula with rice cereal - 1 tsp RC/1oz formula (make nipple hole bigger) - position - hold child upright after feeds for 20-30 min - supine while sleeping due to risk of sids OOR
31
TREATMENT
pharmacological therapy for moderate to severe -poor weight gain, irritable, no improvement with modification of feeding habits and position
32
H2 RECEPTOR antagonists
ACTION- decreased gastric acid production - famotidine -Pepcid - ranitidine - zantac
33
PROTON PUMP INHIBITORS
action- blocks acid production by inhibiting proton pumps, increases LEs tone , more effective than H2 receptor agonists lansoprazole(prevacid) omeprazole (Prilosec)
34
SEVERE GERD
- severe gerd with failure to thrive , aspiration - surgical management -nissen fundoplication - involves a 360 wrap of the fundus of the stomach around the distal esophagus - gastrostomy tube is inserted during surgery and left in place for 6 weeks or longer
35
NURSING MANAGEMENT
IN CHILDREN WITH GERD - observe for respiratory distress , monitor vs - provide adequate nutrition- small frequent feeds - position - elevate HOB - prone position with caution (while awake only0 POST OP FUNDOPLICATION -GT- maintain skin integrity, secure tube, provide pacifier -educate parent about home care- feeding , position, medication, suctioning
36
HIRSCHSPRUNG DISEASE
-congenital aganglionic megacolon decreased motility causes obstruction of the intestines - incidence 1:5000, males more than females - familial tendency - can occur with down syndrome ,congenital heart disease, other syndromes
37
PATHOPHYSIOLOGY
-absence of ganglion cells in one segment of the colon causes lack of innervation in that segment - usually rectosigmoid colon - prevents peristalsis- leads to blockage , and stool builds up behind blockage - results in constipation, abdominal distention, poor weight gain, poor growth
38
CLINICAL MANIFESTATIONS
Newborn - lack of meconium stool - bilious vomiting - S/S enterocolitis Older Child -chronic constipation alternating with diarrhea, ribbon like stools, abdominal distention, poor weight gain, decreased growth
39
DIAGNOSIS
-barium enema,abdominal Xray- dilated bowel - rectal examination - rectum small, no stool -anal manometry -rectal biopsy- absence of ganglionic cells confirms diagnosis
40
TREATMENT CHILD WITH MILDER DEFECT
- dietary modification - high fiber diet - stool softeners - enemas to prevent impaction in children not toilet trained
41
TREATMENT -INFANCY
- surgical removal of the aganglionic bowel and pull through procedure - temporary colostomy- closure 2-6 months later - normal bowel function depends on the amount of bowel involved - enterocolitis- serious complication
42
ENTEROCOLITIS
- inflammation of small intestine and colon - results in ischemia and ulceration of bowel wall - may occur before or after surgery - greatest cause of morbidity and mortality in hirschsprungs
43
ENTEROCOITIS
- presents with abdominal pain, fever, foul smelling and or/bloody stools - should be suspected if neonate has distended abdomen, feeding intolerance with bilious vomiting and delay of meconium - if not recognized may progress to sepsis and perforation - Tx, IVF, antibiotics, NGT, monitor electrolytes and vs
44
NURSING MANAGEMENT PREOPERATIVE
- dependent on condition - assess; skin turgor,fontanels,urinary output,MMs - monitor fluid and electrolyte balance - maintain nutrition - TPN if NPO - ensure patent NG tube if NPO - monitor abdominal circumference - encourage parent to hold and cuddle infant
45
NURSING MANAGEMNET POSTOPERATIVE
- po clear or breast milk in several hours - observe for signs of enterocolitis - monitor I/O - avoid pressure on incision -diapering - provide comfort , pain relief - encourage parents to partake ininfant's care - discharged when tolerating full feeds
46
INTUSSUSCEPTION
- occurs when one portion of the intestine invaginates or telescopes into another - one of the most frequent causes of intestinal obstruction in children - more common in males - peak age 3-9 months up to 3 yrs - cause - unknown , viral infection , intestinal polyps, medications, rotasheild vaccine
47
PATHOPHYSIOLOGY
- most common site is the ileocecal valve - telescoping of the intestines obstructs the passage of stools - intestinal walls run together causing inflammation , edema and decreased blood flow - leads to necrosis, perforation , hemorrhage, peritonitis
48
CLINICAL MANIFESTATIONS
- sudden onset of abdominal pain - draw legs to chest - may vomit - periods of calm between episodes of pain - abdominal pain and distention - palpable "sausage shaped mass" in upper right quadrant - passage of "currant jelly stools "
49
DIAGNOSIS
- made on subjective findings, history - abdominal X-ray - abdominal ultrasound confirms diagnosis
50
TREATMENT
- may spontaneously reduce without treatment - hydrostatic reduction by air, saline, or barium enema - rare- surgery to reduce or to remove necrotic bowel - NG tube to for gastric decompression
51
NURSING MANAGEMENT
- preoperative - maintain IVF, fluid and electrolyte balance, NGT for decompression , antibiotic therapy - postoperative- monitor for infection, pain management , NG tube patency , assess VS, check for abdominal distention , bowel sounds - discharge when tolerating feeds - D/C teaching ; can reoccur after enema or surgery, must return for fever , pain , bloody stools

Pediatrics (7 decks)

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