EXAM 2 Flashcards
What is the primary objective when analyzing assessment findings in children with gastrointestinal dysfunctions?
Recognize fluid/electrolyte imbalances and employ appropriate nursing interventions.
common GI motility disorders in children
- Diarrhea
- Constipation
- Vomiting (emesis)
- Hirschsprung Disease
- GERD/ GER
- Irritable Bowel Syndrome (IBS)
- Inflammatory Bowel Disease (IBD)
- Appendicitis
- Intussusception
- Celiac Disease
What is the most common intestinal parasite in children?
Giardiasis: protozoan (Giardia intestinalis)
Teaching plan for prevention of intestinal parasitic disease:
- Always wash hands and fingernails with soap and water before eating and handling food and after toileting.
- Avoid placing fingers in mouth and biting nails.
- Discourage children from scratching bare anal area.
- Use superabsorbent disposable diapers to prevent leakage.
- Change diapers as soon as soiled and dispose of diapers in closed receptacle out of children’s reach.
- Do not rinse cloth or disposable diapers in toilet.
- Disinfect toilet seats and diaper-changing areas; use dilute household bleach (10% solution) or ammonia (Lysol) and wipe clean with paper towels.
- Drink only treated water or bottled water, especially if camping.
- Wash all raw fruits and vegetables and food that have fallen on the floor.
- Avoid growing foods in soil fertilized with human or untreated animal excreta.
- Teach children to defecate only in a toilet, not on the ground.
- Keep dogs and cats away from playgrounds and sandboxes.
- Avoid swimming in pools frequented by diapered children.
- Wear shoes outside.
How can clinical manifestations of appendicitis
Appendicitis
* RLQ abdominal pain {rebound pain at McBurney’s Point}
* low-grade fever (<100ºF)
* rigid abd
* decreased or absent bowel sounds
* vomiting (typically follows onset of pain)
* constipatipon or diarrhea
* nausea/ anorexia
* tachycardia
* rapid, shallow breathing
* pallor
* lethargy
* irritability
* stooped posture
* sudden pain relief (may indicate rupture/ perforation, which will lead to peritonitis)
What are the two types of sodium imbalances?
- Hyponatremia
- Hypernatremia
Where is potassium primarily found in the body?
Intracellular fluid (ICF).
What are the two types of potassium imbalances?
- Hypokalemia
- Hyperkalemia
Infants and young children have a greater need for what? And are more vulnerable to alternations in what?
- water
- fluid and electrolyte balance
What defines dehydration in children?
total output > total intake
What are common causes of dehydration?
- Reduced oral intake
- Vomiting
- Diarrhea
- Diabetic Ketoacidosis
- Burns
What is the initial compensatory mechanism in dehydration?
ICF moves to ECF to conserve intravascular volume
What is Oral Rehydration Therapy (ORT) used for?
treating mild to moderate dehydration in children
- is less expensive
* involves fewer complications than therapy (IV)
Therapeutic Managment of Mild to Moderate Dehydration
- Oral Rehydration Therapy (ORT)
- Child is awake, alert, and not in danger
- Pedialyte (popsicles- avoid red)
- Mild (50 mL/ kg of Oral Rehydration Solution)
- Moderate (100mL/ kg of Oral Rehydration Solution)
Therapeutic Management
IV Fluid Therapy
What is the definition of diarrhea?
Passage of loose, watery, and unformed stools.
What are the types of diarrhea based on location?
- Gastroenteritis
- Enteritis
- Colitis
- Enterocolitis
What differentiates acute diarrhea from chronic diarrhea?
Acute: Sudden onset; Chronic: Duration of > 14 days.
What is the most common cause of diarrhea in children under 5 years?
Rotavirus.
What should be monitored in a child with acute diarrhea?
- Electrolyte levels
- Skin integrity
- Signs and symptoms of dehydration
What is constipation defined as?
Infrequent and difficult passage of dry, hardened stool.
What is encopresis?
Constipation with fecal incontinence.
What dietary management is recommended for constipation?
- High fiber diet
- Adequate fluid intake
- Exercise
What are the main concerns when a child is vomiting?
- Dehydration
- Electrolyte disturbances
- Metabolic alkalosis
- Aspiration
What is Hirschsprung Disease?
Congenital anomaly affecting colon motility.
What is the confirmative diagnosis for Hirschsprung Disease?
A rectal biopsy.
What is the therapeutic management for Hirschsprung Disease?
- Relieving constipation
- Low-fiber, high-calorie, high-protein diet
- Stool softeners
- Surgical procedures
What are the main types of Inflammatory Bowel Disease (IBD)?
- Crohn’s disease (CD)
- Ulcerative colitis (UC)
- Inflammatory bowel disease unspecified (IBDU)
What are the clinical manifestations of Crohn’s disease?
- Diarrhea
- Cramping abdominal pain
- Fever
- Weight loss
What characterizes Irritable Bowel Syndrome (IBS)?
Increased GI motility causing spasms and pain.
What is the classic presentation of intussusception?
- Sudden abdominal pain
- Abdominal mass
- Currant jelly-like stools
What is the definitive diagnostic test for intussusception?
Abdominal ultrasound.
What is the dietary management for Celiac Disease?
Eliminating gluten from the diet.
What are the functions of bile?
- Digest fat
- Absorb fat-soluble vitamins
- Carry waste products
- Neutralize pH in the duodenum
- Provide bactericidal activity
What are the types of hepatitis?
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Hepatitis E
What is the function of bile?
To aid in the digestion of fats and facilitate the removal of waste from the liver to the intestines
Bile provides an alkaline fluid to neutralize pH of the chyme and has bactericidal activity against microorganisms present in ingested food.
What is Hepatitis?
Acute or chronic inflammation of the liver
Can be infectious (e.g., Hepatitis A, B, C, D, E) or noninfectious.
What are the phases of Hepatitis?
- Anicteric (Prodromal) Phase
- Icteric Phase
- Recovery Phase
Each phase has distinct symptoms.
What are common symptoms in the Anicteric (Prodromal) Phase of Hepatitis?
Anorexia, fever, nausea/vomiting/diarrhea, RUQ abdominal pain, hepatomegaly, arthralgia (HBV), pruritic rash (HBV)
RUQ stands for right upper quadrant.
What is the highest incidence age group for Hepatitis A Virus (HAV)?
Preschool and school-age children < 15 years
Transmission is primarily via the fecal-oral route.
What is the treatment for Hepatitis A?
Self-limiting condition with supportive treatment; Hepatitis A vaccine recommended
Two-dose series: first dose at 12 months, second 6-18 months later.
How is Hepatitis B Virus (HBV) transmitted?
Found in all bodily fluids, primarily through blood, semen, and saliva
Breastfeeding is recommended in all infants.
What are the symptoms of Hepatitis B?
Gradual onset, pruritic rash, arthralgia; jaundice possible
Severity ranges from mild/self-limiting to fulminant/fatal.
What is unique about Hepatitis C Virus (HCV)?
Most common cause of chronic liver disease; no vaccine available
Prior infection does not confer immunity.
What are the risk factors for Hepatitis D Virus (HDV)?
Coinfection or superinfection with HBV; parenteral and sexual transmission
More severe than HBV and can lead to severe liver damage.
What are the symptoms of Hepatitis E Virus (HEV)?
Devastating to pregnant women, causes fulminant hepatitis
Transmission occurs via the fecal-oral route, primarily from contaminated water.
What is Biliary Atresia (BA)?
Rare disease in infants causing a blockage in the bile ducts
Can lead to cholestasis and requires early diagnosis and treatment.
What are the clinical manifestations of Esophageal Atresia (EA)?
Coughing, choking, cyanosis, regurgitation, vomiting, abdominal distention
Often occurs with Tracheoesophageal Fistula (TEF).
What is Giardiasis?
Intestinal parasitic disease caused by the protozoa Giardia duodenalis
Common in crowded environments; symptoms include abdominal cramping and diarrhea.
What are the signs of Pinworms (Enterobiasis)?
Intense perianal itching, irritability, restlessness, poor sleeping
Diagnosed with the tape test.
What is a common cause of accidental poisoning in children?
Ingestion of cosmetics, personal care products, cleaning products, and plants
Most common between ages 1-5 years.
What is the toxic dose of Acetaminophen in children?
150 mg/kg or higher
Seriousness is determined by amount ingested and time before intervention.
What is lead poisoning?
Excessive accumulation of lead in the blood affecting multiple body systems
Universal screening recommended for children 1-2 years old.
What is Chelation Therapy?
Treatment to remove lead from circulating blood and organs
Medications include calcium disodium edetate and succimer.
clinical manifestations of peritonitis
Peritonitis
* rigid, boardlike abdomen
* fever
* chills
* sudden relief from pain after perforation
* diffuse pain
* guarding of the abd
* progressive abd distention
* tachycardia
* tachypnea {rapid, shallow breathing (as child refrains from using abd muscles)}
* pallor
* irritability
* restlessness
