[Exam 4] Chapter 42 – Alteration in Bowel Elimination/Gastrointestinal Disorder Flashcards
Stomach: Capacity in newborn vs adult?
10-20 in newborn
2000-3000 in adult
Insensible Fluid Losses: Fever increases fluid loss to a rate of what?
7 mL / kg / 24 - hour period.
Common Medical Txs: Protuberant (bulging outward) abdomen suggests what?
Presence of ascites, fluid retention, gaseous distention, or even a tumor
Common Medical Txs: Right upper quadrant tenderness could indicate what
liver enlargement.
Common Medical Txs: Right lower quadrant pain can be a warning sign of what?
appendicitis
Cleft Lip and Palate: Most common anomalies associated with this?
heart defects, ear malformations, skeletal deformities, and GU abnormality
Cleft Lip and Palate: Complications of this?
Feeding difficulties, altered detention, delayed speech and otitis media.
Cleft Lip and Palate: What may occur in babies with cleft palate when feeding?
Gagging, choking, and nasal regurgitation.
Cleft Lip and Palate: Opening in cleft palate contributes to the build-up of fluid where?
Middle ear (otitis media ) which can lead to an acute infection. Can lead to permanent hearing loss.
Cleft Lip and Palate - Patho: When does this normally form?
Lip - by 5-6 weeks
Palate - by 7-9 weeks.
Cleft Lip and Palate - Therapeutic Mx: What does their team consist of?
Plastic surgeon, oral surgeon, dentist, psychologist, social worker and speech pathologist.
Cleft Lip and Palate - Therapeutic Mx: When are cleft lip and palates repaired?
Lip - 2-3 months
Palate: 6-9 months.
Cleft Lip and Palate - Therapeutic Mx: Risk factos for this?
Maternal smoking
Prenatal infection
Advanced maternal age
Cleft Lip and Palate - Labs: This may be diagnosed how?
By prenatal ultrasound.
Cleft Lip and Palate - Nursing Mx, Preventing Injury to Suture Line: How to best do this?
Do not allow infant to rub the facial suture line. Place them in supine or side-lying position. Restraints may be used.
Cleft Lip and Palate - Nursing Mx, Preventing Injury to Suture Line: What options can be used to clean this?
Petroleum jelly or devices like Logan Bow (curved thin metal apparatus) or butterfly adhesive.
Cleft Lip and Palate - Nursing Mx, Preventing Injury to Suture Line: Should things be placed in the mouth?
No. No suction catheters, spoons, or straws.
Cleft Lip and Palate - Nursing Mx, Preventing Injury to Suture Line: What to do with crying?
Prevent it. Give medications for pain or cuddle and distract the child
Cleft Lip and Palate - Nursing Mx, Promoting Adequate Nutrition: Infant with unrepaired cleft palate is at risk for what
aspiration. Prosthodontic device may prevent breast milk from being aspirated.
Inguinal Hernia: What is this?
When the abdominal or pelvic viscera travel through the internal inguinal ring into canal.
Inguinal Hernia: Who is more likely to have this?
Boys, especially those who are premature
Inguinal Hernia: WHich is surgical correction performed?
When the infant is several weeks old and has been thriving
Inguinal Hernia - Assessment: How will they appear?
THere will be a bulging mass in th elower abdomen or groin area. Often seen only during crying, strainiing.
Inguinal Hernia - Nurse Mx: What can nurse do if mass felt?
Reduce hernia by pushing it back through the external inguinal ring.
Inguinal Hernia - Nurse Mx: What should happen if reduction not possible?
Hernia could be incarcerated. Can evantualaly lead to bowel strangulation
Inguinal Hernia - Nurse Mx: What is the only way to fix this?
Surgically. Can be manually reduced until surgery.
Inguinal Hernia - Nurse Mx: When should parents call physical or NP?
If inguinal hernia becomes hard, discolored, or painful
Umbilical Hernia: What causes this?
Caused by incomplete closure of the umbilical ring, allowing intestinal contents to herniate through opening.
Umbilical Hernia: How is this fixed?
Will have spontaneous closure of umbilical hernia by 4 years of age.
Umbilical Hernia: When is surgical herniation necessary?
For largest umbilical hernias that have failed to close by time child is 4.
Umbilical Hernia, Nursing Mx: Main part of nrusing management?
Teach the child and family how to reduce the hernia. Can have some self-esteem issues.
Dehydration: Why is the risk increased here?
Because they have more ECF percentage and a relative increase in body water compared to adults.
Dehydration: What contributes to increased risk for this?
Increased basal metabolic rate, increased BSA, immature renal function, and increased insensible fluid losses.
Dehydration: If untreated, can lead to what
hypovolemic shock.
Dehydration, Health Hx: Risk factors for this?
Diarrhea, Vomiting, Decreased oral intake, and sustained high fever or burns.
Dehydration, Health Hx: How will fontanels appear?
Will be sunken
Dehydration, Health Hx: How will heart rate change?
Will be increasd, and then progressing to bradycardia.
Dehydration, Health Hx: Once initial fluid volume restored, more IV fluids may be ordered with maintenance fluid. What is this?
Refers to the amount needed under normal conditions of normal hydration.
Dehydration, Health Hx: Formula for fluid requirement?
100 ml/kg per first 10 kg
50 mL/kg for next 10 kg
20 mL/kg for remaining kg
Vomiting: Occurs as a reflex with what three different phases?
PRodromal Period (Nausea and signs of stimulation)
Retching
Vomiting
Vomiting, Health Hx: Assessment of vomiting should include what
Contents/Character of emesis
Effort force of vomiting
Timing
Vomiting, Health Hx: Bilious vomiting suggests what
obsturction, whereas bloody emesis can signify esophageal or gi bleeding
Vomiting, Health Hx: Vomiting that occurs several hours past meals could signify what?
delayed gastric emptying
Vomiting, Health Hx: Pain in epigastric area could signify what
peptic ulcer disease, pancreatitis, or cholecystitis
Vomiting, Health Hx: What can be used to role out causes?
Abdominal Ultrasound
Upper GI series
Plain abdominal x-rays
Vomiting, Nursing Mx: What should be done for child with mild-to-moderate rehydration?
Withold oral feedings for 1-2 hours. Then give infant 0.5 to 2 oz of oral rehydration every 15 minutes.
Vomiting, Nursing Mx: What natural things can be used to reduce nausea?
Ginger capsules, ginger tea and candied ginger
Diarrhea - Patho: What causes acute?
Caused by viruses, may also be related to bacterial enteropathogens
Diarrhea - Patho: How will diarrhea caused by viruses, bacteria, and parasites look?
Viruses: Loose, watery forming
Bacteria: May be bloody or mucousy
Parasites: Fever, watery stools
Hypertrophic Pyloric Stenosis: What is this?
Circular muscle of pylorus becomes hypertrophied, causing thickness in luminal side of pyloric canal. Creates a gastric outlet obsturction, causing vomiting present between 3-6 weeks.
Hypertrophic Pyloric Stenosis: How is this fixed?
Surgical intervention. Pyloromyotomy performed to cut hte muscle of the pylorus and relieve gastric outlet obsturction
Hypertrophic Pyloric Stenosis, Health Hx: Signs of this may include what?
Forceful vomiting
Hunger soona fter vomiting
Weight loss due to vomiting
Hypertrophic Pyloric Stenosis, Health Hx: Palpate for what?
Hard, moveable olive in upper right quadrant.
Hypertrophic Pyloric Stenosis, Nursing Mx: THis is aimed at what?
FLuid management and correcting abnormal electrolyte values.
Hypertrophic Pyloric Stenosis, Nursing Mx: When do infants resume feeding
?
After 1-2 days
Intussusception: What is this?
When proximal segement of bowel telescopes into a more distal segment, causing edema, vascular compromise, nad ultimately partial or total bowel obsturction. It caves in on each other.
Intussusception: What can be done to help reduce this?
Barium Enema, and by surgery.
Intussusception, Health Hx: Symptoms may include what?
Sudden onset of abdominal pain SEvere Pain Vomiting Diarrhea Jelly Stools Lethargy
Intussusception, Health Hx: How often do symptoms appear?
They flare and then regress.
Intussusception, Health Hx: What is the hallmark sign of this?
Sausage-shaped mass in the upper midabdomen
Intussusception, Health Hx: How is this diagnosed?
With an air or barium enema.
Appendicitis: What is this?
Acute inflammation of the appendix.
Appendicitis - Patho: What is thought to cause this?
Fecal material that is impacted into a relatively narrow appendix. May cause perforation.
Appendicitis - Patho: What does perforation cause to happen in appendix?
Causes inflammatory fluid and bacterial contents to leak into the abdominal cavity, resulting in peritonitis.
Appendicitis - Therapeutic Mx: What is done for this>
Surgery. Done by laparoscopic technique.
Appendicitis - Health Hx: Common signs reported include what?
Vague abdominal pain
N/V
Small-volume, frequent soft stools
Fever
Appendicitis - Health Hx: How do they appear?
Anorexic and ill. They often cannot walk or climb up.
Appendicitis - Health Hx: Maximal tenderenss can occur where?
McBurney Point, in the right lower quadrant.
Appendicitis - Health Hx: Labs for this?
CT
WBC Testing
C-Reactive Protein
Appendicitis - Health Hx: What should be administerd after surgery?
48-72 hours of ordered antibiotics, to the child with nonperforated appendix. 7-14 days IV antibiotics needed with surgery
GERD: What is this?
Passage of gastric contents into esophagus, and when it is not a pathologic proces.
GERD: When are the symptoms of this seen?
As a result of damaging components of the refluxate
GERD: What may this cause?
Esophagitis, esophageal stricture, barrett esophagus or anemia.
GERD, Therapeutic Mx: How is feeding done?
With appropriate postioning. Head of bed upright and keep infant upright for 30 mins after feeding. Also give smaller feedings.
GERD, Therapeutic Mx: What surgery may be performed?
Nissen fundoplication. Gastric fundus wrapped aorund lower 2-3 cm of esophagus.
GERD, Health Hx: Signs of this may include what?
Recurrent vomiting WEight Loss Irritability in infants Respiratory symptoms Hoarsenes/Sore Throat Heartburn Abdominal Pain
GERD, Health Hx: Risk factors for this?
Prematurity
Dietary Habits
Current Medications
Smoking/Alcohol Use.
GERD, Health Hx: How will children appear?
May appear underweight.
GERD, Health Hx: Wat labs may be done for this?
Upper GI series Esophageal pH probe Esophagogastroduodenoscopy CBC Hemoccult
GERD, Nursing Mx, Promoting Safe FEeding Techniques/Positons: How often should feedings occur for infants?
Give them small, frequent feedings using a nipple. And frequently burp. Keep upright for 45 mins after feeding.
GERD, Nursing Mx, Maintaining Patent Airway: What to do if child has apnea or ALTE?
Use an apnea or badycardia monitor to monitor for episodes
GERD, Nursing Mx, PostOp Care: What to do if abdomen becomes distended?
Open the gastrostomy tube to air to decompres the stomach
Constipation and Encopresis: Functional constipation has to meet what criteria?
<3 BMs weekly
At least one episode of fecal incontinence
Stool or withholding behavior
Large fecal rectal mass
Constipation and Encopresis: What is encopresis?
Term used to describe soiling of fecal contents into underwear beyong age of expected toilet training (4-5 years).
Constipation and Encopresis: Why is encopresis often seen?
As a result of chronic constipation and withholding of stool. Rectal muscle stretches, causing fecaal impactations causing liquid stool leakage.
Constipation and Encopresis - Therapeutic Mx: How can this be managed?
With dietar manipulation. This as increasing fiber and fluids. Some may require laxative surgery.
Constipation and Encopresis - Health Hx: Common signs and symptoms reported may include what?
altered stooling patterns Pain with defecation Withholding behaviors Complaints of abdominal pain and crmaping Diarrhea leakage
Constipation and Encopresis - Health Hx: What are some RF of this?
Family hx of GI disorders.
History of rectal bleeding
History of sexual abuse
Constipation and Encopresis - Health Hx: Why should the lower back be assessed?
Check for deep pilonidal dimple with hair tuff, which suggests spina bifida occulta.
Constipation and Encopresis - Health Hx: If percussed, dullness would reveal what?
A fecal mass
Constipation and Encopresis - Health Hx: What labs can be done?
Stool for occult blood.
Abdominal X-Ray
Barium Enema
Constipation and Encopresis - Nursing Mx, Educating Fam: How can parents promote daily bowel evacuation?
Have child sit on the toilet twice daily for 5-15 minutes. Give a star for compliance.
Hirschsprung Disease (Congential Aganglionic Megacolon): What is this?
Movement disorder of the intestinal track resulting in obstruction. Commonly known as failure to pass a stool within 24 hours.
Hirschsprung Disease (Congential Aganglionic Megacolon): Why does this occcur
Due to lack of ganglion cells in the bowel, which causing inadequate motility.
Hirschsprung Disease (Congential Aganglionic Megacolon), Therapeutic Mx: What must be done to treat this?>
Surgical resection of the aganglionic bowell and reanastomosis of remaining intestine.
Hirschsprung Disease (Congential Aganglionic Megacolon), Therapeutic Mx: This surgery requires child to get what?
An ostomy, to divert the stool through the stoma. Allows resected bowel to heal before its used.
Hirschsprung Disease (Congential Aganglionic Megacolon), Health Hx: How is this determined?
Most children do not pass stool within 24-48 hours of life.
Hirschsprung Disease (Congential Aganglionic Megacolon), Health Hx: How is abdomen usually appear?
Is typically distended and can palpate sotol masses in the abdomen.
Hirschsprung Disease (Congential Aganglionic Megacolon), Health Hx: What will a rectal exam reveal?
No stool in the rectum. At the end however , child may have a forceful explusion.
Hirschsprung Disease (Congential Aganglionic Megacolon), Health Hx: Labs for this?
Barium Enema
Rectal Suction Biopsy
Hirschsprung Disease (Congential Aganglionic Megacolon), Nursing Mx: Possible complication of this?
enterocolitis
Hirschsprung Disease (Congential Aganglionic Megacolon), Nursing Mx: Signs and symptoms of enterocolitis?
Fever, abdominal distention, Chronic Diarrhea, Expolsive stools, Rectal Bleeding
Celiac Disease: What is this?
When gluten causes damage to the small intestine. Villi damaged due to immuno response to gluten.
Celiac Disease: What is the function of the vili?
To absorb nutrients into the bloodstream. Without this, malnutrition occurs.
Celiac Disease: Treatment for this?
strict gluten-free diet. Allows villi of intestines to heal and function normally
Celiac Disease: sIGNS AND SYMPTOMS of this?
Diarrhea
Steatorrhea (Fatty Stools)
Constipation
Failure to Thrive
Poor Muscle Tone
Irritability
Celiac Disease: How will they appear?
Will have distended abdomen, wasted buttocks, and very thin extremities
Celiac Disease: What labs can be performed?
IgA, intestinal biopsy, and genetic testing.
Celiac Disease: Small bowel biopsy will reveal what?
atrophy or blunting of the villi
Celiac Disease: Gluten is found in what products?
What products, rye, barley, and possibly oats
A mother brings her 6-month-old infant to the clinic. The child has been vomiting since early morning and has had diarrhea since the day before. His temperature is 38°C, pulse 140, and respiratory rate 38. He has lost 6 oz since his well-child visit 4 days ago. He cries before passing a bowel movement. He will not breastfeed today. What is the priority nursing diagnosis?
thermoregulation alteration pain (abdominal) related to diarrhea fluid volume deficit related to excessive losses and inadequate intake alteration in nutrition, less than body requirements, related to decreased oral intake
fluid volume deficit related to excessive losses and inadequate intake
A child presents with a 2-day history of fever, abdominal pain, occasional vomiting, and decreased oral intake. Which finding would the nurse prioritize for immediate reporting to the physician?
temperature 101.9°F rebound tenderness and abdominal guarding Parents will be leaving the child alone in the hospital. Child can tolerate only sips of fluid without nausea.
rebound tenderness and abdominal guarding
A 3-day-old infant presenting with physiologic jaundice is hospitalized and placed under phototherapy. Which response indicates to the nurse that the parent needs more teaching?
“My infant is at risk for dehydration.” “My infant needs to stay under the lights, except during feeding time.” “My infant can continue to breastfeed during this time.” “My infant has a serious liver disease.”
reastfeed during this time.”
“My infant has a serious liver disease.”
A 3-month-old infant presents with a history of vomiting after feeding. The plan for the infant is to rule out GER. What information from the history would lead the nurse to believe that this infant may need further intervention?
poor weight gain small “spits” after feeding sleeps through the night difficult to burp
poor weight gain
The nurse is caring for a child who has had diarrhea and vomiting for the past several days. What is the priority nursing assessment?
Determine the child’s weight. Ask if the family has traveled outside of the country. Assess circulation and perfusion. Send a stool specimen to the lab.
Assess circulation and perfusion.
