Gastrointestinal Conditions (high priority; 20 questions) Flashcards
Diarrhea and gastroenteritis
prevention: Rotavirus vaccine; d/c antimicrobial agents for C.diff
tx: manage symptoms
- fluid replacement
- nutritional support
Diarrhea & gastroenteritis - what kind of electrolyte imbalance?
metabolic “ass”idosis - due to lots of stool
vomiting - what kind of electrolyte imbalance?
L for linguistics (tongue/mouth)
“if it’s coming out of your mouth (vomiting/hyperventilating) –> alkalosis
metabolic alkalosis
vomiting interventions
- anti emetic meds
- if gut works, use it
- if not, IV fluids
- evaluate feeding methods (burping, air in nipple)
- teach positioning
Pyloric stenosis
- skinny, angry babies
- presents over time - between 1-3 mos of life
- projectile vomiting (no bile)
- dehydration - assess for metabolic alkalosis from frequ emesis
Dx - palpation of classic “olive-like” mass in abdomen
- abdominal US
Intervention for pyloric stenosis
- hydration and electrolyte balance
- NPO pre-op
- begin PO feeding 4-6 hours s/p surgery
Gastoesophageal Reflux (GER) - risk factors and complications
- prematurity
- bronchopulmonary dysplasia
- CP
complications: aspiration pna, failure to thrive
Gastoesophageal Reflux (GER) - interventions
- small, more freq feeding (thicken formula)
- positioning - upright for 30 post feeding; avoid sitting in car seat (reclined position); back to sleep
- antacids; PPIs
Prep for Nissen fundoplication – if all else fails
necrotizing enterocolitis – assessment
common in preemies
- abdom distention
- incr gastric residual vol
- vomiting
- bloody stool
- glucose + stool
necrotizing enterocolitis - intervention
- bowel rest (NPO, TPN)
- decompress abd (NGT to low suction)
- abx
- reduce stress (cluster care; maintain body temp)
Complications: colostomy; abd perforation (can lead to sepsis, shock, death
cleft lip and palate - nursing considerations
Pre-surgery:
- feed slowly and in upright position
- burp freq
- use special nipple
- small, freq feedings
Prep for surgery:
- cleft lip: 1-4 mos of age
- cleft palate: when baby able to drink from a cup (6-12 mos) – don’t want them to suck
cleft lip and palate - post op considerations
cleft lip - observe for resp distress; maintain sutures; keep infants’ hands away from mouth
cleft palate - nothing in mouth (nipples, pacy, straws, toys)
- feed w/open cup, syringe
- elbow restraints until palate healed
- speech therapy
Esophageal Atresia and Tracheoesophageal Fistula
- do not feed orally (g-tube)
- always have suction at bedside
- surgical repair done in stages
Appendicitis - S/S
Pain - localizes at McBurney’s point; rebound tenderness
Infection s/s - fever, incre WBC
GI signs - decr bowel sounds, N/V, abd distention, rigidity, guarding
S/S of peritonitis - if appendix bursts –> sudden relief of pain, followed by diffuse pain
Celiac disease - s/s, treatment
s/s - steatorrhea (fatty stools)
- abdom distention
- failure to thrive
Tx - Gluten free diet; vitamin suppl. (multi, folic acid, iron)
Teaching: GF diet; assume anything w/thickness has gluten
- low residue diet during bowel inflammation (low residue = low fiber)
Hirschsprung Disease (Congenital Aganglionic Megacolon)
- ribbon-like, liquid stools
- abd distention
- constipation
intervention: temp ostomy; surgical repair
Intussusception (intestinal telescope)
Most common in kids 3 mo to 2 years
- currant-jelly stools (later sign)
- sudden onset of pain
- bilious vomiting (drawing up of knees)
- inconsolable crying
Dx - best is Barium Enema
Nonsurgical tx: successful 80% of time (hydrostatic reduction w/barium enema OR water soluble contrast w/air pressure
Surgical tx: manual reduction w/or w/o surgical resection of gangrenous bowel resection
Encopresis
- fecal soiling of underwear in child older than 4 years
- often due to resistance to having bowel movements
- constipation - treat w/stool softeners, lubes, suppositories, enemas; high fiber diet, encourage fluid intake, psych support
2 types of Inflammatory Bowel Disease
- Ulcerative Colitis - inflammation in colon and rectum only; affects 2 layers of bowel wall
- Crohn’s Disease - inflammation can be in any part of GI tract; affects all layers of bowel wall
Inflammatory Bowel Disease s/s
- bloody diarrhea
- abdominal cramps/pain
- weight loss
- growth retardation
Inflammatory Bowel Disease tx
Goal - achieve remission
Medications:
- analgesic and antispasmodic (pain relief)
- corticosteroids (inflammation)
- immunomodulators (methotrexate and cyclosporine)
- biologics (Remicade = infliximab)
(SE - chills, dizziness, fatigue, pain in chest or stomach, infection)
Nutritional support - enteral & TPN (for gut rest)
- high protein, high calorie
- vitamins: multi, folic acid, iron
Surgical - total colectomy
Biliary Atresia
- can cause liver failure and death - no way for bilirubin to leave liver
S/S - jaundice; itching; pale stool (no bile)
–> failure to thrive/poor weight gain: caused by decreased absorption of fat soluble vitamins –> ADEK
Intervention: administer fat soluble vits; Kasai procedure (but only bandaid; kids need liver transplant by 5-6 years old), BUT make great candidates for the transplant
NGT
pH < 5
confirm Q4H w/continuous feeds; w/each medication and feeding
Acetaminophen dosage
10-15 mg/kg/dose Q4H
