Gastrointestinal Dysfunction Flashcards
Describe esophageal atresia (EA) / tracheoesophageal fistula (TEF)
Esophagus connects to trachea (food enters airway)
What are the manifestations of EA / TEF? (3)
- Coughing
- Choking
- Cyanosis
Why is abdominal distention associated with EA / TEF?
Air accumulation in the stomach
What is the primary goal of treatment for EA / TEF?
Prevent aspiration pneumonia until surgical intervention
Describe the nursing interventions associated with EA / TEF (3)
- NPO
- NG tube
- Suction
What is gastroesophageal reflux (GER)?
Backflow of gastric contents into the esophagus
Untreated / prolonged GER can lead to ______
GERD
The development of GER can be related to …
Increased abdominal pressure (coughing, sneezing, overeating)
Describe the therapeutic management of GER (4)
- Avoid irritating foods
- Small frequent meals
- Thickened feedings
- Upright position 30 - 45 minutes after eating
Describe the pharmacologic management of GER (2)
- pepcid (H2 blocker)
- protonix (PPI)
What is the purpose of thickening formulas with rice cereal?
Keeps food in stomach to prevent reflux
What surgical intervention is used for severe GER?
Nissen fundoplication
Describe nissen fundoplication
Top of gastric fundus is wrapped around lower esophageal sphincter (laparoscopic)
Describe cleft lip / cleft palate
Incorrect fusion of nasal / maxillary processes
Cleft lip / cleft palate is readily apparent at birth and can cause …
Severe emotional reactions in parents
At what age can closure / reconstruction of a cleft lip occur?
2 - 6 months
At what age can closure / reconstruction of a cleft palate occur?
9 - 18 months
______ is encouraged for an infant recovering from cleft lip / cleft palate
Breastfeeding
Describe the post-op management of cleft lip / cleft palate (2)
- Suction GENTLY
- Slow feeding with dropper
Describe the importance of pain management for infants / small children post-op
Minimize stress on operative site from crying / straining
Describe hypertrophic pyloric stenosis (HPS)
Narrowing of pyloric sphincter prevents stomach from emptying into duodenum
HPS has an extremely higher incidence in ______
Males
How is HPS diagnosed?
Ultrasound
What are the manifestations of HPS? (2)
- Projectile vomiting
- Left-to-right peristalsis after eating
Emesis from HPS does not contain ______
Bile
What is the primary concern associated with HPS?
Dehydration / electrolyte imbalances due to excessive vomiting
What surgical intervention is used for HPS?
Pyloromyotomy
Describe the nursing interventions associated with HPS (3)
- NPO
- NG tube
- Fluid / electrolyte replacement
Describe intussusception
Part of the intestine telescopes into another causing obstruction
What complications are associated with intussusception? (4)
- Bleeding
- Necrosis
- Perforation
- Peritonitis
Since fecal material cannot pass beyond obstruction in the case of intussusception, what substances do stools primarily contain? (2)
- Blood
- Mucus
What are the manifestations of intussusception? (2)
- “Currant jelly” stools
- Severe abdominal pain
What is the primary treatment of intussusception?
Air / saline enema to relieve obstruction
What sign indicates spontaneous reduction of intussusception?
Passing of a normal stool
Describe hirschsprung disease
Lack of intestinal motility due to absent nerve cells
What are the manifestations of hirschsprung disease? (3)
- Megacolon
- “Ribbon-like” stools
- Chronic constipation
Describe the surgical interventions associated with hirschsprung disease (2)
- One stage
- Two stage - uses temporary colostomy (more common)
What complications are associated with hirschsprung disease? (3)
- Anal strictures
- Incontinence
- Enterocolitis
Appendicitis is characterized by ______
Rebound tenderness
Describe the pain associated with appendicitis
Begins around umbilicus and localizes to RLQ (McBurney’s point)
Describe gastroenteritis
Enterotoxins cause severe diarrhea
______ is the most common cause of hospitalization associated with gastroenteritis
Rotavirus
Which type of dehydration is typically seen in children?
Isotonic dehydration
Describe isotonic dehydration
Balanced water / electrolyte loss
Describe the therapeutic management of dehydration (3)
- NO anti-diarrheal meds
- Oral rehydration therapy (ORT) if vomiting
- Clear liquids
What signs of dehydration are considered a medical emergency? (5)
- Vomiting for > 12 hours
- > 10 watery stools in 1 day
- Urinary retention for > 6 hours
- Crying with no tears
- Sunken anterior fontanel
Describe encopresis
Voluntary / involuntary passage of stool in inappropriate places
Describe the criteria required for diagnosis of encopresis
Must occur once per month for at least 3 months after age 4
In order to treat encopresis, it is important to …
Determine the underlying cause
Describe toilet training associated with encopresis
Encourage child to sit on toilet for 10 - 15 minutes after meals
