Gastrointestinal System Flashcards
Birth defect characterized by incomplete formation of the lip
Cleft lip
Birth defect characterized by incomplete formation of the roof of the mouth
Cleft palate
Treatment of cleft lip
Surgical repair between 3-5 months of age
Treatment of cleft palate
Surgical repair between 9-12 months of age
Bottle feeding a baby with cleft lip
Use bottle that has a nipple with a wide base, squeezing baby’s cheeks together while feeding can help get a good lip seal
Bottle feeding a baby with cleft palate
Position baby in upright position, use bottle with one-way flow valve and a specialty nipple that increases the flow of liquid, burp the baby frequently
Cleft lip or palate post-op precautions
- protect site!
- petroleum jelly along suture line to keep area moist and promote wound healing
- elbow immobilizes used to prevent baby from touching and damaging site
- avoid pacifiers
- feed baby with syringe or dropper (bc sucking disrupts suture line)
Birth defect by which the upper part of the esophagus is not attached to lower esophagus
Esophageal atresia
Birth defect characterized by an abnormal connection between the esophagus and the trachea
Tracheoesophageal fistula
Signs of esophageal atresia and tracheoesophageal fistula
- prenatal: ultrasound reveals presence of polyhydramnios (baby cannot swallow amniotic fluid d/t defect)
- after birth: choking, respiratory distress during feeding, cyanosis, abdominal distention
Post-op nursing care for esophageal atresia and tracheoesophageal fistula
Maintain patent airway, suction upper esophageal pouch to prevent aspiration, NPO, administer IV fluids and antibiotics
Esophageal atresia and tracheoesopageal fistula place infants at risk for
Aspiration pneumonia and respiratory distress
Factors that contribute to GER in children
Underdeveloped lower esophageal sphincter, consumption of primarily liquid diet, spending a lot of time on back
S/S of GER in infants
Spitting up, crying, arching back, FTT, respiratory difficulties
S/S of GER in children
Dyspepsia, regurgitation, chest pain, Dysphagia, chronic cough
GER is self-resolving for most children by age ___
1
Family teaching for infants with GER
Feeding infants in upright position and kept in upright position for 20-30 min after feeding, recommend thickening infant formula
Family teaching for children with GER
Avoid fatty, fried, citrus, or spicy foods. Eat smaller meals rather than large meals, remain upright after meals, elevate HOB to prevent regurgitation
Thickening of the pyloric sphincter that blocks the movement of food from the stomach into duodenum
Hypertrophic pyloric stenosis
S/S of hypertrophic pyloric stenosis
Projectile vomiting, palpable olive-shaped mass in RUQ, visible peristaltic waves, signs of dehydration
Labs associated with hypertrophic pyloric stenosis
Hypokalemia, metabolic alkalosis
Treatment for hypertrophic pyloric stenosis
IV fluids and electrolytes, pyloromyotomy (surgery to enlarge opening at pylorus)
Congenital defect characterized by a diverticulum or pouch in the lower part of the small intestine
Meckel’s diverticulum
Signs of Meckel’s diverticulum
Painless rectal bleeding, red currant jelly stool, abdominal pain, anemia
Treatment of Meckel’s diverticulum
Surgical removal
Meckel’s diverticulum nursing care
Monitor for rectal bleeding and signs of hypovolemic shock such as hypotension, tachycardia, and pallor
Condition that causes part of the intestine to fold into the section next to it resulting in obstruction, impaired blood flow, and ischemia
Intussusception
S/S of intussusception
Sudden, severe abdominal pain which may cause child to draw knees up to chest, vomiting, lethargy, weight loss, sausage-shaped mass in RUQ, currant jelly stool, fever
Diagnosis of intussusception
Ultrasound reveals bullseye or target sign, air enema provides diagnosis and treatment
Intussusception treatment
Air or barium enema, surgery
Intussusception nursing care
NG tube placement, IV fluids, monitor stool for blood
Decrease in the length of the small intestine, typically resulting from surgery that required resection of the intestine
Short bowel syndrome
Key complication of short bowel syndrome
Malabsorption (d/t decreased surface area)
Signs of short bowel syndrome
Malnutrition, weight loss, diarrhea, steatorrhea, dehydration
Treatment for short bowel syndrome
Nutritional support: parenteral or enteral nutrition, oral rehydration, dietary modifications
Autoimmune disorder where ingestion of gluten causes damage to the villi in the small intestine
Celiac disease
S/S of celiac disease
Lethargy, abdominal pain and distention, diarrhea, steatorrhea, vomiting, constipation, FTT, anemia (d/t impaired absorption of iron, folate, B12)
Treatment for celiac disease
Strict-gluten free diet (avoid barley, rye, oats, wheat)
Congenital defects of the abdominal wall that allow for herniation of abdominal organs
Omphalocele and gastroschisis
_________ defect occurs through the umbilical ring with herniation of abdominal organs that are covered with peritoneum
Omphalocele
_________ defect occurs to the right of the umbilicus with herniation of the bowel that is NOT covered with peritoneum
Gastroschisis
Diagnosis of Omphalocele and gastroschisis
Prenatal ultrasound, elevated MSAFP during pregnancy
Omphalocele and gastroschisis treatment
Surgical closure of defect, administration of IV fluids, electrolytes and antibiotics
Omphalocele and gastroschisis nursing care
Place orogastric tube to decompress stomach, protect exposed bowel prior to surgery — place protective non-adherent dressing over area, place lower have of infant in sterile, clear plastic bowel bag (gastroschisis)
Birth defect characterized by missing ganglion cells in segments of the colon
Hirschsprung disease
S/S of Hirschsprung disease
Failure to pass meconium in the first 48 hrs of life, abdominal distention, constipation, ribbon-like stool, vomiting that contains biles, palpable fecal mass, FTT
Treatment of Hirschsprung disease
Surgical removal of the part of the colon that is missing ganglion cells, ostomy in some cases
Hirschsprung disease nursing care
Monitor for complications such as enterocolitis (inflammation and infection of intestines)
S/S of enterocolitis
Fever, bloody diarrhea, abdominal pain
Inadequate weight gain in a pediatric patient that may be due to insufficient calories intake or absorption, or excess calories expenditure
Failure to thrive (FTT)
Risk factors for FTT
Low socioeconomic status, increased psychosocial stress in home
S/S of FTT
Weight below 5th percentile, developmental delays, decreased levels of prealbumin
Focus of FTT treatment
Increasing calorie intake, addressing issues with feeding behaviors
Increasing calorie intake for infants/children with FTT
Concentrate formula for infants, replace whole milk with high-calorie milk drinks for toddlers, tube feeding or parenteral nutrition may be required for severe case
FTT family teaching
Establish regular meals times and routines, limit juice and empty calorie consumption
Inconsolable infant crying and screaming without an obvious cause
Colic
S/S of colic
Continual infant crying and screaming unrelieved by soothing, red-faced with legs drawn up
Colic diagnosis
Rule of 3’s: episodes that last more than 3 hrs/day, 3 times/week, for over 3 weeks; symptoms usually start around 3 weeks of age
Colic treatment
Supportive: swaddling, massage, providing quiet, dark environment. In breastfed infants, probiotics and strict maternal hypoallergenic diet may reduce symptoms
Colic nursing care
Educate family that colic usually resolves by 4 months of age. Teach family coping strategies: DO NOT shake baby (can lead to brain damage and death), lay crying infant safely in crib and walk away
Virus that is transmitted through the fecal-oral route, and is the most common cause of diarrhea under five
Rotavirus
Bacteria transmitted through the fecal-oral route and contaminated food
E.Coli
Strain of E.Coli that can cause blood diarrhea and hemolytic uremic syndrome
Shiga toxin producing E. Coli
Bacteria transmitted through contaminated food such as undercooked meat
Salmonella
Protozoan infection that is transmitted through contact with infected people or animals or unfiltered water
Giardia
Risk factors for infectious diarrhea
Recent travel, recent antibiotic use, poor hygiene, crowded living conditions, poor sanitation, lack of clean water, consuming raw, undercooked and contaminated foods
Labs associated with diarrhea
Hypokalemia, hyponatremia, metabolic acidosis, increased urine specific gravity
Treatment of infectious diarrhea in children
Oral rehydration solution, IV fluids and electrolytes, antiemetics
Infectious diarrhea nursing care
Monitor weight, I&O, educate family about prevention
Weight loss associated with mild, moderate, and severe dehydration
- mild: 3-5%
- moderate: 6-10%
- severe: >10%
LOC associated with mild, moderate, and severe dehydration
- mild: alert, thirsty
- moderate: irritable
- severe: lethargic or coma
Capillary refill associated with mild, moderate, and severe dehydration
- mild: </= 2 sec
- moderate: 2-4 sec
- severe: > 4 sec
Urine output associated with mild, moderate, and severe dehydration
- mild: normal
- moderate: decreased
- severe: oliguric or anuric
Eyes associated with mild, moderate, and severe dehydration
- mild: normal
- moderate: slightly sunken, decreased tears
- severe: deeply sunken, no tears
S/S of dehydration
Poor skin turgor, dry mucous membranes, sunken fontanelles, hypotension, tachycardia, tachypnea
Prevention of infectious diarrhea
Hand hygiene before eating, handling food, and after using restroom. Cook foods thoroughly, refrigerate perishable items within 2 hours of purchasing or cooking, unsafe water should be avoided, super absorbent diapers should be used to prevent leaking and contamination, gloves should be worn when handling diapers or stool of an infected child, sandboxes should be covered when not in use to prevent animals using them as a litter box
Infectious diarrhea family education
Provide oral rehydration in small, frequent intervals. Avoid fruit juices, caffeine, soda, gelatin and broth. Monitor hydration by counting the number of wet diapers per day (normal is 6-8)
Helminthic infection caused by E. Vermicularis transmitted through fecal-oral route
Enterobiasis (Pinworm)
Enterobiasis risk factors
Poor hygiene, crowded environments (daycare)
S/S of pinworm infection
Intense perinatal itching that is worse at night, poor sleep, irritability
Diagnosis of pinworms
Tape test — press tape against skin surrounding child’s anus first thing in the morning before using the bathroom, cleaning up, or getting dressed, repeat for 3 consecutive mornings
Treatment for pinworms
Anthelminthic agent such as albendazole, treat ALL household members, perform meticulous hand hygiene, take daily showers, and wash pajamas, underwear, and bedding in hot water to prevent reinfestation
