GI

Question 1

Types of dehydration

Answer 1

Isotonic/isonatremic
Hypertonic/hypernatremic
Hypotonic/hyponatremic

Question 2

What is isotonic or isonatremic dehydration

Answer 2

Equal loss of water and electrolytes
Major fluid loss involved extracellular components and circulating blood volume
Hypovolemic shock may occur

Question 3

Cause of isotonic/isonatremic dehydration

Answer 3

Occurs when fluid loss not balanced by intake
Most common cause: vomiting and diarrhea

Question 4

Labs with isotonic/isonatremic dehydration

Answer 4

Serum Na: normal, may decrease
Cl: decreased
K: normal, may decrease

Question 5

What is hypertonic/hypernatremic dehydration

Answer 5

Primarily a loss of water

Question 6

Pathology of hypertonic/hypernatremic dehydration

Answer 6

Excessive water loss compared to electrolytes –>
Fluid shifts from intracellular to extracellular –>
Neurologic disturbances (seizures)

Question 7

S/S of hypertonic/hypernatremic dehydration

Answer 7

Delay of onset S/S due to compensatory mechanisms
Altered LOC, confusion, lethargy/dizziness

Question 8

Labs with hypertonic/hypernatremic dehydration

Answer 8

Na: increases (>145)
Cl: increases
K: varies

Question 9

Causes of hypertonic/hypernatremic dehydration

Answer 9

DI
Administration of IV fluids or feeds with high electrolytes

Question 10

What is hypotonic/hyponatremic dehydration

Answer 10

Primarily a loss of electrolytes

Question 11

Pathology of hypotonic/hyponatremic dehydration

Answer 11

Water shifts from extracellular to intracellular in an attempt to compensate –>
Further increases loss of ECF –>
Can result in hypovolemic shock

Question 12

Labs for hypotonic/hyponatremic dehydration

Answer 12

Serum Na: decreases (<135)
Cl: decreases
K: level varies

Question 13

Causes of hypotonic/hyponatremic dehydration

Answer 13

Severe/prolonged vomiting/diarrhea
Burns
Renal dz
IV fluids without electrolytes

Question 14

Treating dehydration

Question 15

Pathophysiology of pyloric stenosis

Answer 15

Elongation and thickening of the pylorus, leading to hypertropthy
May progress to nearly complete obstruction of gastric outlet

Question 16

History & assessment pyloric stenosis

Answer 16

Sudden onset of forceful (projectile) vomiting immediately after eating
Dehydration, metabolic disturbances (metabolic alkalosis)
Peristaltic waves on inspection
Olive-shaped mass in right upper quadrant
Familial; males 4x more affected than females
Can happen at 1-12 weeks, but most common around 3-5 weeks

Question 17

Management of pyloric stenosis

Answer 17

NPO until after surgical correction, NG tube to decompress stomach
Meet fluid, electrolyte, nutritional needs
Prevent infection, promote comfort, support parents

Question 18

Pathology of appendicitis

Answer 18

Obstruction occurs in the appendiceal lumen
Causes of obstruction include hard fecal mass, stenosis, parasitic infection, hyperplasia of lymphoid tissue, or a tumor
After obstruction, mucus continues to be secreted, bacteria proliferate, and intraluminal pressure increases
Elevated pressure leads to lymphatic and venous congestion, impaired perfusion, and eventual ischemia
Necrosis occurs
The appendix becomes gangrenous and ruptures
Rupture can lead to bacterial contamination of the peritoneum, causing bacterial peritonitis

Question 19

History & assessment for appendicitis

Answer 19

Cramping around umbilicus, decreased appetite, nausea, fever
Often present with RLQ abd pain
Rebound tenderness at mcburney’s point
Rovsing’s sign- pushing on the LLQ elicits pain in the RLQ
Pain becomes more intense and constant
Guarding and abd rigidity occur
Sudden, spontaneous relief usually means rupture
Monitor for signs of sepsis and shock

Question 20

Management of appendicitis

Answer 20

NPO until surgery, NG tube to decompress stomach
Pain relief, promote comfort
Maintain hydration
Administering antibiotics (pre- and post-op)
Post-op care

Question 21

GERD pathophysiology

Answer 21

Passage of gastric contents into the esophagus
Occurs during episodes of transient relaxation of the LES, such as swallowing, crying, valsalva maneuvers that increase intra-abdominal pressure
Delayed gastric emptying
Neurologic dz

Question 22

Assessment of GERD

Answer 22

Past medical hx and risk factors
Onset and progression of symptoms
Physical exam

Question 23

Management of GERD

Answer 23

Protecting airway- risk for apnea or ALTE
Maintaining/restoring fluid balance/nutrition
Thicken bottle feeds with infant cereal (usually rice cereal)
Reflux precautions and family education
Postop care, if child requires a fundoplication

Question 24

Pathophysiology of Hirschsprung’s

Answer 24

Congenital aganglionic megacolon
A portion of the intestinal tract (usually the rectum or sigmoid colon) is missing neuronal ganglion cells
Aganglionosis causes absence of peristalsis and motility

Question 25

Hx and assessment of Hirschsprung’s

Answer 25

Can occur at any age
Digital rectal exam reveals an empty rectal vault
If untreated, enterocolitis can develop

Question 26

Management of Hirschsprung’s

Answer 26

Surgical correction- determined by the child’s health and comorbidities
Short-term colostomy may be necessary
Nursing care: pre- and post-op care, pain control, prevent infection
No rectal temps