GI Flashcards
Types of dehydration
Isotonic/isonatremic
Hypertonic/hypernatremic
Hypotonic/hyponatremic
What is isotonic or isonatremic dehydration
Equal loss of water and electrolytes
Major fluid loss involved extracellular components and circulating blood volume
Hypovolemic shock may occur
Cause of isotonic/isonatremic dehydration
Occurs when fluid loss not balanced by intake
Most common cause: vomiting and diarrhea
Labs with isotonic/isonatremic dehydration
Serum Na: normal, may decrease
Cl: decreased
K: normal, may decrease
What is hypertonic/hypernatremic dehydration
Primarily a loss of water
Pathology of hypertonic/hypernatremic dehydration
Excessive water loss compared to electrolytes –>
Fluid shifts from intracellular to extracellular –>
Neurologic disturbances (seizures)
S/S of hypertonic/hypernatremic dehydration
Delay of onset S/S due to compensatory mechanisms
Altered LOC, confusion, lethargy/dizziness
Labs with hypertonic/hypernatremic dehydration
Na: increases (>145)
Cl: increases
K: varies
Causes of hypertonic/hypernatremic dehydration
DI
Administration of IV fluids or feeds with high electrolytes
What is hypotonic/hyponatremic dehydration
Primarily a loss of electrolytes
Pathology of hypotonic/hyponatremic dehydration
Water shifts from extracellular to intracellular in an attempt to compensate –>
Further increases loss of ECF –>
Can result in hypovolemic shock
Labs for hypotonic/hyponatremic dehydration
Serum Na: decreases (<135)
Cl: decreases
K: level varies
Causes of hypotonic/hyponatremic dehydration
Severe/prolonged vomiting/diarrhea
Burns
Renal dz
IV fluids without electrolytes
Treating dehydration
Pathophysiology of pyloric stenosis
Elongation and thickening of the pylorus, leading to hypertropthy
May progress to nearly complete obstruction of gastric outlet
History & assessment pyloric stenosis
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
Management of pyloric stenosis
NPO until after surgical correction, NG tube to decompress stomach
Meet fluid, electrolyte, nutritional needs
Prevent infection, promote comfort, support parents
Pathology of appendicitis
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
History & assessment for appendicitis
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
Management of appendicitis
NPO until surgery, NG tube to decompress stomach
Pain relief, promote comfort
Maintain hydration
Administering antibiotics (pre- and post-op)
Post-op care
GERD pathophysiology
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
Assessment of GERD
Past medical hx and risk factors
Onset and progression of symptoms
Physical exam
Management of GERD
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
Pathophysiology of Hirschsprung’s
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
Hx and assessment of Hirschsprung’s
Can occur at any age
Digital rectal exam reveals an empty rectal vault
If untreated, enterocolitis can develop
Management of Hirschsprung’s
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
