GI Flashcards
before birth… what provides nutrients and handles waste?
placenta
no absorption or excretion from GI until after delivery
is the GI tract structurally complete at birth?
yep but its immature
at what age does sucking and swallowing become voluntary?
6 weeks
newborn has small stomach capacity and rapid peristalsis, what should their feedings be like?
small and frequent
describe the deficiencies in digestive enzymes until 4-6mo of age
- deficient in amylase, lipase, and tripsin
- leads to abdominal distention and gas
why is regurgitation a common finding in newborns?
relaxed cardiac sphincter
what liver functions are immature in newborns
- gluconeogenesis: formation os glycogen from noncarbs
- deamination: removal of amino group from amino compound
- vitamin storage
- ketone formation
- plasma protein function immature until 1 year
describe how the stomach capacity increases
- birth: 10-20ml (marble sized)
- 1 month: 30ml or one ounce
- 12mo: 360ml or 8ounces
- 24mo: 500ml or three time a day feeding capacity
at what age do children have control for three meals a day with excretory control?
age 2
what are some signs and symptoms of GI disorders
- inability to gain weight or weight loss
- vomiting, diarrhea, constipation
- lack of energy - lethargy
- abdominal distention or tenderness
describe cleft palate
- failure of maxillary processes to fuse
- clefts of the hard palate from a continuous opening between mouth and nasal cavity
- may be unilateral or bolateral and may involve just the soft palate or both soft and hard palate
when does the palate close during gestation
5th and 12th week
when is cleft palate/lip generally diagnosed?
prenatally, ultasound as early as 13wks
how is clinical confirmation of cleft palate done
ultrasound and palpation of the palate with a finger
describe cleft lip
- can occur alone or with cleft palate
- incomplete cleft lip has a bridge of tissue connecting the central and leteral lip
- varying degrees of nasal deformity may also be present
what are some possible causes of cleft lip and palate
- maternal use of tobacco/alc
- use of anticonvulsants, valproic acid, carbamazapine
- steroid use during pregnancy
- combination of envirnmental and genetic factors
- increased incidence in Native Americans and Asians
- increased incidence and fam history
what are some pre op nursing interventions for cleft lip/palate
- assessments every 2 hours with VS
- suction and bulb syringe at bedside
- provide emotional support to fam
- assess daily weight
- position infant on back
- education with fam on signs and symptoms of resp distress
when is cleft lip usually repaired?
at 3-5months
early repair facilitates easier feeding and speech
may require additional surgeries depending on severity
when is cleft palate usually repaired?
9 and 12months
this protects tooth buds and allows development of normal speech patterns
may require additional surgeries depending on severity
what education is important to include regarding feeding with cleft lip/palate
- bulb syringe available
- feed sitting upright
- hold upright for 30min after feeds
- burp frequently: after 15-30ml of formula
- use of cleft lip/palate special nurser bottle
describe cleft lip/palate post op nursing care
- assessments especially resp status
- VS
- maintain suture line
- pain meds
- feeding/nutrition/I+O
- education with fam
describe maintaining the suture line regarding cleft lip/palate post op nursing care
- position on back only
- soft elbow immobilizers
- antibiotic ointment to suture line as ordered
- keep comfy and content
- no pacifiers, straws, metal sppons or forks
- cleanse with water or NS after feedings
describe feeding and nutrition regarding cleft lip/palate post op nursing care
- dropper, syringe or special nurser bottle
- sit upright
- frequent burping
- 5-15ml of water after feeds
describe homegoing education for cleft lip/palate
- teach family to swaddle the infant at home to protect surgical site
- identify and address homecare needs well in advance of discharge
- discuss all aspects of care throughout hospitalization and after surgery
- involve parents in care to increase comfort before discharge
- teach feeding techniques
- recognize signs of infection
- how to position and care for suture line
- discusss financial implications of long term care
what is pyloric stenosis
- hypertrophy of the pyloric muscle, which is between the stomach and duodenum
- the hypertrophy obstructs the pyloric canal
- the pyloric area become obstructed and inflamed until obstruction becomes complete
- as it ptogresses, vomiting become forceful and projectile and infant becomes dehydrated
what is the peak age for pyloric stenosis
3-5 wks
whats clinical therapy for pyloric stenosis
- abdominal ultrasound confirms diagnosis
- surgical correction: pylormyotomy-pyloric muscle is split
what symptoms are expected with pyloric stenosis
- good eater who vomits occasionally
- multiple formula changes
- projectile vomiting
- infant hungry after emesis
- failure to gain weight
- abnormal stools
- dehydration
- metabolic alkalosis
- peristaltic waves acreoss abdomen
- olive size mass in RUQ
preoperative management of pyloric stenosis includes…
- NPO
- I+O
- maintain IV therapy
- assessments
- insert and monitor NG tube (low intermittent suction)
- correct fluid and electrolyte imbalance
- emotional support to fussy, irritable baby
- provide support to family
describe post op nursing management of pyloric stenosis
- assessments and vital signs frequently
- wound assessment: steri strips or collodion (look for signs and sx of infection)
- feedings begun per surgeons orders
- small amount f clear liqs first then advance volume and strength
- if infant vomits, next feed is decreased
- pain assessments (FLACC)
- family education
describe home going to instruction following pyloromyotomy
- infant may be bottle or breast fed
- infant may vomit after surgery (doesnt mean the surgery was unsuccessful)
- if the infant vomits, offer breast or bottle as soon as interest in feeding occurs
- burp every 1-2oz during feeding or 5-10min with breatsfeeding
- after feeding, stay upright for 30min
- keep incision sites clean and dry, strip can fall off which is normal
- infant should be sponge bathed only, no baths until heald or instructed by provider
- notify provider if there are any signs of infection or vomiting the majority of two consecutive feedings
describe GER
- affects half of all children with peak onset 0-3 months of age
- lower esophageal sphincter relaxes and allows passive regurgitation of stomach contents into esophagus, may also enter airway (aspiration)
- more common in children with neurological impairments and obesity
- usually resolves by 12 months
what are some signs and symptoms of GER
- relfux of formula with normal weight gain
- not uncomfortable or crying when spits up
- no frquent respiratory infections
- regurgitation that continues and increases in frequency may be caused by GER and require further investigation
what is the normal role of the lower esophageal sphincter
has a band of smooth muscle that relaxes during feeding but remains constricted after meals to prevent reflux of stomach contents into esophagus
how is GER diagnosed
upper GI series and esophageal pH monitoring
what is the treatment for GER
- smaller, more frequent meals
- thickened feeds as directed by provider; oatmeal cereal is the recommendation bc some rice cereals have been shown to contain arsenic
- maternal diet may need modified for breastfed babies
- burp every 1-2oz or after each side with breastfeeding
- hold upright for 20-30min after feeds
- avoid infant seat/carseat after feeds (semiupright position can complicate symptoms)
- monitor weight gain and growth and development
describe GERD
- serious manifestation of GER
- regurgitation of gastric contents back into the esophagus
- approximately 50% of healthy infants experience symptoms of GERD
- immature LES more prone to gastroesophageal reflux (wet burp vs emesis)
- frequently hungry and irritable
- requires treatment
what are some clinical manifestations of GERD
- poor weight gain and failure to thrive
- genralized irritability/excessive crying with feedings
- refusal to eat, vomiting
- sleep disturbances
- arching of back with feedings
- esophagitis
- persistent respiratory problems ( coughing, choking, wheezing)
describe clinical therapy for GERD
- thorough hisotry
- diagnosis with UGI and pH probe
- same treatment interventions as GER: smaller more frequent feedings, frequent burping, positioning and thickening of feeds
- meds: histamine H2 receptor anatagonists or PPIs
what med teaching is important for GERD
- doses, administration, timing
- takes time for the meds to have noticable positive effects
what is the surgical correction for GERD and when is it used
- nissen fundoplication, the fundus of the stomach is wrapped around the distal esophagus
- used for GERD that is not responding to pharmacological treatments or kids with GERD that is leading to life threatening complications
pre op nursing management for nissen fundoplication includes…
- reinforce education with family
- NPO
- hydration
post op nursing management for nissen fundoplication includes…
- assessments and vital signs
- intake and output
- wound assessment
- pain management
- activity
- education
what is intussusception and describe it a little
- pediatric emergency
- one portion of the intestine prolapses and then innervates (or telescopes) into itself
- frequent cause of intestinal obstruction in infants
- occasionally due to intestinal lesions (10%)
- cause is often unknown
who is at higher risk for intussusception
- most cases occur n boys ages, 65% of cases occur prior to 1yr of age
- most common cause of intestinal obstruction in children ages 3mo to 3yrs
- children with cystic fibrosis at higher risk
intussusception results in…
- obstructed blood flow
- ischemia and necrosis
- hemorrhage, perforation if untreated
what are some clinical manifestations of intussusception
- usually abrupt onset - screaming with legs drawn up to abdomen
- acute abdominal pain
- very irritable and inconsolable
- vomiting that usually starts soon after pain begins
- red currant jelly stools (mix of blood and mucus) (may initially have normal stool)
- sometimes sausage shaped mass in RUQ (happens abruptly)
how is intussusception diagnosed
ultrasound or enema (air or barium)
air enemas are also therapeutic - reuces approximately 90% of cases and is considered safer due to decreased risk for perforation
what are some interventions for intussusception
- spontaneous reduction
- hydrostatic reduction with barium enema or water soluble contrast with air pressure instead of barium
- surgery - reduction/resection
can intussusception recur after interventions?
yep
describe Hirschsprung disease
- agangliotic megacolon
- congential absence of ganglion cells in the wall of colon or rectum
- peristalsis prevented and intestinal contents accumulate with abdominal distention
- causes mechanical obstruction
describe the symptoms of Hirschsprung disease
varies with age of onset
newborns:
- no meconium stool in 48hrs
- abdominal distention
- bilious vomiting
older children:
- failure to thrive
- constipation, hard dry stool
- malnutrition
- recurrent fecal impaction
describe diagnosis of Hirschsprung disease
history, bowel patterns, radiographic studies, and rectal biopsy
rectal biopsy revealing absences of ganglionic cells and presence of hypertophic nerve bundles has proven to be the most reliable test for confirmation and diagnosis
whats the treatment for Hirschsprung disease
surgical removal of aganglionic bowel
temporary colostomy may be needed with subsequent reanastomosis (parent will need support)
descrbe assessment of Hirschsprung disease
careful nursing assessment for passage of meconium is important
tell parents to notify physician if meconium is not passed in first 48hrs after birth or if theres abdominal distention
- vomiting, constipation abd distention
- ribbon lik, foul smelling stools
when are most cases of Hirschsprung disease diagnosed?
first few months of life
- complete and careful history
- xray, barium enema studies
- anorectal manometric exam
- rectal biopsy to confrim diagnosis
describe preparation for surgery for Hirschsprung disease
- bowel irrigation
- antibiotics
- NG
- parent/child teaching for ostomy care
- post op teaching
- stoma/skin care
describe appendicitis
- inflammation/obstruction of the appendix
- may perforate causing peritonitis
- medical emergency
- leading cause of acute abdominal pain in older children
- early diagnosis and treatment is essential
- increased morbidity and mortality associated with perforated appendix
- increased rate for perforation in younger children than older ones
what is the surgical correction for appendicitis
appendectomy
whats used in the diagnosis of appendicitis
- elevated WBC
- history of illness, pain in RLQ
- ultrasound is preferred over CT to limit radiation exposure
what are some clinical manifestations of appendicitis
- periumbilical cramps, pain in RLQ
- abdominal tenderness, nausea, vomiting, anorexia, fever
- guarding, rigidity, right side lying position
- pain most intense at mcburneys point, halfway between anterior superior iliac crest and umbilicus
- rebound tenderness upon palpation
what are some clinical manifestations of a perforated appendix
- sudden relief of pain
- fever
- gaurding
- abdominal distention
- rapid shallow breathing
- pallor
- chills
- irritibility and restlessness
what shoud you do if you suspect a perforated appendix
- call surgical resident
- assess for signs of septic shock and peritonitis
describe pre op nursing care for appendicitis
- assessment and vital signs
- pain assessment
- intake and output
- NPO and IV fluids, electrolytes, and antibiotics
- education
describe post op care for appendicitis
- assessments and vitals every 4 hours
- assess fluid volume status every 2 hours
- wound assessment
- intake and output
- pain management
- incentive spirometer/cough and deep breathe
- assess for return of bowel function
- activity
- education
- perforated: NG tube, foley, antibiotics
- avoid strenuous activities and contact sports in immediate post op periods
if a child has uncomplicated appendicitis when is discharge expected
when bowel functions return
if a child has a perforated appendix when can discharge be expected
longer hospital stay due to several days of IV antibiotics
describe crohns
- chronic inflammatory process
- can occur randomly throughout the GI trat
- ileum, colon, and rectum most common
- enteric fistulas develop between loops of bowel or nearby organs
- mucosal ulcers begin small and grow in size and depth into mucosal wall, can be severe
- most oftern develops in adolescents and young adults
- etiology is unkown but there is strong evidence to genetic association
what is used in the diagnosis of crohns
- history and physical
- upper endoscopy and colonoscopy with biopsy
what are some symptoms of crohns
- abdominal pain and cramping
- diarrhea
- fever
- anorexia
- growth failure and weight loss
- malaise
- joint pain
what clinical therapy is used for crohns
- antibiotics
- corticosteroids/other anti inflammatories
- immunosuppressants
- nutritional support
- education
- biologic therapies
describe nutritional support for crohns
- several small meals with increased caloric count
- limit fiber, whole grains, and nuts
- may need dietary supplements
- avoid foods that may exacerbate symptoms
describe gastroenteritis
- inflammation of stomach and intestines (can affect any part of GI tract)
- may be accompanied by vomiting and diarrhea
- can be acute caused by viral, bacterial, or parasite or chronic
- rotavirus is leading cause of gastroenteritis in children less than 5 years worldwide, although not as common in vaccinated children
- norovirus is common cause in vaccinated children
- dehydration can occur quickly and put em at risk for hypovolemic shock
are kids with gastroenteritis put on any kind of precautions?
yep
contact precautions with handwashing with soap and water
what are some clinical manifestations of gastroenteritis
- fever
- diarrhea
- N/V
- irritability
- anorexia
- signs of dehydration
what clinical therapy is used for gastroenteritis
- diagnosis based on history and lab findings, stool cultures, ova and parasite stool sample
- treat cause
- correct dehydration and electrolyte imbalances
nursing management for gastroenteritis shoudl include what?
- I+O and IV therapy
- weigh diapers carefully and describe stool
- daily weight
- assesments and vital signs every 4 hours
- obtain stool samples
- hand washing with soap and water
- education
- isolation
- skin care
- can eat or drink as tolerated but limit super sugary drinks
