GI disorders Flashcards
common
so much of their body is made up of water
kidneys don’t function like adults
sweating with a fever diarrhea and vomiting
can look for - not making tears; have weight loss; increased respiration and increased pulses; decrease in blood pressure; limited urine output; skin turgor won’t be very good again; See that sunken eyes if they’re a baby we see that sunk in fontanelle
can do an IV but can do Pedialyte; Popsicles
Why are kids at higher risk for dehydration?
What causes kids to become dehydrated?
Manifestations of dehydration
Correcting fluid imbalance
Dehydration
Diarrhea, nausea, vomiting
Intake
Fevers
What causes kids to become dehydrated?
Depends on severity
Manifestations of dehydration
IV or ORS
Correcting fluid imbalance
Use these formulas to calculate your patient’s 24-hour maintenance fluid requirement.
0 – 10 Kg: 100 ml/Kg/day
10 – 20 Kg: 1000 ml + 50 ml for each Kg over 10 Kg
> 20 Kg: 1500 ml + 20 ml for each Kg over 20 Kg
What is the child’s 24-hour maintenance fluid requirement? ______ ml/day and _______ml/hr. For my __ hr shift, my patient should have a total of ____ml
fluid/maintence balance
occurs when the bones and tissue of that upper jaw and Palette fail to fuse completely at midline okay and this happens during that first trimester of pregnancy
some things that can increase the risk of this happening such as a syndrome genetic inheritance if the mom has decreased folic acid during pregnancy alcohol smoking anti-convulses and steroids and retinols
surgery for that is within usually 2 to 3 months after birth and they don’t usually need more than one surgery to correct that cleft palates there’s quite a bit more and it really depends on how severe the defect is usually we don’t do surgery on that until about 12 to 18 months and usually it’s a couple surgeries that palette grows
got to figure out how we’re going to get the nutrition in them while they’re at home and not in the hospital
another thing we worried about is ear infections and respiratory infections they are at a higher risk of having ear infections so a lot of times when they’re having surgery to correct these they’ll put tubes in the ears too
Long-term care with these kids we got to monitor them as they grow and monitor that palette as they grow
Facial malformations that occur during embryonic development
Interprofessional management
Nursing Interventions
Cleft lip and palate
Feeding
Preoperative care
Postoperative care
Long-term care
Nursing Interventions
failure of the esophagus to develop as a continuous passage
different types
seen before the child is born we can see this with that ultrasound that a child will get obviously
three C’s so kids with this esophageal atresia or tracheostula are going to have coughing choking and cyanosis
suction it out these kids are also going to be prepared for surgery pretty quickly afterwards the type of surgery is going to depend on the type of defect and how severe it is the goal is to you know reattach esophagus to the stomach and separate that from the trachea
will put an IV in for nutrition and then hopefully it’s a surgical we can fix this and then we can start doing an NG and then move on to either nursing or bottles
Esophageal atresia: Failure of esophagus to develop as a continuous passage
TEF: Failure of the trachea to separate into a distinct structure
Manifestation:
3 C’s
Treatment:
Nursing Intervention:
Esophageal atresia and tracheoesophageal fistula (TEF)
not always present at delivery - fine right after delivery and then they go home and they start having these symptoms - kids start to vomit after their feeding or within a short period time of their feeding and they will literally vomit their entire bottle and it will be like a projectile vomit
sphincter continues to get thicker and thicker so that force of that projectile vomiting continues to get worse and worse on presentation so when you are assessing these typically they come in and they are starving like they act like they’re hungry and they want that bottle they want to eat that drive to eat is there they just can’t keep it in so we were worried about dehydration
start falling off of that gross curve
See peristaltic waves in that stomach and they usually go from left to right
feel shaped mass in that upper right quadrant
Treatment: surgery - get an IV and we’re going to correct that dehydration first and then we’re going to prep them for surgery after surgery these kids get back on growth curve and do great
Constriction of pyloric sphincter with obstruction of gastric outlet
Manifestations:
Nursing Interventions:
Preoperative and postoperative care
Treatment
Prognosis
Pyloric stenosis
congenital anomaly
it’s not something we normally see before a child is born
Mechanical obstruction from inadequate motility or peristalsis of that intestine this normally happens in the lower part of that colon area in a healthy infant the ganglion cells activate - hirschsprungs these nerves are not activated this usually leads to a blockage
see that dilated colon above that obstruction
one big red flag for this is that a newborn has not pooped or it is a delayed poop which that you know that first one is called that maconium
chronic constipation that has begun since birth a poor weight gain which can lead to failure to thrive they have abdominal pain and distension when we suspect this at in a child will get a x-ray of that stomach area and then to confirm and diagnosis will have to have a biopsy so we’ll take up biopsy out and this will show the absence of cells
Also called “congenital aganglionic megacolon”
Congenital anomaly
Mechanical obstruction from inadequate motility of intestine
Absence of ganglion cells in colon
Clinical manifestation:
Nursing Interventions:
Treatment:
Hirschsprung’s
the inflammation and obstruction of the blind sack at the end of the cecum
most common major surgical disease in the school age child it usually Peaks between 10 and 12ish years
appendix does regularly fill and empty itself with food
what causes it to become inflamed: usually Lumen becomes obstructed with fecal matter with some type of calcium buildup tumors strictures from infection
can lead to infection necrosis and perforation if this appendix ruptured or perforates the infected content spill into the abdominal cavity and this is causes peritonitis
start with mid abdominal cramps and they have some tenderness it’s kind of diffuse kind of all through the stomach area and eventually it localizes into the right lower quadrant okay this is known as mcburney’s Point - have rebound tenderness; have some nausea and vomiting; low grade fever and later complaints included lethargy irritability constipation
all of a sudden there’s no pain and the kids like oh I feel better that’s a big red flag okay cuz is that appendix burst there’s going to be a brief period where they feel better you know they’re feeling great and then the infection is going to set in and they’re going to be real sick - will use a CT scan and all kind of show us if it’s inflamed
tell them what to expect when they wake up we want to be there with them if we can have those parents there when they wake up that’ll be even better for them when they do come back they’ll probably have an IV and an NG we’re going to position that child right side with knees bent because this will help decrease pain
IV fluids to help prevent dehydration
Inflammation of the vermiform appendix
Clinical manifestation:
McBurney point
Treatment:
Nursing Interventions:
Ruptured appendix
Postoperative care
Appendicitis
