GI disorders Flashcards
1
Q
Organic Failure to Thrive
A
physical cause
2
Q
Non Organic Failure to Thrive
A
no physical cause
3
Q
FTT related factors
A
poverty beliefs knowledge family stress feeding resistance insufficient breast milk
4
Q
s/s FTT
A
< 3-5% birth weight development muscle mass abdominal distention behavior
5
Q
FTT Assessment
A
psychosocial history
infant parent interactions
caregiver response to child’s cues
parents confidence
6
Q
FTT feeding approaches
A
consistent staff quiet atmosphere give directions about eating face to face posture feeding routine high calorie formula 24 kcal/oz (norm 20 kcal)
7
Q
cleft lip and palate
A
structures altered during 1st trimester
- unilateral or bilateral
- cleft palate less obvious
8
Q
cleft lip diagnosis
A
in utero w/ ultrasound
at birth in newborn exam
9
Q
cleft lip Tx
A
- lip repair at 3-6 mos
- palate repair at 6-24 mos
- early repair= better feeding
10
Q
Cleft Lip RN Management
A
- allow parents to express feelings
- emotional support
- mom can still BF
- follow feedings w/ H20
- teach cleaning and to position upright after feeding
11
Q
Cleft Lip Post-Op Management
A
- medical asepsis, keep suture line clean
- resume feeding per MD orders
- keep away straws, pacifiers, fingers, spoons/utensils
- use elbow “nono’s”
- don’t brush teeth x1-2 weeks
12
Q
Gastroenteritis
A
- Acute inflammation on stomach and intestines
- vomiting and diarrhea
- children >5, avg 2-3 episodes/yr
13
Q
Gastroenteritis s/s
A
- mild-severe diarrhea
- irritability
- anorexia, N/V
- ELECTROLYTE IMBALANCE
- DEHYDRATION
14
Q
Gastroenteritis Dx testing
A
- neutrophils & RBC on stool specimin, very indicative of bacterial gastroenteritis
- Rotovirus is most likely cause of V/D
15
Q
Questions to ask about infant vomiting
A
- Parents should keep written record
- Can you wipe the vomit off with a rag?
- Was it eaten or curdled?
- What color was it? How much?
- Was it projectile?
16
Q
Gastroenteritis RN assessment and management
A
> fluids with fever
observe for dehydration
acute diarrhea may be caused by abx
no antidiarrheals for acute diarrhea
17
Q
Gastroenteritis Rehydration
A
oral rehydration therapy avoid plain water IV: LR or 0.9% NaCl KCL only after adequate urine output Food as soon as rehydrated and tolerating PO BRAT or ABC diet
18
Q
Gastroenteritis diet
A
start when rehydrated & vomiting stopped
no diarrhea x3 days
ABCs diet: applesauce, bananas, strained carrots
BRAT diet: bananas, rice, applesauce, toast
19
Q
Lactose Intolerance
A
inability to digest lactose
congenital (rare) or developmental
20
Q
Lactose Intolerance s/s
A
diarrhea
pain, cramping
abdominal distention
excessive flatus
21
Q
Lactose intolerance Dx
A
1+ or > of clinitest stool
breath hydrogen testing
improvement of sxs of lactose-free diet
22
Q
Lactose Intolerance Management
A
Examine labels for milk/milk products
soy based, lactose free formulas, soy milk
BF mothers- limit dairy intake
Ca & Vit D suppplements
yogurt, hard cheeses etc. addded to diet after sxs disappear
23
Q
High Calcium Diet
A
egg yolks green leafy vegetables dried beans cauliflower molasses
24
Q
Hirshsprung Disease
A
Absence of ganglion cells in segment of colon
stool accumulates proximal to defect
obstruction results
25
Hirshsprung Disease Dx
barium enema
rectal biopsy
history & PE
26
Hirshsprung Disease s/s
Meconium stool, constipation in 1st month
pellet like or ribbon, foul smelling stools
visible peristalsis
abdominal pain, refusal to feed
bile stained vomit
27
Hirshsprung Disease Preop Tx
```
Observation for s/s meconium passage
obtain hx, weight gain/loss, bowel habits
daily enemas
low-fiber, high-cal, high protein diet
monitor fluid & lytes
if severe NPO & TPN
```
28
Hirshsprung Disease OR and post op
```
bowel resection or temp colostomy
NPO until NG to LIS
no rectal temps
fluid/ lytes monitoring
pt edu for colostomy care
```
29
Hypertrophic Pyloric Stenosis (HPS)
Pyloric muscle hypertrophies= narrowing of the pyloric canal
obstructs gastric emptying
develops in 1st few weeks of life
30
HPS Dx
```
H & P (Familial disposition)
flat panel of abdomen
ultrasound
barium swallow
labs: metabolic alkalosis
```
31
HPS s/s
```
projectile vomiting
palpable mass in RUQ
deep paristaltic waves in stomach
FTT
constipation/ dehydration= metabolic alkalosis
```
32
HPS Tx
```
Pyloromyotomy
Preop: restore hydration & lytes
postop: may vomit 24-48 hrs post op
may have NG to LIS
advance to 1/2 strength formula or BF
```
33
Intussusception
- Proximal bowel segment telescopes into more distal segment
- vasculature compressed resulting in lymphatic & venous obstruction
- eventually arterial supply stops, results in ischemia
34
Intussusception s/s
- sudden actute abd pain, may be colicky
- stool:
- palpable sausage-shaped mass in RUQ
- vomiting (bile-stained)
- bowel sounds:
- peritonitis if not treated
35
Intussusception Tx
```
Hydrostatic reduction
-barium or air enema
*monitor for bowel function return
surgery
-manual reduction
-resection of nonviable areas of bowel
```
36
Intussusception RN management
focused to restore fluid & lyte balance
37
Intussusception post-op care
```
monitor for early s/s infection
manage pain
assess vitals
assess abd distention and bowel sounds
may have NG to LIS (keep patent)
```
38
GER
Gastroesophageal reflux
| The transfer of gastric contents into the esophagus
39
GERD
sxs or tissue damage from GER
40
GER etiology
- return of gastric contents into esophagus due to relaxation of lower esophageal spincter (LES)
- may occur at any time
- not always related to having a full stomach
41
GER causes
- LES dysfunction from transient relaxation of the sphincter
- delay in gastric emptying
- poor clearance of esophageal acid
- esophageal mucosa susceptibility to acid injury
42
GER Dx
```
Hx & PE
Esophageal pH monitoring (Tuttle test)
Scintigraphy
endoscopy
UGI
```
43
physiologic GER
```
painless vomiting after meals
parents may think it's normal
rarely occurs during sleep
no FTT
pharmacologic and medical management
```
44
Pathologic GERD
```
FTT
aspiration, pneumonia, asthma
apnea, coughing and choking
frequent vomiting
may require surgery and pharm tx
```
45
Infant sxs GER
```
spitting up/ vomiting
crying, irritable, arching back, stiffening
weight changes
cough, wheeze, gag, choking
hematemisis
apnea
```
46
GER sxs in children
```
heartburn
abd pain
noncardiac chest pain
dsyphagia
nocturnal asthma, recurrent pneumonia
```
47
Infant feedings w/ GER
thickened formula (w/ rice cereal) caloric intake
small freq feedings, burp often
trial of hypoallergenic formula
HOB- supine position, no car/ infant seat after feedings
48
Toddler diet GER
feed solid foods 1st
follow w/ liquids
same restrictions as older child diet
49
Older child diet GER
```
restrictions can < GER
Avoid: -fatty foods
-caffeine
-spicy
-carbonated drinks & fruit juice
obesity> abd pressure> GER
```
50
GER management children > 1
sleep on R side
| elevate HOB
51
GER medications
```
antacids: sx relief
H2 Antagonists: < acid, < espohagitis
mucosal protectants: barrier protection
prokinetic agents: > gastric emptying
PPIs: block acid production
```
52
uncontrolled GER complications
esophageal strictures due to esophagitis
laryngitis
recurrent pneumonia
anemia
53
GER surgical tx criteria
```
recurren pneumonia
apnea
esophagitis
FTT
failed medical tx
```
54
GER surgical complications
```
Breakdown of the wrap
gas-bloat syndrome
infection
retching
dumping syndrome
```
55
GER prognosis (infants)
Improve by 12-18 mos w/o surgical tx
56
Traecheoesophageal Fistula & Esophageal Atresia
| TEF & EA
```
Can occur together or seperatley
failure of the esophagus to develop as a continual tube
4th-5th wks gestation
cause unknown
common in preemies and low birth weight
```
57
EA & TEF Dx
```
confirmed by NG placement
x-ray
ultrasound
bronchoscopy/ endoscopy
hx of maternal polyhydramnios
```
58
EA & TEF s/s
```
excessive saliva and drooling
3 C's: coughing, choking, cyanosis
apnea
> resp distress after feedings
abdominal distention
vomiting
```
59
EA & TEF RN Management
```
Positioning: HOB @ 30 degrees, lay supine
NPO
suction to PRN (protect airway)
NG to LIS
monitor hydration
```
60
EA & TEF surgery and pos-op care
surgery: -fistula ligation
- atresia anastomosis
post op care: -resp assessment
- tubes: G-tube, NG tube, chest tubes
- non-nutritive sucking--> pacifier
61
Meckel Diverticulum
Most common GI anomoly
a fiberous band connecting small int to umbilicus
most symptomatic in childhood < 10 yr
surgical pts usually < 10 yr
pouch in the ileum is formed which secretes acid
62
Meckel Diverticulum s/s
usually occurs before age 2
painless rectal bleeding
abdominal pain
intestinal obstruction signs
63
Meckel Divertculum Dx/Tx
Meckel scan
blood studies: anemia
surgical intervention
- clip diverticulum
- bowel resection if severe
64
Meckel Diverticulum RN management
post op care related to abdominal surgery
watch for s/s infection
monitor I&O
stool for OB (occult blood)
65
Causes of Apendicitis
hardened fecalith
swollen lymphoid tissue
parasite
66
McBurney's Point & Revsing's Sign
McBurney: midway between anterior iliac crest & the umbilicus in RLQ
-classic area for localized tenderness during late stages of Apendicitis
Revsings: pushing on the L side causes R side to hurt (pushing abd contents to R side)
67
Appendicitis s/s
```
RLQ pain >pulse
fever >shallow resp
rigid abd pallor
V/D, constipation lethargy, irritable
anorexia stooped posture
```
68
Assessing Apendicitis
sxs develop slow over 12 hr period
if pain precedes vomiting suspect Apendicitis, if vomiting before pain-> gastroenteritis
Knee-chest position
initial generalized pain, then focused to RLQ
69
Appendicitis Dx
CT scan- most often used
ultrasound
> WBC
CRP: c-reative protien (> in 12 hrs of inf)
70
Appendicitis Assessment
Allow pt to be in position of comfort
classic abd sxs, OPQRSTm vitals
sudden spike in fever and relief of pain = indicates preforation
71
Appendectomy pre/post op
Pre: -no laxatives/ enemas
-no heat to abd
post: -Abx: - non pref: cefepime -pref: meropenem
72
Appey post-op abcess
> pain
restlessness
irritability
< ambulation
