GI disorders Flashcards
Organic Failure to Thrive
physical cause
Non Organic Failure to Thrive
no physical cause
FTT related factors
poverty beliefs knowledge family stress feeding resistance insufficient breast milk
s/s FTT
< 3-5% birth weight development muscle mass abdominal distention behavior
FTT Assessment
psychosocial history
infant parent interactions
caregiver response to child’s cues
parents confidence
FTT feeding approaches
consistent staff quiet atmosphere give directions about eating face to face posture feeding routine high calorie formula 24 kcal/oz (norm 20 kcal)
cleft lip and palate
structures altered during 1st trimester
- unilateral or bilateral
- cleft palate less obvious
cleft lip diagnosis
in utero w/ ultrasound
at birth in newborn exam
cleft lip Tx
- lip repair at 3-6 mos
- palate repair at 6-24 mos
- early repair= better feeding
Cleft Lip RN Management
- allow parents to express feelings
- emotional support
- mom can still BF
- follow feedings w/ H20
- teach cleaning and to position upright after feeding
Cleft Lip Post-Op Management
- 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
Gastroenteritis
- Acute inflammation on stomach and intestines
- vomiting and diarrhea
- children >5, avg 2-3 episodes/yr
Gastroenteritis s/s
- mild-severe diarrhea
- irritability
- anorexia, N/V
- ELECTROLYTE IMBALANCE
- DEHYDRATION
Gastroenteritis Dx testing
- neutrophils & RBC on stool specimin, very indicative of bacterial gastroenteritis
- Rotovirus is most likely cause of V/D
Questions to ask about infant vomiting
- 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?
Gastroenteritis RN assessment and management
> fluids with fever
observe for dehydration
acute diarrhea may be caused by abx
no antidiarrheals for acute diarrhea
Gastroenteritis Rehydration
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
Gastroenteritis diet
start when rehydrated & vomiting stopped
no diarrhea x3 days
ABCs diet: applesauce, bananas, strained carrots
BRAT diet: bananas, rice, applesauce, toast
Lactose Intolerance
inability to digest lactose
congenital (rare) or developmental
Lactose Intolerance s/s
diarrhea
pain, cramping
abdominal distention
excessive flatus
Lactose intolerance Dx
1+ or > of clinitest stool
breath hydrogen testing
improvement of sxs of lactose-free diet
Lactose Intolerance Management
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
High Calcium Diet
egg yolks green leafy vegetables dried beans cauliflower molasses
Hirshsprung Disease
Absence of ganglion cells in segment of colon
stool accumulates proximal to defect
obstruction results
Hirshsprung Disease Dx
barium enema
rectal biopsy
history & PE
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
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
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
Hypertrophic Pyloric Stenosis (HPS)
Pyloric muscle hypertrophies= narrowing of the pyloric canal
obstructs gastric emptying
develops in 1st few weeks of life
HPS Dx
H & P (Familial disposition) flat panel of abdomen ultrasound barium swallow labs: metabolic alkalosis
HPS s/s
projectile vomiting palpable mass in RUQ deep paristaltic waves in stomach FTT constipation/ dehydration= metabolic alkalosis
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
Intussusception
- Proximal bowel segment telescopes into more distal segment
- vasculature compressed resulting in lymphatic & venous obstruction
- eventually arterial supply stops, results in ischemia
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
Intussusception Tx
Hydrostatic reduction -barium or air enema *monitor for bowel function return surgery -manual reduction -resection of nonviable areas of bowel
Intussusception RN management
focused to restore fluid & lyte balance
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)
GER
Gastroesophageal reflux
The transfer of gastric contents into the esophagus
GERD
sxs or tissue damage from GER
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
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
GER Dx
Hx & PE Esophageal pH monitoring (Tuttle test) Scintigraphy endoscopy UGI
physiologic GER
painless vomiting after meals parents may think it's normal rarely occurs during sleep no FTT pharmacologic and medical management
Pathologic GERD
FTT aspiration, pneumonia, asthma apnea, coughing and choking frequent vomiting may require surgery and pharm tx
Infant sxs GER
spitting up/ vomiting crying, irritable, arching back, stiffening weight changes cough, wheeze, gag, choking hematemisis apnea
GER sxs in children
heartburn abd pain noncardiac chest pain dsyphagia nocturnal asthma, recurrent pneumonia
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
Toddler diet GER
feed solid foods 1st
follow w/ liquids
same restrictions as older child diet
Older child diet GER
restrictions can < GER Avoid: -fatty foods -caffeine -spicy -carbonated drinks & fruit juice obesity> abd pressure> GER
GER management children > 1
sleep on R side
elevate HOB
GER medications
antacids: sx relief H2 Antagonists: < acid, < espohagitis mucosal protectants: barrier protection prokinetic agents: > gastric emptying PPIs: block acid production
uncontrolled GER complications
esophageal strictures due to esophagitis
laryngitis
recurrent pneumonia
anemia
GER surgical tx criteria
recurren pneumonia apnea esophagitis FTT failed medical tx
GER surgical complications
Breakdown of the wrap gas-bloat syndrome infection retching dumping syndrome
GER prognosis (infants)
Improve by 12-18 mos w/o surgical tx
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
EA & TEF Dx
confirmed by NG placement x-ray ultrasound bronchoscopy/ endoscopy hx of maternal polyhydramnios
EA & TEF s/s
excessive saliva and drooling 3 C's: coughing, choking, cyanosis apnea > resp distress after feedings abdominal distention vomiting
EA & TEF RN Management
Positioning: HOB @ 30 degrees, lay supine NPO suction to PRN (protect airway) NG to LIS monitor hydration
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
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
Meckel Diverticulum s/s
usually occurs before age 2
painless rectal bleeding
abdominal pain
intestinal obstruction signs
Meckel Divertculum Dx/Tx
Meckel scan
blood studies: anemia
surgical intervention
- clip diverticulum - bowel resection if severe
Meckel Diverticulum RN management
post op care related to abdominal surgery
watch for s/s infection
monitor I&O
stool for OB (occult blood)
Causes of Apendicitis
hardened fecalith
swollen lymphoid tissue
parasite
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)
Appendicitis s/s
RLQ pain >pulse fever >shallow resp rigid abd pallor V/D, constipation lethargy, irritable anorexia stooped posture
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
Appendicitis Dx
CT scan- most often used
ultrasound
> WBC
CRP: c-reative protien (> in 12 hrs of inf)
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
Appendectomy pre/post op
Pre: -no laxatives/ enemas
-no heat to abd
post: -Abx: - non pref: cefepime -pref: meropenem
Appey post-op abcess
> pain
restlessness
irritability
< ambulation
