GI Dysfunction of the Child Flashcards
deficit of lyses AND water
isotonic dehydration
deficit of lytes with more water
hypotonic dehydration
deficit of water with more lytes
hypertonic dehydration
what is the most important determinant of fluid loss in children
weight
what is usually the earliest sign of dehydration
tachycardia
what is a late sign of dehydration
LOW BP- when this happens we arent getting blood to our tissues causing tissue hypoxia
in the tx of dehydration what should NEVER be done
give rapid bolus to hypertonic dehydration because it could lead to cerebral edema
this is given to provide AT LEAST minimum fluid requirements
enteral (PO) rehydration- for mild to mod dehydration.
when child is unable to digest lytes to meet daily physiological needs, replace previous deficit needs with
parenteral (IV) rehydration- severe dehydration and child is unable to keep enough fluids and lytes down
acute diarrhea=
less than 14 days and self limiting;
chronic diarrhea=
more than 14 days
protozoa that is ingested and eventually excreted in stool, transmitted person to person, improper prepared food
contaminated water and animals
giardiasis
s/s of giardiasis=
abd cramping, mal odorous floating stool, diarrhea and vomiting
who is giardiasis confirmed and treated
stool sample
metrinozole or tinidazole
transmitted- fecal oral mouth or by object, shed through poop and by contaminated hands/food/water
rotavirus
when a person is infected with rotavirus does this mean immunity
NO! reinfection can occur at any age but subsequent infections are usually less severe
what should you NOT give to a person with rotavirus
antidiarrheal because this is how it gets out
a decrease in bowel movement frequency or trouble defecating for more than 2 weeks
constipation
congenital anomaly results in mechanical obstruction of part of the intestines from inadequate motility of part of the intestines, this is a result of absence of ganglion cells
hirschsprung disease
what are ganglion cells=
nerve cells in intestines that help coordinate peristalsis
confirmation of hirschsprung disease is only made by
rectal biopsy demonstrating the absence of ganglion cells
what is important NOT to do post op of hirschsprung
nothing given per rectum
what are CM of hirschsprung
failure to pass meconium within 48 hrs abd distention vomiting constipation, diarrhea and/or ribbon-like, foul smelling stool easily palpable stool mass
the transfer of gastric contents into the esophagus
gastroesophageal reflux
what is the gold standard for dx GER
24hr intraesophageal monitoring
lining is replaced with tissue that is similar tot the intestinal lining but this puts the pt at risk for esophageal carcinoma
barrett’s esophagus
what are tx for GER
thicken milk with teaspoon of rice cereal, feed in small frequent intervals if breast feeding
have them sit up for 30 minutes-1hr after feeding
what are the 3 medication for GER
H2 antagonists
Proton Pump Inhibitors
Pro kinetic Agents
what surgical treatment is done for GER
nissen fundoplication= funds of stomach is placed behind the esophagus, this helps strengthen the lower esophageal sphincter and help prevent regurgitation of fluids and food
infant will have an NGT post op of nissen fundoplication, if it comes out what should you do
you as the nurse DO NOT replace NGT because this could disrupt the surgical incision so call the physician
inflammation of the vermiform appendix caused from an obstruction of the lumen of the appendix
appendicitis (avg age is 10 yrs)
CM of appendicitis
abd pain in RIGHT LQ rigid abd decreased or absent BS fever vomiting
when is there a sudden relief of pain in appendicitis
after the appendix perforates- then they will be in pain again following by tachycardia chills and fever (becoming septic)
what should you never give to the pt who has appendicitis
laxatives, enemas or heat!
what 2 diseases fall under inflammatory bowel disease
ulcerative colitis and crohns disease
inflammation limited to colon and rectum
ulcerative colitis
what is the most dangerous form of severe colitis
toxic megacolon
what does ulcerative colitis look like inside
red and inflamed
involves ANY part of the GI tract from mouth to anus (most often affects terminal ileum) involves all layers of the intestinal wall
crohns disease
what does crohns disease look like inside
cobble stoning
what is the biggest thing to know for ulcerative colitis
rectal bleeding and weightloss
what is the biggest thing to know for crohns disease
more painful
a progressive inflammatory process that results in intrahepatic and extra hepatic bile duct fibrosis, resulting in ductal obstruction
biliary atresia= flow of bile from liver to gallbladder is blocked (death within first 2 years of life)
CM of biliary atresia
jaundice lasting beyond 2 wks of age
putty-white or clay stools (absence of bile)
tea colored urine
itching and irritability (bile salt on skin)
malnutrition
what is the red flag of biliary atresia
baby 3-4 wks of age bilirubin levels start to creep up
how is biliary atresia dx
US and percutaneous liver bx
ERCP
*early dx is critical
in first 60 days= 80% chance of bile flow
60-90= 50% chance
>90= 10% chance
what is the tx for biliary atresia
Kasai procedure= bile drainage but sclerosis will occur so MOST children will need a liver transplant
defect in cell migration resulting in failure of the maxillary and premaxillary processes to merge between the 4th and 10th weeks of embryonic development
cleft lip and cleft palate
what are immediate problems of cleft lip/cleft palate
reaction of the parents
feeding
for infants with cleft lip/cleft palate begin ______ ASAP, ________ can conform to shape of mouth
breastfeeding; breasts
if breastfeeding is not possible for children of cleft lip/palate what should be done
large soft nipples with soft holes
since cleft lip/palate babies get tired easier and at an increase risk for aspirating, what is the ESSR feeding technique
enlarge the nipple
stimulate suck reflex
swallow
rest
for cleft lip surgical repair what is the “rule of 10s”
at least 10wks old
10 pounds
hemoglobin of 10
when is cleft palate sx done and if they are not a candidate for it what could they do
between 6 and 12 months but preferable before their first words and if they can’t have it done yet then a prosthetic can be made until sx
what is important when caring for a post op cleft lip/palate sx
do NOT place anything in mouth resume feeding as tolerated pain control restraints (oral stage) reduction of tension on suture line
narrowing of the pyloric canal producing outlet obstruction
hypertrophic pyloric stenosis
what are the CM of hypertrophic pyloric stenosis
olive like mass in upper abd vomiting after feedings dehydration met. alkalosis growth failure ultrasound
what dx hypertrophic pyloric stenosis and what is the tx
H&P
US to confirm
tx is pyloromyotomy= incision through the muscle allows compression of the lumen to be released
what is important to know about pre op of a pyloromyotomy
keep pt NPO
who should feedings be given post op of pyloromyotomy
clear liquids with glucose and lytes
small volumes at frequent intervals
progress to formula in increments
occurs when one segment of bowel telescopes into another segment
intussesception
what is a red flag for intussusception
mucous causing jelly like stool
what are CM of intussusception
palpable mass in RUQ empty RLQ vomiting lethargy red, currant jelly like stool tender distended abd acute, severe, int abd pain
