GI/GU Flashcards
Stomach capacity of infant
30 to 300 mL
T or F: Gastric reflux doesn’t hurt the infant.
TRUE
normal reflex ok
not as acidic
T or F: Food remains in the infant stomach for longer periods of time
FALSE
shorter
eat more often
Dehydration definition
total output of fluid exceeds the total intake
Low urine output = < __ ml/kg/hour
< 1 ml/kg/hr
Minimum # of voids we want to see in the first 6 days of life
1 void a day, per day up to 6 days of life
Minimum # of diapers we want to see a day
6 diapers a day
We get concerned when child hasn’t voided in __ hours
8 hours
Dehydration symptoms (many)
decreased urine output
darker colour
LOC changes
dry mucous membranes
sunken eyes
sunken fontanelles
tachycardia
tachypnea
headache
thirst
low BP
What is a later, concerning sign of dehydration?
low BP
Best fluid type to give:
a) oral fluids
b) IV fluids
a) oral fluids
give IV fluids if severely dehydrated or can’t keep fluids down
Medication commonly given with fluids
anti-emetic
Ondansetron
to keep fluids down
Fluid amount to give dehydrated child
start with 10 mL every 10 minutes
Bolus amount to give
10-20 mL/kg
normal saline
20 mL/kg if SEVERE
Nursing care
encourage hydration
ins and outs
assessing symptoms
parent education
Symptoms of GI dysfunction (many)
underweight, weight loss
N/V
diarrhea
jaundice
abnormal bowel sounds
blood in vomit or stools
abdominal pain*
abdominal distention
dysphagia - not as common in children
Failure to thrive
weight less than 2nd percentile for age and sex
decreased velocity of weight gain disproportionate to growth in length
Reasons for failure to thrive (5)
1) inadequate caloric
2) inadequate absorption
3) increased metabolism
4) defective utilization
5) increased urinary or intestinal losses
Reasons for inadequate calories (many)
finances
appetite
inadequate breast milk
inadequate formula prep
eating disorders
ARFID
drinking too much cow’s milk
Reasons for inadequate absoprtion
Crohn’s
Celiac
obstruction
Reasons for increased metabolism
cardiac issues
hyperthyroidism
Reasons for ineffective utilization
Trisomies
Reasons for increased urinary or intestinal losses
diarrhea
vomitting
Evaluation of failure to thrive
history**
age of onset, pattern over time
family history
diet & feeding
psychosocial issues, ACES
examination (-weight, length, ratio
head circumference in infants)
development and behaviour - milestones
T or F: There is no definitive diagnostic test for failure to thrive
TRUE
lab tests - immune?
-CBC
-ESR
urinalysis and culture - UTI? protein? carbs?
Mainstay of failure to thrive management
nutritional therapy!
gives calories and nutrition
if they gain weight, then we know its social
Disorders of Motility (5)
1) diarrhea
2) constipation
3) Hirshprung disease
4) vomitting
5) Gastroesophageal reflux
Most significant complication of diarrhea
dehydration!
Common causative organisms of diarrhea in children (3)
1) COVID
2) norovirus
3) salmonella
-reptiles, turtles
Acute diarrhea
SUDDEN increase in frequency & change in consistency of stools
> 3 loose or watery stools in 24h; OR several watery stools that exceeds the child’s usual number by 2 or more
may be associated with URI or UTI, antibiotic therapy or laxative use
T or F: Acute diarrhea is usually self-limiting.
TRUE
<14 days
Nursing considerations for acute diarrhea management
emotional support
child may not want to talk about it
rest and comfort
adequate nutrition
handwashing
teach about symptoms of dehydration
T or F: You should not offer the child with acute diarrhea liquids if they already have an IV in place.
FALSE
offer liquids throughout
Diarrhea prevention
teach personal hygiene
clean water supply
careful food prep
handwashing
Idiopathic (functional) constipation
no known cause
Chronic constipation
may be due to environmental or psychosocial factors
The first meconium should be passed with the first ___ to ___ hours of ife
24 to 36 hours
Causes of constipation in the newborn period
1) imperforated anus
2) Hirschsprung disease
3) hypothyroidism
4) meconium plug
5) meconium ileus (CF)
T or F: Constipation is rare in the breastfed infant.
TRUE
more common in formula fed infants due to iron
Constipation in infancy
diet related (formula)
transitioning to solids
Interventions for constipation infancy
making sure they’re mixing formula correctly (not too thick/concentrated)
rule out organic causes - e.g. Hirschprung
Constipation in childhood
often due to environmental changes or control over body functions
painful defecation
toilet training and pressure on child
stress
encopresis
Encopresis
involuntary passage of stool in underwear after acquisition of toilet training
liquid stool passing around rock hard stool
requires intervention
Encopresis types (2)
1) retentive
-most common*
2) non-retentive
-psychosocial link
Constipation management
hydration
mobility
heating pad for comfort
diet - prunes
glycerin suppositories
decrease in stress
Approach for encopresis
from TOP and BOTTOM
TOP: strong laxative like PEG 3350
BOTTOM: enema
Hirschsprung Disease
aka congenital aganglionic megacolon
mechanical obstruction from inadequate motility of intestine
absence of ganglion cells in colon
lack of innervation = no peristalsis
Part of the colon affected by Hirschsprung Disease
rectosigmoid area
Major/serious side effect of Hirschsprung Disease
enterocolitis
enterocolitis
inflammation of small bowel & colon
leading cause of death
can lead to toxic megacolon
Diagnosis of Hirschsprung Disease
rectal biopsy
Treatment of Hirschsprung Disease
surgery
T or F: Gastroesophageal Reflux (GER) is a cause for concern.
FALSE
typically resolves in 1st year of life
gastric contents not as acidic
underdeveloped sphincter in stomach
Management of GER
no intervention for child that is growing
avoid tobacco smoke
feeding positions
medications – dependent on severity, most can be treated with meds
surgery – Nissen Fundoplication
When would surgery be considered for GER?
in severe cases
causing aspiration, pneumonia, affecting respirations
Nursing considerations for GER
dehydration
keeping upright
emotional support
Gastroesophageal Reflux Disease (GERD)
serious manifestation of GER
lower esophageal sphincter relaxes
poor weight gain
esophagitis
persistent resp symptoms
requires treatment!
Treatment for GERD
PPI
omeprazole
Immediate goal of vomiting management
recognize SERIOUS conditions for which immediate intervention is required
Concerning signs of vomiting in neonates
vomiting > 12 h
green/yellow vomiting (bile)
Concerning sign of vomiting in children under 2
vomiting > 24 h
Concerning sign of vomiting in older children
vomiting > 48 h
Other concerning signs
dehydration symptoms
altered LOC
symptoms of appendicitis, infection, head injury, meningitis etc.
Treatment of vomiting
aimed towards cause
Ondansetron
Why is Ondansetron preferred over Gravol?
Gravol makes you drowsy
Nursing considerations - vomiting
ins and outs
rehydration
characteristics of emesis
mental health - binge/purge
T or F: The BRAT diet is recommended for gastro.
FALSE
lacks protein and calories
whatever they want that is easily digestible for the next 48 hours
Inflammatory disorders (2)
1) appendicitis
2) IBD
Acute appendicitis
obstruction of the lumen of the appendix, usually by a fecalith
most common cause of emergency abdominal surgery in children
peak: 10 to 16 years, rare < 5
Symptoms of acute appendicitis
pain - RLQ
vomiting, nausea
fever
increased WBC
increased signs of infection
abdominal distention
Complication of acute appendicitis
ruptured appendix
Symptoms of a ruptured appendix
more septic looking, more symptoms, full body
pain STOPS!** (swelling is relieved when it bursts - then comes back but more generalized)
Diagnosis of acute appendicitis
history and physical
blood work - WBC
younger kids: ultrasound
older kids: CT
Treatment of acute appendicitis
rehydration
antibiotics - typically not
surgical intervention
Treatment of ruptured appendix
appendectomy (laparoscopic)
may give antibiotics
Post-op appendectomy - perforated
IV antibiotics
bowel rest (probably going to have paralytic ileus)
NG - decompression
NPO
drains
Important considerations for NG
replace NG losses to avoid dehydration and hypokalemia
normal saline and potassium
“Sham clear fluid”
letting child drink, but suctioning it so it doesn’t count towards intake
comfort measure
Discharge post-appendectomy
need to be at least passing gas
stable, pain controlled
regular diet as tolerated
no lifting over 10 pounds for 6 weeks
shower: wait 48 hours
swim/bath: wait 2 weeks
Forms of IBD (2)
1) ulcerative colitis
-limited to colon and rectum
2) Crohn’s
-any part of GI, most often terminal ileum
Symptoms of IBD
diarrhea
anorexia
bloody stools
weight loss
joint pain
Diagnosis of IBD
H&P
lab Tests – CBC, ESR, CRP
endoscopy & colonoscopy – biopsies
CT & Ultrasound
Goal of IBD management
control inflammatory process to reduce or eliminate symptoms
IBD management
surgery - moreso for UC
meds - 5-ASAs, corticosteroids, immunomodulators, antibiotics, biologics
nutritional support
-partially broken down formulas
mental health, stress, emotional support
Structural defects (2)
1) cleft lip or palate
2) hernias
Cleft lip or palate
embryonic development
lip and/or palate
linked to teratogens
more common in boys
cleft LIP - ultrasound
cleft palate - feel with gloved hand
Biggest nursing consideration for cleft lip or palate
assistance with feeding!
upright position
special nipples
-CL/CP nurser
-Haberman Nipple
head cradled in hand
Long-term consideration for cleft lip or palate
speech therapy
What to avoid in cleft lip or palalate
suction
tongue depressors
spoons
straws
When is repair for cleft LIP typically done?
4 months
When is repair for cleft PALATE typically done?
9 to 12 months
Hernias
protrusion of a portion of an organ or organs through an abnormal opening
Hernias types (4)
1) umbilical hernia
2) inguinal hernia
3) omphalocele
4) gastroschisis
Omphalocele
congenital defect caused by abdominal wall that doesn’t close properly
internal organs - stomach, intestines, liver - outside of body through hole
Omphalocele care considerations
deliver as close to term as possible
may need to do C-section
NICU
keep covered and moist**
Gastroschisis
hernia through the bowel
put in silo and moves down through gravity
Gastroschisis care considerations
long-term: constipation
good recovery
body image - umbilicus isn’t in normal spot
Obstructive disorders (2)
1) pyloric stenosis
2) intussusception
Pyloric stenosis
hypertrophic obstruction/enlargement of the pyloric sphincter at bottom of stomach
food can’t empty from stomach –> duodenum
symptoms begin around 3-5 weeks of age
Symptoms of pyloric stenosis
non-bilious emesis***
projectile emesis***
emesis - food they’ve just eaten
right after eating
hungry, irritable
abdominal pain
Nursing considerations for pyloric stenosis
fluids and electrolytes
minimize weight loss
surgery needed*
promote rest and comfort
prevent infection
provide supportive care
T or F: Vomiting after pyloric stenosis surgery is a cause for concern.
FALSE
may vomit, caused by swelling
but won’t be projectile
reassure parents
Intessuption
proximal segment of bowel telescopes into more distal segment, pulling mesentry with it
Symptoms of intussusception
red jelly stool*
colocy pain that comes and goals
vomiting
Treatment for intussusception
pneumatic or hydrostatic reduction
surgery if more severe
How to know if intussusception has resolved?
passage of brown stool
T or F: Recurrence of UTIs is normal.
FALSE
recurrence isn’t normal
needs investigation
Factors contributing to development of UTI (many)
hygiene
short urethra
urinary stasis
alteration in urine and bladder chemistry
hydronephrosis
VUR
Most common cause of UTIs
E. coli
UTI symptoms
incontinence in a toilet-trained child
pain
strong or foul-smelling urine
frequency or urgency
UTI diagnosis
urine culture and sensitivity
UTI treatment
antibiotics
penicillin, sulfonamide, cephalosporins, nitrofurantoin
Sign that UTI is causing kidney infection
back pain
more sick
Wilm’s tumour
aka nephroblastoma
malignant renal and intraabdominal tumor of childhood
Wilm’s tumour symptoms
abdominal mass
hematuria
decreased urine output
hypertension
What do you need to be careful about when assessing for Wilm’s tumour
be careful during palpation
don’t want tumour to rupture
Wilm’s tumour treatment
surgery
chemo
