GI/GU Flashcards
Cleft Lip and Cleft Palate In Utero
- 5-6 weeks gestation: tissue that forms lip fuses
2. 7-9 weeks gestation: palate closes
Risk Factors for Cleft Lip or Palate
- Maternal smoking
- Prenatal infection
- Advanced maternal age
Cleft Lip and Cleft Palate are usually associated with what other disorders?
- Heart defects
- Ear malformations
- Skeletal deformities
- Genitourinary abnormalities
Cleft Lip and Palate Specialized Healthcare Team
- Craniofacial specialist
- Nurse
- Social worker
- Audiologist
- SLP (speech language pathologist)
Criteria for Cleft Lip/Palate Surgical Repair
Must be infection-free and stable to have the surgery
When is a cleft lip surgically repaired?
2-3 months old
When is a cleft palate surgically repaired?
9-18 months old
Complications of Cleft Lip/Palate
- Feeding difficulties (weight loss, failure to thrive)
- Altered dentition
- Delayed or altered speech
- Otitis media
Cleft Lip/Palate Nursing Management
- Protect suture line
- Adequate nutrition
- Bonding and support
How do you protect the suture line of a patient with cleft lip/palate?
- Apply ointment as ordered
- Apply mitts to hands
- Avoid spoon, straw, catheters in mouth
- Prevent vigorous crying
How do you provide adequate nutrition to a patient with a cleft lip/palate?
- They benefit from breastfeeding
- Burp well
- High risk for aspiration with cleft palate
- They can tire very easily
- Listen intently to sound of feeding for aspiration
How do you encourage bonding and support for the parents of a patient with a cleft lip/palate?
- Encourage parents to hold infant
- Support in helping parents feed
- Cleft Palate Foundation
Inguinal Hernia
Bulging mass in the lower abdomen or groin area
- More visible during crying or straining
- Boys more susceptible than girls
- Surgical correction when infant is several weeks old and thriving (gaining weight)
Umbilical Hernia
Bulging mass herniating through umbilical ring
- More visible during crying or straining
- Will usually self-correct by age 5
- Surgery after age 5
What babies are most susceptible to hernias?
Preemies
Reducing Hernias
Reduction: pushing the hernia back into the inguinal ring or umbilical ring
- Temporary management of hernias
- Teach family how to do it
What problems with hernias should you contact your HCP about?
Contact the surgeon immediately if the hernia becomes irreducible, hard, or discolored
- If not reducible it can lead to an incarcerated hernia which could lead to bowel strangulation
Appendicitis
The lumen of the appendix is obstructed which leads to edema, pressure, bacterial overgrowth, and eventually perforation
- It is a surgical emergency due to risk of perforation
- Appendix is removed through minimally invasive laparoscopic technique
Pathophysiology of a perforated appendix
Inflammatory fluid and bacterial contents leak into abdominal cavity = peritonitis
- Open emergency surgery required to lavage abdominal cavity
Diagnostic Tests for Appendicitis
- CT
- CBC
- C-reactive protein (will be elevated)
Appendicitis S/Sx
- Pain - gradual and persistent, will intensify
- Vague abdominal pain (localized RLQ)
- Rebound tenderness
- N/V
- Small volume, frequent soft stools
- Low grade fever
S/Sx of perforated appendix
- Sudden pain relief
- Diffuse tenderness
- Distention
Nonruptured, Nongangrenous Appendix Nursing Management
- No antibiotics
2. Routine surgical care
Gangrenous, Nonruptured Appendix Nursing Management
- 48-72 hours of antibiotics
2. Routine surgical care
Perforated Appendix Nursing Management
- 7-14 days of IV antibiotics
2. Routine surgical care
Gastrointestinal Reflux (GER)
- Passing of gastric contents into the esophagus during relaxation of the lower esophageal sphincter (LES)
- Considered normal in healthy infants, usually outgrown by 12 months old
When does GER progress to GERD in infants?
If they have feeding problems, are losing weight, or reflux continues past 12 months
Complications of GERD
- Esophagitis
- Esophageal stricture
- Chronic esophageal erosion
- Laryngitis
- Recurrent pneumonia
- Asthma
GERD Diagnostics
- Upper GI
2. Esophageal scope
S/Sx of Reflux
- Recurrent vomiting or regurgitation
- Can have “silent” GERD with no vomiting
- Weight loss, poor weight gain
- Irritability in infants
- Hoarseness/sore throat
- Halitosis
- Dysphagia or feeding refusal
- Poor dentition (from acid erosion)
GERD Treatments (Noninvasive)
- Elevating HOB, keeping infant upright for 30 minutes after feeding
- Smaller, more frequent feedings
- Burp frequently
- Thicken formula with rice cereal
GERD Treatments (Medications)
- H2 Blockers (ranitidine, famotidine)
- Prokinetics (metoclopramide)
- Proton Pump Inhibitors (omeprazole, pantoprazole)
Reflux Nursing Management (Maintain Airway)
- GERD often involves the airway
- Apnea can lead to quick respiratory decline
- Teach parents CPR
- Have suction nearby
GERD Treatment (Surgery)
Nissen Fundoplication
Gastrostomy Tube (Care)
- Clean skin around G-tube once a day
- Rotate button a quarter turn a day to prevent skin breakdown
- For infants, still provide pacifier during feedings
- Maintain normalcy of “active” feeding times
- Elevate HOB 30 degrees for nighttime feedings
- Allow a normal routine
- Walking, crawling, whatever is normal for their developmental level
Hirschprung Disease
- Common cause of neonatal intestinal obstruction
- Lack of ganglion cells in bowel leads to lack of peristalsis
S/Sx of Hirschprung Disease
- Constipation
- No meconium in 24-48 hours
- Required rectal stimulation to pass meconium
- Poor feeding and failure to thrive
Hirschprung Disease Diagnostics
- KUB
2. Barium enema
Hirschprung Disease Treatment
Surgical resection of the aganglionic bowel and reanastomosis of remaining intestine
- Commonly requires a temporary ostomy while the bowel heals
Hirschprung Disease Potential Complication
Enterocolitis
Hirschprung Disease Nursing Management
- Ostomy care
2. Monitor for s/sx of enterocolitis
S/Sx of Enterocolitis
- Fever
- Abdominal distention
- Explosive stools
- Bloody stools
Gastroschesis
- Exposed, herniated organs
- Thick, edematous, inflamed
- Silo bag or surgical correction
- Significant mortality and morbidity rates due to feeding intolerance, failure to thrive, prolonged hospital stays
Omphalocele
- Umbilical ring defect allows contents into external peritoneal sac
- Associated with genetic syndrome 50% of the time
- Surgical correction
Nursing Management specific to Omphalocele
- Using strict sterile technique, wrap moist gauze soaked in warm sterile saline around contents
- Handle gently to prevent trauma
Nursing Management of both Gastroschesis and Omphalocele
- Inspect contents closely (color, twisting of organs, presence of liver)
- Prevent hypothermia!!!
- Place OG tube to low intermittent suction
- IV fluids and IV antibiotics
- Closely monitor bowels (color and temperature)
Hypertrophic Pyloric Stenosis
Pylorus becomes hypertrophied -> thickness in the luminal side of the pyloric canal -> gastric outlet obstruction -> nonbilious projectile vomiting
When does Hypertrophic Pyloric Stenosis Typically Present?
Between 2-4 weeks of life
Hypertrophic Pyloric Stenosis Treatment
Surgery = Pyloromyotomy
S/Sx of Hypertrophic Pyloric Stenosis
- Nonbilious, forceful vomiting
- Weight loss
- Hunger after vomiting
- Dehydration
- Irritable
Hypertrophic Pyloric Stenosis Diagnostics
- Palpable “olive” in RUQ
2. Ultrasound
Hypertrophic Pyloric Stenosis Nursing Management
- Fluid management and electrolyte correction
- Check fontanels for hydration status
- Address high family anxiety and provide emotional support
- Usually resume oral feedings after 1-2 days after surgery
S/Sx of Nephrotic Syndrome
- Edema
- Weight gain
- Ascites
- Weakness
- Irritability
- Usually normal BP
Nephrotic Syndrome Diagnostics
- Protein in urine
- Low serum protein and albumin
- high serum cholesterol and triglyceride
- Creatinine and BUN increase if there is renal failure
Nephrotic Syndrome Treatment
- Corticosteroids
- IV albumin
- Possibly diuretics
- Immunosuppressive therapy for steroid-resistance
Potential Complications of Nephrotic Syndrome
- Anemia
- Infection
- Poor growth
- Peritonitis
- Thrombosis
- Renal failure
Nephrotic Syndrome Nursing Management
- Taper or wean steroids
- Monitor potassium (furosemide)
- Diet high in potassium - Monitor temperature for infection
- Possible fluid restriction
- Possibly Na restriction
- Encourage protein in diet
- Emotional support
Hypospadias and Epispadias
Urethral defect at birth, but can still urinate pre-op
- Hypo = below
- Epi = above
Future S/Sx of Hypospadias and Epispadias
- Difficulty with urinary stream
- Infertility
- Self-esteem issues
When is surgery done on an baby born with hypospadias or epispadias?
Surgical repair at 1 year of age
What other disorders are usually associated with hypospadias or epispadias?
- Undescended testes
- Hydrocele
- Inguinal hernia
Double Diapering
Double diapering is a method used to protect the urethra and stent or catheter after surgery; it also helps keep the area clean and free from infection. The inner diaper contains stool and the outer diaper contains urine, allowing separation between the bowel and bladder output.
Double Diapering Method
Double Diapering:
Cut a hole or a cross-shaped slit in the front of the smaller diaper.
Unfold both diapers and place the smaller diaper (with the hole) inside the larger one.
Place both diapers under the child.
Carefully bring the penis (if applicable) and catheter/stent through the hole in the smaller diaper and close the diaper.
Close the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.
