GI/Nutrition Flashcards
Therapeutic management of ab wall defects
- loosely cover with saline soaked pads and pastic drape
- IV fluids
- antibiotics
- surgical correction—stages, silo pouch
- NC—sterile, monitor for ileus, family support, D/C planning, home care
Cloacal exstrophy
Bowel and bladder is on the outside of the body
Cloacal exstrophy
Bowel and bladder is on the outside of the body
Therapeutic management for anorectal malformations
- Anal stenosis—manual dilation, widen the anus gradually
- Perianal fistula—opening btwn bowel and vagina so need surgery (anoplasty—move the opening)
- imperforate anus—surgery in stages
- extensive defects; colostomy
What to check in the anus at birth?
Check for patency and meconium, check for the external opening
Anorectal malformation NC
- identify problem
- look for meconium in first 24h
- look for poorly developed gluteal folds and anal opening
- pre-op—IVF and GI decompression
- post-op—anorectoplasty; need good peri care, expect diarrhea, colostomy care, nutrition ASAP after bowel sounds return, side lying with elevated legs or supine
- fam support and edu
Omphalocele
Herniation of the ab contents thru the umbilical ring; intact peritoneal sac but grows outside of the body
Gastroschisis
Intestines are not contained and grown outside the body through the umbilical ring; intestines swell bc not compressed
Abdominal wall defects NC
- can be diagnosed prenatally and best to be born with C-section
- if born with it, need IVF and antibiotics
- intestines covered with sterile pad
- surgical correction—put intestines in silo to contain, squeeze them down with silo
- may not be able to get all intestines in which can cause small bowel/short bowel syndrome
- careful handling, monitor for ileus, family support, home care maybe
Gastroenteritis
- most common cause of morb/mort worldwide in kids
- causes diarrhea—3+ loos or watery stools per day
- alteration in normal BM with inc freq and Dec consistency
- less than 14 days duration
Viral diarrhea
Most common—rotavirus or norovirus often
- low grade fever, N/V/D, belly hurt
- virus can shed for weeks after sx resolve (still contagious)
Bacterial diarrhea
- all age groups
- fecal-oral transmission (contaminated food) often
- sx: bloody diarrhea, severe cramp, malaise
- antibiotic tx not always needed
Diarrhea tx
- HYDRATION—oral rehydration solution—pedialyte, naturalyte, rehydralyte
- avoid fruit juice, colas, sports drinks, etc bc lots sugar
- normal diet with ORS for mild-moderate dehydration
- IVF for moderate-severe dehydration
Nursing management for diarrhea
- Gloves
- prevent skin b/d
- good nutrition
- Dec fear/anxiety by explain/reassure
- infection control
- provide health education for prevention and home management
- restore F&E balance by ORS and IVF
Constipation
- quality, not quantity
- structural disorders, hypothyroidism, hypercalcemia, lead poisoning, drugs, spinal cord lesions
- most is functional—kids not taking the time to slow and go
- dietary, stool softeners
Constipation tx
- emphasize good exercise, water, nutrition, fiber is age+5
- give half juice half water
- give prunes
- give K rose sugar to the bottle
- Miralax—works in 3 days
takes about 6M after constipation for colon to un-stretch back to normal
Encopresis
Chronic constipation with soiling (fecal impaction) from psychological trauma and voluntary withholding
Encopresis management
- purge the bowel
- stool softeners
- bowel retraining
Encopresis NC
- teaching
- support compliance with long-term therapy
- empower the child
- positive reinforcement
- use toilet that is appropriate size so kid can chill
Hirschsprung disease (congenital aganglionic megacolon)
Absence of autonomic parasympathetic ganglion cells in 1+ segment of the colon causing enlargement and inability for peristalsis to occur—mechanical obstruction
- most dangerous complication is enterocolitis (caused by ischemia)—bloody diarrheal, fever, lethargy
CM of Hirschsprung disease
- newborn—failure to pass meconium w/i 48h, food refusal, bilious vomiting, ab dissension
- infancy—poor wt gain, constipation, ab distinction, D/V
- childhood—chronic constipation, ribbon like foul stool, poor appetite and growth, palpable fecal mass, ab distension
Hirschsprung tx
- Dx—Barium enema, rectal biopsy, anorectal manometry (use Cath and balloon to study)
- tx for mild-mod disease can be repeated enemas to keep cleaned out or surgical removal (temporary ostomy) and Soave endorectal pull-thru (attach colon to rectum)
- prognosis is good—may have anal stricture and incontinence post-op
Pre-op NC for Hirschsprung
- note first BM on all babies
- measure ab girth daily
- bowel prep—enemas and antibiotics
- monitor hydration, fluid, electrolyte status
- teach enema technique—1 tsp salt and 1 pint water is best (avoid tap water)
Post-op Hirschsprung NC
- N/G to suction
- NPO
- I&O to include N/G losses and ostomy drainage
- ostomy care
- hydration and electrolyte balance
- ab assessment
Gastroesophageal reflux disease (GERD)
Passive transfer of gastric contents into the esophagus—transient and inappropriate relaxations of the lower esophageal sphincter (LES) like CNS prob OR dev exaggerated enteric reflex OR ab pressure
Factors inc risk of GERD
- born premature
- bronchopulmonary dysplasia
- esophageal scar tissue
- scoliosis
- neuro dx
- asthma
- CF
- some meds
Infant s/s GERD
- spit up lots
- intermittent vomit
- hematemesis and melena
- irritability
- back arch
- ALTE or apnea
- persistent aspiration pneumonia
Childhood s/s of GERD
- heartburn (older kids)
- anemia from blood loss
- persistent aspiration pneumonia
- chronic cough
- difficulty swallowing
- ab pain
Therapeutic management of GERD
- Dx—UGI, 24h pH probe, endoscopy, labs
- Meds—antacids or histamine receptor antagonists, proton-pump blocker—omeprazole (Prilosec), prokinetic meds like raglan, bethanechol, cisapride
Nissen fundoplication
Take top of stomach and wrap it around the esophageal sphincter to tighten it—keep stomach contents in the stomach
NC for GERD
- position baby with elevated HOB 30 degree and wedge under mattress, harness after eating
- small frequent feedings with thickened formula
- avoids fatty foods, chocolate, tomato products, carbonated liquids
- educate parents
- burp often
Hypertrophic pyloric stenosis
Circular muscle of the pylorus becomes thickened causing obstruction of the gastric outlet
- some genetic component
- develops in first few weeks of life causing edema and inflammation inc with obstruction
- much more common in males
CM of HPS
- projectile from w/o bile
- hunger and irritable progress to lethargy
- dehydration and weight loss
- visible gastric peristalsis
- olive-shaped mass
HPS therapeutic management
Diagnose with H&P, ultrasound, ab x-ray, labs show metabolic alkalosis, hyponatremia, hypokalemia
- surgical removal
- pyloromyotomy—correct dehydration and acid/base balance prior to surgery
HPS NC
- observe for clinical features
- regulate fluid therapy
- pre-op—NPO, strict I&O, monitor IVF, monitor for F&E balance, may need NG tube
- post-op—pain control, titrate PO feedings—may be very slow process, begin with pedialyte and gradually get to formula
Intussusception
Invagination or telescoping of one portion of the intestine into another
- common in kids with CF
- can be viral infection
Intussusception complications
Obstruction, inflam, edema, ischemia, perforation, peritonitis, shock
Clinical manifestations of Intussusception
- severe paroxysmal ab pain
- scream and draw knees to chest
- vomit—bile or fecal stained
- palpable sausage-shaped mass URQ
- currant jelly-like stool
- ab is tender and distended
Intussusception therapeutic management
- diagnosed with H&P, flat plate for free air followed by barium enema—caused telescoping of the bowel to straighten out when air goes in
- non-surgical hydrostatic reduction
- surgical reduction and resection
NC for Intussusception
- recognize sx and refer for tx
- NG for decompression
- monitor for signs of shock
- administer antibiotics safely
- hydration and nutrition
- routine post-op care—observe for signs of ab distention
- family support
Celiac disease
Chronic inflammation of the small intestinal mucosa which may result in varying degrees of atrophy to intestinal villi, malabsorption, and a variety of CM
- triggered by inability to digest gluten
- results in accum of a toxic substance that damages the mucosal surface and interferes with the absorption of nutrients
- gluten includes wheat, rye, barley, oats
Celiac disease CM
- no sx for first 6M
- major sx appear between 1-5Y
- progressive malnutrition—anorexia, muscle wasting, ab pain, distention
- secondary deficiencies—anemia, rickets
- watery, pale, foul smell stool
- vom, constipation
- celiac crisis
Therapeutic management (Celiac disease)
- Diagnosis—jujunal biopsy, abnormally elevated levels of endomysial and anti-tissue transglutaminase antibodies
- Eliminate wheat, rye, barley, oats
- diet high in calories and protein, low fat
- supplemental vitamins and iron
- inc risk of malignant lymphoma of small intestine
Celiac disease NC
- promote compliance with dietary restrictions
- teach parents to read labels, what they can and can’t have
- stress long-term complications of this
Short bowel syndrome
- malabsorptive disorder that occurs as a result of dec mucosal surface area
- etiologies are congenital anomalies (jujunal and ileal atresia, gastroschisis), ischemia, trauma, long segment resection
probs with SBS
- dec intestinal surface area for absorption of nutrients and fluids
- inc and disorganized transit time for intestinal contents
SBS therapeutic management
- keep as much bowel as possible
- maintain optimum nutrition
- stimulate intestinal adaptation with feedings that use the bowel
- dec complications
- prob need TPN but as last resort
Can you feed immediately after surgery?
No, need to let bowel rest then use TPN to allow the gut to still work
Complications of SBS and TPN admin
- central venous cath infection and technical probs
- metabolic probs–electrolyte disturbances, hyper/hypo glycemia, HLD, cholestasis, liver dysfxn
- bacterial overgrowth
- gastric acid hypersecretion
SBS NC
- TPN–sterile set up and consistent rate
- CVAD–infection, occlusions, dislodgement
- enteral feedings–non-nutritive sucking, check placement, daily stools for occult blood
- teach home care
- skin care
- chronic diarrhea
- promote development
Acute appendicitis
Inflam of the veriform appendix (blind sac at end of cecum)
- uncommon before age 2; assoc with inc probs
- rapidly progresses to perforation and peritonitis
- obstructs lumen of the appendix, hardened fecal material, foreign bodies, microorgs, parasites (not pin worms)
Acute appendicitis CM
- colicky ab pain and renderness (McBurney point) to LRQ
- guarding ab
- rebound tenderness–hurts more when you let go
- N/V
- anorexia
- low fever; over 102 means perforation
- signs of peritonitis
What does it mean when appendicitis pain gets better suddenly?
Rupture–pallor, etc
Acute appendicitis therapeutic management
- diagnose with H&P, CBC, ab ultrasound
- apppendectomy–pre-op fluids and antibiotics–remove appendix (may need to do later to not cause more damage)
- peritonitis–fluids, antibiotics, NG tube, delayed closure to prevent abscess formation
Appendicitis NC
- assess
- avoid enema and heating pad
- prep for surgery–psych and phys
- post-op care–not big deal if not ruptured
- if ruptured, probs eating, fever, may need peritoneal washed out multiple times
Meckel Diverticulum
fibrous band connecting small intestine to umbilicus
- most common congenital malformation of the GI tract
- complications–bleeding from peptic ulcer or perforation, obstruction, inflammation
Meckel diverticulum CM
- painless rectal bleeding
- ab pain
- s/s obstruction
- currant jelly stool (hematochezia)
- intussusception
Meckel diverticulum therapeutic management
- diagnose H&P, radionuclide imaging
- surgical removal–correct shock and/or infection first
- prognosis–full recovery if treated early; 2.5-15% mortality rate if untreated
NC for meckel diverticulum
- psych support
- bleed–monitor for shock, bed rest, record blood loss in stool
- post-op–IVF, NG to suction
