NRSR 22 Unit 3: Peds GI Disorder Objectives Flashcards
- Describe the anatomy and physiology of the gastrointestinal system; explain age-related differences.
- No voluntary control over swallowing until 6 weeks.
- Peristalsis is fast
- Cardiac sphinctor is relaxed. Regurgitation is common.
- Digestive Enzyme deficiency until 4-6 mo (Amylase, trypsin, lipase)
- Liver function is immature.
2a. What are age related differences related to ultrasound and appropriate nursing interventions
- Maintain NPO status for abdominal studies
- Ensure procedure is painless and no exposure to radiation.
- Confirm no tests received that may interfere with results (eq. Upper GI Series).
- Instruct child to remain still during procedure.
2b. What are age related differences related to Barium or contrast enema and appropriate nursing interventions?
- Instructions regarding diet, laxatives and/or enema before procedure.
- Prepare to expect sensation of fluid entering the rectum.
- Do not have bowel movement until told it is ok.
- Ensure child holds still while radiograph is taken place.
2c. What are age related differences related to CT and appropriate nursing interventions?
- Ensure child is NPO and had bowel evacuation before study.
- If contrast or dye used, obtain history about hypersensitivity to iodine, seafood or radiographic contrast dye. (If allergy, antihistamine/steroids may be ordered.
- Educate the child on equipment, noises and other sensations. Have child help during procedures.
- If contrast is used, encourage fluids after procedure.
2d. What are age related differences related to Endoscopy and appropriate nursing interventions?
- Keep child NPO
- Administer sedation and monitor child during and after procedure.
- Inform child some pressure will be felt when endoscope is inserted.
2e. What are age related differences related to GI Series and appropriate nursing interventions?
- Keep child NPO, may have a low residue diet the night before.
- Withhold medication as ordered.
- Record VS: note epigastric pain or discomfort.
- Inform child all liquid must be be swallowed.
- Inform that test will not cause pain or discomfort.
- Inform that stool will be light after test.
2f. What are age related differences related to Intraesophageal pH Probe Monitoring and appropriate nursing interventions?
- Prevent infant or child from adverting removal of probe. Put on soft mittens if necessary.
- Monitor and record pH measurements.
- Instruct parents to keep diary of child’s activities while probe in place.
2g. What are age related differences related to Radio graphs (X-ray) and appropriate nursing interventions?
- Determine if other radiographic procedures were performed recently (eq. contrast dye).
- Explain procedure and the need for lead apron.
- Have child to practice to stay still.
4a. What are the feeding strategies for child with cleft clip and palate preoperatively?
- Allow additional time to eat and provide opportunity to rest after meals.
- Feed infant with head and chest elevated.
- Beep frequently
4a. What are the feeding strategies for child with cleft clip and palate post-operatively?
- When clear liquids are started, use dropper, syringe or special feeder.
- Put infant in a sitting position to avoid aspiration.
- Clean suture with water or NS solution to avoid accumulation of feedings.
- After palate surgery, avoid use of metal utensils or straws, which may disrupt the surgical site.
- Identify specific nursing measures to prevent injury to the surgical sites after cleft lip/palate repair.
- Position infant with cleft lip repair on side or back only.
- Use soft elbow immobilizers and remove every 2 hours and replace.
- Maintain suture line or Steri-Strips placed over cleft lift repair to minimize scarring.
- Avoid metal utensils or straws.
- Do not allow pacifiers
- Keep infant comfortable to minimize crying.
- Discuss the relationship between cleft lip palate and speech development.
- Speech problems are common.
- At age 5, child speech normalizes.
- Child should have regular visits to the speech pathologist to assess child’s speech production.
7a. Identify nursing diagnosis and intervention for deficient fluid volume related to inadequate intake and vomiting.
Withhold oral feedings. Inform parents to maintain child NPO preoperatively. IV is administered to correct electrolyte imbalances and maintain hydration. Maintain patency of NG tube and measure aspirated contents.
7b. Identify nursing diagnosis and intervention for imbalanced nutrition.
Monitor daily weight. (Possibly, paraenteral nutrition?) need to confirm if there are any other intervention.
