Nutritional and GI dysfunctions Flashcards
meconium
thick black tarry stools, sticks to babies skin
will turn to a yellow paste after 3 days
swallowing becomes an automatic reflex action until
6 weeks of age
at birth mechanical functions of digestion are
immature
stomach acid is not fully present until what age?
6m of age
most common vitamin deficiencies in childhood?
A,C, B2, B6, B12
iron deficiency occurs most frequently in children aged
12-36 months
Failure to thrive
inadequate growth resulting from the inability to obtain and/or use calories required for growth
criteria to be diagnosed with FTT
weight/height below 5th percentile or persistent deviation from an established growth curve
organic FTT
has a physical cause such as CF
non-organic FTT
no underlying medical issue psychosocial factor (parents on drugs, don't recognize hunger cues, depression, neglect)
idiopathic FTT
unknown cause
factors that contribute to NFTT (non-organic)
caregiver has difficulty perceiving and assessing the infants needs, they become frustrated and angered at infants dissatisfied response poverty health beliefs inadequate nutritional knowledge family crisis feeding resistance insufficient breast milk
therapeutic management of NFTT
catch up growth multidisciplinary team approach (peds forensics, PT/OT, dietician, case management) correct nutritional deficits treat underlying cause educate parents/ primary care givers
feeding guidelines for NFTT
staff consistency quiet non stimulating environment be persistent (don't force, create a positive environment) fact to face posture introduce new foods slowly follow a structured routine
cleft lip/palate
abnormal openings in the lip and/or palate
unilateral or bilateral
what is cleft lip/ palate caused by
multi-factorial inheritance, factors and teratogens
clinical findings with CL/CP
difficulty feeding mouth breathing ( more swallowed air with distended abdomen and pressure on diaphragm, dry cracked mucous membranes, increased risk of infection and aspiration pneumonia)
what do you wait for before a CL/CP repair?
for teeth to form, but fix palate before speech starts
when do you perform CL repair?
within the first weeks of life
z-plasty minimizes notching and lengthen the lip
when do you perform CP repair?
12-18 months with obturators
preop nursing considerations for CL/CP- parents
promote bonding
allow parents to express grief and fears
emphasize the positive
express optimism
preop nursing considerations for CL/CP- infants
feeding difficulties ( breast is recommended, so mom will pump them bottle feed) upright position special nipples (Haberman, pigeon) stimulate suck reflex swallows fluid appropriately rest burp frequently
post op considerations for CL/CP infants
protect airway- position on belly right after OR
prevent hypothermia
prevent infection
protect suture line
pain mgmt
avoid objects in mouth and suction with caution
how do you protect the suture line of CL
avoid laying on stomach
elbow restraints “no no’s”
remove restraints and check skin q2 hours
what are long term consequence of CL/CP
altered speech
altered dentation
hearing problems
discharge teaching for CL/CP
good oral care
watch ears
promote speech development
esophageal atresia (EA) and tracheoesophageal fistula (TEF)
failure of esophagus to develop as a continuous passage and/or failure of the trachea and esophagus to separate
clinical manifestations of esophageal atresia and tracheoesophageal fistula
frothy saliva in mouth and nose
chocking and coughing
feedings return through nose and mouth, may become cyanotic and apneic
what are the three C’s of TEF?
chocking
coughing
cyanosis
how do you diagnose EA and TEF?
passage of radiopaque catheter until obstruction is encountered
preoperative nursing considerations of EA and TEF
early detection maintenance of airway prevention of pneumonia gastric or blind pouch decompression antibiotics antibiotics prepare for surgical correction
anorectal malformations
imperforate anus- surgery done in stages
anal stenosis- manual dilations
perineal fistulas- anoplasty during newborn period
extensive defects- colostomy
preoperative nursing considerations of anorectal malformations
GI decompression
IV fluids
post operative nursing considerations of anorectal malformations
meticulous perineal care
positioning (side lying or supine with legs suspended, hips elevated)
colostomy care
nutrition ( NG, IV, Lipids) when bowel sounds return you can start oral feeds as tolerated
bowel training
abdominal wall defets
omphalocele
omphalocele
herniation of the abdominal contents through the umbilical ring. intact peritoneal sac
contained in a sac
gastroschisis
herniation of abdominal contents, right of the umbilical ring
no peritoneal sac
not contained
why is it difficult to reduce the intestines of gastroschisis
because intestines expand and have to be decompressed before putting back in
how do you are for expose intestines?
loosely cover with saline soaked pads and plastic drape
IV fluid
antibiotics
surgical correction done in stages, silo pouch
done in a sterile fashion
what is the goal of gastroschisis repair
to get as much bowel as possible back into the body
you can hear bowel sounds through a silo
ensure that an ileus is not forming
a large amount of lost gut can result in short gut syndrome
disorders of motility
diarrhea constipation encopresis hischprung disease GERD
gastroenteritis
2nd leading cause of death world wide diarrhea ( stool exceeds 200grams/day) viral cause 70-80% of time bacterial cause 10-20% of time protozoan: less than 10%
viral gastroenteritis
most likely the cause of infectious diarrhea
rotavirus and norovirus most common
symptoms of gastroenteritis
low grade fever nausea vomiting abdominal cramps watery diarrhea viral shedding for weeks after symptoms resolve
bacterial diarrhea
affects all age groups
fecal-oral transmission (contaminated food)
symptoms of bacterial diarrhea
bloody diarrhea, severe cramping, and malaise
ABX not always necessary
treatment of diarrhea
oral rehydration-ORS ( infalyte, pedialyte, naturalyte, or rehydralyte)
normal diet with ORS or mild-mod dehydration
IV fluids for mod to severe dehydration
what do you avoid with ORS for diarrhea
fruit juices
colas
sports drinks
causes of constipation
structural disorders hypothyroidism hypercalcemia lead poisoning drugs spinal cord lesions
management of constipation
dietary
stool softeners
encopresis
chronic constipation with soiling
causes of encorpesis
psychological trauma
voluntary withholding
management of encorpesis
purge the bowel
stool softeners
bowel retraining
Hirschsprung disease (megacolon)
congenital anomaly
absence of autonomic parasympathetic ganglion cells
causes enlargement of the bowel proximal to defect, results in mechanical obstruction from inadequate motility
what is the most dangerous complication of Hirschsprung disease?
enterocolitis (caused by ischemia) bloody diarrhea, fever, lethargy
newborn clinical manifestations of Hirschsprung disease
failure to pass meconium within 48 hours food refusal, bilious vomiting, abdominal distention
infancy clinical manifestations of Hirschsprung disease
poor weight gain, constipation, abdominal distention, episodes of diarrhea and vomiting
childhood clinical manifestations of Hirschsprung disease
constipation
ribbon-like, foul-smelling stools, palpable fecal mass, abdominal distention, poor appetite, growth
how do you diagnose Hirschsprung disease
barium enema
rectal biopsy
anorectal manometry
treatment of mild to mod Hirschsprung disease
based on relieving the chronic constipation
surgery in 2 stages 1. temporary ostomy 2. soave endorectal pull through
prognosis: good, may have anal stricture and incontinence post op
pre-op nursing considerations for Hirschsprung disease
note first BM on all babies measure abdominal girth bowel prep- enemas and antibiotics monitor hydration, fluid, and electrolyte status teach enema techniques
post op care for Hirschsprung disease
NG suction NPO I and O to include NG losses and ostomy drainage hydration and electrolyte balance abdominal assessment ostomy care
GERD
the passive transfer of gastric contents into the esophagus
transient and inappropriate relaxations of the LES
factors increasing risk of GERD
prematurity bronchopulmonary dysplasia esophageal scar tissue scoliosis asthma CF
signs and symptoms of GERD in infants
spitting up alot, may be forceful hematemesis and melena irritability classic back arching ALTE or apnea persistent aspiration pneumonia
signs and symptoms of GERD in children
heartburn anemia persistent aspiration pneumonia chronic cough difficulty swallowing abdominal pain
diagnosis of GERD
UGI
24 hour pH probe
Endoscopy
Labs
medications for GERD
antacids or histamine receptor antagonists
PPI - omeprazole
prokinetic medications (reglan, bethanechol, cisapride)
surgical treatment of GERD
nissen fundoplication
take part of stomach and wrap upper portion of stomach around the LES
nursing considerations for GERD
positioning HOB 30 degrees
wedge under mattress
harness
small frequent feedings with thickened formula
avoid fatty foods, chocolate, tomato products, and carbonated liquids
burp frequently
obstructive GI disorders
hypertrophic pyloric stenosis (HPS)
intussusception
hypertrophic pyloric stenosis (HPS)
circular muscle of pylorus becomes thickened causing obstruction of gastric outlet
unknown cause; maybe genetic component
males 5x more likely to get
develops first few weeks of life, edema, and inflammation increases the obstruction
clinical manifestations of HPS
projectile vomiting without bile hunger and irritability progressing to lethargy dehydration and weight loss visible gastric peristalsis OLIVE SHAPED MASS
therapeutic management of HPS
H&P, abdominal xray, US
labs show metabolic alkalosis
hyponatremia
hypokalemia
pyloromyotomy
surgical correction of HPS
corrects dehydration and acid/base balance prior to surgery
nursing considerations HPS
regulation of fluid therapy
pre-op: NPO, strict I and O, monitor IV fluids, monitor for F & E balance, NG tube
post op: pain control, titrate PO feedings
intussusecption
invagination or telescoping of one portion of the intestine into another
most common in 1st year, males 2x greater than females
complications of intussusception
obstruction inflammation edema ischemia perforation peritonitis shock
clinical manifestations of intussusception
severe paroxysmal abdominal pain screaming and drawing knees to chest vomiting bile or fecal stained emesis palpable SAUSAGE shaped mass URQ Current Jelly stools abdomen becomes tender and distended
therapeutic management of intussusecption
flat plate for free air followed by barium enema (air enema)
non surgical hydrostatic reduction
surgical reduction and resection
nursing considerations for intussesecption
NG for decompression monitor for signs of shock administer antibiotics hydration and nutrition routine post op care family support
malabsorption syndromes
celiac disease
short bowel syndrome
celiac disease (gluten sensitive enteropathy)
chronic inflammation of small intestine mucosa, results in varying degrees of atrophy to intestinal villi, malabsorption, and a variety of clinical manifestations
inability to digest gluten
results in accumulation of toxic substance that damages mucosal surface and interferes with the absorption of nutrients
gluten is in
wheat, rye, barley, oats
clinical manifestations of celiac disease
no symptoms for at least 6 months major symptoms appear between 1-5 years progressive malnutrition; anorexia, muscle wasting, abdominal pain and distention watery, pale, foul smelling stool vomiting, constipatoin celiac crisis
what is a secondary deficiency of celiac disease
anemia and rickets
diagnosis of celiac disease
jujunal biopsy
abnormally elevated levels of endomysial and anti-tissue transglutaminase antibodies
what do celiac patient eliminate from their diets?
wheat, rye, barley, oats
what type of diet do celiac patients have
high in calories and protein, low in fat
supplemental vitamins and iron
celiac patients are at an increased risk of
malignant lymphoma of small intestine
nursing considerations of celiac disease
promote compliance with dietary restrictions
teach pt’s to read labels; cereals, baked goods, grains are often added to processed foods, hydrolyzed vegetable protein
stress long range complications
short bowel syndrome
malabsorptive disorder that occurs as a result of decreased mucosal surface area
part of bowel has been removed causing elimination problems. (diarrhea, malabsorption)
causes of short bowel syndrome
congenital anomalies (jejunal and ileal atresia, gastroschisis) ischemia, trauma, long-segment resection.
problems with SBS
decreased intestinal surface area for absorption of fluid, electrolytes, nutrients
increased and disorganized transit time of intestinal contents
therapeutic management of SBS
preserve as much bowel as possible
maintain optimum nutrition
stimulate intestinal adaptation
minimize complications
complications of SBS and TPN
CVA, risk of infection
metabolic complications- electrolyte disturbances, hyperglycemia, hypoglycemia, hyperlipidemia, cholestasis, and liver dysfunction
bacterial overgrowth
gastric acid hypersecretion
acute appendicitis
inflammation of the veriform appendix (blind sac at the end of the cecum) can be full of stool
uncommon before age 2; associated with increased complications and morality
rapidly progress to perforation and peritonitis
causes of acute appendicitis
obstruction of the lumen of the appendix hardened fecal material foreign bodies microorganisms parasites (not pin worms)
clinical manifestations of acute appendicitis
colicky abdominal pain and tenderness at McBurneys point guarding abdominal pain rebounding tenderness n/v/anorexia low grade fever >102 mean perforation look for signs of peritonitis
diagnosis of appendicitis
CBC, abdominal ultrasound
pre-op appendectomy
IV fluids and antibiotics
Management of peritonitis
fluids, antibiotics, NG tube, delayed closure to prevent abscess formation
nursing considerations for acute appendicitis
avoid enemas and heating pads
prep for surgery
how long does it take for the colon to return to normal size and tone after constipation (large stool burden?)
6 months- 1 year
how long does it take for miralax to work?
3 days
McBurneys point
pain around umbilicus and radiating down the right side
a sign of acute appendicitis
