Pedi GI Flashcards by Vanessa McCorkle

What kind of stools might you expect with intussusception?

Jelly-like stool that looks like red currant jelly.

Stool is mixed with mucus and blood.
The invaginated sections of intestine block off lymphatic and venous flow to the area. Causes edema, ischemia, and increased mucus.

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Nursing care for Intussusception? What is a treatment that may fix intussusception without surgery?

IV Fluids, Pain management, NG tube for decompression
Air enema —> Air will push the folded in intestine back outward.

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A sausage-shaped mass between the LUQ and RUQ is associated with?

Intussception

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An olive-shaped mass in the RUQ is associated with?

Pyloric stenosis.

The thickened pyloric sphincter muscle creates a firm lump that feels like an olive.

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Fundoplication is a sx associated with? What is it?

GERD. Fundus of the stomach is wrapped around the esophagus like a scarf.

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How many bowel movements per week defines constipation?

< 3/week

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What kind of diet for constipation?

High-fiber

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Complications associated with Hirschsprung disease? (Hint: Food is stuck in one place in the bowel)

Entercolitis is main one. Deadly
Infection
-Perforation
Necrosis
-Bowel obstruction

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Symptoms associated with entercolitis?

Projectile, uncontrolled diarrhea
Fever
- It is a necrotizing process.

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Lack of ganglion cells in Hirschsprung disease affects what?

Bowel motility

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GI Disorders associated with Short bowel syndrome?

Intussception
-Hirschsprung

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Itching would be associated with?

Hepatic disease- Elevated Bilirubin.

Hepatomegaly, or an enlarged liver, can cause itching primarily due to a buildup of bile salts in the bloodstream when the liver isn’t functioning properly, which then irritates nerve endings in the skin, leading to the sensation of itching; this phenomenon is often referred to as “cholestasis” and is a common symptom of liver disease.

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What is an omphalacele? #1 priority?

All abdominal cavity contents/organs form in a sac outside the body.

Prevent infection

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What is intussusception?

Piece of proximal bowel “telescopes” or invaginates into the distal bowel

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Pre-op nursing actions for cleft lip or palate?

Assess ability to feed and suck
-Obtain a baseline weight
Initiate strategies for successful feedings.

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Isolated cleft lip feeding strategies?

-Encourage breastfeeding
-Wide based nipple for bottle feeding
- Squeeze infant’s cheeks together during feeding to decrease the gap

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For cleft palate, what are strategies for feeding?

-Position upright while cradling head during feeding

Use special bottle with one-way valve and specially cut nipple—> One way valve will allow milk to flow out only when compressed by the baby. Compensates for their inability to create a proper suction seal.
May need to syringe feed
-Burp frequently

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Post-op nursing actions for cleft lip and palate?

Keep them pain and stress free to reduce crying- This will put strain on surgical site.
Avoid having the infant suck on nipple or pacifier
-Avoid objects that could go into the mouth and damage the site.
Strict I&Os
-Elbow restraints if needed.

Palate specific-

Airway obstruction and bleeding.
Change position frequently to facilitate drainage
Side lying to drain secretions.

Diagnostic procedures for GERD?

Endoscopy
24hr intraesophageal pH study to measure the amount of gastric acid reflux into the esophagus

What education might you give for an infant with GERD?

Place infants supine to sleep
-Thicken formula with 1 tsp- 1 tbsp rice cereal per 1 oz formula.

How might an infant with GERD present?

Arching of the back with feedings
Tongue pushing
Apnea
Pissed off

Omphalocele vs. Gastroschisis

With omphalocele, abdominal contents form outside of the body in a ________ (cele). Whereas in Gastroschisis, All contents are formed outside of the body without the _____.

-sac x2

With omphalocele, priority revolves around infection prevention and you must cover the sac with a sterile, non-adherent dressing (So as not to tear open the sac). In contrast, what do you do for Gastroschisis?

Wrap them in sterile plastic wrap. #1 priority is still infection prevention until they go to surgery (usually right away).
- ALWAYS leave supine. Don’t even put them on their side.

What are the names of the two drugs that a child might give for thrush? Which would you give to younger and which to older child? How are they given?

Younger child —> Nystatin or Fluconozole. May be applied to the cheeks with cotton swab.
Older —> Nystatin Swish

Side effect of Fluconozole?

Hepatotoxicity.

Aside from red currant stools and the sausage mass, what are the presentations of intussusception?

- Sudden, intermittent, severe abdominal pain —> May draw knees to chest to relieve pain. - Screaming (makes sense) - Distention - Bilious Vomiting, fever

What is the pylorus?

The valve (sphincter) that opens and closes during digestion. Allows partially digested food to pass from the stomach to the small intestine.

What is Hypertrophic Pyloric Stenosis? What is the problem with this?

Thickening of the pyloric sphincter, which creates an obstruction. Food can’t pass from the stomach to the small intestine.

If hypertrophic pyloric stenosis means food won’t pass from the stomach to the small intestine…. What symptoms do you expect?

- Failure to gain weight - Dehydration (cool lips is not a manifestation of dehydration that I would have thought of) - Insatiable hunger - Vomiting following feedings, sometimes hours after. - Peristaltic wave that moves from left to right across the abdomen. (The stomach is contracting forcefully in attempt to move food past the blockage) (Apparently peristalsis is also in the stomach and not just the intestines.)

Nursing Care of child with Hypertrophic Pyloric Stenosis?

- NPO - NG tube for decompression - I&Os - Daily weights - Fluid replacement - Clear liquids 4-6 hours after sx

What is meconium?

Meconium is the first stool passed by a newborn baby. It is a thick, sticky, and dark green or black substance that is present in the baby's intestines before birth. Meconium is composed of: Bile pigments, Cells shed from the intestinal lining, Mucus, and Hair.

What is Hirschsprung’s Disease? What is the fix?

Lack of ganglionic cells in segments of the colon resulting in decreased motility and mechanical obstruction. (Ganglions = Cell bodies of parasympathetic neurons. Ie: No peristalsis) - Fix= Surgical removal of the aganglionic sections of bowel (So shortening the bowel). May need temporary colostomy.

Aside from other general, very expected findings, what key things might you see with Hirschsprung’s disease? Diagnosis?

- Newborn —> Failure to pass meconium in first 24-48 hours - Undernourished, anemic appearance - Foul-smelling ribbonlike stool - Rectal biopsy to determine absence of ganglion cells.

Nursing care of Hirschsprung’s?

- Fluids - Nutrition - Teach parents high protein, high calorie, low fiber diet - May need TPN - May need to prep the bowel with saline enemas and oral abx prior to surgery

What is short bowel syndrome? Causes? (Hint: It’s secondary, technically…)

- Malabsorption disorder. Characterized by lack of small intestine to absorb nutrients. - Causes include surgical removal of intestine sections or being born with areas of non-functioning bowel (Ie: Hirschsprung’s, Intussusception)

If the primary issue of Short Bowel Syndrome is malabsorption, what do you think the biggest symptom is? (Not appearance of malnourishment). - So to fix this, you may need….?

Severe diarrhea - And thus, dehydration, malnutrition, and weight loss. - Fluid replacement and/or PN or EN

Malabsorption as a consequence of short bowel syndrome results in dysbiosis of the gut flora. This puts them at increased risk for _________.

Infection

Why do Hirschsprung’s patients have an anemic appearance? ….. And actual anemia

- They aren’t absorbing nutrients (Like iron)

10% weight loss and lethargy would be considered mild/moderate/severe dehydration?

Severe

For the child that is dehydrated and having diarrhea, how often should you offer them a cup of rehydration fluid?

Every time they have diarrhea- It needs to be a one-to-one basis in order to maintain electrolyte balance. - Fruit juice isn’t a good method because it contains too many carbohydrates.

What should you put on the infant that has an excoriated perineum?

Zinc oxide

For the child with diarrhea, you should not offer them foods high in what macro?

Carbohydrates- Sugars Sugars will make the diarrhea worse. Causes water to be pulled into the bowel because of the sugar content in the bowel (Osmolality= Total number of solute particles in relation to water content.)