Pediatrics Test 2: GI Disorders Flashcards
What is dehydration
Output of fluids exceeds the intake of fluid
Enequal fluid balance
What Is the primary symptom of pyloric stenosis
Projectile vomiting
What are some causes of dehydration
Diane that causes insensible loss through skin and respiratory tract
Increased renal excretion: high output kidney failure
Increase loss in GI tract: vomit and diarrhea
Diabetic ketoacidosis
Extensive burns
Shock
Tachycardia
Radiant Warmers
Phototherapy
Diabetes insipidus
How much fluid do we need to stay healthy
Important for baseline data
Weight 1-10 kg there is 100mL/kg
Why are infants at greater risk
Longer GI tract relative to body size
Greater body surface
Higher metabolic rate
Less able to concentrate urine
What are some clinical manifestations to dehydration
Weight loss Poor skin turgor Dry mucous membrane Absent tearing and salivation Sunken fontanel Tachycardia Rapid respirations Irritable to lethargic
Extent of dehydration
Look at the slide
Fluid volume deficiet outcomes
Moist mucous membranes Sodium and potassium elevated Capillary refill of 2 seconds or less Skin turgor brisk Fluid I & O balanced Voiding >1 mL/kg/hr
Oral hydration management
Mild dehydration: 50ml/kg over 4-6 hours
Moderate dehydration: 100ml/kg over 4-6 hours
Solution addresses electrolyte needs
Don’t want too much glucose because it will push fluid loss
Introduce fluid loss in 24 hours
Predisposing factors to diarrhea
Virus is big in daycare
Hand washing and sanitation: in fields and food packing area
Recent travel and hiking
Recent antibiotic use
What are the diarrhea bacterial agents
E. Coli Salmonella Shigella Campylobacter jejuni Clostridium difficile
E. Coli reasons
Food borne
Watery
Abdominal cramps
Common in summer
Salmonella
Person to person or food borne
With children often transmitted from pet
Common in summer
Loose, slime, green, seldom bloody, rotten egg smell
Shigella
Most common less than 9 years
Appears very sick
Watery yellow green stool, blood with mucous
Campylobacter jejuni
Contaminated food and pets
Peak in less than 1 year
Watery and foul smelling, profuse diarrhea
Clostridium difficile
Alterations in normal flora
1-3 day incubation
Most mild watery diarrhea and can progress to extreme illness with high fever and prolonged diarrhea
Diarrhea parasitic agents
Entamoeba histolytica
Giardia lambs: most common intestinal parasite
- bloating and flatulence with loose greasy stool
Constipation causes
Passage of infrequent hard stools due to defects
Functional (inorganic): no underlying cause, can be gene
Organic: strictures, Hirschsprungs
Drugs: antacids, diruetics, opioids, iron, antihistamines
Metabolic: hypothyroidism, hypercalcemia, lead poisoning
Neuromuscular: spinal cord lesions
Psychiatric: stool holding, anorexia
Nursing measures for constipation
Increase fluids
Give smaller goals to accomplish
Increase fiber intake
Hirschsprungs disease
No peristolsis in bowel
Continuous smooth muscle spasm
Clinical manifestations of Hirschsprungs disease
Neonatal: failure to pass meconium, bilious vomiting, poor feeding
Later: chronic constipation, ribbon like foul smelling stool
Physical findings of Hirschsprungs
Enlarged distended abdomen
Palate fecal matter
Empty rectal ampulla
Visible peristalsis
Treatment for Hirschsprungs
Resection of aganglionic segment
May have temporary colostomy before pull, through reanastomosis at rectum
Let family know it is temporary
Nursing measures for Hirschsprungs
Help patient adjust to congenital defects
Foster parent-infant bonding
Prepare them for medical and surgical interventions
Assists with colostomy care
What is gastroesophageal reflux
Flow of gastric content in esophagus as result of neuromuscular failure of lower esophageal sphincter
Becomes GERD is there symptoms or tissue damage from reflux-failure to thrive, bleeding, pneumonia
Apnea second to GERD
Clinical manifestations of GERD
Regurgitation - spitting up Excessive crying Weight loss Esophagitis - heartburn, dysphasia Anemia Irritability Pulmonary symptoms: cough, choke, wheeze Nocturnal asthma Cry after eating
Treatment of GERD
Avoid foods that exacerbate acid reflux Weight control Small, more frequent meals Thickened feeding Upright positioning Prone after feeding Medication Head elevated 30 minutes Surgery for infants
Acute appendicitis
Inflammation of vermiform appendix caused by obstruction of lumen of appendix usually hardened by fecal matter RLQ Anorexia Vomiting Diarrhea or constipation Low grade fever
Physical finding of acute appendicitis
Pain at McGruneys point, right iliac fossa
Bowel sound depressed or hyperactive
Rectal exam may show tenderness
Diagnosis and treatment for GERD
CAT scan
Laparoscopic
Current treatment philosophy
- see if body walls off abscess and if it does make a drain and have body naturally clear it out
Cleft lip and palate
Most common congenital deformity
Facial malformation that occurs during embryonic period
Failure of the maxillary and median nasal processes to fuse
Midline fissure of the palate that results fro. Failure of two slides to fuse
May occur separate or together
Nursing measures of cleft lip
Feeding issues Parental emotional needs Post operative Occur with other syndromes Drug associated is diluadid Surgical repair is two steps - lip 6 months, concerned about maintaining lip line - palate 12-18 months, mouth grows and want more room. Preserve speech
What I’d pyloric stenosis
Congenital hypertrophy of circular muscle of pyloric sphincter
More common in males
Increased family incidence
Milk can’t get into small intestines
Clinical manifestations of pyloric stenosis
Vomiting after feelings: progressive
Usually start 2-4 weeks post-birth
Surgically treated by opening the muscle
Intussusception
Imagination of one segment of bowels usually the terminal ilium, into the cecum
Telescopes in upon itself
Clinical manifestations of intusseption
Intense pain Knees upto chest Pain lasts several minutes and child is quiet Early non-bilious vomiting Current (red) jelly diarrhea stools
Physical finding of intussuception
Sausage shaped mass palpable in RUQ abdominal distention in tenderness Fever Bloody mucous on rectal exam Shock like state Cramping
Treatment of Intussuception
Hydrostatic enema
