Peds GI/GU Flashcards
Describe Failure to Thrive
Physical signs of malnutrition that characterized by growth rates that do not meet expected standards for children < 3 years old
Weight for age < 5th percentile on multiple occasions (3 or more visits) OR weight decline that crosses two major % lines on the growth chart
Possible Causes of FTT
Puts kids at risk for…
Possible Causes:
- Inadequate energy intake
- Inadequate nutrient absorption
- Neglect
- Underlying genetic condition
Increased risk of…
- Growth deficiency/Short stature
- Susceptibility to childhood disease
- Heart disease later in life
- Affects brain development
Organic vs. Nonorganic FTT
S/S
Organic: chronic
- Disease/disability that affect digestion, absorption
- Can be common with SBS
- Example: GERD, Chronic Diarrhea, cerebral palsy
- S/S = vomiting, diarrhea, abd distension
Nonorganic
- Poor growth with no medical diagnosis
- Commonly associated with DD, abnormal behavior, autism, and/or an altered infant-caregiver interaction
- S/S = food restriction, food rituals, and poor appetite
Management Goals of FTT
Rule out:
Nutrition with appropriate weight gain
- Parenteral/enteral/milk donor/fortifier etc
- 4-6 months: double birth weight
- Healthy weight gain from 0-6 months is 5-7 oz/week
Promote weight gain and monitor improvement in lab work
- Prealbumin (20-40 mg/dL)
Find the cause & Treat it.
Parent and Caregiver Education
Rule Out: Abuse
Emergent Intervention of FTT
- Fluid rehydrate
- Promote nutrition (parenteral/enteral) -> check blood sugars*
- Daily weights (same time, same thing on, preferably no clothes)
- Strict I/O, weigh diapers
- Keep in hospital till adequate weight gain
- Specialty care: PT, OT, speech, therapy
Short Bowel Syndrome
What is it?
Causes?
S/S?
*SBS is caused by an insufficient length of the small intestine.
*Congenital
- Intestinal problems that your baby was born with.
- Intestinal atresia or stenosis
- Gastroschisis
- Volvulus
- Hirschsprung’s (severe)
*Illness
- NEC: an illness that damages the intestinal tissues in babies and can lead to holes or areas of narrowing (strictures) in the intestines.
- Crohn’s
- Ulcerative Colitis
*Traumatic
- Traumatic injury to small bowel
- Bowel perforation
- Abdominal wall blunt trauma
*S/S:
- Abd pain
- Weight loss
- Dehydration
- Diarrhea
- Vomiting
- Mineral/vitamin deficiencies
Diagnostics for Short Bowel Syndrome
*Diagnostic Imaging
- Abdominal US to evaluate blood vessel structures and various organs
- Abd Xray with contrast material to better define the GI anatomy and function
*Endoscopy
- A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract.
- Tissue samples from inside the digestive tract may also be taken for examination.
- In some cases, fluid is collected during an endoscopy to help aid with diagnosis and treatment of small bowel bacterial overgrowth.
*Colonoscopy
- A test that uses a small, flexible tube with a light and a camera lens at the end (colonoscope) to examine inside the large intestine
- Tissue samples from inside the digestive tract may also be taken
*Barium Swallow
- Modified barium swallow to analyze upper GI anatomy and function
Treatment Expectations for SBS
Nutritional Support
What is associated with SBS?
Nutritional Support
- Parenteral: via IV/CVC (TPN/Lipids)
- Enteral: via NG/OG/G or J Tube (Formula)
- Important to always check your patient’s glucose no matter the route
Dumping Syndrome is associated with SBS
Poisonings
Ingestions vs. Poisonings
Accidental vs. Intentional
Ingestion is on purpose = intentional poisoning
Poisoning = intentional vs. unintentional
- Accidental vs. Intentional
- Accidental ingestion: kid consumes pills, cleaners
Poisonings
Emergent Nursing Care
*Detailed patient history
- History of event
*Vitals & Bloodwork
*Urine Drug Screen
*Continuous Cardiopulmonary Monitoring
- Interventions as needed
*Notification of Poison Control: provider driven on following recommendations
- Poison Control: recommendation only; document what they tell you in the EMR for legal/liability coverage for you as the nurse and the hospital treating the patient and follow what the MD orders for the patient to receive as ordered treatment. If they differ, that is okay, just be sure to DOCUMENT!
- Medication Admin if indicated
*Radiology (if indicated)
*Possible Hospitalization - admit for cardiac involvement, seizures, airway adjunct
Education about Battery Button
Do not let child swallow button battery, saliva creates a chemical reaction and burns a hole in the esophagus.
IF the child is over one, you can give them honey
IF the child is under one, do NOT give honey
Nephrotic Syndrome
Patho
Clinical Presentation
Types
- The loss of protein in the urine changes the oncotic pressure within the intravascular space causing intravascular depletion and extracellular edema.
- Massive Proteinuria (4+), Edema, Hypoalbuminemia, Hyperlipidemia with no known etiology
- Tachycardia, oliguria, and orthostatic hypotension
Types - Minimal change: most common
- Focal segmental glomerulosclerosis
- Membranoproliferative glomerulonephritis
- Mesangial proliferative glomerulonephritis
Nephrotic Syndrome
Children are at high risk for…?
Infection
- The most common complication, followed by thromboembolism
- Spontaneous Peritonitis due to immunosuppression from steroids
- All of a sudden abd pain and distension and fever
Thromboembolism
- The combination of immunosuppressive therapy (steroids) and the increase in platelet aggregation that occurs with nephrotic syndrome as well as the loss of coagulation inhibitors (proteins) in the urine
Nephrotic Syndrome
Diagnostic Tests
*Urinalysis and Lab Work
- Massive Proteinuria (+4 or more)
- C3 and C4 proteins in the blood indicates inflammation. Usually will be decreased in Nephrotic Syndrome
- Coags: Fibrinogen, pTT, D-Dimer are elevated due to platelet aggregation. Proteins are clotting inhibitors = if proteins are gone, clotting increases
- Hypoalbuminemia
- Hyperlipidemia
*Renal US if needed: possible structural abnormalities
*CXR if if pleural effusion is suspected
Nephrotic Syndrome
Nursing Care
*O2 for Distress
*IVF at 20 ml/kg - hemodynamics - based on I/O
*Corticosteroid and Diuretic Treatment
- IV diuretics q 6-12 hours
- Prednisone: helps kidneys, decrease inflammation
*Strict I&O
- 1 mL/kg per hour = adequate urine output
- If low, increase diuretic or fluids
*Fluid restrictions
*Daily Weights
*Diet Restrictions: Low Sodium
*Broad spectrum abx should be initiated as soon as we think infection; sensitivities can help with type at a later time.
*Labs
- Coagulation - risk for thromboembolism
- CMP
- UA
