TLO 2.4 Gastrointestinal/Bowel Child Flashcards
Functional differences in the colon of a child
Large intestine of children is shorter than adult
Less epithelial lining to absorb water from feces resulting in softer stool and more rapid peristaltic waves
Fever increases the rate of peristalsis
Stool frequency in infants, bottle vs breast, color
Bottle: 1-3 per day
Breast: 4-6 per day
Color: dark green first week then yellow
Causes of constipation in children
Changes in diet Dehydration Lack of exercise Emotional stress Medication Pain from anal fissure Excessive dairy intake
Diagnosis of constipation
Abdominal x-ray: enlarge rectum with stool and gas present
Rectal exam: rarely performed r/t emotional impact
Thorough history usually sufficient to diagnosis
Constipation treatment
Best through prevention
Dietary modifications:
increase water and fiber intake
decrease sugar and milk intake
Teach:
sit child on toilet 5-10 min approx. 30 min after breakfast and dinner
offer charts and prized to reward success
proper use of enema is physician suggest
Infectious Gastroenteritis (infectious diarrhea): causes
Rotavirus: most common viral cause
Giardia: most common pathogen in daycare setting
Communicable diarrhea
Massive fluid and electrolyte loss
Sepsis
Death
Giardia: incubation, spread, s/s, diagnosis, treatment
Incubation: 1-2 weeks. Most common parasitic diarrhea
Spread in contaminated food and water
S/S: afebrile, abdominal distention, cramps and gas
Diagnosis: ova and parasites found in stool
Treatment: Flagyl x7 days
Contact precautions
Rotavirus: incubation, spread, s/s, diagnosis, treatment
Incubation: 1-3 days. Common in winter months
Spread by fecally contaminated food
S/S: vomiting, diarrhea, low grade fever. Last 3-7 days
Diagnosis: virus in stoll detected enzyme immunoassay
Treatment: no pharmacologic treatment, supportive care, maintain hydration, rotavirus vaccine at 2, 4, 6 months
Contact precautions
Gastrointestinal/bowl assessment finding?
Assess hydration status Dry mucus membranes Poor skin turgor, crying without tears Sunken fontanel in infants Increased respiratory rate r/t metabolic acidosis
Gastroenteritis teaching
Wash hands frequently
Child to use separate bathroom if available
Administer PO fluids to rehydrate
Avoid fruit juices, cola, tea, sugary drinks, sports drinks
Continue breast mild and formula
No OTC without asking doctor
Call PCP when: diarrhea worsens/blood s/s dehydration vomiting increases and cannot keep down any fluids child reports severe abdominal pain child hasn't urinated for over 6 hours
Intussusception, what is it?
Folding of one part of the intestine into another causing bowel obstruction. Occurs around 3-6 months
Relatively rare usually but when occurs it is and emergency
Recurrence does sometimes occur
Causes of intussusception?
Unknown
Contributing factors:
Preexisting URI or other vial infection
Pathologic condition within the colon (mass/defect)
More common in boys than girls
Children with cystic fibrosis are more susceptible
Intussusception diagnosis and prognosis?
X-ray: gas patterns like bowel obstructions
Ultrasound: identifies location of intussusception
Barium or air enema: reduces the obstruction (both diagnostic and treatment) 80-95% effective
Prognosis: death is uncommon, 80% success with nonsurgical
Intussusception assessment
History reveals sudden crying and flexing legs in infants
Pain that come and goes and progresses to constant severe
Bloody mucus currant jelly stools/diarrhea, vomiting
Sausage shaped abdominal mass
Intussusception assessment >12-24 hours
Shock Sepsis Listlessness Fever Decrease LOC Increased heart rate Blood pressure changes
Intussusception treatment
Spontaneous reduction occurs in <10% of cases
Conservative treatment:
-Radiologist guided pneumo enema (air enema)
-Barium enema, 80-95% effective
Ultrasound guided hydrostatic (saline) enema
-Prior to hydrostatic procedure: IV fluids, NG decompression, antibiotic therapy
Surgery is conservative treatment fails
Intussusception nursing interventions
Observe passage of barium following BE
Monitor stools, passage of normal stool color indicates resolution
Assess for s/s bowel obstruction
Monitor for normal bowel function
NPO post op until bowel function returns
Listen to parents description of symptoms
Hirschsprung disease, what is it?
AKA Congenital Aganglionic Megacolon
Strong heredity component, Down Syndrome
Results from absence of ganglion nerve cells in the rectum that regulate the activity of the colon
Can be acute, life threatening or chronic condition
Major cause of lower bowel obstruction in infants
Hirschsprung disease assessment
Pellet or ribbon like foul smelling stools Distended abdomen Refusal to feed/intolerance Bilious vomiting Delay in passage of meconium Growth failure Constipation problems since birth Episodes of diarrhea/vomiting
Hirschsprung disease, signs of enterocolitis
Inflammation of the small bowel and colon
Fever
Abdominal distention
Diarrhea
May be severe with life threatening dehydration or sepsis
Hirschsprung disease diagnostic tests
Rectal exam: tight anal sphincter and absence of stool followed by explosive release of gas and stool
Barium enema: reveals change in size in color
Anorectal manometric exam: tube inserted rectally has balloon that filled with air to measure function of muscles and nerves inside rectum
Definitive diagnosis: punch biopsy shows absence of ganglionic cells
Hirschsprung disease medical management
Relieving chronic constipation
- stool softeners
- isotonic enema
- low residue diet
Surgical intervention
- removes aganglionic portion of bowel
- 2 stage surgery most cases
Botox: to relax anal sphincter
Hirschsprung disease nursing intervention
No rectal temp Assess change in abdominal circumference Bowel sounds Prepare child for surgery Prevent infection Maintain skin integrity Maintain nutrition and hydration Reduce pain NPO, NG tube, intermittent suction
Appendicitis, what is it? Causes?
Inflammation and infection of the vermiform appendix
Causes:
lymphoid swelling r/t viral infection, impacted fecal material, foreign bodies, parasites
often no cause found
