UNIT 2 GI PEDI Flashcards
True or false: The distribution of water does not change with growth?
False
What % water makes up a term newborn and decreases to ___% in late adolescents?
- 75%
- 45%
Premature babies require even more water
Under normal conditions the amount of water we ingest should relate to….
How much urine we excrete in a 24 hour period
Water & electrolyte imblanaces occur more frequently & more rapidly in what age population?
Infants
children adjust less quickly to these changes
What are sensible water loss?
Losses that can be measued and we are more aware of… like urine, vomiting… measurable fluid loss
What is insensible water loss?
Fluid loss that cannot be measured… perspirations, fluid loss through lungs, fluid in poop…
What are important factors in fluid loss?
- Insensible fluid loss
- 2/3 of insensible water loss occurs thorugh the skin, 1/3 happens through the resp. tract.
- example of insensible water loss… since childrens immune system is not as mature infants and children are more prone to infections… with infections your chances to sweat increases… and even your respirations may increase…
- Body surface area
- infants and children have an increased body surface area… the smaller the patient the larger body surface area…
- Basal metabolic rate
- Higher in children…because of there larger body surface area… any condition that increases there BMR causes greater heat production which leads to insensible fluid loss… higher to support tissue and cellular growth.
- Kidney function
- Not fully developed so they are functionally immature at birth… they are **inefficient in excreting waste products of metabolism so infants kidney have a harder time being able to concentrate and dilute urine. **
- Fluid requirements
- Have higher fluid requirements… maintance fluid have to include both water and electroloytes
What are different types of distubances of fluid and electorlyte imbalances?
- Water intoxication
- Causes: too much water, electrolyte free water can lead to water intoxication, consistent tap water enemias, incorrectly mixed formula, hypotonic fluid admin.
- What happens when you drink to much water is that it decreases your serum sodium which can actually worsen dehydration
- Dehydrations
Causes: Incorrectly mixed formula… too much formula not enough,
What are different types of dehydration?
- Isotonic
- Water and electrolytes are decreased in balanced proportions
- Sodium level normal
- Hypotonic
- Electrolyte deficit exceeds the water deficit
- More water less electrolytes so sodium is decreased.
- Hypertonic
- Water loss in excess of electorlyte loss
- More electrolytes less water… increased sodium
**- slowly hydrate this patient. **
What is the most important determinant of total body fluid loss in infants & young children?
- Weight.
What are clinical manifestations of dehydration?
- Depends on the degree of dehydration
- Dry mucous membrane
- Decreased skin turgor
- Dark Urine
- Sunken fontenales
- Lethargic
- Extremities will be cool to the touch
- No tears
- Dry mucous membrane
- **Earliest detectable sign is usually tachycardia **
- Compensatory mechanisms
What is a very late sign of dehydration?
Drop in blood pressure
What is the treatment for isotonic and hypotonic dehydration?
- Inital phase of IV therapy is rapid fluid replacement
- May need a bolus or two
What is the treatment of hypertonic dehydration?
Rapid infusion of IV fluid may lead to cerebral edema (central pointine myelinoysis)
How much weight loss is cause for concern in a pedi patient?
1-2 weight loss within 24 hours but mostly dependant on situation and trend
True or false: Pulse ox may not work well if dehydrated?
True
If a child is in mild or moderate dehydration what should we do?
- Enteral (PO) rehydration
- Oral replacement therapy (ORT) over 4-6 hours
- Goal is to keep fluids in them and down.
- Provide at least minimum fluid requirements
How are we going to know that our ORT is working?
Urine output increases
If a child is in severe dehydration what should we do?
Parenteral (IV) rehydration
1. Severe- child is unable to keep enough fluids and electrolytes down to:
- Meet daily physiological needs
- to replace previous deficits
- To replace ongoing abonormal losses
What is considered acute diarrhea?
<14 days
self-limiting
often seen in viral infections
What is considered chronic diarrhea?
> 14 days
related usually to chronic conditions…
lactose intolerant, IBD
What do we need to do for exterme amounts of diarrhea?
We want to replinish loss to avoid dehydration and get back to normal urine output. Once we achieve that we want to restore childs diet to a normal diet
What is rotavirus?
Viral infection and the most common cause of acute diarrhea in children less than 5 years.
When is rotavirus more severe age wise
Infants 6-12 months… remember the smaller the patient the more they will be affected by the fluid loss
What route is the immuization of the rotavirus given?
Oral
How is rotavirus spread?
- Fecal-oral route
- Person-to-person
What symptoms does rotavirus produce?
- Very watery diarrhea which can be severly dehydrating
- fever
- vomiting
- Very distint foul smell
How long does the diarrhea from rotavirus last?
2-7 days
Does infection mean immunity for Rotavirus?
No- so if they have the oral vaccine it doesnt mean they wont get it. It will just be a less severe case
What are some interventions and education for Rotavirus?
- Hand washing
- Change diapers frequently and dispose of properly
- Anti diahhrea meds prolong the shedding of the virus so it is not recommended
- Avoid fruit juices and carbonated drinks since they are high carb, low electorlyte, and high in sugar. Could increase diarrhea
- Chicken soup avoid high in sodium… futher dehydrates patient
- Fluid replacemtn thearpy- pedialyte
What is constipation?
A decrease in bowel movement frequency or trouble defecating for more than 2 week
What are some causes of constipation?
- Failure to pass 1st stool after birth
- Low thyroidism: alot of the bodys functions tend to slow down
- Imperforated anus
- Strictures and/or anal fissures
Between formula fed and breast fed infants who is going to have the most stool output?
Breastfed
True or false: If at any time mom switches from breastfed to formula we do not need to inform mom that babies poop and frequency will change?
False– we need to tell mom
Can stress cause constipation
Yes
What is a common cause of constipation in school aged children?
Fear of going at school
What can we do to help prevent constipation?
- Dietary restirctions- as they get older and begin to eat we can increase the amount of fruits, cerals, fiber and fluid intake… we can educate to avoid cheese
If the problem continues we can recommeded OTC stool softners
What is Hirschsprung disease
AKA congenital ananglionic megacolon
Congenital anomoly that results from a mechanical obstruction from inadequate motility of part of the bowel caused by a absence of ganglion cells
What are ganglion cells?
Nerve cells that coordinate perstalisis
What is the patho of Hirschsprung diesase?
- Absences of ganglion cells
- Absence of peristalisis
- Loss of retrosphincteric reflex
- Sool accumulation
- Megacolon
- Intestinal ischemia may devlope
- Enterocolitis may develop
- damage to the mucosal cells linging the bowel wall. Which decreases blood supply and lead to cell death.
What are the clincal manifestations of hirschsprung in infants?
- Failure to pass meconium
- Abdominal distention
- Feeding intolerance/vomiting
What are clincal manifestations of hirschsprung in older children?
- Constipation
- Diarrhea and/or ribbon-like, foul smelling stools
- Easily palpable stool mass.
How is Hirschsprung diagnosed?
Rectal biopsy… looking for ganglion cells
How is Hirschsprungs treated?
Surgery- Hirschsprung’s endorectal pull-through.
What are some pre/post op considerations?
- Nothing per rectum
- Monitor stool output
- Monitor abdominal circumferences
- Prep Iv and do prophylactic antibiotics
- Post IV used for pain meds but with caution due to pain medications affect on GI issues
What is gastroesophageal Reflux?
The transfer of gastric contents into the esophagus
How is Gastroesophageal reflux diagnosed?
- Hx & physical assessment
- Upper GI series
- For anatomical abnormalities related to refulx.
- 24-hour intraesophageal monitoring
- Endoscopy w/ biopsy
- Helps detect the seveirty of the esophagitis
- Scintigraphy
- Detects radioactive substances after feeding can also assess gastric emptying.
At what age do we start seeing issues with Gastroesophageal reflux
In infants aroud 4 months of age but usually out grow it by 1 year…
GERD is seen in what age population?
Adults
Reasons for reflux include?
- All liquid diet
- Infants are born with a more relaxed esophegeal sphincter
- Delayed gastric emptying
How long should you have a baby sit up after feeding to help prevent reflux?
30 mins
What are some clinical manifestations of reflux in infants?
- Spitting up/vomiting (passive regurgitation)
- Irritabily
- Arching of back
- Poor weight gain (need smaller more frequent meals)
- Chocking with feedings
- Respiratory issues
What are some clinical manifestations of reflux in children/adolecents?
- Heartburn
- Abdominal pain
- Chronic pain (after eating)
- Dysphagia
- Recurrent vomiting
- Horse voice
- Hx of asthma
What should we avoid with reflux
- Avoid foods that are acidic
- Avoid caffine
- Avoid citrus food
- Avoid spicy food
- Avoid peperment