Updated GI Disorders Flashcards
What are indicators of fluid status?
Urinary output, mucous membranes, capillary refill, decreased skin elasticity and turgor, decreased blood pressure, increased HR, sunken eyes and fontanels
T or F. Compared to older children and adults, infants and young children have a greater need for water and are more vulnerable to alterations in fluid and electrolyte balance?
TRUE
Fluid losses can be divided into 3 categories, what are they?
Insensible losses (occur through the skin), Urinary, and Fecal
Heat and humidity, body temperature, and respiratory rate influence what type of fluid loss?
Insensible losses
Name 4 sources of fluid loss
Diarrhea, NG tube drain, polyuria, third spacing. If fluid intake and output are not matched, fluid imbalance can occur rapidly.
Sarah weighed 19lbs and 8 ounces at her MD visit last week. Today she weighs 8.1 kg, what is her weight loss (percent of dehydration)?
8.6 percent
Insufficient use of nutrition to meet the demands for growth
Failure to thrive (FTT)
Premature birth, GERD, short bowel syndrome, malabsorption, and cleft lip are all examples of what?
Organic causes of FTT
State of cachexia caused by environmental factors describe what?
Inorganic causes of FTT. This includes abuse, inadequate preparation of formula by caregiver.
Abnormal signs and symptoms of MILD dehydration (3-5 percent)?
Tachy or slightly dry buccal mucosa, normal or mildly reduced UO, increased thirst.
Abnormal signs and symptoms of MODERATE dehydration (6- 9 percent)?
Rapid pulse, normal to low SBP, deep and increased RR, dry buccal mucosa, sunken anterior fontanels, sunken eyes, cool skin, reduced skin turgor, markedly reduced UO, listlessness and irritability.
Abnormal signs and symptoms of SEVERE dehydration (more than 10 percent)?
Rapid and weak or absent pulse; low SBP, deep; tachypnea or decreased to absent RR; parched buccal mucosa; markedly sunken anterior fontanels; markedly sunken eyes; tenting skin turgor; cool, mottled, acrococyanosis skin; anuria; grunting, lethargy, coma
What are 6 common causes of Infantile Colic?
Allergic reactions, GERD/ acid reflex, overstimulation, gas producing foods, air intake (from feeding or crying), immature digestion and nervous system
You’re caring for a child you suspect has Infantile Colic. What are 6 common symptoms you expect to see?
Trapped stomach and intestinal gas, abdominal bloating, acute gastric and intestinal pains, intense and prolonged crying, sleeplessness/ exhaustion, stressed out parents
T or F. In the US, almost 200,000 under 5 are hospitalized for gastroenteritis and approx 200 children under 5 die of diarrhea and dehydration each year?
TRUE
T or F. Acute gastroenteritis is caused by a variety of viral and bacterial pathogens only?
False. It is caused by a variety of viral, bacterial, and parasitic pathogens, such as rotavirus, e.coli, salmonella, and staphylococcus organisms.
BUN, SG, Lytes, Stool culture and stool WBC, O and P, and UA are common diagnostic test used to identify what condition?
Gastroenteritis
Baby Amy is admitted for acute gastroenteritis. How will you treat her?
Assess state of hydration, correct fluid and electrolyte imbalance, and give PO ASAP (very mild, like pedialyte)
In regards to treatment for gastroenteritis/ acute diarrhea, what are the 4 major goals the management of this condition?
- Assessment of fluid and electrolyte imbalance 2. Rehydration 3. Maintenance fluid therapy 4. Reintroduction of an adequate diet.
T or F. Infants and children with acute diarrhea and dehydration should be treated with fluid replacements, such as juice or plain water?
False. Infants and children should be first treated with oral rehydration therapy (ORT) and avoid juice, soda, and plain water
How is FTT managed?
Identify the cause (prenatal hx, patient’s hx, current home practices), treat underlying cause to catch up weight gain by nutritional intervention and behavior modification, provide family support
In patients with gastroesophageal reflex, the lower esophageal __________ is open allowing reflex.
Sphincter
The MD on your floor has just reviewed Baby Johnny’s diagnostic tests and has diagnosed him with gastroesophageal reflex (GERD). What tests did the MD evaluate to reach this diagnosis?
Upper GI series and PH probe
T or F. GERD becomes a disease when complications such as FTT, bleeding, and dysphagia develop/.
TRUE
How is GERD managed?
By providing small, frequent feedings and implementing reflex precautions
What is included in reflex precautions?
thickening feedings with one tablespoon of rice cereal per ounce of formula and elevating the HOB 30 degrees after feeds.
Tagamet and Prevacid are examples of medications used to treat what condition?
GERD. Tagamet is a H2 Receptor antagonist and Prevacid is a PPI
Before a Nissen Fundoplication (surgery to tx GERD) can take place, what must first be observed and documented?
FTT, Esophagitis, and Recurrent aspiration pneumonia
This disease is described as the congenital absence of autonomic parasympathetic ganglion cells in a distal portion of the colon and rectum.
Hirschsprung Disease (HD). It is a mechanical obstruction caused by inadequate motility. Because there is no nerve stimulation, substances collect there and stretch the colon
What is the first sign of HD in infants?
Failure to pass meconium within 24 to 48 hrs after birth
In addition to failure to pass meconium, what are other common symptoms of HD?
Abdominal distention, vomiting, poor feeding, constipation, diarrhea and vomiting.
Ribbon like stools is a common symptom of _____ in older children
HD. Younger children are usually constipated
T or F. For patients with HD, it is best to assess their temperature orally?
False, you should take their axillary temp (hesi hint)
What is another name for HD?
Congenital Aganglionic Megacolon
T or F. Any section of the colon can be affected in HD?
True, however the lower the defect, the better.
What is the primary nursing diagnosis for patients with pyloric stenosis?
Alteration in nutrition, less than bodily requirements related to frequent vomiting
T or F. The younger the child, the more vulnerable they are to fluid and electrolyte imbalances and the greater is the need for caloric intake required for growth?
True. Nutritional needs and fluid and electrolyte balance are key problems for children with GI disorders.
T or F. Fecal contents accumulate BELOW the aganglionic area of the bowel?
False, ABOVE
Baby Mike is diagnosed with HD and his parents want to know how the MD plans to correct it, what would you say?
Correction usually involves a series of surgical procedures (2). A temporary colostomy and later, a reanastomosis and closure of the colostomy.
When managing HD, what are 3 important interventions to keep in mind?
Keep patient NPO, initiate fluids to fluids to correct FE imbalance, and IV antibiotics if sepsis and enterocolitis is suspected.
How is HD diagnosed?
Biopsy to confirm intestinal involvement.
Baby Mike is scheduled for surgery to correct his HD the following day. What pre-op tasks are most important to complete?
Give him an ENEMA, fluid and electrolyte correction, early central lines and nutritional support, IV antibiotics administration
Post-op care for Baby Mike (HD) should include?
ostomy care, parental education and support for second surgery (pull through procedure with ostomy takedown) later on
Name 5 conditions that are considered surgical emergencies.
Malrotation, pyloric stenosis, intussusception, appendicitis, and incarcerated inguinal hernia
When is an incarcerated ingunial hernia considered an emergency situation?
When there is a color change. Assess for hernia discoloration.
T or F. An incarcerated hernia is very common in preemie girls?
False. It is more common in preemie boys
Baby Timmy is admitted to the ER and you suspect that he has an incarcerated hernia. What symptoms helped you reached this conclusion?
Edematous inguinal hernia with erythema.
When is surgery for an incarcerated hernia usually performed?
When manual reduction (applying pressure and analgesia) is not successful or the hernia has been incarcerated for more than 12 hours.
This surgical emergency is described as hypertrophy of the pyloric sphincter and narrowing of the pyloric canal
Pyloric stenosis
T or F. Pyloric stenosis usually occurs in first born females?
False, first born males. 4 to 1 (boys to girls)
When is pyloric stenosis most often first recognized as an issue?
When babies are 2 to 4 weeks old or during the first few months of life.
T or F. For patients with pyloric stenosis, vomiting usually begins after 14 days of life and becomes projectile?
True.
What are the most common signs and symptoms of pyloric stenosis?
Projectile vomiting, hungry, fretful infants, weight loss, dehydration, olive shaped mass in RUQ that is palpable, visible peristaltic/ gastric waves
T or F. In regards to pyloric stenosis, the prognosis following surgery is excellent?
True.
Small intestine fails to UNTWIST itself during gestational period
Malrotation. Midgut does not rotate correctly and twist occurs (volvulus)
T or F. Malrotation by itself is not considered an emergency?
True. When volvus is included however, it becomes an emergency.
A common sign of Malrotation with Volvulus is bilious vomiting related to obstruction. What color is this emesis?
Green
T or F. Malrotation with Volvulus is compatible with life?
False. This condition is not compatible with life. Emergency surgery is needed to avoid bowel necrosis and or death.
Intussusception
Telescoping of one part of the intestine into another part of the intestine, usually the ileum into the colon.
T or F. In regards to intussuseption, blood vessels become trapped in the telescoping bowel, causing necrosis.
True. Blood flow is cut off distally from telescoping and a partial or complete bowel obstruction occurs.
In what age would you expect children to be diagnosed with Intussuseption?
6 to 18 months
T or F. Intussuseption is more common in boys than girls?
True. 3 to 1 (boys to girls)
What are common sign and symptoms of intussuseption?
Colicky abdominal pain, episodes of screaming with legs/ knees drawn UP to abdomen every 15 mins, vomiting, currant jelly stools, sausage shaped mass in RUQ.
What are currant jelly stools?
Stools mixed with blood and mucus. This is a LATE symptom of intussuseption that indicates sloughing of intestines.
How is intussuseption usually managed?
Fluids resuscitated if indicated, abdominal US, iodinated contrast or air enema to reduce it, image guided reduction (for recurrent cases), and laparotomy.
Abdominal pain that starts in the periumbilical area and migrates to RLQ. This condition results from the inflammation of the VERIFORM appendix.
Appendicitis
What are the classic first symptoms of appendicitis?
Periumbilical pain, followed by nausea, RLQ pain, and later vomiting with fever.
What 2 assessments can help determine if a patient has appendicitis?
Low grade temp and the hop off the table test.
T or F. Perforation of the appendix can occur approx 48 hrs of the initial complaint of pain?
True. If perforation occurs, you will notice decreased bowel sounds, distention, and abdominal pain in the patient
Why should you be worried about the risk of perforation of the appendix?
Perforation is an emergency situation due to risk of peritonitis. It causes fecal and bacterial to spread in the abdomen resulting in infection.
What does post op care for a ruptured appendix include?
A focused assessment and focused interventions to relieve pain, infection, and fluid and electrolyte imbalance
T or F. Colic is self limiting?
True, patients will outgrow it
Bacterial, viral, and fungal invasion of lower and or upper urinary tract
UTI. However, UTIs are most commonly caused by e.coli (80 percent).
Identify 5 risk factors for UTIs
Vesicoureteral reflex, female anatomy, uncircumcised males, neurogenic bladder, constipation, infrequent voiding, poor hygiene, and sexual activity.
T or F. 20 percent of bacterial UTIs are asymptomatic?
False, 40 percent are asymptomatic
What are the most common symptoms of cystitis (bladder infection)?
pyrexia, pyuria, hematuria, dysuria, urinary frequency and foul smelling urine
What are the most SERIOUS symptoms of pyelonephritis (kidney infection)?
ALL of the symptoms of cystitis, plus back or flank pain, abdominal pressure or pain, chills, high fever, extreme fatigue, and emesis.
What is a common issue that results from recurrent UTIs?
More scarring on the kidneys occurs with recurrent infections. Scarring can eventually lead to the need for dialysis
The most common diagnostic tests for a UTI are an UA and Culture, how is this performed?
By collecting a clean catch of urine, catheterization, or from a suprapubic tap
T or F. When collecting urine for a UA, it is best to use the first void of the day?
TRUE
When is a renal ultrasound and VCUG used as a diagnostic test?
For patients with recurrent UTIs
Why is pyelonephritis more serious than cystitis?
The kidneys are above the bladder, therefore it becomes more serious the higher the infection is. Requiring more aggressive treatment
T or F. Tx for UTIs usually require antibiotics for 7 to 10 days?
True. It can be given IV (Ceftriaxone) or PO (Bactrim, Keflex).
In regards to UTI management, what else should be considered besides follow up urine cultures every 1 to 2 years?
Education for prevention and the importance of increasing fluid intake.
VCUG
Voiding cystourethrogram
Nephrotic Syndrome
A kidney disorder characterized by 3 clinical signs, proteinuria, edema (facial and lower extremity), and hypoalbuminemia and hyperlipidemia
Baby Jess is admitted for Nephrotic Syndrome. What symptoms would you expect to see?
Weight gain, stretched skin, periorbital edema that progresses to general edema, respiratory difficulty, dark, frothy urine but with decreased output
Corticosteroids, IV albumin, diuretics, and a no salt diet is a common treatment plan for which condition?
Nephrotic Syndrome. For resp distress, apply O2.
This disorder is characterized by increased glomerular permeability to plasma protein, which results in massive urinary protein loss.
Nephrotic Syndrome.
A disease of the kidney in which there is severe inflammation of the glomerular capillaries as a reaction to group A streptococcal infection.
Acute glomerulonephritis. The onset of the dz is preceded by post strep infections, such as a viral URI
Common S/S of Acute Glomerulonephritis include?
High fever, sudden onset of hematuria, hypertension and circular congestion, edema and proteinuria.
What does an elevated positive ASO titer indicate?
That the immune system is working overtime
Common dx tests used for Acute Glomerulonephritis include?
Blood tests (ASO titer, BUN, Cr), US, CT scan and biopsy
Proteinuria, azotomia, and hematuria are all indicators of what?
Acute glomerulonephritis (AG).
T or F. To prevent AG, you should treat the underlying cause first?
TRUE
Besides prevention, management of AG includes?
Fluid restriction, diuretics, penicillin to eradicate strep, corticosteroid to suppress the immune system, and monitoring of BP and UO.
What is the best treatment for mild and moderate dehydration?
ORS. They enhance and promote the reabsorption of sodium and water.
These solutions greatly reduce vomiting, volume loss from diarrhea, and the duration of the illness
ORS.
T or F. ORS is also given to replace ongoing loss of STOOL in both the MILD and MODERATE dehydration phases?
True.
Baby Alex comes into the ED and is Dx with MILD dehydration. What is the most important nursing intervention to perform at this time?
ORS 50 ml per kg over 4hrs and q2h reassessment of Alex’s hydration status and ongoing losses.
Baby Meredith comes into the ED and is Dx with MODERATE dehydration. What is the most important nursing intervention to perform at this time?
ORS 100 ml per kg over 4hrs, q1h reassessment of Meredith’s hydration status and ongoing losses.
T or F. Unlike treatment for MILD dehydration, treatment for MODERATE dehydration MUST be done in a medically supervised setting?
True.
T or F. In regards to ORS, you should add the ongoing losses to the next hour of ORS?
True.
How will you know that a patient has SEVERE dehydration?
Based on your percentage of dehydration calculation (10 percent or more) and other findings, such as symptoms.
T or F. SEVERE dehydration is a medical emergency that requires emergent ORS administration?
False. It is an medical emergency that requires emergent IV therapy with rapid infusion of 20 ml per kg of ISOTONIC saline.
A rare, uncommon acute renal dz that affects children under the age of 10 that is thought to be precipitated by E Coli from contaminated food and water
Hemolytic Uremic Syndrome (HUS)
T or F. in HUS, platelet aggregation that results from damage to the glomerular endothelium produce thrombocytopenia?
True. Platelet aggregation leads to destruction of RBCs, thus causing obstruction to the tiny vessels in the kidneys. The end result is Acute renal failure
Common S/s of HUS include?
Vomiting, irritability, lethargy, marked pallor, oliguria or anuria, CNS symptoms such as seizures, coma, or stupor; bruising, petechiae, jaundice, and bloody diarrhea; Acute heart failure (sometimes).
How is HUS managed?
PREVENTION, fresh frozen plasma, plasmapheresis, dialysis for oliguria for more than 24hrs.
Hypospadias
Characterized by the urethral opening on ventral surface of the penis. The urinary meatus is located on the ventral surface or anywhere along the penile shaft.
T or F. Repair of Hypospadias should be done before age 5?
False. Before potty training.
T or F. Circumcision on a male with Hypospadias is ok before correction?
False.
Twisting of the testicle on its spermatic cord that occurs in infants and children between the age of 10 and 14.
Testicular Torsion
Testicular Torsion is a SURGICAL EMERGENCY. What are the common s/s of the condition?
Sudden onset of unilateral pain; N/V; edematous, red, taut, scrotal skin; firm, fixed swollen testicle
Enuresis
Involuntary voiding after established control
What is the difference between primary and secondary enuresis?
Primary- no history of dryness; Secondary- occurs in kids who have been bladder trained for 6 months or more, and is also inherited.
What are 3 causes of Enuresis?
Emotional stress, possible organic factors, and inappropriate toilet training.
T or F. Scientific evidence demonstrates potential medical benefits of newborn male circumcision?
True, however these data are not sufficient to recommend routine neonatal circumcision.
