Week 3 Chapter 42 Flashcards by Steven Singh

What are the primary functions of the GI?

GI includes mouth to anus.

Digestion and absorption of nutrients, water, and elimination of waste products, and secretion of substances for digestion.

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When is the GI system fully developed and mature at what age?

2 years old

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Highly vascular and makes it common entry point for infection.

Mouth

Commonly bring objects to the mouth.

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LES is not fully developed until the age of

1 years of age.

Causing regurgitation and reflex.

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What is the newborn stomach capacity?

10-42 mL

Increases to 200mL by several months of age

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Is the small intestine not functionally mature at birth.

True

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Cm of small intestine in infants?

250cm

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Cm of small intestine in adults?

600cm

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Small bowel loss equates to what type of problems?

Problems with absorption and diarrhea

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When do pancreatic enzymes adult age level?

Age 2.

Liver is large at birth.

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Who is at the greatest risk for fluid balance losses?

Infants and children.

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Infants and children have the least amount of body water than adults which places them at increased risk of fluid loss due to fever or GI upset.

False

Fluid balance and losses

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Prematurity
Family Hx
Genetic Syndromes
Chronic Illness
Prenatal Factors
Exposure to Infectious Agents
Foreign Travel
Immune Deficiency/ Chronic Steroid Use
Unvaccinated Children- Hep B vaccine reduces the lifetime risk

Risk Factors for GI Disorders

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Data Collected in the Physical Assessment

Inspection and Observation:
Child’s color, hydration status, abdominal size and shape, mental status

Auscultation:
Hyperactive or hypoactive bowel sounds.

Percussion:
Dullness, flatness, tympany

Palpation:
Reserve for last sequence: palpable kidneys may indicate tumor or hydronephrosis: RLQ pain may warn appendicitis

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Soft, muffled thud- like tone over fluid or solid organs (Liver or Spleen)

Dullness

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Soft, short tone over solid tissue like muscle and bone.

Flatness

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High Pitched, drum-like over gastric bubble (gas)

Tympany

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What is the most common result of GI illness is?

Dehydration requiring fluid therapy at home or in most serious cases in the hospital.

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Common Medical Treatments in GI

-Hydration: oral (preferred) enteral, and IV
-Providing adequate nutrition ( oral, enteral, and IV)
- Enemas and Bowel Preparations
- Ostomies- Surgical Opening into a digestive organ
- Probiotics: Support/ intestinal microbial flora.

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Common Laboratory and Diagnostic Tests

Abdominal Ultrasonography
Barium swallow, small bowel series
Blood work: amylase, electrolytes, lipase, LFTs
Esophageal Manometry/ Esophageal pH probe
Endoscopy ( Gastroscopy, colonoscopy)
Hemoccult, stool sample/ culture, stool O&P
HIDA Scan- hepatobillary
Liver biopsy
Lactose tolerance Test, Urea breath test

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Use a tongue blade to scrape a specimen into the collection container

Diaper Collection Technique

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How would obtain a stool collection on a runny stool?

-A piece of plastic wrap in the diaper may catch the specimen.
- Very liquid stool may require application of a urine bag to the anal area.

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Stool collection technique for older ambulatory child

First urinate in the toilet

Retrieve specimen a clean collection container fitting under the seat at the back of the toilet.

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Stool Collection for Bedridden child

Collect the specimen from a clean bedpan

Do not allow urine to contaminate the stool specimen

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Histamine -2 Blockers, PPIs Prokinetics Antibacterial/ Antibiotics Corticosteroids/ Immunosuppressants Stimulants/ Laxatives Antidiarrheals and antiemetics Anticholinergics Anti-Inflammatories

Medications for Management for GI Disorders

Stool diversions can be temporary or permanent Portion of the intestine is brought to the level of the skin to allow passage of stool

True

Nursing Steps for Performing Ostomy Care

1.Set up the Equipment - Warm wet washcloths or paper towels -Clean pouch and clamp -Skin Barrier powder, paste, and/ or sealant -Pencil or Pen -Scissors -Pattern to measure the stoma size 2. Take off the pouch ( may need to use adhesive remover or wet washcloth to ease pouch removal) 3. Observe the stoma and surrounding skin. Clean the stoma and skin as needed, allowing it to dry. 4. Measure the stoma, mark the new pouch backing, and cut the new backing to size. 5. Apply the new pouch.

Cleft Lip and Palate Meckel Diverticulum Hernias (inguinal and umbilical)

Structural Anomalies of the GI Tract

Most common congenital craniofacial anomaly occurring 1:700 births worldwide

Cleft Lip and Palate

Risk Factors for Cleft Lip and Palate

Maternal Smoking, prenatal infection , AMA, use of anticonvulsants, steroids, and other medications during early pregnancy.

This is associated with heart defects, ear malformations, skeletal deformities, and GU abnormalities.

Cleft Lip and Palate

Development of cleft occurs in?

Pregnancy

Tissue that forms the lip fuses by how many weeks of gestation

5-6 weeks Palate closes between 7 and 9 weeks

How many % of infants born with cleft lip also have cleft palate?

50%

Feeding Difficulties Altered Dentition Delayed or altered speech development Otitis Media Aspiration

Complications of Cleft Lip and Palate

When is cleft lip repaired at what months?Palate?

2-3 months 6-9 months

Result of an incomplete fusion of the omphalomesenteric duct during embryonic development

Meckel Diverticulum Fibrous band to connect the small intestine to the umbilicus

S/S of MD

Blood or mucous in stools Severe, colicky abdominal pain Complications Include - Bleeding - Anemia- May require blood transfusion - Intestinal Obstruction

What is necessary for children with MD?

Surgical Correction

Occurs when the processes vaginalis falls to close completely during the embryonal development

Inguinal Hernia - Abdominal or pelvic viscera to travel through internal inguinal ring to inguinal canal

If mass is felt, what may the MD do for Inguinal Hernia ?

Reduce it. Temporary If reduction is not possible, hernia could be incarcerated - Bowel Strangulation

When is surgical correction needed for infant with inguinal hernia?

Several Weeks old and has been thriving.

Occurs commonly in preterm infants

Umbilical Hernia

This is caused by incomplete closure of the umbilical ring allowing intestinal contents to herniate through the opening

Umbilical Hernia

When do we notify the surgeon for umbilical hernia?

Notify the surgeon Incarceration is rare

S/S of Umbilical Hernia

Abdominal Pain, tenderness or redness at the umbilicus

Spontaneous closure of umbilical hernia occurs at ?

4 years of age - Surgical Correction if large or fail to close

Dehydration, vomiting, diarrhea Oral Candidiasis and Oral Lesions Hypertrophic Pyloric Stenosis Intussusception, malrotation, volvulus Appendicitis

Acute GI Disorders

Risk Factors for Dehydration

Diarrhea Vomiting Decreased Oral Intake Sustained high fever DKA Extensive Burns - Important to document characteristics of the products related to vomiting or diarrhea ( volume, color, frequency)

Oral Rehydration Solution should contain

75mmol/ L sodium chloride 13.5 g/L glucose Standard ORS solutions include: Pedialyte, Infalyte, and Ricelyte

What is not appropriate for oral rehydration?

Tap water Milk Undiluted fruit juice Soup Broth

Mild to Moderate dehydration requires what?

50-100 ml/ kg over 4 hours

IV FLUID BOLUS rate is

20ml/ kg of NS over 20-30 min (max of 1L per bolus) - Reassess the Hydration status

MD may order IV fluids maintenance rate or 1.5 times maintenance

True 100ml/ kg 1st 10kg 50ml/ kg Next 10 kg 20ml/ kg for remaining kg Add for total 24 hr. and divide by 24 for hourly rate

Should one hang potassium when the patient has NOT voided?

No hold the K+ until the patient voids

S/S of Diarrhea and Dehydration

Sunken eyes and fontanels Dry mucous membranes Weight loss= Water Loss Fatigue, Lethargy Decreased Tearing Decreased Skin Turgor

Viral Infection is most common for diarrhea and dehydration?

True Leads to severe fluid and electrolyte depletion

Bacteria and parasites typically come from?

Undercooked food causing salmonella and poor sanitation or lack of clean drinking water. Diarrhea and Dehydration

Medications causing Diarrhea and Dehydration are?

Antibiotic and Laxatives Lactose Intolerance can cause diarrhea and dehydration

Interventions for Diarrhea and Dehydration

ORS- oral Rehydration Solutions IV Fluids: 20ml/kg- IV Normal Saline bolus (0.9 Sodium Chloride) or LR (Lactated Ringers )

S/S of Diarrhea and Dehydration

Sunken Eyes and fontanels Dry Mucous Membranes Weight loss= Water Loss Fatigue, Lethargy Decreased Tearing Decreased skin turgor

Condition in newborns, where the lower sphincter of the stomach becomes enlarged, preventing food from entering the small intestine

Pyloric Stenosis

More common in males and occurs between 3 and 6 weeks of life

Pyloric Stenosis

Forceful, projectile, non- bilious vomiting Hunger soon after vomiting episode Weight loss due to vomiting Hard, moveable " olive" mass in RUQ Progressive Dehydration with subsequent lethargy Family History Requires Surgical Intervention

Pyloric Stenosis

Occurs when 1 part of the intestine slides inside another part of the intestines, like a telescope Creates an obstruction that blocks normal flow of bowels, leading to increased pressure, swelling, and decreased blood flow within the bowels causing ischemia ( lack of oxygen to the bowel tissues leading to tissue death)

Intussusception

Most cases occur in toddlers in 1-2 years old Medical Emergency can lead to perforation and peritonitis where the bowels explode and infection settles into the peritoneal cavity Patients can go into sepsis and die quickly

Intussusception

Symptoms flare and then regress Symptoms include Intermittent, crampy abdominal pain Severe Pain Vomiting ( non projectile) and diarrhea Current Jelly like stool Sausage Shaped Abdominal Mass Lethargy Bilious vomiting- Obstruction Requires air or barium enema; surgery

Intussusception

Results from disruption in embryonic development When malrotation occurs, the intestine is abnormally attached and the mesentery narrows, twisting on itself (volvulus)

Malrotation and Volvulus

Most case will present in the first few weeks of life Symptoms include Bilious vomiting Abdominal Pain Shock Symptoms Abdominal Distention Tachycardia Bloody Stools Requires Surgery- Ladd Procedure

Malrotation and Volvulus

Due to closed loop obstruction it is thought that the obstruction is due to fecal matter impacted into the narrow ....

Appendix Appendicitis

_____________ causes inflammatory fluid and bacterial contents leak into the abdominal cavity resulting in peritonitis

Perforation

Most common cause of emergent abdominal surgery in children Peeks in prevalence in the second decade of life Symptoms include: Vague Abdominal pain initially, localizing to the RLQ over a few hours Nausea and Vomiting Small Volume, frequent soft stools Fever

Appendicitis

If pain is suddenly relieved without intervention ...

Suspect Perforation and notify MD Requires Surgical Perforation

Gastroesophageal Reflux, Peptic Ulcer Disease Constipation, Encopresis Hirschsprung Disease Short Bowel Syndrome Inflammatory Bowel Disease Celiac Disease- Gluten Free Diet Recurrent Abdominal Pain- Functional, non-ulcer dyspepsia, and IBS Failure to Thrive and Chronic Feeding Syndrome

Chronic Gastrointestinal Disorders

Most common cause of neonatal intestinal obstruction

Hirschsprung Disease Characterized by constipation

Feeding adjustments are an essential part of _____________ management

Reflux

Give infants __________ and ________ frequent feedings

Smaller and more Use a nipple that controls flow well Frequently burp the infant to control reflux

_____________ of formula with products such as ______- and ________ cereal can help keep the formula and gastric contents down

Thickening ,Rice; oatmeal

Keep infants upright for? after feeding by holding them and/ or elevating the head of the crib 30 degrees

30-45 minutes

Infrequent bowel movements or difficult passage of stools that persists for several weeks or longer

True Causes stress, low fluid, and fiber

Causes of constipation of newborn/ infant

Meconium Plug Hirschsprung Disease Cystic Fibrosis Hypothyroidism DI Dietary Changes Withholding

Toddler and Ages 2-4 Years old causes of constipation

Anal Fissures Withholding Toilet Refusal Short Segment Hirschsprung Disease Spinal Cord Neurologic Disorders

School Age causes of constipation

Toilet or bathroom access limited Tethered Cord Withholding

Adolescent causes of constipation

Spinal Cord Injury Dieting Anorexia Pregnancy Laxative Abuse IBS

Any Ages causes of constipation

Medication Side Effect Previous Anorectal Surgery Hypothyroidism

Affects the large intestine and causes problems with passing stool Results due to missing nerve cells in the colon, which leads to bowel obstruction as the anal sphincter is unable to relax and coupled with no peristalsis

Hirschsprung's Disease

S/S of Hirschsprung's Disease

No passage of stool (meconium)or thin ribbon like stool Distended Abdomen Refusing to feed and vomiting green bile

Complications of Hirschsprung's Disease

Fever and episodes of foul smelling Diarrhea Report to HCP immediately Surgery is often required to bypass the affected part of the colon or remove it entirely

Rome Committee 12 Week Criteria for IBS

Abdominal Pain relieved by defecation Onset of pain or discomfort associated with a change in frequency of stool Onset of pain or discomfort associated with a change in form of stool. No structural or metabolic explanation for this abdominal pain Types can be designated as constipation , diarrheal, or mixed Use FODMAP diet, avoid dietary triggers

Common causes of ___________ include abdominal trauma, drugs and alcohol, multisystem disease, infections, congenital anomalies, obstruction or metabolic disorders.

Pancreatitis

Usually associated with hyperlipidemia, obesity, pregnancy, birth control pill use, or cystic fibrosis.

Cholelithiasis

Pancreatitis Gallbladder Disease Jaundice Biliary Atresia Hepatitis Cirrhosis and Portal HTN Liver Transplantation

Hepatobiliary Disease Cholelithiasis is presence of stones in the gallbladder

Child and Family education dependent on GI disorder . Key focus is to prevent illness from progressing

True Teaching Plan

For a child with dehydration, what are the goals?

Restore fluid Volume and prevent progression to hypovolemia. Child with vomiting- Promote fluid and electrolyte balance

Nurses should teach parents that to facilitate daily bowel evacuation, what should the child do?

Sit on the toilet twice daily after breakfast and dinner for 5 to 15 minutes

Psychosocial Impact GI

Constipation can be stressful process Sensitive and embarrassing topic Behavior modification is necessary

Children with short bowel syndrome are considered medically___________ for a lengthy period, causing much anxiety related to the initial bowel resection that resulted in short bowel

Fragile

Sometimes long term hospitalization is required for GI disorders. Causes parents to miss work and cutting down on the time they have to spend with other children. Creates further stress and even more anxiety about finances and relationships.

True