Week 3 Chapter 42 Flashcards
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.
When is the GI system fully developed and mature at what age?
2 years old
Highly vascular and makes it common entry point for infection.
Mouth
- Commonly bring objects to the mouth.
LES is not fully developed until the age of
1 years of age.
Causing regurgitation and reflex.
What is the newborn stomach capacity?
10-42 mL
Increases to 200mL by several months of age
Is the small intestine not functionally mature at birth.
True
Cm of small intestine in infants?
250cm
Cm of small intestine in adults?
600cm
Small bowel loss equates to what type of problems?
Problems with absorption and diarrhea
When do pancreatic enzymes adult age level?
Age 2.
Liver is large at birth.
Who is at the greatest risk for fluid balance losses?
Infants and children.
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
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
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
Soft, muffled thud- like tone over fluid or solid organs (Liver or Spleen)
Dullness
Soft, short tone over solid tissue like muscle and bone.
Flatness
High Pitched, drum-like over gastric bubble (gas)
Tympany
What is the most common result of GI illness is?
Dehydration requiring fluid therapy at home or in most serious cases in the hospital.
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.
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
Use a tongue blade to scrape a specimen into the collection container
Diaper Collection Technique
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.
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.
Stool Collection for Bedridden child
Collect the specimen from a clean bedpan
Do not allow urine to contaminate the stool specimen
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
