Week 5: CH 25 GI Flashcards
stomach of a newborn
20mL
stomach of a 30 day old
90mL
stomach of a 1 year old
360mL
why is gas not uncommon
stomach enzymes are deficient until 4-6 months
cleft lip
failure of the maxillary processes to fuse by 6 weeks gestation and failure of the tongue to move down at the correct time prevents the palatine from fusing
cleft palate vs cleft lip
cleft palate is harder to detect
approach to therapy for a cleft defect
plastic surgeon, dentist, audiologist, speech, ENT, lactation, and social work
post op care of cleft defect
- vitals
- monitor I/O
- observe for s/s of infection
- place upright and burp frequently
- use special feeder or dropper to start clear liquids
- nothing in the mouth
GER
return of gastric contents into the esophagus
3 mechanisms that allow reflux to occur
- lower esophageal relaxations
- incompetent lower esophageal sphincter
- anatomic disruption of esophagogastric junction
manifestations of GER
- regurgitation
- spitting up
- vomiting
- hungry/irritable
treatment of GER
- depends on severity
- medications or specific formula can be used if severe
pyloric stenosis
hypertrophied pyloric muscle causes symptoms of projectile vomiting and visible peristalsis
nursing considerations of pyloric stenosis
- avoid oral feeding
- IV therapy
- NG tube
- Strict I/O
- minimize weight loss
- promote rest/comfort
- prevent infection
omphalocele
congenital malformation that results when the intra-abdominal contents herniate through the umbilical cord
when does omphalocele occur
in week 11 of gestation when abdominal contents fail to return to the abdomen
where are the abdominal contents stored in omphalocele
in a sac that if ruptured the organs are eviscerated
what causes omphalocele
- multiple causes
- 50-70% of infants with omphalocele will have an associated anomaly
gastroschisis
congenital defect in which the bowel protrudes through the abdominal wall
difference in omphalocele vs gastroschisis
omphalocele has a sac and has higher % of anomaly
intussusception
portion of the intestine goes inside another part of the intestine
most common site of intussusception
ileocecal valve
manifestations of intussusception
- abdominal pain
- JELLY STOOLS
- vomiting
treatment of intussusception
- air reduction enema
- surgical reduction if needed
hirschsprung disease
rare birth defect (1:5000) defined by absence of ganglion cells in the rectum and colon
what are ganglion cells responsible for
opening and closing of peristalsis
hirschsprung can cause?
megacolon
manifestation of hirschsprung
- no passing of meconium in the first 48hr
- abdominal distention
- feeding intolerance
- bili emesis
treatment of hirschsprung
take out part of bowel that doesn’t have ganglion cells and replace with the good bowel and connect to anus
complication of hirschsprung
- can cause enterocolitis
- inflammation of the intestines
- s/s of chrons
long term effect of hirschsprung
weight gain can be hard
nursing considerations for hirschsprung
- make sure the baby poops
- watch for vomiting
- newborn nutrition
gastroenteritis
inflammation of the stomach accompanied by vomiting and diarrhea
most severe complication of gastroenteritis
dehydration
appendicitis
inflammation of the vermiform appendix and is the most common cause of emergency surgery in children
when is appendicitis most common
- children ages 10-19
- younger = higher risk of perforation
manifestations of appendicitis
- PANT (only happen in this order)
- Pain
- Anorexia
- Nausea
- Temp
labs for appendicitis
- CBC (elevated WBC)
- electrolytes
what is the preferred method to take images of appendicitis
- U/S is less radiation
- Adults are CT
management of appendicitis
- IV fluids
- NPO
- incision care
- antibiotics
hyperbilirubinemia
- elevated serum bilirubin level
- very common in 84% of term newborns
patho of hyperbilirubinemia
shortened RBC life span
manifestations of jaundice
- lethargic
- decreased PO intake
diagnostic for jaundice
total serum bilirubin
nursing management of jaundice
- educate breastfeeding
- strict I/O
- IV hydration
- phototherapy
- vital signs
nursing dx for jaundice
- FVD
- Risk for impaired attachment
- Risk for imbalanced body temp
