Week 8 Part 2: PEDS GI Flashcards
What things are more frequent and faster in pediatric GI systems
frequent feedings
frequent bowel movements
faster intestinal motility (peristalsis)
faster rate of dehydration
all due to a higher basal metabolic rate
Since children dehydrate fast, it is important to assess…
assess skin turgor
assess fontanels
lack of tearing
dry mucus membrane assessment
thirst level
skin temp
activity level
What is different regarding breast fed and formula fed infants
the breast milk is easier to digest so more frequent stools and easier stools occur
S/S of a GI disorder in infants/children
vomiting and regurgitation
irritability and fussiness
abdominal pain and distention
FTT
weight loss
stool changes
abdominal pain
fussy with feedings
What are some subjective things to assess regarding Pediatric GI
- Lifestyle and family factors including family hx
- Diet - are they gaining or losing, hx of feeding pattern, allergies, do they spit up
- Elimination patterns - I?Os, encorpresis/constipation, stool patterns
What are some objective things to assess regarding pediatric GI
observe for abdominal distention, symmetry, bumps, bulges, massess, and the umbilicus
Auscultate hyper and hypo active bowel sounds
percussion - tympany v dullness
palpation - light v deep, rebound tenderness, McBurneys point
Always listen ___ before you feel for GI assessments
before
McBurneys Point
area third of the distance laterally of a line drawn from the umbilicus to the anterior superior iliac spine
this corresponds to the base of the appendix
Types of Disorders of the GI System
Structural Defect
Disorders of Motility
Inflammatory Disorders
Disorders of Malabsorption
Hepatic Disorders
Injuries to the GI System
What are some important structural defects to know for peds GI
cleft lip and cleft palate
esophageal atresia and tracheoesophageal fistulas
pyloric stenosis
intussusception
abdominal wall defects
anorectal malformations
umbilical hernia
What is the start of the GI system
the oral cavity
Cleft Lip and Cleft Palate
Structural congenital anamoly that occurs as a result of failure of soft tissue or bony structures to fuse during weeks 6-12 of gestation
multifactorial causes
Do cleft lip and cleft palate always occur together?
they each can appear by themselves or be seen together
Cleft lip can occur ____ or ____
unilaterally or bilaterally
What is the msot common craniofacial deformities overall in the US
cleft lip and cleft palate
Complications caused by cleft lip and cleft palate
Feeding Problems (ability to suck, swallow, breath w/out distress to be checked)
Speech development
Otologic
Dental and orthodontic
Developmental
Why do otologic issues occur with cleft lip and cleft palate
because there is more drainage into the ear leading to more frequent ear infections
What needs to be done in the time between being born but before having surgery to correct a cleft lip or palate
special feeding techniques that will take more time such as the Haberman feeder or ESSR method
Haberman Feeder
special device used for feeding cleft lip and palate babies
It involves holding the infant upright and it stimulates sucking by rupping the nipple to allow the child to get food into the back of the throat withou strong sucking
can even give breast milk instead of formula by first pumping the milk and then putting it inside
ESSR Method
method for feeding cleft lip and palate babies
it stands for: Enlarge nipple (hole) Stimulate sucking Swallow Rest
This allows the baby to not put too much strain and take plenty of time to eat
When feeding the cleft palate or lip baby it is important to allow…
for small and frequent feedings that allow time to swallow and burp frequently
When is cleft lip repair surgery usually done
usually 1-3 months post birth
Cleft Lip Repair
suture line staggered “Z shape” occurs to close the cleft
A logan bar is then put over the child’s mouth along with elbow restraints
Logan Bar
a bar that goes over a post op cleft lip babies mouth to reduce tension on the suture line
What is the purpose of elbow restraints following a cleft lip repair
it prevents the baby from bending the elbow to pick or pull at the incision
Incision care following a cleft lip repair involves…
cleaning sutures with sterile cotton swab and half strength H2O2 followed by saline to prevent crusting
Antibiotic ointment is then applied to suture line
Elbow restraints should be released…
every 2 hours`
What is the feeding technique following a cleft lip repair
Breck Feeder Technique
Breck Feeder
A droplet device that allows for feeding a post-op cleft lip repair infant
Baby must be on their back or side lying to feed
When is a cleft palate usually repaired
it is usually repaired IN STAGES between 6 months to 2 years old
What does a cleft palate repair protect against
altered dentitions and speech dysfunction
What is a common problem for cleft palate babies
frequent otitis media due to an open nasopharynx
For a cleft palate infant to undergo repair, they must be able to…
drink from a cup
Cleft Palate Repair Post Op Considerations
Post Op: Maintain Airway and O2 Sat MOnitor
No bottles, straws, pacifiers, spoons for 7-10 days
Elbow restraints and mittens
Clear to soft diet
all feedings followed by rinsing the mouth with water to clean the suture line
no brushing teeth 1-2x weeks
pain medication
What things should be avoided following a cleft palate repair to prevent injury
bottles
straws
pacifiers
spoons
for at least 7-10 days
What must be done after every post op cleft palate repair feeding
rinse mouth with water to clean suture line
Why is red dye avoided following a cleft palate repair
because you cannot tell it apart from blood
Esophageal Atresia (EA)
structural defect
congenital disruption of the upper and lower portions of the esophagus
basically the esophagus ends in a sac not connected to the stomach
Tracheoesophageal Fistula (TEF)
structural defect
abnormal communication b/t the trachea and the esophagus
a fistula or abnormal connection occurs - so like the esophagus could lead into the trachea which then leads abck to stomach or the two are connected lower down or the esophagus just drains into the trachea
Do EA and TEF occur together?
Usually they occur together but they can occur alone
EA and TEF are associated with
Maternal Polyhydramnios
Too much fluid
S/S of EA and TEF
In the immediate newborn period:
Respiratory Distress
Difficulty Feeding
Excessive Drooling
Choking, Coughing
Cyanosis
How is EA and TEF diagnosed
it is initially notices when the NG tube cannot pass through
Esophageal Atresia (EA) is…
a surgical emergency!
What is the treatment for EA and TEF
surgical correction
Pre Operative Nursing Care for EA and TEF Surgery
Maintain airway
NG Tube to suction - dont want to aspirate
Prevent aspiration by raising HOB and keeping them NPO
IV fluids and TPN
Sometimes a G tube may be placed to drain stomach contents and allow air to escape
May need tracheostomy and care for it
What is the surgical intensity like for EA and TEf surgery
it depends - it can be a single repair or staged surgery depending on age, size, length of gap
Post Operative Nursing Care for EA and TEF Surgery
Initially NPO
TPN
G Tube Feeding
Feeds start with clear diet (pedialyte) then advance over several days
Family teaching
What are some complications that can occur from EA and TEF surgery
tears
strictures
gastric reflux
infection
Pyloric Stenosis
structural defect
narrowing of the pyloric part of the stomach
Etiology of Pyloric Stenosis?
Unknown - but it is present at birth and often affects FIRST BORN MALES 2-5x more than females
How is pyloric stenosis diagnosed
by ultrasound
Where is pyloric stenosis occurring
between the stomach and the duodenum
What is causing the pyloric stenosis in physiologic terms
hypertrophy of the circular muscles of the pylorus that causes narrowing of the pyloric canal between the stomach and the duodenum
S/S of Pyloric Stenosis
Eating/Food leading to irritation, progressive edema, further narrowing, FTT, NV, and poor feeding
What is the hallmark symptom of pyloric stenosis
projectile vomitting (forceful, shortly after meals, 2-4 feet)
Things seen on clinical assessment for pyloric stenosis
vomiting progresses from mild regurgitation to projectile vomiting
The vomiting is forceful, occurs after meals
constant funger, fussiness, and crying
Decreases in size and number of stools
failure to gain weight or loses weight
dehydration results / lyte imbalance
What is sometimes palpable on abdominal exam of an infant of pyloric stenosis
olive shaped mass
What is the treatment for Pyloric Stenosis
Pyloromyotomy - surgery
Preop consideration for pyloromyotomy
NPO
IV fluids for fluids and electrolyte management
NG tube
Post op considerations for pyloromyotomy
maintain IVF, analgesics, d/c NG tube
start feeds - pedialyte, 1.2 strength formula, then full str formula