Lecture 10 GI

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Lecture 10 GI
2012-11-28 16:07:30

Lecture 10 GI
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  1. What are some acute (short-term) GI problems?
    • Pyloric stenosis
    • Intussusception
    • GERD
    • Appendicitis
    • Cleft lip/palate
  2. What are some chronic (long-term) GI problems?
    • IBD (crohn's and ulcerative colitis)
    • Hirschsprung's Disease
    • Celiac Disease
    • Short gut or short bowel syndrome
  3. What is the most common cause of diarrhea?
  4. What is a common side effect of constipation?
  5. What are you going to do about constipation
    • May have to give laxatives (GoLytely, metamucil, Docusate sodium, enemas)
    • Educate (encourage fiber, encourage fluid intake, increase activity)
  6. What is dehydration?
    • Common body fluid disturbance in infants and kids
    • occurs whenever the total output of fluid exceeds the total intake, regardless of cause
  7. what are some problems with fluid loss specific to peds?
    • body surface area (infants have greater BSA allowing larger quantities of fluid to be lost in insensible perspiration)
    • proportionally longer GI tract in infants
    • Basal metabolic rate is higher
    • kidney function is immature
  8. What is the minimum urine output in kids and infants
    • infants = 2 mL/kg/hr
    • kids = 1 mL/kg/hr
  9. What might you see with dehydration?
    • change in urine output
    • skin color changes
    • issues with capillary refill (slow)
    • mucous membrane changes
    • fontanels in infants (depressed)
    • behavioral changes (confused, lethargic)
    • vital sign changes (increased HR, decreased BP)
  10. How do you treat dehydration?
    • Encourage fluid intake
    • daily weights (particularly infants)
    • IV fluids and boluses
    • Monitor VS, LOC, and general patient status
    • Educate
    • Document
  11. What is a food allergy or hypersensitivity
    • consists of an immunologic mechanism
    • immunoglobulin E (IgE)
    • immediate or delayed reaction
    • mild or severe reaction
    • (ex of reactions = hives, itching, N/V, anaphylaxis, histamine reaction)
  12. what is a food intolerance
    • not related to immune system response
    • more related to deficiency of enzymes
    • (ex = lactose intolerance, not allergic to milk body just can't digest milk proteins or milk enzymes)
  13. What is pyloric stenosis
    • Narrowing and dysfunction of the pyloric sphincter
    • Won't allow stomach contents to empty
    • Nothing to intestines so nutrients aren't getting absorbed
  14. What are the is the main manifestation of pyloric stenosis
    Projectile vomiting - may travel 3-4 feet in side lying position 1 ft in back lying position, occurs after a feeding (about 30-60 min after), may not occur for several hours, non-bilious (no bile so just formula coming back up), pt is hungry since they can't keep food down
  15. What are other manifestations of pyloric stenosis
    • no evidence of pain/discomfort
    • weight loss
    • s/s of dehydration
    • abdominal distention and visible peristaltic waves
    • palpable olive-shaped "lump"
  16. When palpating the abdomen of an infant with pyloric stenosis what is felt?
    An olive shaped mass in the right upper quadrant.
  17. What is the treatment of choice for pyloric stenosis?
  18. When can feedings begin post op in an infant treated for pyloric stenosis and how?
    4-6hrs post op and with small, frequent feedings of clear liquids. If tolerated, advance the infant to formula or breast milk feedings.
  19. What are we going to do for the infant with pyloric stenosis
    • May have NG tube placement
    • surgical prep
    • post-op management (slowly progress diet)
    • parental support
  20. What are we going to teach the parents regarding pyloric stenosis
    • post-op feeding
    • will vomiting occur again (possible for a few days but not projectile vomiting)
    • surgical incision/dressing care (usually done laprascopic)
  21. What is a frequent cause of intestinal obstruction in kids from 3 months to 3 yrs old?
  22. Is intussusception more common in males or females?
  23. What is the common cause of intussusception?
    • about 90% are idiopathic
    • majority related to viral infection
  24. What is intussusception
    • intestine telescoping in on itself
    • associated mesentery getting strangulated
    • blood leaking into intestinal lumen from cardiovascular pressure
    • happens in small intestine and causes an obstruction
  25. What are subjective and objective signs of intussusception?
    • currant jelly stools
    • sudden acute abdominal pain
    • voiting
    • lethargy
    • tender, distended abdomen
    • S/S of peritonitis (for advanced cases)
  26. How is intussusception dx?
    • contrast enema
    • x-ray
  27. How is intussusception treated?
    • telescoping can be reduced non-surgically (insert air into bowel and it pops out)
    • if non-surgical attempt unsuccessful, surgery is required for reduction and/or resection of telescoping intestine
  28. What are we going to do for intussusception
    • document symptoms
    • patient/family education
    • family support
    • post-op management
  29. what is the most common site of intussusception
    The ileocecal valve
  30. What is the most common cause of emergency abdominal surgery in the US
  31. what is appendicitis
    • inflammation of the appendix (terminal end of colon on right side)
    • 1/3 of cases involved perforated (ruptured appendix)
  32. What are S/S of appendicitis
    • RLQ pain (McBurney's Point)
    • fever
    • rigid, tender abdomen
    • vomiting
    • tachycardia, tachypneic
    • stooped posture
    • if it is painful then feels better it may have ruptured then infection can get into peritoneum
  33. How is appendicitis dx?
    • possible elevated blood count
    • ultrasound and CT scan
  34. What's a major complication of appendicitis?
  35. What are we going to do for appendicitis
    • antibiotic therapy
    • post-surgical management (laparoscopic vs open appendectomy)
    • pain management
    • monitoring for complications
  36. What is GERD
    • GastroEsophageal Reflux disease
    • The transfer of gastric contents into the esophagus
    • sphincter relaxes and contents bubble up into esophagus
    • may occur w/o regurgitation
    • represents symptoms or tissue damage that results from GER
  37. What is GER
    • GastroEsophageal Reflux
    • may occur without reflux disease
    • becomes a disease when complications develop
    • LES dysfunction vs TRLES
  38. What is LES dysfunction
    lower esophageal sphincter dysfunction = particularly decreased tone, thought to be initial cause of GER/GERD
  39. what is TRLES
    Transient relaxation of LES = now thought to be mechanism leading to GER/GERD
  40. Why is GERD a problem?
    Can erode esophagus and lead to cancer
  41. Who is at most risk for GERD
    • premature infants
    • infants with bronchopulmonary dysplasia
    • kids with transesophageal/esophageal atresia repair
    • kids with neurological disorders
    • kids with scoliosis, asthma, CF or cerebral palsy
    • smoking, alcohol, spicy food, chocolate, caffeine
  42. What are we going to do for GERD
    • pharmacological interventions (antacids or proton pump meds like zantac, pepcid, prilosec, etc)
    • nutritional interventions (avoid hot and spicy foods, avoid caffeine)
    • surgical interventions - nissen fundoplication (band so reflux doesn't happen)
    • prop HOB up at night
  43. How is GER diagnosed
    • barium swallow
    • 24 hour probe study
    • upper endoscopy
  44. What patient would receive surgical interventions for GERD
    kids with severe complications like recurrent aspiration pneumonia, apnea, failure to respond to medical therapy, and positional changes
  45. What causes IBD
    • etiology unkown
    • shows multifactoral etiology (inflammatory response to bacteria or viruses in GI tract, genetics, sociocultural aspects, psychological problems)
  46. What is ulcerative colitis
    • inflammation limited to colon and rectum
    • affects mucosa, submucosa
    • varying degrees of ulceration, bleeding and edema
    • most cases include bloody diarrhea, abdominal pain
  47. What is crohn's disease
    • affects any part of the GI tract (most commonly the terminal ileum)
    • affects all layers of bowel wall in a discontinuous fashion
    • most cases involve abdominal cramping and diarrhea
  48. What is Inflammatory Bowel Disease (IBD)?
    Disorders of the GI tract with no known etiology: ulcerative colitis and crohn's disease.
  49. How should IBD be treated
    • possible resection of affected intestine
    • cancer screening
  50. who has greater risk of developing cancer, patients with crohn's or ulcerative colitis
    crohn's has greater risk of developing cancer
  51. what are we going to do for IBD
    • family and pt support
    • nutritional monitoring (small frequent meals rather than 3 meals a day, low fiber, high protein and high calorie)
    • observe for dehydration
    • possible ostomy care
  52. What is hirschsprung's disease
    • Also known as congenital aganglionic megacolon
    • mechanical obstruction caused by inadequate motility of part of the intestine
    • accounts for about 1/4 of all cases of neonatal obstruction
  53. what does Hirschsprung's disease look like?
    • failure to pass meconium within 24-48 hours
    • refusal to feed
    • abdominal distention
    • explosive, watery diarrhea
    • constipation
  54. how is Hirschsprung's disease dx?
    • barium enema
    • radiography (x-rays, CT scans)
    • rectal biopsy
  55. How are we going to care for the child with Hirchsprung's disease
    • post-surgical management (ostomy care, pain management)
    • fluid management
    • observe for dehydration and complications (monitor stools)
    • family support
    • education
  56. What is Hirchsprung's disease caused by?
    • no autonomic parasympathetic innervation in portion of the colon
    • newborn doesn't pass meconium after 24-48 hours, FTT, child has constipation
  57. How do we fix hirschsprung's disease
    With a temporary colostomy (remove diseased part). Once child is 20lbs resect and reattach bowel
  58. What is a normal bowel size
    • 200-250cm small intestine for infant > 35 week gestation
    • 100-120 cm small intestine for infant <30 week gestation
  59. what is small bowel
    loss of 80% small intestine
  60. Why is short gut/small bowel a problem?
    • absorption of nutrients
    • fluid balance
    • normal bacterial flora
    • failure to thrive
    • tiny
    • dehydrated
  61. What causes short gut/small bowel?
    • congenital anomalies
    • ishemia (big cause NEC)
    • trauma or vascular injury
  62. How are we going to treat short gut/small bowel?
    • monitor for s/s of dehydration, surgical complications
    • post-surgical care
    • TPN and lipids or enteral tube feeding
    • education
    • family support
    • interventions for side effects
  63. What is the problem with having cleft lip/palate
    • Speech (#1)
    • dental
    • feeding
    • body image/bonding
  64. what is the medical management for cleft lip/palate
    • lip closure w/in 3 months
    • palate closure w/in 12-18 months
    • repeated surgeries for growth problems
    • orthodontics
    • speech therapy
  65. Where is cleft lip/palate dx?
    in utero
  66. You have a patient with Crohn's disease. What diet would be most appropriate for them to eat?
    small frequent meals, high protein high calorie
  67. You are the nurse in a busy pediatric emergency room. A 3-wk old child is brought in with a 4-day history of vomiting. Per the parents, the patient usually vomits 30-45 minutes after a feed, but the vomited formula has minimal curdling and is not bilious. As you are gathering your admission history, the patient vomits, sending a stream of formula to the foot of the bed about 3 feet away from the patient's head.You suspect that your patient likely has
    Pyloric stenosis
  68. what disorder is characterized by a failure to pass meconium within the first 24-48 hours of life?
    Hirschsprung's disease
  69. TRUE OR FALSE: Patients with Crohn's Disease have a greater chance of developing carcinomas than patients with ulcerative colitis.
  70. Which is the most common cause of serious gastroenteritis among children?
  71. An infant with moderate dehydration has what clinical signs
    • dry mucous membranes
    • capillary filling of more than 2-3 secs
  72. The nurse would expect to see which of the following clinical manifestations in the child dx with Hirschsprung disease
    • constipation
    • visible peristalsis
    • palpable fecal mass
  73. What would alert the nurse to possible peritonitis from a ruptured appendix in a child suspected of having appendicitis
    temp of 103, absent bowel sounds, and sudden relief from abdominal pain 
  74. a common feature of IBD is
    growth abnormalities
  75. The best definition of biliary atresia is
    progressive inflammatory process causing bile duct fibrosis
  76. An invagination of one portion of the intestine into another is called
  77. A 5 month old is suspected of having intussusception. What clinical manifestations would he most likely have?
    Crying with abdominal exam, vomiting, and currant-jelly-appearing stools
  78. 5 month old's intussusception is treated with hydrostatic reduction the nurse should expect care after the reduction to include
    observation of stools
  79. The nurse observes frothy saliva in the mouth and nose of the neonate and frequent drooling. When fed the infant swallows normally, but suddenly the fluid returns through the nose and mouth of the infant. The nurse should expect what medical condition
    esophageal atresia
  80. The preop nursing plan for an infant with pyloric obstruction should include
    • rehydration by IV fluids for fluid and electrolyte imbalance
    • NG tube placement to decompress the stomach
    • parental support and reassurance
  81. The prognosis for kids with short bowel syndrome has improved as a result of
    total parenteral nutrition and enteral feeding
  82. When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration include:
    Tachycardia, parched mucous membranes, sunken eyes and fontanel.
  83. Which statement best describes Hirschsprung’s disease?
    The colon has an aganglionic segment.
  84. A child has a nasogastric (NG) tube after surgery for acute appendicitis. The purpose of the NG tube is to:
    Prevent abdominal distention.
  85. Therapeutic management of the child with an inflammatory bowel disease (IBD) includes a diet that has which component?
    Vitamin supplements
  86. What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia?
    Liver transplantation may be needed eventually.
  87. The nurse assesses the neonate immediately after birth. A
    tracheoesophageal fistula should be suspected if what condition is present?
    Excessive amount of frothy saliva in the mouth
  88. The nurse is caring for a boy with probable intussusception. He had diarrhea before admission; but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. What is the most appropriate nursing action?
    Notify physician