Peds GI Disfunctions

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Author:
alyn217
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186491
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Peds GI Disfunctions
Updated:
2012-12-01 23:58:15
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PT3
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Description:
A Child with Gastrointestinal Alteration
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  1. What are some important differences in a child's GI system?
    • Infants have almost no saliva
    • Swallowing not under voluntary control until 6 weeks
    • Peristalsis can reverse in infancy and is faster
    • Neonatal liver is immature--> v vit/min breakdown and absorbtion
    • Large intestine is shorter-->less time to absorb water/nutrients-->looser stools.
  2. Why is it important to correct cleft palate early in infancy?
    Will improve speach early on. 
  3. What is Esophageal Atresia and Tracheoesophageal Fistula 
    • • Esophagus terminates before it reaches the stomach
    • And/or a blind pouch is present that forms an unnatural connection with the trachea (fistula) 
  4. What are nursing implications for esophageal atresia/tracheoesophageal fitula?
    • Catch it!
    • • Prenatal: History of Polyhydraminos
    • • 3 C’s: Coughing, Choking, Cyanosis
    • • Excessive salivation/drooling
    • Then!
    • • NPO
    • • Positioning
    • • Suction
    • • Surgical Emergency!, ie gtube or surgical correction
  5. What is a Hiatal hernia?
    • • Protrusion of portion of the stomach through the esophageal hiatus of the diaphragm 
  6. Other childhood hernias?
    Congenital diaphramatic hernia: Opening in the diaphragm through which abdominal contents herniate into thoracic cavity-->resp distress/HF.

    Umbilical hernia: Incomplete closure of umbilical ring allows abdominal contents to push outward at umbilicus during straining and crying 
  7. What is gastroschisis?
    • Protrusion of intraabdominal contents through defect in abdominal wall lateral to umbilical ring
    • There is never a peritoneal sac 
  8. Tx for gastroschisis?
    • IV Nutrition
    • NG tube
    • If large, contents are suspended to return to gut by gravity
    • Eventual Surgical closure 
  9. What is oomphalocele?
    • Protrusionof intrabdominal contents into base of umbilical cord. 
    • sac is present and covered with peritoneum 
  10. What is encopresis?
    • Fecal incontinence (uncontroled pooping) due to:
    • --change in diet
    • --dehydration
    • --v exercise
    • --emotional stress
    • --certain Rx
  11. What would be some concerns if baby has not passed first meconium withing 24-36hrs?
    • Meconium plug:
    • » Caused by meconium that has reduced water content
    • Meconium ileus:
    • » Initial manifestation of CF
    • » Luminal obstruction of the distal small intestine by abnormal meconium
  12. What is most common illness in children <5yrs?
    • Acute diarrhea.
    • Tx by:
    • – F/E assessment and management
    • – Rehydration
    • – Reintroduction of an adequate diet
    • – BRAT diet?
    • – Immodium? 
  13. What is Recurrent abd pain/Irritable bowel syndrome?
    • diffuse abdominal pain unrelated to meals or activity; alternating constipation and diarrhea; mucus in stool 
    • Tx with:
    • Nutrition
    • Identify triggers
    • reduce bowel spasms 
  14. What is infectious gastroenteritis?
    Caused by a group of bacteria, viruses, and parasites capable of causing serious communicable diarrhea 
  15. What are some risks for aquiring infectious gastroenteritis?
    • • Children in daycare centers, preschools, and long-term care facilities
    • • Giardia is most common pathogen seen in daycare settings
    • • Rotavirus is the most common GI pathogen in infants and young children 
  16. SnSs of infectious gastroenteritis?
    • Diarrhea of varying amount and consistency
    • Vomiting
    • Abdominal pain
  17. Tx and nursing implications of infectious gastroenteritis?
    • Dehydration is a potential complication
    • Diagnosis is made by rectal of stool culture
    • Hydration and F/E balance are priority! 
  18. What is appendicitis?
    • • Inflammation and infection of the vermiform appendix
    • • Most common cause of emergency surgery in children and adolescents
    • • Etiology: viral infection, impacted fecal material, foreign bodies, and parasites
    • • Cardinal symptom: pain in RLQ at McBurney point 
  19. Additional SnSs of appendicitis?
    • • N/V
    • • Anorexia
    • • Diarrhea or constipation
    • • Fever and chills
    • • Rupture of appendix-->Sudden relief of pain 
  20. Tx for appendicitis?
    • • Observe possible sepsis/shock if rupture has occurred
    • • Pain Medication/comfort measures
    • • No heat application!
    • • If ruptured: IV antibiotics 
  21. Crohn's vs Ulcerative colitis?
  22. What is hypertrophic pyloric stenosis?
    • SnSs:  projectile nonbilious vomiting
    • olive-shaped mass in RUQ
    • strong peristaltic waves LUQ --> RUQ
    • Treatment: surgical release of the pyloric muscle
    • (pyloromyotomy) 
  23. What is intussusception?
    • • Invagination (telescoping) of a section of the intestine into the distal bowel that causes bowel obstruction
    • • Primarily occurs in children under 2 years of age
    • • Pediatric emergency!
  24. SnSs of Intussusception?
    • Paroxysmal (sudden onset) pain
    • Vomiting
    • Classic s/s: Bloody mucous stool (“currant jelly”) and a slightly tender sausage-shaped abdominal mass. 
    • Therapeutic Management: hydrostatic reduction with barium or air enema
    • If unsuccessful or patient is too ill, surgical reduction is completed 
  25. What is Volvulus?
    • • Malrotation or twisting of the bowel that results in bowel obstruction
    • • S/S: bilious vomiting and pain
  26. What is Hirschsprung Diseas?
    • • Also called congenital aganglionic megacolon
    • • Mechanical obstruction from inadequate motility of intestine
    • • Absence of ganglion cells in colon 
  27. SnSs of Hirschsprung disease/ananglionic megacolon?
    • • Absence of meconium stool within 24-36 hours after birth
    • S/S of bowel obstruction: vomiting, abdominal pain and distension, failure to thrive
    • Ribbon-like stools that are foul smelling
    • Therapeutic Management: Surgical removal of aganglionic portion 
  28. What is Tx for Hirschsprung disease?
    • Two-stage surgery.
    • – Temporary ostomy
    • – Second stage—“pull-through” procedure 
  29. Nursing considerations when caring for pt with Hirschsprung disease?
    • • Preoperative care
    • – TPN
    • – Abdominal circumference
    • – Enterocolitis management
    • • Postoperative care
    • – Treatment of colostomy
    • • Discharge care
    • – Extensive teaching 
  30. What is Celiac disease?
    • AKA gluten enteropathy or topical sprue
    • Results from the inability to digest the protein part of wheat, barley, rye, and oats.
    • Life-long deficiency that requires diet modications
    • Etiology: considered genetic
    • Manifestations: diarrhea and growth failure
    • Diagnostic test: serum transglutaminase 
  31. What is biliary atresia?
    • • Obstruction or absence of the extrahepatic bile ducts
    • • Leads to significant cellular damage and eventual liver failure and death
    • • Clinical manifestations: healthy at birth.
    • Then: acholic (without color) stool, bile-stained urine, and hepatomegaly 
  32. Tx of Biliary atresia?
    • • Surgery to aid in bile drainage (Kasai procedure)
    • • Hepatic dysfunction will still persist
    • • Liver Transplantation
    • • Nutritional support
    • – Malabsorption of fats, vitamins
    • – Fat-soluble vitamin deficiencies
    • – Growth failure 

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