Peds GI Disfunctions
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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.
Why is it important to correct cleft palate early in infancy?
Will improve speach early on.
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)
What are nursing implications for esophageal atresia/tracheoesophageal fitula?
- Catch it!
- • Prenatal: History of Polyhydraminos
- • 3 C’s: Coughing, Choking, Cyanosis
- • Excessive salivation/drooling
- • NPO
- • Positioning
- • Suction
- • Surgical Emergency!, ie gtube or surgical correction
What is a Hiatal hernia?
- • Protrusion of portion of the stomach through the esophageal hiatus of the diaphragm
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
What is gastroschisis?
- Protrusion of intraabdominal contents through defect in abdominal wall lateral to umbilical ring
- There is never a peritoneal sac
Tx for gastroschisis?
- IV Nutrition
- NG tube
- If large, contents are suspended to return to gut by gravity
- Eventual Surgical closure
What is oomphalocele?
- Protrusionof intrabdominal contents into base of umbilical cord.
- sac is present and covered with peritoneum
What is encopresis?
- Fecal incontinence (uncontroled pooping) due to:
- --change in diet
- --v exercise
- --emotional stress
- --certain Rx
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
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?
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:
- Identify triggers
- reduce bowel spasms
What is infectious gastroenteritis?
Caused by a group of bacteria, viruses, and parasites capable of causing serious communicable diarrhea
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
SnSs of infectious gastroenteritis?
- Diarrhea of varying amount and consistency
- Abdominal pain
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!
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
Additional SnSs of appendicitis?
- • N/V
- • Anorexia
- • Diarrhea or constipation
- • Fever and chills
- • Rupture of appendix-->Sudden relief of pain
Tx for appendicitis?
- • Observe possible sepsis/shock if rupture has occurred
- • Pain Medication/comfort measures
- • No heat application!
- • If ruptured: IV antibiotics
Crohn's vs Ulcerative colitis?
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
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!
SnSs of Intussusception?
- Paroxysmal (sudden onset) pain
- 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
What is Volvulus?
- • Malrotation or twisting of the bowel that results in bowel obstruction
- • S/S: bilious vomiting and pain
What is Hirschsprung Diseas?
- • Also called congenital aganglionic megacolon
- • Mechanical obstruction from inadequate motility of intestine
- • Absence of ganglion cells in colon
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
What is Tx for Hirschsprung disease?
- Two-stage surgery.
- – Temporary ostomy
- – Second stage—“pull-through” procedure
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
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
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
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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