GI disorders affecting Children

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GI disorders affecting Children
2013-03-05 01:45:00
SPC Nursing Gi Disorders Children

SPC nursing Pedi Gi disorders children.
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  1. What does the upper GI system include?
    • Mouth
    • Esophagus
    • stomach
  2. Major
    categories of GI abnormalities
    Birth defects

    Motility problems

    Inflammatory conditions

    Obstructive disorders

    Malabsorption conditions

    Hepatic and liver disorders
  3. Cleft
    lip and palate
    Exact cause is unknown

    • May be due to genetic and environmental
    • factors

    Occurs during 1st trimester of pregnancy
  4. Incidence of cleft lip and palate?
    Cleft lip affects 1 in 750 births

    More males suffer from cleft lip

    More females are born with cleft palate

    Combined defects affect 1 in 2500 births

    Asians are affected most often
  5. Manifestations of cleft lip/ palate
    • A “cleft”
    • is defined as an opening made by cleaving or a crack or crevice

    • Cleft
    • lip has a notched vermillion border,
    • variably-sized clefts involve the alveolar ridge and dental abnormalities

    • Cleft
    • palate —nasal distortion, midline or bilateral
    • cleft with variable extension from the uvula and soft and hard palates with
    • exposed nasal cavities
  6. Diagnosis of cleft lip/palate
    Based on observations at birth

    • May be detected by palpation if the
    • palate is involved

    • Feeding abnormalities if not detected
    • sooner

    May be seen prenatally by ultrasound
  7. management of cleft lip/palate.
    • The
    • defect requires a team of experts including surgeons, nurses, geneticists,
    • orthodontists, ENT’s,
    • and therapists

    • Early
    • surgery for cleft lip at 3-6 months helps promote bonding

    • Cleft
    • lip may require modification at 4-5 years of age

    • Cleft
    • palate repair depends on the severity of the defect and closure by 6-24 months
    • aids speech development
  8. Additional
    nursing concerns of cleft lip/palate?
    • Feeding
    • difficulties

    • Risk
    • for aspiration

    • Emotional
    • issues for parents

    • Surgery
    • pre-op education

    • Postoperative
    • care to preserve suture site and prevent infection

    • Use
    • of “no-no”
    • restraints

    • Upright
    • feeding

    • At
    • high risk for otitis media infection
  9. in a cleft lip how does it result?
    the medial nasal and maxillary processes fail to join at 6-8 weeks gestation.
  10. THe cleft palate results from what?
    failure of the primary palatal shelves or processes that fuse at 7-12 weeks of gestation.
  11. What is the first sign of a cleft palate?
    Formula coming from the nose.
  12. how can you confirm diagnosis of cleft palate?
    a gloved finger placed in the mouth ot feel the defect of the palate or visual examination with a flashlight.
  13. What device can be used to expand or realign parts of palate or decrease the size of a wide lip cleft.
    A lathan device.
  14. when is cleft lip repair usually done?
    3-6 months
  15. When is cleft palate repaired?
    between 6-12 months
  16. Esophageal
    atresia with tracheoesophageal fistula (TEF)
    • Actually
    • 2 disorders where either the esophagus terminates before it reaches the stomach
    • or…

    • A
    • fistula is present that causes an unnatural tracheal connection

    • Incidence
    • 1:2000-4000 births

    • Often
    • affects premature or low birth weight infants
  17. Symptoms of Esophageal atresia with tracheosophageal fistula?
    At higher risk if pregnancy was polyhydramnios

    • Failure to pass NG tube or catheter at
    • newborn exam (10-11 cm beyond gum line)

    Excessive oral secretions

    Coughing, choking, cyanosis

    Vomiting or abnormal appearing abdomen
  18. How can atresia be suspected?
    If the NG tube cannot be passes 10-11 cm beyond the gum line?
  19. Why do you keep the infant supine with the head of the bed elevated in atresia?
    To decrease the chance of gastric secretions entering the lungs.
  20. What are the three C's of tracheoesophageal fitula?
    • COUGH
    • chocking
    • cynosis
  21. What do you do with the g-tube in the immediate postop of atresia?
    Leave it open to drain in order to allwo gastric contents and air to escape.
  22. Fistula
    • Oral
    • intake goes into lungs, the baby will cough and choke with feeding, the abdomen
    • is distended. 
    • Aspiration—pneumonia—respiratory distress.
  23. Atresia
    • Risk
    • remains for aspiration of saliva and fluids. 
    • The abdomen will appear airless and scaphoid
  24. Management of atresia or fistula?

    Staged repair

    • G-tube and cervical esophagostomy with later anastomosis, colon
    • interposition, and dilation
  25. Nursing
    • Importance
    • of newborn exam

    • Assess
    • for 3 “c’s”—coughing,
    • choking, and cyanosis

    • Keep
    • baby supine to prevent aspiration preoperatively

    • Tube
    • feedings

    • Keep
    • baby warm and well oxygenated

    • Postop--expect
    • chest tubes and g-tube
  26. Imperforate
    Incidence is 1:4000-5000 births

    • Failure to pass meconium stool within 24
    • hours

    Absence of anorectal canal

    Presence of anal membrane

    External fistula to perineum
  27. Diagnosis
    • Newborn
    • exam with rectal temp

    • No
    • stool within 24-48 hours

    • Newborn
    • exam may note skin dimpling

    • Observation
    • may include stool in urine or vagina

    • X-ray,
    • Ultrasound, CT

    • Management varies from repetitive
    • dilation to surgery that could involve a colostomy and bowel pull-through
    • procedure
  28. Gastroschisis
    • An
    • embryonic weakness in the abdominal wall causing herniation of the gut on one
    • side of the umbilical cord during early fetal development.  Results in viscera outside of the abdominal
    • cavity and “free
    • floating” in
    • the amniotic sac

    • Incidence
    • is 1:4000

    • Mortality
    • is 10-15%

    • Delivery
    • may or may not be a c/section

    • Management
    • issues include—IV, NG, TPN, coverage of gut, slow re-introduction of contents
    • into abdomen (about 28 days), staged surgery to repair the defect and also if
    • there was any bowel necrosis.
  29. Omphalocele
    • Large
    • herniation of gut into umbilical cord. 
    • Viscera are outside of abdomen but inside a sac. 

    • Incidence
    • is 1:5000-6000 births

    • Mortality
    • is 20-30% due to risk for sepsis and obstruction

    • Management
    • and nursing care are very similar to gastroschisis
  30. Umbilical
    • Not
    • as serious a defect and involves imperfect closure of the umbilical ring
    • allowing the gut to push outward and with increased abdominal pressure the
    • defect is more obvious.

    • Incidence
    • is most common among African American babies and if baby was low birth weight.

    • Management---no
    • intervention unless the defect persists beyond age 5—usual regression by age
    • one

    • If
    • strangulated or size increases--surgery may be indicated
  31. Nursing
    considerations for umbilical hernia
    Do not bind

    Monitor size

    • Monitor for irreducible mass or change in
    • bowel patterns

    • Teach parents ER warnings including:
    • signs of strangulation, vomiting, pain, or an irreducible mass at umbilical
  32. Congenital
    diaphragmatic hernia
    • An
    • opening in the diaphragm resulting in abdominal contents herniated into the
    • thoracic cavity—usually has some pulmonary effects

    • Mortality
    • 50-80% and improving to 40% if the baby has ECMO.

    • Incidence
    • 1:220-5000

    • Surgical
    • intervention within 6-18 hours after birth and management at a tertiary care
    • center

    • Postop
    • respiratory assistance until lungs are functional—no O2 face masks to avoid air
    • into stomach
  33. What is silastic used for?
    To cover the intestines in gastroschisis.
  34. Gastroesphageal reflux disease
    • regurgitation of gastric contents
    • back into esophagus

    Delayed gastric emptying


    Hiatal hernia

    • Infants have a short lower abdominal
    • esophageal sphincter-usually resolves by age 1-2

    • Increased
    • intra-abdominal pressure


    • Swallowing
    • dysfunctions
  35. Symptoms
    of GER

    Spitting up after meals


    Recurrent otitis media

    Weight loss

    • Severe may see hematoemesis, melena, anemia
    • Failure
    • to thrive


    • Discomfort
    • and abdominal pain

    • Respiratory—coughing,
    • choking, wheezing, pneumonia, apnea, bradycardia
  36. Management
    of GER
    • Based
    • on severity of symptoms

    • Positioning
    • at 30 degrees prone

    • Lying
    • on right side

    • Excepted
    • from usual positioning to prevent SIDs

    • Medications
    • may be indicated such as PPI’s,
    • H2 blockers, antacids, mucosal protectants, and metocloproamide
  37. Dietary
    Interventions for GER
    • Small,
    • frequent feedings

    • Predigested
    • baby formula

    • Rice
    • thickened cereals may decrease vomiting but does not reduce reflux since it
    • delays gastric emptying

    • Eliminate
    • caffeine

    • May
    • need NG or other supplemental feedings if failure to thrive
  38. Additional
    considerations of GER
    • Acute
    • bleeding is a complication of long-standing GER.  Treated with stomach lavage but not iced
    • saline. May require interventions to coagulate bleeder

    • 15%
    • require surgery—fundoplication which “tightens”
    • the LES.  Postoperatively, these patients
    • are at risk for “gas
    • bloat” due
    • to difficulty burping.
  39. Why do infants have gastroesophageal reflux more often?
    they have a shorter abdominal lower esophageal sphincter (LES)
  40. What are the hallmarks of GERD?
    • Vomiting or spitting up after meals
    • hiccuppin 
    • recurent otitis media related to pooled secretions in the nasopharynx during sleep.
  41. What can sever GERD result in?
    hematemiesis or melena and anemia
  42. Constipation
    and encopresis
    • Infrequent
    • or difficult passage of hard stool

    • When
    • constipation persists in the child over 4 years of age, encopresis defined
    • as  repeated and involuntary defecation with no disorders of the GI
    • tract

    • Encopresis
    • secondary to recurrent fecal impaction and an enlarged rectum due to chronic
    • constipation
  43. Predisposing
    factors of constipation and encpresis?
    Poor toilet training and habits

    • Psychological stressors such as starting
    • to school, new sibling, etc.

    • Typical age of onset 3-7 years and more
    • common among boys

    • Also seen more frequently with lower
    • socioeconomic and learning disabled
  44. S/S of Constipation?
    Absence of expected amount of stool

    Abdominal pain

    Cramping without distention

    Palpable, movable fecal mass

    Decreased bowel movements






    • Anal
    • fissure

    • At
    • risk for UTI’s
  45. S/S Encopresis
    • Soiled
    • clothing

    • Fecal
    • odor

    • Anal
    • irritation

    • Social
    • withdrawal

    • Avoidance
    • of overnight outings

    • Increased
    • UTI’s or
    • incontinence
  46. Management of constipation and encopresis?
    • Disimpaction—enemas
    • until clear using fleets at 1 ounce per kg or if over 20 kg use adult dose q 12
    • hours—usually effective within 48 hours. 

    • Stool
    • softeners

  47. Managment of Encoporesis

    • Mineral
    • oil 2 ml/kg with bid dosing and mixed with food of fluids—may note leakage of
    • oil

    • Lactulose
    • or milk of magnesia for children older than 6 months

    • Limit
    • milk and sugar while increasing water and residue

    Changing the Retention Habit

    • Sitting
    • on toilet 20-30 minutes after meals

    • Behavior
    • charts

    • Positive
    • reinforcement

    • Change
    • of clothes with school nurse

    • Goal—for
    • child to pass 2-3 soft painless stools daily and wean off medications
  48. If an
    infant is constipated?
    • Do not encourage rectal stimulation, may try dietary such as barley cereal,
    • fructose (prune juice), lactulose, high fiber vegetables
  49. Irritable
    bowel syndrome
    • Diffuse
    • abdominal pain

    • Alternating
    • diarrhea and constipation

    • Undigested
    • food and mucous seen in stools

    • Child
    • has normal growth pattern and is negative for other GI disorders

    • May
    • have past history of colic

    • Occurs
    • after infancy and is common among toddlers and adolescents
  50. Management
    of irritable bowel syndrome
    Encourage child to eat slowly

    Eliminate carbonated drinks

    Excess diet drinks may cause diarrhea

    Moderate fiber intake

    • Reassure family that disease is
    • self-limiting and usually resolves without affecting growth

    Health promotion and exercise

  51. Ulcers—loss of tissue in areas of
    digestive tract exposed to pepsin
    • Multiple
    • factors such as H. pylori, lack or prostiglandins, excessive acid secretion, medications,
    • and physiological stress may cause ulcers

    • Symptoms--the
    • child complains of pain (burning, cramping) when their stomach is empty

    • Child
    • may also experience awakening at night or early morning with pain

    Hematoemesis, melena
  52. Infectious
    • Giardia
    • is the most common found in daycare centers

    • Rotavirus
    • most often affects infants and children

    • 20
    • million cases among those younger than 5 and U.S. mortality is 300-400 children
    • yearly.
  53. S/S of infectious gastroenteritis?
    • Diarrhea,
    • vomiting, abdominal pain, tenesmus
    • (ineffective, painful, or continuous urge to defecate), and fever.

    • Children
    • under 2 at increased risk for dehydration

    • Pathogens
    • include—shigella,
    • salmonella, E. Coli, campylobacter, giardia lambia,
    • rotavirus, and clostidium
    • difficile—see
    • text p. 1087
  54. Managment concerns for infectious gastrenterities?
    • Oral rehydrating solutions at 50-100
    • ml/kg over 4-6 hours

    Avoid high sugar drinks and juices

    Avoid anti-diarrheal medications

    Electrolyte management

    Antibiotics for giardiasis and shigella

    Possible vaccine for rotavirus
  55. Appendicitis
    • Inflammation
    • and infection of the vermiform appendix located at the end of the cecum.
  56. Incidence of appendicitis?
    • Most
    • common type of emergency surgery for children

    • Most
    • cases occur adolescence or early adulthood

    • 80,000
    • appendectomies each year in U.S>

    • Young
    • children are harder to diagnose and more prone to rupture

    • Perforation
    • rate for children under 2 years if age is 70%
  57. Symptoms of appendicitis?
    • Progressive
    • pain RLQ at McBurney’s
    • point.

    • Abdominal
    • pain—may ask child to stand on tiptoes and drop to flat feet



    • Often
    • supine flexing right leg or knee-chest

    • Increased
    • WBC’s

    • Fever,
    • chills

    • Diarrhea
    • or constipation

    • Pain
    • may subside temporarily with rupture

    • Following
    • rupture—symptoms worsen, rigid abdomen, fever and shock, dehydration.
  58. Differential
    • If vomiting precedes the pain, it is more likely gastroenteritis.  Appendicitis presents with sudden and
    • simultaneous pain, anorexia, or nausea and vomiting with fever
  59. Management of Appendicites?

    • Nursing
    • care pre-op

    • No
    • enemas or laxatives

    • No
    • heat to abdomen

    • sMay
    • provide cold or reposition

    • Pain
    • medication

  60. Management of post op appendectomy?

    • If
    • ruptured more serious

    NG tube


    Wound care

    Infection prevention

    • Elevate head of bed or right side
    • positioning

    Advance diet slowly

    • ER warnings postop infection or
    • obstruction
  61. Inflammatory
    bowel disease
    • Chronic
    • inflammatory conditions of the small and large intestines such as Crohn’s
    • and ulcerative colitis
  62. Crohn’s
    • Pathology—affects
    • entire GI tract

    • Transmural
    • involvement

    • Fistulas
    • are common

    • Marked
    • by remissions and exacerbations

    • Biopsy
    • reveals skip lesions with deep fissures, granulomatous, and intermittent normal
    • mucosa
  63. Ulcerative
    • Involves
    • only the colon

    • Mucosa
    • and submucosa
    • only

    • Rare
    • fistulas

    • Remissions
    • are uncommon

    • Biopsy
    • reveals continuous spreading—ulcers are superficial and no areas of normal
    • mucosa are seen
  64. Crohn’s
    • Incidence
    • 5:10,000

    • Equal
    • gender

    • Not
    • seen in infants, peak incidence teen’s
    • and 20’s

    • Clusters
    • in families

    • Higher
    • socioeconomic
  65. Ulcerative colitis
    Incidence 5:100,000

    Equal gender

    Peaks at 15-40 years

    Clusters in families

    Affects more caucasians
  66. How does Crohn's present?
    Abdominal pain

    Non-bloody diarrhea


    Palpable abd. mass

    Anorexia, weight loss

    Perianal, anal lesions

    Fistulas, obstructions

    Arthritis, arthralgias
  67. Ulcerative colitis Presents with?
    Rare abdominal pain

    Bloody diarrhea, may hemorrhage

    No masses

    Moderate weight loss

    Rare lesions

    Mild growth impairment

    Risk for toxic megacolon
  68. Crohn's cont
    Life expectancy not reduced

    • 50-70% will require surgery for fistulas,
    • obstructions, etc.

    Surgery is not curative

    Dietary--often  see malnutrition

    • NG
    • feedings indicated

    • Supplements
    • should include—iron, fish oil, folic acid, and glutamine
  69. Ulcerative colitis?
    12-15 % mortality

    • 10% chance of cancer after 10 years with
    • disease

    Removal of colon cures disorder

    Diet should avoid milk

    Low fiber, low residue, high protein

    Occasional TPN
  70. Nursing care for Chrons and ulcerative colitis?
    • Ongoing
    • evaluation of child’s
    • growth and development

    • Nutrition
    • management

    • Medication
    • administration

    • At
    • risk for oral lesions, perianal skin breakdown, emotional issues, social
    • problems


    • ER
    • warnings—weight loss, blood loss, severe abdominal pain
  71. Necrotizing
    enterocolitis (NEC
    • Most
    • commonly acquired GI disorder of neonates involving intestinal lesions—usually
    • in proximal colon and ileum
  72. Necrotizing enterocolitis cont?
    • Incidence
    • for all NICU admissions is 1-15% and of those 80-90% premature births

    • Usually
    • occurs first 14 days of life

    • Baby
    • develops apnea, bradycardia,
    • temperature instability, lethargy, abdominal distention, skin turns shiny and
    • discolored, and at latter stages—hypotension and shock
  73. Diagnosis of Necrotizing enteroclitis?
    • X-ray will reveal dilated bowel loops and
    • presence of air in intestinal wall, portal vein and/or abdominal cavity

    • Altered white count, decreased platelets,
    • metabolic acidosis, electrolyte imbalances
  74. Managment of Necrotizing enteroclities?
    Prevention using immunoglobin IgA, IgG via breast milk,cortocosteroids, slow feeding protocols

    • Decompress GI by NG tube and keep baby
    • NPO

    Sepsis control

    • Fluid
    • resuscitation

    • Measure
    • abdomen

    • Respiratory
    • support


    • Decrease
    • stimulation

    • Position—not
    • prone

    • High
    • risk for recurrence for several weeks
  75. Obstructive
    • Pyloric
    • stenosis, intussusception, volvulas,
    • and Hirschsprung’s
    • disease
  76. (Hypertropic)
    pyloric stenosis
    • Occurs when the muscle surrounding the pyloris
    • hypertrophies and obstructs gastric emptying
  77. Symptoms of hypertonic pyloric stenosis?
    • Progressive, non-bilious projectile
    • vomiting

    Blood tinged vomitus

    • Movable, palpable firm olive-shaped mass
    • that is visible in RUQ

    Visible, gastric peristaltic waves
  78. Managment and prognosis of hypertonic pyloric stenosis?
    • Pyloromyotomy—incision
    • of pyloric muscle to release the obstruction

    • Performed
    • within 24-48 hours

    Excellent prognosis
  79. Intusussusception
    • Pediatric
    • emergency where a section of the intestine invaginates
    • into the distal bowel causing an obstruction—rare diagnosis—most common cause
    • of bowel obstruction for children under 2.
  80. Presenting symptoms of intusussusce?
    • Passage of bloody mucous, diarrhea, and
    • currant jelly stools in a previously healthy child

    Sausage shaped abdominal mass

    Paroxysmal pain

  81. Diagnosis of intusussusce?
    • X-ray
    • and ultrasound

    • May
    • be able to remedy disorder with barium, water, or air enema ultrasound guided

    • Surgery
    • if bowel damage is evident

    • Best prognosis if detected within 24
    • hours

    • Nursing care supportive and explaining
    • diagnostic tests, condition, and treatment to parents
  82. Hirschsprung’s
    Disease (Mega-colon)
    • Lacking
    • ganglion cells in colon

    • A
    • congenital condition

    • Without
    • ganglion, normal peristalsis is impossible

    • Accounts
    • for 25% of neonatal obstructions

    • Affects
    • 1:5000 births

    • More
    • common among males and babies with Down’s
  83. Symptoms of Hirschsprungs disease?
    • Delayed
    • passage of meconium

    • Child
    • is constipated

    • Infrequent
    • stools

    • May
    • present with bowel obstruction—abdominal pain, vomiting, failure to thrive
  84. Managment of Hirschsrung disease?
    • Mild
    • to moderate disease—with stool softeners and rectal irrigations

    • Moderate
    • to severe disease—removing abnormal areas surgically, temporary colostomy, and
    • complete repair once the child reaches 18-20 pounds
  85. Malabsorption disorders
    • Lactose
    • intolerance

    • Celiac
    • disease
  86. Lactose
    • Unable to digest lactose as a congenital
    • or acquired problem

    • Lactose is the sugar found in dairy
    • products

    • Congenital presents initially and is more
    • severe

    Developmental onset is usually at age 3
  87. Clinical
    findings and treatment of Lactose intolerance?
    • Frothy,
    • but not fatty, diarrhea

    • Abdominal
    • distention

    • Cramping
    • and abdominal pain

    • Excessive
    • flatus

    • Presumptive
    • diagnosis—eliminate lactose and patient will improve

    • If
    • breast feeding, the mother should eliminate milk…formula babies should be given
    • lactose-free formula
  88. Celiac
    • Gluten
    • enteropathy
    • or tropical sprue—unable
    • to digest the protein part of wheat, barley, rye, and oats

    • Affects
    • 1:1000 births in U.S. with higher incidence in Europe

    • Usual
    • onset at 9-12 months due to dietary introductions
  89. Symptoms of Celiac disease?
    • Foul
    • smelling and fatty diarrhea

    • Failure
    • to grow—below 25th
    • percentile

    • Abdominal
    • distention


    • Anorexia,
    • muscle wasting


    • Folate
    • deficient
  90. managment of celiac disease?
    • Eliminate
    • rye, wheat, barley, and oats

    • Replace
    • with corn and rice

    • Vitamin
    • supplements—especially folate

    • Expect
    • life-long dietary changes

    • Celiac crisis
    • can present with profuse, watery diarrhea and metabolic acidosis—usual cause is
    • infection or ingestion of unknown gluten product—this is an emergency
  91. Hepatic

    • Biliary
    • atresia

  92. Viral
    and non-viral hepatitis
    Acute or chronic liver inflammation

    • May be secondary to rubella, CMV,
    • Epstein-Barr, HSV, etc.

    Infectious hepatitis A-E

    Hepatitis A and E spread oral-fecal

    • Hepatitis B and C via blood or body
    • fluids and are transmissible to fetus
  93. Symptoms
    of hepatitis
    • May
    • be asymptomatic or mild flu-like. 

    • Older
    • children more prone to fever, malaise, anorexia, nausea, jaundice

    • Icteric
    • stage—jaundice, urticaria,
    • dark urine, clay-colored stools

    • Fulminant
    • is capable of producing bleeding abnormalities, encephalopathy, ascites, and
    • acute liver failure--rare
  94. Management
    of Hep A
    • Prevention
    • of further spread

    • A
    • virulent pathogen able to live outside of the body for weeks

    • Immune
    • A globulin

    • Vaccine
    • for those at risk—chronic liver disease, homosexual males, foreign travel,
    • healthcare workers, hemophiliacs, inmates

    • Reportable
    • disease
  95. Management
    of Hep B
    • Universal
    • precautions

    • Hep
    • B vaccine

    • Hep
    • B immune globulin

    • Nursing
    • care is supportive and generally patients are not hospitalized unless
    • neurological changes, bleeding, ascites—no over-the-counter medications or
    • alcohol
  96. Biliary
    • Obstruction or absence of extrahepatic
    • bile ducts.  Normal newborn and as liver
    • damage increases—symptoms worsen

      Affects 1:10,000-20,000 births

      Most common cause of liver   transplants among children
  97. Symptoms Biliary atresia?
    • Healthy
    • at birth

    • Evolves
    • into bile-stained and acholic
    • stools

    • Enlarged
    • liver—spleen may also be affected

    • Increased
    • abdominal girth

    • Failure
    • to thrive, rickets, pruritis,
    • skin infections

    • Persistent
    • jaundice of newborn
  98. Lab
    findings and management of biliary atresia?
    • Increased
    • ALT, AST, clotting time

    • Liver
    • biopsy—bile plugs, edema, fibrosis

    • Treat
    • malnutrition, skin care, vitamins, at risk for GI bleed, liver transplant
    • candidate
  99. Serum PH <7.35
  100. Serum ph >7.45
  101. Absence of urine formation?
  102. Fluid found outside the cell?
    Extracellular Fluid (ECF)
  103. Serum sodium >150. meq/L
    Hypernatremic (hypertonic) dehydration
  104. Condition that occurs when sodium concentration falls below that of normal body fluids
    Hyponatremic (Hypotonic) dehydration
  105. Fluid found within the cells
    Intracellular fluid (ICF)
  106. Fluid surrounding the cells including lymph fluid?
    Interstital fluid.
  107. Fluid within the blood vessels?
    Intravascular fluid
  108. Condition that occurs when sodium concentration is identical to that of body fluids
    Isonatremic isotonic dehydration
  109. Diminished amounts of urine output.
  110. T/R- Isotonic dehydration occurs when water and electrolytes are lost in the same proportion as they occure in the body?
  111. T/F- In dehydration fluid loss occurs first in the ICF
  112. T/F- an infant who has lost 7% of his body weight has moderate dehydration?
  113. T/F-Inital therapy in sever dehydration is aimed at preventing shock
  114. When a child is severly dehydrated electrolytes such as potassium are replaced by admin them by slow IV Push
  115. Either ringer lactate solution or 0.9% sodium chloride is an appropriate fluid choice for parenteral rehydration?
  116. Diluted Gatorade is an acceptable oral rehydrating solution for a toddler
  117. wahat is diarrhea?
    An increase in the frequency fluidity and volume of stools
  118. Diarrhea caused by infection is usually called?
  119. List four causes of diarrhea?
    • Food intolerance 
    • Medications
    • malabsoprtion
    • colon disease 
    • irritable bowel syndrome
    • stress infectious
  120. Why are sports drinks and colas inappropriate fluid choices for a child with diarrhea?
    The high carbohydrate content of thees drinks may worsen diarrhea in addition they don not replace electrlytes lost through diarrhea.
  121. Explain why an infant with diarrhea should continue to revceive breast milk or full strenght formula?
    To prevent dehydration to reduce stool frequency and volume and to reduce duration of diarrhea.
  122. What common foods are generally well tolerated during diarrhea?
    Chose from complex carbohydrates (rice,bread, cereals, noodle, potaotes crackers) yogurt cooked vegtables and lean meats avoid fatty foods and simple sugars.
  123. HOw can skin breakdown be prevented in infants with diarrhea?
    Change diaper immediately after each bowel movement wash skin with mild soap and pat dry apply barrier oinment A&D and avoid using commercial baby wipes reposition at least every 2 hours.
  124. T/F- Vomiting can result from allergic reactions
  125. T/F- Emesis with a fecal odor may indicate lower intestinal obstruction
  126. T/F- Projectile vomiting is usually a result of overfeeding
  127. T/F- Oral rehydrating solution cannot be used when a child has vomited?
  128. An otherwise healthy infant is admitted to teh hopital with dehydration and diarrhea she is hyperirritable and agitated and she has flushed skin and dry mucous membranes. The nurse supects
  129. An infant who has been vomiting frequentlly is at risk for
    Metabolic alkalosis
  130. Which statement about the compensatroy mechanisms that maintain normal PH is true?
    If serum PH rises above normal teh kidneys conserve hydrogen ions.
  131. Indicators of dehydration in a 4 year old child include?
    Thirst and specific gravity of 1.038
  132. Infants with dehydration must be monitored for signs of impending shock. A late sign of shock in the infant is?
    decreased B/P
  133. A preschooler with moderate diarrhea who is just admitted to the hospital and who is not nothing by mouth NPO status wants something to drink teh nurse best choice is to offer
    An oral rehydration solution.
  134. an infant with diarrhea has tolerted clear liquids but begins having diarrhea again when she returns to her regular formula her diet should be changed to
    Soy formula
  135. A child weighing 14 kg is reciveing maintenance IV fluids. How many milliliters per hour should the child receive.
    50 mm
  136. An infant weighed 6.4 kg at the peiatricians office 2 days ago he has had diarrhea since then he now weighs 5.9 kg his mucous membranes are dry his fontanel is sunken and his capillary refill is approximately 5 seconds the infant has
    moderate dehydration
  137. An infant has viral gastroenteritis to prevent its spread to other family members teh nurse teaches the family
    Proper handwashing