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Nursing 3 Test 4
Care of Child with GI Alterations
| Question | Answer |
|---|---|
| Functions of GI System | 1)Ingestion, digestion and absorption of fluids and nutrients 2)Metabolism of needed nutrients 3)Excretion of waste products |
| Pediatric GI illnesses can result from: | Congentital defect(present at birth), Acquired disease(develops after birth), Infection & Injury |
| What do GI illnesses affect? | Nutrient absorption [short and long(growth delay) term] |
| Gi tract is structurally complet at birth but is immature (T or F) | True |
| Has voluntary control over sucking & swallowing reflexes until 6 weeks of age (T or F) | False. DOES NOT have voluntary control over sucking & swallowing reflexes until 6wks of age |
| What causes frequent regurgitation of small amounts of feeding | relaxed cardiac sphincter |
| cardiac sphincter | the smooth muscle surrounding the opening of the esophagus into the stomach. In health, it seperates these linked organs from each other, preventing the feflux of stomach acids into the esophagus |
| stomach capacity of newborns? | 10-20ml |
| where does digestion take place | duodenum |
| Enzymes that aid in digestion are minimal until what age? | 4-6 months therefore abdominal distention from gas |
| What is the stomach capacity at age 2? | 500ml |
| When does the liver mature? | over the first year of life |
| How many meals a day should a 2yr old be eating and why? | 2 yrs old & b/c of excretory control |
| What changes in GI tract come with time? | Intestinal motility slows & Enzyme secretion increases |
| Causes of Structural GI defects? | Growth and development of GI tract was interrupted in first trimester, Malposition and nonclosure |
| Atresia | Absence or closure of a normal body orifice |
| Structural Defects | Cleft lip & palate, esophageal atresia w/tracheoesophageal fistula, pyloric stenosis |
| fistula | opening between two organs |
| pyloric stenosis | hypertrophic obstruction of the pyloric sphincter |
| How does cleft lip and palate occur? | singly or in combination |
| What happens when a cleft lip and palate is present? | maxillary processes fail to fuse |
| What are the suspected multifactoral causes of cleft lip and palate? | environment, genetics, folate |
| Nursing care of cleft lip & palate? | emotional support, postop support, long-term care and f/u |
| Esophageal atresia and tracheoesophageal fistula(TEF) | Esophagus and trachea don not develop as parallel tracts |
| What occurs in Esophageal Atresia and tracheoesophageal Fistula | Esophagus ends as either a blind pouch or is connected to trachea by a fistula |
| Nursing Care for Esophageal Atresia & TEF | Detection, preparation for surgery, feeding regimen |
| Which sex does pyloric stenosis occur more in? | boys |
| With pyloric stenosis the hypertrophic obstruction of the pyloric sphincter results in? | obstruction of sphincter, inability to move food from stomach to duodenum, projectile vomitting which can lead to severe dehydration |
| Nursing Care for Pyloric Stenosis | Rehydration, correction of electrolyte imbalances, post op care, feeding regimen |
| Intussusception | one portion of the intestine prolapses and then invaginates (or,"telescopes") into itself |
| What does intussusception result in? | obstructed blood flow, ischemia and necrosis, hemorrhage, perforation if untreated |
| What is intussusception a frequent cause of? | intestinal obstruction |
| Most cases of intussusception occur in boys 3 months to 6 years (T or F) | True |
| Nursing Management for Intussusception? | F&E balance, post-op care, nasogastric tube patency(open), feeding regimen |
| Abdomen Wall Defects | Omphalocele, Gastroschisis |
| Omphalocele | Congential malformation that has intra-abdominal contents herniate through umbilical cord & is covered w/peritoneal membrane and often associated w/other anomalies |
| Gastroschisis | When abdominal organs herniate through abdominal wall but are not covered w/peritoneal membrane |
| Anorectal Malformations | Can be minor or complex & occur in isolation or with other defects, and can affect the rectum, urinary & reproductive system |
| VACTERL | presence of 3 or more anomalies |
| VACTERL | Vetebral anomalies, Anal atresia(absence or closure of a normal body orifice), Congenital heart disease, TracheoEsophageal fistula, Renal anomalies, Limb defects |
| Anal Stenosis | Narrowing of the anal opening |
| Hernia | Protrusion of an organ through the muscle wall fo the cavity that normally contains it |
| Anal Atresia(Imperforate anus) | condition in which the anus is closed |
| Types of Hernias | Inguinal, Diaphragmatic, Umbilical |
| Diaphragmatic Hernia | Abddominal contents protrude into lung cavity through the diaphragm, it can be life threatening and severe respiratory distress can occur shortly after birth |
| Umbilical hernia | Results from weak or imperfectly closed umbilical ring;diastasis recti |
| diastasis recti | a seperation of the two halves of the rectus abdominus muscles in the midline at the linea alba. This condition is benign when it occurs in pregnant women |
| How often does umbilical hernias occur in children? | 1 out of every 6 |
| Umbilical Hernia | Area protrudes with coughing,crying or straining |
| Disorders of Motility | Gastroesophageal reflux and Hirschsprung Disease |
| Gastroesophageal Reflux | Lower esophageal sphincter relaxes & allows passive regurgitation of stomach contents into esophagus, may also enter airway(aspiration) |
| GER | Gastroesophageal Reflux |
| Gastroesophageal Reflux | should be compared with GERD and affects half of all children |
| GERD | Gastroesophageal Reflux Disease |
| GERD | Characterized by poor weight gain, esophagitis and persistent respiratory symptoms...requires treatment |
| Hirschsprung Disease | Portion of large intestine lacks parasympathetic(controls bowels & bladder) innervation(stimulation of a part through action of nerves) |
| Hirschsprung Disease | congenital aganglionic megacolon, congenital anomaly |
| What does Hirschsprung Disease result in? | inadequate motility adn obstruction of the intestine |
| What is the incidence of Hirschsprung's disease? | Occurs approx 1 in 5000 live births, more commin in males adn can occur as a single anomaly or in combo w/congenital heart defects and chromosomal abnormalities(down syndrome) |
| Aganglionic megacolon(Hirschsprung's Disease) occurs? | In most cases the area lacking the ganglionic cells is the rectosigmoid region of the colon |
| Symptoms of Aganglionic megacolon(Hirschsprung's Disease)? | Failure to pass meconium in the first 48hrs after birth would be the key component, abdominal distention, bilious vomiting |
| Nursing Interventions for Hirschsprung's Disease? | Bowel regimen pre-op, post-op care, colostomy teaching |
| Gastroenteritis | Acute diarrhea, inflammation of stomach and intestines, may be acute or chronic |
| What are symptoms of gastroenteritis? | F&E loss, dehydration, N/V and diarrhea |
| What kind of IV is given with Gastroenteritis? | Isotonic or lactated ringers |
| How is Gastroenteritis treated? | with oral rehydration solutions(pedialyte,hydralyte etc) |
| What is the etiology of gastroenteritis cases? | most cases are viral but can be bacterial or parasitic as well |
| In Third-world countries this can result in 3 million deaths annually? | Gastroenteritis |
| How is therapy determined in gastroenteritis? | by estimating the percentage of dehydration. If >5% may initiate rx with isotonic saline or lactated ringers (BUN is high if pt is dehydrated) |
| Inflammatory Disease | Reactions of tissue in the GI tract to trauma caused by:Injuries,foreign bodies,chemicals,microorganism & surgery (may be acute or chronic) |
| Inflammatory diseases in childhood | appendicitis,peptic ulcers,inflammatory bowel disease(crohn's & Ulcerative colitis) |
| Appendicitis | Inflammation of verniform appendix |
| Which sex does appendicitis occur more in? | adolescent boys but can occur at any age |
| What is the pathophysiology of appendicitis? | obstruction of appendiceal lumen-may perforate or rupture as pressure increases |
| Appendicitis nursing care | pain control,hydration,emotional support,monitor for infection,prevent respiratory complications |
| Malabsorption disorders | cannot digest or absorb nutrients in diet |
| Types of malabsorption disorders? | celiac disease,lactose intolerance,short bowel syndrome |
| Celiac Disease? | Gluten-sensitive enteropathy-genetic predisposition |
| What kind of intolerance is involved in celiac? | gluten-protein found in wheat,barley,oats and rye |
| What results in celiac disease? | accumulation of glutamine,which is toxic to intestinal mucosa |
| What does the toxic effect of mucosa have on the intestines from celiac? | damages villi and long term risk of GI tract cancers |
| What do celiac patients have a deficiency in? | vitamins |
| What are symptoms of celiac disease? | fat absorption,steatorrhea,vomiting,anorexia,poor weight gain/failure to thrive, abdominal distention, and secondary illnesses |
| Steatorrhea? | stools are fatty, foul smelling, frothy |
| What are secondary illnesses to celiac disease? | atopic dermatitis,alopecia,oral ulcers,etc |
| What are foods to avoid in a celiac diet? | gluten based foods such as breads,cakes,doughnuts,cookies and crackers |
| What foods are allowed in a celiac diet? | rice or corn flour prepared foods,fruits and vegetables |
| What are some nursing implications in celiac disease | dietary counseling(involve dietician),products to avoid,cost factors,and age considerations |
| S/S of GI disorders? | Inability to gain/loose weight,vomiting,diarrhea,constipation,lack of energy(lethargy),abdominal distention/tenderness |
| S/S of pyloric stenosis? | projectile vomiting |
| S/S of intussusception? | currant jelly stools |
| S/S of GERD? | regurgitation,respiratory distress |
| S/S of Hirschsprung disease? | failure to pass meconium w/in the first 48 hrs,abdominal distention,bile stained emesis |
| S/S of appendicitis? | RLQ apin, rebound tenderness |
| What are the general principles of nursing care for GI disorders? | assess abdominal girth and bowel sounds, begin oral feeding w/frequent,small feedings of clear liquids-advance diet as tolerated |
| What are the general principles of GI disorders? | assess location and type of pain child is experiencing, assess n/v,determine stool pattern,monitor I |
| What are some growth and developmental diets for GI disorders? | facilitate breastfeeding in infants w/structural defects(special bottles), Instruct parents in the thickening agents for GER or GERD |
Created by:
jbittner
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