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Gastro peds

patho, dx, s/s, nursing care

aspects of childs gi system that is important to identify, such as Swallowing is reflex for 3 months. Children have increased needs. Children dehydrate faster. Newborn’s resistance to infection incompletely developed. Infant’s stomach small & empties rapidly. Newborn produces very little saliva. Infants have poor fat absorption. Newborns have immature livers. Swallowing is reflex for 3 months.
What makes newborns more prone to jaundice? Immature livers.
Dehydration occurs when the total output exceeds the total intake.Can be caused by: Lack of intake. Abnormal losses: Vomiting. Diarrhea.
what exemplifies the childs greater needs for water balance? Newborns lose a large amount at birth and maintains a larger amount of extracellular fluid than the adult. Children have a greater surface area. Increased metabolic rates and heat production are 2-3 times greater in infants.
of the different types of dehydration (isotonic, hypotonic, hypertonic) which is most dangerous? Hypertonic: Proportionately larger loss of water in excess of electrolyte loss. Most dangerous.
what is the dehydration dx eval based on? weight, Level of consciousness. Response to stimuli. Decreased skin turgor. Prolonged capillary refill. Increased heart rate. Sunken eyes or fontanel
dehydration nursing care includes: identify s/s , measure I/O's and observe for what? Urine color, frequency and volume. Stool volume and frequency. Vomit for volume, frequency and type. Sweating
continue to monitor what signs for improvment? Vital signs. Skin color, temperature, turgor and presence of edema. Mucous membranes. Body weight. Sensory alterations and presence of thirst.
: What are the signs of dehydration? Percentage of weight loss, increased pulse, irritability and lethargy, dry mucous membranes, absence of tears, sunken eyes or fontanel and delayed capillary refill.
what is acute diarrhea? Usually self limiting. Referred to as acute infectious gastroenteritis caused by a variety of viral, bacterial and parasitic pathogens.
what is chronic diarrhea/ Diarrhea lasting over 14 days. Caused by chronic conditions.
what is intractable diarrhea? occurs in first few months of life and lasts longer than 2 weeks.
what generally is diarrhea caused by? abnormal intestinal water and electrolyte transport.
how is it spread or contracted? Most are spread by fecal-oral route through contaminated water or food and is spread from person to person.
what causes gastroenteritic? Rotavirus, ABX are frequently associated with diarrhea.
what three steps are generally associated with the pathophysiology of diarrhea? Invasion of the GI tract Increased intestinal secretions Dehydration, Acid-base imbalance, Shock
what lab tests are used to support dx eval? CBC, Electrolytes, Creatinine and Blood urea nitrogen. Stool cultures.
what are the goals of treatmen? assess imbalance, rehydrate, reintroduce adequate diet. Once under control, investigate and treat cause of diarrhea.
what are concerns for rehydration? Oral rehydration. (Avoid fruit juices and carbonated and/or caffeinated soft drinks.) Maintenance fluid therapy. (IV fluids containing 5% dextrose in water.)
Diarrhea nursing care? Support the child Monitor for signs of dehydration. Obtain accurate daily weights. Collect specimens as ordered. Protect the skin from excoriation. pt teach child and family on handwashing/diaper disposal, and prevention with meticulous hygeine
what is constipation? Constipation is an alteration in the frequency, consistency, or ease of passing stool.
what is obstipation? is when there are long intervals between stools.
what is encopresis? constipation with fecal soiling
what is the main cause of constipation? Constipation may be secondary to many organic disorders or systemic disorders. The majority of children have constipation without an identifiable cause.
how does age affect the child's effect from constipation at birth? Normally passes first meconium stool within 24 – 36 hours after birth. Meconium plugs are caused by meconium with reduced water content. Meconium ileus is an actual obstruction of the small intestines by abnormal meconium.
how does age affect the child's effect from constipation at infancy Constipation may result from organic causes. Often constipation is due to dietary practices.
how does age affect the child's effect from constipation at childhood Most constipation is due to environmental changes or normal development. The onset of constipation in the school-age child is due to environmental changes and stresses.
How is care for constipation delivered? Increase the amount of carbohydrates in infant’s formula will often relieve the problem. Increase amounts of fiber and fluids. and differentiate b/w acute and chronic constipation?
What is the difference between obstipation and encopresis? Obstipation is when there are long periods between stools whereas encopresis is the lack of stools.
Hirschsprung’s Disease Pathophysiology Absence of ganglionic innervation of bowel. Lack of normal peristalsis. More common in boys. Familial tendency.
Hirschsprung’s Disease Manifestations Failure to pass meconium. Constipation. Ribbon-like stools. Abdominal distention. Anorexia. Vomiting. Failure to thrive. Shock. Enterocolitis.
nursing care, Surgically corrected. Temporary colostomy. Avoid tap water enemas
What is the earliest sign of Hirschsprung's disease? Failure to pass meconium stools.
vomiting Is common and is usually self-limiting. Complications occur when it leads to dehydration and electrolyte disturbances, malnutrition, aspiration and Mallory-Weiss syndrome.
what is management of vomiting directed towards? Detection. Treatment of the cause. Prevention of complications., fluid given, antiemetics zofran, reglan, phenergan
To include the need to wash teeth or rinse mouth after vomiting, what are further nursing considerations? FTAP Focus is on observation and reporting episodes. Teach feeding techniques. After episodes have stopped, offer fluids. Position the child on their side or semi-reclining to prevent aspiration.
Gastroesophageal Reflux transfer of gastric contents into the esophagus, Premature infants. Infants with bronchopulmonary dysplasia. Children with tracheoesophageal or esophageal atresia repair. Children with neurologic disorders, cystic fibrosis or cerebral palsy.
what is important for the nurse to remember about GER? Child with GER is predisposed to aspiration and respiratory symptoms.
what is dx eval based on for GER An upper GI series. Esophageal pH monitoring, clinical manifestations,
what are clinical manifestations of GER Spitting up, regurgitation, vomiting. Excessive crying, irritability, arching of the back. Weight loss or failure to thrive. Respiratory problems. Heartburn or abdominal pain. Dysphagia. Esophagitis.
How is treatment organized? No treatment if thriving. Small frequent feedings with thicker formula and positioning. Medications if persistent: H2 agonists. Proton pump inhibitors. Surgical Management: Nissen fundoplication
Nursing Care is directed at Identifying children with symptoms. Educating parents. Providing care for the child undergoing surgery. Teaching older children and adolescents that caffeine, chocolate, and spicy foods may aggravate symptoms. Weight management.
Which position is recommended for a child with GER? The upright prone position
When teaching an adolescent about GER, how do they need to adapt their diets? They need to avoid caffeine, chocolate and spicy foods because they may aggravate their symptoms.
what is the explanation and average age of Appendicitis pt? nflammation of the appendix. Appendix may become gangrenous or rupture. Average age is 10 years.
Pain on lifting the thigh while supine, elevated WBC, vomiting after periumbilical pain that is localized to RLQ Appendicitis Manifestations
postoperative goals for nursing care of appendicitis Pain management. Prevention of infection. Early ambulation.
What tests may show an enlarged appendix? Ultrasound or CT.
Meckel’s Diverticulum A small blind pouch near the ileocecal valve fails to disappear completely and may be connected to the umbilicus by a cord.
other descriptions of Meckel's diverticulum based on pathophysiology A fistula may form. Susceptible to inflammation. More common in boys. The most common congenital malformation of the GI tract.
Meckel’s Diverticulum Manifestations Symptoms before 2 years. Painless bright red or dark red bleeding. Abdominal pain. Barium enema for diagnosis.
Symptoms for Meckel's diverticulum usually appear at what age? Before 2 years old.
Crohn's Disease Manifestations Is a chronic inflammation that involves all layers of the bowel wall.Abdominal pain. Weight loss. Fever. Anorexia. Rectal bleeding. Anal fistulas.
Crohn's Disease Diagnostic Evaluation Lab tests. Stool studies. GI series.
Crohn’s Disease Therapeutic Management Control the inflammation. Obtain long-term remission. Promote normal growth and development. Normal lifestyle. for inflammation Corticosteroids. Sulfasalazine. Antibiotics to treat complications and fight bacteria.
what is controlled for nutritional support? Well-balanced, high-protein, high-calorie diet. Enteral formulas. TPN.Plan meals with child. Encourage small, frequent meals. Serve meals around medication schedules. Prepare high-protein, high-calorie foods.
What type of diet should be encouraged for the child with Crohn’s disease? A well balanced, high-protein, high-calorie diet.
What is Gastric PUD? Involve the mucosa of the stomach.
What is Duodenal PUD? Involve the pylorus or duodenum.
What is Primary PUD? Absence of predisposing factors and common in children over 6 years.
What is Secondary PUD? Result from other factors and are more common in infants and children less than 6 months.
Peptic Ulcer Disease Diagnostic Evaluation based on what symptoms? Epigastric abdominal pain. Nocturnal pain. Oral regurgitation. Heart burn. Weight loss. Hematemesis. Melana.
Peptic Ulcer Disease Diagnostic Evaluation Symptoms. Lab studies. Upper GI. Endoscopy is most reliable procedure.
Peptic Ulcer Disease Therapeutic Management goals Relieve discomfort. Promote healing. Prevent complications & recurrence.
Peptic Ulcer Disease Therapeutic Management Meds Antacids. H2 receptor antagonists: Cimetidine (Tagamet). Rantidine (Zantac). Famotidine (Pepcid). Proton pump inhibitors: omeprazole (Prilosec, Prilosec OTC). lansoprazole (Prevacid).
Peptic Ulcer Disease Nursing Considerations nutritious diet, Promote healing through encouraging the family. Educate the child and family on the role of stress and the development of ulcers.
Peptic Ulcer Disease Nursing Considerations The tissues of the gastrointestinal tract fail to separate properly from the respiratory tract in utero. May occur in combination or separate. Fatal without early diagnosis and treatment.
Most occur in combination with what abnormalities? VATER and VACTERL? VATER: VACTERL: Vertebral Vertebral Anorectal Anorectal Tracheoesophageal Cardiovascular Renal Tracheoesophageal Renal Limb
EA and TEF-Five Types: Upper esophagus connects to the trachea and the lower esophagus ends in a blind pouch. Normal trachea and esophagus are connected by a fistula, and what else? Upper esophagus and lower esophagus end in a blind pouch. Upper esophagus ends in a blind pouch and the lower esophagus connects to the trachea. Upper and lower esophagus connect to the trachea.
EA & TEF Diagnostic EvaluationSuspected The exact type is seen on chest films based on what manifestations: Excessive salivation and drooling. Three C’s: coughing, choking, cyanosis. Apnea. Increased respiratory distress after feeding. Abdominal distension.
Surgical correction consists of dividing the fistula and doing an end-to-end anastomosis. , what is the therapeutic managment for this correction? EA is a surgical emergency. Maintain airway and pouch must be decompressed. Upon suspicion, keep infant NPO, start an IV and place in position to prevent aspiration.
Postoperative care Leave G-tube open to air. Attempt oral feedings after order is written, using sterile water first.
EA & TEF Nursing Considerations Keep infant NPO. Notify the provider immediately if you suspect EA/TEF. Place a NG tube to low intermittent suction.
Special problems may occur during care for EA & TEF including Respiratory complications. Provide a pacifier for non-nutritive sucking to prevent oral aversions. Support the parents.
Prepare for discharge: Teach skills to care for infant at home. Signs of respiratory distress. Signs of constriction of the esophagus: Poor feeding. Dysphasia. Regurgitation of undigested food.
: What does VATER and VACTERL stand for? VATER: vertebral, anorectal, tracheoesophageal and renal. VACTERL: vertebral, anorectal, cardiovascular, tracheoesophageal, renal and limb abnormalities that may be present with children who have EA/TEF.
You expect a newborn has EA/TEF. What is the first thing you should do? The first thing you should do is stop oral feedings, then notify the provider immediately.
what is the difference b/w inguinal and umbilical hernia? Inguinal hernia is a protrusion of part of the abdominal contents into the groin. Umbilical hernia is a protrusion of part of the intestines through the umbilical ring.
what is the difference b/w incarcerated and strangulated hernia? An incarcerated hernia cannot be reduced. A strangulated hernia has a diminished blood supply and occurs before 6 months of life.
Hernia Manifestations Unilateral or bilateral. Symptom free. Irritability, fretfulness, & constipation. Vomiting & sever abdominal pain if strangulated.
How is treatment and care for hernia? Surgery. Well-tolerated & simple. Routine postoperative care.
What is the surgery called to repair a hernia? Herniorrhaphy.
Pyloric Stenosis Pathophysiology Narrowing of the lower end of the stomach occurs related to hypertrophy of the circular muscles of the pylorus or by spasms of the sphincter.A congenital anomaly that is more common in boys and has a hereditary tendency.
Symptoms at 2-3 weeks of age. Projectile vomiting. Constant hunger. Dehydration. Olive-shaped mass in RUQ. Pyloric Stenosis Manifestations
Pyloric Stenosis Treatment and Nursing Care Pyloromyotomy. IV therapy. Thickened feedings. Burp before & during feedings. Daily weights. I & O. Frequent position changes. Monitor VS. Avoid overfeeding
: What is pyloromyotomy? It is a surgical procedure in which the pyloric muscle is incised to enlarge the opening to allow food to pass.
Intussusception Pathophysiology A slipping of one part of the intestine into another portion of the intestine below it The intestinal obstruction can strangulate and burst causing peritonitis. common in boys 3 mos. to 3 yrs old
Intussusception Manifestations Sudden, severe abdominal pain. Loud cry, straining efforts, kicks & draws legs in. Vomiting. Diminished flatus & BMs. Currant jelly stools. Febrile. Shock. Rigid abdomen.
Intussusception Treatment Medical emergency. Barium enema. Surgery if barium enema unsuccessful.
Children with Intussusception may have bowel movements containing blood and mucus and no feces. What are these called? Currant-jelly stools.
Celiac Disease Pathophysiology Leading malabsorption disorder in children. Inherited disposition. Symptoms at 1 year to 5 years of age.
Celiac Disease Manifestations Failure to thrive. Large, bulky & frothy stools. Abdominal distention with atrophy of buttocks.
Celiac Disease Treatment & Nursing Care caused by gluten, a substance in wheat, grains, i.e. bread, cake, cereal, pasta, commercial dairy, alcoholic beverages
: A child diagnosed with celiac disease must restrict foods containing what? Gluten.
Lecture main points? Gastrointestinal system of a child. General aspects of water balance, types of dehydration, diagnosis and care of dehydration. Treatment of diarrhea. constipation. Hirschsprung's disease. care 4 child w/ vomiting. (GER).
Created by: redhawk101