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67 Cards in this Set
- Front
- Back
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GASTROINTESTINAL DISORDERS
INFLAMMATORY |
ulcerative colitis, peritonitis-spreading inflammation from throughout body with appendicitis.
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Fecalith
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hardened fecal material which is obstruction that causes appendicitis.
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Parasite Enterobius vermicularis is
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pinworms which can obstruct appendiceal lumen.
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Average age of child with Appendicitis
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10 years old boys and girls equally.
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Symptoms of Appendicitis
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periumbilical pain followed by nauseau right lower abd pain, vomiting with fever within 48 hours perfusion 1/3 already perforated when presentation occurs.
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Complications of Appendicitis
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major abcess, phlegmon, enterocutaneous fistula, perittonitis, and partial and partial bowel obstruction. Also caused by viral infection swollen lymphoid tissue.
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Appendicitis drain used after surgery
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Penrose
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Appendicitis never
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administer laxatives, supply heat, (stimulate bowel motility and increase risk of perforation.
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Appendicitis recovery time and peritonitis
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usually 7-10 days in hospital
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Meckal Diverticulum
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remnant of the fetal omphalomes-enteric duct that connects the yolk sac with the primitive midgut during fetal life. Failure may result in OMPHalomesenteric fistula a fibrous band connecting the small intestine to umbilicus.
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Gastroschisis
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protrusion of intraabdominal contents through a defect in abdominal wall lateral to umbilical ring; there is never peritoneal sac.
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Encopresis
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involuntary overflow of incontient stool causing soiling or incontinence secondary to fecal retention or impaction.
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Hematemesis
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vomiting of bright red blood or denatured blood from GI tract or from swallowed blood from nose.
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Hematochezia
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passage of bright red blood per rectum, usually indicating lower Gi tract bleeding.
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Melena
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passage of dark-colored, "tarry" stools resulting from denatured blood, suggesting upper GI tract bleeding or bleeding from right colon.
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Dysphagia
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difficulty swallowing caused by abnormalities in the neuromuscular function of pharynx or by disorders of esophagus.
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Cleft Lip results from
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failure of of the maxillary and midean nasal processes to fuse. CL may vary from small notch to a complete cleft extending into the base of the nose. Unilateral or bilateral. deformed dental structures
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Cleft Palate results
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is a midline fissure of the palate that results from failure of the two sides to fuse. Involved with soft and hard palates. When associated with CL the defect may involve midline and extend into soft palate on one or both sides.
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Cleft lip and palate (CL/P)
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are more common than CP alone.
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ESSR Feeding
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Modified nipple 1) enlarge the nipple 2) stimulate suck reflex 3) swallow fluid appropiately 4)rest when baby gives facial signal.
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Isotonic Dehydration
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Water and Salt are lost in equal amounts. FLUID LOSS IS FROM EXTRACELLUR FLUID COMPARTMENT
PRIMARY FORM OF DEHYDRATION IN CHILDREN |
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HYPOTONIC DEHYDRATION
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ELECTROLYTE LOSS IS GREATER THAN WATER LOSS
•WATER MOVES TO INTRACELLULAR •FURTHER INCREASES EXTRACELLULAR FLUID LOSS |
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HYPERTONIC DEHYDRATION
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WATER LOSS IS GREATER THAN ELECTROLYTE LOSS
WATER MOVES FROM ICF TO ECF INFANTS HAVE MORE FLUID IN ECF—BECOMES EVEN MORE DEHYDRATED MOST DANGEROUS, REQUIRES SPECIFIC FLUID THERAPY |
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See ATI Children page 249
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Hypotonic-
Hypertonic Isotonic |
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Dehydration
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Mild: slight thirst gravity 1.020
Moderate: cap refil 2-4 second, thirst irratablility pulse increased, mucus membranes dry, turger increased 1.020 gravity Sever greater than: 4 seconds, tachycardia, orthostatic blood pressure, extreme thirst anterior fontanele. scant or urine |
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DIARRHEA
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GASTROENTERITIS
STOMACH & INTESTINE |
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ENTERITIS
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SMALL
INTESTINE |
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COLON
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COLITIS
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INTRACTABLE DIARRHEA OF INFANCY
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SYNDROME
OCCURS 1ST MONTHS OF LIFE LASTS LONGER THAT 2 WEEKS NO RECOGNIZED PATHOGENS DIFFICULT TO TREAT USUALLY DUE TO INFECTIOUS DIARRHEA 6-54 months |
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CHRONIC NONSPECIFIC DIARRHEA
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IRRITABLE COLON OF CHILDHOOD
TODDLER’S DIARRHEA Loose stools Undigested food particles Greater than 2 weeks GROW NORMALLY NO BLOOD IN STOOL NO INFECTION ETIOLOGY CONTAMINATED FOOD, WATER CLOSE CONTACT Daycare etc SPREAD FECAL –ORAL PERSON TO PERSON |
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ROTAVIRUS
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70-80% of INFECTIOUS DIARRHEA
NOSOCOMIAL MOST SEVERE 3-24 MONTHS OLD VACCINE |
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ATI Childresn
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p 234
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Moderate
Severe Dehydration |
6-9%
> 10 |
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TREATMENT
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MONITOR FLUID & ELECTROLYES
REHYDRATE MAINTENANCE FLUID THERAPY REINTRODUCTION OF DIET |
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NONE of these if dehydrated:
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NO:
CLEAR LIQUIDS FRUIT JUICES CARBONATED SOFT DRINKS GELATIN CHICKEN OR BEEF BROTH BRAT DIET HOW COME |
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NURSING MANAGEMENT
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TEACH FAMILY HOME CARE
VOMITING NOT A CONTRAINDICATION FOR ORT MONITOR IV FLUID & ELECTROYTLE REPLACEMENT MONITOR STOOLS SKIN CARE |
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CONSTIPATION
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ALTERATION IN:
FREQUENCY, CONSISTENCY PAINFUL STOOLS RETENTION OF STOOLS |
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IDIOPATHIC OR FUNCTIONAL CONSTIPATION
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NO UNDERLYING CAUSE
ENVIRONMENTAL PSYCHOSOCIAL TRANSIENT |
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NEWBORN CONSTIPATION
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MECONIUM PLUG reduced water content
•MECONIUM ILEUS abnormal meconium Functional: Cystic Organic: something outside add fiber Ie cystic fibrosis |
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Diahrreha Nursing Process:
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page 823 Wong's
Introduction of new food area high susceptibility allergic use of laxative sorbitol and apple juice deficient fluid volume related organisms. impaired monitor fluid loss |
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HIRSCHSPRUNG DISEASE
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MECHANICAL OBSTRUCTION-
INADEQUATE MOTILITY IN PART OF INTESTINE ABSENCE OF GANGLION NERVE CELLS DISTENTION, ISCHEMIA ENTEROCOLITIS |
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NONBILIOUS VOMITING
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high food chunks no bile
may be obstruction (but high) |
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BILIOUS VOMITING
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atresia. malrotation, appendicitis. interssuption, lesion, hernia bile distal blockage
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NURSING IMPLICATIONS
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THIRST MECHANISM can guide fluid needs
REPLACEMENT FLUIDS POSITION ON SIDE OR SITTING BRUSH TEETH OR RINSE MOUTH AFTER VOMITING INTAKE & OUTPUT ANTIEMETICS PRN |
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GASTROESOPHAGEAL REFLUX
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PHYSIOLOGIC IN INFANTS
RESOLVES BY 1 YEAR IF INFANT IS THRIVING & HAS NO RESPIRATORY COMPLICATIONS NO TREATMENT IS INDICATED |
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GASTROESOPHAGEAL REFLUX DISEASE
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p 827 wongs
UPRIGHT POSITION AVOID SPICY, FRIED FOODS WEIGHT CONTROL MEDICATIONS SURGERY |
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FUNCTIONAL ABDOMINAL PAIN DISORDERS
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FUNCTIONAL ABDOMINAL PAIN
FAP IRRITABLE BOWEL SYNDROME IBS ABDOMNIMAL MIGRAINE-discrete, paroxysmal episodes of sever abdominal pain between which child is completely norma, aura, photophobia. More common in winter months |
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IRRITABLE BOWEL SYNDROME
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ABD PAIN ASSOCIATED WITH BM’S
MAY ALSO EXPERIENCE: DIARRHEA,CONSTIPATION, MUCUS IN STOOL, SENSE OF INCOMPLETE EVACUATION etc |
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ACUTE APPENDICITIS
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APPY MOST COMMON CAUSE OF EMERGENCY PED ABD SURGERY
AVERAGE AGE -10 PERIUMBILICAL PAIN, NAUSEA, RLQ PAIN, VOMITING WITH FEVER PERFORATION CAN OCCUR 48 HOURS AFTER ONSET OF SYMPTOMS |
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APPENDICITIS
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ISCHEMIA
ULCERATION BACTERIAL INVASION NECROSIS PERFORATION OR RUPTURE PERITONITIS ILEUS ELECTROLYTE IMBALANCE HYPOVOLEMIC SHOCK MCBURNEY’S POINT AREA OF MOST INTENSE PAIN IMPORTANT TO ASSESS TH E SEVERITY OF THE PAIN p830 APPENDECTOMY nursing-up and moving p831-832 PERITONITIS AFTER RUPTURE |
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MECKEL DIVERTICULUM
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CONGENITAL
FORMS DURING FETAL DEVELOPMENT BOX 24-8 p 833---SYMPTOMS PAINLESS RECTAL BLEEDING ABD PAIN SIGNS OF OBSTRUCTION DARK RED, CURRENT BERRY STOOLS SURGERY |
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INFLAMMATORY BOWEL DISEASEs
TREATMENT |
CHRON’S DISEASE
ULCERATIVE COLITIS CONTROL INFLAMMATION TO REDUCE THE SYMPTOMS OBTAIN LONG-TERM REMISSION PROMOTE NORMAL GROWTH & DEVELOPMENT ALLOW AS NORMAL OF A LIFESTYLE AS POSSIBLE ANTI-INFLAMMATORIES IMMUNOMODULATORS ANTIBIOTICS BIOLOGICAL THERAPIES NUTRITIONAL SUPPORT—PREVENT GROWTH FAILURE SURGICAL TREATMENT |
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ULCERATIVE COLITIS
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INFLAMMATION LIMITED TO COLON & RECTUM
TOXIC MEGACOLON MOST DANGEROUS FORM OF SEVERE COLITIS |
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CHRON’S DISEASE
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CAN OCCUR FROM MOUTH TO ANUS
TERMINAL ILEUM IS USUAL SITE FISTULAS CAN FORM BETWEEN INTESTINE AND ADJACENT STRUCTURES fistulas |
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PEPTIC ULCERS
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ACUTE OR
CHRONIC 2X GREATER IN BOYS GASTRIC OR DUODENAL PRIMARYNO PREDISPOSING FACTOR TEND TO BE CHRONIC MORE FREQUENT IN THE DUODENUM MORE COMMON KIDS OVER 6 YEARS NO PREDISPOSING FACTOR TEND TO BE CHRONIC MORE FREQUENT IN THE DUODENUM MORE COMMON KIDS OVER 6 YEARS STRESS ULCER primary- chronic secondary-stressSTRESS ULCER UNDERLYING STRESS OR INJURY ie severe burns, sepsis, ICP, trauma MORE FREQUENTLY ACUTE & GASTRIC MORE COMMON KIDS > 6 MONTHS ANACIDS •HISTAMINE RECEPTOR ANTAGONISTS(ANTISECRETORY DRUGS) •PPIs—BLOCK ACID PRODUCTION •MUCOSAL PROTECTIVE AGENTS •BISMUTH COMPOUNDS-INHIBIR GROWTH OF BACTERIA •SURGERY |
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H. PYLORI
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SIGNIFICANT
PRESENCE IN ULCERS |
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CIRRHOSIS
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IRREVERSIBLE DAMAGE
SCARRING END STAGE LIVER DISEASE LIVER TRANSPLANT |
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BILIARY ATRESIA
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DESTRUCTIVE, INFLAMMATORY DISEASE
DESTROYS THE BILIARY TREE JAUNDICE—1ST SYMPTOM |
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PPI
Mucosal HIstamine blocker |
prohibits hydrogen ion pumps in paritieal cells inhibitiing acid. Omeprazole
Bismuth compound-MAALOX prevacid, pepcid, zantac, tagament |
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BILIARY ATRESIA
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DESTRUCTIVE, INFLAMMATORY DISEASE
DESTROYS THE BILIARY TREE JAUNDICE—1ST SYMPTOM ABSENCE OF DUCTAL PATENCY ABSENCE OF BILE DUCT REMNANTS INFECTION (primary) or IMMUNE Stools lighter than expected. dark urine enlarged spleen and liver poor fat metabolism poor weight gain failure to thrive KASAI PROCEDURE-attach intestine to liver. INTESTINE ANASTOMOSED TO THE LIVER CIRRHOSIS LIVER FAILURE, LIVER TRANSPLANT, DEATH |
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Cleft Lip Feeding
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vertical nipple
ESSR syringe some can be breastfeed no pacifiers tongue depressors thermomenters spoons straws |
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ESOPHAGEAL ATRESIA WITH
TRACHEOESOPHAGEAL FISTULA |
OCCURS AT 4TH WEEK OF GESTATION
CAN OCCUR WITH OR WITHOUT A TEF MONITOR LUNG SOUNDS… ^ risk (crackles) if fluid of aspiration |
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HERNIAS
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p 850
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PYLORIC STENOSIS
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SEE CLINICAL MANIFESTATIONS BOX 24-13 PAGE 851
IE Weight loss Visible peristalisis REQUIRES SURGERY |
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INTUSSUSCEPTION
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CLINICAL MANIFESTATIONS
e red currant jelly like stools TREAT AIR, CONTRAST, BARIUM OR SALINE ENEMA SURGERY sudden acute abdominal pain child screaming and drawing the knees onto the chest child appearing normal and comfortable between episodes of pain vomiting lethargy passage of red, currant jelly-like stools (stool mixed with blood and mucus) TEnder, distended abdomen palpable sausage-shaped mass in upper right quadrant empty lower right quadrant (dance sign) eventual fever, prostration, and other signs of peritonitis |
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ANORECTAL MALFORMATIONS
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p 854
Persistent cloaca rectum, vagina, and urethra drain into a common channel that opens onto the perineum or genitourinary system. |
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CELIAC DISEASE
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BOX 24-15 PAGE 856 TX GLUTEN FREE DIET
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