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57 Cards in this Set

  • Front
  • Back
Clinical Manifestations of GI Dysfunction
Failure to thrive
Spitting up/regurgitation
Nausea, vomiting, diarrhea, constipation
Abdominal pain, distention, GI bleeding
Hypoactive, hyperactive, or absent bowel sounds
Types of dehydration
Diagnostic evaluation Therapeutic management
Nursing consideration
Daily Maintenance Fluid Requirements
Calculate child's wt in kg Allow 100 mL/kg for first 10 kg body wt Allow 50 mL/kg for second 10 kg body wt Allow 20 mL/kg for remaining body wt
Acute diarrhea is leading cause of illness in children <5 yrs
20% of all deaths in developing countries are related to diarrhea and dehydration
Acute infectious diarrhea: variety of causative organisms
Diarrheal Disturbances
Enteritis Colitis
Types of Diarrhea
Acute infectious/infectious gastroenteritis
Intractable diarrhea of infancy
Chronic nonspecific diarrhea (CNSD)
Etiology of Diarrhea
Salmonella, shigella, campylobacter
Clostridium difficile
Antibiotic therapy
Diarrhea Concept of Oral Rehydration
Rehydration solution of 75-90 mEq of
Na+ per liter
Give 40-50 mL/kg over first 4 hours
Maintain hydration with solution of 40-60 mEq Na+ per liter
Daily volume of maintenance hydration <150mL/kg/day
Prevention of Diarrhea
(Most diarrhea is spread by the fecal-oral route)
Teach personal hygiene
Clean water supply/protect from
Careful food preparation
An alteration in frequency, consistency, or ease of passage of stool May be secondary to other disorders Idiopathic (functional) constipation—no known cause
Chronic constipation—may be due to environmental or psychosocial factors
Newborn Period
First meconium should be passed within 24-36 hrs of life; if not, assess for:
- Hirschsprung disease, hypothyroidism
- Meconium plug, meconium ileus (CF)
Often related to diet Constipation in exclusively breastfed infant almost unknown - Infrequent stool may occur because of minimal residue from digested breastmilk
Formula fed infants may develop
Constipation in Childhood
Often due to environmental changes or control over body functions Encopresis: inappropriate passage of feces, often with soiling May result from stress Management
Nursing Considerations Constipation
History of bowel patterns, medications,
Educate parents and child
Dietary modifications (age appropriate
Hirschsprung Disease
AKA congenital aganglionic megacolon Mechanical obstruction from inadequate motility of intestine Incidence: 1 in 5000 live births; more common in males and in Down syndrome Absence of ganglion cells in colon
Clinical Manifestations of Hirschsprung
Aganglionic segment usually includes the rectum and proximal colon Accumulation of stool with distention Failure of internal anal sphincter to relax Enterocolitis may occur
Therapeutic Management Hirschsprung
Surgery Two stages
- Temporary ostomy
- Second stage—"Pull-through" procedure
Nursing Considerations Hirschsprung
Pre-operative care Postoperative care Discharge care
Therapeutic management Nursing considerations
Gastroesophageal Reflux (GER)
Defined as transfer of gastric contents
into the esophagus
Occurs in everyone
Frequency and persistency may make it
May occur without GERD
GERD may occur without regurgitation
GER (cont'd)
Therapeutic management Nursing considerations
Acute Appendicitis
Etiology and pathophysiology Diagnostic evaluation Therapeutic management
- Ruptured appendix
- Prognosis
Nursing considerations
Hypertrophic Pyloric Stenosis (HPS)
Constriction of pyloric sphincter with obstruction of gastric outlet
Pyloric Stenosis
Diagnostic evaluation
Therapeutic management
Nursing considerations
Pyloric Stenosis Symptoms
•Usually 2-4 weeks after birth
•Projectile vomiting
•Peristaltic waves seen right to left
•Mass in RUQ abdomen
Diagnosis Stenosis
Upper GI
Weight loss
Treatment Stenosis
IV fluids Special feedings Pyloromyotomy
Postop Care
-NPO then clear liquids after 3-6 hours
-Tolerates increasing amounts of formula
-Home 24-48 hours
Inflammatory Bowel Disease (IBD)
Includes ulcerative colitis (UC) and
Crohn's disease (CD)
•Etiology and pathophysiology
■Diagnostic evaluation
•Therapeutic management
•Medical treatment
•Nursing considerations
Iterative Colitis
- Rectal bleeding
- Severe diarrhea
- Little or no pain
- Mild or mod anorexia
- Mod wt loss
- Mild growth retardation
- Mild to moderate joint
- Mild rashes
Cleft Lip and/or Cleft Palate
Facial malformations that occur during embryonic development May appear separately or together Etiology and pathophysiology Diagnostic evaluation
Surgical Correction of Cleft Lip
Closure of lip defect precedes correction
of the palate
Z-pIasty to minimize retraction of scar
Protect suture line with Logan bow or other methods
Surgical Correction of Cleft Palate
Typically 12-18 months of age
Effect on speech development
Nursing considerations
Cleft Lip and Palate Feeding
Techniques and interventions Special feeding equipment Breastfeeding issues
Management of TEF
Surgical interventions
Associated tracheomalacia
Nursing considerations
•Definition: a protrusion of portion of an
organ through an abnormal opening
•Danger of incarceration/strangulation
Pediatric Hernias
* Umbilical/abdominal
- Omphalocele
- Gastrochisis
Telescoping or invagination of one portion of intestine into another Occasionally due to intestinal lesions Often cause is unknown
Dx: Barium Enema, digital exam that reveals mucous, blood
Mgt: Barium enema, water soluble contrast or air pressure per radiologic exam Surgery
Intussusception (cont'd)
■Diagnostic evaluation
■Therapeutic management
•Nursing consideration
FTT is a syndrome or symptom, NOT a diagnosis
-Organic: Result of a physiological cause.
Accounts for less than 1/2
-Nonorganic: Definable cause not related to
Idiopathic: Unexplained by the usual organic and environmental etiologies
ASSESSMENT Intussusception
-Growth failure
-Developmental retardation - social, motor,
adaptive, language
-Poor hygiene
-Withdrawn behavior
Assessment (cont.) Intussusception
-No fear of strangers( at appropriate age)
-Avoidance of eye contact
-Radar Gaze
-Stiff and unyeilding or flaccid and
-Minimum smiling
-Feeding or Eating disorders
Other Indicators of FTT
Weight below 5th percentile
Muscle hypotonia and less mass
Repetitive stimulating behaviors
Sleep disturbances
Lack of parental preference
Malabsorption Syndromes
Characterized by chronic diarrhea and malabsorption of nutrients May result in failure to thrive Digestive defects Absorptive defects Anatomic defects
Celiac Disease
•AKA gluten-induced enteropathy and celiac sprue
•Four characteristics
-General malnutrition
-Abdominal distention
-Secondary vitamin deficiencies
Celiac Disease (cont'd)
Pathophysiology Diagnostic evaluation Therapeutic management Nursing considerations
Short Bowel Syndrome (SBS)
A malabsorptive disorder
Results from decreased mucosal surface area, usually as result of small bowel resection
Etiology and pathophysiology
Therapeutic management
Nursing considerations
Cystic Fibrosis
Autosomal recessive trait Chromosome 7 Mostly Caucasian children Average life expectancy is 26 Affects 1:2000-3000 live births
Manifestations of CF
•Growth failure
•Voracious appetite
•Respiratory disease, cough
•Increased Cl levels in perspiration
•Deficient pancreatic enzymes
Diagnosis of CF
Sweat chloride
Presence of chronic lung disease
Stools for trypsin and fat
Management of CF
Pancreatic enzyme replacement High caloric, high protein, mod. fat diet
Possible tube feedings at noc
Supplements of fat soluble vitamins
Pulmonary therapy Breathing exercises Antibiotics PRN Genetic counseling
Autosomal recessive genetic trait Absence of enzyme need to metabolize phenyalanine Primarily affects white Manifestations: FTT, vomiting, hyperactivity, erratic behavior Leads to mental retardation
Treatment is diet restriction(20-30 mg/kg/d)
Some cereals, breads, starches
Special formula ie, Lofenalac
Avoid all protein foods
Avoid aspartame
Drug Products Containing Phenylalanine
(per tablet)
Dimetapp 8mg Childrens Tylenol 4-6 mg Benadry 4mg
Valu-Rite Expectorant DM Clear cough syrup 14mg/5ml
Toxicity in Children Acetaminophen
— Most common
- May occur with large
doses or long
- Activated charcoal
- Mucomyst(N-acetylcystiene)
Toxicity in Children Salicylate
- Syrup of Ipecac (emesis)
- Hospital for severe
- Activated charcoal early
- Sodium Bicarb
- External cooling - Diazapam for seizures
- Vitamin K for bleeding
Poisons include cosmetics, personal care
products, cleaning products, plants, meds
Poison control number in easy access
Watch children
Safe storage
Treat meds as drugs, not candy
Instruct re: correct administration of meds
Syrup of Ipecac in home