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57 Cards in this Set
- Front
- Back
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Clinical Manifestations of GI Dysfunction
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Failure to thrive
Spitting up/regurgitation Nausea, vomiting, diarrhea, constipation Abdominal pain, distention, GI bleeding Jaundice Dysphagia Hypoactive, hyperactive, or absent bowel sounds |
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Dehydration
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Types of dehydration
Diagnostic evaluation Therapeutic management Nursing consideration |
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Daily Maintenance Fluid Requirements
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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
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Diarrhea
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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 |
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Diarrheal Disturbances
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Gastroenteritis
Enteritis Colitis Enterocolitis |
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Types of Diarrhea
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Acute
Acute infectious/infectious gastroenteritis Chronic Intractable diarrhea of infancy Chronic nonspecific diarrhea (CNSD) |
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Etiology of Diarrhea
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Rotavirus
Salmonella, shigella, campylobacter Giardia Cryptosporidium Clostridium difficile Antibiotic therapy |
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Diarrhea Concept of Oral Rehydration
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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 |
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Prevention of Diarrhea
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(Most diarrhea is spread by the fecal-oral route)
Teach personal hygiene Clean water supply/protect from contamination Careful food preparation Handwashing |
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Constipation
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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 |
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Newborn Period
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First meconium should be passed within 24-36 hrs of life; if not, assess for:
- Hirschsprung disease, hypothyroidism - Meconium plug, meconium ileus (CF) |
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Infancy
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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 Interventions |
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Constipation in Childhood
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Often due to environmental changes or control over body functions Encopresis: inappropriate passage of feces, often with soiling May result from stress Management
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Nursing Considerations Constipation
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History of bowel patterns, medications,
diet Educate parents and child Dietary modifications (age appropriate |
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Hirschsprung Disease
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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
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Clinical Manifestations of Hirschsprung
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Aganglionic segment usually includes the rectum and proximal colon Accumulation of stool with distention Failure of internal anal sphincter to relax Enterocolitis may occur
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Therapeutic Management Hirschsprung
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Surgery Two stages
- Temporary ostomy - Second stage—"Pull-through" procedure |
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Nursing Considerations Hirschsprung
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Pre-operative care Postoperative care Discharge care
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Vomiting
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Therapeutic management Nursing considerations
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Gastroesophageal Reflux (GER)
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Defined as transfer of gastric contents
into the esophagus Occurs in everyone Frequency and persistency may make it abnormal May occur without GERD GERD may occur without regurgitation |
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GER (cont'd)
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Diagnostics
Therapeutic management Nursing considerations |
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Acute Appendicitis
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Etiology and pathophysiology Diagnostic evaluation Therapeutic management
- Ruptured appendix - Prognosis Nursing considerations |
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Hypertrophic Pyloric Stenosis (HPS)
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Constriction of pyloric sphincter with obstruction of gastric outlet
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Pyloric Stenosis
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Pathophysiology
Diagnostic evaluation Therapeutic management Prognosis Nursing considerations |
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Pyloric Stenosis Symptoms
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•Usually 2-4 weeks after birth
•Projectile vomiting •Peristaltic waves seen right to left •Mass in RUQ abdomen |
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Diagnosis Stenosis
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Upper GI
Ultrasound Dehydration Weight loss |
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Treatment Stenosis
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IV fluids Special feedings Pyloromyotomy
Postop Care -NPO then clear liquids after 3-6 hours -Tolerates increasing amounts of formula -Home 24-48 hours |
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Inflammatory Bowel Disease (IBD)
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Includes ulcerative colitis (UC) and
Crohn's disease (CD) •Etiology and pathophysiology ■Diagnostic evaluation •Therapeutic management •Medical treatment •Nursing considerations |
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Iterative Colitis
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- Rectal bleeding
- Severe diarrhea - Little or no pain - Mild or mod anorexia - Mod wt loss - Mild growth retardation - Mild to moderate joint pain - Mild rashes |
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Cleft Lip and/or Cleft Palate
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Facial malformations that occur during embryonic development May appear separately or together Etiology and pathophysiology Diagnostic evaluation
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Surgical Correction of Cleft Lip
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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 |
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Surgical Correction of Cleft Palate
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Typically 12-18 months of age
Effect on speech development Prognosis Nursing considerations |
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Cleft Lip and Palate Feeding
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Issues
Techniques and interventions Special feeding equipment Breastfeeding issues |
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Management of TEF
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Surgical interventions
Prognosis Associated tracheomalacia Nursing considerations |
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Hernias
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•Definition: a protrusion of portion of an
organ through an abnormal opening •Danger of incarceration/strangulation |
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Pediatric Hernias
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•Diaphragmatic
•Hiatal * Umbilical/abdominal - Omphalocele - Gastrochisis |
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Intussusception
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Telescoping or invagination of one portion of intestine into another Occasionally due to intestinal lesions Often cause is unknown
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Intussusception
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Dx: Barium Enema, digital exam that reveals mucous, blood
Mgt: Barium enema, water soluble contrast or air pressure per radiologic exam Surgery |
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Intussusception (cont'd)
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■Diagnostic evaluation
■Therapeutic management •Prognosis •Nursing consideration |
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FAILURE TO THRIVE
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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 disease. Idiopathic: Unexplained by the usual organic and environmental etiologies |
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ASSESSMENT Intussusception
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-Growth failure
-Developmental retardation - social, motor, adaptive, language -Apathy -Poor hygiene -Withdrawn behavior |
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Assessment (cont.) Intussusception
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-No fear of strangers( at appropriate age)
-Avoidance of eye contact -Radar Gaze -Stiff and unyeilding or flaccid and unresponsive -Minimum smiling -Feeding or Eating disorders |
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Other Indicators of FTT
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Weight below 5th percentile
Muscle hypotonia and less mass Weakness Repetitive stimulating behaviors Sleep disturbances Lack of parental preference |
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Malabsorption Syndromes
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Characterized by chronic diarrhea and malabsorption of nutrients May result in failure to thrive Digestive defects Absorptive defects Anatomic defects
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Celiac Disease
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•AKA gluten-induced enteropathy and celiac sprue
•Four characteristics -Steatorrhea -General malnutrition -Abdominal distention -Secondary vitamin deficiencies |
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Celiac Disease (cont'd)
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Pathophysiology Diagnostic evaluation Therapeutic management Nursing considerations
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Short Bowel Syndrome (SBS)
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A malabsorptive disorder
Results from decreased mucosal surface area, usually as result of small bowel resection Etiology and pathophysiology Therapeutic management Nursing considerations |
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Cystic Fibrosis
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Autosomal recessive trait Chromosome 7 Mostly Caucasian children Average life expectancy is 26 Affects 1:2000-3000 live births
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Manifestations of CF
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•Growth failure
•Steatorrhea •Voracious appetite •Constipation/obstruction •Respiratory disease, cough •Increased Cl levels in perspiration •Deficient pancreatic enzymes |
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Diagnosis of CF
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Sweat chloride
CXR Presence of chronic lung disease Stools for trypsin and fat |
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Management of CF
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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 |
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PKU
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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) |
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Foods
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Vegetables
Fruits Juices Some cereals, breads, starches Special formula ie, Lofenalac Avoid all protein foods Avoid aspartame |
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Drug Products Containing Phenylalanine
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(per tablet)
Dimetapp 8mg Childrens Tylenol 4-6 mg Benadry 4mg Valu-Rite Expectorant DM Clear cough syrup 14mg/5ml |
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Toxicity in Children Acetaminophen
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— Most common
- May occur with large doses or long treatment - Activated charcoal - Mucomyst(N-acetylcystiene) |
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Toxicity in Children Salicylate
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- Syrup of Ipecac (emesis)
- Hospital for severe (lavage) - Activated charcoal early important - Sodium Bicarb transfusions - External cooling - Diazapam for seizures - Vitamin K for bleeding |
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Education
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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 |
