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101 Cards in this Set
- Front
- Back
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Organs of the Digestive Tract
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Mouth: begining of digestion
Pharynx (throat) Esophagus: moves food from mouth to stomach Stomach: churn and mix contents with gastic juices |
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Small Intestine
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Most digestion occurs here
Composed of: Duodenum Jejunum Ileum |
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Large Intestine
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Four major functions:
-completion of absoption -manufacture of certain vitamins -formation of feces -expulsion of feces |
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Large Intestine
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Digestion completed
Composed of: Cecum Appendix colon-Ascending, transverse, descending, and sigmoid Rectum Anus |
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Accessory Organs
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-Teeth and gums: bite, crush, and grind food
-Tongue -Salivary glands: secrete salvia *Parotid *Submandibular *Sublingual -Liver -Gallbladder -Pancreas |
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Liver
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-largest glandular organ in the body & one of the most complex
-In the adult it weighs 3lbs -located just inferior to the diaphragm, covering most of the upper right quad and extending into the left epigastrium. Divided into 2 lobes. -approx. 1500 mL of blood is delivered to the liver every minute by the portal vein and the hepatic artery. |
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Bile
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produced by the cells of the liver
-necessary for the metabolism of fats -liver releases 500 to 1000 mL of bile per day. -travels to the gallbladdeer through hepatic ducts -stored in the gallbladder until needed for fat digestion |
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gallbladder
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3-4 in long located on the right interior surface of the liver
-stores bile until needed for fat digestion |
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Other functions of the Liver
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-managing blood coagulation
-managing cholesterol -managing albumin to maintain normal blood volume -filtering out old RBC's and bacteria -detoxifying poisons (alcohol, nicotine, drugs) -converting ammonia to urea -providing the main source of body heat -storing glycogen for later use -activating vit D -breaking down nitrogenous waste (from protein metabolism) to urea, which the kidneys can excrete as waste from the body |
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Pancreas
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-an elongated gland that lies posterior to the stomach
-active organ, involved in both endocrine and exocrine duties -produces 1000-1500 mL of pancreatic juice to aid in digestion. This juice contians the digestive enzymes protease (trypsin), lipase, (steapsin), and amylase (amylopsin), these are important because of their ability to digest the 3 major components of chyme-protein, fats, and carbohydrates |
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Regulation of food intake
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hypothalamus, a portion of the brain, contains 2 centers that have an effect on eating. One center stimulates the individual to eat & the other signals the individual to stop eating.
Factors that also affect eating: -distention decreases appetite -controls in our bodies, lifestyles, eating habits, emotions, and genetic factors all influence intake of food and blend together to influence each individual's body build. |
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Disorders of the Mouth
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common disorders of the mouth and esophagus that interfere with adequate nutrition include poor dental hygiene, infections, inflammation, and cancer
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Dental Plague and caries
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dental decay is an erosive process that results from the action of bacteria on carbohydrates in the mouth, which in turn produces acids that dissolve tooth enamel
95% of americans have tooth decay. Tooth decay caused by: the presence of dental plaque, a thin film on the teeth made of mucin and colloidal material found in saliva and often secondarily invaded by bacteria. The strength of acids and the ability of the salvia to neutralize them. The length of time the acids are in contact with the teeth. Susceptibility of the teeth to decay. |
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Candidiasis
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any infection caused by a species of Candida, usually C. albicans. Candida is a fungal organism normally present in the mucous membranes of the mouth, intestinal tract, and vagina and is also found on the skin of healthy people. Referred to as thrush and moniliasis. Appears most commonly in the newborn infant, who becomes infected while passing thru the birth canal. Older individual-with leukemia, diabetes, or alcoholism, and ppl taking antibiotics (chlortetracycline or tetracycline) or steriods, or general weakened state, chemotherapy and/or radiation
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Candidiasis-clinical manifestations
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appears as pearly, bluish white "milk curd" membranous lesions on the mucous membranes of the mouth, tongue, and larynx. If patch or plaque is removed painful bleeding can occur
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Candidiasis-Medical Management
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1 to 4 mL of nystatin (Mycostatin) dropped in the infected infant's mouth several times a day.
Adult-nystatin or amphotericin B ) an oral suspension) or buccal tabs and half-strengh hydrogen peroxide/saline mouth rinses may provide some relief. Vaginal-nystatin vaginal tabs(100,000 units dissolved) inserted into vagina 2x a day. |
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Candidiasis-Nursing Interventions
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-meticulous handwashing to prevent spread of infection
-cleanse the infant's mouth of any foreign material, rinsing the mouth and lubrication the lips -inspect mouth using a flashlight and tongue blade -adults-instruct pt to use a soft-bristle toothbrush and admin a topical anesthetic 9lidocaine or benzocaine) to mouth 1 h before meals. -give soft or pureed foods and avoid hot, cold, spicy, fried, or citrus foods |
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Irritable bowel syndrome
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-disorder with episodes of alterations in bowel function
-combination of chronic and recurrent gastrointestinal symptoms-mainly intestinal pain and distubed defecation or abdominal distension-that are not explained by structural or biochemical abnormalities; it is a dysfunction of the intestinal muscles -spastic and uncoordinated muscle contractions of the colon |
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Irritable bowel syndrome-Clinical Manifestations
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-abdominal pain relieved after a bowel movement
-frequent bowel movements with pain onset -sense of incomplete evacuation -abdominal distenstion -flatulence, constipation, and/or diarrhea |
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Irritable bowel syndrome-diagnostic tests
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-hx
-physical exam -exclusion of other causes -screened for Crohn's disease, ulcerative colitis, cancer of colon, diverticulitis, salmonella *when no pathology or structural abnormality is detected and when symptoms and signs include abdominal pain and altered motility, IBS is a probable dx |
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Irritable bowel syndrome-medical management
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Diet & bulking agents (metamucil)
-bulking agents used instead of dietary fiber -anticholinergics-relieve abdominal cramps -milk of mag, fiber, or mineral oil-constipation -Opioids-used in diarrhea-predominant IBS -antianxiety drugs |
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Irritable bowel syndrome-Nursing Interventions
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-logging the type of food for fiber content, consistency of stool, degree of pain
-pt teaching reguarding the relationship of fiber to both constipation and diarrhea and use of bulking agents |
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Chronic Inflammatory Bowel Disease-Ulcerative colitis Etiology/pathophysiology
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-ulceration of the mucosa and submucosa of the colon
-tiny abscesses form, which produce purulent drainage, slought the mucosa, and ulcerations occur (usually starts on left side and progresses to the right side) |
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Chronic Inflammatory Bowel Disease- Ulcerative Colitis Clinical Manifestations and tests
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-diarrhea-may contain mucus, pus and blood; 15-20 stools per day
-abdominal cramping and distention -involuntary leakage of stool tests: barium studies, colonscopy, stool for occult blood |
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Chronic Inflammatory Bowel Disease-Ulcerative Colitis Medical Management
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-medications 4 major categories
-those that affect the inflammatory response -antibacterial drugs -drugs that affect the immune system -antidiarrheal preparations *sulfasalazine(drug of choice for mild) effective in maintaing clinical remission and in treating mild to moderately severe attacks *nonsulfa *corticosteroids *antidiarreals-lopermide, azathiprine -diet: no milk products or spicy foods; high-protein, high-calorie; TPN (severe cases) |
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Crohn's disease-Etiology/pathophysiology
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-inflammation, fibrosis, scarring, thickening of the bowel wall
-cause unknown -primarily occurs in sm. intestine but can affecgt any part of the GI tract -Malabsorpiton-major problem -complications: -pernicious anemia (decrease vitamin B12 absorption in sm intestine) -fluid and electrolyte imbalance (sodium/k+loss) |
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Crohn's disease-clinical manifestations
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-diarrhea
-fatigue -abdominal pain -loss of appetite -dehydration/electroylyte imbalance |
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Crohn's disease-DX tests
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colonoscopy with biopsies (most effective)
-small bowel barium enema |
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Crohn's disease-medical management
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Avoid in diet
-lactose-containing foods (suspected of having lactose intolerance) -cauliflower, broccoli, cabbage -caffeine -beer and carbonated beverages -fatty foods -sugarless (sorbitol-containing) gum and mints -highly seasoned foods Medications: -corticosteroids(preferred treatment) -azulfidine (GI antiinflammatory) -antibiotics (microabscesses which are a complication of Crohn's) -antidirrheals; antispasmodics -enteric coated fish oil capsules -B12 replacement |
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Crohn's disease-surgery
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-segmental resection of diseased bowel with anastomosis
-bypass of diseased bowel (anastomosis) |
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Crohn's disease-nursing diagnoses
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-nutrition (decrease residue, increase protein, increase calorie diet)
-fluid balance (2500 mL/daily) -TPN and tube feedings (severe cases) -monitor weight -I&O (output at least 1500mL/day desired) -beside commode |
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Appendicitis-Etiology/pathophysiology
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-inflammation of the appendix
-most common cause-obstruction of lumen by fecal matter...E.coli multiplies and infection develops |
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Appendicitis-Clinical manifestations
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-rebound tenderness over right lower quadrant of abdomen (McBurney's Point)
-vomiting -low-grade fever, elevated WBC -decreased or absent bowel sounds |
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Appendicitis-Medical Management
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-emergency appendectomy
-perforation of appendix may occur prior to surgery *appendiceal abscess *generalized peritonitis |
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Appendicitis-Nursing Interventions
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-bed rest
-NPO -comfort measures for pain relief so that symptoms will not be masked by medication -fluid and electrolyte replacement -temp, b/p, pulse, and respirations are monitored and documented every hr because of the threat of perforation with peritonitis |
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diverticular disease-E&P
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-Diverticulosis-possible herniations through the muscular layer of colon (particularly sigmoid colon)
-Diverticulitis-inflammation of one or more diverticula -may lead to perforation, abscess, peritonitis, obstruction, and hemorrhage |
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diverticular disease-clinical manifestations
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-diverticulosis
*may have few, if any, symptoms *constipation, diarrhea, and/or flatulence *pain in the left lower quadrant -Diverticulitis *mild to severe pain in the left lower quadrant *elevated WBC and sed rate *fever *if untreated-->septicemia and intestinal obstruction can occur |
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diverticular disease-med management
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-depends on cause
-diverticulosis with muscular atrophy *low-residue diet; stool softners *bedrest -diverticulosis with increased intracolonic pressure and muscle thickening *high-fiber diet *sulfa drugs *antibiotics; analegics -diverticulitis-antibiotics (p.o. or IV), bedrest, possible NG tube and IV fluids |
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diverticular disease-surgery
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-advised if long term problems do not respond to medical management
-mandatory for hemorrhage, obstruction, abscesses, or perforation -types *one-stage-resection of affected bowel with anastomosis *two-stage-resection of affected bowel with diverting temporary colostomy *goal-closure of colostomy within 3 mo |
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Peritonitis
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-inflammation of abdominal peritoneum
-bacterial contamination of peritoneal cavity from fecal matter of chemical irritation |
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Peritonitis-clinical manifestations
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-severe abdominal pain; nausea and vomiting
-abdomen is tympanic; absence of bowel sounds -chills; weakness |
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Peritonitis-tests
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-flat plate of abdomen
-CBC with differential-leukocytosis |
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Peritonitis-med management
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-postion client in semi-fowler's postion
-surgery *repair cause of fecal contamination *removal of chemical irritant -parenteral antibiotics -NG tube to prevent GI distention -IV fluids |
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External hernias
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-protrusion of viscus through an abnormal opening or weakened area in wall of the cavity in which it is normally contained
-types *ventral (incisional) -femoral -inguinal -umbilical |
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External hernia-clinical manifestations
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-protroduing mass or bulge around umblilicus, in inguinal area, or near an incision
-incarceration (cannot be reduced) -strangulation (blood supply and intestinal flow are occluded) |
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External hernia-med management
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-if no discomfort, hernia left unrepaired
-surgery *immediate surgery for strangulated hernia or obstruction *synthetic mesh applied to weakened are of abdominal wall |
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hiatal hernia
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-protrusion of the stomach and other abdominal viscera through an opening in the membrane or tissue of the diaphragm
-contributing factors: obesity, trauma, aging |
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hiatal hernia-clinical manifestations
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-few, if any, symptoms
-gastroesophageal reflux (most common symptom) |
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hiatal hernia-med management
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-head of bed should be slightly elevate when lying down
-surgery |
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Intestinal obstruction
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-intestinal contents cannot pass through the GI tract
-partial or complete -mechanical-adhesions, volvulus -non mechanical-paralytic ileus |
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Intestinal obstruction-clinical manifestations
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-high-pitched or absent bowel sounds
-nausea, vomiting, dehydration -abdominal pain and distention -constipation |
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intestinal obstruction-tests
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-abdominal x-ray (most useful)
-BUN, sodium, potassium, hemoglobin, and hematocrit |
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Intestinal obstruction-medical management
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-evacuation of intestine
*NG tube decompress the bowel ( removal of gas and fluid) *intestinal tube to evacuate intestinal contents Surgery-required for mechanical obstructions |
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Intestinal obstruction-nursing interventions
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-surgery-careful monitoring of fluids and electrolytes, observation of the function of tubes used to decompress and relieve distention, and the administration of analgesics
post op: fowler's position for greater diaphragm expansion and should encourage pt to breathe throught the nose and not swallow air, which would increase distention and discomfort -deep breathing and coughing -nasointestinal suctioning until bowel activity returns -assess bowel sounds and abdominal girth to help determine return of peristalsis |
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Cancer of the colon
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-mallignant neospasm that invades the epithelium and surrounding tissue of colon and rectum
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cancer of colon-clinical manifestations
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-change in bowel habits; rectal bleeding
-abnormal pain, distention and/or ascites -nausea and vomiting -weightloss |
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cancer of colon-tests
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-proctosigmoidoscopy with biopsy
-colonoscopy -stool for occult blood |
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cancer of colon-med management
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-radiation-decrease the size of tumor and rate of lymphatic involvment
-chemotherapy -surgery *depend on location of the tumor, presence of obsruction or perforation of the bowel, possible metastasis, health status and surgeron. -one-stage resection with anastomosis -two stage resection with (1) resection by bring the ends of the bowel to the surface and creating a temp colostomy and mucus fistula or Hartmann's pouch (2) a double-barrel colostomy (3)a temp loop colostomy for closure later **know** Right HEMICOLECTOMY-resection of ascending colon and hepatic flexure; ileum anastomosed to transverse colon *left hemicolectomy; resection of splenic fexure, descending colon, and sigmoid colon anastomosed to rectum *anterior rectosigmoid resection: resection of part of descending colon, the sigmoid colon, and upper rectum; descending colon anastomosed to remaining rectum |
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cancer of colon-treatment
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-treatment of colorectal cancer usually involves surgical removal of the affected portion of the intestine
*right hemicolectomy *left hemicolectomy *anterior rectosigmoid resection -depending on different variables *end to end anastomosis *colostomy (temporary or permanent) |
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cancer of colon-nursing interventions/assessment concerns
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-bowel elimination
-urinary elimination -fluid and electrolyte balance -tissue perfusion -nutrition -pain -gas exchange -infection -peristomal skin integrity |
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Cirrhosis
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-chronic, degenerative disease of liver
-scar tissue restricts flow of blood to liver--->contributes to destruction |
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Types of cirrhosis
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-alcoholic cirrhosis-chronic ETOH ingestion
-postnecrotic cirrhosis-viral hepatitis, hepatotoxins, infection -primary billary cirrhosis-destruction of bile ducts -secondary billary cirrhosis-chronic billary tree obstruction from gallstones or tumor |
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Cirrhosis
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Alteration of liver function
-reduced ability to metabolize albumin -obstruction of portal vein -increased pressure in veins that drain GI tract *Complications -Ascites -Escophageal varices -Hepatic encephalopathy |
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Cirrhosis-clinical manifestations
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Early stages
-abdominal pain -liver is firm and easy to palpate Late Stages -dyspepsia -changes in bowel habits -ascites -nausea and vomiting -gradual weight loss -bleeding tendencies, epistaxis, and anemia -jaundice |
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Cirrhosis-med management
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Eliminate the cause
-alcohol -hepatotxins(ie, acetaminophen) -environmental exposure to harmful chemicals -decrease buildup of fluids in the body -antiemetics -diet therapy-a diet that is well-balanced, high in calorie (2500-3000), moderately high in protein, low in fat, low in sodium, and with add vitamins and folic acid improve deficiencies(with impending liver failure, restrict protein and fluids) |
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Cirrhosis-treatment of complications
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Ascites( an accumulation of fluid and albumin in the peritoneal cavity)
-bedrest -strict I&O -restrict fluids (stometime 500-1000mL) -restrict sodium -diuretics: aldactone, lasix, HCTZ -vitamins K (aquaMephyton) and C, folic acid supplements -Paracentesis (withdrawling fluid from abdominal cavity by gravity or vaccum |
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Hepatitis
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-inflammation of the liver resulting from several types of viaral agents or exposure to toxic substances
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Hepatitis-modes of transportation of the 6 types of viral hepatitits
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(1)hep A(HAV) spreads by direct contact through oral-fecal route, usually by food or water contaminated with feces.
(2) hep B(HBV) is transmitted by contaminated serum via blood transfusion, the use of contaminated needles and instruments, needlesticks, illicit IV drug use, and dialysis, and by direct contact with body fluids of infected people, such as breast milk and sexual contact. (3) hep C (HCV) is transmitted through needle sticks, blood transfusions, and illicit IV drug use and by unidentified means (4) hep D is transmitted the same way as hep B (5)hep E is transmittted by the ooral-fecal route; it spreads through the fecal contamination of water (6) hep G is frequently seen as a coinfection with hep C; it spreads throught bloodbourne exposure |
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Hepatitiis-clinical manifestations
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-general malaise
-aching muscles -photophobia -headaches -chills -abdominal pain -dyspepsia -nausea -diarrhea vs. constipation -pruritus -hepatomegaly -enlarged lymph nodes -weight loss -jaundice -dark amber urine -clay-colored stools |
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Hepatitis-med management
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-treat symptoms
-small, frequent meals, low fat, high carbs -no alcohol for one year -IV fluis for dehydration -Vit C, vitamin B-complex, vitamin K -avoid unnessary meds, especially sedatives -hep B vaccine *should be given to people identified as high risk for developing hep B |
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Choleystitis and cholelithiasis
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an obstruction, gallstone, or tumor prevents bile from leaving gallbladder and the trapped bile acts as an irritant causing inflammation
-risk factors- -female, american indian or white, obesity, pregnancy, diabetes, use of birth control |
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Choleystitis and cholelithiasis-clinical manifestations
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-indigestion after eating foods high in fat
-severe, colicky pain in right upper quadrant -anorexia -nausea and vomiting -flatulence -diaphoresis -low-grade fever -elevated WBC |
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Choleystitis and cholelithiasis-med management
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*mild attacks*
-bed rest -ng tube to suction -NPO -IV fluids -Antispasmodic/analgesic (usually Demoral) -antibiotics -avoid spicy foods when allowed PO intake |
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Choleystitis and cholelithiasis-surgery
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Lithotripsy-treated by a machine that discharges a series of shock waves through water or a cushion that breasks the stone into fragments
Cholecystectomy-removal of gallbladder is usually treatment of choice -laparoscopic-uses a laser or cautery to remove the gallbladder-moving the gallbladder through one of four small punctures in the abdomen -open-jackson-pratt or penrose drain or Davol-the abdominal cavity is inflated with 3-4 L of carbon dioxide to improve visibility. Teh surgeon removes the deflated gallbladder through a laparoscope |
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Pancreatitis
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-inflammation of the pancreas
*acute or chonic -predisposing factors alcohol (common) trauma infectious disease certain drugs |
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Pancreatitis-clinical manifestations
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-abdominal pain radiating to back
-anorexia; nausea and vomiting -malaise -low-grade fever -jaundice |
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Pancreatitis
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-inflammation of the pancreas
*acute or chonic -predisposing factors alcohol (common) trauma infectious disease certain drugs |
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Pancreatitis-med management
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-NPO
-IV fluids -NG tube -Antimetics -PCA for pain control -Antichoinergics -HYperalimentation |
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Pancreatitis-clinical manifestations
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-abdominal pain radiating to back
-anorexia; nausea and vomiting -malaise -low-grade fever -jaundice |
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Pancreatitis-med management
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-NPO
-IV fluids -NG tube -Antimetics -PCA for pain control -Antichoinergics -HYperalimentation |
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Cleft lip/Palate
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facial malformations that occur during embryologic development
-1 in 1000 live births -due to the failure of the medial nasal and maxillary processes to join -may be unilateral or bilateral and is often associated with abnoraml development of the external nose, nasal cartilages, and nasal septum -cleft ot the palate is due to failure of the palatal shelves to fuse-may involve only the soft palate or may extend into the hard palate. -consistent with a multifactorial inheritance |
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Cleft lip/Palate
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facial malformations that occur during embryologic development
-1 in 1000 live births -due to the failure of the medial nasal and maxillary processes to join -may be unilateral or bilateral and is often associated with abnoraml development of the external nose, nasal cartilages, and nasal septum -cleft ot the palate is due to failure of the palatal shelves to fuse-may involve only the soft palate or may extend into the hard palate. -consistent with a multifactorial inheritance |
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Cleft lip/Palate-clinical manifestations
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-feeding difficulties-infants may have an ineffective suck, and salvia and feedings may leak into the nasal cavity, causing gagging and choking, leading to aspiration as the infant breathes
-speech may also be delayed -predisposed to recurrent otitis media -psychologic difficulties |
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Cleft lip/Palate-clinical manifestations
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-feeding difficulties-infants may have an ineffective suck, and salvia and feedings may leak into the nasal cavity, causing gagging and choking, leading to aspiration as the infant breathes
-speech may also be delayed -predisposed to recurrent otitis media -psychologic difficulties |
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Cleft lip/Palate-med management and interventions
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surgical closure of teh cleft lip 2 months of age, when the infant has shown satisffactory weight gain and is free of any oral, respiratory, or systemic infections
-Zplasty Interventions- adequate nutrition prevent aspiration ESSR method after surgery-NPO |
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Cleft lip/Palate-med management and interventions
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surgical closure of teh cleft lip 2 months of age, when the infant has shown satisffactory weight gain and is free of any oral, respiratory, or systemic infections
-Zplasty Interventions- adequate nutrition prevent aspiration ESSR method after surgery-NPO |
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Dehydration
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when the body loses more fluid than it absorbs, as in diarrhea, or when it absorbs less water than it excretes, vomiting...whenever total fluid intake is less than the total fluid output.
-note changes in child's body weight -corresponds to fluid deficits of 5%, 10%, 15% tests: serum sodium, serum glucose, serum bicarbonate, and blood urea nitrogen (BUN) |
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Dehydration
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when the body loses more fluid than it absorbs, as in diarrhea, or when it absorbs less water than it excretes, vomiting...whenever total fluid intake is less than the total fluid output.
-note changes in child's body weight -corresponds to fluid deficits of 5%, 10%, 15% tests: serum sodium, serum glucose, serum bicarbonate, and blood urea nitrogen (BUN) |
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Hypertrophic pyloric stenosis
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obstructive disorder in which the gatric outlet is mechanically obstructed by a congenitally hypertrophied pyloric muscle
-most common reason for an abdominal operation during the first 6mo -1 in 250 live births -males are 3-4 times likely -cause unknown -the circular muscle that surrounds the valve between the stomach and the duodenum decomes diffusely enlarged as the result, the passage becomes more narrow and it is difficult for the stomach to empty. At approx 4-6 wk, infants with HPS begin to vomit almost immediately after feedings--hallmark sign |
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HPS-clinical manifestations
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-signs begin as regurgitation that progresses to projecitle vomiting 30-60 min after feeding
-lethargy, weight loss, poor skin turgor, sunken fontanelles, and loss of subcut tissue may become apparent as dehydration ensues |
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Hypertrophic pyloric stenosis
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obstructive disorder in which the gatric outlet is mechanically obstructed by a congenitally hypertrophied pyloric muscle
-most common reason for an abdominal operation during the first 6mo -1 in 250 live births -males are 3-4 times likely -cause unknown -the circular muscle that surrounds the valve between the stomach and the duodenum decomes diffusely enlarged as the result, the passage becomes more narrow and it is difficult for the stomach to empty. At approx 4-6 wk, infants with HPS begin to vomit almost immediately after feedings--hallmark sign |
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HPS-tests
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-visible peristaltic waves that move from left to right across the epigastric region
-readily palpable olive-shaped mass in the epigastrium just to the right of the umbilicus -Ultrasonography will demonstrate an elongated sausage-shaped mass with an elongated pyloric channel -upper GI radiography |
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HPS-clinical manifestations
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-signs begin as regurgitation that progresses to projecitle vomiting 30-60 min after feeding
-lethargy, weight loss, poor skin turgor, sunken fontanelles, and loss of subcut tissue may become apparent as dehydration ensues |
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HPS-tests
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-visible peristaltic waves that move from left to right across the epigastric region
-readily palpable olive-shaped mass in the epigastrium just to the right of the umbilicus -Ultrasonography will demonstrate an elongated sausage-shaped mass with an elongated pyloric channel -upper GI radiography |
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HPS-med management
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-surgical relief of the pyloric obstruction
-Fredet-Ramstedt procedure (pyloromyotomy) involves surgically splitting the pylorus muscle down to, but not including the submucosa, allowing for a larger lumen. |
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HPS-nursing interventions
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-assist with the establishment of a dx, providing adequeate nutrition, managing preop and postop care, and supporting family.
-NPO -I&O |
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Intussusception
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-most common cause of intestinal obstruction in children 3mo and 6yr
-twice as common in male children -result of the telescoping of one portion of the intestine into another. most commonly the ileocecalvalve, at the juncture of the distal ileum and the proximal colon. As the ileum telescopes into the colon, the passage of intestinal contents distal to the defect becomes obstructed. As the mucosa of the intestinal walls rub together, blood and mucus from the mucosa leak into the intestinal lumen and form "currant jelly" stools (feces that is mixed with blood and mucus from the intestinal mucosa)---hallmark sign serious complications include: -peritonitis, intestinal ischemia, infarction, perforation, and shock |
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Intussusception-clinical manifestations
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-sudden onset of severe abdominal pain in a previously well child
-child will assume fetal position to guard abdomen -vomiting and lethargy usually occur -within 12 h of onset, the child usually passes "currant jelly" |
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Intussusception-tests
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-hx and physcial signs
-barium enema,which will reveal obstruction to the flow of barium throught the intestine -abdominal radiograph is obtained to detect intraperitoneal air from a bowel perfortion, which would contraindicate a barium enema -digital rectal exam |
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Intussusception-med management
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-hydrostatic reduction using barium at the time of dx evaluation. The force exerted by the flowing barium from the enema may successfully force the telescooped portion of the bowel into its correct position
-surgical tx of intussusception involves manual reduction of the invagination (the process of becoming enclosed in a shealth) and, if necessary, resection of nonviable bowel with end-to-end anatomois |
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Hirchsprung's Disease
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-also known as Megacolon (congentialaganglioinic megacolon), is a functional intestinal obstruction caused by the absence of parasympathetic ganglion cells in a portion of the colon.
-more common in chilren with trisomy 21 -there is an absence of innervation to a segment of the bowel -the lower portion of the sigmoid colon just abouve the anus is affected..as result there are no peristalitic waves in the affected portion of the colon to propel the fecal contents, cuasing an intestinal obstruction and distention of the bowel proximal to the defect |
