Gastrointestinal Flashcards
(45 cards)
1
Q
major problems assoc with GI dysfunction
A
- fluid/electrolytes and acid-base imbalance
- failure to thrive - inc metabolic needs and problems with absorption
- vomiting and aspiration
- infection
- pain
2
Q
GI diagnostics
A
- radiologic
- endoscopic
- U/S and scan
- analysis of stools and secretions
- if having a test that requires NPO, teach when and how to do that
- use developmentally appropriate language
- if getting dye, ask if they’ve had any rxns to this dye in their hx
3
Q
alternative means of nutrition and elimination
A
- Nasogastric tube:
- feeding
- decompression
- lavage
- Nasoduodenal tube and nasojejunal
- feeding
- parents are taught to replace G button but if can’t then need to go to a hospital to get it put back in
4
Q
common problems with a gastrostomy tube
A
- leakage around the tube
- blocked tube
- erythema around the stomal site
- vomiting/diarrhea
- bleeding around the tube or stoma
- build up of granulation tissue
5
Q
mushroom device
A
- can be placed as primary button during open gastrostomy procedure
- low profile
- not easily pulled out
6
Q
balloon device
A
- patient and family friendly
- locking feature w/ universal extension tubes
- balloon ruptures
- top heavy
7
Q
what is the proper solution to use for an enema in a child?
A
- use isotonic soln - 0.9% NaCl or mix 1 tbsp of table salt in 500 mLs (1 pint) of tap water
8
Q
enemas
A
- don’t get in habit of giving child enema if constipated b/c invasive and can cause dependence
- try diet changes first or Miralax
- inc fluid intake
- smaller the pt is the, the smaller amount of instillation fluid that is given to them and the smaller the amount of tube that goes into them
- if they feel pain, lower the instillation bag
- instilled fluid should be room temp so as not to cause cramping
9
Q
preop nursing care for child with cleft lip/palate
A
- timing
- prevention of aspiration
- providing nutrition
- prevention of infection
- prevent delay in speech - surgery for cleft palate usually done b/w 9-15 mos
- surgery for cleft lip typically done when child weighs 10 lbs (4.5 kgs) and is 10 weeks old
10
Q
post op nursing care for a child with cleft lip/palate
A
- immediately assess for hemorrhage, shock, and respiratory status (priority!)
- prevent:
- trauma to the suture line: by keeping child supine and elevate to HOB
- F/E imbalances
- pain: can use tylenol (not ibuprofen until after 6 mos)
11
Q
ongoing care after a child has surgery for cleft lip/palate
A
- promote:
- healing - gently wash with soap and water and apply thin layer of abx ointment
- parent-infant attachment
- prevent:
- trauma
- crying
- provide nutrition
12
Q
special interventions for repair of cleft palate
A
- do not use forks, spoons, or straws post op!
13
Q
clinical manifestations of esophageal atresia and tracheoesophageal fistula
A
- maternal polyhydramnios
- excessive mucus
- continuous or sporadic resp distress
- repeated regurgitations of feedings
- acute gaseous abdominal distention
- passage of abnormal amounts of flatus
- three C’s
14
Q
what are the 3 C’s of Tracheoesophageal fistula??
A
- coughing
- choking
- cyanosis
15
Q
preop teaching for TE fistula
A
- place child NPO immediately - b/c don’t want child to aspirate and cause aspiration pneumonia
- oral suctioning to keep airway clear
- parenteral IV fluid therapy - need peripheral line
- abx: if have aspiration pneumonia
- humidified oxygen
16
Q
postop teaching for TE fistula
A
- maintain:
- airway
- nutrition: G button
- prevent:
- fluid and electrolyte imbalance
- infection at operative site
- pneumonia
- promote comfort w/ pain meds
- educate parents about home care
17
Q
what to do if pt has a G button/NG tube and they pull it out after abdominal surgery?
A
- need to call provider b/c can’t just stick it back in since may go thru surgical site
18
Q
clinical manifestations of Hirschsprung Dz
A
- AKA aganglionic colon
- onset w/ in 24-48 hrs of life
- most children dx w/in first few weeks of life
- assess neonates for passage of meconium or bile stained vomitus and abdominal distention
- older infants may present with constipation or overflow diarrhea
- rectal biopsy to confirm dx
19
Q
tx of Hirschsprung Dz
A
- surgery will be performed to create a temporary colostomy
- will have for about 3 mos to get swelling of colon back to normal proportions
- then will have pull through surgery - pull thru innervated tissue to surface so child can defecate
20
Q
preop care for Hirschsprung’s
A
- placement and maintenance at an NG tube - for decompression
- administration of abx (prophylaxis) and vit K (clotting)
- NPO prior to surgery
21
Q
imperforate anus clinical manifestations
A
- may be discovered on a neonate when taking rectal temp b/c there is no rectum
- meconium is not passed
- definitive dx made by xray
22
Q
imperforate anus preop care
A
- maintain IV
- keep NPO
- clean fistulas well after stool passed
- educate parents on colostomy and its care
23
Q
clinical manifestations of pyloric stenosis
A
- may appear normal in first 2 weeks of life and then nonprojectile vomiting or regurgitation will occur
-
projectile vomiting is hallmark sign and will begin about 2 weeks after initial symptoms begin
- vomiting may occur right after feeding or may be delayed an hour or more
- after infant vomits, they will be hungry
- vomitus NOT bile stained b/c don’t make it to small intestine
- F/E imbalances may occur - metabolic alkalosis
- weight loss and FTT
- olive shaped mass on palpation where hypertrophy of pyloric muscle occurs
24
Q
biggest concern with pyloric stenosis
A
- fluid volume deficit and electrolyte imbalances
25
preop care for pyloric stenosis
* establish and maintain IV line
* correct F/E imbalances before surgery - usually hyponatremic and hypokalemic
* educate about postop care
26
postop care for pyloric stenosis
* pain mgmt with tylenol
* prevention of injury to surgical site - supine
* resumption of feedings - stomach has shrunk so have to start with 1 oz feedings and see how they do, b/c if too big will vomit and inc risk of aspiration
27
degree of dehydration
* pre illness weight - illness weight/pre illness weight
* mild: \<5 %
* moderate: 6-9%
* severe: \>10%
28
gastroesophageal reflux dz (GER-GERD)
* GER becomes GERD when have FTT, bleeding, or dysphagia
* clinical manifestations:
* usually start in 1st week of life
* chronic vomiting or regurg
* FTT
* cardiorespiratory symptoms b/c airway doesn't like acid
* hematemesis
29
diagnostic assessment of GER-GERD
* barium esophagram
* esophageal pH monitoring
* scintigraphic studies - radioactive nucleotide added to infant's formula to see if child has problem with gastric emptying
30
non-pharm mgmt of GER-GERD
* formula thickened w/ rice cereal--usually 1 tbsp of TC w/ 1 oz of formula
* small volume feedings
* give feedings slowly
* frequent burping during feeding
* upright prone or side lying position for 1 hr after feeding
* some docs want them prone but have to have order
* HOB elevated - use reflux harness
31
pharm mgmt of GER-GERD
* start these if non pharm meds not working!
* antacids or H2 receptor antagonists:
* ranitidine, cimetidine, pepcid
* PPI
* omeprazole
* prokinetic meds:
* metoclopramide, bethenechol
32
surgical tx of GERD
* Nissen fundoplication
* bring fundus of stomach up around esophagus and tighten
* child can't burp or vomit, so if get air in stomach, then have to decompress
33
intussusception of GI tract
* invagination or telescoping of one portion of the intestine into another portion of intestine
* narrowing of tract occurs and peristalsis has stopped!
34
intussusception clinical manifestations
* sudden abdominal pain
* vomiting - usually bile stained
* passage of currant jelly like stool
* just blood and mucus is passing, no stool
* if child passes a normal stool, then they have self corrected and no longer need tests/care
* abdominal distention
35
dx and tx of intussusception
* hx
* water soluble contrast or air enema
* non surgical hydrostatic reduction
* **cannot be done by a nurse! have to be done by a trained person!** - b/c perforation can occur if too much pressure is used
* used to do barium enemas - but concerned about perforation which would cause barium to go into GI
* tx:
* enema
* surgery if they don't self correct
36
acute appendicitis
* inflammation of the appendix
* cause not understood - but often there is obstruction of the lumen by stool
* have to try to prevent perforation!
37
clinical manifestations of appendicitis
* initially periumbilical and then RUQ abdominal pain (McBurney's point)
* fever
* rigid abdomen
* dec or absent bowel sounds
* vomiting
* constipation or diarrhea
* anorexia
* tachycardia and rapid, shallow respirations
* lethargy
* pallor
* irritability
* stooped posture bc painful to stand upright
38
diagnostics of appendicitis
* H&P
* elevated WBC - usually no higher than 20,000 w/ elevated bands indicating infection
* abdominal U/S or CAT scan
39
mgmt of appendicitis if not ruptured
* before perforation: surgical removal - can do laparoscopically
* preop: prophylactic abx, IV fluids, chem panel and CBC w/ diff
* postop: care of child having abdominal surgery
40
mgmt of appendicits if ruptured
* preop:
* IV administration of fluid, abx, and electrolytes
* placement of NG tube for decompression
* postop:
* maintenance of IV fluids
* triple abx
* NG to wall suction
* wound may or may not be sutured closed by surgeon
41
NG drainage replacement
* when a child is on suction through an NG tube, then we are removing fluids and electrolytes!
* we have to replace this
* this replacement of F/E is **in addition to their maintenance fluids**
* have to look at order and see how doc wants you to replace NG drainage
* may say replace mL/mL lost or 1/2 mL/mL lost
* ie. replace NG drainage mL/mL lost with NS over 4 hours
* if NG drainage is 100 mL, then set pump to deliver 100 mL over 4 hours, so 25 mL/hour
42
short bowel syndrome (SBS)
* malabsorption syndrome that occurs as a result of dec mucosal surface, usually due to extensive resection of the smll intestine
* most common causes:
* congenital anomalies: jejunal/ileal atresia or gastroschiesis (so intestines outside body when born - can't just push back in, so put in sterile silo and slowly reinsert)
* ischemia from necrotizing enterocolitis
* trauma or vascular injury - ie seatbelts
43
goals of therapy for SBS
* preserve as much length of bowel as possible - the more bowel you lose, the less absorption you have, so may need parenteral nutrition
* maintain optimal nutrition status, growth and development while intestinal adaptation occurs
* stimulate intestinal adaptation w/ enteral feedings
* if restarting PO feeds, then must be extremely slowly (1 mL/hour) b/c want to prevent gut from reacting
* minimize complications related to the dz process and tx
44
nutritional support of SBS
* TPN:
* highest % of dextrose in peripheral line that you can give is 10%! - if give too much, then can cause major infiltration
* if higher than 10%, then need central line - must get CXR to confirm placement, use sterile procedure to care for
* complications of TPN: line infection, perforation
* enteral feedings: continuous vs. bolus feedings - know how much can tolerate
* oral feedings: **very, very important to continue stimulating suck reflex during TPN and enteral feedings!**
* so if get to take things PO, will at least still have strength and reflex present
45
Port a Cath
* when not getting tx, then nothing there on the skin
* have to use Huber needle - need pain meds to access b/c it is painful to the child
* use sterile procedure to care for
