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Gastrointestinal disorders Flashcards

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1
Q

At what age do children’s bowels fully develop?

A

2 YO

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2
Q

What is the volume of an adult stomach?

A

2000-3000 mL

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3
Q

What is the volume of a 16 YO stomach?

A

1500 mL

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4
Q

What is the volume of an infant’s stomach?

A

200 mL. HCl levels are similar to that of an adult at 6 months

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5
Q

Explain why infants are more prone to infection and fluid imbalance.

A

Infants have mucosa that is more sensitive and have more vasculature than the adult mouth. This makes them prone to injury and therefore infection. Infants also have underdeveloped immune systems.
Infants are also more prone to fluid imbalances because they have greater surface area to volume ratios. Therefore they lose more water through the skin when feverish or having GI upset.
They also retain relatively greater amounts of water; they ingest more liquid but excrete more liquid. Because they excrete more water, they are at higher risk for fluid-loss d/t fever or GI upset.
D/t rapid growth, infant BMR is higher. Higher BMR requires more water for excretory function, but infant’s kidneys are still immature. They lose more fluid through urine, increasing the risk of dehydration or overhydration.

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6
Q

Why do newborns experience frequent reflux and regurgitation?

A

Newborn lower esophageal sphincters are underdeveloped until about 1 MO. This places them at higher risk of aspiration.

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7
Q

What is the size of the stomach of a 2 MO?

A

10-20 mL

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8
Q

How do the intestines of an infant differ from that of an adult?

A

Infants have guts that are about 250 cm, while adults have guts of 600cm.

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9
Q

What are some causes of a distended or protuberant abdomen?

A

ascites, tumor, constipation, fluid retention, gaseous distention

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10
Q

What does a depressed or concave abdomen indicate?

A

severe abdominal obstruction, dehydration, malnutrition

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11
Q

Describe the physical assessment progress. What do you start with?
What are some abnormal findings?

A

Least invasive to most invasive.
Color: pallor, jaundice, distended veins, ecchymosis
Hydration: skin turgor, tear presence, urine output, fontanelles
Abdomen: soft, flat, non-distended, nontender
Umbilicus: color, discharge, odor, inflammation, herniation
Mental status: irritability or lethargy
Auscultation of all four quadrants for bowel sounds. ~5 min
Hypoactive = obstruction
hyperactive = diarrhea or gastroenteritis
Percussion: tympanic in all quadrants except RUQ (liver) and MLQ (bladder)
Palpation for tenderness, lesions, masses, turgor, sensitivity
Deep palpation: RUQ (liver), LUQ (spleen), RLQ (cecum), LLQ (sigmoid colon)
abn: rebound tenderness (appendicitis); kidneys (hydronephrosis/mass); firmness (tumor/stool)

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12
Q

What is the amylase test and what does it indicate? What are some nursing interventions?

A

Amylase enzyme converts starch into sugar. Abn amylase indicates pancreatic dz or acute cholecystitis.
Amylase levels remain high 3-6 hours after pain onset

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13
Q

What does serum electrolyte test for (7) and what do abnormal values indicate?

A

K+, Na+, Ca++, Cl, CO2, BUN, Cr abn values indicate dehydration

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14
Q

What is the lipase test and what does it indicate? What are some nursing interventions?

A

Lipase converts fats into fatty acids. Abn values indicate pancreatic dz, cholecystitis, or peritonitis. Levels remain high with acute pancreatitis.

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15
Q

What are LFTs and what do they indicate? What are normal LFT values?

A

AST: 9-40
ALT: 7-60
GGT: 5-40
indicates liver disease
elevated LFTs can be caused by infection or medications/drugs

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16
Q

What stool tests are there and what do they test? What are the indications?

A

hemoccult stool/culture: GI bleeding, GI infection, colitis, malabsorption, diarrhea, abd pain
OVA stool: tests for GI parasites - diarrhea/abd pain (needs 2 tbsp stool)

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17
Q

What does the lactose tolerance test indicate?

A

lactose intolerance

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18
Q

What is the urea breath test for and what are the nursing interventions?

A

H. Pylori. Stop PPIs for 5 days, antacids/antibiotics for 14 days

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19
Q

Which tests visualize the esophagus and upper GI? Briefly describe each.

A

Barium swallow - motility, peristalsis. CI w/ pregnancy, admin to infants via syringe
Esophageal manometry/pH probe - esophageal contractility, GERD. Enters through the nose.
EGD - scopes upper GI tract. Requires sedation/anesthesia
Gastric emptying scan - use of isotopes to measure rate of gastric emptying.

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20
Q

Which tests visualize the liver and other abdominal organs

A

Abdominal ultrasound - impaired by barium use
Colonoscopy - complications: perforation, bleeding, pain
Hepatobiliary HIDA scan - gallbladder EF/view, biliary system. IV radionuclide use
Liver biopsy - examines liver tissue microscopically. requires 8 hr bedrest

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21
Q

What kind of health history do you want to obtain from an initial assessment?

A

medical history, present illness history, family hx, surgical hx
signs and symptoms: quantity, quality, description, onset, duration, frequency

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22
Q

What can cause dehydration in children?

A

Fever, increased metabolic needs, increased urinary output, decreased fluid intake

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23
Q

What can cause irritability or lethargy in children?

A

dehydration, anaphylaxis, increased ammonia levels

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24
Q

When do the fontanelles close?

A

anterior: 9-18 months
posterior: 2 months

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25
What is the normal urine output for infants and children?
2ml/kg/hr for newborns. 1ml/kg/hr for children
26
What are the signs and symptoms of dehydration?
sunken fontanelles, sunken eyes, dry mucosa, lack of tear production, irritability, increased HR and RR, skin tenting, decreased UO
27
What are the risk factors for GI disorders in children?
prematurity, prenatal factors, teratogens family history genetic syndrome, congenital disease chronic illness -> nutritional deficits, immunocompromised, steroid use exposure to infectious agents/foreign travel
28
Describe the pathophysiology of cleft lip and palate. What are some complications that result?
Cleft lip or palate or both can occur when the lip fails to fuse at 5-6 wk gestation or the palate at 7-9 wk gestation. Separation of the lips can cause feeding difficulty, and separation of the soft palate can lead to aspiration or middle ear infections. Both can cause dentition and speech problems.
29
What is the treatment and care of cleft lip/palate?
surgical repair of the lip at 2-3 months and palate at 6-9 months. Postop care includes protecting the sutures (prevent infant from touching it, avoid putting things in the mouth, using protective devices, preventing crying). Promote breastfeeding and bonding. Use false palate or special nipples for feeding if necessary.
30
What are the risk factors for cleft-lip and palate?
advanced maternal age teratogen exposure (esp. psych or seizure meds) prenatal infection
31
What are some common associated defects to cleft lip/palate
heart, ear, GU, skeletal defects
32
What are the signs and symptoms of esophageal/tracheal fistula/atresia?
Polyhydramnios abdominal distention of stomach frothy mucus drooling coughing, choking, cyanosis inability to put in G-tube
33
What are some complications of esophageal/tracheal fistula/atresia?
difficulty feeding aspiration imbalanced nutrition/fluids/electrolytes
34
What are some nursing considerations for surgical repair of esophageal atresia/fistula?
Preop: NPO, prevent aspiration, maintain fluid balance, OG tube care Post-op: TPN, abx, breastfeeding
35
What is the difference between an omphalocele and a gastroschisis?
An omphalocele is caused by a defective umbilical ring, and results in the internal organs protruding out with the peritoneal sac. A gastroschisis is the protrusion of internal organs out of the abdominal wall, and is not protected by a membrane.
36
What do you want to observe for in a baby with an omphalocele or gastroschisis?
perfusion of organs (color, size, temperature) signs of infection/trauma abdominal distention signs of dehydration or electrolyte imbalance
37
What do you want to assess with anorectal malformations?
No meconium <24hr after birth = check for malformation assess UO for other problems signs of intestinal obstruction (distention, biliary vomiting)
38
What are the nursing interventions for anorectal malformation repair?
Preop: NPO, gastric decompression, IVF, antibiotics, education Post-op: ostomy care, pain management, NPO until BS+, skin protection Normal liquid stools postop
39
What are the nursing interventions for the treatment/management of omphaloceles and gastroschisis?
postop management: pain, abx, monitor vitals, I&O, bleeding. OG suction and drainage. Short bowel syndrome prevent hypothermia maintain organ perfusion protect exposed organs from infection/trauma promote bonding
40
What are the signs and symptoms to look for when assessing anorectal malformations?
meconium passage <24 hr after birth signs of intestinal obstruction presence of anal opening UO abnormalities may indicate malformation affects other parts of GU
41
What is Meckel diverticulum and what are some possible complications?
Fusion of the small bowel with the umbilicus can cause bleeding, bowel obstruction (abdominal pain, hypoactive bowel sounds, distention, abdominal mass, rebound tenderness), anemia
42
How is Meckel diverticulum diagnosed?
Meckel (barium) scan to determine intestinal path.
43
Which of the following is NOT a sign/symptom of an inguinal hernia? I. An increase in the size of the bulge when standing II. A decrease in the size of the bulge when straining or coughing III. Potentially, pain and aching in the groin area
I. An increase in size of the bulge when standing. Inguinal hernias increase in size with straining or coughing and may cause pain. Long-term complications include hernia incarceration and bowel strangulation.
44
Fill in the signs and symptoms chart for mild to severe dehydration. Mental status, Fontanel, Eyes, Oral Mucosa, Skin turgor, HR, BP, Extremities, Urine output, weight lost
alert | lethargy | listless Soft and flat | sunken | sunken normal | Mildly sunken | Deeply sunken Pink and moist | Dry and pale | dry elastic | decreased | tenting normal | elevated | Elevated or bradycardic normal | normal | Normal, hypotensive Warm, pink, good cap refill | Delayed refill | Cool, dusky, sig delayed refill Normal to slightly low | <1mg/mL/hr| Sig <1mg/mL/hr <3% | 3-9% | >9%
45
What is the concentration of molecules in OSR?
75 mmol/L NaCl, 13.6 g/L glucose 1qt water, 8 tsp sugar, 1 tsp salt
46
What is the IV fluid of choice for severe dehydration?
20 mg/kg NS or LR
47
What is the rate of OSR administration for mild to moderate dehydration?
50-100 mL/kg over 4 hours
48
What is the fluid maintenance rate for a child of 23 kg?
100 × 10kg = 1,000 50 × 10kg = 500 20 × 3kg = 60 1,000 + 500 + 60 = 1,560 1,560/24 = 65 mL/hr or 1.5x that
49
What vitamins and minerals are absorbed in the small intestine?
fat-soluble vitamins, Ca, Mg, zince
50
Describe the differences between ulcerative colitis and Crohn's disease
Both Crohn's disease and ulcerative colitis are inflammatory bowel diseases. They are caused by autoimmune processes that cause chronic inflammation in the GI tract. Crohn's disease does not affect the entire bowel but can affect any section of the GI tract. CD can also cause fistulas, abscesses, strictures, or fibrosis. UC affects the entire bowel and causes microscopic abscesses. UC is more likely to cause bloody diarrhea or stool. CD: elevated ESR, anemia, low iron, low albumin, hi SCA UC: elevated ESR, anemia, hi WBC, hi ACA CD tx: surgery only to remove obstruction/abscesses UC tx: total proctocolectomy
51
Describe the differences between IBS and IBD
IBD is caused by an autoimmune response, while IBS often has unknown organic etiology. Both present with similar symptoms of abd pain, but IBS is relieved with bowel movements and does not interrupt sleep.
52
What are the medications prescribed to treat Crohn's disease?
mesalamine (lialda) (anti-inflammatory ASA) metronidazole or ciprofloxacin (prophylaxis abx) azathioprine (immunomodulator) methotrexate (immunosuppressant) antibody therapy for antitumor growth
53
What are the medications used to treat ulcerative colitis?
mesalamine (Lialda) Azathioprine (immunomodulator) cyclosporine/tacrolimus (immunosuppressant) antibody therapy for antitumor growth
54
What are the medications used to treat ulcerative colitis?
mesalamine (Lialda) Azathioprine (immunomodulator) cyclosporine/tacrolimus (immunosuppressant) antibody therapy for antitumor growth
55
What are the three phases of vomiting?
prodromal (nausea, ANS stimulation) retching vomiting
56
What are the common causes of vomiting?
infection, structural/organic disease, diabetic ketoacidosis, neurological damage, food/toxicity, IBD, cyclic vomiting syndrome
57
What is the treatment for vomiting?
Ondansetron (Zofran) or Promethazine fluid maintenance ginger
58
Describe the different causes of diarrhea
viral: rotavirus = loose, watery stools; vomit bacterial: salmonella = bloody or mucous stools parasites: giardia = fever, watery stools
59
Determine whether the following are virus, bacteria, or parasites. Giardia Rotavirus Shigella Salmonella Entamoeba E. coli
Giardia - parasite Rotavirus - virus Shigella - bacteria Salmonella - bacteria Entamoeba - parasite E. coli - bacteria
60
What are the most common causes of diarrhea in infants?
Hirschsprung disease, malabsorption, food intolerance
61
What are the most common causes of diarrhea in toddlers?
nonspecific, UC, celiac disease, tumor
62
What are the most common causes of diarrhea in school-aged children?
IBD, appendiceal abscess, lactose intolerance, fecal incontinence
63
What are some nursing interventions for the management of diarrhea?
- fluid balance and restoration (10mL ORS/diarrhea) - avoid high-glucose fluids
64
What are the risk factors of oral candidiasis in children?
immunocompromised or infection from the mother
65
What are the medications used to treat oral candidiasis and what are some nursing interventions?
Fluconazole - administer w/ food to prevent GI upset (risk of hepatotoxicity) Nystatin - administer TID after feeds
66
Describe the three types of oral lesions. Etiology, symptoms, and treatment.
aphthous ulcers - d/t vit D insuff, IBD. red border, yellow appearance. Tx w/ topical corticosteroids. gingivostomatitis - d/t HSV. vesicular lesions w/ fever. Tx w/ acyclovir herpangina - d/t enterovirus. BRulcers w/ fever. Tx: supportive, pain relief.
67
What are the key symptoms of hypertrophic pyloric stenosis?
bilious vomiting after meals, hunger after vomiting, palpable mass in RUQ.
68
How is hypertrophic pyloric stenosis treated?
pyloromyotomy
69
What are the risk factors for intussusception?
meckel diverticulum, cysts, hemangiomas, polyps, tumors, cystic fibrosis, celiac disease
70
What are the key symptoms of intussusception?
sudden episodic abdominal pain with screaming. abdominal mass jelly-like stools
71
What are the treatments for malrotation and volvulus?
Ladd procedure or ostomy
72
What are the key symptoms of appendicitis?
RLQ pain at McBurney's point hard, tender, distended abdomen N/V and frequent soft stools/diarrhea decreased or absent BS
73
What is the symptom indicative of peritonitis?
hard, tender, distended abdomen with diffused abdominal pain. Tachycardia, fever, chills, pallor
74
What are the nursing care considerations for appendicitis?
- IV fluid or electrolyte replacement - avoid enemas or laxatives - assess bowel sounds - notify provider immediately if change in symptoms - NPO pre and postop - continuous low NG suction
75
What are common signs and symptoms of Meckel's diverticulum?
bloody, mucus stools or rectal bleeding abd pain
76
A nurse is assessing and infant who has hypertrophic pyloric stenosis. Which of the following manifestations should the nurse expect? a. projectile vomiting b. dry mucus membranes c. currant jelly stools d. sausage-shaped abdominal mass e. constant hunger
a. projectile vomiting b. dry mucus membranes e. constant hunger c. symptom of intussusception d. symptom of intussusception
77
A nurse is caring for a child who has Hirschsprung disease. Which of the following actions should the nurse take? a. encourage a high-fiber, low protein, low calorie diet b. prepare family for surgery c. place an NG tube for decompression. d. initiate bedrest
B. prepare family for surgery a. patient should have low fiber, high protein, high calorie diet c. not appropriate d. not appropriate. Appropriate for Meckel diverticulum.
78
A nurse is caring for an infant who has just returned from PACU following cleft lip and palate repair. Which of the following actions should the nurse take? a. remove the packing in the mouth b. place the infant in an upright position c. offer a pacifier with sucrose d. assess the mouth with a tongue blade
b. place the infant in an upright position to prevent aspiration. a. leave packing in place c/d avoid putting things in infant's mouth to avoid damaging the sutures
79
A nurse is caring for an infant who has just returned from PACU following cleft lip and palate repair. Which of the following actions should the nurse take? a. remove the packing in the mouth b. place the infant in an upright position c. offer a pacifier with sucrose d. assess the mouth with a tongue blade
b. place the infant in an upright position to prevent aspiration. a. leave packing in place for 2-3 days c/d avoid putting things in infant's mouth to avoid damaging the sutures
80
A nurse is caring for a child with Meckel's diverticulum. Which of the following manifestations should the nurse expect? a. abdominal pain b. fever c. mucus and blood in stools d. vomiting e. rapid, shallow breathing
a. abdominal pain c. mucus and blood in stools b. fever = appendicitis, IBD, pancreatitis, cholecystitis, hepatitis d. vomiting = bowel obstruction, infection, inflammation of GI organs, IBD, food poisoning, toxicity, hypertrophic pyloric stenosis, malrotation/volvulus, intussusception, PUD, cirrhosis, GERD, rotavirus e. rapid, shallow breathing = appendicitis
81
A nurse is teaching a parent of an infant about GERD. Which of the following should the nurse include in the teaching? a. offer frequent feedings b. thicken formula with rice ceral. c. use a bottle with a one-way valve. d. position baby upright after feedings e. use a wide-based nipple for feedings
a. offer frequent feedings b. thicken formula with rice cereal d. position baby upright c. for cleft lip/palate e. for cleft lip/palate
82
What are common symptoms of GERD?
frequent reflux or forceful vomiting heartburn, sore throat weight loss or poor weight gain respiratory symptoms (chronic cough, wheezing, asthma, apnea, adventitious lung sounds ) dysphagia hematemesis chronic sinusitis or otitis media
83

Pediatrics (10 decks)

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