Gastrointestinal Dysfunctions

Question 1

Disrupts Fluid Balance

Answer 1

Fever
Vomiting, diarrhea
High output kidney failure
DM, DKA
Burns, shock
Tachypnea
Radiant warmer, photo therapy

Question 2

Greatest Risk for Fluid Imbalance

Answer 2

Less than 2 years old
Larger extracelluar fluid percentage
High body surface
High metabolic rate + Less interstitial Fluid Reserve = Increased Risk for Imbalance

Question 3

High Oral Needs 1st Year of Life

Answer 3

Poor swallowing control until 6 weeks
Swallowing is reflexive for 3 months
Wet burps
No feeling of fullness 
Formula feedings every 3- 4 hours
Breastfeedings every 2-3 hours
Increased peristaisis

Question 4

Daily Fluid Requirements

Answer 4

Up to 10kg * 100ml/kg/day
11 - 20kg * 50ml/kg/day
> 21kg * 20ml/kg/day

Question 5

Diagnostic Tool: X-ray

Answer 5

Plain film looks at detect foreign body, looks at bowel gas pattern, detect perforation or obstruction

Question 6

Diagnostic Tool: Upper or Lower GI Series

Answer 6

Barium to look at the function, reflux and other problems

Drink lots of water!! Can cause impaction

Question 7

Stool Sample

Answer 7

To look for blood for infection
Teach to save diapers, fresh is best
GLOVES!

Question 8

Abdominal Ultrasound

Answer 8

Look for tumors, size and placement of abdominal contents
May require sedation — NPO
Explain the gel

Question 9

CT/ MRI

Answer 9

View density of organs, detects blood and masses
CT is a shorter test, MRI is longer
MRI- IV, PO, contrast, no radiation, worry about magnets
Not painful

Question 10

pH Probe

Answer 10

Placement like NG tube, measure pH over 24 hours
Determines frequency and duration of GER
Teach parents about a diary: feedings, irritability
No antacids, proton pump inhibitors or H2 blockers

Question 11

Metabolic Acidosis

Answer 11

< 7.35 pH
Normal PCO2
< 22 HCO3
Loss of bicarbonate - diarrhea

Question 12

Metabolic Alkalosis

Answer 12

> 7.45 pH
Normal PCO2
26 HCO3
Loss of acid – vomiting

Question 13

Hypotoinc Dehydration

Answer 13

Loss of salt > water
Prolonged vomiting and diarrhea, burns and renal disease
Fluid shifts from extracellular to intracellular
Shock

Question 14

Hypertonic Dehydration

Answer 14

Loss of water > salt
Diabetes Insipidus
Na+ > 150
*Neuro changes and seizures

Question 15

Isotoinc Dehydration

Answer 15

Water loss = salt loss
Most commonly from vomiting and diarrhea
Great risk for shock

Question 16

Dehydration Treatment

Answer 16

Look at electrolyte panel!
Treat fluid imbalance
Treat underlying cause
Oral re-hydration works well
If not thirsty - administer small volumes frequently
For severe dehydration - IVF bolus then oral feedings

Question 17

Cleft Lip and Palate

Answer 17

Early in embryonic development - 6 weeks
At birth - nurse feels for intact palate at birth
Genetic or environmental factors 
Facilitate bonding - can breastfeed!
Haberman bottle if not breastfeeding

Question 18

Closure of Lip Defect

Answer 18

Correction of the palate is done as early as 2 to 3 months to allow for better seal for feeding ans speech

Question 19

Closure of Lip Defect POSTOP

Answer 19

Supine or side lying
Incision care - clean with normal saline, keep moist
Medicating for discomfort
Observe for signs of bleeding
Teach home care

Question 20

Closure of Palate

Answer 20

Closure happens anytime between 9 and 15 months to maximize speech production and growth of the midface

Question 21

Closure of Palate POSTOP

Answer 21

Lie prone or side lying
No metal utensils or straws
Elbow restraints to keep hands away from their mouth
Clear diet – Soft diet
Rinse mouth after eating with water
Pain management
Increase risk of otitis media - can cause hearing issues

Question 22

Tracheoesophageal Fistula with Esophageal Artesia

Answer 22

Diagnosed by X-ray
Polydraminous
Respiratory distress, cyanosis
Frothy Saliva
Coughing, drooling
Aspiration

Question 23

TEF with AE PreOP

Answer 23

Reduce respiratory distress and potential for aspiration
NPO, HOB elevated, suctioned as needed
If strictures present then the child will need serial dilations

Question 24

TEF with AE PostOP

Answer 24

NG tube for suction
Parental nutrition
Chest Tube
Pain management!
High risk for developing a feeding aversion
High incidence of GER

Question 25

Anorectal Malformation/ Anal Atresia

Answer 25

No anal opening Meconium exits via a fistula into bladder in boys and vagina in girls NPO, IV hydration, gastric de-compensation with NG tube Often requires a colostomy Toilet training will be delayed, bowel training with stool softeners, diet modification, bowel irrigations

Question 26

Umbilical Hernia

Answer 26

Protrusion through the umbilical ring Assess for incarceration- should be soft is not present Incarcerated -- immediate surgery Small defects will close on its own- if not be age 5 surgery Do not tape hernia

Question 27

Inguinal Hernia

Answer 27

Boys > Girls Result from failure of the proximal portion of the processus vaginalis to atrophy and close Fluid or abdominal structures may move in Diagnosed with transillumination Fix around 9 months - once they start to stand and walk the bowels and slip into the hernia

Question 28

PICA

Answer 28

Eating non- food items May be triggered by nutritional deficiency Impaction or obstruction possible Nutritional Deficiency b/c the non- food items fill them up

Question 29

Constipation

Answer 29

A symptom not a disease Alternation in the frequency, consistency or ease of passing stool May result from toilet training, environmental changes, stress, low fiber diet, not wanting to go at school Treat with diet change, increase fluids, MiraLax. Chronic- can take up to 6-12 months

Question 30

Hirschsprung Disease - Congenital Aganglionic Megacolon

Answer 30

Absence of ganglion cells which affects the itnernal sphincter that impairs motility Inability to push stool out Diagnosed by exam and rectal biopsy Treatment - temporary colostomy, removal of affected bowel and pull through

Question 31

Hirschsprung Disease Symptoms

Answer 31

Newborn- no meconium within 48 hours, refusal to feed, bilious vomiting, abdominal distension Infancy- FTT, constipation, abdominal distension, episodes of diarrhea and vomiting, explosive watery diarrhea, fever Childhood - constipation, ribbon like foul smelling stool, abdominal distension, palpable fecal mass, undernourished

Question 32

Gastroesophageal Reflux

Answer 32

Gastric contents into the esophagus | Upper GI and pH probe aids in the diagnosis

Question 33

GER Symptoms

Answer 33

``` Spitting up, vomiting Excessive crying and irritability Weight loss and FTT Heartburn Abdominal pain, chest pain Chronic cough ```

Question 34

GER Management

Answer 34

Aspiration precautions - teach thicken feeds, upright position for after feedings Proton pump inhibitor, h2 receptors Surgery indicated for all other methods Overfeeding is an issue!!

Question 35

Appendicitis

Answer 35

Abdominal pain, RLQ Side lying Fever, rigid abdomen, decreased or absent bowel sounds Vomiting, constipation, anorexia Tachycardiac, pallor, lethargic, irritability Diagnosed by CT, also a pregnancy test!

Question 36

Appendicitis Treatment

Answer 36

Ruptured -- put drain in, wait for abscess to wall off, NPO, IVF, antibiotics, IV PCA for pain, NG tube, dressing changes Not ruptured -- Surgery, laparoscopic

Question 37

Pyloric Stenosis

Answer 37

Projectile like vomiting -- shortly after feedings Olive like abdominal mass Ultrasound for diagnosis HYPERTROPHY of the muscle -- restricts stomach emptying leading to the projectile vomiting

Question 38

Pyloric Stenosis PREOP

Answer 38

NPO Treat dehydration Correct metabolic alkalosis with IVF NG tube to decompress the stomach

Question 39

Pyloric Stenosis POSTOP

Answer 39

Feeding per surgeon order EBP = early feeding Monitor VS, I/O's, weight, pain, diet tolerance Emesis should not be more than 1/2 of feeding

Question 40

Intussusception Symptoms

Answer 40

``` Abdominal pain Draws knees to chest Sausage like mass in abdomen Jelly like stools with blood Green colored emesis-- billious Lethargic ```

Question 41

Intussusception

Answer 41

Telescoping of the bowel on itself | Hydrostatic reduction with air enema or water soluble contrast

Question 42

Celiac Disease

Answer 42

Large, pale, oily, frothy, foul smelling stools Irritability, anorexia, weight loss DIET CHANGE! NO wheat, rye, barley, or certain oats Untreated - atrophy in small bowel and vitamin deficiencies of ADEK Diagnosed through biopsy

Question 43

Colic Symptoms

Answer 43

Loud, continuous crying Distended, tense abdomen Crying stops when exhausted or passes stool or gas

Question 44

Colic Etiology

Answer 44

``` Cause is unknown Cow's milk allergy higher incidence Rule out organic cause or intussusception Subsides by 3 or 4 months Greater risk for shaken baby ```

Question 45

Failure to Thrive

Answer 45

Inadequate calorie intake, inadequate absorption, increased metabolism or defective utilization Disturbed parent child interactions Assessment of diet, growth, activity, home environment Careful documentation

Question 46

Mild Dehydration

Answer 46

``` 3-5% weight loss Normal activity Dry skin Normal mucus membranes Cap refill >2 seconds ```

Question 47

Moderate Dehydration

Answer 47

``` 6-9% weight loss Irritable Clammy skin Dry mucus membrane Cap Refill 2-4 seconds ```

Question 48

Severe Dehydration

Answer 48

>10% weight loss Lethargic Parched mucus membranes Cap refill >4 seconds