GI Dysfunction

Question 1

Dehydration

Answer 1

• Incrd risk for dehydration due to high % of water in body
• Kidneys don’t reutake water like adults
• Causes
  > diarrhea, N/V
  > dcrd intake
  > sweating w/ fevers

Question 2

Dehydration - CMs

Answer 2

• No forming tears
• Wt loss
• Incrd respirations
• Incrd pulses
• Dcrd BP
• Limited urine output
• Dcrd skin turgor
• Sunken eyes
• Sunken fontanels
  want to correct before it causes shock

Question 3

Correcting Fluid Imbalance

Answer 3

• IV hydration
  > not 1st option
• Oral rehydration solution
  > pedialyte; electrolyes, low sugar
  > give small amnt
  > popsicles

Question 4

Cleft Lip & Palate

Answer 4

• Facial malformations tht occur during embryonic development
• Bones & tissue fail to fuse completely at midline
  > 1st trimester

Question 5

Cleft Lip & Palate - Risk Factors

Answer 5

• Syndromes
• Genetics
• Mom has dcr in folic acid during pregnancy
• Alcohol
• Smoking
• Anticonvulsants, steroids, retinols
  > incr change

Question 6

Interprofessional Management

Answer 6

• Can have cleft lip & palate at same time
  > can have one or the other
• Cleft lip easier to treat
  > don’t usually need more than 1 surgery
• Cleft palate more difficult
  > can be a couple of surgeries, around 12-18 months

Question 7

Cleft Lip & Palate - Nursing Interventions

Answer 7

• Feeding
  > difficulty suctioning
  > want longer nipple, Haberman
• Pre & post op care
• Long-term care
  > monitor palate as they grow
• At higher risk for ear infections
  > tubes may be placed during correction surgeries

Question 8

Esophageal Atresia & Tracheoesophageal Fistual (TEF)

Answer 8

• Esophageal Atresia: Failure of esophagus to develop as a continuous passage
  > esophagus doesn’t attach to stomach or anything, or attaches to trachea
• TEF: Failure of trachea to separate into a distinct structure
• Seen on ultrasound
• **Fluid going to lungs or straight back out

Question 9

Esophageal Atresia & Tracheoesophageal Fistual (TEF) - Manifs

Answer 9

• Coughing
• Choking
• Cyanosis

Question 10

Esophageal Atresia & Tracheoesophageal Fistual (TEF) - Nursing Interventions

Answer 10

• Have continuous suction set up
• Prepared for surgery
  > pretty quickly after birth
  > goal: reattach esophagus to stomach & separate from trachea
• Maintain airway
• Feedings through IV
  > NOT NG until after surgery

Question 11

Pyloric Stenosis

Answer 11

• Constiction of pyloric sphincter w/ obstruction of gastric outlet
  > result of the thickening of pyloric sphincter which leads to obstruction
• Not always present at delivery, happens w/in 1st few wks
• Not usually seen on ultrasound before brith

Question 12

Pyloric Stenosis - Manifs

Answer 12

• Vomit after feedings
  > projectile; entire feeding
• Act very hungry
• Dehydration
• Failure to thrive
• Peristaltic waves
  > left to right
• Oval shaped mass

Question 13

Pyloric Stenosis - Treatment

Answer 13

Surgery

Question 14

Pyloric Stenosis - Nursing Interventions

Answer 14

• Gain IV access to correct hydration
• Postop, kids usually progress great
  > usually no long term effects

Question 15

Hirschsprung’s

Answer 15

• AKA “congenital aganglionic megacolon”
  > congenital anomaly
  > usually seen after they are born
• Mechanical obstruction from inadequate motility (peristalsis) of intestine
  > absence of ganglion cells in colon
  > leads to a blockage above area

Question 16

Hirschsprung’s - CMs

Answer 16

• Red Flag: newborn hasn’t pooped or delayed passage of meconium
  > severe case
• Not formed stool
• Chronic constipation since birth
• Poor wt gain
  > failure to thrive
• Abdominal pain & distention

Question 17

Hirschsprung’s - Treatment

Answer 17

• X-ray for diagnosis
• Biopsy for confirmation
  > shows absence of ganglionic cells
• Clear obstruction
• Remove section of colon tht does not have ganglion cells
• Long term usually no issues
  > maybe digestive issues & continence

Question 18

Appendicitis

Answer 18

• Inflamation of ther veriform appendix
  > inflammation and obstruction of the blind sac at the end of the cecum
• Most common major surgical disease in the school age
  > peaks at 10-12yrs
• No known function
• Lumen becomes obstructured (fecal matter, calcium buildup, tumors, trauma, infection)
  > inflammation can lead to infection, necrosis, perforation
• Infected contents spill into abdominal cavity if ruptures
  > causes peritonitis

Question 19

Appendicitis - CMs

Answer 19

• Mid abdomen cramps
• Abdominal tenderness
• Localizes into RLQ
  > McBurney point
• Gaurding
• Rebound tenderness
• N/V
• Low grade fever
• Lethargy, irritability, constipation, diarrhea
• Normal bowel sounds
• Pain w/ deep breathing

Question 20

Appendicitis - Nursing Interventions

Answer 20

• Worried abt ruptured appendix
  > peritonitis
• Suddenly no pain
  > red flag, appendix bursts
• CT scan for diagnosis
  > shows inflammation
• Parents present when waking up from surgery
• IV & NG after surgery
• Right-side lying position w/ knees bent
• IV fluids
  > NPO until bowel sounds/flatus
• Prevent infection
• Manage wound
• Antibiotics & pain meds

Question 21

Appendicitis - Treatment

Answer 21

Surgery
laparoscopic if hasn’t bursts yet
usually emergent