GI pt.3 (Exam 2) Flashcards by Isaiah Smith

Hirschsprung Disease

Congenital Problem

Absences nerves one or more segments of the colon

Causes enlargement of the bowel proximal to defects

Results in mechanical obstruction from inadequate motility

THIS IS WHY IT IS IMPORTANT THAT NEWBORN HAVE STOOLS

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Hirschsprung Disease: Most dangerous complication? What are the clinical manifestations of this?

Rupture or leaking can lead to

Necrotizing Enterocolitis (inflammation of intestines) (caused by ischemia)

-bloating
-bleeding stools
-vomiting
-fever

GO TO ER (This can cause death)

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Hirschsprung Disease: Clinical Manifestations

Newborn:
-Failure to pass meconium within 48-hours
-food refusal
-bilious vomiting, abdominal distention

Infancy:
-Poor weight gain (feel full)
-constipation
-abdominal distention
-episodes of diarrhea & vomiting

Childhood:
-Constipation
-ribbon like stool
-foul smelling stools
-palpable fecal mass
-abdominal distention
-poor appetite and growth)

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If newborns have not passed meconium within 48-hours, what do we get worried about?

Hirschsprung

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Hirschsprung: Treatment

Remove part of colon and let colon rest

Surgery temporary ostomy d/t
surgery to remove part of colon

Will go back and pull down colon to attach to rectum

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Hirschsprung: Pre-Op Nursing Considerations

Note fist BM on all babies

Measure abdominal girth daily (watching for enterocolitis)

Bowel prep-enemas and antibiotics

Monitor hydration - F&E

Teach enema techniques

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Hirschsprung: Post Op Care

N/G to LWS (bowl rest)

NPO

TPN / Lipids

I&O

Hydration and Lyte balance

Abdominal assessment

Ostomy care (Teach Parents)

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Gastroesophageal Reflux Disease

Infant (feeding to much or LES weak)

Adolescents (Poor diet)

The passive transfer of gastric content into the esophagus

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What to do with baby who are happy spitters?

Leave them alone

Only treat when super fussy

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In infants the Lower esophageal sphincter is already more relaxed so it is common for them to

Spit up

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GERD: Infant Clinical Manifestations

Spitting up alot

Intermittnet vomiting

Irritability

Back arching (burnings)

ALTE or apnea

Persistent aspirations PNA

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GERD: Older Child Manifestations

Heartburn

Anemia

Persistent aspiration

Chronic cough

Difficulty swallowing

Abdominal pain

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GERD: Diagnosis

UGI

24 hour pH probe

Endoscopy

Labs

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GERD: Medicaitons

Antacids or histamine receptor antagonists

Proton pump inhibitors

(Reglan) Pro-kinetic medications

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GERD: Nursing Considerations

Position HOB 30% or greater (do not sit up straight) (do not lay flat on back)

Position kid in upright position after eating (if infant they can not sit up on their own) (muscle will put more pressure on belly)

Small frequent feedings with thickened formula

Avoid fatty foods, caffeine, chocolate, tomato products, and carbonation

Burp frequently

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Hypertrophic Pyloric Stenosis

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Circular muscles of the pylorus becomes thicken causing obstruction of gastric outlet

Contents can not go from stomach into intestines

Exorcist Baby

Hypertrophic Pyloric Stenosis: Manifestations

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Exorcist Baby

-Projectile vomiting without bile

-Hunger and irritability

-Dehydration and weight loss

-Visible gastric peristalsis

-FTT

-OLIVE SHAPED MASS

Hypertrophic Pyloric Stenosis: Diagnosis

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Addominal X-ray

Labs

Hyponatremia / hypokalemia

Hypertrophic Pyloric Stenosis: Treatment

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Pyloromyotomy (surgery on pyloric sphincter)

Correct dehydration and Electrolytes

Pre op for hypertrophic pyloric stenosis

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NPO

Strict I&O

Monitor IV fluids

Monitor eletrolyte balance

Post op for hypertrophic pyloric stenosis

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Move from NPO to IV fluids to Clear fluids to Feedings

Start will very small amount of pedialyte

Ok if they throw up, give them time to recover (15-30 min) and feed again

Slowly increase feedings

Intussuception

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Invagination or telescoping of one portion of the intestine into another

Bowel is folded back onto itself

Food cannot pass through

Intussusception: Clinical Manifestations

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-Pain (spazz with peristalsis) (belly hurt than okay than belly hurt)

-Drawing knees to chest

-Vomiting

-Currant Jelly like stools

-Palpable sausage shaped mass (URQ)

How do we diagnosis: Intussuscepton

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X-ray

Barium Enema

(Air Enema) Flat plate for free air followed by barium enema

What often fixes intussuscepton

Barium or Air enema If not than surgery but Enema commonly fixes this condition

Intuzzuzceptoin: Nursing Consideration

Recognize symptoms and refer for treatment NG / LWS Monitor for shock Monitor for abd distention Administer antibiotics

Celiac Disease

Chronic inflammation of the small intestinal mucosa, which may result in varying degrees of atrophy to intestinal vili, malabsorption and variety of clinical manifestations Triggered by inability to digest gluten Results in accumulation of toxic substance that damage the mucosal surface and interferes with absorption of nutrients WHEAT _ RYE _ BARELY _ OATS

Celiac Disease: Clinical Manifesations

No symptoms for first 6 months of life Major symptoms appear between 1-5 years Progressive malnutrition: -Anorexia -Muscle Wasting -Abdominal Pain -Distention Watery pale and foul smelling stool Celiac crisis

Celiac: Diet

Eliminate wheat - rye - barely - oats High in calories and protein Low in fat

Short Bowel Syndrome

Malabsorptive disorder that occurs as result of decreased mucosal surface area part of the child's bowel has been removed Food travels through body faster so it can not be absorbed

SBS: Therapeutic Management

Preserve as much bowel as possible Maintain optimum nutrition (TPN + Lipids) Stimulate intestinal adaption These kids really struggle

Acute Appendicitis

Inflammation of the vermiform appendix (blind sac at the end of cecum)

Etiology of appendicitis

obstruction of the lumen of the appendix, hardened fecal material, foreign bodies, microorganisms, parasites (not pin worms)

Symptoms of Appendicits

-tenderness around umbilical area to the LRQ -N/V -low grade fever -rebound tenderness & guarding -pain w/ movement

How to confirm appendicitis?

CT scan or Ultrasound

With appendicits, a fever of 102 or greater means

Perforation

Appendicitis: Signs of Perforation (and Peritonitis)

Sudden relief of pain Tachycardia Rapid shallow breathing Irritability / restlessness

Peritonitis: Management

need fluids, antibiotic, NG tube, and has delayed closure to prevent abscess formation

Nursing Consideration for Appendicitis

Assessment (catch before it gets serious) Avoid enemas and heating pads Avoid contact sports for a couple weeks Post-operative care

GI pt.3 (Exam 2) Flashcards

(39 cards)