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Gastrointestinal Dysfunction

Terms in this set (53)

Nutritional Disorders
-Vitamin imbalances
-Mineral imbalances
-Risk for growth failure: (Cancer, Human immunodeficiency virus (HIV), Sickle cell disease, Cystic fibrosis, Low birth weight)
-Nursing care: (Dietary reference intakes (DRIs), Standardized growth charts, World Health Organization, Centers for Disease Control and Prevention, Encourage breast-feeding for the first 6 months, preferably for the first year)
Protein-energy malnutrition (PEM)
-Severe childhood undernutrition
-Significant problem in developing countries
-Kwashiorkor : ( is a form of malnutrition when there is not enough protein in the diet)
-Marasmus: (form of severe malnutrition characterized by energy deficiency)
-In the United States, milder forms of PEM occur
-Treatment with ready-to-use therapeutic food
Food Allergy
Allergy: A specific immune response upon exposure to a given food
Intolerance: Situation in which a food elicits an adverse reaction without an immunologic mechanism (Example: lactose intolerance)
Food Intolerance
Clinical manifestations
Systemic: (Anaphylaxis)
Gastrointestinal: (Abdominal pain, diarrhea)
Respiratory: (Cough, wheeze)
Cutaneous: (Atopic dermatitis)
Gastrointestinal Dysfunction
Growth failure
Spitting up/regurgitation
Nausea, vomiting, diarrhea, constipation
Abdominal pain, distention, gastrointestinal (GI) bleeding
Jaundice
Dysphagia, dysfunctional swallowing
Fever
Dehydration
Occurs whenever total output of fluid exceeds intake: (Insensible fluid loss, Increased renal excretion, GI tract dysfunction (vomiting and diarrhea), Ketoacidosis, Burns)
Types of Dehydration:
Isotonic: (Water and salt are lost in equal amounts, This is primary form of dehydration in children)
Hypotonic: (Electrolyte deficit exceeds water deficit)
Hypertonic: (Water loss exceeds water deficit)
Accurate Measurement of Intake and Output
Urine and stools, Vomitus, Sweating, Vital signs, Skin turgor and mucous membranes, Body weight, Fontanel in infants, Sensory alterations (older child)
Diarrhea
Acute diarrhea is leading cause of illness in children <5 years of age
Diarrheal disturbances have several forms: (Gastroenteritis, Enteritis, Colitis, Enterocolitis)
Types of Diarrhea
Acute
Acute infectious/infectious gastroenteritis
Chronic
Intractable diarrhea of infancy
Chronic nonspecific diarrhea (CNSD)
Causes of Diarrhea
Rotavirus: (most common cause of severe diarrhea. genus of double-stranded RNA virus)
Salmonella, Shigella, Campylobacter organisms
Giardia organisms
Cryptosporidium organisms
Clostridium difficile
Plesiomonas, Yersinia organisms
Antibiotic effects
Therapeutic Management of Diarrhea
Assessment of fluid and electrolyte imbalance
Rehydration: (Oral rehydration therapy (ORT), Intravenous rehydration)
Maintenance of fluid therapy
Reintroduction of an adequate diet
Prevention of Diarrhea
Two rotavirus vaccines are available
Teach personal hygiene
Clean water supply/protect from contamination
Teach careful food preparation
Encourage handwashing
Constipation
-An alteration in frequency, consistency, or ease of passage of stool
-May be secondary to other disorders
-Idiopathic (functional) constipation: no known cause
-Chronic constipation: may be due to environmental or psychosocial factors
Constipation During Newborn Period
First meconium should be passed within 24-36 hours of birth; if not, assess for : Intestinal atresia, stenosis, Hirschsprung disease, hypothyroidism, Meconium plug, meconium ileus (CF)
Constipation During Infancy
-Often related to diet
-Almost unknown in exclusively breastfed infants: ( Stool may become infrequent because of minimal residue from digested breast milk)
-May develop in formula-fed infants
-Interventions
Constipation During Childhood
Often due to environmental changes or control over body functions
Encopresis: inappropriate passage of feces, often with soiling
May result from stress
Management
Constipation: Care Management
History of bowel patterns, medications, diet
Education of parents and child
Dietary modifications (age appropriate)
More aggressive management
Hirschsprung Disease
-Also called "congenital aganglionic megacolon" (Congenital anomaly)
-Mechanical obstruction from inadequate motility of intestine
-Incidence: 1 per 5000 live births; more common in boys and in children with Down syndrome
-Absence of ganglion cells in colon
Hirschsprung Disease: Pathophysiology
-Aganglionic segment usually includes the rectum and proximal colon
-Accumulation of stool with distention
-Failure of internal anal sphincter to relax
-Potential for enterocolitis

s/s: *ribbon like stool. unable to pass stool in first few days of life. bowel sounds: hypoactive
Hirschsprung Disease: Diagnostic Evaluation
Most cases diagnosed in the first few months of life
Complete and careful history
X-ray, barium enema studies
Anorectal manometric examination
Rectal biopsy to confirm diagnosis
Hirschsprung Disease: Therapeutic Management
Surgery
Two stages: (Temporary ostomy, Second stage: "pull-through" procedure)
Nursing care: ( Preoperative, Postoperative, Discharge)
Vomiting
Forceful ejection of gastric contents through the mouth
Often accompanied by nausea
Nonbilious and bilious
Therapeutic management
Nursing care management
Gastroesophageal Reflux (GERD)
-Transfer of gastric contents into the esophagus
-Occurs in everyone
-Frequency and persistency: abnormal
-May occur without GER disease
-GER disease may occur without regurgitation

Pathophysiology:
Diagnostic evaluation: vomiting with bile
Therapeutic management: (Surgical intervention, Nissen fundoplication)
Nursing care: positioning, diet measures, surgery
Intestinal Parasitic Disease
The most frequent infections in the world
In humans, caused by a variety of organisms
Two most common in the United States: Giardiasis (fecal oral, can survive outside the month for months) and Pinworms (enterobiasis. treat with fermectin)
Acute Appendicitis
Inflammation of the vermiform appendix
Diagnostic evaluation: (McBurney point) hard because kids cant explain (all organs are close together)
Therapeutic management: (Treatment of ruptured appendix)
s/s: fever, radiating pain, vomiting, anorexia
Prognosis: if pain immediately goes away: ruptured
Postoperative care:
Meckel Diverticulum
-Remnant of the fetal mesenteric duct
-The most common congenital malformation of the GI tract

Pathophysiology: (Ulceration, bleeding, intestinal obstruction) -reminisce of embryonic cells
Diagnostic evaluation: (Radionucleotide scintigraphy)
Therapeutic management: (Surgical removal of the diverticulum) start on NPO and may need nasal decompression.
Prognosis: (If diagnosed and treated early, full recovery)
s/s: painless bloody stool (jelly like), GI bleeding, intestinal obstruction, acute inflammation of diverticulum
Inflammatory Bowel Disease (IBD)
Includes ulcerative colitis and Crohn's disease
Causes and pathophysiology: the structure of the bowel is not abnormal, system inflammation
s/s: rectal bleeding, diarrhea, pain, anorexia
Medical treatment or surgical treatment: induce remittion. aspirin and corticosteroid therapy (steroids for longterm treatment)
Nutritional support: more prone to become gluten intolerant.
Prognosis:
Peptic Ulcer Disease (PUD)
Acute or chronic condition
Causes and pathophysiology:
Diagnostic evaluation:
Therapeutic management
Medical-
Surgical-
Prognosis:
Hepatic Disorders
Acute or chronic inflammation of the liver: (Virus, Nonviral, Autoimmune, Metabolic, Hemodynamic, idiopathic)
Types of Hepatitis
Hepatitis A (fecal oral )
Hepatitis B (fecal oral)
Hepatitis C (blood or bodily fluids)
Hepatitis D (blood or bodily fluids)
Hepatitis E (blood or bodily fluids)
Hepatitis G (blood or bodily fluids)
Hepatitis
Concept of non-A, non-B hepatitis
Diagnoses:
Therapeutic management:
Prognosis:
Prevention:
Infection control: (Handwashing, Avoidance of illicit drug use)
End-Stage Liver Disease
Cirrhosis: (Irreversible damage to the liver ,Infectious, Autoimmune, Toxic)
Transplantation
Biliary Atresia
Also called "extrahepatic biliary atresia"
Exact cause unknown
Diagnostic evaluation:
Therapeutic management:
Prognosis: (If left untreated, will result in cirrhosis)
Cleft Lip and Cleft Palate
-Facial malformations that occur during embryonic development
-May appear separately or together

Diagnostic evaluation: (Multifactorial inheritance), can have connections to hearing loss and problems (check ears twice a year), speech abnormalities, and risk for food going up nose
Surgical Correction of Cleft Lip
-Closure of lip defect precedes correction of the palate: (Performed when patients are 2-3 months of age, "Rule of tens", Z-plasty to minimize retraction of scar, Millard rotational advancement technique)
-Protect suture line with Logan bow or other methods
Surgical Correction of Cleft Palate
Typically performed when patients are 6-12 months of age
Effect on speech development

Nursing care: protect with elbow restraints, clean sites with only water (make sure to get formula off (sugar) breastmilk can help)
Cleft Lip and Cleft Palate: Feeding
avoid suction, feed upright, burp a often, lambs nipple.
watch for failure to thrive
feeding: ESSR enlargement, stimulate, swallow, rest method
Esophageal Atresia and Tracheoesophageal Fistula (TEF)
Esophageal atresia: failure of esophagus to develop as a continuous passage
TEF: failure of the trachea to separate into a distinct structure
May occur separately or in combination
Cause unknown

Clinical manifestations: coughing, coking, cynosis
Management of TEF
-Maintenance of a patent airway
-Prevention of pneumonia
-Gastric or blind pouch decompression
-Supportive therapy
-Surgical repair (NPO prior to surgery)
Prognosis: good in otherwise healthy children
Hernia
Protrusion of portion of an organ through an abnormal opening: (Danger of incarceration/strangulation
Types: (Diaphragmatic, Abdominal wall, Inguinal canal)
-umbilical and inguinal (undescended testicle) are most common. strangulated is worst kind
s/s: swelling, bulge, smooth mass that isnt tender, localized pain
Hypertrophic Pyloric Stenosis
Constriction of pyloric sphincter with obstruction of gastric outlet
Pathophysiology: narrowing of pylorus, the opening from stomach to small intestine. more common in males, 2-5 weeks old, congenital anomaly

s/s: projectile vomiting, changes in stool, olive like mass in stomach

treatment:
Nursing care management:
Intussusception
-Telescoping or invagination of one portion of intestine into another
-Most common cause of intestinal obstruction in children aged 3 months to 3 years
-Occasionally due to intestinal lesions (10%)
-Cause is often unknown

Diagnostic evaluation: (Subjective findings, Ultrasonography)
Therapeutic management: (Spontaneous resolution in 10% of patients), barium or air enema hydrostatic anima (uses pressure)
s/s: jelly stool (blood mixed with mucus) abd pain, knees drawn up, vomiting
Malrotation and Volvulus
-Malrotation: abnormal rotation of intestine around the superior mesenteric artery during embryologic development
-Volvulus: twisting of intestine around itself, thereby compromising blood supply to intestines
-May cause necrosis, peritonitis, perforation, and death
Anorectal MalformationsClassification
Classification: (High, Intermediate, Low)
Imperforate anus
Perineal fistulas: (Cloaca -posterior opening that serves as the only opening for the intestinal (girls), Rectourethral prostatic (boys), Vestibular (girls))
Malabsorption Syndromes
-Characterized by chronic diarrhea and malabsorption of nutrients
-May result in failure to thrive
-Classification: (Anatomic defects, Biochemical defects)

-wont pass stool for first 24 hours, or will pass it in/with urine. no butts. if there a hole and you try and take a rectal temp, but there is no poo - problem
Celiac Disease
Also called "gluten-sensitive enteropathy" and "celiac sprue"
-Four characteristics: (Steatorrhea, General malnutrition, Abdominal distention, Secondary vitamin deficiencies)
-Pathophysiology: (Villous atrophy in the small bowel, Genetic predisposition)
-Diagnostic evaluation:
-Therapeutic management: (Primarily dietary, Low-gluten -diet)
Short Bowel Syndrome (SBS)
-A malabsorptive disorder
-Results from decreased mucosal surface area, usually as result of small bowel resection
-Causes and pathophysiology: (Necrotizing enterocolitis,
Gastroschisis)
Therapeutic management:
Nutritional support:
Ingestion of Injurious Agents
Most frequently ingested: (Pharmaceuticals, Cosmetic and personal care products, Cleaning products, Plants, Toys, Miscellaneous substances)
Principles of emergency treatment:
Heavy Metal Poisoning
-Mercury thermometers
-Lead poisoning (most common): (Lead-based paints in older homes, Lead-contaminated bare soil in the yard, Cultural or ethnic traditions)
-Screening for lead poisoning: (Chelation therapy)

give charcoal to soak up. DONT give ipecac
What type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion"?
A. Isotonic dehydration
B. Hypotonic dehydration
C. Hypertonic dehydration
D. All types of dehydration in infants and small children

answer A (didnt look up)
compartment syndrom
Trama: 5 P's
pain, pulselessness, paralysis, palor, poikilothermia
Biliary Atresia
patho: a blockage in the ducts that carry bile form the liver to gallbladder. **liver cant drain bile

s/s: jaundice, dark urine, floating stool that pale clay like and smelly. jaundice may cause them to be itchy
treatment: may lead to liver failure -> liver transplant or a Kasai operation that reconnects liver to small intestine
gastoschisis
protrusion of intra abd, connects through defect and abd wall.
s/s: obvious at delivery if not detected in ultrasound, lump in abd
treatment: immediate surgical repair
nursing care: cover sad with bowl bag, NG decompression, observe vitals for s/s of necrosis, antibiotic feeding
foods kids like that are high in fiber
cereal, oatmeal, rasins, rice cereal, popcorm

folate acid: leafy greens, strawberries, beans
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