Unit 3

Gastrointestinal System
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Terms in this set (28)
-Manifestations (Abnormal opening of lip and/or palate; Difficulty with feedings; Difficulty swallowing, with potential for liquids or foods to come out the nose)
-Tx (Modified feeding: May need specialized cleft palate bottle; Place baby in an upright, sitting position to prevent the formula from flowing back into the nose area; Keep the bottle tilted so the nipple is always filled with milk and pointed down away from the cleft; surgical repair)
-Priority Nursing Concerns (Impaired nutrition; Potential threat to airway; Insufficient knowledge for parents; Impaired speech)
-Nursing Care (Assess resp. status when feeding; feed in upright position; Utilize special nipple/syringe; Promote parental involvement; After Sx NO: straws; oral temp, spoons, pacifiers, fingers in mouth)
Infectious Gastroenteritis-Causes: Shigella, Salmonella, E.Coli, Campylobacter, Giardia, Rotavirus -Dx: Stool culture, Assess travel Hx, Blood cultures -> can become septic, ^ WBC, fever, dehydrated -Nursing Concerns: Fluid Volume Deficit, Electrolyte ImbalanceAppendicitis-symptoms develop slowly over approx 12-hr period -pain, anorexia, nausea/vomiting, fever occur simultaneously (if vomiting precedes pain, suspect gastroenteritis) -child may lie down in a knee-chest position -greatest pain is usually in right lower quadrant (RLQ) -s/s: ABD pain, localized to RLQ; nausea, vomiting; fever, chills; elevated WBC (15,000-20,000); anorexia; diarrhea or constipation -Dx: ultrasound of appendix; CBCHyptertrophic Pyloric Stenosis-blockage of the passage out of the stomach due to thickening (hypertrophy) of the muscle at the junction between the stomach and the intestines -not present at birth -occurs during the first 2-5 weeks of life -more common in full term than pre-term infants -may feel like "olive" like mass in upper ABD -results in projectile vomiting (metabolic alkalosis) -diagnosed by ultrasound; cottage cheese vomit -treated w/ pylormyotomyIntussusception-telescoping of one portion of the intestine into another (edema from obstruction causes ischemia) -typically occurs from 3 mnths-3 yrs of age -most common in boys & diagnosed w/ cystic fibrosis -s/s: ABD; sausage shaped ABD mass; bloody "currant jelly" stools **if detected w/in 24 hrs mortality is greatly reduced** -Tx: IV fluid; NG decompression; Antibiotic therapy; Conservative Tx (air/saline enema); Corticosteroids; Laparoscopy (keyhole surgery) -Nursing Implications: Stool/Bowel assessments; Pain management; Parent education/anxiety reductionHirschsprung's Disease (Congenital Megacolon)-congenital defect which affects the large intestine -increased incidence in males & Down Syndrome -most common cause of lower intestinal obstruction in neonates -s/s: constipation, ABD distention, bilious vomiting (yellow tinge); failure to pass meconium w/in 24 hrs of birth **passage of foul smelling "ribbon" like stool** -Dx: Voiding Hx, Biopsy to confirm aganglionosis; ABD Xray -Tx: Dietary modification, Stool softeners, Isotonic irrigation; Sx to remove aganglionic bowel (usually 2 steps), NG tube preop -Nursing Implications: Monitor elimination patterns, Monitor fluid status, Educate parents on care, Maintain nutrition, Monitor for infectionCeliac Disease in Children-s/s: abdominal bloating & pain, chronic diarrhea, vomiting, constipation, pale foul-smelling or fatty stools (Steatorrhea), iron-deficiency anemia, weight loss, fatigue, irritability & behavioral issues, dental enamel defects of the permanent teeth, delayed growth & puberty, short stature, failure to thrive, ADHD -Should Be Tested: Diabetics, !st Degree Relative, Autoimmune Disorder, Down Syndrome -Dx: IGA Testing, Hydrogen Breath Test -Diet: fruits, vegetables, meat & poultry, fish & seafood, dairy, beans legumes nutsShort Bowel Syndrome "Short Gut"-Malabsorptive disorder usually r/o small bowel resection (necrotizing enterocolitis, volvulus, gastroschisis) -Prone to fluid & electrolyte imbalances -s/s: malnutrition, steatorrhea, diarrhea, foul smelling stool, hyponatremia & hypokalemia, acidosis -Tx: Sx to preserve as much bowel as possible, TPN (requires central line), Enteral nutrition (NG tube, G-tube) -Nursing Implications: verify placement of tubes, monitor IV site, hydration/nutrition, monitor I&O, family educationBiliary Atresia-blockage in the tubes (ducts) that carry bile from the liver to the gallbladder -Dx: Liver Function Tests (bilirubin, ALT, AST, Clotting Studies: Pt; PTT), Hep B titers, Urine/Stool samples, Liver biopsy -Nursing Implications: monitor skin (jaundice, itching, skin infections), monitor for ascites & GI bleeding after Sx, monitor for development of portal hypertension, monitor I&O, daily weights, calorie counts, educate family & caregiversGenitourinary System-Structure (bean-shaped kidneys are located one on each side of the spinal column; ureters extend down from the kidney and enter the bladder wall; nephron is the kidney's functional unit) -Function (maintain fluid & electrolyte balance; BP maintenance; Buffer system; Erythropoietin (increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues))Genitourinary System Differences-Kidneys operate at a functional level appropriate for body size. -Kidneys reach near adult function at 6 to 12 months of age. -Infants cannot concentrate urine as efficiently as older children or adults. -Shorter urethras predispose children to UTIs. -Achieve complete bladder control by 4 to 5 years of age -Increased risk for kidney traumaEnuresis-Difficulty in maintaining bladder control -Nocturnal enuresis (Hx of bed-wetting; unable to sense a full bladder; should not be a concern until greater than 6 years of age; common in boys) -Diurnal enuresis (urgency, frequency, and inappropriate wetting during the day) -Therapeutic Management (Diagnostic evaluation; Limiting fluid/altered diet; Record keeping; Behavioral conditioning; Setting alarm to void; Desmopressin acetateUrinary Tract Infection (UTI)-Upper Urinary Tract: Pyelonephritis (most common UTI in children; E. Coli); Ureteritis -Lower Urinary Tract: Cystitis; Urethritis -Cont: Urinary Tract Obstructions; Voiding Dysfunction (urinary stasis); Anatomic Differences (females); Individual Susceptibility to Infection; Vesicoureteral Reflux (VUR); Urinary Retention while Toilet-Training; Bacterial Colonization (males) -Diagnostics: Urinalysis (nitrates & leukocytes esterase; hematuria; WBCs; bacteria); Ultrasound; Cystourethography (VCUG) -Medications: antibiotics -Education: Prescribed meds for full # of days; Wipe front to back; Avoid "holding urine"; Plenty of fluids; Cotton underwear; Avoid bubble baths (irritation); Good hygeine for sexually active femalesVesicoureteral Reflux-Occurs when urine w/in the bladder flows back up into the ureter & often back into the kidney (acute pyelonephritis and renal scarring) -Grade I (reflux into a ureter w/out dilation -Grade II (reflux into the renal pelvis and calyces w/out dilation) -Grade III (mild-to-moderate dilation of the ureter, renal pelvis, and calyces w/ minimal blunting of the fornices) -Grade IV (moderate ureteral tortuosity & dilation of the renal pelvis & calyces) -Grade V (gross dilation of the ureter, pelvis, & calyces; loss of papillary impressions; and ureteral tortuosity)Anomalies of the GU Tract-Cryptorchidism (at least one undescended testicle at birth; premature infants have greater risk) -Epispadias (urethral opening is above its normal location) -Hypospadias (urethral opening is below its normal location on the glans of the penis)Acute Post-Streptococcal Glomerulonephritis-Primarily affects glomerulus of kidney -Manifestations: Hematuria (tea colored urine), Proteinuria, Hypertension, Edema, Renal insufficiency (oliguria) -Diagnostics: Elevated BUN, Elevated creatinine, Electrolyte imbalance, Elevated erythrocyte sedimentation rate (ESR), Renal Ultrasound, Urinalysis -Treatment: Possible antibiotic therapy, Antihypertensives, Support (should resolve in 6-12 wks) -Nursing Implications: Monitor I&O, Monitor VS & Neurological status (lethargy), Assess for edema, Educate parentsNephrotic Syndrome-Primary Nephrotic Syndrome (MCNS): occurs in absence of identifiable systemic disease (proteinuria, hyperlipidemia, hypoalbuminemia; occurs in preschool age & toddlers, higher in males) -Secondary Nephrotic Syndrome: occurs in the presence of an identifiable systemic disease (Systemic Lupus Erythematosus (SLE), Hepatitis, Cancer, Heavy metal poisoning -Manifestations: Edema (periorbital, sacrum), Anorexia, Fatigue, ABD pain, Increased weight, Respiratory infection, Dark frothy urine, Normal BP -Diagnostics: Protein (3+-4+); Serum Labs (Elevated Hgb, cholesterol, triglicerides, hct); Kidney biopsy -Treatment: Medications (diuretics, prednisone), (low salt diet & fluid restriction) -Nursing Implications: Assess fluid balance, Daily weights, Strict I&O, Med Admin, Parental Education, Nutritional support, Prevent infection, Frequent position changesAcute Renal Failure (AKI)-Indications for Dialysis: Severe fluid overload, Pulmonary edema or congestive heart failure, Severe hypertension, Metabolic acidosis or hyperkalemia not responsive to meds, Blood urea nitrogen greater than 120 mg/dlChronic Renal Failure-An irreversible loss of kidney function over months to years -End-stage renal disease (CKD 5) -Families that are affected require multidisciplinary care -Kidney transplantation