ATI Ch.23 Gastrointestinal Structural and Inflammatory Disorders

Clinical manifestations for Child with Hirschsprung's disease

-Undernourished, anemic appearance -Abdominal distention -Visible peristalsis -Palpable fecal mass -Constipation -Foul‑smelling, ribbonlike stool

A nurse is caring for a child who has Meckel's diverticulum. Which of the following manifestations should the nurse expect? (Select all that apply.) A. Abdominal pain B. Fever C. Mucus, bloody stools D. Vomiting E. Rapid, shallow breathing

A. CORRECT: Abdominal pain is a manifestation of Meckel's diverticulum. C. CORRECT: Mucus and bloody stools are a manifestation of Meckel's diverticulum.

Medicine for Ulcerative colitis

Aminosalicylates-Sulfasalazine Infliximab (Remicade) Adalimumab (Humira)

How is GER/GERD diagnosed?

Endoscopy intraesophageal pH study

Nursing care preop for Hirschsprung's

Prepare for surgery High protein, high calorie, low fiber diet until surgery

Nursing considerations for hypertrophic pyloric stenosis:

Prepare for surgery: NPO, IV fluids NG tube

Clinical manifestations of Intussusception

Sudden episodic abd pain Sausage shape abd mass Stools of red currant jelly

How is Omphalocele/Gastroschisis diagnosed?

US Maternal serum alph-fetoprotein (MSAFP)

appendicitis is diagnosed by...

a CT scan of the appendix

S/S of Volvulus

bilious vomiting (green) bloody stools irritability

Where is the Intussusception usually located?

ileocecal valve

Cause of Omphalocele/Gastroschisis

maternal obesity Trisomy 18

What should the nurse prepare for if the client has an appendicitis

Laparoscopic surgery use a pillow transfer

S/S of Ulcerative colitis

Lower abd pain and cramping Bloody diarrhea Moderate weight loss Mild growth impairement

clinical manifestations of appendicitis

McBurney's pt RLQ Abd pain Decreased of absent bowel sounds Anorexia Rapid shallow breathing Tachycardia

GERD risk factors

Neurologic impairments hiatal hernia morbid obesity

How is hypertrophic pyloric stenosis diagnosed?

Ultrasound will see elongated mass at elongated pyloric canal

Nursing care for GER/GERD

small frequent feedings thickened formula upright position during and after meals supine is ok avoid irritating foods

Tx for Ulcerative colitis

surgery for ostomy and possible colostomy

Hirschsprung's disease is...

(congenital aganglionic megacolon) is a structural anomaly of the GI tract caused by lack of ganglionic cells in segments of the colon resulting in decreased motility and mechanical obstruction.

Postoperative nursing care for cleft lip/palate

-pain mgt -access for crusting, bleeding, and infection -avoid putting anything in in the mouth including nipple or pacifier. use IV fluids or cup -monitor I&O -daily weights -use elbow restraints -antibiotic ointment

Complications with GER/GERD

Recurrent pneumonia Weight loss FAILURE to Thrive

Clinical manifestations for newborns with Hirschsprung's disease

-Failure to pass meconium within 24 to 48 hr after birth -vomiting bile -Refusal to eat -Abdominal distention

Clinical manifestations for infants with Hirschsprung's disease

-Failure to thrive -Constipation -Vomiting -diarrhea

Clinical manifestations of GER/GERD in infants

-Spitting up or forceful vomiting -irritability, excessive crying, arching of back, stiffening -blood in vomitus -Respiratory problems -Failure to thrive -Apnea

A nurse is assessing an infant who has hypertrophic pyloric stenosis. Which of the following findings should the nurse expect? (Select all that apply.) A. Projectile vomiting B. Dry mucus membranes C. Currant jelly stools D. Sausage‑shaped abdominal mass E. Constant hunger

A. CORRECT: A client who has a pyloric stricture has thickening of the pyloric sphincter, resulting in projectile vomiting. B. CORRECT: A client who has pyloric stricture is unable to consume adequate food and fluid, resulting in dehydration. Dry mucous membranes is a manifestation of hypertrophic pyloric stenosis. E. CORRECT: A client who has pyloric stricture is unable to consume adequate food and fluid, resulting in constant hunger.

A nurse is teaching a parent of an infant about gastrointestinal reflux disease. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Offer frequent feedings. B. Thicken formula with rice cereal. C. Use a bottle with a one‑way valve. D. Position baby upright after feedings. E. Use a wide‑based nipple for feedings.

A. CORRECT: Frequent feeding will assist in decreasing the amount of vomiting episodes. B. CORRECT: Thickened formula will assist in decreasing the amount of vomiting episodes. D. CORRECT: Positioning the infant in an upright position following feedings will assist in decreasing the amount of vomiting episodes.

A nurse is caring for a child who has Hirschsprung's disease. Which of the following actions should the nurse take? A. Encourage a high‑fiber, low‑protein, low‑calorie diet. B. Prepare the family for surgery. C. Place an NG tube for decompression. D. Initiate bed rest.

B. CORRECT: A client who has Hirschsprung's disease requires surgery to remove the affected segment of the intestine. Preparing the family for surgery is an appropriate action for the nurse to take.

A nurse is caring for an infant who is postoperative following cleft lip and palate repair. Which of the following actions should the nurse take? A. Remove the packing in the mouth. B. Place the infant in an upright position. C. Offer a pacifier with sucrose. D. Assess the mouth with a tongue blade.

B. CORRECT: Placing the infant in an upright position will facilitate drainage and prevent aspiration.

Tx for volvulus

Emergency exploratory surgery** possible ostomy leading to SBS

Complications with Hirschsprung's disease

Enterocolitis: maintain hydration, antibiotics, measure girth Monitor for sepsis, peritonitis, or shock Anal stricture and incontinence: bowel retraining therapy

Explain the surgical tx for GER/GERD

Fundoplication surgery = wrap the greater curvature of the stomach around the distal esophagus to help the sphincter But suture could come off and need to be repeated

Clinical manifestations of GER/GERD in children

Heartburn abdominal pain difficulty swallowing chronic cough noncardiac chest pain

GER risk factors

Prematurity bronchopulmonary dysplasia neurological impairments asthma cystic fibrosis cerebral palsy scoliosis

Tx for Hirschsprung's disease

Surgical removal of aganglionic section of the bowel (temporary colostomy)

Postoperative positioning for cleft palate

abdomen change position and use elbow restraints

Preoperative nursing care for cleft lip/palate

access ability to suck and feed use wide based nipple nipple squeeze the cheeks together when feeding stay upright one way valve or special cut nipple burp frequently syringe feeding

What is the treatment for intussesception

air enema by radiologist surgery if it is reoccurring

Postop care for appendicitis

assess for bowel sounds maintain NPO... If it was ruptured then NG tube and access for peritonitis

Postoperative positioning for cleft lip

back and upright position side lying change position and use elbow restraints

S/S of Crohn's disease

cramping abd pain Non bloody diarrhea severe weight loss growth failure

Clinical manifestations for hypertrophic pyloric stenosis

projectile vomiting constant hunger olive-shaped mass in RUQ Failure to gain weight Signs of dehydration

Medications for GER/GERD

proton pump inhibitor ** omeprazole, esomeprazole, pantoprazole (-AZOLE) H2 receptor antagonist **ranitidine, cimetidine, famotidine

Tx for Omphalocele/Gastroschisis

surgery w/in 24hrs of life immediate antibiotics cover with bowel bag and NS to prevent hypothermia, infection and injury