GI disorders
Irritable bowel syndrome s/s
- cramping, bloating, diarrhea - sudden onset - family history of this - less able to deal with stress, anxiety, depression, trouble sleeping
Gastroesophageal Reflux (GERD) predisposing factors
- neurological defects - chronic resp disorders - esophageal atresia - obesity - genetic preposition, - premature children, - tracheoesophageal repairs, - asthma, - cystic fibrosis, - CP
Dehydration s/s
- thirst, - dry mouth, - headache, - dizziness, - irritability, - lethargy, - excessive fatigue - possibility cramps, - tachycardia, - neuro changes, - changes in sensorium, - delayed cap refill
constipation treatment
-Enemas (hold as long as possible), - Milrax for chronic constipation - Digital dissimpaction - IV fluids
Intussusception management
1. Make npo, 2. IV therapies 3. NG placement 4. Go get barium enema or pneumo-enema
Crohn's s/s
- Abd pain (often RLQ), can mimic app - Fever * N,V,D * Anorexia - Other S/S (wt loss, fatigue, vomiting, no appetite, delayed G/D, diarrhea, anemia, malnourished, _____ - Mild to severe, exacerbations, - Extraintestinal (outside intestine) - canker sores, erythemal nodulosum (painful red pumps particularly below the knee
Crohn's
- Antibiotics, - corticosteroids, - ciclosporins, - infliximab, - surgery, - immunosuppressants (5ASA), - immunomodulators,
Ulcerative Colitis diagnostics
- CBC, - Total protein, - albumin, - Iron, - Stool sample, - Colonoscopy with tissue biopsy
Crohn's diagnostics
- CBC, liver enzymes, sed rate, CRP, - Urinalysis, Stool testing - Colonoscopy
A 13-year-old female is brought to the clinic with a 2-day history of nausea and vomiting. The teen has a fever of 101.8°F and episodic abdominal pain at the umbilicus and right lower quadrant. She weighs 48kg The labs return: WBC are 22,000 (high) CRP is 15 (high) U/S results: unable to visualize BMP remarkable for dehydration; no urine available What orders do you anticipate now? How will you prepare the child? (tell as go along and explain) What is the priority intervention?
- CT scan - Antibiotics - IV fluids - PRN pain meds - Surgeon consult - Worry about infection, pain, and hydration
Vomiting management
- Detection and treat cause - Prevent complications (dehydration & malnutrition) - Antiemetic drugs (Ondansetron) - Oral rehydration, parenteral fluids(see dehydration - Monitoring behaviors of vomiting, associated symptoms - Assessment (emesis, behavior of childZ) - Reduce vomiting
Gastroesophageal Reflux (GERD) treatment
- Diagnostics - Monitor i/o, weight gain - Medications reninadien & lansoprazole (PPI) - Surgery if severe: fundoplication
Irritable bowel syndrome treatment
- Eat smaller meals - Figure out trigger foods (fatty foods, dairy, carbonated beverages, caffeine) - Keep a diary on what is happening to identify patterns - Inc fiber in diet - Ensure enough PO
Gastroesophageal Reflux (GERD) diagnostics
- Endoscopies, barium swallows - Usually based off symptoms - Wt, length, hc, - Stool for occult blood, CXR, pH probe, - Fundoplication
Vomiting diagnostics
- H & P (descriptions, relation to food, pain, behaviors, other things - UA, electrolytes, x-ray, U/S, bone scans, endoscopy
Short Bowel Syndrome s/s
- Lack nutrition and slower growth
Volvulus management
- NPO, - prep for surgery, - vasopressors to keep bp up, - IV fluids
Dehydration diagnostic values
- Note physical s/s - Labs: Na, NaHCO3, other electrolytes - Urinary analysis - Body weight
Short Bowel Syndrome management
- Nutrition: PN then enteral feeds but as elemental formulas by continuous infusion then oral feeds asap - Preserve as much of the bowel as possible - Maintain optimal nutrition status - Minimize any complications that happen - Monitor for nutritional deficiencies
Dehydration management
- Oral rehydration solutions (Pedialyte) - need 2-5 mL every 2-3 min wait and try again if throw up - Ondansetron!!! (tablet is good bc absorbed) - Parenteral fluid therapy - if first two don't work -> severe dehydration, can drink -> NS or LR -> when NPO or not enough NPO - - Treat underlying cause - NO k+!! - Kool-Aid, popsicles, ect.
It is determined that the teen has acute appendicitis and will require emergent surgery. What are the nursing priorities postoperatively?
- Pain management, - VS (monitoring for infection), - see affects of med, - deep breathing, - ambulating, ctn. - Diet as tolerated
Ulcerative Colitis s/s
- Rectal bleeding - skin lesions - joint pain - inflammation - growth failure
Gastroesophageal Reflux (GERD) s/s
- Recurrent vomiting, - slow or no weight gain, - excessive irritability - crying (esp after meals), - Sandifer syndrome: flex neck back (trying to relive pain but may think it is a seizure) - Passive regurgitation in infants - Chronic resp issues: Upper airway inflammation/irritation (stridor), pneumonia, ect. - Poor growth Intermittent vomiting - Older: heartburn, regurgitation, reswallow, inflammation, chronic blood loss (slow bleed) -> anemia - silent GERD: burning, coughing, choking , arching after meals, apnea, chronic cough
Intussusception s/s
- Sudden onset of severe, intermittent abdominal pain - screaming and drawing up legs with periods of calm in between episodes - abdominal pain/mass - currant jelly stools (blood and mucus) - sausage shaped mass in RUQ
Ulcerative Colitis- nursing interventions
- Total colectomy - Antibiotics, pain meds, antidiarrheals, immune suppressants - Lots of EDU, must have doc for peds GI may have trouble getting to appointments)
A 13-year-old female is brought to the clinic with a 2-day history of nausea and vomiting. The teen has a fever of 101.8°F and episodic abdominal pain at the umbilicus and right lower quadrant. She weighs 48kg What diagnostic tests are expected?
- US - CBC (WBC), chemistry (hydrations) - Ct sacn (last)
s/s of gastroenteritis
- Watery diarrhea - Abd cramping - vomiting - Poss fever and chills (t >/= 102.5) - dehydration - Symptoms last 1- days up to 10 days
A 13-year-old female is brought to the clinic with a 2-day history of nausea and vomiting. The teen has a fever of 101.8°F and episodic abdominal pain at the umbilicus and right lower quadrant. She weighs 48kg What are the nursing priorities for this child?
- When start, how long, where, type of pain, - anyone else been sick?, - baseline weights, - last menstrual period, - are you drinking okay, - when did you last eat. - Place on NPO, - VS, - pregnancy test, - address pain, - IV access, - urinary analysis
Initial pain in the periumbilical area that moves to the right lower quadrant of the abdomen
Appendicitis
Right upper quadrant pain with vomiting, pain may radiate to the right scapula, fever
Cholecystitis and Gallstones
It is determined that the teen has acute appendicitis and will require emergent surgery. What are the nursing priorities preoperatively?
Consent, make sure understand
Often presents as right lower quadrant pain, fever, diarrhea (possibly bloody), aphthous ulcers in mouth, periods of exacerbation and remission
Crohn's
Hereditary disorder that affects exocrine glands
Cystic Fibrosis
Weight for age that is less than 5th percentile on multiple occasions, or weight deceleration that crosses two major percentile lines on a growth chart
Failure to Thrive
Infrequent stools (<2 per week), leaking of stool between bowel movements, pain with stooling
Functional constipation
Watery diarrhea, abdominal cramping, vomiting, headache, signs of dehydration, stools with blood or pus
Gastroenteritis
Eating can be unpleasant for infants: coughing and choking, arching of back, can present as apnea
Gastroesophageal Reflux (GERD)
Volvulus s/s
Intermittent bilious vomit (green), - recurrent abd pain, - distention, - lower GI bleed
Sudden drawing up of legs, increased abdominal distention, may be caused by Meckel's diverticulum, pain that occurs in regular intervals every 15 to 20 minutes, currant-jelly stools
Intussusception
Changes in stool appearance: loose or hard, thin or like pellets, mucous in the stool
Irritable Bowel Syndrome
Poor feeding, high risk for preterm infants, lethargy, may have signs of infection, elevated bilirubin
Neonatal Jaundice
Becoming more prevalent in adolescents, may be asymptomatic, may be associated with diabetes, polycystic ovary disease, celiac disease
Nonalcoholic Fatty Liver Disease
Recurrent abdominal pain, nausea, vomiting, crampy epigastric pain, decrease in growth, anemia
Peptic Ulcer Disease
Forceful, progressive, nonbilious vomiting after each feeding, palpation of mass in midepigastrium (Olive sign)
Pyloric stenosis
Failure of the esophagus to develop as a continuous passage separate from the trachea
Tracheoesophageal fistula
Frequent bouts of bloody diarrhea, fever, and abdominal cramping
Ulcerative Colitis
Abnormal rotation of the GI tract (usually intestine) can impair blood flow to Mesenteric artery
Volvulus
A 9-year-old is admitted with an inguinal hernia. In assessing this child, what signs would indicate incarceration? Select all that apply. a. Increase in pain b. Bilious vomiting c. Bradycardia d. Diarrhea e. Presence of a hydrocele
a,b
Cystic fibrosis is a hereditary disorder that affects the pancreas, intestines, and bronchi. Which of the following are common assessment findings? Select all that apply. a. Steatorrhea b. Meconium ileus c. Failure to thrive d. Jaundice e. Dark urine and light-colored stools
a,b,c
Review the following nurse's note that was written at 0830 and the lab results that were reported at 0900. Select to highlight findings that indicate the client is not progressing as anticipated after his laparoscopic appendectomy. Select all that apply. a. Client reporting pain at 6 out of 10 on the FACES scale. b. Abdomen tender to palpation. c. Hypoactive bowel sounds. d. NG tube with 30 mL of bilious output since 0200. e. NG tube clamped at 0600. f. Client given ice chips and water at 0700. g. Client vomited x2 after drinking water. h. Client passing gas. i. No bowel movements since surgery. j. Regular heart rate and rhythm. k. Lungs clear to auscultation bilaterally. l. Pulses 2+ in four extremities. m. Capillary refill time less than 3 seconds. n. Client ambulating to bedside chair only. o. Incision sites pink with approximated edges; no drainage noted. p. No dressing in place. q. Temp 100.6°F (37.8°C), r. HR 100 bpm, s. RR 24 breaths/min, t. SpO2 98% on room air, u. BP 102/67 mm Hg, v. WBC 18 (5-10 103/mm3), w. RBC 4.8 (4.6-4.8 106/mm3), x. Platelets 225,000 (150,000-400,000/mm3), y. Hemoglobin 16.2 g/dL (13.36-17.5 g/dL), z. Hematocrit 45% (39%-49%)
a,b,c,d,g,n,q,v
A newborn had a repair of Type I tracheoesophageal fistula (TEF). Which statement would be correct in educating the family of what to expect in the immediate post-operative period? Select that apply. a. "Frequent suctioning with a pre-measured catheter is required." b. "The head of bed should be elevated 30-45 degrees." c. "If there is no leak 5-7 days after the surgical repair, oral feedings will be started." d. "This type of TEF cannot be surgically repaired." e. "The baby will be on acid suppression therapy using a proton pump inhibitor (PPI), such as Lansoprazole postoperatively."
a,b,c,e
The nurse has been asked to prepare the client for an appendectomy. Which of the following actions should the nurse take? Select all that apply. a. Educate the client and caregiver regarding what to expect before surgery. b. Complete surgical consent. c. Provide the client with ice chips or water until surgery. d. Ensure the client has a hospital ID bracelet on. e. Assess for any personal or family history of problems with anesthesia or bleeding disorders. f. Ensure the parent understands the risks and benefits of the surgery. g. Obtain a urine specimen for hCG prior to transferring the client to the operating room. h. Assess the client's IV in the right hand to ensure patency.
a,b,d,e,f,h
Which of the following nursing interventions are considered emergent for an infant diagnosed with tracheoesophageal fistula? Select all that apply. a. Oxygen if needed b. Prevention of aspiration c. Prone positioning with head elevation d. Nasogastric feeding tube for nutrition e. IV access for fluids and antibiotics
a,b,e
Which of the following clinical manifestations are associated with Celiac disease? Select all that apply. a. Iron deficiency anemia b. Low-grade fever c. Abdominal bloating d. Foul-smelling stools e. Weight gain
a,c,d not e bc weight loss is normal
Which is associated with Hepatitis B a. petechiae, ecchymosis, spider angiomas b. vaccine at birth and 12 mths c. risk of transmission at birth d. hepatosplenomegaly e. abdominal pain f. HTN g. oral-fecal transmission h. jaundice
a,c,d,e,h
Which findings below are related to a diagnosis of acute appendicitis? Drag each finding that relates to this diagnosis to the box on the right. select all that apply. a. right lower quadrant pain b. absence of vomiting or diarrhea c. temp of 100.4 d. lying still with knees bent e. recent travel f. decreased oral intake g. 2-year-old sibling who attends daycare h. mild bruising on bilateral knees
a,c,d,f
Which is associated with Hirschsprung's Disease a. ribbon-like watery stools b. full rectum on digital exam c. failure to pass meconium d. enemas e. high-pitched crying f. genetic counseling is not encouraged g. lack of nerves in bottom segment of colon h. anorectal manometry definitive test for diagnosis
a,c,d,g
The nurse knows the emergent care for clients with Crohn's disease include which of the following? Select all that apply. a. High dose corticosteroid therapy b. Encourage the client to eat solids c. Diet high in potassium d. Intravenous (IV) fluid therapy e. Treatment with aspirin to decrease inflammation
a,d
Which is associated with Constipation a. polyethylene glycol 3350 for treatment b. lactulose not recommended for infants c. dietary changes include decreasing fruits and veggies d. food as rewards for behavior modification e. functional or idiopathic f. avoid probiotics g. holding behaviors h. encopresis
a,e,g,h
A nurse is providing discharge instructions to an older child and the caregiver for the diagnosis of gastroesophageal reflux disease (GERD). All of the following would be included except? a. Proton pump inhibitor with breakfast daily b. Encourage weight loss if child is obese c. Avoidance of caffeine, chocolate, and carbonated beverages d. No eating or drinking 2 hours prior to bedtime
a. Proton pump inhibitor with breakfast daily no need to give 30 min before feedings
A nurse is caring for a severely dehydrated child. The child has had nausea and vomiting for three days. The health care provider orders a 20 ml/kg bolus of intravenous (IV) fluid of an isotonic crystalloid. Which IV fluid would be the best choice? a. Sodium Chloride 0.9% (normal saline) b. Dextrose 10% and water (D10W) c. Dextrose 5% and 0.45% normal saline (D5 ½ NSS) d. Dextrose 5% and 0.9% normal saline (D5NSS)
a. Sodium Chloride 0.9% (normal saline)
The client has been diagnosed with a possible acute appendicitis. For each provider order in the list below, please indicate whether the order is anticipated, nonessential, or contraindicated for the client in the ER. a. Complete blood count (CBC) with differential b. Regular diet for age c. Abdominal ultrasound d. Chest x-ray e. Administer IV fluids f. Ambulate 3 times a day g. Administer pain medication as prescribed
anticipated: a,c,e nonessential: d,f contraindicated: b,g g is contraidicated bc do not want it to mask rupture
A 13-year-old female is brought to the clinic with a 2-day history of nausea and vomiting. The teen has a fever of 101.8°F and episodic abdominal pain at the umbilicus and right lower quadrant. She weighs 48kg what are you thinking this is?
appendicitis
At a well checkup, the parent reports that her child is constipated. What questions should the nurse ask to gain knowledge about the child's stool pattern? Select all that apply. a. "Do you force your child to go to the bathroom?" b. "How often does your child have a bowel movement?" c. "What is the consistency of the stool when they have one? Is it hard, soft, or liquid?" d. "Does your child have a ritual when they go to the bathroom?" e. "Does your child strain when having a bowel movement?"
b,c,d,e
Which of the following assessment findings are associated with the diagnosis of Hirschsprung's disease? Select all that apply. a. Foul-smelling stools b. Vomiting c. Ribbon-like or watery stools d. Scaphoid appearance to abdomen e. Poor weight gain
b,c,e
Gastroesophageal reflux disease is characterized by which of the following in infants? Select all that apply. a. Increased hunger b. Arching of back, neck, and head during feeding c. Bilious vomiting d. Crying e. Currant-jelly stools
b,d
Which is associated with Cystic Fibrosis? a. endocrine gland disorder b. steatorrhea c. water-soluble vitamins d. pancreatic enzymes with meals e. meconium ileus f. delayed immunizations g. genetic disorder h. abnormal weight gain
b,d,e,g
Which is associated with Crohn's Disease a. low dose corticosteroids for moderate flares b. Opthalmic examination c. urgency to defecate d. oral aphthous ulcers e. mimics appendicitis f. usually affects sigmoid colon g. anemia h. delayed development
b,d,e,g,h
Which of the following gastrointestinal disorders are associated with a lack of or significant delay in the passage of meconium in the newborn? Select all that apply. a. Pyloric stenosis b. Cystic fibrosis c. Celiac disease d. Newborn jaundice e. Hirschsprung's disease
b,e
Which is associated with Neonatal Jaundice a. normal neonatal jaundice develops 24 hrs after birth b. low level of jaundice is a normal finding in newborn c. indirect sunlight is recommended for treatment d. average risk for preterm infants e. poor feeding and lethargy f. opisthotonic posturing g. seizures h. high-pitched cry
b,e,f,g,h
The pediatric unit nurse is reviewing the client's postoperative orders (post appendectomy). Which provider orders should the nurse question? a. cefazolin 500 mg IV every 12 hrs b. regular diet c. place nasogastric (NG) tube to low wall suction d. incentive spirometer e. contact isolation with enteric precautions f. VS every 4 hrs g. monitor pain using 1-10 scale h palpate for olive shaped mass with every physical exam
b,e,g,h
The nurse observes a newborn become cyanotic when feeding. What procedure will the nurse perform as prescribed to assess for a tracheoesophageal fistula (TEF)? a. Feed the newborn with smaller, frequent feedings b. Attempt to pass a nasogastric tube (NG tube) c. Check for simian creases on the palms of the hands d. Administer a saline lavage
b. Attempt to pass a nasogastric tube (NG tube)
Which of the following is a potential assessment finding in an infant with pyloric stenosis? a. Sandifer's syndrome b. Forceful vomiting c. Abdominal distention d. Watery diarrhea
b. Forceful vomiting
The parent of a client who had a ruptured appendix thought their child was just constipated. The parent is now verbalizing feelings of guilt. What should the nurse say in order to reassure the parent? a. "Perhaps you should have brought the child in sooner." b. "Would you like me to call your husband, as children and youth services have been notified?" c. "It's OK, there was no way for you to know that it was his appendix." d. "He has a fever. Did he have cold recently? It could be related to that."
c. "It's OK, there was no way for you to know that it was his appendix."
The nurse is educating a client with celiac disease about nutrition. Which diet would be the best choice? a. Tuna on wheat toast b. Ham and Swiss cheese on rye bread c. Rice and beans d. Chicken salad on a croissant
c. Rice and beans
Ulcerative Colitis
causes inflammation and ulcers in lignin of large intestine (usually sigmoid colon and rectum) but can be in entire colon
VS: 1115 Temp 99.7°F (37.6°C) HR 90 bpm RR 22 breaths/min SpO2 98% on room air BP 99/72 mm Hg Pain 4 out of 10 on FACES scale Height 42 inches (106.6 cm) Weight 45 lb (20.4 kg) 1230 Temp 100.4°F (38°C) HR 95 bpm RR 20 breaths/min SpO2 98% on room air BP 105/75 mm Hg Pain 0 out of 10 on FACES scale lab results: WBC 15 (5.0-10.0 103/mm3) RBC 4.8 (4.6-4.8 106/mm3) Platelets 200,000 (150,000-400,000/mm3) Hemoglobin 13.8 g/dL (13.6-17.5 g/dL) Hematocrit 42% (39%-49%) Sodium 137 mEq/L (135-145 mEq/L) Potassium 4.0 mEq/L (3.5-5.0 mEq/L) BUN 8 mg/dL (8-20 mg/dL) Creatinine 1.0 mg/dL (0.6-1.2 mg/dL) Glucose 88 mg/dL (60-100 mg/dL) The nurse should recognize that the priority concern for the client would be the _______ . The nurse should _________
client reports no longer experiencing pain; report finding to healthcare provider
The mother of a newborn diagnosed with tracheoesophageal fistula (TEF) asks the nurse about the condition. Which statement is correct in educating this mother about TEF? a. "This was caused because of you not taking enough folic acid in the first trimester of your pregnancy." b. "Your child will most likely be prone to frequent fractures of the extremities." c. "Your child will need to be on antibiotics of invasive procedures prophylactically." d. "Your baby should be able to start tube feedings in 2 to 3 days after the surgical repair."
d. "Your baby should be able to start tube feedings in 2 to 3 days after the surgical repair."
A nurse caring for a patient diagnosed with peptic ulcer disease is aware that a medication regimen known as "triple therapy" is often prescribed for treatment. Which of the following medication combinations is correct? a. Amoxicillin, pantoprazole, polyethylene glycol 3350 b. Metoclopramide (Reglan), clarithromycin, Flagyl c. Famotidine, omeprazole, amoxicillin d. Flagyl, clarithromycin, omeprazole
d. Flagyl, clarithromycin, omeprazole
Constipation is treated with __________________ in infants, and with ________________ in older children and adolescents. a. Mineral oil; lactulose b. Docusate sodium; polyethylene glycol 3350 c. Bisacodyl; lactulose d. Lactulose; polyethylene glycol 3350
d. Lactulose; polyethylene glycol 3350
A parent brings a child to the emergency department (ED). The client has been reporting abdominal pain for over a week and reports feeling constipated. Admission vital signs are: Temp 102.1, HR 110, RR 30, BP 115/84. An abdominal ultrasound revealed free fluid in the abdomen. What would most likely be the child's issue? a. Constipation b. Intussusception c. Crohn's disease d. Ruptured appendix
d. Ruptured appendix
which is worrisome? if a hernia does not inc when crying or does inc when cry
does not increase with cry - it is stuck this in an emergency - older kids have cough and bear down
Volvulus can lead to
necrosis, peritonitis, and death
hernia risk
preemies, AA
Intense crying, usually occurs before 6 months of age, abdominal distention, vomiting (usually bilious), pulling up of legs
volvulus
Crohn's affects
whole GI
Tracheoesophageal fistula nursing interventions
• Emergency—prevent aspiration ‒ Tube placed in pouch * IV access * Supine with HOB elevated • Acute Hospital—prep for surgery ‒ Chest tube care * abx * frequent suction * HOB elevated ‒ Tube feeds 2-3 d after surgery • Chronic—watch for stricture
Tracheoesophageal fistula diagnostic
•Coiling of feeding tube in x-ray •Contrast eval for fistula •Abnormal bowl gas pattern •US
