GI Conditions (3b/3)
Therapeutic procedures Intussusception
*Hydrostatic reduction with saline or air enema *Observe in hospital for 24 hours *2-5% recurrence rate within 24 hours *Surgical repair (bowel resection)
______ of Intussusception spontaneously resolve
10%
pyloric stenosis occurs ___________ in _____ than in ______________
3-4X Males Females
______________________ to detect free air in the abdomen (indicative of bowel perforation)
Abdominal X-ray
Intussusception Dx
Abdominal X-ray Ultrasound Abdominal exam: palpation of a sausage shaped mass
Complications of Intussusception
Bowel obstruction, inflammation, edema, ischemia, perforation, peritonitis,shock
GER vs PS
GER = passive vomit PS = projectile vomit @ about 6 weeks
______________ is one of the most common causes of intestinal obstruction in kids
Intussusception
Pyloromyotomy Post-Op Care
Oral electrolyte solution start with 5 ml q 15 minutes; increase amount if tolerated Monitor NG color, amount Nutrition: small amounts feeding, burping, vomiting
CM of Intussusception
Paroxysmal, episodic abdominal pain and vomiting Periods of no symptoms Mucoid, bloody stool (current jelly), lethargy, change in level of consciousness
CM of pyloric stenosis
Projectile vomiting usually after eating; (@~ 2-6 weeks of age) Hunger, irritability Dehydration Constipation Abdominal distention Olive size mass occasionally palpable in epigastric region
Lab for Pyloric Stenosis
Specific Gravity Electrolytes BUN Creatinine
Nursing Care for Intussusception Post-Op
Standard post op care Assess bowel sounds, passage of normal stool
nursing care Pre-Op for Intussusception
Standard pre op GI care Exam all stools (they can "untelescope")
____________ to detect intussusception
Ultrasound
A 4-week-old infant is diagnosed with hypertrophic pyloric stenosis and is scheduled for surgery. Oral feedings are usually initiated a few hours after surgery. The nurse expects that initially the infant will receive: a. clear fluids b. half strength formula c. full strength formula d. thickened formula with cereal
a. clear fluids
in intussusception, when the overlapped portion constricts during peristalsis, what can occur?
blood flow to the rest of the intestines is cut off = necrosis
During the initial post-operative period after a 1-month old infant has had a cleft lip repair, the nurse should feed the infant using a: a. spoon b. soft nipple c. 10 ml syringe d. nasogastric tube
c. 10 ml syringe
During the initial post-operative period after a 1-month old infant has had a cleft lip repair, the nurse should feed the infant using a: a. spoon b. soft nipple c. 10 ml syringe d. nasogastric tube
c. 10 ml syringe
pyloromyotomy involves
cutting out the pyloric muscle
After several episodes of abdominal pain and vomiting, a 5-month-old infant is admitted to the pediatric unit. A diagnosis of intussusception is made. To assist in confirming the diagnosis, the priority nursing assessment should be: a. auscultating for bowel sounds b. listening for high-pitched crying c. measuring fluid intake and output d. observing characteristics of stool
d. observing characteristics of stool
After several episodes of abdominal pain and vomiting, a 5-month-old infant is admitted to the pediatric unit. A diagnosis of intussusception is made. To assist in confirming the diagnosis, the priority nursing assessment should be: a. auscultating for bowel sounds b. listening for high-pitched crying c. measuring fluid intake and output d. observing characteristics of stool
d. observing characteristics of stool
pyloric stenosis is due to
enlarged pylorus muscle building up on the outside and pushing in → Narrowing of pyloric canal → bowel obstruction (nothing in stomach will get to intestines) → Hyper-peristalsis of the Stomach, which causes more muscle build up
Surgical repair of intussusception if
hydrosatic reduction unsuccessful, if child in shock, or peritonitis or intestinal perforation
Intussusception is usually
idiopathic
how does Intussusception usually occur?
if a child has some kind of gasstroeneritis or flu or tummy ache → irritation of intestines → telescoping
how does bloody stool (current jelly) occur with intussusception?
ischemia → necrosis → perforation → current jelly
why does Hyper-peristalsis of the Stomach occur with pyloric stenosis
stomach is contracting to get the food out
Intussusception is the
telescoping of one portion of the intestine into another
pyloric stenosis develops during
the first few weeks of life