Pediatric GI dysfunction

You are taking care of an infant who has come back from having cleft lip and palate repair. The nurse would include all of the following in the plan of care except: A. Use of pacifier to prevent vigorous crying B. Holding, cuddling and rocking of infant C. Arm restraints or mummy restraint D. Placing infant in the supine position

A

Your patient is 4 days post-opt from an appendectomy. Which assessment finding requires further evaluation? A. The patient reports their last bowel movement was the day before surgery. B. The patient reports incisional pain. C. The patient coughs and deep breathes while splinting the abdominal incision. D. Options A and C

A

Which kinds of hepatitis are spread through the fecal-oral route?

A and E

Abdominal circumferences are monitored on a child with progressive abdominal distention secondary to a bowel obstruction. The appropriate procedure for assessment includes: A. Measuring abdomen after feedings B. Marking the point of measurement with a pen C. Measuring circumference at the symphysis pubis D. Using a new tape measure with each measurement to assure accuracy

B

Which of the following assessment findings would the nurse most expect to find in the child who has been diagnosed with having hypertrophic pyloric stenosis? A. Currant jelly stools and a palpable, hard mass in the right upper quadrant B. Projectile vomiting and hunger soon afterwards C. Weight loss and bloody diarrhea D. Severe, crampy abdominal pain and lethargy

B

You're providing education to a group of nursing students about the care of a patient with appendicitis. Which statement by a nursing student requires re-education about your teaching? A. "After an appendectomy the patient may have a nasogastric tube to remove stomach fluids and swallowed air." B. "Non-pharmacological techniques for a patient with appendicitis include application of heat to the abdomen and the side-lying position." C. "The nurse should monitor the patient for signs and symptoms of peritonitis which includes increased heart rate, respirations, temperature, abdominal distention, and intense abdominal pain." D. "It is normal for some patients to have shoulder pain after a laparoscopic appendectomy."

B

Select all the following options that are NOT causes of appendicitis: A. Fecalith B. Routine usage of NSAIDs C. Infection due to Helicobacter pylori D. Lymph node enlargement due to viral or bacterial infection E. Diet low in fiber

B, C, E

Describe the pathophysiology of appendicitis

Blockage causes increased pressure in appendix because mucus and bacteria has no way out. Increased pressure causes inflammation and possible rupture

A patient is scheduled for appendectomy at noon. While performing your morning assessment, you note that the patient has a fever of 103.8 'F and rates abdominal pain 9 on 1-10. In addition, the abdomen is distended and the patient states, "I was feeling better last night but it seems the pain has become worst." The patient is having tachycardia and tachypnea. Based on the scenario, what do you suspect the patient is experiencing? A. Pulmonary embolism B. Colon Fistulae C. Peritonitis D. Hemorrhage

C

A mother and 7 month old infant present to the pediatric clinic. The infant appears developmentally appropriate and healthy, but the mother tells you that she is exacerbated. She says yesterday her infant had been incessantly crying with vomiting and jelly-like stool. But now is fine. What is the nurse's first action? A. Determine prenatal status of the mother and child B. Prepare the child for immediate surgery C. Palpate the stomach for a mass D. Administer barium enema

C; a "sausage-like" mass in the upper mid-abdomen is a hallmark sign of intussusception.

A child presents with anorexia, right lower quadrant pain, and nausea. Which instruction can the nurse give to the child to enhance comfort? A. "Lie on your back." B. "Lie on your abdomen." C. "Lie on your left side with knees bent." D. "Sit up straight in the chair with your legs dangling."

C; children with symptoms of appendicitis may feel less pain in this position

An adolescent with irritable bowel syndrome comes to see the school nurse. The nurse should know that: A. A low fiber diet may be helpful B. Milk products are a contributing factor C. Pantoprazole (a proton pump inhibitor) is effective in treatment D. Stress management may be helpful

D

Congenital diaphragmatic hernia

Diaphragm doesn't fully develop allowing abdominal organs to migrate into the chest cavity, compressing the lungs

What GI symptoms can cause fluid/electrolyte imbalance, malnutrition, and dehydration?

Diarrhea and vomiting

Costipation

Difficulty in passing stools for 3 or more days, painful stools, or retention of stool with or without soiling

Inflammatory bowel disease (IBD)

Disorder that causes inflammation of the intestines

Esophageal Atresia

Failure of the esophagus to develop a continuous passage and or failure to develop structural separation

Why is growth failure and failure to thrive commonly seen in patients with IBD?

IBD is a malabsorption disorder, so children are not able to absorb vitamins and nutrients needed for optimal health and growth

Hepatitis

Inflammation of the liver

Tracheoesophageal fistula (TEF)

Abnormal passageway pertaining to the trachea and esophagus

Hirschsprung disease

Absence of ganglion cells in area of rectum and proximal colon leading to lack of intestinal sphincters relaxation and lack of motility -Does not get the message to dilate, so stool begins to accumulate in the sigmoid colon

What are the signs and symptoms of celiacs disease?

-Chronic diarrhea -Abdominal distention -Anorexia -Failure to thrive

What are the stages of hepatitis?

-Preicteric -Icteric -Posticteric

What are the clinical manifestations of intussusception?

-Sudden, severe, crampy, abdominal pain -Bilious vomiting -Inconsolable crying with pulling knees to chest -Currant jelly-like stools -Rectal bleeding -Lethargy -Palpable, sausage shaped abdominal mass

What are the symptoms of mild dehydration?

-Thirst -Vague discomfort -Loss of appetite -Dry mucus membranes

How can hepatitis A be prevented?

-Vaccine -Hand-washing

How long after onset of jaundice do serum bilirubin levels peak?

5-10 days

How much fluids should be given to a patient with mild dhydration?

50mL/kg over the first 4 hours

At what point in gestation does cleft lip occur?

6-8 weeks

At what point in gestation does cleft palate occur?

7-12 weeks

____% of hepatitis cases are caused by hepatitis viruses

90%

A patient is recovering after having an appendectomy. The patient is 48 hours post-opt from surgery and is tolerating full liquids. The physician orders for the patient to try solid foods. What types of foods should the patient incorporate in their diet? A. Foods high in fiber B. Foods low in fiber C. Foods high in carbohydrates D. Foods low in protein

A

Which characteristics of the infant gastrointestinal system result in an inability to digest complex foods? A. Immature liver B. Minimal saliva C. Short large intestine D. The location of the stomach E. Swallowing not under voluntary control

A

Cleft lip

A birth defect in which there is a deep groove of the lip running upward to the nose as a result of the failure of this portion of the lip to close during prenatal development

Ulcerative colitis (UC)

A chronic inflammatory bowel disease (IBD) primarily located in the colon and rectum

How is appendicitis treated?

Appendectomy

What is the most common abdominal surgical emergency in childhood?

Appendicitis

A nurse working at a children's hospital receives report on four patients who were just admitted to the unit within the past hour. Which nurse should the nurse assess first? A. A 9-month-old infant who has been vomiting for the past 12 hours who has a fever of 100.3. B. A 4-month-old who is resting quietly right now with reports of jelly-like stools and severe pain for the past 6 hours. C. A 2-year-old who with a fractured femur who was medicated 30 minutes ago for pain. D. A 3-month-old who has passed runny stools frequently overnight with sunken anterior and posterior fontanelles.

B

Which of the following is a high-fiber food that the nurse could recommend for a child with chronic constipation? A. White rice B. Popcorn C. Fruit juice D. Ripe bananas

B

An 18 year old patient is admitted with appendicitis. Which statement by the patient requires immediate nursing intervention? A. "The pain hurts so much it is making me nauseous." B. "I have no appetite." C. "The pain seems to be gone now." D. "If I position myself on my right side, it makes the pain less intense."

C

infant present to the pediatric clinic. The infant appears developmentally appropriate and healthy, but the mother tells you that she is exacerbated. She says yesterday her infant had been incessantly crying with vomiting and jelly-like stool. But now, the infant appears fine. Which of the following GI disorders does the nurse suspect? A. Hypertrophic pyloric stenosis B. Celiac's disease C. Intussusception D. Encopresis

C

Chron's disease

Chronic inflammation of the entire intestinal tract

Who is more likely to be diagnosed with pyloric stenosis?

First born male

Preicteric phase

First phase of hepatitis in which malaise, fatigue, nausea, fever, abdominal pain, and loss of appetite are commonly seen

Describe the prophylaxis of Hepatitis B

HBIG id effective in preventing HBV infection after 1-time exposure (if given within 72 hours)

Which forms of hepatitis have vaccines?

Hep A and Hep B

Which types of hepatitis are seen mostly in pediatric patients?

Hepatits A and E

How should a severely dehydrated patient be treated?

IV Lactated Ringers at 40mL/kg/hr until the pulse and state of consciousness return to normal, then 50-100mL/kg/hr

Describe the prophylaxis of Hepatitis A

If exposed, standard immune globulin is used to prevent Hep A infection if given within 2 weeks

What are the symptoms of congenital diaphragmatic hernia?

Immediate post-birth respiratory distress, cyanosis, decreased cardiac output, and shock

Appendicitis

Inflammation of the appendix

Celiacs disease

Intestinal intolerance to gluten proteins found in wheat, barley, and rye

How is Hirschsprung disease managed?

Mild-moderate; management by daily enemas/rectal irrigation Moderate- severe; Neonates get two stage repair, receive temporary colostomy first to relieve obstruction

Describe the etiology of appendicitis

Physical obstruction of the lumen causing inflammation

How does it feel when the appendix bursts?

Sudden relief of pain

How should the nurse help manage feedings of a child with cleft lip?

Teach the mom to that she can use her hands or extra breast tissue to cover cleft lip and create a seal to allow breast feeding

What assessment findings tell the nurse that their newborn patients is dehydrated? Select all that apply A. Dry skin B. Sunken fontanelles C. Wet mucus membranes D. Increased skin turgor E. No tears

A, B, E

Describe the pathophysiology of celiacs disease

Villi atrophy from exposure to gluten-containing foods leads to malabsorption

Roughly how much does a baby have to weigh to surgically correct cleft lip?

10 pounds

How much fluid should be given to a patient with moderate dehydration?

100mL/kg over 4 hours

How old is a child when cleft palate is usually repaired?

12-18 months

How long after birth should the first meconium be passed?

24-36 hours

Describe the pathophysiology of hepatitis

-Inflammation leads to necrosis and scarring (cirrhosis) -Portal hypertension occurs: edema, ascites, splenomegaly w/ pancytopenia, varices -Decreased bilirubin metabolism = jaundice, bile deficiency, light stools -Increased urobilinogen = dark urine -Decreased clotting factors and albumin from liver dysfunction -Decreased hormone metabolism = reproductive disorders, overproduction of ADH and aldo facilitating edema -Decreased nutrient metabolism

What are the symptoms of Chron's disease

-Intestinal ulceration -Diarrhea -Abdominal pain -Cramps -Fever -Severe weight loss and growth failure -Arthritis -Mouth ulcers

What are the most common consequences of GI disease in children?

-Malabsorption -Fluid and electrolyte disturbances -Malnutrition -Poor growth

How are esophageal atresia and TEF managed?

-NPO -NG suction -IV fluids -Antibiotics (prophylaxis for pneumonia) -Surgical interventions

What are the symptoms of pyloric stenosis?

-Projectile vomiting -Dehydration -Weight loss -Metabolic alkalosis -Failure to thrive

What are the symptoms of severe dehydration?

-Rapid, thready pulse -Tachypnea -Cyanosis -Lethargy

What nursing considerations are seen in IBD?

-Reinforce diet of high protein and calories -Manage stress and adjust to chronic illness -Observe for side effects of steroids

What are the symptoms of appendicitis?

-Right lower quadrant pain (McBurney's point) -Rebound tenderness -Poor appetite -Fever -Nausea/vomiting -Fetal position -Constipation

What is the prognosis for a child with cleft lip/palate?

-Some speech impairment -Frequent otitis media -Cognitive and motor delay -Swallowing issues -Aspiration risk

What are the clinical manifestations of Hirschsprung disease?

-Abdominal distention -No meconium in 48 hours -Vomiting -Chronic constipation

Nursing considerations of dehydration

-Administer IV fluids -Daily weight -Monitor I&Os -Monitor urine specific gravity -Provide good oral hygiene

When is hepatitis B-D commonly seen?

-Birth (contact with mothers blood) -Later in life (sexual activity, tattoos, drugs, etc.)

What are the symptoms of ulcerative colitis?

-Bloody diarrhea -Minimal abdominal pain -Mild anorexia -Growth failure -Fever -Weigh loss -Malabsorption of fluid and electrolytes

What are the 2 types of cleft lip

-Complete -Incomplete

What is the therapeutic management of ulcerative colitis and chron's disease?

-Corticosteroids and sulfasalazine for inflammation -Antibiotics and antiprotazoal drugs (Flagyl, ciprofloxacin)

What are the symptoms of moderate dehydration?

-Decreased skin turgor -Sunken eyes and fontanelles

What are the types of esophageal atresia?

-Esophagus has no connection to anything -Esophagus connects to the trachea -Trachea connect to stomach and esophagus is not connected to anything -Esophagus attached to trachea, and trachea attached to the stomach -Esophagus attached to trachea and stomach

What are the signs and symptoms of esophageal atresia?

-Frothy saliva in the mouth and nose -Drooling -Choking -Coughing -Vomiting

What are some common causes of hepatitis?

-Hepatitis viruses -Epstein-Barr virus -Cytomegalovirus -HIV

What are the nursing considerations for pyloric stenosis?

-Hydration before surgery -Post-surgery feeding every 4-6 hours beginning with small, frequent clear liquids, then breastmilk or formula -Manage post-operative vomiting -Monitor I&Os -Pain control after surgery

What are the nursing interventions of appendicitis?

-IV pain medication -No heat/ deep palpation -NPO -Antibiotics if ruptured

Hypertrophic Pyloric Stenosis (HPS)

Pyloric muscle becomes thickened, resulting in obstruction of pyloric canal and gastric outlet

How is pyloric stenosis treated?

Pyloromyotomy

Icteric phase

Second stage of hepatitis in which jaundice, dark urine, pale stools, and hepatomegaly occur

Intussusception

Telescoping or invagination of one portion of intestine into another

Cleft palate

The failure of the palate to close during the early development of the fetus