Peds ch 36

volume capacity of newborn stomach

15 to 20 mL

70 to 75 mL

What is the difference in the capacity of the stomach of a newborn compared with that of a 2-week-old? 1) 15 to 20 mL 2) 60 mL 3) 70 to 75 mL 4) 90 ml

Rice cereal with milk and banana, apple juice

While teaching a mother about appropriate dietary choices for her 7-year-old child, who has been recently diagnosed with celiac disease, the nurse helps the mother plan daily meals. Which breakfast is an appropriate choice for this child? 1) Oatmeal with brown sugar, orange juice, fresh fruit 2) Rice cereal with milk and banana, apple juice 3) Pancakes with syrup, mixed fruit, milk 4) Scrambled eggs with rye toast, bacon, grape juice

encopresis

a form of chronic constipation that requires a bowel training routine; preschool boy presents with frequent incontinence of stool during late afternoon; complains of dirty underwear everyday, every few days produces large stool; child seemingly not aware or bothered by presence or smell; recommendations: enema on day one, followed by toilet time, 10 minutes, 3 times a day; do not punish child for accidents; diet modifications: increased oral fluids, fiber, fruits, vegetables, high fiber cereal

esophageal atresia

a newborn presents with an abnormal termination of the esophagus alone or with congenital defects; food does not enter the stomach, risk for aspiration assess: may present with respiratory distress after introduction of formula/breastmilk; check for: excessive oral secretions, coughing, choking, respiratory distress, intermittent cyanosis, esophageal/tracheal fistuala; interventions: immediately report findings; maintain sNPO status until a PEG tube is passed for feeds; suction frequently; prepare child for surgery nursing: feed small amount initially to assess for presence of defect

intussesception

an acute GI condition that is characterized by invagination or telescoping of one bowel segment into the other; most common site of telescoping is the ileocecal valve; associated with hyperactive peristalsis, intestinal polyps, abnormal bowel lining; can recur, lead to peritonitis; between 6 and 24 mos presents in acute abdominal pain, guarding, drawing knees up toward chest; can become life threatening if bowel becomes ischemic and necrotic; gangrene=immediate surgery; assess: acute abdominal pain, passage of red, blood-tinged stool referred to as red currant jelly stool; abdominal distention and tenderness; possible passage of bile-stained vomitus interventions: rapid interventions, immediate reduction of invagination is required to prevent sever tissue inflammation, injury, hypoxia, and death to tissues; barium enema, water-soluble contrast enema, air pressure may be used to confirm and reduce telescoped bowel; prepare child and family for surgery if enema not successful nursing: teach condition can recur, immediate care must be sought; state which symptoms should be monitored for; report to emergency room

constipation

an increased consistency and decreased amount of stool when compared to normal and expected stooling pattern; most common complaint during childhood; an abnormal state of dry, hard, and infrequent stooling; acute or chronic; diet low in liquids, push fluids, high fiber; increase activity; assess: note frequency of passing hard, dry and infrequent stools, how long is present; ask for sample of stool for guaiac test; measure abdominal girth; assess level of pain; assess perirectal area for rashes, inflammation, bleeding, fissures; question reluctance to use toilet in public, friend's house, etc interventions: modify diet, stool softener/meds, least invasive measure first; add fiber to diet, suppositories, mineral oil, colace, corn syrup to formula, lubricate anal area, digitally remove if appropriate nursing: discuss with physician laxatives; may have obstructive condition, encopresis; follow up

gastroenteritis

an inflammatory process that occurs in the stomach, small intestine, or large intestine; s/s: nausea, vomiting, anorexia, abdominal distention, abdominal pain, diarrhea assess: degree of hydration, report severity of condition promptly

GI physical assessment

assess weight and height ask about bowel elimination routine and last bowel movement, normal frequency and consistency determine hydration status: mucous membrane moisture, turgor, presence or absence of tears, peripheral pulses inspect abdomen for contour, rashes, lesions, asymmetry, massess, pulsations palpate light and deep and assess for rebound tenderness

Tracheoesophageal fistula (TEF)

born with a congenital defect of an abnormal opening between the trachea and esophagus; cardiac defects may accompany; after feeding the newborn suffers tracheal irritation as the stomach acid enters the trachea, causing inflammation and discomfort assess: rapid, thorough assessment of airway, swallow/choking; Assess for coughing, choking, inermittent cyanosis, abdominal distention, pain or discomfort interventions: maintain NPO status, patent airway, suction available, prepare for surgery nursing: educate and reassure parents; explain surgery, g-tube feedings

crohn's disease

causes ulcerations along mucosal lining of the bowel but may affect any part of the alimentary tract, from mouth to anus; lesions called skip lesions, discontinuous with healthy bowel in between; known to cause fistulas, fissures, thickened intestinal walls, 50% result in granulomas assess: mild or severe, remissions and exacerbations; diarrhea with frank or occult blood; moderate to sever cramping abdominal pain; weight loss with eventual growth retardation, abscess formation, perianal fissures, fistulas, extraintestinal manifestations of finger clubbing, arthritis, amenorrhea, delayed sexual development interventions: pharmacological to reduce inflammation: antidiarrheals, antiinflammatories, analgesics; correct nutritional deficiencies; 70% of cases=surgery

imperforate anus

congenital condition in which the child is born with the absence of an anal opening; requires surgery, does not pass meconium or any stool substance; identify immediately; reconstrucive surgery

enteral feedings

congenital intestinal function disorders, oral malformations, dysphagia, FTT, neurological disorders; nasogastric tube (NGT) primary means to administer nutrition for short-term; gastrostomy tube for extended feeds, called PEG tube (percutaneous tube) or a button; monitor close for risk for aspiration

health history for GI disorder

food habits: daily intake, calories, amount of fluids, levels of appetitie elimination habits and patterns problems associated with digestive/elimination process: refusal, dysphagia, evidence of heart burn, delayed stomach emptying, spitting up, wet burps, regurgitation of food, abdominal pain, abnormal stooling patterns, excessive flatulence past medical history related to GI system: illnesses, injuries, accidents, surgeries, significant family history

celiac disease

has the absence of an enzyme in his or her intestinal mucosal cells, villi located in proximal small intestine atrophy, leading to decreased intestinal absorption; gluten intolerance, gluten sensitive enteropathy; unable to fully digest glutenin or gliadin protein components of certain grains: rye, wheat, oat, barley; accumulation of amino acid glutamine is toxic to intestinal lining and chronic diarrhea results; assess: flare-ups, celiac crises; passage of steatorrhea, greasy, bulky, malodorous stools, frothy, full of fat; organic FTT, weight loss, lack of gain, muscle wasting, anemia, anorexia, abdominal pain; intervention: gluten free diet; correct electrolyte disturbance; restore fluids nursing: reinforc plan for gluten free diets; support

Diarrhea

increased frequency and decreased consistency of stool; water increases in the bowel because of an osmotic pull, an electrolyte imbalance, poor water absorption with inflammatory process or when peristalsis is increased; infectious process, food allergies, exposure to toxins, malabsorption conditions; dehydration is associated with stool loss; assess: measure overall stool loss, duration of symptoms, I&O, assess for imbalances; check color/consistency, weigh daily, assess pain/cramping, presence of frank or occult blood, relationship w/feedings, skin integrity around anus, hydration status, bowel sounds, mass distention, fever, stress, inflammatory bowel disease, food sensitivities, intolerances, allergies, medications interventions: NPO for bowel rest; oral rehydration, avoid fruit juices, introduce foods slowly; brat or bratty diet, antidiarrheal, antiprotozoals, abx, cleanse area gently nursing: contact precautions; if cdiff=expanded precautions; educate family

appendicitis

inflammation and infection of the small lymphoid tissue called the vermiform appendix; average onset is 10 years old; most common cause of emergency abdominal surgery; assess: no deep palpations if suspected; progressive Lower right abdominal pain w/ nausea, vomiting, chills, fever; elevated WBC; positive ultrasound enlarged or distended appendix; sudden stop of persistent and progressive abdominal pain report immediately=perforation or rupture interventions: immediate surgery for ruptured; milder nonsurgical means and IV ABX; prepare child and family for surgery, maintain NPO status; place in semi-fowler; postop monitor for pain, bleeding, wound infection; anticipate slower healing for postop ruptured appendix; more pain, need for NGT, drainage device nursing: without rupture: early ambulation, restore oral fluids, progressive diet; ruptured: abx, more pain, slower ambulation time; monitor for sepsis; peritonintis: high fever, increased WBC, severe abd pain, absence of bowel sounds, regid boardlike abdomen, shock, death

necrotizing enterocolitis

inflammatory disease of the intestinal tract that occurs in premature infants, sick full-term infants; marked by varying degrees of dead or necrotic tissue in either transmural or mucosal segments of intestines; life threatening, ICU assess: history of prematurity, maternal pre eclampsia, hemorrhage, umbilical catheters, cocaine exposure, sepsis, asphyxia; free peritoneal gas and bowel inflammation; three stages: 1 marked by fluctuating temperatures, hypoglycemia, abdominal distention, heme-positive stools, poor perfusion, lethargy, recurrent apnea/bradycardia; 2. marked by above plus severe distention, grossly bloody stools, extreme abd tenderness, absent bowel sounds; 3. marked by evidence of the beginning of septic shock, including the deterioration of vital signs, metabolic acidosis, severe edema of abd wall, DIC interventions: IV ABX, vascular support, IV feedings, ICU; ostomy may be required nursing: life threatening with long healing time; associated with mortality; requires astute high level of intesive care; emotional support, teach how to care for ostomy

sterile gut

neonates are born with; entire intestinal lining must be introduced to normally expected bacteria to aid the infant in the process of digestion and elimination

cleft lip/cleft palate

occurs during fetal development; occurs because the failure of tissues to fuse completely and may be partial or complete, unilateral or bilateral; lip: more common in boys than girls; palate: more common in girls than boys; surgical repair for lip: 10 weeks and weighs 10 pounds; palate: 10 months, weaned from bottle assess: initial assessment in utero; then postbirth; assess for respiratory distress during feedings; ability of infarnt to product a complete and quality suck and swallow, presence of air tight seal around nipple; development of abdominal distention during feedings, burp baby frequently; bonding issues, provide support interventions: preop/postop; feed smaller more frequent feedings, upright position; stop feedings frequent to provide throughout burping; gavage feedings; administer small amount of sterile water to infant after feedings to remove residual formula/breast milk from accumulating in open palate area; emotional support and education; nursing: ESSR: Enlarged nipple, Stimulate sucking, Swallow, Rest; focus on prevention of suture line injury; do not allow infant to rub suture line; position supine or side lying to prevent injury to surgical site

Applying No-Nos restraints

A 12-week-old infant is brought to the pediatric unit following surgery to repair a cleft lip. What is one intervention the nurse needs to include in the plan of care? 1) Applying No-Nos restraints 2) Starting oral feedings as soon as the child is awake 3) Suctioning oral secretions 4) Promoting crying to expand the lungs post anesthesia

"After diapering, we'll wash with hand cleaner or soap and water."

A 16-month-old has been in the hospital for diarrhea caused by Clostridium difficile. The nurse has given his parents instructions for his care at home. Which statement by the parents indicates a need for further teaching by the nurse? 1) "We'll be sure he finishes all his antibiotics." 2) "I'll tie up the bag of used diapers." 3) "After diapering, we'll wash with hand cleaner or soap and water." 4) "We'll keep him on a low-sugar diet until he's all better."

Food habits Past medical history related to GI system Elimination habits

A 5-year-old with a complaint of abdominal pain is admitted to the pediatric unit for a work-up. The nurse needs to perform a health history. What are some items that need to be included? (Select all that apply.) 1) Food habits 2) Birth weight 3) Past medical history related to GI system 4) Elimination habits 5) Breast or bottle fed as an infant

Finishing the GI history and performing a GI assessment

A 6-month-old is brought to the emergency department (ED) with a complaint of vomiting and diarrhea. As the nurse is taking a gastrointestinal (GI) history, she notices the infant is crying, but there are no tears and his mouth is dry. Which is the nurse's priority action? 1) Drawing laboratory work 2) Reporting these findings to the health-care provider 3) Starting an IV of dextrose 5% in water 4) Finishing the GI history and performing a GI assessment

"Is there any possibility she may have swallowed something she shouldn't have?"

A 7-year-old is brought to the ED with a complaint of frequent vomiting. The girl vomits three times in the first half hour she is there, and antiemetics are given without effect. Which important question does the nurse need to ask first? 1) "What has she had to eat in the last 24 hours?" 2) "Is there any possibility she may have swallowed something she shouldn't have?" 3) "Is she having diarrhea also?" 4) "Has she complained of any pain?"

CBC, BMP, ESR

A mother brings her 14-year-old daughter to the clinic with complaints of severe diarrhea, weight loss, fatigue, and joint pains. The nurse notices the girl is quite pale. Vital signs are T - 100.6° F, P - 116 beats per minute, R - 20 breaths per minute, and BP 92/64 mm. Hg. Which blood work should the nurse prepare to draw? 1) CBC, ANA, vitamin D 2) CBC, BMP, ESR 3) BMP, liver profile, BUN/creatinine 4) Renal profile, H&H, ANA

Administer IV antibiotics

An 11-year-old girl is 3 days postop from surgery for a ruptured appendix. She continues to have no bowel sounds and now complains of abdominal pain. Her temperature is 103.8o F, and her abdomen is rigid. Which should the nurse be prepared to do? 1) Administer IV antibiotics 2) Send the child to surgery 3) Place a nasogastric tube (NGT) 4) Administer a laxative

Watch for acute abdominal pain. The condition can recur, and immediate care must be sought to prevent complications. Observe the child for abdominal distention and tenderness.

An 8-month-old who has had surgery for reduction of intussusception will be going home tomorrow. What are some points the nurse needs to include in discharge teaching for the parent? (Select all that apply.) 1) Observe the child for bloody vomitus. 2) Watch for acute abdominal pain. 3) If the child has black stools, come to the ED. 4) The condition can recur, and immediate care must be sought to prevent complications. 5) Observe the child for abdominal distention and tenderness.

common diagnostic tests for GI function

Labs: Chemistry panels, CBC, liver profiles, lipid profiles, ESR, thyroid function, CRP, fecal fat collection (72 hour), stool examination; Diagnostic: bowel and abdominal radiograph, abdominal and pelvic ultrasound, upper GI series, barium enema, rectal biopsy, rectosigmoidoscopy

vomiting (emesis)

the forceful expulsion or emptying of stomach content caused by either a GI disorder or by a non-GI disorder such as increased intracranial pressure, food allergies or intolerances, ingestion of a toxic substance, or administration of chemo; GI disorders: reverse peristalsis from pyloric sphincter blockage, esophageal reflux, overdistension from increased intake, severe gastroenteritis

gastroesophageal reflux disease (GERD)

the return of stomach content through the esophagus; caused by either a poorly developed or incompetent cardiac sphincter; acidity of stomach content causes pain, repeated exposure can erode esophagus; symptoms appear immediately after food is consumed as levels of stomach acid increase assess: for severity, tissue damage, behaviors in relation to eating/feeding patterns; onset in relation to positioning; pH of stomach content; coexisting weight loss or FTT; severity of discomfort; prepare for diagnostic assessment procedures: barium swallow, upper GI Interventions: prevent complications; place in upright position pre and post feed; provide small meals, feed slowly, assess for tolerance; burp frequently; administer medications: famotidine, cimetidine, ranitidine; work with nutritionist Nursing: identify early, differentiate it from other pain such as indigestion, heart pain; provide pharmacological and non pharm such as positioning, sleeping w/HOB elevated

chemoreceptor trigger zone

vomiting experience is controlled by the emetic center of the medulla; antiemetic meds work by influencing this center

pyloric stenosis

when the circular areas of muscle that surround the pyloric valve hypertrophy, the stenosis leads to blocked gastric emptying; identified with classic episodes of projectile vomiting and the clinical findings of an olive shaped mass during palpation; at risk: male, caucasion; pylorectomy is required assess: note: progressively worsening projectile vomiting, palpable olive-shaped mass located in RUQ of abdomin; clinical signs of dehydration: ⬇ UOP ⬇ tears, poor turgor, sunken fontanels, metabolic alkalosis; may resume feeding after projectile vomiting subsides Interventions: prepare for surgery, maintain NPO status, prepare family postop care, before surgery position child on right side to help prevent aspiration of vomitus; after surgery, maintain NGT patency, flush as needed, monitor strict I&O; introduce clear fluids slowly nursing: may present with FTT, moderate to severe dehydration; assess for distress, report any changes immediately

hirschsprung's disease

presents with poor passage of stool, infrequent explosions of stool, or ribbonlike stool, congentital ananglionic megacolon is suspected; characterized by the absence of neuro tissue called ganglia cells in the lower colon; most commonly affects the rectosigmoid region of the bowel; most common in the male gender; assess: diagnosed during early infancy, may not be severe enough to present until early toddlerhood; history of infrequent stools, explosive stools, stools that are thin and ribbonlike; failure of NB to mass meconium stool, chronic constipation, FTT, hypoproteinemia and anemia, vomiting, constipation, episodic, explosive stooling, abdominal distention, distress, reluctance to ingest feedings interventions: surgical to remove segment of bowel that does not have nerves, causing lack of peristalsis; preop assess stooling pattern and characteristics, prepare family for surgical procedure, if anal pull through is performed, monitor for bleeding, edema, unusual drainage, fever, alteration in skin integrity; postop, provide meticulous skin care, antibiotic, pain control, teaching support family, learn stoma care; after return of bowel sounds, passage of confirm flatus, introduce feedings slowing and monitor for tolerance nursing: preop monitor for symptoms of electrolyte imbalances and dehydration; postop: educate family, support to care for temp colostomy and how to assess

ulcerative colitis

primarily affects large intestine, continuous lesions involving superficial mucosa, demonstrate lead pipe visual appearance, muscle tissue hypertrophies, deposited fat and fibrous tissues; assess: copious frequent bloody stools 3 to 20 per day; after defication, abdominal pain relieved; significant weight loss, anemia, electrolyte imbalances, increased ESR; fever, tachycardia, palor, fatigue; extraintestinal symptoms: joint tenderness, arthritis, skin rashes interventions: pharmacological to reduce inflammation: antidiarrheals, antiinflammatories, analgesics; modification of diet; sever exacerbations: IV hyperalimentation, IV steroidal anti-inflammatories, correction of acidosis and anemia; 25% cases require surgery