Peds ATI Chapter 23 GI Inflammatory Disorders

What is Meckel's Diverticulum?

A complication resulting from failure of the omphalomesenteric duct to fuse during embryonic development.

What is Hirschsprung's disease?

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.

What are the symptoms of intussusception?

Abdominal mass, Red currant jelly stools (blood mixed with mucus) Sudden abdominal pain Screaming while drawing knees to chest during episodes of pain.

What are the symptoms of appendicitis?

Abdominal pain in the right lower quadrant Rigid abdomen Decreased or absent bowel sounds Fever Diarrhea/Constipation Lethargy Tachycardia Rapid, shallow breathing Anorexia Possible vomiting

What are the post-operative nursing actions for Meckel's diverticulum?

Assess respiratory status and maintain airway. O2 as prescribed VS Analgesics Assess surgical site for bleeding/abnormalities Assess bowel sounds and bowel function Admin IV fluids/antibiotics NPO NG Tube to low, cont suction

When is CLEFT LIP and CLEFT PALATE repaired?

CLEFT LIP: 2-3 months of age CLEFT PALATE: 6-12 months of age, most require a second surgery. Think: You w .ork your way in when kissing.

What is the diagnostic procedure for Appendicitis?

CT Scan to show enlarged diameter of appendix as well as thickening of the appendiceal wall.

What are the nursing actions for a post op cleft palate?

Change position frequently to facilitate drainage and breathing. Placed on abdomen. Clear liquids for the first 24 hours. Avoid placing a straw or anything hard in the mouth. Elbow restraints. Close observation of airway obstruction, hemorrhage and laryngeal spasm. Face mask to deliver oxygen.

What is the difference between cleft lip and cleft palate?

Cleft lip results from the incomplete fusion of the ORAL CAVITY during intrauterine life; Cleft palate results from the incomplete fusion of the PALATES during intrauterine life. **Can appear together or alone. They can be one-sided or two-sided.

What are the symptoms of dehydration?

Dry, Pale skin Cool lips Dry mucuous membranes Decreased skin turgor Diminished urinary output Concentrated urine, thirst, rapid pulse and sunken eyes.

What are the complications of cleft lip/palate?

Ear infection (feed in an upright position), hearing loss, speech and language impairment, Dental problems (Orthodontia is usually necessary later on in life) teeth will not erupt normally.

What are the symptom's of Hirschsprung's disease in an infant?

Failure to thrive Constipation *Vomiting Episodes of diarrhea and vomiting

What are the symptoms of peritonitis?

Fever, sudden increase in pain, irritability, rigid abdomen, abdominal distention, tachycardia, rapid, shallow breathing, pallor and chills. Teach family incision care.

What are the symptoms of Hirschsprung's disease in a child?

Undernourished, anemic appearance *Abdominal distention Visible peristalsis Palpable fecal mass Constipation ***Foul-smelling, ribbon-like stool***

When feeding a newborn with ISOLATED CLEFT LIP:

Use a wide-based nipple for bottle feeding. Encourage breast feeding. Squeeze the infants cheeks together during feeding to decrease the gap.

What are the symptoms of hypertrophic pyloric stenosis?

Vomiting after feeding As obstruction worsens, Projectile Vomiting Constantly hungry Can be blood tinged vomit Failure to gain weight/dehydration ***Olive-shaped mass in the right upper quadrant of the abdomen and possible peristaltic wave that moves from left to right when lying supine

What is the diagnostic procedure to confirm Meckel's diverticulum?

Radionucleotide Scan: Meckel's Scan

What are they symptoms of Meckel's Diverticulum?

Rectal bleeding, usually painless Abdominal pain Bloody, mucus stools

What are the complications of GER/GERD?

Recurrent pneumonia, weight loss, and failure to thrive.

What is the nursing care for intussusception?

Stabilize, IV fluids to correct and prevent dehydration NG tube for decompression ***Air enema for a therapeutic procedure. ***Complication is reoccurring intussusception (Surgery is required for reoccurring cases.)

What is the treatment for Hirschsprung's disease?

Surgical removal of the aganglionic section of the bowel. A temporary colostomy may be required. Nursing Action: Monitor for enterocolitis Bowel prep with saline enemas & oral antibiotics Assess surgical site for bleeding/other abnormalities, foley care.

What is the therapeutic procedure for Meckel's diverticulum?

Surgical removal of the diverticulum

What is intussusception?

The proximal segment of the bowel telescopes into a more distal segment, resulting in lymphatic and venous obstruction causing edema.

What is hypertrophic pyloric stenosis?

The thickening of pyloric sphincter that causes an obstruction. *Usually occurs in the first few weeks of life.

What are the symptoms of GER in infants? Children?

(Infants) Spitting up or forceful vomiting, irritability, excessive crying, blood in vomitus, arching of back, stiffening, respiratory problems, failure to thrive, apnea. (Children) Heartburn, abdominal pain, difficulty swallowing, chronic cough, noncardiac chest pain

What are the symptom's of Hirschsprung's disease in a newborn?

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

What are the preoperative nursing actions for Meckel's diverticulum?

1. Blood transfusions to correct hypovolemia 2. Admin IV fluid and electrolyte replacement 3. Provide O2 4. IV antibiotics 5. Maintain bedrest 6. Closely monitor blood loss in stools.

What is the major complication(s) of Hirschsprung's disease?

1. Enterocolitis: Inflammation of the bowel. Assess abdominal girth (paper tape, level of the umbilicus or at the widest point of the abdomen) Mark with a pen to continue accurate measurements. Treatment: Resolve inflammation, prevent bowel perforation, maintain hydration, antibiotics, surgery for colonostomy/ileostomy. 2. Anal stricture and incontinence (Bowel-retaining therapy, can require further procedures, such as dilation).

What are the nursing actions for GER? For GERD?

GER: Depends on the severity of the symptoms Offer small, frequent meals Thicken infants formula with 1 tsp to 1 tbsp rice cereal per 1 oz formula. Avoid foods that cause reflux. (Caffeine, Citrus, Peppermint, spicy or fried foods) Assist with weight control. Position head elevated after meals. Position prone with extreme caution; supine is the recommended position. GERD: Proton Pump Inhibitor (omeprazole,-ole) or a H2 receptor antagonist such as (ranitidine, -idine) & GER nursing actions

What are complications of Meckel's Diverticulum?

GI Hemorrhage and bowel obstruction (for untreated Meckel's Diverticulum)

What is Gastroesophageal reflux? (GER) GERD?

Gastric contents reflux back up into the esophagus, making esophageal mucosa vulnerable to injury from gastric acid, resulting in GERD.

What is the diet for a child with Hirschsprung's disease?

High protein, high calorie, low-fiber diet. TPN in some cases. (Improve nutritional status before surgery)

What age does intussusception normally occur?

Infants and children 3 months to 6 years.

What is appendicitis?

Inflammation of the vermiform appendix caused from an obstruction of the lumen of the appendix. Average age is 10.

For the removal of the nonruptured appendix:

Laparoscopic surgery Pre-Op NA: IV replacement and antibiotics Post-Op NA: Resp status/airway, O2, VS Analgesics, assess surgical site for bleeding, assess bowel sounds/function

What therapeutic procedure is used for severe GERD?

Nissen fundoplication: Laparoscopic surgical procedure that wraps the fundus of the stomach around the distal esophagus to decrease reflux.

What are the nursing actions of appendicitis?

No heat to the abdomen Avoid enemas or laxatives

What are the nursing actions for cleft lip?

Position on BACK and UPRIGHT, or on the SIDE Post-Operatively. ELbow restraints. Normal saline, water, or diluted hydrogen to clean the incision site. Antibiotic ointment.

When feeding a newborn with CLEFT PALATE or CLEFT LIP AND PALATE:

Position upright while cradling the head during feeding. Use a specialized bottle with a 1-way valve and a specially cut-nipple. Burp frequently. Syringe feeding can be necessary for the infant who is unsuccessful with other methods.

What are the nursing actions for the removal of a ruptured appendix?

Pre-Op: F&E replacement, Place NG tube for decompression, admin IV antibiotics. Post-Op: Important to maintain NPO status, Maintain NG tube to low continuous suction, Provide wound care for open surgical sites with wound irrigations with antibacterial solution or saline-soaked gauze as prescribed. Provide drain care. Assess for peritonitis.

What is the treatment for hypertrophic pyloric stenosis?

Pylorotomy by laparoscope (Pre-Op) NG Tube NPO I&O Daily weights. (Post-Op) Start clear liquids 4-6hr after surgery. Advance to breast milk or formula as tolerated 24hr after surgery.