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