Wk 9- Pediatrics acute GI issues
What assessments should be done for a child with acute GI conditions?
-hydration status (skin turgor), skin color, sunken eyes, sunken fontanels, absence of tears -LOC -recent weight loss -Stool? feeding? vomiting? -jaundice? -auscultate BS -distended abdomen -pain? -palpitate abdomen for masses and to assess for tenderness
What is appendicitis?
*Surgical emergency (most common in kids) -acute inflammation of appendix -can perforate and cause peritonitis
What are the nursing managements of appendicitis?
->Pre-op: parents present while marking surgical site ->Non-ruptured appendix: no antibiotics (abx) ->Gangrenous: 48-72hrs of abx ->Ruptured: 7-14 days of IV abx, will need to teach parents care of PICC line ->Dressing Change: Pre-medication for pain, parent assist
How do we Dx esophageal atresia?
-CXR -failed feeding tube insertion (resistance felt) -prenatal Ultrasound (can show absence of gastric bubble)
What is the Tx plan for esophageal Atresia?
-NPO -Surgical repair w/in 24hrs of birth -IVFs -Pain management -monitor electrolyte levels -anti-biotics if aspiration has occurred -suctioning of airway
What are the clinical manifestations of Appendicitis?
-RLQ pain (McBurney's point) -N/V -abdominal distension -small volume, frequent stools -fever (low to high grade) = perforation *if severe pain suddenly relieves = perforation call HCP!!
What is the Tx plan for hypertrophic pyloric stenosis?
-Requires Surgery -Clear liquid PO -IVFs -position infant on R-side to promote gastric emptying
What is the Tx of Intussusc
-Surgery -IVFs -Abx -NGT to decompress -monitor labs
How do we dx appendicitis?
-abd CT scan -elevated WBCs (very high neutrophils) -Elevated C-reaction protein (CRP)
Why is diarrhea a concern in children?
-decreased fluid absorption -children become volume depleted much more rapidly than adults (increased surface/volume ratio and limited renal compensatory capacity
What assessments should we do for a child with diarrhea?
-fever -vomiting -Pain -UOP -travel history -pets -day care attendance -Weigh diapers**
What is the treatment for diarrhea?
-fluids -nutrition -Oral rehydration**
How do we Dx hypertrophic pyloric stenosis?
-palpitation of hard "olive" in RUQ -metabolic alkalosis
What is some post-op education for parents after their child received cleft lip repair surgery?
-prevent touching of sutures, no binky, use special bottles, prevent sustained crying
What are the S/Sx of Intussusception?
-severe, intermittent abd pain -screaming -knee tuck to chest -Vomiting (bilious= immediate report as obstruction) -Fatigue -currant jelly stools (bloody)
When can you resume breastfeeding after surgery on child w/ hypertrophic pyloric stenosis?
1-2 days post-op
What are the clinical manifestations of esophageal atresia?
3 C's= choking, coughing, cyanosis -infant drooling -cyanosis -resp. distress
What is Intussusception?
A proximal segment of bowel telescopes into a distal segment, causing obstruction! -vulnerable points more susceptible (appendix, polyp, cyst, tumor)
The nurse is caring for an infant w/ and unrepaired cleft lip and palate. Which measure would be most effective in helping retain oral feedings? A- burp the infant at frequent intervals B- Feed the infant small amounts at one time. C- Place the end of the nipple far to the back of infants tongue. D- Maintain the infant in a supine position while feeding.
A- Burp the infant at frequent intervals
The nurse obtains the nursing Hx from the parent of an infant admitted w/ suspected intussusception. Which question would be most helpful for the nurse to ask? A- When was the last time your child urinated? B- What do the stools look like? C- Is your child eating normally? D- Has your child had any episodes of vomiting?
B- What do the stools look like?
What is the most common cause of diarrhea in children?
Bacterial infection (giardial or parasitic) *largest reason for child mortality across the world
The nurse admits an infant w/ pyloric stenosis to the hospital. Which aspect of the plan of care should the nurse implement first? A-Begin an intravenous infusion B-Switch the infant to an oral electrolyte solution C-weigh infant D-Orient the parent to the hospital
C- weigh infant
How do we dx diarrhea (its complications)?
CBC, blood cultures, LFT's, lipas, amylase, stool CX (check for parasite), occult blood in stool, electrolytes, KUB (abd xray)
The nurse assesses an 8-month-old infant admitted w/ severe diarrhea. which finding does the nurse recognize as being most significant? A- BS every 5 secs B- pale yellow urine C-Normal skin elasticity D- Depressed anterior fontanelle
D- depressed anterior fontanelle
What is the biggest concern in children?
Dehydration
When would you use oral hydration therapy?
Dehydration in children -lasts over 30 mins (will need to go slow) -educate parents to assist
How should we classify chronic >2 wks of loos or frequent stools?
Diarrhea -big concern for decreased fluid absorption
What should we be worried about after surgery for intussusception?
Infection!! SIRS -look for increased HR, decreased BP and WBC
What are the S/Sx of hypertrophic pyloric stenosis?
Projectile vomiting (non-bilious)
How do we manage cleft lip and when is it repaired?
Surgery and it occurs within 2-3 months or 6-9 months
How would we dx Intussusception?
X-ray, palpitation of "sausage" -Barium enema
When does a cleft lip occur and what are the complications?
fusion does not occur in 9 wks of pregnancy Complications: aspiration (from air or milk), Quick fatigue, delayed speech, poor feeding
What is hypertrophic pyloric stenosis? Main party impacted?
hypertrophied muscle of pylorus causing obstruction (no digestion occuring) ->Males at highest risk
What is McBurney's point?
point of maximal tenderness
What is Esophageal Atresia? Causes?
rare congenital anomaly in which the esophagus fails to develop past some point, can fuse to trach and cause aspiration Cause: infectious disease, alcohol, maternal DB, advanced maternal age, employment in agriculture
Why do we assess inside the mouth if a baby has a cleft lip?
they can also have a cleft palate
