The Child with Gastrointestinal Dysfunction

What is Appendicitis

○Inflammation of appendix- could rupture and cause peritonitits bc you could put fecal matter into peritoneal cavity

○Symptoms

○Abd pain, McBurney’s point- right lower quadrant , rebound tenderness- push and when you let go theres pain. , fever, N&V, guarding- don’t want you to touch lower right quadrant., periumbilical pain.

○Diagnosis, history/ pyshicla, CBC, urinalysis, CT

○Pain, hydration, support, infection, education

Could perforate and rupture- if they have a sudden relief of pain worried about peritonitis. will feel better when ruptures

Tx- surgery,

• or drain if ruptured- will pull out bacteria and junk while irrigating it, then wait a few weeks until surgery

• if not ruptured- go in and remove it

Early assessment and intervention could prevent this

Surgery - pre and post op care- IV fluids, pain management, abx,

If had Surgery- splint incision- can put pillow on stomach if they have to cough, s/s infection, respiratory we need to arelate lungs- blow bubbles, incentive spiromotor, advance their diet slowely and then progress, Watch for N/v even after. if olfer kid- adolecnece body image is important.

What is Meckel Diverticulum

○Out-pouching ( buldge) of ileum containing gastric or pancreatic tissue that secretes acid – causes ulceration in pockets of the bowel.. Congenital malformation- 2-4%- more common in males.

○Symptoms

○Often asymptomatic

○Painless rectal bleeding, “currant jelly”- will look like strawberry jelly  stools- blood mixed w muscus , abd painful and tight, signs of obstruction, hypotension if bleeding severe- watch s/s of shock

○Diagnosis & Treatment- hx, physical, imaging, scanning

○Nursing Management

○Pre and post-op care- tx- will remove affected bowel.

○If showing signs shock before surgery or hypotensive fix before surgery

Test stool for blood. lab work,

○I and O important to monitor , pain control,

after surgery- watch s/s infect, pain, iv fluids, NGT to decompress stomach, monitor return of normal bowel fx

WHat is Peptic Ulcer Disease

○Chronic condition of ulcers affecting stomach or duodenum

○Symptoms

○Epigastric pain- high up pain , nocturnal pain- when lay down at night , oral regurgitation, heartburn, weight loss, hematemesis- blood in stool or vomit , melena

○Diagnostics

○Management

○Releive discomfort and promote healing

○If dt H pylori- will be tx w antibitotics

○PPI, anatacids, H2 antagonist meds- pepsid,

○Can be so severe- may hemmorage , or hypotensive shock- give blood transufion and IV fluids

○Surgery- they can cut the vagus nerve- helps control stomach acid.- saved if aggressive, reocurring, doesn’t go away w meds

What are the types of hepatitis

Type	Hep A	Hep B	Hep C	Hep D	Hep E
Route	Fecal-Oral	Most occur perinatally in children	Blood and body fluids; Perinatal	Blood and body fluids	Fecal-oral
	Contaminated food or water	Any bodily fluid	Drug use, sexual transmission Can effect liver	Previously infected with HBV	Contaminated food or water; Not common in children

How do we tx hepatitis

○Treatment- don’t need to know meds

○Goals and Prevention – from replicating, catch early, look s/s for worsening liver fx, prevent spread disease.

○Cluster care bc get tired easily

○Nursing Management

○Diet- like vit k

○Rest

○Medications- vaccines, educate, hand washing, standard precuations, teach to make sure meds are sfae to give if liver impaired.

○Education

What is Biliary Atresia- closed or absent

○Extrahepatic bile ducts fail to develop or are closed

○Symptoms

○Asymptomatic, mild jaundice, abd distension, hepatomegaly

○Progresses to splenomegaly, bruising, prolonged bleeding, intense itching for build up of bile, putty-like white or clay stools, tea-colored urine

○  Nursing Management

○  Medical Management

○    Kasai Procedure

Juandice will last. Could be immune or viral response

Can lead to cerosis, liver failure, death

Failure tot thrive- don’t grow and develop,

Educate and support, teach tepid baths- lukewarm, don’t want them to scratch- pat skin, keep nails cut short, cluster care- tire easily.

Diagnose early to hopefully survive

Have vit k before procedures

Fat soluble vitamin- a, d, e, k

Can still be breast fed-or bottle  enteral or tpn formula

What is the kasai procedure

oRemoves blocked bile duct and attaches a part of small intestines= new flow for bile.

o1/3 still have to have a liver transplant even w this procedure

What is cirrhosis

oOccurs as result of hepatitis, biliary atresia, infection, autoimmune disorder, or chronic disease (hemophilia, CF)

Damage is not reversable.

S/S- jaundice, anemic, poor growth, weak, lethargic, acities,

No tx to stop progression- prognosis is poor without a liver transplant

Role- prevent complications and Monitor liver fx, tests,

identify early s/s

Risk for malnutrition, hemmorhage, ecncephalopathy- brain dysfunction

oGoal- Liver transplant

What is cleft lip and palate

can be separate as well

Check for other anomalies or syndromes

Exposure to toxins in utero or folate deficiency in mom might cayse, or unkown

○Maxillary processes fail to fuse

○Medical Management

Nursing Management pre-op

○Assessment- Presurgery- assessing, immediate concern= feeding- will interfere with suck. There are different models like johsnon and johsn that have a special model. Will suck more air- burb more frequently, keep more upright before and after feed, aspiration risk, keep bulb syringe nearby, lactation consulatant.

Nursing Management post-op

If have surgery- don’t want to put prone ( stomach), elbow immbolizers so don’t pull suture lines, don’t put anything in their mouth- promote healing. Resume feeds as tolerate post op

Team w kids- plastic surgeon, at risk for hearing problems. will have freq hearing screen.

Will repair cleft lip sooner- 2/3 months. Wait a little and repair cleft palette Repair palate 6-12 months bc want skeletal features to have time to grow. Don’t want to wait to long bc increase risk for speech delays

WHat is Esophageal Atresia & Tracheoesophageal Fistula (TEF)

○Esophagus ends in blind pouch or connects to trachea by fistula- fistula connecting trachea  to espohagus

Symptoms

○Excess saliva, drooling, 3 C’s

○Apnea

○Increased distress post feed

○Abd distension

○Diagnosis

RF- polyhydramnios- too much amniotic fluid.

If see coughing, cyanosis, choking

Might sneeze and fluid will come out nose

Cant pass NGT

Will do radiographic studies, or while pregnant,

Watch for resp ditress, maintain airway, keep NPO, resp support, remove secretions to prevent aspiration and pneumonia, keep uright for drainage

How to you tx Esophageal Atresia & TEF

Nursing Management

○Airway, NPO

○Prevent complications

○Suction

Medical Management

○Surgery in stages- might wait for espohagus to grow,

Emotional support and education

If have fistula most important thing to correct first, then wait to connect esophagus to rest of digestion system.

Surgery- monitor resp, pain

Gastric tubes placed, iv fluids, possibly abx, progress feeding if tolerate

What is a replogle tube

○Double lumen tube inserted into stomach via mouth or nose- conncected to suction on wall.

○One lumen for draining saliva

○Other lumen works as air vent

○Provides decompression

○Avoids secretion overflow into trachea

WHat is Hypertrophic Pyloric Stenosis

○Hypertrophy of pyloric muscle with obstruction of gastric outlet

Symptoms

○Projectile vomiting

○Visible peristalsis

○Olive-sized mass upper abdomen

○Diagnosis and Treatment  - US, upper GI, labs to check

Correct electrolute imabalances before surgery

Preop- keep NPO, NGT to decompress stomach, check ouput freq, fluids, prootote comfot, pacifiers, swadall

After sugery- start clear fluids then progress, pain s/s infect, when change diaper don’t push on incision and pull their legs up, slide diapers underneath,

Nursing Management

Msucle thickens and causes projective vomiting

Increase in 1^st born white babies or family hx. Detected 2-8 wks after birth

Wont have bild in it

Can throw up to 8ft.

Will be irratible, not grow, dehydrate, failure to thrive

Peristalsis- olive shaped mass.

What is a Diaphragmatic Hernia

○Abd contents - organs in stomach push on chest cavity. protrude into lung cavity through diaphragm. The diaphragm didnt form completely , Life threatnening

Symptomsxx x.

○Resp distress, sunken abd, bowel sounds in chest

○Barrel chest bc everything being pushed up, dyspnea, cyanosis

○Diagnosis- US prior to birth or x ray after

○Medical Management: Life Threatening- Airway, NG/OGT, IVF, surgery

○Nursing Management

Monitor, IVF, post-op care

NICU- resp support, itnutbate them, immed drop NGT to decompress stomach- will help reduce the pressure on their lungs. do not bag mask ventilate them- bc you will inflate instestines w air

Umbilical artery catheter for IV fluids

ECCMO- pumps and oxygen outside of body- allows lungs and heart to rest

Propolactic abx, surgery asap

Keep upright- put head higher so we can keep things down, watch resp complic, decrease stimuli

What is Omphalocele and Gastroschisis

○Protrusion of abdominal contents through abdomen

○Omphalocele- through umbilical cord (covered)- clear membrane covering it.

○Gastroschisis- no membrane covering organs

○Diagnosis- Associated w other defects, Can detect at US, can deliver vag or c sect

○Medical Management

Nursing Management

○Temperature

○Hydration

○Postop

At deliver- if organs outside body cover w sterile saline gauze, bowel bag bcs bowels radiate heat, surgery in stages- have to wait till hemodynamically stable

Good skin care

NGT for stomach decompression

NPO before sugery

Post op- concerned w circulation in lower extemetiies, return of bowel fx, fluid and electrolyte balance.

What is a silo

•Temporary housing unit

•Reduces contents slowly depending on type

•Helps reduce intestinal edema Helps recuded inflammation and slowly go in.

What is Intussusception

○Portion of intestine prolapses and telescopes into another- pushed

Symptoms

○Abd pain + vomiting

○Currant jelly stools

○Palpable sausage-shaped mass in RUQ or mid-upper

○Diagnosis and Treatment- US

○Nursing Management

○Fluids and electrolytes

Monitor, assess, meds

Blood flow obstructions, hemmorhage

More common boys 3 months to 6 years

Tx- ar barium air  enema and sometimes the pressure pushed bowel where its supposed to be and correct itself , if it doesn’t= surgery, are at risk for it occurring again. Borwn poop= resolved

WHat is Volvulus (Malrotation)

○Twisting of intestines and cut off blood flow and cause necrosis of bowels 

Symptoms

○Intermittent bilious vomiting

○Firm, distended abdomen

○Irritable, painful

○Bloody stools

○Diagnosis- upper GI w contrast

○Nursing management

Surgery, Keep npo, iv fluids, ngt stomach decompression, surgery

Check vs, return of bowel sounds after surgery, IV fluids, progress to regular diet

Sometimes need colon resection and ostomy.

What are Pediatric Ostomies

○Opening into small or large intestine that diverts fecal matter providing an outlet

Pediatric considerations

○Lifestyle

○Anxiety

○Electrolyte imbalance

○Nutritional deficiency

Pre and post-op care

Can happen during surgery and or electively

At risk for electrolyte emablances,

Skin integrity

School ages- deomstrate, show them

What are Gastric Buttons

○Indications

○Multiple types and sizes

○Balloon or no balloon

○G-J Button: Jejunal portion for feedings, bypasses stomach

○Assessment

○Teach routine care

Ballon w inflate. Flesh onstomach, can get feedings, med, fluid

WHat are the common Ingested Agents

○Corrosives (batteries, house cleaners, denture cleaner)

○Hydrocarbons (gasoline, lighter fluid, paint thinner)

○Acetaminophen

○Salicylate (aspirin)

○Iron (vitamin or mineral supplement)

○Plants

How do you assess posioning- emergency tx

1.Assess victim:

  Initiate CPR if needed (airway, breathing, circulation)

  Take VS, reevaluate routinely

  Treat associated complications

2.Terminate exposure:

  Empty mouth

  Flush eyes with NS or room temp tap water for 15-20 min

  Flush skin and wash with soap and water, remove contaminated clothes

3.Identify the poison:

  Ask questions, look for environmental clues

4.Prevent poison absorption:

  Place child side-lying, sitting, or kneeling position with head below chest to prevent aspiration

  Administer activated charcoal if ordered (usually 1g/kg unless amount of toxin is known), administer drug antidote, or perform gastric lavage

Don’t have to memorize

Adivse parent– need to call posion control and they will educate on next steps.

If don’t know what ingested- can go into hospital

How does lead posining affect symptoms

Don’t have to memorize. Absoprtion can effect systems. , toys, paint

Can cross blood brain barrier

If anemic can sbosrp lead faster

Draw blood an

What do you do for lead posioning

○Screening

○1-2 years old

○Low risk exceptions

Management

○Education

○Chelation therapy- pull lead out of body

○Prevention

Can give im injections- chelation. Remove lead from blood and organs. Side effects- hard on kidneys, make sure stay well hydrated.