GI

what is celiacs disease

what is celiacs disease

gluten sensitivity causing inflammation in the small intestines

what are the s/s of celiac disease

N/V/D, malabsorption, weight loss

what foods should a person with celiac disease avoid

wheat, barely, rye, some oats

what are the s/s of gastroenteritis

acute onset of diarrhea (3 or more watery stools in 24 hours) with or without abdominal pain, fever, N/V

what is the treatment for viral gastroenteritis

monitor weight, fluids

what is the treatment for bacterial gastroenteritis

antibiotics if the child is <3 months, immunocompromised, or has severe disease

what is the treatment for parasitic gastroenteritis

metronidazole

what should the diet of a patient with gastroenteritis be

increase carbs, protein, and fluids (avoid juice and carbonation), BRAT diet not recommended

what medications should not be given to children with gastroenteritis

Imodium or pepto

what is the transmission route for rotavirus

fecal-oral

what are the s/s of rotavirus

fever, N/V/D, risk for dehydration and electrolyte imbalance

what is the prevention of rotavirus

vaccine

what is intussusception

part of the small intestines folds over on itself causing an intestinal obstruction

what are the s/s of intussusception

knees to chest position, colic, vomiting, bloody diarrhea with mucous (currant, jelly-like), sausage shaped mass in RLQ

what is the tx for intussusception

hydrostatic barium or air enema to correct the fold

what is the nursing care for a pt who is awaiting correction of intussusception

keep NPO to avoid further obstruction

what are the complications of correction for intussusception

risk for perforation

what is pyloric stenosis

narrow opening of the gastric outlet preventing contents from draining into the duodenum

what are the s/s of pyloric stenosis

forceful, projectile, non0bilious vomiting, persistent hunger and dehydration, olive sized mass in RUQ, weight loss, irritable

what are complications of pyloric stenosis

dehydration, metabolic alkalosis, FTT

what is the treatment for pyloric stenosis

fluid and electrolytes, pylorotomy (opens stenosed area by splitting muscle)

pt education for post-op pylorotomy

only water/electrolytes (pedialyte or breastmilk) for the first 4-6 hours then advance as tolerated, vomiting is common for 24-48 hours

what are the s/s of meckels diverticulum

abdominal pain, bloody stool (dark red), anemia

what is the tc for meckels diverticulum

surgical removal of pouch

what is chrons disease

inflammatory bowel disease causing chronic inflammation of the GI tract

what is hirschsprungs disease

absence of ganglion nerve cells in the colon so there is no peristalsis, normal portion of bowel becomes hypertrophied and dilated

what are s/s of hirschprungs disease in a newborn

failure to pass meconium, abdominal distention, bile stained vomitus, refusal to feed

what are the s/s of hirchsprungs disease in older children

chronic constipation with episodes of explosive stool passage, abdominal distention, poor weight gain, ribbon like stool, foul smelling stool

what is the treatment for hirschsprungs disease

surgical removal of the portion of the colon affected and placement of an ostomy while the colon heals, once heal anastomose (reattach) the colon, pain meds, fluid/nutrition

what is a cleft palate

v or u shaped, effecting either the soft or hard palate or both

what are the s/s of cleft lip and palate

feeding difficulty, milk coming from the nose, FTT, airway obstruction, recurrent otitis media

what is the tx of cleft lip and palate while awaiting surgical correction

special enlarged nipples, small frequent feedings, keep upright during feeding, burp often

what is the ESSR method for feeding a baby with a cleft lip or palate

enlarge nipple, stimulate sucking reflex, swallow (insert bottle inverted with milk already in nipple), rest (limit feeding to 20-30 min)

when can cleft lips be surgically repaired

3-6 months

when can cleft palates be surgically repaired

9-12 months

what is the pre-op nursing care for a patient with cleft lip/palate

use a large syringe or elongated nipple (lambs nipple) for feedings

what are the post-op nursing interventions for a patient with a repaired cleft lip or palate

encourage fluids, logan bar in place to protect suture, no straws or pacifier, mittens on baby to prevent grabbing at suture

what is an esophageal atresia

esophagus ends in a blind pouch

what is a tracheoesophageal fistula

connection between the esophagus and trachea

what are the s/s of esophageal atresias and tracheoesophageal fistulas

excessive oral secretions, coughing, choking, and cyanosis during feedings, abdominal distention

what is the nursing management for a patient with a suspected esophageal atresia or tracheoesophageal fistula

do not feed, NPO

what is the treatment for and esophageal atresia or tracheoesophageal fistula

surgical repair

what is an oamphalocele

intestines are outside of the body in a sac

what is gastrochisis

intestines are outside of the body and not in a sac

what is the treatment for an omphalocele and gastrochisis

prevent hypothermia, maintain sterility (sterile bowel bag with saline), surgical repair

what is an umbilical hernia

weak umbilical ring causing intestine to protrude through the weak muscle wall

pt education for an umbilical hernia

binders are not effective in correcting a hernia

what are the s/s of appendicitis

abdominal pain starting at periumbilical area and then at RLQ “mcburneys point” (earliest sign), N/V/D/C, anorexia, fever

what would you expect during to see in the assessment of a child with appendicitis

guarding, rebound tenderness, decreased bowel sounds

what is the cause of appendicitis

fecalith (fecal stone)

what is the nursing management of appendicits prior to surgical repair

avoid laxatives and enemas

what is the treatment for pre-op appendectomy

NPO, fluids, pain meds

what is the nursing care post-op appendectomy

NPO until bowel sounds return, progress from clear liquids to full diet, pain meds

what is the treatment fir a ruptured appendix with an abcess

drain placed, antibiotics, surgery at a later date

how to calculate % dehydration

(pre-illness weight - illness weight/pre-illness weight) x100

s/s of mild dehydration

<5% weight loss, alert, slightly increase HR and RR

what are the s/s of moderate dehydration

7-9% weight loss, restless, thirsty, high HR (weak pulse), low BP, high RR, decreased UO, sunken fontanel in infants

what are the s/s of severe dehydration

10% weight loss, lethargic, cold extremities, high HR (some non-palpable pulses), low BP, deep and rapid RR, severely decreased UO

what do you use for fluid rescue

breast milk or pedialyte

how to use fluid rescue calculation

give 5-10 ml every 5-10 min, gradually increase as tolerated, 500-100ml/kg every 4 hours, if they vomit wait one hour then restart