Peds GI Disorders PDF

​ Dehydration: body fluid disturbance when the output exceeds intake and results from causes such as fluid loss through the skin, respiratory, urinary, or GI tract ○​ Mild: 3-5% infants and 3-4% in children ○​ Moderate: 6-9% infants and 6-8% in children ○​ Severe: greater tha...

​ Dehydration: body fluid disturbance when the output exceeds intake and results from causes such as fluid loss through the skin, respiratory, urinary, or GI tract ○​ Mild: 3-5% infants and 3-4% in children ○​ Moderate: 6-9% infants and 6-8% in children ○​ Severe: greater than 10% in infants and children ○​ Oral hydration ○​ 20 ml/kg IV bolus, maintenance IV fluids, push/pull method ​ Diarrhea and dehydration ​ Appendicitis: inflammation of the vermiform appendix caused from an obstruction of the lumen of the appendix ○​ Average client is 10 years ○​ Expected findings: ​ Abdominal pain in RLQ and relief from pain is an indicator of burst appendix ​ Rigid abdomen and rebound tenderness ​ Decreased or absent bowel sounds ​ Fever and lethargy ​ Diarrhea or constipation ​ Tachycardia ​ Rapid shallow breathing ​ Anorexia ​ Possible vomiting ○​ Prepare child and family for surgery, avoid enemas or laxatives, avoid applying heat to the abdomen ○​ Ruptured therapeutic procedures ​ Preoperative for ruptured ​ Electrolyte and fluid replacement ​ IV antibiotics ​ NG tube for decompression ​ Postoperative for ruptured ​ Obtain vitals, pain meds, assess bowel sounds, assess for peritonitis ​ NPO and NG tube ​ Intussusception: proximal segment of the bowel telescopes into a more distal segment, resulting in lymphatic and venous obstruction causing edema in the area ○​ With progression, ischemia and increased mucus in intestines will occur ○​ Common between the ages of 3 months to 6 years ○​ Expected findings ​ Sudden abdominal pain ​ Screaming with knees to chest  ​ Abdominal sausage shaped mass ​ Stool mixed with blood and mucus that resemble jelly ​ Vomiting & fever ​ Distended abdomen ○​ Air enema or Surgical intervention ​ Pyloric stenosis: thickening of pyloric sphincter, creates an obstruction, occurs in 1st few weeks ○​ Vomiting following feeding ○​ Non-bilious emesis can be blood tinged ○​ Constant hunger ○​ Olive shaped mass in upper right quadrant ○​ Possible peristaltic wave that moves left to right when lying supine ○​ Failure to gain weight ○​ Manifestations of dehydration: pallor, cool lips, dry skin and mucous membranes, decreased skin turgor, decreased urine output, concentrated urine, thirst, rapid pulse, sunken eyes ○​ Treatment: surgery, NPO, monitor I&O ​ Hirschsprung’s disease ○​ Structural anomaly in GI tract caused by lack of ganglionic cells in segments of the colon resulting in decreased motility and mechanical obstruction ○​ Expected findings in newborn/infant ​ Failure to pass meconium in 24-48 hrs after birth ​ Vomiting bile ​ Refusal to eat ​ abdominal distention ​ Failure to thrive ​ Constipation ​ Episodes of diarrhea and vomiting ○​ Expected findings in child ​ Undernourished and anemic experience ​ Abdominal distention ​ Visible peristalsis ​ Palpable fecal mass ​ Constipation ​ Foul-smelling and ribbonlike stool ○​ Therapeutic procedures ​ Surgical removal of aganglionic section of the bowel ​ Temporary ostomy can be required ​ GERD: gastric contents back up into the esophagus and cause tissue damage  ○​ 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, non cardiac chest pain ○​ Nursing care and education ​ Offer small frequent meals ​ Position child with head elevated after meals ​ Thicken infants formula with rice cereal ​ Give proton pump inhibitors and H2 receptor antagonists ​ Meckel’s Diverticulum ○​ Complication resulting from failure of the omphalomesenteric duct to fuse during embryonic development ○​ Expected findings ​ Painless rectal bleeding ​ Abdominal pain ​ Bloody stool with mucus ○​ Surgical removal of diverticulum