Exam 2: 60-75 multiple choice questions. Questions will primarily be application-type requiring
use of information in decision making, making nursing diagnosis or identifying problem, identifying
goals, choice of intervention and action, evaluation of intervention, establishing priority. Numbers
of questions for each topic are approximate. Material comes from the class discussion, PowerPoint
slides, and main topics in your readings and videos.
Gastrointestinal disorders (10-15 questions): assessment, treatment, medications, laboratory
findings, and nursing care
Diarrhea
→ Diarrhea is a symptom that results from disorders involving digestive, absorptive, and
secretory function
● Caused by abnormal intestinal water and electrolyte transport
● Can require hospitalization
● Can cause death in children
● Classified as acute or chronic
→ Pathogens causing diarrhea spread by the fecal oral route
● Contaminated food
● Contaminated water
● Person to person
→ Major risk factors
● Lack of clean water
● Crowding
● Poor hygiene
● Nutritional deficiencies
● Poor sanitation
→ Acute diarrhea
● Sudden increase in frequency and change in consistency of stools
● Leading cause of illness in < 5 years (less then)
● Often caused by infections agent in GI tract
● Usually self limiting (<14 days)
● Subsides without specific treatment unless dehydration occurs
● May be associated with an upper respiratory or urinary tract infections, antibiotic therapy,
or laxative use
, ● Acute infections diarrhea (infectious gastritis) caused by viral, bacterial and parasitic
pathogens
→ Clinical manifestations of acute diarrhea
● Diarrhea
● Nausea
● Vomiting
● Abdominal pain
● Weight loss
● Fever
● Electrolyte imbalance
● Dehydration
→ Management of acute diarrhea
● Assessment of fluid and electrolyte imbalance
● Rehydration
○ Oral rehydration therapy (ORT) with oral rehydration solutions (ORS)
● Replace ongoing stool losses 1:1 with ORS or 10mL/kg (infants) and 150-240 mL (older
child) is stool volume unknown
● Maintenance fluid therapy
● Probiotics
● Reintroduction to an adequate diet
→ Nursing care
● Monitor strict I & O
● Monitor stool frequency and consistency
● Specimen collection
● Education
○ Monitoring for signs of dehydration
○ Oral rehydration therapy and replacement of stool loses
○ Good hand hygiene
○ Appropriate sanitary practices, especially with diaper changing
○ Children who are infected or have diarrhea should not swim until free of infection
○ Discourage swimming in stagnant water (water that does not move or flow)
→ Chronic diarrhea
● An increase in stool frequency and increased water content lasting > 14 days
● Often caused by chronic conditions
, ○ Malabsorption syndromes
○ Inflammatory bowel disease (IBD)
○ Immunodeficiency
○ Food allergy
○ Lactose intolerance
○ Chronic nonspecific diarrhea
○ Inadequate treatment of acute diarrhea
→ Antibiotic associated diarrhea
● Antibiotics alter the normal intestinal flora, resulting in overgrowth of bacteria, especially
clostridium difficile
● Hospitalized children usually placed in isolation/contact precaution
● Treatment with antibiotics
○ Metrondiazole (flagyl)
○ Vancomycin
● Probiotics to restore normal bacterial
→ complications of diarrhea
● Dehydration
● Acidosis from acid base imbalance
● Shock
Vomiting
→ forceful ejection of gastric contents through the mouth
● Controlled by the CNS
● Often accompanied by nausea and retching
● Common in childhood
● Usually self limiting
● Categorized as
○ Nonbilious
○ Bilious (bright yellow to dark green in color)
→ Bilious vomiting
● Implies a disorder of motility or distal physical blockage
, → Nonbilious vomiting
● Caused by infectious inflammatory, metabolic, endocrinologic, neurologic, and
psychological causes
→ Managements
● Detection and treatment of cause and prevention of complications from fluid loss
→ Antiemetic drugs
● Ondasteron (zofran)
● Trimethobenzamide (Tigan)
→ Nursing care
● Monitoring vomiting behavior, associated symptoms, vomitus color
● Strict I & O
● Maintaining hydration
● Positioning to prevent aspiration
● Mouth care
● Education
○ Underlying disorder
○ Proper feeding methods
GER/GERD
→ GER
● Transfer of gastric contents into the esophagus
● Occurs throughout the day and most frequently after meals and at night
● Usually resolved by 1 year of age
● Gastroesophageal reflux disease (GERD) : Is the symptoms or tissue damage from GER
● Upper GI to rule out structural abnormalities
● Diagnosed using a 24 hour intraesophageal monitoring study or barium swallow test
● Treatment is dependent upon severity
→ Therapeutic management
● No treatment is needed for the child who is thriving and has no respiratory complications
● Avoidance of caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried food
● Weight if indicated
use of information in decision making, making nursing diagnosis or identifying problem, identifying
goals, choice of intervention and action, evaluation of intervention, establishing priority. Numbers
of questions for each topic are approximate. Material comes from the class discussion, PowerPoint
slides, and main topics in your readings and videos.
Gastrointestinal disorders (10-15 questions): assessment, treatment, medications, laboratory
findings, and nursing care
Diarrhea
→ Diarrhea is a symptom that results from disorders involving digestive, absorptive, and
secretory function
● Caused by abnormal intestinal water and electrolyte transport
● Can require hospitalization
● Can cause death in children
● Classified as acute or chronic
→ Pathogens causing diarrhea spread by the fecal oral route
● Contaminated food
● Contaminated water
● Person to person
→ Major risk factors
● Lack of clean water
● Crowding
● Poor hygiene
● Nutritional deficiencies
● Poor sanitation
→ Acute diarrhea
● Sudden increase in frequency and change in consistency of stools
● Leading cause of illness in < 5 years (less then)
● Often caused by infections agent in GI tract
● Usually self limiting (<14 days)
● Subsides without specific treatment unless dehydration occurs
● May be associated with an upper respiratory or urinary tract infections, antibiotic therapy,
or laxative use
, ● Acute infections diarrhea (infectious gastritis) caused by viral, bacterial and parasitic
pathogens
→ Clinical manifestations of acute diarrhea
● Diarrhea
● Nausea
● Vomiting
● Abdominal pain
● Weight loss
● Fever
● Electrolyte imbalance
● Dehydration
→ Management of acute diarrhea
● Assessment of fluid and electrolyte imbalance
● Rehydration
○ Oral rehydration therapy (ORT) with oral rehydration solutions (ORS)
● Replace ongoing stool losses 1:1 with ORS or 10mL/kg (infants) and 150-240 mL (older
child) is stool volume unknown
● Maintenance fluid therapy
● Probiotics
● Reintroduction to an adequate diet
→ Nursing care
● Monitor strict I & O
● Monitor stool frequency and consistency
● Specimen collection
● Education
○ Monitoring for signs of dehydration
○ Oral rehydration therapy and replacement of stool loses
○ Good hand hygiene
○ Appropriate sanitary practices, especially with diaper changing
○ Children who are infected or have diarrhea should not swim until free of infection
○ Discourage swimming in stagnant water (water that does not move or flow)
→ Chronic diarrhea
● An increase in stool frequency and increased water content lasting > 14 days
● Often caused by chronic conditions
, ○ Malabsorption syndromes
○ Inflammatory bowel disease (IBD)
○ Immunodeficiency
○ Food allergy
○ Lactose intolerance
○ Chronic nonspecific diarrhea
○ Inadequate treatment of acute diarrhea
→ Antibiotic associated diarrhea
● Antibiotics alter the normal intestinal flora, resulting in overgrowth of bacteria, especially
clostridium difficile
● Hospitalized children usually placed in isolation/contact precaution
● Treatment with antibiotics
○ Metrondiazole (flagyl)
○ Vancomycin
● Probiotics to restore normal bacterial
→ complications of diarrhea
● Dehydration
● Acidosis from acid base imbalance
● Shock
Vomiting
→ forceful ejection of gastric contents through the mouth
● Controlled by the CNS
● Often accompanied by nausea and retching
● Common in childhood
● Usually self limiting
● Categorized as
○ Nonbilious
○ Bilious (bright yellow to dark green in color)
→ Bilious vomiting
● Implies a disorder of motility or distal physical blockage
, → Nonbilious vomiting
● Caused by infectious inflammatory, metabolic, endocrinologic, neurologic, and
psychological causes
→ Managements
● Detection and treatment of cause and prevention of complications from fluid loss
→ Antiemetic drugs
● Ondasteron (zofran)
● Trimethobenzamide (Tigan)
→ Nursing care
● Monitoring vomiting behavior, associated symptoms, vomitus color
● Strict I & O
● Maintaining hydration
● Positioning to prevent aspiration
● Mouth care
● Education
○ Underlying disorder
○ Proper feeding methods
GER/GERD
→ GER
● Transfer of gastric contents into the esophagus
● Occurs throughout the day and most frequently after meals and at night
● Usually resolved by 1 year of age
● Gastroesophageal reflux disease (GERD) : Is the symptoms or tissue damage from GER
● Upper GI to rule out structural abnormalities
● Diagnosed using a 24 hour intraesophageal monitoring study or barium swallow test
● Treatment is dependent upon severity
→ Therapeutic management
● No treatment is needed for the child who is thriving and has no respiratory complications
● Avoidance of caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried food
● Weight if indicated
