GI WORKSHEET (NUR 230/231/254)
Condition Presentation (notes) Interventions: Assess, Monitor, Medicate, Educate
DEHYDRATION Causes: vomiting, diarrhea, inadequate intake ORT 1st then IVF; Weights (indicator of improvement)
Tachycardia (1st), dry MM, sunken fontanel, irritable, Calculations: Maintenance fluids & urine output
Mild/Mod/Severe coolness/ mottling, ↓ LOC (Metabolic Acidosis) Meds: antiemetic (ondansetron)
DIARRHEA Causes: dietary intake; viral GE. Usually self-limiting BRAT controversial; avoid dairy/sugars; Antidiarrheals?
CONSTIPATION Straining, refusal to poop; Encopresis (holding) ↑fiber, fluids; toileting routine; ? stool softeners/laxatives
CLEFT LIP Visible defect (small notch, split) uni-/bilateral Special nipples, BR feeding; Speech therapy, orthodontics
CLEFT PALATE Parental fear & bonding issues Surgery: CL (2-3 mos) CP: (<12 mos); cosmetic surgery
Elbow restraints, protect suture line
ESOPHAGEAL ATRESIA EA: blind pouch / TEF: hole X-ray, broncho – Surgery (closure/separation, attachment)
TRACHEO-ESO FISTULA 3 Cs: Coughing, Choking, Cyanosis - STOP FEEDS IVF, Elevate HOB, gastrostomy for nutrition w/healing
PYLORIC STENOSIS Projectile vomiting, wgt loss, hunger, dehydration U/S = diagnosis; NPO, IVF, Surgery (pyloromyotomy)
FTT, Olive-shaped mass Diet: FLAP (small feedings to tolerance)
HIRSCHSPRUNGS NB: Meconium Ileus, Distension Dx: Barium enema (1st), rectal biopsy
Aganglionic megacolon Infant: FTT, vomiting; Explosive diarrhea = enterocolitis Surgery (pull-through); Ostomy, rectal dilatation
Child: Constipation, Ribbon-like stools Stem Cell (NEW)
INTUSSUSCEPTION Telescoping bowel, sudden intense pain (comes & goes), Xray, CT, U/S - Enemas (air, saline), surgery
bilious vomiting; Currant jelly stools
ANORECTAL Imperforate anus: infant – no BM; abd distension U/S, MRI, X-ray
MALFORMATIONS Fistula: Meconium mixed in urine Surgery – anoplasty, anal dilatation?
CELIAC DISEASE Intolerance of gluten in diet blood test (nutritional def), biopsy
Steatorrhea, gas/bloating, malnutrition, poor growth Diet: Avoid BROW (hidden sources). Rice/corn ok
GERD Peak: 4 mos Weight loss, FTT, crying/irritability Dx: UGI, gastric probe; Small freq meals; thicken formula;
upright w/feeds; H2 blocker (Ranitidine); Rare = surgery
INGESTIONS Ex: Caustics, Acetaminophen, Lead - PREVENTION Poison Ctrl Ctr guides care. Gastric lavage
(POISONINGS) Environmental exposure (history & screenings) Activated Charcoal, Mucomyst, Chelation
Care Considerations
History & Exam helps determine if GI/GU origin; Monitor stools, I&O, Nutritional status, F&E balance (K+ added to IVF)
Post surgery care/monitoring: PAIN assessment tools; dressing changes, drains, ostomy care
Dehydration Levels: % Body Weight Loss: 3-5% (mild); 6-9% (mod); >10% (severe)
Condition Presentation (notes) Interventions: Assess, Monitor, Medicate, Educate
DEHYDRATION Causes: vomiting, diarrhea, inadequate intake ORT 1st then IVF; Weights (indicator of improvement)
Tachycardia (1st), dry MM, sunken fontanel, irritable, Calculations: Maintenance fluids & urine output
Mild/Mod/Severe coolness/ mottling, ↓ LOC (Metabolic Acidosis) Meds: antiemetic (ondansetron)
DIARRHEA Causes: dietary intake; viral GE. Usually self-limiting BRAT controversial; avoid dairy/sugars; Antidiarrheals?
CONSTIPATION Straining, refusal to poop; Encopresis (holding) ↑fiber, fluids; toileting routine; ? stool softeners/laxatives
CLEFT LIP Visible defect (small notch, split) uni-/bilateral Special nipples, BR feeding; Speech therapy, orthodontics
CLEFT PALATE Parental fear & bonding issues Surgery: CL (2-3 mos) CP: (<12 mos); cosmetic surgery
Elbow restraints, protect suture line
ESOPHAGEAL ATRESIA EA: blind pouch / TEF: hole X-ray, broncho – Surgery (closure/separation, attachment)
TRACHEO-ESO FISTULA 3 Cs: Coughing, Choking, Cyanosis - STOP FEEDS IVF, Elevate HOB, gastrostomy for nutrition w/healing
PYLORIC STENOSIS Projectile vomiting, wgt loss, hunger, dehydration U/S = diagnosis; NPO, IVF, Surgery (pyloromyotomy)
FTT, Olive-shaped mass Diet: FLAP (small feedings to tolerance)
HIRSCHSPRUNGS NB: Meconium Ileus, Distension Dx: Barium enema (1st), rectal biopsy
Aganglionic megacolon Infant: FTT, vomiting; Explosive diarrhea = enterocolitis Surgery (pull-through); Ostomy, rectal dilatation
Child: Constipation, Ribbon-like stools Stem Cell (NEW)
INTUSSUSCEPTION Telescoping bowel, sudden intense pain (comes & goes), Xray, CT, U/S - Enemas (air, saline), surgery
bilious vomiting; Currant jelly stools
ANORECTAL Imperforate anus: infant – no BM; abd distension U/S, MRI, X-ray
MALFORMATIONS Fistula: Meconium mixed in urine Surgery – anoplasty, anal dilatation?
CELIAC DISEASE Intolerance of gluten in diet blood test (nutritional def), biopsy
Steatorrhea, gas/bloating, malnutrition, poor growth Diet: Avoid BROW (hidden sources). Rice/corn ok
GERD Peak: 4 mos Weight loss, FTT, crying/irritability Dx: UGI, gastric probe; Small freq meals; thicken formula;
upright w/feeds; H2 blocker (Ranitidine); Rare = surgery
INGESTIONS Ex: Caustics, Acetaminophen, Lead - PREVENTION Poison Ctrl Ctr guides care. Gastric lavage
(POISONINGS) Environmental exposure (history & screenings) Activated Charcoal, Mucomyst, Chelation
Care Considerations
History & Exam helps determine if GI/GU origin; Monitor stools, I&O, Nutritional status, F&E balance (K+ added to IVF)
Post surgery care/monitoring: PAIN assessment tools; dressing changes, drains, ostomy care
Dehydration Levels: % Body Weight Loss: 3-5% (mild); 6-9% (mod); >10% (severe)
