Pediatrics Exam 3
Unit 6 Gastric
Chapter 10: Newborn pg. 363
Chapter 16: GI pg. 523-530, 538-545, 784
Elimination: Gastric
• General Information:
o Infants’ stomachs are smaller- empty in 2-3 hours (frequent feeding)
o Liver and pancreas do not mature until 6 m/o
o No solids until 4 m/o
o Pancreatic lipase: not secreted until 1 y/o (cow’s milk cannot be absorbed)
o Infant- double weight by 6 months, triple by 1 year
o When pooping- infant is straining (immature muscle coordination)
o Children with GI conditions are susceptible to physical growth and development complications
o Breastfed infants = watery stools
o Formula infants = soft and seedy
o Toddlers= decreased appetite. And reduced metabolic rate- food “jags.”
o Pre-schoolers- fluctuation of overeating or refusal to eat
o Do not force a child to eat foods they don’t like
o Least invasive technique for assessing the GI in a child
o Children =. Ticklish
• Dehydration
o Pathophysiology:
§ Occurs when the total output of fluid exceeds intake
o Clinical Manifestations:
§ Tachycardia, Hypotension, decreased tears, weight loss, thirst, irritability, sunken eyes, and fontanels
o Diagnosis:
§
o Medical Care:
§ Fluids
o Nursing Care:
§ Fluid maintenance requirements:
• Intake:
o 0-10 kg= 100mlx
o 11-20kg= 1000ml + 50x
o >20kg= 1500ml + 20x
• Output:
o Infants: 2-3ml/kg/hour
o Toddler/preschooler: 2mL/kg per hour
o School age: 1-2mL/kg per hour
o Adolescent: 0.5-1mL/kg per hour
§ Fluid replacement, electrolyte monitoring and replacement, safety considerations
• Electrolytes:
• Acute Diarrhea
o Etiology:
§ Diet or food allergies
§ Toxic substances
§ Infections
§ Medications
o Pathophysiology:
§ Increased frequency of bowel movements
§ Other s/s (vomiting, fever, pain)
o Diagnosis:
§ History
§ Physical Exam
• Abdomen
• Perineum
o Medical Care:
§ Metronidazole (Flagyl) if bacterial
, § Lactobacillus
o Nursing Care:
§ Prevention:
• Hand hygiene, food handling
§ Therapeutic Management:
• Monitor strict I+O’s
• IV and PO fluids
• Daily weights
• Monitor Electrolytes
o Electrolytes:
• Chronic Diarrhea
o Pathophysiology:
§ 3 or more stools passed per day for 14 days or longer
o Clinical Manifestations:
§ Abdominal distention
§ Hyperactive bowel sounds
§ Weight loss
§ Dehydration
§ Perineal irritation
§ Blood in stool
o Diagnosis:
§ Stool for C&S
§ Occult blood test
o Medical Care:
§
o Nursing Care:
§ Educate on prevention
§ Prevention:
• Hand hygiene, proper food handling, care of clothes/diapers, and limit exposure to others
§ Hydrate
§ Identify the underlying cause
§ Reduce fruit juices
§ Daily weights
§ Strict I+O’s
• Cleft Lip and Palate
o Etiology:
§ Risk factors: Males and Native Americans
o Pathophysiology:
§ Facial malformations that occur during embryonic development
§ Failure of the maxillary and premaxillary processes to come together
o Clinical Manifestations:
§ Unilaterally or bilaterally cleft lip
§ With or without hard/soft palate
§ The uvula can contain a cleft
o Diagnosis:
§ Examination of the mouth
o Medical Care:
§ Surgical repair of cleft lip and palate
• Multiple surgeries may be necessary
• Site care
• Elbow splints
• Pain control
o Nursing Care:
§ Maintain nutrition
• Breastfeeding concerns
• Use of a special nipple (Haberman feeder)
§ Promotion of bonding
§ Consults:
• Speech therapy, Dentistry, Audiology, Dietician
• Hirschsprung’s Disease
, o Pathophysiology:
§ Absence of ganglion cells in the colon
§ Mechanical obstruction from inadequate motility of the intestine
o Clinical Manifestations:
§ Failure to pass meconium
§ Failure to thrive
§ Poor feeding
§ Chronic constipation
§ Vomiting
§ Abdominal obstruction
§ Diarrhea
§ Ribbon-like stools in older children
o Complications:
§ Enterocolitis
• Explosive bowel movements
o Diagnosis:
§ Intestinal biopsy
§ Radiographic studies
§ Barium enema
o Medical Care:
§ NG tube
§ IV fluids and electrolytes
§ Pain medication
§ Surgery and Post op care
• Resection of affected bowel
• Risk for short bowel syndrome
o Nursing Care:
§ Colostomy care education
§ Referral to community resources
• Pyloric Stenosis
o Pathophysiology:
§ Constriction of the pyloric sphincter with obstruction of the gastric outlet
o Clinical Manifestations:
§ Projectile vomiting
§ Insatiable appetite
§ Weight loss
§ Dehydration
§ Olive-shaped mass
o Diagnosis:
§ Ultrasound
§ Palpate mass
§ Abdominal x-ray
§ Upper GI series
o Medical Care:
§ Surgery: Pyloromyotomy procedure
o Nursing Care:
§ Signs of dehydration
§ NPO prior to surgery
§ Monitor VS
§ Prevent post op infection
§ Feedings begin 6 hours after surgery
• Pyloric feeding protocol
• Vomiting may still occur immediately post op
• Intussusception
o Pathophysiology:
§ One portion of the bowels slides into the next, much like the pieces of a telescope, creating an obstruction
o Clinical Manifestations:
§ Acute abdominal pain
§ Pull legs toward abdomen
§ Pain is relieved once the abdomen relaxes
§ Vomiting
Unit 6 Gastric
Chapter 10: Newborn pg. 363
Chapter 16: GI pg. 523-530, 538-545, 784
Elimination: Gastric
• General Information:
o Infants’ stomachs are smaller- empty in 2-3 hours (frequent feeding)
o Liver and pancreas do not mature until 6 m/o
o No solids until 4 m/o
o Pancreatic lipase: not secreted until 1 y/o (cow’s milk cannot be absorbed)
o Infant- double weight by 6 months, triple by 1 year
o When pooping- infant is straining (immature muscle coordination)
o Children with GI conditions are susceptible to physical growth and development complications
o Breastfed infants = watery stools
o Formula infants = soft and seedy
o Toddlers= decreased appetite. And reduced metabolic rate- food “jags.”
o Pre-schoolers- fluctuation of overeating or refusal to eat
o Do not force a child to eat foods they don’t like
o Least invasive technique for assessing the GI in a child
o Children =. Ticklish
• Dehydration
o Pathophysiology:
§ Occurs when the total output of fluid exceeds intake
o Clinical Manifestations:
§ Tachycardia, Hypotension, decreased tears, weight loss, thirst, irritability, sunken eyes, and fontanels
o Diagnosis:
§
o Medical Care:
§ Fluids
o Nursing Care:
§ Fluid maintenance requirements:
• Intake:
o 0-10 kg= 100mlx
o 11-20kg= 1000ml + 50x
o >20kg= 1500ml + 20x
• Output:
o Infants: 2-3ml/kg/hour
o Toddler/preschooler: 2mL/kg per hour
o School age: 1-2mL/kg per hour
o Adolescent: 0.5-1mL/kg per hour
§ Fluid replacement, electrolyte monitoring and replacement, safety considerations
• Electrolytes:
• Acute Diarrhea
o Etiology:
§ Diet or food allergies
§ Toxic substances
§ Infections
§ Medications
o Pathophysiology:
§ Increased frequency of bowel movements
§ Other s/s (vomiting, fever, pain)
o Diagnosis:
§ History
§ Physical Exam
• Abdomen
• Perineum
o Medical Care:
§ Metronidazole (Flagyl) if bacterial
, § Lactobacillus
o Nursing Care:
§ Prevention:
• Hand hygiene, food handling
§ Therapeutic Management:
• Monitor strict I+O’s
• IV and PO fluids
• Daily weights
• Monitor Electrolytes
o Electrolytes:
• Chronic Diarrhea
o Pathophysiology:
§ 3 or more stools passed per day for 14 days or longer
o Clinical Manifestations:
§ Abdominal distention
§ Hyperactive bowel sounds
§ Weight loss
§ Dehydration
§ Perineal irritation
§ Blood in stool
o Diagnosis:
§ Stool for C&S
§ Occult blood test
o Medical Care:
§
o Nursing Care:
§ Educate on prevention
§ Prevention:
• Hand hygiene, proper food handling, care of clothes/diapers, and limit exposure to others
§ Hydrate
§ Identify the underlying cause
§ Reduce fruit juices
§ Daily weights
§ Strict I+O’s
• Cleft Lip and Palate
o Etiology:
§ Risk factors: Males and Native Americans
o Pathophysiology:
§ Facial malformations that occur during embryonic development
§ Failure of the maxillary and premaxillary processes to come together
o Clinical Manifestations:
§ Unilaterally or bilaterally cleft lip
§ With or without hard/soft palate
§ The uvula can contain a cleft
o Diagnosis:
§ Examination of the mouth
o Medical Care:
§ Surgical repair of cleft lip and palate
• Multiple surgeries may be necessary
• Site care
• Elbow splints
• Pain control
o Nursing Care:
§ Maintain nutrition
• Breastfeeding concerns
• Use of a special nipple (Haberman feeder)
§ Promotion of bonding
§ Consults:
• Speech therapy, Dentistry, Audiology, Dietician
• Hirschsprung’s Disease
, o Pathophysiology:
§ Absence of ganglion cells in the colon
§ Mechanical obstruction from inadequate motility of the intestine
o Clinical Manifestations:
§ Failure to pass meconium
§ Failure to thrive
§ Poor feeding
§ Chronic constipation
§ Vomiting
§ Abdominal obstruction
§ Diarrhea
§ Ribbon-like stools in older children
o Complications:
§ Enterocolitis
• Explosive bowel movements
o Diagnosis:
§ Intestinal biopsy
§ Radiographic studies
§ Barium enema
o Medical Care:
§ NG tube
§ IV fluids and electrolytes
§ Pain medication
§ Surgery and Post op care
• Resection of affected bowel
• Risk for short bowel syndrome
o Nursing Care:
§ Colostomy care education
§ Referral to community resources
• Pyloric Stenosis
o Pathophysiology:
§ Constriction of the pyloric sphincter with obstruction of the gastric outlet
o Clinical Manifestations:
§ Projectile vomiting
§ Insatiable appetite
§ Weight loss
§ Dehydration
§ Olive-shaped mass
o Diagnosis:
§ Ultrasound
§ Palpate mass
§ Abdominal x-ray
§ Upper GI series
o Medical Care:
§ Surgery: Pyloromyotomy procedure
o Nursing Care:
§ Signs of dehydration
§ NPO prior to surgery
§ Monitor VS
§ Prevent post op infection
§ Feedings begin 6 hours after surgery
• Pyloric feeding protocol
• Vomiting may still occur immediately post op
• Intussusception
o Pathophysiology:
§ One portion of the bowels slides into the next, much like the pieces of a telescope, creating an obstruction
o Clinical Manifestations:
§ Acute abdominal pain
§ Pull legs toward abdomen
§ Pain is relieved once the abdomen relaxes
§ Vomiting
