Presentation on theme: "Gasrointestinal Disorders In Infants and Children"— Presentation transcript:
1 Gasrointestinal Disorders In Infants and Children Lori Fox, RN, MSN, APRN, BCReferences: Society of Pediatric Nursing : Pediatric Nursing ReviewSaunders Comprehensive Review for the NCLEX Exam 2002Dorlands's Illustrated Medical Dictonary Twenty Sixth Edition 1981
2 General Energy Requirements: Depend/Based on energy expenditures from: 1. Basal Metabolism2. Body Activity3. Growth4. Dynamic action of food5. Fecal lossRequirements are the minimum estimated values needed (e.g. calories, vitamins etc.)Dynamic action of food= increased heat production after ingestion of food
3 General Distribution of Calories: Important so foods chosen contain all essential elementsNormal Full -Term Infant:Protein: 6-8 %Fat: %Carbohydrate: approximately 50-60%
4 GeneralWater Requirements vary with energy produced or calories metabolized.Requirements affected by : fluid intake, protein and mineral content of diet, renal solute load, metabolic rate, respiratory rate and body temperature.
5 GeneralDeficiencies or excess amounts of any of these requirements can lead to skin issues, metabolic issues, renal issues etc.
6 General Assessment Assessment should include: Diet history Frequency AllergiesElimination patternsDiet history:Formula/Br milk: how much, how oftenTable foods: "typical meal" including snacksFood allergiesFrequency of bowel movements, how many wet diapers/day and issues with constipation/diarrhea/blood in stool etc.
7 Disorders in Newborns/Young Infants Imperforate Anus: "Incomplete development or absence of its normal position in the perineum"-Saunders, Third Edition-2002Assessment findings:Failure to pass meconium/stoolAbsence or stenosis of the anal rectal canalPresence of an anal membraneExternal fistula to the perineum or genitourinary systemUsually identified in NB nursery- exam is very important
8 Disorders in Newborns/Young Infants Necrotizing Enterocolitis: "NEC"Common in neonatal periodIncreased risk with preemiesCausative agent: conditions which cause vascular compromise to the intestineSx/Sx: lethargy, apnea, bradycardia, hypotension, temperature instabilitySepsis and asphyxia can cause thisSymptoms in NB very similar, to that of sepsis, so have to put as differential in your diagnosis.ABD X-ray to look for increased gas produced from bacterial growth which invade the necrotic tissue created by asphyxic event
9 Disorders in Newborns/Young Infants Pyloric Stenosis: A narrowing of the pyloric canal as it exits the stomachProjectile Vomiting=High index of suspicion. (hallmark)Olive sized bulge below the right costal margin (hallmark)Tx: pyloromyotomy=incision through muscle fibers of the pylorusSymptoms seen early 2 wks to 6months-not usually seen right away (until about 2 weeks or older) by it is an increasing hyperplasia and hypertrophy of the circular muscle at the pylorus Hypertrophy= increased thickening of a wall etc.More common in boysProjectile vomiting related to increased narrowing which leads to forceful vomitingEmesis does not contain bilePyloromyotomy can be done via laparoscopy
10 Disorders in Newborns/Young Infants Pyloric Stenosis PyloroplastyPyloroplasty- widen the narrowed/stenosed pylorus
11 Disorders in Newborns/Young Infants Biliary Atresia: "obliteration or absence of extrahepatic biliary structures"Cause: UnknownSx/Sx: Early jaundice; dark urine; pale stools (absence of bile); absorption issues→growth issuesDX: Liver biopsyAtresia = congenital absence or closure of a normal body orifice or tubular organFat soluable vitamins not well absorbed so need to replace these with water-miscible formsTemporary correction can be done by creating a substitute duct (Kasai procedure)Liver transplant if atresia is uncorrectable
12 Disorders in Newborns/Young Infants Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)Atresia=absence or closure of a orifice or tubular organFistula: "tube like connection between two structures" Designated by the organs or parts which with it communicates (e.g. rectovaginal)P. 190 in review book- great explanations (number 4 and 5).Associated with polyhydramnios- excess amniotic fluid as fetus cannot swallow itOften associated with other disorders- especially cardiac, limbs etc.
13 Disorders in Newborns/Young Infants Sx/Sx: Choking/Coughing during feeds can have intermittent cyanosisEA TEFStaged surgical repair (number 5 page 191 in review book) ligate=tie reanastomose= reconnect two formerly separate structures
14 Disorders in Newborns/Young Infants Cleft Lip and PalateCongenital Defect -soft tissue or bony structure fails to fuse during embryonic development.Can be unilateral or bilateralApparent at birthCauses: genetic; hereditary; environmentalClosure of lip defect occurs before palate-first few weeks of life with palate around mo.Palate is closed after lip to allow for normal growth of the palate and done before child can develop speech problems.
15 Disorders in Newborns/Young Infants Gastroesophageal Reflux (GER)Underdeveloped esophageal sphincterSome amount of GER is normal in newbornsOften causes apnea
16 Disorders in Newborns/Young Infants Hirschsprung's Disease (congenital aganglionosis megacolon):Absence of ganglion cells in the retum and colonMechanical obstruction from inadequate motilityDX: Rectal biopsySerious Complication: EnterocolitisTx: mild disease: relief of chronic constipationmost children require surgeryneonates often require temporary colostomy
17 Disorders in Young Infants Intussusception: Prolapsing of one portion of the intesine into the lumen of the immediately adjoining partOccurs at about 6 months of ageCauses: bowel lining abnormality; polyps; hyperactive peristalsis; unknownInflammation→ swelling →obstruction →necrosis from occlusion of bowel blood supplyCan be acute or chronic and can lead to peritonitis.Hallmark: RED Currant jelly like stool (red blood and mucous)TX: Barrium enema or water soluble contrast with air pressure to reduce invagination by hydrostatic pressureSurgery may include temporary colostomy
19 Disorders in Children Inflammatory Bowel Disease: 1. Crohn's disease=regional enteritis-asymmetrical and patchy lesions.Affects all layers of bowel wall; enlargedregional lymph nodes; occurs at any pointalong the GI tract.2. Ulcerative colitis=symmetrical andcontiguous GI ulcersAffects bowel mucosa; large intestine
20 Disorders in ChildrenCauses: unknown- exacerbated by emotional factorsCommon to occur in AdolescentsDX: made by barium enema; biopsy of GI mucosa; stool studies
21 Disorders in ChildrenAppendicitis: Inflammation and obstruction of blind sac at end of cecumResults in ischemia; gangrene; perforation and peritonitisCauses: include: infections, dietary intake, constipation and parasitesCommon in school age childrenPain that is diffuse- then localizes in right lower quadrantREBOUND tenderness in lower right quadrantGuarding; decreased bowel sounds, N/V Position in semi-fowlers on right sideIf ruptures often have sudden relief of pain followed by diffuse pain
22 Disorders in Newborns/Young Infants Celiac Disease: Absence of intestinal mucosal cell enzyme →villi of small intestine atrophy → decreases absorptionGluten intolerance-FATTY STOOLS (Steatorrhea) and chronic diarrheaIgA deficiency and early introduction of protein solids related.Occurs around 2-4 months after solid foods introducedGlutens- rye, oat, wheat and barleyGluten malabsorption leads to fatty stoolsGluten free diet: rice; corn, soy and potato flour; Probana formula and fresh fruit
23 Disorders in ChildrenParasitic Worms: Aquired through skin; ingestion of dirt or raw vegetables not well washedPinworms are the most commonLive in cecum and crawl to anus at night to lay eggsTape testAnal itching; abdominal distentionMedication used may discolor stool redTeach good handwashing technique and sanitary stool disposalWearing shoes in infested area
24 Disorders in Children Viral Hepatitis: 1. A: Fecal -oral route 2. B: Blood and body secretions3. C: predominantly parentally spreadSX/SX: anorexia; malaise, fatigues easily, fever; jaundice and dark urine; pale stoolsDX: antigenic markers and body immune responseHBIG for Hep B
25 Disorders in Children Acetaminophen Poisoning: Hepatotoxicity is concern plasma levels greater than 200 µm/ml.Monitor for liver damage hours after overdoseMucomyst is an antidote (acetylcysteine)
26 Disorders in Children Vomiting and Diarrhea: Issues= frequency, consistency; volume; support electrolytes and hydrationConstipation: Frequency, consistency of stools (variation from normal for that child- not necessarily no daily stool)P. 186 of review book- USE CAUTION with recommendation under #3 intervention to add corn syrup to or sugar to infant formula this can lead to botulism.
27 Endocrine Disorders in Children Inborn Errors of Metabolism:Tested for at birth after first 24 hours of feedings: Early diagnosis leads to better outcomePKU- defect in hydroxylation of phenylalanine to form tryosine →build up of phenylalanine → brain damage/mental retardation.Musty odor to urine
28 Endocrine Disorders in Children Inborn Errors of Metabolism Con't:Galactosemia: deficiency in galactose enzyme →liver failure; renal tubular problems and cataractsMaple Syrup Urine Disease (MUD):Deficiency of decarboxylase that degrades amino acids →altered tone; seizuresUrine has odor of maple syrup
29 Endocrine Disorders in Children Diabetes Type I and Type IIReview Endocrine section in review book-good overview.
30 Endocrine Disorders in Children Hypothyroid Disease:Thyroid regulates basal metabolic rateCX: decreased secretion froma. Thyroid gland development issuesb. Medications that suppress hormoneproductionc. Thyroid relies on early dietary iodineand tyrosine for normal function
31 Endocrine Disorders in Children Hypothyroid Disease Continued:SX/SX: Easy wt gainFatigue/tirednessDry, scaly skinSlow pulseCool body tempConstipation
32 Endocrine Disorders in Children Cushing Syndrome: HyperadrenocorticismHyper functioning of the adrenal gland. High levels cortisol → decreased ACTH secretionCause: Tumor in pituitary gland/prolonged or excessive use of corticosteroidsSx/Sx: MOON FACE; muscle weakness; easy bruising; facial hair growth (hirsutism= excessive hair growth); decreased linear growth; HTN; mood disorders; poor wound healingTX: Taper steroids if possible ; remove tumor- Takes weeks/months for hormones to clear body
33 Endocrine Disorders in Children Deficient Anterior Pituitary Hormone: Pituitary DwarfismResults in decreased growth hormoneCause: idiopathic; brain tumor; trauma; lesionsNormal body proportions, but short statureBone age studies reveal growth retardationTx: Administer growth hormoneEmotional Support
34 Endocrine Disorders in Children Hypersecretion of anterior pituitary hormone: Gigantism or acromegaly:Causes: hyperplasia of pituitary cells or pituitary tumorBone age studies are normal. Signs of gigantism occur if increased release of hormone happens before growth plates closeElongation and enlargement of long bones, facial bones and accompanying body tissueAcromegaly = enlargement of the extremities of the skeletonIdiopathic = self originated or unknown causeHyperplasia= Increase in the number of cells in normal arrangement in a tissue
35 Endocrine Disorders in Children Hypersecretion of anterior pituitary hormone: Gigantism or acromegaly Continued:Late closure of fontanelsAcromegaly if release of hormone occurs after growth plates close: enlarged hands; feet; nose; tongue; jawThickening of skin and facial featuresTX: Radiation may be used to retard growthEmotional supportAcromegaly
36 TEST QUESTIONS1. A 3 year old is hospitalized because of persistent vomiting. A nurse monitors the child closely for:a. Diarrheab. Metabolic Acidosisc. Metabolic Alkalosisd. Hyperactive bowel sounds
37 TEST QUESTIONS2. A nurse is monitoring for signs of dehydration in a 1 year old child who has been hospitalized for diarrhea. The nurse prepares to take the child's temperature and avoids which method of measurement?A. TympanicB. AxillaryC. RectalD. Electronic
38 TEST QUESTIONS3. A home care nurse provides instructions to the mother of an infant with cleft palate regarding feeding. Which statement if made by the mother indicates a need for further instructions?A. "I will use a nipple with a small hole to prevent choking"B. "I will stimulate sucking by rubbing the nipple on the lower lip"C. "I will allow the infant time to swallow"D. " I will allow the infant to rest frequently to provide time for swallowing what has been placed in the mouth"
39 TEST QUESTIONS4. An infant has just returned to the nursing unit following a surgical repair of a cleft lip located on the right side of the lip. The nurse places the infant in which most appropriate position?A. On the right sideB. On the left sideC. ProneD. Supine
40 TEST QUESTIONS5. A clinic nurse reviews the recoord of an infant seen in the clinic. The nurse notes that a diagnosis of esophageal atresia with trachesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?A. Severe projectile vomitingB. Coughing at nightimeC. Choking with feedingsD. Incessant crying
41 TEST QUESTIONS6. A nurse prepares a teaching plan for the parents of an infant with gastroesophageal reflux regarding proper positioning to manage reflux. The nurse documents that the infant should be maintained in which position following feedings and at night?A. 30-degree angle when supineB. 60-degree angle when supineC. Head-Elevated prone positionD. 20-degree angle when supine
42 TEST QUESTIONS7. A nurse provides feeding instructions to a mother of an infant diagnosed with gastroesophageal reflux.To assist in reducing the episodes of emesis, the nurse tells the mother to :A. Thin the feedings by adding water to the formulaB. Thicken the feedings by adding rice cereal to the formulaC. Provide less frequent, larger feedingsD. Burp the infant less frequently during feedings
43 TEST QUESTIONS8. A nurse admits a child to the hospital with a diagnosis of pyloric stenosis. ON admission assessment, which data would the nurse expect to obtain when asking the mother about the child's symptoms?A. Vomiting large amounts of bileB. Watery DiarrheaC. Increased urine outputD. Projectile vomiting
44 TEST QUESTIONS9. A nurse provides home care instructions to the parents of a child with celiac disease. The nurse teaches the parents to include which of the following food items in the child's diet?A. RiceB. Rye toastC. OatmealD. Wheat Bread
45 TEST QUESTIONS10. A clinic nurse reviews the record of a 3 week old infant and notes that the physician has documented a diagnosis of suspected Hirshsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant?A. DiarrheaB. Projectile vomitingC. Regurgitation of feedingsD. Foul-smelling ribbon like stools
46 TEST QUESTIONS11. A nurse is caring for a newborn infant with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which of the following is a clinical manifestation associated with this disorder?A. Sausage-shaped mass palpated in the upper right abdominal quadrantB. Bile stained fecal emesisC. Failure to pass meconium stool in the first 24 hours after birthD. The passage of currant jelly -like stools
47 TEST QUESTIONS12. The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which symptom of this disorder documented?A. Bright red blood and mucus in the stoolsB. Profuse projectile vomitingC. Watery DiarrheaD. Ribbon like stools
48 TEST QUESTIONS13. A pediatric nurse educator provides a teaching session to the nursing staff regarding phenylketonuria. The nurse educator tells the nursing staff that:A. Phenylketonuria is an autosomal dominant disorderB. Treatment includes dietary restriction of tyramine.C. All 50 states require routine screening of all newborn infants for phenylketonuria.D. Phenylketonuria primarily affects the gastrointestinal system.
49 TEST QUESTIONS14. A school-aged child with type 1 diabetes mellitus has soccer practice three afternoons a week. The school nurse provides instructions regarding how to prevent hypoglycemia during practice. The school nurse tells the child to:A. Take one half of the amount of prescribed insulin on practice daysB. Eat twice the amount normally eaten at lunchtime.C. Take the prescribed insulin at noontime rather than in the morning.D. Eat 6 graham crackers or drink a cup of orange juice before soccer practice.
50 TEST QUESTIONS15. A home care nurse is teaching an adolescent with type 1 diabetes mellitus about insulin administration and rotation sites. Which statement if made by the adolescent, would indicate effective teaching?A. "I need to use a location in one major site for the morning injection and another location for the same major site for the evening injection for 2 to 3 weeks before changing major sites"B. "I need to use a different site for each insulin injection"C. " I need to use the same site for 1 month before rotating to another site"D. " I should use only my stomach and my thighs for injections"
51 TEST QUESTIONS16. The mother of a 6-year old who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse instructs the mother toA. Come to the clinic immediatelyB. Hold the next dose of insulinC. Administer an additional dose of regular insulinD. Encourage the child to drink calorie-free liquids.
52 TEST QUESTIONS17. A child with type 1 diabetes mellitus is brought to an emergency room by the mother, who states that the child has been complaining of abdominal pain and has a fruity odor of the breath. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer:A. 5% dextrose IV infusionB. Normal Saline IV infusionC. NPH insulin IV infusionD. Potassium IV infusion
53 TEST QUESTIONS18. A two month old infant arrives at the pediatric clinic. Upon assessment, the baby exhibits the following characteristics. Which characteristic does the nurse relate to a diagnosis of congenital hypothyroidism? Select all that applyA. Open fontanelsB. Protruding tongueC. TachycardiaD. HypertoniaE. HypotoniaSource: Child Health Nursing Second Edition: Reviews and Rationales 2007Answer is : B and E (often accompanied by bradycardia). Open fontanels are normal for 2 month old
54 TEST QUESTIONS19. An infant with congenital hypothyroidism shows which sing or symptom?A. Shrill CryB. DiaphoresisC. HypothermiaD. DiarrheaReference questions 19-: Straight A's In Pediatric Nursing-A review series Lippincott Williams and Wilkins, 2004
55 TEST QUESTIONS20. The nurse administers oral thyroid hormone to an infant with hypothyroidism. The nurse should observe the infant for which signs of overdose?A. Tachycardia, fever, irritability, and sweatingB. Bradycardia, cool skin temperature and dry scaly skinC. Bradycardia, fever, hypotension, and irritabilityD. Tachycardia, cool skin temperature and irritability
56 TEST QUESTIONS21. The nurse draws blood from the heel of an infant for a Guthrie screening test. The Guthrie screening test is used to diagnose which inborn error of metabolism?A. Gludcose-6-phosphate dehydrogenase deficiencyB. PhenylketonuriaC. GalactosemiaD. Hypothyroidism
57 TEST QUESTIONS22. The nurse is teaching the mother of a child with diabetes how to recognize the sings an symptoms of hypoglycemia. Which signs and symptoms should the nurse discuss?A. Behavioral changes, increased heart rate, sweating and tremorsB. Nausea, fruity breath odor, headache and fatigueC. Polydipsia, polyuria, polyphagia, and weight lossD. Enlarged tongue, hypotonia, easy weight gain and cool skin temperature.
58 TEST QUESTIONS23. The nurse is assessing a child who might have diabetes. Which laboratory values help confirm a diagnosis of diabetes?A. A fasting plasma glucose level of 110mg/dlB. A fasting plasma glucose level of 126 mg/dlC. A random plasma glucose level of 180mg/dlA 2-hour glucose tolerance test of 140 mg/dl
59 TEST QUESTIONS24. the nurse is teaching the parents of child with diabetes. Which agent should the nurse teach the parents to administer if their child suffers a severe hypoglycemic reaction?A. IV DextroseB. Subcutaneous insulinC. Subcutaneous glucagonD. Oral fast-acting carbohydrate
60 TEST QUESTIONS25. Which foods may be eaten by a child with galactosemia? Select all that apply.A. Instant PotatoesB. ChickenC. Lima BeansD. Whole Wheat BreadE. ApplesF. 2% Cow's milk