alterations in GI functions

Question 1

how is the anatomy and physiology of children’s GI tract different than adults?

Answer 1

• immature until about 2 years of age
• deficient in amylase, lipase, and trypsin until 4-6 months of age
• smaller stomach capacity and greater intestinal motility
• liver function is immature

Question 2

what are possible causes of GI disorders?

Answer 2

• a congenital defect
• acquired disease
• infection
• injury
• structural problems (usually occur in 1st trimester when GI is developing)
• inflammatory disorder

Question 3

what is necrotizing enterocolitis?

Answer 3

• an inflammatory disorder
• death of tissue in the small or large intestine because of inflammation
• may be caused by intestinal ischemia, bacterial or viral infection, immaturity of GI mucosa

Question 4

why does necrotizing enterocolitis occur more commonly in premature infants?

Answer 4

• weaker immune systems

- less time to develop

Question 5

what are the symptoms of necrotizing enterocolitis

Answer 5

• manifests between 3-14 days of life up to 3 months old most commonly
• general signs of being sick
• vomiting and increased gastric residual
• irritability and lethargy
• abdominal distention
• bloody stools
• temperature instability
• rapid progression of shock

Question 6

what is an ileostomy?

Answer 6

• a surgically-created opening in the abdomen through which the end of the ileum is brought up to the surface of the skin to provide an outlet for feces when a bowel obstruction or non-functioning structure prevents normal elimination
• may also be done to “rest” an area lower down after surgery
• can be temporary or permanent
• when temporary, there are often two holes

Question 7

what are indications that may result in an ileostomy?

Answer 7

• bowel infections
• bowel injuries
• bowel obstruction
• cancer
• conditions that cause severe bowel inflammation

Question 8

Central venous catheters are often used for TPN with pediatric patients, what are the 5 types of CVLs?

Answer 8

• short term, percutaneous
• tunneled
• PICC (peripherally inserted central catheters)
• implanted
• hemodialysis

Question 9

what are complications that may occur with central venous lines?

Answer 9

• infection
• bleeding
• can be pulled out
• can become occluded
• can get an air emboli
• can be damaged

Question 10

why are CVLs used for TPN on pediatric patients?

Answer 10

• children are often hard to poke
• TPN is hard on veins and easily lost
• TPN requires daily blood work, another reason to have a CVL!

Question 11

why is total parenteral nutrition used?

Answer 11

• to provide intravenous nutritional support
• fluids usually contain glucose, amino acids, electrolytes, vitamins, proteins, and lipids
• tailored to meet needs of pediatric patient
• can be used as primary therapy, adjunctive or sole source

Question 12

what is the normal range for WBCs?

Answer 12

4.0-11.0

Question 13

what is the normal range for Hgb

Answer 13

135-175

Question 14

what is the normal range for platelets?

Answer 14

100-400

Question 15

what is the normal range for MCV?

Answer 15

0.40-0.54

Question 16

what is the normal range for sodium?

Answer 16

135-145

Question 17

what is the normal range for potassium

Answer 17

3.5-5.1

Question 18

what are complications associated with a cleft lip and/or palate?

Answer 18

• susceptibility to colds
• hearing loss
• speech defects (this can be helped by early surgery)
• larger than average number of dental cavities, missing/extra/malformed or displaced teeth
• otitis media because eustachian tubes don’t drain fluid properly from middle ear into throat
• feeding dificulties

Question 19

what is hirschprung?

Answer 19

a congenital aganglionic megacolon

• the absence of autonomic parasympathetic ganglion cells of the colon that prevents peristalsis at that portion of the intestine
• can lead to obstruction

Question 20

what is a tracheosophageal fistula

Answer 20

an abnormal opening between the trachea and esophagus

Question 21

what are some complications that can occur in premature infants?

Answer 21

• apnea
• patent ductus arteriosus
• intraventricular hemorrhage
• retinopathy of prematurity
• anemia because RBC life is shorter in infants than other children
• respiratory distress syndrome

Question 22

how is liver damage detected?

Answer 22

it can be detected by simple blood work that looks for presence of certain liver enzymes in the blood
-under normal circumstances they reside in the cells of the liver, but when liver is injured, they enter the blood

Question 23

what are the normal ranges for liver enzymes?

Answer 23

AST 5-40 units per litre of serum
ALT 150-500 units per litre of serum
Bilirubin 3-22 units per litre of serum

Question 24

how is necrotizing enterocolitis diagnosed and treated?

Answer 24

• septic workup
• radiographs
• NPO
• NG for drainage
• maintain fluid balance
• TPN (done if fluid balance can’t be maintained or treatment takes long)
• antibiotics if septic
• possible bowel resection
• ileostomy or colostomy
• isolations

Question 25

what are some nursing interventions for a bowel obstruction?

Answer 25

- IV maintenance - NG tube insertion - monitor abdominal girth - abdominal x-ray - antibiotics - monitor blood tests - monitor stool

Question 26

what is involved in medical treatment for a bowel obstruction?

Answer 26

- surgery - temporary or permanent ostomy - feeding gradually to prevent refeeding problems - management of infections and hydration

Question 27

what is refeeding syndrome?

Answer 27

- metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, malnourished, or metabolically stressed - potentially fatal shifts in fluids and electrolytes - hypophosphatemia - abnormal sodium and fluid balance - changes in metabolism of fat, protein, and glucose - thiamine deficiency - hypokalemia - hypomagnesaemia

Question 28

what are some long-term complications of NEC?

Answer 28

- malabsorption - short bowel syndrome - scarring and narrowing of bowel causing obstruction - scaring within the abdomen causing later pain and possible female infertility - problems relating to long-term use of TPN including cholestasis

Question 29

what is cholestasis?

Answer 29

- a reduction or stoppage in bile flow - bile flow is a digestive fluid and without it bilirubin escapes into bloodstream and accumulates - common symptom is jaundice, dark urine, light-colored stools, itchiness - calcium and vitamin d are poorly absorbed because of lack of bile in intestine - vitamin K is also then poorly absorbed from intestine and can lead to clotting problems and bleeding

Question 30

what is short bowel syndrome?

Answer 30

-too little bowel present to absorb all the nutrients needed by the body

Question 31

what is a cleft palate?

Answer 31

-where the maxillary processes fail to fuse

Question 32

how is a cleft lip and palate diagnosed?

Answer 32

- cleft lip is apparent at birth and often easy to diagnose - cleft palate defects can be less obvious, especially when they do not present with a cleft lip - palate should be palpated to look for defects, however signs may be feeding issues or recurrent infections r/t food entering where it shouldn't be

Question 33

how is a cleft lip treated?

Answer 33

surgery, usually done within 2-10 weeks of birth

Question 34

how is a cleft palate treated?

Answer 34

surgery, usually between 6-18 months of age

Question 35

what are some potential nursing diagnoses related to cleft lip and/or cleft palate?

Answer 35

- potential for inadequate nutrition - potential for infection - potential for inadequate fluid intake - potential for bleeding or pain post-op

Question 36

what are some post-operative nursing interventions for nurses for a patient with a cleft palate repair?

Answer 36

- airway management due to post-op edema - arm restraints to protect incision - wound management - cleaning site with sterile water after each feed - crusting can increase scarring, want to keep incision looking as good as possible - keep feeds under 60 minutes

Question 37

what medications may be used post-operatively for cleft lip/palate repairs?

Answer 37

- morphine - tylenol - gravol

Question 38

what is a tracheoesophageal fistula?

Answer 38

an abnormal opening between the trachea and esophagus

Question 39

what is esophageal atresia?

Answer 39

a congenital defect where upper esophagus fails to connect to lower esophagus and stomach before birth -can simply dead end, but more commonly coexists with tracheoesophageal fistula

Question 40

how is a tracheoesophageal fistula and or esophageal atresia diagnosed?

Answer 40

- may include maternal history of hydramnios - pt history of vomiting - may be unable to pass an NG tube which is how it is noticed - barium swallow test is used for official diagnosis of what is going on

Question 41

how is a tracheoesophageal fistula and/or esophageal atresia treated?

Answer 41

- surgery to close fistula and/or connect esophagus | - oral feeds stopped and intravenous fluids started or TPN depending how long diagnosis and treatment takes

Question 42

what is an imperforated anus?

Answer 42

an obstruction of the passage of fecal matter by a structural anomaly of the anus and rectum -may occur with or without a fistula

Question 43

how does rectal atresia present clinically?

Answer 43

-failure to pass meconium and abdominal distention

Question 44

how is an imperforate anus diagnosed?

Answer 44

- visual inspection of perineum - xray - retrograde urethrocystogram used to diagnose or rule out rectourethral fistual

Question 45

what is intussusception?

Answer 45

when one portion of bowel slides into the next, can lead to decreased blood flow and necrotic tissue

Question 46

how is an intussusception treated?

Answer 46

- may try a barium enema to expand area using fluid | - may require surgery