occurs whenever the total output of fluid exceeds the total intake, regardless of cause
what are some problems with fluid loss specific to peds?
body surface area (infants have greater BSA allowing larger quantities of fluid to be lost in insensible perspiration)
proportionally longer GI tract in infants
Basal metabolic rate is higher
kidney function is immature
What is the minimum urine output in kids and infants
infants = 2 mL/kg/hr
kids = 1 mL/kg/hr
What might you see with dehydration?
change in urine output
skin color changes
issues with capillary refill (slow)
mucous membrane changes
fontanels in infants (depressed)
behavioral changes (confused, lethargic)
vital sign changes (increased HR, decreased BP)
How do you treat dehydration?
Encourage fluid intake
daily weights (particularly infants)
IV fluids and boluses
Monitor VS, LOC, and general patient status
What is a food allergy or hypersensitivity
consists of an immunologic mechanism
immunoglobulin E (IgE)
immediate or delayed reaction
mild or severe reaction
(ex of reactions = hives, itching, N/V, anaphylaxis, histamine reaction)
what is a food intolerance
not related to immune system response
more related to deficiency of enzymes
(ex = lactose intolerance, not allergic to milk body just can't digest milk proteins or milk enzymes)
What is pyloric stenosis
Narrowing and dysfunction of the pyloric sphincter
Won't allow stomach contents to empty
Nothing to intestines so nutrients aren't getting absorbed
What are the is the main manifestation of pyloric stenosis
Projectile vomiting - may travel 3-4 feet in side lying position 1 ft in back lying position, occurs after a feeding (about 30-60 min after), may not occur for several hours, non-bilious (no bile so just formula coming back up), pt is hungry since they can't keep food down
What are other manifestations of pyloric stenosis
no evidence of pain/discomfort
s/s of dehydration
abdominal distention and visible peristaltic waves
palpable olive-shaped "lump"
When palpating the abdomen of an infant with pyloric stenosis what is felt?
An olive shaped mass in the right upper quadrant.
What is the treatment of choice for pyloric stenosis?
When can feedings begin post op in an infant treated for pyloric stenosis and how?
4-6hrs post op and with small, frequent feedings of clear liquids. If tolerated, advance the infant to formula or breast milk feedings.
What are we going to do for the infant with pyloric stenosis
May have NG tube placement
post-op management (slowly progress diet)
What are we going to teach the parents regarding pyloric stenosis
will vomiting occur again (possible for a few days but not projectile vomiting)
surgical incision/dressing care (usually done laprascopic)
What is a frequent cause of intestinal obstruction in kids from 3 months to 3 yrs old?
Is intussusception more common in males or females?
What is the common cause of intussusception?
about 90% are idiopathic
majority related to viral infection
What is intussusception
intestine telescoping in on itself
associated mesentery getting strangulated
blood leaking into intestinal lumen from cardiovascular pressure
happens in small intestine and causes an obstruction
What are subjective and objective signs of intussusception?
currant jelly stools
sudden acute abdominal pain
tender, distended abdomen
S/S of peritonitis (for advanced cases)
How is intussusception dx?
How is intussusception treated?
telescoping can be reduced non-surgically (insert air into bowel and it pops out)
if non-surgical attempt unsuccessful, surgery is required for reduction and/or resection of telescoping intestine
What are we going to do for intussusception
what is the most common site of intussusception
The ileocecal valve
What is the most common cause of emergency abdominal surgery in the US
what is appendicitis
inflammation of the appendix (terminal end of colon on right side)
1/3 of cases involved perforated (ruptured appendix)
What are S/S of appendicitis
RLQ pain (McBurney's Point)
rigid, tender abdomen
if it is painful then feels better it may have ruptured then infection can get into peritoneum
How is appendicitis dx?
possible elevated blood count
ultrasound and CT scan
What's a major complication of appendicitis?
What are we going to do for appendicitis
post-surgical management (laparoscopic vs open appendectomy)
monitoring for complications
What is GERD
GastroEsophageal Reflux disease
The transfer of gastric contents into the esophagus
sphincter relaxes and contents bubble up into esophagus
may occur w/o regurgitation
represents symptoms or tissue damage that results from GER
What is GER
may occur without reflux disease
becomes a disease when complications develop
LES dysfunction vs TRLES
What is LES dysfunction
lower esophageal sphincter dysfunction = particularly decreased tone, thought to be initial cause of GER/GERD
what is TRLES
Transient relaxation of LES = now thought to be mechanism leading to GER/GERD
Why is GERD a problem?
Can erode esophagus and lead to cancer
Who is at most risk for GERD
infants with bronchopulmonary dysplasia
kids with transesophageal/esophageal atresia repair
kids with neurological disorders
kids with scoliosis, asthma, CF or cerebral palsy
smoking, alcohol, spicy food, chocolate, caffeine
What are we going to do for GERD
pharmacological interventions (antacids or proton pump meds like zantac, pepcid, prilosec, etc)
nutritional interventions (avoid hot and spicy foods, avoid caffeine)
surgical interventions - nissen fundoplication (band so reflux doesn't happen)
prop HOB up at night
How is GER diagnosed
24 hour probe study
What patient would receive surgical interventions for GERD
kids with severe complications like recurrent aspiration pneumonia, apnea, failure to respond to medical therapy, and positional changes
What causes IBD
shows multifactoral etiology (inflammatory response to bacteria or viruses in GI tract, genetics, sociocultural aspects, psychological problems)
What is ulcerative colitis
inflammation limited to colon and rectum
affects mucosa, submucosa
varying degrees of ulceration, bleeding and edema
most cases include bloody diarrhea, abdominal pain
What is crohn's disease
affects any part of the GI tract (most commonly the terminal ileum)
affects all layers of bowel wall in a discontinuous fashion
most cases involve abdominal cramping and diarrhea
What is Inflammatory Bowel Disease (IBD)?
Disorders of the GI tract with no known etiology: ulcerative colitis and crohn's disease.
How should IBD be treated
possible resection of affected intestine
who has greater risk of developing cancer, patients with crohn's or ulcerative colitis
crohn's has greater risk of developing cancer
what are we going to do for IBD
family and pt support
nutritional monitoring (small frequent meals rather than 3 meals a day, low fiber, high protein and high calorie)
observe for dehydration
possible ostomy care
What is hirschsprung's disease
Also known as congenital aganglionic megacolon
mechanical obstruction caused by inadequate motility of part of the intestine
accounts for about 1/4 of all cases of neonatal obstruction
what does Hirschsprung's disease look like?
failure to pass meconium within 24-48 hours
refusal to feed
explosive, watery diarrhea
how is Hirschsprung's disease dx?
radiography (x-rays, CT scans)
How are we going to care for the child with Hirchsprung's disease
post-surgical management (ostomy care, pain management)
observe for dehydration and complications (monitor stools)
What is Hirchsprung's disease caused by?
no autonomic parasympathetic innervation in portion of the colon
newborn doesn't pass meconium after 24-48 hours, FTT, child has constipation
How do we fix hirschsprung's disease
With a temporary colostomy (remove diseased part). Once child is 20lbs resect and reattach bowel
What is a normal bowel size
200-250cm small intestine for infant > 35 week gestation
100-120 cm small intestine for infant <30 week gestation
what is small bowel
loss of 80% small intestine
Why is short gut/small bowel a problem?
absorption of nutrients
normal bacterial flora
failure to thrive
What causes short gut/small bowel?
ishemia (big cause NEC)
trauma or vascular injury
How are we going to treat short gut/small bowel?
monitor for s/s of dehydration, surgical complications
TPN and lipids or enteral tube feeding
interventions for side effects
What is the problem with having cleft lip/palate
what is the medical management for cleft lip/palate
lip closure w/in 3 months
palate closure w/in 12-18 months
repeated surgeries for growth problems
Where is cleft lip/palate dx?
You have a patient with Crohn's disease. What diet would be most appropriate for them to eat?
small frequent meals, high protein high calorie
You are the nurse in a busy pediatric emergency room. A 3-wk old child is brought in with a 4-day history of vomiting. Per the parents, the patient usually vomits 30-45 minutes after a feed, but the vomited formula has minimal curdling and is not bilious. As you are gathering your admission history, the patient vomits, sending a stream of formula to the foot of the bed about 3 feet away from the patient's head.You suspect that your patient likely has
what disorder is characterized by a failure to pass meconium within the first 24-48 hours of life?
TRUE OR FALSE: Patients with Crohn's Disease have a greater chance of developing carcinomas than patients with ulcerative colitis.
Which is the most common cause of serious gastroenteritis among children?
An infant with moderate dehydration has what clinical signs
dry mucous membranes
capillary filling of more than 2-3 secs
The nurse would expect to see which of the following clinical manifestations in the child dx with Hirschsprung disease
palpable fecal mass
What would alert the nurse to possible peritonitis from a ruptured appendix in a child suspected of having appendicitis
temp of 103, absent bowel sounds, and sudden relief from abdominal pain
a common feature of IBD is
The best definition of biliary atresia is
progressive inflammatory process causing bile duct fibrosis
An invagination of one portion of the intestine into another is called
A 5 month old is suspected of having intussusception. What clinical manifestations would he most likely have?
Crying with abdominal exam, vomiting, and currant-jelly-appearing stools
5 month old's intussusception is treated with hydrostatic reduction the nurse should expect care after the reduction to include
observation of stools
The nurse observes frothy saliva in the mouth and nose of the neonate and frequent drooling. When fed the infant swallows normally, but suddenly the fluid returns through the nose and mouth of the infant. The nurse should expect what medical condition
The preop nursing plan for an infant with pyloric obstruction should include
rehydration by IV fluids for fluid and electrolyte imbalance
NG tube placement to decompress the stomach
parental support and reassurance
The prognosis for kids with short bowel syndrome has improved as a result of
total parenteral nutrition and enteral feeding
When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration include:
Tachycardia, parched mucous membranes, sunken eyes and fontanel.
Which statement best describes Hirschsprung’s disease?
The colon has an aganglionic segment.
A child has a nasogastric (NG) tube after surgery for acute appendicitis. The purpose of the NG tube is to:
Prevent abdominal distention.
Therapeutic management of the child with an inflammatory bowel disease (IBD) includes a diet that has which component?
What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia?
Liver transplantation may be needed eventually.
The nurse assesses the neonate immediately after birth. A
tracheoesophageal fistula should be suspected if what condition is present?
Excessive amount of frothy saliva in the mouth
The nurse is caring for a boy with probable intussusception. He had diarrhea before admission; but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. What is the most appropriate nursing action?