NURSING 379 TEST ONE GI

• Infants younger than 6 weeks do not produce tears.
• In an infant a sunken fontanel may indicate dehydration- closes at 12-18 months
• Infants are dependent on others to meet their fluid needs
• Infants have limited ability to dilute and concentrate urine

• The smaller the child, the greater the proportion of body water to weight and proportion of extracellular fluid to intracellular fluid.
• Infants have a larger proportional surface area of the GI tract than adults-get dehydrated quicker
• Infants have a greater body surface area and higher metabolic rate than adults

• GI tract not mature until 4-6 months
• Eruption of teeth (baby 6 mo, lose 6 yr.)
• Volume of stomach(30-90ml, goes up 150 a year)
• Changes in appetite-growth spurts
• fluid is of great importance in children because it makes a greater portion of the child's weight

• Fever
• Vomiting & Diarrhea
• High-output renal failure
• Diabetes insipidus (DI)- lots of urine
• Burns
• Shock
• Tachypnea

• Congestive heart failure-overload would = dec. resp.
• Renal failure
• Head trauma/ meningitis=inc. ICP.

• First 10kg----100ml/kg/day
• 10-20 kg------100ml+50ml/kg of body wt. more than 10kg
• >20kg---------150 ml+ 20ml/kg of body wt.>than 20 kg

• Dry skin and mucus membranes
• Poor skin Turgor
• Sunken eyes (dec. IOP)
• Depressed anterior fontanel
• Gray or ashen in color
• Rapid and weak pulse
• Decreased BP (child compensates 25% body loss, bp does not drop right away)
• Oliguria
• Decreased tears (after 6wks)
• Irritability
• Delayed capillary refill
• Inc. Hgb, Hct

• A group of clinical syndromes manifested by nausea, vomiting, and diarrhea
• Inflammation of the stomach and intestines
• Rotovirus is the leading cause of pediatric gastroenteritis

• Poor sanitation
• Improper handling of food
• Daycare-use spray cleaner, soap & water
• Antibiotics
• Previous bowel surgery
• Hospital acquired
• Presence of other infectious processes
• Anxiety-inc. motility

• More common in winter
• Rotavirus-most common in children 6-24 months
• Norwalk-affects all ages (daycares, cruise ships)
• adenovirus

• More common in summer
• mild to severe symptoms
• Most recover without treatment
• Salmonella (turtles, baby chicks)
• Shigella (oral/fecal, monkeys)
• E-Coli (undercooked foods)

• Warm, "doughy" skin texture
• hypertonia
• hyperreflexia
• lethargy with irritability when touched

• weakness
• Illeus with abdominal distention
• Cardiac arrhythmias

• Assessment of dehydration
• Oral rehydration (inc. po fluids if diarrhea inc, give po fluids slowly if vomiting., resume diet slowly)
• Avoid fluid with high carbohydrate and low electrolyte values (pop)
• Advance to normal diet as soon as possible
• Nursing mothers should continue to breast feed
• Use of anti-diarrheal agents discouraged
• Protect skin
• IV therapy for inadequate circulating blood volume
• Hylinex-SQ rehydration (acts quickly)

• Assess child's hydration status
• Strickt intake and output
• Daily weights
• Hourly monitoring of IV rate and site of infusion
• *increase fluids if increase in vomiting or diarrhea
• *decrease fluids when taking po fluids or signs of edema

• Difficulty passing hardend stool
• May be due to underlying disease
• May occur when trasitioning from formula/breast milk to cow's milk
• More common in toddler years
• management-diet, exercise, behavior modifications
• Encorpresis-retention of stool with recurrent soiling

• Congenital Aganglionic Megacolon
• Absence of autonomic parasympatheic ganglion cells in the mucosal and muscular layers of the colon
• Peristalsis normal
• results in obstruction and dilation of the proximal bowel

• failure to pass meconium
• enlarged, distended abdomen
• vomiting
• fecal mass palpable
• rectum is empty of stool
• anorectal manometry (test the sphincter's reaction to rectal distention)
• Biopsy to confirm diagnosis

• Medical management-monitor F&E balance, May need regular rectal irrigation
• Surgical removal of the agangliionic portion of the bowel
• May need temporary ostomy proximal to the aganglionic segment
• complete correction- pull-through procedure

• May be too malnourised to withstand immediate surgery (High calorie, high protein, low fiber diet OR TPN)
• Enterocolitis
• *Inflammation of the small bowel and colon
• *Leads to ischemia and ulceration of bowel wall
• * surgical emergency if bowel perforation occurs

• Retrograde flow of gastric contents into the esophagus
• Effortless vomiting-not having sufficient intraluminar pressure to prevent spitting up
• Failure of the sphincter mechanism at the junction of the esophagus and the stomach
• May see spontaneous improvement by 6-9 months
• GERD-GER with complications (aspiration, apnea)

• spitting up
• vomiting
• weight loss
• gagging, chocking at the end of feedings
• respiratory problems
• heartburn/irritability

• pH probe- Probe is placed in the distal esophagus to detect pH changes below 4.0pH is measured and recorded q 4-8 sec.
• UGI-fluroscopic and radiographic examinations of the esophagus, stomach, and small intestine.
• Swallow study-Oral barium or water soluble contrast agent is swallowed. The barium or contrast is observed as it passes through the digestive tract and films are taken.
• Scintiscan -gastric emptying study
• Flexible endoscopy-visualize the internal structures of the esophagus, stomach, and duodenum.

• Change to soy formula
• Frequent burping
• Small feedings-not over 30 minutes
• Elevate the HOB
• Lay on right side after feeding
• Thicken feeding with rice cereal
• Weight monitoring
• SURGICAL
• Nissen Fundoplication-Wrapping the gastric cardia with adjacent portions of the gastric fundus around esophagus (cannot vomit)
• G-Tube-decreases the incidence and discomfort of gas (vents stomach)

• Zantac (Rantidine)
• Pepcid (Famotidine)
• Tagament (Cimetidine)

Inhibition of the histamine-2 receptor on the gastric parietal cell, thus blocking gastric acid secretion

• May be administered with/out food
• If antacids are perscribed, administer 2 hours before or after H2 antagoinist
• Teach parents to avoid OTC medications without check with healthcare provider

• Bradycardia
• Constipation
• Nausea
• Fatigue
• Confusion
• Dizziness
• headache
• Irritability
• Rash
• Thrombocytopenia

• Pravacid (Lanzoprazole)
• Prilosec (Omeprazole)

• Inhibits acid secretions, alleviates symptoms and helps to heal esophagitis
• Block the final common pathway of acid production by inhibiting activated proton pumps in the gastric parietal cell canaliculus

• Administer in the morning on an empty stomach
• Teach family to inform HCP if sever diarrhea occurs
• Teach family to inform HCP if changes in urinary elimination, such as pain or discomfort associated with urination occur

• Abdominal Pain
• Diarrhea
• Dizziness
• Fatigue
• Headache
• Hematuria
• Nausea
• Proteinuria
• Rash

Reglan (Metoclopramide)

• Promotes Gastric emptying
• Improves gut motility

• Mild sedation
• Fatigue
• Restlessness
• Nausea
• Rash
• Headache
• Insomnia
• Diarrhea
• Constipation

• Sulfasalazine
• mesalamine

• Used for anti-inflammatory effect
• Inhibition of prostaglandins known to cause diarrhea and affect mucosal trasport

• Administer after meals
• Do not crush or chew sustained released tablets
• Teach patient or parents to supplement daily intake of iron

• Nausea
• vomiting
• bloody diarrhea
• anorexia
• rash
• headache

• Prednisone
• Prednisolone
• Hydrocortisone enema

• Used for anti-inflammatory effect
• **Main one used**

• Administer oral medications with meals to reduce gastric irritation
• Teach family to avoid abrupt discontinuation of medication
• Teach family to report delayed wound healing

• Nausea
• Vomiting
• Cushingoid appearance (moon face)
• immunosuppression
• growth suppression
• hypertension
• acne
• altered mood

• Tumor necrosis factor-alpha (TNF-alpha)
• Infliximab (Remicade)
• Interleukin-10
• Thalidomide

Prevents TNF-alpha from binding to its receptors (TNF-alpha have been found in stools of patients with crohn's disease)

• Reconstitute IV preparation according to manufacture directions and administer according to agency protocol
• D/C IV infusion if infusion reaction is evident (fever, chills, chest pain, hypotension, dyspnea, urticaria)

• Metronidazole
• Ciprofloxacil

Antibacterial aganst anaerobic bacteria and some gram-negative bacteria

• Extended release form should not be chewed or crushed
• Administer with food or milk to reduce gastrointestinal distress

• Fever
• Headache
• Diarrhea
• Nausea
• Vomiting
• Fungal overgrowth