Gasrointestinal Disorders In Infants and Children - PowerPoint PPT Presentation

1 / 60
About This Presentation
Title:

Gasrointestinal Disorders In Infants and Children

Description:

... hyperplasia of pituitary cells or pituitary tumor Bone age studies are normal. Signs of gigantism ... fistula is suspected ... about the child's symptoms ... – PowerPoint PPT presentation

Number of Views:568
Avg rating:3.0/5.0
Slides: 61
Provided by: lori102
Category:

less

Transcript and Presenter's Notes

Title: Gasrointestinal Disorders In Infants and Children


1
Gasrointestinal Disorders In Infants and Children
  • Lori Fox, RN, MSN, APRN, BC
  • References Society of Pediatric Nursing
    Pediatric Nursing Review
  • Saunders Comprehensive Review for the NCLEX Exam
    2002
  • Dorlands's Illustrated Medical Dictonary Twenty
    Sixth Edition 1981

2
General
  • Energy Requirements
  • Depend/Based on energy expenditures from
  • 1. Basal Metabolism
  • 2. Body Activity
  • 3. Growth
  • 4. Dynamic action of food
  • 5. Fecal loss

3
General
  • Distribution of Calories
  • Important so foods chosen contain all essential
    elements
  • Normal Full -Term Infant
  • Protein 6-8
  • Fat 30-55
  • Carbohydrate approximately 50-60

4
General
  • Water 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
General
  • Deficiencies 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
  • Allergies
  • Elimination patterns

7
Disorders in Newborns/Young Infants
  • Imperforate Anus "Incomplete development or
    absence of its normal position in the
    perineum"-Saunders, Third Edition-2002
  • Assessment findings
  • Failure to pass meconium/stool
  • Absence or stenosis of the anal rectal canal
  • Presence of an anal membrane
  • External fistula to the perineum or genitourinary
    system

8
Disorders in Newborns/Young Infants
  • Necrotizing Enterocolitis "NEC"
  • Common in neonatal period
  • Increased risk with preemies
  • Causative agent conditions which cause vascular
    compromise to the intestine
  • Sx/Sx lethargy, apnea, bradycardia,
    hypotension, temperature instability

9
Disorders in Newborns/Young Infants
  • Pyloric Stenosis A narrowing of the pyloric
    canal as it exits the stomach
  • Projectile VomitingHigh index of suspicion.
    (hallmark)
  • Olive sized bulge below the right costal margin
    (hallmark)
  • Tx pyloromyotomyincision through muscle fibers
    of the pylorus

10
Disorders in Newborns/Young Infants
  • Pyloric Stenosis Pyloroplasty

11
Disorders in Newborns/Young Infants
  • Biliary Atresia "obliteration or absence of
    extrahepatic biliary structures"
  • Cause Unknown
  • Sx/Sx Early jaundice dark urine pale stools
    (absence of bile) absorption issues?growth
    issues
  • DX Liver biopsy

12
Disorders in Newborns/Young Infants
  • Esophageal Atresia (EA) and Tracheoesophageal
    Fistula (TEF)
  • Atresiaabsence or closure of a orifice or
    tubular organ
  • Fistula "tube like connection between two
    structures" Designated by the organs or parts
    which with it communicates (e.g. rectovaginal)

13
Disorders in Newborns/Young Infants
  • Sx/Sx Choking/Coughing during feeds can have
    intermittent cyanosis
  • EA TEF

14
Disorders in Newborns/Young Infants
  • Cleft Lip and Palate
  • Congenital Defect -soft tissue or bony
    structure fails to fuse during embryonic
    development.
  • Can be unilateral or bilateral
  • Apparent at birth
  • Causes genetic hereditary environmental
  • Closure of lip defect occurs before palate-first
    few weeks of life with palate around 12-18 mo.

15
Disorders in Newborns/Young Infants
  • Gastroesophageal Reflux (GER)
  • Underdeveloped esophageal sphincter
  • Some amount of GER is normal in newborns
  • Often causes apnea

16
Disorders in Newborns/Young Infants
  • Hirschsprung's Disease (congenital aganglionosis
    megacolon)
  • Absence of ganglion cells in the retum and colon
  • Mechanical obstruction from inadequate motility
  • DX Rectal biopsy
  • Serious Complication Enterocolitis
  • Tx mild disease relief of chronic constipation
  • most children require surgery
  • neonates often require temporary colostomy

17
Disorders in Young Infants
  • Intussusception Prolapsing of one portion of the
    intesine into the lumen of the immediately
    adjoining part
  • Occurs at about 6 months of age
  • Causes bowel lining abnormality polyps
    hyperactive peristalsis unknown
  • Inflammation? swelling ?obstruction ?necrosis
    from occlusion of bowel blood supply

18
(No Transcript)
19
Disorders in Children
  • Inflammatory Bowel Disease
  • 1. Crohn's diseaseregional enteritis-
  • asymmetrical and patchy lesions.
  • Affects all layers of bowel wall
    enlarged
  • regional lymph nodes occurs at any
    point
  • along the GI tract.
  • 2. Ulcerative colitissymmetrical and
  • contiguous GI ulcers
  • Affects bowel mucosa large intestine

20
Disorders in Children
  • Causes unknown- exacerbated by emotional
    factors
  • Common to occur in Adolescents
  • DX made by barium enema biopsy of GI mucosa
    stool studies

21
Disorders in Children
  • Appendicitis Inflammation and obstruction of
    blind sac at end of cecum
  • Results in ischemia gangrene perforation and
    peritonitis
  • Causes include infections, dietary intake,
    constipation and parasites
  • Common in school age children

22
Disorders in Newborns/Young Infants
  • Celiac Disease Absence of intestinal mucosal
    cell enzyme ?villi of small intestine atrophy ?
    decreases absorption
  • Gluten intolerance-FATTY STOOLS (Steatorrhea) and
    chronic diarrhea
  • IgA deficiency and early introduction of protein
    solids related.
  • Occurs around 2-4 months after solid foods
    introduced

23
Disorders in Children
  • Parasitic Worms Aquired through skin ingestion
    of dirt or raw vegetables not well washed
  • Pinworms are the most common
  • Live in cecum and crawl to anus at night to lay
    eggs
  • Tape test
  • Anal itching abdominal distention

24
Disorders in Children
  • Viral Hepatitis
  • 1. A Fecal -oral route
  • 2. B Blood and body secretions
  • 3. C predominantly parentally spread
  • SX/SX anorexia malaise, fatigues easily, fever
    jaundice and dark urine pale stools
  • DX antigenic markers and body immune response
  • HBIG for Hep B

25
Disorders in Children
  • Acetaminophen Poisoning
  • Hepatotoxicity is concern plasma levels greater
    than 200 µm/ml.
  • Monitor for liver damage 24-36 hours after
    overdose
  • Mucomyst is an antidote (acetylcysteine)

26
Disorders in Children
  • Vomiting and Diarrhea
  • Issues frequency, consistency volume support
    electrolytes and hydration
  • Constipation Frequency, consistency of stools
    (variation from normal for that child- not
    necessarily no daily stool)

27
Endocrine Disorders in Children
  • Inborn Errors of Metabolism
  • Tested for at birth after first 24 hours of
    feedings Early diagnosis leads to better outcome
  • PKU- 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
    cataracts
  • Maple Syrup Urine Disease (MUD)
  • Deficiency of decarboxylase that degrades amino
    acids ?altered tone seizures
  • Urine has odor of maple syrup

29
Endocrine Disorders in Children
  • Diabetes Type I and Type II
  • Review Endocrine section in review book-good
    overview.

30
Endocrine Disorders in Children
  • Hypothyroid Disease
  • Thyroid regulates basal metabolic rate
  • CX decreased secretion from
  • a. Thyroid gland development issues
  • b. Medications that suppress hormone
  • production
  • c. Thyroid relies on early dietary
    iodine
  • and tyrosine for normal function

31
Endocrine Disorders in Children
  • Hypothyroid Disease Continued
  • SX/SX Easy wt gain
  • Fatigue/tiredness
  • Dry, scaly skin
  • Slow pulse
  • Cool body temp
  • Constipation

32
Endocrine Disorders in Children
  • Cushing Syndrome Hyperadrenocorticism
  • Hyper functioning of the adrenal gland. High
    levels cortisol ? decreased ACTH secretion
  • Cause Tumor in pituitary gland/prolonged or
    excessive use of corticosteroids
  • Sx/Sx MOON FACE muscle weakness easy
    bruising facial hair growth (hirsutism
    excessive hair growth) decreased linear growth
    HTN mood disorders poor wound healing
  • TX Taper steroids if possible remove tumor-
    Takes weeks/months for hormones to clear body

33
Endocrine Disorders in Children
  • Deficient Anterior Pituitary Hormone Pituitary
    Dwarfism
  • Results in decreased growth hormone
  • Cause idiopathic brain tumor trauma lesions
  • Normal body proportions, but short stature
  • Bone age studies reveal growth retardation
  • Tx Administer growth hormone
  • Emotional Support

34
Endocrine Disorders in Children
  • Hypersecretion of anterior pituitary hormone
    Gigantism or acromegaly
  • Causes hyperplasia of pituitary cells or
    pituitary tumor
  • Bone age studies are normal. Signs of gigantism
    occur if increased release of hormone happens
    before growth plates close
  • Elongation and enlargement of long bones, facial
    bones and accompanying body tissue

35
Endocrine Disorders in Children
  • Hypersecretion of anterior pituitary hormone
    Gigantism or acromegaly Continued
  • Late closure of fontanels
  • Acromegaly if release of hormone occurs after
    growth plates close enlarged hands feet nose
    tongue jaw
  • Thickening of skin and facial features
  • TX Radiation may be used to retard growth
  • Emotional support

36
TEST QUESTIONS
  • 1. A 3 year old is hospitalized because of
    persistent vomiting. A nurse monitors the child
    closely for
  • a. Diarrhea
  • b. Metabolic Acidosis
  • c. Metabolic Alkalosis
  • d. Hyperactive bowel sounds

37
TEST QUESTIONS
  • 2. 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. Tympanic
  • B. Axillary
  • C. Rectal
  • D. Electronic

38
TEST QUESTIONS
  • 3. 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 QUESTIONS
  • 4. 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 side
  • B. On the left side
  • C. Prone
  • D. Supine

40
TEST QUESTIONS
  • 5. 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 vomiting
  • B. Coughing at nightime
  • C. Choking with feedings
  • D. Incessant crying

41
TEST QUESTIONS
  • 6. 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 supine
  • B. 60-degree angle when supine
  • C. Head-Elevated prone position
  • D. 20-degree angle when supine

42
TEST QUESTIONS
  • 7. 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
    formula
  • B. Thicken the feedings by adding rice cereal to
    the formula
  • C. Provide less frequent, larger feedings
  • D. Burp the infant less frequently during
    feedings

43
TEST QUESTIONS
  • 8. 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 bile
  • B. Watery Diarrhea
  • C. Increased urine output
  • D. Projectile vomiting

44
TEST QUESTIONS
  • 9. 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. Rice
  • B. Rye toast
  • C. Oatmeal
  • D. Wheat Bread

45
TEST QUESTIONS
  • 10. 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. Diarrhea
  • B. Projectile vomiting
  • C. Regurgitation of feedings
  • D. Foul-smelling ribbon like stools

46
TEST QUESTIONS
  • 11. 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 quadrant
  • B. Bile stained fecal emesis
  • C. Failure to pass meconium stool in the first
    24 hours after birth
  • D. The passage of currant jelly -like stools

47
TEST QUESTIONS
  • 12. 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 stools
  • B. Profuse projectile vomiting
  • C. Watery Diarrhea
  • D. Ribbon like stools

48
TEST QUESTIONS
  • 13. 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
    disorder
  • B. 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 QUESTIONS
  • 14. 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 days
  • B. 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 QUESTIONS
  • 15. 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 QUESTIONS
  • 16. 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 to
  • A. Come to the clinic immediately
  • B. Hold the next dose of insulin
  • C. Administer an additional dose of regular
    insulin
  • D. Encourage the child to drink calorie-free
    liquids.

52
TEST QUESTIONS
  • 17. 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 infusion
  • B. Normal Saline IV infusion
  • C. NPH insulin IV infusion
  • D. Potassium IV infusion

53
TEST QUESTIONS
  • 18. 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 apply
  • A. Open fontanels
  • B. Protruding tongue
  • C. Tachycardia
  • D. Hypertonia
  • E. Hypotonia
  • Source Child Health Nursing Second Edition
    Reviews and Rationales 2007

54
TEST QUESTIONS
  • 19. An infant with congenital hypothyroidism
    shows which sing or symptom?
  • A. Shrill Cry
  • B. Diaphoresis
  • C. Hypothermia
  • D. Diarrhea
  • Reference questions 19- Straight A's In
    Pediatric Nursing-A review series Lippincott
    Williams and Wilkins, 2004

55
TEST QUESTIONS
  • 20. 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
    sweating
  • B. Bradycardia, cool skin temperature and dry
    scaly skin
  • C. Bradycardia, fever, hypotension, and
    irritability
  • D. Tachycardia, cool skin temperature and
    irritability

56
TEST QUESTIONS
  • 21. 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
    deficiency
  • B. Phenylketonuria
  • C. Galactosemia
  • D. Hypothyroidism

57
TEST QUESTIONS
  • 22. 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 tremors
  • B. Nausea, fruity breath odor, headache and
    fatigue
  • C. Polydipsia, polyuria, polyphagia, and weight
    loss
  • D. Enlarged tongue, hypotonia, easy weight gain
    and cool skin temperature.

58
TEST QUESTIONS
  • 23. 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/dl
  • B. A fasting plasma glucose level of 126 mg/dl
  • C. A random plasma glucose level of 180mg/dl
  • A 2-hour glucose tolerance test of 140 mg/dl

59
TEST QUESTIONS
  • 24. 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 Dextrose
  • B. Subcutaneous insulin
  • C. Subcutaneous glucagon
  • D. Oral fast-acting carbohydrate

60
TEST QUESTIONS
  • 25. Which foods may be eaten by a child with
    galactosemia? Select all that apply.
  • A. Instant Potatoes
  • B. Chicken
  • C. Lima Beans
  • D. Whole Wheat Bread
  • E. Apples
  • F. 2 Cow's milk
Write a Comment
User Comments (0)
About PowerShow.com