Title: Gasrointestinal Disorders In Infants and Children
1Gasrointestinal 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 -
2General
- Energy Requirements
- Depend/Based on energy expenditures from
- 1. Basal Metabolism
- 2. Body Activity
- 3. Growth
- 4. Dynamic action of food
- 5. Fecal loss
3General
- 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
4General
- 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.
5General
- Deficiencies or excess amounts of any of these
requirements can lead to skin issues, metabolic
issues, renal issues etc.
6General Assessment
- Assessment should include
- Diet history
- Frequency
- Allergies
- Elimination patterns
7Disorders 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
8Disorders 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
9Disorders 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
10Disorders in Newborns/Young Infants
- Pyloric Stenosis Pyloroplasty
11Disorders 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
12Disorders 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)
13Disorders in Newborns/Young Infants
- Sx/Sx Choking/Coughing during feeds can have
intermittent cyanosis - EA TEF
14Disorders 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.
15Disorders in Newborns/Young Infants
- Gastroesophageal Reflux (GER)
- Underdeveloped esophageal sphincter
- Some amount of GER is normal in newborns
- Often causes apnea
16Disorders 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
17Disorders 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)
19Disorders 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
20Disorders in Children
- Causes unknown- exacerbated by emotional
factors - Common to occur in Adolescents
- DX made by barium enema biopsy of GI mucosa
stool studies
21Disorders 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
22Disorders 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
23Disorders 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
24Disorders 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
25Disorders 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)
26Disorders 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)
27Endocrine 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
28Endocrine 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
29Endocrine Disorders in Children
- Diabetes Type I and Type II
- Review Endocrine section in review book-good
overview.
30Endocrine 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
31Endocrine Disorders in Children
- Hypothyroid Disease Continued
- SX/SX Easy wt gain
- Fatigue/tiredness
- Dry, scaly skin
- Slow pulse
- Cool body temp
- Constipation
32Endocrine 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
33Endocrine 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
34Endocrine 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
35Endocrine 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
36TEST 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
37TEST 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
38TEST 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"
39TEST 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
40TEST 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
41TEST 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
42TEST 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
43TEST 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
44TEST 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
45TEST 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
46TEST 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
47TEST 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
48TEST 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.
49TEST 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.
50TEST 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"
51TEST 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.
52TEST 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
53TEST 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
54TEST 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
55TEST 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
56TEST 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
57TEST 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.
58TEST 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
59TEST 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
60TEST 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