Pediatric Nursing

Gastrointestinal

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Function
1. Assists in maintaining F&E and acidacidbase balance  2. Processes and absorbs nutrients to maintain metabolism and support growth and development  3. Excrete waste products from digestive process


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Recommended Daily Allowance

Calories: 120 cal/Kbw/day; 360-380 cal 360daily  Protein 2.2 g/Kbw/day  Fluids 16-20 cc/kg/day 16

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Supplementary Feeding
Supplementary feeding 4-6 months  Never wean an infant if in  1. Solid foods in order:  - cereals rich in iron  - fruits  - vegetables  - meat

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2. begin in small quantities  3. Finger foods offered at 6 months  4. Soft table foods 1 year  5. Dilute fruit juices 6 months; 1 is to 4 ounces of water  6. Never give half cooked eggs salmonelliosis/gastroenteritis  7. Don t give honey infant botulism

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8. Offer food one at a time interval of 4-7 days  Total body fluids 65-85% of body 65weight  Greater in extracellular dehydration


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Acid-Base Balance
       

1. Chemical buffers 2. Renal and respiratory system 3. Dilution of strong acids and bases in blood Respiratory acidosis carbonic acid excess - hypoventilation - RDS - COPD - Laryngotracheobronchitis
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Respiratory alkalosis deficit  - hyperventilation  - fever  - encephalopathy



carbonic acid

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Metabolic acidosis base HCO3 deficit etabolic  - diarrhea  - severe dehydration  - malnutrition  - ciliac crisis


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Metabolic alkalosis case HCO3 excess  - uncontrolled vomiting  - NGT insertion  - gastric lavage


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Problems Leading to F&E Imbalance

1. Vomiting forceful expulsion of stomach contents  Sx:  Nausea  Dizziness  Facial flushing  Abdominal cramping

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Assess:  Amount  Frequency  Force projectile  Mgt:  BRAT diet banana, rice, apply sauce, toast

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Diarrhea
Exaggerated excretion of intestinal contents  Types:  1. Acute related to gastroenteritis, salmonellasis  - dietary indescretion  - antibiotic use (Ampicillin, tetracycline)

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2. Chronic non-specific non Cause:  1. food intolerance  2. Excessive fluid intake  3. carbohydrate and protein malabsorption  Assess:  Frequency, consistency, appearance  Best criteria: consistency teret


Complication:  Dehydration  Mild 5% wt loss  Moderate 10% wt loss  Sever 15% wt loss


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Early signs and symptoms:  Tachycardia, tachypnea, hypotension  Increase temp, sunken fontanel and eyeballs, absence of tears  Weight loss, scanty urine, dry skin  Severe dehydration: marked oliguria, prolonged capillary refill

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Mgt:  Acute:  - NPO  - IV therapy  - prone to hypokalemia  Drug NaHCO3



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Chronic:  - thickened feeding with baby cereals  - feed slowly, burp often (every 1 ounce)


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Hirschprungs s Disease
Congenital aganglionic megacolon  Earliest sign:  1. failure to pass meconium after 24 hours  2. abdominal distention  3. vomitus of fecal material  4. foul smelling breath  Early childhood ribbon-like stool ribbon
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Diagnosis
1. Barium enema reveals narrowed portion of bowel  2. Rectal biopsy reveals absence of aganglionic cells  3. Abdominal X-ray Xreveals dilated loops on intestine  4. Rectal manometry reveals failure of intestine sphincter to relax

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Management
1. NGT feeding  2. Surgery  - Temporary colostomy  - anastomosis and pull through porcedure  Diet increase protein, increase calories, decrease residue pasta

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Gastroesophageal Reflux Disease

Achalasia  Regurgitation of stomach contents into the esophagus  Complication esophagitis; aspiration pneumonia


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Management
Anticholinergic  1. Betanicol (Urecholine) increase esophageal tone and peristaltic activity  2. Metachlorpromide (Reglam) decrease esophageal pressure by relaxing pyloric duodenal segments  - increase peristalsis without stimulating secretions

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3. H2 Receptor Antagonist decrease gastric acidity and pepsin secretion  - Ranitidine (Zantac)  Antacid neutralizes gastric acid between feedings  - Maalox  Surgery Nissen funduplication

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Esophageal Cancer
Assessment:  1. Chronic vomiting  2. Failure to thrive syndrome  4. Melena or hematemesis


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Diagnosis
1. Esophagoscopy  2. Esophageal manometry relveals lower esophageal sphincter pressure  3. Intra esophageal pH content reveals pH of distal esophagus


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Pyloric Stenosis
Hypertrophy of muscles of pylorus causing narrowing and obstruction  Outstanding sign projectile vomiting  - vomiting initial sign of upper GI obstruction  - vomitus of upper GI blood tinged  - vomitus of lower GI bile streaked; bilous

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- abdominal distention lower GI obstruction  Metabolic alkalosis  Failure to gain weight  Olive shaped mass


major sign of

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Diagnosis
Increase Na and K, decrease Cl  Ultrasound  X-ray with barium swallow  ABG


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Management
1. Pyloromyotomy incision of pyloric muscle  2. Fredt-Ramstedt procedure Fredtseparation of hyperthrophied muscle without incision


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Intussusception
Invagination or telescoping of position of bowel to another  Common site: distal ileum and proximal colon  Prone: eats fast  Complication - peritonitis


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Sn/Sx:  1. persistent paroxysmal abdominal pain severe  Frequency 1515-20 minutes  2. vomiting contains bile  3. currant jelly stool after 12 hours  4. sausage-shaped mass sausage
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Management
Hydrostatic reduction with barium enema  Pneumatic insufflation air  Surgery anastomosis and pull through


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Inborn Errors of Metabolism

Phenylketonuria (PKU)  Deficiency of liver enzyme phenylalanine hydroxylase  Prevents conversion of phenylalanine to tyrosine  Tyrosine epinephrine, thyroxine, melanin

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Signs and Symptoms

1. Urine has musty or mousy odor phenylpyruvic acid  2. Atopic dermatitis  3. Seizures  4. Growth retardation - thyroxine


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Diagnosis
Guthrie test bacterial inhibition  Pheric chloride green spots in the diaper as sign of PKU


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Diet
Low phenylalanine diet contraindicate high protein foods  Lofenalac extremely-low extremelyphenylalanine formula


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Galactosemia
Carbohydrate metabolism disorder  Deficient: galactose 1-phosphate 1uridyltransferase  May die at 3 days of age  Symptoms:  Galactosemia  Galactosuria

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Diagnosis


Beutler test blood

screening test; uses cord

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Management
Diet galactose-free galactose Nutramigen milk substitute formula


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Celiac Disease
GlutenGluten-induced Enteropathy  Intolerance to: B barley R rye O oat W wheat  Inability to absorb fat

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Early sign:  1. Diarrhea  2. Constipation  3. Vomiting  Late sign:  1. Abdominal pain abdomen  2. Steatorrhea

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protuberant

Diagnosis
1. history and clinical symptoms  2. Serum analysis IgA antigliadin antibodies


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Management
GlutenGluten-free diet lifetime  Rice and corn OK  Vitamin supplements  Mineral supplements


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