GASTRO

• Signs of FLUID LOSS


  • poor skin turgor
  • dry mucous membranes
  • lack of tearing
• Assessment Questions to Ask


  • how many times a child has voided
  • how many diapers have been wet in the past 24 hours and whether this is less than usual
  • current weight with past weight measurements
• Examples of nursing diagnoses

  • Impaired parenting related to interference with establishing the parent-infant bond
  • Interrupted family processes related to a chronic illness in child
  • Risk for deficient fluid volume related to chronic diarrhea
  • Imbalanced nutrition, less than body requirements, related to malabsorption of necessary nutrients
  • Situational low self-esteem related to feelings of being different resulting from special dietary restrictions
• Digestion


  occurs the same in children and infants as it does in adults beginning with the mouth, where food is broken down into small particles and mixed with saliva. Digestion continues in the stomach and small intestine.
• Esophagus


  pierces the diaphragm to serve as a passageway to the stomach
• Gastroesophageal (cardiac) sphincter

  A section of circular muscle at the junction of the esophagus and the stomach
• Newborns


  This sphincter is immature and allows fluid to regurgitate into the esophagus (gastroesophageal reflux)
• Pyloric sphincter


  At the distal end of the stomach, a muscular channel that can become narrowed (stenosed) in some infants, preventing food from flowing out of the stomach freely
• Diagnostic and Therapeutic Techniques

  • endoscopy
  • small intestine wireless enteroscopy (capsule endoscopy)
  • colonoscopy
  • radiology studies
• Children

  • Need good preparation for all of these procedures because they are all potentially frightening
  • If children receive conscious sedation or anesthesia for a procedure, they need preparation for this as well as for the actual procedure
  • They should receive a clear and simple explanation of what will occur and be reassured that the parent can remain with them until they fall asleep
  • Involvement of child life specialists can be helpful for anxious children
• Fluid, electrolyte, and acid-base imbalances

  The gastrointestinal tract is the main route by which substances are taken into the body, it can be a major source of fluid and electrolyte loss if vomiting or diarrhea occurs
• Fluid distribution in body

  • Intracellular (within cells), 35% to 40% of body weight
  • Interstitial (surrounding cells), 20% of body weight
  • Intravascular (blood plasma), 5% of body weight
• Body water accounts for % of total weight

  • Adults: 60%
  • Infants: 75% to 80%
  • Children: 65% to 70%
• ECF portion of total body weight

  • Adults: 45%
  • Infants: 30%
  • Children: 25%
• Isotonic dehydration


  Water and salt are lost in proportion to each other
• Hypertonic dehydration

  Water is lost in a greater proportion than electrolytes
• Hypotonic dehydration


  There is a disproportionately high loss of electrolytes in proportion to fluid loss
• Overhydration


  Excessive body fluid intake, can be as serious as dehydration and generally occurs in children who are receiving IV fluid
• Vomiting and Diarrhea


  Can lead to a disturbance in hydration, electrolyte, or acid-base balance, and in many infants can be more threatening to the child than the primary disease
• Causes of vomiting

  • Viral infection
  • Bacterial infection
  • Obstruction
  • Increased intracranial pressure
  • Metabolic disease
• Acute diarrhea


  Usually associated with infection
• Chronic diarrhea


  More likely related to a malabsorptive or inflammatory cause
• Common viral pathogens that invade the GI tract

  • Rotaviruses
  • Adenoviruses
• Common bacterial pathogens

  • Campylobacter jejuni
  • Salmonella
  • Clostridium difficile
  • Escherichia coli
• Mild diarrhea

  Anorectic, irritable, and appear unwell; fever of 101° to 102°F (38.4° to 39.0°C) may be present; 2 to 10 loose, watery bowel movements per day; dry mucous membranes and warm skin, rapid pulse
• Therapeutic management of mild diarrhea


  Offer an oral rehydration solution like Pedialyte in small amounts, continue breastfeeding for infants, administer probiotics, and reduce elevated temperature
• Severe diarrhea


  Infants appear obviously ill, with high fever, weak and rapid pulse and respirations, pale and cool skin, depressed fontanelle, sunken eyes, poor skin turgor, liquid green stool perhaps mixed with mucus and blood passed with explosive force every few minutes, scanty and concentrated urine output, elevated hematocrit, hemoglobin, and serum protein levels, metabolic acidosis
• Common methods to prevent contracting an infection from these organisms

  • Salmonellosis
  • Listeriosis
  • Shigellosis (Dysentery)
  • Staphylococcal Food Poisoning
• Gastroesophageal reflux

  The regurgitation of stomach secretions into the esophagus through the lower esophageal (cardiac) sphincter, a normal physiologic process that occurs throughout the day in infants, children, and adults
• Gastroesophageal reflux in infants

  Occurs due to the immaturity of the lower esophageal sphincter, which allows easy regurgitation of gastric contents into the esophagus, very common during infancy with about 70% of infants affected, usually requires no treatment, starts within 1 week after birth and may be associated with a hiatal hernia
• Gastroesophageal reflux disease (GERD)


  Diagnosed when infants develop complications from reflux such as irritability, failure to thrive, esophagitis, and, in severe cases, aspiration pneumonia, wheezing, and apnea
• Pyloric stenosis

  Hypertrophy or hyperplasia of the muscle surrounding the sphincter between the stomach and duodenum, making it difficult for the stomach to empty, occurs most frequently in first-born White male infants, the exact cause is unknown but multifactorial inheritance is likely
• Assessment of pyloric stenosis

  At 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding, the vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 ft
• Peptic ulcer disease


  Shallow excavation formed in the mucosal wall of the stomach, pylorus, or duodenum, occurring in only 1% to 2% of children and more frequently in males than females, includes gastritis and is more commonly seen in childhood, in infants ulcers tend to occur in the stomach while in adolescents they are usually duodenal
• Causes of peptic ulcer disease

  Primary form caused by infection with H. pylori bacteria, secondary form that follows severe stress or chronic ingestion of medications
• Projectile vomiting

  Vomiting that projects as much as 3 to 4 ft
• Onset of projectile vomiting

  1. Begins 4 to 6 weeks after birth

  2. Occurs almost immediately after each feeding

  3. Grows increasingly forceful
• Peptic ulcer disease

  Shallow excavation formed in the mucosal wall of the stomach, the pylorus, or the duodenum
• Peptic ulcer disease

  • Occurs in only 1% to 2% of children
  • More frequently in males than females
  • Includes gastritis (irritation of the lining of the stomach or duodenum)
  • More commonly seen in childhood
• Peptic ulcers in infants


  Tend to occur in the stomach