TLO 2.4 Gastrointestinal/Bowel Child Flashcards
Functional differences in the colon of a child
Large intestine of children is shorter than adult
Less epithelial lining to absorb water from feces resulting in softer stool and more rapid peristaltic waves
Fever increases the rate of peristalsis
Stool frequency in infants, bottle vs breast, color
Bottle: 1-3 per day
Breast: 4-6 per day
Color: dark green first week then yellow
Causes of constipation in children
Changes in diet Dehydration Lack of exercise Emotional stress Medication Pain from anal fissure Excessive dairy intake
Diagnosis of constipation
Abdominal x-ray: enlarge rectum with stool and gas present
Rectal exam: rarely performed r/t emotional impact
Thorough history usually sufficient to diagnosis
Constipation treatment
Best through prevention
Dietary modifications:
increase water and fiber intake
decrease sugar and milk intake
Teach:
sit child on toilet 5-10 min approx. 30 min after breakfast and dinner
offer charts and prized to reward success
proper use of enema is physician suggest
Infectious Gastroenteritis (infectious diarrhea): causes
Rotavirus: most common viral cause
Giardia: most common pathogen in daycare setting
Communicable diarrhea
Massive fluid and electrolyte loss
Sepsis
Death
Giardia: incubation, spread, s/s, diagnosis, treatment
Incubation: 1-2 weeks. Most common parasitic diarrhea
Spread in contaminated food and water
S/S: afebrile, abdominal distention, cramps and gas
Diagnosis: ova and parasites found in stool
Treatment: Flagyl x7 days
Contact precautions
Rotavirus: incubation, spread, s/s, diagnosis, treatment
Incubation: 1-3 days. Common in winter months
Spread by fecally contaminated food
S/S: vomiting, diarrhea, low grade fever. Last 3-7 days
Diagnosis: virus in stoll detected enzyme immunoassay
Treatment: no pharmacologic treatment, supportive care, maintain hydration, rotavirus vaccine at 2, 4, 6 months
Contact precautions
Gastrointestinal/bowl assessment finding?
Assess hydration status Dry mucus membranes Poor skin turgor, crying without tears Sunken fontanel in infants Increased respiratory rate r/t metabolic acidosis
Gastroenteritis teaching
Wash hands frequently
Child to use separate bathroom if available
Administer PO fluids to rehydrate
Avoid fruit juices, cola, tea, sugary drinks, sports drinks
Continue breast mild and formula
No OTC without asking doctor
Call PCP when: diarrhea worsens/blood s/s dehydration vomiting increases and cannot keep down any fluids child reports severe abdominal pain child hasn't urinated for over 6 hours
Intussusception, what is it?
Folding of one part of the intestine into another causing bowel obstruction. Occurs around 3-6 months
Relatively rare usually but when occurs it is and emergency
Recurrence does sometimes occur
Causes of intussusception?
Unknown
Contributing factors:
Preexisting URI or other vial infection
Pathologic condition within the colon (mass/defect)
More common in boys than girls
Children with cystic fibrosis are more susceptible
Intussusception diagnosis and prognosis?
X-ray: gas patterns like bowel obstructions
Ultrasound: identifies location of intussusception
Barium or air enema: reduces the obstruction (both diagnostic and treatment) 80-95% effective
Prognosis: death is uncommon, 80% success with nonsurgical
Intussusception assessment
History reveals sudden crying and flexing legs in infants
Pain that come and goes and progresses to constant severe
Bloody mucus currant jelly stools/diarrhea, vomiting
Sausage shaped abdominal mass
Intussusception assessment >12-24 hours
Shock Sepsis Listlessness Fever Decrease LOC Increased heart rate Blood pressure changes
