gastoenteritis
inflammation of the stomach and intestines
intestinal lining must be introduced to
bacteria
vitamin k cannot be used until what is established
normal flora
newborns receive vitamin k to support
clotting factors
birth stomach capacity
15-20 ml
stomach capacity by 2nd week of life
90 ml
physical assessment
ht, wt, bowel elimination, routine, last bm, hydration status, inspection of abd, auscultation, percussion, palpation
place child in what pos during GI assessment
comfortable supine pos
CBC
level of anemia from bleeds or deficiencies
liver profile
liver in the inflammatory process
ESR (erythrocyte sedimentation rate)
denotes severity of bowel inflammation
CRP (C-reactive protein)
presence and severity of inflammation
fecal fat collection
demonstrates how the body processes dietary fat
stool examination
presence of ova, parasites, and culture
during a home visit the mother of a 2 week old infant is upset because the child will not drink entire bottle when feeding. what should the nurse emphasize to the mother
infants stomach capacity is 3 oz (90 ml)
reasons for receiving enteral feedings
congenital intestinal function, oral malformations, dysphagia, FTT
nutritionalist determines
caloric needs
risk factors of enteral feedings
aspiration, neurological impairment, inadequate cough
pt teaching guidelines for enteral feedings
mix feeding w solutionsafely administering the solutionworking the feeding tubemaintaining patencymonitor: bloating, diarrhea, constipation, vomit
nasogastric tube (NGT)
short term requirements
gastrostomy tube
extended feeds, surgically placedabdominal wall to the stomach
jejunostomy tube
extended feeds, surgically placedabdominal wall through the stomach into the jejunum, used when the upper GI tract needs to be bypassed
checking residual
slowly aspirate stomach contents for volume remaining in childs stomach. check order for residual amount and return residual to stomach
pt teaching for enteral feedings
check order for feeding procedurewash handsmix feed correctlyattach feeding bag to connective tubingcheck placement of tubecheck for residual feeding solutionflush tubing w 3-10 ml of clean water for patencymonitor child for aspiration
prefeeding
complete order: solution, amt, time, period, frequency, length, residual, medsensure formula is correct and NOT expired
how often should the tubing and bag be changed for feeding
q 24 hr. (daily)
intrafeeding
confirm placement of NGT and patencymonitor: feed for tolerance and aspiration
postfeeding
disconnect tubing and flush NGTmonitor: distension, discomfort, diarrhea, assess tolerance
feeds left at room temp longer than 4 hrs are at risk for
bacterial contamination
vomiting can be caused by
increased intracranial pressurefood allergies and intolerancestoxic substance ingestionchemotherapy
GI disorders causing vomiting are
reverse peristalsis from pyloric sphincter blockesophageal refluxoverdistension gastoenteritis
meds that reduce vomiting by working on the chemoreceptor trigger zone in the medulla
antiemetic
wet burps
spit ups of breast milk, formula, or indigested food
projectile vomiting
pyloric stenosis
do antiemetic meds help w nonretractable N/V
NO
vomit characteristics
blood, bile, mucus, undigested food
what do we look for in dehydration
skin tugormucus membranethirsttachycardia
aspiration interventions for pt w decreased consciousness
NPO for 12-24 hrsupright pospresence of suckingintroduce fluids first- then progressgive meds rectally
fluid imbalance interventions
maintain strict input and output
vomiting+ headache +change in LOC
CNS/metabolic disorder
forceful vomiting
hypertrophic pyloric stenosis
vomiting+fever+diarrhea
infection
vomiting+constipation
anatomic obstruction
vomiting+localized abd pain
appendicitis or pancreatitis
caused by poorly developed or incompetent cardiac sphincter
gastroesophageal reflux disease (GERD)decreased muscle tone
GERD
return of stomach contents through the eosphagus, the acidity of stomach contents can cause pain for the child
how to determine GERD
barium swallow or an upper GI series
meds prescribed to reduce stomach acid
famotidineranitidine
nissens pfundoplication surgery
creates anti-reflux valve using the fungus of the stomach to reduce reflux of stomach acid
diarrhea
increased frequency, decreased consistency of stool
diarrhea is caused by
infection, food allergies, and toxins
isotonic
water and NA are proportional
hypotonic
NA is low, <130
hypertonic
NA is high, >150