NSG 101 Nursing Care Of A Family When A Child Has Gastrointestinal Problems Study Guide_2021

NSG 101 NURSING CARE OF A FAMILY WHEN A CHILD HAS GASTROINTESTINAL PROBLEMS STUDY GUIDE 2021 Anatomy and Physiology of the GastrointestinalSystem: • Digestion begins in the mouth, where food is broken down into small particles and mixed with saliva from the sublingual, submandibular,and parotid glands. • Gagging and swallowing reflexes are present even in newborns, to prevent aspiration withswallowing • Digestion continues in the stomach, and smallintestine, the same as adults. • The esophagus pierces the diaphragm to serveas a passageway to the stomach. • Occasionally, an infant is born with a portion ofthe bowel or stomach protruding through the diaphragm’s esophageal opening. - Hiatal or Diaphragmatic Hernia • At the junction of the esophagus and the stomach is the gastroesophageal (cardiac) sphincter. In some newborns, this sphincter is solax that fluid regurgitates into the esophagus - gastroesophageal reflux • At the distal end of the stomach is the pyloricsphincter. In some infants, this valve is narrowed (stenosed), preventing food from flowing out of the stomach freely - pyloric stenosis • The small intestine is divided into threesections: - duodenum, jejunum, and ileum • The large intestine is divided into the cecum, ascending colon, transverse colon, descendingcolon, sigmoid colon, and rectum • The appendix, which frequently becomes diseased in children, is attached to the cecum. Diagnostic and Therapeutic Techniques3 Common diagnostic procedures 1. A lighted optical instrument to see inside the body. It allows the physician to get a clear look to confirm normal structures or look at any abnormalities of the nasal structures, upper andlower throat, base of the tongue and vocal cords. - Fiberoptic endoscopy 2. A colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum. During acolonoscopy, a long, flexible tube (colonoscope) is inserted intothe rectum. A tiny video camera at the tip of thetube allows the doctor to view the inside of the entire colon - Colonoscopy 3. A barium enema is a type of X-ray imaging testthat allows doctors to examine your lowerNSG 101 NURSING CARE OF A FAMILY WHEN A CHILD HAS GASTROINTESTINAL PROBLEMS STUDY GUIDE 2021 intestinal tract. It involves delivering a contrast solution that contains the metallic element barium into your rectum while a technician takes X-ray images of the area. The barium solution will be delivered using an enema — a process in which your doctor pushes a liquid into your rectum through your anus. The bariumsolution helps to improve the quality of the X- ray images by highlighting certain areas of tissue. - Barium Enema Fluid, Electrolyte, and Acid-Base Imbalance • GI system plays a major role in maintaining fluid,electrolyte, and acid– base balance. • It is the main route by which substances are taken into the body and can be a major sourceof loss if vomiting or diarrhea occurs. FLUID BALANCE • Retaining fluid is of greater importance in thebody chemistry of infants than that of adults because fluid constitutes a greater fraction of the infant’s total weight • In adults, body water accounts for approximately 60% of total weight. In infants, itaccounts for as much as 75% to 80% of total weight in children • Fluid is distributed in 3 body compartments: 1. intracellular (within cells), 35% to 40% of bodyweight; 2. interstitial (surrounding cells and bloodstream),20% of body weight; and 3. intravascular (blood plasma), 5% of bodyweight. • The interstitial and the intravascular fluid together are often referred to as the extracellular fluid (ECF), totaling 25% of bodyweight. • In infants, the extracellular portion is much greater, totaling up to 45% of total body weight. • In young children, this amount is 30%; • in adolescents, it is 25%. • Fluid is normally obtained by the body throughoral ingestion of fluid and by the water formedin the metabolic breakdown of food • Primarily, fluid is lost from the body in urine andfeces. Minor losses, insensible losses, occur from evaporation from skin and lungs and from saliva • Infants do not concentrate urine as well as adults because their kidneys are immature. As a result, they have a proportionally greater loss of fluid in their urine • In infants, the relatively greater surface area to body mass also causes a greater insensible loss.NSG 101 NURSING CARE OF A FAMILY WHEN A CHILD HAS GASTROINTESTINAL PROBLEMS STUDY GUIDE 2021 • Fluid intake is altered when a child is nauseatedand unable to ingest fluid or is vomiting and losing fluid ingested. When diarrhea occurs, or when a child becomes diaphoretic because of fever, the fluid output can be markedly increased. Dehydration occurs when there is anexcessive loss of body water. FLUID IMBALANCES - Under most circumstances, water and salt arelost in proportion to each other - isotonic dehydration - Occasionally, water is lost out of proportion tosalt or water depletion or - hypertonic dehydration occurs - Occasionally, electrolytes are lost out ofproportion to water - hypotonic dehydration 1. Isotonic Dehydration - When a child’s body loses more water thanit absorbs (as with diarrhea) or absorbs lessfluid than it excretes (as with nausea and vomiting), the first result will be a decreasein the volume of blood plasma, the body compensates for this rapidly by shifting interstitial fluid into the blood vessels - The composition of fluid in these two spaces is similar, so the replacement by thisfluid does not change plasma composition. However, this replacement phenomenon can proceed only until the interstitial fluid reserve is depleted—a danger point for a child because it is difficult for the body to replace interstitial fluid from the intracellular fluid. - If an infant continues to lose fluid after thispoint, the volume of the plasma will continue to fall rapidly, resulting ultimatelyin cardiovascular collapse. 2. Hypertonic Dehydration - Water is lost in a greater proportion than electrolytes when fluid intake decreases in conjunction with a fluid loss increase, as might occur in a child with nausea (preventing fluid intake) and fever (increased fluid loss through perspiration); profuse diarrhea, where there is agreater loss of fluid than salt; or renal disease associated with polyuria such as nephrosis withdiuresis - Fluid loss is out of proportion to the loss of electrolytes, and, with such an increased loss offluid, electrolytes concentrate in the blood. Fluid shifts from the interstitial and intracellularspaces into the bloodstream š Dehydration occurs in the interstitial and intracellular compartmentsNSG 101 NURSING CARE OF A FAMILY WHEN A CHILD HAS GASTROINTESTINAL PROBLEMS STUDY GUIDE 2021 - The red blood cell count and hematocrit will beelevated because the blood is more concentrated than usual. Levels of electrolytessuch as sodium, chloride, and bicarbonate will also likely be increased. 3. Hypotonic Dehydration - With hypotonic dehydration, there is a disproportionately high loss of electrolytesrelative to fluid lost. The plasma concentration of sodium and chloride will be low. - This could result from excessive loss of electrolytes by vomiting or from low intakeof salt associated with extreme losses through diuresis - When low levels of electrolytes occur, theosmotic pressure in extracellular spaces decreases. The kidneys begin to excrete more fluid to decrease ECF volume and bring the proportion of electrolytes and fluid back into line. This may lead to a secondary extracellular dehydration. Classifications of Dehydration 4. Overhydration • Overhydration may be as serious as dehydration. It generally occurs in children whoare receiving IV fluid • The excess fluid in these instances is usually extracellular. The condition is serious becausethe ECF overload can lead to cardiovascular overload and cardiac failure. • When large quantities of salt-poor fluid (hypotonic solutions) such as tap water are ingested or are given by enema, the body transfers water from the extracellular space intothe intracellular space to restore normal osmotic relationships. This transfer results in intracellular edema manifested by headache, nausea, vomiting, dimness and blurring of vision, cramps, muscle twitching, and seizures. ISOTONIC HYPERTONIC HYPOTONIC Thirst Mild Moderate Extreme Skin turgor Poor Very poor Moderate Skin consistency Dry Clammy Moderate Skin temperature Cool Cool Warm Urine output Decrease d Decreased Decreased Activity Irritable Lethargic Very lethargic Serum Normal Reduced IncreasedNSG 101 NURSING CARE OF A FAMILY WHEN A CHILD HAS GASTROINTESTINAL PROBLEMS STUDY GUIDE 2021 ACID-BASE IMBALANCE • The GI system often is involved with 2 severe acid–base imbalances: metabolic acidosis andmetabolic alkalosis. • These imbalances occur with severe diarrhea orvomiting. • When dealing with acid–base balance, a key component is pH. The abbreviation “pH” refersto two French words that mean the “power of hydrogen.” pH denotes whether a solution is acid or alkaline, determined by the proportionof hydrogen (H+) ions in relation to hydroxide (OH-) ions • A solution is acid (pH below 7.0) if it contains proportionately more H+ ions than OH- ions. Itis alkaline (pH above 7.0) if the proportion of OH- ions exceeds that of H+ ions 1. Metabolic Acidosis - Metabolic acidosis may result from diarrhea. When diarrhea occurs, a great deal of sodium islost with stool. This excessive loss of Na+, in turn, causes the body to conserve H+ ions in anattempt to keep the total number of positive and negative ions in serum balanced - As a result, a child becomes acidotic as the number of H+ions in the blood increases proportionately over the number of OH- ionspresent - With metabolic acidosis, arterial blood gas analysis will reveal a decreased pH (under 7.35) and a low HCO3 value (near or below 22 mEq/L). The lower the HCO3 value is, presumably the more Na+ ions that have been lost or the more extensive the diarrhea has been. - - -