PEDs GI, GU, Musculoskeletal Study
Questions and Correct Answers
Dehydration ✅•Types of dehydration- isotonic, hypotonic, hypertonic
•Degrees of dehydration-mild, moderate, severe
•Diagnostic evaluation-clinical manifestations, labs
•Therapeutic management
•Oral rehydration solution
•Parenteral fluid therapy
•Nursing considerations- VS, weight checks
Daily maintenance fluid requirements ✅•Calculate the child's weight in kilograms
•Allow 100 ml/kg for the first 10 kg of body weight
•Allow 50 ml/kg for the second 10 kg of body weight
•Allow 20 ml/kg for the remaining kilograms of body weight
Clinical manifestations of GI dysfunction ✅•Impaired functional integrity
•Failure to thrive
•Spitting up, regurgitation
•Constipation
•GI losses of fluid; absorption disorders
•Nausea, vomiting
•Diarrhea
•GI track anomalies
•Inflammatory disorders
•Crohn disease; liver failure
•Fever
Diarrhea ✅•Acute diarrhea is the leading cause of illness in children younger than 5
years of age
•In developing countries, 20% of all deaths are related to diarrhea and dehydration
•Acute infectious diarrhea has a variety of causative organisms
•Various types
•Acute, chronic, intractable, nonspecific diarrhea
Diarrheal disturbances ✅Diarrheal disturbances
-Gastroenteritis
•Rotovirus infection-mild to moderate fever, most common cause
•Bacterial pathogens- e coli, salmonella
•Antibiotic-associated etiology- C diff
Diarrhea management ✅•Diagnostic evaluations
•Therapeutic management
•Oral rehydration therapy- effective & safe
,•Continue to Breastfeed/Formula
•Prevention
•Nursing considerations-education for parents, skin care
Constipation ✅•An alteration in frequency, consistency, or ease of passage of stool
•May be secondary to other disorders
•Idiopathic (functional) constipation has no known cause
•Chronic constipation may be due to environmental or psychosocial factors
Constipation in newborn period ✅•First meconium should be passed within 24 to 36
hours of life; if not, assess for
•Hirschsprung disease
•Hypothyroidism
•Meconium plug or meconium ileus (cystic fibrosis)
Constipation in infancy ✅•Often related to diet
•Constipation in exclusively breastfed infants is almost unknown
•Infrequent stool may occur because of minimal residue from digested breast milk
•Formula-fed infants may develop constipation
•Nursing management-increase Fruit and Vegetables
Constipation in childhood ✅•Often a result of environmental changes or control over
body functions
•Encopresis is inappropriate passage of feces, often with soiling
•May result from stress
•Relationship to urinary tract infections
•Nursing management
Hirschsprung disease ✅•Also called congenital aganglionic megacolon
•Mechanical obstruction from inadequate motility of the intestine
•Incidence is 1 in 5000 live births; more common in males and in children with Down
syndrome
•Absence of ganglion cells in colon
Clinical manifestations of hirchsprung disease ✅•Accumulation of stool with distention
•Failure of internal anal sphincter to relax
•Enterocolitis may occur
Dx evaluation of hirschsrung disease ✅•X-ray, barium enema
•Anorectal manometric examination
•Confirm the diagnosis with rectal biopsy
Therapeutic management of hirsschsprung disease ✅•Surgery
•Preoperative care
•Postoperative care
, •Discharge planning and care
•Two stages
•Temporary ostomy
•Second stage is the pull-through procedure
Vomiting ✅•Nonbilious and bilious types
•Often accompanied by nausea and vomiting
•Therapeutic management-ORS, parenteral therapy, antimetics
•Nursing management
**Bilious- green
Color and consistency can indicate cause
Curtailed- poor gastric emptying or high obstruction in intestines
Bilious- suggests bowel obstruction
Increase carbs, avoid reclining position to avoid aspiration
Ondasteron
Gastroesophageal reflux ✅•Defined as transfer of gastric contents into the esophagus
•Predisposition and prevalence-occurs at 4 months old
•Frequency and persistency may make it abnormal
•Diagnosis- history and Exam, 24-hr intraesophageal study
•Management-depends on severity, H2-receptors, ppis
•Nursing management
Acute appendicitis ✅•Etiology and pathophysiology-obstruction of the lumen of the
appendix
•Diagnostic evaluation- Mcburney point, CBC, UA, CT/MRI
•Therapeutic management-
•Ruptured appendix-can occur w/I 48 hours, Peritonitis, Ileus
•Prognosis- Recovery rate good after surgery
•Nursing considerations
•Postoperative care- Bowel Sounds, drain Mgmt, Pain Mgmt
Meckel diverticulum ✅•Most common congenital malformation of the GI tract
•Occurs in 2% to 4% of the population
•Pathophysiology-bleeding, obstruction, or inflammation
•Diagnostic evaluation- Meckel Scan, CT, MRI
•Therapeutic management-surgery
•Nursing management-IVF, NG
Inflammatory bowel disease ✅•Includes ulcerative colitis (UC) and Crohn disease
•Etiology and pathophysiology
•Diagnostic evaluation-ESR, CBC, CRP, Stool Samples
•Therapeutic management
•Goal is to induce and maintain remission
•Nutritional support- high protein, high calorie
•Surgical interventions-subtotal colectomy, ileostomy
