Gastro Intestinal pg 1 of 6
Diabetic Ketoacidosis
-Treatment differences
• True Na: adjust upward 1.6 mlEq/L for every 100 mg/dL increase in blood glucose
• Potential serious CNS effects; 2-5% mortality rate
• Correct dehydfration (there’s more here)
Correction of Hypernatremia
-Rapid fall in serum concentration (Na)
-she did not talk about how this is corrected in kids
Water Intoxication
• Baby: gets it from diluting formula, giving baby water in a bottle
• Kids swimming in pools and drinking the water
• Hazing occurs with older adolescents (college fraternities and such)
Altered Fluid Requirements
• Children have increased needs for
• Fever
• Vomiting, diarrhea
• DI
• High output renal fialure
• TachyP
• Burns (1st 24 horus)
NCLEX
What is the most appropriate treatment for rehydration of an 8-month old child diagnosed with acute diarrhea and
mild dehydration
a) beginning oral rehydration of 50 ml/kg within 4 hours
b) restarting lactose-free formula
c) Encouraging oral intake of clear fluids such as fruit juice and gelatin
d) Feeding the BRAT diet
Decreased needs for fluids in:
• CHF
• Meningitis/neuro injury
• Mechanical ventilation
• Post-operatively
• Oliguric renal failure
Venous Access Devices
• Peripheral: peripheral IV or SL
• Central Venous Access: PICC, tunneled catheters, implanted ports
• Can also be Intraossous!
NCLEX Question!
• Which of the following should the RN include in the plan to start an IV infusion on a 4-year-old child?
• a. Gather supplies in the child’s hospital room
• b. Gather supplies in the treatment room since this is not a “safe place”
• c. Realize that the pt will need to be restrained
• d. Start at the proximal site of the vein and move distally if the first attempt fails
Gastro Intestinal pg 2 of 6
A 6 years old child with bacterial endocarditis requires long term IV antibiotic therapy, and the decision is made to
place a peripherally inserted central catheter (PICC) line so that treatment can continue at home. In explaining the
PICC line to the parents, which of these instruction should the parents be given?
• “Your child will go to the operating room to have the line placed.”
• “The public health nurse will rotate the site every three days.”
• “You will need to make certain the arm board is on at all times.”
• “The PICC line will last several weeks with proper care.”
Kids are different
• Infants prone to hypoglycemia
• Newborn stomach capacity is only 10 to 20 ml….expands to 200ml by one month
• Fast emptying time
• Faster metabolic rate
• Regurgitation is common
Obstructive Disorders
• Hypertrophic Pyloric Stenosis
• Gastro Esophageal Reflux
• Intussusception
• Hirschsprung disease
Pyloric Stenosis
• Incidence and etiology: males > females
• Pathophysiology: pyloric sphinctor is too tight. Food goes into stomach,
but does not empty readily.
• Clinical manifestations: baby cries, nonbilious projectile vomiting b/c no
place for food to go
• Symptoms develop between the 2nd and 4th week of life
• Vomiting increases in frequency and becomes projectile
• Baby feels better after vomiting
• Diagnosis
• History, ultrasound, barium swallow, nuclear scan
• Palpated olive-shaped mass
• Treatment
• Surgery: pyloromyotomy
• After surgery give small feedings, see how it goes
• Nursing management
• Assessment
• Nursing diagnoses prior to surgery
• Inadequate nutrition: less than
• Dehydration
GERD
• Gastro-esophageal reflux
• Clinical manifestations
• Weight loss
• Apnea (ALTE)
• Vomiting/Regurgitation
• Diagnosis
• History
• pH probe: another step….put a little something in the nose, and it
measures the pH of the esophagus; mom has to keep a log
• Barium swallow
NCLEX Question
A 2-month-old male infant is admitted with a
diagnosis of pyloric stenosis. Due to the projectile
vomiting he has had, he’s at risk for:
• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Hyperkalemia
• D. Hypernatremia
NCLEX Question
A six week old male infant is admitted to the peds
floor for persistent and forceful vomiting. On
examination of abdomen, an olive shaped mass
is palpated in the right upper quadrant. The
emesis will most likely consist of:
• Bile
• Blood
• Mucous
• Breast milk or formula
NCLEX Question
A nurse provides feeding instructions to a mother
of an infant diagnosed with gastroesophageal
reflux. To assist in reducing the episodes of
emesis, the nurse tells the mother to:
• A. Thin the feedings by adding water to the
formula .
• B. Thicken the feeding by adding rice cereal
to the formula.
• C. Provide less frequent, larger feeding.
• D. Burp the infant less frequently during
feedings.
Gastro Intestinal pg 3 of 6
• Treatment for GERD
• Dietary modifications: can try to change the diet to lactose-free or various other adjustments; add rice cereal to
give weight to food; switch formula around to see what works; if breastfeeding, mom may need to alter diet
• Positioning: feed upright, back to sleep
• Medications: multiple meds; kids gain weight really fast so you have to go up on the doses of meds.
• GERD Treatment
• Reglan: increases stomach motility; gets the food out of the stomach
• Tagamet/Zantac: stops the acid secretion?
• Protonix: Stops acid from being produced (proton pump inhibitor)
• Surgery
• Nissen Fundoplication; used for kids that are at very serious risk for aspiration; downside is that the child can
no longer vomit effectively, so they will probably also have a GT.
Intussusception (usually occurs around 2 years old)
• Clinical manifestations
• Colicky
• Intermittent abdominal pain
• Vomiting
• Currant jelly stools (red jelly-like, mucus and blood mixed together)
• Diagnosis: parent’s history of child’s symptoms, air enema or barium
enema
• Treatment: air enema or barium enema
• Nursing management & family teaching
• Carefully interview parents for symptoms, frequency, etc...
Hirschsprung’s Disease
• Clinical manifestations
• Fail to pass meconium within 24-48 hours of birth
• Nerve to large intestine hasn’t grown in properly, so not enough nerves
to get stool out...so the colon gets bigger causing a
“megacolon” (aganglionic megacolon)
• Refusal to feed
• Constipation or foul, ribbon-like stools; complete obstruction
• Abdominal distention
• Bile-stained vomitus
• Diagnosis: biopsy of bowel tissue shows lack of ganglions
• Treatment: two-stage surgical procedure
• Colostomy is the first step; the bowel can heal so the nerves can
grow in; colostomy lasts about a year
• Take-down to put the bowel back together.
• Nursing management and family teaching
• Preoperative
• Postoperative
Issues with Physical development
• Cleft lip and palate
• Esophageal atresia with tracheoesophageal fistula
• Imperforate anus
• Hernias - umbilical, inguinal, diaphragmatic
Cleft Lip and Palate
• Incidence and etiology
• Pathophysiology: maxillary and nasal tissue fail to fuse
• Unilateral or bilateral
NCLEX Question
An 18-month-old child is admitted to the pediatric
unit with intussusception. As the nurse is
preparing the child for a barium contrast
reduction, he passes a soft brown stool. What
should the nurse do?
• A. Notify the doctor in order to cancel the
procedure
• B. Prepare the child for emergency surgery
• C. Take vital signs and monitor the abdominal
sounds
• D. Administer an enema to clear the rectal are
for testing
NCLEX Question
A clinic nurse reviews the record of a 3-week-old
infant and notes that the physician has
documented a diagnosis of suspected
Hirschsprung’s disease. The nurse reviews the
assessment findings documented in the record,
knowing that which symptom most likely led the
mother to seek health care for the infant?
• A. Diarrhea
• B. Projectile vomiting
• C. Regurgitation of feedings
• D. Foul-smelling ribbonlike stools
NCLEX Question
Which of the following symptoms is a primary
manifestation of Hirschsprung’s disease in the
newborn?
• a. Failure to pass meconium during the first
24 to 48 hours after birth
• b. High grade fever
• c. Skin turns yellow then brown over the first
48 hours of life
• d. A fine rash over the trunk
Gastro Intestinal pg 4 of 6
Cleft Lip and Palate, cont’d
• Diagnosis: she didn’t go over this
• Treatment: surgery
• Assessment: she didn’t go over this
• Nursing diagnoses: she didn’t go over this
• Preoperative
• Altered nutrition: less than bodyrequirements
• Pot. altered parenting
• Body image
• Risk for aspiration
• Postoperative Care
• Risk of injury and infection: keep suture line clean
• Pain
• Deficient knowledge
• Alteration in Growth & Development
Esophageal Atresia (esophagus doesn’t go into stomach) and
Tracheoesophageal Fistula (look at these pictures)
• Diagnosis
• Baby will be drooling a lot
• History of maternal polyhydramnios (can usually see this on
sonogram)
• Prenatal sonogram
• Radiographic studies
• Treatment = surgery
• Nursing management
• Do not feed them
• Prep for surgery
Constipation
• Functional constipation: no cause found
• Obstipation: extremely long intervals between poops
• Encoporesis: fecal soiling
Anorectal Malformations (there are pictures)
• Incidence and etiology
• Pathophysiology
• Clinical manifestations
• Usually obvious at birth
• Can be normal-appearing anus
• Can see thin translucent anal membrane
• Possible deep anal dimpling
Acute Gastroenteritis
• Incidence and etiology
• Rotavirus –most common, spread by contact
• Pathophysiology: damages endothelial lining of GI tract
• Infection damages epithelial lining of intestine
• Clinical manifestations of Acute Gastroenteritis
• Water-loss stools, N/V
• Abdominal pain
• Dehydration
NCLEX Question
A home care nurse provides instructions to the
mother of an infant with cleft palate regarding
feeding. Which statement if made by the mother
indicates a need for further instructions?
• A. “I will use a nipple with a small hole to
prevent choking.” (want to make the hole
bigger)
• B. “I will stimulate sucking by rubbing the
nipple on the lower lip.”
• C. “I will allow the infant time to swallow.”
• D. “I will allow the infant to rest frequently to
provide time for swallowing what has been
NCLEX Question
An infant just returned to the nursing unit
following a surgical repair of a cleft lip located on
the right side of the lip. The nurse places the
infant in which most appropriate position?
• A. On the right side
• B. On the left side
• C. Prone (this is the position for before
surgery)
• D. Supine
NCLEX Question
To prevent tissue infection and breakdown after
cleft palate or lip repair, the nurse would use
which of the following interventions?
• A. Keep suture line moist at all times
• B. Allow infant to suck on his pacifier
• C. Rinse the infants mouth with water after
each feeding (keeps suture line clean)
• D. Follow orders from the physician not to feed
the infant by mouth
NCLEX Question
A clinic nurse reviews the record of an infant
seen in the clinic. The nurse notes that a
diagnosis of esophageal atresia with
tracheoesophageal fistula is suspected. The
nurse expects to note which most likely sign of
this condition documented in the record?
• A. Severe projectile vomiting (pyloric stenosis)
• B. Coughing at night (maybe GERD)
• C. Choking with feedings
• D. Incessant crying (maybe the intesuception)
Gastro Intestinal pg 5 of 6
• Diagnosis for Acute Gastroenteritis: I think a stool sample is needed
• Treatment
• Nursing management
• Monitor fluid status, electrolytes
• No antiemetic or anti-diarrheal medications
• ORT if mild to moderate dehydration
• BRAT diet not recommended
Biliary Atresia
• Incidence & etiology
• Pathophysiology: biliary tree gets inflamed and then is obliterated
• Hepatic ducts replaced with fibrous tissue
• Clinical manifestations
• Light colored stools b/c there is no bile in them
• Jaundice
• Diagnosis (she did not go over this)
• Treatment
• Kasai procedure; done as soon as possible on infant, attach small intestine to liver
• Liver transplant (most kids end up needing a transplant)
• These kids used to not live past 10 years...but treatments are getting bettter.
• Nursing management (she did not go over this)
Hernias
• Incidence and etiology (she did not go over this)
• Pathophysiology (she did not go over this)
• Umbilical – through belly button
• Inguinal – through inguinal canal or scrotum
• Diaphragmatic – through diaphragm into thoracic cavity
• hear bowel sounds in lung fields
• respiratory distress
• Clinical manifestations
• History of FTT, light colored stools, irritable
• Diagnosis (she did not go over this)
• Treatment (she did not go over this)
• Nursing management (she did not go over this)
Short Bowel Syndrome
• Incidence and etiology
• Kids have damaged bowel d/t treatments (short-bowel resection for necrotizing enterocolitis or some other
bowel-damaging disease)
• Length is < 30% of normal length
• Child does not absorb food correctly, we see them for FTT
• Treatment for SBS
• TPN (may be on TPN for the rest of your life if you have less than 40 cm of bowel)
• Enteral feedings
• Nursing management
• Nutrition
• Prevent infection
• Home nursing care
GI Acute Care Needs
• Orogastric (OG)
• Nasogastric (NG) Tube
• For feeding and/or decompression
Gastro Intestinal pg 6 of 6
Gastrostomy tubes (she did not go over this)
• TPN/Lipids
• Use pump
• Wean on and off
• Glucose checks
NCLEX questions
• A nurse is caring for a newborn infant with a suspected diagnosis of
imperforate anus. The nurse monitors the infant, knowing that which of
the following is a clinical manifestation associated with this disorder?
• A. Sausage-shaped mass palpated in the upper right abdominal
quadrant
• B. Bile-stained fecal emesis
• C. Failure to pass meconium stool in the first 24 hours after birth
• D. The passage of currant jelly-like stools
A 12-year-old boy is admitted to the pediatric unit with complaints of RLQ
abdominal pain and vomiting. When the nurse checks on the child 2 hours
later, he states that the pain has stopped. The nurse should suspect that:
• A. He had indigestion, which has been relieved
• B. He’s afraid of going to surgery
• C. His appendix has ruptured
• D. He has irritable bowel syndrome
NCLEX Question
The student nurse is preparing to give
medications to a 5month old child with an NG
tube. Which of the following statements would
cause the RN to intervene?
A. “The pH of the aspirate was 7.2 this
morning”
B. “I will flush with water before and after giving
each medication”
C. “I will let the infant suck on the pacifier while
giving feedings”
D. “I will put the NG feedings on a separate pole
from the IV pumps”
NCLEX Question
A child has a nasogastric (NG) tube after surgery
for acute appendicitis. The purpose of the NG
tube is which of the following?
• A.Maintain electrolyte balance
• B.Maintain accurate record of output
• C.Prevent spread of infection
• D.Prevent abdominal distention
A nurse is completing discharge teaching for a child and her parents regarding her diet to treat celiac disease. Which
meal selection would be appropriate for this child?
• A. A bologna sandwich on whole wheat bread, a chocolate chip cookie, and a glass of milk
• B. A vegetable pizza, an apple, and a diet cola
• C. A corn tortilla with hamburger and cooked vegetables, and a glass of fruit juice (it has no wheat)
• D. A hot dog on a roll, celery and carrot sticks, and a chocolate milk shake.
A client is taught to eat food high in potassium. Which food choices would indicate that this teaching has been
successful?
• A. Porkchop, Baked acorn squash, brussel sprouts
• B. Chicken breast, rice, and green beans
• C. Roast beef, baked potato, and diced carrots
• D. Tuna casserole, noodles, spinach
Which of the following should the nurse consider when providing support to a family whose infant has just been
diagnosed with biliary atresia?
• A. Liver transplantation may be needed eventually.
• B. Death usually occurs by 6 months of age.
• C. Prognosis for full recovery is excellent.
• D. Children with surgical correction live normal lives.
The nurse assesses the neonate immediately after birth. A tracheoesophageal fistula should be suspected if which of
the following is present?
• A.Jaundice
• B.Bile-stained vomitus
• C.Absence of sucking
• D.Excessive amount of frothy saliva in the mouth (I think)