NSG 101 NURSING CARE OF A FAMILY WHEN A CHILD
HAS GASTROINTESTINAL PROBLEMS STUDY GUIDE
2021
Anatomy and Physiology of
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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.
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