gastrointestinal disorders in pediatric patients
DESCRIPTION
Gastrointestinal Disorders in Pediatric Patients. Marlene Meador RN, MSN Fall 2006. Cleft Lip and Cleft Palate. Etiology- Failure of maxillary and median nasal processes to fuse during embryonic development Remember the psycho-social implications for these children and families. photos. - PowerPoint PPT PresentationTRANSCRIPT
Gastrointestinal Gastrointestinal Disorders in Pediatric Disorders in Pediatric
PatientsPatientsMarlene Meador RN, MSNMarlene Meador RN, MSN
Fall 2006Fall 2006
Cleft Lip and Cleft PalateCleft Lip and Cleft Palate
Etiology- Failure of maxillary and Etiology- Failure of maxillary and median nasal processes to fuse median nasal processes to fuse during embryonic developmentduring embryonic development
Remember the psycho-social Remember the psycho-social implications for these children and implications for these children and
families families
pphhoottooss
AssessmentAssessment
Unilateral, bilateral, midlineUnilateral, bilateral, midline
TreatmentTreatment
Surgical repair done ASAPSurgical repair done ASAP Rule of 10 > 10#, 10 weeks, 10 HGBRule of 10 > 10#, 10 weeks, 10 HGB Multidisciplinary teamMultidisciplinary team
Management Pre-opManagement Pre-op
Maintain nutrition Maintain nutrition
Prevent aspirationPrevent aspiration
Pre-op TeachingPre-op Teaching
Remind parents that defect is Remind parents that defect is operable- show photographs of operable- show photographs of corrected cleftscorrected clefts
Introduce cup, spoon feeding devices Introduce cup, spoon feeding devices (see page 1114 for feeding tips) (see page 1114 for feeding tips)
Explain restraints Explain restraints Explain Logan BowExplain Logan Bow
Post-OpPost-Op
Prevent trauma to suture linePrevent trauma to suture line Facilitate breathingFacilitate breathing Maintain nutritionMaintain nutrition Cleanse suture lines as orderedCleanse suture lines as ordered Referral to appropriate team Referral to appropriate team
membersmembers
Esophageal AtresiaEsophageal Atresia
Failure of the esophagus to totally Failure of the esophagus to totally differentiate during uterine differentiate during uterine development.development.
AssessmentAssessment
Respiratory difficultiesRespiratory difficulties Drooling Drooling Coughing, chokingCoughing, choking Gastric distention Gastric distention Hx of ??? during pregnancy?Hx of ??? during pregnancy?
Management Management
Early diagnosisEarly diagnosisUltra soundUltra sound
Radiopaque catheter inserted in the Radiopaque catheter inserted in the esophagus to illuminate defect on X-rayesophagus to illuminate defect on X-ray
Surgical repair- thoracotomy and Surgical repair- thoracotomy and anastomosisanastomosis
Pre-OpPre-Op
Maintain airway Maintain airway Keep NPO- administer IV fluidsKeep NPO- administer IV fluids Elevate HOB 30 degreesElevate HOB 30 degrees Suction PRNSuction PRN Prophylactic antibioticsProphylactic antibiotics
Post-OpPost-Op
Maintain airwayMaintain airway
Maintain nutritionMaintain nutrition
Prevent trauma Prevent trauma
Gastroesophagial Reflux Gastroesophagial Reflux (GER)(GER)
The cardiac sphincter and lower The cardiac sphincter and lower portion of the esophagus are weak, portion of the esophagus are weak, allowing regurgitation of gastric allowing regurgitation of gastric contents back into the esophagus.contents back into the esophagus.
Assessment: InfantAssessment: Infant
Regurgitation almost immediately Regurgitation almost immediately after each feeding when the infant is after each feeding when the infant is laid downlaid down
Excessive crying, irritability Excessive crying, irritability FTHFTH Complications of aspiration Complications of aspiration
pneumonia, apneapneumonia, apnea
Assessment: ChildAssessment: Child
HeartburnHeartburn Abdominal painAbdominal pain Cough, recurrent pneumoniaCough, recurrent pneumonia DysphagiaDysphagia
DiagnosisDiagnosis
Assess Ph of secretions in esophagus Assess Ph of secretions in esophagus if <7.0 indicates presence of acidif <7.0 indicates presence of acid
Also diagnosed using Barium Swallow Also diagnosed using Barium Swallow and visualization of esophageal and visualization of esophageal abnormalities abnormalities
Management & Nursing Management & Nursing CareCare
Nutritional needsNutritional needs PositioningPositioning Medications Medications CPR instruction for CPR instruction for
parents/caregiversparents/caregivers Surgery Surgery
Diarrhea/GastroenteritisDiarrhea/GastroenteritisSevereSevere
A disturbance of the intestinal tract A disturbance of the intestinal tract that alters motility and absorption that alters motility and absorption and accelerates the excretion of and accelerates the excretion of intestinal contents.intestinal contents.
Most infectious diarrheas in this Most infectious diarrheas in this country are caused by Rotoviruscountry are caused by Rotovirus
Critical ThinkingCritical Thinking
Why is there an increase in incidence Why is there an increase in incidence of diarrhea in lower socio-economic of diarrhea in lower socio-economic groups?groups?
Why is there and increase in young Why is there and increase in young children?children?
Clinical ManifestationsClinical Manifestations
Increase in peristalsisIncrease in peristalsis Large volume stoolsLarge volume stools Increase in frequency of stoolsIncrease in frequency of stools Nausea, vomiting, crampsNausea, vomiting, cramps Increased heart & resp. rate, Increased heart & resp. rate,
decreased tearing and fever decreased tearing and fever
ComplicationsComplications
DehydrationDehydration
Metabolic AcidosisMetabolic Acidosis
DiagnosisDiagnosis
Stool cultureStool culture
O&PO&P
Diagnose Metabolic AcidosisDiagnose Metabolic Acidosis
Treatment & Nursing CareTreatment & Nursing Care
Treat causeTreat cause Fluid and electrolyte balanceFluid and electrolyte balance Weigh dailyWeigh daily Monitor I&OMonitor I&O Assess for dehydrationAssess for dehydration IsolateIsolate Skin careSkin care
AppendicitisAppendicitis
Inflammation of the lumen of the Inflammation of the lumen of the appendix which becomes quickly appendix which becomes quickly obstructed causing edema, necrosis obstructed causing edema, necrosis and pain. and pain.
Clinical ManifestationsClinical Manifestations
Abdominal painAbdominal pain Silent abdomenSilent abdomen Anorexia and nauseaAnorexia and nausea DiarrheaDiarrhea Elevated temperatureElevated temperature Sudden reliefSudden relief
DiagnosisDiagnosis
History and PhysicalHistory and Physical Laboratory valuesLaboratory values X-ray or UltrasoundX-ray or Ultrasound
Management and Nursing Management and Nursing Care: Pre-OpCare: Pre-Op
NPONPO IVIV Comfort measuresComfort measures AntibioticsAntibiotics Thermal therapyThermal therapy EliminationElimination Patient educationPatient education
Management and Nursing Management and Nursing Care: Post-OpCare: Post-Op
NPONPO AntibioticsAntibiotics AnalgesiaAnalgesia Patient teachingPatient teaching
Pyloric StenosisPyloric Stenosis
Pyloric sphincterPyloric sphincter IncidenceIncidence Possible genetic predispositionPossible genetic predisposition
AssessmentAssessment
VomitingVomiting Constant hunger and fussinessConstant hunger and fussiness Distended upper abdomenDistended upper abdomen Hypertrophied pylorusHypertrophied pylorus Visible peristaltic wavesVisible peristaltic waves
DiagnosisDiagnosis
History and PhysicalHistory and Physical UltrasoundUltrasound Laboratory valuesLaboratory values
Management and Management and Nursing CareNursing Care
FredFred Ramstedt procedure- Ramstedt procedure- Pylorotomy via laproscopyPylorotomy via laproscopy
Pre-OpPre-Op
Hydration and electrolyte balanceHydration and electrolyte balance Weigh daily & I and OWeigh daily & I and O Support of parentsSupport of parents
Post- Op:Post- Op:
I & OI & O FeedingFeeding PositionPosition Surgical siteSurgical site Patient teachingPatient teaching
Critical ThinkingCritical Thinking
A 4 week old infant with a history of A 4 week old infant with a history of vomiting after feeding has been vomiting after feeding has been hospitalized with a tentative diagnosis of hospitalized with a tentative diagnosis of pyloric stenosis. Which of these actions is pyloric stenosis. Which of these actions is priority for the nurse?priority for the nurse?– Begin an intravenous infusionBegin an intravenous infusion– Measure abdominal circumferenceMeasure abdominal circumference– Orient family to unit Orient family to unit – Weigh infantWeigh infant
IntussuceptionIntussuception
Most commonly seen in infants 3-12 Most commonly seen in infants 3-12 monthsmonths
Typically follows what type of illness?Typically follows what type of illness?
AssessmentAssessment
PainPain VomitingVomiting StoolsStools DehydrationDehydration Serious complicationsSerious complications
DiagnosisDiagnosis
X-rayX-ray
Abdominal ultrasoundAbdominal ultrasound
Therapeutic InterventionTherapeutic Intervention
Hydrostatic reductionHydrostatic reduction
Surgery Surgery
Nursing Care:Nursing Care:
NPO- NGNPO- NG
AssessAssess
Monitor stoolsMonitor stools
Re-introduce foodRe-introduce food
Hirschsprung’s DiseaseHirschsprung’s Disease
Congenital disorder of nerve cells in lower Congenital disorder of nerve cells in lower coloncolon
AssessmentAssessment Failure to pass meconiumFailure to pass meconium VomitingVomiting
Bowel assessmentBowel assessment
BreathBreath
Older childOlder child
DiagnosisDiagnosis
History & PhysicalHistory & Physical
Barium enema (X-ray)Barium enema (X-ray)
Rectal biopsy- absence of ganglionic Rectal biopsy- absence of ganglionic cells in bowel mucosacells in bowel mucosa
Management Management
Surgical intervention Surgical intervention –ColostomyColostomy–ResectionResection
Nursing Care:Nursing Care:
Pre-opPre-op– Cleanse bowel Cleanse bowel – Patient/parent teachingPatient/parent teaching
Post-opPost-op– NPONPO– VSVS– AssessmentAssessment– Patient/parent teachingPatient/parent teaching
Volvulus & MalrotationVolvulus & Malrotation
Assessment- pain, bilious vomiting, S Assessment- pain, bilious vomiting, S & S & S bowel obstructionbowel obstruction
Treatment- surgery to prevent Treatment- surgery to prevent ischemiaischemia
Nursing Care- same as Intussuception Nursing Care- same as Intussuception and and Hirschsprung’sHirschsprung’s
GastroschisisGastroschisis
Assessment- noted on ultrasound Assessment- noted on ultrasound and and obvious at birthobvious at birth
Treatment- surgical repair in stagesTreatment- surgical repair in stages
Nursing care- support parents loss of Nursing care- support parents loss of “Perfect Child”“Perfect Child”
OmphaloceleOmphalocele
Assessment- ultrasound and at birthAssessment- ultrasound and at birth
Treatment- surgical repair in stagesTreatment- surgical repair in stages
Nursing care- same as for Nursing care- same as for GastroschisisGastroschisis
Imperforate AnusImperforate Anus
Assessment- note failure to pass Assessment- note failure to pass meconium, Ultrasound & CTmeconium, Ultrasound & CT
Treatment- repeated dilation or surgical Treatment- repeated dilation or surgical intervention dependent on intervention dependent on
extentextent
Nursing Care- note skin dimples or stool Nursing Care- note skin dimples or stool in in urine or vaginaurine or vagina
Umbilical HerniaUmbilical Hernia
Assessment- abdominal muscle of NB Assessment- abdominal muscle of NB does does not meet around umbilical not meet around umbilical ringring
Treatment- resolve by age 1 yr. Surgical Treatment- resolve by age 1 yr. Surgical if if not resolved by 5 years or not resolved by 5 years or
becomes strangulated or enlargesbecomes strangulated or enlarges Nursing care- Binding not effective. Nursing care- Binding not effective.
Monitor for obstruction or Monitor for obstruction or strangulationstrangulation
Failure to Thrive (FTH)Failure to Thrive (FTH)
Assessment- low growth for age, Assessment- low growth for age, developmental delays, developmental delays,
apathyapathy Diagnosis- History to determine Diagnosis- History to determine
organic-organic- vs- non-organic vs- non-organic Nursing Care- Teaching on nutrition Nursing Care- Teaching on nutrition
feeding techniques, feeding techniques, feeding feeding cues, cues, praisepraise
Community resourcesCommunity resources
Helminths/Parasitic Helminths/Parasitic DisordersDisorders
Assessment- parasites identified in Assessment- parasites identified in stoolstool
Treatment- oral medications specific Treatment- oral medications specific to to helminthhelminth
Nursing care- Nursing care- preventionprevention education, education,
Celiac DiseaseCeliac Disease
Assessment- Growth pattern, GI patternAssessment- Growth pattern, GI pattern
Treatment- Treatment- Dietary restrictions Dietary restrictions Nursing Care- monitor for dehydration, Nursing Care- monitor for dehydration,
encourage compliance with encourage compliance with dietary restrictions, provide dietary restrictions, provide support groups for patient and support groups for patient and
caregivercaregiver
Please contact me with any questions Please contact me with any questions or concerns regarding my lecturesor concerns regarding my lectures
Marlene Meador RN, MSNMarlene Meador RN, MSN
[email protected]@austincc.edu