nursing care of the child with a gastrointestinal disorder
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Nursing Care of the Child with a Gastrointestinal Disorder. Normal Gastrointestinal System. Disorders of Development. Cleft Lip and Cleft Palate. Etiology- Failure of maxillary and median nasal processes to fuse during embryonic development - PowerPoint PPT PresentationTRANSCRIPT
Cleft Lip and Cleft PalateCleft 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
TreatmentTreatment
Surgical repair between 3 and 6 months Multidisciplinary team Reconstruction begins in infancy and can continue
through adulthood. Homecare by the family prior to surgery
Pre-op Nursing CarePre-op Nursing Care
Remind parents that defect is operable- show photographs of corrected clefts
Before After
Post-OpPost-Op Prevent trauma to suture line
Protect site Advance diet as tolerated Maintain upper arm restraints Position supine No hard objects in mouth 7-10 days
Reduce Pain Prevent Infection
Cleanse suture lines as ordered – rinse with water after each feeding.
Call Doctor for any swelling or redness Referral to appropriate team members
Malformation from failure of esophagus to Malformation from failure of esophagus to develop as a continuous tubedevelop as a continuous tube
Upper Esophagus
Trachea
Lower Esophagus
Signs and SymptomsSigns and Symptoms
Excessive amounts of salivation / mucus, frothy bubbles Three “C’s”: Coughing, choking, and cyanosis when fed Food may be expelled through the nose immediately
following the feeding Rattling respirations and frequent respiratory problems
such as aspiration pneumonia Gastric distention, if fistula
Diagnosis and ManagementDiagnosis and Management
Early diagnosis Ultrasound Radiopaque catheter inserted in the esophagus to
illuminate defect on X-ray
Surgical repair Thoracotomy and anastomosis
Post-OpPost-Op
Maintain airway
Maintain nutrition Gastrostomy tube feedings
Prevent trauma
Monitor for potential complications
Monitor weight, growth and developmental achievements
AssessmentAssessment
Most commonly diagnosed upon Newborn Assessment
Symptoms Absence of anorectal canal Failure to pass meconium Presence of anal membrane
OmphaloceleOmphalocele
Herniation of abdominal contents through the umbilical cord. Contents are covered by a translucent sac.
Gastroschisisherniation of abdominal viscera outside the abdominal cavity through a defect in the abdominal wall to the side of the umbilicus. Not covered.
Treatment and Nursing CareTreatment and Nursing Care
Pre-operatively – provide protection of the contents/sac. Cover with warm, sterile, saline-soaked dressings Maintain temperature – esp. with gastroschisis
May choose to replace the gut to the abdomen gradually over several weeks.
May place silo or silastic material
over gut until it returns to the
abdomen. Surgery used to close defect.
Post-op CarePost-op Care
Assess for ileus
Maintain parenteral feedings
Provide support to the parents.
Gastroesophageal Reflux Disease(GERD)
The cardiac sphincter and lower portion of the esophagus are weak, allowing
regurgitation of gastric contents back into the esophagus.
Assessment: InfantAssessment: Infant
Regurgitation almost immediately after each feeding when the infant is laid down
Excessive crying, irritability
Failure to Thrive
Life Threatening Risk / Complications: aspiration pneumonia apnea
DiagnosisDiagnosis
Assess Ph of secretions in esophagus if <7.0 indicates presence of acid
Also diagnosed using Barium Swallow and visualization of esophageal abnormalities
Management & Nursing CareManagement & Nursing Care
Small frequent feedings of predigested formula or thicken the formula
Frequent burping Positioning --prone position- flat prone or head elevated prone. Use
reflux board to keep head elevated.
Avoid excessive handling after feedings. Nissen Fundoplication
Reflux board
MedicationsMedications H2 Histamine receptor antagonists – reduce gastric acidity
Zantac and Pepcid Proton-pump inhibitors
Prevacid Prilosec
Gastric emptying Reglan
Antacids Gaviscon
Diarrhea/GastroenteritisDiarrhea/GastroenteritisSevereSevere
A disturbance of the intestinal tract that alters motility and absorption and accelerates the excretion of intestinal contents.
Most infectious diarrheas in this country are caused by Rotovirus but can be C. Difficele
Clinical ManifestationsClinical Manifestations
Increase in peristalsis Large volume stools Increase in frequency of stools Nausea, vomiting, cramps Increased heart & resp. rate, decreased tearing and
fever
The newborn and infant have a high percentage of body weight comprised of water, especially extracellular fluid, which is lost from the body easily. Note the small stomach size which limits ability to rehydrate quickly.
Treatment & Nursing CareTreatment & Nursing Care
Treat cause Fluid and electrolyte balance Weigh daily Monitor I&O Assess for dehydration Isolate Skin care
Appendicitis
Inflammation of the lumen of the appendix which becomes quickly obstructed causing
edema, necrosis and pain.
Management and Nursing Management and Nursing Care: Pre-OpCare: Pre-Op
NPO IV Comfort measures – semi-fowlers or R side lying Antibiotics Elimination Patient education
**Narcotic pain medications are used minimally so as not mask the signs of appendicitis.
AppendicitisAppendicitis
What is the most common symptom indicating that the appendix may have ruptured?
Management and Nursing Management and Nursing Care: Post-OpCare: Post-Op
NPO Antibiotics Analgesia Patient teaching
Pyloric Stenosis
The pylorus muscle which is at the distal end of the stomach becomes thickened causing
constriction of the pyloric canal between the stomach and the duodenum and obstruction of
the gastric outlet of the stomach.
Treatment and Nursing CareTreatment and Nursing Care
Treatment: Surgery Pyloromyotomy
Post Operative Care: I & O Feeding
Feeding begins with clear liquids containing glucose and electrolytes. Regime example: 8 hours NPO, 10cc sterile water feed X 2. Increase to 15cc X 2, progressing to ½ strength formula, then full strength formula. Observe and record the infant’s response to feeding.
Position with head elevated Assess Surgical site to prevent infection Patient teaching
Critical ThinkingCritical Thinking
A 4 week old infant with a history of vomiting after feeding has been hospitalized with a tentative diagnosis of pyloric stenosis. Which of these actions is priority for the nurse? Begin an intravenous infusion Measure abdominal circumference Orient family to unit Weigh infant
IntussuceptionIntussuception
Most commonly seen in infants 3-12 months Bowel “telescopes” within itself
AssessmentAssessment
Pain Vomiting Stools – resemble currant jelly Dehydration Serious complications
Therapeutic Intervention Therapeutic Intervention
IntussuceptionHydrostatic ReductionSurgery
VolvulusSurgery
Diagnosis & ManagementDiagnosis & Management
Diagnosis History & Physical Barium enema (X-ray) Rectal biopsy- absence of ganglionic cells in bowel
mucosa
Management Surgical intervention
Colostomy Resection Colostomy takedown
Nursing CareNursing Care Pre-op
Cleanse bowel Patient/parent teaching
Post-op NPO Vital Signs – never take a rectal temperature Assessment Patient/parent teaching
Colostomy care Skin care Nutrition
Lactose Intolerance
Inability to tolerate the sugar found in dairy products as a result of an absence or deficiency of lactase.
Signs and Symptoms Signs and Symptoms
The child with celiac disease commonly demonstrates
failure to grow and wasting of extremities. The abdomen can appear large due to intestinal distension and malnutrition
Complications: Hypocalcemia, osteomalacia, osteoporosis, depression.