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Gastrointestinal Disorders in Pediatric Patients

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Gastrointestinal Disorders in Pediatric Patients Powered By Docstoc
					   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
p
h
o
t
                 Assessment
   Unilateral, bilateral, midline
              Treatment

 Surgical repair done ASAP
 Rule of 10 > 10#, 10 weeks, 10 HGB
 Multidisciplinary team
          Management Pre-op
   Maintain nutrition

   Prevent aspiration
          Pre-op Teaching
 Remind parents that defect is operable-
  show photographs of corrected clefts
 Introduce cup, spoon feeding devices (see
  page 1114 for feeding tips)
 Explain restraints
 Explain Logan Bow
               Post-Op
 Prevent trauma to suture line
 Facilitate breathing
 Maintain nutrition
 Cleanse suture lines as ordered
 Referral to appropriate team members
         Esophageal Atresia


Failure of the esophagus to totally
  differentiate during uterine development.
             Assessment
 Respiratory difficulties
 Drooling
 Coughing, choking
 Gastric distention
 Hx of ??? during pregnancy?
             Management

Early diagnosis
  Ultra sound
  Radiopaque catheter inserted in the esophagus
    to illuminate defect on X-ray
Surgical repair- thoracotomy and
  anastomosis
                 Pre-Op
 Maintain airway
 Keep NPO- administer IV fluids
 Elevate HOB 30 degrees
 Suction PRN
 Prophylactic antibiotics
                   Post-Op
   Maintain airway

   Maintain nutrition

   Prevent trauma
     Gastroesophagial Reflux
             (GER)

The cardiac sphincter and lower portion of
 the esophagus are weak, allowing
 regurgitation of gastric contents back into
 the esophagus.
         Assessment: Infant
 Regurgitation almost immediately after
  each feeding when the infant is laid down
 Excessive crying, irritability
 FTH
 Complications of aspiration pneumonia,
  apnea
         Assessment: Child
 Heartburn
 Abdominal pain
 Cough, recurrent pneumonia
 Dysphagia
               Diagnosis
 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 Care
 Nutritional needs
 Positioning
 Medications
 CPR instruction for parents/caregivers
 Surgery
      Diarrhea/Gastroenteritis
              Severe

 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
           Critical Thinking
 Why is there an increase in incidence of
  diarrhea in lower socio-economic groups?
 Why is there and increase in young
  children?
       Clinical Manifestations
 Increase in peristalsis
 Large volume stools
 Increase in frequency of stools
 Nausea, vomiting, cramps
 Increased heart & resp. rate, decreased
  tearing and fever
              Complications
   Dehydration



   Metabolic Acidosis
                    Diagnosis
   Stool culture

   O&P

   Diagnose Metabolic Acidosis
    Treatment & 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.
      Clinical Manifestations
 Abdominal pain
 Silent abdomen
 Anorexia and nausea
 Diarrhea
 Elevated temperature
 Sudden relief
               Diagnosis
 History and Physical
 Laboratory values
 X-ray or Ultrasound
Management and Nursing Care:
         Pre-Op
 NPO
 IV
 Comfort measures
 Antibiotics
 Thermal therapy
 Elimination
 Patient education
Management and Nursing Care:
         Post-Op
 NPO
 Antibiotics
 Analgesia
 Patient teaching
         Pyloric Stenosis
 Pyloric sphincter
 Incidence
 Possible genetic predisposition
             Assessment
 Vomiting
 Constant hunger and fussiness
 Distended upper abdomen
 Hypertrophied pylorus
 Visible peristaltic waves
               Diagnosis
 History and Physical
 Ultrasound
 Laboratory values
       Management and
        Nursing Care

Fred Ramstedt procedure-
 Pylorotomy via laproscopy
                 Pre-Op


 Hydration and electrolyte balance
 Weigh daily & I and O
 Support of parents
               Post- Op:
 I&O
 Feeding
 Position
 Surgical site
 Patient teaching
                Critical 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
              Intussuception

   Most commonly seen in infants 3-12
    months

   Typically follows what type of illness?
              Assessment

 Pain
 Vomiting
 Stools
 Dehydration
 Serious complications
         Diagnosis


X-ray


Abdominal   ultrasound
       Therapeutic Intervention



Hydrostatic    reduction

   Surgery
               Nursing Care:

   NPO- NG

   Assess

   Monitor stools

   Re-introduce food
       Hirschsprung’s Disease




Congenital disorder of nerve cells in lower colon
                  Assessment
   Failure to pass meconium

   Vomiting

   Bowel assessment

   Breath

   Older child
                  Diagnosis

   History & Physical

   Barium enema (X-ray)

   Rectal biopsy- absence of ganglionic cells
    in bowel mucosa
            Management


Surgicalintervention
 –Colostomy
 –Resection
Nursing Care:

   Pre-op
    – Cleanse bowel
    – Patient/parent teaching
   Post-op
    – NPO
    – VS
    – Assessment
    – Patient/parent teaching
         Volvulus & Malrotation
   Assessment- pain, bilious vomiting, S & S
                bowel obstruction

   Treatment- surgery to prevent ischemia

   Nursing Care- same as Intussuception and
                 Hirschsprung’s
               Gastroschisis
   Assessment- noted on ultrasound and
                obvious at birth

   Treatment- surgical repair in stages

   Nursing care- support parents loss of
                 “Perfect Child”
               Omphalocele

   Assessment- ultrasound and at birth

   Treatment- surgical repair in stages

   Nursing care- same as for Gastroschisis
            Imperforate Anus
   Assessment- note failure to pass
                meconium, Ultrasound & CT

   Treatment- repeated dilation or surgical
           intervention dependent on extent

   Nursing Care- note skin dimples or stool in
                 urine or vagina
           Umbilical Hernia
 Assessment- abdominal muscle of NB does
          not meet around umbilical ring
 Treatment- resolve by age 1 yr. Surgical if
          not resolved by 5 years or
          becomes strangulated or enlarges
 Nursing care- Binding not effective.
          Monitor for obstruction or
          strangulation
      Failure to Thrive (FTH)
 Assessment- low growth for age,
          developmental delays, apathy
 Diagnosis- History to determine organic-
               vs- non-organic
 Nursing Care- Teaching on nutrition
               feeding techniques, feeding
               cues, praise
 Community resources
    Helminths/Parasitic Disorders
   Assessment- parasites identified in stool

   Treatment- oral medications specific to
                helminth

   Nursing care- prevention education,
              Celiac Disease
   Assessment- Growth pattern, GI pattern

 Treatment- Dietary restrictions
 Nursing Care- monitor for dehydration,
          encourage compliance with
          dietary restrictions, provide
          support groups for patient and
          caregiver
Please contact me with any questions or
     concerns regarding my lectures



       Marlene Meador RN, MSN
       mmeador@austincc.edu

				
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