Gastrointestinal Disorders in Pediatric Patients

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Gastrointestinal Disorders in Pediatric Patients

• Marlene Meador RN, MSN
• Fall 2006

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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

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photos
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Assessment

• Unilateral, bilateral, midline

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Treatment

• Surgical repair done ASAP
• Rule of 10 gt 10, 10 weeks, 10 HGB
• Multidisciplinary team

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Management Pre-op

• Maintain nutrition
• Prevent aspiration

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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

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Post-Op

• Prevent trauma to suture line
• Facilitate breathing
• Maintain nutrition
• Cleanse suture lines as ordered
• Referral to appropriate team members

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Esophageal Atresia

• Failure of the esophagus to totally differentiate
  during uterine development.

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Assessment

• Respiratory difficulties
• Drooling
• Coughing, choking
• Gastric distention
• Hx of ??? during pregnancy?

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Management

• Early diagnosis
• Ultra sound
• Radiopaque catheter inserted in the esophagus to
  illuminate defect on X-ray
• Surgical repair- thoracotomy and anastomosis

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Pre-Op

• Maintain airway
• Keep NPO- administer IV fluids
• Elevate HOB 30 degrees
• Suction PRN
• Prophylactic antibiotics

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Post-Op

• Maintain airway
• Maintain nutrition
• Prevent trauma

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Gastroesophagial Reflux (GER)

• The cardiac sphincter and lower portion of the
  esophagus are weak, allowing regurgitation of
  gastric contents back into the esophagus.

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Assessment Infant

• Regurgitation almost immediately after each
  feeding when the infant is laid down
• Excessive crying, irritability
• FTH
• Complications of aspiration pneumonia, apnea

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Assessment Child

• Heartburn
• Abdominal pain
• Cough, recurrent pneumonia
• Dysphagia

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Diagnosis

• Assess Ph of secretions in esophagus if lt7.0
  indicates presence of acid
• Also diagnosed using Barium Swallow and
  visualization of esophageal abnormalities

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Management Nursing Care

• Nutritional needs
• Positioning
• Medications
• CPR instruction for parents/caregivers
• Surgery

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Diarrhea/GastroenteritisSevere

• 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

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Critical Thinking

• Why is there an increase in incidence of diarrhea
  in lower socio-economic groups?
• Why is there and increase in young children?

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Clinical Manifestations

• Increase in peristalsis
• Large volume stools
• Increase in frequency of stools
• Nausea, vomiting, cramps
• Increased heart resp. rate, decreased tearing
  and fever

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Complications

• Dehydration
• Metabolic Acidosis

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Diagnosis

• Stool culture
• OP
• Diagnose Metabolic Acidosis

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Treatment Nursing Care

• Treat cause
• Fluid and electrolyte balance
• Weigh daily
• Monitor IO
• Assess for dehydration
• Isolate
• Skin care

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Appendicitis

• Inflammation of the lumen of the appendix which
  becomes quickly obstructed causing edema,
  necrosis and pain.

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Clinical Manifestations

• Abdominal pain
• Silent abdomen
• Anorexia and nausea
• Diarrhea
• Elevated temperature
• Sudden relief

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Diagnosis

• History and Physical
• Laboratory values
• X-ray or Ultrasound

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Management and Nursing Care Pre-Op

• NPO
• IV
• Comfort measures
• Antibiotics
• Thermal therapy
• Elimination
• Patient education

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Management and Nursing Care Post-Op

• NPO
• Antibiotics
• Analgesia
• Patient teaching

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Pyloric Stenosis

• Pyloric sphincter
• Incidence
• Possible genetic predisposition

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Assessment

• Vomiting
• Constant hunger and fussiness
• Distended upper abdomen
• Hypertrophied pylorus
• Visible peristaltic waves

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Diagnosis

• History and Physical
• Ultrasound
• Laboratory values

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Management and Nursing Care

• Fred Ramstedt procedure- Pylorotomy via laproscopy

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Pre-Op

• Hydration and electrolyte balance
• Weigh daily I and O
• Support of parents

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Post- Op

• I O
• Feeding
• Position
• Surgical site
• Patient teaching

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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

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Intussuception

• Most commonly seen in infants 3-12 months
• Typically follows what type of illness?

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Assessment

• Pain
• Vomiting
• Stools
• Dehydration
• Serious complications

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Diagnosis

• X-ray
• Abdominal ultrasound

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Therapeutic Intervention

• Hydrostatic reduction
• Surgery

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Nursing Care

• NPO- NG
• Assess
• Monitor stools
• Re-introduce food

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Hirschsprungs Disease

• Congenital disorder of nerve cells in lower colon

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Assessment

• Failure to pass meconium
• Vomiting
• Bowel assessment
• Breath
• Older child

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Diagnosis

• History Physical
• Barium enema (X-ray)
• Rectal biopsy- absence of ganglionic cells in
  bowel mucosa

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Management

• Surgical intervention
• Colostomy
• Resection

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Nursing Care

• Pre-op
• Cleanse bowel
• Patient/parent teaching
• Post-op
• NPO
• VS
• Assessment
• Patient/parent teaching

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Volvulus Malrotation

• Assessment- pain, bilious vomiting, S S
  bowel obstruction
• Treatment- surgery to prevent ischemia
• Nursing Care- same as Intussuception and
  Hirschsprungs

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Gastroschisis

• Assessment- noted on ultrasound and obvious
  at birth
• Treatment- surgical repair in stages
• Nursing care- support parents loss of
  Perfect Child

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Omphalocele

• Assessment- ultrasound and at birth
• Treatment- surgical repair in stages
• Nursing care- same as for Gastroschisis

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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

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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

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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

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Helminths/Parasitic Disorders

• Assessment- parasites identified in stool
• Treatment- oral medications specific to
  helminth
• Nursing care- prevention education,

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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

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• Please contact me with any questions or concerns
  regarding my lectures
• Marlene Meador RN, MSN
• mmeador_at_austincc.edu