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Gastrointestinal Disorders in Pediatric Patients

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Cleanse suture lines as ordered. Referral to appropriate team members. Esophageal Atresia ... nerve cells in lower colon. Assessment. Failure to pass meconium ... – PowerPoint PPT presentation

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Title: Gastrointestinal Disorders in Pediatric Patients


1
Gastrointestinal Disorders in Pediatric Patients
  • Marlene Meador RN, MSN
  • Fall 2006

2
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

3
photos
4
Assessment
  • Unilateral, bilateral, midline

5
Treatment
  • Surgical repair done ASAP
  • Rule of 10 gt 10, 10 weeks, 10 HGB
  • Multidisciplinary team

6
Management Pre-op
  • Maintain nutrition
  • Prevent aspiration

7
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

8
Post-Op
  • Prevent trauma to suture line
  • Facilitate breathing
  • Maintain nutrition
  • Cleanse suture lines as ordered
  • Referral to appropriate team members

9
Esophageal Atresia
  • Failure of the esophagus to totally differentiate
    during uterine development.

10
Assessment
  • Respiratory difficulties
  • Drooling
  • Coughing, choking
  • Gastric distention
  • Hx of ??? during pregnancy?

11
Management
  • Early diagnosis
  • Ultra sound
  • Radiopaque catheter inserted in the esophagus to
    illuminate defect on X-ray
  • Surgical repair- thoracotomy and anastomosis

12
Pre-Op
  • Maintain airway
  • Keep NPO- administer IV fluids
  • Elevate HOB 30 degrees
  • Suction PRN
  • Prophylactic antibiotics

13
Post-Op
  • Maintain airway
  • Maintain nutrition
  • Prevent trauma

14
Gastroesophagial Reflux (GER)
  • The cardiac sphincter and lower portion of the
    esophagus are weak, allowing regurgitation of
    gastric contents back into the esophagus.

15
Assessment Infant
  • Regurgitation almost immediately after each
    feeding when the infant is laid down
  • Excessive crying, irritability
  • FTH
  • Complications of aspiration pneumonia, apnea

16
Assessment Child
  • Heartburn
  • Abdominal pain
  • Cough, recurrent pneumonia
  • Dysphagia

17
Diagnosis
  • Assess Ph of secretions in esophagus if lt7.0
    indicates presence of acid
  • Also diagnosed using Barium Swallow and
    visualization of esophageal abnormalities

18
Management Nursing Care
  • Nutritional needs
  • Positioning
  • Medications
  • CPR instruction for parents/caregivers
  • Surgery

19
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

20
Critical Thinking
  • Why is there an increase in incidence of diarrhea
    in lower socio-economic groups?
  • Why is there and increase in young children?

21
Clinical Manifestations
  • Increase in peristalsis
  • Large volume stools
  • Increase in frequency of stools
  • Nausea, vomiting, cramps
  • Increased heart resp. rate, decreased tearing
    and fever

22
Complications
  • Dehydration
  • Metabolic Acidosis

23
Diagnosis
  • Stool culture
  • OP
  • Diagnose Metabolic Acidosis

24
Treatment Nursing Care
  • Treat cause
  • Fluid and electrolyte balance
  • Weigh daily
  • Monitor IO
  • Assess for dehydration
  • Isolate
  • Skin care

25
Appendicitis
  • Inflammation of the lumen of the appendix which
    becomes quickly obstructed causing edema,
    necrosis and pain.

26
Clinical Manifestations
  • Abdominal pain
  • Silent abdomen
  • Anorexia and nausea
  • Diarrhea
  • Elevated temperature
  • Sudden relief

27
Diagnosis
  • History and Physical
  • Laboratory values
  • X-ray or Ultrasound

28
Management and Nursing Care Pre-Op
  • NPO
  • IV
  • Comfort measures
  • Antibiotics
  • Thermal therapy
  • Elimination
  • Patient education

29
Management and Nursing Care Post-Op
  • NPO
  • Antibiotics
  • Analgesia
  • Patient teaching

30
Pyloric Stenosis
  • Pyloric sphincter
  • Incidence
  • Possible genetic predisposition

31
Assessment
  • Vomiting
  • Constant hunger and fussiness
  • Distended upper abdomen
  • Hypertrophied pylorus
  • Visible peristaltic waves

32
Diagnosis
  • History and Physical
  • Ultrasound
  • Laboratory values

33
Management and Nursing Care
  • Fred Ramstedt procedure- Pylorotomy via laproscopy

34
Pre-Op
  • Hydration and electrolyte balance
  • Weigh daily I and O
  • Support of parents

35
Post- Op
  • I O
  • Feeding
  • Position
  • Surgical site
  • Patient teaching

36
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

37
Intussuception
  • Most commonly seen in infants 3-12 months
  • Typically follows what type of illness?

38
Assessment
  • Pain
  • Vomiting
  • Stools
  • Dehydration
  • Serious complications

39
Diagnosis
  • X-ray
  • Abdominal ultrasound

40
Therapeutic Intervention
  • Hydrostatic reduction
  • Surgery

41
Nursing Care
  • NPO- NG
  • Assess
  • Monitor stools
  • Re-introduce food

42
Hirschsprungs Disease
  • Congenital disorder of nerve cells in lower colon

43
Assessment
  • Failure to pass meconium
  • Vomiting
  • Bowel assessment
  • Breath
  • Older child

44
Diagnosis
  • History Physical
  • Barium enema (X-ray)
  • Rectal biopsy- absence of ganglionic cells in
    bowel mucosa

45
Management
  • Surgical intervention
  • Colostomy
  • Resection

46
Nursing Care
  • Pre-op
  • Cleanse bowel
  • Patient/parent teaching
  • Post-op
  • NPO
  • VS
  • Assessment
  • Patient/parent teaching

47
Volvulus Malrotation
  • Assessment- pain, bilious vomiting, S S
    bowel obstruction
  • Treatment- surgery to prevent ischemia
  • Nursing Care- same as Intussuception and
    Hirschsprungs

48
Gastroschisis
  • Assessment- noted on ultrasound and obvious
    at birth
  • Treatment- surgical repair in stages
  • Nursing care- support parents loss of
    Perfect Child

49
Omphalocele
  • Assessment- ultrasound and at birth
  • Treatment- surgical repair in stages
  • Nursing care- same as for Gastroschisis

50
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

51
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

52
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

53
Helminths/Parasitic Disorders
  • Assessment- parasites identified in stool
  • Treatment- oral medications specific to
    helminth
  • Nursing care- prevention education,

54
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

55
  • Please contact me with any questions or concerns
    regarding my lectures
  • Marlene Meador RN, MSN
  • mmeador_at_austincc.edu
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