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Gastrointestinal Disorders in Pediatric Patients

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Gastrointestinal Disorders in Pediatric Patients Revised, Summer 2009 * * Complications: dehydration and acidosis (metabolic) * * * Pain begins in the center of the ... – PowerPoint PPT presentation

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Title: Gastrointestinal Disorders in Pediatric Patients


1
Gastrointestinal Disorders in Pediatric Patients
  • Revised, Summer 2009

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
Assessment
  • Unilateral, bilateral, midline

4
Treatment
  • Surgical repair done ASAP
  • Rule of 10 gt 10, 10 weeks, 10 HGB
  • Multidisciplinary team
  • Homecare by the family prior to surgery
  • E-enlarge opening in nipple
  • S-stimulate suck reflex
  • S-swallow fluids appropriately
  • R-rest when infant signals

5
Pre-op Teaching
  • Remind parents that defect is operable- show
    photographs of corrected clefts
  • Introduce cup, spoon feeding devices (see your
    book for feeding tips)
  • Explain restraints

6
Post-Op
  • Prevent trauma to suture line Do not allow to
    suck!
  • Facilitate breathing
  • Maintain nutrition
  • Reduce pain to minimize crying
  • Prevent infection
  • Cleanse suture lines as ordered
  • Referrals to appropriate team members

7
Esophageal Atresia/ Tracheoesophageal fistula
  • Failure of the esophagus to totally differentiate
    4-5th wk gestation
  • Both are malformations of ESOPHAGUS
  • Cause is unknown

8
Assessment
  • 3Cs -coughing, choking, cyanosis when feeding
  • Respiratory difficulties
  • Drooling
  • Inability to pass suction catheter, NG _at_ birth
  • Abdominal distention if fistula present

9
Management
  • Early diagnosis
  • Ultra sound
  • Radiopaque catheter inserted in the esophagus to
    illuminate defect on X-ray
  • Surgical repair- thoracotomy
  • Anastomose ends of esophagus if possible (may
    need 2 stage repair)
  • Ligate fistula

10
Pre-Op
  • Maintain airway
  • Keep NPO- administer IV fluids
  • Elevate HOB 30 degrees
  • Suction PRN
  • Gastrostomy for feedings
  • Prevent aspiration pneumonia
  • Suction
  • HOB 30 degrees
  • Prophylactic antibiotics

11
Post-Op
  • Maintain airway
  • Maintain nutrition
  • Prevent trauma
  • Monitor growth and development

12
Gastroesophageal Reflux Disease(GERD)
  • The cardiac/lower esophageal sphincter (AKA LES)
    and lower portion of the esophagus are weak,
    allowing regurgitation of gastric contents back
    into the esophagus.

13
Assessment Infant
  • Regurgitation almost immediately after each
    feeding when the infant is laid down
  • Excessive crying, irritability
  • FTH
  • Risk for
  • aspiration (pneumonia)
  • Apnea
  • Development of respiratory problems (asthma)

14
Assessment Child
  • Heartburn
  • Abdominal pain
  • Cough, recurrent pneumonia
  • Dysphagia

15
Diagnosis
  • Ph of secretions in esophagus lt7.0acid
  • Barium Swallow and visualization of any
    esophageal abnormalities

16
Management Nursing Care
  • Nutritional needs
  • Positioning PRONE (supine worsens GERD)
  • Medications
  • H2 receptor antaqgonists (-tidine)
  • Cholinergics metoclopramide (Reglan)
  • Proton pump inhibitors (-prazole)
  • CPR instruction for parents/caregivers
  • Possible Nissen Fundoplication

17
Diarrhea/GastroenteritisSevere
  • A disturbance of the intestinal tract that alters
    motility and absorption and accelerates the
    excretion of intestinal contents. 3-30
    stools/day!!!
  • Most infectious diarrheas in this country are
    caused by Rotovirus, but can be c.diff

18
Clinical Manifestations
  • Increase in peristalsis
  • Large volume stools (loose, watery, green)
  • Increase in frequency of stools with cramps,
    nausea, vomiting
  • Urge with small stool present
  • Increased heart resp. rate, decreased tearing
    and fever

19
Complications
  • Dehydration
  • Mucus membranes dried, cracked
  • Decreased elasticity of skin
  • Depressed fontanels, eyes sunken
  • Decreased urinary output, dark
  • Metabolic Acidosis
  • pH lt7.35
  • HCO3 /lt22mEq/L

20
Diagnosis
  • Stool culture
  • -causative organism
  • -OP
  • ABGs to diagnose Metabolic Acidosis

21
Treatment Nursing Care
  • Contact isolation
  • Treat cause
  • Weigh daily
  • Monitor IO, assess for dehydration
  • Skin care
  • Fluid and electrolyte balance
  • Oral rehydration
  • IV rehydration (RL or D5NS)

22
Appendicitis
  • Inflammation of the lumen of the appendix which
    becomes quickly obstructed causing edema,
    necrosis and pain.

23
Clinical Manifestations
  • Pain
  • Vague
  • Periumbilical
  • Rebound tenderness
  • No bowels sounds silent abdomen
  • Anorexia with or without vomiting
  • Diarrhea
  • Increased temperature
  • If ruptures/perforates, there is immediate relief
    of pain followed by high fever and dehydration

24
Diagnosis
  • WBC lt15-20,000
  • Rebound tenderness at McBurneys point
  • Abdominal ultrasound or xray - fecalith

25
Management and Nursing Care Pre-Op
  • NPO, IV
  • Comfort measures, knee chest position
  • Antibiotics
  • Thermal therapy Ice pack
  • No elimination
  • Patient education for post-op
  • /- NG tube
  • Penrose drain vs open wound bed

26
Management and Nursing Care Post-Op
  • NPO, IVs
  • Antibiotics
  • Analgesia
  • Patient teaching
  • Wound care
  • Open vs laproscopic
  • No contact sports, PE, lifting until released by
    surgeon

27
Pyloric Stenosis
  • Pyloric sphincter
  • Incidence
  • Possible genetic predisposition

28
Assessment
  • Vomiting character??
  • Constant hunger and fussiness
  • Distended upper abdomen
  • Visible peristaltic waves
  • Hypertrophied pylorus
  • No pain
  • Weight loss
  • Dehydration and electrolyte imbalance

29
Diagnosis
  • History and physical
  • Abdominal ultrasound
  • Laboratory data

30
Pre-op care
  • Restore fluid and electrolyte balance
  • NPO
  • I O
  • Urine specific gravity
  • Parental support
  • Guilt think they are bad parents
  • Emphasize structural problem not parental feeding
    technique

31
Management and Nursing Care
  • Pylorotomy via laproscopy
  • I O
  • Feeding
  • Position HOB elevated slightly
  • Surgical site infection free
  • Patient teaching s/s recurrence

32
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

33
Intussuception
  • Most commonly seen in infants 3-12 months but can
  • occur in older child
  • Bowel telescopes
  • within itself usually
  • at ileocecal valve

34
Assessment
  • Pain colicky, knee chest position
  • Vomiting can contain stool
  • Stools currant jelly
  • Dehydration
  • Serious complications

35
Diagnosis
  • Abdominal xray intraperitoneal AIR
  • Abdominal ultrasound

36
Therapeutic Intervention
  • Hydrostatic reduction
  • Surgery

37
Post-op care
  • NPO with NG tube
  • Monitor bowel sounds and passage of stool
  • Gradual introduction of fluids and solids

38
Hirschsprungs Disease
  • Congenital disorder of nerve cells in lower colon

39
Assessment
  • Failure to pass meconium
  • Vomiting with reluctance to feed
  • Bowel assessment
  • Breath

40
If in older child
  • Constipation
  • Offensive ribbon-like stools
  • History of REGULAR laxative use
  • Palpable fecal mass

41
Diagnosis
  • History Physical
  • Barium enema (X-ray)
  • Rectal biopsy- absence of ganglionic cells in
    bowel mucosa

42
Management
  • Surgical intervention
  • One stage resection
  • Two stage
  • Temporary diverting colostomy with resection
  • Re-anastomosis and take-down of colostomy

43
Nursing Care
  • Pre-op
  • Cleanse bowel
  • Neomycin per rectum
  • Patient/parent teaching re ostomy
  • Post-op
  • NPO N/G tube, IV fluids
  • No rectal thermometers, monitor VS
  • Monitor bowel sounds and abdominal girth
  • Patient/parent teaching
  • Incision care, s/s infection
  • Pain management
  • ?colostomy teaching

44
Volvulus Malrotation
  • Assessment- pain, bilious vomiting, S S
    bowel obstruction
  • Treatment- surgery to prevent ischemia
  • Nursing Care- same as Intussuception and
    Hirschsprungs

45
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

46
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

47
Diagnosis
  • Measure fetal fat
  • Duodenal biopsy
  • Screen IgA

48
Complications
  • Hypocalcemia
  • Osteomalacia
  • Osteoporosis
  • Depression
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