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Nursing Care of the Child with a Gastrointestinal Disorder

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Nursing Care of the Child with a Gastrointestinal Disorder * * 30. Explain the feeding regime following surgical correction of pyloric stenosis. – PowerPoint PPT presentation

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Title: Nursing Care of the Child with a Gastrointestinal Disorder


1
Nursing Care of the Child with a Gastrointestinal
Disorder
2
Normal Gastrointestinal System
3
Disorders of Development
4
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

5
Assessment
  • Unilateral, bilateral, midline

6
Treatment
  • 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

7
Pre-op Nursing Care
  • Remind parents that defect is operable- show
    photographs of corrected clefts

Before
After
8
Pre-op Nursing Care
Two Main Goals 1. Prevention of Aspiration 2.
Maintain Nutrition
9
Latham Device
10
Post-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

11
Esophageal Atresia
12
Malformation from failure of esophagus to develop
as a continuous tube
Upper Esophagus
Trachea
Lower Esophagus
13
Signs and Symptoms
  • Excessive amounts of salivation / mucus, frothy
    bubbles
  • Three Cs 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

14
Diagnosis and Management
  • Early diagnosis
  • Ultrasound
  • Radiopaque catheter inserted in the esophagus to
    illuminate defect on X-ray
  • Surgical repair
  • Thoracotomy and anastomosis

15
Pre-Op
16
Post-Op
  • Maintain airway
  • Maintain nutrition
  • Gastrostomy tube feedings
  • Prevent trauma
  • Monitor for potential complications
  • Monitor weight, growth and developmental
    achievements

17
Imperforate Anus
  • Incomplete development or absence of anus in its
    normal position in perineum.

18
Assessment
  • Most commonly diagnosed upon Newborn Assessment
  • Symptoms
  • Absence of anorectal canal
  • Failure to pass meconium
  • Presence of anal membrane

19
Treatment
  • Anal stenosis is treated with repeated anal
    dilation
  • Surgery

20
Omphalocele Gastroschisis
Abdominal Wall Defects
21
Omphalocele
Herniation of abdominal contents through the
umbilical cord. Contents are covered by a
translucent sac.
22
Gastroschisis
  • herniation of abdominal viscera outside the
    abdominal cavity through a defect in the
    abdominal wall to the side of the umbilicus. Not
    covered.

23
Diagnosis
Provide an early diagnosis
Alpha-fetaoprotein
Ultrasound
24
Treatment 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.  

25
Post-op Care
  • Assess for ileus
  • Maintain parenteral feedings
  • Provide support to the parents.

26
Gastroesophageal Reflux Disease(GERD)
  • The cardiac sphincter and lower portion of the
    esophagus are weak, allowing regurgitation of
    gastric contents back into the esophagus.

27
Assessment 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

28
Assessment Child
  • Heartburn
  • Abdominal pain
  • Cough, recurrent pneumonia
  • Dysphagia

29
Diagnosis
  • Assess Ph of secretions in esophagus if lt7.0
    indicates presence of acid
  • Also diagnosed using Barium Swallow and
    visualization of esophageal abnormalities

30
Management 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
31
Medications
  • H2 Histamine receptor antagonists reduce
    gastric acidity
  • Zantac and Pepcid
  • Proton-pump inhibitors
  • Prevacid
  • Prilosec
  • Gastric emptying
  • Reglan
  • Antacids
  • Gaviscon

32
Diarrhea
Infectious Gastroenteritis
33
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 but can be C. Difficele

34
Clinical Manifestations
  • Increase in peristalsis
  • Large volume stools
  • Increase in frequency of stools
  • Nausea, vomiting, cramps
  • Increased heart resp. rate, decreased tearing
    and fever

35
Diagnosis
36
Complications
Dehydration
Metabolic Acidosis
37
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.
38
Treatment Nursing Care
  • Treat cause
  • Fluid and electrolyte balance
  • Weigh daily
  • Monitor IO
  • Assess for dehydration
  • Isolate
  • Skin care

39
Appendicitis
  • Inflammation of the lumen of the appendix which
    becomes quickly obstructed causing edema,
    necrosis and pain.

40
Management and Nursing Care 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.

41
Appendicitis
  • What is the most common symptom indicating that
    the appendix may have ruptured?

42
Management and Nursing Care Post-Op
  • NPO
  • Antibiotics
  • Analgesia
  • Patient teaching

43
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.

44
Pyloric Stenosis
  • Narrowing of the pyloric spincter
  • Delayed emptying of the stomach

45
Assessment
46
Treatment 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 infants response to feeding.
  • Position with head elevated
  • Assess Surgical site to prevent infection
  • Patient teaching

47
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

48
Intussuception Volvulus
  • Both are forms of bowel obstruction

49
Intussuception
  • Most commonly seen in infants 3-12 months
  • Bowel telescopes within itself

50
Volvulus
  • A twisting of the bowel that leads to a bowel
    obstruction.
  •  

51
Assessment
  • Pain
  • Vomiting
  • Stools resemble currant jelly
  • Dehydration
  • Serious complications

52
Therapeutic Intervention
  • Intussuception
  • Hydrostatic Reduction
  • Surgery
  • Volvulus
  • Surgery

53
Hirschsprung's Disease
54
Hirschsprungs Disease
  • Congenital disorder of nerve cells in lower colon

55
Assessment
56
Diagnosis Management
  • Diagnosis
  • History Physical
  • Barium enema (X-ray)
  • Rectal biopsy- absence of ganglionic cells in
    bowel mucosa
  • Management
  • Surgical intervention
  • Colostomy
  • Resection
  • Colostomy takedown

57
Nursing 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

58
Lactose Intolerance
  • Inability to tolerate the sugar found in dairy
    products as a result of an absence or deficiency
    of lactase.

59
Celiac Disease
  • inability to digest gliadin which is a
  • by-product of gluten breakdown.

60
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.  
61
Treatment and Nursing Care
Teach parents DIETARY REGULATIONS
NO !
Gluten Free Diet
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