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Caring for children with gastrointestinal dysfunction

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Title: Caring for children with gastrointestinal dysfunction


1
Caring for children with gastrointestinal
dysfunction Chap 17
  • ????
  • ???????????

2
????(?)
  • ?????
  • ??????
  • ?????
  • ????
  • (LGI?UGI? ?)
  • ???
  • ?????
  • ?????
  • ?????
  • ???????????
  • ?????
  • ????
  • ?????
  • ?????
  • ?????

3
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  •  Intestinal obstruction
  • Intussusception
  • Inflammatory disorders
  • Appendicitis
  • Disorders of motility
  • Gastroenteritis(Acute diarrhea)
  • Dehydration ---Chap 10
  • Constipation
  • Feeding disorders
  • Colic
  • Disorders of malabsorption
  • Celiac disease
  • Lactose Intolerance
  • Short bowel syndrome

4
Intussusception P602
  • Etiology and pathophysiology ?1?
  • One portion of the intestine prolapses and then
    invaginates(??) or telescopes (???) into
    another.?1?
  • One of the most frequent causes of intestinal
    obstruction during infant
  • Between the age of 3 months and 6 years
  • Siteileocecal valve ?2?
  • Telescoping of the Intestine obstructs the
    passage of stool.
  • The walls of intestine rub together
  • ? inflammation?edema?decreased blood flow
  • ? necrosis?perforation?hemorrhage? peritonitis
  • In infant, intussusception is commonly associated
    with measles, viral disease, and gastroenteritis
    syndromes. P603 Fig17-7

5
Clinical manifestations P603?2?
  • Onset is abrupt
  • Acute abdominal pain(periods of comfort between
    acute episodes of pain)
  • Vomiting
  • Passage of brown stool?become red and resemble
    currant jelly
  • A palpable mass may be present in the upper right
    quadrant or mid-upper abdomen
  • ????????
  • ?????
  • ???????????
  • ??????(Dance??)

6
Diagnosis P603?2?
  • History
  • Radiographs and ultrasound of the abdomen
  • Barium enema

7
Treatment P603?3?
  • Hydrostatic pressure???Barium enema
  • Oxygen(air)?saline?aqueous contrast material
  • Surgery
  • Supportive care
  • ????
  • ?????
  • ???

8
Nursing management
  • Maintain fluid and electrolyte balance
  • Post OP
  • Monitoring for early signs of infection
  • Pain management
  • Maintain NG tube patency
  • Assess vital signs?Abdominal distention?
  • Listen for bowel sounds every 4 hours
  • After normal bowel function
  • Clear liquid feeding? half- strength milk and
    other foods

9
Appendicitis P609
  • Is an inflammation of the vermiform appendix.
  • Most often in adolescent boys(10-19 y/o)rarely
    seen before 2 years of age
  • Etiology and pathophysiology
  • Result from an obstruction in the appendiceal
    lumen
  • Caused by a fecalith,parasitic infestations,stenos
    is,hyperplasia of lymphoid tissue,or a tumor
  • Obstruction?continued secretion of
    mucus?pressure? ?ischemia,cellular death,and
    ulceration
  • Complicationperforation or rupture ? peritonitis
    ? small bowel obstruction,electrolyte
    imbalances,septicemia,and hypovolemic shock

10
Clinical manifestations
  • Pain
  • Fever, vomiting, diarrhea, constipation P610?2?
  • Motionless, side-lying position with knees flexed

Caution
  • Some children
  • Appendix is in a different location P609??1?
  • Differentiation P609???2?
  • Ovulation
  • Ruptured ectopic pregnancy
  • Pelvic inflammatory

11
Pain
  • Periumbilical cramps,abdominal tenderness?1? ?
    pain in the right lower abdomen become
    constant?4?
  • Most intense halfway between the anterior
    superior iliac crest and umbilicus ? rigidity and
    rebound tenderness P610?2? ? if sudden relief of
    pain(ruptured)

12
Signs and symptoms of a ruptured appendix
include

P609??
  • Fever
  • Sudden relief from abdominal pain
  • Guarding
  • Abdominal distention
  • Rapid shallow breathing
  • Pallor
  • Chills
  • Irritability or restlessness

13
Diagnosis evaluation over several hours P610
  • WBC?(teenagers)?2?
  • Abdominal pain
  • X-ray
  • Abdominal ultrasound
  • Focused appendiceal computerized tomography(FACT)

14
Treatment ?3?
  • Preoperatively
  • NPO NG decompression
  • IV fluids electrolytes
  • Antibiotics
  • Appendectomy
  • Postoperatively
  • Antibiotics
  • If ruptured
  • Penrose drain
  • Wound irrigations

15
Nursing management
  • Promote comfort
  • Maintain hydration
  • Provide emotional support
  • Recognize symptoms of infection
  • Support respiratory function
  • Discharge planning and home care teaching

16
Disorders of motility
  • Diarrhea
  • ???????????????????
  • ???
  • (1)????????????
  • (2)???????????
  • (3)???????????????
  • ????????????????,????????????????????

17
  • ??????????????????,?????????????????????
  • ???????????????,? ????????

18
Gastroenteritis(Acute diarrhea)P617
  • Is an inflammation of the stomach and intestines
    ?1?
  • Vomiting and diarrhea
  • Infants and small children with gastroenteritis
    or
  • diarrhea can quickly become dehydrated and
    are
  • at risk for hypovolemic shock .

19
Etiology and pathophysiology (P617?2?)
  • Decrease in the absorptive capacity?decrease in
    surface area for absorption?alteration of
    parasympathetic innervation
  • High risk-day-care centers?improper sanitation
    (?56?)
  • Causes(Table 17-2)

20
Clinical manifestations P617
  • Mild
  • -Slightly increased in number and more liquid
  • Moderate
  • -Several loose or watery stools
  • -Irritability?anorexia?nausea?vomiting
  • -Self-limiting
  • Severe
  • -Continuous watery stools
  • -Fluid and electrolyte imbalance
  • -Cramp?extremely irritable?difficult to console

21
Diagnosis clinical therapy??1?
  • History
  • Physical examination
  • Laboratory finding-S/R?S/C ?urine sp.gr
  • Presence of ova, parasite, infectious organisms,
    viruses, fat, and undigested sugars.

22
Treatment P618?2?
  • Depends on the severity of the diarrhea and fluid
    and
  • electrolyte imbalances.
  • Goalcorrect the fluid and electrolyte
  • Mild to moderate
  • -Oral rehydration therapy ( Contain water,
    carbohydrate, sodium, potassium, chloride and
    lactate P315 )
  • -Carbonated beverages and those containing high
    amounts of sugar should NOT be given
  • Severe
  • -IV(N/S with glucose?one half or one quarter
    normal
  • saline? or L/R)?3?
  • -NPO
  • -Antiemetics and antidiarrheals should generally
    not be used in
  • infants and young children. P618??
  • Lactose-free milk, breast milk, half-strength
    milk. P315???4?

23
Nursing assessment P618
  • Frequency, color, amount and consistency of
    stools?4?
  • The amount and type of vomitus
  • Observing dehydration
  • Urine output and specific gravity
  • Weight
  • Vital signs ( Febrile )
  • Skin integrity

24
Nursing diagnosis management P619
  • Anxiety
  • Provide Emotional support
  • Sleep pattern disturbance
  • ?????
  • Promote rest and comfort
  • Altered nutrition
  • Ensure adequate nutrition
  • CRAM (Complex carbohydrates, Rice and Milk )
    P619??
  • Diarrhea related to infectious process P620 care
    plan
  • Fluid volume deficit P620
  • Risk for impaired skin integrityP621

25
Dehydration Chap 10 --P313
  • There is not enough fluid in the extracellular
    compartment.
  • The state of body water deficit is called
    dehydration.
  • Sodium is generally lost along with water ?
    hyponatremia

26
Etiology and pathophysiology
  • Causes P313 ?1??2?
  • Loss of fluid containing sodium are
    vomiting?diarrhea?nasogastric suction?hemorrhage
    and burns
  • Radiant warmers ?2??2?
  • Adrenal insufficiency and overuse of diuretics
  • Bulimic adolescents

27
  • Blood urea nitrogengt25mg/dL
    clinical therapy?1??3?
  • Serum bicarbonategt17mEq/L

28
Medical management P315
???????
  • Oral rehydration therapy-mild and moderate
    dehydration
  • Contain water, carbohydrate, sodium, potassium,
    chloride and lactate
  • Lactose-free milk, breast milk, half-strength
    milk ???4?
  • IV-severely P316?1?
  • L/R, one half or one quarter normal saline

29
Nursing assessment
  • Weight
  • I/O
  • Urine specific gravity
  • Consciousness
  • Pulse rate and quality
  • Skin turgor and mucous membrane moisture
  • Respiration
  • Blood pressure

30
Nursing management
  • Provide oral rehydration therapy guidelines
  • Teach parents oral rehydration methods
  • Monitor intravenous fluid administration
  • Discharge planning and home care teaching

31
Disorders of malabsorption P627
  • ???????????????????
  • ?????????????????,??????Lactose Intolerance ?
  • ?????????????????,????????(?Celiac
    Disease)??????????????,?short bowel
    syndrome,??????????????,??????

32
Lactose Intolerance P628
  • Etiology and pathophysiology
  • Inability to digest lactose(a disaccharide)?1?
  • A congenital or acquired deficiency of the enzyme
    lactase
  • Congenital
  • Rare ?3?
  • Acquired
  • Highest(?100)among Asian and Native American
    ?5?

33
  • Clinical manifestations ?4?
  • Abdominal pain
  • Flatulence
  • Diarrhea

Diagnosis ?2? History Hydrogen breath
test Lactose-free diet for confirming the
diagnosis
34
Treatment ?2? ?4?
  • Diet
  • Infant-soy-based formula
  • Older children-eliminating lactose-containing
    foods
  • Enzyme tablets

35
Nursing management
  • Support
  • Explain dietary modifications and discuss
    alternate sources of calcium P337??
  • Discuss the need for supplementation of calcium
    and vitamin D
  • Read food labels

36
Short bowel syndrome(SBS)P628
  •   Etiology and pathophysiology ?1?
  • It is a decreased ability to digest and absorb a
    regular diet because of a shortened intestine.
  • Causesnecrotizing enterocolitis(NEC)?inflammatory
    disorders?congenital bowel anomaly
  • The extent and location of the involved bowel
    determine the severityof the disorder. ?2?
  • Adaptation periodincreases its absorptive
    surface area ?5?

37
  • Clinical manifestations?2?
  • Watery diarrhea ?4?
  • Treatment ?2?
  • Nutritional support ?6?
  • TPN?elemental formula?MCT
  • Enteral feeding
  • High-fat, low-carbohydrate diet
  • Nucleotide, glutamine, polyamine, and fatty acid
  • Surgical(?)

38
Complication(?)
  • ??50???(????????)??????
  • ??70??????????????
  • ????TPN????,?sepsis or TPN-cholestasis

39
Nursing management
  • Meeting the childs nutritional and fluid needs
  • Oral and enteral feedings are instituted
    gradually
  • Feeding pump
  • Feeding tube
  • Emotional support
  • Arrange home visits to monitor the childs growth
    and development and observed side effects (fluid
    and electrolyte imbalance and diarrhea)
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