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Caring for children with gastrointestinal dysfunction

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Caring for children with gastrointestinal dysfunction Chap 17 Gastroenteritis Acute diarrhea – PowerPoint PPT presentation

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Title: Caring for children with gastrointestinal dysfunction


1
Caring for children with gastrointestinal
dysfunction Chap 17
  • ???????????
  • ??
  • ?????????
  • Gastroenteritis(Acute diarrhea)
  • Intestinal obstruction--Intussusception
  • Congenital defects
  • Cleft lip and palate
  • Anorectal malformation
  • Esophageal atresia Tracheoesophageal fistula
  • Hirschsprungs Disease(Megacolon)

2
Anatomy and physiology of pediatric differences
  • GI system is immature at birth. P586?1??2?
  • Absorption and excretion do not begin until after
    birth
  • Sucking reflex
  • Not have voluntary control over swallowing
  • Stomach
  • Stomach capacitysmall
  • Frequently regurgitate
  • Intestinal
  • Peristalsis is greater than older children
  • Deficiency of several enzymeamylase, lipase,
    trypsin

3
Anatomy and physiology of pediatric differences
  • Liver function is also immature
  • Second year of life
  • Digestive processes are fairly complete
  • Stomach capacity increase
  • Excretory function can be achieved

4
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  • ?????

5
Caring for children with gastrointestinal
dysfunction
  • Etiology and pathophysiology
  • Clinical manifestations
  • Diagnostic tests
  • Medical management
  • Nursing assessment management

6
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

7
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)

8
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

9
Diagnosis clinical therapy??1?
  • History
  • Physical examination
  • Laboratory finding-S/R?S/C
  • Presence of ova, parasite, infectious organisms,
    viruses, fat, and undigested sugars.

10
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?

11
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

12
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
  • Fluid volume deficit P620
  • Risk for impaired skin integrityP621

13
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

14
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

15
  • Blood urea nitrogengt25mg/dL
    clinical therapy?1??3?
  • Serum bicarbonategt17mEq/L

16
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

17
Nursing assessment
  • Weight
  • I/O
  • Urine specific gravity
  • Consciousness
  • Pulse rate and quality
  • Skin turgor and mucous membrane moisture
  • Respiration
  • Blood pressure

18
Nursing management
  • Provide oral rehydration therapy guidelines
  • Teach parents oral rehydration methods
  • Monitor intravenous fluid administration
  • Discharge planning and home care teaching

19
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

20
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??)

21
Diagnosis P603?2?
  • History
  • Radiographs and ultrasound of the abdomen
  • Barium enema

22
Treatment P603?3?
  • Hydrostatic pressureBarium enema
  • Oxygen(air)?saline?aqueous contrast material
  • Surgery
  • Supportive care
  • ????
  • ?????
  • ???

23
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

24
Cleft lip and palate P586
  • More common in Native Americans and Asian
    P586??1?
  • Etiology and pathophysiology P594
  • A failure of the maxillary processes of fuse with
    the elevations on the frontal prominence during
    the sixth weeks of gestation.
  • Hard and soft palates is completed in the first
    trimester.
  • Congenital defectstracheoesophageal
    fistula,omphalocele,trisomy 13,skeletal
    dysplasias
  • Causemultifactorial(environmental and genetic
    influences)

25
Clinical manifestation P587
  • Cleft lip
  • Unilateral or bilateral
  • Alone or in combination with a cleft palate
    defect
  • Nasal deformity
  • Cleft palate
  • Less obvious
  • A continuous opening between the mouth and nasal
    cavity
  • Soft palate or both the soft and hard palate
  • Unilateral or bilateral

26
Clinical manifestation---?
  • ????
  • ?????
  • ????
  • ????
  • ??????

27
Diagnostic tests and medical management P588
  • Physiologic assessment ?1?
  • Medical managementmultidisciplinary team(plastic
    surgery?hearing?speech?dentistry)
  • Clef lip
  • 2-3months of age ?2?
  • Logan bow or other stabilizing device or dressing
    is put in place.
  • Crying is minimized by use of medication.
  • Clef palate
  • Depends on the size and severity of the cleft.
  • 18 months
  • Longer nipples with enlarged holes(before
    surgical)
  • Antibiotic therapyrecurrent otitis media
  • Orthodontic care
  • ????

28
Nursing assessment
  • Physiologic assessment
  • Observable
  • Palpation
  • Psychosocial assessmentlow self-esteem
  • Familys reaction
  • Low self-esteem
  • Developmental level and social interactions

29
Nursing management
  • 1.Risk for aspiration
  • 2.Provide emotional support
  • Explaining the cause
  • Interact and speak to the infant
  • Point out positive attributes
  • Self-blame
  • Anxiety
  • 3.Altered nutrition

Preoperative care P590
1.Risk for infection 2.Ineffective
breathing pattern related to anesthesia and
increased secretions 3. Impaired tissue
integrity 4. Knowledge deficit 5. Altered
nutrition
Postoperative care P592
30
Care in the community
Nursing management
  • Feeding techniques
  • Recognize signs of infection and complications
    (fever, vomiting, respiratory distress)
  • How to position the infant
  • How to care the suture line
  • Preparation of the sibling
  • Support groups
  • Prevent the infant from touching the suture line

31
Anorectal malformation ( Imperforate anus ) P604
  • Etiology and pathophysiology
  • Malformations of the anus and rectum.
  • Often associated with anomaliesurinary tract,
    esophagus, and duodenum.
  • VACTER Syndrome

32
Clinical manifestations
Diagnosis
  • Failure to pass meconium
  • Stool in the urine
  • Ribbonlike stools
  • ?????
  • Assessment anorectal structure and rectal patency
  • Ultrasound
  • Lower GI
  • PA CXR
  • ??3???x-ray
  • ????

33
Medical management
  • Dilation
  • ??-Excised surgery,then daily manual dilation
  • ??-Reconstructive surgery (Posterior Sagittal
    AnorectoplasyPSARP )?temporary
    colostomy?????????

34
Nursing management
  • Assessment
  • Developed anal dimple or sacral anomalies
  • Rectal thermometer
  • Observation and recording of passage of meconium

35
Managemen
Preoperation
Postoperation
  • Preventing infection
  • Respiratory complication
  • Maintaining hydration
  • Assess vital signs
  • If stable?try feeding
  • Colostomy care
  • ?????????
  • IV fluids
  • NG decompression
  • Monitor I/O
  • Monitor cardiorespiratory function
  • ????
  • Emotion support

36
Discharge planning and home care teaching
  • How to take the infants temperature
  • Signs and symptoms of infection
  • Feeding
  • Toilet training
  • Assess vital signs
  • If a colonstomy
  • How to care
  • Reassure the colostomy will be closed
  • Follow-up
  • Home care visits

37
Esophageal atresia Tracheoesophageal fistula
P595
  • Etiology and pathophysiology
  • Failure of the esophagus to develop as a
    continuous tube during the fourth and fifth weeks
    of gestation. ?1?
  • The foregut fails to lengthen, separate, and fuse
    into two parallel tubes during fetal development.
    ?2?
  • End in a blind pouch or develop as a pouch
    connect to the trachea by a fistula.

38
  • Maternal historypolyhydramnios?prematurity?low
    birth weight
  • Associated anomalies ?2??5?
  • Congenital heart defects
  • Gastrointestinal or urinary tract anomalies
  • Musculoskeletal abnormalities
  • VACTERLvertebral?anus?cardia?trachea?esophageal?r
    enal?limb

39
Clinical manifestation ?3?
  • Excessive salivation and drooling
  • 3C(coughing, choking, cyanosis)and sneezing
  • Returns fluid through the nose and
    mouth?pneumonia
  • Abdomen become distended
  • Vomiting soon after feeding

40
Diagnosis ?4?
  • Nasogastric tube meets resistance and can be
    advanced only minimally.
  • X-ray(air pouch?NG coiling?pneumonia?distended
    stomach intestine-???fistula)
  • Echocardiogram(2D echo)and abdominal
    ultrasound(Renal echo) P596

41
Treatment P596?2?
  • OG suction
  • Antibiotics
  • Fluids
  • Surgeryseveral stages
  • Ligation of the fistula and insertion of a
    gastrostomy tube
  • Reconnect the two ends of the esophagus(anastomosi
    s)
  • Potential postoperative complications
  • Gastroesophageal reflux?aspiration?stricture
    formation?esophageal motor dysfunction

42
Nursing management
Preoperation
  • Maintain a patent airway
  • Suction-(continuous or low intermittent)
  • Place the head of the bed slightly lowered
  • Continuous or low intermittent suction is used to
    remove secretions from the blind pouch.
  • Change position
  • NPO
  • Maintain with intravenous fluids administered
    through an umbilical vein catheter.

43
Postoperation
  • Gastrostomy drainage
  • IV fluids and antibiotics
  • TPN
  • Maintain a patent airway
  • Emotional support for parent
  • Discharge planning
  • Gastrostomy tube care and feeding?signs of
    infection?prevent postoperative complications.
    P598 families want to known

44
Megacolon(Hirschsprung Disease) P603
Etiology and pathophysiology
  • Congenital aganglionic megacoloninadequate
    motility causes mechanical obstruction
  • Absence of autonomic parasympathetic ganglion
    cells in the colon? accumulation of intestinal
    contents and abdominal distention
  • Combination with congential heart defects?Down
    syndrome?Imperforate anus
  • More common in boys
  • It can be acute or chronic

45
Clinical manifestations P604?2?
Newborn
Older child
  • Failure to gain weight and delayed growth
    ?3?
  • Abdominal distention
  • Constipation alternating
  • with diarrhea
  • Vomiting
  • Stool may be normal or
  • ribbonlike
  • Failure to pass meconium
  • Refusal to suck
  • Abdominal distention
  • Bile-stained emesis
  • ? complete obstruction, respiratory distress, and
    shock

46
Diagnosis
  • History
  • Bowel pattern
  • Anorectal manometry
  • Radiographic contrast studies
  • Rectal biopsy
  • Palpation

47
Treatment
  • Newbornsurgery
  • Several cases or ill infants temporary colostomy
    ? closure of the colostomy and
    reanastomosis(Soave procedure)
  • Child with milder defectdietary
    modification?stool softeners?isotonic irrigations

48
Complication P604?7?
  • Fecal incontinence and constipation
  • Enterocolitis
  • GI bleeding and diarrhea?ischemia and ulceration
  • TPN
  • Lactose-free diet

49
Nursing management Assessment
?1?
  • Observation for the passage of meconium
  • History of weight gain
  • Nutritional intake
  • Bowel habit

50
Management
  • Monitoring fluid and electrolyte balance
  • Maintain nutrition
  • Teach parents how to ensure regular bowel
    movements
  • Daily rectal irrigations
  • Prevent skin breakdown
  • Surgery
  • Monitoring for infection
  • Managing pain
  • Maintain hydration
  • Measuring abdominal circumference
  • Emotion support
  • Teach parent about-Ostomy care?signs of
    complications ? Be alter for signs of poor growth
    or malnutrition
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