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Nursing Care of the Child with Gastrointestinal Disorders

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Title: Gastrointestinal Disorders in Pediatric Patients Author: Marlene Meador Last modified by: AHearn Created Date: 3/19/2004 1:34:11 AM Document presentation format – PowerPoint PPT presentation

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Title: Nursing Care of the Child with Gastrointestinal Disorders


1
Nursing Care of the Child with Gastrointestinal
Disorders
  • Ann Hearn RNC, MSN
  • Fall 2009

2
Cleft Lip and Cleft Palate
  • Unilateral, bilateral, midline

3
photos
4
Treatment
  • Surgical repair done ASAP
  • Rule of 10 gt 10, 10 weeks, 10 HGB
  • Multidisciplinary team

5
Pre-op Goals
6
Prevent Aspiration / Maintain Nutrition
  • Breast feed small cleft lip
  • Bottle feed special feeding devises
  • Special nipples
  • Enlarge cross cut hole
  • Bubble frequently
  • Hold upright
  • ESSR

7
Provide Emotional Support
  • Assist with accepting of defect
  • Teach proper feeding
  • Point out positive attributes
  • Encourage participation in care
  • Explain surgical procedure

8
Pre-op Teaching
  • Remind parents that defect is operable- show
    photographs of corrected clefts
  • Introduce cup, spoon feeding devices
  • Explain elbow restraints
  • Explain Logan Bow

9
Post-Op
  • Prevent trauma to suture line
  • Reduce pain infection
  • Cleanse suture lines as ordered
  • Facilitate breathing
  • Maintain nutrition
  • Referral to appropriate team members

10
Esophageal Atresia
11
Assessment Findings
  • Respiratory difficulties
  • Drooling
  • Coughing, choking, cyanosis
  • Gastric distention - if fistula present
  • Hx of ??? during pregnancy?
  • Polyhydramnios
  • gastrointestinal obstruction
  • fetus unable to swallow

12
Management
  • Early diagnosis
  • Ultrasound
  • Radiopaque catheter inserted in the esophagus to
    illuminate defect on X-ray
  • Surgical repair
  • Thoracotomy and anastomosis

13
Pre-Op Nursing Priority
  • Maintain airway
  • Prevent aspiration pneumonia
  • Keep NPO- administer IV fluids
  • Elevate HOB 30 degrees
  • Suction PRN
  • Prophylactic antibiotics

14
Post-Op
  • Maintain nutrition
  • TPN
  • Gastrostomy
  • Maintain airway
  • Prevent aspiration
  • Monitor weigh, growth and development
    achievements
  • Complications
  • GERS
  • Stricture formation

15
Teaching Plan Gastrostomy Tube
  • Equipment
  • Procedure
  • Psychosocial needs
  • Medication administration
  • Stoma care
  • Problem solving

16
Gastroesophagial Reflux Disease(GERD)
17
Assessment findings Infant
  • Regurgitation almost immediately after each
    feeding when the infant is laid down
  • Excessive crying, irritability
  • Failure to thrive (FTH)
  • Complications
  • aspiration pneumonia
  • apnea

18
Assessment findings Child
  • Heartburn
  • Abdominal pain
  • Cough, recurrent pneumonia
  • Dysphagia

19
Diagnosis
20
Management Nursing Care
  • Nutritional needs
  • Small frequent feedings
  • Frequent burping
  • Positioning
  • Prone flat or head elevated after feedings (not
    for sleep)
  • Medications
  • CPR instruction for parents/caregivers

21
Surgery
  • Nissen fundoplication

22
Post Op Nursing Care
  • Feedings
  • Burping (bubbling)
  • Positioning
  • Airway
  • Medications

23
Medications
  • H2 Histamine receptor antagonists suppress
    gastric acid secretions
  • Zantac and Pepcid
  • Proton-pump inhibitors reduce gastric acid
    production
  • Prevacid and Prilosec
  • Gastric emptying - increases
  • Reglan
  • Antacids neutralize gastric acidity
  • Gaviscon
  • be sure to study nursing implications and side
    effects

24
Pyloric Stenosis
  • Incidence 3 in 1000 births
  • Possible genetic predisposition

25
Pyloric Stenosis
  • Narrowing of the pyloric spincter
  • Delayed emptying of the stomach

26
Assessment
  • Vomiting - projectile
  • Constant hunger and fussiness
  • Distended upper abdomen
  • Hypertrophied pylorus olive shaped mass
  • Visible peristaltic waves

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

28
Surgery
  • Fred Ramstedt procedure-
  • Pyloromyotomy via laparoscopy
  • Pre-op
  • Hydration and electrolyte balance
  • Weigh daily I and O
  • NG tube
  • Support of parents

29
Management and Nursing Care Post-Op
  • NPO until bowel function
  • Progressive feeds 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 for infection - Antibiotics
  • Analgesia
  • Patient teaching

30
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?
  • a. Begin an intravenous infusion
  • b. Measure abdominal circumference
  • c. Orient family to unit
  • d. Weigh infant

31
Gastroschisis Omphalocele
32
Gastroschisis
33
Treatment and Nursing Care
  • Pre-operatively focus is on protection of the
    contents / sac. Cover with warm, sterile,
    saline-soaked dressings over the defect.
  • 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.  

34
Gastroschisis
  • Assessment- noted on ultrasound and obvious
    at birth
  • Treatment - surgical repair in stages
  • Nursing care
  • monitor thermoregulation and loss of fluids
  • assess for ileus
  • maintain parenteral feeding
  • provide support to the parents

35
Omphalocele
36
Omphalocele
  • Assessment- ultrasound and at birth
  • Treatment - surgical repair in stages
  • Nursing care- same as for Gastroschisis

37
Intussuception
  • Results in inflamed bowel bleeding
  • Leading to necrosis perforation

38
Intussuception
  • Most commonly seen in infants 3-12 months
  • Bowel telescopes within itself

39
Intussuception Clinical Manifestations
  • Intermittent then constant pain
  • Vomiting
  • Abdominal distention
  • Currant jelly-like stools
  • Diarrhea
  • Dehydration
  • Serious complications
  • Ischemia, perforation shock

40
Volvulus
41
Clinical Manifestations and Assessment
  • Pain
  • Vomiting (fecal material)
  • Abdominal distention
  • Stools
  • Dehydration
  • Serious complication shock

42
Diagnosis
  • X-ray
  • Abdominal ultrasound

43
Therapeutic Intervention
  • Hydrostatic reduction
  • Laparoscopic Surgery

44
Post-op Nursing Care
  • NPO- NG tube, IV
  • Assess V/S, pain
  • Monitor stools
  • Re-introduce food

45
Appendicitis
46
Clinical Manifestations
  • Abdominal pain McBurneys point
  • Silent Abdomen
  • Anorexia nausea
  • Diarrhea
  • Elevated temperature
  • IF PERFORATED
  • Sudden pain relief
  • Fever
  • Dehydration

47
Diagnosis
  • History and Physical
  • Ultrasound
  • X-Ray
  • Laboratory values
  • increased WBC 15,000 20,000

48
Management and Nursing Care Pre-Op
  • NPO
  • IV
  • Comfort measures
  • Antibiotics
  • Thermal therapy
  • Elimination
  • Patient education

49
  • What is the most common symptom indicating that
    the appendix may have ruptured?

50
Hirschsprungs Disease
51
Assessment
  • Failure to pass meconium
  • Vomiting
  • Bowel assessment
  • Breath
  • Older child

52
Diagnosis
  • History Physical
  • Barium enema (X-ray)
  • Rectal biopsy- absence of ganglionic cells in
    bowel mucosa

53
Management
  • Surgical intervention
  • Colostomy
  • Resection

54
Nursing Care
  • Pre-op
  • Cleanse bowel
  • NPO
  • Patient/parent teaching
  • Post-op
  • NPO
  • VS (no rectal temperatures)
  • Assessment
  • Patient/parent teaching

55
Diarrhea/GastroenteritisSevere
  • Most infectious diarrheas in this country are
    caused by Rotovirus but could be C. difficele

56
Clinical Manifestations
  • Increase in peristalsis
  • Large volume stools
  • Increase in frequency of stools
  • Nausea, vomiting, cramps
  • Metabolic Acidosis
  • Increased heart resp. rate, decreased B/P,
    arrhythmias
  • Cold, clammy skin
  • Changes in CNS stupor, lethergy

57
Diagnosis
Blood gases
Stool O P
Stool culture
58
Complications
59
Priority Nursing Interventions
  • Treat underlying cause
  • Restore fluid electrolyte balance
  • Daily weights
  • IO
  • Assess for dehydration
  • Isolation protocol
  • Monitor electrolytes/metabolic acidosis
  • Skin care

60
Oral Rehydration
61
Critical Thinking
  • Why is there an increase in incidence of
  • diarrhea in lower socio-economic
  • groups?
  • Why is there and increase in young
  • children?

62
Celiac Disease
  • This results in the accumulation of the amino
    acid glutamine which is toxic to the mucosal
    cells in the intestines. Damage to the villi
    impairs the ability of the small intestines to
    absorb nutrients

63
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.  
64
Celiac Disease
  • Assessment - Growth pattern, GI pattern
  • Failure to Thrive
  • Treatment - Dietary restrictions
  • Nursing Care - monitor for dehydration,
    encourage compliance with dietary
    restrictions, provide support groups for
    patient and caregiver

65
Diagnostic Findings
  • Measurement of fat content
  • Duodenal or Jejunal biopsy
  • Elevated IGA antibodies

66
Treatment and Nursing Care
Teach parents DIETARY REGULATIONS
NO !
Gluten Free Diet
  • Disease specific support groups

67
  • The End
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