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Guided Lecture Notes, Chapter 42, Nursing Care of the Child With an
Alteration in Bowel Elimination/Gastrointestinal Disorder
Learning Objective 1. Compare the differences in the anatomy and physiology of
the gastrointestinal system between children and adults.
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Explain that babies are born with immature GI tracts that are not fully
mature until age 2; therefore, there are many differences between the
digestive tract of the young child and that of the older child or adult.
(Refer to PowerPoint slide 2.)
Review the differences in the anatomy of the mouth, esophagus, stomach,
intestines, and biliary system of children compared to adults. (Refer to
PowerPoint slide 2.)
Learning Objective 2. Discuss common medical treatments for infants and children
with alterations in bowel elimination (gastrointestinal disorders).
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Note that the most common result of GI illness is dehydration, requiring fluid
therapy at home or, in more extreme cases, in the hospital. Stress the fact that it is
important to take GI disorders seriously until symptoms are controlled. (Refer to
PowerPoint slide 3.)
Learning Objective 3. Discuss common laboratory and diagnostic tests used to
identify disorders of the gastrointestinal tract.
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Explain the types of tests commonly ordered by physicians for children with
GI illnesses. (Refer to PowerPoint slide 4.)
Outline the laboratory and diagnostic tests ordered for the assessment of
appendicitis. (Refer to PowerPoint slide 5.)
Learning Objective 4. Discuss medication therapy used in infants and children with
alterations in bowel elimination (gastrointestinal disorders).
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Point out that for infants with oral candidiasis, the nurse must ensure
appropriate administration of oral antifungal agents by administering
Mycostatin suspension four times per day following feeding to allow the
medication to remain in contact with the lesions. (Refer to PowerPoint slide
6.)
Discuss the various medications used to manage short bowel syndrome.
(Refer to PowerPoint slide 7.)
Learning Objective 5. Recognize risk factors associated with various gastrointestinal
illnesses.
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Explain that cleft palate is the most common congenital craniofacial anomaly
occurring once in every 700 births worldwide. Discuss the other anomalies
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associated with this disorder, including heart defects, ear malformations,
skeletal deformities, and genitourinary abnormality. (Refer to PowerPoint
slide 8.)
Discuss the risk factors associated with dehydration and differentiate mild,
moderate, and severe dehydration. (Refer to PowerPoint slide 9.)
Review the risk factors for oral candidiasis, including young age, immune
suppression, antibiotic use, use of corticosteroid inhalers, and presence of
fungal infection in the mother. (Refer to PowerPoint slide 10.)
Note the risk factors for intussusception including common lead points for the
disease: Meckel diverticulum, duplication cysts, polyps, hemangiomas,
tumors, or the appendix. Note that children with cystic fibrosis, celiac disease,
and Crohn disease are at higher risk for the disease. (Refer to PowerPoint
slide 11.)
Learning Objective 6. Differentiate between acute and chronic gastrointestinal
disorders.
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Review that acute GI disorders include dehydration, vomiting, diarrhea, oral
candidiasis, oral lesions, hypertrophic pyloric stenosis, necrotizing
enterocolitis, intussusception, malrotation and volvulus, and appendicitis.
(Refer to PowerPoint slide 12.)
Explain that structural anomalies of the GI tract include cleft lip and palate,
omphalocele and gastroschisis, hernias (inguinal and umbilical), and anorectal
malformations. (Refer to PowerPoint slide 13.)
Point out that diarrhea is either an increase in the frequency or a decrease in
the consistency of stool. Discuss the viral, bacterial, and parasitic causes of
acute infectious diarrhea. (Refer to PowerPoint slides 14 and 15.)
Discuss chronic GI disorders that exist, including gastroesophageal reflux,
peptic ulcer disease, constipation/encopresis, Hirschsprung disease, short
bowel syndrome, inflammatory bowel disease, celiac disease, recurrent
abdominal pain, failure to thrive, and chronic feeding problems. (Refer to
PowerPoint slide 16.)
Learning Objective 7. Distinguish common gastrointestinal illnesses of childhood.
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State that esophageal atresia refers to a congenitally interrupted esophagus
where the proximal and distal ends do not communicate; the upper esophageal
segment ends in a blind pouch and the lower segment ends a variable distance
above the diaphragm. (Refer to PowerPoint slide 17.)
Describe imperforate anus: congenital malformation of the anorectal opening.
Discuss other congenital anomalies associated with imperforate anus. (Refer
to PowerPoint slide 18.)
Review the types of oral lesions affecting infants and children. (Refer to
PowerPoint slide 18.)
Describe the condition pyloric stenosis and point out that hypertrophic pyloric
stenosis is one of the most common conditions requiring surgery in the first 2
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months of life. Note that a pyloromyotomy is performed to cut the muscle of
the pylorus and relieve the gastric outlet obstruction. (Refer to PowerPoint
slide 18.)
Review that intussusception is a process that occurs when a proximal segment
of bowel “telescopes” into a more distal segment, causing edema, vascular
compromise, and, ultimately, partial or total bowel obstruction. (Refer to
PowerPoint slide 18.)
Point out that appendicitis is the most common cause of emergent abdominal
surgery in children. Review the signs and symptoms of appendicitis. (Refer to
PowerPoint slide 19.)
Review that Hirschsprung disease is the most common cause of neonatal
intestinal obstruction and is characterized by constipation in newborns. (Refer
to PowerPoint slide 19.)
Discuss the causes and signs and symptoms of Crohn disease and ulcerative
colitis. (Refer to PowerPoint slide 20.)
Outline the three categories of recurrent abdominal pain in children:
functional abdominal pain, nonulcer dyspepsia, and irritable bowel syndrome.
(Refer to PowerPoint slide 21.)
Discuss the incidence of hepatobiliary disorders including pancreatitis,
gallbladder disease, jaundice, biliary atresia, hepatitis, cirrhosis and portal
hypertension, and liver transplantation. (Refer to PowerPoint slide 22.)
Review the common causes of pancreatitis including abdominal trauma, drugs
and alcohol, multisystem disease, infections, congenital anomalies,
obstruction, or metabolic disorders. (Refer to PowerPoint slide 23.)
Point out that cholelithiasis is the presence of stones in the gallbladder and is
usually associated with hyperlipidemia, obesity, pregnancy, birth control pill
use, or cystic fibrosis. (Refer to PowerPoint slide 24.)
Learning Objective 8. Discuss nursing interventions commonly used for
gastrointestinal illnesses.
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Explain that children may undergo stool diversions for a variety of GI
disorders. Note that surgical procedures involve the creation of an ostomy,
primarily an ileostomy or colostomy, by bringing a portion of the small or
large intestine to the surface of the abdomen. (Refer to PowerPoint slide 25.)
Point out that nurses should assess infants and children with an inguinal hernia
for the presence of a bulging mass in the lower abdomen or groin area. (Refer
to PowerPoint slide 26.)
Review that therapeutic management of vomiting most often involves slow
oral rehydration and at times may require administration of antiemetics.
(Refer to PowerPoint slide 26.)
Review that the only current treatment for celiac disease is a strict gluten-free
diet, which will cause the villi of the intestines to heal and function normally,
with subsequent improvement of symptoms. (Refer to PowerPoint slide 26)
Learning Objective 9. Devise an individualized nursing care plan for
infants/children with an alteration in bowel elimination/gastrointestinal disorder.
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Outline the data nurses obtain when inspecting and observing the
gastrointestinal system. (Refer to PowerPoint slides 27, 28, and 29.)
Review that nurses should perform a brief mental status examination of all
children with GI complaints. Point out that lethargy and listlessness occur
more rapidly in children than adults.
Explain common findings upon auscultation, percussion, and palpation of a
child with a gastrointestinal disorder. (Refer to PowerPoint slides 27, 28, and
29.)
Discuss the signs and symptoms and nursing management of a newborn with
Meckel diverticulum. (Refer to PowerPoint slide 30.)
Learning Objective 10. Develop teaching plans for family/child education for
children with gastrointestinal illnesses.
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Stress the fact that child and family education related to the treatment of
GI disorders is key to preventing the illness from progressing to an
emergency situation. (Refer to PowerPoint slide 31.)
Devise a teaching plan for a child with dehydration. Note that the goals are
to restore fluid volume and prevent progression to hypovolemia. (Refer to
PowerPoint slide 31.)
Discuss the nursing management for a child with vomiting and note that
the focus is to promote fluid and electrolyte balance. Brainstorm with the
class to devise a list of teaching points for children who are vomiting.
(Refer to PowerPoint slide 31.)
State that nurses should teach parents that to facilitate daily bowel
evacuation, the child should sit on the toilet twice a day (after breakfast
and dinner) for 5 to 15 minutes. (Refer to PowerPoint slide 31.)
In a class discussion, outline a teaching plan for explaining the
medications used to treat a child with Crohn disease. (Refer to
PowerPoint slide 32.)
Learning Objective 11. Describe the psychosocial impact that chronic
gastrointestinal illnesses have on children.
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Stress the fact that childhood constipation can be a very stressful process for
both the child and family and behavior modification is necessary for many
children. Brainstorm with the class to devise a list of interventions to help
families deal with toileting issues with their children.
Note that children with short bowel syndrome are considered to be medically
fragile for a lengthy period, causing much anxiety related to the initial bowel
resection that resulted in short bowel.
Point out that sometimes long-term hospitalization is required for GI
disorders, causing parents to miss work and cutting down on the time they
have to spend with other children. Explain that this can lead to even more
anxiety about finances and relationships. (Refer to PowerPoint slide 32.)