Download Gastrointestinal Disorders in Pediatric Patients

Gastrointestinal
Disorders in Pediatric
Patients
Marlene Meador RN, MSN
Fall 2006
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
p
h
o
t
Assessment

Unilateral, bilateral, midline
Treatment
Surgical repair done ASAP
 Rule of 10 > 10#, 10 weeks, 10 HGB
 Multidisciplinary team

Management Pre-op

Maintain nutrition

Prevent aspiration
Pre-op Teaching
Remind parents that defect is operableshow photographs of corrected clefts
 Introduce cup, spoon feeding devices (see
page 1114 for feeding tips)
 Explain restraints
 Explain Logan Bow

Post-Op
Prevent trauma to suture line
 Facilitate breathing
 Maintain nutrition
 Cleanse suture lines as ordered
 Referral to appropriate team members

Esophageal Atresia
Failure of the esophagus to totally
differentiate during uterine development.
Assessment
Respiratory difficulties
 Drooling
 Coughing, choking
 Gastric distention
 Hx of ??? during pregnancy?

Management
Early diagnosis
Ultra sound
Radiopaque catheter inserted in the esophagus
to illuminate defect on X-ray
Surgical repair- thoracotomy and
anastomosis
Pre-Op
Maintain airway
 Keep NPO- administer IV fluids
 Elevate HOB 30 degrees
 Suction PRN
 Prophylactic antibiotics

Post-Op

Maintain airway

Maintain nutrition

Prevent trauma
Gastroesophagial Reflux
(GER)
The cardiac sphincter and lower portion of
the esophagus are weak, allowing
regurgitation of gastric contents back into
the esophagus.
Assessment: Infant
Regurgitation almost immediately after
each feeding when the infant is laid down
 Excessive crying, irritability
 FTH
 Complications of aspiration pneumonia,
apnea

Assessment: Child
Heartburn
 Abdominal pain
 Cough, recurrent pneumonia
 Dysphagia

Diagnosis
Assess Ph of secretions in esophagus if
<7.0 indicates presence of acid
 Also diagnosed using Barium Swallow and
visualization of esophageal abnormalities

Management & Nursing Care
Nutritional needs
 Positioning
 Medications
 CPR instruction for parents/caregivers
 Surgery

Diarrhea/Gastroenteritis
Severe
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

Critical Thinking
Why is there an increase in incidence of
diarrhea in lower socio-economic groups?
 Why is there and increase in young
children?

Clinical Manifestations
Increase in peristalsis
 Large volume stools
 Increase in frequency of stools
 Nausea, vomiting, cramps
 Increased heart & resp. rate, decreased
tearing and fever

Complications

Dehydration

Metabolic Acidosis
Diagnosis

Stool culture

O&P

Diagnose Metabolic Acidosis
Treatment & Nursing Care
Treat cause
 Fluid and electrolyte balance
 Weigh daily
 Monitor I&O
 Assess for dehydration
 Isolate
 Skin care

Appendicitis

Inflammation of the lumen of the
appendix which becomes quickly
obstructed causing edema, necrosis and
pain.
Clinical Manifestations
Abdominal pain
 Silent abdomen
 Anorexia and nausea
 Diarrhea
 Elevated temperature
 Sudden relief

Diagnosis
History and Physical
 Laboratory values
 X-ray or Ultrasound

Management and Nursing Care:
Pre-Op
NPO
 IV
 Comfort measures
 Antibiotics
 Thermal therapy
 Elimination
 Patient education

Management and Nursing Care:
Post-Op
NPO
 Antibiotics
 Analgesia
 Patient teaching

Pyloric Stenosis
Pyloric sphincter
 Incidence
 Possible genetic predisposition

Assessment
Vomiting
 Constant hunger and fussiness
 Distended upper abdomen
 Hypertrophied pylorus
 Visible peristaltic waves

Diagnosis
History and Physical
 Ultrasound
 Laboratory values

Management and
Nursing Care
Fred Ramstedt procedurePylorotomy via laproscopy
Pre-Op
Hydration and electrolyte balance
 Weigh daily & I and O
 Support of parents

Post- Op:
I&O
 Feeding
 Position
 Surgical site
 Patient teaching

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
Intussuception

Most commonly seen in infants 3-12
months

Typically follows what type of illness?
Assessment
Pain
 Vomiting
 Stools
 Dehydration
 Serious complications

Diagnosis
X-ray
Abdominal
ultrasound
Therapeutic Intervention
Hydrostatic

Surgery
reduction
Nursing Care:

NPO- NG

Assess

Monitor stools

Re-introduce food
Hirschsprung’s Disease
Congenital disorder of nerve cells in lower colon
Assessment

Failure to pass meconium

Vomiting

Bowel assessment

Breath

Older child
Diagnosis

History & Physical

Barium enema (X-ray)

Rectal biopsy- absence of ganglionic cells
in bowel mucosa
Management
Surgical
intervention
–Colostomy
–Resection
Nursing Care:

Pre-op
– Cleanse bowel
– Patient/parent teaching

Post-op
– NPO
– VS
– Assessment
– Patient/parent teaching
Volvulus & Malrotation

Assessment- pain, bilious vomiting, S & S
bowel obstruction

Treatment- surgery to prevent ischemia

Nursing Care- same as Intussuception and
Hirschsprung’s
Gastroschisis

Assessment- noted on ultrasound and
obvious at birth

Treatment- surgical repair in stages

Nursing care- support parents loss of
“Perfect Child”
Omphalocele

Assessment- ultrasound and at birth

Treatment- surgical repair in stages

Nursing care- same as for Gastroschisis
Imperforate Anus

Assessment- note failure to pass
meconium, Ultrasound & CT

Treatment- repeated dilation or surgical
intervention dependent on extent

Nursing Care- note skin dimples or stool in
urine or vagina
Umbilical Hernia
Assessment- abdominal muscle of NB does
not meet around umbilical ring
 Treatment- resolve by age 1 yr. Surgical if
not resolved by 5 years or
becomes strangulated or enlarges
 Nursing care- Binding not effective.
Monitor for obstruction or
strangulation

Failure to Thrive (FTH)
Assessment- low growth for age,
developmental delays, apathy
 Diagnosis- History to determine organicvs- non-organic
 Nursing Care- Teaching on nutrition
feeding techniques, feeding
cues, praise
 Community resources

Helminths/Parasitic Disorders

Assessment- parasites identified in stool

Treatment- oral medications specific to
helminth

Nursing care- prevention education,
Celiac Disease

Assessment- Growth pattern, GI pattern
Treatment- Dietary restrictions
 Nursing Care- monitor for dehydration,
encourage compliance with
dietary restrictions, provide
support groups for patient and
caregiver

Please contact me with any questions or
concerns regarding my lectures
Marlene Meador RN, MSN
[email protected]