1 / 43

Chapter 25

Chapter 25. Caring for a Child with Gastrointestinal Disorders. A & P Review. Gastrointestinal system responsible for: Ingestion Digestion Absorption Metabolism Elimination. Gastrointestinal System . Upper portion is responsible for nutrient intake (ingestion) Includes: Mouth

fathi
Download Presentation

Chapter 25

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 25 Caring for a Child with Gastrointestinal Disorders

  2. A & P Review • Gastrointestinal system responsible for: • Ingestion • Digestion • Absorption • Metabolism • Elimination

  3. Gastrointestinal System • Upper portion is responsible for nutrient intake (ingestion) • Includes: • Mouth • Esophagus • Stomach

  4. Gastrointestinal System • Lower portion is responsible for remainder of digestion, absorption & metabolism • Includes: • Small intestine • Large intestine • Rectum • Anus

  5. Gastrointestinal System • Accessory Structures: • Liver • Gallbladder • Pancreas

  6. Developmental Aspects(each developmental stage contributes to the promotion of the health of the child) • Infant: • Prevent choking • Suck-swallow • Frequent feedings • Carefully introduce foods about 1 year of age

  7. Developmental Aspects • Toddler: • Weight gain (5-6 lbs/year) • Deceased caloric needs • Food “jags”

  8. Developmental Aspects • Preschooler: • Eats a full range of food • Appetite fluctuation • School-age: • GI tract stable (digestive system is adult sized) • Stools well formed

  9. Structural Gastrointestinal Disorders

  10. Inguinal Hernia • Signs & symptoms: • Painless swelling extending toward or into the scrotum • Complications: • Incarcerated (strangulated) • Nursing Care: • Surgery (pre-post operative care) • Discharge instructions

  11. Umbilical Hernia • Signs & Symptoms: • Soft midline swelling in the umbilical area • Complications: • Incarcerated (strangulated) Nursing Care: • Most resolve spontaneously by 3-5 yrs of age • Surgery (pre-post operative care) • Discharge instructions

  12. Anorectal Malformations • Signs & Symptoms: • Rectal atresia (closure) and stenosis (constriction or narrowing of a passage) • Complications: • Depends on the defect and accompanying multisystem involvement • Nursing Care: • Extensive treatment depending on defect and associated organ involvement • Preoperative care (caregiver education & IV fluids) • Postoperative care (pain control, s/s of infection, good skin care, NG tube, oral feedings resumed) • Discharge instructions

  13. Obstructive Gastrointestinal Disorders

  14. Hypertrophic Pyloric Stenosis • Signs & Symptoms: • Typically: healthy, male infant: new onset non-bilious vomiting progressing to projectile vomiting • Diagnosis: • Palpating the pyloric mass (olive-shaped) • Nursing Care: • Surgery (Ramstedt pyloromyotomy) • Assess dehydration, changes is VS, weight loss & discomfort • Preoperative care (NPO, NG tube,) • Postoperative care ( maintain fluids & electrolyte balance, feedings, infection, keeping the wound clean & pain relief) • Discharge instructions (care of incision, s/s infection, response to feedings)

  15. Intussesception • Signs & Symptoms: • Acute abdominal pain, currant jelly stools, fever, dehydration, abdominal distention, lethargy and grunting due to pain • Diagnosis: • Based on history & presence of sausage-shaped mass • Nursing Care: • A barium or air enema/prompt surgical correction • Provide information about condition & reassurance to parents • Preoperative care (NPO, NG tube, IV fluids, monitor for perforation or peritonitis & monitor & record stools)

  16. Malrotation and Volvulus • Signs & Symptoms: • Most common during first month of life: intermittent bilious vomit, abdominal distention, recurrent pain, palpable epigastric mass, dehydration & lethargy • Complications: • Shock (signs include; tachycardia, tachypnea, hypotension & cool, clammy or cyanotic skin) • Nursing Care: • Surgery • Preoperative care (hydration, NG tube, IV antibiotics) • Postoperative care (see nursing care plan)

  17. Inflammatory Disorders

  18. Irritable Bowel Syndrome (IBS) • Signs & Symptoms: • Abdominal pain, flatus, bloating, constipation or diarrhea, “nervous stomach”, muscle spasms when exposed to triggers • Additional Symptoms: • Headache, nausea, mucus in stools, anorexia & weight loss • Nursing Care: • Dietary; discover triggers • Drinking plenty of fluids • Promote regular bowel elimination • Children taught to share feelings

  19. Inflammatory Bowel Disease (IBD) • Two types • Crohn’s Disese • Ulcerative Colitis

  20. Crohn’s Disease • Signs & Symptoms: • Abdominal pain, diarrhea, anorexia, & weight loss • Additional Symptoms: • Growth & sexual delay, arthralgias, arthritis, stomatatis, ulcers, inflammation of the eye, renal stones & rash on shins • Nursing Care: • Pharmacologic • Nutritional • Surgical • Emotional support

  21. Ulcerative Colitis • Signs & Symptoms: • Abdominal pain, bloody diarrhea, urgency, and tenesmus (spasmodic contraction of the anal sphincter with pain) • Additional Symptoms: • Arthritis/arthralgias, oral ulcera, liver inflammation, skin lesions & rash • Nursing Care: • Disease control, remission, preventing relapse & achieving normal growth & lifestyle • Pharmacological, nutritional, surgical & psychosocial management

  22. Appendicitis • Signs & Symptoms: • Earliest symptom; periumbilical pain, vomiting • Followed by: right lower quadrant pain (classic sign) • Clinical Alert: • Children who respond yes to being hungry most likely do not have appendicitis • Nursing Care: • Surgery • Postoperative care (monitor intake & output, wound care, pain control, NPO until peristalsis returns, discharged home in 2-3 days) • If perforate appendix intravenous antibiotics are given, NPO with NG tube until bowel function returns

  23. Omphalitis • Signs & Symptoms: • Redness & edema of the soft tissue • Diagnosis: • Culture obtained to confirm diagnosis • Nursing Care: • Prevention by good perinatal care & caregiver education • Intravenous broad-spectrum antibiotics

  24. Meckel Diverticulum • Signs & Symptoms: • Abdominal pain, painless rectal bleeding, stools (bright or dark red with mucus) • Complications: • If undetected severe anemia & shock can occur • Nursing Care: • Surgical removal of the diverticulum or pouch • Postoperative antibiotics • Correct fluid & electrolyte imbalances • Monitor for shock & blood loss • Provide rest • Fluid replacement & NG tube

  25. Functional Gastrointestinal Conditions

  26. Infantile Colic • Signs & Symptoms: • Persistent, unexplained crying – younger than 3 months • Episodes occur at the same time each day • Diagnosis: • Based on symptoms occurring for more than 3 weeks, for 3 days (2-3 hours a day) • Nursing Care: • Rule out acute conditions • Management strategies (see Box 25-1)

  27. Acute Diarrhea • Signs & Symptoms: • Increased frequency & fluid content of the stools with or without associated symptoms • Additional Symptoms: • Caregiver asked about vomiting, fever, pain, number of wet diapers in previous 24-hours) • Nursing Care: • Hydration & dietary needs • Pharmacology treatment not ordered • IV fluids essential with impaired circulation and possible shock

  28. Chronic Diarrhea • Signs & Symptoms: • Reflective of underlying pathology • History of the diarrhea; frequency & appearance • Additional Symptoms: • Abdominal distention or tenderness, hyperactive bowel sounds, dehydration & condition of the perineal area • Nursing Care: • Treat the underlying cause • Enteral or TPN is provided for the child who is unable to maintain adequate oral intake • Caregiver educated on prevention

  29. Vomiting • Signs & Symptoms: • Assessment includes description of onset, duration quality, quantity, appearance, presence of undigested food and precipitating event • Additional Symptoms: • Fever, diarrhea, ear pain, headache • Nursing Care: • Treatment of the cause & prevent of complications • Bowel is allowed to rest • Rehydration • Bland solids reintroduced • Antiemetic drugs • Dehydration, monitor fluid intake & output • Oral hygiene

  30. Cyclic Vomiting Syndrome • Signs & Symptoms: • Recurrent episodic vomiting, usually lasts 24-48 hours. Vomiting occurs at regular intervals, usually every two to four weeks • Diagnosis: • Rule out other conditions • Nursing Care: • Supportive care: fluid replacement, rest, pharmacotherapy & psychiatric evaluation • Calm stress-free environment

  31. Constipation • Signs & Symptoms: • Poor appetite, straining with stools • Additional Symptoms: • Blood may occasionally be seen, tenderness in colon & small intestines, rectal fissures • Nursing Care: • Focus: dietary intake, keeping the bowel relatively empty • Adequate intake of water • Regular diet (fruits & fiber) • Stool softeners • Chronic constipation may include bowel cleansing, maintenance therapy & bowel retraining

  32. Encopresis • Signs & Symptoms: • Stained underwear, difficult or painful defecation, large and/or hard stools, reports of bloating and/or pain, streaks of bright blood, anorexia, evidence of attempts to retain stool • Diagnosis: • Radiography & laboratory test to rule out other causes • Nursing Care: • Establish regular bowel habits • Dietary monitoring (fiber & water intake) • Stool softeners & laxatives are avoided • Child & caregiver instructed on the need to establish a routine toileting • Management of children with constipation begins with a catharsis phase followed by a maintenance phase & follow up care • Anticipatory guidance, caregiver support & education

  33. Gastroesophageal Reflux (GER) • Signs & Symptoms: • Vomiting & regurgitation • Additional Symptoms: • Fussy, refuse to feed because of discomfort, choking courting, wheezing apnea, weight loss, respiration infections and vomit • GERD; persists beyond 18 months • Nursing Care: • Caregiver support & anticipatory guidance • Pharmacological therapy for complications • Surgery (Nissen fundoplication)

  34. Hirschsprung Disease • Signs & Symptoms: • Failure to pass meconium within the first 48 hours of life, failure to thrive, poor feeding, chronic constipation, & Down syndrome • Complications: • Entercolitis is the most ominous presentation (abrupt onset o foul smelling diarrhea, abdominal distention & fever. Rapid progress may indicate perforation & sepsis • Nursing Care: • Surgical resection (colostomy) • Preoperative care (fluid & electrolyte status, NPO, NG tube, IV fluids) • Postoperative care (maintain NG tube, monitor for abdominal distension, assess for bowel sounds) • Teach caregiver how to car for colostomy, s/s of complications)

  35. Malabsorption Disorders

  36. Lactose Intolerance • Signs & Symptoms: • Bloating, cramping, abdominal pain & flatulence • Diagnosis: • Based on history/physical & decrease in symptoms with elimination of lactose from the diet • Nursing Care: • Elimination of dairy products or the use of enzyme replacement • Dietary education (alternative sources of calcium)

  37. Celiac Disease • Signs & Symptoms: • Non-specific and include anorexia, irritability, weight loss & listlessness • Additional Symptoms: • Classic presentation begins around age 6 months to 2 years as gluten products are introduced into the diet • Nursing Care: • Gluten-free diet • Caregiver introduced to hidden sources of gluten • Assess symptoms, growth and adherence to dies • Measurement of transglutaminase (TTG) levels is recommended in individuals with recurrent or persistent symptoms after initiation of gluten free diet

  38. Short Bowel Syndrome • Signs & Symptoms: • Malnutrition & diarrhea • Additional Symptoms: • Steatorrhea & carbohydrate malabsorption result in diarrhea and failure to thrive • Nursing Care: • Maintain adequate nutrition & prevent complications • Total parenteral nutrition (TPN) via central line • Enteral feedings via nasogastric or gastrostomy tube • Feeding tolerance • Emotional & developmental needs • Assist parents with coping • Home care services

  39. Hepatic Disorders

  40. Biliary atresia, or extrahepatic biliary atresia (EHBA) • Signs & Symptoms: • Jaundice, dark urine, lighter (tan-white) than normal stools, poor weight gain, failure to thrive, pruritus, hepatomegaly, splenomegaly • Diagnosis: • Early diagnosis in the key to survival. • Nursing Care: • Primarily supportive & focuses on providing nutritional support • Surgical resection: correct obstruction & provide drainage of bile from the liver into the intestines • Preoperative care (educate family & long term care) • Postoperative care (educate family on skin & stoma care, nutritional therapy, complications, psychological support) • Potential transplant

  41. Cirrhosis • Signs & Symptoms: • Vary depending on the cause • Jaundice, growth failure, muscle weakness, anorexia & lethargy • Diagnosis: • Based on history, laboratory values & liver biopsy • Nursing Care: • Preventing & treating complications • Nutritional support • Liver transplant • Monitor for complications • Comfort measures & emotional support

  42. Hepatitis • Signs & Symptoms : • Headache, anorexia, malaise, abdominal pain, nausea & vomiting • Diagnosis: • Based on history of exposure, symptoms & serologic testing • Nursing Care: • Primarily supportive: no specific treatment • Provide rest to the liver, hydration, maintain comfort, adequate nutrition, & prevent complications • Immune globulin given to children who have been exposed to a person with HAV • Vaccine available for HAV, HBV & HDV • Educate family regarding prevention measures (see Critical Nursing Actions Prevention of Hepatitis A and Hepatitis B)

  43. Abdominal Trauma: Injuries • Injuries are the leading cause of death in children • Ten percent of serious trauma occurs as a result of abdominal & genitourinary injury • See Table 25-5 Injuries Caused by Abdominal Trauma

More Related