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Variations from the Adult

Variations from the Adult. Mechanical functions immature No voluntary control over swallowing until 6 weeks Stomach capacity decreased Peristalsis increased, faster emptying time Relaxed cardiac sphincter Liver functions immature Decreased production of antibodies lining mucosa.

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Variations from the Adult

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  1. Variations from the Adult • Mechanical functions immature • No voluntary control over swallowing until 6 weeks • Stomach capacity decreased • Peristalsis increased, faster emptying time • Relaxed cardiac sphincter • Liver functions immature • Decreased production of antibodies lining mucosa

  2. Variations from the Adult (cont) • Digestive processes not mature until toddlerhood • Gastric acidity low until school age • Decreased saliva & ability to digest starches • No voluntary control of elimination until myelinization of spinal cord.

  3. Categorization of Conditions • Developmental (congenital) • Problems w/motility • Inflammation or infections • Obstructive disorders • Malabsorption conditions

  4. Fluid & Electrolyte Differences • Percent body water /total body weight • Infant higher percentage fluid ECF • Greater insensible loss • Renal function immature • Infants unable to communicate thirst

  5. Maintenance Fluid Requirements per 24 hours • ≤ 10 Kg: 100 ml/kg/day • 11-20 kg: 1,000 ml + 50 ml/kg/day • >20 kg: 1500 ml + 20 ml/kg/day

  6. Minimum Urine Output • Infants, toddlers • >2-3 ml/kg/hr • Preschool, young school-age • >1-2 ml/kg/hr • Older school-age & Adolescent • 0.5-1 ml/kg/hr

  7. Etiology of Fluid Imbalances(the “related to”) • Imbalance of intake vs output • Result: fluid volume deficit or fluid volume excess • Secondary to therapy or disease process • All organ systems can be cause

  8. Types of Dehydration • Isonatremic • Hyponatremic • Hypernatremic • Normal serum Na = 135-145 mEq/L F

  9. Key Factors in Diagnosing Dehydration • History of acute or chronic fluid loss • Serum electrolyte values • Clinical manifestations • Weight of the child F

  10. Clinical Manifestations • Level of consciousness • Urine output • Weight • Pulse • Cap refill • Respirations • Skin turgor F

  11. Clinical Manifestations (cont) • Mucous membrane • Blood pressure • Fontanel • Thirst • Sunken eyes • No tears • “toxic looking”

  12. Cleft Lip and Palate • CL: the lip does not completely form during fetal development • CP: Nonunion of the tissue & bone hard/soft palate during embryologic development.

  13. Problems: cleft lip/palate • Feeding difficulties • Speech & language difficulties • Ear infection and hearing loss • Dental problems

  14. Surgical Management • Cheiloplasty: correction of cleft lip • Functional & cosmetic • age 3-6 mo (McKinney) • “rule of 10s”: 10 weeks, 10 lbs, Hgb of 10 g/dL • Palatoplasty: cleft palate repair • 6 mo to 2 yrs (most: 1 year) • Before speech • Able to take liquids from cup

  15. Nursing management: preop • Feed in upright position • Burp frequently, w/ periods of rest • Large-holed nipple or rubber-tipped syringe • Finish feeding w/H2O • Small, frequent feedings • Emotional support

  16. Nursing Diagnoses – Pre-op

  17. Post-op cleft lip • Patent airway • Assess for hemorrhage • Protect the operative site !!! • No pressure on cheeks • No prone position • Elbow restraints • Pain relief • Feed when awake • Keep site clean – prevent infection

  18. Post-op cleft palate Immediate post-op goals • Airway • OK to be on side or abdomen – drain secretions • Pain • Prevent injury to suture site

  19. Instructions to Mother Risk for injury to surgical site • Progress diet • Only cups for liquids • Provide soft toys • Elbow restraints • Cleanse mouth after eating • No rough play

  20. Long-term care CP Team approach • Hearing evaluation • Speech & language therapy • Dentist, orthodontist • Plastic & maxilofacial surgeon • Social worker

  21. Other Developmental Gastrointestinal Defects • Esophageal atresia with tracheoesophageal fistula • Imperforate anus • Gastroschisis • Omphalocele • Umbilical or diaphragmatic hernia F

  22. GER • Physiologic • Functional • Painless, frequent emesis after meals • No failure to thrive • 40% asymptomatic by 3 months • 70% asymptomatic by 18 months • Medical management very effective

  23. Therapy for Gastroesophageal Reflux Disease • Diet • Positioning • Lifestyle change • Acid-suppressant therapy • Prokinetic therapy • G-tube • Surgery – Nissen Fundiplication F

  24. Constipation and Encopresis[information only] • Definitions • Common causes of constipation • dietary transition • voluntary withholding • Emotional issue • Treatment

  25. Inflammatory or Infectious Conditions • Necrotizing Enterocolitis (NEC) • Appendicitis • Inflammatory bowel disease • Viral gastroenteritis • Hepatitis • Parasites

  26. Appendicitis - diagnosing • History • Pain, then vomiting • Ultrasound • CT

  27. Treatment • Uncomplicated: may watch • Rehydration, Antibiotics prior to surgery • Complicated • Surgery • Non-operative: fluid replacement, IV antibiotics, analgesics

  28. Interventions Uncomplicated Appendicitis Pre-op • VS • Comfort measures • No enemas, laxatives • No heat to abdomen • IV fluids, abx • Monitor for perforation Post-0p • Laparoscopic • Pain control • C & DB • Early ambulation • NPO until bowel function returns

  29. CMs of perforation: • Sudden relief from pain, then increased pain • Rigid abdomen • Early shock • Infants: refusal to eat, behavior changes • Danger: peritonitis

  30. Appendicitis: perforation &/or abscess • Surgical or medical management • Percutaneous drainage of abscess • NG tube • IV fluids and Antibiotics • Drains • Pain med: ATC • Routine post-op: C&DB, move • Monitor for sepsis, abscess

  31. Obstructive Disorders • Hypertrophic Pyloric Stenosis • Hirschprung’s Disease • Intussusception

  32. Hypertrophic Pyloric Stenosis F

  33. Post-op Pyloromyotomy • Nursing priorities • Hydration status • Pain • Infection

  34. Hirshprung’s Disease Typical Presentation • 2 1/2 week old child • Poor weight gain • 38 weeks gestation • Easily takes 2-3 oz of formula • Has frequent vomiting after feeds, some bile-stained • Constipation • Dx: rectal biopsy

  35. Celiac disease: definition • Immune-mediated disease induced by ingestion of defined proteins in subjects who are genetically predisposed • EBP: exclusive 6 month breast feeding delays onset of sx.

  36. Patho: Celiac Disease F

  37. Celiac Disease – Assessment “classic” • Symptoms 3-6 mo after gluten introduced • Steatorrhea • Abdominal distention, vomiting, anorexia • Growth retardation, muscle wasting • Anemia • During crisis: severe dehydration

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